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From YouTube: 5/12/2021 - Assembly Ways and Means and Senate Finance, Subcommittees on Human Services
Description
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B
A
And
I
am
here:
will
you
please
mark
assemblywoman
benitez
thompson
present
as
soon
as
she
arrives
and
again
good
morning,
everyone
and
welcome
to
our
committee
meeting.
We
will
be
hearing
six
post
budget
closings
from
the
department
of
health
and
human
services,
division
of
health
care
finance
and
two
from
the
director's
office
and
without
further
ado
we
will
get
started
with
the
first
one
on
our
agenda.
A
B
Thank
you,
medicare
kathy,
crockett,
fiscal
analysis,
division
for
the
record.
The
first
budget
is
the
administration
budget.
It
begins
on
page
three
of
your
packet
and
this
budget
provides
administrative
staff
and
support
for
services
for
the
division
of
healthcare
financing
and
policy,
which
includes
administration,
accounting,
budgeting
personnel
rates,
compliance
utilization
review
privacy,
recipient
rights,
provider,
enrollment
and
information
technology.
B
B
The
governor
recommends
funds,
totaling
489
of
404,
of
which
50
percent
is
general
fund
and
50
is
federal
fund
to
fund
a
contracted
state.
Dental
health
officer
position,
as
discussed
at
the
budget
hearing
on
march
23rd
2021,
the
government
finance
office,
submitted
budget
amendment,
a
2150831,
eliminating
the
original
e400
decision
unit
to
add
the
contract
position
and
adding
a
new
e125
decision
unit
and
rather
than
adding
a
contract
position.
B
According
to
the
agency,
adding
the
position
of
state
staff,
as
opposed
to
a
contractor,
enables
the
receipt
of
75
federal
matching
funds
rather
than
50,
as
is
typical
for
administrative
costs.
Recommended
annual
salary
for
the
position
is
107..
Eighty
five
thousand
a
hundred
ninety
one
dollars
per
year,
which
is
equivalent
to
a
senior
physician
range
c.
The
final
salary
of
the
position
will
be
determined
when
the
pay
bill
is
considered
for
background.
Regarding
this
position,
the
2001
legislature
approved
establishing
a
state
dental
health
officer
physician
that
must
be
licensed.
B
Dentist
appointed
by
the
division
of
public
and
behavioral
health
from
2016
through
2020,
the
state
dental
health
officer
position
was
funded
in
the
public
and
behavioral
health.
Chronic
disease
budget
through
fee
generated
reserve
funds
transferred
from
the
radiation
control
budget,
considering
decreasing
reserves
within
that
budget.
During
the
2019
session,
the
funding
mechanism
was
approved
for
fy20
and
money
committees
issued
a
letter
of
intent
directing
the
agency
to
identify
a
different
funding
source
beyond
this
clear
2020.
B
If
it
wished
to
retain
the
position
in
the
agency's
letter
of
intent
response,
it
indicated
moving
the
position
to
healthcare
financing
and
policy
was
being
considered,
noting
that
such
a
move
would
require
a
statutory
change
in
fiscal
year
2021
the
position
was
funded
through
a
work
program
using
tobacco
settlement
funds,
maternal
child
health,
federal
block
grant
funds
and
a
communicable
disease
budget.
B
Hiv
prevention
grant
and
the
agency
seeks
to
locate
the
position
within
healthcare
financing
and
policy
to
provide
a
sustainable
funding
source
and
to
strengthen
the
clinical
expertise
of
the
medicaid
program
agency
indicates
the
position
would
oversee
the
medicaid
dental
benefits,
administrator
liberty.
Dental
plan
provide
clinical
oversight
and
policy
support
for
medicaid
and
a
dental
services
and
provide
medicaid
related
education
painting
to
oral
health
and
support
the
division's
efforts
to
develop
a
waiver
to
provide
dental
coverage
to
the
adults
with
diabetes
and
pursuant
to
nrs4227247.
D
B
B
Although
a
bill
draft
was
not
submitted
to
support
this
recommendation,
considering
the
statute
requires
a
physician
to
be
appointed
by
the
public
and
behavioral
health
division
rather
than
division
of
health
care,
financing
and
policy,
it
would
be
appropriate
to
amend
statute
to
locate
the
position
within
the
dhcfp
and
the
agency.
As
indicated,
this
would
be
appropriate.
B
The
position
is
currently
filled
and
the
incumbent
would
transfer
over
to
the
division
of
healthcare
financing
and
policy.
The
agency
indicates
the
physician
would
serve
as
an
advisor
to
the
drug
use
review
board
and
the
silver
state
scripps
board
review
pharmacy
utilization
data
to
target
areas
for
efficiencies,
provide
oversight
to
the
pharmacy
benefit
manager.
Contract,
advise
the
division
on
general
pharmacy
issues,
as
well
as
lead
the
department's
efforts
to
lower
overall
cost
of
prescription
drugs
within
the
state.
B
Regarding
funding,
as
previously
discussed
with
the
state
dental
officer,
a
federal
like
regulations
do
allow
for
a
75
federal
match
for
skilled
medical
professionals
and
staff
has
completed
technical
adjustments
to
reflect
this
75
federal
funding,
which
would
increase
general
fund
savings
by
about
109
326
dollars
when
compared
to
the
governor's
recommended
budget.
B
Regarding
the
addition
of
the
state,
dental
officer
and
senior
pharmacy
advisor
position,
while
the
division
currently
has
a
number
of
healthcare
coordinator,
nurse
positions
that
serve
in
various
policy
and
oversight
roles,
it
does
not
currently
have
other
high-level
licensed
medical
professionals
on
staff,
and
the
agency
indicates.
It
would
benefit
from
increased
clinical
expertise
and
developing
policy
for
the
medicaid
and
checkup
programs
by
ensuring
programs
are
evidence-based
and
aligned
with
the
most
recent
clinical
guidelines.
A
D
B
The
governor
recommends
one
new
business
process
analyst
to
support
data
quality
initiatives
for
federal
reporting
at
a
cost
of
142
925
with
a
10
general
fund
match
the
position
would
work
on
data
quality
initiatives
related
to
reporting
for
the
transformed,
medicaid
statistical
information
system,
which
is
a
federal
unreporting
system.
B
B
If
the
federal
government
were
to
determine
the
state
was
not
meeting
data
quality
standards,
the
agency
indicates
it
would
have
to
submit
a
plan
to
address
issues.
If
issues
were
not
addressed
within
six
months,
the
agency
would
be
at
risk
of
decreased
federal
matching
funds
or
its
medicaid
management
information
system
decreasing
from
75
to
50
matching.
B
B
Okay,
the
first
decision
is:
does
the
subcommittee
wish
to
recommend
approval
of
budget
amendment
five?
Oh
eight,
three
one,
five:
eight
to
add
one
unclassified
state,
dental
officer
position
and
associated
operating
travel
and
equipment
costs
at
a
total
cost
of
four
hundred
and
eighty
one
thousand
and
sixteen
dollars,
130
833
general
fund
and
350
183
federal
funds
over
the
biennium,
with
the
understanding
that
the
final
salary
of
the
state,
dental
officer
position
would
be
determined
by
the
money
committees.
B
What
the
table
is
considered
with
authority
for
technical
adjustments
and
to
request
a
bill
draft
to
locate
the
position
under
the
division
of
health
care,
financing
and
policy
rather
than
the
division
of
public
and
behavioral
health.
The
second
decision
does
the
subcommittee
wish
to
recommend
approval
of
transferring
in
one
unclassified
a
senior
physician
and.
B
E
A
B
Thank
you,
madam
chair.
The
next
issue
relates
to
pharmacy
benefit
manager,
contract
and
status
of
pharmacy
benefits.
The
governor
recommends
total
funding
of
8.1
million,
including
2.6
million
in
fy
2022
and
5.5
million
in
fy
2023
to
support
increased
costs
associated
with
the
agency's
pharmacy
benefit
manager,
contract.
B
Currently,
the
managed
care
organizations
ncos
administer
prescription
drug
benefits
for
those
participants
enrolled
in
an
nco
and
the
agency's
fiscal
agent
subcontracts
with
a
pharmacy
benefit
manager
for
those
enrolled
in
fee
for
service.
The
agency
seeks
to
enter
into
a
direct
contract
with
a
pharmacy
benefits
manager
for
improved
compliance
and
transparency
purposes.
B
At
the
december
18
2020
meeting
of
the
interim
finance
committee,
a
contract
was
approved
for
a
contractor
to
assist
with
the
development
of
the
request
for
proposals
for
the
contract,
with
the
pharmacy
benefit
manager.
In
response
to
questions
by
fiscal
staff.
In
preparation
for
the
meeting
the
agency
indicated
it
was
intending
to
carve
out
pharmacy
benefits
from
the
mco
contracts,
with
the
implementation
of
the
new
direct
pharmacy
benefit
manager.
B
Contract
under
a
carve
out
model
capitation
payments
to
the
ncos
would
decrease,
replaced
with
payments
to
the
pharmacy
benefit
manager,
which
could
lead
to
a
decrease
in
the
insurance
premium.
Tax
revenue
positive
deposited
into
the
general
fund,
estimated
at
roughly
9.4
million
dollars
per
year.
However,
during
the
meeting,
the
agency
did
not
confirm
its
intent
to
carve
out
pharmacy
benefits
in
response
to
questions.
Regarding
the
governor's
recommended
budget,
the
agency
indicated
its
initial
intent
was
to
carve
out
these
benefits
effective
july
2022.
B
However,
in
recognition
of
loss
of
the
insurance
premium
tax
revenue
associated
with
the
policy
change,
the
agency
now
seeks
to
further
analyze
the
total
fiscal
impact
of
the
state,
including
savings
associated
with
improved
management
of
prescription
drugs
and
increased
drug
rebate
revenue.
Before
moving
forward
during
the
budget
hearing,
the
agency
indicated
it
does
not
intend
to
move
forward
with
carving
out
prescription
drug
benefits
during
the
upcoming
biennium.
A
B
B
The
first
project
relates
to
just
continuing
the
implementation
of
the
electronic
visit
verification
system
decision
unit
m518
at
a
cost
of
1.4
million
over
the
biennium.
This
is
a
vendor
operated
system
that
involves
recipients
providing
electronic
verification,
such
as
through
a
web
portal.
The
services
were
provided
provider
prior
to
the
agency
processing
payments
to
providers.
B
Governor
recommends
2
million
over
the
biennium
for
costs
associated
with
providing
application
programming
interfaces
as
a
means
of
providing
participants
with
access
to
healthcare
data,
which
is
also
a
federally
mandated
product
project.
This
would
result
in
a
mobile
digital
platform
which
would
allow
participants
to
access
claims
clinical
data
appointment
scheduling,
as
well
as
an
electronic
medicaid.
D
B
The
agency
indicates
there
may
be
future
cost
reductions
associated
with
a
reduced
printing
and
mailing.
The
next
project
e-225
relates
to
health
information
exchange
projects.
The
governor
has
recommended
a
1
million
dollars
with
the
state
share
provided
through
donations,
rather
than
general
fund
and
fy
2022,
to
support
underserved
facilities
and
provider
officer
offices
with
connecting
to
healthy
nevada,
statewide
health
information
exchange
on
april
2nd
2021.
B
The
agency's
request
for
federal
funding
in
support
of
this
project
was
denied
by
the
center
or
medicare
and
medicaid
services,
as
the
donation
was
deemed
to
be
an
impermeable
source
of
funding
for
the
non-federal
share
of
project
costs,
as
federal
funding
for
the
project
is
not
authorized.
The
agency
indicates
this
decision
unit
should
not
be
approved
next
decision.
Unit
e-226
relates
to
the
medicaid
management
information
system.
Modernization.
B
The
governor
recommends
42
000
in
fy
2022
to
support
costs
to
complete
the
modernization
project.
This
was
initially
implemented
in
the
2007
to
9
biennium,
and
this
is
the
final
closeout
phase
of
that
project.
No
costs
are
anticipated
in
the
upcoming
or
beyond
the
upcoming
biennium
for
the
modernization
project.
B
On
march
2020
or
march
28
2021
budget,
amendment
a21503158
was
submitted
to
provide
158
440
funded
with
a
90
federal
funds
and
a
10
or
approximately
16
000
in
general
funds
in
fy
2022,
for
a
contact
contractor
to
perform
it
related
tasks
required
by
a
cms,
including
an
environmental
scan
of
the
state's
current
health.
It
landscape
update,
updating
the
agency's
health,
I.t
road
map
and
plan,
and
the
agency
anticipates
the
work
will
be
complete
by
march
2022.
B
D
Run
again
helps
providers
who
see
medicaid
patients
and
with
that
communication,
and
in
the
long
run,
perhaps
indeed
saves
money
not
repeating
tests
able
to
exchange
some
of
that
needed
information.
Is
there
some
alternative
things
that
the
agency
has
looked
at
since
cms
denied
that,
and
I
understand
that
we
wouldn't
want
to
commit.
E
B
On
the
letter
from
us
as
this
particular
project
was
denied
because
it
appeared,
the
donation
was
coming
from
an
entity
that
would
be
the
direct
beneficiary
of.
C
D
Thank
you,
madam
chair,
and
I
appreciate
this
is
the
first
time
I'm
I'm
hearing
about
it.
I
I
believe
that
the
hie
is
resubmitting
its
application,
and
I
agree
with
dr
titus.
I
think
you
know
the
health
information
exchange
provides
a
really
important
service.
There
are
no
general
funds
in
this.
D
Is
there
a
way
to
sort
of
authorize
it
contingent
on
federal
funds
getting
or
federal
funds
getting
approved,
or
something
to
that
effect,
so
that,
if
they're
able
to
get
this
process
that
that
they
would
able
to
be
able
to
move
forward
with
the
project
I
might
have
to
that
might
be
on
this
a
question
to
miss
crockett.
B
Staff
would
note
that
these
types
of
projects
are
funded
with
90
federal
funds,
10
percent
non-federal
match.
So
if
a
donation
was
not
available,
then
you
know,
perhaps
general
fund
would
need
to
be
used
for
the
non-federal
share.
If
the
agency
was
able
to
identify
an
additional
funding
source
for
the
non-federal
share,
perhaps
during
the
interim,
a
different
donation,
or
something
of
that
nature
that
was
deemed
to
be
appropriate
by
the
federal
government
processing,
would
always
be
an
option.
D
B
E
Thank
you
chair,
so
I
just
want
to
just
want
to
make
sure
that
we
have
clarity
on
this.
One
so
sounds
like
what
I
heard
was
that.
E
There's
potential
that
a
different
donor
that
doesn't
have
a
direct
benefit
might
be
accepted
by
cms.
The
agency
is
perhaps
looking
into
that,
but
then
I
think
what
I
heard
the
answer
is
is
based
on
the
authority
that
medicaid
already
has.
If
they
are
able
to
secure
a
donor,
they
are
able
to
secure
the
cms
approval.
E
Are
you
ready
for
a
motion
chair?
I
am
fantastic,
so
I'll
go
ahead
and
read
this
one.
We
wish
to
recommend
approval
for
of
four
it
projects,
including
decision
units
m517,
m518,
e226
and
budget
amendment,
a
two
one:
five:
zero,
zero
three
one:
five,
eight
at
a
total
cost
of
three
point:
five
million:
seven
hundred
seventy
five
thousand
five
and
540
000
in
general
funds
over
the
2123,
biennium
and
disapproval
of
decision
unit
e
225
as
cms,
did
not
approve
federal
funding
for
the
project.
A
Thank
you
so
much
for
the
motion.
Can
I
get
a
second
second,
it's
been
moved
by
senator
raddy
and
seconded
by
assemblywoman
carlton
any
discussion
on
the
motion
scene.
None
all
in
favor
of
the
motion,
please
say
aye.
Any
opposed
motion
carries
unanimously
with
the
members
present
we'll
move
on
to
the
final
closing
item
in
this
budget.
B
E
Absolutely
recommend
other
closing
items,
one
through
five
be
closed,
as
recommended
by
the
governor
and
other
other
clothing
clothing
items,
not
clothing.
It's
closing
items
six
through
nine
be
closed
with
the
noted
technical
adjustments
with
authority
for
staff
to
make
further
necessary
technical
adjustments.
A
B
The
next
budget
is
the
medicaid
budget.
There
are
eight
major
closing
issues
within
this
budget.
The
first
closing
issue
relates
to
federal
medical
assistance
percentage
fmap
rates,
the
government,
the
governor's
recommended
updating,
fmap
rates
based
on
projected
changes
in
these
rates.
The
federal
government
pays
states
for
a
specified
percentage
of
medicaid
and
check-up
program.
Expenditures
referred
to
as
the
f-map
rates.
The
remaining
portion
of
program
costs
must
be
paid
by
some
other
funding
source,
such
as
general
fund
appropriations
or
transfers
from
local
governments.
B
Variations
in
fmap
rates,
which
are
revised
by
the
federal
centers
for
medicare
and
medicaid
services
or
cms
each
federal
fiscal
year,
have
a
material
impact
on
the
amount
of
general
fund
appropriations
required
to
support
the
division's
budgets.
All
decision
units
in
the
budgets
are
calculated
using
updated
fmap
rates.
The
budget
does
not
include
separate
decision
unit
that
quantifies
the
general
fund
impact
of
fmap
rate
changes.
B
The
federal
funds
information
for
states
released
information
on
the
final
federal
fiscal
year,
2022
f
map
rates
in
september
2020,
which
are
included
in
the
executive
budget
and
was
initially
anticipated
to
provide
federal
fiscal
year.
2023
projected
f
map
rates
in
march
2021,
with
limited
exceptions.
The
f
map
rate
used
to
determine
the
funding
split
of
program
expenditures
is
based
on
the
eligibility
group
of
the
participant.
The
standard
f
map
range
for
each
state
is
determined
annually,
based
on
the
per
capita
income
of
the
state
relative
to
the
per
capita
income
of
other
states.
B
With
a
floor
of
50,
the
affordable
care
act
provided
100
federal
funding
or
costs
of
participants
covered
under
the
medicaid
expansion
expansion
group,
known
as
the
newly
eligible
f
math
from
2014
through
2016.
beginning
in
2017.
The
f
map
rate
for
this
population
gradually
began
decreasing
until
it
reached
90
percent
in
2020,
where
it
will
remain
a
temporary
23
point
increase
in
the
enhanced
children's
health
insurance
program
shift
after
map
rate
was
in
effect
from
october
1st
2015
through
september
30th
2020.
B
The
calculation
of
the
enhanced
chip
f
map
rate
is
based
on
the
standard
f
map
rate,
and
this
temporary
increase
leads
to
a
4.34
percentage
point
increase
in
the
chip,
enhanced
f
map
rate.
A
temporary
increase
does
not
apply
to
the
newly
eligible
fmap
rate
regarding
2022
f
map
rates.
The
executive
budget
recommends
f
map
rates
for
the
upcoming
biennium,
assuming
the
expiration
of
the
temporary
f
map
rate
increase
on
june
30th
2021,
based
on
existing
public
public
health
emergency
declarations.
B
At
the
time,
the
budget
was
prepared.
A
public
health
emergency
has
been
in
effect
since
january
20th,
most
recently
on
april
15
2021.,
the
federal
government
extended
the
public
health
emergency
through
july
20th
meeting
the
temporary
increase
in
fmap
rates
would
be
available
through
september
30th
2021.
B
Additionally,
in
a
january
22nd
2021
letter
to
state
governors,
the
acting
secretary
of
the
federal
department
of
health
and
human
services,
indicated
the
public
health
emergency
would
likely
remain
in
place.
The
entirety
of
2021,
meaning
the
temporary
increase
in
fmap
rates,
may
be
available
through
december
31st
2021..
B
Accordingly,
the
agency
provided
updated
revenue
allocations
between
general
funds
and
federal
funds
based
on
the
temporary
increase
applying
through
that
point
in
time.
These
rates
are
applied
to
the
base
budgets
and
decision
units
throughout
the
base
throughout
the
divisions,
budgets
there's
a
table
on
page
21
that
compares
the
governor's
recommended
lended
rates
and
those
blended
rates
converts.
The
federal
fiscal
year
rates
to
state
feels
clear
for
budgeting
purposes,
assuming
the
continuation
of
the
temporary
increase
in
rates
through
december
31st
2021
for
the
standard
fmap
rate.
B
That
would
be
a
3.1
percent
increase
for
the
enhanced
chip
f
map
rate.
It
would
be
a
2.17
increase
regarding
the
fy,
2023
f
map
rates.
Typically,
the
federal
funds
information
for
states
would
release
the
federal
fiscal
year
23
rates
in
late
march.
However,
this
year
the
release
was
delayed
due
to
timing
of
the
decennial
census,
data
being
released
by
the
federal
government.
B
The
official
f
map
rates
for
the
federal
fiscal
year
2023
will
be
released
in
fall,
2021
and
federal
funds.
Information
for
the
states
indicated
it
anticipates
significant
revisions
to
data
that
affects
fmap
rates
at
that
time,
due
to
coven-related
changes
in
personal
income,
meaning
that
the
federal
fiscal
year
2023
mates
rates
may
vary
materially
from
the
projections.
B
At
the
work
session,
the
department
of
health
and
human
services
had
provided
an
estimated
fy23
blended
rate
based
on
information
available.
At
that
time.
However,.
D
D
B
Provided
a
revised
revenue
allocations
based
on
these
updated
projections,
there's
a
table
on
page
2022
or
page
22
that
displays
the
governor's
recommended
and
the
most
recent
updated
projections
for
the
fmap
rates.
B
There
are
material
impacts,
as
previously
mentioned
to
general
funds
required
to
support
the
medicaid
budget
based
on
fluctuations
in
the
fmap
rates.
There's
a
table
on
page
22
that
displays
a
fiscal
staff's,
estimated
difference
in
the
base
budget
in
fy
2022.
The
increase
in
the
rates
results
in
about
a
56.7
million
dollar
savings
in
general
fund
and
in
fy
2023.
B
The
decreased
rate
compared
to
the
governor's
recommended
budget
results
in
about
a
19.2
million
dollar
general
fund
increase
in
total.
The
f
map
rate
changes
result
in
about
a
37.4
million
dollar
general
fund
savings
over
the
upcoming
venue.
There
is
more
uncertainty
surrounding
projected
f
map
rates.
That
is,
and
is
typical
during
legislative
session
as
a
temporary
increase
in
the
rate
may
be
extended,
and
the
fy
2023
rates
may
vary
materially
from
the
initial
projections.
A
D
Thank
you,
madam
chair.
I
think
that
additional
language
in
the
authorizations
act
is
both
prudent
and
probably
really
important.
I'm
really
concerned
about,
what's
going
to
happen
with
our
2023
f
map
rate,
with
all
the
money
just
getting
pumped
into
the
into
the
state
through
the
federal
government
and
that's
going
to
have
downward
pressure
potentially
on
our
2023
rate.
So
I
think
it
would
make
sense
to
give
this
sort
of
flexibility
to
the
department.
A
Thank
you
so
much
for
the
motion.
A
second,
oh
yeah.
It's
been
moved
by
senator
ratty
and
enthusiastically
seconded
by
assemblywoman
carlton.
Any
discussion
on
the
motion.
Cnn.
All
in
favor,
please
say
aye
any
opposed.
The
motion
carries
unanimously
of
the
member's
present.
Moving
on
to
the
next
item.
B
E
B
2023
to
support
projected
changes
in
medicaid
case
load
during
the
current
biennium
actual
medicaid
caseload
has
been
higher
than
legislatively
approved
due
to
the
economic
situation
in
the
state,
with
average
monthly
mfy
21,
he
said
projected
to
be
about
706
000,
which
is
about
118
000
or
18.5
percent.
Higher
than
legislatively
approved
caseload
of
approximately
640
000.
in
february
2020
caseload
was
in
line
with
legislatively
approved
level
at
approximately
638
000.
B
However,
by
october
2020
actual
caseload
had
increased
by
114
000
or
approximately
18
to
about
700
000,
as
with
other
departmental
caseloads
and
consistent
with
previous
legislative
sessions.
The
agency
provided,
updated
march
caseload
projections
based
on
february
2021,
actual
caseload
and
costs
as
prepared
by
the
department
analytics
during
the
budget
hearing,
the
agency
testified.
The
march
caseload
updates
would
be
based
on
the
public
health
emergency
continuing
through
december
31st
2021.
B
There
are
several
requirements
for
states
to
receive
the
temporary
effort
increase
authorized
through
the
family's
first
coronavirus
response
act,
including
not
terminating
medicaid
enrollment
unless
an
individual
requests
voluntary
termination
or
ceases
to
be
a
state
resident
referred
to
as
the
maintenance
of
effort
or
continuous
eligibility
requirements.
B
Therefore,
while
the
public
health
emergency
is
in
effect,
case,
load
will
be
higher,
as
individuals
are
not
disenrolled
when
they
no
longer
meet
standard
program,
eligibility
requirements,
thus
remaining
on
the
case
load.
The
subcommittee
expressed
concern
with
the
agency's
planned
reproductions
and
questioned
the
rationale
for
budgeting
for
the
higher
case
load
without
the
accompanying
increase
in
fmap
rate,
recognizing
that
the
higher
case
load
would
increase
cost,
thus
requiring
additional
general
funds
in
the
budget.
B
During
the
april
15
2021
work
session,
the
subcommittee
expressed
an
interest
in
budgeting
for
the
medicaid
case
load,
assuming
the
public
health
emergency
continues
through
december
31st
2021
for
consistency
with
budgeting
for
the
temporary
increase
in
the
map
rates
through
the
same
date
with
the
public
health
emergency
continuing
through
december
2021.
Economic
recovery
is
expected
to
begin
in
the
first
quarter
of
2022.
B
However,
employment
numbers
would
not
be
projected
to
get
back
to
pre-covered
levels
during
the
upcoming
biennium.
The
eligibility
redetermination
process
would
begin
january,
1st
2022
and
last
approximately
six
months.
A
monthly
average
case
load
would
increase
by
about
25
000
from
822
000
in
july
2021,
to
about
847
000
in
december.
2021
then
decrease
by
about
34
000
from
january
2022
through
december
2022
during
the
redetermination
process,
and
gradually
increase
over
the
biennium
to
approximately
829
000
in
june
2023.
B
B
The
largest
increase
in
the
most
recent
projections
is
in
the
newly
eligible
population
which
covers
childless
adults
within
comes
up
to
138
of
the
federal
poverty
level,
with
variances
of
about
16.9
percent
or
about
47
000
participants
in
fy,
2022
and
14.1
percent,
or
about
38
000
participants
in
2023
as
caseload
for
this
population
tends
to
fluctuate
upwards,
as
economic
conditions
deteriorate
and
caseload
would
go
downward
as
conditions
improve,
while
caseloads
for
other
populations,
such
as
the
medical
assistance
staged,
blind
and
disabled,
and
to
remain
relatively
stable
as
economic
conditions
change,
and
there
is
a
table
on
page
25
that
displays
governor
recommends
and
revised
caseload
projections
by
eligibility
group.
D
B
D
A
E
I
go
ahead
and
make
a
motion
to
recommend
approval
of
the
updated
caseload
projections,
as
described
in
the
motion
on
page
25.
A
B
The
budget
amendment
would
recommend
to
rescind
budget
reductions
approved
during
the
31st
special
session,
at
a
cost
of
147
million,
of
which
74.5
million
would
be
general
fund
in
fy
2022
and
26.7
million
7.3
million
general
fund
in
fy
2023.
As
mentioned
this
budget
amendment
has
not
previously
been
heard
by
the
subcommittee
in
approving
assembly
bill
3.
The
legislature
approved
general
fund
reductions,
totaling
about
134
million
in
this
budget
and
section
31
of
the
bill,
outlines
specific
budget
reduction
measures
to
be
implemented.
B
First
reduction
was
reduce
fee
schedule,
provider
rates
by
six
percent
and
neonatal
intensive
care
unit
rates.
As
discussed
during
the
budget
hearing,
the
agency
has
not
received
a
federal
approval
to
implement
rate
reductions
for
the
majority
of
providers.
The
rate
reduction
has
been
federally
approved
for
two
providers,
according
to
the
agency
for
waiver
for
frail
elderly
and
waiver
for
physically
disabled
providers,
although
most
of
the
rate
decreases
have
not
yet
been
approved
by
cms,
the
agency
has
incorporated
savings
associated
with
the
rate
reductions
into
the
per
participant
per
month.
B
Adaptation
rates
made
to
the
managed
care
organizations
effective
january
1st
2021..
To
restore
this
budget
reduction.
The
agency
would
contact
the
cms
and
withdraw
its
request
to
reduce
the
rates
and
request
that
the
rates
for
the
two
provider
types
for
which
reductions
have
already
been
approved,
be
increased
to
the
previous
level
effective
july.
1St
2021,
as
rate
increases,
cannot
be
retroactive.
According
to
the
agency,
the
agency
would
also
have
its
actuary
recalculate,
managed
care
organization,
capitation
rates
and
restore
funding
to
the
managed
care
organizations
which
payments
anticipated
to
be
made
by
december
2021.
B
The
second
budget
reduction
item
was
to
eliminate
a
2.5
acute
care
hospital
rate
increase
approved
through
senate
bill
528
of
the
2019
session.
The
agency
had
not
received
cms
approval
to
implement
the
rate
increase,
effective
january
1st
2021,
as
originally
intended
prior
to
the
31st
special
session.
Therefore,
it
was
not
necessary
to
seek
cms
approval
to
reduce
this
rate
following
the
special
session.
B
If
I'm
restoring
the
rate
decrease
is
approved,
the
agency
indicates
it
would
not
be
able
to
implement
this
retroactively
and
would
seek
cms
approval
to
implement
the
2.5
increase
effective
july
1st
2021..
B
The
next
budget
reduction
approved
relates
to
revising
the
methodology
for
determining
habilitation
rates,
as
noted
during
the
special
session-
and
this
was
a
savings
measure
implemented
in
response
to
comply
with
federal
guidance
and
continued
compliance
as
necessary.
This,
therefore,
this
budget
reduction
measure
should
not
be
restored.
B
B
B
As
noted
at
the
budget
hearing,
the
governor's
recommended
budget
did
not
include
ongoing
savings
associated
with
implementing
the
specialty
pharmacy
provider
network.
Therefore,
no
budgetary
adjustment
on
this
item
is
needed
in
decision
unit
e
351,
which
will
be
discussed
in
the
next
major
closing
issue.
The
governor
recommends
restoring
the
six
percent
provider
fee
schedule
rates
increase
effective
october
1st
2021.
B
The
budget
amendment
establishes
a
new
e353
decision
unit
and
recommends
rescinding
the
provider.
The
six
percent
provider
rate
reduction
effective
fiscal
year,
2021
funded
with
a
fiscal
year,
2021
budgetary
surplus
at
an
estimated
cost
of
approximately
125.4
million
27.7
million
general
fund
to
support
the
rate
restoration
and
to
support
the
rate
restoration
of
july
through
september
2021.
B
B
The
pub
budget
amendment
also
recommends
eliminating
decision
unit
e678
and
reducing
the
60
million
dollar
balance
board
of
statement.
Net
benefit
recommended
in
deceit,
decision
unit
e
678
to
19.5,
19.9
million,
based
on
the
current
projected
surplus,
offset
a
portion
of
the
cost
of
restoring
a
provider
rate
reductions
in
fy
2022.
B
B
the
2.5
acute
care
hospital
rate,
restoration,
total
cost
is
about
26.7
million
dollars
in
each
fiscal
year.
The
managed
care
organization,
provider
rate
restoration
for
the
six
percent
rate
reduction
that
has
already
been
passed
on
to
the
managed
care
organizations
would
be
at
a
total
cost
of
45.7
million
dollars
in
fy
2022..
B
B
The
school
staff
notes
that
section
31
of
assembly
bill
3
of
the
31st
special
sessions
specified
budget
reduction
measures
that
are
now
recommended
to
be
reversed.
Accordingly.
If
the
subcommittee
wishes
to
recommend
approval
of
the
budget
amendment,
it
should
also
recommend
language
in
the
appropriations
act
to.
B
Bill
3
to
remove
language
directing
the
agency
to
implement
budget
reduction
measures
that
would
no
longer
take
place
companion.
Budget
amendments
were
also
submitted
for
the
checkup
and
intergovernmental
transfer
budgets.
If
the
subcommittee
wishes
to
approve
this
budget
amendment,
the
companion
budget
amendments
should
also
be
approved.
B
The
decision
for
the
subcommittee
does
the
subcommittee
wish
to
recommend
approval
of
budget
amendment
a216813243
to
rescind
budget
reductions
approved
during
the
31st
special
session,
including
the
elimination
of
decision
unit
e-678
at
a
cost
of
147
million
74.5
million
general
funds
in
fy
2022
and
26.7
million
7.3
million
general
funds
in
fy
2023
and
recommend
approval
of
language
in
the
appropriations
act
to
amend
language
in
assembly
bill
3
of
the
31st
special
session
to
remove
applicable
language
relating
to
the
budget
reductions.
A
C
And
thank
thank
you,
madam
chair,
so
you
know,
I
remember
very
distinctly
that
evening,
as
one
of
our
colleagues
said
the
other
day
sitting
in
4100,
with
our
caucus
going
through
the
list
of
these
cuts
and
looking
at
the
faces
of
some
of
the
folks
who
had
never
faced
something
like
this
before
and
that
just
they
were
deer
in
headlights.
They
were
just
in
shock
that
we
had
to
make
these
these
types
of
decisions
and
make
these
types
of
cuts.
C
C
D
Thank
you,
madam
chair.
So,
ms
crockett,
I
want
to
clarify
exactly
what
we're
doing
so,
the
in
the
chart
on
page
27.
It
indicates
the
six
percent
rate
reduction
is
being
restored
for
the
first.
What
three
months
of
the
current
fiscal
year
is,
that
is
that
the
way
I'm
reading
that
or
that
I'm
sure
the
next
fiscal
year
july,
20
of
the
2022
fiscal
year.
B
Yes,
the
rates
of
budget
reduction
measures
would
be
rescinded.
Effective,
fy,
2021
funded
with
a
surplus
in
2021.
There
were
savings
built
into
the
fy
21
projections,
assuming
the
savings
would
be
realized.
B
Those
savings
would
be
removed
from
the
agency's
budget,
which
the
surplus,
which
was
used
as
a
budgetary
savings
measure
in
decision
unit,
e6
678,
which
is
being
reversed,
and
then
within
the
budget
amendment
it
would
fund
the
first
three
months
of
the
six
rate,
restoration
and
a
separate
decision
unit
e351,
which
is
in
the
next
major
closing
issue,
would
fund
the
rape
restoration
for
the
remainder
of
the
biennium.
D
The
the
rates
had
not
yet
been
approved
by
cms
for
the
reductions
that
had
been
approved
during
the
special
session
right,
and
the
expectation
was
that
we
were
going
to
ask
all
the
providers
to
write
us
a
big
check
for
the
reductions
between
whenever
we
approved
it
for
august
1st
or
whatever
it
was
through
the
end
of
the
fiscal
year.
Is
that
also?
Is
that
being
accommodated
in
the
40
million
dollars
in
state
net
benefit
or
how
is
that
being
addressed?.
B
Initially,
the
governor
had
recommended
40
million,
I'm
sorry
60
million
dollars
to
balance
forward
from
fy
2021
to
fy
2022
that
has
been
reduced
by
40
40
million
about
19
million
dollars.
B
So
that
is
essentially
what
the
what
the
cost
of
restoring
it
in
fy.
D
2021,
yes,
okay!
So
I'm
reading
that
correctly,
it's
the
it's
the
nature.
It's
the
state
net
benefit
reduction
of
40
million
dollars.
That
is
accommodating
the
sort
of
forgiveness.
If
you
will,
of
the
six
percent
rate
cut
that
we
had
made
during
the
special
session
that
was
effective
in
fiscal
year,
21.
D
Senator
thank
you
very
much.
I
wanted
to
make
sure
that
that
was
clear
for
everybody
and
I
certainly
usually
don't
like
getting
budget
amendments
late,
but
this
was
an
awfully
good
one.
So
thank
you.
E
E
We
apply
for
the
state
plan,
amendment
that
we
are
still
in
process
for
that
state
appointment
plan
amendment,
so
that
will
be
rescinded,
but
the
way
that
the
bulk
of
our
medicaid
services
are
funded
are
through
managed
care
organizations,
and
my
understanding
is
that
at
least
one
managed
care
organization
has
already
implemented
implemented
some
of
these
cuts,
and
so
it
would
be
then
incumbent
upon
that
managed
care
organization
to
work
with
the
providers
within
their
network
to
restore
the
cuts
that
they
have
already
absorbed.
Those
providers
is
that
am
I
understanding
this
correctly.
B
Yes,
you
are,
you
are
correct:
the
managed
care,
capitated
rate
have
been
decreased
and
so
part
of
the
budget
amendment
would
be
to
have
their
agency's
actuary
recalculate.
The
rates
as
the
rate
reduction
were
taken
place
and
make
this
characterization.
Those
are
anticipated
to
be
made
by
the
end
of
this
calendar
year
with
regard
to
rates
paid
by
the
managed
care
organizations
to
providers
of
the
division's
contract.
B
Bots
allow
the
agency
to
directly
control
what
rates
are
paid
by
the
managed
care
organization,
so
I
do
not
think
there
would
be
any
guarantee
that
the
managed
care
organizations
would
be
required
to
reduce
or
restore
their
rates.
E
E
E
Right
so
I
would
wish
to
recommend
the
approval
of
budget
amendment
82168
13243
to
rescind
budget
reductions
approved
during
the
31st
special
session,
including
the
elimination
of
descent
decision
unit
e
678,
at
a
cost
of
147
million,
74.5
million,
with
your
general
funds
in
fiscal
year
22
and
26.7
million
7.3,
which
three
million,
which
are
general
funds
in
fiscal
year.
2023
and
recommend
approval
of
language
in
the
appropriation
act
to
amend
language
and
assembly
bill
3
of
the
31st
special
session
to
remove
applicable
language
relating
to
the
budget
reductions.
A
B
Thank
you,
madam
chair
kathy
hopkins
for
the
record.
The
fourth
item
relates
to
provider,
reimbursement
rate
increases,
the
governor
recommends
funding
totaling,
368
million
in
fy
2022
and
571.2
million
in
fy
2023
for
mandatory
and
discretionary
reimbursement
rate
increases
for
providers.
The
first
item
is
decision
unit
m101,
mandatory
rate
increases
in
the
governor's
recommended
budget,
managed
care
organization
and
dental
capitation
rates,
along
with
provider
rates
for
rural
health
and
federally
qualified
health.
B
B
prescription
drug
costs
were
recommended
to
increase
by
5.5
of
the
in
each
year
of
the
upcoming
biennium,
due
to
a
typographical
error
in
march
2021
caseload
projection
the
agency
updated
inflation
rates
based
on
moody's,
analytics
february
2021
projections,
including
prescription
drug
inflation
of
2.71
in
fy,
2022
and
3.48
in
fy,
2023
and
managed
care
organization,
rural
health
center,
federally
qualified
health
center
inflation
of
2.76
percent.
In.
D
B
2022
and
3.48
in
fy
2023.,
as
previously
noted
regarding
prescription
drug
inflation,
the
executive
budget
had
recommended
a
fee
for
service
inflation
for
prescription
drugs
at
5.5.
B
B
B
On
march
2020
march,
29
2021,
the
agency
sent
a
memo
to
fiscal
staff
and
the
governor's
finance
office
expressing
concern
with
the
revised
prescription,
drug
inflation
rate
and
requested
a
rate
of
6.62
per
year,
based
on
a
four-year
average
over
overall
fee
for
service
drug
expenditures.
B
The
agency
indicated
the
higher
rate
could
account
for
increased
utilization
of
certain
high-cost
drugs.
However,
projected
changes
in
prescription
drug
utilization
have
not
usually
been
budgeted
for
as
high-cost
drugs
are
continually
introduced,
while
patents
on
existing
drugs
also
expire
enabling
generics.
Furthermore,
difficulty
of
in
projecting
utilization
of
high-cost
drugs
maybe
experience
during
the
work
session.
The
agency
just
indicated
the
6.62
inflation
rate
was
appropriate
based
on
the
recent
cost
increase
as
described,
and
they
noted
the
introduction
of
a
high
cost
drug
or
spinal
muscular
atrophy
was
anticipated
to
increase
for
subscription
drug
costs.
B
However,
cost
increases
in
prescription
drugs
rating
relating
to
a
mutilation
trend
are
separate
from
true
inflationary
cost
increases
and
should
be
requested
in
a
separate
enhancement
decision
unit,
rather
than
combined
in
the
federally
mandated
m
101
decision
unit.
According
to
the
agency
increasing
the
prescription,
drug
inflation
rate
would
require
additional
general
funds
of
12.6
million
over
the
upcoming
biennium
as
an
alternative
to
approving
additional
general
funds
to
support
the
requested.
6.62
inflation
rate,
as
the
oppressed
request,
appears
to
be
related
to
speculative
changes
in
prescription
drug
utilization,
rather
than
true
inflationary
cost
increases.
B
With
the
exception
of
the
administration
budget,
general
funds
appropriated
to
the
division
are
limited
to
amounts
included
in
the
appropriations
act
and
the
division
shall
not
request
an
additional
appropriation
with
certain
exceptions
that
are
laid
out
in
the
bill
to
provide
authority
for
the
agency
to
request
a
supplemental
appropriation,
the
subcommittee
could
recommend
approval
of
language
in
the
2021
appropriations.
Act,
authorize
an
exception
to
the
appropriations
limit.
B
The
next
item
relates
to
discretionary
rate
increase
and
decision
unit
e351.
As
previously
discussed.
This
would
restore
the
six
percent
reduction
in
fee
schedule,
reimbursement
rates
paid
to
providers
approved
during
the
31st
special
session,
effective
october
1st
2021,
based
on
the
march
2021
caseload
projection
and
up
map
updates.
The
cost
of
this
decision
unit
has
increased
from
436.5
million
117.3
million
general
funds
to
481.2
million
126.8
million
general
fund
over
the
biennium.
B
There
are
two
decisions
for
the
subcommittee
and
the
first
decision
has
three
options
or
decision
unit
m101.
B
Drug
cost
increases
at
a
total
cost
of
366.3
million
106.6
million
general
fund
over
the
biennium
option
b,
approved
decision
unit
m101
based
on
the
march
2021
caseload
and
fmap
updates,
and
moody's,
analytic
inflationary
rates
and
provide
approval
for
one-time
authority
for
the
agency
to
seek
a
supplemental
appropriation
experience.
A
general
fund
shortfall
caused
by
prescription
drug
cost
increases
through
one
time
language
in
the
2021
appropriations
act
at
a
cost
of
366.3
million
106.6
million
general
fund
over
the
biennium
option
c
approved
decision
unit
m
101
based
on
the
march
case,
load
and
f.
B
Math
updates
and
moody's
analytics
inflationary
rates
at
a
cost
of
366.3
million
over
the
biennial
and
also
approve
an
additional
12.6
million
in
general
fund
over
the
biennium
to
support
higher
prescription
drug
inflation
than
projected
by
moody's
analytics
and
separately
decision
unit.
E351
does
the
subcommittee,
which
recommended
approval
of
funding
to
restore
the
six
percent
reduction
of
fee
schedule
rates
effective
october
first
2021
at
a
cost
of
481
million,
of
which
126.8
million
would
be
general
funds.
A
D
B
B
Change
stay
within
that
general
fund
limit.
The
appropriations
act
thus
specify
very
certain
circumstances
in
which
the
agency
could
seek
assault,
and
so
without
language
relating
to
cost
increases.
The
agency
would
would
not
be
allowed
to
seek
that,
but
there's
nothing
that
would
preclude
the
leadership
from
appropriating
additional
funding
if
it
deemed
deemed
necessary.
B
A
Any
other
questions
all
right
with
that.
I
will
ask
for
a
motion
for
the
electric
decision.
E
Absolutely
chair:
I
appreciate
the
opportunity
to
work
this
through
with
chair
monroe,
moreno
and
obviously
this
is
a
challenging
budget
to
project
because
of
the
high-end
prescription,
drugs
that
can
swing
it
one
way
or
another.
So
I
appreciate
the
work
that's
been
done.
I
appreciate
the
opportunity
to
work
with
chair
on
this
and
agree
with
her
recommendation.
A
B
The
fifth
item
relates
to
a
budget
reduction
measures
service
eliminations
as
a
cost
saving
measure.
The
governor
recommends
eliminating
basic
skills,
training,
psychosocial
rehabilitation,
services,
biofeedback
and
neurotherapy
services
and
behavioral
health
case
management,
effective
january
2022
for
savings
totaling
22.4
million
in
fy
2022
and
48.2
million
in
fy
2023
states
determine
the
type
amount,
duration
and
scope
of
services
provided
within
federal
guidelines.
B
Federal
law
requires
states
to
provide
certain
mandatory.
Medicaid
benefits
allows
states.
The
choice
of
covering
other
optional
benefits
and
nevada
covers
a
number
of
these
optional
benefits
that
are
considered
to
be
cost-effective.
The
governor
has
proposed
eliminating
several
services
that
are
considered
optional
under
federal
law
as
a
budget
reduction
measure.
B
The
agency
also
indicated
they
reviewed
services
and
determined
those
for
elimination
that
were
anticipated
to
have
the
least
impact
on
participants
to
achieve
targeted
level
of
savings.
The
first
item
is
decision
unit
e
682
basic
skills,
training.
These
are
services
which
are
intended
to
reduce
cognitive
and
behavioral
impairments
and
restore
individuals
to
their
highest
level
of
functioning
through
how
does
positive
reinforcement,
modeling,
operant,
conditioning
and
other
training
techniques,
and
this
would
result
in
a
savings
of
11.7
million
3.8
million
general
fund,
based
on
the
updated
march
projections
agency
reports
in
fiscal
year
2020.
B
Although
other
behavioral
health
services
would
continue
to
remain
available
decision
unit,
e683,
behavioral
health
case
management,
which
are
services
that
assist
an
individual
in
gaining
access
to
needed,
medical,
social,
educational,
other
supportive
services
for
non-seriously
mentally
ill
and
non-seriously
emotionally
disturbed
populations
is
recommended
for
elimination
for
savings
of
2.9
million,
of
which
approximately
478
000
would
be
general
fund.
Based
on
the
updated
projections,
the
agency
indicates
the
populations
for
which
services
would
be
eliminated,
have
a
lower
level
of
care
based
on
an
intensity
of
needs,
evaluation
tool,
case
management
services
include
assessments,
care.
B
The
agency
indicates
participant
may
experience
some
difficulty
in
identifying
and
accessing
needed
services
agency
reports,
4160
individuals,
utilize
these
services
in
fy,
2020,
various
other
participant
groups,
would
continue
to
have
access
to
services,
including
children
and
adults,
or
children
and
adolescents,
who
are
seriously
emotionally
disturbed
adults
who
are
seriously
mentally
ill
persons
with
intellectual
disabilities
and
related
conditions
of
developmentally
delayed
infants
and
toddlers
under
the
age
of
three,
the
juvenile
parole
population,
the
juvenile
populat
probation
population
and
child
protective
services.
B
At
the
budget
hearing
the
agency
indicated
it
has
identified
two
groups
for
possible
expansion
of
case
management
to
be
provided
by
county
agencies,
including
criminal
justice
involved
adults
and
pregnant
women.
To
expand
services
to
these
two
groups,
estate
plan,
amendment
and
medicaid
service
manual.
B
B
In
decision
unit
e
684,
psychosocial
rehabilitation
services
are
recommended
for
elimination,
and
these
are
rehabilitative
interventions
designed
to
reduce
psychosocial
dysfunctions
and
restore
individuals
to
their
highest
level
of
functioning
for
savings
of
18.8
million,
of
which
5.9
million
would
be
general
fund
based
on
updated
projections.
B
B
Indecision
unit,
e685,
biofeedback
and
neurotherapy
services,
which
are
therapies
designed
to
help
participants,
learn
to
control.
Some
bodily
functions,
such
as
heart
rate,
as
a
treatment
for
mental
health
disorders,
is
recommended
for
elimination
for
savings
of
39.6
million,
of
which
12.9
million
would
be
general
fund
based
on
updated
projection.
B
The
agency
indicates-
and
these
services
are
not
evidence-based
and
are
not
covered
by
many
private
insurances
or
other
state
medicaid
programs
in
2020.
The
agency
indicates
approximately
8
200
individuals
utilize
these
services
and
if
the
services
are
eliminated,
the
participants
may
experience
difficulty
in
continuity
of
care
and
they
may
require
other
behavioral
health
services.
B
B
Okay,
the
first
decision
approved
decision
unit
e-682
to
eliminate
basic
skills,
training
for
savings
of
11.7
million,
of
which
3.8
million
would
be
general
fund
and
8
million-
would
be
federal
and
other
fund
reduction
decision
unit
e683
to
eliminate
behavioral
health
case
management
for
certain
participants
for
savings
of
2.9
million,
of
which
478
508
would
be
general
fund
and
2.5
million
in
federal
and
other
funds
decision.
B
Unit
e
684
to
eliminate
psychosocial
rehabilitation
services
or
savings,
totaling,
18.8
million,
of
which
5.9
million
would
be
general
fund
and
12.9
million,
would
be
one
other
fund
and
decision.
Unit
e
685
eliminate
biofeedback
and
neurotherapy
services
for
savings
of
39.6
million,
of
which
12.8
million
would
be
general
fund
and
26.7
million
would
be
federal
and
other
funds,
as
recommended
by
the
governor
adjusted
for
march
2021.
Caseload
projections
and
fmap.
A
Rate
changes.
Thank
you
so
much.
Ms
crockett.
We
have
questions
from
the
committee
I'll
start
with
assemblywoman
carlton.
C
And-
and
thank
you,
madam
chairman,
so
we're
in
this
opportune
moment,
where,
typically,
if
we
were
going
to
do
some
ad
backs,
this
would
be
the
moment
in
time
that
we
would
have
those
conversations.
C
Staff
would
kick
us
out
of
the
building
very
happily
if
we
did
that
so
being
able
to
close
these
correctly
so
that
we
wouldn't
have
to
do
a
larger
add-back
later
on,
I
think,
would
be
very
appropriate
at
this
time.
So
I
would
like
to
suggest
to
the
committee
for
conversation
that,
as
far
as
add-backs
go,
that
we
consider
the
basic
skills,
training,
the
behavioral
health
case
management
and
the
psychosocial
rehabilitation
services-
I'm
not
suggesting
e685
at
this
time.
C
In
reading
some
of
the
backup
documents,
I'm
I'm
not
sure
we
want
to
go
there
with
this
one
at
this
moment,
but
I
believe
the
other
three
that
I've
noted.
We
could
have
a
conversation
about
adding
those
particular
items
back.
So
if
you
would
consider
that
a
conversation
point
and
and
we
can
go
from
there-
thank
you,
madam.
E
Yes,
thank
you
chair
and
I
just
wanted
to
say
I
expressed
a
lot
of
concerns
and
questions
about
these
proposed
eliminations
and
I
I
appreciate
the
the
vice
chair
suggestion
and
in
agreement
with
doing
whatever
we
can
to
to
add
those
back,
and
I
understand
we
can't
perhaps
do
all
of
it
today,
but
I
I
am
in
support.
Thank
you.
E
Thank
you,
chair
yeah.
I
just
want
to
emphasize,
because
I
I
appreciate
the
discipline
that
this
committee
and
other
finance
committees
have
executed
through
the
entirety
of
the
first
102
days
of
the
session,
to
make
really
challenging
decisions
on
lots
of
different
budgets
and
we're
changing
things
a
little
bit
today
by
making
a
different
decision
as
the
chair
or
vice
chair,
described
in
terms
of
timing.
E
This
also
becomes
a
point
place
for
we
want
to
focus
some
attention.
I
will
just
say
that
we've
been
working
really
hard
to
make
progress
on
behavioral
health
and
to
have
to
absorb
significant
behavioral
health
cuts
would
be
challenging,
I
think,
for
the
state,
but
I
would
also
emphasize
we're
at
a
place
where
we
really
don't
know
yet
how
much
money
we're
going
to
have
to
do
everything,
and
so
we
do
still
need
to
make
difficult
decisions.
E
So,
while
I
don't
really
want
to
cut
the
biofeedback
and
neuro
neurotherapy,
I
can
do
it
services
necessarily
because
I
have
a
concern
about
a
relatively
abrupt
cutoff
of
services.
For
folks
who
are
receiving
some
behavioral
health
care,
we
still
need
to
have
discipline.
We
still
need
to
make
tough
decisions,
and
I
think
this
is
a
tough
decision
that
I
can
definitely
support,
given
where
we
are
in
the
session.
So
with
that,
I
think
it's
not
accepting
the
recommendations
on
items.
One
two
and
three
and
accepting
the
recommendation
on
four
is
a
great
path
forward.
C
E
C
E
B
The
next
item
relates
to
budget
reductions,
savings
measures
to
achieve
savings
of
182
million,
of
which
37.8
million
would
be
general
fund
in
fy,
2022
and
16.8
million,
of
which
5.1
million
would
be
general
fund
in
fy
2023.
The
governor
recommends
several
cost-saving
measures,
including
using
a
projected
fy
2021
surplus
to
pay
certain
managed
care
organization
costs
in
fy
2021,
rather
than
fy
2022
implementing
personal
care
services
policy
changes,
reducing
non-emergency
transportation,
monthly
capitated
payments
and
implementing
a
two-sided
risk.
B
The
governor
recommends
making
certain
payments
to
the
ncos
in
fiscal
year
2021
rather
than
2022,
including
reversing
the
delay
of
payments
to
the
ncos
related
to
certain
maternity
cases
and
very
low
earth
weight
newborns
and
stop
loss
reinsurance
payments
when
certain
costs
of
a
participant
exceed
a
100
000
annual
threshold
from
fy
21
to
fy
2022,
as
approved
in
assembly,
bill
three
of
the
31st
special
sessions.
So
that
would
be
reversing
that
decision
and
paying
projected
july
2021
capitated
payments
for
the
newly
eligible
population
in
fy
2021.
B
Instead
of
fy2022.
These
recommendations
shift
costs
from
fiscal
year
to
fiscal
year
and
do
not
represent
an
overall
savings
to
the
state.
The
agency
would
support
these
two
savings
measures
in
fy
2021,
with
the
projected
general
fund
surplus
in
this
budget,
currently
projected
at
79.2
million.
According
to
the
most
recent
projections,
based
on
actual
case,
loading
costs,
recommendations
noted
previously
would
utilize
at
31.6
million
leaving
47.6
remaining,
which
would
be
used.
D
B
D
B
According
to
the
agency,
a
functional
assessment
completed
by
a
physical
or
occupational
therapist
places
participants
into
four
categories
for
activities
of
daily
living,
zero
would
be
independent,
one
would
be
minimum
assistance
required.
Two
would
be
moderate
assistance
and
three
maximum
assistance.
B
The
policy
changes
for
meal
assistance
would
be
eliminated
for
participants
with
a
score
of
one
and
time
for
housekeeping
and
laundry
assistance
would
be
eliminated
for
participants
with
scores
of
one
or
two
with
30
minutes
a
week
authorized
based
on
functional
need
compared
to
the
45
minutes
per
week.
Currently
authorized
decision.
Unit
e686
relates
to
savings
in
non-emergency
transportation
per
month
per
member
per
month.
Capitated
payments
and
the
agencies
indicated
its
existing
contracts
is
expiring
and
it
will
be
entering
into
a
new
contract
with
the
same
provider
at
a
reduced
rate.
B
The
cms
authorized
implementation
of
a
two-sided
risk
corridor
for
fy
2020
for
the
states
and
managed
care
organizations
to
share
in
the
risk
of
the
current
situation
in
the
two-sided
risk
corridor.
If
the
monthly
capitation
rates
to
managed
care
organizations
were
too
high
compared
to
actual
costs
incurred
based
on
utilization,
the
state
would
recover
funds
from
the
managed
care
organizations.
B
The
most
recent
projection
provided
by
the
agency
projects
at
3.3
million
in
savings,
including
1.1
million
of
which
is
general
fund
based
on
the
updated
calculation.
The
agency
estimates
the
state
would
receive
funds
from
two
managed
care
organizations,
including
anthem,
2.6
million
and
silver
summit,
735
000
in
fy
2022.
Based
on
the
current
estimates.
B
There
are
four
separate
decisions
for
the
subcommittee
for
these
budget
reduction
measures:
item
a
approved
decision
units
e689
and
e690
to
make
certain
managed
care
organization
payments
in
fy
2021,
rather
than
fy
2022
for
savings
of
168.5
million,
31.6
million
of
which
is
general
fund
in
fy
2022
decision
unit
e
687
for
personal
care
service
policy
changes
to
reduce
certain
services
to
participants
with
a
living
caregiver
for
savings
of
23.9
million,
of
which
7
million
would
be
general
fund
over
the
upcoming
biennium
decision
unit,
e686
to
reduce
per
member
per
month.
B
Payments
to
the
non-emergency
transportation
provider
for
savings
of
919,
344,
of
which
243.034
would
be
general
fund
and
decision.
Unit,
e7676
or
fy2022
projected
savings
associated
with
a
two-sided
risk
corridor
or
savings
of
3.3
million,
of
which
1.1
million
would
be
a
general
fund
in
fy
2022..
C
Thank
you
very
much,
madam
chairman,
and
it's
taken
me
a
while
to
wrap
my
brain
around
this
two-sided
wrist
corridor,
and
I
I
think
now
that
I've
heard
it
for
the
third
time
I
think
it's
finally
sinking
in.
I
guess
my
concerns
are
yes.
C
So
with
this
two-sided
risk
corridor,
the
state
could
end
up
possibly
having
to
cover
some
of
those
costs
in
the
future.
If
I
understand
it
correctly
and
miss
crockett
when
when
you
need
to
stop
me,
stop
me
so
I'm
just
curious.
The
the
dollars
that
have
come
through
the
cares
act
and
went
directly
to
hospitals
to
help
with
some
of
these
costs.
C
I
know
this
is
a
complicated
puzzle,
but
I'm
just
trying
to
think
the
thing
about
capitated
rates
is
there's
predictability
for
the
state,
and
sometimes
we
win,
and
sometimes
we
lose
all
it
takes.
Is
a
couple
million
dollar
babies
preemies
at
umc,
and
you
know
you've
you've
got
your
capitated
rate
back
you're
you're
in
good
shape.
C
And
and
thank
you,
madam
chair,
and
I
think
that's
where
it
took
me
a
while
to
really
figure
out
what
this
actually
did
and-
and
I
want
to
thank
miss
crockett
for
making
it
so
clear
this
this
last
time
around
and
I
apologize.
I
don't
want
to
throw
us
off
base,
but
you
know
the
whole
reason
behind
capitated
rates
and
managed
care
is
so
that
the
state
has
that
predictability
going
forward.
C
I'm
just
afraid
by
doing
this
for
this
one
year
in
2020,
when
we
know
what
those
hospitals
and
look
like,
but
then
we
also
know,
on
the
other
side,
that
what
the
doctor's
offices
look
like
people
weren't
going.
There
was
a
util.
There
was
this
weird
utilization,
roller
coaster.
You
had
hospital
utilization
at
one
level
and
primary
care
utilization
at
the
other
level.
C
So
I
I'm
just
concerned
that,
for
the
cost
of
a
million
dollars
to
the
general
fund,
we
could
be
opening
ourselves
up
in
this
two-sided
risk
corridor
to
all
these
unforeseen
charges.
That
might
be
coming
from
all
this
intensive
care
and
all
this
health
care
that
happened
over
this
last
year
in
2020.
So
I
might
be
seeing
you
know
things
behind
the
bushes
or
whatever
I
just
I
hate
to
see
us
give
up
that
predictability,
and
I
just
wanted
to
make
sure
that
we
had
a
thorough
conversation
about
it.
E
Thank
you,
ma'am,
chair,
just
regarding
what
the
chair
commented
about.
The
unforeseen.
D
B
I
do
know
that
the
agents
billing
timelines
that
are
laid
out
in
their
medicaid
service
manual-
I
can't
recall
off
the
top
of
my
head,
what
those
billing
time
frames
are,
but
there
is
a
limited
period
of
time
in
which
providers
can
submit
bills.
The
agency
would
be
able
to
speak
more
directly
to
the
exact
time
frames.
A
D
Thank
you,
chairwoman,
so
miss
crockett
is
correct.
We
have
a
90-day
window
for
billing
in
medicaid,
and
our
managed
care
program
tends
to
stay
to
that
window
as
well.
So
so
there
is
a
limited
amount
of
time
for
for
timely
building.
For
all
of
these
costs.
D
The
the
purpose
of
the
two-sided
risk
corridor
is
really
to
mitigate
the
risk
both
for
the
state
and
the
managed
care
plans
in
these
unpredictable
events,
and
it's
it
is
possible
for
not
to
fall
on
either
side.
It
is
set
up
so
that
so
that
both
the
state
and
the
plans
are
at
risk
and
I'd
invite
our
fiscal
staff
to
add
anything
they
feel
is
relevant
if,
if
you're
so
inclined
to
chair,
thank
you
so
much.
D
Thank
you
chip,
madam
chair,
through
you
to
mrs
carlton,
so
that
the
risk
corridor
does
take
some
extensive
time
to
work
through
again.
This
is
designed
to
make
sure
that
we
don't
over
or
underpay
and
at
the
time
that
we
worked
through
this.
There
was
a
limited
time
from
cms
for
us
to
implement
a
risk
corridor
and
there
was
significant
concern
that
we
might
end
up
overpaying
significantly
the
managed
care
plans.
D
So
this
is
the
one
option
that's
available
to
us
to
make
sure
that
that
does
not
happen
for
the
2020
year
or
did
not
happen.
Forgive
me.
C
Well,
this
is
getting,
I
feel,
like
I've
gone
down
a
rabbit,
hole
man,
I'm
sure.
I'm
really
sorry,
because
we
shouldn't
be
doing
this
at
a
closing
this
and-
and
I
apologize-
I
should
have
done
this
at
the
work
session.
I
understand
what
we're
trying
to
do,
but
I
think
we
made
a
deal
with
the
folks
when
they
signed
on
to
be
medicaid
providers
that
they
were
going
to
get
a
certain
rate
and
good
bad
or
ugly.
C
C
E
Ready
so-
and
I
apologize
but
we've
sort
of
opened
this
up
so
now
I
have
some
clarifying
questions,
so
thank
you
for
the
discretion,
so
I
guess
so
my
question
is
it
only?
It
only
applies
to
2020,
and
so
the
the
concept
here
is
certainly
when
you
were
having
to
do
your
budget
back
in
september
and
then
the
governor
approving
it.
In
january,
we
were
in
the
depths
of
the
pandemic
and
the
shutdown
and
what
we
were
seeing
was
increased
utilization
in
certain
settings
because
of
covid,
but
under
utilization
everywhere
else.
E
In
the
healthcare
system,
people
weren't
going
to
doctors,
people
were
canceling
their
optional
surgeries.
All
of
those
things,
and
so
the
idea
here
is
that,
because
this
situation
was
so
unique
both
for
the
and
I
want
to
say
it's-
the
managed
care
organizations
not
so
much
the
providers.
This
is
a
conversation
between
the
state
and
the
managed
care
organization
and
does
not
get
down
to
the
provider
level.
The
provider
level
still
is
going
to
get
their
reimbursement
based
on
their
contract
with
their
mco
or
their
payer
source.
E
D
Suzanne
biermann
administrator
of
dhcfp
for
the
record
senator
ratty.
I
agree
with
your
summary
and
also
to
the
point
of
you
know.
As
we've
seen,
utilization
trends
come
in
in
the
beginning.
I
think
there
was
a
lot
of
concern
that
we
would
be
overpaying
and
then
with
some
additional
utilization
trends,
the
risk
of
not
producing.
D
D
I
was
just
saying
that
sorry
about
that.
I
agree
with
the
way
that
you
summarized
it.
I
think
you
summarized
the
issue
nicely.
I.
D
To
add
that
point
about
the
changes
in
utilization
and
how,
over
time
you
know,
we
think
it's
less
likely.
B
D
B
E
Concept
forward,
all
right,
so
the
bottom
line
is
where
we
are
now
is
all
the
buildings
should
be
in,
but
we
it
takes
two
years
to
sort
of
analyze
it
to
decide.
If
we
can
get
that
savings
in
2022,
but
your
bottom
line
is,
as
of
today,
you
still
think
the
state
will
be
on
the
upside
of
a
two-sided
risk
corridor
based
on
the
experience
of
the
pandemic.
That's
your
best
estimate
for
today.
D
So
I
think
back
to
assemblywoman
carlton's
point
there
is,
there
is
great
risk
there
right
it's
on
each
side
and
originally
we
thought
the
likelihood
of
us
seeing
savings.
Would.
B
C
Helps
thank
you,
madam
chair
and
again
I
I
really
apologize.
I
I
can
remember
having
my
blood
pressure
go
up
when
I
was
sharing,
and
somebody
did
this,
but
so
I
just
want
to
put
that
on
the
record
again.
C
C
I
have
serious
concerns
for
a
one
million
dollar
ad
back
the
possible
risk
to
the
state
in
one
or
two
very
complicated
cases
that
could
come
back
to
us
and
then
I
always
go
back
to
the
we
had
an
agreement
with
these
folks.
C
We
didn't
know
there
was
going
to
be
a
pandemic,
they
didn't
know
there
was
going
to
be
a
pandemic,
there's
costs
and
risks
and
everything
that
we
do
if
they
come
out
a
little
bit
ahead.
That's
one
thing
knowing
full
well
that
managed
care
has
to
put
80
percent
into
care
and
twenty
percent
off
to
the
side,
so
we
gotta
make
the
aca
stuff
is
overarching
on
it.
C
I
I'm
concerned
that
putting
a
million
dollars
putting
a
million
on
the
line
as
a
bet
on
this
one
may
not
be
a
very
good
bet
for
the
state
at
this
time.
So
that's
that's
where
I
would.
I
would
be
leaning
at
this
moment
just
trusting
my
gut.
That's
what
it
boils
down
to.
D
So,
ms
crockett,
our
notes
on
page
35,
indicated
that
there
are
updated
calculations
right
above
the
decision
box
that
the
agency
estimates
the
state
would
remit
funds
to
two
mcos
at
those
levels.
Those
are
that's.
Is
that
just
what
is
the
updated
number
that
that
you
project.
B
B
Yes,
yes,
that's
correct,
so
the
net
general
fund
savings
would
be
1.1
million
of
3.3
million
savings
projected
for
fy2022.
B
They
were
provided
to
stop
march
case
load
projections
and
updated
for
the
f
max
rate
so
initially
received
those
in
early
april.
D
A
A
A
D
D
Okay,
I
appreciate
that,
but
just
I
think
that
would
have
probably
made
sense
when
the
budget
was
built,
but
that's
us
paying
ongoing
operating
expenses
with
one-time
money,
so
I'll
probably
vote
against
that
one
when
we
get
to
it
on
the
as
we
check
move
down
the
line.
Thank
you.
E
Thank
you
chair
for
the
discretion,
just
one
that
I'd
like
to
get
on
the
record
on
item
c,
where
there's
a
reduction
in
the
919
000
with
243
000
of
it
being
general
fund.
I
just
want
to
confirm
that
that
is
not
a
reduction
in
service
level,
but
actually
results
from
a
renegotiation
of
the
contract
that
lowered
the
rate.
E
E
Thank
you
so,
on
item
a
I
would,
I
heard
the
concerns,
but
I
actually
think
with
the
strangeness
of
all
of
the
different
funding
sources
that
we're
dealing
with
that.
It
still
makes
sense
to
do
this.
So
I
would
make
a
motion
to
recommend
decision
units
e689
and
e690
to
make
certain
certain
managed
care
organization
payments
in
fiscal
year
21
rather
than
fiscal
year,
22
for
savings
of
1.1,
168.5
million
31.6
million
in
general
fund
and
fiscal
year,
2022.
A
Thank
you,
senator
reddy
for
the
motion,
a
second
second
from
assemblywoman
carlton,
any
discussion
on
the
motion,
all
right,
all
in
favor
of
the
motion.
Please
say
I
any
opposed
those
that
are
an
opposition.
If
you
could
raise
your
hand,
I
have
assemblyman
robert
assembly,
roman
titus,
senator
kieker.
A
B
A
E
Thank
you
chair.
This
was
another
area
where,
like
our
prior
discussion,
where
this
is
a
significant
and
critical
medicaid
optional
service
that
allows
folks
to
stay
in
their
home
and,
I
think,
does
warrant
consideration
for
being
added
back.
So
I
would
make
a
motion
not
to
approve
decision
unit
687
item
number
b
on
page
35.
A
C
A
E
Thank
you.
I
would
make
a
motion
to
recommend
decision
unit
e686
to
reduce
per
member
per
month,
capitated
payments
for
non-emergency
transportation,
services
for
savings
of
hundred
and
forty
thousand
two
hundred
and
forty
three
and
thirty
four
dollars
worth,
which
is
general
fund
over
the
2123
biennium.
A
Thank
you
for
the
motion.
In
a
second,
we
have
a
motion
from
senator
reddy,
a
second
from
assemblywoman
carlton.
Any
discussion
on
the
motion,
seeing
none
all
in
favor
of
the
motion,
please
say
aye.
Any
opposed
motion
carries
unanimously
of
the
members
present.
Moving
on
to
the
last
item
on
this
budget
item
at
item
d.
E
Thank
you,
chair
unusually,
swung
back
and
forth
and
changed
my
mind
three
times
on
this
decision,
but
I'm
going
to
go
ahead
and
make
a
motion
to
accept
decision
unit
e676
for
fiscal
year.
22
projected
savings
associated
with
the
two-sided
risk
corridor
and
calendar
year,
2020
for
a
savings
of
3.3
million,
1.1
million
of
which
would
be
general
fund
and
fiscal
year.
E
A
B
B
B
Caseloads
are
also
projected
to
be
higher
than
recommended
in
the
executive
budget
overall
by
the
end
of
the
biennium
hundred
7.
Ninety
seven
waiver
slots
are
projected,
which
is
increase
from
the
seven
hundred
seven
thousand
two
hundred
and
thirty
seven
projected
in
the
executive
budget
based
on
the
updated
projections.
Nf
map
rate
changes,
total
funding
is
projected
to
be
55.2
million,
8.2
million
of
which
is
general
fund,
which
is
a
5
million
increase
from
the
50.2
million
overall
funding
recommended
by
the
governor
regarding
caseload
growth.
B
The
cost
associated
with
the
caseload
growth
requires
additional
funding
of
six
point:
three
million
eight
hundred
and
forty
thousand
seven
hundred
and
ninety
four
dollars
general
fund
in
fy,
2022
and
16.6
million,
2.7
of
which
would
be
general
fund
in
fy
2023
to
support
a
projected
caseload
growth
with
regard
to
wait
list
reductions
as
separate
enhancements,
the
governor
recommends
I'm
increasing
waiver
slots
to
reduce
waitlists
for
client
clients
waiting
longer
than
90
days
for
services
after
adjusting
for
caseload
updates,
11
million
1.1
million
in
general
fund
is
required
in
fy
2022
and
21.1
million
in
fy,
2023,
of
which
3.6
million
of
would
be
general
fund.
B
B
fiscal
staff
recommends
the
subcommittee
recommend
approval
of
updated
waiver
case
loads
consistent
with
its
actions.
In
closing
the
aging
budgets,
does
the
subcommittee
wish
to
recommend
approval
of
waiver
slot
increases
based
on
march
2021
projections
and
fmap
rates
at
a
total
cost
of
55.2
million
funded
with
8.2
million
in
general
funds,
4.7
million
in
county
reimbursements
and
42.3
million
in
federal
funds
consistent
with
its
actions?
In
closing
the
aging
and
disability
services,
division
budgets.
E
Yes,
regarding
so,
I
would
amend
that
emotion
to
be
the
approval
of
the
waiver
slot
increases,
as
described
on
page
38.,.
A
B
B
Although
approval
of
a
medicaid
1915,
I
state
plan
option
change
to
implement
new
services,
which
include
intensive
in-home,
supports
and
in-home
crisis
stabilization
for
the
specialized
foster
care
population,
as
discussed
by
the
subcommittee
in
considering
the
division
of
child
and
family
services
budget
previously
of
the
1915.
I
state
plan
option
for
services
pending
final
approval.
Final
approval
is
currently
anticipated
or
june.
An
analysis
provided
by
the
agency
projects.
B
520
individuals
would
receive
services
and
estimate
additional
costs
of
9.2
million,
of
which
3.4
million
would
be
general
fund
in
fy,
2022
and
9.3
million,
of
which
3.4
million
would
be
general
fund
in
2023..
B
The
costs
in
the
agency's
analysis
or
net
of
projected
savings
associated
with
reductions
in
other
behavioral
health
treatments
and
the
agency's
analysis
indicates
protected
net
general
funds
over
the
biennium.
How?
However,
there
is
no
decision
units
in
the
budget
to
support
these
costs
at
the
budget
hearing
the
agency
indicated
it
anticipated
savings
and
other
services
would
offset
costs.
A
A
B
A
E
A
B
The
next
budget
is
the
checkup
budget.
There
are
five
major
closing
issues,
most
of
which
are
interrelated
to
decisions
that
have
been
made
in
the
medicaid
budget.
The
first
major
closing
issue
relates
to
the
fmap
rates
similar
to
the
medicaid
budget.
Fmap
rates
have
been
updated
and
reprojected
in
fy
2020.
The
blended,
enhanced
chip
fmap
rate
was
91.46
percent
and
decreased
to
81.64
in
2021
and
is
projected
to
increase
or
decrease.
I'm
sorry
to
76.11
in
fy
2022
and
73.88
in
fy
2023
consistent
with
continuing
the
temporary
4.34
percentage
point
increase
through.
E
B
December
31st
2021
and
the
temporary
increase
in
the
f
map
rate
in
2022
results
in
general
fund
savings
and
the
decrease
in
the
rates
in
fy
2023
requires
additional
general
funds
in
this
budget.
Overall,
the
changes
in
the
base
budget
results
in
net
general
funds.
Savings
of
approximately
576
thousand
dollars
over
the
upcoming
a
fiscal
staff
recommends
that
fmap
rates
be
approved
consistent
with
actions
including
enclosing
the
medicaid
budget.
A
E
Thank
you.
I
would
recommend
approval
of
the
revised
fmp
rates,
including
a
temporary
4.34
percentage
point
increase
in
the
enhanced
chip
f
map
rate
through
december
31st
2021
for
fiscal
year
2022
and
approve
fiscal
year.
2023
f
map
rates
based
on
the
may
6
2021
federal
funds,
information
for
states
projection
again
with
pleasure.
E
A
B
For
projected
increases
in
checkup
caseload,
similar
to
the
medicaid
caseload.
This
caseload
has
been
reprojected
in
march,
based
on
february,
2021,
actual
caseload
and
costs
consistent
with
the
medicaid
budget.
The
updated
caseload
projections
assume
the
public
health
emergency
continues
through
december
31st
2021.
B
there's
a
table
on
page
43
that
reflects
the
governor's
recommended
budget
and
march
updated
projections.
The
updated
projections
are
lower
than
recommended
in
the
executive
budget
by
approximately
5,
which
equates
to
roughly
1500
individuals
per
year.
As
previously
indicated
during
the
work
session,
the
agency
indicates
that
checkup
caseload
tends
to
decline
when
medicaid
case
load
increases,
as
unfavorable
economic
conditions
may
result
in
people
shifting
from
checkup
to
medicaid
caseload,
which
has
lower
income
eligibility
requirements
as
queso
would
be.
B
Lower
costs
would
also
be
lower
when
compared
to
costs
in
the
executive
budget
and
the
m200
and
m201
decision
units.
There's
a
table
on
page
44
that
displays
governor's,
recommended
and
projected
caseload
changes
in
total.
The
march
case
of
projections
and
f
map
changes
decreased
general
funds
by
1.6
million
over
the
biennium
from
2.7
to
1.1
million.
A
B
Although
division,
the
division
is
not
required
to
align
coverage
for
services
and
rates
with
checkup
and
medicaid,
it
does
so
for
consistency,
so
fiscal
staff
would
recommend
the
subcommittee
approve
rate
increases
consistent
with
its
decisions,
including
in
closing
the
medicaid
budget.
E
D
B
The
next
item
is
depends
on
those
mostly
mirror
the
service
eliminations
in
the
medicaid
budget,
based
on
updated
caseload
and
f
map
rate
changes.
A
basic
skills,
training
elimination
would
result
in
total
savings
of
about
89
000
over
the
biennium
psychosocial
rehabilitation
services.
Savings
would
total
about
five
hundred
and
seventy
one
thousand
dollars
over
the
upcoming
biennium
for
biofeedback
and
neurotherapy
savings
would
total
about
three
hundred
and
nineteen
thousand
dollars
over
the
biennium
and
similar
to
provider
rates.
B
A
Thank
you
so
much
and
members
to
be
aligned
with
the
decisions
we
made
earlier
today.
E
Thank
you
chair,
so
with
that
I
would
make
a
motion
to
not
recommend
approval
of
items
one
and
two
and
to
recommend
approval
of
item
three
to
eliminate
neuro
neurotherapy
for
savings
of
three
hundred
and
eighteen,
nine
hundred
thirty,
eight.
Eighty
thousand
nine
hundred
forty
general
fund
savings
over
the
twenty
twenty
one.
Twenty
three
biennium
and
the
adjusted
load
projections
and
f
map
rate
changes.
A
B
B
A216833178
this
was
not
discussed
at
the
budget
hearing
the
budget
amendment
as
previously
noted
emerson's
primer
provider,
reimbursement
rate
reductions
approved
through
assembly
bill
3
of
the
31st
special
session
in
this
budget.
The
budget
amendment
adds
funding
of
2.8
million,
including
629
339
in
general
fund
and
fy2022
and
30
657,
of
which
25209
is
a
general
fund
reduction
in
fy
2023.
B
There
is
an
adjustment
to
correct
unmapping
for
decision
unit
e351,
which
is
a
major
closing
issue.
Three
a
burst
replaces
general
funds
with
intergovernmental
transfers
for
a
general
fund
reduction
of
62
503
over
the
biennium,
which
results
in
the
net
general
fund
reduction.
You
see
in
fiscal
year.
2023
and
consistency
with
the
medicaid
budget
is
also
recommended
for
this
item.
Does
the
subcommittee
wish
to
recommend
approval
of
budget
amendments
a
2168-33178
at
a
cost
of
2.8
million
net
general
funds
of
604-310
over
the
upcoming
biennium.
A
B
There
is
one
major
closing
issue
in
this
budget,
which
is
the
prescription
drug
rebate.
The
governor
recommends
establishing
a
standalone
budget
to
receive
drug
rebate.
Revenues
in
the
upcoming
biennium
funding
received
in
this
budget
would
be
transferred
to
the
medicaid
budget
to
offset
general
fund
appropriations
and
federal
funds
in
that
budget.
B
Recognizing
the
magnitude
and
variability
of
drug
rebates
received
by
the
agency,
the
2019
money
committees
issued
a
letter
of
intent
directing
the
agency
to
evaluate
various
drug
reration
methodologies
as
a
means
and
means
of
increasing
transparency
of
drug
rebates.
The
establishment
of
this
budget
is
recommended
in
response
to
the
letter
of
intent,
which
recommends
the
division
recognized
out
of
rebates,
received
as
revenues
rather
than
offsets
to
expenditures.
B
The
division
receives
drug
rebates
from
participating
drug
manufacturers
through
a
federal
program
that
helps
offset
the
cost
of
outpatient
prescription.
Drugs
rebates
received
are
split
between
the
state
and
the
federal
government
based
on
the
f
map
rates
and
the
state
person
serves
as
offset
to
general
fund
appropriations
required
to
support
the
medicaid
budget.
Currently,
drug
rebates
are
recorded
as
an
offset
to
expenditures
in
the
offline
category
of
the
medicaid
budget.
There
is
overall,
no
net
physical
impact
to
locating
drug
rebate
revenue
within
this
budget,
similar
to
other
budgets.
E
A
B
This
budget
is
the
intergovernmental
transfer
program
budget
and
it
contains
two
major
closing
issues.
The
first
relates
to
the
continuation
of
the
managed
care
organization
directed
payment
program.
The
governor
recommends
continuing
this
program
during
the
upcoming
biennium.
It
was
initially
approved
by
the
ifc
at
its
january
27
2021,
meeting
retroactive
to
january
1st
2020.
B
this
payment
program.
There
was
a
previous
enhanced
mco
payment
program
that
was
initially
approved
by
the
2015
legislature
due
to
changes
in
federal
rules.
That
program
needs
to
be
phased
out
and
sunset
over
a
10-year
period
and
in
response
to
the
pending
phase
out
of
the
program,
the
agency
developed
an
alternative
in
consultation
with
a
unc
and
clark
county
university
medical
center,
and
that
is
the
mco
directed
payment
program.
B
Additionally,
the
recommended
amount
of
supplemental
payments
would
reduce
umc's
compensated
care,
which
there
was
a
concern
that
could
potentially
lead
to
a
reduction
in
umc's,
disproportionate,
shared
hospital
payments
fiscal
year.
2021
supplemental
payments
have
also
been
reduced.
Creating
a
5.9
million
dollar
general
fund
decrease
in
the
state
net
benefit,
which
has
the
effect
of
reducing
the
agency's
projected
fiscal
year.
2021
surplus,
the
previously
discussed
fy21
surplus
numbers
do
factor
that
amount
in
there.
B
In
total.
The
change
to
the
nco
directed
supplemental
payment
program
results
in
a
general
fund
increase
of
approximately
14
million
dollars
over
the
upcoming
biennium
in
the
medicaid
budget
agency
indicates
a
contract
reflecting
the
updated
intergovernmental
transfers
anticipated
from
clark
county
and
will
be
submitted
to
the
june
board
of
examiners
meeting
or
consideration.
B
There's
a
table
on
page
56
that
displays
the
originally
recommended
payments
to
unc
clark,
county
intergovernmental
transfers
and
state
net
benefit
and
the
revised
amounts
based
on
updated
information
from
the
agency
and
case
loan
and
map
rate
changes.
D
Thank
you,
madam
chair.
Ms
crockett.
This
is
a
pretty
significant
hit
to
umc.
The
the
following
item
is
related
to
the
continuation
of
of
of
dish.
Payments
is
that,
do
you
know
how
much
of
this
loss
is
offset
by
the
by
the
unexpected
continuation
of
the
dish
payments.
B
I
do
not
have
a
projected
dish
payments
by
provider
type
available
in
the
upcoming
biennium.
At
the
moment.
I
I
don't
know
if
the
agency
has
those
available,
or
we
could
certainly
work
on
that
and
and
provide
a
follow-up
to
the
committee
as
well.
If
they
don't
have
it
on
hand,.
D
Not
not
essential,
but
I
could
follow
up
thanks.
A
C
A
B
Next
item
relates
to
the
disproportionate
share
hospital
program,
referred
to
as
the
dish
program
on
the
executive
budget
and
recommended
participating
hospitals
receive
payments
of
33.9
million
in
fiscal
year,
2022
and
13.8
million
in
fiscal
year.
2023
a
provision
in
the
patient
protection
and
affordable
care
act.
Aca
reduces
federal
disallowments
on
the
assumption
that
there
are
fewer,
uninsured
and
less
uncompensated
care
with
the
expansion
of
health
care
coverage.
B
Subsequent
legislation
several
times
has
delayed
reductions
to
these
federal
allotments,
most
recently
until
federal
fiscal
year
2024
through
the
consolidation
consolidated
appropriations,
act,
which
was
signed
into
law
on
december
27th
2020
and
the
executive
budget
reflects
disallowment
reductions
effective
at
federal
fiscal
year
2021
as
the
bill
that
extended
the
time
frame
for
reducing
those
allotments
was
passed
very
close
to
the
governor's
budget
being
completed
based
on
the
federal
delay
of
reducing
the
payments.
Disallowments
to
the
state
would
be
higher
than
initially
anticipated
in
the
governor's
recommended
budget.
E
A
B
Staff
would
also
note
that
the
budget
amendments
that
is
a
companion
to
the
amendments
approved
by
the
subcommittee
in
medicaid
and
checkup,
is
also
incorporated
into
the
other.
Closing
items
in
number.
Three
and
staff
recommends
other
closing
items
one
through
ten
be
closed,
as
recommended
by
the
governor
with
noted
technical
adjustments
with
authority
for
staff
to
make
further
technical
adjustments.
E
A
D
B
Nursing
care
budget,
there
are
no
major
closing
issues
in
this
budget.
The
executive
budget
recommends
continuing
the
financing
methodology
approved
by
the
2019
legislature.
Staff
has
made
technical
adjustments
to
align
with
the
fmap
rate,
changes
and
staff
recommends
the
budget
be
closed.
Another
closing
item
to
be
closed
is
recommended
by
the
governor
with
noted
technical
adjustments
with
authority
for
stop
to
make
further
technical,
necessary
adjustments.
E
A
B
B
There's
a
minor
technical
adjustment
to
align
with
some
updated
information
by
the
agency
regarding
a
couple
of
the
contracts.
After
the
adjustments
and
updating
or
fmap
rate
changes
transfers
to
the
division
of
healthcare,
financing
and
policy
that
are
used
to
support
the
private
hospital,
upl
supplemental
payment
program
are
anticipated
to
be
8.1
million
in
fiscal
year.
B
D
A
B
Under
the
revised
methodology,
counties
would
contribute
entire
non-federal
share
of
costs.
For
the
county
match
participants
and
certain
waiver
participants
up
to
the
proceeds
of
an
8
cent
tax
on
each
hundred
dollars
of
assessed
valuation
of
all
taxable
property
in
the
county.
B
Regarding
the
impact
to
the
indian
accident
fund
supplemental
payment
program,
the
agency
estimates,
this
decision
unit
would
reduce
supplemental
payments
from
about
121
million
to
70.7
million
in
fy
2022.
That's
a
50.3
million
dollar
reduction
and
from
114.2
to
70.1
million
of
44.1
million
reduction
in
fy
2023.
B
During
the
budget
hearing
the
agency
indicated,
it
did
not
anticipate
this
reduction
in
supplemental
payments
to
create
access
to
care
issues
for
medicaid
participants.
B
B
E
B
A
I
have
a
motion
from
senator
radio
second
from
assemblywoman
carlton.
Any
discussion
on
the
motion
see
none
all
in
favor
of
the
motion.
Please
say:
aye
any
impulse
motion
carries
unanimously
and
members
that
was
our
last
budget,
miss
crockett.
Thank
you
so
much.
We
had
a
great
discussion
today
and
we
did
some
good
work
here
today,
so
we
can
all
leave
and
not
have
the
tears.
I
normally
have
at
the
end
of
our
budget
meetings.
That
brings
us
up
to
our
last
item
on
our
agenda
and
that
is
public
comment.
D
D
Caller,
with
the
last
three
digits
five
two
eight
please
slowly
state
and
spell
your
name
for
the
record.
You
will
have
two
minutes
and
may
begin
adam's
chair
and
members
of
the
city
for
the
record.
My
name
is
barry
gold,
b-a-r-r-y-g-o-l-d
and
I'm
the
director
of
government
relations
for
aarp
nevada.
D
D
Some
of
those
terrible
decisions
we
had
to
make
during
the
pandemic
in
the
special
session
you've
been
able
to
reverse,
and
something
that
I
have
talked
about
and
asked
about
and
implored
has
become
a
reality.
One
of
my
dreams
has
come
true.
Today.
I've
talked
about
the
waiver
programs
and
not
just
funding
for
caseload
growth,
but
to
eliminate
waiting
lists
wow.
What
a
great
day
that
the
committee
today
and
the
governor
recommend
funding
to
eliminate
the
waiting
list.
D
As
I've
said
before,
people
who
have
to
wait
too
long
terrible
things
can
happen,
they
go
into
nursing
homes
or
they
die
well,
not
in
nevada
anymore,
because
we're
going
to
be
able
to
put
them
into
the
waivers
and
get
them
the
care
they
need
in
the
community.
So
they
can
be
as
independent
and
live
with
dignity
as
they
want
to
so
aarp.
Yes,
on
behalf
of
the
345
thousand
members
across
the
state,
absolutely
thanks
you
for
funding
those
waiver
programs
for
caseload
growth
and
for
to
eliminate
waiting
lists.
Thank
you
very
much.
C
D
D
D
My
name
is
connor
kane
c-o-n-n-o-r-c-a-I-n
and
I'm
providing
public
comment
on
behalf
of
comprehensive
cancer.
Centers
of
nevada
cccn
is
proud
to
accept
all
types
of
medicaid
and
treat
a
high
vol
volume
of
medicaid
patients
we,
but
like
the
last
caller,
we
we
appreciate
that
you
have
had
to
make
many
difficult
decisions
over
the
past
year
as
stewards
of
the
state
budget
and
are
grateful
for
your
efforts,
governor
sislex
efforts
and
dhhs's
efforts
to
restore
medicaid
cuts.
Thank
you.
D
D
P-A-I-G-E-B-A-R-N-E-S,
I'm
with
crowley
infrarado
public
affairs
today
representing
the
nevada
nurses
association.
We
wanted
to
express
our
gratitude
to
the
committee
for
restoring
the
medicaid
but
cuts
to
providers
during
the
2020
special
sessions.
As
frontline
providers
we've
seen
the
devastating
health
impact
from
the
pandemic.
We
understand
the
hard
decisions
everyone
had
to
make
over
the
last
year
and
don't
envy
those
decisions
you
all
had
to
make.
But
today
we
are
happy
to
be
here
under
better
health
and
economic
conditions.
D
D
D
Thank
you
chair
members
of
the
committee
for
the
record.
This
is
jessica,
ferrado,
j
s,
j-e-s-s-I-c-a
f-e-r-r-a-t-o
here
today,
on
behalf
of
the
nevada
chapter
of
the
american
college
of
emergency
physicians,
we
represent
more
than
400
emergency
physicians
and
together
we
serve
more
than
1.5
million
patients
per
year.
We
represent
emergency
physicians,
emergency
medicine
residents
and
medical
students.
Our
members
are
part
of
the
nevada,
statewide
team,
fighting
daily
on
the
front
lines
against
coven
19.
D
2020
brought
unprecedented
times
to
the
state
of
nevada
as
frontline
healthcare
providers.
We
have
seen
and
worked
through
the
unthinkable
moments.
Over
the
last
year,
all
nevadans
have
been
confronted
with
unexpected
challenges
and
the
devastating
impact
from
the
pandemic.
We
know
the
decisions
made
by
our
state
leaders
last
year
were
not
easy.
We
want
to
thank
the
committee
for
restoring
the
six
percent
medicaid
cuts
that
were
made
last
year.
This
is
a
significant
impact
for
our
most
vulnerable
patients
and
the
health
care
system
as
a
whole.
Thank
you.
D
A
D
Just
to
quickly
thank
the
committee
and
echo
all
the
comments
of
my
my
colleagues
before
me.
Nevada's
healthcare
providers
have
been
anxiously
anticipating
the
implementation
of
the
six
percent
medicaid
cuts
for
the
last
10
months,
and
today's
action
provides
a
huge,
huge
sign
of
relief
within
the
healthcare
community
of
nevada.
We
are
grateful
to
the
governor
to
staff
and
legislative
leadership
for
prioritizing
nevada's
healthcare
safety
net.
D
D
Queue
with
the
last
three
digits
one,
two
two
please
slowly
state
and
spell
your
name
for
the
record.
You
will
have
two
minutes
and
may
begin
good
morning,
chair
monroe
moreno
members
of
the
committee
for
the
record,
my
name
is
katie
ryan
k-a-t-I-e-r-y-a-n,
and
I
am
system
director
of
nevada
government
relations
for
dignity,
health
state
rise,
dominican
and
just
as
my
other
colleagues
have
previously
said,
I'm
here
today
to
thank
this
committee.
D
Medicaid
and
the
governor's
office
were
withdrawing
the
medicaid
reimbursement,
cuts
from
last
summer's
special
session
and
then
restoring
rates
back
to
what
they
previously
were.
We
are
extremely
grateful
for
everyone's
commitment
to
flexibility
around
this
issue
during
this
most
unprecedented
time
and,
as
the
chair
said
today
is
a
very
good
day
for
health
care
providers
in
nevada.
Thank
you.
A
D
D
As
been
said
by
some
of
my
colleagues,
this
is
a
great
day.
I've
set
here
since
1999
through
many
sessions,
both
regular
and
special
sessions,
where
much
different
decisions
had
to
be
made
with
very
few
times
that
we
were
actually
able
to
see
any
progress
made
in
reimbursement
to
providers
for
health
care
services
and
medicaid.
D
With
that
I'd
like
to
say
on
behalf
of
the
members
of
the
nevada
hospital
association
and
all
nevada
healthcare
providers.
I
would
like
to
thank
the
governor
and
this
body
for
its
efforts
today
to
restore
the
medicaid
cuts
imposed
in
the
nevada
first
nevada's
31st
special
session
hospital
and
healthcare
workers.
D
Again.
On
behalf
of
the
members
of
the
nevada
hospital
association,
we
appreciate
your
support
today.
Nevada,
hospitals
and
providers
look
forward
to
working
with
you
and
the
governor
in
our
state's
efforts
to
successfully
cross
the
finish
line
in
the
battle
against
clover19.
Thank
you
again
for
your
support.
Today.
D
Good
morning
madam
chair
paul,
moratkin
m-o-r-a-d-k-h-n
with
the
vegas
chamber,
the
chamber
also
like
to
reiterate
its
appreciation:
the
work
of
the
subcommittee
and
governor
syslak
in
restoring
the
medicaid
reimbursement
rates.
We
believe
it's
good
fiscal
policy
and
health
care
policy.
Thank
you
very
much.
D
My
name
is
george
ross.
I'm
testifying
on
behalf
of
hca
healthcare,
which
includes
sunrise,
sunrise,
children's
mountain
view
and
southern
hills.
Hospital
in
southern
nevada
hca
is
very
grateful
to
the
governor
and
his
office
and
this
committee
for
restoring
the
medicaid
cuts
in
particular
to
going
back
and
paying
and
providing
the
payments
for
those
cuts
that
had
to
be
made
last
summer,
and
we
understood
that.
But
we
really
really
are
very
grateful
for
having
that
money
restored,
as
well
as
bringing
the
rates
back
up
to
where
they
were
prior
to
those
cuts.
D
Sunrise
provides
40
the
highest
amount
of
medicaid
care
in
the
country
in
the
state,
rather
42
of
its
patients.
56
of
its
emergency
room
are
medicaid,
and
this
restoration
by
you
all
makes
a
big
difference
to
that
hospital
and
those
people.
Thank
you
very
much.
A
D
Thank
you,
madam
chair
and
committee
misty
grimmer
with
the
ferrari
group
representing
north
vista
hospital.
I
would
echo
the
comments
of
my
other
colleagues
in
the
hospital
industry
and
thank
the
committee
and
the
governor's
office
and
mr
whitley
and
his
team
for
restoring
the
medicaid
cuts.
I
know
the
cuts
were
hard
to
make
and
you
guys
have
a
lot
of
other
needs
for
the
money,
but
we
really
appreciate
that
you've
restored
these
cuts.
C
D
C
A
C
A
Thank
you
so
much
well,
it
appears
that
is
the
last
person
we
have
for
public
comment
and
committee
with
that.
This
meeting
is
adjourned,
and
I
wish
you
all
a
great
day.