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From YouTube: 2/26/2021 - Assembly Ways and Means and Senate Finance, Subcommittees on Human Services
Description
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A
C
B
F
B
A
And
I
am
here-
I
will
let
you
know
as
soon
as
the
same
as
senator
canazero
joins
the
meeting
to
update
our
minutes
for
the
day.
I'd
like
to
welcome
every
welcome
everyone
to
our
meeting.
Today
we
have
a
lot
of
work
ahead
of
us.
It's
important
that
we
get
through
the
eight
budgets
today
in
a
very
timely
manner.
A
Before
we
begin
today's
meeting
I'd
like
to
briefly
review
how
our
virtual
meetings
meet.
As
everyone
now
knows,
the
building
is
closed
to
the
public
and
all
participation
is
either
through
zoom
or
by
telephone.
I
ask
the
committee
members
to
mute
your
phones
and
leave
your
cameras
on
so
that
we
can
maintain
a
quorum.
A
Any
public
comment
will
be
held
at
the
end
of
our
meeting
and
we
ask
that
when
you
call
in
that,
you
speak
clearly
and
spell
your
name
for
the
record
and
only
take
no
more
than
three
minutes
for
comments
so
that
we
can
get
everyone's
comments
in.
As
I
said,
we
have
a
lot
of
work
ahead
of
us,
so
we're
going
to
dive
right
in.
A
G
Thank
you,
madam
chair,
for
the
record.
My
name
is
richard
whitley
I
serve
as
the
director
for
the
department
of
health
and
human
services.
Both
budget
accounts
that
I'll
be
presenting
today
cover
pass-through
programs
to
the
division
of
health
care,
finance
and
policy
to
make
supplemental
payments
to
hospitals.
G
Starting
on
page
two
of
my
presentation,
budget
account
3244
is
the
indigent
hospital
care
program.
This
program
was
established
to
reimburse
hospitals
for
care
provided
to
uninsured
persons.
The
fund
for
hospital
care
to
indigent
persons
is
administered
by
the
board
of
trustees
appointed
by
the
governor.
The
board
of
trustees
include
four
county
commissioners:
one
county
social
service
agency
director
the
counties
seek
reimbursement
from
funds
for
indigent
care,
provided
in
excess
of
twenty
five
thousand
dollars.
G
The
majority
of
the
funding
is
transferred
to
medicaid
to
be
used
for
supplemental
payments.
This
is
expected
to
be
approximately
26.8
million
dollars
in
fiscal
year
22
and
approximately
29.5
million
dollars
in
fiscal
year
23,
and
will
allow
medicaid
to
pay
approximately
17
million
in
supplemental
payments
in
fiscal
year
22
and
81.5
million
in
supplemental
payments
in
fiscal
year
23
with
the
federal
match.
G
G
Supplemental
payments
to
the
counties
to
offset
their
long-term
care
assessments,
the
board
of
trustees
voted
for
this
change.
At
their
february
7
2021
meeting
the
governor's
recommended
budget
includes
the
reduction
to
hospital
supplemental
payments
as
follows:
in
fiscal
year,
22
101.5
million
to
72
million
in
fiscal
year,
23
won
14.2
million
to
81.5
million.
The
county
match
program
also
draws
federal
match,
so
we
don't
lose
any
federal
match.
It
just
shifts
one
from
one
program
to
another.
This
concludes
the
overview
of
this
budget.
Account
3244
and
I'd
be
happy
to
answer
any
questions.
A
B
Stacy
johnson
deputy
director,
for
the
record,
the
only
change
is
just
the
truing
up
the
projections
in
this
fiscal
year
21.
So
we
are
estimating
approximately
six
million
dollars
more.
That
will
increase
the
carry
forward
in
22..
The
primary
reason
for
that
is
the
abalone
tax.
We
have
a
couple
quarters
of
actuals
now,
so
we
are
projecting
about
2.4
million.
B
For
that
we
also
have
the
actual
amount
of
unmet
free
care
and
that's
expected
to
be
about
1.6
million
more
typically,
we
budget
about
a
one
and
a
half
million
dollars
for
traditional
claims,
but
this
year
we
didn't
receive
any.
So
we
have
an
extra
one
and
a
half
million
and
then
the
medicaid
upl
offset
is
going
to
be
approximately
600
000
less
than
originally
anticipated.
B
So
the
board
did
vote
at
their
february
meeting
this
month
to
split
that
six
million
dollars,
fifty
percent
for
hospital,
supplemental
payments
and
fifty
percent
for
the
county
offset.
So
that's
the
primary
reason,
differences
between
gov
govrek
and
what
we
see
today.
I
G
I
G
Record
richard
whitley,
it
really
is
that
our
uninsured
rate
I
mean
has
has
so
greatly
improved
with
the
affordable
care
act
and
the
coverage
that
people
have,
that
we
have
less
uncompensated
care.
I
G
Great
for
the
record,
richard
whitley
director
for
health
and
human
services.
Turning
to
page
six
in
my
presentation,
budget
account
3260
is
for
the
upper
payment
limit
program.
This
is
a
pass-through
account
associated
with
the
private
hospital
upper
payment
limit,
nevada
clinical
services,
a
nevada
non-profit
corporation
as
part
of
their
charity
care
initiatives
assume
some
of
the
department's
contracted
services.
G
G
We
are
projecting
46
contracts,
which
is
approximately
12
million
dollars
for
each
year.
The
budget
includes
transfer
the
medicaid
of
approximately
nine
million
dollars
per
year
and
reversions
to
the
general
fund
of
approximately
3.1
million
dollars
with
federal
match.
This
allows
medicaid
to
generate
approximately
23
million
dollars
in
supplemental
payments.
There
are.
E
F
Thank
you,
madam
chair,
very
much
appreciate
that
so
I've
been
around
as
we've
talked
about
this
upper
payment
limit,
holding
account
for
a
very
long
time
and
it's
it's
a
little
a
little
complicated
how
it
actually
works.
So
it's
to
to
put
it
in
basic
english
is
the
money
that
we
save
by
contracting
some
of
these
services
out.
F
G
For
the
record,
richard
whitley
and
the
match
is,
is
the
f
map,
so
it's
we
use
that
as
a
state
share
of
of
funds
for
cms.
F
Okay,
that's
that's
what
I
thought
so,
as
these
contract
services
go
on.
F
J
J
I
think
venture
church
woody.
I
saw
that
the
southern
nevada,
most
team,
was
being
added
to
one
of
the
services.
That's
being
that's,
that's
being
contracted
out
in
this
way
or
added
to
added
to
this.
Holding
account
is.
Is
that
something
that
is
there
a
new
funding
mechanism,
that's
allowing
that
that
wasn't
allowed
in
the
past,
or
why
is
that
happening
for
the
first
time
this
session?
This.
G
Richard
whitley,
we
can,
we
can't
use
federal
funding
to
you,
know
to
to
get
a
match,
but
we
can
use
fun
for
healthy
nevada,
and
so
those
dollars
can
be
used
as
well
as
general
fund.
So
we
continue
like
I
said
there
were.
There
are
46
non-profits
that
ordinarily
would
receive
general
fund,
but
the
nevada
clinical
services
is
actually
being
the
funder
to
to
those
agencies.
We
continue
to
review
every
opportunity
for
additional
programs
that
may
fit
the
criteria.
G
We
have
to
run
those
by
nevada
clinical
services,
so
that
change
with
most
using
fund
for
healthy
nevada
has
allowed
us
to
to
utilize
nevada
clinical
services.
K
I'm
understanding
that
the
nevada
clinical
services
is
kind
of
the
overseer
and
the
state
contracts
with
them,
and
then
they
determine
these
other
subcontractors.
Is
that
correct
director.
G
For
the
record,
richard
whitley,
no,
actually
these
are
identified
agencies
that
the
state
would
have
ordinarily
engaged
to
work
with,
to
provide
services
to
nevadans
and
as
part
of
their
charity
care
initiative.
Nevada,
clinical
services
is
providing
it
and,
as
a
result
of
that,
we're
able
to
use
that
funding
then
as
a
as
as
a
match
for
cf
with
cms
for
medicaid.
K
So
are
all
the
and
thank
you
for
that.
So
are
all
of
these
con
subcontractors,
then
are
they
all
that?
Must
they
all
be
non-profit.
K
Thank
you
for
that
clarity,
because
I
always
have
some
angst
over
contracting
with
folks
that
are
for-profit
on
on
federal
and
state
dollars,
and
it
makes
me
a
little
anxious
about
that.
Sometimes,
and
then
I
don't
see
on
your
list
of
contractors.
K
Services
provided
by
non-profit
organizations,
the
family
home
nurse
program
is
that
going
to
be
on
a
separate
budget.
G
The
the
home
visitation
for
the
record,
richard
whitley,
if
it's
proposed
to
be
funded
with
tan
of
funding,
and
we
we
cannot,
we
cannot
use
federal
funding.
You
know
to
hold
up
as
a
match
back
to
the
feds,
with
cms.
K
Correct
that
make
that
makes
good
sense.
Thank
you
and
then
I've
heard
sometimes
different
positions.
I
I'm
hearing.
You
say
that
it
actually
saves
the
state
money
to
do
this
sub
contract.
Is
that
what
I'm
hearing
as
opposed
to
hiring
the
personnel
that
then
operates
into
the
say,
rural
clinics,
the
hot
the
hotline,
the
suicide
intervention
on
some
of
those
things?
So
it
makes
better
sense
to
have
a
subcontract
with
a
private
person
for.
K
C
L
Tools,
thank
you,
madam
chair,
and,
and
I
apologize
if
I
may
have
missed
this
in
the
answers
to
senator
keith
keffer
and
vice
chair
carlton.
L
But
as
I
just
looked
over
the
list,
I
know
that
we
are
increasing
funding
utilization
of
the
contracts
with
the
most
program,
but
I
see
that
we're
decreasing
in
some
cases,
pretty
significantly
with
mental
health
health
placements
with
a
crisis
intervention
with
psychiatric
services
to
lakes
crossing,
and
I
was
just
and
then
the
community
triage,
and
so,
if
you
could
just
help,
walk
me
through
a
little
bit.
What
and
forgive
me
I'm
new
to
this-
you
know
this
is
my
first
time
in
in
ways
and
means.
L
G
Sure
for
the
record,
richard
whitley
there's
not
a
reduction
in
the
services,
but,
as
I
said
previously,
we
can't
we
can't
leverage
federal
funds
and
hold
that
up
as
a
match.
So
as
you'll
see,
as
you
have
heard,
throughout
our
department,
presentations
and
divisions
because
of
just
the
the
fiscal
crisis
we're
in
we
have.
We
have
leveraged
federal
funds
that
have
a
margin
to
be
utilized
in
programs
that
we
can
and
to
maximize
those
federal
dollars.
G
But
we
cannot
use
those
federal
dollars
as
a
match
so
with
cms,
so
we
can
only
use
general
fund
and
the
fund
for
healthy
nevada,
non-federal
funding
and
so
you're.
You
we're
not
reducing
those
services,
but
the
funding
streams
which
you'll
hear
in
when
the
division
of
public
and
behavioral
health
presents
their
behavioral
health
budget
in
the
upcoming
weeks,
you'll
hear
more
specifically
about
how
those
programs
are
supported,
but
the
reduction
isn't
in
services.
It's
a
change
in
how
it's
funded
to
leverage
these
dollars.
L
A
Thank
you,
I
believe
assemblywoman
carlton
had
a
follow-up
question.
F
And
thank
you
very
much,
madam
chair,
for
recognizing
me
the
second
time,
and
I
think
dr
titus
pointed
out
a
very
important
point.
The
state
usually
doesn't
subcontract
out
services
like
this.
We've
not
had
very
good
luck
when
we've
done
that
in
the
past.
I
believe
the
difference
with
this
is
mr
whitley
and
and
correct
me
if
I'm
wrong,
but
nevada
clinical
services
actually
donates
part
of
the
cost
of
doing
this
as
a
portion
of
their
free
care
that
they
provide
their
charity
here.
F
So
it's
not
as
though
they're
in
the
business
of
doing
this.
This
is
a
service
that
they're
providing
to
the
state
and
it's
a
little
more
complicated
than
a
regular
subcontract
situation.
F
G
Is
correct,
I
I
I
would.
E
G
That
I
know
of
no
other
non-profit
organization
that
would
function
in
this
role.
Usually
those
intermediate
agencies
are
for
profit.
A
Thank
you
and
for
our
final
question
on
this
budget,
assemblyman
roberts.
M
Thank
you,
madam
chair,
and
I
I
appreciate
you
allowing
me
the
time
so.
Mr
whitley,
you
had
mentioned
a
three
million
dollar
reversion
to
the
to
the.
G
For
the
record
for
the
record,
richard
whitley
sure
any
any
general
fund
dollars
could
be
used
when
opportunities
exist
to
like
leverage
federal
dollars.
I
I
assure
you
that
we
have
leveraged
all
the
all
the
dollars
that
are
available.
G
N
G
Again
for
the
record
richard
whitley,
so
it
would
be,
it
would
be
the
f
map,
the
the
federal
match
for
the
population
being
served
by
medicaid,
so
it
would,
it
would
depend
on
the
service
if,
if,
for
example,
you
wanted
to
add
a
service
to
medicaid
that
that
that
cost
3.1
million
depending
on
what
the
service
was
to
what
population
there
would
be
a
federal
match
that
would
be
assigned
to
that.
So,
but,
but
again
I
would.
G
I
would
just
highlight
that
in
reverting
it
to
general
fund,
our
programs
then
do
like
medicaid
does
get
general
funds.
So
it's
it
does.
It
does
come
back
around
and
and
and
has
lev
has
leveraged
capability?
G
You
know
I,
I
guess
the
significant
thing
here
is:
it
doesn't
stay
in
my
budget
in
a
discretionary
way
that
I
can
reallocate
it.
It
goes
back
into
the
general
fund
so
based
on
the
budget
and
medicaid,
we
leverage
all
the
dollars
that
are
are
possible
with
medicaid
and
then
revert.
What's
left
over
to
general
fund.
M
G
B
Yeah,
this
is
kathy
crockett
with
analysis
for
the
record.
I
believe
characterized
it
correctly.
The.
A
I
I
believe
richard
whitley,
he
did
characterize
it
correctly,
so
that
that
excess
money
within
this
budget
account
reverts
to
the
general
fund
for
general
fund
use
and
goes
to
you
know
back
to
medicaid
or
other
state
agencies
and
the
fund.
A
A
Moving
on
next
up,
we'll
have
the
division
of
health
care
financing
and
policy.
So
I
now
invite
administrator
susannah
berryman
to
present
the
remaining
budgets
that
are
on
our
agenda
today
and
we'll
start
with
the
prescription,
drug
rebate,
budget.
A
A
E
Good
morning,
suzanne
biermann
for
the
record,
I
apologize
for
our
technical
difficulties
this
morning.
Do
you
just
want
to
pause
and
make
sure
we're
good
now?
Can
you
hear
us
okay,
great,
thank
you.
Well,
I'm
the
administrator
for
the
division
of
healthcare,
financing
and
policy.
E
F
D
E
The
deputy
administrator
for
managed
care
and
compliance,
phillip
burrell,
our
deputy
administrator
for
finance
and
melissa
loffer-lewis,
the
division's
administrative
officer
for
her
finance-
if
I
could
just
briefly
have
the
indulgence
of
acknowledging
that
this
has
been
a
challenging
and
unprecedented
time
for
staff
managing
through
a
lot
of
uncertainty
related
to
dakova
and
the
corresponding
budgetary
crisis.
I
just
wanted
to
take
a
quick
moment
and
thank
staff
here
and
the
entire
division
staff
for
all
of
their
long
hours
and
hard
work.
E
E
It's
not
really
a
part
of
any
of
our
decision
units,
but
just
wanted
to
provide
a
quick
update
on
medicaid
caseload,
certainly
something
that
we
spent
a
lot
of
time
talking
about
through
the
special
session
and
has
big
implications
for
our
budget
and
certainly
in
the
medicaid
and
checkup
budget
accounts.
We'll
talk
about
our
caseload
projections,
but
I
did
just
take
want
to
take
a
quick
minute
here
to
recognize
the
significant
caseload
growth
that
we've
had
over
the
course
of
the
past
year.
E
E
So
did
you
just
want
to
to
flag
that,
and
also
note
that
this
is
tied
to
the
public
health
emergency
and
some
additional
enhanced
federal
funding
that
the
division
is
getting
through
the
family's
first
coronavirus
response
act
that
has
some
maintenance
of
effort
eligibility
requirements
tied
to
it
so
again-
and
I
know
we'll
talk
more
about
this,
but
did
just
want
to
acknowledge
our
our
current
caseload
and
then
we'll
we'll,
certainly
talk
more
about
projections
in
our
budget
accounts.
E
So
with
that,
if
we
could
go
to
slide
five,
please,
this
slide
provides
a
very
high
level
overview
of
the
division's
request
for
this
biennium.
E
A
E
Changes
here
include
caseload
inflation
changes,
changes
related
to
the
rate
restorations
that
were
made
during
the
special
session
and
changes
in
the
other
category.
If
you
can
see
that
one
there's
quite
a
large
change
in
that
category-
and
I
asked
the
question
what's
accounting
for
that-
and
that
is
really
due
to
transfer
of
drug
rebates
into
standalone
budget
account,
which
is
our
first
budget,
account
that
we
will
discuss
today
but
did
want
to
start
with
this
high
level
overview
of
our
overall
budget
account.
G
E
E
Here
we
have
an
overview
of
the
prescription
drug
rebate.
This
is
a
a
new
account.
It
is
a
transfer
of
funds
that
are
being
moved
to
this
new
account
3245
from
the
medical
account.
As
you
can
see,
revenue
is
over
300
million
and
we
just
wanted
to
provide
a
slide
in
some
context
that
this
is
due
to
increased
transparency
related
to
the
drug
rebate
program,
and
there
are
no
decision
units
related
to
this
program,
but
did
want
to
flag
this
here.
E
For
you
all,
oh
I'm
sorry,
I
misspoke
there
are
two
decision
units
here,
creating
this
new.
This
new
budget
account.
So
you
can
see
those
here
900,
which
is,
as
I
mentioned,
the
the
transfer
from
our
medical
account
into
the
standalone
budget
account
and
b9
p501,
which
aligns
revenues
and
expenditures
with
the
transfer
of
drug
rebates
in
900..
E
B
Watts
chair
good
morning,
miss
baron.
Thank
you
for
the
presentation.
I
just
have
a
question
about
this:
what's
the
anticipated
time
frame
for
evaluating
drug
rebate
revenue
projection
methodologies
good
morning,
this
is
melissa
locker-lewis.
That
is
something
that
the
division
began.
Last
biennium
we.
C
E
Great,
thank
you.
Our
next
budget
is
budget
account
3157,
our
intergovernmental
transfer
account.
This
account
here
collects
payments
from
counties
and
public
entities
to
pay
for
the
non-federal
share
of
medicaid.
Supplemental
programs
reduces
the
general
fund
appropriations
in
support
of
the
disproportionate
share
hospital
payments
that
the
division
makes
to.
E
So
this
here
was
just
an
overview
of
this
particular
decision
units
in
this
account
e350,
which
is
the
indigent
accident
fund
county
match
program.
E
E352
here
is
a
request
to
fund
managed
care
organizations
through
a
directed
payment
program.
Another
supplemental
payment
program-
and
this
is
a
this
request-
is
a
companion
to
e352
in
the
checkup
budget
account
and
e352
in
the
medicaid
budget
account
in
2016
just
for
some
context.
Cms
issued
information
regarding
the
limitation
and
phase
out
of
this
prior
safety
net
program
and
hospitals
were
facing
a
10-year
phase
out
effective
in
2017..
E
E
To
provide
a
little
bit
of
additional
context
on
that
decision
unit
and
the
next
is
e678,
which
is
the
balance
forward
of
the
state
net
benefit.
This
request
balances
forward.
The
state
net
benefit
into
the
title:
19
medicaid
budget
account
32
43
to
offset
general
fund
appropriations
for
medicaid
expenditures
and
as
a
companion
to
decision
unit.
678
in
budget
account
3243
we're
requesting
this
decision
unit
as
a
part
of
our
the.
A
Thank
you
so
much
for
on
that
presentation.
Before
we
move
on
to
questions,
I
would
just
like
to
let
our
committee
secretary
know
that
senator
canazero
has
joined
the
meeting.
I
forgot
to
tell
you
as
soon
as
she
got
in,
but
I'd
like
to
show
her
as
present
so
on
to
questions.
I
believe
we
have
senator
john
darrell
luke
with
a
few
questions.
B
P
J
P
Phil
burrell
w
administrator
for
the
record
good
morning.
Thank
you
for
your
question.
So
the
primary
difference
between
the
two
is
essentially
the
change
in
federal
requirements
for
the
previous
program,
the
mco
enhanced
program
to
the
requirements
for
the
mcl
directed
payment
program,
and
what
this
entails
is
what
administrator
biermann
was
highlighting
was
in
2016
cms,
released
additional
guidance
to
give
us
further
direction
and
understanding
on
how
to
proceed
with
this
passive
program.
P
B
B
P
Good
morning,
phil
morrell,
deputy
administrator
for
the
record,
yes
ma'am,
the
dish,
this
disproportionate
share
hospital
payment,
allotments
are
being
pushed
back
to
that
date.
As
you
said,
101
2023
and
the
reason
for
that
is
from
end
of
last
year.
The
consolidated
appropriations
act
passed
by
congress
included
the
language
for
making
this
change
happen.
K
Thank
you,
and
thanks
for
your
presentation
and
and
try
to
get
some
clarity
here,
but
my
understanding
that
these
payments,
these
mco
directed
payments,
are
actually
provided
to
medicaid
participants
that
are
associated
with
quality
measures
and
actually
the
number
of
medicaid
particip
participants
that
are
seen
or
taken
care
of
or
visits.
It's
always.
I
need
a
clarity
here
and
I
need
some
numbers
because
at
the
early
part
of
this
presentation
we
saw
the
increased
number
by
20
of
medicaid
enrollees.
K
This
particular
budget
involves
actually
medicaid
participants
and
and
and
perhaps
their
treatments.
How?
How
much
has
the
patient
interaction
numbers
increased?
K
This
budget
just
means
that
you're
getting
more
money
because
you
have
x
number
of
people
there,
but
makes
I
want
to
see
how
many
contacts
how
much
care
was
actually
given,
and
I
want
to
see
if
that
number
increased,
because
my
perception
that
the
actual
patient
contacts,
patient
visits,
patient
hospitalizations
have
gone
down,
and
so
I
I
just
need
to
see
some
numbers
if
what
this
reimbursement
is
tied
to
actual
patient
direct
services,
not
a
presumptive
services,
direct
services,
hands-on.
E
E
I
I
can't
say
that
we
did
look
at
this
from
a
very
high
level
on
a
per
capita
basis
recently
and
can
say
that
we
saw
a
slight
decline
in
utilization
between
2019
and
2020
when
you
looked
at
it
again,
accounting
for
the
huge
enrollment
growth
that
we've
had
over
the
course
of
the
past
year.
But
when
we
analyzed
the
data
looking
at
a
per
capita
basis,
we
did
see
small
declines
in
utilization
over
the
course
of
the
past
year.
K
Great
thank
you,
follow-up
manager,
because
that's
I
appreciate
that.
I
I'm
sure
every
member
of
the
committee
would
like
to
actually
see
the
utilization,
because
again
these
are
direct
services
and,
along
as
when
you
get
that
report
the
thing
and
and
later
on,
we'll
see
reimbursements
to
physicians
and
some
other
budget,
but
included
in
that
report
is
if
these
are
all
about
direct
services,
it
would
be
important
to
know
again
how
many
increase
in
providers
you
have
enrollment
and
maybe
a
reimbursement
turnaround
time.
K
The
earlier
question
regarding
that
reimbursement
to
the
facilities
that
senator
dunder
loop
asked
about
the
delay
in
getting
these
payments
to
these
facilities.
It's
all
about
access
to
care,
and
you
mentioned
that.
There's
no
delay
in
access
to
care.
Well,
if
these
facilities
close
because
they
haven't
gotten
their
payments,
this
can
be
a
huge
access
to
care
issues.
So
I
think
all
that
information
is
critical
again,
we
need
more
details
than
just
the
number
of
enrollees.
Thank
you,
madam
chair.
F
Oh,
thank
you,
madam
chair.
I
think
my
questions
been
asked.
I'm
gonna
hang
back
and
and
go
go
from
there,
but
along
the
line
of
dr
titus
is
questioning.
I
know
that's
this
kind
of
how
managed
care
works,
it's
sort
of
a
safety
valve
for
the
state
that
we
funded
along
the
lines
of
a
per
member
per
month,
sort
of
formula
and
and
that
sometimes
the
the
provider
does
well
or
the
facilities
do
better,
but
it
does
protect
the
state.
F
So
I
think
what
we're
talking
about
is
just
generally,
how
managed
care
works
and
all
it
would
take
is
a
couple
of
million
dollar
babies
to
kind
of
blow
that
formula
out
of
the
water.
So
I
believe
that
was
the
biggest
discussion
point
we
had
years
ago
as
we
moved
to
manage
care.
So
I
just
think
that
needs
to
be
part
of
the
conversation.
Also.
Thank
you
very
much
for
the
statement
appreciate
it.
F
J
Mm
chair.
Thank
you,
mr
spearman.
With
the
extension
of
the
dish
program,
there
should
be
some
extended
and,
I
think
benefit.
Our
staff
indicates
it's
about
24.2.
C
J
Thank
you
for
that,
and
we
also
understand
that
you're
carrying
it
forward
about
2.4
million
dollars
in
state
net
benefit
from
fiscal
year,
2020
that
wasn't
expended
that
would
be
available
to
us
in
the
first
year
of
the
biennium.
I.
F
And
I
don't
see
any
of
those
discussion
points
included
here,
but
I
do
know
that
there
were
dollars
that
did
go
to
the
hospitals
to
help
them
get
through
the
pandemic
because
of
the
the
way
their
their
their
business
actually
ended
up
running.
So
was
that
part
of
the
discussions,
as
you
put
some
of
these
things
together,
I'm
not
sure
if
it's
appropriate
here
but
becau,
because
we're
talking
about
disproportionate
shared
impacts
to
hospitals.
I
thought
I
might
ask
it
here.
E
Thank
you
for
the
question
assemblywoman
carlton.
Well,
for
for
the
division,
the
primary
place
that
we
saw,
additional
funding
from
the
federal
government
was
from
the
family's
first
coronavirus
response
act,
and
that
is
a
6.2
enhancement
of
the
fmap
for
the
program
that
we've
been
receiving
through
since
2020..
F
E
Fund
and
that's
separate
from
the
funding
that
came
into
the
division
but
worked
very
closely
and
tried
to
provide
a
lot
of
outreach
and
education
to
providers,
hospitals
and
actually
a
wide
range
of
medicaid
providers
to
let
them
know
that
additional
funding
from
the
federal
government
was
available
through
the
provider
relief
fund.
So
we
could
follow
up
with
additional
information
regarding
the
amount
of
money
that
came
into
nevada
through
that
provider
relief
fund
but
specific
to
the
division.
A
E
Thank
you,
suzanne
biermann,
for
the
record
budget.
Account
3158
is
the
medicaid
administration
account.
So
this
is
the
account
with
the
decision
units
that
really
fund
the
administrative
and
operational
aspects
associated
with
the
state's
medicaid
program.
So
I'm
happy
to
go
through
all
of
our
major
decision
units
in
this
budget
account.
E
Here
we
just
provided
this
graph
related
to
weber,
peace,
loads
and
we'll
talk
about
this
more
in
the
medicaid
medical
budget
when
we
get
to
it
too,
but
there
are
some
administrative
costs
associated
with
the
increase
in
waiver
caseloads.
So
I
did
just
want
to
provide
this
slide
here
and
on
this
chart
green.
The
green
section
of
this
graph
is
related
to
anticipated
caseload
growth,
and
the
orange
section
here
is
the
additional
caseload
growth
beyond
that.
That
is
being
requested
to
comply
with
olmsted
and
ensure
no
one
is
waiting.
E
E
So
these
are
the
decision
units
that
we
are
seeking
to
address.
The
administrative
costs
related
to
the
increases
in
weber
caseloads,
and
these
are
things
like
quality
reviews,
processing
eligibility
for
waivers
and
compliance
monitoring
and
oversight.
Those
are
some
of
the
administrative
tasks
that
go
along
with
the
waivers
and
the
increases
in
caseload.
E
So
here
we
have
again
they're
they're,
two
distinct
requests
related
to
the
waivers
one
was
the
the
wait
list
reduction
this
one
to
meet
the
the
waiting
list
and
the
additional
slots
that
are
being
requested
to
address
olmstead
related
issues.
Again,
all
of
these
amounts
are
related
to
the
division's
administrative
costs
related
to
to
the
waivers,
and
these
increase
in
slots
or
case
load
next
slide.
Please.
E
Okay
on
this
slide,
we
have
a
couple
of
our
it
initiatives
and
the
first
of
these
is
related
to
interoperability.
Medicaid
providers
have
many
different
data
systems
and
here
we're
requesting
funding
for
the
administrative
costs
so
that
we
can
ensure
that
the
data
systems
talk
to
each
other
and
from
a
consumer
perspective,
the
feds
are
requiring
what
is
being
called
an
application,
programming,
interface
or
an
api.
So
the
division
here
is
of
requesting
funding
in
this
decision
unit
to
comply
with
that
federal
mandate.
E
They
are
related
to
the
development
of
these
apis
and
you
know:
do
you
think
that
this
has
value
for
consumers
and
making
their
their
data
more
accessible,
so
that
is
m517
m518?
The
second
decision
unit
here
funds
contracts
for
the
continued
implementation
of
the
state's
electronic
visit
verification
system
or
what
we
call
ebv
for
short,
and
that's
also
a
federal
requirement
that
we're
working
to
implement
that
allows
the
division
to
automatically
verify
that
recipients
are
receiving
services
that
they're
entitled
to
specifically
in
the
long-term
care
at
home
and
community-based
services
services.
E
The
next
decision
unit,
e-226
mmis
modernization
project-
is
something
I
know
the
committee
has
heard
a
lot
about
over
the
last
years.
Maybe
I
don't
know
if
it's
a
an
exaggeration
to
say
a
decade,
but
these
are
definitely
long.
I.T
projects
in
the
work
and
massive
undertakings
for
the
state
and
I'm
happy
to
report
that
the
state
has
had
a
really
successful,
mmis
modernization,
and
this
is
just
the
last
remaining
piece
of
work
that
is
related
to
the
state's
mmis
modernization
project.
E
E
Okay!
On
this
slide,
we
have
several
decision
units
related
to
some.
E
So
just
looking
for
some
extra
support
to
to
dive
a
little
bit
deeper
into
those
mlr
reports
and
ensure
that
that
requirement
is
being
made
being
met.
The
next
decision
unit
here
e-228,
is
seeking
funding
for
a
pharmacy
benefit
manager
a
separate
contract.
Currently,
those
services
are
provided
through.
B
E
I
hope
that
we
have
defined
that
it
is
escaping
me
at
the
moment,
but
I
can
say
to
emphasis:
is
a
data
initiative?
That's
been
very
important
to
our
federal
partners,
the
centers
for
medicare
and
medicaid
services.
E
It's
been
one
of
their
long-standing
priorities
and
also
important
for
the
division,
because
it
allows
us
to
improve
our
data
quality
and
have
some
efficiencies
in
our
reporting
and
also
have
data
that
helps
inform
policy
decisions.
So
we
are
seeking
one
new
position
to
help
with
those
data
quality
efforts
and
ensure
that
we
stay
meeting
all
of
our
tms
requirements
and
work
to
improve
our
data
quality
going
forward
next
slide.
Please.
E
Okay-
and
that
brings
us
to
the
decision
units
related
to
the
certified
community
behavioral
health
centers,
and
here
we're
looking
for
contracts
to
assist
with
rate
setting
and
quality
incentive
payments,
and
that
will
help
us
improve
our
our
quality
and
make
sure
that
the
rates
that
are
funding
those
credible
certified
community
behavioral
health
centers
are
adequate
and
on
the
mark.
E
So
that
is
e350
and
e351
below
is
seeking
assistance
to
fund
actuary
costs
related
to
restoring
the
six
percent
rate
reduction
to
to
have
some
actuarial
help
and
with
with
the
managed
care
component
of
our
program
and
ensuring
that,
as
is
part
of
the
governor's
recommended
budget,
the
six
percent
rate
reduction
that
was
made
during
the
31st
special
session
is
able
to
to
be
restored
and
have
the
the
technical
support
needed
to
update
our
our
cost.
To
manage
care.
As
a
part
of
that.
E
Okay,
this
decision
unit
is
related
to
cost
allocation.
This
funds
revenue
adjustments
that
we
transfer
to
multiple
state
agencies,
things
like
the
division
of
welfare
and
supportive
services,
those
medicaid
determinations,
so
it
really
just
funds
the
work
to
make
sure
that
we
have
appropriate
cost
allocation
plans
in
place
next
slide.
Please.
E
Okay,
this
slide
outlines
the
position
changes
that
the
division
is
seeking
during
this
biennium
and
they
are
all
listed
on
this
one
slide.
Two
of
those
are
related
to
clinical
transfers
from
the
division
of
public
and
behavioral
health
to
the.
E
Care
and
financing
policy
and
the
last
three
are
related
to
qa
efforts
from
dhc
from
dhcfp
to
adsd
slide,
please.
So.
This
slide
just
provides
a
high
level
summary
of
the
positions
that
we
just.
F
A
Thank
you.
We
have
a
few
questions.
I
will
ask
members
to
mute
their
mics
if
they're
not
talking.
I
will
start
the
question
with
senator
ratty.
I
Thank
you
chair
and
thank
you,
mr
spearman.
There's
always
a
lot
in
this
budget,
so
I'm
going
to
try
to
focus
my
questions
on
some
of
the
professional
and
clinical
personnel
that
you're
making
some
they're
in
some
of
these
decision
units
229,
400,
501
and
901.
I
believe
so
just
starting
with
the
dental
health
officer.
So
I'm
grateful
that
we've
found
a
way
to
have
a
sustainable
funding
source
for
this,
but
I
do
want
to
dig
into
any
consequences
intended
or
otherwise
that
might
come
from
moving
them
onto
this
particular
funding
source.
I
D
You
senator
ready,
cody
finney,
deputy
administrator
for
the
record.
You
know
the
the
work
of
medicaid
really
is
largely
improving
access
and
improving
the
quality
of
health
care,
as
we've
moved
into
the
aca
era,
and
so
in
order
to
have
that
work
for
us,
it's
incredibly
helpful
for
us
to
have
expertise
like
a
dental
health
officer
that
can
inform
our
policy
and
make
sure
we
that
the
policy
we
have
is
clinically
sound.
D
We've
had
a
lot
of
success
in
aligning
the
benefits
that
we
do
currently
provide
with
updated
clinical
practice
and
and
working
with
the
dental
officer
currently
and
the
benefit
of
that
as
we
serve
that
that
25
of
the
population.
That's
with
us
now
spreads
then
to
the
rest
of
the
community,
because
we
have
we
have
an
improved
network
for
for
medicaid.
It
improves
the
network,
broadly.
D
So
from
from
my
perspective,
having
worked
on
both
sides,
we're
really
we're
really
seeing
a
lot
of
overall
benefit.
That
will
continue
from
what
the
oral
health
program
had
started
years
ago.
That
will
continue
through
and
benefit
largely
the
medicaid
population,
but
really
also
the
entire
network
of
and
access
to
oral
health
care
in
the
community.
I
D
Cody
finney
for
the
record,
you
know
it.
It
was
our
intent
and
not
asking
for
for
a
change
in
that
statute
to.
D
With
our
sister
agency
at
dpbh,
we
perceive
that
could
be
done
successfully
either
by
that
appointment
being
made
from
dhcfp
or
at
dpvh.
So
that
was
the
purpose,
but
we
are
happy
to
work
with
that,
as
this
body
sees
fit.
I
B
I
O
Good
morning,
dwayne
young
deputy
administrator
of
our
programs
for
the
record,
madam
chair,
through
you
to
the
senator
already
the
same
in
the
same
vein
as
ms
finney
has
pointed
out,
the
the
pharmacy
benefit
manager
managing
25
of
the
population
is
really
going
to
help
drive
the
initiatives
for
where
the
department
wants
to
go
and
managing
the
cost
of
high-cost
drugs.
Starting
through
that,
you
know,
managing
both
the
program
from
the
oversight
of
the
fee
for
service
program,
also
through
managed
care.
O
We
will
be
talking
later
about
our
pharmacy
benefit
manager,
contract
and
moving
to
a
combined
contract
with
the
adap
program,
the
aids
drug
assistance
program
for
the
division
of
public
and
behavioral
health.
That
will
not
only
increase
the
state's
buying
power
but
use
medicaid
really
as
the
force
and
the
core
to
drive
the
mission
throughout
the
state
and
look
at
other
state
models
such
as
ohio,
where
they
have
a
combined
pbm
for
many
of
the
state's
functions
and
move
that
beyond
the
state
and
so
moving.
The
pharmacy
benefit.
Manager.
O
Position
to
medicaid
just
makes
sense,
because
that
is
where
you
will
have
your
most
powerful
drive
for
the
combined
purchasing
power
of
the
drugs,
where
the
state's
roadmap
wants
to
be.
I
O
So
the
senior
pharmacy
advisor
serves
really
as
a
clinical
portion
for
the
staff
of
the
division
of
healthcare,
financing
and
policy,
because
the
dirt
board
sets
the
utilization
criteria
for
for
the
drugs
that
are
fda
approved,
as
well
as
with
silver
straight
scripts.
Taking
into
account
what
is
preferred
and
not
preferred
senate
bill
378
from
the
last
session
allowed
us
to
discuss
costs
for
the
first
time,
but
that
is
secondary
to
the
clinical
criteria.
O
And
so
the
pharmacy
benefit
manager
is
really
even
though
there's
clinical
expertise
within
our
fiscal
agent
and
their
sub.
Vendor
they're,
really
there
to
guide
the
clinical
direction
of
the
policy
and
to
help
myself.
The
deputy
administrator
and
the
chief
over
pharmacy
make
the
best
decisions
and
ensure
that
the
clinical
criteria
is
really
at
its
highest
standard
and
is
not
just
taking
that
cost
into
consideration.
But
doing
what
is
right
for
all
nevadans.
I
E
Susann
biermann
for
the
record
senator
ratty.
We
are,
we
confirmed
with
both
our
council,
the
deputy
attorney
general's
office
and
the
centers
for
medicare
and
medicaid
services.
There
is
a
federal
regulation
that
allows
the
division
to
collect
clinical
match,
which
is
paid
at
a
75,
federally
funded
rate
for
both
the
dental
position,
as
well
as
the
pharmacist
position.
F
And
thank
you,
madam
chair,
and
I
guess
my
questions
are
going
to
focus
around
the
pharmacy
benefit
manager
contract
and
where
we're
going
with
that
at
the
ifc
meeting
that
we
had
in
december
of
last
year.
Gosh
it's
not
long
ago,
but
it
seems
like
a
very
long
time
ago.
We've
had
a
lot
of
conversation
about
a
carve
out
and
the
impact
that
that
would
have
to
the
state
general
fund.
F
So
I
guess
I
want
to
get
an
update
on
where
we
are.
I'm
not
sure
we
got
a
definitive
answer
on
those
questions
and
I
guess
I
really
want
to
have
something
on
the
record
that
talks
about
the
agency's
intent
on
that
carve
out
prescription
drug
benefit
for
managed
care,
because
it
will
have
a
significant
general
fund
impact.
So
if
they
could
address
that,
please.
E
Suzanne
beerman
for
the
record
I'll
start
and
others
may
have
additional
information
on
this
one
to
add
in,
but
I
can
say
that
we
heard
the
message
of
this
body
loud
and
clear
and
are
working
to
go
back
and
analyze
and
evaluate
the
overall
impact
of
that
particular
policy
option,
collecting
more
information
and
realizing
that
it
does
have
significant
impacts
outside
of
the
division
on
the
state's
budget
in
terms
of
premium
tax
revenue.
E
So
I'm
currently
working
on
on
that
analysis
and
to
provide
a
commitment
that
we're
you
know
not
moving
forward
in
the
near
term
without
additional
consultation
and
providing
that
additional
level
of
analysis.
F
And
if
I
made
madame
chair
so
what's
the
time
frame
on
that
and
I'm
a
little
concerned
about
the
word
consultation,
something
could
happen
and
we
may
not
be
in
control
of
the
horizontal.
So
if
you
could
elaborate
on
the
time
frame
and
a
little
bit
more
on
the
consultation
part.
E
So
I
can
tell
you
previously
suzanne
biermann
for
the
record.
Thank
you
for
the
question.
Assemblywoman
carlton
there
had
been
language
to
try
to
move
that
benefit
carbonata
for
managed
care
earlier
in
this
next
upcoming
rfp
we've
put
the
brakes
on
that
so
again,
aren't
moving
forward
with
that
carve
out
at
this
time
and
I'll
have
to
follow
up
with
fiscal
unless
they're
able
to
provide
additional
details
on
the
timeline
related
to
that.
E
Analysis
today,
but
it's
it's
not
our
intent
to
move
forward
with
that
at
at
this
time
and
definitely
want
to
provide
further
information
related
to
the
impact
that
that
has
on
the
state
premium,
tax
and
other
factors.
F
And
madam
chair,
I'm
sorry
if
it
sounds
like
I'm
beating
the
proverbial
horse,
but
when
I
hear
at
this
time
so
miss
biermann
is
your
definition
of
at
this
time
the
this
biennium.
So
this
will
not
have
a
discussion
through
this
biennium
and
it
will
possibly
be
discussed
as
a
change
in
the
next
legislative
session.
Is
that
the
goal.
E
Suzanne
biermann
for
the
record.
Yes,
I
think
that
is
our
goal.
Unless
there's
you
know
it's
included
in
our
budget.
For
this
time
there
there's
not
an
intention
on
our
part
to
move
forward
with
that
absent
that
being
decided
in
our
budget
for
this
biennium.
Otherwise,
it
would
be
for.
F
Okay
and
madam
chair,
just
to
make
sure
we
have
a
very
complete
record
time,
has
taught
me
a
number
of
very
tough
lessons.
Medicaid
does
have
the
opportunity
to
change
how
they
do
things
through
cms,
so
I
just
thank
you
for
the
latitude
of
being
able
to
get
some
things
on
the
record.
I
think
this
is
a
big
policy
shift
and
could
have
some
implications,
and
I
think
everyone
needs
to
be
aware
of
those
before
we
make
that
decision.
F
A
M
I
just
have
one
question
regarding
your
tbm:
I
want
to
go
back
to
that
discussion.
You
know
recently
in
the
last
few
sessions
we've
had
a
lot
of
discussion
on
what
cbn
does.
A
M
B
M
So,
mr
man,
over
the
last
few
years,
we
had
a
lot
of
discussion
about
pbms
and
pretty
much
the
whole
transmission
of
drugs
from
manufacturer
to
the
seller,
to
the
to
the
the
buyer,
and
you
know,
we've
talked
about
transparency
in
your
estimation
and
well
actually
how
you
vision
the
way
the
pbm
would
work
for
the
state.
M
Just
can
you
see
them
also
being
asked
to
adhere
to
all
the
transparency,
regulations
and
laws
that
we've
passed
and
asked
as
well,
how
transparent
will
their
work
be
to
the
general
public.
E
Thank
you
for
the
question.
Senator
hammond,
what's
being
proposed
here
is
a
direct
contract
for
the
medicaid
fee
for
service
population
with
pbm.
We
do
think
that
there
will
be
more
transparency,
because
currently
those
services
are
handled
through
a
larger
contract
that
then
subcontracts
to
a
pbm.
E
So
we
think,
by
moving
to
a
direct
contract,
the
division
will
have
greater
transparency
into
the
workings
of
the
the
pbm,
and
the
goal
is,
is
certainly
to
have
increased
transparency
and
what
would
certainly
require
our
vendors
to
comply
with
any
state
and
federal
laws
that
are
passed.
B
Oh
stuck
on
me.
Thank
you,
madam
chair.
Yes,
I
was
just
wondering:
have
any
programmatic
efficiencies
been
identified
since
the
electronic
visit
verification
system
was
deployed.
O
Good
afternoon
dwayne
young
for
the
record
deputy
administrator
for
the
division.
Madam
chair,
through
you
to
assemblyman
howard
watts,
we
have
not
identified
any
systemic
changes
that,
from
this
policy,
nevada
was
one
of
the
leaders
and
one
of
the
first
states
to
implement,
and
so
my
team
is
presented
at
several
national
conferences.
What
we've
found
is
just
general
trepidation.
O
Many
people
believe
in
the
government
is
tracking
them
facilities
willing
to
give
variances
to
long-time
staff
and
provider
caregivers
who
are
hesitant
about
using
technology,
and
so
we
have
been
slowly
troubleshooting
and
diving
into
these
cases
and
then,
once
we
have
more
systemic
data,
we'll
be
able
to
look
at
policy
changes.
I
think
really.
The
intent
of
electronic
visit
verification
is
to
prove
that
the
services
are
happening
and
so
we're
not
seeing
large
amounts
of
fraud.
Waste
abuse
currently
and
there's
no
major
active
investigations
into
those,
and
so
that's
really.
O
What
we
want
to
see
from
this
program
is
that
people
are
getting
the
services
that
they
say
they're
getting.
B
Great
thank
you
for
that.
I
also
had
a
question
about
the
m517
decision
unit.
What's
the
status
of
application
programming
interfaces
associated
technology.
P
Good
morning,
philip
earl
w
administrator
for
the
record,
the
status
is,
we
are
in
the
implementation
process
now
beginning
in
march.
We
will
be
moving
forward
with
the
project
to
implement
the
the
decision
unit.
We're
talking
here
about
m517,
we
have
an
expected,
go,
live
to
be
at
or
before
july,
1st.
P
Good
morning
again,
phillip
burrell,
the
administrator
for
the
record.
This
is
in
relation
to
this
decision
in
his
relation
to
our
healthy,
healthy
hie
exchange
here
in
nevada
as
part
of
the
program,
it
is
required
for
us
fcms
approval
of
this,
and
so
I
see
this
as
it
is
currently
in
review
right
now.
If
there
is
a
determination
that
the
approval
process
is
not
is
it
is,
it
is
unsuccessful.
Excuse
me
would
not
be
able
to
move
forward.
B
Okay,
thank
you
and
then
I
have
one
last
question
on
the
modernization
project
e226.
So
I
just
wanted
to
get
some
clarity
on
the
record.
Is
the
the
project
expected
to
be
fully
complete
in
fiscal
year?
22.
P
Phillip
administrator
again
for
the
record:
yes,
the
project
is
the
modernization
work
with
the
systems.
Enhancement
is
complete.
This
is
the
final
project.
Sorry,
the
final
contract
for
this
project,
and
essentially
what
it's
doing
is
we've
been
wrapping
up
the
post.
If
you
will
post
the
implementation
in
regards
to
the
project
management.
C
Thank
you
so
much,
madam
chair,
so
my
question
is
on
the
new
data
quality
position.
The
business
process
analyst
position:
it's
like
we're
in
requirements
with
the
federal
government
for
or
we're
in
compliance
right
now,
but
it
also
looks
like
got,
I
think,
at
state
71
data
quality
issues
waiting
to
be
resolved,
so
imagine
that
this
position
would
make
it
so
that
those
those
quality
issues
are
completely
resolved.
C
And
then
I
guess,
if
you
could
give
me
some
insight
into
what
those
quality
issues
are,
whether
they're
just
reconciliations
and
billing
or
coding,
is
among
I'd
like
in
the
in
the
mcos
versus
fee
for
service.
I
thought
you
if
you
could
give
a
fight
on
the
record
as
to
what
those
are.
I
P
Deputy
administrator
for
the
regular
I'll
begin,
and
then,
if
the
team
has
any
additional
comments,
we
can
definitely
try
to
add
additional
information
for
you.
Yes,
ma'am
the
program.
This
position
is
as
part
of
the
team
effort
here,
if
accepted,
to
be
able
to
be
a
part
of
our
data
quality
team
to
focus
on
and
improve
the
data
quality
as
part
of
our
teams.
This
administrator
biermann
spoke
to
earlier
today,
reporting
and
and
data
quality.
P
As
you
mentioned,
you
know
we're
continuing
to
work
with
the
updated
information
for
cms
federal
guidance
on
the
support
for
the
data
quality
and
submission
and
reporting,
as
it
relates
to
our
federal
reporting
and
so
as
a
part
of
this
effort.
With
this
role
in
this
position,
this
will
be
a
part
of
that
data
team
that
helps
with
managing
the
traffic
and
and
reports
and
requests
that
we
need
to
fulfill
for
our
federal
requirements.
C
Sorry,
I
I
lost
a
piece
of
that.
Just
the
sound.
P
I
give
phil
morel,
deputy
administrator
apologies
for
the
sound
problem.
P
The
role
and
position
here
is
a
part
that
is
going
to
be
a
part
of
the
data
quality
team,
if
approved,
to
allow
us
to
continue
compliance
with
federal
requirements
for
this
position
and
for
our
teams
is
the
transformed,
medicaid
statistical
information
system
that
administrator
commissioner
biermann
spoke
about
earlier
on
this
decision
unit,
and
it
is
for
us
to
continue
to
meet
federal
compliance
as
we
continue
to
enhance
in
the
data.
C
C
And
if
I
guess
we'll
just
I'm,
I'm
fine
with
some
written
follow-up,
I
just
didn't.
I
wanted
some
more
insight
into
what
the
data
quality
issues
were
since
so
much
of
that
data
like
utilization,
like
claims
and
expenditure
data,
we
rely
on
to
make
decision
numbers.
So
I
just
thought
it
would
be
helpful
for
the
committee
to
have
a
little
bit
understanding
of
what
those
quality
issues
might
be
and
then
how
this
business
analyst
process
position
might
help
us.
C
A
Staff,
thank
you
well
looks
like
the
the
sound
issue
has
gone
for
now.
I
believe
assemblywoman
carlton
has
a
follow-up.
F
And
thank
you
very
much,
madam
chair
on
the
medicaid
management
information
system.
This
has
been
a
very
long
project.
It
was
initiated
in
2007
and
I
just
want
to
congratulate
folks
for
getting
through
it.
It
hasn't
been
easy,
but
we
have
seen
other
technology
requests
not
go
this
well
in
the
state,
so
we
are
on
the
downhill
side
of
this
it'll
be
done.
F
It
looks
like
in
2022,
which
is
fantastic
if
you'd
have
asked
me
to
bet
if
it
would
have
been
this
smooth
back
when
we
started
I,
I
would
not
have
laid
money
on
this
one,
but
I
just
wanted
to
congratulate
them
on
getting
this
project
done,
because
it
really
will
make
a
difference
as
far
as
the
system
goes.
So
congratulations
on
getting
this
huge
project.
A
A
E
You,
I
think,
there's
a
fan
or
something
that
is
blowing
in
this
room
and
we're
we're
trying
to
resolve
that
on
our
end,
so
we
appreciate
your
patience
so
ba
3160
is
the
increased
quality
of
nursing
care
budget
account
also
known
as
the
skilled
nursing
facility
provider
fee.
The
goal
here
is
to
improve
long-term
nursing
care,
and
this
is
funded
by
a
provider
fee
revenue.
E
There
is
a
maintenance
decision
unit
here
in
150,
but
there
are
no
caseload
changes
associated
with
this.
So
again
apologize
for
our
technical
difficulties,
I
think
we're
in
the
right
place
and
our
audio
has
been
resolved
so
again,
thank
you
all
for
your
patience
with
us
but
happy
to
answer
any
questions
that
the
committee
might
have
on
budget
account.
3116.
B
Thank
you
very
much.
I
I
actually
think
the
sound
sounds
like
an
ultrasound
which
is.
B
Are
not
what
you
would
consider
a
reserve
in
this
account,
but
this
account
continues
to
collect
continues
to
collect
funds
throughout
the
state
fiscal
year
and
then,
once
we
have
finished
collecting
funds
for
the
state
fiscal
year,
we
don't
have
reconciled
to
determine
if
the
providers
have
over
paid
any
taxes
that
that
would
be
refund
if
there's
an
overpayment
due,
but
there's
not
really
a
reserve.
The
program
continues
to
operate
throughout
the
year.
A
B
B
Okay,
so
is
there
a
way
to
maintain
that
rate
that
I
don't
budget?
I
don't
want
to
call
to
reserve.
Then.
Is
there
a
way
to
maintain
that
budget
at
that
that
900
level
or
below
for
the
record
sterling?
We
do
not
allow
the
reserve
to
go
below
900
000,
but
it
is
very
unlikely
that
there
will
ever
be
900
000
in
that
account
because
we're
continuing
to
collect
throughout
the
year
and
then,
as
we
have
enough
in
the
account
to
transfer
the
non-federal
share
of
payments
to
3243.
We
do
that.
L
Thank
you,
madam
chair.
My
questions
were
answered.
L
E
Great
thank
you.
Moving
on
to
budget
account
3178.
This
is
the
budget
account
for
the
nevada
checkup
program,
which
is
what
we
call
the
children's
health
insurance
program
here
in
the
state
of
nevada.
It
provides
coverage
for
thousands
of
low-income,
uninsured
children
who
aren't
eligible
for
medicaid
because
of
the
income
limits
associated
with
that
program
and
checkup
serves
a
slightly
higher
income
calculation,
so
we
will
proceed
and
go
through
the
decision
units
related
to
checkup
next
slide.
Please!
E
Okay!
Here
we
have
m101,
which
is
related
to
agency
specific
inflation
increases,
so
we
are
requesting
projected
rate
increases
for
capitated
payments
and
for
fee
for
service
expenditures
for
a
variety
of
services,
federally
qualified
health,
centers,
rural
health,
centers,
pharmacy
and
hospice.
So
you
can
see
that
outlined
here
at
m101.
E
Next
slide,
please,
okay!
This
is
our
first
caseload
slide
and
these
projections
were
done
by
the
office
of
analytics
and
it
does
provide
caseload
forecasts
using
data
from
the
division
of
welfare
and
supportive
services.
I
will
say
that
the
projections
are
expected
to
be
updated
in
march,
so
we're
looking
forward
to
that
and
know
that
in
this
uncertain
and
volatile
time,
it's
been
a
little
hard
to
to
predict
at
caseloads.
But
here
we
have
what
was
put
together
at
the
end
of
last
year.
E
You
know
reflecting
that
the
best
information
available
at
the
time
by
the
office
of
data
analytics-
and
we
use
this
information
to
determine
a
cost
per
eligible
per
recipient,
and
this
is
then
used
to
budget
medical
expenditures.
Next
slide,
please,
okay!
So
again,
this
just
outlines
that
the
increases
for
caseload
here,
m200
and
201.
E
Please
you'll
see
companions
to
these
decision
units
in
the
medicaid
medical
services
budget
as
well,
but
going
back
to
the
special
session
the
summer,
the
31st
special
session
e351
funds
rate
restorations
for
those
six
percent
rate
reductions
to
rates
that
were
included
in
the
fee
schedule
that
the
division
reduced
to
address
the
economic
crisis
and
the
governor's
recommended
budget
does
propose
restoring
those
rates
effective
october
1st
2021.,
and
you
can
see
that
information
here.
E
The
next
decision
unit
is
related
to
funding
for
the
managed
care
supplemental
payment
program,
the
directed
payment
program
that
we
talked
about
earlier-
and
this
is
a
companion
to
e352
in
the
igt
program,
which
is
in
budget
account
3156
next
slide.
Please.
E
Okay,
this
slide
outlines
two
of
the
proposed
service
eliminations
as
part
of
the
reductions
the
division
is
proposing
to
meet.
You
know
the
continuing
economic
crisis.
These
services
have
been
identified,
basic
skills,
training
and
psychosocial
rehabilitation
for
elimination,
and
these
decision
units
outline
those
requests
next
slide
crazy.
E
E
B
Thank
you
for
recognizing
me,
madam
chair,
so
can
you
tell
me
why
the
case
load
is
lower
and
the
legislatively
approved
budget?
I
mean
the
legislative
proof
one
we
had
in
the
2019-21
biennium.
E
So
that
is
a
trend
that
we
do
expect
to
see
as
the
economy
worsens.
Given
the
differences
in
the
income
thresholds
for
medicaid
and
ship,
it's
not
uncommon
when
the
economy
gets
worse,
to
see
children
transition
from
checkup
coverage
to
medicaid
coverage,
which
then
results
in
a
reduction
of
usage
of
the
checkup
program
and
an
increase
in
the
medicaid
program,
so
that.
B
Okay
and
then
I
see
that
the
checkup
case
loads
projected
to
be
9.1
in
2022,
but
only
that
only
projected
to
increase
like
2.5
in
2023,
and
so
can
you
kind
of
walk
me
through
that
a
little
bit.
Thank
you.
E
Thank
you
for
the
question,
senator
john
darrell
loop
and
I'll
start
and
if
others
have
additional
information,
that
would
be
great
to
you.
I
think
that
that
assumption
that
goes
into
the
caseload
projections.
There
has
a
lot
to
do
with
timing
around
when
the
economy
may
improve
and
again
as
the
economy
gets
better,
you
see
less
usage
and
checkup
or
as
the
economy
is
better,
you
see
increased
usage
in
checkup
and,
as
the
economy
is
worse,
more
usage
in
medicaid.
So
I
think
that
that
is
a
reflection
of
projected
economic
trends.
B
L
Yes,
thank
you,
chair
for
the
questions
and
just
looking
ahead
and
dirty
six,
eight,
two,
six,
eight
four
and
six,
eight
five
and
seeing
that
we're
recommending
some
service
eliminations
for
basic
skills,
training,
psychosocial
rehabilitation,
biofeedback
and
neurotherapy,
and
I
I
remember
we
had
this
discussion
in
the
very
early
presentations
at
the
beginning
of
our
pre
recession.
Hearings
and
I
know
that
we're
basing
some
of
those
reductions
based
on
utilization
during
2020.
L
I
just
wonder
if
we
see,
as
as
people
move
back
into
this
into
this
bracket,
if
we're
gonna
see
a
higher
demand
for
using
these
services
in
22
and
23
that
maybe
we
need
to
project
that
there's
going
to
be
a
greater
need
in
utilization,
so
perhaps
eliminating
or
reducing
them
may
not
be
the
right.
The
right
course
of
action.
L
So
just
could
you
speak
a
little
bit
more
to
how
we're
how
we're
using
2020
figures
to
estimate
in
22
and
23.
O
Good
morning,
madam
chair,
through
you
to
assemblywoman
tolls,
I
I
just
want
to
say
that,
with
behavioral
health
services,
there
is
a
slight
difference
in
that
we
didn't
really
see
a
shark
util
utilization
decrease
in
overall
behavioral
health
services.
O
What
we
actually
saw
was
the
stabilization
due
to
telehope,
because
telehealth
has
always
been
promoted
for
behavioral
health
services.
O
In
addition,
because
the
federal
allowance
allowed
for
telephone
services
and
our
policy
is
always
allowed
for
telephone
services
for
case
management
and
crisis
intervention
incidents,
we
did
see
an
increase
in
crisis
intervention
incidents
as
well
as
outpatient,
counseling,
outpatient
counseling
is
what
we
wanted
to
see
an
increase
in,
because
this
means
that
clients
are
accessing
clinically
licensed
staff
for
those
higher
level
interventions,
and
so,
even
in
looking
at
2019
data.
O
These
services
have
never
been
allowed
by
tele
telehealth,
because
they're
not
really
appropriate
interventions
for
telehealth,
and
so
as
we
migrate
into
those
higher
level
clinical
services
and
have
backfilled
the
needs
in
other
areas.
It's
really
a
proposed
elimination
of
the
services
based
off
of
the
lower
utilization
because
they
weren't
available
to
telehealth,
but
those
higher
level
services
were,
and
we
did
see
people
accessing
them.
L
O
B
A
B
L
Thank
you,
madam
chair.
If
it
worked
out
well,
because
I
got
a
chance
to
calculate
a
little
bit
of
math
on
on
my
end,
so
maybe
I
can
articulate
the
question
a
little
better
and
I
I
also
want
to
clarify
that.
I
understand
that
these
are
elimination
of
these
programs,
not
reductions,
and
so
from
my
notes.
I
have
that
by
eliminating
these
three
programs,
we
would
save
to
the
general
fund
a
grand
total
of
two
hundred
and
thirty
nine
thousand
six
hundred
and
thirty
two
dollars.
L
We
would
also
be
leaving
on
the
table
matching
federal,
679,
046
dollars
and,
and
so
we're
we're
just
eliminating
three
programs
that
cannot
be
replaced
by
telehealth
that
have
a
direct
impact
on
on
citizens
and
leaving
a
significant
amount
of
federal
funding
on
the
table
for
239
000
worth
of
savings,
not
correct.
If,
if
we
approve
the
elimination
of
those
programs.
E
Suzanne
biermann
for
the
record.
I
will
start
and
confirm
that
the
proposal
is
to
eliminate
these
three
services
defer
to
finance
team
on
on
the
math
and
also
deputy
director
dwayne
young,
on
some
of
the
other
services
that
we
think
can
appropriately
address
the
same
and
similar
needs
for
the
patients
that
we
serve.
O
Doing
young
deputy
administrator
for
the
division,
so
I
want
to
clarify
that
those
numbers
are
based
on
the
checkup
budget.
But
when
we
look,
these
decision
units
are
mirrored
in
the
medicaid
budget
as
well,
and
so
you
will
see
a
greater
savings
of
general
fund,
and
that
is
correct.
O
We
will
forfeit
that
federal
match,
but
as
with
medicaid
as
other
services
grow,
and
we
see
funds
shift
as
we
had
in
2020
shift
to
more
outpatient,
intensive
outpatient,
partial
hospitalization
and
crisis
utilize
services,
which
are
services
that
are
provided
by
license
and
credential
professionals.
We
will
draw
down
more
of
those
federal
mass
dollars
for
those
services.
L
Thank
you
chair
for
the
questions
and
thank
you
for
the
clarifications.
I
still
still
hope
we're
able
to
get
more
people
off
of
medicaid
out
of
those
income
brackets
and
into
higher
income
brackets,
so
they
won't
need
so
much
of
that
assistance
there,
but
we
can
get
them
closer
to
being
back
up
on
their
feet.
Thank
you.
K
Thank
you,
madam
chair
deputy
deputy
young.
I
just
really
have
to
to
circle
back
on
what
someone
told
just
ask
you
this
question
regarding
the
choices
on
what
you've
chosen
to
eliminate,
because
it
from
from
my
medical
standpoint,
no
there's
no
way
that
a
teleconference
call
can
substitute
for
basic
skills,
training
cycle
rehabilitation
and
biofeedback
and
north
node
neurotherapy.
K
So
I
need
to
hear
there
was
37
people
in
the
one
program
154
in
the
other
program
and
85
in
the
third
program
and
you're
telling
us
that
you
have
decided
and
I'd
love
to
see
the
scientific
articles
behind
it
that
a
telehealth
call
can
substitute
for
those
services.
That's
my
first
question.
A
second
question
is
you're
using
2020
data
of
access
to
services,
what
from
2019
and
what's
the
one
from
2018?
We
know
that
2020
was
this
point
in
time
that
folks
could
not
access
this
care.
K
So
are
these
numbers
up
or
down
or
were
the
brand
new
programs?
What's
the
outcome
from
these
programs
and
the
services
that
these
folks
had
and
I'm
just
not
accepting
that
that
you're
going
to
eliminate
all
this
and
just
tell
them
to
have
a
phone
call
and
that
you
that
you're
maybe
going
to
pay
for
some
telehealth
or
phone
calls?
K
O
Again,
deputy
minister
dwayne
young
for
the
record,
madam
chair,
through
you
to
the
assemblywoman,
dr
titus,
let
me
first
let
me
clarify
a
few
things
that
were
said
in
the
first
statement.
O
These
were
not
replaced
by
a
phone
call,
because
these
services
have
not
been
traditionally
allowed,
nor
were
they
allowed
during
the
pandemic
via
telehealth,
with
the
only
exception
was
psychosocial
rehab
for
those
under
18
for
our
specialized
foster
care
population,
because
any
any
clinical
intervention
is
better
than
no
clinical
adventure
at
all,
even
though
these
wouldn't
meet
the
standard
to
be
done
through
a
telephone
call.
As
you
pointed
as
you
point
out,
and
so
I
think
that
answers
the
question
as
yes,
there
was
higher
utilization
in
19
because
we
weren't
in
a
pandemic.
O
People
were
beating
face
to
face,
and
there
was
higher
utilization
in
2020.
We
didn't
allow
it
via
telehealth,
where
I'm
pointing
to
the
higher
utilization
and
telehealth
in
2020
is
in
our
clinical
counseling
services.
One
of
the
exceptions
that
we
made
as
part
of
our
1135
waiver
was
to
allow
for
group
counseling
to
happen
via
zoom.
This
is
not
something
that
we
would
have
done
before,
but
there
were
several
clinical
articles
that
support
it
again.
As
we
know,
any
clinical
intervention
is
any
evidence-based.
Clinical
intervention
is
better
than
no
intervention
at
all.
O
I
think
what
we
saw
on
the
trend-
and
I
I
know
we're
all
aware
of-
is
that
with
our
children
and
adults,
the
complexities
of
the
pandemic
and
just
20
20
overall,
have
impacted
and
caused
higher
acuity
levels
and
more
individuals
in
crisis
that
meant
more
individuals,
reporting
to
our
emergency
rooms
and
more
individuals
needing
higher
access
and
levels
to
care.
O
The
elimination
of
these
decision
units
is
really
to
push
people
into
those
higher
levels
of
care
through
licensed
and
clinical
professionals
that
I've
pointed
out
before,
and
so
we
do
want
to
see
an
increase
in
outpatient
counseling.
We
do
want
to
see
greater
utilization
of
our
certified
community
behind
our
health
centers.
We
do
want
to
see
a
greater
utilization
of
these
services.
Now
there
are
some
individuals
for
which
recovery
may
not
always
be
possible.
O
They
are
in
need
of
that
long-term
maintenance
and
services
for
behavioral
health,
and
so
we
have
two
alternative
programs,
one
we'll
discuss
later
for
children
in
specialized
foster
care
and
that's
a
1959
state
plan
option
that
replaces
these
services
and
there's
an
embargo
in
policy,
not
allowing
these
services
to
happen
at
the
same
time
as
those
services
in
specialized
foster
care,
because
those
children
have
a
specific
need
for
in-home
services
to
work
with
the
agency
and
the
foster
parents
to
stabilize
those
children
through
crisis
stabilization
and
intensive
in-home
services.
O
The
other
need
is
for
those
adults
and
children
that
need
that
have
that
are
not
able
to
cover
that
cycle
in
and
out
of
our
hospitals
and
need
the
support.
These
services
were
never
met,
the
rehabilitative
mental
health
services.
They
were
never
meant
to
be
long-term
services,
and
so
we
have
long-term
services
and
support.
O
And
so
what
we
really
find
is
that
people,
those
services
of
long-term
services
and
supports,
are
more
appropriate
for
helping
this,
this
population,
with
their
activities
of
daily
living
and
their
instrumental
activities
of
daily
living
and
helping
them
in
that,
instead
of
putting
them
in
a
rehabilitative
behavioral
health
services,
but
more
something
more
long-term.
K
Follow-Up,
madam
chair,
thank
you,
mr
young,
for
for
that
clarity.
You
made
a
statement.
Just
then
about
you
are
eliminating
these
programs,
so
you
could
push
folks
into
a
higher
level
of
care
and
so
and
then
you
listed
a
few
of
those
programs
that
you
anticipate
pushing
folks
into
a
higher
level
of
care,
and
I'm
again
I
just
have
some
concerns
that
and
I
I
would
like
to
really
see
again.
It's
the
outcome.
K
Data
that
I'd
like
to
see
do
we
want
do
all
folks
need
to
be
into
a
higher
level
and
an
extended
care,
or
do
they
need
some
basic
skills
training?
Do
they
need
that
intervention
early
and
I
think
that's
a
discussion
we
could
we
could
have
offline
and
then
also.
I
still
would
like
to
see
the
numbers
of
utilization
from
from
your
the
2019
and
really
all
the
comments
that
you've
made
in
good
faith
or
to
help
folks.
K
But
I'd
really
like
to
see
an
a
and
madam
chair
with
commissioned
for
the
whole
committee,
some
of
your
strategic
plan
on
where
the
how
those
dots
all
fit
together.
So
you
made
a
lot
of
comments
and
I
trust
that
you
truly
want
to
improve
outcomes,
but
how
does
that
fit?
And
so
perhaps
maybe
a
follow
up
on
some
information
on
the
breakdown
of
where
you're
substituting
you're
getting
rid
of
this
program?
But
the
hopes
are
that
you've
extended
these
other
programs.
K
I
think
it
would
be
helpful
for
all
of
us
to
see
on
really
what
this
is
and
not
just
this
little
micro
vision
right
now
and
what
we
see
on
the
on
our
paper.
So
I
appreciate
what
you're
doing
I.
I
appreciate
that
you're
truly
trying
to
improve
the
mental
health
of
of
nevadans,
but
I'm
gonna.
I
I
would
really
love
to
see
this
program's
being
eliminated,
but
here's
here's
the
other
things
that
we
are
offering
because
it
sounds
like
that's
what
you're
trying
to
do.
I
just
don't
see
it
in
these
numbers.
I
Thank
you,
madam
chair.
I
appreciate
the
opportunity
I'm
staying
on
the
service
cuts,
so
so,
first
of
all,
I
do
think
it's
important
that
there's
some
context
around
this,
and-
and
this
would
be
chip,
of
course,
but
probably
even
more
so
in
medicaid.
They
just
are
you
know
parallel
across
the
two
programs.
I
So
so,
first
of
all,
I
wanted
to
acknowledge
that
going
back
to
the
special
session
when
we
were
all
struggling
together
in
july
and
august,
there
was
a
long
list
of
medicaid
optional
services
that
were
on
the
table,
and
so
I
just
want
to
say,
as
you
were,
trying
to
address
your
budget
cuts
that
were
requested
by
the
governor
during
this
challenging
financial
time
that
we
have
worked
to
manage
to
not
have
dental
or
prosthetics
or
other
significant
medicaid
and
chip
funded
programs
on
this
list.
I
So
just
to
to
say,
there's
some
good
news
in
this
budget
that
we
don't
don't
see
because
it's
not
listed
as
a
cut.
So
then,
what
I
believe,
if
I'm
tracking
correctly
is
these,
are
the
optional
medicaid
services
that
you
are
recommending
for
as
a
cut
specifically
a
to
help
meet
the
financial
gap
that
we
have.
I
I
guess
my
question
is:
is
do
we
actively
help
folks
navigate
so
the
37
checkup
participants
under
basic
skills,
training,
154
under
cycle
social,
the
85
under
biofeedback
and
neuropathy
neurotherapy,
sorry
into
new
programs,
with
a
very
warm
handoff
to
make
sure
that
that
happens
so
that
we
know
that
they
don't
get
lost.
O
Deputy
administrator
going
in
for
the
record
now,
I'm
sure
through
you
to
senator
ratty,
so
what
I
will
say
is-
and
I
think
miss
finney.
My
colleague
would
agree
that
managed
care
has
always
had
a
warm
handoff
in
the
transition
to
the
services.
You'll,
see
typically
lower
utilization
of
these
particular
services
and
managed
care
than
you
will
in
fee
for
service
and
fee
for
service.
O
What
we
really
tried
to
do
through
the
governor's
budget
and
last
year
through
the
expansion
of
the
community,
behavioral
health
clinics
or
ccbhc's,
as
we
call
them,
is
really
give
people
a
behavioral
health
home
same
as
they
would
with
federally
qualified
health
centers
on
the
medical
side
is
to
move
clients
into
these
homes
and
to
have
a
place
that
looks
at
the
whole
care
of
the
person
and
links
to
that
medical
component
as
well.
O
And
so
yes,
the
transition
is
to
link
these
recipients
into
those
other
services
where
they
can
receive
services
from
clinical
professionals,
but
also
link
them
into
other
services
like
personal
care
services.
If
there's
a
need
for
assistance
with
those
activities
of
daily
living.
O
Again,
dwayne
young
deputy
administrator
for
the
record
mountain
chair
through
you
to
senator
ratty,
I
think
if
we
weren't
in
a
challenging
budget
situation,
I
think
we,
what
you
would
see
is
a
limiting
and
curtailing.
If
you
may
remember,
in
the
2017
session,
we
did
bring
a
budget
initiative
to
lower
this
rate
and
cut
some
of
the
hours
on
some
of
these
services,
and
at
that
time
we
were
really
met
with
the
impetus
to
have
a
replacement
of
services
for
children
within
specialized
foster
care.
O
The
division
has
accomplished
that,
and
so
I
think,
regardless
of
the
budget,
you
would
have
seen
an
impetus
to
curtail
some
of
these
programs
more
and
to
shape
them.
I
think
that
has
been
accelerated
due
to
the
the
the
pandemic
in
the
state's
current
budget
situation,
and
so,
while
there
probably
would
have
been
more
training
wheels
on
this,
we
do
think
that
this
is
ultimately
the
direction
which
the
state
needs
to
move.
I
And
then
final
question:
thank
you,
chair
for
the
discretion
in
in
behavioral
health
crisis
stabilization,
specifically,
but
more
broadly,
across
the
behavioral
health
system
of
care.
We
are
doing
a
lot
of
work
to
make
sure
that
we
are
utilizing
the
workforce.
That
is
peers,
and
I
I
believe,
if
I'm
understanding
correctly,
that
these
are
services
that
are
often
provided
by
peers.
I
But
we
are
also
recognizing
peers
as
an
incredibly
valuable
workforce,
and
so
I'm
just
wondering
if
we're
eliminating
this
are
there
other
places
that
we
are
making
sure
that
peers
are
still
part
of
the
solution.
Knowing
that
we
have
a
shortage
of
licensed
clinical
professionals
and
knowing
that
the
research
is
showing
that
peers
can
be
an
asset
to
a
behavioral
health
journey.
O
I
O
Deputy
administrator
for
the
record,
senator
raddy.
Yes,
that's
the
excellent
question
I
think,
while
peers
can
certainly
can
perform
these
colds
and
enroll
in
medicaid,
there's
a
separate
set
of
cpt
codes
that
are
utilized
for
peer
support
services,
as
well
as
having
peer
support
services
integrated
into
our
ccdhcs.
And
so
we
don't.
We
actually
see
the
role
of
peers
increasing
you
know.
Obviously
there
is.
This
body
has
considered
this
many
times
and
there's
a
certification
process.
To
that
there
is.
O
There
are
regulations
involved
around
that
that
really
support
the
clinical
efficacy
of
the
model
that
appears,
and
so
the
division
sees
that
when
we
talk
about
like
not
just
licensed
professions
but
actually
panel,
and
when
we
actually
see
them
certified
professionals
we're
speaking
of
peers
as
well,
and
we
see
that
as
a
model
that
continues
to
gain
support
and
would
not
be
would
not
be
impacted,
as
they
have
separate
billing
codes
than
from
these
service
eliminations,
and
I
do
want
to
just
clarify
if
I
have
just
a
bit
of
levity,
to
clarify
that
these
services
can
still
be
provided
in
the
context
of
an
outpatient
therapy.
O
Appointment
or
a
group
therapy
appointment
so,
but
if
it's
part
of
the
client's
treatment
plan
that
a
clinician
finds
it's
clinically
appropriate
to
still
have
them
do
as
minority
leader
titus
pointed
out,
they
can
do
that
as
part
of
the
individualized
treatment
plan
and
perform
those
services
within
the
context
of
psychotherapy,
so
we're
not
eliminating
or
handicapping
the
peers
or
the
clinical
professionals
ability
to
really
work
with
the
client
in
their
treatment
plan.
We're
just
talk,
we're
just
altering
the
service
mechanism
which
they
occur.
A
E
Suzanne
german
for
the
record
3243
is
the
nevada
medicaid
medical
budget
account.
This
is
the
account
from
which
we
pay
for
medical
services
for
the
medicaid
program,
which
we've
mentioned
now
covers
one
in
four
nevadans
next
slide,
please
so
just
jumping
right
in
and
going
through.
The
decision
units
in
this
budget
account.
E
The
first
is
similar
to
what
you
saw
in
the
chip
account
but
specific
to
the
medicaid
program
for
agency.
Inflation
increases
for
the
same
range
of
services
that
we
discussed
in
the
checkup
budget,
pharmacy,
hospice,
federally
qualified
health,
centers,
rural
health,
centers
and
indian
health
services.
B
E
Okay,
again
we're
to
our
caseload,
slides
except
this
time
for
the
medicaid
budget.
These
decision
units
fund
caseload
changes
in
the
medicaid
program.
As
we've
discussed
many
times.
These
projections
are
are
volatile
and
have
some
implications
related
to
the
public
health
emergency.
How
long
that
lasts?
This
particular
projection
was
done
in
2020
and
will
be
updated
in
march,
so
just
wanted
to
provide
a
graphic
representation
of
caselid
and
the
the
two
decision
units
that
are
on
the
next
slide.
E
E
Okay-
here
again,
we
talked
about
this
previously,
but
these
are
the
medical
costs
associated
with
the
increases
in
the
three
home
and
community
based
services.
Waiver
case
loads.
So
you
can
see.
M202
here
is
for
the
waiver.
Caseload
increase
for
the
intellectual
individuals
with
intellectual
disabilities
waiver
m203.
E
The
increase
in
the
waiver
caseload
for
individuals
on
the
frail
elderly,
human
community,
based
waiver
and
m204
is
the
requested
increase
in
waiver
caseload
for
individuals
on
the
physically
disabled
waiver
pay
slip.
Next.
B
E
Please
so
again,
this
being
broken
out
when
we
go
back
to
that
graph
that
we
did
earlier
with
the
the
green
and
the
orange
pieces
of
the
bar
graph,
one
being
related
to
general
waver,
crease
load
growth
and
the
other
focused
on
the
number
of
additional
waiver
spots
needed
to
eliminate
the
wait
list
and
fully
comply
with
the
olmstead
provisions
related
to
the
waivers
next
slide.
Please.
E
Okay,
so
budget
decision
unit
350
here
proposes
to
divert
the
1.5
tax
revenue
from
the
indigent
accident
fund,
supplemental
payment
program
to
help
counties
with
obligations
for
the
long-term
care
county
match
program
increase,
as
we
discussed
a
little
bit
earlier
in
our
presentation
and
e351
talked
about
this
again
in
the
checkup.
But
this
is
the
medicaid
medical
companion
decision
unit.
That
here
shows
the
decision
unit
related
to
restoring
the
provider
rate
reductions
that
were
required
to
address
the
economic
crisis
and
passed
during
the
31st
special
session
next
week.
Please
all
right.
E
This
slide
has
three
decision
units
one
we've
talked
about
before,
but
it's
related
to
the
managed
care
organization
directed
payment
program.
E
The
next
one
e676
is
one
of
the
measures
that
we're
taking
to
address
some
of
the
financial
uncertainty
and
a
risk
mitigation
measure
related
to
managed
care
payments,
and,
as
this
committee
has
noted,
before,
the
managed
care
organizations
are
paid
a
monthly
capitated
fee,
and
this
is
to
fund
an
estimated
recruitment
from
the
managed
care
organizations
based
on
one
of
these
risk
mitigation
strategies,
which
is
called
a
risk
corridor
decision
unit.
678
here
is
related
to
balancing
forward
the
state
net
benefit
from
the
intergovernmental
transfer
account
3157.
E
So
these
are
the
companions
that
we
talked
about
in
checkup
related
to
the
proposed
elimination
of
these
three
services:
basic
skills,
training,
psychosocial
rehabilitation
services.
I
would
also
note
that
behavioral
health
case
management
services
is
included
here
and
on.
The
next
slide
is
the
bio
feedback
and
neurotherapy
decision
unit
that
proposes
the
elimination
of
that
service
as
well.
E
Next
slide,
please,
in
addition
to
those
proposed
eliminations,
we
also
have
some
proposed
reductions
here.
E686
proposes
reducing
the
rate
again,
it's
a
monthly
capitated
rate
that
the
division
pays
to
the
non-emergency
medical
transportation.
Vendor
and
e-687
proposes
policy
changes
to
the
personal
care.
E
E
Okay,
this
slide
has
three
additional
decision
units.
The
first
of
these
two
will
address
the
budget
shortfall
by
changing
the
timing
of
certain
payments
to
the
current
fiscal
year,
making
them
during
this
current
fiscal
year
rather
than
in
the
future
biennium.
E
So
one
of
our
ways
to
reduce
cuts
that
would
otherwise
be
needed
in
the
upcoming
biennium
budget
is
by
making
some
of
these
capital
capitation
payments
in
in
this
current
fiscal
year,
and
so
those
are
decision,
units
e,
689
and
690.
E
500
unit
500
here
relates
to
the
transfer
of
drug
rebates
that
we
discussed
earlier
in
the
presentation
related
to
our
newest
budget
account.
E
F
Thank
you
very
much,
madam
chair,
and
I
guess
I
I
really
want
to
have
a
conversation
about
caseload.
I
think
it's
really
important
for
us
to
analyze.
What's
going
on
here,
I
know
in
a
special
session
I
made
a
couple
of
statements
about
what
I
was
afraid
was
going
to
happen.
I
know
there
was
some
discussion
in
the
third
in
one
of
the
special
sessions
about
thinking
that
the
medicaid
dollars
were
going
to
come
in
higher
than
proposed
than
we
thought
and
we
shouldn't
be
making
certain
cuts.
F
But
if
you
look
at
the
dollars
that
are
here
that
in
this
medicaid
program
in
this
interim,
we
are
recommending
10
billion
dollars,
10
b,
with
a
billion
over
the
20
20
21
23
biennium,
I
mean
that
that
is
just.
This
is
huge
when
we
often
think
about
it,
and
this
is
health
care
for
families
in
nevada
that
we
want
to
have
health
care.
So
when
you
look
at
that
caseload
growth
that
it
could
possibly,
I
think,
if
you
project
it
out,
we
could
end
up
with.
F
F
So
I
think
I'd
really
like
to
have
a
a
conversation
with
with
folks
of
the
agency
about
these
projections
on
health
care
and
what
investigations
have
they
done
to
figure
out
who's
going
to
be
accessing
it?
How
are
they
going
to
be
able
to
process
all
these
folks?
E
E
We've
talked
previously
about
the
enhanced
fmap
that
the
division
is
receiving
currently
from
the
family's
first
coronavirus
response
act,
which
has
been
incredibly
helpful.
That
funding
is
tied
to
the
declaration
of
public
health
emergency.
I
think
we
had
some
of
these
conversations
during
the
special
session
too,
but
it's
also
tied
to
or
has
conditions
related
to,
maintenance
of
effort
for
eligibility.
E
E
Caseload
during
this
time
period
of
the
public
health
emergency
and
those
are
primarily,
I
think
that
there's
three
exceptions
to
the
general
rule,
and
that
is
if
someone
dies,
moves
out
of
state
or
makes
an
affirmative
ask
that
their
case
be
closed.
Otherwise,
anyone
that
was
on
at
any
point
during
the
public
health
emergency
will
remain
getting
coverage
through
medicaid
and
chip
during
the
the
duration
of
the
public
health
emergency.
E
So
the
timing
of
the
public
health
emergency
is
really
critical
and
one
of
the
things
that
state,
medicaid
directors
and
other
medicaid
stakeholders
really
pushed
for
it
with
some
additional
clarity
from
the
biden
administration.
Regarding
how
long
the
public
health
emergency
might
last
to
help
provide
some
additional
clarification
and
information
regarding
caseload
levels
and
also
f
math
levels
and
try
to
provide
some
additional
certainty
in
in
state
budget.
So
I
I
guess
my
overall
arching
point
is
that
there
are
a
lot
of
factors
at
play
here.
One
is
definitely
how
quickly
the
economy
recovers.
E
For
the
long
run-
and
we
are
aware
and
have
been
working
with
some
of
those
large
employers
that
you're
referring
to
and
so
know
that
that
certainly
is
a
component
of
what's
driving
our
caseload
increase.
But
as
long
as
the
public
health
is
emergency
remains
in
place,
we
can
expect
to
see
those
maintenance
of
effort.
Requirements
remain
in
place,
and
I
think
we
should
be
prepared
for
our
caseload
to
remain
high
for
the
duration
of
the
public
health
emergency.
F
And
thank
you
very
much,
madam
chairman,
and
just
one
real,
quick
follow-up.
I
know
a
number
of
months
ago
there
was
a
list
out
that
was
shared
about
what
employers
actually
have
a
large
percentage
of
their
employees
on
medicaid,
and
I
will
not.
F
This
legislature
needs
to
have
a
discussion
about,
because
we're
supposed
to
be
here
for
those
families
that
are
really
being
impacted
not
being
a
subsidy
for
private
business
that
just
doesn't
want
to
step
up
to
the
plate
and
be
a
good
corporate
citizen
and
provide
health
care
I'll
get
off.
My
soapbox,
madam
chair,
thank
you
very
much
for
the.
J
Thank
you
very
much,
madam
chair.
I
appreciate
that
I
probably
said
piggyback
a
little
bit
on
ms
carlton.
I
think
it's
worth
noting
that,
as
as
we
see
these
dramatic
increases
in
caseload,
you
should
probably
remember,
too,
that
we
have
much
more
restrictive
eligibility
requirements
than
a
lot
of
other
states
do
for
this
program,
so
that
number
could
be
a
lot
higher.
J
E
Thank
you
for
the
question
senator
kiekever.
It
is
my
understanding
that
that
could
happen
and
medicaid
could
be
the
secondary
payer.
It
is
also
my
understanding
during
this
period
that
the
reasons
for
which
division
of
welfare
and
supportive
services
may
close
cases
is
really
limited
to
those
three
factors
that
I
mentioned
earlier:
death
moving
out
of
the
state
or
asking
for
their
case
to
be
closed.
So
I
I
think
in
the
situation
they're
outlining
that
as
possible
and
that.
J
E
So,
thank
you
for
the
question
senator
kiker.
I
will
turn
to
deputy
administrator
cody
financier
if
she
knows
that
statistic
off
the
top
of
her
head,
if
not
we'd,
be
happy
to
to
find
out
and
see.
If
that
is
information
that
we
could
provide
at
a
later
date,.
D
D
D
Excuse
me,
delivery
model,
and
many
of
the
folks
who
are
impacted
as
assemblywoman
carlton
and
described
by
losing
their
job
and
in
the
area,
particularly
in
clark
county,
would
go
into
our
managed
care
program
because
of
the
way
we
have
that
designed.
So
we
would
pay
a
capitated
payment
for
those
recipients.
D
D
So
so
there
are
some
safeguards
in
place
to
make
sure
that
people
are
being
connected
with
health
services
and
we're
not
just
paying
a
capitated
rate
and
not
getting
anything.
D
Pardon
me
I'm
so
sorry,
beyond
that
you
did
see
our
decision
unit
looking
to
get
some
help
with
making
sure
that
we
are
appropriately
assessing
that
medical
loss
ratio
and
we
do
have
the
risk
corridor
in
place
to
make
sure
that
our
managed
care
partners
aren't
walking
away
with
un
reasonable
amounts
of
profit.
O
J
So
I
mean
you
saw
where
I
was
going
right.
I
mean
it's
great
that
we're
the
payer
last
resort,
but
if
we're
paying
a
capitated
rate
then
and
we're
still
having
expenses
for
these
folks,
even
though
they
might
be
covered
through
another
source.
So
I
appreciate
that
clarification
on
the
also
as
it
relates
to
that
letter.
You
know
so
we're
budgeting
caseload
based
on
this
letter,
right
that
we're
saying
that
they're
going
to
extend
the
public
health
emergency,
so
we're
going
to
have
this
moe.
J
So
this
is
our
caseload
projection,
but
yet
we're
not
using
this
letter
to
justify
the
enhanced
fmap
for
the
rest
of
the
calendar
year.
So
why
are
we
using
it
for
caseload,
bonada.
E
Thank
you
for
the
question
senator
kikepper,
I
think
in
the
caseload
projections
and
please
I
would
invite
our
finance
team
to
correct
me
if
I
have
this
wrong,
but
the
current
caseload
projections
were
predated
the
letter,
so
I
I
don't
think
that
they're
reflected
in
the
caseload
projections
today,
but
will
be
in
that
march,
update.
E
Thank
you
for
the
question:
senator
peacock.
Yes,
according
to
the
letter
from
the
biden
administration,
the
secretary
of
health
and
human
services,
who
is
responsible
for
continuing
the
public
health
emergency
until
it's
no
longer
renewed,
they
have
indicated
that
they
plan
to
continue
the
public
health
emergency
throughout
calendar
year
2021,
and
so
that
would
be
for
two
additional
quarters
of
this
upcoming
iam
quarters.
Three
and
four,
the
first
two
quarters
of
the
upcoming
biennium
and
again,
I
think.
J
Right
so
so,
when
we
update
this
in
march,
with
the
in
hand
with
the
additional
caseload,
are
you
also
going
to
update
with
the
enhanced
fmap
for
those
two
quarters?
My
understanding
is
that
we
packed
that
usually
at
about
30
million
dollars
a
quarter,
so
that
would
be
about
60
million
dollars
to
the
plus
for
us
right.
E
That
that
is
the
statistic
suzanne
berman
for
the
record.
Thank
you
for
the
question
that
has
been
the
the
ballpark
estimate
that
we've
used
is
about
30
million
dollars
a
quarter.
Certainly
due
to
a
number
of
you
know
what.
E
Group,
everyone
falls
into
you
and
a
number
of
other
factors.
You
know
that's
just
kind
of
our
ballpark
estimate
and
we've
seen
fluctuation
as
we've
gotten,
this
actual
quarters
of
public
health
emergency
enhanced
fmap
in,
but
that
that
is
the
ballpark
figure
that
we
use
for
estimating
future
quarters
of
public
health
emergency.
E
Enhanced
death
map
under
the
family's
first
coronavirus
response
act.
Yes,
you're.
J
I
Thank
you
chair,
so
I'd
like
to
go
back
to
the
service
eliminations
and
to
avoid
retreading
comments
that
we
had
under
the
chip
budget
that
I
think
applied
to
both
this
one
includes
basic
skills:
training
again
it
includes
psychosocial
rehabilitation
again,
and
it
includes
biofeedback
and
neurotherapy
again.
I
Is
this
a
strategic
shift
to
a
different
kind
of
service,
or
is
this
just
plain
old
budget
cuts
and
we
needed
to
find
something
to
cut?
How
are
we
going
to
be
okay
without
behavioral.
M
O
Deputy
administrator
dwayne
young
for
the
record,
madam
chair
through
you
to
senator
ratty,
that's
a
very
good
question
and
in
fact
it
does
not
look
like
it
on
this
paper,
but
the
division
is
actually
expanding.
The
array
of
case
management
services.
O
What
we're
doing
this
is
a
unit
of
behavioral
case
management
that
can
be
done
for
non-seriously,
mentally
ill
and
non-seriously,
emotionally
disturbed
children
that
can
be
handled
by
community
providers
and
it
was
titrated
on
their
ability
to
receive
hours
minimizing
each
month
where
we're
expanding
case
management
services
are
those
that
are
be
able
to
be
formed
by
governmental
entities,
and
so
we
have
our
other
eight
existing
target
case
groups,
which
include
seriously
mentally
ill
and
seriously
emotionally
disturbed,
as
well
as
bringing
on
new
targeted
case
groups
that
focus
on
pregnant
women
and
homelessness
that
will
be
administered
by
the
counties.
O
And
so
what
this
is
doing
is
one
shifting
that
to
the
continued
state
funding,
you'll,
see
that
represented
in
adsd's,
dcfs
and
dpbh's
budget
of
providing
those
services
and
contracting
with
community
provider
partners
to
perform
those
services
as
an
extension
of
their
agency.
But
you'll
also
see
now
a
migration
of
these
services
to
be
performed
by
the
counties
and
the
county.
O
Deformed
public
and
private
partnerships
with
agencies,
and
so
those
dollars
aren't
coming
from
the
state,
but
rather
for
the
county
for
them
to
pay
the
match
and
then
draw
down
the
federal
share
to
help
fund
some
more
ambitious
projects,
such
as
housing
initiatives
and
overall
connections
to
social
determinants
of
health.
O
Again,
dwayne
young,
thank
you
senator
for
the
question
I
believe,
through
the
creation
of
some
of
these
other
target
groups,
if
they're
homeless,
but
not
necessarily
seriously
mentally
ill.
As
we
talked
about
the
tenancy
supports,
that's
still
coming
online
from
last
session,
the
pregnant
women,
those
that
are
criminally
justice
involved,
those
that
have
us
have
a
need
that
is
cool
morbid
with
some
medical
condition.
We
will
be
hitting
those
individuals
if
they
just
need
a
little
extra
help
or
navigation.
O
I
I
This
is
how
we're
cross-walking
it
over
to
how
we're
doing
it
in
the
future,
and
this
is
where
we
see
a
new
category
of
folks
getting
additional
assistance,
and
this
is
how
we
see
the
folks
who
have
traditionally
been
served
in
these
programs
continuing
to
not
fall
through
the
cracks
and
end
up
just
elevating
into
some
of
those
higher
levels
of
service.
So
perhaps
that's
something
that
we
could
ask
you
to
bring
back.
I
guess
my
other
question
on
this
is
public
engagement
in
terms
of
conversations
with
providers
or
families
who
make
these
decisions.
O
Deputy
minister
dwayne
young
for
the
record
senator
again,
thank
you
for
the
conversation.
Typically,
we
do
public
engagement
sessions
through
public
workshops
and
then,
of
course,
we
are
required
through
cms
to
have
a
public
hearing
on
the
matter
in
which
comments
can
be
put
on
the
record.
We
have
just
began
any
typical
engagement
sessions
when
we
put
something
through
our
budget
because,
as
it
goes
through
the
governor's
budget
process,
obviously
it's
confidential
once
it's
released
to
the
public.
O
We
work
one-on-one
with
stakeholders
to
answer
questions,
but
we
really
let
things
pay
out
in
this
public
process
and
then
towards
the
end.
Once
our
budget
is,
is
finalized.
We
will
start
the
public
engagement
sessions
through
workshops.
I
Okay,
thank
you
and
then
on
continuing
a
little
bit
on
the
line
of
service,
eliminations
or
significant
cuts
if
we
just
touch
on
the
personal
care
services.
So
it
looks
like
the
policy
decision.
Is
that
if
you
are
an
in-home
caregiver,
then.
I
O
Again:
dwayne
young
deputy
administrator
for
the
division.
Senator.
If
you
allow
me
to
clarify,
you
would
still
be
eligible
for
those
services.
What
you
would
lose
is
the
assistance
with
instrumental
activities
of
daily
living
and
those
are
really
activities
that
help
the
person
live
independently.
O
Obviously,
the
person
is
not
living
independently,
so
some
of
those
structures,
so
they
would
lose
some
time,
particularly
in
housekeeping
assistance
with
chores
and
some
food
preparation.
They
would
lose
some
time
in
that
area
because
they
do
have
a
living
caregiver.
They
would
still
be
eligible
for
assistance
with
activities
of
daily
living,
but
they
what
the
proposal
is
ultimately
proposing
is
those
not
with
just
a
home
income.
Caregiver
would
see
some
reductions
on
the
lower
level
scarce
of
those
that
need
the
lower
level
services.
O
Also,
what
you'll
see
reflected
in
the
increase
in
waiver
caseload
slots?
Certainly,
we
know
that
any
change
in
medicaid
services
obviously
changes
services
that
impacts
the
budget
of
aging
and
disability
services,
and
so
opening
up
those
waiver
slots
is
really
moving
those
again.
Those
higher
acuity
level.
People
who
are
really
meant
for
more
long-term
services
support
the
higher
progression
into
the
waiver
services,
as
well
as
being
getting
the
waiver
like
services
from
adsd.
So
you'll
see
some
discussion
on
that
next
week.
O
P
I
Yeah
and
again
I
just
want
to
unlock
some
concerns
on
this
particular
account.
We've
had
lots
of
conversation
about
how
do
we
support
caregivers
to
be
able
to
keep
people
in
their
homes
because,
of
course,
if
we
can
keep
people
in
their
homes,
it's
significantly
less
expensive
than
if
they
go
into
a
care
facility
of
some
sort,
and
I
know
that
I
hear
I
completely
hear
what
you're
saying
that
the
activities
of
daily
living
is
really
intended
to
be
the
piece
that
keeps
the
individual
supported.
I
But
the
help
with
housekeeping
keeping
cleaning
shopping
is
the
things
that
keeps
the
caregiver
supported
and
it
does
sound
like
for
a
whole
group
of
households,
a
support
that
they
have
organized
their
life
around
will
no
longer
be
there.
So
I
would
just
like
to
have
us
continue
that
conversation,
because
I
think
caregivers
generally
have
been
put
through
the
ringer.
I
We
have
all
the
data
that
shows
that
caregivers
generally
have
shorter
life
spans
and
all
those
things
and
caregivers
caregivers
during
the
pandemic
have
just
been
so
isolated
and
so
under
duress
that
to
start
20,
you
know
to
have
things
start
to
turn
around
and
then
to
say:
hey
we're
taking
away
this
extra
support
feels
justified
pops,
possibly
from
a
budget
standpoint,
but
from
the
real
humans
who
are
involved.
B
Thank
you,
madam
chair,
can
you
clarify
or
confirm
for
me?
Did
the
agency
experience
a
decrease
in
provider
enrollment
for
any
provider
tops
or
no
access
to
care
issues
for
medicaid
participates
following
the
announcement
of
the
six
percent
rate
reduction
that
would
be
approved
during
the
31st
special
session.
D
D
Finney
for
the
record
senator
donderol
to
you
through
madame
chair
monroe
moreno,
the
agency
has
not
seen
a
decrease
in
overall
provider
enrollment
or
identified
a
noticeable
decrease
in
any
individual
provider
type
since
the
announcement
of
those
cuts.
We
do
monitor
that
overall.
Over
the
last
three
years,
our
provider
enrollment,
is
trending
slightly
upward.
D
We
were
able
to
implement
some
flexibilities
with
the
public
health
emergency
to
ensure
that
that
providers
could
enroll
as
easily
as
possible.
So
that
may
have
had
some
impact.
I
will
say
we
were
notified
by
about
three
providers
that
they
would
not
continue
as
a
result.
They
would
not
continue
and
would
not
see
new
medicaid
patients
out
of
the
35
000
that
we
have
there
were
about
three
groups.
D
We've
had
some
discussion
with
other
states
about
their
experience
and
that's
consistent
with
their
experience
that,
while
that
is
a
concern,
they
don't
see
large
decreases
in
that
in
that
enrollment
we've
also
not
been
able
to
identify.
Particular,
I
specific
access
to
care
issues,
but
we
do
continue
to
monitor
that
and
we
continue
to
work
with
cms
to
improve
our
mechanisms
and
our
comparison
studies.
The
way
in
which
we
are
doing
those
that
monitoring.
D
Well,
cody
finney
for
the
record.
We
would
certainly
we
would
certainly
hope
I
I
know
for
a
fact
that
the
providers
would
be
much
more
satisfied
with
our
program
with
those
restorations
and
much
more
likely
to
continue
to
see
medicaid
patients
and
a
medicaid
at
a
higher
percentage
of
medicaid
patients
as
they
had
been
in
the
past.
B
B
Thank
you,
madam
chair.
I
had
a
couple
of
questions.
One
is
around
the
inclusion
in
this
budget
of
utilizing
projected
savings
in
fiscal
year,
2021
from
the
general
fund,
and
I
was
just
wondering,
given
the
caseload
trends
that
were
gone
over
earlier.
How
confident
are
you
that
the
the
budget
surplus
will
materialize
as
it's
projected.
G
E
Question
assembly
assemblyman
watts,
suzanne
biermann,
for
the
record.
I
think
you
know
we
we've
acknowledged
that
this
is
a
volatile
time
and
that
there
are
a
number
of
volatile
and
unpredictable
factors
in
the
the
medicaid
realm.
However,
regarding
this
current
year
surplus,
I
think
we
felt
reasonably
confident
given
the
fact
that
it's
in
the
next
couple
of
months
and
it's
harder
to
project
out
over
the
course
of
say
two
years
than
just
for
the
next
four
months.
E
So
I
think
we
feel
reasonably
certain
that
for
the
next
four
months
we
have
a
good
understanding
that
the
public
health
emergency
will
be
in
place
that
will
be
receiving
the
enhanced
death
map.
So
at
this
point
we
acknowledge
that
there
are
some
variables
out
there
that
make
budgeting
for
medicaid
difficult
during
this
time,
but
for
for
the
remainder
of
this
fiscal
year,
I
think
we
feel
reasonably
certain
about
those
projections.
B
Thank
you
for
that,
and
then
I
know
one
of
the
things
that
was
included
in
the
the
31st
special
session
was
the
implementation
of
a
specialty
pharmacy
network,
which
was
anticipated
to
generate
some
general
fund
savings.
Can
you
give
us
an
update
on
what
the
status
of
that
is.
O
Again,
dwayne
young
deputy
administrator
for
the
record,
madam
chair
through
you
to
assemblyman
watts
the
especially
pharmacy.
As
you
may
be
aware,
as
some
of
you
may
have
been
contacted
by
constituents,
we
did
hold
a
public
engagement
section
or
workshop
to
talk
about
the
classes
of
drugs
that
were
moving
into
specialty
pharmacy.
The
1915
b
waiver
was
submitted
to
cms.
O
However,
it
also
requires
a
spa
that
had
not
been
submitted
and
would
not
be
submitted
until
after
our
public
hearing,
the
1915b
waiver
asked
us
to
address
how
we
would
incorporate
the
hemiophilia
treatment
center
as
part
of
because
each
state
has
one
and
that's
a
requirement
through
cms.
They
expressed
some
concerns
during
that
public
workshop,
and
so
we
are
actively
working
with
them
as
well
as
our
subcontractor,
through
our
fiscal
agent,
to
come
to
an
agreement
to
launch
specialty
pharmacy.
O
L
The
hearings,
just
in
that
last
answer
to
that
question
and
wondering
if
you
also
had
a
process
by
which
you
engaged
the
various
policy
boards
in
determining
these
these
cuts
and
and
and
changes
that
you're
proposing.
Thank
you
again.
O
Deputy
administrator,
william
for
the
record,
madam
chair,
for
you
to
assemblywoman
tolls.
That's
an
excellent
question.
That's
a
point
that
we
didn't
bring
up
earlier
myself
and
my
staff
attend
all
the
regional
behavioral
health
policy
boards,
as
well
as
all
the
boards
and
commissions
through
each
of
our
sister
agencies,
addressing
each
of
the
areas
of
care
within
medicaid
policy.
O
What
is
very
important,
I
think
the
regional
behavior
health
coordinators
will
tell
you
they've,
had
conversations
with
me
over
the
years
and
one
of
the
strategies
that
we
had
talked
about
before
was
cutting
these
services,
so
that
we
could
use
the
savings
from
them
to
increase
the
rates
for
other
services
to
attract
more
psychologists,
psychologists
and
licensed
clinicians.
Unfortunately,
because
of
the
impotence
of
the
pandemic.
O
In
our
current
budget
situation,
we
weren't
able
to
bring
that
proposal
to
the
table,
but
they
they're
not
foreign
to
these
discussions
of
the
efficacy
of
these
services
and
the
need
to
move
people
into
services
that
are
done
by
certified
peers,
someone
who
has
an
accountability
board
representing
them
and
then
other
arrays
of
service.
C
Thank
you,
chairwoman,
so
real
quick,
the
proposed
increase
for
the
home
and
community-based
waiver
slots.
You
know
absolutely
supportive
of
getting
more
dollars
in
and
realized
that
it's
important
you
know
in
order
for
us
to
stay
in
compliance
with
the
olmstead
act,
to
make
sure
that
people
aren't
waiting
more
than
90
days
and
that
we
have
a
pathway
for
people
not
to
be
institution
to
waive
them
out
of
institutions
and
into
the
community
and
those
supports.
C
I
guess
I
would
just
be
interested
as
we
move
through
this
process
of
having
a
deeper
conversation
about
the
staffing
side
of
it,
because
I
think
that
we
could
hypothetically
fun
slots
to
the
nth
degree,
but
without
the
appropriate
staffing
on
the
adsd
side,
I
don't
think
we're
going
to
have
the
resource
actually
enroll
and
move
through.
I
think
just
like
we're
seeing
right
now,
where
we've
got
a
wait
list,
despite
the
fact
that
we've
got
approved
slots
just
speaks
to
that.
C
So
I
I
guess
I
guess
the
question
I
would
ask
then
is:
do
you
think
that
there's
a
likelihood
that
the
waiver
caseload
increases
will
materialize
next
biennium.
O
Deputy
administrator
dwayne
young
for
the
record,
can
you
hear
me?
Okay?
Thank
you,
madam
chair,
for
you
to
assembly,
one
assembly,
woman
vice
chair,
benitez
thompson.
I
think
that
you'll
hear
some
of
that
conversation
next
week
in
asian
disability
services,
budget
presentation.
O
I
think
it's
no
mystery
that
the
state
is
often
challenged
in
recruiting
and
hiring
social
workers,
and
so
I
think
that
is
always
that
been
at
the
forefront
of
the
department's
mind
is
making
sure
that
we
can
recruit
and
retain
staff.
But
I
also
think
I
I
went
to
particularly
in
the
last
year
commend
staff
and
for
the
ways
in
which
they
have
worked
with
the
current
waiver
recipients
and
really
organized
their
processes,
and
so
I
know
that
administrator
schmidt
and
her
staff
will
speak
to
that
more
directly.
C
Thank
you
and
we'll
have
that
conversation
there.
I
just
want
to
make
sure
that
I
I
noted
it
the
la
the
last
thing
that
I
wanted
to
touch
on
real,
quick,
madam
sherwood.
If
it's
okay-
and
I
know
we
we
could
get,
we
could
probably
be
on
this
conversation
for
a
good
amount
of
time,
and
but
what
I
was
hoping
to
do
was
just
have
you
put
on
the
record.
C
If
you
could,
the
timeline
of
we've
submitted
the
state
plan
with
the
recommendation
for
the
cuts
of
this
of
the
six
percent
from
special
session.
Those
cuts
have
not
yet
been
implemented,
so
we
know
that
there's
this
lag
between
our
legislative
budgets
and
how
we
fund
appropriate,
unappropriate
things
and
then
how
those
dollars
flow
out
to
providers
and
hit
services
in
the
real
world.
C
So
I
thought
that
you
could
just
give
for
us
when
you
thought
that
the
our
state
plan
for
those
cuts
might
be
actualized
when
providers
might
start
to
see
the
reduced
rates
paid
to
them
and
then
and
what
that
might
all
actually
kind
of
hit
the
ground.
C
E
You
for
the
question
vice
chair,
benitez
thompson,
suzanne
biermann
for
the
record,
it's
a
great
question
and
I'll
start
and
if
others
have
information
to
add,
certainly
welcome
that
from
our
team.
You're
correct
the
process
is
lengthy.
We
started
working
on
implementing
the
cuts
from
the
special
session
in
the
summer,
we're
still
in
process
of
that.
A
handful
of
the
state
plan,
amendments
related
to
those
rate
reductions
have
been
approved
and
are
being
implemented
into
the
minority.
The
vast
majority
are
still
pending
cms
approval.
E
We've
been
in
a
couple
of
those
periods,
just
because
cms
does
take
these
issues
of
access
to
care
very
seriously,
as
does
the
division
have
been
working
with
others
in
the
state.
I
want
to
specifically
highlight
the
public
employees
benefit
division,
they've
been
extremely
helpful
in
providing
us
with
data
and
information.
That's
been
requested
by
cms.
You
know
just
related
to
their
rates
and
access
to
care
in
the
state
generally,
so
we
are
still
working
through
that
process.
E
But
do
you
want
to
highlight
that
our
state
plan
amendments
did
seek
retroactive
approval
and
we
have
preserved
those
dates
of
august
15th,
so
we're
still
working
through
this
process
and
we'll
implement
as
soon
as
we
get
cms
approval.
But
do
you
want
to
highlight
that
it'll
be
back
to
that
period
of
august
15
2020
and
then,
with
the
governor's
recommended
budget
of
that
being
restored
as
of
october
1st
2021,
so
that
will
be
the
timeline
that
the
rate
reductions
are
actually
in
place
and
we
are
still
working
through
the
process.
H
P
This
is
phil
brown,
adobe
administrator
food
record
and
to
follow
up
with
that
just
some
additional
detail.
We
are
actually
meeting
with
cms
weekly
on
this
we're
working
with
our
rai
process,
making
sure
we
can
get
them
the
additional
information
they
need
to
understand.
The
questions
that
are
asked
as
a
part
of
the
access
to
care
monitoring
review
plan
a
federal
requirement
when
you
are
pursuing
a
cut
of
more
or
greater
than
three
point
nine
percent,
for
in
this
case
we
are
pursuing
the
six
percent.
P
It
is
required
to
go
through
the
access
care
monitoring
review
plan
where
we
will
ensure
and
look
into
the
details
on
access
to
care
to
ensure
that
we're
not
hurting
or
detrimenting
the
state
in
any
way.
So
we
are
meeting
with
cms
weekly
going
through
the
process
and
then
we'll
continue
to
expedite
move
that
up
forward
as
quickly
as
possible.
D
And
deputy
administrator
cody
finney,
if
I
could
just
beg
one
indulgence
in
the
interest
of
full
transparency,
I
do
want
to
make
sure
that
everyone's
clear
that
our
the
payment
for
our
managed
care
plans
that
has
been
implemented
and
the
managed
care
plans
have
because
those
rates
changed.
D
So
we
had
to
do
new
rates
for
our
our
new
capitation
rates
for
our
managed
care
plans
with
that
six
percent
reduction
those
have
been
implemented
and
some
of
the
managed
care
plans
have
implemented
passing
those
on
to
their
providers
through
their
processing
mechanisms.
So
cms
is
aware
of
that
there.
Everyone
is
aware
that
we're
still
working
through
the
approval
process-
and
that
is
that
is
something
that
is
allowed-
should
something
change.
Then
those
rates
would
be
reprocessed,
but
I
just
want
to
in
the
interest
of
full
transparency,
make
sure
that's
clear.
C
And
thank
you
and
I
appreciate
that
because
I
think
that
that
helps
me
to
know
a
piece
of
the
medic
universe
is
is
already
accounting
for
those
cuts
and
if
it's
mcos,
it's
probably
going
to
be
a
bigger
piece.
So
it's
mostly
the
fee
for
service
folks
and
vast
majority,
who
are
still
kind
of
going
along
with
business
as
usual,
and
I
think
just
where
this
is
important
and
for
us
as
legislators,
is,
as
we
have
the
conversation
about,
potentially
restoring
cuts.
C
You
know
we
might
take
that
action,
but
while
we're
taking
that
action
in
the
real
world,
those
six
percent
cuts
will
actually
be
implemented,
and
so
you
know,
for
you,
know
more
community
providers
or
you
know
let
those
providers
who
maybe
don't
have
aren't
surrounded
by
lobbyists
and
lawyers.
Quite
frankly
right,
you
know
there
might
be
some
confusion
about
how
this
is
all
about,
because
there's
such
a
long
lag
to
how
these
decisions
get
implemented,
and
that's
just
what
I
wanted
on
the
record.
F
Thank
you,
madam
chair,
and,
if
I
could
ask
to
address
the
two-sided
risk
corridor,
senator
kieker
glanced
upon
it
earlier,
but
I'm
still
a
bit
confused
about
what
a
two-sided
wrist
corridor
is.
So
if
you
could
just
elaborate
a
little
bit
on
exactly
what
you're
what
the
problem
is
and
what
we're
trying
to
fix.
That
would
really
help
me.
So
just
give
me
those
in
the
interest
of
time
and
then
we're
just
doing
this
for
one
year
for
2020.
Do
we
plan
on
doing
this
again.
D
Thank
you,
assemblywoman
carlton,
cody
finney,
for
the
record.
This
a
two-sided,
wrist
corridor
is
a
strategy
that
is
used
in
these
prospective
payment
models
like
managed
care,
and
that
allows
us
to
address
situations
in
which
it's
very
difficult
to
predict,
as
the
pandemic
has
definitely
been.
It's
been
very
difficult
for
the
actuaries
to
make
the
usual
firm
predictions
about
how
much
things
are
going
to
cost,
because
we
didn't
know
how
much
the
actual
coveted
care
was
going
to
cost.
D
We
didn't
know
how
much
the
the
utilization
reductions
from
shutdowns
would
impact
things
so
cms
allowed
in
2020
the
implementation
of
a
two-sided
of
a
risk
corridor
that
allows
the
state
and
the
plans
to
share
what
that
unpredictable
risk
will
be.
So
if
the
plans,
if
those
capitation
payments
were
too
high,
then
the
state
would
get
some
of
that
funding
back.
If
they're
too
low,
then
the
state
would
seek
to
have
some
pay
for
some
of
those
services.
D
The
usually
these
arrangements
have
to
be
done
in
advance
before
the
beginning
of
the
period,
so
it
would
have
to
be
set
up
all
contracted
and
done
before
the
beginning
of
2020..
Because
of
the
very
unusual
circumstance
this
year,
cms
allowed
us
to
set
that
up
during
that
rate,
and
we
do
in
doing
that
period.
We
do
intend
to
continue
for
2021,
because
we,
as
we
know
this
situation
continues,
but
over
time
and
risk
quarters
can
be
used
for
different
mechanisms.
D
Aimed
at
this
unusual
period
to
try
to
make
sure
that
we're
not
that
we're
good
partners
and
that
we're
also
that
our
partners
are
good
partners
to
us
as
well.
F
And
thank
you
very
much
miss
finney
and
madam
chair.
If
I
could
just
follow
up
with
the
statement
that
I
heard
earlier
that
I
just
wanted
to
make
sure
that
I
understood
correctly
somewhere
in
the
conversation,
a
statement
was
made
that
some
of
the
responsibilities
of
the
next
fiscal
year
are
going
to
be
paid
for
out
of
this
fiscal
year
and
I'm
not
sure
if
we've
done
that
before
and
how
can
we
pay
for?
F
B
So
I
think
a
little
bit
of
clarification
so
in
terms
of
decision
unit
e690,
this
is
related
to
the
non-capitation
payments
that
were
proposed
to
be
delayed
via
ab3
of
the
special
session.
These
are
truly
state
fiscal
year
21
expenses.
However,
because
of
the
budget
reductions
during
special
session,
we
have
proposed
to
process
those
payments
in.
F
A
Okay,
just
to
make
sure
that
I
may
have
missed
it
earlier.
I
I
like
to
ask
about
our
specialized
foster
care
services.
I
just
want
to
make
sure.
Does
the
agency
anticipate
additional
general
fund
costs
beyond
the
amount
that
was
recommended
in
the
executive
budget
in
the
upcoming
biennium,
which
is
associated
with
the
new
specialized
foster
care
services?
If
the
state
plan
amendment
is
approved
by
the
centers
for
medicare
and
medicaid
services,
did
I
miss
that?
Did
you
answer
that
earlier
and
if
you
did,
I
apologize.
O
Good
morning
again,
dwayne
young
for
the
division.
Madam
chair,
we
addressed
specialized
foster
care,
but
we
did
not
answer
that
specific
question,
and
so
what
we
will
see
is
an
offset
to
the
expenditures
that
assembly
minority
leader
dr
titus,
alluded
to
because
of
the
bst
and
psr
were
used
for
that
population
of
specialized
foster
care.
O
We
did
allow
special
allowances
during
the
pandemic
for
psr
to
occur
via
telehealth
for
for
children
18
and
under,
but
then
certainly
there
was
a
dip
in
services
of
bst
and
then
an
increase
because
we
were
not
able
to
bring
the
specialized
foster
care
system
in
time
that
state
plan
was
actually
approved.
Already
we
have
providers
that
are
going
through
the
enrollment
process
and
the
training
process.
We
put
together
a
joint
training
with
the
division
of
child
and
family
services.
O
In
the
meantime,
what
we
have
done
is
waved
the
titration
down
on
those
rehabilitative
mental
health
services
to
support
the
specialized
foster
care
providers
as
they
move
over
once
they
enroll
they
have
60
days
to
move
over
and
out
of
the
other
provider
type
with
all
providers
expected
to
be
moved
out
of
june.
O
So
we
will
see
some
late
year,
expenditures
in
the
current
fiscal
year
for
specialized
foster
care,
but
we
won't
see,
we
won't
see
a
skyrocketing
effect
and
then,
in
the
new
fiscal
year
we
will
see
some
expenditures
for
those
services.
But
knowing
that
part
of
those
expenditures
because
of
the
case,
management
and
assessment
opponent
will
be
done
by
the
state
and
county
will
be
contained
within
those
budgets.
And
what
we'll
only
be
seeing
is
the
service
provision.
O
A
A
I
thank
you
for
joining
us
here
and
I'm
getting
through
the
six
budgets
and
by
the
sound
of
it
we'll
be
hearing
from
you
again
next
week.
We'll
see
you
again
next
week.
So
thank
you
administrator
and
your
staff
and
have
a
wonderful
weekend.
A
Members
that
brings
us
to
the
last
item
on
our
agenda
and
that
last
item
is
public
comment.
Just
as
a
reminder
for
those
who
are
joining
us
virtually.
You
may
register
online
to
either
speak
to
the
committee
by
telephone
or
you
can
submit
your
comments
to
us
by
email.
So
I
will
ask
our
staff:
do
we
have
anyone
in
the
waiting
room
for
public
comments.
B
B
M
B
B
B
H
Yes,
good
afternoon,
madam
good
morning,
madam
chair,
it's
almost
afternoon,
madam
chair
members
of
the
committee
for
the
record,
my
name
is:
barry
gold,
b-a-r-r-y
last
name
g-o-l-d,
the
director
of
relations
with
government
relations
for
aarp
nevada.
First,
I'd
like
to
thank
senator
raddy
for
her
absolute
great
recognition
of
the
critical
role
that
family
caregivers.
Do.
H
We
rely
on
them
in
the
350
000
of
them
to
take
care
of
older
adults,
and
I'd
also
like
to
thank
majority
floor
leader
benitez
thompson
for
talking
about
the
staffing
need
to
go
ahead
with
caseload
growth
and
the
waiting
list,
growth
for
the
waiver
programs.
But
I'm
really
wanting
to
talk
to
you
about
the
waiver
programs,
for
those
of
you.
Who've
heard
me
talk
about
this
before
those
waiver
programs
keep
people
living
independently
where
they
want
to
be
with
dignity
and
they're,
important,
plus
they're.
The
fiscally
prudent
thing
to
do.
H
I've
talked
to
you
before
about
that.
The
nevada
legislature
has
been
wonderful
about
funding
caseload
growth
for
these
waiver
programs,
but
we
really
need
to
talk
about
the
waiting
list
as
well.
The
decision
units,
m203
and
m511
have
to
do
with
caseload
growth
and
the
waiting
list
for
the
frail
elderly
waiver
and
it's
so
important
that
we
fund
those
because
we
need
to
keep
people
out
of
those
nursing
homes,
as
you
heard
before,
it's
much
more
expensive.
H
It
costs
about
fourteen
thousand
dollars
to
keep
somebody
in
the
waiver
program,
as
opposed
to
about
eighty
thousand
plus
to
put
them
in
a
nursing
home,
and
we
pay
for
all
that.
What
I
want
to
mention
is
I'm
at
the
commission
on
aging
meeting
last
time.
I
asked
how
many
people
dropped
off
the
waiting
list
in
this
biennium.
H
For
what
reasons-
and
I
was
kind
of
appalled
to
find
out
that
approximately
200
people
have
dropped
off
the
waiting
list
because
they
either
died
or
they
went
into
a
nursing
home
and
if
they
went
into
a
nursing
home.
That's
terrible
because
it's
costing
us
all
more
money
and
they
didn't
want
to
go
in
a
nursing
home.
They
would
have
much
preferred
to
stay
living
in
the
more
independently
in
the
community
and
if
they
died.
H
Well,
that's
just
a
human
tragedy,
something
that
possibly
we
could
have
prevented
if
we'd
have
found
space
to
put
them
in
these
waiver
programs.
So
it's
really
important
that
we
fund
these
different
programs
and
in
terms
of
the
waiting
list.
I
know
the
olmstead
asked.
Olmstead
act
talks
about
90
days
or
more,
but
what
I
will
tell
you
is:
there
are
frequently
often
people
in
the
waiting
list
more
than
90
days.
H
B
B
M
We
believe
this
will
help
sustain
the
program
and
draw
more
policy
initiatives
ubiquitously
throughout
the
state
to
help
oral
health
and
the
underserved
populations,
and
so
we
would
like
to
show
our
support
for
the
budget
item
e-400
that
you
heard
today
as
well
as
dpph,
but
budget
item
3220
and
chronic
disease
and
oral
health
program.
Thank
you
for
your
attention
and
support
for
this
initiative.
B
M
M
That
people
like
me
who
live
in
douglas
county
in
rural
nevada
are
so
short-handed
in
caregivers
because
they
can
make
more
money
going
and
working
for
a
fast
food
joint.
I
was
forced
to
put
myself
into
a
care
facility
for
which
I
thought
was
going
to
be
a
month
or
two
ended
up
being
30
months.
I
was
in
the
care
facility
because
there
was
not
caregivers
available
to
meet
my
need
and
my
wife
is
physically
disabled
and
is.
J
M
Able
to
provide
my
care,
although
at
this
moment,
while
I'm
waiting
to
get
back
on
the
list,
she
is
doing
what
she
can
requiring
me
to
stay
in
bed
to
every
other
day
or
so
to
be
able
to
just
provide
to
get
me
out
of
the
care
facility,
because
the
cobit
19
had
attacked
that
care
facility
so
greatly
that
there
was
10
people
in
one
testing
in
my
hall
that
were
copied
positive,
and
so
I
said
I.
M
Just
looking
for
a
paycheck
and
taking
you
know,
we
had
things
stolen
in
the
past,
because
the
pay
was
so
little
that
they
had
to
supplement
their
pay
in
some
way,
so
they
stole
money,
they've
stolen
drugs,
and
it's
because
private
pay,
caregivers
are
being
paid
20
to
25
an
hour
where
the
best
caregivers
under
the
programs,
the
waiver
program
and
and
whatnot
only
get
like
10.50
an
hour.
And
I.
N
M
Would
probably
flip
burgers
before
doing
this
work
for
that
kind
of
pay?
So
I
hope
that
you
guys
understand
that
we
are
out
here
a
lot
of
people
and
I
I
hope
my
other
cohort
who
is
on
the
line
earlier
will
make
a
statement,
but
we
are.
N
M
B
B
N
C-O-N-N-I-E-M-C-M-U-L-L-E-N
and
I
represent
the
personal
care
association
of
nevada,
which
is
about
30
personal
care
companies,
and
thank
you
very
much
for
your
approval
and
support
of
restoring
the
six
percent
reduction
and
increasing
the
waiver
slots
for
the
frail
elderly,
intellectual
disabilities
and
people
with
disabilities.
N
Our
concern
is
with
item
e687,
which
is
in
personal
care
policy
reductions
that
will
be
limited,
modified
or
reduced,
and
that
the
instrumental
activities
of
daily
living
will
be
limited
to
those
only
with
the
greatest
need
when
a
caregiver
is
present.
As
you
know,
we
are
in
a
caregiver
crisis.
There
are
shortages,
as
mr
nagle
said,
we
are
really
challenged
to
go
out
to
rural
areas.
N
We
also
thank
you
for
clarification
on
the
payments
when
the
rates
were
reduced
and
when
they
will
be
resumed
or
restored.
I've
been
asking
and
asking
because
the
bottom
line
is
always
how
much
money
they're
going
to
get
for
caring
for
people,
and
I
just
could
not
seem
to
get
that
answer.
So.
Thank
you.
I
I'm
amazed
at
some
of
the
knowledge
and
the
questions
that
you
have
asked,
and
I
thank
you
so
much
for
giving
me
this
time
on
behalf
of
the
personal
care
association.
Thank
you.
B
M
Thank
you,
madam
cure.
This
is
bill.
Welch
w-e-l-c-h,
president,
ceo
of
the
nevada
hospital
association,
appreciate
the
opportunity
in
speaking
to
the
committee
first
I'd
like
to
acknowledge
your
questions
that
you
were
asked
today.
I
think
they
were
right
on
cue.
There
were
a
number
of
things
that
were
presented
today
that
we
would
like
to
respond
to
as
well
as
a
number
of
questions.
Two
minutes
certainly
won't
allow
that,
so
we
will
be
preparing
comments
to
be
submitted
to
you.
In
writing.
M
This
is
clearly
a
very
important
issue
to
the
medical
community,
particularly
the
hospital
community,
and
so
we
will
be
submitting
questions
and
comments
to
you
in
the
next
couple
of
days
and
appreciate
that
opportunity
to
provide
that
input
to
you.
M
A
B
A
Thank
you
so
much
so
remember
seeing
that
there's
no
other
individuals
wishing
to
make
public
comment.
That
would
conclude
today's
meeting
and
I'd
like
to
thank
all
of
our
presenters,
the
committee
broadcast
staff
and
the
members
of
the
public
who
joined
us
here
virtually
so
with
that.
This
meeting
is
adjourned,
and
I
wish
you
all
a
wonderful
weekend.