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From YouTube: 09/14/2020 - Legislative Committee on Health Care
Description
This is the eighth and final meeting of the 2019-2020 Interim and the Committee's work session. 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
Okay,
let's
get
started
then.
A
Good
morning,
welcome
to
the
eighth
and
final
meeting
of
the
legislative
committee
on
healthcare
for
the
2019-2020
interim
thanks
to
everyone
who
is
joining
us
online
and
throughout
the
interim
we
appreciate
your
participation
members.
Please
remember
to
mute
your
microphone
when
you
are
not
speaking.
C
C
C
C
A
A
Anyone
who
would
like
to
receive
electronic
notification
of
an
access
to
the
committee's
agendas,
minutes
or
final
report
can
sign
up
on
the
nevada
legislature's
website
we're
going
to
have
two
periods
of
public
comment.
One
at
the
beginning
of
the
meeting
one
at
the
end
of
the
meeting
public
comment
is
limited
to
two
minutes
per
speaker.
A
There
are
four
ways
to
provide
public
comment,
all
of
which
are
listed
on
the
agenda,
and
these
include
calling
the
phone
number
is
area
code,
669,
nine,
zero,
zero,
six,
eight,
three
three!
So
that's
six,
nine,
nine,
I'm
sorry,
six,
six,
nine,
nine,
zero,
zero,
six,
eight
three
three
and
then
then
entering
the
meeting
id
number:
nine:
six:
five:
zero,
eight
five:
two:
two:
six:
zero,
eight
hashtag,
so
nine
six,
five
zero,
eight
five:
two:
two:
six:
zero:
eight
hashtag
emailing
comments
to
healthcare
at.
A
A
So
as
an
overview,
our
agenda
includes
a
report
regarding
the
committee
to
conduct
an
interim
study
concerning
the
cost
of
prescription
drugs
and
our
work
session.
But
first
we're
going
to
open
up
to
public
comment.
So
we'll
move
to
agenda
item
two
to
do
that.
Once
again,
public
comment
is
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
mess
methods
listed
on
the
agenda.
A
D
D
D
Go
ahead,
caller
hello!
Thank
you,
committee
members
for
your
dedication
to
overall
health
in
our
state.
My
name
is
annette,
lindsey
come
and
I'm
speaking
to
agenda
item
number
5f
on
behalf
of
the
nevada,
dental
hygienist
association,
the
only
organization
in
nevada
that
represents
the
nearly
2
000
licensed
dental
hygienist
and
the
newly
adopted
mid-level
provider.
Dental
therapist.
We
would
like
to
go
on
records
showing
support
for
the
bdr
for
oral
health
and
would
love
to
see
it
move
out
of
this
committee.
D
D
We
would
like
to
propose
to
add
the
dental
hygienist
and
dental
therapist
has
recognized
health
care
providers
in
2018,
the
u.s
department
of
labor
changed
the
standard
occupational
classification
for
dental
hygienists
to
29-1000
a
treating
or
diagnosing
practitioner
the
same
as
dennis.
We
would
appreciate
the
committee
to
consider
adding
language
that
accurately
represents
these
two
very
important
professions:
bringing
nevada
statute
up
to
date,
also
section
a3,
page
nine
telegenic
redefinition.
D
Only
two
of
the
possible
four
pathways
of
teledentistry
are
listed
in
the
definition
we
recommend
also
including
mobile,
dentistry
and
remote
patient
monitoring,
section
a5,
page
9,
dental
home
definition.
The
proposed
definition
of
dental
home
is
limited
to
children.
Many
entities
like
the
american
dental
hygienist
association
have
definitions
of
dental
home
that
are
not
age
restricted,
which
support
the
importance
of
dental
home
for
all
populations,
and,
finally,
section
c,
section
d,
page
10
mandated
ce
for
licensure
and
mandated
liability
insurance
in
statute
to
avoid
unnecessarily
bogging
down
proposed
legislation.
D
D
D
F
We
are
a
kind
of
a
late
ad
to
the
work
session
document
agenda.
Item
number
v1
you'll
see
is
information
from
the
children's
mental
health
consortiums,
and
I
just
wanted
to
ask
the
committee
with
the
indulgence
of
the
chair
and
again
I
appreciate
the
chair
as
well
as
megan
kamalaski,
adding
our
information.
Many.
F
The
nrs433b
335
requires
us
to
do
many
things,
and
one
of
them
is
to
put
together
our
10-year
strategic
plan
in
the
documents
that
you
received.
We
tried
to
put
together
some
goals
and
strategies
both
and
there's
three
consortiums:
there's
the
rural
consortium,
the
washoe
consortium
and
the
clark
county
consortium.
F
The
clark
county
consortium
put
together
in
your
documents
that
the
committee
considers
supporting
our
strategies,
our
goals
of
advocating
on
behalf
of
children's
mental
health,
and
that
you
prepare
a
letter
and
support
both
for
the
legislature
and
the
director
of
hhs.
And
again,
I
thank
you
for
the
opportunity.
Thank
you,
madam
chair,
as
well
as
megan's
inclusion
of
our
documents,
and
thank
you
very
much.
D
H
Of
the
vatican's
have
a
chronic
disease,
the
significance
of
chronic
disease
has
been
dramatically
and
tragically
emphasized
by
its
role
in
the
risk
factors
and
deaths
associated
with
covet
19.
nccc
advocates
so
nevadans
with
chronic
health
conditions
become
healthier
and
less
costly
to
the
health
care
system.
We've
brought
three
policy
issues
to
the
committee's
attention:
each
aggressive
barrier
to
access
or
result
in
cost
to
the
system
or
the
patient
unnecessarily
many
nevada,
chronic
care
patients
rely
on
co-payment
assistance
programs
to
be
able
to
afford
their
specialty
medications.
H
The
health
plans
adjuster
program
precludes
any
financial
assistance
from
crowding
towards
the
patient's
deductible
under
step
therapy
or
fail.
First,
even
though
a
doctor
has
recommended
drug
a
for
a
particular
patient,
an
insurer
may
require
the
patient
to
first
try
lower
cost
drug
b
or
c
or
d.
Only
after
a
step,
series
of
drugs
are
shown
to
be
ineffective.
While
the
patient
received
the
treatment
their
doctor,
determined
was
the
most
effective
in
the
first
place.
Step
therapy
is
often
applied
to
chronic
diseases,
raising
life-threatening
or
quality
of
life
concerns.
H
Prior
authorization
is
a
health
insurance
process
that
requires
a
provider
to
qualify
for
specific
payment.
Okay,
before
providing
the
service
to
an
insured
patient
legislation,
would
increase
transparency
and
improve
health
outcomes
by
offering
standards
for
approval
times,
expectation
of
payment
and
ensuring
that
the
voice
of
the
patient's
provider
is
part
of
the
process.
H
The
current
lack
of
time
standards
can
lead
to
severe
adverse
medical
events
and
even
hospitalization
for
occluded
care
patients.
While
the
committee's
work
session
agenda
fails
to
include
these
access
to
health
care
barriers,
we're
pleased
to
see
that
it
does
address
some
potential
legislation
that
would
benefit
chronic
care
in
nevada.
Thank
you.
D
H
F-U-N-K-E,
I
am
the
president
of
nevada,
dental
association,
so
dear
derek
cohen
and
legislative
committee
on
health
care.
The
nevada
dental
association
supports
the
work
session
documents
submitted
regarding
the
oral
health
initiative
encompassing
tele-dentistry
emergency
dental
responders
and
dental
loss
ratio.
I
would
encourage
this
committee
to
not
make
any
amendments
to
these
work
session
documents
and
to
pass
it
in
their
entirety.
Dental
professionals
play
an
important
role
in
health
care,
and
these
initiatives
will
increase
dental
care
throughout
the
entire
state
of
nevada
and
add
to
the
access
to
care
for
everyone.
D
D
I
L-E-A-C-A-R-T-W-R-I-G-H-T,
the
nevada
psychiatric
association
supports
work
session
item
b4
a
and
b
requiring
dhcsp
to
apply
for
an
1115
demonstration
waiver.
This
waiver
will
increase
patient
access
to
psychiatric
treatment
beds
across
the
state
that
are
not
available
due
to
outdated
federal
medicaid
rules.
I
I
We
would
also
like
to
express
our
support
for
item
c6b,
expanding
postpartum
medicaid
coverage
from
60
days
to
12
months
following
childbirth.
According
to
the
cdc
erased,
maternal
mortality
update
for
the
western
district
mental
health
conditions
are
the
leading
cause
of
preventable
pregnancy-related
deaths.
I
A
D
F
F
Thank
you,
madam
chair,
and
the
committee
and
everybody
who's
attending
today's
meeting
I
represent
usarehabcenters.org.
F
What
we
found
was
that,
if
you
were
looking
for
a
hotel
on
the
beach
and
ocean
view,
king
bed,
non-smoking
pet
friendly
free
wi-fi
and
a
continental
breakfast,
there
were
a
half
a
dozen
different
websites
that
you
could
create
a
multi-criteria
search
and
instantly
retain
those
results,
but
in
the
treatment
industry
there
wasn't
an
effective
resource
for
that
and
that's
what
we
created
a
user-friendly
experience
for
individuals
to
find
the
services
precise
services
that
they
need.
F
What
we're
here
today
to
do
is
to
ask
for
the
support
and
those
members
of
the
state
legislative
body,
senators,
assembly,
persons
that
are
interested
in
championing
our
cause
with
us
and
getting
the
word
out.
We
just
launched
this
and
the
most
critical
thing
we
can
do
in
light
of
the
covet
19
pandemic,
which
is
increased,
addiction,
alcoholism,
overdose
deaths
and
suicides
is
get
this
populated
with
the
providers
as
quickly
and
efficiently
as
possible
and
for
providers
to
list
their
services.
F
It
takes
less
than
10
minutes,
it's
all
online
and
automated
and
they
can
go
to
usarehabcenters.org
and
then
click
on
list
your
facility
again.
That
should
take
them
less
than
10
minutes,
and
if
anybody
needs
any
assistance
in
getting
those
facilities
listed,
they
can
call
me
directly
again
mitch.
Bernie
at
usa,
rehab,
centers,
dot,
org
and
my
phone
number
is.
F
775-571-1928
again,
775-5711
or
email
me
at
mitch,
usa,
rehab,
centers,
dot.
Org
again,
I
just
ask
every
provider
of
drug
addiction,
alcoholism,
inpatient
mental
health
providers
and
legal
services
for
those
in
need
to
please
get
online
and
list
your
facilities.
There
is
a
free
listing,
so
there
is
no
obligation.
F
So
please,
thank
you.
Thank
you,
yeah,
that's
fine!
Just
everybody
know
that
it's
free
no
obligation
and
they
can
upgrade
their
listings
if
they
so
choose.
Thank
you
for
allowing
me.
D
A
Thank
you
with
that
we're
going
to
move
to
agenda
item
3,
which
is
the
approval
of
the
minutes.
A
A
With
that,
I
will
entertain
emotion.
Well,
let
me
ask:
are
there
any
questions
regarding
these
minutes.
A
Okay,
do
I
have
a
second.
A
Dr
hardy
moved
to
approve
and
senator
woodhouse
seconded
first.
A
And
we
will
take
a
roll
call
vote
then
miss
kablasi.
C
B
J
A
Okay
with
that
the
motion
passes,
so
we
will
move
on
to
agenda
item
four.
The
report
regarding
the
committee
to
conduct
an
interim
study
concerning
the
cost
of
prescription
drugs,
as
required
by
senate
bill
276
of
the
2019
legislative
session,
and
with
that
I'll
ask
senator
ivana
kinsella
the
chair
of
the
committee
to
conduct
an
interim
study
concerning
the
cost
of
prescription
drugs
to.
Please
provide
us
your
presentation
and
thank
you
so
much
for
coming
this
morning
and
giving
us
this
information
whenever
you're
ready.
K
K
We
started
our
work
and
I
guess
the
if
you
start
on
page
five
of
the
packet
of
our
work.
It
outlines
senate
bill
276's
mandate
and
outlines
the
different
meeting
dates
we
had.
K
As
you
can
see,
we
were
able
to
fulfill
our
work
within
four
meetings
and
I'll
talk
briefly
about
each
of
our
four
meetings
and
how
I
attempted
to
within
that
short
amount
of
time,
create
a
broad
picture
on
drug
pricing.
So
we
started
by
looking
at
the
state
and
the
state's
work
on
drug
pricing
and
we're
so
fortunate
to
have
experts
at
dhhs
who
walked
us
through.
Not
only
the
work.
K
That's
been
done
on
transparency
across
the
drug
spectrum,
both
for
diabetes
and
asthma
drugs,
but
also
work
that
has
been
done
on
transparency
and
other
pieces
of
the
drug
pricing
system.
On
pharmaceutical
sales.
Reps
on
pharmacy
benefit
managers
on
non-profits
that
operate
in
the
health
space
and
we
had
folks
at
dhhs
really
walk
us
through
the
mechanics
of
how
drug
increased
drug
costs
are
a
burden
to
our
state,
and
these
presentations
got
deep
into
the
weeds
on
how
programs
like
medicaid
operate
in
terms
of
their
drug
purchasing.
K
In
the
second
meeting,
we
focused
on
the
private
sector,
and
it
was
my
intention
to
open
the
floodgates
so
that
any
entity
that
is
interested
or
involved
in
drug
pricing,
regardless
of
what
their
position
is
on
different
issues,
would
be
able
to
come
forward
before
the
committee
and
both
give
a
presentation
and
also
ask
have
committee
members,
ask
questions.
So
these
included
presentations
by
pharma
by
the
pbm
association
pcma
by
ahip,
which
is
the
american
health
insurance
plan
association.
K
I
may
be
butchering
what
the
p
stands
for,
but
in
any
event,
it
is
a
trade
group
for
private
insurance
plans.
We
invited
non-profit
insurance
plans
and
they
were
represented
by
the
culinary
health
fund.
We
heard
from
aarp-
and
we
heard
from
a
couple
of
other
private
sector
interests
the
most
important
voice,
though,
in
my
opinion,
that
we
heard
from
at
every
meeting
were
patients
themselves
who
told
us
about
what
happens
when
they
can't
afford
their
medications
and
who
told
us
about
what
kinds
of
changes
they
would
like
to
see.
K
So,
at
every
meeting
we
heard
potential
ideas
from
patients.
In
our
third
meeting,
we
attempted
to
take
everything
we
know
about
what
the
state
does
everything
we
know
about
what
the
private
sector
does
and
then
figure
out.
What
are
the
boundaries
of
what
a
state
authority
allows
for
us
to
do
with
all
this
information,
and
we
had
a
really
thorough
presentation
by
our
lcb,
our
lcb
staffer,
eric,
whose
last
name
I'm
forgetting
at
the
moment,
but
who
did
such
a
terrific
job
at
outlining?
K
Right
now
on
issues
like
transparency
like
pbm
regulations
and
we
as
a
state
have
to
be
mindful
of
that,
not
only
because
we
want
to
pass
bills
that
don't
end
up
getting
that,
don't
end
up
creating
litigation,
but
also
because
there
are
opportunities
to
seize
on
these
gray
or
yet
unchallenged
areas
to
create
new
and
innovative
policy,
and
we
took
all
of
that
together
to
also
examine
what
were,
I
think
somewhere
between
18
and
25.
K
The
first
bill
draft
request
was
one
we
added
during
the
last
meeting
and
if
you're,
following
along
in
the
packet,
we're
on
page
seven.
So
the
first
recommendation
came
from
a
presentation
that
we
heard
in
our
third
meeting
that
deals
with
inter
and
intra-state
drug
purchasing.
So
in-state
we
have
grant.
We
have
a
bill
draft
request
that
would
grant
the
authority
for
dhhs
to
work
across
agencies
to
pool
needs
in
or
in
order
to
enhance
our
drug
purchasing
power.
K
So,
for
example,
what
if
medicaid
worked
with
pebb
worked
with
corrections
to
purchase
hepatitis
drugs
as
opposed
to
having
corrections
purchasing
those
drugs
on
their
own?
Could
that
purchasing
coalition
ultimately
lower
the
costs
on
the
state
and
there's
reason
to
believe
it?
Would
we
also
looked
at
what
happened?
What
would
happen
if
we
partnered
with
other
states?
So
what?
If
we
did?
K
What's
happened
in
the
pacific
northwest,
where
a
number
of
states
have
banded
together
to
purchase
drugs
as
an
interst
as
a
state
as
an
interstate
entity
where
they're
able
to
share
the
ultimate
costs
and
thus
create
reductions
in
prices
for
patients?
I
thought
it
was
one
of
the
most
interesting
presentations
that
came
before
the
committee
and
really
highlighted
just
how
creative
states
can
be
not
only
by
banding
together
with
each
other,
but
with
the
entities
in
their
states
that
are
interested
in
lowering
their
drug
costs.
K
K
Today
we
are
one
of
a
handful
of
states
that
has
said
we
want
all
of
the
data
that
is
captured
within
the
affordable
care
act,
sunshine
provision
that
the
sunshine
act.
The
sunshine
act
is
a
provision
of
the
affordable
care
act
that
dictates
what
pharmaceutical
sales
reps
have
to
report
out
each
year.
As
a
result
of
that
data
in
nevada,
we've
learned
that
pharmaceutical
sales,
reps
were
now
registered,
spent
a
little
more
than
two
and
a
half
million
dollars
last
year
as
part
of
their
work
in
in
working
with
doctors,
offices
and
doctors.
K
The
bulk
of
that
was
spent
on
food
and
beverage
for
doctors,
offices
and
doctors
themselves.
That
transparency
is
now
potentially
going
to
take
an
extra
step
forward
which
would
be
to
license
these
pharmaceutical
sales
reps
in
the
state.
Thus
far,
illinois
and
washington
dc
have
similar
programs
that
our
legislation
could
be
modeled
off
of,
and
it's
an
important
step
to
ensure
that
we
continue
to
receive
these
reports
and
also
that
we
build
on
the
current
the
law
we
currently
have
on
the
books.
K
The
third
piece
of
legislation
deals
with
transparency.
Today
we
have
transparency,
mandates
on
asthma
and
diabetes
drug
manufacturers,
and,
as
a
result
of
that
transparency,
we've
learned
quite
a
bit
about
how
both
how
many
factors
in
both
spaces
operate.
It's
data
that
helps
us
as
a
state
not
have
to
look
to
trade
associations
or
entities
with
special
interests
in
the
matter
to
be
able
to
make
policy
decisions.
K
K
K
All
together,
we
have
a
package
that
had
only
one
we've,
only
only
a
handful
of
unanimous
votes,
which
to
me
is
indicative
that
we're
prepared
to
have
some
really
tough
conversations
on
an
issue
that
is
indeed
multifaceted
and
complicated,
and
that
we
should
all
be
digging
in
on,
because
no
one
should
have
to
decide
whether
or
not
they
can
afford
the
medicines
they
need
to
stay
alive.
So
thank
you
for
the
indulgence
and
at
your
discretion.
Madam
chair.
If
there
are
questions,
I'd
be
happy
to
answer
them.
A
Thank
you
very
much
for
the
presentation.
We
do
have
some
questions.
I've
got
a
question
from
dr
titus
to
begin
with,.
L
Thank
you,
madam
chair,
and
thank
you
for
the
presentation.
It
has
been
challenging
to
have
these
meetings,
but
they're
so
important,
and
this
issue
has
been
important
for
several
several
sessions.
So
thank
you
a
couple
questions
on
your
presentation,
especially
if
we'll
start
with
number
five,
the
suggestion
for
number
five,
I'm
curious.
As
to
you
said
it
came
from
pharma
this
particular
one.
L
I
want
to
know
how
it
was
picked
to
have
at
least
half
of
the
health
plans
included
and
what
happened
to
the
other
half
and
how
will
that
be
decided?
Number
one
number
two,
the
the
flat
amount
prescriptions
is
that
going
to
be
stable
throughout
the,
even
though
the
cost
of
the
drugs
might
change,
and
then
the
the
last
one
was
the
the
limited
co-payments
for
and
how
that's
going
to
work
and
that
will
that
be
all
of
them
or
just
that
half
and
then
I
have
some
other
questions.
K
I
think
these
are
the
kinds
of
questions
that
we'll
work
on
in
drafting
and
that
committee
members
will
give
feedback
on
once
we
have
a
piece
of
legislation,
it's
my
opinion
that-
and
this
is
me
speaking
as
senator
kinsella-
not
necessarily
not
at
all
representative
of
the
other
members
of
the
committee,
but
it's
my
opinion
that
we're
going
to
have
some
challenges
in
answering
some
of
these,
because
what
health
plans
get
this
benefit
and
what
what
health
plans
do?
Not
I'm
not
sure
that
there's
a
formula
for
that.
K
It
may
end
up
being
that
all
health
plans
fall
to
this.
We
also
have
to
navigate
erisa
and
whether
or
not
there
are
certain
health
plans
that
are
inevitably
exempted
because
of
federal
preemptions
and
we'll
have
to
decide
how
to
ensure
to
your
point
that
we
stay
constant,
regardless
of
changes
in
prices.
So
these
are
great
questions
and
ones
that
I
will
take
back
to
drafting
as
we
are
figuring
out
the
language
for
this
bill.
L
Great
thank
you.
I
know
this
is
a
heavy,
lift,
lift
and
happy
to
be
a
participant
and
all
along,
because
I
think
it's
really
important.
The
next
question,
if
I
might
have
madam
sheriff
that's
all
right
with
you,
I
have
a
question
regarding
the
the
purchasing
and
the
interest
rate
and
interstate
purchasing
agreement.
L
I'm
sure
you
know
now
that
your
members
of
your
committee
are
getting
way
educated
on
the
pharmaceuticals
and
where
they're
produced,
and
how
do
you
purchase
them,
but
a
lot
of
our
drugs
are
now
international,
a
lot
of
our
drugs
that
are
safe
drugs.
I
mean,
I
think
we
need
to
make
sure
that
these
pharmaceutical
companies
are
international
companies
and
that
many
of
these
drugs
are
not
produced
in
the
united
states.
A
lot
of
our
our
patients
go
to
canada
to
get
their
drugs.
K
So
I
should
have
said
this
in
in
my
overview
of
meetings,
because
it
was
something
that
we
talked
about
quite
a
bit.
Nevada
has
a
lot
on
the
books
that
allows
for
us
to
partner
with
canadian
pharmacies
to
import
drugs.
It's
a
program,
that's
been
on
the
books,
but
never
fully
utilized,
and
we
dug
in
a
bit
as
to
why
that
is
but
weren't
able
to
deduce
a
definitive
answer.
K
So
there
is
potential
to
explore
international
drug
importation.
It's
something
that
I
know
florida
passed
in
their
last
legislative
session
and
it's
a
way
to
look
for
cheaper
drugs.
The
intention
of
this
legislation
of
this
potential
bdr
is
not
to
focus
so
much
on.
The
internet
is
not
to
focus
on
international
importation.
Rather
it's
to
work
within
current
purchasing
structures
to
the
degree
that
there
is
already
purchasing
happening
from
international
manufacturers.
K
L
So,
just
for
clarification,
thank
you
for
that,
if
there
wouldn't
be,
since
we
already
have
an
agreement
with
canadian
or
some
sort
of
agreement,
I'd
be
curious.
I'd
like
to
follow
up
on
that
a
little
bit
more
and
at
some
point
I'll
do
that
on
my
own
and
look
for
that
particular
you
know
document
or
legislation
or
wherever.
L
That
is,
but
I
think
it's
certainly
something
we
can
pursue,
but
I
want
to
make
sure
this
doesn't
negate
that
that
this
wouldn't
limit
us
and
not
be
able
to
do
that,
and
so
I
think
that
it
wouldn't.
It
would
be
okay
to
continue
to
pursue
the
canadian
option.
K
Yes,
that's
we're
already
able
to
work
with
canada
on
drug
purchasing,
and
I
will
send
you
if
it's
not
part
of
the
it
would
have
been
part
of
the
second
committee
meetings
agenda
items.
If
it's
not
there,
then
I
will
send
you
what
we
received
from
legal
just
explaining
where
it
is
in
statute
and
what
the
legislative
history
was
on
the
canadian
purchasing.
A
I
know
that
a
couple
of
our
members,
assemblywoman
monk
and
senator
hardy,
are
on
your
committee,
so
they're
well
versed
in
this
and
I'm
sorry.
A
If
you
addressed
this
already,
I
had
some
connectivity
issues
but
as
you
I
did
hear
where
you
were
talking
about
how
how
many
attempts
were
made
to
have
these
meetings
because
of
covet
and
the
rescheduling
so
with
our
citizens
being
kind
of
in
the
same
position
themselves
during
that
time
and
and
dealing
with
lots
of
issues
in
their
own
personal
lives
and
maybe
not
being
able
to
follow
along
at
that
time.
But
maybe
now
finding
out
about
this
committee
is
the
best
way.
A
If,
if
nevadan
wants
to
make
sure
you've
got
information
got
their
story,
what
they
want.
You
and
your
committee
to
know
as
you
get
into
the
drafting
phase
as
you
get
into
moving,
these
bdrs
forward
is
the
best
way
for
them
to
contact
the
committee
through
the
website
or
is
there
another
way
you
want
them
to
get
a
hold
of
you.
K
They
can
certainly
contact
me
directly
as
the
chair
and
I'll
disseminate
information
to
committee
members
and
make
sure
it
gets
to
legal
or
constituent
services
if
appropriate
and
can
also
reach
out
to
the
email
address
on
the
website.
Either
ways
is,
would
love
to
hear
from
folks.
A
Great,
thank
you
and
then
again,
I'm
sorry.
If
I,
if
you
covered
this-
and
I
just
missed
it
with
my
connectivity
issues
but
the
I
was
interested
in
the
number
four
with
the
the
pbm
legislation,
the
the
making
pbm's
fiduciaries
is
that
something
that's
come
out
of
that
you
saw
from
another
state
and
if
so,
how
has
that
been
working
from
what
you've
seen.
K
K
Other
states
have
looked
at
it,
but
it
hasn't
become
law
that
I'm
aware
of
in
many
states,
and
it
seems
to
me,
based
on
what
was
done
in
2017
and
the
lack
of
debate
around
it
in
2019
that
we
should,
at
the
very
least
answer
the
question
of
why
we
made
the
change
between
the
two
legislative
sessions
and
have
a
definitive
answer
as
to
which
way
we
want
to
continue
to
move
forward
in
nevada.
K
It
seems
to
me
the
fiduciary
duty,
which
is
a
term
a
legal
term
of
art,
should,
at
the
very
should
apply
to
some
degree,
so
that
states,
municipalities
and
other
entities,
even
for-profit
insurers
are
being
met
with
their
financial
best
interest
top
of
mind,
rather
than
a
pharmacy
benefit
manager's
profits
top
of
mind.
Now
there
is
clearly
a
mixed
sentiment
on
this
in
this
day,
based
on
what
we've
done
as
a
legislature,
and
so
this
would
allow
us
to
make
a
final
determination
as
to
what
our
position
is
as
a
state.
A
Thank
you
for
that.
Do
we
do
we
have
any
other
questions?
A
Okay,
seeing
none!
Thank
you
so
much
for
your
presentation
and
I
will
remind
any
members
of
the
public
who
are
watching
that
that
these.
A
Of
the
conversations
and
and
your
participation
is
welcome,
and-
and
we
definitely
want
you
know-
these
are
important
issues
to
nevadans
and
we
want
to
make
sure
that
you
understand
that
your
participation
is
welcome
and,
and
these
bdrs
tend
to
change
and
as
they
become
bills
and
there's
lots
more
opportunity
for
participation.
A
So
thank
you
again,
senator
and
with
you.
We
are
going
to
move
on
to
agenda
five,
which
is
agenda,
item
number
five,
which
is
our
work
session.
The
work
session
document
is
available
on
the
committee
web
page.
A
A
These
recommendations
were
proposed
during
committee
meetings
and
in
response
to
the
formal
solicitation
of
recommendations
we
issued
in
the
spring
with
and-
and
I
will
again
remind
people
just
as
I
was
saying
in
the
last
part
of
our
meeting-
that
these
bdrs
are
the
beginning
of
the
conversation
and
the
public
is
certainly
welcome
to
participate.
A
If,
if
these
bdrs
go
forward
in
in
crafting
the
let
the
legislation
that
they
end
up
being
with
that,
I
will
turn
this
over
to
miss
kamalasi
to
see
if
she
has
any
remarks
taking
us
into
the
work
session.
B
B
B
The
committee
may
endorse
the
members
of
the
committee
do
not
necessarily
support
or
oppose
these
recommendations
that
are
included
in
the
recession
document,
but
the
proposals
have
been
compiled
so
that
committee
members
can
review
them
and
decide
whether
they
want
to
accept
reject,
modify
or
take
no
action
on
the
recommendations.
B
Any
votes
regarding
recommendations
will
be
taken
today
as
roll
call
votes
and
for
clarity.
Members.
Please
use
the
terms
yes
or
no
to
indicate
your
vote
and
then
please
be
advised
that
lcb
staff
at
the
direction
of
the
chair,
may
coordinate
with
interested
parties
to
obtain
additional
information
for
drafting
purposes
or
for
information
to
be
included
in
the
committee's
final
report.
B
B
So
the
first
recommendation
on
page
one
of
the
work
session
document
was
submitted
or
discussed
by
dwayne
young
of
the
division
of
healthcare
financing
and
policy
at
the
committee's
december
11th
meeting,
and
it
proposes
legislation
to
require
medicaid
to
reimburse
the
services
of
community
health
workers
who
provide
services
under
the
supervision
of
a
physician,
physician
assistant
or
advanced
practice
registered
nurse,
and
I
believe
mr
young
is
available
to
answer
any
member.
L
Dr
titus
go
ahead,
yeah.
Thank
you
and
thank
you,
I'm
sure
for
the
question
I'm
curious
about
what
the
estimated
cost
would
be.
What
do
you
see
how
many
providers
do
you
think
we
have
at
our?
During
our
interim
sessions
we
reduced,
we
provided
reimbursement
rates
and
I'm
just
curious
as
to
where
this
will
put
us.
I'm
not
saying
I
don't
support
it.
I'm
just
saying
we
should
know
the
cost
of
this
decision.
E
Dr
titus
for
the
question,
so
the
community
health
worker
proposal
has
come
forward
a
couple
times
in
the
last
couple
sessions,
but
I
believe
that
the
testimony
that
we
heard
during
the
presentation
on
this
was
that
it
would
be
cost
neutral
that
the
community
health
workers
were
able
to
do
some
things
at
a
a
lower
level.
That
would
actually
reduce
costs
of
medicaid.
E
I
don't
know
that
for
a
fact,
but
we
really
won't
know,
of
course,
the
full
cost
until
we
get
the
fiscal
note
in
the
regular
legislative
session,
so
I've
heard
have
been
met
with
have
had
the
community
health
workers
meet
with
me
multiple
times,
pressing
how
important
this
issue
is,
and
so
I'm
hoping
that
we
can
support
this
committee,
because
that
that
fiscal
note
will
really
give
us
the
answer.
But
my
recollection
was
this:
was
either
cost
neutral
or
cost
saving.
L
If
we
move
forward
with
this-
and
that's
really
where
I
was
where
I
was
going,
because
I
think
it's
I
mean
the
conversation
of
costs
and
money
and
budget
can't
go
unnoticed
or
unnoted,
and
so
as
long
as
we're
making
sure
it's
our
belief-
and
it
is
truly
my
belief
also,
that
if
a
community
health
worker
gets
out
into
the
public
and
and
perhaps
intervene
so
that
patient
then
doesn't
have
to
go
to
the
hospital
go
to
the
er.
As
we
know
it's
much
more
expensive.
L
E
It's
my
dream,
someday
that
we
could
get
fiscal
notes
for
interim
bdrs.
That
would
be
a
wonderful,
wonderful
thing,
but
I
know
it'd
be
an
awful
lot
of
work
for
everyone.
Thank
you.
A
Thank
you,
and
with
that,
mr
young,
if
you're
here
do
you
have
anything
to
add
to
that.
A
I
C
Okay,
I'm
sorry,
mr
young.
M
I
would
just
add
to
senator
ratty's
statement
that,
of
course,
when
we
brought
this
measure
before
and
many
times,
it's
been
budget
neutral
and
that's
dependent
upon
medicaid
case
load
and
there's
varying
factors
within
medicaid,
and
so
when
we
did
the
calculations
prior
there,
there
was
a
very
small
fiscal
note,
but
that
can
often
be
absorbed
depending
upon
where
our
final
case
load,
that's
legislatively
approved,
falls,
and
so
in
previous
years.
M
As
far
as
contact
tracing
as
far
as
being
able
to
help
manage
help,
physicians
and
providers
manage
people
with
chronic
diseases
and
that's
not
something
that
we've
been
able
to
calculate
yet,
because,
obviously
this
is
a
new
situation
for
all
of
us,
but
have
we
had
those
services
approved?
They
would
continue
to
play
a
vital
role
and
really
fighting
cove
at
19.
L
Madam
chair
may
ask
another
question:
I'm
sorry
go
ahead
so
that
just
comes
to
mind
with,
and
thank
you
for
that.
But
since
the
majority
of
our
medicaid
patients
are
now
assigned
to
a
managed
care
organization,
but
we
mandate
that
these
managed
care
organizations
have
to
have
these
community
health
workers
on
their
provider
network.
How
will
that.
M
Work
so
if
a
service
is
covered
by
state
plan,
then
managed
care
has
to
cover
it
and
they
have
to
have
a
degree
of
network
adequacy.
Many
of
the
managed
care
organizations
use
community
health
workers.
Now,
however,
it's
not
a
state
plan
service,
and
so
therefore
it's
not
mandated
and
the
division
doesn't
have
control
about
how
they're
utilized
or
when
they're
utilized.
But
it
is
my
understanding
that
our
managed
care
organizations
are
using
their
community
health
workers
in
the
capacity
to
help
with
some
of
this
covet
testing
and
tracing.
M
A
A
A
Okay
with
that,
the
recommendation
will
pass
on
and
we
will
move
on
to
recommendation
number
two
miss
kamlasi
comments.
Please.
B
Madam
chairman
kamalasi
for
the
record.
The
second
item
in
the
work
session
is
to
include
a
statement
of
support
for
health
in
all
policies
in
nevada
in
the
committee's
final
report.
Health
and
all
policies
is
an
approach
to
addressing
the
social,
determined
determinants
of
health
and
supporting
health
equity
through
collaboration
between
public
health
entities
and
non-traditional
stakeholders.
A
Thank
you
committee
members.
Are
there
any
questions.
A
I
believe
that
was
senator
woodhouse.
Second,
second,
from
vice
chair
rowdy.
Do
we
have
any
discussion,
miss
kamlasi?
If
you'll,
please
take
the
role
senator
hardy.
J
L
A
B
Madam
chair
megan
kamalasi
for
the
record
item
three
was
submitted
by
representatives
of
dignity,
health,
saint
rose,
dominican
and
the
empowered
program
empowering
mothers
for
positive
outcomes
with
education,
recovery
and
early
development.
We
heard
from
a
couple
of
folks
who
started
this
program
at
one
of
the
early
meetings
and
the
initial
recommendations
that
they
submitted.
B
B
It
would
also
require
healthcare
professionals
who
are
authorized
to
provide
prescribed
controlled
substances
in
nevada
to
obtain
two
hours
of
continuing
education
in
espert
as
a
condition
for
licensure
licensure
or
license
renewal,
and
such
prescribers
would
only
have
to
complete
expert
training
once
during
licensure
in
the
state.
This
proposal
also
would
allow
completion
of
approved
expert
training
to
fulfill
existing
continuing
education
requirements
related
to
substance
use
for
prescribers.
B
A
Thank
you
before
I
ask
for
questions
I'll,
just
thank
dignity,
health
and
and
the
empower
program
for
being
willing
to
amend
your
request
with
understanding
the
financial
position
that
the
state
is
in
right
now
and
with
that
I'll
ask
if
we
have
any
questions.
J
Thank
you
inasmuch
as
we're
trying
to
encourage
people
to
get
the
waiver
in
order
to
be
able
to
have
medication,
assisted
treatment
with
buprenorphine,
for
instance,
I'm
looking
at
this
anytime,
you
do
the
waiver,
you
are
encouraged
anything
you
do
for
buprenorphine,
for
instance,
to
treat
a
substance
use
disorder.
J
You
are
required
to
marry
the
counseling
part
of
that
with
the
medication
part
of
that.
So
esper
is
a
integral
part
of
that
process
when
you're
dealing
with
someone
with
an
opioid
use,
disorder,
and
so
inasmuch
as
esport
is
so
critical
to
that
process
as
well
as,
even
if
you
don't
get
the
waiver,
I'm
looking
at
the
waiver
probably
ought
to
asbert
training
probably
ought
to
count
for
some
of
the
requirement.
J
We
have
for
pain
management,
for
instance,
and
if
you
have
the
waiver,
then
you
get
to
count
it,
but
if
we
can
encourage
the
waiver
by
giving
even
a
double
two
for
one
as
it
were
for
hours,
if
we,
if
I
encourage
the
waiver
and
encourage
expert,
then
I
will
have
more
opportunities
to
treat
the
substance
use
disorder
so
that
we
can
allow
more
and
better
pain
management
in
the
state
of
nevada.
J
So
this
is
one
of
those
where
I
would
suggest
that
not
only
do
we
approve
it,
but
we
make
sure
that
it
counts
for
the
pain
management
and
that
we
give
two
for
one
credits
if
they
get
the
waiver
out
of
this,
we
need
to
do
something
over
and
above
thinking,
out
of
the
one-hour
backgrounds
and
the
encouraging.
We
need
to
put
our
mouth
our
words
where
our
mouth
is.
J
A
Hey
thank
you
for
that.
I'm
sorry,
I
didn't
catch
the
name
of
the
doctor
from
manpower.
A
Dr
peterson,
would
you
like
to
respond
to
dr
hardy's
statement.
N
A
Okay,
thank
you
and
then
committee
members.
Are
there
any
other
questions.
L
I
have
a
question
manager.
Please
go
ahead,
dr
titus,
thank
you
and
thank
you
for
that,
and
thank
you,
dr
hardy,
for
your
comments.
Also.
I
have
two
questions
actually.
First,
the
cost
of
doing
this
program.
L
We
all
know
that
we
have
a
lot
of
requirements,
the
cme
etc,
and
so
I
have
a
question:
what
would
be
the
cost
of
the
provider
to
do
this
because
you're
asking
all
providers
to
take
this
if
we
have
our
pharmacy
license
and
we
can
prescribe
narcotics
and
is
it
just
for
narcotics
or
is
it
for
all
scheduled
drugs?
That's
my
first
question.
L
Second
question
is:
what's
availability
of
the
program,
if
you're
asking
all
of
us
to
take
this
with
within
the
next
four
years
that
we
all
have
to
do
this
program
to
our
program,
is
it
an
online
service?
Is
it
going
to
be
available?
Is
it
already
up
and
running
and
can
how?
How
quickly
can
we
actually
do
this.
N
Those
are
great
questions.
We
have
actually
been
working
through
the
group
that
we
do
with
opioid
use,
disorder
and
pregnancy
and
with
dr
stephanie
woodard,
and
there
are
some
ces
that
are
already
available
through
different
project
echoes.
So
it
is
my
understanding
that
the
state
already
has
some
things
available
and
there
would
not
be
a
difficult
process
to
create
something
for
them.
N
L
L
So
this
particular
training
is
there
anything?
So
if
we
have
a
lot
of
pop-up
trainings
or
is
there
anything
that
the
state
recognized
as
appropriate
training
for
this,
and
that
that's
the
other
thing
so
that
somebody
doesn't
go
sign
up
for
one
program
that
you
that's
not
recognized
by
the
state
so
how's
that
going
to
be
who's
going
to
guarantee
the
program
that
I
take
is
one
that's
recognized.
I
mean
how
will
that
all
be
sought
out.
N
Yeah,
I
believe
that
that's
a
good
question
too.
I
believe
that
stamp
set
and
dr
honestly,
dr
woodard,
is
probably
better
at
answering
this
question
than
I
would
be,
but
I
believe
this
samsa
actually
has
different
expert
trainings
that
are
available.
B
O
Good
morning,
can
you
hear
me?
Okay,
yes,
so,
yes,
espert
is
a
nationally
recognized,
evidence-based
practice
for
the
screening,
brief
intervention
and
referral
to
treatment
for
individuals
who
are
either
at
risk
for
or
have
a
substance
use
disorder.
O
There
are
very
specific
standards
that
have
been
set
forth
already
through
national
organizations
and
so
moving
this
legislation
forward.
We
would
make
sure
that
we
put
forth
policy
to
align
with
those.
L
Very
good,
thank
you
and
thank
you
for
being
available
because,
as
you
know,
we're
again
we're
asking
providers
to
do
more
and
again
I
support
it.
I
want
to
make
sure
that
we're
not
making
it
this
huge
hill
to
climb
over
when
we
want
to
encourage
people
to
be
knowledgeable
before
they
write
that
prescription,
but
it
can't
be
so
onerous
that
nobody
wants
to
do
this.
So
thank
you
again,
for
you
know.
J
J
In
the
training
for
your
waiver
that
we're
talking
about,
they
allude
to
and
do
a
training,
maybe
not
four
hours
or
five
hours
of
the
training,
but
they
do
training
in
the
expert
itself,
and
so
it
is,
and
the
waiver
is
free.
J
You
know
you,
you
can
get
it
through
the
pcss
program
and
you
can
get
it
for
free
four
hours
online,
four
hours
in
person
and
it's
still
free,
but
it
we
need
to
have
more
people
doing
it
and
and
it's
not
just
the
free
that
will
entice
them.
But
if
we
recognize
that
that
counts
for
your
pain
requirement
for
your
cme.
J
This
certainly
ought
to
account
for
that
as
well,
because
it's
an
integral
part
of
the
pain
management
that
we're
talking
about
or
the
addiction
things
that
we're
talking
about.
So
I
would
be
very
generous
in
the
counting
of
the
hours
as
well
as
counting
it
towards
the
pain
management.
Part
of
that.
A
Okay,
do
I
have
a
second
second
okay
and
I
think
that
was
from
assemblywoman
monk
correct.
Thank
you.
Okay!
So
we'll
now
take
a
roll
call
vote
on
the
motion
to
amend
and
you
pass
we're
just
gonna.
Oh
I'm
sorry,
discussion
on
the
motion.
Did
you.
E
C
E
O
So
what
we
don't
have
control
over
are
what
the
national
or
federal
requirements
are
for
the
waiver,
but
what
we
could
do
is
certainly
allow
people
to
have
the
two
hours
of
credits
for
esper
to
account
towards
the
requirements
that
were
put
forth
in
eb-474,
which
I
believe
dr
hardy
is
referring
to
related
to
pain
management.
O
So
that
definitely
gets
us
a
lot
closer
to
making
sure
that
we
are
affording
the
opera
opportunity
for
individuals
who
are
already
required
to
get
ceus
to
meet
this
mandate
and
then,
over
and
beyond
that
senator
hardy.
I
believe
what
you
were
talking
about
was
potentially
even
amplifying
the
number
of
ceus
that
could
be
granted
for
an
individual
if
they
have
a
waiver,
not
necessarily
that
these
training
hours
would
count
towards
their
waiver.
So
I
guess
that
would
be
a
question
of
clarification.
J
To
get
the
waiver
there's,
there
are
criteria
that
we
don't
have
control
over
to,
but
we
do
have
control
over
what
we've
made
a
law
for
and
so
to
amplify
and
get
two
for
one.
Yes,
that
is
where
I
would
be
going
with
that.
J
C
J
O
So
stephanie
record
chair,
may
I
follow
up.
O
So
senator
hardy,
thank
you
for
that
clarification.
I
think,
then,
from
a
state
policy
perspective,
we
certainly
would
be
able
to
grant
those
individuals
who
have
received
their
waiver
as
essentially
meeting
this
minimum
requirement
and
potentially
following
senator
hardy's
recommendation,
providing
them
with
four
cme
credits
for
that
waiver
training,
as
opposed
to
the
two
senator
hardy.
Do
I
have
that
correct.
J
E
A
Implement
okay,
so
with
no
further
discussion,
we'll
take
a
roll
call
vote.
A
A
A
I
understand
dr
hardy
is
back
connected
so
with
that
he'll
come
back
to
the
work
session
and
move
on
to
number
four,
mr
posse.
If
you
would
please
go
forward.
B
C
A
F
A
B
Thank
you,
madam
chair
and
megan
kamalasi
for
the
record
item.
Four
proposes
legislation
to
require
the
division
of
health
care,
financing
and
policy
to
apply
for
a
medicaid,
1115
demonstration
waiver
to
pay
for
substance,
use,
disorder,
treatment,
services
and
institutions
for
mental
disease
in
nevada,
and
it
also
proposes
to
authorize
dhcfp
to
apply
for
an
1115
waiver
for
adults
with
serious
mental
illness
or
children
with
a
serious
emotional
disturbance.
L
Please
go
ahead,
dr
titus.
Thank
you
mentor.
My
question
resolves
around
how
many
institutions
do
we
have
that
have
more
than
16
beds
number
one
and
number
two
again,
as
I
brought
up
earlier,
that
we
have
a
managed
care
program
here
in
our
state,
where
the
majority
of
our
medicaid
recipients
are
on
managed
care
again.
I
just
want
to
point
out
the
importance
of
having
our
managed
care
associations
and
the
people
that
we
contract
with
as
a
state
making
sure
that
network
accuracy
includes
those
institutions.
Thank
you.
A
Okay,
thank
you
for
that.
There's
two
questions.
Yes,
dr
bernard,
mr
young,
would
you
like
to
address
those.
M
Questions
order
just
pulling
up
the
information
on
the
number
of
facilities
that
do
provide
those
services.
What
I
will
say
is
that,
within
of
course,
with
md
for
service,
we
are
restricted
for
paying
for
those
services
managed
care
also
falls
under
that
rule.
However,
they
do
have
the
in
lieu
of
which
allows
them
in
lieu
of
more
expensive
services
that
they
would
be
providing
for
that
patient
to
provide
up
to
15
days
inpatient
a
month
facilities
for
that
person
on
a
calendar,
and
so
they
cannot
go
beyond
those
15
days
per
month.
M
And
then
the
average
length
of
stay
from
our
data
shows
that
most
people
who
are
within
those
facilities
for
five
or
seven
days
now
when
an
individual
is
seriously
and
persistently
mentally
ill
and
they
do
fit
under
the
eligibility
code
of
age,
blind
and
disabled
they're
mp
for
service
medicaid
and
those
are
the
people
who
are
going
to
need
those
longer
stays
and
they
rely
on
our
state
facilities
for
those
stays.
M
And
so
yes,
while
to
answer
your
question,
while
there
are
those
facilities
enrolled
for
fee
for
service,
there's
not
a
current
payment
mechanism
for
them
and
they
are
enrolled
in
managed
care
as
part
of
their
network
for
other
services,
and
they
aren't
utilized
under
that
in
lieu
of
role.
There's
really
not
a
not
a
gap
to
catch
people
who
are
more
seriously
and
persistently
mentally
ill
and
have
those
longer
stays
unless
they're
within
the
state
system.
L
O
All
right,
good
morning,
stephanie
woodard
for
the
record.
There
are
at
least
10
hospital
facilities
in
nevada
that
meet
criteria
for
imd
and
then,
when
we
also
look
at
other
facilities
that
could
be
covered
under
the
imd
exclusion.
We
could
also
extend
that
to
our
residential
treatment
facilities
and
those
residential
treatment
facilities
and
detox
facilities.
L
Right
and
so
along
the
then
the
second
question
that
I
had
was
and-
and
then
you
brought
this
up
about
the
managed
care
peers
are
already
covering
these
folks.
That
would
be
the
fee
for
services.
Folks
that
are
would
be
benefit
from
this.
Is
that
what
I'm
hearing.
M
Yes,
that's
that's
exactly
what
we're
hearing
under
the
in-law
overall
again,
they
can
cover
up
to
15
days
if
they
are
enrolled
in
managed
care
in
lieu
of
more
expensive
services
that
they
might
have
if
they
were
not
hospitalized
but
fee
for
service.
There
is
no
mechanism
because
of
the
imdb
rule
other
than
the
state
facilities
and
those
the
seriously
persistent
mentally
ill
are
usually
under
the
age
blind
and
disabled
category,
which
is
a
mandatory
enrollment
and
fee
for
service.
L
Thank
you
and
then
you
mentioned
network
adequacy,
and
I
also
had
brought
that
up
before.
Is
there
any
mandate,
when
you
sign
with
these
managed
care
organizations
that
they
have
a
contract
with
a
mental
health
provider,
mental
health
facility?
Any
rules
that
way
for
that
network
adequacy.
M
L
F
J
A
A
Great
with
that
recommendation
number
four
passes
and
we
will
move
on
to
recommendation
number
five.
So,
ms
kamlasi,
if
you'll,
please.
B
Man,
I'm
sure
megan
come
lassie
for
the
record
item.
Number
five
proposes
to
send
letters
to
the
senate
and
assembly
committees
on
health
and
human
services
and
to
the
director
of
the
department
of
health
and
human
services,
expressing
the
committee's
support
for
the
priorities
and
goals
identified
by
the
children's
mental
health
consortiums
their
priority
and
documents
and
plans
are
available
on
the
committee's
web
page,
and
this
recommendation
was
submitted
by
dan
musgrove
on
behalf
of
the
three
free
children.
Mental
children's
mental
health
consortium.
A
B
Will
thank
you,
madam
chairman.
Megan
come
lassie
for
the
record
item.
Six
was
proposed
by
various
presenters
at
the
committee
meeting
on
january
15th
and
it
proposes
legislation
to
require
the
division
of
health
care,
financing
and
policy
to
the
extent
authorized
by
federal
law
to
expand
medicaid
coverage
to
pregnant
women,
and
it
includes
four
pieces
increasing
medicaid
coverage
for
pregnant
women
in
nevada,
from
165
percent
to
200
percent
of
the
federal
poverty
level,
implementing
presumptive
medicaid
eligibility
for
pregnant
women.
A
Sorry,
dr
hardy,
and
I
believe
it
was
a
second
from
senator
roddy.
Okay,
do
we
have
any
discussion
seeing
none?
I'm
sorry
does
someone
have
discussion.
A
J
A
Great
and
with
that,
with
six
passing,
we
will
move
on
to
number
seven.
Ms
kamala
say:
if
you
will
please.
B
Thank
you,
madam
chairman
kamalasi
for
the
record
item.
Seven
was
proposed
or
recommended
by
julia
peake
and
candice
mcdaniel
of
the
division
of
public
and
behavioral
health.
Am
I
needed,
I'm
good
okay
cool
at
the
january
15th
meeting,
and
there
are
three
pieces
to
this
proposal
for
legislation.
The
first
part
a
revises.
B
Nrs442.0101A
to
clarify
when
a
pregnant
woman
must
be
tested
for
syphilis,
and
so
it
clarifies
when,
during
the
first
trimester,
the
third
trimester
and
then
also
that
a
woman
would
be
tested
for
syphilis
at
the
time
of
delivery,
if
deemed
high
risk.
Part
b
is
kind
of
part
of
the
first
and
that
would
revise
nrs442.020
to
make
the
penalty
for
violating
the
piece
of
statute
above
civil
penalty
rather
than
a
misdemeanor,
and
that
civil
penalty
would
not
exceed
500.
B
The
second
piece
of
this
proposal
is
part
c,
which
would
require
hospital
emergency
departments
and
other
medical
facilities
to
test
pregnant
women
who
seek
care
in
the
facility
and
to
test
them
for
civilis,
regardless
of
what
they
are
seeking
care
in
the
emergency
department.
B
For
if
a
woman
indicates
that
she
has
not
had
recommended
prenatal
care
and
then
the
third
piece
is
part
d,
which
would
require
screening
for
chlamydia,
gonorrhea,
gonorrhea,
hepatitis
b
and
hepatitis
c
for
all
pregnant
women,
as
recommended
by
the
cdc.
That's
the
centers
for
disease
control
and
prevention
or
its
successor
organization,
and
I
believe
either
julia
and
or
candace
are
available
to
answer
any
questions,
and
I
believe
we
also
will
have
bill
welch
or
marisa
brown
from
the
nevada
hospital
association
on
the
line
to
answer
any
questions
from
the
hospital
perspective.
J
J
I
get
a
little
confused
when
it
says
and
or
so
is
it
and
or
is
it
or
is
it.
B
Right
this
is
megan
kamalasi.
I
should
have
been
clear
on
that.
The
committee
can
choose
to
pursue
any
or
all
of
these
recommendations
and
so
or
any
combination
thereof.
Q
Julia
before
the
record
hi
dr
hardy,
we
had
provided
in
our
very
first
presentation.
I
don't
know
if
the
slides
are
still
available
to
align
directly
with
what
the
cdc
guidelines
recommend.
We
worked
with
miss
kamwasi
to
ensure
that
the
recommendations
you
have
in
front
of
you
align
more
closely
with
what
the
cdc
recommends.
Q
I
think
they're
a
standard
of
care
for
the
most
part,
but
we
did
want
to
ensure
that
it's
written
in
statute
so
that
we
solidify
the
recommendations
ongoing
as
opposed
to
just
having
it
as
a
guideline
or
a
standard
of
care.
Q
Oh
great
question:
I
apologize.
I
didn't
answer
that
clearly,
the
first
time
julia
peaked
for
the
record,
the
cdc
would
say,
and
they
would
be
all
bullet
points
for
the
recommendation.
So
what
we've
provided
you
if
you've
selected
and
with
the
one
exception
testing
in
the
emergency
room
for
women
who
hadn't
had
prenatal
care,
the
centers
for
disease
control
and
prevention,
sent
out
a
team
earlier
in
the
year
to
look
at
our
congenital
syphilis
and
opportunities
for
intervention?
Q
That
was
a
recommendation
that
they
had
for
us.
We
had
been
trying
to
implement
something
similar
prior
one
of
the
biggest
challenges
that
we
had.
Is
that
there's
a
challenge
giving
the
woman
the
result
of
the
test
prior
to
her
leaving
the
emergency
room
encounter,
but
public
health
would
be
notified
of
that.
Then
we
would
be
able
to
follow
up
with
her.
So
that
was
a
guideline
provided
for
a
suggestion
provided
directly
to
nevada.
During
that
visit
from
the
centers
for
disease
control
and
prevention.
J
Q
Julia
p
for
the
record,
some
of
those
is
just
cleaning
up
the
language
in
442.,
it's
similar
in
441a,
where
it
is
a
criminal
misdemeanor.
It's
just
a
challenge
to
implement
something
like
that,
and
we
would
not.
We
would
not
do
it
under
any
circumstance.
So
that's
a
combination
of
the
cdc
guidelines
that
are
posted
publicly
for
all
states.
Q
It's
part
of
the
direct
intervention
that
we
had
related
to
congenital
syphilis
in
nevada
and
then
just
cleaning
up
some
language
when
we
were
going
over
it
with
miss
kamalasi
to
make
it
more
easy
to
implement
in
our
state
and
then,
if
we
do
have
misreporting
or
under
reporting,
we
can
follow
up
directly
with
the
clinician
or
facility
and
it
wouldn't
be
a
criminal
misdemeanor.
It
would
just
be
a
fine.
So
a
combination
of
those
very
three
specific
things
posted
nationally
as
a
recommendation
or
guideline
specific
to
nevada.
J
So
your
your
anytime,
you
use
the
word
like
and
or
then
I
get
confused
number
one.
I
need
to
make
it
a
civil
penalty
instead
of
a
misdemeanor.
I
need
to
do
that
number
two.
I
need
to
test
them
in
their
first
trimester,
their
third
trimester
and
at
delivery
and
in
the
emergency
room
and
number
five
or
six
need
to
screen
for
chlamydia
gonorrhea
hepatitis
b,
hepatitis
c,
as
recommended
by
the
cdc,
is
that
what
you're
saying.
Q
Julia
peek
for
the
record,
if
you
did
the
and
for
all
of
those
scenarios,
we
would
be
giving
our
moms
and
the
babies
the
best
possible
screening
based
on
the
guidelines
and
then
additional
screening
based
on
our
high
rates
of
congenital
syphilis.
So
if
you
were
to
go
with
the
and
statements
instead
of
the
or
statements,
I
think
we'd
have
the
best
policy
to
put
forward.
Q
Julia
peak
for
the
record,
some
things
would
be
required.
You'd
just
be
pulling
out
the
different
parts
that
you
support.
So,
for
example,
if
you
supported
the
first
section,
but
you
didn't
support
the
testing
in
the
ed,
that's
absolutely
something
you
can
consider
and
miss
kamalasi
has
given
you
that
option.
G
We
see
approximately
1
million
100
000
patients
in
our
ers
annually.
Of
that,
we
would
estimate
that
slightly
more
than
those
are
female
and
of
the
500
plus
thousand,
who
would
be
potentially
female.
There
would
be
somewhere
between
200
and
300
000
women,
who
would
be
in
the
child-bearing
age
category.
G
Would
that
be
so?
There
would
be
200
to
300
000
women
that
we
would
need
to
ensure
that
we
were
asking
the
question
as
to
whether
they
were
pregnant
or
not.
Currently,
when
a
woman
presents
to
the
er,
unless
they
are
presenting
specifically
for
a
pregnancy,
related
issue-
and
we
do
have
about
a
thousand
of
those
type
of
cases
a
year
in
the
hospital,
but
for
the
general
female
population,
they
would
not
be
asked
the
question
of
whether
they
were
pregnant.
G
Unless
they
were
going
to
have
certain
type
of
medical
examinations
done
particularly
related
to
radiological
procedures.
They
would
routinely
ask
if
the
woman
was
pregnant
to
ensure
that
they
were
taking
all
the
precautions
necessary
to
protect
the
baby
of
of
those
total
number
of
female
patients
who
potentially
would
be
need
to
be
screened,
at
least
from
determining
whether
they
were
pregnant
or
not.
About
16.
000
of
them
are
insured,
and
we
would
ask
we
would
guess
that
most
of
those
patients
are
getting
prenatal
care.
G
There
are
in
excess
of
15
000
of
the
patients
who
are
medicaid
or
of
some
other
subsidized
program
in
in.
We
believe
that
most
of
those
women
would
also
be
receiving
prenatal
care
at
some
point
in
their
pregnancy,
but
it
may
not
be
immediately
because
some
of
the
women
become
eligible
for
medicaid
after
they've.
Been
identified
as
being
pregnant,
and
then
we
had
a
little
over
2
000
of
the
patient
population,
who
in
fact
are
uninsured
and
not
likely
to
have
any
prenatal
care.
G
We
do
have
a
couple
high
pregnancy
risk
centers
in
the
state,
and
these
centers
do
try
to
accommodate
and
address
the
uninsured
population
as
best
as
possible,
but
obviously
that
is
something
that's
voluntarily
voluntary
on
the
patient's
behalf,
as
far
as
whether
they
utilize
those
facilities
or
not
the
cost
to
perform,
and
this
is
the
cost
to
the
hospital.
This
is
not
the
cost
that
would
be
charged,
but
the
cost
to
the
hospital
to
perform.
The
basic
syphilis
test
is
ranges
from
90
to
113
dollars,
depending
upon
which
reference
lab
is
being
used.
G
If
the
patient
tests
positive
and
they
do
follow-up
tests,
the
test
cost
to
the
hospital
again
is
a
186
dollars
per
case.
G
Some
of
the
challenge
that
we
see
is
ensuring
that
we
modify
and
get
all
of
our
staff
orientated
to
be
sure
that
they're
having
this
as
a
standard
questions,
we
have
so
many
questions
that
we're
screening
patients
that
come
in
that
are
coming
into
the
hospital
now
it'll
take
a
little
time
to
make
sure
that
we
are
able
to
make
sure
that
this
is
on
the
check
off
list
and
that
we're
getting
that
question
asked
of
all
female
patients
who
would
be
in
the
child
varying
range
of
age.
G
The
test
results
for
most
of
in
most
cases
are
not
coming
back
for
three
to
five
days,
and
so
the
hospital
is
not
going
to
know
whether
the
patient
was
confirmed
to
have
symptoms
or
not
until
days
later,
in
most
cases,
and
so
then
there's
the
issue
of
who
will
do
the
follow-up
with
the
patient
if
they
are
in
fact
confirmed
to
have
syphilis,
as
we've
talked
with
representatives
from
the
state,
it's
our
understanding
that
it
would
be
public
health.
But
we
would.
G
We
would
say
that
currently
we
know
that
public
health
is
is,
is
is
stretched
to
its
max
and
we
routinely
do
get
asked
to
help
them,
and
we
do
our
best
to
do
this,
but
to
assist
them
in
following
up
with
patients
that
otherwise
would
normally
be
followed
up
with
public
health.
So
so
that
would
be
something
that
we
would
want
to
make
sure
is
in
fact
covered,
because
this
potentially
could
be
a
significant
number
of
individuals.
G
G
I'm
not
clear
how
it
works
for
the
physician's
office,
because
a
lot
of
this
would,
in
the
first
couple
phases
of
the
testing
would
be
done
at
the
physician's
office.
G
So
I'm
not
sure
how
the
payment
arrangements
are
with
physicians,
particularly,
I
believe
that
this
similar
to
the
hospitals,
but
we
are
on
a
per
diem
rate
and
that
per
diem
rate
is
to
be
in
all-inclusive
of
whatever
we
need
to
do
to
it
to
meet
the
the
the
women
in
the
baby's
medical
needs
at
the
time
of
delivery.
G
This
would
be
a
similar
situation
for
medicaid,
at
least
with
the
hospitals
again
medicaid
for
those
patients
who
are
in
the
hospital.
So
this
would
really
relate
to
the
patients
who
are
delivering
and
have
delivered
in
the
hospital
and
then
we're
performing
these
tests.
At
that
time,
we
would
want
to
make
sure
that
that
wasn't
automatically
assumed
to
be
part
of
the
per
diem
rate.
That's
already
been
established
in
the
fee
schedule
that
didn't
include
this
cost.
G
I
guess
the
last
thing
and
we've
talked
with
the
state
about
this,
and
we
certainly
want
to
work
with
the
state.
We
understand
nevada
is
ranked
we
believe
number
two
in
the
nation,
and
we
certainly
need
to
do
something
to
address
that.
But
we
would
also
make
sure
there's
been
a
lot
of
legislation
in
recent
legislative
sessions
about
patient
rights,
etc.
G
If
the
female
patient
refused
to
allow
us
to
do
the
test,
and
so
that
was
the
information
that
I
wanted
to
provide
to
you
today.
But
I'm
happy
to
answer
any
questions
as
best
as
I
can.
J
Well,
I
I
guess
I
had
the
same
kind
of
questions
when
I
look
at
the
mandate.
J
L
Please
go
ahead,
thank
you
and
thanks
dr
hardy,
because
I
had
the
same
concerns
and
questions
regarding
that
portion
of
this
legislation
during
the
2019
session.
I
I
multiple
times
commented
that
I
was
appalled
that
nevada
was
number
two
in
congenital
syphilis
and
that
we
needed
to
come
make
a
change
to
make
sure
that
we
improve
those
numbers
and
one
of
the
ways
to
approach
that
is
the
presumptive
eligibility
which
we
all
just
supported
on
a
prior
bill.
L
This
particular
piece
of
legislation,
I'm
not
sure,
gets
to
really
the
problem
here.
We
know
that
at
least
I
I
think
a
lot
of
the
women
that
we
identify
ultimately
at
some
point,
post
delivery,
etc
did
not
have
any
prenatal
care
so
mandating
that
they
come
to
the
emergency
room
without
saying
who's
going
to
pay
for
this,
and
and
also
whether
a
patient
accepts
that
that's
my
one
of
my
big
things.
That
is
that
the
patient
has
a
right
to
refuse
this
test.
L
That's
number
one
number
two,
a
lot
of
these
folks
do
not,
they
may
see
not
be
in
a
hospital
setting.
So
what's
that
definition,
if
it's
in
a
private
practice
office-
and
then
the
third
thing
would
be,
we
do
do
have
home
deliveries,
we
have
midwives,
we
have
some
of
those
out
there
birthing
centers.
Would
they
be
included
in
this?
I'm
just
wondering
about
how
this
breaks
down
and
just
really
we
need
to
do
something.
It's
not
acceptable
that
we're
number
two
or
any
rank.
L
E
E
First
of
all,
I
just
want
to
clarify
the
process,
because
I
think
there's
been
a
little
bit
of
confusion
about
the
end
or
so
the
and
or
is
just
for
us
in
this
work
session,
to
choose
whether
or
not
we're
moving
this
forward
right.
So
we
wouldn't
write
legislation
at
hand
and
or
or
in
it
if
we
so.
Basically,
we
should
be
looking
at
these.
E
Those
four
separate
standalone
ideas
and
we're
moving
them
all
together
in
one
bill,
but
we're
just
deciding
which
ones
we're
going
to
move
we're,
not
it
wouldn't
say
or
in
the
legislation
giving
options.
It
would
just
be
we're
just
choosing
not
to
move
that
one
forward
is
that,
am
I
understanding
that
correctly?
C
E
Great
so
then,
so
I
I
would
first
of
all
like
to
thank
bill
welch
and
the
hospital
association
for
clearly
taking
a
good
chunk
of
time
and
reaching
out
to
the
members
and
getting
so
that's
some
good
feedback,
and
I
think
there
are
many
things
that
were
brought
up.
It
reminds
me
a
little
bit
of
the
newborn
screening
bill
from
last
session
and
the
whole
conversation
about
the
daily,
the
daily
rate
for
births,
maybe
a
little
bit
of
ptsd.
E
You
just
caused
for
me
there,
mr
welch
of
how
we
have
this
conversation
when,
when
all
of
the
pregnancy
is
bundled
into
one
payment.
So
I
think
those
are
legitimate
concerns.
I'm
not
sure
that
we
can
get
to
the
level
of
detail
based
on
how
many
conversations
that
took
in
today's
work
session.
But
I
just
want
to
put
on
the
record
that
I
think
that
how
these
get
paid
for
is
the
concern
that
shouldn't
be
addressed
and
as
this
bill
moves
forward.
E
But
what
I
heard
from
miss
peak-
and
I
just
want
to
make
sure
that
I
understand
this-
is
that
this
our
syphilis
rate
is
so
bad
in
the
state
of
nevada.
That
not
only
are
we
making
changes
one
and
two
to
revise
our
existing
nrs,
to
strengthen
it
and
to.
G
E
You
know
have
this
conversation
to
see
whether
or
not
it
makes
sense
to
see
how
we
would
pay
for
them
to
do
all
those
things.
But
I
would
hate
to
eliminate
recommendations
that
the
cdc
provided
to
the
state
of
nevada
to
address
this
issue
here
at
the
work
sessions
stage
and
not
have
the
opportunity
to
have
a
conversation.
So
I
just
want
to
recognize
those
legitimate
concerns,
but
also
say
that
I'd
like
to
see
it
move
forward.
E
I
also
think
perhaps
a
simple
amendment
that
we
could
do
today
would
be
to
add
that
the
patient
has
the
right
to
opt
out,
and
so
that
that
is
that
is
clear
from
the
get-go
that
the
patient
has
the
right
to
opt
out.
That
seems
to
me,
like
relatively
simple
thing,
that
we
can
all
agree
to
today.
A
Thank
you
for
that.
So
to
going
along
those
lines,
I
just
would
like
our
counsel
just
to
confirm
that
there
are
other
tests,
and
I
don't
know-
maybe
mr
welcher
or
a
deputy
administrator-
can
can
chime
in
on
this.
But
I
believe
we
have
several
other
tests
that
that
citizens
can
opt
out
of
when
they're
in
the
hospital
or
the
emergency
room
setting.
So
this
would
be
no
different
than
that.
A
Is
that
correct?
If
we,
if
we
decided
to
put
in
an
opt-out
provision,.
Q
Julia
peak
for
the
record.
Yes,
I
would
recommend
this
be
an
opt-out
opportunity
again,
you
wouldn't
be
forced
to
provide
the
test.
You'd
offer
the
test,
and
I
think
the
points
that
mr
welch
brought
up
on
behalf
of
his
association.
I
think
those
are
all
very
good
and
valid
points.
Q
I'll
just
add
specifically
to
what
several
of
you
have
mentioned:
the
first
section
where
we
fixed
the
first
and
third
trimester
to
be
more
specific
that
is
based
on
data
as
well,
as
is
the
recommendation
for
emergency
departments,
specifically
dr
titus,
not
the
wide
variety
that
you
spoke
of
earlier.
This
is
specific
to
emergency
departments,
because,
as
we
look
at
these
moms
that
we've
identified
during
birth
that
had
syphilis
and
then
the
baby
then
had
congenital
syphilis,
they
went
to
the
er
many
of
them.
I
could
get
you.
Q
The
exact
data
went
to
the
er
for
an
unrelated
reason
and
could
have
been
offered
a
test,
and
so
it's
a
missed
opportunity
that
we
might
have
been
able
to
find
that
mom
earlier
in
her
pregnancy
and
then
again
the
emergency
room
is
based
on
the
information.
So
those
are
two
data
points
that
we
found
when
we
looked
at
our
congenital
syphilis
cases.
Q
The
other
recommendation
that
I
might
make
is
perhaps
within
the
statute,
you
identify
either
what
a
sunset
per
se,
but
if
our
rate
of
congenital
syphilis
gets
to
a
much
lower
level,
perhaps
that
testing
is
not
needed
because
we
have
such
high
rates
now.
That's
the
reason
the
cdc
recommended
it.
Those
would
be
my
suggestions
if
you,
if
I
didn't
answer
the
question,
please
let
me
know
happy
to
try
again.
A
L
Is
that
I
I'm
not
sure
my
question
was
answered,
though
I
had
multiple
questions
in
that
and
and
I'm
again
that
who's
going
to
be
liable
is,
as
you
clarified.
Perhaps
it
was
just
the
emergency
rooms,
but
are
you
going
to
expand
it
at
once?
Some
point
to
offices
all
providers
etc
number
two,
the
the
payment
process,
which
has
been
brought
up
already.
Yes,
the
patient
can
opt
out,
but
who's
going
to
pay
for
it
if
they
opt
in
and
it's
going
to
be
a
mandate
for
the
who's
gonna
who's
gonna
cover.
L
So
if
a
patient
has
no
coverage,
which
we
know
part
of
the
problem
is
most
of
these
moms
have
no
car
and
they
don't
get
care,
maybe
they
show
up
in
the
er
for
some
unrelated
problem
or
maybe
it's
the
pregnancy.
I
absolutely
there's
a
standard
of
care
where
you
test
for
these,
especially
high-risk
moms,
but
it
should
be
tested
for
anybody.
It
doesn't.
You
know
it's
an
interesting
criteria.
L
It
makes
you
high
risk,
but
I
would
say
that
if
you
show
up
in
the
er
it's
great
to
be
tested
but
to
offer
someone
a
pap
when
they're
in
the
ear
or
when
I'm
in
the
er
there's
no
way,
I'm
doing
a
pap
on
somebody.
It's
just
not
possible
we're
in
my
little
emergency
room.
It's
not
set
up
to
do
that.
Can
we
do
blood
tests,
certainly,
but
then
who's
going
to
cover
that
who's
going
to
pay?
L
For
that
and
again,
I
think
I'm
not
comfortable,
including
c
in
there,
unless
we
we
work
this
out.
You
know
at
least
with
some
understanding
before
we
move
this
forward,
I'm
off
on
four
a
b
and
d,
but
not
c.
Unless
I
I
have
some
understanding
about
process,
liability
and
payment
before
we
move
this
forward.
A
Sorry,
well,
I
I
think,
dr
hardy,
let's
let
let's
let
the
deputy
administrator
answer
those
questions.
First,.
Q
Q
So
we
upon
getting
that
we
begin
to
reach
out
to
the
woman
and
try
to
get
her
the
treatment
needed,
but
there's
liability
identified
in
nrsnec
441a
for
review
related
to
the
payment
process.
I
think
that's
something
that
the
committee
should
discuss
and
figure
out
what
that
looks
like
we
can
provide
additional
data
on
the
number
of
pregnant
moms
by
insurance
provider.
A
Fees:
okay,
dr
hardy,
please
go
ahead.
J
J
So
I
I
think
we
may
be
trying
to
do
something
that
we
don't
need
to
do.
So,
if
you
take
the
where
to
for
the
top
two,
are
we
the
top
two
we're?
Probably
we're?
Probably
the
top
one.
If
we
didn't
figure
out
the
people
who
were
getting
prenatal
care
so
julia,
do
you
have
kind
of
demographic
statistics
that
bear
out
who
we
need
to
check
and
who
we
need
to
not
necessarily
not
checked,
but
how
aggressive
we
have
to
be
at
the
time
of
delivery.
Q
Julia
before
the
record
we'd
be
happy
to
provide
you
with
the
data.
We
did
prepare
an
fe
profile,
we're
also
working
with
the
university
of
nevada,
las
vegas
to
do
a
much
more
in-depth
clinical
review
of
the
cases
than
what
we
get
in
just
surveillance
data.
So
your
comments
about
these
women
may
traditionally
have
lack
of
insurance
or
other
issues.
They
also
have
co-morbidities,
including
some
substance,
use
disorder
and
others.
So
we
have
data
both
on
demographics,
comorbidity
insurance
type
happy
to
provide
that
to
the
committee
for
their
review.
J
I
appreciate
that
we're
probably
not
going
to
have
that
come
back
to
this
committee,
because,
as
I
understand
that
this
is
the
last
one,
what
on
number
one
a1,
the
first
trimester
of
pregnancy
at
the
woman's
first
visit
or
as
soon
as
practical,
a
woman
could
come
into
a
doctor's
office.
For
instance
in
her
first
trimester
and
it's
not
for
pregnancy
and
so.
J
Then
it
turns
out
two
months
later
that
now
I'm
at
15
weeks
or
whatever,
and
now
I
know
that
I'm
pregnant
and
oh,
I
should
have
had
that
done,
but
you
didn't
and
then
therefore
you
have
a
civil
liability
that
you
have
to
pay
for
because
you
didn't
do
it
in
my
first
trimester
teach
me
who's
that
applied
to.
Q
Julie
p,
for
the
record,
I
think
that
question
was
directed
at
me,
so
we
tried
to
add
language
in
there
as
soon
as
practical
after
knowing
so
first
and
third
trimester.
Q
The
data
point
related
to
this
that
we
were
trying
to
address
is
we
were
seeing
moms
come
in
after
the
first
trimester
and
then
would
not
be
tested
till
the
third
trimester,
and
so
we
want
to
make
sure
as
soon
as
is
possibly
practical
after
she's
been
identified.
If
that
second
trimester,
the
liability
wouldn't
fall
to
the
physician
for
not
testing
in
the
first
trimester,
if
they
didn't
know
that
she
was
pregnant,
they
just
need
to
test
her
at
the
point
that
that
they
see
her
again,
first
trimester,
second
trimester
or
third
trimester.
J
Let
me
make
it
simpler
than
that
if
a
person
comes
into
the
family
doctor
for
a
cold
in
her
first
trimester
and
doesn't
say
and
doesn't
even
know
that
she's
pregnant,
so
is
that
family
doctor
or
is
that
a
cvs
pharmacy,
urgent
care
person?
Does
that
count
as
that
first
visit,
or
is
it
the
first
visit
for
her
pregnancy.
Q
Julia
for
the
record,
so
it
would
be
related
to
her
prenatal
care
visit.
So
with
her
ob
gyn,
then
we
added
the
additional
I
I
know
you
were
just
talking
about
that
first
section,
but
to
jump
to
the
ore
section
with
eds.
It
would
be
emergency
departments
that
type
of
facility
or
related
to
your
prenatal
care,
where
it's
the
first
second
or
third
trimester,
not
your
family
doctor
or
an
unrelated
visit.
A
Thank
you
and
then.
A
A
deputy
administrator
is
that
is
that
miss
mcdaniel.
Next
to
you.
A
Okay,
I
just
wanted
to
make
sure
if
there
was
anything
else
you
wanted
to
add,
since
this
is
your
this,
your
wheelhouse,
when
we're
talking
about
maternal
and
child
health.
O
All
right
craig,
thank
you
candace,
maybe
for
the
record,
I
would
say,
deputy
peek
touch
on
all
of
those
important
issues
that
we
really
feel
critical
to
address
and
look
at
so
very
much
appreciate
your
time.
A
Okay,
thank
you
for
that
director,
okay,
so
unless
we
have
any
questions,
any
more
questions
with
that
I'll,
entertain
emotion
on
recommendation
number,
seven.
A
Okay,
sort
of
a
motion
by
senator
woodhouse
do
I
have
a
second
seven.
C
Seconds
I,
what
I
wanted
to
do
was
into
the
record
that
we
moved
to
approve
item
number
seven,
including
a
b
c
m
d,
with
the
provision
for
the
patient
to
have
the
right
to
opt
out.
That's
my
motion.
C
A
Sorry
about
that,
thank
you.
So
I
have
a
motion
from
senator
woodhouse
to
amend
and
do
pass
so
that
the
motion
includes
seven,
a
b
c
d
and
adding
a
motion,
a
provision
for
the
patient
to
opt
out
of
testing.
A
Do
I
have
a
second
I'm
coming?
Let
me
get
my
motion
first
and
well.
I'm
sure
I
seconded
I
have
a
second
from
vice
chair
ratty
and
dr
titus.
Please
go
ahead.
L
Yeah,
thank
you,
madam
chair.
Unfortunately,
I
will
not
be
able
to
support
that
motion.
I
just
feel
we.
We
cannot
move
forward
with
this.
I
think
it's
critical
that
we
address
the
problem
of
syphilis
in
our
state
and
that
it
includes
prenatal
care.
It
includes
neonatal
care
and
we
can't
ignore
it.
However,
I
can
not
accept
this
legislation
or
this
potential
bdr
without
clarification
on
mandates
for
who
will
pay
for
this.
J
I
think
it's
not
soup
yet,
and
so
I
will
not
be
supporting
it,
not
because
we
don't
need
to
do
something,
but
I
think
we
need
to
do
it
in
such
a
way
that
it's
more
pointed
to
what,
where
we're
at
and
what
we
need
to
do.
I
think
it's
laudable,
but
it's
got
so
many
different
things
that
haven't
been
resolved
in
it.
A
Okay,
well,
I
you
know
as
to
something
not
being
ready.
I
think
we
have
different
different
people
have
different
positions
on
that,
but
I'm
sure
that
the
deputy
administrator
and
the
and
miss
mcdaniel
will
continue
to
work
with
the
hospitals
and
anyone
else
who
preventing
the
spread
of
syphilis
and
these
other
diseases
in
nevada.
A
With
that
miss
kamasi.
If
you'll,
please
take
roll.
C
B
C
A
Okay,
with
that
number
seven
passes,
we
will
move
on
to
number
eight
miss
kamwasi.
B
The
recommendation
was
submitted
by
assemblywoman
cohen
in
consultation
with
margo
chapel
and
others
at
the
division
of
public
and
behavioral
health,
and
it
would
propose
legislation
to
require
dpvh
to
adopt
regulations
regarding
mandatory
training
for
unlicensed
caregivers,
who
provide
care
at
certain
facilities,
homes
and
agencies
that
are
licensed
under
chapter
449
of
nrs.
B
The
dpdh
would
also
review
and
revise
required
topics
of
training
periodically
to
address
new
or
relevant
issues
that
affect
health
and
safety,
and
they
would
identify
nationally
recognized
evidence-based
organizations
that
provide
free
or
low-cost
training
modules
on
required
training
topics
and
then,
finally,
the
recommendation
would
provide
the
administrator
at
each
facility
subject
to
the
regulations
would
be
responsible
for
ensuring
that
staff
complete
required
training
and
that
they
document
the
completion
of
such
training.
And
then
the
administrators
would
also
develop
and
implement
an
infection
control
plan
based
on
nationally
recognized
evidence-based
guidelines
for
the
facility.
L
Please
go
ahead.
Thank
you,
madam
chair.
I'm
can
we
have
a
definition
of
what
quote
unquote
care
is,
I
know
in
most
these
facilities,
as
I've
said
many
times,
I
still
the
long-term
care
medical
director
for
cell
phone,
medical
centers,
long-term
care,
and
what
what
are
you
talking
when
I
mean
when
you
say
care?
What?
What
is
that
and
what
does
that
mean.
D
Thank
you
care,
I'm
not
sure
we
have
an
official
definition
of
care,
but
I
have
letitia
matheral
who's,
deputy
bureau
chief
and
paul
schubert,
who
is
bureau
chief
of
the
healthcare
quality
and
compliance
bureau,
but
care
generally
this.
This
is
talking
about
people
who
work
in
the
non-medical
facilities,
such
as
assisted
living
facilities
or
people
who
might
work
in
a
medical
facility
that
are
not
necessarily
a
credentialed
staff
person,
but
who
are
an
integral
part
of
their
care.
D
R
It
could
be
administration
of
medication
to
the
residents
or
clients
in
a
facility,
or
it
could
be
assistance
with
activities
of
daily
living
or
it
could
be
assistance
in
bathing
or
assistance
in
feeding.
So
it
just
depends
on
the
activities
that
are
occurring
in
the
facility
and
the
type
of
services
that
that
particular
facility
is
offering.
L
So,
thank
you
for
that,
and
so
would
you
perhaps
would
there
be
a
stratification
on
based
on
what
type
of
care
they're
giving
on
how
many
hours
of
training
you're
going
to
require?
So
I
would
guess
that
somebody's
administering
medication
already
has
some
sort
of
licensure.
The
phil
facility
has
licensure
etc
or
their
family
member.
How
much
levels
of
training
how
many
hours
will
be
required?
Who's,
gonna
who's
gonna
decide
all
of
that
based
on
what
they
do.
If
a
certified
nurse
nurse's
aide
goes
through
a
certain
training,
we
have.
L
D
Good
morning
margot
chapel
for
the
record,
it
may
be
defined
somewhere.
We
can
look
at
other
states.
We
did
not
do
that
in
the
process
of
this,
and
we
usually
do,
but
we
we
didn't
in
this
case.
I
think
we
would
probably
what
we
were
looking
at
when
we
were
writing.
This
together
was
a
standardized
set
of
training
that
was
needed
or
would
be
required
in
regulation
and
law
versus
setting
different
levels
for
different
people
or
different
roles.
D
As
you
pointed
out,
dr
titus,
the
other
professional
medical
professionals
have
requirements
for
training
already,
and
so
this
would
be
generally
for
caregivers,
and
I
think
we
might
we
could
entertain
anyway.
We
can
discuss
that
further.
R
If
I
may
again,
it's
paul
schubert,
the
only
thing
I
would
add
is
that
currently
we
do
stratify
the
training
requirements
again
specific
to
facilities
and
in
particular
oh-
and
I
I'm
sorry,
it
looks
like
I
may-
have
lost
things,
but
anyway,
in
particular
for
medication
management.
R
There's
requirements
for
residential
facilities
for
groups
that
are
different
than
the
requirements
well
in
other
facilities.
Medication
administration
is
not
necessarily
allowed.
So
if
you're,
a
personal
care
attendant
service
provider,
you
would
not
be
going
into
a
person's
home
and
administering
medicaid
or
your
your
employees
would
not
be
going
into
a
person's
home
and
administering
medications
to
them
so
again,
depending
on
the
type
of
facility.
There
are
some
stratification
already
within
our
regulations
for
training
requirements.
R
But
all
of
those
non-licensed
caregivers
would
receive
the
same
type
of
infection
control,
training
and
then,
of
course,
it
would
be
evidence-based
and
and
from
a
nationally
recognized
organization.
D
L
So
I
I
guess
I
I
want
to
bring
an
example
of
a
personal
caregiver
say
taking
care
of
a
family
member,
because
we
recognize
that
that's
a
reimbursable
thing,
a
family
member
is
taking
care
of
mom
at
home.
Are
you
know,
will
this
then
they
be
required
for
the
you
know,
infectious
disease,
education
and
believe
me.
I
support
that.
I
I
support
that,
if
you're
going
to
give
care
to
somebody
universal
infectious
precautions,
some
of
the
stuff
that
we
know
is
just
critical,
especially
elderly,
etc.
L
They
should
be
educated
on
that,
and
I
just
wanted
to
know
again
that
stratification,
who
are
you
going
to
require
to
have
this
done?
How
will
be
available?
You
know
reimbursement
for
that
again
and
and
just
want
to
make
sure
that
we're
thoughtful
about
this
process
models
in
other
states
which
miss
chapel
said
you
know
you
haven't
done,
I'm
just
wondering
a
little
bit
more.
How
how
well
this
has
been
thought
out.
Thank
you.
A
Well,
and
if
I
can
jump
in
before
the
others
respond,
this
especially
the
first
section
has
been,
has
been
vetted
and
has
been
thought
out.
It
was
based
on
what
was
going
on
in
another
state
and
it
was
a
concern
with
people
who
were
in
facilities,
providing
care
and
didn't
have
any
training,
so
they
could
be
helping
a
a
resident
in
and
out
of
the
bathtub
and
not
have
the
proper
training
and
causing
an
injury.
Because
of
that.
So
it
certainly
isn't
the
intent
to
you
know.
Q
A
Everyone
in
the
facility,
but
those
people
who
haven't
had
training
and
then
with
that.
I
will
just
turn
it
over
to
mr
schubert
and
miss
chapel
if
they
want
to
respond
to
the
rest
of
the
question.
D
Thank
you,
chair
cohen,
marco
chapel,
for
the
record
again,
thank
you
for
that
clarification
too.
I
apologize.
Oh,
I
have
to
start
my
video
back
up
again.
Thank
you
so,
and
also
I
just
wanted
to
clarify
dr
titus
that
we
would
not.
This
is
not
for
unlicensed
caregivers.
So
if
it's
a
a
family
member
taking
care
of
a
family
member
in
home
and
that
facility
is
not
licensed,
this
would
not
apply
to
them.
L
So
so
again
follow
up
on
that
it's.
This
is
only
for
a
licensed
facility,
not
a
individual
family,
those
type
of
things.
This
legislation
will
only
be
mandated
for
a
license,
someone
that
is
licensed
under
the
state
of
nevada.
That.
J
J
And
in
a
home-
and
maybe
we
can
clarify
that-
I
think
the
intent
is
good.
I
can
support
it,
understanding
that
we
aren't
real
anxious
to
require
a
everybody
who
is
giving
here
in
a
home
to
be
a
licensed
person,
because
if
we
had
that
we
don't
have
enough
licensed
people
to
take
care
of
people.
B
Please
do
so
if
you
continue
reading
that
same
sentence,
senator
hardy,
so
regarding
mandatory
training
for
unlicensed
caregivers
who
provide
care
at
certain
facilities,
homes,
agencies
or
providers
licensed
under
chapter
449
of
nrs,
so
we're
only
talking
about
facilities,
homes,
agencies
and
providers
that
are
licensed
under
chapter
449
of
nrs.
So
it's
not
a
home,
that's
unlicensed,
but
it
is
anybody
who
provides
care
or
is
is
unlicensed
an
unlicensed
caregiver
who
provides
care
at
these
licensed
facilities.
B
So
only
licensed
facilities
must
be
subject
already
to
date,
licensing
requirements
under
hcqc,
I
think,
typically
within
dpbh.
So
this
would
just
be
another
piece
of
training
or
requirement
as
a
part
of
their
licensure
appreciate.
F
C
A
A
Thank
you.
Thank
you
with
that.
The
recommendation
has
passed
and
we
will
move
on
to
recommendation
number
nine.
B
Thank
you,
madam
chairman.
Molossi
for
the
record
item.
Nine
was
submitted
by
john
packham
of
the
office
of
statewide
initiatives
and
he
discussed
it
at
the
june
17th
meeting.
This
was
a
proposal
that
was
initially
developed
by.
I
think
it
was
an
nga
working
group
related
to
health,
workforce
data
collection
and
it
would
propose
legislation
to
enact
the
health
care
workforce,
data
collection,
analysis
and
policy
act
to
improve
available
data
on
health
care
workforce
in
nevada.
B
The
data
would
be
used
to
inform
health
policy
planning
and
workforce
development,
including
health,
professional
shortage
area,
designation
designations
and
funding
tied
to
hipster
designations
for
health
professionals
and
facilities
in
medically
underserved
areas
of
the
state.
B
Part
b
would
require
an
applicant
for
a
new
renewal
of
a
license
by
a
board
to
provide
the
information
described
by
dhhs
to
their
licensure
board,
and
it
would
apply
to
licensees
under
the
board
of
medical
examiners,
board
of
osteopathic
medicine
board,
dental
examiners,
board
of
psychological
examiners,
board
of
examiners
for
social
workers,
marriage
and
family
therapists
and
clinical
professional
counselors
state
board
of
nursing
and
state
board
of
pharmacy.
B
B
It
has
part
d,
provides
that
the
state
board
of
health
with
input
from
licensing
boards
and
others
will
adopt
rules
regarding
the
manner
form
and
content
of
data
reporting,
and
then
it
provides
that
at
a
minimum,
the
core
essential
data
set
must
include
things
like
demographics
practice,
status,
education
and
training.
Average
hours
worked
percentage
of
practice
engaged
in
direct
care
and
other
activities
practice
plans
for
the
near
future
and
then
any
additional
elements,
data
elements
identified
by
the
state
board
of
health.
So
then
it
it
requires.
B
B
Part
f
authorizes
other
licensor
licensure
boards
that
aren't
required
to
submit
the
data
to
submit
data
if
they
would
like
to
part
g
provides
that
the
board
shall
keep
confidential
personally
identifiable
data,
that
only
aggregate
de-identifiable
data
may
be
made
public
and
that
none
of
the
data
required
to
be
collected
by
the
state
board
of
health.
That's
not
typically
collected
as
part
of
licensure
renewal
may
be
used
by
boards
to
make
decisions
regarding
licensure
renewal.
B
It
allows
boards
to
promulgate
rules
as
necessary
in
order
to
comply
with
these
requirements
and
then
part.
I
creates
the
healthcare
workforce
and
requires
the
director
of
dhhs
to
create
the
health
care
workforce
advisory
group,
which
shall
advise
the
state
board
of
health
on
the
development
of
regulations
related
to
required
data
collection,
survey,
methodology
and
other
issues,
and
then
also
the
state
board
of
health
and
other
stakeholders
on
the
use
of
the
data.
A
Thank
you.
Do
we
have
any
questions
committee.
L
Thank
you,
madam
chair,
and
I
appreciate
your
tolerance
with
my
questions.
I
I
support
this.
I
mean,
I
think,
it's
important,
that
we
know
where
we
are,
that
we
understand
the
who
the
providers
are
where
they
are.
This
coveted
crisis
is
a
perfect
example
of
need
to
establish
data
and
make
sure
we
have
adequate
providers.
It
also
will
help
us
in
the
future,
knowing
where
we
need
to
emphasize
our
education
and
make
sure
our
workforce
development
plans
are
are
adequate.
L
Having
said
that,
however,
I
have
a
significant
cern
concern
over
number
d
and
then
subsection
six.
I
I
just
think
that
is
not
a
reasonable
request
for
any
profession,
let
alone
focus
on
health
care.
I
don't
know
who
else
when
they
apply
for
a
license
in
the
state
of
nevada
is
required
to
give
the
five-year
plan
on
where
you
will
be
in
the
future.
L
I
think
many
of
us
sitting
in
front
of
the
screen
right
now
wouldn't
be
able
to
say
what
we're
going
to
be
doing
in
five
years,
whether
it's
because
you're
going
to
stop
and
raise
a
family,
whether
it's
you
have
a
health
care
issue
or
whatever.
I
just
think
that
that
particular
one
is
is
going
a
little
bit
beyond
what
we
need
to
gather
data
probably
wouldn't
support
that
but
curious
to
see
where,
if
dr
peckham
is
on
available,
could
answer
what
other
professions
are
you
gathering
that
kind
of
information
on.
P
I
can
actually
address
that.
That's
typically
a
question
in
this
type
of
data
collection.
That's
a
very
general
question
that
I
actually
think
would
be
quite
relevant
for
pandemic
planning,
and
that
is
it's
a
garden
variety.
Well
vetted.
We
can
compare
it
with
other
states.
P
Do
you
plan
on
retiring
in
the
next
two
to
five
years?
Do
you
plan
on
continuing
to
practice
in
the
state
of
nevada
for
the
next
two
to
five
years?
Most
of
us
don't
know
what
we'll
be
doing
next
month,
given
the
pandemic,
but
again
it's
just
a
very
general
way
of
getting
a
temperature
across
professions
on
what
they
plan
to
do.
I
would,
I
would
also
say
that
each
one
of
those
data
elements,
I
would
argue,
are
to
be
determined,
for
example,
race
and
ethnicity.
P
I
would,
I
would
see
consultation
from
other
states
that
have
been
doing
this
for
years
to
see
what
questions
yield
the
best
data,
which
questions
even
get
answered.
That's
one.
That's
often
skipped
on
surveys.
People
don't
like
to
tell
you
their
race
and
ethnicity.
I
believe
it's
very
important
for
the
legislature
and
other
policy-making
bodies,
though
to
know
whether
the
workforce
looks
and
reflects
the
populations
they
serve,
including
race
and
ethnicity.
L
I
want
to
make
sure
it's
broad
enough
to
say
that
if
you
check
the
box,
when
I
renew
my
license
practice
plans,
you
can
don't
be
unknown,
can't
tell
up
in
the
air
whatever
it's
not
going
to
be
a
mandate
that
we
have
to
submit
each
provider
a
practice
plan
literally.
In
writing
my
plans
for
the
future,
because
I
just
think
that's
way
too
invasive,
and
I
just
want
to
make
sure
it's
going
to
be
a
very
open-ended
question
check
box.
L
You
plan
on
staying
in
nevada
for
the
next
five
years
sure
check
the
box.
That's
an
easy
question
versus
my
plan
for
the
next
five
years
is
as
follows,
and
again
I
understand
the
need
for
information,
but
want
to
make
sure
that
these
are
general
questions
and
again
just
for
workforce
development
and,
as
you
said,
emergency
crisis,
are
we
going
to
have
people
here
in
five
years
or
is
everybody
retire?
So
I
think
that's
important,
but
just
want
to
make
sure
we're
not
painting
us
into
a
corner
of
requiring
that
providers
provide
a
plan.
L
P
I
would
not
want
any
of
this
to
get
in
the
way
of
one
person
not
getting
their
licenses
expeditiously
as
possible.
P
Yeah,
well,
the
the
the
data
would
be
aggregated
it
would,
it
would
be
collected
by
the
boards.
It
would
be
aggregated
and
sent
to
hhs
and
then
made
available
to
the
legislature.
Researchers,
medicaid,
the
state
primary
care
office
for
hipsa,
designation.
P
A
Okay,
do
we
have
any
other
questions.
A
E
Senator
browning,
not
not
a
question.
I
just
wanted
to
make
a
comment
that
I
wanted
to
thank
dr
beckham
for
his
persistence
on
this.
One
he's
been
working
on
some
form
of
this
for
a
while
now
and
wanted
to
recognize
that
there
are
members
of
this
committee
who
have
pitched
in
and
tried
to
move
this
along.
E
A
Thank
you
for
that
and
then
deputy
administrator
finney
do
you
have
anything
you'd
like
to
add.
O
Thank
you
chairwomanco,
and
I
just
would
say
that
this
could
be
incredibly
beneficial
both
to
us
at
medicaid
and
at
the
primary
care
office,
to
make
sure
that
we
have
this
additional
kind
of
data
to
to
support
our
efforts
and
making
sure
we
do
have
a
a
workforce.
That's
both
adequate
and
reflects
our
population
and
and
just
layer
in
very
briefly
to
dr
hardy's
point
that
many
of
the
states
we
spoke
to
during
the
governor's
association
project.
O
This
data
is
separated
in
the
design
of
the
survey,
is
separated
from
the
rest
of
the
licensure
data
in
a
way
to
to
address
your
concerns.
So
really
appreciate
the
opportunity
to
share
that
and
the
opportunity
to
help
support
this
great
project.
A
Okay,
so
I
have
a
motion
from
dr
hardy:
do
I
have
a
second
second?
Second,
I
think
that
was
from
assemblywoman
monk.
Any
discussion.
A
A
B
Thank
you,
madam
chair
megan,
kamalasi
with
the
research
division
for
the
record
item.
Nine
was
submitted
by
dr
capuro,
who
is
the
state's
chief
dental
officer.
This
proposal,
or
similar
proposals
were
presented
at
the
committee's
meeting.
I
think
it
was
in
february
which
related
to
oral
health
and
it
may
not
have
been
exactly
presented
in
this
way.
B
Dr
capuro
was
another
of
the
presenters
who
had
identified
initial
proposals
for
legislation
pre-pandemic
and
revised
those
proposals
based
on
the
fiscal
status
of
the
state,
to
try
to
move
the
needle
on
oral
health
in
a
way
that
is
cognizant
of.
What's
happened
in
the
last
few
months.
So
item
number
10
proposes
legislation
to
enhance
access
to
dental
care
through
teledentistry,
to
establish
emergency
dental
responders
and
to
revise
provisions
related
to
the
dental
loss
ratio.
B
B
B
And
16,
and
if
you
look
towards
the
top
of
the
page
on
page
16,
there
are
some
provisions
related
to
teledentistry
and
medicaid,
also
towards
the
bottom
of
page
16.
It
begins
the
provisions
related
to
emergency
dental
responders,
which
just
in
case
that's
a
term
that
you're
not
familiar
with.
A
Right
yeah,
I
was
just
noticing
that
so
miss
come
on
dude
we
go
for.
B
B
I
mean
all
of
the
information
is
the
same
and
I
just
went
through
the
wrong
page
numbers,
so
I
can
go
through
it
again
or
if
you
look,
there
are
subheadings
that
indicate
the
provisions
related
to
teledentistry
emergency,
dental
responders
and
dental
loss
ratio,
and
I
can
go
through
the
page
numbers
with
you
in.
A
I
think,
for
the
sake
of
record,
for
the
record,
we
have
to
have
the
arguments
match
up,
but
vice
chair
ready.
C
E
Now
jerry
didn't
have
a
comment
before
we
got
to
emotion,
though
I
appreciate
and
I'm
on
board
with
doc
hardy's
efficient
suggestion,
though
understand
we
have
what
we
have
to
do
so
we
had
public
comment
and
I
believe,
written
information
that
was
submitted
to
the
committee
may
not
be
posted
yet,
but
we.
C
E
E
The
third
one
was
to
expand
the
definition
in
section
a5,
the
definition
of
dental
home
to
include
to
be
broader
than
just
children,
and
I
believe
the
fourth
one
was
under
section
c
and
d.
The
mandated
continuing
education
like
licensure,
suggesting
that
that
be
done
by
regulation.
So
those
were
the
four
recommendations.
E
I
would
like
to
suggest
that
when
we
do
make
an
emotion
that
we
amend
the
emotion
to
include
the
first
three
recommendations
that
would
keep
the
fourth
still
in
statute.
It
may
be
wise
that
we
eventually
move
that
to
regulation,
but
really
what
I'm
looking
to
do
here
is
to
get
all
of
it
into
drafting.
C
E
Better
when
we
have
the
language
and
can
go
through
it
line
by
line,
so
I'm
just
hoping
that
when
we
do
get
to
the
point
of
making
a
motion
that
we
can
include
those
first
three
recommendations
from
the
dental
hygienists.
As
I
just
read
them
back
to
you.
A
Okay,
thank
you
so
miss
kamasi
can
we.
I
just
want
to
make
sure
we've
got
a
clear
record.
B
Thank
you,
madam
chair.
Yes,
the
dental
hygienist
submitted
their
written
remarks
as
well,
and
so
we
have
those
laid
out
in
writing
in
the
same
format
that
senator
ratty
just
went
through
them.
So
if
the
understanding
is
that
you'll
include
the
first
three
with
this
bdr
and
not
the
one
that
changes
moves
the
continuing
education
requirements
to
regulation,
then
that
is
clear
enough.
A
Thank
you
and
then
also
just
going
back
to
the
original
work
session
document
being
with
the
page
numbers
being
off
from
oh.
C
A
Or
statement
I
just
want
to
make
or
we've
got
that
cleared
up.
A
L
Dr
titus,
thank
you
I'm
just
curious
as
to
the
is
it
will
it
be
mandatory.
Then,
and
again
I
support
this
legislation.
I
I
think
it's
a
great
idea.
We
know
that
access
to
dental
care
in
our
state
is
is
very
limited
at
best
and
it
does
affect
over
our
health
of
our
constituents
for
sure.
So,
looking
under
the
proposal,
though,
going
down
to,
I
think
I'm
trying
to
figure
this
out
here
under
b.
L
L
That
looks
require
a
dental
practitioner
to
obtain
two
hours
of
continued
medical
education
intel
dentistry.
What?
If
these
dentists
aren't
going
to
do
any
tele
dentistry?
Why
would
you
men
maintain
mandate
that
they
require
get
two
hours.
I
Hello,
this
is
dr
peppero
for
the
records.
So
to
answer
that
question,
the
ce
requirement
was
built
for
all
providers
as
a
way
to
provide
baseline
information
about
tele-dentistry
digital
records
and
recording,
and
to
encourage
dental
and
dental
hygiene
students
to
be
trained
on
using
this
technology
in
other
states
such
as
ohio
professionals
that
wish
to
use
teledentistry
are
required
to
apply
for
a
permit
and
then,
as
part
of
the
permit
and
fee
requirements
are
continuing
education
requirements.
L
That
it
seems
like
why
does
my
dentist
who's
been
practicing
as
long
as
I've
been
practicing,
medicine
has
to
now
take
two
hours
to
do
this
when
he
may
or
may
not
retire
in
the
next
four
year
or
five
years.
It
just
seems
like
to
require
that
they
take
that
to
be
licensed
and
required
by
2022
is
when
they
have
no
intention
of
doing
it
just
seems
a
little
bit
excessive,
certainly
going
forward.
L
If
somebody
you
know,
needs
to
be
able
to
do
that
for
future
license,
but
but
current
current
folks,
who
already
have
a
license
now
to
mandate
that
they
take
this
two
hours
just
seems
a
little
bit
excessive
to
me.
I
Chair,
can
I
address
that
additionally,
please
do
so.
On
that
note
I
it
would
be
the
hope
of
this
legislation
that
teledentary
would
be
widespread
and
used
by
the
large
dental
community
team.
I
A
provider
could
have
a
patient
come
to
their
practice
that
had
attention
a
teledental
visit
from
another
provider
and
understanding
how
that
appointment
was
handled
or
how
to
request
the
records
would
be
something
I
think
would
be
useful.
I
think
this
would
be
a
a
methodology
of
practice
that
would
be
so
widespread
that
it
would
need
to
be
common
knowledge.
I
think
that
was
kind
of
the
the
intent
behind
making
it
just
a
one-time
ce
requirement.
A
I
would
say
I
think
it
makes
sense,
because,
if
we're
going
to
use
the
hypothetical
of
dr
titus's
dentist,
who
plans
to
retire
in
the
next
few
years,
what
if
next
for
her
next
cleaning,
dr
titus
decide,
tells
her
doctor.
You
know
what
I
decided
I'm
moving
to
garbage,
and
I
I
just
don't
want
to
be
it's
it's
getting
too
crowded
around
where
I
live,
and
even
though
that
doctor
that
dentist
isn't
going
to
use
telemedicine,
that
dentist
should
have
the
knowledge
to
be
able
to
explain
to
her
okay.
L
That's
just
the
way
I
see
it
but
yeah,
but
I'm
sorry,
but
to
use
that
analogy.
You'd
have
to
say
say
all
accountants
have
to
know
how
to
use
quickbook.
I
mean
I
just
think
that
I'm
just
anxious
that
you're
mandating
and
it
doesn't
really
it's
a
standard
of
care.
We're
looking
at
that
as
a
standard
of
care
that
everybody
does
is,
is
really
teledentistry
the
best
standard
of
care
or
still
being
seen
in
person.
L
I
think
what
we're
trying
to
do
is
solve
a
problem
of
inadequacy:
solving
a
problem
of
access
to
care
of
dentistry,
but
not
mandating
that
that's
a
better
standard,
and
if
my
dentist
mandates
that
we
have
to
come
in,
then,
then
I
think
to
me
a
higher
standard
is
having
somebody
actually
in
in
real
time
in
your
office,
whether
it's
in
healthcare,
primary
care,
family
practice,
whatever
it's
still
the
best
standard
for
me,
I
I
would
be
hesitant
to
to
accept
that
attella
anything
is
better
care
than
the
in
person
laying
on
of
the
hands
actually
seeing
a
person
in
the
office.
A
E
Yeah
this
type
of
question,
dr
capraro.
E
But
I
think
dr
caprero
you've
had
the
most
contact
with
dental
professionals
as
you
are
in
building
these
regs,
and
so
I
guess
my
question,
for
you
is:
do
dentists
have
a
concern
about
that
ce,
or
do
they
see
it?
As
you
know,
an
introduction
to
this
topic
is
not
a
bad
thing
for
all
dentists
to
have,
as
you
know,
being
on
the
sort
of
leading
edge
of
where,
where
dentistry
is
going
so
dentists
raise
any
concerns
with
you
about
this
specific
provision
or
any
dental,
any
dental
provider
type
for
that
matter.
I
I
J
I
For
your
input,
yeah,
thank
you
so
much
for
the
question
number.
I
under
c
describes
the
waiver
for
a
dental
practitioners,
which
are
dentist,
dental
hygienist
and
dental
therapist
that
have
completed
a
tele-dentistry
course
as
part
of
their
coursework
for
graduation.
A
A
You
have
a
motion.
I
will
move
that.
Okay,
I
have
a
motion
from
senator
woodhouse
and
do
you
have
a
second
okay?
I
have
a
second
for
vice
chair
ratty.
Do
we
have
any
discussion?
A
Okay,
seeing
none
miss
kamasi.
Can
we
please
have
a
roll
call
vote.
C
A
Great
thank
you,
and
that
is
number
10
passing
that
will
move
on
to
agenda
item
six,
which
is
public
comment
with
that.
We're
gonna
need
two
minutes
to
give
the
live
stream
enough
time
to
catch
up
and
for
members
of
the
public
to
have
a
chance
to
call
in
so
let's
do
a
two-minute
recess
while
bps
takes
care
of
that.
A
R
A
Okay,
so
with
that,
we
will
we'll
come
back
from
recess
with
our
with
that.
So
we
were
on
agenda
item
number
six
and
thanks
ubps
for
informing
us
that
we
don't
have
anyone
waiting
for
public
comment.
So
with
that
we
will
move
to
member
comments.
Members.
If
anyone
has
any
comments
before
we
adjourn.
E
A
comment:
okay,
please
go
ahead.
I
just
wanted
to
take
this
minute
to
thank
you
as
the
chair
for
steering
us
through
a
very
interesting
time
in
health
and
public
health.
Generally,
I
was
impressed
by
the
organization
and
the
focus
from
the
beginning
and
then
on
carrying
through
on
what
we
said
we
were
going
to
do,
which
is
you
know,
always
nice
to
see
that
happen.
E
I
think
there's
really
good
work
here
on
behavioral
health,
maternal
health,
oral
health,
public
health,
but
I
also
thank
you
as
chair
were
responsive
to
emerging
requests
as
they
came
forward,
and
certainly
we
got
great
information
about
the
pandemic
as
it
was
happening.
So
I
just
wanted
to
thank
you
and
commend
you
on
a
job
well
done.
E
A
You
I
appreciate
that
and
thank
you
very
much
for
your
assistance,
which
was
very
much
needed
and
again
appreciated
and
I'll
just
take
this
opportunity
to
thank
our
staff,
as
always
just
the
most
amazing
people
that
I
I
don't
know
that
the
citizens
of
nevada
know
that
the
the
hard-working
treasure
they
have
in
lcb
staff,
from
bps
to
legal
research.
A
Everyone
miss
kamalasi,
patrick
who,
who
was
helping
out
while
ms
kamalasi
was
in
wasn't,
was
away
so,
and
I
don't
want
to
name
names,
because
I'm
very
worried
that
we're
going
to
forget
someone
that
I'm
going
to
forget
someone.
But
but
thank
you
please
understand.
We
know
that
this-
that
it
was
very
hard
on
everyone,
and
I
definitely
appreciate
the
committee's
hard
work
and
getting
this
done.
A
We
we
also
had
to
continue
some
hearings
and
reschedule,
and-
and
I
know
that
it's
a
very
it's-
a
committee
made
up
of
very
busy
members.
So
I
appreciate
that-
and
I
certainly
also
appreciate
all
of
the
state
representatives
from
the
different
state
agencies
who
participated
with
us,
even
though
you
were
very
busy
helping
to
take
care
of
our
state
dealing
with
covid.
A
A
Just
remember
that
your
comments
for
the
public-
you
can
still
provide
us
with
your
comments
and
concerns
regarding
these,
these
bills
that
we're
putting
forward
and
that
they
there
will
continue
to
be
a
discussion
of
these
as
the
session
commences
that
that
you'll
probably
see
these
bills
change
as
as
the
session
goes
forward,
and
that's
the
way
the
process
is
supposed
to
work.
So
with
that,
I
will
adjourn.
Thank
you.