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From YouTube: 3/18/2021 - Senate Finance and Assembly Ways and Means, Subcommittees on Human Services
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A
A
Here,
thank
you.
Go
ahead
and
mark
speaker
fryerson
a
majority
leader
canazarro
as
excused
and
as
assistant
majority
leader
benitez
thompson
present
as
she
arrives.
A
Well,
we've
been
doing
this
for
a
while,
and
so
I
will
just
start
with
the
remarks
if,
for
some
reason,
you're
new
to
us
this
particular
meeting
and
you're
wanting
to
know
how
to
participate.
I
encourage
you
to
google
nevada
legislature
and
get
on
the
nevada
legislature
website.
When
you
get
there,
you'll
see
that
there's
a
help.
A
Tab
on
every
page
and
that
help
tab
will
tell
you
all
the
different
ways
that
you
can
participate,
including
calling
in
for
public
comment
at
the
end
of
this
meeting.
With
that
we're
going
to
go
ahead
and
jump
into
our
first
budget
and
invite
the
folks
from
the
aging
disability
services
division.
You
join
us.
B
C
C
The
developmental
services
programs,
these
programs
provide
for
purchase
services
for
people
with
intellectual
and
developmental
disabilities
and
their
families
with
the
goal
of
maximizing
independence
and
community
inclusion.
The
services
in
these
programs
include
things
like
service
coordination,
family
support
programs,
respite
services,
purchase
of
service,
clinical
assessments,
in-home
habilitation,
counseling
services
thousand
day
training
and
supported
living
services.
C
Just
for
a
little
context,
I
think
it's
important
to
talk
about
the
difference.
We
often
include
intellectual
and
developmental
disabilities
in
this
budget.
Intellectual
disabilities
is
a
disability
characterized
by
significant
limitations,
both
in
intellectual
functioning,
such
as
reasoning,
learning
and
problem
solving
and
in
adaptive
behaviors,
which
covers
a
range
of
everyday
social
and
practical
skills.
C
C
C
C
This
program
provides
financial
assistance
on
a
monthly
basis
to
low-income
families
residing
in
nevada
who
are
providing
care
in
their
home
for
family
members,
who
will
who
have
a
profound
and
severe
intellectual
disability
slide.
Eight
are
the
caseload
projections
for
this
program
and
slide.
Nine
is
the
one
decision
unit
for
this
program.
C
A
That
I'm
sorry
so
that
budget
account
I
may
have
you're
looking
at
m
201.
yeah.
B
B
Thank
you,
madam
chair.
I'm
sorry,
I
lost
my
my
unmute
button
and
I
too
got
a
little
confused
here
at
the
beginning
when
we
went
straight
to
31.66,
so
I
guess
on
on
this
one.
I
guess
our
overarching
question
on
a
lot
of
these
is
going
to
be.
How
is
the
pandemic
affected
the
program,
the
caseload
and
the
ability
to
serve
nevada
families
that
really
need
these
services?
C
Finishing
it,
the
record
so
3166,
the
family
preservation
program
is
very
specific.
It's
a
monthly
financial
supplement
to
families,
so
we
have
that
has
not
been
impacted
by
covered
in
this
budget.
Account.
There's
no
wait
list
for
these
services.
Currently
all
families
who
qualify
and
request
this
service
have
been
able
to
receive
that.
We
also
don't
anticipate
any
wait
list
for
this
service
in
the
next.
B
B
It
is
thursday
right
okay,
so
where
are
we
with
the
caseload
and
what
do
we
think
is
going
to
happen
in
the
future,
especially
with
all
the
need
that
is
out
there
right
now.
C
So
jessica,
adams,
for
the
record,
as
of
february,
we
have
647
families
receiving
this
service.
D
B
And
we
have
not
increased
this
amount
in
a
number
of
years.
If
I,
if
I'm
remembering
correctly,
I
don't
think
this
has
gone
up
since
I've
been
in
the
assembly.
B
A
D
Do
thank
you
so
much
so
I
guess
I
know
it's
odd,
because
we've
got
this
rate
specifically
built
into
statute,
and
so
there
isn't
any
authority
or
ability
or
permission
for
the
division
to
come
to
us
and
say:
hey,
we've
done
a
needs
assessment
and
it
looks
like
374
dollars
in
2021
terms
is
not
the
same
as
you
know
what
it
meant
in
2029
terms,
and
so
I'm
just
wondering
is
that
assumption
right?
Are
you
able
to
do
a
needs
assessment
about
the
for
these
families?
D
I
imagine
that
that
these
are
families
who
are
opting
out
of
the
formal
work
environment,
voluntarily,
unemployed,
home,
all
full-time,
to
take
care
of
their
of
these
of
their
loved
ones.
And
so
I
guess
I'm
I'm
just
wondering
if
we
know
anything
more
about
how
these,
how
far
these
dollars
go
for
those
families.
C
Punishment
for
the
record
so
in
statute,
the
division
does
have
regulatory
authority
over
this
program,
so
we
could
set
the
rates
through
regulatory
processes.
We
have
not
done
that.
Historically,
we've
left
it
at
that
same
rate,
but
we
do
have
the
authority
to
adopt
regulations
to
establish
the
rates
within
the
program.
D
D
There's
always
budget
consequences
to
that,
but
it
just
it
feels
really
static,
and
I
want
to
make
sure
that
we
as
a
legislature
and
whenever
the
435.365
was
put
in
place,
that
tying
the
hands
and
and
making
such
a
static
rate
wasn't
an
unintended
consequence
that
we
didn't
leave
the
department
without
an
avenue
to
do
any
analysis
over
this
rate
and
that
was
kind
of
what
I
was
trying
to
figure
out.
So
thank
you
for,
for
the.
A
C
C
C
m201
funds,
caseload
increases
in
this
in
the
sierra
regional
center
budget.
C
Moving
to
slide
13
are
the
budget
reductions
associated
with
this
budget.
Account
e680
keeps
frozen
six
vacant
positions,
while
e-690
is
a
reduction
in
payments
through
our
fiscal
intermediary
program.
This
program
allows
family
and
children
under
the
age
of
18
to
purchase
specialized
treatment,
skill
building
and
programming
to
assist
with
successful
integration
into
the
community.
A
B
Thank
you,
and-
and
this
goes
back
to
the
the
comment
that
I
alluded
to
earlier-
I
think
in
all
these
budgets
there's
going
to
be
conversations
about
caseloaded
adjustments
and
then
what
so,
I
I
think
just
talking
about
them.
All
I
believe
in
in
general,
will
be
good
the
case
loads
adjustments
in
the
changes
in
the
service
utilization
and
the
service
request
and
then
provider
capacity.
Could
you
address
that
when
it
comes
to
the
sierra
regional
center,
please
finish.
C
It
for
the
record,
so
I
will
start
and
then
I
will
refer
to
jessica
adams
to
help
kind
of
fill
in
if
I
miss
anything
so
during
proven
19,
many
of
our
services,
as
across
all
of
our
programs
within
adsb,
were
temporarily
put
on
hold
so
jobs
and
day
training
programs
were
probably
the
number
one
impact
that
we
closed,
many
of
our
jobs
and
date
training
centers
for
months.
C
However,
our
supported
living
arrangement
services
continued
because
those
folks,
because
they
weren't
going
somewhere
during
the
day,
have
an
increased
need
for
services
and
supports
during
the
day.
So
we've
seen
a
little
bit
of
issue
the
most
recent
caseload
projections
that
have
been
done.
Look
like
we
are.
C
To
grow,
we
don't
have
major
concerns
with
that
and
I'll
turn
it
to
jessica,
just
to
talk
about
provider
capacity
and
what
we've
seen
over
the
past
the
past
year
learning
just
adam's
honestly.
Our
providers
have
been
amazing
at
making
whatever
shifts
and
whatever
changes
that
you
know
they
they
need
to
make.
As
miss
schmidt
said,
we
did
have
to
close
our
congregate
jdt
sites
for.
B
C
Really
stepped
up
brought
in
a
whole
lot
of
staff
worked
with
a
lot
of
those
agencies
to
bring.
C
Staff
so
that
people
weren't
losing
jobs,
that
sort
of
thing
so
really
doing
a
lot
of
really
good
work.
I
think,
overall,
where
we
have
seen
some
decreases
as
far
as
covet
with
our
service
system.
E
C
Seeing
quite
a
bit
of
a
decrease
in
the
average
number
of
cases
open
every
single
month,
people
haven't
necessarily
been
coming.
D
C
Applying
for
services
at
the
same
level
that
they've
done
in
the
past,
along
with
that,
we've
also
seen
a
increase
in
the
number
of
closed
cases
averaged
out
per
month.
C
Some
of
those
have
to
do
with
maybe
families
that
don't
want
people
in
their
homes
and
have
just
asked
us
to
close
their
case
for
the
time
being,
and
I
think
that
probably
as
opposed
to
our
our
bigger
program,
the
sla
program
and
the
jdt
program,
some
of
our
family
support
services
programs
have
also
seen
some
decrease
in
utilization
such
as
respite.
We
have
a
lot
of
families
who
are
either
not
using
respite
at
this
point
in
time,
because
maybe
the
places
that
they.
C
It
has
closed
or
once
again
they
don't
want
people
coming
into
their
into
their
family
home.
C
So
hoping
all
of
those
things
come
come
back,
but
if
I
could
just
add
to
that
also
I
want.
I
think,
it's
important
for
us
to
note
too
that
during
the
pandemic,
our
medicaid
partners
worked
really
closely
with
us
to
do
an
appendix
k
waiver,
which
did
allow
a
lot
of
flexibilities
in
our
services.
C
A
C
Able
to
continue
a
lot
of
services
in
manners
that
we
didn't
used
to
be
able
to
do
such
as
jobs
and
day
training
in
the
home
environment,
so
that
kind
of
helped
our
providers.
It
also
gave
us
the
ability
to
make
supplemental
payments
to
our
providers
during
the
pandemic.
So
all
of
those
things
really
helped
support
the
network
so
that
we
didn't
see.
B
E
A
Pandemic,
thank
you.
So
it
looks
like
we
have
questions
from
senator
kikefer
and
assemblywoman
benitez
thompson.
I
think
I
just
want
to
acknowledge
that
a
lot
of
the
answers
that
you
may
be
given
may
apply
to
not
just
this
regional
center,
but
also
to
desert
regional
center
and
to
these
rural,
regional
centers.
A
So
when
you're
giving
your
answers,
if
you
would
just
sort
of
indicate
if
the
answer
sort
of
region
or
universally
applies
to
all
the
regional
centers,
I
think
that
will
help
facilitate
us
moving
through
all
of
the
budgets
as
we
go
and
for
the
members.
If
your
question
is
specific
to
the
sierra
regional
center
or
all
of
the
regional
centers
feel
free
to
clarify
that
as
well.
We
may
be
a
little
erratic,
but
we're
going
to
make
we're
going
to
make
it
through
this.
I
think
that'll
make
for
a
clearer
record,
so
senator
kikifer.
F
You,
madam
chair,
thank
you
mission.
It's
good
to
see
you.
I
I
think
you
answered
some
of
my
questions
about
I'm
sort
of
the
ability
to
retain
some
of
our
community
providers
and
what's
happened
to
them
during
the
during
the
pandemic,
but
you
know:
we've
we've
done
some
rate
increases
in
recent
years,
particularly
I
think
for
jdt,
and
maybe
some
slas
as
well.
F
Can
you
can
you
talk
a
little
bit
about
where
we
are
in
terms
of
our
reimbursements
to
our
community
partners
and
whether
they're
it's
at
a
space
right
now
that
allows
them
to
sort
of
function
robustly
or
are
they
struggling
based
on
some
of
the
reimbursements.
C
For
the
record,
thank
you
senator
take
care.
So
if
you
were
correct
in
our
jobs
and
day
training
programs
across
all
the
regions,
we
did
a
great
increase.
The
last
biennium
we
are
still
not
at
the
maximum
allowable
rate
for
those
services.
B
C
Our
supported
living
arrangements
or
do
I
have
that
backwards?
Sorry,
I
have
that
backwards,
so
we
did
the
rate
increase
in
the
sla
and
the
jobs
and
their
training
are
already
maxed
out.
They
are.
B
C
Medicaid
to
do
a
rate
study,
I
think
we've
discussed
last
section
too.
The
need
for
a
rate
study
to
establish
not
only
what
the
appropriate
rates
are
to
maintain
this
network,
but
also
really
looking
at
the
ability
to
create.
C
Rate
structure,
as
I
mentioned
earlier,
we're
seeing
increased
levels
of
need,
and
so
how
do
we
build
a
rate
structure
that
allows
us
to
support
those
high
levels
of
you
know
higher
levels
of
need
for
certain
individuals
and
not
across
the
board
across
all
services,
so
that
rate
study
is
still
being
passed
or
conducted
as
we
speak
as
soon
as
we
have
that
I
anticipate
in
the
future,
we'll
be
looking
at
what
what
that
rate
structure
looks
like
and
again,
the
provider
network.
Yes,
they
have
struggled
they've
struggled
to
retain
staff.
B
C
F
Said
as
a
quick
follow-up,
do
you
anticipate
that
that
that
rate
study
is
going
to
be
completed
during
the
coming
by
upcoming
interim,
or
this
is
a
longer
term
process
and
I'm
sure
it
got
stalled
a
little
bit
due
to
covet.
C
Just
added
to
the
record,
so
the
rate
study
is
happening
right
now.
Providers
are
turning
in
their
their
paperwork
to
the
vendor.
Now
I
think
it's
due
in
the
next
week
or
two,
so
I
believe
we
should
be
getting
the
results
of
that
study,
probably
pretty
close
to
the
end
of
this
session,
so
we
will
definitely
have
them
for
the
interim.
D
Thank
you.
Thank
you
so
much,
madam
chairwoman,
so
I
I
think
I
caught
a
hint
to
part
of
the
answer
of
the
question
that
I
have,
because
I
did
see
that
in
our
for
the
2021
work
programs,
that
spending
was
higher
than
the
2019
2020
actual
you
know
specific,
like
residential
supports
family,
supports
the
title.
19
community
services
job
and
day
training,
so
services
doesn't
necessarily
come
to
halt.
It
sounds
like
you
were
able
to
shift
them
and
continue
them
just
in
in
different
ways.
C
Finish
it
for
the
record,
that
is
correct.
So,
with
those
appendix
k
flexibilities,
we
were
able
to
continue
many
of
the
services
just
do
them
either
virtually
or
in
non-traditional
settings.
So
some
of
those
very
structured
rules
were
lifted,
so
it
allowed
us
to
be
a
little
bit
more
flexible
in
our
delivery
service
and
then
again,
like
I
mentioned
the
retainer
payments
to
the
providers
that
were
allowable
under
that
appendix
allowed
us
to
provide
continued.
D
I
didn't
realize
that
there
had
been
that
much
flexibility
when
it
came
to
these
programs-
and
I
mean
I,
I
think
it's
wonderful,
because
it
shows
that
that
there
were
it,
looks
like
a
quick
pivot
to
to
change
how
we
do
things
here
and
that
we
were
still
able
to
keep
supports
in
place
and
dollars
going
out
the
door.
So
I
appreciate
that.
A
C
C
The
challenges
that
all
the
other
24-hour
facilities
across
the
state
have
had
include
with
regarding
the
pandemic,
including
outbreaks
of
proven
within
our
facility
shortages
of
supplies,
needed
increased
safety
protocols,
the
creation
of
isolation
homes
and
really
with
no
additional
staff
to
do
that.
So
this
was
a
struggle
this
past
year,
for
our
staff
at
the
icf
have
done
an
amazing
job.
They
got
very
creative
in
ways
to
keep
folks
occupied
and
busy
during
the
day
and
still
productive.
C
We
had
to
increase
our
staffing
during
the
daytime
hours,
normally,
where
our
residents
would
be
going
out
off-site
to
a
dogs
or
day
training
site.
Many
of
them
were
all
staying
home
all
day,
and
so
we
had
to
increase
the
sapping
levels
during
the
day.
So
this
really
created
some
a
huge
approval
of
excessive
overtime.
I
think
we
paid
over
1.6
million
dollars
in
overtime
in
fiscal
year
20.
and
in
fiscal
year,
21
we're
already
at
1.2
million
dollars
in
overtime
costs.
C
So
though,
you
don't
see
any
decision
units
in
this
budget
account
related
to
that
icf.
I
just
thought
it
was
important
to
mention
the
struggles
and
a
shout
out
to
our
staff
for
all
that
they've
done
and
all
they've
been
through
in
the
last
year.
Over
the
it's
been
a
challenge
like
I
say,
and
if
you
remember
last
session,
we
got
21
new
positions
for
that
facility
based
on
the
cms
findings
and
our
system,
improvement
agreements
and
the
recommendations
from
a
vendor
group.
C
But
I
would
say
that,
based
on
the
overtime
we've
had
to
utilize
that
there
is
still
a
burden
on
our
personnel
and
we
do
have
concerns
with
burnout
at
that
facility.
C
B
C
Moving
to
slide
18
are
additional
enhancements
for
3279
with
e805
is
a
request
to
combine
two
part-time
positions
into
one
full-time
developmental,
specialist
and
e-900
and
500
is
a
transfer.
I
think
we
discussed
this
in
the
medicaid
budget
of
three
audit
positions
from
the
division
of
health
care,
finance
and
policy
to
the
aging
disability
services
division,
and
these
will
conduct
audits
on
our
sla
at
jdt
funding.
C
C
Oh
and
then
slide
20
is
the
wait
list.
Let's
yeah
the
wait
list
for
all
the
regional
centers.
These.
This
wait
list
represents
individuals
waiting
over
90
days
for
services
and
slide
21
has
the
decision
units
to
fund
those
weightlift
services.
C
B
Thank
you,
madam
chair.
I
have
two
questions.
If
that's
all
right,
the
first
one
is
really
a
clarifying
question,
so
you
noted
in
your
slides
that
the
there
was
the
pilot
program
in
decision
unit
e380,
but
the
e684
eliminates
it.
So
you
just
confirmed
that,
and
essentially
both
of
those
decision
units
should
be
they
cancel
each
other
out,
so
they
should
be
they're.
Not
part
of
the
the
budget
recommendation
is
that
correct.
C
Finishment
for
the
record
that
is
correct.
This
was
an
oversight,
and
that
should
not
be
it
should
have
been
in
there.
B
Okay,
thank
you.
I
appreciate
that
clarification
and
then
I
I
just
had
another
question
about
the
dental
program
at
the
intermediate
facility,
so
you
were
talked
about
some
of
the
things
that
have
gone
on
there,
especially
over
the
last
year,
or
so.
I
was
just
wondering
if
you
could
speak
a
little
bit
more
to
the
dental
care
program
in
particular,
and
how
that
is
assisted
the
the
clients
and
facility
and
and
improved
their
quality
of
life.
C
Finishing
it
for
the
record,
so
we
have
been
working
with
the
university
of
nevada,
dental
school
dental
school.
They
have
a
specialized
national
clinic
where
they
serve
people
with
intellectual
developmental
disabilities.
It's
a
very
sensory,
specific
room,
and
so
they
have
a
special
special
services
that
our
population
needs,
and
many
of
we
find
that
many
of
our
people
that
we
serve
struggle
to
get
dental
services.
C
So
we
are
hopeful
that
this
partnership
will
kind
of
give
us
a
access
to
specialized
services
for
those
people
that
we
serve
and
we've
been
unable
to
access
dental
services
in
the
community.
We
will
continue
to
offer.
They
will
always
have
the
option
of
accessing
services
in
the
community,
but
this
partnership
is
really
look.
Is
we.
C
C
Obviously
we
were
all
impacted
and
dental
school
was
not
providing
services,
so
we
are
hopeful
that,
as
we
move
out
of
the
pandemic,
that
we
are
able
to
kind
of
increase
these
services
and
really
it's
a
win-win
situation
for
the
school
gets
the
experience
with
our
person
served
and
we
get
the
benefit
of
specialized
services.
D
Thank
you,
madam
chair.
I
have
a
few
questions
about
the
wait
list,
with
the
governor's
recommendation
to
reduce
the
waiver
waitlist
for
the
supported
living
arrangements
and
jobs
and
the
day
training
programs
do
do
you
anticipate
serving
all
the
projected
clients
waiting
more
than
the
90
days
for
the
waiver
services
in
the
upcoming
biennium
and
also
in
lieu
of
maintaining
a
wait
list
for
the
medicaid
waiver
slots?
C
Schmidt
for
the
record,
so
I'll
start
the
answer
and
also
have
joseph
to
help
fill
in
for
me.
So
we
do
anticipate.
We
would
hope
that
we
could.
We
could
serve
everybody
on
the
waitlist
with
that
decision
unit.
One
of
the
challenges
that
we
have,
as
we
mentioned
earlier,
is,
as
we
see
an
increase
in
complex
behaviors.
B
C
Qualify
for
the
waiver,
some
may
have
such
low
levels
of
service.
It
doesn't
really
make
sense
to
put
them
onto
the
waiver.
So
again,
I
think
our
waiver's
a
little
bit
different
in
that
people
are
getting
services
if
they
to
some
extent,
even
if
they're
not
getting
a
waiver
spot.
D
E
E
A
Okay,
great,
can
you
talk
about
how
the
agency
has
been
managing
your
human
resource
needs
currently
and
what
prompted
the
recommendation
for
the
human
resource
positions
at
the
desert
regional
center.
C
Danish
fit
for
the
record,
so,
as
you
know,
we
are
because
we
operate
a
24
hour
facility,
and
so
we
are
very
similar
to
the
southern
nevada,
adult
mental
health
program.
We
really
look
at
their
structure
and
how
to
support
the
operations
of
a
24-hour
facility,
as
well
as
community
programs,
and
so
those
are
in
alignment
with
what
we
see
in
the
public
and
behavioral
health
budgets
to
support
those
staff.
So
a
lot
of
times
what
happens
is
we
will
get
caseworkers,
but.
B
A
And
then
could
you
talk
about
the
anticipated
impact
of
particularly
on
clients,
of
course,
of
holding
the
33
positions
vacant.
C
For
the
record,
so
yes
holding
positions
does
increase.
The
caseload
ratios
for
our
staff
and,
as
we
know
with
increased
caseload
ratios,
is
a
reduction
in
quality
of
service.
So
we
do
anticipate.
There
would
be
some
impact
to
the
quality
of
services
and
the
amount
of
time
that
our
folks
are
actually
spending
with
the
people
we
serve
and
ensuring
that
services
are
happening.
A
A
Question
maybe.
B
I
I'm
also
on
the
thursday
track
of
trying
to
wrap
my
brain
around.
All
of
this.
B
What
will
you
go
to
the
next
person
and
come
back
to
me.
B
I
think
that
assembly,
woman,
bernice
thompson
may
have
a
question.
A
D
You
so
much,
I
you
know
me:
I've.
I've
always
got
questions,
probably
obnoxiously,
so
so
the
I
I
was.
These
were
kind
of
the
same
questions
that
I
had
asked
before
on
the
src,
but
I
see
just
a
couple
of
different
things
that
were
happening
in
the
drc
budgets
and
I
just
didn't
want
to
make
any
assumptions
about
anything
so
once
again
see
the
increased
spending
for
the
under
the
title,
19,
the
waiver
and
the
community
services.
D
I
think,
under
the
waiver
one.
What
I
noticed
that
was
different
was
that
the
spending
for
the
drc
was
twice
as
much
of
an
increase
as
what
we
saw
for
the
the
src,
and
so
I
it
looks
like
there
was
probably
more
for
work
to
accommodate
changes
there
in
this
past
year.
That
that
I
guess
we
might
not
have
seen
on
the
same
scale
in
washoe
is-
is
that
right.
C
Finishment
for
the
record,
so
to
your
question
about
the
increased
spending
and
yes
that
is
you'll,
see
those
that
apply
across
all
you
know.
The
answer
is
yes.
That
does
apply
to
all
budgets
so,
but
you've
seen
that
desert
regional,
obviously
is
a
much
larger
regional
center
than
the
other
two,
so
that
I
think
that
would
be
the
the
reason
you
would
see
that
the
majority
of
our
folks
that
we
serve
are
in
are
served
by
desert
regional
center.
D
Thank
you
so
much
and
in
my
apology
it
was
a
title
19,
the
icf,
the
id
one
where
I
saw
a
twice
amount
of
increase
in
spending
in
2021
versus
2020,
and
so
I
I
was
just
wondering
why
that
was,
I
said,
said
waiver.
But
that
was
incorrect
because
it
was
ifcid
so
and
then
here
also
as
well.
More
of
a
sub
increase
in
those
those
slas.
D
But
I
did
yeah,
I
I
guess
if
there
was
anything
that
was
substantially
different,
the
dynamic
of
the
what
was
happening
with
our
southern
nevada
population
versus
our
northern
nevada
population.
You
could
just
let
me
know,
I
don't
know,
maybe
different
places
use
respite
differently
or
maybe
there
were
different
dynamics
that
that
caused
some
of
this
to
look
a
little
bit
different.
But
it's
just
more
general
curiosity
than
anything
else.
C
Schmidt
for
the
record,
I'm
going
to
try
to
answer
questions
and
to
me
I
think
what
you're
looking
at,
like.
Let's
talk
about
the
type
the
title
20
funding
the
increase
in
this
biennium
over
last
year,
so
the
title
20.
We
gave
up
the
funding
for
title
20
in
the
last
fiscal
year
due
to
to
work
with
our
partners
during
the
budget
cuts.
C
But
due
to
offset
other
budget
issues
and
items
we've
all
been
faced
during
the
special
session,
we
were
able
to
give
those
dollars
up,
but
you
do
see
the
increase
coming
back
on.
So
it's
not
really
an
increase
in
service
dollars.
It's
just
a
replacement
of
dollars
that
were
previously
in
our
budget.
A
B
C
Finished
fit
for
the
record,
so
really
the
families
that
receive
those
will
have
to
they'll
have
less
service
available,
so
they
use
those
funds
to
purchase
services
and
specialized
services.
So
it
will
reduce
the
amount
of
specialized
services
that
each
family
will.
B
B
So
so,
just
as
a
follow-up
to
that
do
they
have
the
means
or
the
support,
to
find
those
services
that
they're
not
going
to
get
status
for
the
record.
C
C
The
families
that
do
qualify
for
this
program
do
you
have
to
be
at
300
percent
of
poverty
or
less
so
we
would
be
trying
to
find
other
other
other
resources
that
are
not
costing
money
to
be
able
to
have
them
supplement
what
they
are
losing.
A
Okay,
I'd
like
to
just
go
back.
I
think
assemblywoman,
monroe
and
reynold
covered
this,
but
I'd
like
to
just
go
back
to
it
a
little
bit
on
the
on
the
waiting
lists.
A
B
C
Needs,
while
we're
trying
to
find
a
provider
that
can
support
their
higher
level,
needs
so
often
times.
For
example,
many
people
will
get
case
management
services
or
certain
services
that
they
need
kind
of
help
them
as
we
work
to
get
them
on
the
waiver
and
try
to
find
an
appropriate
provider.
Oftentimes.
The
people
that
are
waiting
for
medicaid.
B
A
A
Any
other
questions
we
still
have
the
rural
regional
center
budget.
I
believe,
are
there
any
other
questions
generally
about
globally
or
the
sierra
or
desert
regional
centers.
C
Management
for
the
record
moving
to
slide
22
is
the
rural
regional
center
and
in
this
budget,
account
we'll
be
looking
at
much
of
the
same
that
we've
talked
about
in
the
previous
two
budget
accounts
by
22.
There's
a
program
description
while
slide.
23
is
case,
load
projections
for
this
particular
budget
account
and
then
moving
to
slide.
24
is
the
decision
unit
m201,
which
again
funds
caseload
increases
for
this
budget
account
and
slide.
25
are
the
budget
reductions
that
look
much
like
50
and
the
others
e680
is
holding
vacant.
C
A
C
B
C
The
developmental
services,
if
there
are
any,
but
that
is
the
conclusion
of
our
presentation,.
A
I
appreciate
that
I
think
we
we
bounced
around
a
little
bit,
but
I
think
we
got
there.
I
think
if
just
to
summarize,
I
just
want
to
again
express
my
gratitude
to
you
and
frankly,
the
whole
team
that
you
represent,
that
I'm
sure
was
working
with
a
lot
of
stressed
out
individuals
to
help
them
navigate
a
pandemic
with
some
sounds
like
you
got
some
great
flexibility
in
some
of
your
funding
sources
to
be
able
to
be
nimble
and
to
react.
So
I
wanted
to
just
thank
everybody
for
that.
A
So
just
wanted
to
acknowledge
that
and
express
that,
in
the
midst
of
all
that,
that
was
heard
sounds
like
we
have
some
impacts,
based
on
keeping
some
vacancies
open,
a
rate
increase
in
the
family
preservation
program
that
hasn't
gone
up
in
a
while
the
cut
to
the
fiduciary
problem
program,
and
so
we
appreciate
you
taking
the
time
to
walk
us
through
it,
and
I
apologize
have
been.
A
Am
I
leading
the
discussion
we
jumped
around
a
little
bit,
but
I
think
we
got
the
information
we
needed,
but
thank
you
thank
you
to
you
and
your
team
again
with
that.
I'm
going
to
go
ahead.
I'm
looking
around.
I
don't
see
any
lingering
questions,
I'm
going
to
go
ahead
and
ask
vps
we're
going
to
move
to
public
comment.
So
if
you
would
go
ahead
and
open
up
the
lines
for
public
comment.
B
B
B
E
C
E
Being
the
state's
partner
to
care
for
our
state,
seniors
and
individuals,
with
intellectual,
developmental
and
even
physical
disabilities,
I
appreciate
you
allowing
me
to
speak
today,
nevada,
adult
day.
Healthcare
centers
is
an
alternative
level
of
care
for
individuals
who
want
to
continue
to
live
at
home
with
their
families
rather
than
being
institutionalized.
E
E
E
Dina
schmidt,
jessica
adams,
jennifer
frishman
and
her
management
team
and
javon
kaver
and
his
team
at
desert
regional
centers
have
been
in
constant
communication
with
their
providers
and
have
reminded
us
that
we
are
essential
for
the
health
and
safety
of
nevada's
individuals
with
intellectual,
physical
and
developmental
disabilities.
E
B
B
Correct,
oh
I
I
don't
know
how
much
you
heard
of
what
I
said
that
if
I
may
continue
these.
C
B
Those
were
okay.
Thank
you.
Thank
you.
I
appreciate
that
snapshows,
those
with
intellectual
disabilities
to
meet
their
housing,
transportation,
social
and
employment
related
needs,
and
snap
really
appreciates
the
professionalism
and
the
dedication
of
dina
schmidt
and
her
team
at
adsd.
In
the
regional
centers
snap
membership
is
statewide
working
with
all
three
regional
centers.
We
represent
the
vast
majority
of
providers
in
the
state.
We
appreciate
your
assistance
in
helping
providers
meet
the
needs
of
those
they
serve
by
providing
occasional
adjustments
and
rates.
B
You
will
be
hearing
about
the
concerns
providers
have
with
the
minimum
wage
increase.
They
are
completely
supported
this
supportive
of
the
increase,
but
they
need
the
legislature
to
remember
that
most
are
100
percent
reliant
on
medicaid
dollars
to
support
their
operations
and
pay
their
employees
and
they're
unable
to
raise
outside
dollars.
B
A
B
F
Thank
you
for
taking
the
time
to
listen
to
my
public
comment
this
morning,
I'm
the
chief
operations
officer
for
chrysalis
chrysalis
partners
with
all
three
adsd
regional
centers
desert,
regional
center,
sierra
regional
center
and
world
regional
center.
We
provide
services
for
over
220
people
with
intellectual
and
developmental
disabilities
in
nevada,
and
we
employ
nearly
600
professionals
throughout
the
state.
It's
my
priority
to
use
our
state
medicaid
resources
responsibly
and.
E
F
Individual
meet
their
full
potential.
One
of
our
biggest
challenges
is
ensuring
that
our
medicaid
supported
reimbursement
rates
sustain
a
fair
wage
for
direct
the
direct
care
staff.
We're
very
concerned
about
the
limiting
crisis
that
is
coming
to
our
industry.
The
increasing
state
minimum
wage
in
nevada
will
cause
rates
for
critical
disability
services
to
fall
behind
our
ability
to
pay
staff
at
least
minimum
wage.
It's
necessary
to
raise
these
medicaid
rates
to
be
at
least
commensurate
with
the
rising
state
minimum
wage
that
began
to
go
into
effect
last
year.
F
Funding
for
these
services
relies
exclusively
on
rate
adjustments
from
this
legislative
body.
Raising
the
minimum
wage
without
also
raising
our
rates
for
these
services
will
create
a
crisis
where
disability
providers
will
no
longer
be
able
to
operate
in
the
state
of
nevada.
To
be
clear,
I'm
not
opposed
to
the
increasing
minimum
wage
in
nevada.
On
the
contrary,
I'm
very
supportive
of
the
efforts
to
raise
wages
for
our
direct
care
staff.
Our
staff
provide
an
essential
social
safety
net
for
some
of
nevada's,
most
vulnerable
citizens
without
heroic
caregivers.
F
Many
people
with
disabilities
would
be
at
risk
of
neglect
or
homelessness.
Their
work
is
noble
and
deserving
of
a
fair
wage.
I'm
grateful
for
the
state's
commitment
to
serving
this
wonderful
population
of
citizens
and
chrysalis
is
extremely
thankful
for
the
legislature's
willingness
to
provide
to
provide
the
increases
we
have
previously
previously
received,
as
those
increases
allowed
us
to
raise
wages
for
our
direct
caregivers
across
the
state.
Thank
you.
B
F
F
I
also,
I
also
appreciate
the
time
to
testify
in
support
of
dina
schmidt
and
adsd's
budget
presented
for
the
regional
centers
lisa
foster,
snaps
executive
director
and
lobbyist
emailed,
an
infographic
to
members
of
the
committee,
which
identifies
the
major
support
concerns
we
have
for
our
services
in
july.
Minimum
wage
is
going
to
increase
by
75
cents
and
will
do
so
at
the
same
rate
for
the
next
four
years.
Within
16
months,
we
will
be
unable
to
pay
our
caregivers
the
salaries
required
to
attract
and
retain
them
for
the
jobs
they
perform.
F
These
employees
responsibilities
far
exceed
duties
consistent
with
a
minimum
wage
occupation.
At
our
current
funding
levels,
minimum
wage
increases
outpace,
nevada's
funding
for
services
without
a
corresponding
rate
increase.
We,
as
providers
will
not
be
able
to
pay
our
employees
enough
to
provide
the
supports
that
are
necessary.
F
Currently,
the
federal
government
pays
approximately
66
percent
of
the
cost
of
our
services,
with
the
most
recent
coveted
relief
package
that
funding
has
increased
by
an
additional
10
percent
for
the
next
year.
We
ask
that
if
these
additional
federal
funds
have
been
allocated
for
our
services,
the
legislature
act
to
increase
service
rates
in
order
to
keep
pace
with
nevada's
minimum
wage
increases.
B
B
E
J-U-S-T-I-N-B-E-L-D-O
one
of
my
biggest
concerns-
and
I
do
work
for
aging
and
disability
and
quality
insurance
department-
is
that
the
with
the
raising
cost
of
housing
that
are
we
able
to
maintain
and
much
like
mr
vito
mentioned?
Are
we
able
to
maintain
an
income
level
that
the
providers
can
afford
and
that
our
our
front
line
direct
support
staff
can
live
off?