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From YouTube: 08/19/2020 - Legislative Committee on Health Care
Description
This is the seventh meeting of the 2019-2020 Interim. Please see agenda for details.
For agenda and additional meeting information:https://www.leg.state.nv.us/App/Calendar/A/
Videos of archived meetings are made available as a courtesy of the Nevada Legislature.
The videos are part of an ongoing effort to keep the public informed of and involved in the legislative process.
All videos are intended for personal use and are not intended for use in commercial ventures or political campaigns.
Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
A
C
Go
good
morning
welcome
to
the
seventh
meeting
of
the
legislative
committee
on
healthcare
for
the
2019-2020
interim
thanks
to
everyone,
who's
joining
us
online.
Today
we
appreciate
your
participation
members.
Please
remember
to
mute
your
microphone
when
you're,
not
speaking
our
committee
policy,
analyst
is
going
to
call
the
role
today.
Miss
kamlasi!
Please
go
ahead.
C
A
D
C
C
Some
housekeeping
items
meeting
materials
can
be
found
on
the
committee's
web
page.
Anyone
who
would
like
to
receive
electronic
notifications
of
an
access
to
the
committee's
agenda
minutes
or
final
reports
can
sign
in
at
the
nevada.
It
might
still
be
sorry
can
sign
in
at
the
nevada
legislature's
website.
We'll
have
two
periods
of
public
comment.
C
One
at
the
beginning
of
the
meeting
and
one
at
the
end
of
the
meeting
public
comment
is
limited
to
two
minutes
per
speaker.
The
initial
period
of
public
comment
will
be
limited
to
45
minutes.
Any
additional
public
comment
could
be
provided
at
the
end
of
the
meeting.
There
are
four
ways
to
provide
public
comment,
all
of
which
are
listed
on
the
agenda.
C
Once
again,
that's
not
id
number,
nine
one:
zero,
nine,
seven,
three,
eight
four:
three
zero
one
hashtag
or
emailing
comments
to
healthcare.
All
one
word:
healthcare:
at
l,
c
b,
dot
state
spelled
out
s-t-a-t-e
n,
so
that's
healthcare
at
lcbstate.nv.us,
mailing
comments
to
the
research
division
at
401,
south
carson
street
carson
city,
nevada,
89701.
C
C
C
Before
I
begin,
we
begin
I'd
like
to
note
that
the
results
of
two
studies
that
the
committee
was
required
to
conduct
will
be
posted
on
the
court
committee's
webpage
under
the
meeting
material
tab
for
today's
meeting
senate
bill
636
required
the
committee
to
study
stem
cell
research
centers
and
assembly
bill
131
continues
the
study
from
the
last
interim
of
training
for
unlicensed
personnel
who
provide
care
to
people
in
certain
residential
group
and
health
care
facilities
due
to
the
abbreviated
nature
of
the
virtual
meetings.
C
Ab131
is
for
will
be
forthcoming,
so
it's
not
up
just
yet,
but
it
will
be
there
in
time
for
the
committee
to
make
necessary
decisions,
and
so
with
that
move
on
to
public
comment,
and
let
me
just
get
my
phone
ready,
so
I
can
do
the
timing.
C
Okay
and
again
each
speaker,
each
speaker
will
be
provided
two
minutes
to
ensure
everyone
is
given
a
fair
opportunity
to
speak.
We
also
encourage
members
of
the
public
to
submit
written
testimony
through
one
of
the
methods
listed
on
the
agenda.
All
callers
should
state
and
spell
their
name
clearly
for
the
record.
Lcb's
broadcast
and
production
services
staff
are
coordinating
the
public
comment,
telephone
line,
bps
staff.
Please
add
the
first
caller
to
the.
G
A
A
Madam
chair,
could
I
take
a
few
seconds
here
to
get
this
rolling
and
give
me
two
seconds
here.
One
moment
please.
A
A
A
B
Last
name
is
walter
w-a-l-t-e-r,
I'm
the
executive
director
for
remsa
care
flight
out
of
reno,
and
I'm
also
representing
the
nevada
ambulance
association
association
today
learned
about
the
agenda
earlier
actually
late.
Last
night
and
I
understand
there's
an
item
on
there
from
the
national
conference
state
legislatures
concerning
the
cost
of
aero
medical
services,
not
sure
exactly
what
they're
going
to
be
discussing.
But
I
wanted
to
extend
an
opportunity
if
you
would
send
an
opportunity
to
that
association
for
equal
time
to
identify
some
of
the
dynamics
facing
the
air
services
in
nevada
and
across
the
country.
B
B
B
This
cost
shift
is
just
a
reality
of
our
nation's
health
care
system
today
and
unfortunately,
what
we've
been
seeing
is
health
insurers
unwilling
to
participate
in
this
cause
and
decreasing
reimbursements
over
the
last
several
years
with
this
atmosphere,
the
survival
of
both
air
and
ground
ems
services
is
a
is
a
very
much
concern.
Our
margins
are,
and
things
are
becoming
sustainable.
Yes,.
C
Over
two
minutes,
so
what
I'll
invite
you
to
do
is
please
provide
us.
The
information
that
you'd
like
to
have,
please
feel
free
to
send
it
to
the
committee
and
we'll
make
sure
that
all
the
members
get
copies
of
anything
you'd
like
to
provide
us.
A
A
A
A
First
of
all,
I
would
like
to
thank
you
for
creating
hearing
aid
program
for
children
under
13
for
the
deaf
and
hard
of
hearing
community
during
the
80th
session.
That
is
a
great
step
to
ensuring
children
have
access
to
hearing
aids
during
the
critical
time
in
their
development
hearing.
Aids
are
not
covered
by
many
insurance,
but
when
they
are,
it
offers
a
high
deductible.
A
A
A
B
B
C
A
C
C
C
Second,
okay.
I
believe
that
was
another
thing
from
dr
titus
and
a
second
from
an
assemblywoman
monk,
yeah,
okay,
great
we'll,
take
a
roll
call
vote
to
approve
the
motion.
Miss
kamlasi.
F
A
C
Okay,
with
that,
the
motion
passes.
Thank
you
with
that.
We
will
move
on
to
agenda
item
four,
which
is
a
consideration
of
the
regulations
proposed
or
adopted
by
certain
licensing
boards
pursuant
to
nrs
430.225
number
or
letter
a
is
lcb
file,
r040
dash,
20
of
the
state
board
of
pharmacy
and
then
b
is
lcb
file.
R04
1-2-0
also
the
state
board
of
pharmacy,
mr
robbins.
If
you'd
like
to
go
forward
with
that.
G
Okay,
eric
robbins
lcb
legal,
as
the
chairwoman
said,
we
have
two
regulations
both
from
the
board
of
pharmacy,
both
have
been
adopted
by
the
board,
but
have
not
yet
been
approved
by
the
legislative
commission,
and
I
believe
someone
from
the
board
of
pharmacy
should
be
available.
If
the
committee
has
further
questions
on
the
regulations.
C
Right
and
I
believe
that
is
dave-
the
executive
secretary
for
the
state
board
of
pharmacy.
If
anyone
does
have
any
questions.
I
Yeah,
this
is
brett
kant
from
the
state
board
of
pharmacy
general
counsel.
I
just
unneeded
myself
to
let
you
know
I'm
available.
If
there
any
questions
I'll
meet
myself
again,.
C
C
Okay,
I
know
I
have
a
question.
Let
me
just
find
that
in
my
notes,
sorry,
I'm
working
with
multiple
screens
for
my
notes.
C
C
It's
it's
an
nrs.
C
Which
of
the
files
that
came
from
or
which
of
the
regulations
that
was
mentioned
in,
I
guess
that's
in
so
that's
I
get
mentioned
in
chapter
639
of
nac,
mentions
that
the
executive
secretary
may
require
a
person
who
submits
their
application
for
issuance
of
a
license
or
permit
pursuant
to
chapter
453,
454
or
639
of
nrs,
or
an
application
through
the
renewal
of
any
such
license
certificate
or
permit
to
appear
at
the
next
regular
meeting
of
the
board.
C
If
the
application
contains
any
information
that
indicates
the
applicant
engaged
in
conduct,
which
would
be
prohibited
pursuant
to
nrs
453,
236,
639.210
or
639.28.95,
so
that
just
led
me
to
nrs
639.210
and
the
language
about
the
grounds
for
suspension
or
revocation,
and
as
I
mentioned,
the
this
committee
before
has
has
questioned
other
boards
about
concerns
about
kind
of
vague
language
in
and
boards,
having
ability
to
look
at
at
people's
moral
character.
You
know
this.
This
includes
in.
C
If
you
go
to
nrs
639.2
reference
to
if
a
person
is
a
good
moral
character,
is
guilty
of
habitual
intemperance
talks
about
intoxication,
which
that
obviously,
that
that
is
definitely
concerned,
but
then
is
guilty
of
unprofessional
conduct
or
conduct
contrary
to
public
interest,
substance,
use,
disorder
and
then
convictions,
violations
of
federal,
gov
of
the
federal
government
relate
to
control,
controlled
substance,
etc.
C
I,
I
guess,
can
you
just
address
that
section
of
the
statute
and
what
the
board
does
how
those
determinations
are
made?
Clearly
we
want
our
our
pharmacists
to.
You
know
not
not
break
federal
federal
law
when
it
comes
to
controlled
substances.
C
That's
that's
a
very
clear,
bright
line,
but
what's
going
on
with
the
board
when
it
comes
to
making
a
decision
about
moral
character
or
moral
turpitude,
that
type
of
thing.
I
Okay,
thank
you
for
your
question
once
again,
brett
kent
general
council
council
to
the
board
for
the
record,
and
I
just
by
way
of
brief
background,
the
the
proposed
regulation
would
codify
an
existing
practice.
I
have
tried
to
identify
instances
in
which
the
board
has
an
existing
practice
in
the
way
it
regulates
its
licensees
that
I
think
should
be
reflected
in
a
regulation,
and
so
that's
simply
what
this
does,
but
to
get
back
to
the
heart
of
your
question.
I
Understand
that
the
board
not
only
licenses
and
regulates
pharmacists
but
license
and
regulates
the
entire
distribution
chain
for
introducing
dangerous
drugs
and
controlled
substances
into
our
state
and
ultimately
getting
them
to
patients
and
so
you're
talking
about
giving
doctors
controlled
substance,
registration
to
prescribe
and
dispense.
I
You're
talking
about
wholesalers
that
are
distributing
drugs
into
our
state.
And
so
the
issue.
Is
we
if,
if
an
applicant,
whether
it's
for
an
individual
seeking
a
a
registration
as
a
pharmacist
or
as
a
doctor
wanting
to
prescribe
or
dispense
or
whether
it's
an
owner
of
a
company
that
wants
to
manufacture
wholesale
distribute
or
something
else
in
the
supply
chain?
The
concern
is
to
make
sure
that
they
don't
have
a
criminal
background.
I
It
could
pose
a
risk
to
to
the
public
and
to
nevada
patients
and
two
that
they
don't
have
a
substance
abuse
issue
themselves,
or
at
least
if
they
have
had
it,
that
it's
disclosed
and
that
the
board
can
make
a
determination
that
the
individual
substance
abuse
issue
has
been
solved,
treated
and
solved,
and
that
the
individual
might
not
be
a
risk
for
diversion
if
they
have
access
to
controlled
substance
or
dangerous
drugs.
I
The
board
wants
to
be
able
to
assess
that
individual
or
that
applicant
or
on
an
initial
application
or
on
renewal
that
happens
once
they've
been
licensed
to
determine
whether
the
individual
can
once
again
engage
in
that
licensed
activity
in
a
way
that
doesn't
pose
a
risk
to
nevada.
C
F
F
Thank
you,
I
mean
recognizing
the
reality
of
substance
abuse.
What
is
the
plan
for
those
who
have
already
partaken
of
the
forbidden
fruit,
I'll
call
it,
and
how
do
we
keep
them
in
the
system?
And
how
do
we
then
allow
others
to
do
this
and,
like
the
chair
said,
I
have
another
concern
because
you
know
I'm
a
republican
and
I
have
voted
against
attacks
and
have
been
called
immoral,
because
that's
not
immoral,
so
that
that's
a
fraction
of
moral
interpreted
by
some
people,
so
that
the
concept
of
morality
is
a
flexible
thing.
I
Well,
once
again,
the
board
makes
these
determinations
on
the
record
at
a
public
meeting,
and
it's
had
a
long
precedent
that
it
is
focused
on
criminal
conduct
or,
if
there's
been
past
substance,
abuse
to
the
extent
it's
directly
related
to
the
activity
for
which
they
want
a
license
and
and
and
nothing
further
than
that
and,
like
I
said,
I
think,
there's
a
direct
nexus.
I
If
an
individual
has
a
criminal
history,
that's
related
to
whether
it's
trafficking,
whether
it's
diversion
something
related
to
controlled
substances
and
dangerous
drugs
and
sampling,
that
they've
got
that
substance
abuse
history.
I
Now,
if
they
have
a
substance,
abuse
history
or
they
develop
a
substance
abuse
issue,
while
a
licensee,
the
board
doesn't
well
one,
they
have
a
due
process
right
in
their
license,
but
the
board
seeks
to
provide
them
assistance
and,
to
you
know,
get
them
resources
to
address
their
substance,
abuse
issue
to
an
extent
that
the
board
then
deems
them
able
to
go
back
to
practicing
in
a
safe
manner
in
a
way
that
doesn't
pose
any
risk
to
nevada
patients.
I
And
so
the
board's
goal
is
one
of
compliance
rather
than
to
be
punitive
to
a
licensee
or
an
applicant.
I
Well,
you
know,
I
think,
that's
a
term
that
probably
is
a
dated
term.
I
think
it
was
a
term
that
was
commonly
used
in
legislation
in
the
past.
C
Thank
you.
Do
we
have
any
other
questions?
Okay
and-
and
mr
can't,
you
you
mentioned
that
I
believe
you
said
that
that
the
regulations
go
up
and
down
the
supply
chain.
C
So
with
that,
when
you
also
talked
about,
if,
if
people
need
treatment
in
order
to
continue
working,
that
type
of
thing
are
are,
for
instance,
you
know,
texts
given
pharmacy
texts,
given
the
same
type
of
ability
to
seek
treatment
as
a
pharmacist
is
given
in
order
to
stay
in
this
field
and
to
continue
their
employment
as
opposed
to
being
told
nope.
You
just
have
to
go,
find
a
new
career
path.
I
I
However,
whether
you're
talking
about
a
pharmacist,
a
pharmaceutical
technician,
a
doctor,
a
nurse
or
some
other
professional
that
develops
a
substance,
abuse
problem.
You
know
the
the
the
immediate
issue
is,
you
know
that?
Can
they
currently
practice
safely
and
whether
their
ability
to
currently
practice
and
have
access
to
controlled
substance
and
dangerous
drugs
needs
to
be
suspended
for
some
period
of
time
to
allow
them
to
then
seek
treatment
and
address
the
underlying
issue?
I
And
then,
when
they
demonstrate
that
they've
addressed
the
underlying
issue,
they
come
back
before
the
board
and
the
board
restores
their
license
and
that
that
happens
regularly,
and
it
doesn't
matter
once
again
whether
it's
pharmacists,
a
farm
tech
or
a
doctor.
I
We've
had
all
three
instances
where
the
individual
wants
to
to
seek
treatment
and
address
their
issue
and
continue
their
career
and
once
they
address
the
issue
through
through
treatment
and
and
demonstrate
to
the
board
satisfaction
that
they
no
longer
pose
a
risk
to
to
nevada
patients
and
having
access
to
controlled
substances
and
dangerous
drugs.
The
board
regularly
restores
an
individual's
licenses
in
that
instance,.
C
Okay,
thank
you
for
that.
So,
with
that
we're
going
to
move
on
to
agenda
item
number
five,
which
is
a
presentation
regarding
air
ambulance
costs
and
I'll
ask
colleen,
becker
who's
the
senior
policy
specialist
for
health
programs
from
the
national
conference
of
state
legislature
state
legislatures
to
provide
her
presentation
for
us
on
air
ambulance
costs
and.
K
K
Yes,
great,
thank
you
so
again,
thank
you
for
letting
me
present
today
on
state
action
related
to
the
issue
of
surprise
billing
and
air
ambulances.
My
name
is
colleen
becker
and,
as
the
chair
said,
I'm
a
senior
policy
specialist
with
the
national
conference
of
state
legislatures
and
quickly.
K
Our
members
include
the
7
383
legislators
and
the
20
to
30
or
so
thousand
legislative
staff,
for
whom
we
provide
research
assistance,
not
only
introduce
legislation,
but
also
on
existing
laws
and
policies.
Most
importantly,
we
do
not
take
ends,
nor
do
we
craft
model
legislation.
K
K
K
K
And
here
I've
included
the
maps
from
the
gao
study
of
both
types
of
providers,
and
we
can
see
that
nevada
also
saw
the
addition
of
at
least
a
few
hair
helicopter
bases
and
at
least
one
new
airplane
base,
and
this
is
the
fixed
wing
basis.
K
L
K
K
Researchers
involved
in
the
gao
study
investigated
private
insurance
data
and
found
that
in
2017,
the
median
price
for
a
helicopter
transport
was
about
was
over
36
000
and
the
median
price
of
an
airplane
transport
was
just
shy
of
41
000.
K
K
K
So
currently,
there
are
30
states
that
have
at
least
some
protections
for
their
consumers
from
surprise
balance
spills,
including
nevada,
but
those
protections
only
extend
to
insurance
plans.
The
state
can
regulate
and,
moreover,
states
are
precluded
from
regulating
air
ambulances
due
to
the
airline
deregulation
act
of
1978.
K
In
the
interest
of
time,
I'm
not
going
to
go
into
this
slide,
but
it
details
has
a
lot
of
detailed
information
from
the
georgetown
center
on
health
insurance
reform,
and
I
inserted
it
because
it
describes
the
specific
balanced
billing
protections
in
nevada.
However,
again
nothing
in
nevada,
state
law
addresses
surprise
billing
from
air
ambulance.
Surprise
billing
from
areas
providers.
K
There's
a
long
precedent
of
federal
rulings
and
law,
preventing
states
from
regulating
numerous
aspects
of
the
industry.
But,
as
I
just
said,
the
most
notable
is
the
airline
deregulation
act
of
1978
or
the
ada,
which
specifically
preempts
states
from
regulating
the
rates,
route
and
service
of
air
carriers
which
air
ambulances
are
certified.
As
the
ada
includes
issues
such
as
certificates
of
need,
or
public
necessity,
pilot
training,
limitations
on
geographic
service
areas
and
mandating
services
included
in
a
provider's
subscription
or
membership.
Oops
sorry
jumped
ahead
there,
so
you're,
probably
thinking
well.
K
What
can
a
state
do
and
what,
if
lawmakers
tried
before,
even
with
the
ada
employee
legislators
have
made
several
attempts
to
pass
laws
to
prevent
air
ambulances
from
balance
billing
patients,
and
although
many
of
them
have
failed,
a
few
of
them
have
had
some
limited
success
where
most
state
proposals
have
synergy.
Is
that
patients
should
not
be
in
the
middle
of
balanced
billing
disputes
period?
K
So,
for
instance,
a
montana
law
passed
in
2017
holds
patients
harmless
in
situations
where
they
are
transported
by
an
out-of-network
air
ambulance
provider.
The
insurer
must
negotiate
payment
directly
with
the
provider
and
they're
prohibited
from
balance
billing
the
patient,
and
importantly,
though,
this
law
only
applies
to
hospital
loan
ambulances
and
not
independently
owned
or
government
owned.
K
North
dakota
also
passed
legislation
in
2017,
which
did
three
things.
The
first
thing
it
did
is
required
hospitals
that
refer
patients
for
non-emergency
transport
to
another
facility
to
first
notify
the
patient
or
their
representative
of
the
contractual
contractual
relationship.
If
any,
between
the
patient's
health
insurer
and
the
air
ambulance
provider.
K
K
And
the
third
thing
it
does
is
that
it
bans
air
ambulance
providers
from
balance
billing
patients.
In
instances
where
an
air
ambulance
is
out
of
network
the
insurer
is
is
required
to
pay
the
out
of
network
provider
the
average
of
in-network
rates
they
pay
for
other
providers
of
the
same
type
which
they
contract
with.
K
So
that's
regardless
of
network
status,
and
this
went
into
effect
in
january,
and
I
have
not
heard
or
seen
that
it
is
being
challenged
yet
and
then
I
added
this,
even
though
it
was
denied,
it
was
a
kind
of
an
innovative
approach.
K
All
state
residents
would
be
covered
under
the
state
medicaid
program
for
the
purposes
of
air
ambulance
services,
regardless
of
income
level,
and
then
providers
would
have
had
to
bid
on
contracts
for
specific
areas,
geographic
areas
and
they
would
have
been
paid
a
flat
rate.
However,
it
was
rejected
for
two
reasons.
K
So
the
last
slide
here
I'll
talk
a
little
bit
about
federal
action,
because
it's
going
to
take
a
change
in
federal
law
to
both
address
the
ada
preemption
and
also
apply
to
health
coverage
of
all
types
plus.
Surprise.
Billing
is
one
area
where
we've
seen
bipartisan
support
in
both
chambers,
both
nationally
and
at
the
state
level.
K
The
committee
did
begin
its
work
in
january
this
year,
but
that
work
stalled
out
due
to
the
onset
of
the
pandemic,
and
there
were
also
several
pieces
of
legislation
addressing
surprise
bills
as
a
whole
that
were
moving
through
committees
in
bold
chambers.
But
most
of
those
efforts,
too
have
stalled,
but
the
most
promising
effort
that
included
an
air
ambulance
provision
is
from
the
senate,
health
and
house
energy
and
commerce
committees,
which
was
a
compromise,
and
it
was
called
the
lower
health
care
costs
act.
K
I'm
sure
many
of
you
have
heard
and
know
about
it
and
it
specifies
that
patients
are
held
harmless
from
surprise
air
ambulance
medical
bills
and
that
patients
are
only
required
to
pay
the
in-network
cost-sharing
amount
and
it
also
allows
for
either
the
provider
of
the
health
plan
or
the
the
fair
ambulance
provider
to
initiate
an
independent
resolution
process
and
also
on
a
high
note
as
well.
K
F
F
K
So
you're
right
there
is
an
established
fee
for
air
ambulances
through
medicaid
and
I
apologize.
I
don't
know
what
that
actual
percentage
is,
but
traditionally
you're
right,
most
medicare
and
medicaid
fee
is
are
substantially
less
than
what
commercial
payers
pay.
So
you
know
there's
that
balance
and
as
I
was
stating
earlier
anywhere
from
you
know,
56
to
70
percent
of
air
ambulance
transports
are
medicare
or
medicaid-based.
K
So
that
is
definitely
something
to
consider
when
considering
these
proposals
and
how
they're
going
to
affect
different
hackers
in
the
in
that
in
that
chain,
but
yeah,
so
I
don't
know
actually
what
the
percentage
is
and
I'd
be
happy
to
look
into
it
or
I'm
not
sure
if
some
other
folks
were
going
to
participate
and
send
some
materials.
But
I
will
make
sure
that
I
look
into
that,
for
you.
F
Well,
let
me
ask
it
this
way:
would
125
medicare
rate
even
pay
for
the
gas
that
islet
etc?
I
mean
recognizing
that
if
it
weren't
for
the
payers
that
are
paying
out
of
network
how
in
the
world,
are
you
going
to
pay
for
over
50
of
your
flights,
taking
a
hit
where
you
don't
make
any
money
at
all
right,
you
don't
even
break
even.
K
Sure
and
I'm
not
certain
what
their
costs
are,
and
it's
not
just
even
gas
too
it's
personnel
and
you
know
maintenance
and
having
the
right
equipment
on
board,
so
I'm
not
sure
how
much
their
costs
are
and
what
that
that
balance
is
to
the
the
thirty
to
forty
thousand
dollars
that
they
have
to
charge.
But
again
to
your
point,
you
have
to
make
up
those
costs
somewhere.
So
I'm
not
sure
I'm
not
sure
what
those
costs
are,
though,.
C
Yeah,
you
woke
up
and
miss
becker
kind
of
following
up
on
on
senator
hardy's
question,
so
you
mentioned
that
flights
can
be
independent,
hospital-based
government-owned
providers.
C
Do
we
do
we
know?
Is
there
a
difference
in
what
ledges,
where
there
tends
to
be
more
of
which
kind?
What
in
which
states
and
where
the
legislation
is
I
mean,
for
instance,
you
know
when
you
talk
about
okay,
well,
they've
passed
this
in
california
or
they
passed
that
in
texas.
Does
there
tend
to
be
more
hospital
based
in
texas?
You
know
that
type
of
thing
are
there.
Are
there
trends
like
that
that
we're
seeing.
K
K
I
had
outreached
them
to
kind
of
get
the
division
of
insurance
to
get
a
little
bit
more
information
about
why
they
went
with
hospital
loan
versus
other
providers,
as
well
as
some
of
the
background
on
the
legislation,
and
I
have
not
yet
been
able
to
connect
with
them,
but
I
don't
know
what
the
balance
is
per
state.
K
I
would
assume
that
it
would
be
very
different.
All
I
have
is
the
gao
report
with
the
maps
as
to
which
provider
or
how
many
providers
are
in
which
I
know
that
there
is
also
an
atlas
as
well
that
is
accessible
through
aams,
but
the
data.
As
I
understand
it,
is
much
it
is
a
snapshot
in
time
versus
you
know
concrete
numbers,
so
I
think
it's
an
evolving
thing
so,
but
that's
about
the
only
information
I
have
and
again
I'd
be
happy
to
look
into
nevada,
for
you.
C
K
C
K
I
they
do
have
some
information
on
that.
I
think
part
of
it
is
the
increase
in.
C
Okay,
I
was,
I
was
also
kind
of
wondering,
for
instance,
if
it's,
if
there
might
be
a
correlation
between
closures
of
rural
hospitals
and
rural
clinics,
and
that
might
be
causing
more
of
the
usage.
But
I
I
so
I'd
be
kind
of
interested
to
see
if
that
has
any
correlation
to
it,
but
anyway,
okay,
do
we.
C
Find
for
you,
thank
you,
I'd
appreciate
it.
Do
we
have
any
other
questions
committee,
I'm
sure
dr
hardy.
F
Thank
you,
madam
chair.
Is
there
a
statute
of
federal
statute
that
forces
a
business
to
do
business
in
a
given
state?
In
other
words,
so
if
nevada
did
something
egregious
to
the
industry
and
the
industry
said
well,
you
know
we
can't
afford
to
be
there.
Then
we've
basically
taken
our
rural
population
and
the
people
who
drive
on
our
roads
through
the
rural
population
and
we've
said
sorry.
We
don't
have
any
way
to
get
you
there
in
time.
So
is
there
a
statute,
federally
forces,
state
state
or
else
to
have
a
air
ambulance.
K
Service
yeah,
I
believe
it's
state
law
that
we
have
to
have
there's
not
a
national
law
that
I
know
of,
but
I
believe,
there's
many
state
and
local
laws
saying
that
there
must
be
services
available,
not
including
your
network
adequacy
standards
very
often
apply
to
those
services
as
well.
Again,
I'm
not,
I
don't
know
the
specifics
as
far
as
nevada
and
what
the
requirements
are
as
far
as
networks
there,
but
I
would
assume
most
states
have
it
built
into
a
lot
of
their
network
adequacy.
F
F
I
mean
that
they
can
say:
okay,
we
we
don't
go
there,
but
the
insurance
companies
have
to
do
that.
So
we
have
a.
Apparently
we
have
a
state
law
that
says:
if
you're
going
to
do
business
with
any
insurance
company
in
nevada,
you
have
to
provide
the
same
service
for
somebody
who's
out
of
network.
Is
that
what
you're
saying.
F
So
I
I
guess,
when
we
do
an
insurance
policy
in
the
state
where
we
require
somebody
to
an
insurance
company
to
cover
a
certain
population
of
their
specific
people
and
does
that
does
that
flight
in
short
flight
requirement,
their
ambulance
requirement
require
them
to
pick
up
anybody
anywhere
in
the
state,
or
do
they
have
the
option
not
to
pick
up
anybody
if
they're,
not
in
their
network,.
K
Well,
that's
I
mean
it's
dependent
for
kind
of
mixing,
two
things
there
so
you're
right,
the
insurers
have
contract
with
specific
folks,
but
I
don't
believe
air
ambulance
providers
have
an
option
on
picking
up
folks
whether
or
not
they
want
to.
They
have
an
obligation,
a
state
legal
obligation
to
pick
folks
up
whether
or
not
they
get
paid
or
not.
K
State
law,
as
far
as
I
I
knew
I
don't
think,
there's
national
law,
I
could
be
wrong.
This
is
not
I'm
not
as
well
versed
on
the
national
scope
of
this.
This
issue,
I'm
more.
I
would
need
to
ask
my
co-colleagues
in
dc.
I
apologize.
I
don't
know
that
information,
whether
there's
a
national
law.
I
just
know
that
there
are
state
laws.
F
So,
as
a
state,
we
don't
have
the
right
to
say
you're
near
ambulance,
you
have
to
pick
up
everybody
and
anybody
unless
we
tie
that
to.
If
you
want
to
do
insurance
business
in
the
state
of
nevada,
then
you
have
to
also
pick
up
other
people
who
aren't
insured.
Is
that
my
understanding
is
that
correct.
K
F
K
A
Senator
hardy,
this
is
megan.
We
can
also
look
into
that
as
staff
eric
robinson
look.
C
Meeting,
thank
you
miss
kamasi,
with
that
we
have
a
question
from
dr
titus.
J
So,
thank
you,
madam
chair,
and
along
the
same
line
of
question
that
dr
hardy
had
I'm
curious
about
the
regulations
here
in
nevada
would
appreciate
megan
if
you
and
eric
could
maybe
get
us
what
the
requirements
are
here
for
our
state,
because
I
think
there's
some
misunderstanding
about
obligations
and
and
mandatory
transports
et
cetera,
the
the
911
calls
that
go
out,
especially
in
the
rural
areas.
There
are
lifeline
air
ambulances
are,
but
it's
not
the
fixed
wing.
J
It's
actually
usually
a
helicopter,
the
care
flights
and
I'd
really
like
to
have
a
follow-up,
maybe
some
document
or
information
from
them.
I
do.
I
think
that
our
care
flight
does
do
balanced,
medicare
building
and
would
like
to
see
that.
I
also
would
like
to
see
hear
about.
Maybe
what
other
states
would
they
pass
regulations
if
any
of
the
air
ambulance
services
have
been
forced
to
close
down,
they
say:
there's
a
mandatory
price
that
we'll
pay
and,
if
that's
grossly
below
what
their
actual
cost
is.
How
can
somebody
stay
in
business?
J
So
I
think
we're
lacking
a
lot
of
information
here.
Unfortunately,
this
isn't
a
decision
item.
This
is
just
information,
but
I
think
now
that
it's
been
opened
and
I'm
I'm
sensing
the
concern
about
balance,
billing
and
and
people
left
to
cover
a
covered
charge.
I
I
see
which
is
going
and
maybe
why
this
was
on
here
today,
but
we
need
a
lot
of
information
before
we
can
say.
J
No,
no,
you
can't
come
after
the
individual,
et
cetera
and
or
you
know,
should
we
be
holding
the
insurance
companies
accountable
and
mandate
that
they
pay
these
bills
and
that
that's
one
of
my
concerns
in
rural
in
rural
nevada.
J
Believe
me,
when
we
heard
from
remsa
earlier
and
public
comment
and
regarding
carefly
and
the
transport,
our
local
ambulance
services
will
not
transport
so
many
frequently
from
our
hospital
to
the
tertiary
centers,
it
is
only
fair
flight
that
will
do
that
many
times
we
don't
have
paramedics
out
here
and
to
assume
that
that
they're,
going
to
do
that
pro
bono
always
and
still
stay
open
is
is
pretty
naive.
So
I
I
think
we
need
a
lot
more
information.
J
It's
a
topic
that
we
haven't
discussed
before,
but
boy
since
we've
we've
gotten
here.
I
think
it
would
be
helpful
to
get
to
see
what
the
rules
are
here
in
nevada
see
what
the
bottom
lines
are.
As
far
as
you
know,
staying
afloat
and
again
back
to
our
presenter.
What
states
have
they
lost
any
providers?
Air
ambulance
providers
by
having
regulations?
Do
we
have
any
information
on
that?
That
would
be
my
question.
J
So
I
think
the
following
then,
would
be
to
see
what,
where
we
are
in
nevada,
see
what
the
obligation
is
for
because
I
frankly
had
when
I
call
when
I'm
doing
remember
in
the
emergency
room,
and
I
need
somebody
transported
out.
I've
called
our
local
ambulances
and
they
can't
come
they're
busy
or
they
won't
transport.
They
don't
have
anybody
available.
J
You
know
the
the
air
conditions
aren't
such
like
a
smoky
day
like
today,
in
nevada,
careflight
can't
fly,
I
mean
it
can
be
a
fairly
disparate
and
desperate
and
pretty
dramatic
time
trying
to
get
somebody
transported
out.
So
any
limiting
on
on
that
accessibility
would
be
pretty
dramatic
to
rural
nevada.
C
Okay,
well,
I
I
would
say
dr
titus,
I
don't
think
you
should.
You
know
state
that
that
you
see
where
something's
going
every
legislator
has
a
right
to
bring
any
bdr
they'd
like
to
bring,
and
certainly
you
know,
every
bill
is
vetted
during
session.
C
So
you
know
if
a
bill
comes
from
a
presentation,
it
will
be
fully
vetted
during
session
and
all
parties
will
have
an
opportunity
to
present
at
a
at
a
hearing
if
there
is
in
fact
a
hearing,
but
don't
presume
because
we
have
a
presentation
at
an
interim
committee
that
the
writing
is
on
the
wall
about
anything
with
that
said,
as
I
told
the
commenters
during
public
comment,
they
certainly
have
a
right
to
provide
us
with
any
information
that
they'd
like
to
provide
us
with,
and
we
definitely
appreciate
miss
becker,
providing
us
with
the
information
that
she's
providing
with
us
today,
because
this
is
an
important
issue
for
a
great
deal
of
nevada,
especially
in
the
rural
areas.
C
As
ms
kamalasi
stated,
she
and
mr
robbins
can
provide
that
information
to
you
and
to
the
rest
of
the
committee
and
answer
dr
hardy's
questions
and,
and
ms
becker
stated,
as
she
stated,
she'll
provide
us
with
more
information
so
that
we
can
get
a
fuller
understanding
of
this
of
the
situation
and,
what's
going
on
in
other
states
and
how
legislation
is
impacting
the
citizens
in
those
states
when
they
do
have
legislation,
that's
passed
with
that.
Do
we
have
any
other
questions,
go
ahead.
Vice
chair,
ready.
A
Thank
you,
madam
chair,
just
wanted
to
ask,
as
all
the
parties
are
gathering
information
to
share
it
with
us,
whether
that
be
the
folks
who
presented
during
public
comment
or
our
friends
at
ncsl
or
our
own
staff,
if,
as
you're
looking
at
the
information,
if
you
could
sort
of
break
it
out
into
emergency
transport,
that
is
part
of
the
ems
system,
as
in
there's
a
crisis
that
person
needs
to
be
transported
now,
it's
a
9-1-1
call
and
medical
transport
that
needs
to
happen,
but
there's
more
flexibility
around
timing
and
there's
often
you
know
more
opportunity
to
have
options
or
to
to
be
thinking
about
different
ways
to
do
it,
and
I
understand
that
the
situations
and
the
rules
there's
maybe
a
scarcity
of
options,
but
since
we're
looking
at
not
just
what
happens
in
the
rurals,
but
also
what
happens
in
our
larger
urban
areas,
I
do
think
that
that
distinction
is
really
important,
because
I
think
our
at
least
from
what
I'm
familiar
with
in
washoe
county.
A
The
mechanisms
for
doing
those
two
things
are
are
quite
different.
I
think
in
washoe
county
we
have
a
franchise
agreement
with
a
single
entity
that
accounts
for
those
types
of
things.
So
it's
a
single
entity
system,
whereas
medical
transport
is
very
different,
so
just
as
readiness
that
information,
if
you
could
break
it
into
those
two
buckets
of
the
true
part
of
the
ems
system,
that
is,
that
that
important,
critical
need
and
then
medical
transport
generally.
I
would
appreciate
it.
Thank
you.
C
All
right
and
anything
else,
you
would
like
to
add
ms
becker.
C
Okay
with
that,
thank
you
very
much
so
much
then.
We
certainly
appreciate
ncs
stella,
always
providing
us
such
good
information,
such
always
such
a
good
partner
for
us
in
the
nevada
legislature.
We
really
appreciate
it,
so
thank
you.
C
H
Thank
you,
madam
chair.
Madam
chair
members
of
the
committee.
My
name
is
jennifer
robertson
and
I'm
a
mom
of
five
children
here
in
las
vegas,
and
I'm
with
you
today
to
talk
about
four
of
my
kids
when
my
husband,
brian
and
I
were
still
dating.
We
had
all
of
those
conversations
we
all
have
about
how
many
children
we
wanted
and
what
our
hopes
for
the
future
were
for
our
family
and
he
wanted
two
kids.
I
was
an
only
child
and
wanted
three
well.
H
H
So
when
brian
and
I
talked
about
starting
a
family,
I
told
him
that
I'd
like
to
look
into
foster
care.
I
think
he
cocked
his
head
and
said:
oh
okay,
and
that's
about
how
much
thought
went
into
that
agreement
years
later,
when
we
were
unable
to
start
a
family.
Naturally,
we
looked
at
each
other
and
said
want
to
call
about
foster
classes,
and
that
was
an
easy
next
step.
We
never
looked
back
and
we
were
licensed,
foster
parents
for
almost
10
years.
We
had
kids
in
and
out
the
entire
10
years.
H
We
were
lucky
enough
to
adopt
our
very
first
placement.
He
was
a
wildly
angry
two-year-old
with
fiery
curls
and
he
had
a
temper
to
match
and
less
than
a
year
later
we
got
a
call
for
a
newborn
sibling
who
I
brought
home
from
the
hospital
at
four
days
old.
We
were
excited
to
know
that
they
would
grow
up
together.
H
They
would
share
a
similar
life
experience.
They
would
always
have
someone
who
understood
exactly
what
the
other
one
was
going
through
and
13
years
later.
I
I
can't
tell
you
we
never
could
have
imagined
or
anticipated
the
joy
and
the
challenges
that
those
two
have
brought
us
they've
since
been
joined
by
another
set
of
half-siblings.
A
newborn
girl,
we
were
told,
would
stay
for
a
few
weeks
and
she's
starting
fifth
grade
next
week
and
her
little
sister,
who
came
a
year
later,
who
we
could
not,
of
course
say
no
to
her
placement.
H
We
fought
to
keep
our
first
two
together
as
siblings,
and
we
were
gonna.
Try
to
keep
the
younger
two
siblings
together,
they're
unrelated
to
each
set
of
half-siblings
is
unrelated
to
each
other,
but
we
thought
they
all
deserve
to
stay
together
and
we
were
going
to
try
to
make
that
happen
and
as
a
side
note
the
day
after
that,
fourth
child
came
home,
we
found
out,
I
was
pregnant,
so
we
thought
we
were
done
with
three.
Suddenly
we
had
five
in
a
tiny
house.
One
income
and
every
single
day
was
really
really
hard.
H
We
later
learned
that
all
four
of
them
were
alcohol
and
substance
exposed
in
utero
that's
either
proven
or
suspected
due
to
years
of
parental
use.
You
won't
find
this
on
their
social
summaries
or
on
any
pre-adoption
paperwork,
though
this
was
all
documented
by
us
post-adoption
while
preparing
for
various
evaluations,
educational
testing,
hospitalizations
and
some
neuropsyc
exams,
I
was
able
to
contact
birth
parents
and
family
members
getting
confirmation
of
prenatal,
drinking
drug
use,
diagnosed
and
undiagnosed
mental
health
issues
and
learning
disabilities
compound
all
of
those
issues
with
trauma
and
a
foster
care
history.
H
In
some
cases
a
multi-generational
foster
care
history,
and
you
can
begin
to
understand
the
background
of
my
children.
Even
the
newborns
I
brought
home
from
the
hospital
myself
were
dealt
a
very
difficult
hand
before
they
were
even
born.
Our
children
are
bright,
they're,
funny,
they're,
beautiful
spirited,
loving
they're
entertaining,
but
doesn't
designating
them
as
special
needs.
Adoption
was
fair
and
it
was
accurate
with
the
designation
of
special
needs
came
the
negotiation
of
a
post-adoption
subsidy
from
the
state.
We
were
and
remain
so
grateful
for
that
subsidy.
H
It
allows
us
to
take
care
of
our
children
when,
due
to
their
varying
needs,
I
could
not
work
outside
the
home
with
multiple
therapy
appointments
each
week
foster
care
visits,
appointments,
parental
visits,
specialists,
ieps,
hospitals,
trips
to
school
transportation.
Caring
for
four
kids
with
special
needs
has
been
at
times
overwhelming,
but
it
would
not.
It
would
have
been
impossible
without
the
adoption
subsidies.
We
we
don't
get
the
full
amount.
H
It
was
negotiated
based
on
need
and
expenses,
but
it
helps
with
the
basic
needs
of
our
kids
in
a
way
that
we
can't
make
the
state
enough
for
the
posted
option.
Subsidy
here
in
the
state
of
nevada
stops
on
a
child's
18th
birthday.
So
I'm
here
today
because
our
oldest
turns
18
at
the
very
beginning
of
his
senior
year
of
high
school.
H
Now
this
is
not
unusual.
For
many
kids,
in
fact,
some
of
my
son's
friends
have
jobs
to
help
pay
for
their
own
expenses.
College
savings
pocket
money,
but
my
son,
who
was
a
gate
student
in
elementary
and
he
homeschooled
very
successfully
for
middle
school.
Due
to
his
anxiety
and
other
related
diagnoses
he's
struggling
through
high
school,
he
has
an
iep
in
place
that
we
fought
really
hard
to
get
for
him,
but
just
getting
through
high
school
is
our
only
goal
for
our
four
kids
adopted
to
the
state
one
moment.
I'm
sorry.
H
Of
our
four
kids
adopted
through
the
state,
all
four
have
ieps.
We
have
many
many
diagnoses,
including
fetal
alcohol
spectrum,
disorder,
specific
learning,
disability,
dyslexia,
adhd,
inattentive,
hyperactive
and
combined
type.
We
have
anxiety,
mood,
disorder
and
more.
We
had
a
diagnosis
of
reactive
attachment
disorder
at
one
point
which
we're
choosing
to
believe
was
an
overreaching
diagnosis,
but
it
shows
the
severity
of
the
behaviors
we're
dealing
with
so,
along
with
all
of
those
issues,
my
children
have.
They
also
have
birth
parents
who
struggled
with
these
things
and
more
schizophrenia,
bipolar.
H
I
say
all
of
this
to
stress
our
singular
goal
as
parents
is
to
get
our
kids
through
high
school
graduation.
Honestly,
that's
our
primary
goal.
The
current
dfs
policy
states
quote
after
an
adopted
child
turns
18,
regardless
of
the
level
of
diagnosed
mental
or
physical
disability.
The
adoption
subsidy
terminates.
Dfs
will
refer.
You
to
social
security
administration
for
ssi
assistance,
unquote.
H
My
son
and
many
adopted
kids
with
trauma
backgrounds
and
learning
disabilities
likely
do
not
have
needs
severe
enough
to
qualify
for
ssi,
so
our
oldest
will
lose
with
his
adoption
subsidy
on
his
18th
birthday,
while
living
at
home
as
a
full-time
high
school
student,
his
entire
senior
year
due
to
his
needs
and
the
higher
needs
of
his
siblings.
I
still
can't
work
outside
the
home,
so
our
son
will
be
required
to
get
a
part-time
job
to
help
pay
for
his
expenses,
including
all
those
senior
year
expenses
that
certainly
don't
come
cheap
for
anyone.
H
Currently,
his
only
job
is
high
school,
and
that
is
a
struggle.
It's
the
sole
thing
he
focuses
on.
It's
the
only
real
responsibility
he
has
to
pass
algebra
last
year.
He
brought
an
f
up
to
a
d
and
we
celebrated
it
was
a
real
accomplishment.
He
worked
very
very
hard
and
because
he's
a
really
bright
kid
with
a
drive,
he
was
able
to
pass
a
class.
We
weren't
sure
he
would
pass
had
he
been
required
to
work
a
job
while
work
while
trying
to
improve
his
grades
and
maintain
his
mental
health.
H
H
Other
states
have
this
in
place.
I
don't
know
those
statistics,
only
anecdotal
evidence
from
my
foster
and
adoptive
friends
around
the
country
who
maintain
their
adoption
subsidies
through
the
month
of
high
school
graduation,
not
all
states,
but
many
states
do
have
that.
But
let's
talk
about
statistics,
my
children
are
included
in
so
many
statistics
foster
care
statistics.
Adoption
early
childhood
intervention,
special
ed
stats,
so
many
statistics,
some
of
the
stats
we
do
not
want
them
included
in-
are
high
school
dropout
rates,
incarceration,
stats,
public
assistance,
stats,
teen,
pregnancy,
stats.
H
A
quick
google
search
tells
me
that
30
percent
of
teen
girls,
who
drop
out
of
high
school
say
pregnancy
is
a
main
reason
in
the
national
campaign
to
prevent
teen
and
then
pregnancy
says
that
rate
is
higher
for
latino
and
african-american
kids.
H
The
national
institute
of
health
tells
us
32
percent
of
students
with
adhd
combined
will
drop
out.
Approximately
53
percent
of
adolescents
with
fasd
have
been
suspended
from
school,
29
have
been
expelled
and
25
have
dropped
out.
We
work
very
hard
as
parents
to
prevent
our
kids
from
becoming
part
of
any
of
those
statistics.
H
My
husband
and
I
are
not
alone
in
our
concern:
we're
not
the
only
family.
There
are
hundreds
of
nevada
families,
just
like
ours
with
kids,
who
would
benefit
from
maintaining
an
adoption
subsidy
through
high
school
graduation.
For
many,
including
two
of
my
kids,
this
is
just
a
month
or
so
for
others.
Like
my
son,
it's
nearly
a
year.
One
mom
told
me
her
daughter,
turned
17
at
the
beginning
of
her
junior
year,
and
an
extended
subsidy
would
really
help
her
family.
H
H
I
know
it's
not
an
ideal
time
to
be
asking
for
even
a
few
months
of
additional
subsidy
from
the
state,
but
services
are
being
cut
for
families
like
mine
and
we
need
support
now
more
than
ever.
So
thank
you
for
hearing
our
story.
Thank
you
for
listening
to
this
proud
mom
talk
about
my
very
bright,
very
loved
and
very
resilient
children.
Thank
you
all
for
your
time.
Today.
C
A
Not
a
question
just
wanted
to
take
an
opportunity
to
say
thank
you
for
coming
and
presenting
your
story.
I
was
delivered
to
my
parents
when
I
was
five
days
old
and
I
always
am
so
appreciative
of
any
adoptive
parents.
I
feel
like
I
won
the
parent
lottery
in
my
case,
and
it
sounds
like
your
kids
do.
So.
Thank
you
for
taking
the
time
to
be
here
today
and
to
raise
this
issue
all
right.
C
And,
and
just
so
that
the
committee
is
clear,
mrs
robertson
and
I
have
we've-
we've
had
the
discussion
when
we
first
when
she
first
approached
me
with
this
possible
bdr.
C
It
was
before
the
pandemic
when
things
were
going
well
in
our
state
and
since
that
time
we've
had
the
discussion
about
about,
let's
say
the
the
facts
of
of
life
for
us
in
nevada
right
now,
so
so,
and-
and-
and
I
didn't
want
to
waste
her
time
being
here
today,
knowing
where
we
are
financially
and
and
didn't
want
to
waste
the
committee's
time,
but
I
did
think
it
was
important
for
this
information
to
get
out
for
for
us
to
understand
where
families
in
nevada
are.
C
You
know
you
know
we
I
talked
to
her
about.
I
don't
know
if
some
money
falls
from
the
sky.
I'd
like
the
information
to
be
out
there.
You
know
if
some
amazing
federal
money
comes,
I
I
don't
know
so
so
just
so,
we
all
understand.
We
are
all
on
the
same
on
the
same
page
with
this
that
we
do
it.
C
We
do
all
understand
there
probably
isn't
the
money
and
that
we
that
I
think
probably
most
people
would
want
there
to
be
to
kind
of
fill
this
gap
for
these
kids
and
these
families
that
are
not
just.
C
You
know
these
families
that
are
not
just
frankly
helping
these
these
children,
but
are
basically
helping
our
our
our
state
right,
because
not
only
are
they
making
their
own
families
whole,
but
they're
also
helping
our
state
by
by
taking
these
these
children
in
and
and
supporting
these
children
when
when
otherwise
the
state
would
have
been
doing
it.
C
So
so
I
I
do
very
much
appreciate
you
coming
and
telling
your
story
and
telling
us
about
your
wonderful
family
and
taking
the
time,
especially
knowing
that
that,
where
we
are
financially
as
the
state
and
but
being
willing
to
still
put
that
on
the
record
and-
and
hopefully,
if
not
now,
hopefully
soon
in
the
future,
we
we
will
be
able
to
seriously
consider
this.
C
C
I
think
else.
Okay,
mr
armstrong,
please
go
ahead.
L
Good
morning,
madam
chair
members
of
the
committee,
let
me
also
start
by
thanking
miss
robertson
for
the
true
generosity
that
it
takes
to
be
a
foster
and
adoptive
parent.
The
the
love
and
determination
that
all
of
our
foster
parents
and
adoptive
parents
have
is
is
truly
priceless,
not
for
just
us,
as
you
know,
as
a
state,
but
for
the
the
kids
and
the
the
lives
they
impact
so
certainly
from
the
bottom
of
my
heart.
Thank
you
to
you
for
your
work
and
determination
and
advocacy.
Today.
L
I
have
a
presentation
to
walk
through
kind
of
what
the
adoption
assistance
program
looks
like
and
then
also
an
update
on
ab150,
which
is
related
to
extended
foster
care
bill
from
last
session.
And
so
let
me
share
the
presentation.
Real
quick.
L
Yes,
great
great,
thank
you
so
much
so,
as
I
said,
we're
going
to
talk
about
adoption,
assistance
and
assembly
bill
150.
L
we'll
go,
do
a
quick
overview
of
the
adoption
assistance
program,
the
eligibility
requirements
when
that
terminates,
as
we
heard
it,
it's
upon
that
18th
birthday,
there's
some
other
factors
that
can
help
that
determine
whether,
when
it
terminates
and
expenditures,
although
I'll
talk
a
little
bit
about
that,
the
the
expenditures
information
we
had
was
more
relevant
in
march
than
now.
L
So
we'll
I'll
talk
about
that
when
we
get
there
and
then
the
reasons
that
youth
receive
a
subsidies,
especially
the
additional
subsidies
and
some
options
for
nevada
for
consideration
and
then
assembly,
bill
150
will
do
a
an
overview
and
the
in
the
possible
implications
for
adoption
assistance.
L
So
when
we
talk
about
adoption
assistance
in
this
presentation,
I
think
it's
important
to
note
that
we're
talking
about
adoptions,
where
there
has
been
a
child
welfare
case,
there's
been
either
a
termination
of
parental
rights
or
a
relinquishment
of
parental
rights
to
facilitate
the
adoption
for
permanency.
We
always
go
for
a
permanency
plan
of
adoption.
We
know
that
kids,
young
people
who
are
adopted
have
much
better
outcomes
rather
than
those
who
quote-unquote
age
out
of
the
system.
L
So
when
we
talk
about
adoption
assistance,
it's
in
that
context
of
child
welfare
cases
and
for
the
last
four
years
the
state
of
nevada
has
fluctuated
between
750
and
850
finalized
adoptions,
statewide.
L
So
the
eligibility
requirement
include
the
chat
has
to
be
in
the
custody
of
the
child
welfare
agency
in
nevada.
We
have
three
child
welfare
agencies,
the
division
of
child
and
family
services,
which
provides
child
welfare
services
in
rural
nevada
and
then
washoe
and
clark
counties
operate
their
own
child
welfare
agencies.
So
when
we
talk
about
negotiating
payments,
those
are
all
done
with,
whichever
is
the
local
child
welfare
agency
for
that
child
and
the
child
has
to
meet
the
following
requirements.
The
child
is
getting
adopted
to
be
eligible
for
the
subsidy.
L
L
There
are
special
needs
or
special
factors
that
are
taken
into
consideration
again,
driven
by
driven
by
federal
law,
which
includes
five
years
of
age
or
older,
a
sibling
group
we
heard
from
miss
robertson
about
trying
to
keep
siblings
together.
That's
such
a
critical
and
key
goal
that
we
have
to
try
to
keep
siblings
together,
even
when
they're
removed
from
their
biological
families
has
a
diagnosed
medical,
physical,
emotional
or
mental
disability.
L
L
So
this
instance
comes
in
monthly
payments
and
it's
as
we
as
we
heard
it's
negotiated.
It
cannot
exceed
the
family,
foster
care
maintenance
rate
so
for
foster
parents
who
are
taking
care
of
children.
The
monthly
rate
for
children
0
to
12
is
at
682
and
for
age
13
to
18
is
that
773.,
the
negotiated
rate
for
all
three
nevada
child
welfare
agencies
in
the
last
fiscal
year
really
fluctuated
right
at
about
625
630
dollars
a
month.
L
And
the
termination
of
assistance
is
set
forth
in
state
policy
and
it
reflects
state
law.
The
assistance
terminates
when
the
child
is
attained.
The
age
of
18.
L
That
translates
to
attorneys
fees
for
the
attorneys
who
facilitate
the
adoption
and
those
rates
are
established
during
the
legislature
each
year.
In
terms
of
those
legal
fees,
I
would
note
that
there's
additional
resources
for
families,
especially
with
those
with
developmental
disabilities
from
aging
and
disability
services,
division,
including
family
support
services,
job
and
day
training
and
supported
living
arrangements.
Those
are
outside
of
the
adoption
subsidies,
discussion.
L
You
know
this
made
sense
back
in
march
when
we're
going
to
originally
do
the
presentation
now
we're
in
a
very
different
fiscal
situation
and
so
to
be
helpful
to
this
committee
and
the
current
situation
we
face
we'll
put
together
some
of
those
costs
and
we'll
see
what
we
can
do
in
terms
of
getting
an
estimate
together
of
what
it
would
take
to
do
as
ms
robertson
is
advocating
for
in
terms
of
just
getting
to
the
end
of
high
school
graduation
versus
the
maximum,
which
would
be
to
21.
L
there's
some
reasons
that
children
so
the
different
factors.
Those
help
explain
and
let
you
see
which
which
of
the
special
factors
triggered
the
subsidies.
L
We
get
what's
social
security
for
e-funding
for
foster
care
and
adoption
assistance,
and
it's
a
calculation
of
fmap
which
I'm
sure
you've
heard
of
lots
of
times
and
then
what's
called
the
penetration
rate.
L
So
in
order
to
be
eligible
for
that
for
a
funding
for
foster
care,
for
example,
certain
court
orders
have
to
be
met,
certain
activities
have
to
be
completed
and
our
penetration
rate
for
foster
care
is
right
around
that
45
50
percent,
we're
kind
of
in
the
middle
of
the
country
in
terms
of
the
level
of
our
penetration
rate,
it's
much
higher
for
our
adoption
cases,
it
fluctuates
between
80
and
90
percent,
which
is
great
so
getting
more
federal
assistance
on
the
adoption
end.
L
So
the
federal
requirement
allows
states
to
pay
for
adoption
subsidies
or
requires
them
to
be
terminated
at
18
years
of
age
or
such
a
greater
a
as
the
state
may
elect
under
the
law
and
then
20
years
of
age.
L
If
the
state
determines
the
child
has
a
mental
or
physical
handicap
which
warrants
the
continuation
of
assistance,
so
the
the
main
point
there
is
that
the
federal
statute
allows
for
some
flexibility
to
go
beyond
that
18
years
of
age,
but
our
current
state
law
does
not,
and
so
you
can
find
the
adoption
subsidy
information,
including
who
qualifies
when
it
terminates
in
chapter
127
of
the
nevada,
revised
statutes
and
it
requires
all
financial
assistance
provided
on
a
section
ceases
immediately
when
the
child
attains
a
majority
becomes
self-supporting
is
emancipated
or
becomes
deceased.
Whichever
comes
first.
L
So
a
revision
to
that
statute
would
allow
us
to
take
advantage
of
some
of
that
federal
flexibility
that
we
do
not
have.
Of
course,
that
would
require
an
investment
in
general
fund
match
to
get
those
federal
funds.
L
If
nevada
opts
into
the
federal
4e
extended
foster
care
program,
the
adoption
of
subsidy
could
similarly
be
extended
for
some
foster
youth.
So
we're
going
to
talk
about
ab150
next,
which
talks
about
that.
But
so
I
just
that's
really
it
before
I
go
on
to
the
ab150
specifics.
That's
the
overlay!
The
bottom
line
is:
there's
a
federal
flexibility
that
we
don't
currently
take
advantage
of
in
nevada,
based
on
our
statutes.
L
A
change
in
our
nevada
statutes
could
allow
for
assistance
beyond
that
18th
birthday
and,
of
course,
we'd-
have
to
do
a
fiscal
analysis
on
that
which
we'll
try
to
do
and
get
to
you
shortly
after
this
meeting
in
terms
of
what
would
that
really
look
like
you
know
if
we
said
okay
on
average,
it's
you
know
six
months
more
of
of
assistance.
If
we
get
to
high
school
graduation,
what
does
that
cost
really
look
like
in
terms
of
general
fund
or
if
we
were
to
go
all
the
way
to
21?
L
F
Thank
you,
madam
chair.
What
is
the
difference
between
the
family
who
says,
I'm
I'm
just
going
to
be
foster
parents?
What
is
the
state
county
federal
payment
per
month
for
foster
payments
versus
adoption?
Is
there
a
benefit
for
the
family
to
adopt
fiscally,
or
vice
versa,.
L
You
know
so
the
I
think
in
one
of
the
reasons
that
the
adoption
that
the
adoption
subsidy
amount
can't
go
over,
that
regular
foster
care
amount.
Is
that
so
that
we're
not
creating
a
fiscal
incentive
just
to
adopt
to
adopt.
So
that
is
so,
there's
not
really
a
fiscal
incentive
to
go
from
adoption
or
to
go
from
foster
care
to
adoption.
We
have
some
families
that
want
to
just
provide
foster
care
and
become
a
resource,
parent
and
really
work
with.
L
You
know
the
biological
family,
on
reunification
and
and
there's
a
real
shift
in
child
welfare
practice
in
terms
of
really
facilitating
that
relationship
with
the
biological
family
and
and
the
foster
family.
And
then
there
are
some
families
that
just
become
foster
parents
with
with
the
intent
to
adopt
down
the
road,
and
so
they
may
have
some
foster.
Kids,
you
know
come
in
and
out
as
there's
a
need,
but
they're
they're
hoping
to
adopt
so
there's
not
really
a
fiscal
incentive
created
to
adopt
verse
versus
becoming
a
foster
parent.
L
I
I
will
take
a
look
and
and
see,
and
there's
none
that
come
to
the
top
of
my
head.
I
think
and
believe
that
most
of
the
the
families
that
shift
from
fostering
to
adoption
want
to
do
it
to
to
build
that
family
to
provide
that
permanency
for
those
kids
who
have
been
abused
or
neglected
and
need
need
their
forever
home.
There's
there's
you
know
a
lot
of
support.
L
So
the
the
amount
was
on
slide
seven,
so
the
family
foster
care
maintenance
rate
is
at
six
hundred
and
eighty
two
dollars
a
month
and
then
for
the
older
youth.
It's
the
773.
again.
The
the
adoption
amount
can't
go
above
that
and
our
average
is
for
the
three
jurisdictions
in
terms
of
the
negotiated
amount
floated
right
around
630
dollars.
So
it
would
be.
You
know,
50
50,
to
150
dollars
less
per
month,
as
you
shift
to
adoption.
L
C
Thank
you.
I
mean
I,
I
have
a
question
about
on
slide:
nine,
the
additional
resources,
families
from
adsd
the
family
support
services.
Well,
I
guess
also
the
avail.
C
Well
yeah,
the
available
subsidies,
the
social
services
we
we've
talked
before
about
not
having
enough
services
in
nevada,
so
are
the
the
families
that
are
trying
to
take
advantage
of
family
support
services.
C
L
So
the
the
items
that
are
on
top
of
slide
9
are
all
the
eligible
eligible
activities
for
the
subsidies
from
the
from
the
federal
perspective
for
the
adoption
piece.
Those
other
resources,
especially
as
we
talk
about
youth
with
developmental
disabilities,
oftentimes
they're
plugged
into
the
aging
and
disability
services
division.
Already.
L
There
are
some
additional
opportunities
once
they
hit
that
age
of
18
and
become
independent,
and
so
that
would
be
in
terms
of
the
wait
lists
and
everything
we
can
get
you
the
the
hhs
caseload
data
in
terms
of
waiting
lists
for
different
services,
but
I
think
across
the
board.
You
know
we
do
not
have
enough
services
for
our
families
to
to
meet
all
of
their
needs
and
really
trying
to
look
towards.
L
C
Okay,
thank
you
and
seeing
no
other
questions.
J
Questions,
dr
titus,
sorry,
sorry,
madam
chair,
I
I
have
a
question
regarding
the
the,
as
you
said,
there's
not
enough
services
across
the
state,
and
I
know
over
the
last
couple
sessions
we've
required
more
training
to
be
a
foster
parent,
and
one
of
the
questions
I
asked
during
those
hearings
would
would
we
by
mandating
some
of
the
training
and
the
extra
time
and
hours,
were
we
going
to
lose
people
who
would
be
willing
to
be
foster
parents,
and
I
just
wondered
if
our
our
numbers
are
going
up
or
down?
J
Was
there
any
impact
on
that
and
expectation
for
the
future.
L
Ross
armstrong
for
the
record:
there
is
no
indication
that
those
additional
training
requirements
are
reducing
interested
foster
families.
What
we
see
is
some
drop-offs
during
the
foster
care
licensing
process
going
through
all
of
the
different.
You
know,
foster
care,
licensing
and
then
some
drop-off
of
folks
who
become
foster
families
and-
and
it
may
not
be
quite
what
their
expectations
are
and
so
having
that
better
training
that
it
explains
what
foster
care
looks
like
you
know
there.
L
There
are
some
folks
that
are
struggle
with
the
idea
of
I'm
going
to
take
in
the
child,
who's
been
abused
and
neglected,
and
now
you
know
I'm
being
directed
to
to
really
work
with
the
person
that
abused
the
neglect
of
that
child.
You
know
we
know
that
in
the
long
term,
that's
that's
better
for
the
child.
If
we
can
reunify
and
and
so
making
those
expectations
clear
up
front,
we
are
in
a
desperate
situation
in
nevada
in
terms
of
not
nearly
enough
foster
care
beds.
L
A
bill
last
session
required
each
child
welfare
agency
to
come
up
with
a
plan
and
a
recruitment
plan
to
make
sure
that
those
foster
care
beds
were
in
place,
and
so
the
agencies
have
just
started
to
implement
that
annual
reporting
of
of
where
we
are,
and
we
can
certainly
send
the
last
annual
report
to
this
committee.
So
you
can
see
what
that
looks
like
in
terms
of
agencies
trying
to
recruit
enough
beds
and
and
really
finding
you
know
in.
L
We
do
the
direct
services
in
rural
nevada,
and
so
what
you
need
is
enough
foster
beds
to
meet
all
the
potential
needs
that
come
up.
You
know
we
have
great
foster
parents
down
in
pahrump
who
are
you
know?
We
have
a
good
pool
of
foster
parents
there
that
work
with
older
kids,
which
is
great
if,
if
a
youth
comes
from
pera,
when
we've
got
a
youth
who
needs
a
bed
and
if
from
elko
and
the
only
bed
is
in
perum,
all
of
the
goals
of
the
child
welfare
case
are
frustrated.
L
You
know
by
that
hundreds
of
miles
of
distance
so
really
trying
to
target
making
sure
we
have
enough
beds
in
every
nevada
community
for
any
situation
that
comes
up
it's
a
it's
a
heavy
lift,
but
all
three
agencies
are
are
working
towards
that.
J
Right,
thank
you
for
that,
because
I'd
really
be
interested
in
seeing
the
outcome
of
what
you've
just
asked
your
agencies
to
do,
because
one
of
the
things
we
also
talked
about
was
making
sure
we
keep
the
kids
in
their
schools.
The
school-aged
kids
that
we
didn't
want
to
take
them
out
of
their
local
schools,
their
local
friends
and
make
matters
worse.
So
that
was
one
of
the
goals
is
to
make
sure
that
we
could
provide
the
beds
within
a
community
not
only
within
the
community
but
within
the
school
districts
and
within.
J
Although
now
you
know
we're
kind
of
going
virtual
with
this
covid
nightmare,
but
but
at
the
same
time,
eventually
we'll
we'll
get
all
these
students
back
in
school.
So
I'll
just
really
be
interested
in
seeing
what
efforts
your
agencies
put
forward
and
if
they've
been
successful
and
and
how
you're
trying
to
mitigate
some
of
the
the
need
for
these
beds.
So
thank
you
for
that.
C
He's
seen
no
other
questions,
why
don't
we
move
on
to
assembly
bill
150.
F
L
See
so
assembly
bill
150
passed
last
legislative
session
and
it
required
the
state
of
nevada
to
study
opting
into
extended
foster
care.
Another
bill
from
last
session
that
this
committee
might
be
interested
in
is
assembly
bill
111,
which
required
a
study
of
how
the
child
welfare
agencies.
If
there
are
opportunities
to
maximize
federal
funding,
we
that
study
is
all
being
done
in
the
interim
child
welfare,
juvenile
justice
committee
and
the
draft
reports.
L
There's
no
like
secret
treasure,
chest
of
federal
funds
out
there
that
we
haven't
tapped
into
but
does
help
provide
a
roadmap
for
options
in
the
future.
If
there
are
places
where
we
want
to
invest,
the
general
fund
match
so
assembly
bill
150
addresses,
extended,
foster
care,
and
that
can
be
that's
the
federal
term.
It
can
be
a
little
bit
misleading,
I
think,
extended.
Foster
care
is
really
about.
Providing
all
of
the
supports
you
do.
L
You
would,
with
a
foster
youth
to
a
young
person
over
the
age
of
18.,
and
so
it's
not
that
they're
necessarily
living
in
a
foster
home
and
having
court
all
the
time
and
and
trying
to
find
an
adoption,
but
really
bringing
financial
and
other
resources
care
coordination.
Those
types
of
resources
to
youth
over
the
age
of
18.
L
The
bottom
line
of
ab150
was
to
figure
out
how
nevada
can
improve
outcomes
for
youth
aging
out
of
the
foster
care
system.
We
know
that
the
outcomes
for
youth
who
age
out
of
the
foster
care
system
are
poor.
You
see
high
high
rates
of
incarceration
higher
rates
of
future
allegations
of
abuse
and
neglect,
multi-generational
involvement
in
the
child,
welfare
system,
homeland
homelessness,
incredibly
poor
health
outcomes,
and
so
we
try
to
find
permanency
other
than
aging
out
of
the
foster
care
system,
and
so
the
bill
takes
a
look
at
that.
L
There
was
appropriation
with
the
bill
that
allowed
us
to
contract.
We
contracted
with
social
change
partners,
which
were
experts
really
in
in
the
field
who
have
helped
guide
the
committee
over
this
interim.
L
The
group
was
required
to
look
at
the
programs
and
practices
of
other
states,
the
funding
programs
and
practices
currently
in
place
in
nevada.
So
the
voluntary
jurisdiction
is
a
program
that
nevada
already
has.
It
is
100
general
fund
funded,
whether
that's
through
legislative
general
fund
or
county
general
fund
in
washoe
and
clark,
and
provides
resources
for
youth
18
up
to
the
age
of
20
in
terms
of
a
monthly
fiscal
payment
to
help
them
with
that
transition
and
fafi
and
chaffey
are
federal
funding
sources
that
assist
youth.
L
So
we
were
supposed
to
study
the
potential
ways
to
improve
outcomes,
including
the
federal
4e
extended
foster
care
program
which
would
bring
in
that
federal
funding
to
maximize
assistance
to
that
those
transition
aged
youth
to
estimate
the
fiscal
impact
and
the
report
is
due
october
1st.
So
we
assembled
the
working
group
which
included
everybody.
L
You
see
there
on
the
screen
I'll
note
that
the
nevada
system
of
higher
education
has
implemented
a
tuition
waiver
for
youth
who
have
aged
out
of
the
foster
care
system
and
and
really
providing
support
in
terms
of
of
higher
education
and
opening
up
a
pathway
for
those
youth.
It
included,
foster
youth
and
former
foster
youth
and
parent
advocates.
So
we
really
had
a
lot
of
folks
at
the
table
all
trying
to
figure
out
how
best
to
help
those
transition
aged
youth.
L
The
contracting
group
helped
us
look
at
a
number
of
other
states.
You
see
there
on
the
screen.
The
federal
parameters
around
extended,
foster
care
are
much
more
flexible
than
for
traditional
foster
care,
and
so
states
have
a
lot
of
ability
to
mold
the
program
to
their
needs,
which
includes
how
do
you
make
placement
determinations?
L
How
do
you
figure
out
where
the
payment
payment
goes?
Is
it
just
directly
to
the
youth?
Are
you
allowed
to
give
some
money
to
the
youth
and
some
money
to
let's
say
the
housing
where
they're
living
who's
eligible,
so
there's
a
lot
of
different
factors
and
they
looked
at
a
bunch
of
different
states
in
terms
of
in
terms
of,
were
there
good
ideas
out
there
that
we
could
steal
for
us?
L
We
also
took
a
look
at
the
current
practice
again
the
voluntary
court
jurisdiction
and
then
the
fafi
funds,
and
what
that
looks
like
in
terms
of
extended
foster
care.
What
would
need
to
change
and
really
between
the
court
jurisdiction
and
extended
foster
care?
L
Some
of
the
key
things
that
would
have
to
change
is
there
would
have
to
be
some
additional
determinations
made
in
terms
of
making
each
youth
eligible
for
that
federal,
4e
money
and
then
regular
reviews
by
a
court
or
other
entity
making
sure
that
that
that
support
is
still
appropriate
and
then
some
additional
requirements
around
the
placement
types
that
were
permitted
and
additional
case
work
and
visitation
requirements
that
look
more
like
foster
care
in
terms
of
mandating
that
case
workers
have
thorough
visits
and
and
are
working
with
the
youth
on
a
regular
basis.
L
So
really
took
a
look
at
what
does
it?
Take
the
the
the
truth.
Is
we're
really
not
that
far
off
in
terms
of
the
eligibility
for
entry?
The
state
statute
has
some
of
the
mirrors
some
of
the
language
of
the
federal
statute,
and
so
there
would
not
be
too
much
of
a
heavy
lift
in
terms
of
programmatic
change,
the
biggest
ones
being
some
of
those
placement
oversight
requirements.
The
case
worker
visits,
knowing
what
the
case
worker
case,
those
look
like
already
and
then
some
additional
stuff
over
review
and
eligibility.
L
We
asked
all
the
stakeholders
really
four
main
questions.
We've
compiled
those
you
know
the
vast
majority
said.
Yes,
we
think
we
should
proceed
with
going
forward
with
extended
foster
care
program.
Some
have
concerns
about
the
cost
benefit,
and
so
we're
currently
doing
an
analysis
right
now,
statewide
to
see
what
that
would
look
like
in
terms
of
the
cost
of
those
reviews
and
administering
the
program
versus
the
federal
funding
that
would
come
in
it
would
be
a
separate
penetration
rate.
I
talked
about
the
penetration
rate
earlier
in
terms
of
foster
care
and
adoption.
L
So
the
recommendations
have
all
been
submitted
by
those
groups
were
working
on
synthesizing.
Those
to
you
know
in
a
helpful
way
to
the
interim
committee
on
child
welfare
and
juvenile
justice,
and
then
we've
assembled
a
fiscal
subcommittee
to
really
dive
down
into
the
costs,
especially
given
our
state's
current
fiscal
emergency,
and
you
know
to
take
a
look.
You
know
in
terms
of
comparing
a
b
potential
progress
on
ab-150
versus
extending
adoption
subsidies,
because
we
already
invest
general
fund
in
this.
L
In
this
a
similar
type
of
program
that
whole
the
investment,
I
think,
would
need
to
be
less
because
we're
already
doing
it,
it
would
just
be
potentially
able
to
bring
in
that
federal
funding
how
it
weaves
in
with
adoption
assistance,
is
many
states
align
their
adoption
assistance
programs
for
youth
ages,
18
to
21
with
the
conditions
of
the
foreign
reimbursement,
and
so
if
we
were
to
extend
foster
care
out
to
age
21,
it
would
make
sense
that
that,
at
the
same
time,
we
could
potentially
increase
adoption
assistance
that
far
as
well.
L
You
know,
given
our
current
fiscal
state.
I
think
it
would
definitely
be
worth
taking
a
look
at
what
what
would
it
really
cost
if
we
were
just
to
extend
it
towards
that
that
end
of
high
school,
it
would
be
a
much
less
fiscal
impact
than
all
the
way
to
age.
L
L
And
so,
if
the
state
ops
into
the
federal
fourier
extended,
foster
care
plan,
the
age
limit
for
adoption
assistance
would
move
to
the
age
set
by
the
state's
program
so
for
children
adopted
on
or
after
their
16th
birthday.
So
there's
some
interplay
there
in
terms
of
the
adoption,
assistance
and
and
the
fiscal
analysis
we're
completing
now
as
part
of
ab150,
would
would
take
a
look
at
that
as
well.
L
We
haven't
really
talked
about
it
a
lot
today,
but
guardianship
assistance.
There
are
cases
where
a
guardianship
is
preferred
over
adoption.
A
lot
of
times.
We
see
this
with
a
family
member,
so
either
a
grandma
or
aunt
who
has
trouble
with
with
the
idea
of
advocating
for
the
termination
of
their
their
family's
rights
to
the
to
the
child.
A
guardianship
is,
is
an
option,
a
permanency
option,
there's
more
and
more
resources
for
guardianship
and
and
helping
families
navigate
that,
and
so
it
could
also
be
extended
to
the
age
of
21.
L
In
terms
of
assisting
those
guardians
fiscally
and
extended
foster
care,
we
don't
have
to
go
to
age
21,
that's
another
flexibility
that
the
federal
rules
are
written
in
such
a
way
as
we
could
set
that
age
to
wherever
we
feel
is
most
appropriate
or
you
know
in
the
reality
we
face
now.
What
is
what
is
what
we
can
afford.
L
And
so
I'm
happy
to
take
questions
on
you
know,
ab150
or
ab.
You
know
111
or
or
any
other
items,
but
that
that
ab150,
I
think,
helps
as
we
really
take
a
look
as
an
agency
as
the
division
of
child
family
services.
In
terms
of
how
do
we
give
families
all
families,
adoptive
families,
families
that
are
involved
in
our
mental
health
system
or
juvenile
justice?
How
do
we
empower
them
to
leave
our
involvement
right
for
us
to
say
goodbye
and
to
have
them
only
return
like
on
a
voluntary
basis?
L
How
can
we
really
support
an
effective
path
forward
for
every
youth
and
family
that
that
we're
involved
with
and
and
so
both
of
the
items
we've
talked
about
today,
are
critical
to
supporting
nevada's
families
and
really
giving
those
young
people
who
have
started
out
in
in
a
difficult
position,
a
brighter
path
forward?
So
thank
you,
we're
usually
in
front
of
the
interim
child
welfare
people,
justice
committee.
C
Seeing
none
we'll
certainly
look
forward
to
the
information
that's
provided
to
the
committee
in
october.
When
the
report
is
given,
then
let
me
see
and
to
see
what
the
fiscal
subcommittee
comes
up
with
in
october.
I
think
that's
going
to
be
very
interesting
to
see,
and
then
just
I
I,
I
guess
not
so
much
a
question
just
to
comment
just
following
up
on
the
first
part
of
the
presentation
and
just
something
else
for
the
for
the
committee
to
consider
it.
C
It
occurs
to
me
as
as
ever
as
as
I've.
I've
said
before
during
hearings
that
during
my
day,
job
I'm
a
family
law
attorney
and
and
so
just
to
note,
that
we've
already
established
in
in
nevada
that
when
parents
are
divorced
and
they're
paying
child
support,
if
one's
paying
child
support
to
the
other
child
support
continues
until
the
until
the
child
turns
18
or
19,
if
they're
still
in
high
school.
C
So
something
to
consider
that
we've
already
established
in
the
nrs
that
it
is
important
to
cons
to
continue
to
support
a
child
until
they
actually
get
through
high
school.
C
So
take
that
for
what
it's
worth.
But
thank
you,
mr
armstrong,
for
the
information
and
and
thank
you,
mrs
robertson,
again
for
your
family's
story,
and
I
think
with
that.
C
With
no
other
questions,
we
will
move
on
to
agenda
item
number
seven,
which
would
is
an
overview
of
food
insecurity
in
nevada
and
an
update
on
senate
bill
178
from
the
2019
session,
which
establishes
the
council
on
food
security
and
the
food
for
people
not
landfills
program,
and
with
that
we'll
ask
laura
urban
of
the
food
security
and
well
the
food
security
and
wellness
manager
of
the
office
of
food,
security,
of
the
division
of
public
and
behavioral
health
to
provide
the
pr
her
presentation-
and
I
believe
we
have
the
executive
directors
of
the
major
food
banks
in
nevada-
are
also
available
for
questions.
M
K
M
M
M
All
right
again,
my
name
is
laura
urban.
I'm
the
food
security
and
wellness
manager
with
the
off
the
food
security
within
the
nevada
department
of
health
and
human
services,
as
stated
previously
today,
I'll
be
providing
an
overview
of
food
and
security
in
nevada,
as
well
as
an
update
on
senate
bill
178,
which
created
the
council
on
food
security
and
the
food
for
people,
not
landfills
program.
M
nevada
experienced
a
similar
downward
trend.
While
there
was
a
slight
increase
in
household
in
food
insecurity
between
2016
and
2000
2018,
though
it
still
remained
fairly
consistent,
as
the
increase
was
not
statistically
significant,.
M
While
progress
has
been
made,
the
most
recent
feeding
america
data
show
that
388
420
nevadans
are
still
struggling
with
hunger,
of
which
134
350
are
children
or
1
in
8,
nevadans
and
1
in
5
children
covet
19
has
exasperated
this
issue
while
it'll
be
a
couple
years
until
we
have
postcovid
data
from
both
feeding
america
and
the
united
states
department
of
agriculture.
M
We
do
have
a
recent
report
that
was
just
released
from
feeding
america.
The
impact
of
the
coronavirus
on
local
food
insecurity,
which
shared
food
security
projections
for
states,
including
nevada.
In
that
report,
they
ranked
nevada
as
one
of
the
states,
with
the
highest
rates
of
projected
food
insecurity
for
2020
compared
to
2018..
M
M
M
The
mission
at
the
time
of
its
creation
and
still
to
this
day,
is
to
effectively
improve
the
quality
of
life
and
health
of
nevadans
by
increasing
food
insecurity
or
pardon
me
increasing
food
security
throughout
the
state.
The
group
is
also
tasked
with
addressing
the
objectives
of
their
guiding
plan:
food
security,
nevada,
nevada's
plan
for
action,
which
was
originally
developed
in
2013
and
then
revised
again
in
2018.
M
The
council
on
food
security's
greatest
accomplishment
has
been
the
fact
that
it
has
provided
a
consistent
platform
for
collaboration
among
the
food
security
network
to
discuss
and
strategize
the
best
ways
to
address
food
insecurity
in
nevada.
M
In
the
80th
nevada
legislative
session,
food
security
partners
sought
to
codify
the
council
via
senate
bill
178
and
succeeded
senate
bill
178
also
established
a
new
program
within
the
department
of
health
and
human
services
called
the
food
for
people,
not
landfills
program.
This
new
program
is
administered
by
the
office
of
food
security,
with
guidance
from
the
council
and
was
created
to
increase
food
security
through
decreasing
food
waste,
redirecting
excess
consumable
food
to
a
higher
and
better
purpose
and
recognizing
and
assisting
persons
who
further
those
purposes.
M
Senate
bill
178
also
made
some
slight
changes
to
the
existing
executive
order,
including
some
changes
to
the
membership
with
the
addition
of
the
director
of
health
and
human
services
and
the
administrator
of
the
aging
and
disability
services
division.
It
also
changed
the
number
of
meetings.
Previously
we
met
six
times
a
year
now
we're
meeting
four
times
a
year,
knowing
that
we
will
have
a
number
of
subcommittee
meetings
each
year
and
then,
of
course,
the
creation
and
the
implementation
of
the
food
for
people,
not
landfills
program.
M
M
We
also
have
two
existing
subcommittees,
one
being
the
food
for
people,
not
landfill
subcommittee,
which
I'll
talk
about
more
in
a
second
and
then
the
policy
subcommittee,
which
was
created
to
assess
and
recommend
policy
recommendations
to
the
council
on
food
security
for
the
81st
nevada
legislative
session.
M
Since
covid
began,
we've
had
we
have
two
meetings
scheduled.
One
happened
on
thursday
july
30th,
where
council,
members
and
partners
shared
their
covid
response
efforts,
and
then
our
next
meeting
is
scheduled
for
tuesday
october
6,
where
the
group
will
discuss
their
priorities
and
goals
moving
forward
for
the
food
for
people,
not
landfills
program,
like
I
mentioned
before,
we
established
a
subcommittee
which
is
helping
to
develop
and
guide
that
program.
M
That
subcommittee
is
chaired
by
jody
tyson
of
three
square
food
bank
and
is
comprised
of
five
voting
and
five
ex-officio
members
with
representation
from
nevada
department
of
agriculture.
Mgm
resorts
international
and
catholic
charities
of
southern
and
northern
nevada,
just
to
name
a
few.
M
C
No
other
questions.
I
have
a
question
going
back
up
to
the
definition
of
food
insecurity
when
we
talk
about
nutritionally
adequate
foods.
So
if
someone's
got
enough
food
that
they're
eating-
but
it's
it's
junk
food
is-
is
that
still
does
that
still
meet
the
definition
of
being
food
insecure?
So
someone
who
lives
in
a
neighborhood
where
they're,
mostly
just
getting
their
food
from
a
convenience
store
and
it's
high
price?
You
know
highly
processed
lots
of
sugar
sodium
fats.
That
type
of
thing
not
a
lot
of
fresh
fruits
and
vegetables.
M
Order
for
the
record
asks
you
absolutely
per
the
usda's
definition,
that
is,
that
does
qualify
as
being
food,
insecure.
C
Thank
you
for
that
and
then
so,
as
as
over
the
last
year,
or
so
as
as
the
new
work
has
begun
with,
I
I
mean
obviously
you've
been
working
in
this
field
for
a
while,
but
since
senate
bill
178
was
put
in
place
and
the
council's
been
working
on
this
has.
Has
there
been
anything
that
you've
seen
anecdotally?
That's
that's
kind
of
surprised
you
or
that
you've
learned
that
that
you
didn't
know
before
you
started
the
work
set
out
by.
M
Sb178,
laura
urban
for
the
record,
I
would
have
to
think
about
that
more,
not
necessarily
prior
to
being
in
this
position.
I
worked
at
the
food
bank
of
northern
nevada
and
worked
directly
with
the
community,
so
I
saw
a
lot
in
that
being
in
that
position,
probably
more
than
I
mean
now.
I
this
is
a
completely
different
perspective,
so
that's
been
very
new
and
interesting,
but
no
nothing
that
has
really
surprised
me.
C
Okay
and
then,
as
as
we
have
you
know,
we
have
a
lot
of,
I
think
people
who
watch
these
hearings
and
maybe
aren't
sure
how
they
can
best
assist
as
you
know,
because
they
want
to
help
their
fellow
nevadans.
C
What's
the
best
way
for
regular
nevadans
to
help
to
make
sure
that
they're
getting
you
know
if
they
want
to
assist
to
make
sure
that
they're
helping
feed
their
fellow
nevadans.
Is
there
better
ways
to
do
that
than
other
ways.
M
Laura
irvin
for
the
record.
I
welcome
both
food
banks
to
speak
to
this,
but
from
my
understanding,
getting
connected
with
your
local
food
banks
and
food
pantries
and
volunteering
is
the
way
to
go
as
well
as
monetary
donations,
especially
during
this
time.
C
Thank
you,
and
certainly
I
I
believe,
we've
got
member
we've
got
directors
from
the
food
banks.
If,
if
I'd
like
to
take
a
couple
of
minutes
and
just
make
a
statement
and
just
introduce
yourselves,
tell
us
about
your
food
banks
where
they
are,
if
there's
anything
in
particular
you'd
like
us
to
know,
please
feel
free.
A
Yes,
good
morning,
this
is
ashanti
lewis
for
the
record
from
three
square
food
bank.
Thank
you
for
allowing
me
to
answer
your
question
today,
chair
cohen,
as
laura
said,
you
can
donate
to
the
food
bank
and
we
also
need
volunteers
at
our
mobile
distribution
and
all
of
those
all
that
information
can
be
found
on
our
website,
which
is
three
threesquare.org.
A
Currently
we
have
about
30
mobile
distributions
per
week
through
a
partnership
with
the
clark
county,
school
district
amongst
other
pantries
and
other
locations.
I'm
sure
many
people
have
seen
our
distributions
on
the
news.
We
have
several
hundred
cars
that
many
of
them,
and
so
we
are
looking
for
people
who
can
come
out
and
volunteer.
C
Thank
you,
and,
and
if
I
may
miss
louis
can
can
so
a
couple
days
ago
someone
contacted
me
and
said
that
someone
they
know
gave
them
a
bunch
of
cans
of
soup
and
they
needed
to
know
you
know
they
wanted
to
donate
it,
and
I
didn't
even
think
of
three
square,
because
I
think
of
three
square
as
having
large
donations
that
you
work
in
partnership
with
large
organizations
that
you
do
big
amounts.
If
someone
has
small
amounts
that
they
want
to
donate,
do
you
take
small
amounts
or.
A
A
Ashanti
lewis,
for
the
record
absolutely
absolutely
they
can
come
to
our
main
location
again.
That
information
can
be
found
on
the
website
and
we
can
take
those
donations.
We
do
food
drives
throughout
the
year,
especially
during
non-pandemic
times,
and
so
we
welcome
that
from
the
community.
D
Go
ahead,
this
is
shane
picciani
with
the
food
bank
of
northern
nevada.
Our
food
bank
serves
the
northern
counties,
basically
from
tonopah
north,
and
so
we've
got
a
deeper
sort
of
more
rural
reach
than
three
square
does.
Although
three
square
has
got
a
huge
caseload
doing
the
las
vegas
metropolitan
area,
so
there
there
are
a
couple
of
different
ways
where
somebody
could
be
involved
in
the
food
bank.
D
As
ashanti
pointed
out,
you
could
certainly
volunteer
to
help
pack
foods
or,
to
you
know,
in
our
warehouse
or
at
our
help,
do
a
mobile
distribution,
but
also
we've
got
a
monthly
food
drive
that
happens
on
that.
D
You
can
find
information
for
those
on
our
website
at
fbn.org,
and
this
is
the
really
important
thing
that
I
wanted
to
communicate
and
I
did
communicate
through
a
regular
update
for
the
legislature
during
the
worst
part
of
the
economic
shutdown
was
that
there
are
a
lot
of
places
for
people
who
can
get
help,
so
we
offer
the
kids
cafe
after
school
meal
programs.
Now
that
school
has
started,
we
just
finished
with
summer
food.
D
We
have
got
mobile
distributions
in
just
about
every
county
that
we
serve
and
the
schedules
for
all
of
that
is
on
our
website
under
get
help,
and
so
outside
of
the
federal
nutrition
programs,
the
tfap
snap.
C
Okay,
thank
you
so
you're
saying
that
if
someone
not
necessarily
going
to
be
without
a
job
for
a
long
period
of
time,
but
just
maybe
for
a
week
is
going
to
need
assistance,
something
to
get
them
by,
they
can
just
come
in
absolutely.
D
They
can
come
to
right,
absolutely
shane,
pitching
any
for
their
record.
That
is
true,
chair
cohen,
so,
if
they,
if
they
need
like
emergency
food
today,
it
doesn't
matter
why
they
can
go
to
any
one
of
the
partner
agencies
that
might
be
closest
to
them
or
they
can
look
up
our
mobile
harvest
schedule
and
and
go
there
and
absolutely
no
questions
would
be
asked.
We
will
absolutely
assist
them.
C
Thank
you
for
that
and
I
believe
we
have
a
question
from
dr
titus.
So
before
we
go
on
dr
titus,
please
go
ahead.
J
Oh,
thank
you,
and,
and
thank
you
for
for
being
there
and-
and
I
have
to
tell
you
that
my
awareness
of
food
insecurity
really
was
augmented
when,
when
shane
asked
me
to
come
and
speak
to
the
food
bank
this
last
year
and
having
to
educate
myself
on
so
many
folks
that
that
really
didn't
know
where
the
next
meal
was
coming
from
and
appreciate
all
the
efforts
that
you
do
throughout
the
state
and
especially
obviously
in
northern
nevada.
For
for
the
folks
in
the
rural
areas
too.
J
And
I
think
my
question
may
actually
I'll
probably
ask
director
of
this
also.
But
my
concern
was,
with
the
schools
being
closed.
So
many
of
our
youth
really
that
the
one
guaranteed
meal
they
have
is
through
the
school
program
through
the
snap
program,
whether
it's
the
breakfast,
whether
it's
their
lunch,
and
I
was
just
wondering
if
you
had
any
data
on
increase
of
the
children
that
that
were
served
since
school
was
out
and
how.
J
How
were
we
able
to
coordinate
with
the
different
school
departments
in
each
county
and
to
make
sure
that
those
meals
were
being
served?
I
heard
the
three
squares
did
did
work
with
the
clark
county
school
district
and
I
was
wondering
what
school
districts
that
you
worked
with,
because
I
had
huge
concerns
over
this
closure
of
these
schools
and
what
we
were
doing
for
the
kids
during
that
time
and
throughout
the
summer.
And
if
you
had
any
numbers
on
the
number
of
youth
that
you
actually.
D
Served
shane
piccini
for
the
record
for
you,
chair
cohen,
the
food
bank
of
northern
nevada
collaborated
with
the
washoe
county
school
district
to
make
sure
that
the
kids
during
the
shutdown
in
the
washoe
county
schools
got
meals,
and
so
we
had
about
20
distributions
set
up
that.
D
That
allowed
the
kids
to
get
multiple
days,
so
they
only
had
to
come
a
couple
of
times
to
get
multiple
day.
Meals
in
order
to
help
incur
encourage
the
social
distancing
piece,
and
so
we
were
serving
about
40,
000,
kids
in
washoe
county
and
then,
as
far
as
the
royal
counties
go,
the
sponsorship
of
some
of
these
programs
was
broken
up.
So
I
know
that
the
boys
and
girls
clubs
in
winnemucca,
elko
and
I
believe
in
nearington,
were
also
doing
some
of
their
own
meal
programs.
D
But
we
can
definitely
get
you
a
more
solid
list
of
child
nutrition
numbers.
I
know
that
diane
hogan
with
the
nevada
department
of
agriculture
had
sent
me
a
list
about
three
weeks
ago,
just
before
the
end
of
summer,
with
some
counts,
but
I
can
get
it
updated
and
send
it
out
for
you,
and
so
I
just
want
to
say,
though,
that
you
know
the
washi
in
washoe
county.
We
served
about
300
000
meals
through
the
entire
shutdown
and
the.
D
J
Yeah,
thank
you
for
that,
because
that
that
was
a
big
concern
that
we
had
again
just
kids,
where
were
they
going
to
get
their
meals?
And
so
thank
you
for
following
through
on
that
and
I'd
be
really
interested
to
see
the
numbers
afterwards
when
some
of
this
data
can
be
collected.
So
thank
you
be
happy
too.
C
And
and
then
from
southern
nevada
from
three
square,
miss
lewis.
Yes,
please
go.
A
Ahead,
yes,
absolutely
ashanti,
louis
three
square
food
bank,
chair
cohen,
so
ccsd
continued
to
serve
their
meals
at
some
of
their
sites,
and
I
can
get
that
data
for
the
committee
as
well.
A
One
thing
I
would
like
to
point
out
is:
we
did
have
to
suspend
our
summer
food
service
program
in
order
to
follow
social
distancing
guidelines,
and
so
most
of
our
childhood
nutrition
programs
are
at
a
standstill.
Currently,
we
primarily
work
with
volunteers.
They
come
to
our
facility,
they
help
to
package
kids
meals
and
we
just
cannot
have
people
in
the
facility.
At
this
time
we
have
upwards
of
200.
People
come
in
per
day
per
times
lives,
so
we
are
working
to
slowly
bring
in
childhood
nutrition
or
bring
back
childhood
nutrition.
C
A
I
ashanti
lewis
for
the
record.
I
am
not
completely
aware.
I
do
not
want
to
speak
to
that
just
yet
I
will.
I
will
get
that
information
for
you.
C
Okay,
thank
you
all
right
and
then
I'm
sorry.
If
we
have,
I
think
we
have
another
representative
from
one
of
the
other
food
banks.
C
Okay!
Well,
and
from
which
food.
K
Bank,
what
three
square
food
bank
I
apologize.
C
All
right,
okay,
thank
you
very
much
all
right
and
then
was
there
anyone
else.
We
missed.
C
Okay,
seeing
no
one
else,
the
committee
do
we
have
any
other
questions.
C
Okay,
then
thank
you,
miss
urban
and
the
other
and
the
representatives
from
the
food
banks
and,
of
course,
thank
you
to
you
and
all
your
staffs
and
your
volunteers
for
feeding
nevadans
for
the
for
always,
but
especially
the
last
few
months.
You
know
it's.
It's
done
incredible
work,
certainly,
especially
since
the
pandemic
begun.
C
We
know
that
there
were
people
who
you
know
could
within
a
week
of
not
having
a
paycheck
people
who
had
never
had
to
to
utilize
food
banks
were
were
looking
for
for
places
where
they
could
go
to
to
get
fed.
So
we
really
do
appreciate
that,
with
that
we're
going
to
move
on
to
director
ott
from
the
state
department
of
agriculture
to
talk
about
food
insecurity
during
the
cove
pandemic,
director
ott.
E
E
Thank
you
all
for
your
time
today,
I'm
just
going
to
spend
a
few
minutes
to
talk
about
the
food
security
efforts
in
nevada
through
the
department
of
agriculture
and
our
many
partners,
and
what
we're
looking
at
for
next
steps
for
food
security
in
nevada-
and
I
just
wanted
to-
I
would
be
remiss
I
always
try
to
in
a
public
forum
again
also
to
express
thanks,
like
you
did,
to
our
food
banks
and
all
of
our
partners,
our
school
districts,
for
all
of
their
work.
E
You
know
we
work
with
the
federal
agencies.
We
administer
the
programs
but
they're
the
ones
that
are
on
the
ground,
and
we
just
you
know,
couldn't
do
it
without
them.
So
we
really
appreciate
our
working
relationship
to
start
off.
I
just
wanted
to
provide
a
quick
cheat
sheet
for
you.
These
are
the
major
programs
that
we
worked
with
with
covid.
These
are
not
all
of
our
programs
by
any
means,
but
really
these
were
the
major
ones
that
we
were
working
with
to
address
food
security.
E
You
know,
obviously,
when
school
shut
down
in
march,
we
switched
really
quickly
to
the
summer
food
service
programs
and
there's
two
food
programs.
There's
a
summer
program
run
by
school
districts
and
then
there's
summer
programs
run
by
community
agencies,
and
so
those
were
both
operational
I'll.
Go
into
that
in
a
little
bit.
E
The
emergency
food
assistance
program,
the
tfap
program,
that's
what
shane
piccianini
was
talking
about
with
emergency
food.
That's
what
you
traditionally
think
about
is
food
bank
food,
the
food
distribution
program
on
indian
reservations,
our
federal
program,
that
is,
a
monthly
supplemental
food
for
our
tribal
communities,
so
food
deliveries
are
provided
to
certain
locations
throughout
the
state
every
month
and
then
also
our
commodity
supplemental
food
program,
csfp,
which
is
monthly
food
packages
to
seniors.
E
We
weren't
sure
if
we
were
looking
at
school
closures,
if
we
were
looking
at
illnesses
at
kitchens.
If
we
were,
you
know,
we
just
didn't
really
know
what
we
were
going
to
hit,
but
we
needed
to
be
prepared,
and
so
our
team
put
together,
basically
two
two-tier
plans
to
be
ready
for
whatever
direction
we
might
receive.
So,
on
march
6th
we
started
discussing
with
usda
to
get
waivers
in
place
to
be
able
to
address
many
of
those
issues
that
we
were
potentially
going
to
come
up
against.
E
So
we
had
those
waivers
in
place
on
march
6th
and
if
nevada
wasn't
first,
we
were
definitely
one
of
the
first
in
the
nation
to
have
those
in
place,
which
was
a
good
thing
because
on
sunday
march,
15th
is
the
day
that
we
heard
the
governor
made
the
announcement
of
school
closures
and
directive
zero
zero
one
in
the
first
24
hours.
We
did
a
lot
of
phone
calls.
E
So
you
know
we
were
working
with
our
school
districts
and
our
partners
the
entire
time,
but
that
was
sort
of
really
when
we
were
able
to
put
the
plans
that
we
had
devised
into
place
and
started
making
those
phone
calls.
E
One
of
the
plans
was
to
switch
from
the
national
school
lunch
program
to
the
summer
service
programs,
because
that
was
a
model
that
already
had
assets
in
place
that
we
were
able
to
do
a
grab-and-go
meal
service
very
quickly
and
so
there's
some
school
districts
that
did
not
have
those
summer
programs
in
place.
So
for
that
first
24
hours,
we
were
signing
schools
up
very
quickly,
sort
of
you
know
getting
them
enrolled
in
the
program
and
dealing
with
the
paperwork
later,
and
so.
E
In
the
first
24
hours
there
were
72
sites
available
for
school
children
to
receive
meals.
E
During
that
first
week
you
know,
as
sort
of
the
the
plans
were
in
place
and
we
discovered
new
roadblocks,
we
applied
for
more
waivers
and
got
them
specifically
nutrition,
as
we
were
realizing
that
it
was
not
able
to
source
the
food
that
we
were
needing
to
to
maintain
those
very
strict
nutrition
standards
for
the
school
lunch
program.
So
we
got
those
waivers
in
place,
paperwork
processing
to
make
sure
that
we're
getting
all
of
those
summer
programs
active
for
our
for
dipper
program.
E
That,
first
week
we
had
a
truck
going
to
elko
and
we
were
surprised
we
shouldn't
have
been,
but
we
were
very
surprised
that
we
had
almost
doubled
the
number
of
folks
line
up
in
line
there,
so
we
had
to
very
quickly
pivot
and
send
a
second
truck
and
get
that
done,
and
then
the
family's
first
act
was
signed
on
march
18th,
so
preparing
for
the
funding
acceptance
there
ifc
that
kind
of
thing,
and
I'm
going
to
go
into
a
little
bit
of
funding
at
a
later
slide
and
let
you
know
how
that
really
impacted
us
and
then,
by
the
end
of
week
one
there
were
approximately
150
sites
up
around
the
state,
and
that
was
specifically
excuse
me
just
to
feed
school
children.
E
That
is
the
school
children
response.
In
week,
two
we
were
working
with
our
partners
on
food
availability.
We
were
starting
to
see
trucks
slow
down
when
deliveries
were
supposed
to
be.
You
know
at
the
food
banks
they
weren't
getting
there
and
so
working
to
make
sure
that
they
were
going
to
get
there
and
and
that
they
were
just
delayed.
E
There
was
issues
with
staffing.
Of
course,
you
know
with
the
directive
more
and
more
people
stayed
home
and
so
trying
to
work
with
the
department
of
emergency
management
to
try
to
find
some
solutions.
For
that
again,
you
know
transportation,
logistics
and
then
that
second
week
is
when
illness
reports
started
to
roll
in
either
at
feeding
sites
and
sort
of
how
you
know
those
situations
were
going
to
be
solved
and
then
the
cares
act
was
signed
on
march
27th
and
preparing
for
funding
acceptance.
Then.
E
So,
while
all
of
this
was
going
on,
we
were
still
working.
You
know,
you
know
the
food
banks
were
doing
their
great
jobs
with
with
with
their
missions
and
obviously
I'll
see.
The
numbers
you'll
see
the
numbers
in
a
bit,
but
there's
an
increase
in
numbers.
E
But
while
all
of
this
is
happening,
you
know
we're
still
working
on
essential
services
and
agriculture,
making
sure
our
farmers
and
ranchers
were
getting
the
information
that
they
need.
Processing
was
starting
to
come
to
sort
of
a
slow
down.
E
There
were
some
reports
of
dumping
in
the
state.
We
were
fairly
lucky
that
in
march,
much
of
our
produce
season
is
not
ripe
yet,
and
so
we
didn't
have
produce
dumping
like
other
states
did,
but
we
did
have
aspects
of
milk
dumping.
E
There
were
dairies
that,
because
of
casino
closures
and
because
of
school
closures
couldn't
fulfill
their
contracts
anymore,
and
so
we
were
able
to
work
with
those
and
other
partners
to
redirect
that
milk
to
the
food
banks
and
other
food
response
efforts
and
also,
at
the
same
time,
looking
for
alternative
programs.
E
You
know
boxing
was
an
issue
trying
to
figure
out.
How
are
we
going
to
deliver
boxes?
To
seniors
working
with
our
partners
on
that,
and
so
we
were
able
to
take
advantage
of
two
alternative
programs.
The
meals
to
you
program
was
a
partnership
with
baylor
university
to
deliver
a
week's
worth
of
meals
to
rural
areas
and
esmeralda
county
was
the
recipient
of
the
meals
to
you
boxes
and
then
also
the
farm
to
families.
Box
was
a
program
that
usda
stood
up
really
quickly,
redirecting
fresh
farm
produce
to
food
banks.
E
E
So
this
goes
over
a
little
bit
of
the
funding.
The
family's
first
act,
you
know,
did
provide
funding
for
food
programs
provided
3.76
million
dollars
through
tfap,
but
unfortunately,
what
happened
was
that
the
family's
first
act
didn't
waive
the
federal
procurement
processes,
and
so,
although
the
administrative
funds
were
available
for
pretty
quickly
to
provide
assistance
for
staffing
or
for
gasoline
for
distribution
trucks,
we
weren't
able
to
provide
any
food
until
july.
E
E
So
laura
urban
in
the
previous
presentation
went
over
some
of
the
unemployment
data.
Pre-Covered
here
is
some
postcovid
data.
E
This
next
slide
is
the
tfap
the
emergency
food
participation.
Like
I
mentioned,
you
can
see
that
it
spiked
in
april,
which
tracks
with
the
unemployment
data.
E
What
is
really
interesting
to
see,
and
also,
if
you
think
about
it,
really
exhausting
for
all
of
those
folks
that
are
working
on
the
ground,
is,
from
february
to
april,
we
more
than
doubled
the
number
of
individuals
that
participating
in
emergency
food
distribution.
So
it's
it's
quite
quite
a
problem.
E
You
know
that
that
really
was
a
much
bigger
impact
in
our
rural
communities,
and
so
this
trend
line
reflects
that
more.
It's
also
the
same
feedback
that
we
have
received
from
other
fa-dipper
administering
groups
to
you
know
that
that's
the
trend
they're,
seeing
we
are
dipping
down
to
pre-covered
numbers,
and
we
think
that's
also
just
because
of
snap
adoption,
there's
more
people
participating
in
the
snap
program
because
you
can't
participate
in
both
programs.
E
At
the
same
time
so-
and
I
just
wanted
to
reference
dr
titus's
question
on
the
last
presentation-
food
banks
you're
off
the
hook-
department
of
agriculture
can
gather
those
numbers
together
about
schools.
When
the
question
was
asked,
I
was
furiously
looking
through
my
papers
on
my
desk,
because
I
know
we
have
those
numbers.
E
I
just
couldn't
find
them
fast
enough,
so
we'll
we'll
provide
those
to
you
so
on
the
next
steps,
we're
looking
at
food
security
with
the
department
of
agriculture,
we're
really
looking
at
three
main
things,
and
these
are
very
themes,
and
these
are
very
high
level
themes
for
us
and
where
we're
trying
to
guide
some
of
our
policies
and
some
of
our
relationships
moving
forward.
E
Our
first
main
theme
is
continuing
to
represent
nevada
on
a
national
level
to
receive
the
funding.
We
need
to
address
food
insecurity
and
so
working
with
our
federal
delegation
and
working
directly
with
the
usda
office
in
d.c
to
really
receive
the
funding
that
we
need
and
to
be
able
to
do
that
in
funding
innovative
projects,
new
partnerships,
organizations
that
may
have
been
I've
called
them
pop-up
food
locations.
E
E
I
think
that
you
know
in
the
era
of
this
pandemic,
we've
really
learned
to
adapt
to
a
whole
different
way
of
doing
things,
and
we
can
really
really
take
advantage
of
that
and
make
it
work
for
us
to
address
food
insecurity
and
then
also
altering
improving
our
internal
procedures
to
address
any
efficiencies
that
are
lacking
so
that
we
have
a
more
effective
relationship
in
addressing
these
issues.
E
When
we
talk
about
addressing
food
security,
we're
often
talking
about
the
distribution
portion
of
it,
you
know
we
order
the
food
or
our
partners
order.
The
food
gets
it
into
the
warehouse,
you
know,
packs
it
and
you
know,
gets
it
out
to
the
to
the
groups
and
the
public
that
needs
it,
but
we'd
like
to
kind
of
back
up
the
steps.
E
A
little
bit
and
look
at
the
entire
chain,
how
can
we
improve
that
response
by
looking
at
food
processing
and
packaging
by
looking
at
food
production,
and
how
can
we
support
this
whole
entire
chain
to
have
a
better
end
product
and
to
be
able
to
deliver
to
those
food,
insecure
populations
quicker
and
and
with
more
healthy
food?
And
so
we're
really
looking
at
a
total
systems
approach?
E
And
the
third
main
theme
is,
you
know,
breaking
out
of
our
federally
designated
separation.
So
we
have
these
federal
programs,
which
are
great-
I
mean
they
have
been
very
successful
in
the
state.
You
saw
some
of
the
pre-covered
numbers
that
I'm
reducing
some
of
the
food
insecurity
proved
covid,
but
you
know
we
have
tea
fat
for
emergency
needs.
We
have
school
lunches
that
provide
school.
You
know
children
school
children
with
meals.
During
the
day
we
have
csfp
for
seniors.
E
I
won't
go
too
much
into
food
security
council
because
laura
urban
already
covered
that,
but
I
just
you
know
I
wanted
to
mention
that
I
was
absolutely
honored
to
be
selected
as
chair
of
this
committee
about
a
month
ago,
and
so
I'm
really
excited
about
working
in
just
an
expanded
capacity
with
my
colleagues
going
forward
and
with
that
here
is
the
contact
information
for
our
food
and
nutrition
division.
E
J
I
have
a
question
manager
go
ahead,
oh
thank
you.
I
I
moved
outside,
so
you
might
have
a
little
background
noise
here.
My
waterfall
is
going
and
had
to
just
get
outside.
It
was
too
hot
in
my
house.
So
thank
you
for
all
that
you've
done
director.
I
I
have
had
huge
concerns
with
again
the
accesses
I
brought
up,
especially
for
our
youth.
One
of
my
questions
is:
what
kind
of
waivers
did
you
have
to
get
for
the
food
industry?
J
I
know
in
my
one
of
the
districts
that
I
represent
is
fallon
and,
as
you
know,
in
my
community
here
in
smith
valley
and
in
churchill
county,
there
are
tons
of
dairies
and
I
know
that
one
of
the
dairies
actually
opened
up
and
said
here
come
and
get
your
mouth
because
they
couldn't
distribute
that,
and
so
I
I
just
think
that
community
stepped
up
with
some
of
this
and
and
so
what.
But
what
did
you?
What
waivers?
What
what
hurdles
did
you
have
to
go
through
specifically
to
allow
that
kind
of
thing
to
happen?
J
That
was
my
number
one
question
number
two.
I
know
that
in
the
midwest,
especially
there
was
a
lot
of
dumping
of
meat
products
because
the
meat
packing
plants
had
to
close
down.
There
wasn't
so
you
know
we
would
go
to
the
store
and
the
shells
weren't
just
empty
of
toilet
paper,
but
they
were
empty
of
food,
especially
some
of
the
meat
products.
As
you
mentioned
chicken
and
some
of
those
meat
processing
plants
that
were
closed.
What
did
you
do
and
how?
How
did?
How
could
you
help
with
that.
E
So,
thank
you
very
much.
This
is
jennifer
ott
for
the
record.
I
I
think
that
the
the
answer
to
this
question
is
is
really
it's
the
same
answer
to
both
questions.
So
forget
you
know,
let
me
know
if
I,
if
I
miss
a
nuance,
but
as
far
as
waivers
go,
there
wasn't
really
any
waivers
for
the
agriculture
community
to
be
able
to
move
forward.
E
I
know
the
gentleman
you're
talking
about
and
you
know
they
just
really
did
that
as
a
community
response,
and
it
was
just
really
a
wonderful
effort
by
them
and
their
family,
and
you
know,
and
and
similar
dairymen
and
ranchers
across
the
the
state
have
done
similar
things.
There's
not
waivers
in
place
specifically
for
that.
E
However,
we
are
looking
at
through
the
cares
funds
that
we
were
granted
assistance
to
producers
to
be
able
to
develop
new
market
opportunities
to
develop
new
ways
to
market
we've
released
rfps
to
you
know,
work
with
partners
to
be
able
to
address
those
needs
and
those
I
believe
the
last
one
went
out
this
past
week
and
then
a
previous
wanted.
E
You
know
to
to
be
able
to
develop
more
tools
to
get
products
to
market,
and
so
it
wasn't
really
any
waivers
as
more
as
it's
just
assistance
and
being
able
to
be
here
to
answer
the
questions
to
direct
producers
into
their
assistance
categories.
That
would
work
and
be,
and
it
would
it
would
meet
their
needs
and
we
have
actually
through
cares.
E
Funds
have
been
able
to
hire
somebody,
and
that
is
their
full-time
job
is
to
be
able
to
help
people
fill
out
those
applications
answer
those
questions
and
and
really
work
with
the
producers
to
help
them
through
that,
as
far
as
the
processing
facilities
and
the
meat,
the
initial
depopulation
of
animals
through
the
processing
facilities
is
not
something
that
we
saw
a
lot
of
here
because
of
our
climate
were
set
back
a
little
bit
which
allowed
our
processors
are.
E
I'm
sorry,
our
producers
to
plan
a
little
bit
more
and
we're
also
sort
of
very
early
in
the
supply
chain
of
food.
You
know
you
know
our
our
animals
go
to
market
later,
and
so
we
are
seeing
impacts
of
having
to
hold
back
cattle
or
other
animals
longer,
and
so
there
are
increased
feeding
costs
there,
but
we
haven't
had
the
same
issues
as
we've
had
with
other
states.
When
processing
came
to
a
grinding
hole
because
of
restaurant
closures.
J
Yeah
it
does.
Thank
you
very
much.
I
I
just
want
to
acknowledge
all
the
work
you've
put
into
that
to
this
this
whole
process
and
and
how
important
what
you
do
is
to
the
state
of
nevada.
So
thank
you.
Thank
you.
C
So
director
I
kind
of
following
up
on
on
dr
titus's
question
and
getting
back
to
the
the
issue
of
dumping
that
you
know.
I.
I
definitely
appreciate
your
testimony
early
on
that
we
had
very
little
dumping,
and
I
certainly
appreciate
that
that
though
there
were
local
producers
that
that
opened
their
doors
instead
of
dumping
and
said,
please
come
take
so
that
so
that
they
weren't
dumping.
C
But
is
there
anything
that
the
legislature
can
do
any
anything
that
we
can
do
in
statute
that
can
help
whether
it's
covid,
when
whether
it's
some
other
emergency
in
the
future
that
we
can
put
in
place
now,
so
that
if
there
are
issues
in
the
future
that
to
help
so
that
dumping
won't
be
an
issue?
So
so
I
know
I'm
asking
you
to
look
at
the
crystal
ball
and
say
well
what
what
could
happen
in
the
future,
but
is
there
something
that
can
be
done
to
help
prevent
that.
E
Yeah,
I
think
so
so
I
think
the
easy
answer
is.
This
is
jennifer
ott
for
the
record.
The
the
easy
answer
is
yes,
it's
just
it's.
The
more
complicated
answer
is
it
depends,
so
it
depends
on
the
industry.
E
It
depends
on
the
timing,
so
there
are
some
industries
that
are
either
through
cooperatives
or
through
a
federal
intervention,
do
receive
some
funding,
for
you
know
when
their
circumstances
that
there
is
a
dumping
of
a
food
product.
E
There's
you
know
so
it
just.
It's
really
depends
yes
and
we're
working
on
a
proposal
for
you
all
and
I'd
love
to
be
able
to
talk
about
it.
Now
I
just
you
know
we
don't
have
it
fully
formed,
but
we
are
working
on
a
proposal
that
would
potentially
address
that
you
know
not
in
a
pandemic.
It
would
be
looking
as
just
like.
We
had
like
one
of
my
slides
earlier
as
a
total
food
systems.
E
C
Okay,
seeing
none,
we
certainly
look
forward
to
seeing
that
proposal
and
thank
you
for
the
information
and
all
the
hard
work
as
well
and
for
getting
us
ahead
of
the
the
curve
early
on
when
the
writing
was
on
the
wall
about
the
pandemic,
and
definitely
that
goes
to
to
you,
but
also
your
team.
So
we
appreciate
that.
Thank
you
so
much
thank
you
and
with
that
we're
going
to
move
on
to
agenda
item
nine,
which
is
public
comment.
However,
we
need
three
minutes
to
have
the
live
stream
catch
up.
C
So
I
think
what
we're
going
to
do
the
live
stream
needs
to
catch
up
and
we
need
to
give
members
of
the
public
a
chance
to
call
in
so
why
don't?
We
take
a
very,
very
quick
break
to
allow
members
or
to
allow
the
public
to
call
in
for
the
live
stream
to
catch
up
for
us
to
stretch
our
legs.
A
C
Okay
and
we
are
back
from
recess,
so
we
are
going
to
go
ahead
with
agenda
item
nine
public
comments.
Again,
public
comment
will
be
limited
to
two
minutes.
Let
me
get
my
stock
watch
ready
and
the
speaker
will
be
asked
to
state
and
spell
your
last
name
and
last
name,
and
you
may
also
submit
your
comments
in
writing.
C
So
bps,
please
have
the
first
caller
begin.
B
A
Good
good
noon,
madam
chairwoman
and
the
committee,
my
name
is
sarah
adler.
Can
you
hear
me.
A
Yes,
let's
go
ahead,
oh
good,
all
right.
Sarah
adler
s-a-r-a-h-a-d-l-e-r
today,
I'm
joining
you
as
the
board,
chair
of
the
healthy
communities,
coalition
of
lion
and
story
county,
and
I
wanted
to
add
some
information
on
food
security
from
the
local
level.
A
A
We
are
we're
already
serving
hundreds
of
families
a
week
and
the
need
has
increased
significantly
since
the
pandemic
began.
One
of
the
needs
we
are
seeking
to
meet
is
to
be
able
to
do
homebound
delivery
to
folks
who
are
vulnerable
to
infection.
So
our
response
has
been
to
apply
for
a
community
development
block
grant.
They
have
coronavirus
funds.
A
Cdbg
is
operated
for
rural
nevada
by
goed
and
they
do
a
great
job,
but
I
feel
it
is
significant
to
share
that
goed,
since
the
last
recession
has
put
an
economic
development
lens
on
cdbg,
more
so
than
community
development
needs.
And
since
our
basic
mission
is
poverty
mitigation,
we
feel
it
needs
to
be
understood
that
a
key
to
providing
a
workforce
to
enable
economic
development
is
to
mitigate
poverty
and
help
people
into
the
workforce.
A
Also,
so
many
people
due
to
age
and
disability
in
nevada
are
not
going
to
join
the
workforce,
but
cdbg
can
help
their
meet
their
needs.
That's
we
are
hopeful
that
our
application
will
be
recommended
to
the
governor.
On
september
1st,
I
just
want
to
close
by
saying
that
I'm
proud
to
have
been
a
founding
member
of
the
governor's
council
on
food
security.
A
B
A
Okay,
this
is
dora
uel,
martinez,
d-o-I-a-u-c-h-e-l,
hydrogen
martinez,
m-a-r-t-I-n-e-d
good
morning,
chairwoman
cohen.
Thank
you
so
much
for
the
opportunity.
I
would
like
to
just
agree
with
enough
caller
in
regards
to
people
with
disability
and
underlying
health
issues.
I'm
just
going
to
put
this
out
there.
The
nevada
center
for
independent
living
does
a
a
temporary
food
assistant
program
and
the
phone
number
is.
A
Type
of-
and
they
do
the
insta
card
where
they
will
call
you
once
they
identify
you,
they
will
call
you
and
customize
your
shopping
grocery
list
and
the
store
will
drop
it
to
you.
So
if
you're
like
me,
you
can't
legally
drive,
they
will
drop
the
groceries
at
your
doorstep
and
also
in
the
southern
nevada.
There's
seven
zero,
two
eight
eight
nine
four
two
one:
six
southern
nevada
center,
for
instance
living
and
they
do
the
same
thing,
and
I
would
please
encourage
the
staff
for
the
food
for
the
tabata
to
include.
A
Maybe
they
can
work
cover
with
other
non-profit
organizations
when
people
come
in
and
and
fill
out
the
application
one
once
they're
identified
as
disabled,
and
they
cannot
come
independently
that
they
maybe
they
could
have
like
somebody
to
volunteer
once
a
week
or
a
month
or,
however,
I
plan
to
do
it
to
drop
groceries
at
their
place.
A
Because,
like
me,
I
take
the
city
bus
and
sometimes
when
I
go
to
the
pop-up
food
pantry
place,
their
food
are
either
gone
or
the
line
is
too
long
and
it's
so
hot
that
my
black
lab
is
too
hot
for
him.
So
I
gotta
be
mindful
of
my
service
dog
and
thank
you
so
much
for
the
opportunity.
God
bless
you
all.
Thank
you
have
a
great.
B
C
Okay,
thank
you
very
much
before
we
move
on
to
comments
from
the
members.
I
believe
mr
robbins
has
some
answers
for
us
for
some
of
our
questions
from
earlier
in
the
hearing.
So,
mr
robbins,
if
you
please
go
ahead.
G
Yeah
so
eric
robbins,
lcb
legal,
there
were
questions
earlier
in
the
hearing
about.
Basically
whether
an
ambulance
is
obligated
to
pick
somebody
up,
and
so
I
was
unable
to
find
anything
in
state
law
that
imposed
such
an
obligation.
G
I
will
let
the
committee
know
later,
if,
if
I
am
able
to
find
something
like
that,
but
I
I
don't
think,
there's
anything
in
state
law
or
regulation
that
says
that
I
think
that
the
way
that
it
works
with
ambulances
is
pursuant
to
chapters
244
and
268
of
nrs
counties
and
cities
are
authorized
to
provide
ambulance
services
either
by
providing
them
themselves
or
providing
it
through
an
exclusive
franchise
agreement
and
then
the
the
franchise
if
they
enter
into
a
franchise
agreement,
that
franchise
agreement
will
spell
out
the
obligations
of
the
ambulance
provider.
G
So
those
would
be
legal
obligations
imposed
through
contract
and
then
the
city.
If
the
city
provides
them
the
ambulance
service
itself,
then
it
generally
has
something
in
the
city
code
about
what
it's
going
to
provide
like.
G
So
I
I
think
that
that's
generally
how
it
works
that
the
obligations
are
generally
imposed
by
either
the
contract
or
the
the
city
ordinance
as
applicable,
and
then
I
wanted
to
know
one
other
thing:
imtala
does
apply
to
hospital
owned
ambulance
services.
G
I
don't
know
if
we
have
any
of
those
in
nevada,
but
if
we
do
and
tula
applies
so
if
they
pick
someone
up,
they
are
considered
that
person
is
considered
to
be
like
to
have
come
to
the
hospital
for
emergency
services
pursuant
to
and
tell
us
so
then
the
hospital
is
required
to
treat
somebody
that
that
its
ambulance
service
picks
up.
So
that's
what
I
found
on
that.
J
Can
I
ask
a
question
on
that
sure,
so
you
you
in
your
research,
you
looked
up
and
you
saw
that
the
counties
are
authorized
to
provide
emergency
medical
source
resources
and
then
they
establish
ordinances.
But
is
there
an
obligation?
Must
they
establish
resources?
Must
they
have
a
either
contract
or
some
sort
of
emergency
services?
Are
they
obligated
to.
G
I
think
that
it
is
an
authorization.
Let
me
look
up.
Let
me
look
at
this
statute,
real
quick,
but
I
I
think
that
let
me
let's
see
here.
G
G
G
Yeah,
it
says:
yeah,
the
governing
body
of
an
incorporated
city
may
displace
competition
in
the
area
of
the
ambulance
services,
and
then
it
may
provide
those
services
pursuant
to
or
it
may
provide
those
services
on
its
own
or
grant
an
exclusive
franchise.
So
it's
not
it's
not
a
must
requirement.
G
C
All
right,
thank
you
for
that
information.
So
before
we
adjourn
committee
members,
any
comments.