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From YouTube: 1/14/2021 - Legislative Commission's Audit Subcommittee
Description
This is the third 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.
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Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
Thank
you
everyone.
This
is
the
audit
subcommittee
of
the
legislative
commission
january
14
2001..
Welcome
to
this
third
meeting
of
the
audit
subcommittee
this
interrupt.
I
want
to
thank
the
state
agency
representatives
that
are
participating
in
the
meeting
today
over
the
past
several
months.
Of
course,
I
think
we've
become
more
accustomed
to
meeting
in
this
virtual
manner
be
sure
to
meet
yourself
and
unmute
yourself
as
needed
for
speaking
mr
crossman,
will
you
call
the
role.
C
D
A
Here
all
right,
we
have
a
quorum
and
we
can
begin.
We
will
be
having
two
periods
of
public
comment
today,
one
at
the
beginning
of
the
meeting
and
one
at
the
end
of
the
meeting.
It
is
limited
to
three
minutes
per
speaker.
There
are
ways
to
engage.
Should
you
decide
to
do
so?
You
can
call
in,
and
that
number
is
669
900,
68
33
and
then
enter
our
meeting
id,
which
is
seven
five,
six,
nine
nine
five,
four
five
six
followed
by
the
pound
sign.
You
can
also
email
comments
to
lc
audit.
A
A
A
A
You
I
have
a
first
from
assemblywoman
carlton
and
a
second
from
senator
gokuchiya,
mr
crossman.
If
we
can
call
the
role.
D
A
B
Thank
you
vice
chair
for
the
record
dan
crossman
legislative
auditor.
The
six-month
reporting
process
was
established
in
statute
many
years
ago
to
help
ensure
that
recommendations
are
implemented.
The
follow-up
process
begins
with
the
corrective
action
plan
prepared
by
the
agencies
that
have
been
audited
60
working
days
after
the
report
is
made.
Public
statute
then,
requires
the
director
of
the
governor's
finance
office
to
submit
a
report
to
the
legislative
auditor
six
months
after
the
plan
of
corrective
action
indicating
the
implementation
status
of
each
recommendation
after
we
receive
and
review
those
six
month
reports.
B
We
continue
to
work
with
and
monitor
agencies
on
the
recommendations
that
are
not
fully
implemented.
Today
we
have
five
six-month
reports
to
share
with
you
and
with
that
vice
chair
I'll
turn.
It
back
to
you.
A
All
right,
thank
you.
So
much
so
we
are
going
to
begin
with
the
department
of
health
and
human
services,
division
of
welfare
and
supportive
services,
and
we
have
miss
shannon
rydell,
our
chief
deputy
legislative
auditor,.
D
A
I'm
gonna
see
if
broadcasting,
if
the
sound
is
gonna,
be
a
quality
for
all
members
and
it's
it's
coming
through
as
choppy
on
my
end.
F
Mr
miss
rydel,
could
you
check
in
your
microphone
and.
D
D
D
So
the
six-month
report
indicated
that
implementation
of
the
recommendations
was
impact
impacted
by
the
pandemic
and
that
work
on
implementing
remaining
recommendations
would
not
occur
until
after
pandemic
restrictions
had
been
lifted.
Our
question
to
the
division
is
considering
that
the
pandemic
is
ongoing.
How
much
time
after
actions
have
been
lifted?
Does
the
division
estimate
it
will
need
to
begin
implementing
these
remaining.
D
A
If
we
have
someone
from
the
division
of
welfare
services
present.
D
Thank
you.
So,
for
the
record,
this
is
lisa
schweringer.
I
am
the
chief
of
eligibility
payments
with
the
division
of
welfare
and
supportive
services
for
the
findings.
One
three
and
four
administrator
fisher
testified
back
in
february
of
2020,
stating
that
our
agency
would
look
for
opportunities
that
may
exist
for
real-time
wage
and
employment
data,
so
our
staff
could
take
immediate
action
on
cases
versus
having
to
wait
the
three
or
four
months
with
the
quarterly
data
that
we
were
receiving
from
dieter.
D
We
released
an
rfp
for
eligibility,
verification,
a
solution
back
in
january
of
2020
and
a
subsequent
best
and
final
offer
in
april.
Unfortunately,
due
to
the
pandemic,
we
were
unable
to
complete
the
process
until
november.
D
D
A
A
I
will
say
that
it
is
very
reassuring,
miss
swearington,
to
hear
that,
although
the
covid
caused
a
delay
in
the
process
that
the
department
is
moving
ahead
with
the
process
and
securing
a
data
source
to
help
verify
these
numbers
with
with
where
we
are
right
now
and
the
formal
report
we
have,
we
know
that
we
have
three
of
the
recommendations
that
are,
I
I
won't
say,
no
action,
because
it
sounds
like
there's
some
action
but
actions
in
process.
A
So
we
we
will
go
ahead
and
ask
you
back
at
a
future
meeting
just
so.
We
can
hear
how
the
rest
of
these
implementations
on
these
recommendations
are
going,
but
it
sounds
like
you,
folks,
are
absolutely
moving
in
the
right
direction
and
we'll
get
lots
of
information
from
you
folks.
Regarding
these
recommendations.
A
A
Very
positive
response
at
our
next
update.
Thank
you
so
much
so
at
this
point
I
will
go
ahead
and
take
a
motion
to
approve
the
six-month
report
so
moved.
Madam
chair,
I
have
a
motion
from
us.
Assemblywoman
carlton.
I
have
a
second
from
senator
brooks.
Thank
you.
So
much
I'll.
Have
mr
crossman
call
the
role.
D
A
We're
going
to
move
into
our
next
six-month
follow-up,
which
is
state
department
of
agriculture,
division
of
consumer
equitability
and
miss
rydel
is
yours
again.
D
Okay
is
the
sound
okay?
D
The
office
of
finance
issued
the
six-month
report
on
november
12th
of
2020,
indicating
three
recommendations
were
fully
implemented
and
four
were
partially
implemented.
The
partially
implemented
recommendations
relate
to
eliminating
the
backlog
of
inspections,
establishing
an
equitable
system
of
sanctions,
developing
certain
policies
and
procedures
and
determining
whether
a
new
system
would
be
appropriate.
D
D
Our
questions
relate
to
the
division
related
to
whether
division
has
or
still
anticipates,
implementing
these
recommendations
within
those
time
frames,
and
just
for
ease
of
this
I'll
just
do
ask
them
both
questions
at
the
same
time.
So
if,
when
the
department
responds,
if
they
could
just
respond
to
both,
that
would
be
great.
D
G
Madam
chair
for
the
record
cadence
matiavich,
I
am
the
administrator
of
the
division
of
consumer
equitability
for
the
department
of
agriculture
and,
with
your
permission,
I'm
prepared
to
answer
those
questions.
Please
do.
Thank
you,
madam
chair,
in
response
to
question
number
one.
Yes,
with
legislative
commission
approval
of
lcb
file
number
r08120
on
december
28
2020,
which
established
civil
penalties
for
violation
of
the
state's
laws
and
regulations
pertaining
to
advertisement
of
motor
vehicle
fuels
and
petroleum
products.
We
now
have
a
consistent
set
of
penalties
and
sanctions
established
across
the
scope
of
our
regulatory
responsibilities.
G
We
are
in
the
process
of
updating
our
sops
and
guidance
documents
for
inspectors
to
include
those
newly
established
penalties
from
r08120
and
expect
to
complete
that
by
the
end
of
this
month
for
question
number
two.
The
answer
is
yes,
with
one
caveat
for
recommendation
number
two
regarding
elimination
of
the
backlog
of
inspections
of
the
47
090
licensed
commercial
weighing
and
measuring
devices
in
silver
state
55
have
been
inspected
within
the
last
12
months
and
93
have
been
inspected
within
the
last
24
months.
G
However,
a
number
of
the
devices
that
are
overdue
for
inspection
are
located
in
businesses
that
are
still
temporarily
closed.
Due
to
coded
the
owner
or
operator
of
that
device
has
paid
their
annual
license
fee.
We
will
keep
their
license
active
in
our
system
if
those
locations
are
not
reopened
by
july,
the
devices
will
likely
remain
uninspected
at
that
time
and,
additionally,
depending
upon
the
duration
of
the
current
statewide
pause,
inspection
of
devices
in
certain
indoor
retail
locations
may
be
deferred
until
after
july.
A
Thank
you
so
much
miss
matijevic
questions
from
subcommittee
members
for
miss
matijevic.
D
Madam
chair,
I
have
just
a
a
curiosity
type
question
if
I
could
for
just
a
moment
so,
mr
during
the
height
of
the
pandemic,
when
I
had
to
get
gas
sometimes
the
actual
store
was
closed,
but
the
pumps
were
still
working.
So
did
you
run
into
any
issues
with
that
I
mean.
I
know
you
can't
do
inspections,
but
we're
not
sure
about
the
accuracy
of
those
pumps
was.
G
G
Typically,
we
do
need
an
attendant
there
to
help
activate
the
pump,
but
in
certain
cases
we
we
would
go
ahead
and
actually
can
make
a
purchase
of
the
fuel
in
in
order
to
to
verify
the
the
accuracy
of
the
pump
and
particularly
in
any
case
where
we
had
received
a
complaint
from
consumer.
G
We
would
certainly
act
in
that
fashion.
I'm
pleased
to
say
that
in
most
cases
very
few
locations
now
where
gas
stations
don't
have
an
attendant
outside
and
outdoor
inspections,
are
among
the
lowest
risk
for
us,
and
so
with
respect
to
retail
motor
fuel
devices.
We're
actually
doing
quite
well
on
those
inspections
and
and
have
had
our
inspectors
focused
on
those
outdoor
inspections.
A
I
do
not
believe
that
I
see
any
additional
questions
from
committee
members,
and
so
I
will
go
ahead
and
take
a
motion
to
approve
the
six-month
report
so
moved.
Madam
chair,
thank
you.
Assemblywoman
carlton,
in
a
second
from
second
senator,
brooks,
thank
you
so
much
and
mr
crossman
I'll.
Let
you
call
roll.
D
The
last
one
here
again
had
a
we
issued
the
fleet
services
division
report
in
february
of
2020
and
again
the
six-month
report
was
provided
to
us
on
november
12th
of
2020,
and
that
report
indicated
that
the
office
of
finance
was
unable
to
confirm
the
status
of
all
seven
recommendations
for
fleet
services.
D
Based
on
this
review.
We
believe
the
division
has
fully
implemented
all
recommendations
and
we
do
not
have
any
questions.
However,
we
want
to
emphasize
to
the
division
the
importance
of
sustaining
the
implementation
of
these
recommendations,
since
most
of
the
recommendations
made
in
our
report
of
february
2020
were
from
prior
reports.
D
A
Hey,
thank
you
so
much
miss
rydell,
so
we
have
mostly
fully
implemented,
but
just
the
the
last
sentence
here
that
does
state
that
a
lot
of
these
were
kind
of
repeat
findings
from
the
previous
audit,
so
that
due
diligence
by
the
department
to
continue
these
practices
will
be
helpful.
A
The
next
time
there's
there's
an
audit
any
any
comments
for
the
record
from
fleet
services.
E
A
Okay,
thank
you,
mr
burgess
audit
committee
sub
members.
Any
questions
for
mr
burgess.
A
D
A
H
Good
morning,
can
you
hear
me
vice
chair
perfectly?
Thank
you
great
good
morning.
Vice
chair
benitez
thompson,
members
of
the
audit
subcommittee
for
the
record.
I
am
shirley
ital
bingham
deputy
legislative
auditor.
In
february
2020,
we
issued
an
audit
report
on
the
public
employees
benefit
program,
information
security.
H
H
Our
review
indicated
pebb
has
now
fully
implemented
recommendation
number
five,
however,
pebb
indicates
the
business
continuity
plan
review
and
the
recovery
process
updates
will
be
completed
when
the
chief
information
officer
position
at
pebb
is
filled.
Pebb
anticipates
full
implementation
of
these
two
recommendations
in
january
2021..
H
A
All
right,
thank
you
and
I
believe
we
have
miss
rich
present
or
miss
yes,
hello.
You
can
go
ahead
and
respond.
I
I
E
Yes,
thank
you,
madam
chair
stephen
martin
for
the
record
public
employee,
benefit
program,
chief
information
officer,
and
I
am
prepared
to
answer
those
questions.
A
E
Thank
you.
Yes,
I
have.
I
have
the
questions,
so
I
did
join
the
agency
at
the
end
of
last
year
and
I
have
had
a
chance
to
review
these
audit
findings
as
well
as
our
response
and
these
last
two
items-
items
13
and
14,
which
are
relative
to
the
disaster,
recovery
and
business
continuity
plan.
We
do
have
a
draft
and
we
have
not
yet
fully
reviewed
it
and
implemented
it.
We
started
that
draft.
A
I
tell
bingham:
did
you
want
any
additional
information
from
mr
martin
on
that
response
or
be
satisfied?
You're
satisfied.
E
Yes,
the
the
I
actually
integrated
both
of
my
responses
in
there,
but,
in
short,
the
second
question
I
believe
was
have
we
had
a
chance
to
implement
into
our
policies
the
rest
of
the
business
continuity
disaster
recovery
plan
and
the
answer
to
that
is
not
yet.
We
are
working
on
the
rest
of
our
agency
policies
which,
for
which
drafts
have
been
submitted
and
are
currently
under
review
and
will
be
implemented
this
month.
E
A
A
I
I
had
not.
I
know
that
the
the
auditors
you'll
be
following
up
on
on
this
one.
I
I
know
that
for
on
the
first
review
report
that
we
heard
that
specifically
made
a
note
that
you
know
we
would
have
division
of
welfare
services
come
back
just
because
they
were
in
the
process
of
implementation.
A
It
sounds
like
the
implementation
on
this
heb
information
security
plan
is
going
to
be
in
place
by
the
end
of
this
month.
So
I'll
look
forward
to
those
reports
coming
back
to
the
committee
about
how
that
implementation
looks
and
knowing
that
we've
got
this
important
information
all
secured
with.
That
being
said,
mr
crossman
will
go.
Oh
I'll.
Take
a
motion
to
accept
this
six-month
follow-up
report
so
moved.
Thank
you,
assemblywoman,
carlton's,
second
and
bye
duncan.
B
A
D
A
E
Good
morning
for
the
record
amanda
barlow
deputy
legislative
auditor,
in
february
2020,
we
issued
an
audit
report
for
the
nevada
western
interstate
commission
for
higher
education.
The
six-month
report
prepared
by
the
office
of
finance,
indicated
that
two
recommendations
were
fully
implemented
and
eight
recommendations
remain
partially
implemented.
E
The
recommendations
include
developing
or
revising
policies
and
procedures,
developing
a
program,
tracking
tool
and
monitoring
data
accuracy.
We
contacted
the
office
in
january
2021
regarding
the
status
of
the
partially
implemented
recommendations.
Our
question
for
the
agency
is,
since
the
agency
does
not
expect
full
implementation
until
september
2021.
A
E
E
We
have
one
staff
member
right
now,
which
is
myself
and
have
had
one
staff,
member
myself
for
the
last
year
now
and
due
to
the
pandemic,
we're
unable
to
get
in
even
temporary
help
because
we
don't
have
features
in
the
office
for
social
distancing.
So
we
have
been
making
a
lot
of
progress.
We
had
215
open
accounts,
we've
closed
80
over
the
last
year
and
we
still
have
about
50
to
go
through.
E
So
it's
just
as
I
juggle
that
through
my
other
duties,
it's
just
taking
a
little
bit
of
time
and
then
we
need
to
revise
our
policies
and
procedures.
We'll
probably
just
do
a
full
revision
and
create
a
new
policy
and
procedure
manual.
So
the
answer
is,
it
will
get
done
just
a
little
bit
slower
than
anticipated
or
desired.
A
Okay,
thank
you
so
much
for
that.
We
know
when
you're
a
one-man
band
things
take
longer
and
that
there
was
you
know
quite
a
bit
of
turnover
before
you
came
into
the
office,
so
we're
appreciative
of
the
fact
that
you're
staying
put
staying,
planted
and
doing
this
work
because
we're
not
going
to
get
consistent
policies
if
we
just
have
so
much
turnover
and
staffing
so
appreciate
that.
I
think
then,
that
it
would
make
sense
to
have
you
we'll.
A
G
Amazing,
it
doesn't
look
like
they
are
moving
forward,
especially
senator
greg.
Thank
you,
madam
vice
chair,
but
especially
along
the
lines
of
you
know
with
the
state
accounting
system,
and
it
does
look
like
they're
making
some
some
headways.
So
I
appreciate
that.
A
Yeah,
thank
you.
Mister
senator
gogucci.
It
was
nice
to
see
actually
some
collections
starting
to
happen
on
these
loans
on
delinquent
loans,
because
for
a
long
time
that
work
hadn't
been
done.
So
I
appreciate
that
as
well.
That
being
said,
I
will
go
ahead
and
accept
a
motion
to
accept
the
six-month
report
so
moved.
Thank
you,
assemblywoman
carlton,
a
second
friend
second
senator
gokuchiya
and
mr
crossman.
If
you
can
call
roll.
A
D
A
Yes,
motion
passes
all
right
now,
we'll
get
into
the
new
stuff,
we'll
go
into
agenda
item
five
presentation
of
audit
reports
and
mr
crossman,
the
floor
is
yours.
B
Thank
you,
madam
vice
chair
for
the
record
dan
crossman
legislative
auditor
under
agenda
item
five.
Today
we
will
have
three
performance
audit
reports.
B
These
have
been
maintained
confidential,
with
the
exception
of
information
provided
to
the
agencies
until
now
will
be
made
public,
obviously,
at
this
meeting
and
available
on
our
website
immediately
following
our
meetings
today,
our
first
audit
today
under
agenda
item
5
a
is
the
audit
delivery
of
treatment
services
for
children
with
autism,
which
was
performed
as
directed
by
the
legislature
directed
in
senate
bill
174
of
last
session.
B
The
audit
was
conducted
by
a
team
of
auditors
that
included
jeff
mullen
joe
abattan
jennifer
otto
sean
huser
and
shannon
rydell,
along
with
the
assistance
of
other
members
of
our
office
and
staff.
B
I'd
like
to
thank
our
staff,
as
well
as
the
agencies
that
we
worked
with
on
this
audit
to
to
bring
this
together.
A
lot
of
work
went
into
it
and
we
appreciate
everyone's
assistance
today,
ms
otto
will
be
making
our
presentation,
so
I
would
turn
the
mic
over
to
her.
At
this
point.
J
J
J
It
is
estimated
that
autism
spectrum
disorder
or
asd
impacts
about
1
in
every
54
children
in
the
united
states,
while
determining
the
number
of
children
in
nevada
with
asd
is
difficult.
We
use
the
nevada
department
of
education's
count
of
children
with
autism
as
documented
through
an
individualized
educational
program
or
iep
autism.
J
Pages.
2
and
3
provides
a
definition
for
asd
describes.
The
diagnosis
process,
describes,
applied,
behavior
analysis
or
aba
and
lists
the
types
of
aba
providers
pages.
Four
and
five
gives
an
overview
of
the
autism
treatment
assistance
programmer
atop
and
its
plan
types
as
well
as
the
role
of
nevada
medicaid
in
providing
aba
services
to
children
diagnosed
with
asd.
J
The
audit
scope
and
objectives
are
noted
on
page
six.
Our
objectives
were
to
one
determine
if
revenues
and
expenditures
related
to
autism
therapy
were
sufficient
and
appropriate
to
evaluate
and
review
whether
children
wait
for
services
and
if
enough
providers
exist
to
serve
nevada's
population
of
children
with
asd
and
three
identify
and
assess
factors
that
inhibit
access
to
and
delivery
of
autism
treatment
services.
J
We
conduct
our
audits
in
accordance
with
government
auditing
standards,
and
these
standards
require
us
to
report
any
constraints
imposed
on
the
audit
approach
and
limitations
on
access
to
information,
which
we
discussed.
On
pages
six
and
seven
of
the
report,
the
limitation
included
inaccurate
and
counterclaim
data
received
from
nevada
medicaid.
J
However,
we
do
not
believe
this
limitation
impacted
our
audit
objectives
or
affected
our
conclusions
because
of
other
procedures
performed
the
method
of
the
methodology
section
of
the
report
at
appendix
g,
which
begins
on
page
52,
provides
further
detail
regarding
the
data
obtained
and
assumptions
made
our
findings
and
recommendations
begin
on
page
8..
We
found
that
state
agencies
did
not
spend
all
funds
budgeted
for
autism
treatment.
In
the
2015
legislative
session,
the
state
estimated
costs
to
provide
autism
treatment
to
be
35.7
million
annually.
J
This
amount
was
projected
to
cover
an
estimated
2
500
children
needing
treatment
services.
However,
since
fiscal
year,
2017
only
about
15
million
per
year
on
average
has
been
spent
on
autism
therapy
services
exhibit
2.
On
page
9
shows
the
expenditures
related
to
autism
services
by
program
and
children
served
over
the
last
5
years
for
medicaid.
This
occurred
mostly
because
the
number
of
children
receiving
services
continues
to
be
well
below
that
estimated
during
the
2015
legislative
session.
J
J
J
The
medicaid
system
does
not
have
adequate
system
controls
such
as
edit
checks
to
detect
providers
billing
an
unreasonable
number
of
hours
in
a
day
for
autism
services.
Additionally,
there
are
a
few
system
controls
to
limit
the
number
of
service
hours
billed
and
paid
in
a
single
day
as
required
by
nrs28g.
J
We
reported
this
information
to
the
governor
each
legislator
and
the
attorney
general
appendix
d
on
page
48
contains
that
letter
on
page
17.
We
discuss
our
findings
related
to
nevada
medicaid,
not
detecting
inaccurate
data
provided
by
managed
care
organizations.
Specifically,
we
found
in
counter-data
had
the
following
problems:
claim
information
only
included
service
time
billed
and
not
the
service
time
paid
data
included
medical
procedures
other
than
autism
therapy
when
it
should
not
have,
and
information
provided
directly
by
managed
care
organizations
did
not
always
agree
to
encounter
claim
information.
J
Lastly,
beginning
on
page
19,
we
discussed
our
analysis
of
the
fiscal
notes
provided
by
nevada
medicaid
in
atap,
which
overestimated
the
costs
for
a
proposed
rate
increase
for
autism
therapy
services
in
senate
bill
174
agencies
estimates
were
based
on
unreasonable
assumptions.
These
problems
occurred
because
agencies
did
not
have
adequate
controls
to
ensure
information
submitted
is
appropriate
and
used
universal
templates
without
considering
program,
specific
factors
when
estimating
the
fiscal
impact
of
proposed
legislation
exhibit
10
shows
the
agency's
projected
costs
and
our
recalculated
projected
costs.
J
Pages
20
and
21
contains
seven
recommendations
to
improve
internal
controls
and
other
fiscal
matters.
Our
recommendations
are
the
following:
nevada
medicaid
should
determine
reasonable
limits.
The
number
of
service
hours
in
a
one-day
period
for
both
providers
and
children,
nevada
medicaid,
should
develop
system
methods
to
prevent
claims
with
excessive
service
hours.
J
Nevada
medicaid
should
further
investigate
claims
with
unreasonable
service
hours
and
identify
and
recover
overpayments
and
refer
potential
fraud
to
the
office
of
the
attorney
general
nevada.
Medicaid
should
develop
a
process
to
routinely
review
and
counter
claim
data,
including
procedures
to
ensure
data
submitted
is
accurate
and
services
provided
to
children
are
appropriate.
J
J
J
Chapter
2
begins
on
page
22..
We
note
that
families
frequently
struggle
to
obtain
timely
services
for
their
children
with
autism
continuing
on
page
24.
We
note
that
families
generally
lack
support
from
state
agencies
prior
to
children.
Obtaining
an
autism
diagnosis,
a
lack
of
comprehensive
information
about
programs,
requirements
and
step-by-step
guidelines
on
the
diagnosis
and
treatment
process
is
a
barrier
for
all.
Families
who
suspect
their
child
may
have.
Asd
no
agency
or
licensing
body
maintains
a
list
of
providers
who
diagnose
asd.
J
J
Continuing
on
page
25,
we
note
that
delays
in
getting
services
are
a
major
challenge
for
parents
seeking
aba
treatment
for
their
children.
An
atop
june
2020
report
noted
the
average
time
for
children
on
the
atap.
Waitlist
was
153
days.
Atap's
wait.
Time
calculates
the
time
from
one
child
has
completed
their
atep
application,
which
requires
that
they
already
have
a
diagnosis
of
asd
to
the
date
at
which
a
provider
accepts
a
child.
For
future
services,
the
wait
time
does
not
include
any
time
that
family
waits
to
obtain
a
diagnosis.
J
The
time
from
a
diagnosis
to
when
a
family
completes
an
atap
application
or
the
time
from
when
a
provider
accepts
a
patient
to
the
actual
date
of
the
first
appointment
on
page
27.
We
note
families
do
not
receive
assistance
in
identifying
and
securing
therapy
providers
once
children
receive
a
formal
diagnosis.
J
Limited
capacity
means
children,
wait
for
openings
in
provider
schedules
with
placement
dependent
upon
luck
and
caregiver
tenacity.
Furthermore,
older
children
or
those
with
more
difficult
behaviors
may
wait
longer,
because
providers
can
be
selective
and
after
school
service
hours
are
highly
coveted.
J
On
page
29,
we
have
five
recommendations
for
atapt
to
assist.
Families
obtain
timely
treatment
for
their
children.
Our
recommendations
are
the
following:
atap
should
develop
and
publish
specific
guidance
regarding
how
to
obtain
a
diagnosis
and
apply
behavior
analysis
treatment
for
those
inquiring
about
services.
J
Atep
should
create
and
maintain
a
list
of
healthcare
professionals,
qualified
and
performing
diagnoses
of
autism
spectrum
disorder.
Atep
should
assign
care
managers
to
families
as
soon
as
program
eligibility
is
determined.
Atap
should
actively
monitor
provider
availability
and
assist
families
in
obtaining
and
selecting
a
suitable
provider.
J
Atap
should
develop
a
standardized
process
to
identify
children
with
the
greatest
need
for
immediate
placement.
With
applied
behavior
analysis
providers
to
expedite
services.
Chapter
3
begins
on
page
30..
We
found
nevada
does
not
have
excuse
me.
A
sufficient
provider
base
to
adequately
provide
aba
therapy
to
all
children
with
autism
who
medically
require
services
exhibit
13.
On
page
31
shows
the
growth
in
aba
providers
based
on
licensing
information
only
which
does
not
necessarily
represent
those
providing
services,
as
some
may
be
licensed,
but
leave
the
workforce
as
of
october.
J
J
Consequently,
children
covered
by
medicaid
and
atop
programs
wait
for
treatment
to
begin
longer
than
children
with
private
insurance,
registered
behavior
technicians
or
rbts
who
deliver.
The
majority
of
the
one-on-one
therapy
are
reimbursed
half
the
rate
by
medicaid
and
utep
that
private
insurers
pay.
There
are
many
factors
that
affect
if
a
provider
will
treat
a
particular
child,
but
provider
groups
indicate
that
they
consider
reimbursement
rates
when
filling
openings
continuing
on
page
34.
J
We
know
that
planned
reductions
to
medicaid
rates
would
further
reduce
rates
as
a
result
of
19
related
budget
cuts,
based
on
the
much
higher
rate
for
private
insurance.
Reimbursement
providers
have
a
greater
monetary
incentive
to
serve
children
with
private
insurance
than
those
with
medicaid
exhibit
16.
On
page
35
shows
the
medicaid
rate
in
comparison
to
the
average
rates
paid
by
private
insurers
from
our
sample.
J
We
note
that
the
medicaid
rate
listed
in
the
exhibit
does
not
reflect
the
pending
six
percent
rate
cut
that
would
be
applied
retroactively
from
august
2020,
if
approved
by
centers
for
medicare
medicaid
services,
provider
groups
indicated
medicaid.
Reimbursement
rates
do
not
cover
all
costs
associated
with
employing
rbts.
An
increase
in
the
rbt
reimbursement
rate
would
help
medicaid
compete
for
a
limited
number
of
providers.
J
On
page
36,
we
submit
to
the
legislature
that,
as
funding
becomes
available
or
when
the
legislature
deems
appropriate,
the
legislature
may
want
to
consider
directing
the
medicaid
to
increase
the
reimbursement
rate
for
rbts
to
reflect
more
closely.
The
rates
paid
by
other
insurance
coverage
entities
in
the
state
chapter
4
begins
on
page
38.,
while
state
and
local
agencies
coordinate
efforts
to
some
extent.
Improved
communication
will
enhance
outcomes,
each
transitions
and
result
in
more
robust
delivery
of
services
for
families
with
children
with
autism.
J
School
districts
can
begin
providing
medicaid
reimbursable
services,
which
allows
children
to
receive
aba
during
the
school
day
and
also
provides
additional
federal
funds
to
help
offset
the
costs.
On
page
39,
we
note
that
nine
school
districts
plan
to
build
medicaid
for
autism
therapy,
provided
by
or
through
the
school.
Some
therapy
will
be
provided
by
school
district
staff,
while
others
will
be
provided
through
outside
contractors.
J
Eight
school
districts
currently
do
not
plan
to
build
medicaid
for
autism
therapy.
Appendix
f
on
page
51
displays
specific
school
district
participation
in
billing
medicaid
for
aba
services.
During
the
school
day.
The
decision
to
participate
in
aba
programs
is
unique
to
each
school
district,
which
must
weigh
various
factors
in
deciding
whether
aba
or
other
asd
therapy
is
in
the
best
interest
of
their
students
and
the
district.
J
Page
41
contains
two
recommendations
to
improve
communication
between
agencies
to
better
serve
the
population
of
children
with
asd.
Our
recommendations
are
the
following:
nevada
medicaid
should
continue
working
with
the
nevada
department
of
education
and
nevada
school
districts
on
the
implementation
of
the
state
plan,
amendment
for
school
districts
to
receive
medicaid
reimbursement
for
applied,
behavior
analysis
services,
nevada
medicaid
should
provide
atap
with
contact
information
for
new
and
released,
so
atep
can
offer
targeted
case
management
to
families.
J
Appendix
b
begins
on
page
43.
It
is
an
acronym
list
and
glossary.
Our
audit
methodology
begins
on
page
52
appendices
h
and
I,
which
begin
on
pages
59
and
63,
contain
their
responses
from
nevada,
medicaid
and
the
aging
disability
services
division.
All
14
recommendations
were
accepted
vice
chair
benitez
thompson
and
committee
members.
This
concludes
my
presentation.
I'd
be
happy
to
answer
any
questions.
A
Thank
you
so
much
miss
otto.
At
this
time
we
will
go
ahead
and
invite
up
representatives
from
the
two
different
agencies
in
order
to
offer
remarks
and
then
actually,
no
we'll
at
this
time.
We'll
first
start
with.
If
subcommittee
members
have
questions
for
miss
otto,
not
the
agency,
but
for
our
auditor
on
any
on
any
information
in
the
audit.
E
D
D
To
make
sure
that
I'm
understanding
when
I'm
looking
at
page
46
appendix
c
it
says
provider
1,
2
3.
when
we
use
the
word
provider,
is
that
a
a
group
of
providers
or
is
that
one
single
person
that
was
one
single
person
so
under
provider?
Three,
the
net
payment
was
over
a
million
dollars
over
nine
thousand
service
hours
and
an
hourly
rate
of
a
hundred
and
ten
dollars
for
one
person.
D
D
A
Thank
you
so
much
other
committee
members.
A
I
did
have
a
question
miss
otto,
so
the
ada
services
can
be
provided
by
three
different
licensing
types
ranging
from
the
rbt
who
just
has
a
high
school
diploma
and
then
40
hours
of
training,
all
the
way
up
to
the
board,
certified
behavioral
analysis,
who
has
a
master's
degree
and
then
700
hours
of
supervision
and
then
15
hours
of
independent,
supervised
field
work.
So
quite
a
range
there
did
we
did
you
among
those
licensing
types?
A
J
A
Okay
and
then
also
across
the
different
licensing
types.
A
Well,
I
guess
I
guess
it
would
be
that
the
next
question
I
have
is
probably
going
to
be
one
for
the
department.
That
was
the
only
one
that
I
had
specific
to
the
data
in
the
audit.
D
Vice
chair,
this
is
shannon
rydell
chief
deputy
legislative
monitor.
If
I
could
just
provide
a
little
bit
of
clarity
regarding
this,
so
assemblywoman
carlton,
you
had
some
questions
on
page
46
and
47
and
those
are
individual
providers,
but
those
individual
providers
are
build
through
provider
groups.
A
I
thank
you
very
much
yeah,
so
miss
radel.
I
guess
those
provider
groups
well
we're
not
necessarily
talking
about
the
names
of
those
four
specific
part
provider
groups.
Those
provider
groups
had
the
three
different
licensing
types
or
were
those
provider
groups
mostly
comprised
of
one
kind
of
licensing
type.
A
Are
you
seeing
no
other
questions
from
committee
members
at
this
time,
for
our
auditors
will
go
ahead
and
invite
up
representatives
from
our
our
two
different
agencies,
medicaid
finance
and
aging
and
disability?
And
I
think
I
have
four.
A
It
looks
like
four
individuals
who
are
present
from
medicaid
financing
and
then
three
who
are
present
from
aging
and
disability
services,
and
so
why
don't
we
go
ahead
and
start
with
folks
from
medicaid
financing
and-
and
I
think
ms
biermann
miss
finney
mr
young
and
mr
burrell
is
that
right
morning,.
A
Okay,
so
I
guess
I'll,
let
you
go
ahead
and
start
with
just
comments
and
responses
and
then
open
it
up
to
members
for
questions.
K
Well,
thank
you.
Suzanne
biermann,
for
the
record
administrator
of
the
division
of
healthcare
financing
and
policy
did
want
to
highlight
that
we
have
accepted
all
of
the
recommendations
provided
in
this
audit
always
appreciate
the
opportunity
to
continually
improve
our
program
and
have
already
started
digging
in
looking
at
these
issues.
In
greater
detail
certainly
already
have
some
process
improvements
in
place
and
continue.
We'll
continue
to
be
working
to
improve
our
processes
and
further
research.
K
The
issues
that
have
been
raised
today
do
you
have
all
three
of
the
deputies
from
medicaid
on
as
well.
Some
of
these
issues
get
pretty
technical,
so
we
have
deputy
administrators,
cody,
finney,
dwayne,
young
and
and
phil
burrell,
but
again
just
did
want
to
highlight
that
we
have
accepted
all
of
these
are
working
on
plans
to
further
research
and
address
these
over
the
course
of
this
period
and
throughout.
We
certainly
take
program
integrity
concerns
very
seriously
and
want
to
make
sure
that
we're
being
good
stewards
of
taxpayer
dollars.
D
Questions,
madam
sheriff,
I
may
please
along
the
same
lines
of
the
the
question
that
I
asked
earlier
in
looking
at
this
and
evaluating
it.
You
glanced
along
the
fraud
side,
but
is
there
an
issue
on
the
reporting
side
that
that
causes
a
problem
we
had
this
once
before
and
part
of
it
was
reporting,
so
is.
Is
there
an
issue
with
how
the
reports
are
filed
and
then
aggregated
together?
K
K
Certainly
one
of
the
biggest
projects
that
we've
undertaken
recently
is
the
modernization
of
the
state's
medicaid
management
information
system
and
that's
kind
of
been
finalized
over
the
the
last
two
years,
implemented
in
2019
with
final
certification
activities.
Just
wrapping
up.
So
that's
been
a
large
undertaking
in
the
way
that
we
process
claims
and
have
updated
some
of
our
processes
around
encounter
claims.
As
a
part
of
that
effort,
we've
recently
established
an
encounter
work
group
to
look
at
this
data
in
april.
K
2020
are
also
working
closely
with
the
managed
care
organizations
to
make
sure
that
we
all
stay
on
the
same
page
around
edits
data
quality
and
monitoring
processes
so
have
started.
Establishing
that
work
group.
I
think
that
will
help
address
some
of
these
issues
and
make
sure
that
defects
are
being
identified.
We
have
defect
identified
one
defect
recently.
K
I
know
some
of
it
is,
you
know
pretty
in
the
weeds,
but
we
did
have
one
defect
with
a
duplicate
edit
and
we
have
since
implemented
a
fix
on
that
which
has
improved
our
data
quality
around
encounter
claims
that
have
been
submitted
so
just
wanted
to
to
highlight
that
we've
also
raised
autism
services
to
the
top
of
the
list
of
issues
for
this
work
group
to
address
so
that
monitoring
began
in
january
2021
and
there
will
be
monthly
reports
being
provided
specific
to
these
aba
services.
K
So
there
is
a
lot
going
on
in
terms
of
our
reporting
and
data
and
the
modernization
of
the
mmis
and
some
new
work
groups
that
we've
been
convening
and
working
with
our
managed
care
partners
to
to
make
sure
that
all
of
these
issues
are
being
identified
and
solutions
identified
and
implemented
for
any
defects
that
we
find
along
the
way.
But
I
do
think
to
your
other
question,
and
maybe
deputy
administrator
cody
finney
can
provide
some
additional
detail
on
this
piece.
K
We
do.
We
are
looking
into
this
with
our
surveillance,
utilization
and
review
unit.
I
think
once
they
have
a
deeper
dive.
We
might
have
a
more
specific
answer
to
your
question
right
now.
I
think
we're
we're
trying
to
go
through
and
you
know,
see
what
is
appropriate
for
those
types
of
referrals
and
what
might
be
accounted
for
by
other
just
ways
we
count
days
and
the
way
that
we
pay
claims.
G
Adam
vice
chair
I've,
just
I'm,
I'm
really
not
up
to
speed
on
this
as
much
as
I
probably
should
be,
but
I'm
concerned,
are
we
also
going
to
look
at
you
know
if
we've
got
a
the
professional
at
120
dollars
an
hour
and
then
more
of
a
lay
person,
I'm
going
to
say
at
30
an
hour?
Are
we
also
going
to
look
at?
G
You
know
the
level
of
treatment
and
the
level
of
benefit
and
the
differences
between
those
two
billing
rates.
G
Did
I
make
any
sense
to
you,
you
know
I'm
concerned
if
okay,
we're
charging
all
these
guys,
if
we've
got
the
professional
level
at
120
an
hour,
it's
kind
of
like
okay,
can
we
pay
a
vet
tech
which,
in
my
world,
can
they
do
the
job
adequately
and
not
have
to
pay
the
200.
K
K
Absolutely
we
certainly
review
service
utilization
and
want
to
make
sure
that
we're
providing
services
at
that
adequate
level
of
care,
so
we'll
absolutely
be
taking
a
look
at
that
as
well.
A
So
miss
spearman,
then,
as
you
are
rolling
out
the
new
medicaid
system,
that's
gonna,
the
information
tracking
system.
That's
gonna,
allow
us
to
be
kind
of
more
accurate
on
provider
claims
submitted
and
versus
what
we
pay.
Do
you
expect
that
that
will
address
the
problem
of
excessive
hours
completely
or
do
you
imagine
that
that
will
give
you
a
starting
point
in
terms
of
how
the
process
would
need
to
be
changed
and
then
expect
additional
work
to
be
done.
K
Thank
you
for
the
question
vice
chair,
benitez
thompson.
I
think
part
of
that
is,
if
we
add
additional
edits
to
our
system.
Some
of
that
will
be
addressed
automatically
when
those
claims
then
hit
the
edits
they
they
won't
pay.
If
we
add
new
edits
to
the
system,
which
is
one
of
the
recommendations,
and
we
do
have
a
team
researching
that
potential
option,
so
I
think
that
there's
certainly
a
piece
there
and
I
think,
if
general
information
around
the
process
of
the
surveillance,
utilization
and
review
unit
would
be
helpful.
K
Our
general
program
integrity
activities
and
you
know
how
we
allocate
resources
there,
maybe
a
deputy
administrator.
If
any,
has
it
has
additional
information,
but
I'm
not
sure
if
the
systematic
piece
of
it
was
adequate
and
addressed
your
your
question,
if
you
or
if
you
would
like
more
info
on
how
we
organize
our
surveillance,
utilization
and
review
processes
and
our
program
integrity
efforts
more
broadly.
A
Well,
I
guess
what
I'm
trying
to
get
a
feeling
of
is
knowing
that
you're
responding
to
the
findings
and
you're
working
on
it.
I
just
was
trying
to
set
what
would
be
a
realistic
expectation
for
saying
that
this
problem
is
solved
and
these
types
of
excessive
billing,
and
because
I
imagine
that
it's
it's
shocking
right
now.
I
would
imagine
that,
within
these
community
of
providers,
there's
got
to
be
a
high
level
of
anxiety,
knowing
that
almost
a
good
vast
majority
of
them
might
be.
A
You
know
accused
of
medicaid
fraud
for
excessive
billing
in
a
day
and
that,
if
we
are
talking
about
changing
that
system,
make
sure
that
that
if
there
were
heirs
versus
people
who
are
sending
fraudulent
billing
that
we
would
be
able
to
have
that
sorted
out
in
five
months
six
months
or
what
we
tell
the
public
about,
how
we're
we're
fixing
this
and
how
we
make
sure
the
parents
in
the
community
know
it's
a
little
bit
jumbled
right
now,
but
within
a
year
from
now,
we
should
be
in
a
place
where
this
is
no
longer
happening
or
we're
still
in
transition.
K
Thanks
for
the
question
vice
chair,
benitez
thompson,
I
think
definitely
within
the
year
we'll
know
you
know
with
further
research
into
this
issue
and
an
investigation
into
these
particular
findings.
You
know
have
a
better
sense
of
which
of
them
have
been
moved
on
and
found
warranted
to
move
up
to
the
level
of
the
attorney
general's
office
and
medi
medicaid
fraud
control
unit.
You
know
what
portion
of
them
have
reached
that
level
again.
K
Once
we
look
at
the
data
more,
how
much
might
be
explained
just
in
terms
of
how
the
billing
is
occurring
and
also
whether
or
not
any
system
edits
have
been
put
in
place,
and
I
think
you
know
the
the
process
of
adding
a
system
edit,
I
think,
could
also
be
accomplished
within
a
year.
So
I
think
we'll
have
more
information
for
you.
Certainly
within
a
year
you
know
which
of
those
paths
and
more
information
about
once
we
and
the
the
attorney
general's
office
dig
into
these
specific
claims.
K
You
know
what
level
was
found
to
what
percentage
was
found
to
rise
to
the
level
of
being
investigated,
further
related
to
fraud,
waste
and
abuse,
and
you
know
what
percentage
was
explained
by
service
billing
limits
and
the
way
our
policy
and
system
process
claims.
A
Okay,
any
additional
questions
coming
from
committee
members
for
the
medicaid
healthcare
financing
and
policy
group.
A
Okay,
seeing
none
then
we'll
move
on
to
aging
and
disability
and
I
believe
we
have
miss
schmidt,
miss
rob
and
miss
miss
jamie.
L
Good
afternoon
this
is
dina
schmidt,
administrator
for
aging
and
disability
services,
division
and
yes,
it's
samantha
heine
is
with
us.
She
is
the
program
manager
for
our
autism
treatment,
assistance
program
and
ricky
rob
is
our
deputy
administrator
so
and
they're
both
available
to
answer
any
detailed
questions,
but
I'll
give
you
a
broad
overview.
We
have
accepted
all
of
the
recommendations
in
the
report
regarding
recommendations.
Five
and
six.
L
We
have
already
implemented
a
process
for
reconciling
our
explanations
of
benefits
for
our
insurance
assistance
program,
as
well
as
a
process
for
retaining
that
documentation
in
regards
to
number
seven,
while
fiscal
notes
included
descriptions
in
the
past
of
our
fiscal
assumptions.
I
think
one
of
the
things
we
missed
was
some
of
the
programmatic
assumptions
made
in
our
fiscal
mode
analysis,
so
we
will
ensure
to
improve
those
going
forward
in
regards
to
recommendations,
eight,
nine
and
eleven.
I
think
these
are
all
really
aimed
at
improving
information.
L
L
The
challenge
will
be
is
that
this
information
changes
on
a
regular
basis
is
that
providers
come
in
and
out
of
groups
in
and
out
of
networks,
so
we
will
do
our
best
to
maintain
that
on
a
regular
basis
and
get
it
updated,
and
I
think
the
other
thing
to
make
note
of
is
that
you
know,
while
the
statute
says
that
we
serve
children
with
a
diagnosis,
we
recognize
through
this
audit
the
challenges
that
many
of
these
families
are
facing
before
they
get
the
diagnosis.
L
L
On
the
wait
list,
however,
we
are
developing
a
risk
assessment
tool
that
will
help
us
identify
factors
and
what
what
other
resources
we
could
refer
families
to
so
we
will
ensure
that
we
are
referring
families
to
other
community
services,
state
agencies,
anything
that
we
can
do
to
support
those
families,
while
they're
on
the
wait
list,
and
then
we
would
include
a
request
in
future
bienniums
for
staffing
to
serve
the
waitlist
and
then
recommendation
number
12.
L
Also,
the
risk
assessment
tool
that
I
discussed,
which
is
being
developed,
will
help
us
standardize
a
process
for
identifying
children
with
the
greatest
needs
and
in
order
to
get
them
into
service
the
soonest.
That
tool
is
being
piloted
right
now
and
we
are
hoping
to
have
it
finalized
by
the
end
of
this
month.
A
Thank
you.
I
appreciate
that
just
a
quick
question
on
the
last
piece
there
about
the
risk
assessment
tool
that
you're
developing
piloting-
and
so
is
this
going
to
be
something
that
you
imagine
that
your
your
case
management
staff
would
do.
Or
do
you
imagine
that
this
was
something
that
the
providers
in
the
community
would
use.
L
Punishment
for
the
record,
we
would
be
doing
it.
Our
intake
team
would
be
providing
doing
the
assessment
that
way
when
families
come
to
us
for
services.
We
have
the
ability
to
kind
of
prioritize
those
in
the
with
the
greatest
need,
as
well
as
identifying
other
needs
that
we
can
other
places
to
refer
them
to
and
get
them
additional
services
to
support
them,
while
they're
waiting
either
for
a
diagnosis
or
a
provider.
A
Thank
you
so
much
and
then
the
other
question
I
had
real
quick
was
you
mentioned,
and
you
state
that
you
are
doing
the
enhanced
request
in
the
budget
for
increased
staffing,
and
so
is
that
something
that
we'll
be
seeing
in
the
next
couple
weeks
with
agency
budgets?
That's
that's
in
there
that's
baked
in
the
initiate.
L
For
the
record,
well,
this
recommendation
came
to
us
prior
to
the
process
for
building
our
budgets
and
until
the
governor's
budget
has
been
released.
We
won't
know
that,
but
we
did
not
this.
This
was
not
included
as
we
were
building
our
budget.
We
were
not
familiar
with
this
recommendation,
so
we
were
looking
at
that
for
future
bienniums
in
addressing
as
we
built
develop,
that
caseload
ratio
we'll
have
to
look
at
that
in
a
future.
Biennium.
E
A
I
see
none
so
at
this
point
I
will
go
ahead
and
accept
a
motion
to
approve
the
report
so
moved.
Madam
chair,
a
motion
from
assemblywoman
carlton,
a
second
from
from
senator,
brooks
thank
you
so
much
and
mr
crossman
I'll.
Let
you
call
roll.
D
Senator
just
a
quick
comment
before
we
do
the
role
please
thank
you.
We're
going
to
be
in
session
very
very
soon
and
I
think
addressing
some
of
these
issues,
even
though
we
know
we
have
a
very
tough
session
ahead.
D
So
we
want
to
keep
having
these
discussions
through
next
session
to
make
sure
that
we
can
get
the
information
to
the
parents
so
that
they
know
what
they
need
to
do.
I
understand
the
the
comment
about
next
biennium
and
trying
to
address
some
things,
but
I
think
the
more
we
can
talk
about
this
next
legislative
session
to
see
what
pieces
of
this
we
can
fix,
especially
to
get
kids
diagnosed,
will
benefit
the
children
and
the
families
greatly.
So
just
wanted
to
put
that
on
the
record.
A
I
appreciate
that
assemblywoman
carlton
when
you
think
about
how
long
we've
been
discussing
this
and
trying
to
get
it
right
and
there
was
a
bill
and
then
we
had
to
say
before
we
can
do
more
with
money.
We
just
have
to
really
understand
what's
happening
and-
and
we
have
that
audit
now
and
a
lot
of
good
information
to
direct
us.
So
I
appreciate
those
comments,
mr
crossman
I'll.
Let
you
call.
D
A
A
Audit
thank
you
and
we
have
miss
ital
bingham
presenting
on
this
one.
Thank
you.
H
Vice
chair
benitez
thompson,
members
of
the
audit
subcommittee
for
the
record,
I
am
shirley.
I
tell
bingham
deputy
legislative
auditor.
This
report
addendum,
provides
supplemental
findings,
conclusions
and
recommendations
from
a
performance
audit
of
the
public
employees
benefit
program,
information,
security,
la
2013.
A
A
Assemblywoman
carlton,
I
think
you
are
awesome.
Nobody
called
him,
okay
or
broadcasting.
If
you
could.
Thank
you.
H
Okay,
an
addendum
to
report
la
2013
was
necessary
because
security
vulnerabilities
existed
in
certain
information
systems
within
the
public
employees
benefit
program,
providing
details
regarding
those
vulnerabilities.
At
the
time
we
published,
the
original
report
would
have
unnecessarily
exposed
those
information
security
weaknesses
on
september
9
2019
a
letter
pursuant
to
sb
302,
was
issued
to
the
governor
chair
of
the
legislative
commission,
chair
of
the
audit
subcommittee
and
head
of
the
agency
affected
upon
identifying
our
findings
related
to
the
vulnerable
systems.
H
H
H
The
agency
did
not
ensure
that
operating
systems
and
database
application
software
were
upgraded
to
supported
versions
in
a
timely
manner
without
proper
software
upgrading
upgrade
planning
pub
compromises,
security
performance
and
overall
efficiency
at
the
top
of
page
2.
We
note
that
pebb
was
also
not
conducting
vulnerability
scanning
on
its
servers.
H
Pebb
could
have
identified
outdated
software
and
security
update
issues
earlier,
had
they
performed
vulnerability
scanning
and
maintained
a
software
inventory
at
the
bottom
of
page
2.
We
note
that
pebs
linux
servers
lacked
oversight.
Some
of
the
agencies,
linux
servers
were
not
adequately
maintained.
H
A
I
I
also
have,
as
you
heard
earlier,
steve
martin,
our
new
chief
information
officer
with
me
to
answer
additional
questions
as
well.
First,
I'd
like
to
thank
mr
crossman
and
his
team
for
providing
their
expertise
through
this
audit.
As
you
heard,
the
audit
is
essentially
an
addendum
to
the
initial
audit
conducted
on
pebb's
information
technology
systems,
for
which
the
committee
heard
the
six-month
follow-up
during
the
earlier
agenda
item
and
as
indicated
in
our
response,
pebb
accepts
all
four
findings
associated
with
the
supplemental
audit.
I
Although
pep
has
developed
a
corrective
action
plan
which
is
due
to
be
presented
to
the
peb
board
later
on
this
month,
we
have
already
taken
steps
to
rectify
some
of
those
security
concerns
identified
in
the
report.
As
you
heard
from
ms
bingham,
several
of
those
concerns
are
regarding
security
risks
related
to
the
agencies,
antiquated
systems
and
servers
not
unique
to
pebb.
Unfortunately,
this
is
just
part
of
of
what
we
deal
with
in
state
government,
but
we
have
replaced
or
decommissioned
all
those
obsolete
servers
pep.
A
Okay,
see
none.
Thank
you
so
much
for
your
comments.
Miss
rich
and
I
will
go
ahead
and
accept
a
motion
to
approve
the
report.
A
A
F
This
information
includes
the
main
services
offered
a
description
of
the
workers,
compensation,
litigation
system
in
nevada,
case
statistics
and
a
summary
of
revenue
and
expenditures
towards
the
bottom
of
page.
Two
you
will
find
our
objective
was
to
determine
whether
naiw
had
adequate
controls
over
information
systems,
performance
measures,
sensitive
information
and
case
management
timeliness.
F
The
scope
of
our
audit
focused
on
naiw's
activities
for
the
period
of
july
2018
to
december
2019.
Our
audit
findings
start
on
page
four.
We
found
information
systems.
Administration
needs
improved
monitoring
to
ensure
the
continuation
of
critical
services
at
the
bottom
of
page,
four
you'll
see
that
naiw
was
not
timely
in
renewing
its
service
level
agreement
for
it
services
with
its
vendor
and
continued
to
operate
for
nine
months.
F
Continuing
to
page
five,
we
found
that
naiw
has
now
been
reviewing
user
accounts
that
have
access
to
naiw's
critical
systems.
For
example,
we
found
two
active
accounts
for
former
employees
that
had
not
been
disabled
and
removed.
In
addition,
there
was
an
active
generic
administrative
account
for
an
outside
agency
that
provided
administrative
access
to
naiw
servers.
F
F
In
addition,
naiw
does
not
have
a
written,
I.t
contingency
plan,
so
they
cannot
guarantee
that
services
and
operations
will
continue
in
a
timely
manner.
If
I
t
functions
are
ever
compromised,
whereas
at
the
bottom
of
page,
six
you'll
see
that
background
checks
were
not
conducted
on
the
it
vendors
employees
and
at
the
top
of
page
seven
naiw
was
not
aware
of
its
responsibility
to
ensure
employees
of
the
it
vendor
completed,
required
annual
security
awareness
training.
F
Moving
on
to
the
middle
of
page
seven,
we
note
that
controls
over
calculating
documenting
and
reviewing
performance
measures
are
deficient.
Specifically,
we
could
not
substantiate
the
accuracy
of
measures
reported
in
the
governor's
executive
budget,
exhibit
2
at
the
top
of
page
8
displays
our
testing
of
these
measures.
F
F
The
issues
noted
during
our
testing
can
be
attributed
to
a
lack
of
comprehensive
policies
and
procedures
at
the
bottom
of
page
9
through
the
top
of
page
10.
We
note
that
performance
measure
usefulness
can
be
improved
by
emphasizing
outcome-based
performance
measures.
These
are
recommended,
as
they
better
demonstrate.
An
agency's
impact
on
nevada,
including
how
effective
the
agency
is
in
providing
services
on
page
10,
we
found
that
naiw
does
not
adequately
secure
clients
personally
identifiable
information,
such
as
social
security
numbers
and
medical
records.
F
F
A
Ikov,
I
see
none
perfect
and
I
believe
we
have
someone
from
the
office
of
nevada
attorney
of
injured
workers.
If
you
have
comments
that
you'd
like
to
put
onto
the
record
you're
welcome
to
do
so.
E
E
E
E
A
Thank
you.
I
appreciate
that
in
the
world
of
these
type
of
audits
and
some
of
the
findings
and
recommendations
that
we
get
back,
this
one
was
overall
pretty.
I
thought
better
than
some
of
the
ones
I've
seen
come
back,
which
we,
you
know
can't
even
make
public
for
a
while.
So
thank
you
for
making
that
comment.
A
A
D
A
D
A
B
Thank
you
vice
chair
for
the
record
dan
crossman
legislative
auditor.
The
count
of
money
in
the
state
treasury
is
required
by
nrs
by
353.060
and
must
be
performed
annually
by
our
office.
This
project
involves
a
detailed
process
that
includes
reviewing
reports
from
the
state.
Treasurer
ascending
account
balance
confirmations
to
about
60
financial
institutions
and
reviewing
various
financial
reconciliations.
B
The
culmination
of
this
work
is
this
report
you
have
before
you
today.
We
filed
the
report,
as
required
with
the
secretary
of
state's
office
on
december
21st
of
2020,
at
which
point
it
did
become
a
public
record.
However,
we
are
required
to
present
the
report
to
the
subcommittee
as
well
for
your
acceptance,
the
team
that
works
on
this
is
with
us
today.
In
the
event,
there
are
some
questions,
however.
B
A
A
Yes,
I
thank
you
so
much.
We
have
motion
passes.
A
Audit
governmental
and
private
facilities
for
children,
inspections
and
mr
crossman,
I
will
let
you
take
us
into
this.
B
Thank
you,
madam
vice
chair
for
the
record
dan
crossman
legislative
auditor.
One
of
our
roles
is
to
review
governmental
and
private
facilities
for
children
on
an
ongoing
basis
and
provide
information
to
assist
with
legislative
oversight.
Ultimately,
our
goal
is
to
help
ensure
adequate
protection
of
children
in
these
facilities.
B
C
C
C
Seven
surveys
of
children's
facilities
were
also
conducted
in
response
to
the
covet
19
pandemic
and
related
restrictions,
during
which
we
did
not
perform
on-site
physical
observations
in
12
of
the
15
children's
facilities
inspected.
We
did
not
note
anything
that
caused
us
to
question
the
health,
safety,
welfare
or
protection
of
the
rights
of
the
children.
C
C
C
In
addition,
we
observed
an
unsecured
pair
of
scissors
in
a
child's
bedroom
maintenance
equipment
on
a
shed
roof
and
broken
furniture
and
unsecured
shovels
outside
of
the
home.
We
determined
agency
management
did
not
ensure
its
foster.
Parents
met
minimum,
foster
care
standards
established
in
statutes.
C
Continuing
on
pages
9
through
10,
we
discuss
specialized
alternatives
for
family
and
youth
of
nevada,
incorporated,
which
I
will
refer
to
as
safi
safi
is
a
foster
care
agency
that
is
licensed
by
clark
county
department
of
family
services
at
one
of
the
three
safie
foster
care
homes
that
we
inspected.
We
observed
several
issues.
C
C
C
C
C
Our
conclusions
were
limited
by
the
health
and
safety
restrictions
associated
with
the
covid
19
pandemic,
which
has
had
a
significant
impact
on
our
work.
Specifically,
we
did
not.
We
did
not
physically
observe
the
conditions
of
the
facility
surveyed
to
determine
if
the
facilities
met.
Minimum
standards
established
in
statutes
appendix
a
on
page
12
contains
a
list
of
the
inspections
and
surveys.
Incompleted
appendix
b,
on
pages
13
through
15,
provides
some
background
population
and
staffing
information
on
61
children's
facilities
in
nevada.
C
A
Thank
you
so
much
questions
from
subcommittee
members
for
ms
mcgurk
on
the
audit
information.
A
Miss
mcgirk,
I
I
do
have
a
couple
questions
and
it's
just
to
help
me
put
some
things
into
context.
So
two
of
the
so
12
facilities
doing
well
good
three
facilities,
not
not
doing
well,
two
of
those
facilities
in
licensed
in
washoe
county
one
in
clark
county.
Do
you
know,
or
do
we
ask
in
the
course
of
the
audit
or
verification
of
the
last
time
the
county
had
individuals
in
the
home
either
social
workers
or
a
licensing
worker?
Is
that
something
that
is
is
known
to
us
when
we
do
these
audits.
C
For
the
record
sandra
mcgurk,
it
really
depends
on
the
information
we
get
back
from
the
licensing
agency.
I
do
know
that
one
facility
in
washoe
county
their
workers
were
in
that
home
that
same
week,.
C
A
You
so
much
and
then
I'll
ask
that
I
do
have
a
follow-up
question
which
is
coming
from
page
nine,
and
I
know
I
now
know
I
will
direct
that
to
the
agencies,
and
it's
just
the
it
looks
like
part
of
the
corrective
action
for
angels
care
is
that
the
agency
would
inspect
the
homes
and
do
monthly
visits,
but
I
I'm
pretty
sure
monthly
visits
and
some
fashion
reform
are
already
required
because
there
are
foster
children
placed
there.
A
So
I
I
will
have
that
question
for
them
as
to
how
that
is
an
enhancement
for
protections
when
that
actually
seems
to
be,
I
would
think
the
the
absolute
minimum
if
you
could
talk
a
little
bit
more
again,
miss
kirk.
So
the
way
that
we've
been
the
audit
committee
has
been
doing.
An
audit
staff
has
been
doing
these
kind
of
inspections
for
quite
a
while
quite
a
long
time,
and
every
time
we
go
out
to
do
these
audits.
A
There
are
always
findings,
and
I
guess
the
hope
would
be
that
the
trend
would
be
over
time,
less
findings
of
poor
health
and
welfare
in
these
homes,
in
which
we
we
are
housing,
our
our
foster,
children
and
then
children
in
the
private
facilities.
A
C
Or
the
record
sandra
mcgurk
audit
supervisor,
it
really
depends
you
have
to
look
at
the
different
types
like
if
we
look
at
foster
care
homes,
we
have
to
hold
those
together
in
order
to
determine
if
the
quality
is
improving,
we
have
to
look
at
those
separately
than
the
other
licensing
type
of
entities
such
as
child
care
institutions
and
facilities.
C
C
I
know
that
the
licensing
agencies
have
been
very
responsive
to
what
we've
brought
to
their
attention.
They
have
been
very
transparent
in
the
information
that
we
ask
for
it's
just.
These
are
difficult
issues
to
observe
and
bring
to
the
forefront,
but
I
think
it's
needed
and
I
think
if
we
all
continue
to
collaborate
together,
I
think
we
can
all
work
to
eliminate
these
issues.
I'm
sorry,
I
can't
give
you
a
more
clear
answer
than
that.
A
No,
I
I
appreciate
that,
and
I
imagine
that's
something
that
we
can
go
back
because
we've
been
collecting
data
for
a
while
by
licensing
type,
so
we
could
actually
look
and
see
by
licensing
type
where
we
seem
to
be
making
progress
and
where
we
perhaps
are
are
you
know
they
seem
to
be
stale
in
in
their
level
of
progress,
but
also
really
happy
to
hear
that
there's
going
to
be
more
frequent
eyes
and
ears
from
our
auditors
checking
in
across
these
facilities
that
that
gives
me
great
confidence
that
we'll
be
able
to
see
more
things
and
catch
them
before.
A
E
It's
good
morning,
madam
chair
ross,
armstrong
from
the
division
of
child
and
family
services.
E
As
miss
mcgirk
noted,
the
the
facilities
that
are
highlighted
in
the
report
are
licensed
by
washoe
and
clark
county,
while
dcfs
is
the
licensing
entity
in
the
rurals,
and
so
I
think,
there's
representation
from
those
licensing
entities
on
the
line.
I
see
deputy
director
paoli
on
from
walker
at
least,
and
so
we
have
folks
on
standby
if
there's
general
questions,
but
we
aren't
the
licensing
entity
for
these
three.
E
Yeah
in
case
I,
and
in
case
I
don't
have
the
opportunity
again,
I
just
want
to
thank
miss
mcgurk
and
her
team.
I
think
madam
chair,
you
pointed
out
that
the
trajectory
overall
has
been
good
and
improvement
for
facilities
and
children,
and
we
consider
miss
mcgirk
and
her
team
key
partners
in
improving
improving
the
outcomes
for
kids
across
the
state.
A
I
appreciate
that
so
miss
paoli
from
washoe
county.
I
believe
that
you
are
available
and
on
the
line,
and
so
the
the
question
that
I
had
and
then
I
will
ask
it
again
of
miss
sandvik
in
in
I'm
sorry,
we
have
miss.
Yes,
we
have
I'll
ask
it
again
of
clark
county
if
we
have
a
clark
county
person
available,
but
just
for
miss
sandvik
or
miss
paoli
from
washoe
county.
I
guess
for
for
some
of
the
homes
there
recently
had
been
personnel
from
the
county
in
there.
A
So
do
we
have
a
better
way
of
gauging
you
know
way
where
they
might
not
have
seen
deficiencies
that
our
auditors
had.
I
I
To
answer
your
question,
we
have
workers
caseworkers
assigned
to
the
children
in
the
home,
going
out
there
on
a
monthly
basis
and
licensing
workers.
Don't
have
that
same
requirement
and
so
for
the
particular
home
that
miss
mcgirk
mentioned
workers
had
been
in
the
home.
It
wasn't
the
licensing
worker
that
was
in
the
home.
A
I
appreciate
that
so
when
we
have
the
note
in
here
that
the
agencies
that
washoe
county
human
service
agency
has
notified
the
agency
that
there
would
be
monthly
visits,
those
will
be
by
the
licensing
team.
Then
not
just
the
social
worker
caseworkers
for
the
children
it'll
be
that
specific
licensing
for
purview.
I
Correct
and
so
we
on
the
licensing
side,
especially
when
there's
a
corrective
action
plan
in
place
for
this
particular
circumstance,
we
were
doing
weekly
on
the
licensing
side,
weekly
home
visits
prior
to
covid
occurring
and
then
doing
virtual
weekly
inspections
as
well.
So
we
have
increased
the
frequency
of
the
licensing
entity
visiting
the
home.
A
I
appreciate
that
and
I
imagine
that
it
can
be
hard
to
do
unannounced
visits
virtually.
Are
they
all
scheduled
or
have
you
found
a
manner
where
licensing
can
still
kind
of
in
an
unannounced
way
kind
of
pop
in
to
take
a
look
around
and
see
if,
in
you
know
any
given
moment
of
time
if
standards
are
being
kept
up.
I
We
are
doing
unannounced
virtual
visits
as
well.
It's
a
little
more
challenging,
of
course,
than
being
able
to
to
just
knock
on
a
door,
but
we
still
are
accomplishing
that
successfully.
A
No,
thank
you
all
right.
Thank
you!
So
much
and
then
I
I
don't
think
I
have
someone
from
from
clark
county
to
answer
the
same
question
in
regards
to
the
facility
that
they
license.
A
We
have
the
comment
in
here
coming
on
page
10,
that
they're
requiring
photographic
evidence
from
the
home
for
a
period
of
six
months
and
I'm
just
interested
in
what
that
frequency
is
of
whether
it's
monthly
and
or
whether
there
are
like
washington
county
seems
to
be
doing
unannounced
virtual
visits
at
this
time.
But
I
don't
know
if
we
have
someone
present
to
answer
that.
B
Vice
chairman
thompson,
correct,
if
you'd
like
us
to
ask
those
questions
of
the
clark
county
and
get
back
to
the
committee,
we
can
do
that.
A
All
right,
I
did.
I
did
have
one
last
question,
and
this
is
for
mrs
mcgurk.
We
had
three
different
homes:
the
total
for
the
two
homes
that
had
to
be
closed.
How
do
you
know
the
total
number
of
children
that
were
in
those
homes?
A
C
For
the
nevada
there
were.
C
Five
in
your
home
at
the
time
five
kids
excuse
me.
I
apologize.
I
misled
you.
There
were
four
kids
living
in
home
at
that
time,
ages,
13
through
17.
for
the
three
angels
care
home.
E
A
Okay,
all
right
so
11
of
those
kiddos
now
in
safe
homes.
Thanks
to
your
work,
I
appreciate
that
I'll
go
ahead
and
accept
a
motion
to
accept
the
report.
F
D
A
Yes,
motion
passes
right
at
this
point:
we're
now
at
agenda
item
eight
public
comment
and
so
we'll
ask
our
broadcasting
broadcasting
staff
to
patch
through
any
public
comment.
If
we
have
members
who
would
like
to
address
us.
E
A
Yeah,
let's
give
it
just
a
two
minutes.