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From YouTube: 2/23/2021 - Senate Finance and Assembly Ways and Means, Subcommittees on Human Services
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A
Thank
you,
so
I'm
going
to
go
ahead
and
call
to
order
the
february
23rd
meeting
of
the
human
services
subcommittee
of
the
finance
and
ways
and
means
committees.
We
are,
and
here
are
10
budgets
today
related
to
the
department
of
health
and
human
services.
A
I
wanted
to
remind
the
public
that
there
are
multiple
ways
that
you
can
participate
if
you
found
us
here,
you've
probably
already
been
to
the
website.
The
legislative
website
has
a
help
link
at
the
top
of
every
page.
If
you
click
on
that
link,
it
will
tell
you
about
how
you
can
register
for
meetings
and
sign
up
to
get
a
comment.
You
can
send
us
written
testimony
or
you
can
send
your
opinion
in
through
an
opinion
poll,
if
you're
having
any
challenges
participating
with
the
legislative
session
in
any
way.
A
Please
reach
out
to
the
email
that
is
on
the
agenda
and
staff
will
help
you
to
find
your
way
with
that
we
are
going
to
move
into.
We
have
quite
a
number
of
budgets
today.
Committee
we've
got,
I
believe,
10
that
we
are
going
through
and
so
we're
going
to
make
sure
that
we
get
our
questions
answered,
build
an
a
and
a
public
record
on
these
budgets,
but
also
try
to
move
efficiently.
A
So
I'm
going
to
ask
you
a
favor
that
if
somebody's
already
asked
your
question,
you
can
just
say
pass
and
that
we
stay
on
the
fiscal
items
and
remember
that
this
is
a
finance
committee,
not
a
policy
committee
and
stay
to
the
questions
that
are
going
to
help
us
fill
the
record
on
the
fiscal
side.
So
with
that,
I'd
like
to
invite
up
the
department
of
public
and
behavioral
health
to
kick
us
off
with
budget
3153.
B
Mr
good
we're
just
holding
there,
we
go
okay,
so
my
name
is
lisa
sharik,
I'm
the
administrator
for
the
division
of
public
and
behavioral
health.
Here
with
me
today
is
debbie
reynold,
deputy
administrator
for
administrative
services,
julia
peake,
deputy
administrator
for
community
health
services,
margot
chapel,
deputy
administrator
for
regulatory
and
planning,
and
on
the
phone
we
have
erin
williams,
our
chief
I.t
manager,
moving
to
slide
two.
It
provides
an
overview.
B
Oh
slide,
2
provides
an
overview
of
our
division's
vision
and
mission
slide.
3
provides
an
overview
of
our
division's
organizational
chart.
I'd
like
to
note
on
the
chart
that
in
in
addition
to
the
sections
overseen
by
the
deputy
administrators
here
today,
the
division
has
clinical
leadership
in
the
areas
of
medicine,
epidemiology
and
behavioral
health.
A
I'm
going
to
have
to
interrupt
you
because
I
was
so
enthusiastic
about
getting
going
that
I
completely
missed
doing
roll
call,
so
we're
gonna
have
to
take
a
step
back
and
take
rolls.
So
if
you
could
just
pause
for
a
second
and
staff,
if
you
could
help
me
with
the
role.
C
D
E
C
B
Slide
5
provides
a
snapshot
of
the
division's
requested
funding
for
fy,
22
and
23..
This
includes
general
fund,
which
accounts
for
36
percent
of
revenue
over
the
biennium
federal
funds,
which
account
for
39
percent
of
revenue
over
the
biennium
and
other
funds,
which
account
for
25
percent
of
revenue
over
the
biennium.
B
B
As
we
all
know,
this
past
year
has
been
unprecedented
unprecedented
in
doubling
our
operating
budget
without
additional
fiscal
staff
and
programmatic
support
has
been
beyond
challenging.
However,
I
would
like
to
take
a
quick
moment
to
thank
all
of
the
public
health
staff
who
have
been
working
tirelessly
over
the
past
year
addressing
copid
of
the
416
million
dollars.
This
includes
over
321
million
in
federal
grants,
grant
funds
awarded
to
dbph,
and
it
also
includes
over
95
million
in
cares
relief
treasury
funds,
also
known
as
crf
authorized
through
the
governor's
finance
office
slide.
B
B
A
F
Thank
you
very
much,
and
thank
you
for
that
information.
I
have
a
couple
questions.
Is
this
division
confident
that
the
quality
of
data
that
we're
receiving
from
that
nevada
central
cancer
registry
will
remain
the
same
if
the
fee
increases
is
ultimately
implemented?.
G
Julia
pete
for
the
record.
Thank
you
for
that
question.
I
would
absolutely
I'll
say,
and
I
just
want
to
acknowledge
all
the
efforts
of
both
our
providers
and
our
staff.
This
is
the
first
year
that
we've
been
able
to
meet
a
gold
standard
certification.
The
last
time
we
saw
this
happen
was
2005.
G
and
so,
based
on
the
work
we've
been
doing
this
biennium.
Not
only
do
we
have
the
number
of
cases
that
we
need
with
the
staff
that
you
provided
us
in
the
first
year
of
the
biennium
that
two
ftes
we
were
able
to
get
all
the
cases
abstracted,
cleaned
and
sent
to
our
federal
partners.
So
what
we've
proposed
right
here
with
the
new
schedule
will
get
the
registry
where
they
need
to
be
in
perpetuity.
F
Thank
you
for
that
information
and
just
as
a
follow-up,
madam
chair,
based
on
the
projected
cancer
cases
and
the
amount
of
staff
time
each
case
requires.
Would
you
give
us
a
little
more
information
on
how
the
agency
determined
its
need
for
two
additional
health
program?
Specialists.
B
Julia-
if
I,
if
I
may
say
sorry,
this
is
lisa
sharik,
would
you
prefer
to
answer
these
during
this
director
office
transfer
or
3153
the
cancer
registry
budget?
I
I'm
sorry.
I
probably
wasn't
clear
that
these
transfers
are
not
part
of
3153.
B
F
Okay,
well,
if
you
would.
A
Yeah,
that
was
that
was
thank
you
for
clearing
up
the
confusion,
because
I
was
having
a
hard
time
tracking
as
well.
So
I
thought
we
were
jumping
in
with
3153
but
looks
like
you
had
some
introductory
remarks.
So
anybody
have
any
questions
on
the
introductory
remarks
or
the
transfer.
I
For
the
record,
this
is
debbie
reynolds,
deputy
administrator.
The
transfers
to
the
director's
office
involve
multiple
budget
accounts.
It
involves
a
transfer
from
the
cancer
registry
3153,
as
well
as
the
bureau
of
health
prevention
and
wellness
budget
account,
3170
immunization
program,
3213,
healthcare
quality
and
compliance
3216
office
of
epidemiology
budget
account,
3219
and
also
maternal
and
child
health
budget
account
3222..
I
H
Well,
I
get,
I
guess
I
do
chair,
but
do
you
want
me
to
ask
them
within
the
context
of
the
budget,
or
are
we
free
to
ask
those
all.
A
H
So
I
guess
the
one
thing
that
I
noticed
with
the
budget
transfer,
but
that
I'll
probably
talk
a
little
bit
more.
I
guess,
as
we
get
into
those
budgets,
are
kind
of
some
of
the
federal
corresponding
the
federal
dollars
and
state
dollars
that
go
along
with
them
on
some
of
them.
It
looked
like,
especially
in
the
transfers
to
the
the
new
analytic
office
and
me
the
numbers
just
seemed
the
number
of
ftes
we
were
pulling
over
and
I
guess
why
more
federal
dollars
weren't
following
them.
H
It
looked
like
it
was
just
staff
dollars
and
not
really
operational
dollars.
That
was,
I
guess.
If
we're
talking
about
transfers
the
biggest
question
I
had.
G
Julia,
I
think,
for
the
record.
I
can
answer
that
one
if
you'd
like
me
to
do
that
now.
G
Thank
you
chair.
So
the
way
we
looked
at
the
transfers,
it
is
highly
federal
funding.
As
you
all
know,
public
health
is
almost
entirely
federally
funded,
with
the
rare
exception
of
a
few
programs
that
get
some
general
fund
support.
So
these
programs
were
within
3219
primarily,
but
you
see
the
other
other
budgets
accounts
associated
as
well.
They
were
doing
analytics
work
under
the
supervision
of
our
state
biostatistician
and
most
of
our
federal
funding.
Again,
you
all
know
this,
but
I'll
just
put
it
on
the
record.
G
It
goes
to
staffing
and
pass-throughs
to
our
local
partners.
So
when
you
say
that
it's
primarily
the
staffing,
that's
being
moved,
that's
absolutely
a
true
statement.
That's
primarily
what
we
fund
at
dpvh
is
the
staffing
and
then
a
little
bit
of
operations
as
far
as
rent
and
any
it
expenses
and
those
kind
of
things.
So
it's
just
pulling
that
position,
putting
it
directly
under
the
chief
biostatistician,
formerly
on
paper
and
then
taking
those
funds
with
them.
As
far
as
the
operations,
those
will
remain
in
the
home
budget
accounts
and
we'll
continue
to
push.
J
Partners
chair,
I
have
a
question
on
the
positions.
If
I
might
quickly,
please
you
so
this
is
regarding
is
it's
something
that
I've
seen
and
we've
asked
this
before
in
the
committee,
but
for
a
specific
example,
I
was
going
to
wait
until
that
that
budget,
but
in
the
the
budget
that
you're
moving
over
an
agency
in
the
maternal
mortality
review
committee,
for
example,
you're
moving
folks
over
at
a
higher
at
a
higher
grade,
because
now
you
have
contract
folks
and
again.
J
If
we
need
to
discuss
that
during
that
budget
we
can,
but
it
just
seems
that
globally,
when
you,
when
you
hire
somebody
in
a
new
position,
you're,
not
starting
them
at
step,
one
you
seem
to
be
bringing
them
over,
not
just
you
but
other
departments
at
a
higher
level,
and
in
the
past
we've
heard
that
that's
because
this
person's
been
there,
and
so
it's
that
they
know
their
job.
Is
that
the
case
in
this
budget
too,
that
you
already
have
somebody
that
you're
interested
in
moving
over
to
that
full-time
position?
J
But
my
question
is:
why
don't
you
have
somebody
within
the
agency
take
that
position
and
then
hire
somebody
at
a
lower
level?
Why
do
you
have
to
have
that
person?
That's
been
there,
so
I
think
that's
my
my.
I
need
some
more
information
on
why
you
hire
at
these
higher
levels.
Step
grades,
as
opposed
to
coming
in
at
step.
One.
I
Thank
you
for
the
question.
Debbie
reynolds
for
the
record.
This
particular
transfer
is
an
fte
of
an
existing
position,
and
so
the
transfer
would
include
the
existing
step.
However,
with
regard
to
the
contract
position
that
we
are
converting
to
a
state,
fte
and
budget
account
3222,
we
budgeted
the
position
based
on
the
allowable
steps
that
are
authorized
to
budget,
for
in
this
case,
this
grade
of
position
would
be
authorized
to
budget
for
a
grade
step.
Seven,
it
that's,
really
just
a
budgeting
tool
to
allow
appropriate
authority
to
hire
based
on
the
necessary
skills.
I
A
B
B
These
positions
will
support
abstraction
of
cases,
training
in
quality
assurance
and
analysis
and
reporting
of
cancer
data.
I
would
like
to
highlight
that
the
registry
has
struggled
with
staffing
to
the
level
needed
due
to
funding
challenges,
but
the
two
positions
will
get
the
registry
to
a
place
of
success
and
sustainability.
B
The
two
additional
staff
funded
in
the
first
year
of
the
last
biennium
allowed
our
data
to
be
certified
as
gold
standard.
After
many
years
of
missing,
the
mark
e-226
establishes
a
fee
of
not
more
than
eight
percent
for
the
registration
and
renewal
application
of
a
radiation,
machine,
mammography
machine
healthcare
facility
and
medical
laboratory
to
support
the
cancer
registry.
B
The
language
in
the
proposed
bdr
allows
the
division
to
charge
up
to
eight
percent,
but
our
intent
is
to
only
charge
the
amount
necessary
to
support
the
cancer
registry.
Therefore,
projected
revenue
in
fy
2223
is
calculated,
based
on
a
six
percent
increase
in
fees
paid
to
the
radiation,
control
program
and
healthcare
quality
and
compliance
or
hcqc.
J
You,
madam
chair,
I
appreciate
the
opportunity,
ask
a
question
on
this.
One
too:
it
got
a
little
confusing
there.
Ms
peak
you-
and
I
have
had
many
many
discussions
on
this
cancer
registry
and
trying
to
solve
it,
keep
it
solvent
and
solve
some
problems
and
make
sure
that
the
goal
of
this
is
to
make
sure
we
get
information
in
there.
These
two
folks
that
you're
going
to
hire
these
additional
folks
will
they
be
actually
entering
the
data
into
the
system.
We've
spoken
in
the
past.
G
Thank
you
for
the
question.
Julia
keep
for
the
record
again.
I
appreciate
your
time
over
the
many
years
of
looking
at
this,
so
they
could
do
a
combination
of
many
things.
It
could
be
working
with
a
provider
to
send
a
faster
paper
record
to
us
and
we
could
do
that.
Data
entry-
hopefully
that's
less
common,
but
but
again
totally
an
opportunity
for
the
position
should
that
need
to
occur
with
individual
providers.
G
We're
also
working
hard
to
get
the
web
application
up
so
that
providers
offices
could
enter
via
the
web
and
then
we
could
pull
it
but
again
many
options
for
a
provider
to
report.
We
just
want
to
make
it
as
easy
as
possible.
I
hope
these
positions
will
do
similar
to
what
they've
been
doing
in
the
interim
and
that
they'll
be
taking
the
reports
either
through
paper
submission
or
through
the
electronic
submission
and
developing
the
abstract,
the
quality
needed
to
submit
to
our
federal
partners.
G
They
have
required
variables
this
could
these
positions
could
also
provide
training
and
technical
assistance
if
needed,
if
a
provider
was
struggling
for
whatever
reason
they
audit
records
to
see
if
anything
was
missed
again,
not
to
be
punitive
to,
but
to
figure
out
why
that
case
was
missed
and
make
sure
we
count
it
this
registry,
I'll
just
say
it's
very
unique
in
that
with
communicable
disease
reporting,
we
report
what
comes
to
us
up
to
our
federal
partners
where,
with
the
cancer
registry,
our
federal
partners
say
we
expect
nevada
to
submit
15
000
cancer
reports
and
you
have
to
submit
those
reports
to
a
certain
level
of
quality.
G
And
if
you
missed
the
mark
on
that,
then
they
say
you
missed
cases
and
therefore
wouldn't
get
gold
standard,
probably
more
detail
than
you
needed.
But
I
just
wanted
to
say
that
it's
a
very
unique
program
and
these
positions
will
need
to
be
flexible
as
they
have
been
in
the
interim,
but
it
is
absolutely
a
resource
for
providers,
be
it
from
training
to
data
entry
to
analysis.
Whatever
that
looks
like.
J
Okay,
so
in
summary,
then,
the
goal
is
to
actually
make
sure
we
can
arise
to
the
federal
requirements
for
cancer
registry
gather
good
information,
but
my
concern
is
that
we
don't
want
to
be
penalizing
the
providers
who
give
this
information
and
discourage
them
for
sharing
this
information
if
it
costs
them
more
money.
So,
at
the
end
of
the
day,
we'll
need
reassurance
that
it's
not
going
to
discourage
patients
from
our
providers
from
participating
because
it
will
cost
some
money.
So
thank
you.
Thank
you
for
trying
to
tease
all
this
out.
A
E
Hey
man,
I'm
sure
a
quick
follow-up
to
someone
when
titus
is
regarding
the
the
two
positions-
and
you
mentioned
a
backlog
in
here
of
of
entry,
and
will
this
facilitate
or
are
you
caught
up
and
will
this
help
you
eliminate
the
backlog
with
these
two
additional
positions.
G
Julia
p
for
the
record
I'll
go
ahead
and
answer
that
one
the
way
the
cancer
report
works
is
we.
We
have
a
natural
delay
in
getting
the
data
so,
for
example,.
G
Standard
certification,
when
we
submitted
our
2019
data,
I
believe
it
was
a
year
prior
for
the
actual
year.
It
was
reported.
So
that's
to
say
we
we
don't
have
a
backlog
in
the
current
reporting
year.
We
are
analyzing
the
data
as
it
comes
in
to
report.
G
So
if
we
had
time
in
cases
to
abstract
from
prior
years,
we
can
go
back
and
try
again
and
submit
more
cases,
but
our
priority
will
be
to
ensure
that
we
going
forward,
get
every
case
entered
and
then
at
the
time
we
do
the
call
for
data,
which
is
what
the
federal
partners
call
it,
that
that
record
is
is
fully
up
to
date
for
that
calendar
year
and
we
have
no
backlog.
These
two
ftes,
as
I
mentioned,
were
able
to
pull
that
off
in
the
year
that
we
reported.
G
Julia
for
the
record,
we're
trying
not
to
get
it
with
the
answer,
we're
trying
to
hit
the
nail
right
on
the
head
so
that
we
don't
charge
our
providers
more
than
necessary.
But,
yes,
the
two
fte
were
able
to
abstract
the
number
of
cases
that
our
federal
partners
had
put
in
our
as
our
goal
amount.
E
Thank
you,
madam
chair.
The
question
I
have
is
in
regards
to
the
governor's
recommendation
that
we
saw
that
they're
worried
about
the
solvency
of
the
program,
and
so
they
asked
that
they
find
some
way
to
increase
some
revenue
or
get
some
more
money,
and
I
saw
that
the
first
thing
that
you
know
what
we
would
see
here
is
an
increase
in
fees,
fees
for
mammography
machines,
healthcare
facilities
and
so
forth.
The
only
question
I
had
was
were
there
other
plans,
I
mean.
Obviously,
this
plan
worked.
E
This
is
the
plan
that
you
guys
accepted.
Were
there
any
other
thoughts?
Any
other
plans
that
you
guys
wanted
to
put
into
into
action,
try
and
raise
those
and
raise
the
money
or
to
go
right
to
raising
fees.
G
Julia
peake,
for
the
record,
just
by
way
of
giving
a
brief
history.
Many
years
ago,
the
first
time
we
took
a
stab
at
taking
the
nrs
related
to
the
cancer
registry.
That
was
a
time
when
we
were
charging
hospitals,
eight
dollars
per
correctly
reported
case,
and
so
that's
how
we
were
generating
a
fee
for
lack
of
a
better
term
to
support
the
registry.
We
went
to
the
legislature
and
did
a
bdr
and
pulled
that
back
so
that,
if
they
reported
properly,
then
we
wouldn't
charge
them.
G
G
For
every
version
that
we
put
forward
and
considered,
we
could
probably
fund
the
registry
with
that,
but
to
say
that
this
was
the
best
option
that
we
came
forward.
I
do
know,
there's
an
error
in
one
of
the
budgets
where
it
noted
a
thirty
dollar
amount.
G
That
was
another
consideration
that
we
had
a
straight
charge,
a
thirty
dollar
amount,
but
we
we
decided
that
the
the
more
equitable,
equitable
and
appropriate
way
to
do
the
fee
was
to
do
it
as
a
percentage
to
their
annual
fee
charge
through
our
licensing
body,
because
what
we
saw
is
that
some
some
facilities
have
a
very
low
operating
budget
and
to
charge
them
thirty
dollars
versus
charging
a
large
hospital.
Thirty
dollars
was
probably
not
the
most
equitable
way
to
do
it.
G
So
again,
out
of
all
the
versions
we
looked
at,
we
thought
that
charging
the
smallest
percent
to
their
annual
fee
was
going
to
be
the
least
burdensome,
because
it
would
just
be
one
annual
feed
of
the
agency
and
we
would
transfer
accordingly,
but
also
that
it
was
an
amount
that
was
not
fixed
by
a
facility
type
that
it
would
be
based
on
again.
Their
licensure
fee.
B
B
Slide,
13
health
statistics
and
planning
is
funded,
100
percent
with
other
revenue,
which
includes
fees
and
federal
contracts.
E-805
requests
to
reclassify
five
existing
administrative
assistant,
one
ftes
to
administrative
assistant,
two
ftes
in
the
office
of
vital
records.
This
program
experiences
high
turnover
in
full-time
employees
due
to
promoting
to
higher
pay
grades
within
the
state.
When
opportunities
become
available
with
longevity
being
rare
with
these
positions,
it
has
impacted
the
ability
of
the
program
to
complete
the
increasing
demands
from
constituents.
B
E-550
is
a
request
for
a
vital
record
system.
Upgrade
ovr
is
mandated
per
nrs
and
nac
440
to
register
birth
and
death
records,
issue,
birth
and
death
certificates,
and
to
complete
amendments
for
paternities
adoptions
errors
and
gender
changes.
The
current
system
is
outdated,
difficult
to
use
and
to
modify
mandated
legal
changes.
C
Thank
you
so
with
that
gosh,
this
is
kind
of
in
a
way,
a
sad
budget,
because
we
realize
what
these
folks
have
been
through,
with
what
the
pandemic
has
brought
to
this
state.
So
could
you
just
tell
me
a
little
bit
about
the
workload?
How
much
that's
increased.
K
We'd
have
to
get
this
to
her.
No,
I
do
not
have
the
workload.
B
Lisa
for
the
record,
I
actually
do
not
have
that
information
readily
available,
but
happy
to
provide
after
this
committee,
if
that's
accepted.
Thank.
C
B
C
Appreciate
it,
you
know
whenever
we
see
those
numbers
on
the
tv,
sometimes
I
I
think
of
your
folks
having
to
deal
with
all
that
paperwork,
how
overwhelming
it
might
be
so
with
the
new
system.
I
C
Okay,
can
you
tell
me
what
your
turnaround
time
is
on
death
records
right
now,
because
we
know
on
death
certificates.
C
Okay,
thank
you.
The
backlog
and
turnaround
time
are
two
totally
different
things:
okay,
all
righty!
Thank
you,
madam
chair.
E
I
I
E
E
Yes,
thank
you
so
much
chair
and
my
question
is
just
as
we
look
at
this
new
system.
How
well
will
it
coordinate
with
the
county
systems
and
other
state
agencies
and.
F
E
B
We
don't
have
that
elisa
sheriff
for
the
record.
My
understanding
is,
this
upgrade
will
work
with
all
the
entities
that
use
it
and
was
taken
into
consideration
when
looking
at
this,
but
we
could
provide
additional
information
after
this
committee,
if
necessary,
for
those
specific
details
to
each
of
the
counties.
E
Great
thank
you.
I
just
know
having
been
in
this
business
in
the
past.
Sometimes
we
implement
something
and
then
all
of
a
sudden.
We
get
surprised
with
a
bill
later,
that
we
need
to
bridge
the
technology
between
various
entities
and
just
want
to
make
sure
that
we
are
already
crossed
that
off
of
our
list
of
concerns.
B
First,
chair
and
if
we
may
lisa
sherrick
for
the
record,
debbie
reynolds
does
have
the
reserves.
Information.
I
Thank
you,
debbie
reynolds
for
the
record.
I
apologize
for
the
delay
in
responding
the
minimum
reserve
level
in
this.
Account
is
120
days
and
at
the
end
of
the
biennium
we
will
have.
We
will
exceed
that
minimum
reserve
level
by
by
10
days,
which
equates
to
681
168
dollars,
which
is
adequate
to
run
the
program
for
120
days,
which
is
the
minimum
amount
we
need
before.
Additional
revenues
begin
to
be
collected.
B
Environmental
health
involves
those
aspects
of
public
health
concerned
with
the
factors
and
conditions
in
the
environment
or
surroundings
of
people
that
can
influence
health
and
well-being
ehs
conducts
activities
such
as
permitting
education,
inspections,
enforcement
and
emergency
response
for
the
protection
of
public
health
slide.
15
environmental
health
services
is
mostly
funded
with
other
revenue,
including
license
and
fees,
fda,
food
safety,
contract
and
county
reimbursements,
as
well
as
some
federal
revenue.
B
E225
requests
to
eliminate
three
ftes,
including
one
public
health
rating
and
survey
officer,
one
environmental,
health,
specialist,
three
and
one
administrative
assistant
two
to
meet
revenue
projections
in
the
environmental
health
services
program.
That
concludes
the
major
enhancements
in
this
budget.
Does
the
committee
have
any
questions.
A
Right,
assemblyman
watts.
I
believe
you
have
a
question.
D
Yes,
thank
you,
madam
chair,
could
you
explain
if
the
these
cuts
that
the
agency
is
is
included
in
the
executive
budget
will
allow
them
to
have
sufficient
personnel
to
meet
inspection
needs
over
the
upcoming
biennium.
K
Okay,
good
afternoon,
good
morning,
marco
chapel,
for
the
record,
we
hope
so
it
appears
that
we
might
it's
unpredictable
whether
some
businesses
that
close
during
the
pandemic
will
reopen.
We
did
not
lose
that
much
capacity
during
the
during
the
pandemic,
even
though
we
had
some
bars
and
restaurants
closed
permanently.
K
We
do
have
new
ones
opening
up,
so
that
is
slightly
unpredictable.
H
Thank
you,
madam
chairwoman.
I
have
a
question
about
the
eliminating
elimination
of
the
three
vacant
positions
and
I
guess
I'm
wondering
knowing
that
you
might
as
we
open
up
and
the
need
for
demand,
might
change
for
these
positions.
H
I
Thank
you.
Thank
you
for
the
question.
Debbie
reynolds
for
the
record.
Certainly
the
ability
to
hold
the
positions
would
be
helpful
and
then,
if,
if
we
need
to
request
to
fill
them
again
coming
to
ifc
to
request
approval,
we
would
be
happy
to
do
that.
J
Ma'am
chair
just
to
be
clear,
these
positions
really
are
this.
This
department
is
the
one
that
goes
out
to
the
rural
areas
and
all
the
counties
who
don't
not
have
their
own
food
inspection
personnel.
Is
that
not
correct
so.
J
All
right,
so
I'm
curious,
because
clark
has
iron
marshall,
carson
douglas.
All
the
other
counties
required
rely
on
the
state
to
send
these
folks
out
if
they
want
to
open
again
and
be
inspected,
it's
going
to
be
up
to
the
state
to
help
them
get
there.
So
my
question
really
is:
do
you
currently
have
a
waiting
list
when
somebody
asks
you
to
come
out
and
they're
trying
to
get
open,
they
need
to
be
inspected
or
there's
a
complaint.
J
J
J
Great
because,
as
as
assemblywoman
venus
thompson
mentioned
their
their,
you
know,
many
restaurants
are
closed
and
then
we're
trying
to
get
open.
Hopefully
we
can
all
open.
There
may
be
a
mad
rush
to
get
that
inspection
and
I
just
want
to
make
sure
we
can
get
nevada
back
open
as
quickly
as
possible
when
that
time
happens.
So
thank
you
for
that.
H
B
Lisa
sherick
for
the
record
slide
16
budget
3213
is
the
immunization
program
which
administers
the
federal
vaccines
for
children.
Program
develops
and
promotes
maternal
and
adult
immunization.
Education
programs
maintains
the
statewide
immunization
information
system
develops
state,
immunization
and
vaccine
preventable
disease
regulations
and
laws
maintains
a
quality
assurance
program
for
county
health
districts,
public
health
clinics
and
private
physicians,
who
administer
state
supplied
vaccines.
B
They
also
oversee
the
statewide
immunization
registry,
otherwise
known
as
web
iz
slide
17.
The
immunization
program
is
funded
with
general
fund,
which
is
primarily
used
to
purchase
needed
vaccines
as
the
required
non-federal
match
for
the
nevada,
checkup
program,
federal
funds,
including
various
federal
grants
and
other
revenue,
including
various
transfers.
B
E-225.
This
request
converts
one
full-time
contract
position
to
one
state:
full-time
health
program,
specialist
one
position
needed
to
support
the
vaccines
for
children's
program.
The
proposed
position
will
serve
as
the
immunization
projects
coordinator
to
coordinate
and
oversee
adolescent
and
adult
immunization
programming
and
pandemic
vaccine
planning
and
related
collaboration
with
nevada's
emergency
preparedness
program.
B
M
You,
madam
chair,
I
have
a
few
questions
and
thank
you
for
the
presentation
and
the
work
that
you're
doing
in
our
communities.
Could
you
explain
to
us
just
a
little
bit
more.
You
know
the
opening
story
on
the
news
this
morning
is
how
nevada
is
not
getting
the
vaccines
at
the
rates
that
other
states
are
getting
it.
So
it's
kind
of
fitting
to
have
this
budget
hearing
today.
Could
you
let
us
know
how
many
nevadans
have
received
their
first
dose?
How
many
have
received
their
second?
G
Julia
peak
for
the
record
I'll
go
ahead
and
start.
If
I
miss
any
of
your
questions,
please
ask
them
again.
As
far
as
the
number
of
doses
administered,
we
do
have
a
dashboard
now
on
the
nvhealthresponse.nv.gov
website,
so
I'm
just
going
to
go
ahead
and
know
the
answer
to
the
one
you
asked
again
available
by
county
on
that
dashboard.
We
are
at
556
556,
total
doses
reported
administered
again
a
breakdown
to
more
details
available
there.
G
We,
as
I
mentioned
on
our
health
and
human
services
presentation
but
I'll,
say
it
again:
we've
consistently
had
the
highest
rates
of
administration
in
our
region.
The
biggest
challenge
for
us
remains
supply.
The
demand
is
so
high
and
also
we
have
so
many
opportunities
through
our
pharmacies
through
our
local
partners
to
get
vaccines
and
arms.
G
We
just
do
not
have
the
vaccines
to
get
those
in
arms,
so
we're
ready
when
our
federal
partners
are
able
to
give
us
a
greater
allocation,
we're
going
to
start
soon,
administering
in
more
of
our
federally
qualified
health
centers,
who
are
going
to
be
getting
the
vaccine
sent
directly
to
them.
So
it's
only
growth
in
the
future.
G
In
this
program,
as
far
as
news
on
nevada,
not
getting
the
allocation
that
we
think
we
need
I'll,
just
note
that
our
federal
representatives,
as
well
as
our
governor's
office
and
many
local
partners,
have
been
reaching
out
on
a
regular
basis
expressing
our
concern
over
our
numbers
and
we'll
continue
to
be
the
squeaky
wheel
on
that.
But
we
do
know
our
allocation
is
going
up
every
week.
We're
thankful
for
that
and
we'll
get
that
in
arms.
We
just
every
state,
is
suffering
with
a
supply
issue.
At
this
point,
did
I
miss?
M
You
did
not,
you
actually
answered
what
would
be
my
follow-up
question.
I'm
happy
to
hear
that
you're
working
with
our
federal
delegation
to
get
the
rollout
that
we
need
in
the
state
and
I'm
and
I
believe,
you're
looking
at
other
larger
sites
like
allegiant
stadium,
to
help
push
it
in
the
south
and
other
larger
areas
in
the
north
if
we
are
able
to
get
the
vaccines
that
we
need.
But
the
other
thing
I
also
wanted
to
just
say
is
thank
you
for
what
you
were
doing
with
the
flu
vaccine.
M
G
Yeah
absolutely
I
know
we
had
also
worked
with
the
legislature.
G
Up
in
your
delegation,
so
we've
been
doing
a
lot
with
flu.
We
were
worried
prior
to
the
season
that
we
would.
We
would
have
the
combination
of
a
respiratory
virus
season
of
influenza
and
covid,
and
that
would
have
overwhelmed
our
systems
and
with
everybody
working
so
hard
to
get
flu
vaccination
up
specifically
in
our
adult
population.
It
wasn't
realized
to
the
extent
we
thought
it
would
be.
G
I
will
know
that
nevada
has
some
of
the
lowest
adult
vaccination
rates
in
the
nation,
so
this
is
not
something
that
we
need
to
do
as
a
onesie,
and
this
is
something
that
we'll
need
to
do
in
perpetuity
with
so
much
media
and
outreach
and
education
related
to
vaccinations.
I
don't
want
to
miss
the
opportunity,
while
we're
talking
about
coven,
to
talk
about
the
various
other
vaccinations
that
our
population
can
be
getting
to
be
healthier
long
term,
but
a
ton
of
effort
again
related
to
flu.
G
So
I
want
to
acknowledge
all
our
partners,
but
but
we
have
a
lot
more
work
to
do.
To
be
honest,.
M
And
just
one
more
question:
man,
I'm
sure
if
I
can,
when
you
mention
the
adolescents
and
other
vaccines
that
our
children
need,
are
we
on
track
at
the
pandemic,
interfere
with
parents
getting
their
children,
the
vaccines
that
they
need
on
on
the
time
schedules
that
they
need
to
have
them.
G
Julian
peak
for
the
record,
that
has
been
a
huge
issue,
and
so
we'll
need
to
look
at
getting
people,
specifically
our
kids
and
teens,
as
you
mentioned,
into
their
primary
care
doc,
or
we
may
need
to
stand
up
pods
and
do
it
for
our
kids
to
make
sure
they
get
the
vaccinations
needed.
All
of
us,
including
myself,
have
delayed
some
primary
care
visits
just
because
of
covid,
and
so
once
we
get
more
of
the
population
vaccinated
and
get
those
folks
back
into
their
primary
care.
G
Providers
for
vaccination
and
screenings
that'll
be
a
huge
win
for
us.
I
do
have
some
statistics
just
to
provide
really
quickly
as
far
as
our
kindergartners
we're
really
at
par
with
national
standards,
in
some
cases
we're
just
a
slight
percentage
higher,
but
for
the
most
part,
we're
were
specifically
for
teens,
who
are
slightly
lower
than
the
national
average
of
71.5
percent
of
our
teams.
G
Having
that
vaccination,
we're
at
68.9
so
again,
kind
of
at
par
with
what
the
united
states
is
as
an
average,
but
certainly
more
work
to
do
in
this
area,
because
that
could
prevent
disease
and
outbreaks
long
term.
J
Thank
you,
madam
chair,
and,
and
thank
you
again
for
all
you're
doing
to
for
the
state.
I
don't
think
we
say
that
enough
to
you
real,
quick
on
these
on
the
web.
I
z
and
our
our
flu
vaccines
and
our
covet
vaccines
have
we've
been
able
to
keep
up
the
the
data
entry
to
making
sure
that
we
have
that
all
loaded
up
onto
web
ic
when,
as
folks
get
these
vaccines.
G
Julia
t
for
the
record
we've
been
working
really
hard.
Flu,
I
would
say,
is
not
an
issue.
However,
covid
is
a
challenge,
so
I'm
happy
to
know
that
this
week
we
rolled
out
our
deployment
deployment
of
a
salesforce
tool
specifically
for
public
health
agencies
and
emergency
managers
who
are
interested
in
a
tool.
This
tool
will
allow
for
us
not
to
do
dual
data
entry.
G
So
what
we've
had
to
do
to
this
time
is
typically
the
public
health
agency
would
enter
it
into
some
sort
of
clinical
record
and
then
they'd
have
to
dual
enter
it
into
webid.
The
salesforce
platform
that
we
chose
to
purchase
again
for
the
state
will
do
the
automatic
transfer
of
data
to
webid
so
that
that
dual
data
entry
is
not
required.
G
That
said,
there
is
still
a
backlog,
because
we
just
deployed
this
week,
so
clark
county
is
vigorously
working
to
get
all
of
their
data
entry,
and
I
don't,
I
don't
think
it's
a
large
backlog
anymore,
but
happy
to
provide
that
exact.
J
I
z-
and
I
just
want
to
make
sure
we
have
that
platform
where,
as
we're
giving
these
vaccines
it,
we
can
load
it
up
to
where,
by
z,
from
the
regular
emrs
in
the
provider's
office
and
whether
or
not
now
we're
talking
about
veterinarians
being
able
to
give
this
vaccine
we're
talking
about
dentists
being
able
to
give
that
vaccine.
I
just
want
to
make
sure
we're
not
getting
that
car
to
you
know
a
set
ahead
of
the
horse
and
that
people
can
upload
that
data.
J
A
A
E
Yep
there
it
is,
I
had
to
get
rid
of
the
screen
okay,
so
the
question
I
have
is
with
all
the
data
coming
in
and
the
vaccine
being
rolled
out.
Do
you
happen
to
have
a
rolling
account
of
you
know,
percentage-wise
how
each
county
is
doing?
Have
you
broken
it
down
to
each
county?
I
can
imagine
that,
like
eureka
county,
I
hear
is
really
high.
They've
got
almost
30-35
percent
of
their
population
vaccinated
for
cobit
19..
E
G
Julia
peak
for
the
record
again,
I
would
probably
refer
you
to
the
dashboard.
It's
updated
monday,
wednesday
and
friday,
and
so
it
does
have
all
the
coveted
vaccinations
by
county
we're
also
trying
to
track
really
solidly
where
they
are
according
to
the
playbook,
because,
as
you
know,
one
of
the
things
that
we've
done
is
we
have
a
call
center
who
supports
people
across
the
state
in
booking
vaccinations.
G
So
it's
really
important
that
we
know
where
each
county
is
in
the
playbook,
where,
as
far
as
booking
as
you
know
this
week,
we
started
for
65
plus
statewide.
So
it's
a
combination
of
looking
at
where
they
are
in
the
playbook
and
then,
if
they
have
any
barriers
to
actually
get
vaccines
in
arms,
but
our
state
biostatistician
and
our
vaccination
team
have
done
an
excellent
job
on
that
dashboard.
To
provide
that
information.
It's
also
color
coded
by
county
to
make
it
easier
to
follow.
G
So
I'm
happy
to
provide
the
link
to
the
committee,
but
instead
of
just
reading
through
where
they
each
are.
It's
probably
easiest
just
to
pull
up
on
your
on
your
screen,
but.
A
Thank
you
so
team.
Perhaps
the
multi-million
dollar
question,
which
I
know
there's
some
fluidity
around
right
now,
but
how
are
you
feeling
about
having
the
resources
necessary
at
the
state
and
local
public
health
infrastructure
level,
for
when
that
supply
does
open
up
to
be
able
to
complete
the
vaccine?
Rollout.
G
Hi
julia,
I
think,
for
the
record
I'll
go
ahead
and
take
this
one
again.
So
when
we
looked
at
what
we
thought,
it
would
actually
be
as
far
as
an
expense
to
our
public
health
and
emergency
management
teams.
We
thought
it
would
be
close
to
fifteen
fifty
million
dollars
five
zero
million
dollars
to
do
this
for
the
course
of
a
year.
G
As
you
know,
we
did
get
a
grant
from
the
centers
for
disease
control
and
prevention,
that's
closer
to
28
million,
and
so
we
distributed
that
per
capita
and
then
a
little
to
our
state
dpbh
program.
But
one
of
the
benefits
is
that
our
epidemiology
and
laboratory
capacity
grant
again
we're
not
on
that
budget
account
right
now.
G
But
to
answer
your
question,
our
federal
partners
have
given
us
latitude
in
that
funding
stream
because,
specifically,
it's
written
in
the
guidance
that
if
we
need
to
use
that
for
vaccination
efforts
as
long
as
it's
not
duplicative
to
the
vaccination
grant
or
another
federal
funding
stream.
So
the
way
we've
looked
at
approaching
vaccinations
again.
If
it's
50
million
or
more
we've
looked
at
all
the
different
budget
accounts
that
could
potentially
go
to
vaccination
again.
G
Are
priority
focused
right
now,
and
we've
asked
the
counties
to
prepare
budgets
looking
across
all
the
funding
systems
to
support
that
also
note
that
the
most
important
thing
is
that
it's
easy
for
the
individual
resident
to
get
vaccinated.
So
though
we
will
stand
up
and
support
our
big
pods.
There
are
many
appointments
available
at
walgreens
and
walmart's,
and
your
pharmacy,
where
the
state
doesn't
necessarily
need
to
invest
any
dollars
in
that
the
the
vaccination
comes
directly
to
walgreens
or
walmart,
and
all
we
do
is
assist
individuals
in
booking
that
appointment.
G
So
it's
a
call
center
expense,
but
not
a
an
administration
expense
for
lack
of
a
better
term.
So
we
are
confident
right
now
that
we
do
have
the
funding
necessary,
at
least
for
the
duration
of
this
year,
to
support
what's
what's
needed
as
far
as
vaccinations,
but
but
we
always
get
suppressed
with
cobid.
So
that's
not
to
say
that
we
might
need
more
funding
and
we'll
continue
to
advocate
for
that
at
our
through
our
federal
delegation.
A
Great,
thank
you.
It's
a
big
lift
again.
I
want
to
just
pause
and
express
the
gratitude
of
the
legislature
to
this
team
and
all
of
the
folks
that
you
represent,
who
I
know,
have
been
working
long
hours
creatively
and
thrown
some
curve
balls
over
and
over
again.
A
I
just
you've
done
a
tremendous
job
and
I
know
that
we
don't
always
see
all
the
workings
behind
the
scenes,
but
just
wanted
to
take
a
moment-
and
I
know
this
is
true
across
across
everywhere,
but
in
this
particular
issue,
a
lot
of
focus
and
a
lot
of
attention,
and
we
thank
you
all
right.
Let's
go
ahead
and
move
on
to
3216
healthcare
facilities.
B
B
Over
the
past
year,
we
recognized
we
needed
to
improve
measures
to
prevent
and
control
infections
and
quickly
identified
the
need
for
this
unit
to
specifically
address
infection,
control
and
prevention
in
facilities
where
nevada's
most
vulnerable
citizens
reside
and
foresee.
This
need
continuing
in
the
ongoing
future.
B
Additionally,
the
staff
are
specifically
infection
preventionists,
who
augment
and
work
with
hcqc
inspectors
on
infection,
control,
prevention
and
intervention.
As
of
yesterday
february,
22nd
nevada
continues
to
be
well
below
the
national
average
of
the
percentage
of
deaths
and
facilities,
as
it
compares
to
total
deaths,
and
we
were
at
14.7
percent.
B
B
B
A
I
believe
that
assemblywoman
benitez
thompson
has
some
questions
on
this
budget.
H
Thank
you
so
much,
madam
chair.
I
appreciate
that
and
I
think
what
I
might
do
is
just
maybe
put
a
couple
of
thoughts
that
I
have
in
my
head
on
the
record
and
then
because
the
interest
of
time
just
know
that
it's
some
follow-up
conversations
that
I
would
be
interested
in
having
with
the
division
and
they're,
mostly
around
the
community-based
living
arrangements.
H
Last
session,
we
had
a
couple
of
different
efforts
to
address
the
back
side
of
how
we
we
pay
providers
and
some
cleanup
there,
as
well
as
the
front
end
and
inspections
and
those
position
transfers
from
hcqc.
H
And
so
I
guess
I
would
say
the
the
governor's
recommended
change
in
here
to
you
know,
spend
less
than
the
general
fund
we
gave.
You
makes
makes
me
a
little
bit
nervous.
I,
and
so
I
just
want
to
be
able
to
to
to
talk
about
that
more
and
see
if
that
is
actually
going
to
be
our
best
way
forward
or
if
there's
some
other
considerations
we
might
hold
in
mind
and
that's
all
I'll
put
out
there
chair.
Thank
you.
E
Thank
you
so
much
chair
and
thank
you
for
this
particular
budget
item.
In
this
recommendation,
I
had
a
one
of
one
of
the
skilled
nursing
facilities
in
my
district
was
one
of
the
hot
spots
with
a
at
one
point.
E
I
think
an
85
infection
rate
and
30
losses
of
life,
and
so
I
want
to
commend
this
unit
because
that
was
very,
very,
very
early
on
in
the
pandemic
and
the
response
from
that
point
on
not
just
in
that
particular
facility,
but
also
statewide,
to
recognize
how
incredibly
vulnerable
these
populations
are
and
how
necessary
it
is
to
to
really
you
know
quadruple.
The
efforts
in
terms
of
response
to
infection
control
was
was
was
wonderful
to
see.
E
So
I
really
do
want
to
commend
you
and
in
regards
to
just
some
of
the
questions
it
sounds
like
you.
You
definitely
covered
the
need
for
this
new
unit,
but
if
you
could
just
specify
a
little
bit
more
specifically
what
the
activities
and
services
are,
that
you
anticipate
that
this
unit
will
engage
in
to
help
stop
that
infection
spread
in
the
future.
I
appreciate
it.
G
Okay,
this
is
julia
peak
I'll,
go
ahead
and
start
just
by
way
of
some
history
with
the
infection
control
efforts,
we've
done
at
the
state
related
to
this
program
and
the
combination
with
epidemiology
after
the
hepatitis
c
outbreak
in
clark
county,
we
developed
a
unit
in
our
epidemiology
unit,
working
with
our
healthcare
facility
inspection
team
to
do
help
for
associated
infections
to
better
respond
to
outbreaks
in
those
facilities.
So
when
covent
hit
nevada
was
much
more
solidly
positioned
to
be
ready
to
respond.
G
We
already
had
the
contacts
honestly
in
the
facilities
when
they
had
a
gi
or
other
outbreak.
So
I
just
I
just
want
to
acknowledge
that
we
did
have
a
structure
in
place
that
many
states
didn't
and
our
team
worked
really
hard.
That
said,
what
we
learned
with
covid
is
that
we
can
do
better
and,
as
you
said,
potentially
quadruple
the
amount
of
effort
so
I'll
turn
it
over
to
my
colleague
to
speak
a
little
bit
more
about
how
she's
going
to
build
it
in
her
unit.
E
I
think
the
chair
would
appreciate
me
answering
that
question
with.
Please
send
it
to
the
entire
committee
so
that
we
can
review
it
and
just
to
get
these
last
couple,
questions
on
the
record.
I
I
would
assume
that
the
the
obvious
anticipated
outcome
is
that
we
would
just
continue
to
see
that
good
work
of
minimizing
any
kind
of
spread
and
infection,
but
one
last
question
I
do
have
is:
how
do
we
prioritize
these
facilities
in
terms
of
where
we
direct
that
attention?
E
First,
because
I
know
you
can't
be
in
all
places
at
once,
we've
seen
when
an
outbreak
takes
over
in
one
facility
that
that
can
you
know
in
the
past
had
erupted
quickly.
So
how
do
you
prioritize,
which
ones
and
in
which
regions
across
the
state
you're
going
to
focus
your
energy
on.
K
Marco
chapel
for
the
record.
Thank
you
for
the
question
we
look
at
when
we
do
the
assessment
I
just
when
I
just
mentioned
the
activity
of
the
assessment.
They
look
at
what
infection
control
practices
are
there
and
how
many
people
have
acquired
the
infection
and
and
that's
part
of
how
they've
prioritized.
So
we
look
at
the
specificity
of
the
of
the
the
severity,
I
should
say
the
specificity
and
the
severity
and
I'll
turn
it
over
to
julia.
To
answer
more
about
that,.
G
Yeah-
and
I
would
also
julia
peek
for
the
record-
the
only
thing
I
would
add
is
that
for
all
diseases,
what
we
look
at
is
based
on
the
number
of
cases
that
they
have.
We
work
with
them
remotely
in
many
cases
initially
and
say
here
are
the
infection
control
recommendations
that
we
want
to
put
in
place.
We
then
track
the
number
of
cases
that
they're
reporting
if
it
appears
that
they're
not
administering
that
in
the
way
we
think
is
appropriate,
meaning
there's
more
spread
than
we
would
like
to
see.
G
Based
on
that
epidemiological
curve,
we
will
send
staff
out
to
figure
out
exactly
what's
happening.
It
might
just
be
confusion
with
our
recommendations.
It
could
be
they're
using
the
wrong
cleaning
product,
it
could
be
a
number
of
things,
but
but
that
really
prioritizes
who
gets
an
on-site
visit
and
also
if
they
just
come
in
with
a
huge
number
of
cases
in
an
initial
report,
and
we
say
something's
wrong,
then
we'll
again
send
staff
out
for
that
on-site
inspection
opportunity
versus
a
more
remote
technical
assistance.
A
You're
welcome
wanted
to
jump
in
a
little
bit
more
on,
so
it's
a
fee
based
program
and
it
does
look
like
you
are
expending
more
more
resources
and
starting
to
pick
down
the
reserve.
Did
you
just
talk
about
whether
is
this?
Is
this
program
solvent
and
do
you
have
any
concerns.
I
I
The
reason
for
the
depletion
of
reserves
is
mainly
due
to
the
increase
in
salaries
and
cola.
Step
increases,
as
well
as
a
higher
percentage
of
filled
positions
than
in
years
past.
We're
also
now
hiring
almost
all
health
facility
inspector
rns
at
step,
10
and
other
health
facility
inspector
generalists
with
superior
qualifications
at
increased
steps.
I
We
have
seen
an
increase
in
the
cost
of
category
1
salaries
from
20
fy
20
through
you
know,
prior
to
fy
sorry,
an
increase
from
fy14
to
fy20
in
approximately
four
it's
54,
which
equates
to
about
three
million
dollars
increase
in
salaries
over
that
time
frame.
I
think
that
the
program
definitely
needs
to
look
at
evaluating
our
workload
and
and
the
fees
necessary
to
support
that
workload
and
and
we're
happy
to
follow
up
and
have
additional
discussions
with
your
fiscal
staff.
A
F
Thank
you
very
much,
madam
chair.
These
eight
positions
are
you
going
to
have
the
continuing
need
for
all
of
those
to
meet
your
workload
in
that
community-based,
certifications
and
inspections?.
K
Good
afternoon
I
mean
good
morning
mark
of
chapel
for
the
record,
so
we
need
we
were
not
able
to
complete
the
workload
analysis
this
when
covet
hit.
We
were
halfway
through
it,
and
so
we
would
request
additional
time
to
review
that
to
to
determine
whether
it's
possible
that
some
of
those
positions
may
not
be
necessary.
F
K
F
Thank
you
and
I
echo
the
chairs
responses.
Your
your
work
is,
I
know,
has
been
very
very
hard
the
last
year,
and
I
appreciate
that
this
too,
is
something
that
I
have
experienced
within
my
district
having
a
facility
that
had
an
abundance
of
issues.
So
one
last
question:
will
you
have
sufficient
resources?
Do
you
think
available
for
those
inspections
in
the
2123
biennium,
marco
chapel,
for
the
record?
Yes,
thank
you
very
much
and
thank
you,
madam
chair.
A
Thank
you
and
I'll
just
follow
up.
We
started
with
the
assemblywoman
benitez
thompson
and
I
I
think
that
there's
a
lot
of
interest
on
the
part
of
this
committee
that
the
that
we
don't
go
backwards
on
the
cb
cbla
inspections
and
making
sure
that
we
are
protecting
our
most
vulnerable
citizens
in
those
particular
settings
lots
of
progress
made,
and
so
I
will
just
look
forward
to
continuing
that
conversation
with
staff
and
I'm
getting
that
information
back
to
the
committee
of
we're.
A
B
Epidemiology
lisa
sharik
for
the
record
slide
21
budget
3219,
the
biostatistics
and
epidemiology
budget
account
serves
the
office
of
public
health
investigations
and
epidemiology
or
otherwise
known
as
ophie
ophi
records
and
analyzes
reportable
disease.
Information
conducts
interviews
with
infected
individuals
and
their
contacts
refers
individuals
for
medical
treatment.
Analyzes
data
for
from
disease
investigations
identifies
risk
factors
provides
education
and
recommendations
on
disease
prevention
and
works
in
conjunction
with
appropriate
agencies
to
enforce
communicable
disease
laws.
B
This
transfer
is
requested
because
centers
for
disease
control
or
cdc
merged,
the
hiv
surveillance
and
hiv
prevention
grants
into
a
single
award
with
shared
deliverables
and
to
ensure
that
the
programs
was
more
closely
integrated
in
all
states.
So
nevada
made
the
decision
to
formally
move
them
under
one
manager
to
support
this
federal
push.
B
E-902
transfers,
two
disease
control
specialists
from
community
health
services
budget
account
3224
to
better
align
duties
of
the
positions.
These
positions,
support,
investigation
of
all
reportable
diseases
and
many
of
our
rule
and
frontier
counties.
This
requires
them
to
review,
laboratory
and
clinical
reports
to
identify
infection
interview
the
case
identify
notify
contacts
and
address
outbreaks
in
each
community.
B
B
E
D
I
I
The
majority
of
our
general
fund
is
on
the
behavioral
health
side.
Fortunately,
many
of
these
cuts
were
restored
by
the
governor.
However,
we
do
still
have
general
funds,
some
limited
general
fund.
On
the
public
health
side,
we
tried
to
limit
the
impact
to
the
direct
services
that
we
provide
and
to
our
staff
who
provide
those
services.
I
That
said,
we
don't
have
specific
guidance
from
the
federal
funding
entities
that
this
particular
reduction
is
not
supplanting,
but
we
do
believe
that
we've
made
an
appropriate
decision
based
on
the
the
difficult
decisions
we
had
to
cut
the
general
fund.
D
The
other
question
I
had
was
on
the
transfer
of
the
hiv
surveillance
program
decision
unit
e
900,
and
I
was
just
wondering
you
discussed
some
of
the
how
this
aligns
with
federal
initiatives.
Could
you
also
speak
briefly
to
any
benefits
that
the
state
will
see
in
in
hiv
prevention,
treatment
and
care
by
transferring
this
program
back
to
the
communicable
diseases
budget?.
G
Julia
for
the
record
I'll
go
ahead
and
start
and
then
see
if
my
colleagues
have
anything
to
add,
but
one
of
the
things
we
look
at
with
all
our
programs
is:
who
does
the
staff
talk
to
most
often,
and
in
this
case
we
saw
that
our
surveillance
staff,
especially
when
our
federal
partners
merged
the
two
programs.
They
were
talking
most
often
to
our
prevention
and
care
teams
versus
our
our
epidemiology
teams.
Again
we're
still
addressing
any
outbreaks
in
the
community
and
interviewing
cases
out
of
our
epidemiology
unit.
G
But
the
surveillance
unit,
their
main
rule,
is
to
pool
data
and
look
at
where
there
is
risk
to
the
community
and
provide
that
information
to
our
prevention
and
care
teams
to
direct
resources
and
efforts.
And
so
when
we
saw
that
there
was
opportunity
to
better
integrate
again
with
our
federal
partners.
Seeing
the
same
thing,
we
thought
it
best
to
physically
move
those
staff
under
the
same
manager.
G
Just
because
it
again
we
work
across
all
programs,
but
but
having
the
same
manager
allows
a
level
of
oversight
and
integration
that
you
don't
get
when
you
have
programs
in
different
locations.
So
again,
when
we
looked
at
3219
and
said
what
programs
perhaps
could
live
better
in
a
different
budget
account
and
under
a
different
manager,
we
moved
them.
Accordingly,
it
started
with
the
office
of
analytics
and
then,
as
you
saw
in
the
presentation,
there
is
other
small
grants.
Our
state
systems
development
initiative
for
the
maternal
child
health
program.
G
That
grant
was
better
served
in
the
maternal
and
child
health
program
directly.
So
we
just
did
that
cleanly
throughout
3219
and
put
those
programs
where
their
best
health
housed
elsewhere
throughout
the
division
but
I'll
also
add
pulling
the
disease.
Investigators
back
to
live
under
our
state.
Epidemiologist
was
a
good
decision
as
well,
and
so
there's
a
little
bit
of
swapping
that
it
has
to
do
with
their
daily
activities
and
how
we
can
best
serve
that
frontline
staff
and
then
ultimately
serve
the
community.
D
Thank
you
for
the
clarification
I
appreciate
it
and
because
it
does
provide
some
additional
detail
on
the
efficiencies
that
this
transition.
A
Thank
you.
I
think
we
also
have
some
questions.
I
have
some
questions
around
laboratory
testing
and
capacity.
So
obviously
our
state
lab
has
been
like
an
integral
part
of
our
code.
19
response:
could
you
just
describe
the
lab
and
testing
capacities
and
how
they've
been
expanded
with
federal
funds?
Is
that
impacting
the
lab's
ability
to
do
other
work
and
do
we
have
the
capacity
we
need
as
this?
If
there's
another
spike.
G
Yeah,
julian
peake,
for
the
record-
I
just
I
too
want
to
acknowledge
our
nevada
state,
public
health
lab
and
the
other
labs
in
our
state
for
the
epic
work
they're
doing,
as
well
as
our
health
care
quality
and
compliance
laboratory
team.
The
lift
as
far
as
laboratory
reporting
the
last
year
has
been
incredible.
G
That
said,
our
state
public
health
lab
has
done
such
a
phenomenal
job.
I
just
want
to
acknowledge
that
they
were
first
to
publish
information
on
reinfection.
They
also
have
been
sequencing
to
look
at
variants
prior
to
other
states,
so
I
truly
can't
speak
highly
enough
of
them.
As
far
as
your
exact
question,
though,
related
to
funding,
we
did
give
them
money
off
the
top
for
cares,
relief
funds
for
our
epidemiology
and
laboratory
capacity
funds,
and
so
they've
been
able
to
purchase
equipment,
necessary,
they're,
also
developing
capacity
in
some
of
our
rural
communities.
G
Specifically
they've
been
working
with
elko
and
churchill
county
to
look
at
satellite
sites
and
that
primarily
has
to
do
with
shorter
transport
time
for
the
specimens
and
quicker
turnaround
time.
So
I
appreciate
them
looking
at
that
opportunity
again
to
support
our
rural
communities
right
now.
Their
turnaround
time
is
phenomenal
less
than
24
hours.
When
we
were
at
an
excessive
number
of
cases
in
the
states,
we
did
enter
into
contracts
with
private
labs,
including
quest
and
charles
river,
and
other
to
help
with
that
backlog.
G
G
We
haven't
allocated
funds
to
the
state
public
health
lab
yet
because
they
wanted
the
opportunity
to
hire
a
consultant
to
really
look
like
to
look
at
where
their
lab
needs
to
go
in
the
future,
and
so
so
they've
asked
us
to
hold
some
funding
for
them
and
they'd
like
to
just
hire
that
consultant
to
work
with
them
in
the
future
to
to
look
at
what
nevada
needs
for
the
state
public
health
laboratory.
So
we
look
forward
to
doing
that
with
them
and
then
funding
them
accordingly,
as
much
as
they
need.
G
Julia
peaked
for
the
record.
They've
had
no
issues
again,
general
routine
screening,
unfortunately
has
gone
down.
I'd,
say
probably
with
the
exception
exception
of
newborn
screening,
is
babies
to
continue
to
get
bored
and
get
screened,
but
certainly
there's
been
a
decrease
in
screening
for
sexual
health
and
other
areas,
but
they've
they've
not
had
a
delayed
turnaround
time
in
those
as
well.
They've
always
been
really
phenomenal
with
that
turnaround
time,
but
the
the
need
for
it
has
lessened
with
coped.
B
B
The
section
has
specific
focus
on
improving
clinical
linkages,
statewide
health
promotion
activities
and
evaluation
and
surveillance
activities
pertaining
to
chronic
disease
slide.
26
chronic
disease
is
funded
primarily
with
federal
grants.
Other
revenue,
including
various
transfers
and
general
fund
for
women's
health
connection,
cancer
screening,
e-900
transfers,
one
health
program
specialist
to
the
maternal
child
and
adolescent
service
services,
budget,
account
3222,
ett,
e25
funds,
a
gap
left
by
federal
restrictions
to
provide
breast
cancer
screening
and
diagnostic
services
to
women
ages.
40
through
49.
B
assembly
bills,
388
from
the
2017
legislative
session,
initially
approved
these
funds.
This
enhancement
requests
continued
funding
to
support
these
vitally
important
services.
This
funding
allows
dbph
to
offer
screening
for
women
who
may
fall
outside
of
the
services
provided
with
the
federal
funding.
B
According
to
the
most
recent
behavioral
risk
factor,
surveillance
system,
data
or
brfss
66.4
of
women
in
nevada,
age,
40
or
older
had
a
mammogram
within
the
past
two
years
of
taking
the
survey.
This
is
compared
to
a
national
average
of
71.8
percent
slide
27
e226.
This
request
proposes
alternate
funding
for
the
oral
health
program.
B
Dbph
has
developed
a
strategy
to
diversify
funding
from
radioactive
material,
license
fees
to
other
grants
and
programs
based
on
the
time
and
effort
spent
on
each
activity
to
reflect
a
more
appropriate
cost
allocation.
As
you
may
recall,
dbph
had
a
letter
of
intent
during
the
interim
to
assess
permanent
and
sustainable
funding
for
the
oral
health
program.
B
B
The
state
dental
health
officer
will
be
serving
as
the
clinical
consultant
for
the
medicaid
program,
as
well
as
the
continued
efforts
to
support
public
health
generally.
This
change
will
allow
nevada
to
utilize
federal
match
to
support
the
position,
while
still
maintaining
similar
duties,
e-491
eliminates
revenue
and
expenditures
for
the
colorectal
grant,
which
has
expired
in
july
2020.
The
cdc
released
a
new
funding
announcement
for
public
health
and
health
systems,
partnerships
to
increase
colorectal
cancer
in
clinical
settings.
B
This
grant
opportunity
did
not
include
funding
for
direct
screening
services,
but
did
include
continued
efforts
to
sustain
evidence-based
interventions
and
other
supporting
strategies
in
partnership
with
health
systems
to
increase
colorectal
cancer
screening
rates
nevada
was
awarded
but
not
funded
without
funding.
We
do
not
have
capacity
to
address
these
efforts.
This
concludes
the
major
enhancements
in
this
budget.
Does
the
committee
have
any
questions.
H
Thank
you
so
much
chair
ready.
I
appreciate
it,
so
my
questions
are
going
to
be
specific
to
the
women's
health
connection
and
the
continual
funding
of
that,
and
so
I
guess
we've
had
this
program
in
place
for
a
couple
options
now,
and
it
looks
like
that
the
funding
covers,
if
I'm
correct,
an
additional
2100
women
in
that
age
group
40
to
49,
who
can
receive
this
the
the
diagnostic,
the
screening,
but
generally,
could
you
describe
how
uninsured
or
underinsured
women
can
access
cancer
screening
and
diagnostic
services
in
nevada.
G
Julia
peak
for
the
record,
I'd
start
by
saying:
if
they
wanted
to
visit
our
website
or
reach
out
to
our
agency,
we
can
help
them
navigate.
It
navigation,
I
would
say,
is
probably
one
of
the
hardest
things
related
to
accessing
services
in
our
healthcare
system.
G
We
work
with
access
to
healthcare
network
through
the
women's
health
connection
and
many
of
our
other
programs
and
their
main
role
is
navigation.
So
in
some
cases
these
women
may
have
health
insurance
and
are
just
struggling
to
make
an
appointment
with
a
provider
or
find
a
provider.
In
that
case,
they
don't
need
to
pull
on
these
funds.
It's
just
a
matter
of
navigating
the
system.
G
In
some
cases,
these
women
may
have
access
to
medicaid
or
an
affordable
care
act
program
that
again
provides
the
services.
If
all
of
that
fails
and
for
some
reason,
these
women
are
unable
to
have
insurance
for
whatever
reason,
then
we
would
work
again
with
access
to
healthcare
network
to
get
them
streamed
through
this
program.
If
those
findings
came
back
in
the
negative,
in
other
words,
that
it
was
problematic
and
it
looked
like,
they
did-
have
cancer
access
to
healthcare
network.
G
Again
would
work
with
them
to
navigate
the
healthcare
system,
perhaps
in
a
discount
medical
program
or
otherwise
to
to
make
sure
they
get
the
services
needed.
So
I'll
just
pause
and
say
I
was.
I
was
able
to
be
with
you
at
the
table
and
you
presented
this
bill
initially,
and
so
I
want
to
thank
you
specifically
for
your
support
for
women's
health
services
over
the
years
and
we've
been
able
to
do
really
good
work
and
we
don't
get
a
lot
of
general
fund
in
public
health.
J
Thank
you,
madam
chair.
First,
I
want
to
acknowledge
that
in
your
documentation,
you
actually
included
the
number
of
women
that
have
actually
received
treatment
based
on
the
screening
tool,
and
I
think
that's
one
of
the
questions
I've
asked
for
the
last
four
sessions
is
to
see
outcome.
Data
I
mean:
did
you
actually
do
the
test
and
screen
them?
So
what
if
you
can't
get
them
into
a
provider,
doesn't
really
do
any
good
now?
You
know
they
have
it,
but
nobody
had
treatment.
J
So
I'm
so
pleased
to
see
that
about
88
of
those
women
that
were
diagnosed
through
this
program
actually
have
been
involved
in
treatment.
I
mean,
I
think,
that's
really
the
key.
So
I
want
to
really
thank
you
for
that
particular
budget
item,
but
then
I,
if
I
might,
I
have
actually
some
harder
questions
on
the
the
budget
e226
on
the
oral
health
program
by
my
madam
chair
go
ahead.
Thank
you.
J
So
we've
also
followed
this
in
this
new
position
of
the
hygienist
and
the
our
state
dentist,
and
I
just
I
see
these
positions,
but
I
don't
really
see
any
data,
unlike
the
out
the
treatment
data
on
the
last
budget,
how,
when
you
reach
these
folks,
the
screening?
What
what
are
these
folks
doing?
Have
we
really
increased
access
to
dental
health?
Are
they
really
tracking
that?
I
don't
expect
that
the
dentist
actually
sees
patients,
our
state
dentist?
I
don't
expect
that
a
dental
hygienist
goes
out
and
cleans
teeth.
I
think
the
role
was
broader.
J
The
role
was
to
improve
dental
access
in
my
mind,
because
it
is
so.
We
know
that
that
dental
health
is
truly
a
segway
to
overall
health,
and
that's
that's
one
of
the
reasons
we
authorize
these
physicians.
What
I'd
like
to
see
in
here
is
really
did
they
make
it
just
a
difference
and
I'm
wondering
what
their
actual
activities
were
since
we've
approved
them,
what
their
activity
is
going
to
be
in
the
future
and
what
the
strategic
plan
is,
and
I
want
to
see
some
hard
outcome.
J
Information
on
that
we've
improved
dental
health
here
in
the
state
of
nevada,
and
so
could
you
at
least
answer
that
what
the
their
activities
were.
G
G
Our
oral
health
program,
specifically
under
dr
kapero's
leadership,
has
done
phenomenal
things.
I
just
have
open
her
weekly
memo.
That's
13
pages
long
of
efforts
done
that
week,
so
I
I
could
certainly
provide
you
an
overview
and
it
is.
It
is
everything
from
actually
going
in
the
field
to
doing
streaming.
So
I
appreciate
that's
not
her
soul
duty
or
the
teen
soul
duty.
They
have
done
rural
tours
and
vans
and
sent
pictures
of
truly
horrifying
things.
G
They
were
able
to
address
in
real
time
again,
not
the
bulk
of
their
activities,
but
certainly
have
a
lot
of
data
to
show
what
they've
done
there.
As
far
as
more
systematic
improvements,
they've
been
working
really
closely
with
liberty,
dental
on
a
number
of
things,
including
partnerships
with
medicaid
but
I'll
say
specifically,
because
it's
one
of
my
programs
with
looking
at
oral
health
for
hiv
patients.
I've
been
really
proud
that
they've
been
able
to
tackle
that
so
again,
just
13
pages
in
her
weekly
report.
J
Great,
I
think
all
of
us
would
like
to
see
I'm
sure
that
the
chairs
up,
obviously
to
the
chair
discretion,
but
I
think
just
how
many
patients
are
seeing
and
and
improvement
and
access
and
and
those
discrepancy,
and
even
perhaps
when
we
do
our
statisticians
and
all
the
disparities
in
not
just
general
health
care
for
our
folks
of
color
and
different
backgrounds
and
and
lives.
J
A
Thank
you
for
that.
I'm
just
gonna
go
ahead
and
jump
in
here.
Real
quick,
because
oral
health
is
something
that
the
interim
committee
on
health
has
spent
a
significant
amount
of
time
on,
and
I
want
to
commend.
Dr
capro
have
the
reality
on
the
record
that
we're
talking
about
a
very
small
staff
that
is
trying
to
talk
about
all
oral
health
needs
across
the
entire
state
and
the
fact
that
they're
doing
any
direct
practice.
In
addition
to
trying
to
do
systems
change,
working
with
liberty,
dental
and
medicaid
is
a
little
bit
surprising
to
me.
A
I'm
I'm
sure
that
they
are
because
they
are
very
dedicated
professionals,
so
I've.
The
challenge
in
this
budget
has
been
getting
to
sustainable
funding.
And
so
could
you
just
talk
a
little
bit
more
about
the
the
shift
in
funding
and
moving
away
from
the
radiation
piece
as
the
primary
source
and
toward
where
we're
headed
in
this
structure
in
in
this
budget
to
make
sure
that
we
do
get
to
keep
these
staff.
G
Actually,
at
the
record,
thank
you
senator
ryan.
I
just
want
to
specifically
thank
you
for
really
championing
efforts
around
oral
health
within
the
state.
It's
been
under
your
leadership
and
again
doctor
as
well
with
that
said,
we
did
have
an
loi
as
you're,
well
aware
to
look
at
the
radiation
fees
and
how
we've
been
funding
this
program
in
the
past
and
to
develop
new
strategies.
We
did
look
at
all
of
our
grants
and
tried
to
pull
out
information
related
to
oral
health
deliverables.
G
We
also
looked
at
other
funding
street
streams
again
fund
for
healthy
nevada,
our
partners
at
medicaid
and
what
they
could
fund
for
clinical
services,
and
this
is
what
we
arrived
at,
but
similar
to
the
cancer
registry.
We
looked
at
100
different
iterations
of
how
we
could
potentially
fund
the
program,
and
this
is
the
one
that
we
feel
is
the
most
stable
long
term.
That
said,
by
no
means
are
we
going
to
stop
applying
for
oral
health
grants,
dr
cafero
and
our
team
are
going
to
continue
to
work
hard
to
get
those.
G
We
do
not
want
to
rely
on
grant
funds
if
we
don't
have
to
to
sustain
a
program
such
as
this
again
in
the
same
budget
account
we
presented
how
we
lost
the
colorectal
cancer
screening
grant.
So
when
you
rely
on
federal
grants
like
this
to
do
really
foundational
programs,
the
loss
of
that
federal
funding
could
be
problematic.
So
that's
not
what
we
did
here.
G
As
you
saw,
we
looked
at
a
number
of
different
funding
streams
to
support
the
program,
specifically
the
staffing,
and
that
is,
there
are
again
federal
grants
or
programs
that
need
very
specific
oral
health
deliverables,
we'll
work
with
dr
capraro
and
the
team
to
figure
out
how
we
can
fund
the
oral
health
to
do
those
things,
but
this
again
looking
at
funds
for
healthy
nevada,
material
and
child
and
adolescent
health.
G
Again,
that's
been
funding
this
in
some
capacity
and
then
our
partners
at
a
division
of
health
care,
finance
and
policy
as
well
debbie
did
you
have
anything
left.
I
Yes,
thank
you
julia
for
the
record
debbie
reynolds.
I
just
wanted
to
add
that,
since
this
is
a
clinical
position
as
long
as
the
job
duties
are
aligned
and
solely
benefit,
the
medicaid
program
clinical
match
of
75
is
eligible.
Currently,
the
division
of
public
and
behavioral
health
is
only
eligible
for
50
match,
based
on
our
approved
cost
allocation
plan.
So
we
do
do
believe
that
this
transfer
to
the
division
of
health
care
and
financing
and
policy
will
prove
to
be
a
more
sustainable
model
model
to
support
the
position.
C
Thank
you,
madam
chair.
Actually,
I
have
a
couple
of
questions
so
if
I
could
go
back
to
the
women's
health
connection,
the
conversation
around
that
and
the
navigation
part,
which
has
always
been
really
important-
you
had
mentioned
that
the
navigation
is
through
access
to
health
care
network.
Is
that
basically
northern
nevada,
or
is
that
statewide.
C
Okay,
because
I'm
not
familiar
with
them
in
the
south
at
all,
I'm
not
sure
if
they're
even
listed
on
2-1-1
in
the
south.
C
So
I
just
wanted
to
make
sure
that,
if
we're
paying
them
to
do
a
statewide
purpose
that
people
in
the
south
actually
know
that
they
exist
and
then
I
I
can
look
deeper
into
the
funding
for
that.
Just
to
make
sure
that
the
the
funding
is
appropriate
for
the
work.
That's
being
done.
G
Julia
for
the
record,
I
believe
we've
provided
that
in
our
talking
points,
if
we
did
not
I'm
happy
to
provide
that
to
the
committee
after
the
meeting,
but
we
do
track
all
of
that.
C
C
There
is
no
other
grants
available
out
there.
This
is
this
is
very
important
and
I
would
hate
to
see
these
services
screening
services
go
away.
So
there's
no
other
opportunity
to
screen
for
this.
G
Julia
peak
for
the
record,
we
too
were
very
disappointed
to
get
awarded
but
unfunded
for
this
application.
Our
team
has
worked
very
hard
over
the
years
to
keep
the
service,
but
again
it's
a
risk
with
any
federal
grant.
So
what
we're
doing,
knowing
that
we
did
lose
this
specific
grant,
funding
colorectal
cancer
screening
as
other
preventable
cancer
screenings
are
a
service
provided
through
many
insurance
companies,
specifically
as
it
relates
to
the
affordable
care
act.
So
again,
it's
navigating
those
services.
G
We
remain
to
have
the
comprehensive
cancer
grant
and
so
that
systems
improvement
navigation
will
continue
to
occur.
We
also
have
a
new
five-year
plan
that
I'm
happy
to
provide
the
committee
looking
at
cancer
services,
but
but
we
did
lose
that
grant
not
due
to
lack
of
effort.
I'll
also
note
this
that
this
unit
wrote
for
a
very
competitive
grant
for
dementia
and
alzheimer's
that
they
did
win,
and
so
that's
just
a
luck
of
the
draw.
Unfortunately,
my
team
worked
very
hard
to
keep
and
maintain
this
group,
but
we
again
were
awarded,
but
unfunded.
E
Much
appreciate
it
with
the
expiration
of
this
of
the
colorectal
screening.
Grant
we've
had
that
for
about
a
decade
received
one
seven
million
dollars
over
the
course
of
that.
Is
there
any
sort
of
comprehensive
review
of
outcomes
oftentimes,
I
think
when
these
grants
expire,
it's
a
good
opportunity
to
look
back
and
see
how
we
did
and
what
the
roi
is
on
some
of
our
expenditures.
G
Yeah
I
apologize
if
there's
background
noise,
our
computers
doing
something
real
weird,
but
but
no
we
do
look
at
outcome.
We
also
look
at
national
screening
data
related
to
brfss
and
others
to
see
how
we're
doing
this
specific
grant
did
have
specific
objectives
and
deliverables
and
happy
to
provide
that
again
with
our
grant
application.
If
there's
opportunity
for
review
and
in
three
or
four
years
when
that
grant
becomes
available
again,
we'll
will
apply.
G
But
but
we
do
have
all
the
statistics
on
the
number
of
individuals
who
were
screened,
the
result
of
that
screening
and
then
the
referral
to
treatment
so
happy
to
provide
that
to
the
committee
again.
We're
gonna
work
hard
to
get
that
grant
in
the
future
and
it
was
a
loss
for
our
state
in
our
program.
D
B
Lisa
sharik
for
the
record
slide.
28
budget,
32-22,
maternal
maternal
child
and
adolescent
health
services
supports
things
such
as
early
hearing
detection
and
intervention,
universal
newborn
hearing,
screening,
title
v,
maternal
and
child
health
block
grant
child
and
youth
with
special
health
care
needs,
maternal
infant,
early
childhood
home,
visiting
program,
rape
prevention,
education
program,
personal
responsibility,
education
program,
sexual
risk
advice,
avoidance,
education
program,
nevada
alliance
for
maternal
health,
innovation
program
and
pregnancy,
risk
assessment,
monitoring
system,
otherwise
known
as
prams
slide.
29,
maternal
and
child
health
is
funded
primarily
with
federal
grants.
B
Other
transfer
revenue
and
general
fund
e-225
request
to
convert
a
contractor
position
to
a
state
fte
health
program,
specialist
one
position
to
support
the
maternal
and
child
health,
section
that
experiences
a
regular
contract
staff
turnover
in
difficulty,
finding
a
qualified
workforce
to
address
the
program
implementation
needs
of
serving
the
children
and
youth
with
special
healthcare
needs.
Population
e-226.
B
This
position
will
conduct
medical
record
abstractions
and
pregnancy-related
deaths
will
be
identified
by
abstracting
and
reviewing
deaths
caused
by
pregnancy,
complications
and
other
associated
causes
to
identify
modifiable,
contributing
factors
and
recommend
preventative
interventions,
slide
30
e550,
early
hearing
detection
and
intervention
system,
otherwise
known
as
eddie.
The
eddy
data
is
currently
entered
into
the
vital
records
system.
Ovr
is
intending
to
upgrade
the
current
vital
records
system
and
eddy
functionality
will
not
be
included,
which
creates
the
need
for
a
new
system
to
manage
nevada's
eddy
clients
of
note.
B
This
transfer
aligns
with
the
bureau's
oversight
of
the
state's
behavioral
health
programs
and
improves
alignment
with
the
mission
and
vision
of
the
programs
slide.
31
e-350
request
a
transfer
of
temporary
assistance
for
needy
families
or
tanf
funds
from
the
division
of
welfare
and
supportive
services
to
support
the
home,
visiting
nursing
family
partnership
program.
B
The
program
provides
first-time
pregnant
women
from
identified
priority
communities
with
evidence-based
home
visiting
services
and
providing
delivery
of
materials
and
instructions
to
families
in
various
focus
areas
such
as
maternal
and
newborn
health,
family,
economic
self-sufficiency,
educational
attainment,
child
injury,
injuries,
maltreatment,
emergency
department,
usage,
school
readiness
and
achievement.
Domestic
violence
and
coordination
and
referral
to
community
resources
and
supports
e680
aligns
revenue
from
general
fund
to
federal
funds
for
replacement
equipment.
A
Thank
you
for
the
presentation
assembly,
women,
monroe
moreno,
would
you
let
us
lead.
M
Us
off,
please
sure,
thank
you,
madam
chair.
I
have
questions
on
first,
questions
on
e350
the
tanf
pilot
program,
currently
there's
50
families
and
so
with
the
pilot
program,
we'll
be
able
to
add
an
additional
100
families.
Can
you
just
tell
us
or
explain
a
little
bit
more
how
this
nurse
family
partnership
program
differs
from
other
home
visit
programs
that
exist
or
are
they
one
in
the
same?
And
can
you
explain
to
us
the
eligibility
criteria
for
enrollment
in
the
program.
G
Julia
peak
for
the
record
I'll
go
ahead
and
take
this
one.
Thank
you
for
the
question.
So
the
nurse
family
partnership
and
the
partnership
to
oversee
that
program
with
the
tanf
program
is
not
new
to
nevada.
This
is
a
model
that
other
states
use
and
I'll
say
specifically
this
program,
as
you
mentioned,
are
they
all
the
same?
No
there's
many
different
versions
of
a
nurse
family
partner.
I
mean
of
a
home
visiting
program.
The
nurse
family
partnership
is
the
longest
running
and
strongest
evidence-based
program.
The
reason
it
aligns
really
closely
with
tanf.
G
It
has
three
primary
goals
that
it
tracks
and
that
it
strives
for
the
first
being
to
improve
health
outcomes
for
mom
and
baby,
but
the
third
specifically
is
to
improve
the
economic
self-sufficiency
of
families
by
helping
parents
develop
a
vision
for
their
own
future
plan.
Future
pregnancies
continue
their
education
and
find
work.
So
it's
really
the
other
parts
of
the
the
new
mom's
life
and
her
family's
life
to
set
her
up
for
for
success
and
so
related
to
eligibility.
G
We
do
have
an
eligibility
criteria,
happy
to
read
it
to
you
or
I
can
provide
it
to
the
community
committee
due
to
time
restraints
with
the
tanf
funding.
We've
also
added
that
they
must
be
part
of
the
tanf
program.
That's
the
only
addition
that
we
would
have,
on
top
of
our
normal
nurse
family
partnership
eligibility.
G
The
way
these
moms
come
to
us,
they're,
first-time
moms,
and
that's
another
nice
thing
about
this
program.
Is
we
get
to
the
mom
and
and
her
family
early
on
in
her
life
so
that,
hopefully
again
we
can
work
on
the
trajectory
of
her
life
and
make
an
impact,
as
you
mentioned,
we're
going
to
from
50
to
150
with
this
pilot
program.
But
I
just
want
to
say
by
no
means
is
this
going
to
meet
the
need,
that's
in
the
community
when
they
truly
did
a
needs
assessment
and
have
applied
for
private
grants.
G
The
need
is
in
the
thousands
that
said,
we're
hopeful
that,
with
this
pilot
program,
we
can
show
you
success
with
this
150
families
and
the
partnership
with
panic
and
hopefully
ask
for
more
money
or
promote
the
program
more
widely
in
the
future.
M
M
So
I
appreciate
that
and
when
you
go
to
e225
and
e226
about
the
two
positions,
could
you
just
explain
to
us
how
the
replacement
of
the
contractor
positions
with
permanent
state
positions
and
how
that
will
help
the
agency
address
it's
issues
with
retention.
G
Excellent
question:
so
we've
struggled
with
this
at
the
division
for
a
long
time
we
bring
on
contractors
because
we
are
so
federally
dependent
on
those
funds.
In
this
case,
what
we
put
forward
in
all
our
budget
accounts
is
for
those
positions
that
have
truly
been
with
us
in
a
contract
for
for
years.
In
this
case,
these
positions
have
been
with
us
in
four
plus
years
in
a
contract
position.
Clearly
that
position
is
sustainable
and
needed
long
term.
G
I'd
say
the
children
and
youth
with
special
health
care
needs
has
been
specifically
challenging,
because
that
population
does
need
stability,
and
they
also
need
somebody
with
some
historical
knowledge
of
the
program
and
services,
and
we've
had
a
great
deal
of
turnover,
not
at
the
fault
of
the
program
or
the
staffing.
If
a
permanent
fte
position
opens
up,
then
then
by
all
means
should
that
individual
apply
and
get
health
benefits
and
state
benefits.
So
it's
been.
It's
been
a
true
challenge
with
recruitment
and
retention.
G
Again,
this
has
proven
that
it
has
to
be
a
sustainable
and
the
next
one
same
argument,
except
that
the
maternal
mortality
review
committee
is
newer
to
our
programs,
but
based
on
the
work
they've
done
to
date
and
the
need
for
that
program
in
the
future.
We're
going
to
use
our
state
systems
development
initiative
grants
again,
one
of
those
that
we're
moving
from
3219
and
and
allow
that
to
support
the
program
in
perpetuity
or
again
as
long
as
we
have
that
grant
and
that
grant
has
been
in
place
for
many
many
years.
G
M
Well,
I
was
very
happy
to
hear,
in
the
explanation
overview
of
these
physicians
that
one
of
those
physicians
will
be
supporting
the
mmrc
for
data
collection
and-
and
that
was
one
of
the
main
reasons
to
have
the
mr
mmrc
is
for
data
collection.
So
I
appreciate
seeing
putting
a
position
there
that
can
focus
on
the
data,
especially
the
data,
that
that
impacts
our
communities
of
color
the
most,
because
that
was
one
of
the
big
pushes
for
the
mmrc.
So
I'm
happy
to
see
that
you're
looking
to
put
resources
there.
A
E
Tolls,
thank
you
so
much
chair
and
I
I
believe,
assemblywoman
and
moreno,
touched
on
a
lot
of
the
questions
that
I
had,
but
I
am
interested
in
that
eligibility
piece
in
terms
of
how
we
use
those
tanf
funds,
because
I
know
that
we've
had
questions
in
a
prior
meeting
around
the
reserves
that
are
still
available
and
how
those
might
be
utilized
to
perhaps
expand
this
program
as
well
as
apply
to
other
early
intervention
and
so
forth.
Programs.
So
I'll
just
be
looking
for
that.
E
That
information
that
you
share
and
unless
you
want
to
add
anything
to
that
response.
G
Julia
peek
for
the
record.
I
speak
incredibly
fast,
so
I'll
just
go
ahead
and
read
you
the
eligibility
criteria,
because
I
think
it
is
important
first
mom
before
28
weeks
of
program
entry
and
she
must
meet
the
home.
Visiting
qualifications,
including
a
low-income
household
household,
contains
an
enrollee
who
is
pregnant
under
the
age
of
21.
household,
has
a
history
of
child
abuse
or
neglect,
or
has
interactions
with
child
welfare
household?
Has
a
history
of
substance,
abuse
or
needs
substance
abuse
treatment,
someone
in
the
household
use
tobacco
products
in
the
home.
G
Someone
in
the
household
has
attained
low
student
achievement
or
has
a
child
with
low
student
achievement
household
has
a
child
with
developmental
delays
or
disabilities.
Household
includes
individuals
who
are
serving
or
formerly
served
in
the
u.s
armed
forces
and
again
with
the
tanf
pilot.
These
individuals
also
must
be
enrolled
in
a
tanf
program.
G
So
so
that's
how
the
individual
is
going
to
join
our
program,
as
I
mentioned
earlier,
unfortunately,
150
is,
is
just
a
small
amount
of
effort,
as
this
need
is
large
in
the
thousands,
so
we're
going
to
work
really
closely
with
our
social
service
entities
as
we
bring
these
people
into
the
program
and
hope
we
can
grow
it
in
the
future.
E
Thank
you,
follow-up
chair.
Please
go
ahead,
so
I
appreciate
that
in
regards
to
eligibility
for
the
participants
and
and
what
qualifies
them
to
participate
in
this
program.
E
I
think
my
broader
question
is
just
what
are
the
restrictions
around
the
use
of
tanf
funds
and
and
again
tying
it
back
to
that
reserve
that
we
have,
and
could
we
perhaps
tap
in
because
we
had
talked
about
how
there
was
approximately
16
million
that
was
untapped,
potentially
left
over
in
reserves
and
versus
the
90
days
that
we're
required
to
keep
into
the
bank
and
just
wondering
if
there's
restrictions
around
how
to
use
those
tanf
funds
for
this
program
and
other
programs,
and
that
may
be
a
conversation
offline.
I
Yeah,
thank
you.
Debbie
reynolds
for
the
record.
The
tanf
funds
are
are
within
the
division
of
welfare
and
supportive
services.
So
unfortunately
I
don't
have
the
information
regarding
the
restrictions
for
the
use
of
the
funds
and
I'm
not
able
to
speak
to
their
level
of
reserve.
A
E
Thank
you,
madam
chair.
I
just
I
got
to
back
up
one
one
budget,
really
quick,
miss
peak
you
referenced
when
we
were
talking
about
the
I
think
it
was
the
chronic
disease
budget.
A
document
called
the
art
that
you
refer
to
as
talking
points,
and
I
don't
know
exactly
what
you
were
referring
to.
It
seemed
to
have
some
more.
G
My
apologies
julia
peek,
for
the
record.
I
was
referring
to
the
questions
we
get
from
the
lcd
staff.
They
ask
actually
extremely
good
detailed
questions
and
we
provide
answers.
I
believe
we've
provided
that
level
of
detail
in
those
answers,
but
can
certainly
follow
up
refer
to
them
as
talking
points
in
error,
but
it
is
those
questions
and
answers
from
your
team.
J
Thank
you,
madam
chair,
on
the
same
budget,
the
e350
and
then
into
the
e225,
we're
talking
about
the
the
nurse
family
partnership
program,
you're,
going
to
expand
it
to
150
families
in
that
budget
or
tanf
is
going
to
be
848
thousand
dollars
to
expand
that
program
to
an
additional
100
families.
So
the
total
for
that
money
would
be
150.
Families.
Is
that
correct
that
you're
trying
to
reach.
G
Yeah
for
the
record,
your
correct
50,
current
under
dinners
family
partnership
program
in
that
program
in
clark
county
we're
requesting
to
use
the
talent
fund
for
an
additional
100
for
a
total
of
150
families.
G
Julia
pete
for
the
record,
sorry,
if
that
was
confusing,
they're
actually
not
associated,
so
we
have
in
our
family
partnership
home
visiting,
which
is
a
program
under
the
maternal
and
child
health
adolescent
program.
We
also
have
the
children
and
youth
with
special
health
care
needs
program,
which
is
a
different
program.
Of
course.
They
all
work
together
in
the
same
unit,
but
maternal
mortality
review
program
is
a
program
within
maternal
and
child
health,
but
these
specific
positions
aren't
associated
with
that
specific
item.
J
G
Julian
think,
for
the
record,
I
don't
have
that
number
in
front
of
me,
but
it's
very
easily
out
of
the
hub
award
we
currently
give
to
the
agency.
So
if
I
could
follow
up
with
that
after
the
hearing
it'd
be
easy
to
provide
at
that
point,.
J
Very
good,
so
let's
go
back
down
to
the
the
two
position:
the
contract,
people
that
you're
now
moving
over
to
two
state
permanent
positions.
I
touched
on
this
earlier
about
all
these
new
folks
that
you're
now
hiring
to
state
positions,
you're
bringing
them
in
at
they're
grade
35
you're,
bringing
them
in
at
a
step
seven
and
then
there's
a
grade
37
and
you're,
bringing
that
person
into
step,
seven,
which
there's
cost
to
the
state.
For
that
there's.
I
Debbie
reynolds
for
the
record
again
the
step,
seven
for
the
health
program
specialist
one
and
the
health
program
specialist
too.
It
was
built
into
the
budget
as
a
tool
to
allow
sufficient
authority
to
hire
the
positions.
Actually,
the
the
incumbent
selected
would
be
sorry.
The
steps
selected
would
be
dependent
upon
the
qualifications
of
the
of
the
existing
candidates.
So
it's
not
a
guarantee
that
they
would
be
hired
at
the
level.
That's
budgeted.
J
I
J
A
B
The
office
of
health
administration
is
primarily
funded
with
indirect
and
cost
allocation
revenue,
with
a
small
amount
of
general
fund
to
support
poison
control
services
and
the
memo
van
we
are
requesting
a
cost
allocation
redistribution
to
remove
general
fund
in
the
administrative
administrative
accounts
and
fund
the
full
cost
allocation
into
the
behavioral
health
accounts
for
transparency.
General
fund
will
be
removed
from
the
administrative
account
and
budgeted
in
the
behavioral
health
accounts
and
then
transferred
to
the
administrative
account
through
cost
allocation.
B
Slide:
34
e
900
transfers,
the
public
information
officer
from
the
public
health
preparedness
budget
3218
to
the
office
of
state
health
admin
budget
3223
to
better
align
the
duties
of
the
position,
though
this
position
was
initially
funded
to
communicate
on
public
health
emergencies
and
threats.
There
is
a
much
greater
need
for
public
health
communications
across
the
division
from
all
programs.
B
B
E380
funds,
an
increase
in
conference
call
charges
due
to
operating
remotely
during
covid
19..
As
with
all
other
businesses,
dbph
has
experienced
a
much
greater
demand
for
remote
and
virtual
services
during
covid.
These
tools
have
proven
to
be
the
cornerstone
that
has
enabled
the
continuity
of
our
agency,
even
with
the
change
to
telework
for
many
of
the
public
health
programs.
A
I'm
going
to
ask
assemblyman
watts
to
lead
off.
Yes,.
D
Thank
you,
madam
chair.
First,
could
you
just
explain
in
a
little
bit
more
detail
the
recommended
shift
in
funding
from
general
fund
to
cost
allocation
revenues.
I
Prior
to
state
fiscal
year,
14
the
mental
health
and
developmental
services
division
and
the
nevada
state
health
division
were
two
separate
divisions.
During
that,
during
that
fiscal
year,
we
merged
into
one
account
one
division
and
became
the
division
of
public
and
behavioral
health
services.
With
that
brought
together,
two
large
agencies.
On
the
public
health
side,
we
collect
indirect,
based
on
all
the
eligible
expenditures.
I
On
the
on
the
federal
side
for
the
various
public,
the
various
federal
grants
we
have
to
support
public
health
programs
on
the
on
the
behavioral
health
side,
there's
a
cost
allocation
plan
which
allocates
administrative
support
across
the
division
based
on
that
plan.
I
At
the
time
that
we
merged
the
cost
allocation
that
was
budgeted
for
the
behavioral
health
programs
was
based
really
only
on
the
admit,
the
medicaid
portion
of
revenue
within
the
behavioral
health
budgets,
and
so
it
was
really
just
a
percentage
of
the
revenue
to
the
overall
budget
and
and
then
the
rest
of
the
budget
was
just
general
fund
that
we
had
in
the
account
so
for
transparency.
I
D
Thank
you
I
I
know
you
had
mentioned
the
increased
transparency
in
your
initial
presentation,
but
I
appreciate
the
the
additional
background.
I
Certainly,
thank
you
for
the
question.
Debbie
reynolds
for
the
record.
The
minimum
reserve
level
in
this
budget
account
is
based
on
90
days
of
expenditures.
Based
on
this
assessment,
the
reserve
level
should
be
approximately
1.1
million
dollars.
The
reserve
has
been
depleting
in
the
base
budget
due
to
accounting
for
salary
increases
each
year
and
additional
positions
that
were
added
to
the
budget
over
the
2021
biennium.
I
There's
a
two-year
delay
in
receipt
of
indirect
revenues
annually
we
submit
our
indirect
cost
rate
proposal
to
to
the
feds
and
it
takes
it
takes
about
a
year
to
get
approval
of
those
rates.
For
example,
we
submitted
our
fy
20
proposal
based
on
19
actuals
in
december
of
19,
and
we
still
have
not
received
approval
of
those
rates
likely
due
to
the
delay
in
covid.
I
That
said,
we
have
been
in
communication
with
our
federal
negotiator
and
we
do
expect
approval
within
the
next
three
to
four
weeks,
based
on
three
year
average
of
direct
costs.
We
do
anticipate,
those
rates
do
will
be
increasing
and
we
believe
that
we're
going
to
be
generating
additional
indirect
revenue.
I
Additionally,
when
the
budget
was
balanced,
an
error
was
made.
Revenues
need
to
be
adjusted
to
match
the
maximum
revenue
projected
in
the
budget
and
there's
also
a
transfer
that
remained
that
needs
to
be
removed,
and
we
believe
that,
with
these
adjustments,
accounting
and
accounting
for
the
new
indirect
rates
approved
in
the
near
future
that
this
budget
account
will
not
resolve
intelligence
issues.
A
E
B
B
B
B
J
Thank
you,
chair
ratty.
I
have
questions
and
and
big
concerns
over
this
budget
and
the
leaving
these
positions
vacant.
Could
you
tell
me
how
you,
as
you
state
early
on
in
your
your
comments,
this
is
like.
Sometimes
the
only
critical
access
to
any
preventative
health
care,
public
health
services
in
these
communities-
and
you
currently
have
them
filled
with
contract
nurses.
Is
that
what
I
heard
you
say.
G
Julian
peake,
for
the
record,
it's
really
a
combination,
dr
titus,
and
I
don't
disagree
with
anything.
You
say
they
are
a
safety
net
as
as
we
noted
so
we
chose
these
two
positions
simply
because
they
had
been
vacant
for
the
course
of
a
year.
G
As
you
can
appreciate,
it's
really
hard
to
recruit
for
positions,
so
we
will
really
take
nurses
in
whatever
form
that
they're
willing
to
come
to
us
and
in
some
cases
they
want
to
work
on
a
contractual
basis,
because
perhaps
they
have
a
a
different
full-time
job,
and
this
is
in
addition
to
that.
In
some
cases
they
do
want
an
fte
position
and
that's
why
we
hold
held
the
positions
vacant
again
general
fund
with
those
cuts.
G
Those
were
the
easiest,
but
that
certainly
isn't
a
reflection
of
a
lack
of
need
in
those
communities
all
new,
no
just
specifically
related
to
coven,
because
I
think
it's
important,
we
pulled
out
the
rural
counties
and
gave
them
their
own
per
capita
allocations
for
both
epidemiology
and
vaccination
services
and
they're
working
on
those
budgets.
Now
so
they're.
G
Looking
now
at
a
model
to
either
hire
nurses
locally
or
hire
a
private
company,
again,
private
companies
can
come
to
to
the
county
and
provide
those
services
locally,
at
least
as
it
relates
to
coven,
or
to
build
on
our
community
health
nursing
program
to
hire
the
staffing
as
needed.
So
perhaps
we'll
use
it
as
an
fte
position,
perhaps
we'll
hire
contractors
perhaps
we'll
use
a
third-party
vendor.
It
truly
is
whatever
meets
the
needs
of
the
community
and
again,
if
we
were
to
get
a
different
source
of
funding,
we
let
them
make
it.
G
J
Right,
thank
you.
Obviously,
I
agree
with
what
you're
saying
as
far
as
the
need
my
con.
One
of
my
concerns
also
is
the
the
the
use
of
the
vaccines.
We
know
that
a
place
like
tone
pal
that
does
not
have
a
health
care
facility
now
that
that
home
health
nurse
may
be
the
only
place
they
can
get
that
vaccine
the
cost
of
the
vaccines.
We
know
they
can't
infernally.
I
know,
there's
a
cvs
pharmacy
et
cetera,
they
could
walk
in
there,
there's
a
rallies.
They
could
walk
in
there
and
get
their
vaccines
promised.
J
Those
usually
require
some
resources,
and
so
that
community
health
provider
is
critical
not
only
for
family
planning,
but
now
for,
as
we've
seen,
our
lower
rates
of
vaccination
wanted
to
make
sure
that
these
these
positions
weren't
going
to
be
permanently
eliminated.
That
you're
going
to.
J
These
vaccines
so
anxious
to
hear
further
discussion
along
the
line
when
you
come
down
to
that,
because
I
just
I
just
worry
about
the
services
provided
in
the
rural
areas
and
lack
thereof-
and
you
know
just
what's
going
to
happen
to
these
these
communities
in
general
firmly
in
tonopah.
So
thank
you.
G
Okay,
julia
peak
for
the
record
I'll
just
touch
on
a
couple
things
because
I
think
they're
important.
We
do
have
a
higher
packet
in
for
an
rn
to
be
in
tonopah,
so
we're
moving
the
hawthorne
nurse
to
tonopah.
So
hopefully
we
understand
that's
a
an
area
of
huge
need
and
so
we're
able
to
move
the
positions
based
on
recruitment
and
where
the
individual
wants
to
live
so
totally
understand
in
that
specific
area.
G
Also,
I
want
to
note
we're
looking
for
vaccination
at
opportunities
to
partner
with
home
health
agencies
and
then
also
those
agencies
that
are
already
going
to
individuals,
homes,
senior
meal
programs.
How
can
we
partner
with
them
to
get
vaccination
in
the
home
setting
the
other
thing?
That's
an
allowable
expense
and
we're
absolutely
looking
at
in
the
epidemiology
and
laboratory
capacity
grant.
G
They
encourage
the
use
of
mobile
units
again,
those
mobile
units
can
go
deploy
to
anywhere
in
an
urban
area
where
we're
seeing
low
vaccination
rates
or
in
a
rural
area
where
it's
problematic
for
the
individuals
to
travel.
A
great
distance
also
going
to
be
great
value
when
we
get
a
single
dose
shot,
such
as
the
johnson
and
johnson
one.
G
If
we,
if
we
go
out
to
a
side
and
have
the
opportunity
to
give
a
vaccination
once
because
the
dual
vaccination
is
is
complicated
once
we
make
these
investments
for
mobile
units
and
others
with
the
covid
funds,
again
we're
trying
to
do
as
much
as
we
can
to
build
the
infrastructure
of
public
health
at
this
very
unique
crisis
opportunity
and
so
not
to
divert
too
much
but
we're
improving
our
public
health
laboratory
reporting
systems,
infectious
disease
reporting
systems
again
outreach
and
response
in
rural
and
underserved
areas.
G
So
we're
we're
not
passing
up
the
opportunity
to
use
these
funds
to
improve
a
number
of
different
areas.
So
I
look
forward
to
presenting
to
you
all
on
the
success
of
these
programs,
we're
just
again
working
with
the
counties
on
how
to
implement,
based
on
that
cdc
grant.
J
Great,
thank
you
thank
you,
madam
chair
and
and
miss
peak.
You
know
I
have
you
on
speed
dial,
so
I'll
be
interesting
to
follow
up
on
what
those
are.
So
thank
you
for
what
you're
you're
trying
to
do
there.
Thank
you.
A
All
right,
I
believe
that
that
is
our
final
budget
for
the
day
want
to
commend
the
staff
from
the
department
of
public
and
behavioral
health,
or
that
was
a
lot
of
information,
did
a
very
nice
job
of
quickly
reviewing
each
budget
and
hitting
the
highlights
for
us
so
that
we
could
get
the
questions.
So
thank
you.
Thank
you
so
much
for
your
your
comprehensiveness,
but
your
efficiency.
Today
we
appreciate
it
last
call
for
questions.
N
A
A
N
N
N
N
N
N
L
Thank
you,
chair
ratty
and
members
of
the
senate
committee
on
finance
and
members
of
the
assembly
committee
on
ways
and
means.
My
name
is
john
bill
stein
and
I
am
the
chief
executive
officer
for
comprehensive
cancer
centers
in
nevada.
L
As
back
background,
comprehensive
is
an
award-winning,
multi-disciplinary
oncology
group,
compromising
medical
oncology,
hematology
radiation,
breast
surgery
and
pulmonary
medicine.
Our
practice
is
community-based.
We
are
physician-led
and
owned
and
we
do
treat
more
than
13
000
new
patients
annually
and
a
little
over
375
000
office
visits
per
year
in
our
15
locations
across
southern
nevada.
L
Since
2017,
we've
had
several
conversations
with
ms
julia
peake,
deputy
administrator
for
division
of
public
and
behavioral
health
and
the
nevada
central
cancer
registry,
and
came
to
an
agreement
that
we
would
begin
submitting
our
data
to
the
registry.
Even
though
there
was
an
understanding
of
statute
nrs457.057
that
we
potentially
were
exempt
in
good
faith.
However,
comprehensive
has
worked
with
the
nccr
and
department
in
providing
data
for
the
cancer
registry.
L
On
january
3rd
of
this
of
2020,
we
received
a
letter
regarding
the
technical
bulletin
from
dph
on
basically
a
fee
of
250
that
would
be
assessed
per
patient
diagnosed,
with
cancer
submitted
to
the
nccr.
L
L
As
I
mentioned
in
my
beginning,
beginning
testimony,
we
will
continue
to
report
in
good
faith.
We
will
continue
to
treat
all
the
patients
in
southern
nevada,
we'll
continue
to
work
with
the
department
of
public
and
behavioral
health
and
to
maximize
efficiency
of
reporting,
while
minimizing
any
burden
on
other
practices,
both
of
which
we
believe
can
be
achieved
while
fulfilling
the
intent
of
the
comprehensive
registry.
Again,
we
thank
you
and
we
do
support
this
alternative
that
was
proposed
today.
N
N
N
E
Morning,
esteem,
chair
and
members:
my
name
is
dr
tiffany
tylegar
calling
and
support
on
behalf
of
children's
advocacy
alliance.
I
want
to
specifically
come
in
and
thank
the
department
for
its
service
and,
in
particular,
its
commitment
to
the
home
visiting
pilot.
The
nurse
family
partnership
is
a
nationally
recognized.
N
N
D
E
E
Bradley
mayer
for
the
record,
b-r-a-d-l-e-y
m-a-y-e-r,
I'm
a
partner
with
our
gentleman
partners
representing
the
southern
nevada
health
district
today,
and
we
just
wanted
to
highlight
as
a
means
of
providing
some
information
that
this
chronic
disease
budget
has
eliminated
the
tobacco
prevention
funds
from
sb
263
last
session
and
sb
263
created
taxation
of
alternative
nicotine
products
and
vapor
products
as
tobacco
products.
E
This
reclassification
loans
brought
in
millions
of
extra
revenue
to
the
state
per
year.
You
know
sb263
allocated
two
and
a
half
million
per
year
to
fund
tobacco
control
programs
with
a
goal
to
address
nevada's
youth
vaping
epidemic
as
one
out
of
five
teens
are
currently
vaping.
However,
thinking
about
this
youth
vaping
epidemic
we're
having
an
impact,
as
the
campaign
has
reached
approximately
125
000
teams
to
date,
and
we
saw
a
20
percent
decrease
pre-pandemic
in
violations
for
retailers
selling
vaping
products
to
miners.
So
we.
E
N
O
Good
morning,
for
the
record,
my
name
is
carrie
harrington,
that
is
spelled
c-a-r-I
h-e-r-I-n-g
t-o-n,
I'm
the
director
with
nevada
cancer
coalition,
and
today
I'm
representing
our
partners
across
the
state,
and
I
have
three
items
to
address.
I'm
first
off.
We
strongly
support
the
enhancements
to
the
nevada,
central
cancer
registry
budget,
ensuring
both
the
quantity
and
quality
of
our
registry
data
is
critical
for
health
officials
and
medical
professionals
in
both
addressing
cancer
across
the
state
and
also
in
making
informed
public
health
decisions.
O
So
strongly
support
restoring
funds
to
the
youth
vaping
prevention
activities
established
last
session
through
sb
263
as
a
state,
we've
already
made
a
major
investment
in
this
effort
and
we're
seeing
success,
as
the
previous
caller
had
mentioned,
to
stop
funding.
This
now
would
be
a
true
travesty
for
our
teens
and
finally,
I
had
submitted
a
letter
on
this.
We
respectfully
request
state
funding
for
colorectal
cancer
screening
and
diagnosis
for
underinsured
or
underserved.
O
In
fact,
we
were
just
one
of
five
states
that
had
received
this
funding
most
recently.
Unfortunately,
as
you
heard,
the
cdc
funds
are
no
longer
available
and
that's
why
we
need
state
funding
to
fill
this
gap.
Our
state
has
managed
a
very
successful
and
life-saving
colorectal
cancer
program
in
partnership
with
access
to
healthcare
network
which,
in
the
past
five
years
alone,
served
almost
3
000
underinsured
and
uninsured
people
who
did
not
qualify
for
medicaid,
while
six
cancer
diagnoses
were
made.
O
213
people
also
had
dangerous,
polyps
diagnosed
during
a
routine
screening
thanks
to
this
program
and
that
most
likely
prevented
cancer
for
them
and
and
saved
lives.
We
know
how
to
screen
nevada's
underserved
and
we
have
a
track
record
for
efficiently
and
effectively
saving
lives.
Our
communities
are
currently
struggling
to
fill
this
gap
in
funding,
so
the
state
funding
would
allow
us
to
continue
these
efforts.
Thank
you
very
much.
N
O
J-O-E-L-L-E-G-U-T-M-A-N-D-O-D-S-O-N
calling
today
representing
the
washoe
county
health
district,
and
I
just
wanted
to
follow
up
with
a
letter
we
submitted
in
exhibits
yesterday,
the
the
bill
from
last
session,
sb
263
awarded
the
washoe
county
health
district,
more
than
400
000
dollars
during
last
biennium
to
implement
youth,
vaping
prevention
activities,
and
these
activities
did
a
lot
for
prevention
and
education
around
youth
vaping.
Unfortunately,
that
funding
was
zeroed
out
this
this
biennium
and
without
adequate
funding.
These
youth,
vaping
prevention
activities
and
the
infrastructure
and
capacity
gained
will
be
significantly
reduced.
O
N
N
N
E
My
apologies,
I
forgot.
I
forgot
to
unmute
my
my
question
is:
are
we
in
public
comment
yet.
N
E
Good
morning,
madam
chair
members
of
committee,
stephen
cohen,
for
the
record
I'll,
keep
it
nice
and
short
and
sweet
stephen
with
a
v
cohen.
As
in
the
assembly
woman,
I
wanted
to
address
budget
account.
3213
currently
in
the
south.
Prioritization
lanes
are
being
interpreted
only
for
mobility
disabilities
and
would
like
to
work
with
the
immunization
folks
to
ensure
that
intellectual
and
developmental
folks
are
not
left
behind.
I
am
already
on
the
notification
list
so
just
patiently
waiting
like
that
manager.
Thank
you.
When
I
yield.
N
A
Okay,
thank
you.
So
I'm
going
to
thank
everybody
for
on
the
committee
for
their
good
questions
and
their
efficiency
and
we'll
go
ahead
and
adjourn.
Thank
you.
So.