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Description
This is the second meeting in calendar year 2023. Please see agenda for details.
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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A
C
D
D
A
Here,
thank
you
very
much
and
please
mark
assemblyman
hafen
present
when
he
arrives
and
welcome
to
assemblyman
Watts,
who
is
on
Zoom
before
we
move
on
with
today's
agenda,
I'd
like
to
remind
all
the
committee
members
and
members
of
the
public
to
turn
off
or
mute
any
of
your
electronic
devices
and
for
those
of
you
who
will
be
providing
testimony
today.
Please
remember
to
state
your
name
for
the
record
each
time
before
begin
speaking,
and
if
you
have
a
business
card,
please
provide
that
to
the
community
secretary
before
leaving
the
committee
today.
A
So
we'll
move
on
to
agenda
item
number
two
public
comment:
this
is
the
first
period
of
public
comment.
There
will
be
another
public
comment
period
at
the
end
of
today's
meeting
due
to
time
considerations.
Each
person
will
be
given
two
minutes
and
please
remember,
to
State
and
spell
your
name
for
the
record
and
then
begin
your
statement
to
call
in
to
provide
testimony.
Please
call
669-900.
A
A
E
E
Also,
the
director
of
eaglequest,
the
state's
largest
Therapeutic
Foster
care
provider,
as
well
as
their
state
representative
for
the
family,
focused
treatment,
Association,
bringing
best
practice
to
Therapeutic
Foster
Care
I'm
here
today,
I'm
just
in
support
of
the
governor's
recommended
budget
as
it
pertains
to
the
25.6
percent
increase
to
foster
care
and
I.
Just
really
want
to
thank
Governor
Lombardo
for
supporting
this,
as
well
as
the
tireless
efforts
of
administrator,
pitlock
and
director
Whitley,
to
make
this
possible
as
a
foster
parent
myself.
E
It's
been
years
since
foster,
parents
have
received
an
increase
and,
as
you
guys
know,
as
families
of
your
own
costs
have
gone
up
and
it's
and
it's
really
tough
and
we
are
in
a
national
as
well
as
state
shortage
of
foster
parents.
So
this
increase
I
believe
will
have
a
profound
impact
on
other
people
expressing
interest
to
become
foster
parents
so
that
it's
not
a
financial
burden
and
they
can
care
for
our
communities.
E
Children
and
what
I
ask
everybody
of
the
subcommittee
today
is
regardless
of
what
party
you're
in
or
political
affiliation
I
think
we
all
agree.
Our
most
vulnerable
children
really
need
to
be
at
the
Forefront
and
are
the
future
of
our
community,
and
if
you
could,
please
support
the
governor's
recommendation
here
to
for
the
increase
in
foster
care.
We'd
greatly
appreciate
it.
Thank
you
so
much.
That
concludes
my
public
comment.
Thank
you.
A
C
C
F
C-A-I-T-L-I-N
last
name
g-a-t-c-h-a-l-I-a-n
and
I'm.
The
government
relations
director
for
the
American
Heart
Association
Nevada
division
on
behalf
of
the
American
Heart
Association
I
would
like
to
urge
the
legislature
to
take
action
on
extending
postpartum
Medicaid
coverage
from
60
days
postpartum
to
12
months.
F
Health
insurance,
health
insurance
status
is
one
important
dimension
of
access
to
care
and
Studies
have
documented
disparities
in
health
insurance
coverage
among
low-income,
young
and
minority
populations,
as
well
as
adverse
maternal
and
infant
outcomes
among
uninsured
and
Medicaid
covered
women,
pregnancy
and
birth
complications,
as
well
as
social
determinants
of
Health
increase
risk
for
cardiovascular
disease
in
women.
More
than
one
in
three
maternal
deaths
occur
following
birth,
with
cause
specific
mortality
from
heart,
disease
and
stroke
being
highest
in
the
year
after
giving
birth.
We
all
want
babies
to
have
the
best
possible
start
in
life.
F
So
they
can
get
all
of
the
health
care
services
they
need
to
be
healthy
during
and
following
pregnancy,
better
birth
outcomes
due
to
fewer
costly
medical
complications
during
pregnancy
and
assisting
with
early
identification
and
treatment
of
postpartum
depression,
quitting
smoking,
preventing
violence
and
treating
substance
of
substance
use
disorders,
caring
for
women
and
birthing
parents
in
their
productive
years,
while
ensuring
maternal
health
is
Equitable
across
populations
becomes
long
before
pregnancy
and
lasts
well
beyond
childbirth.
Savings
mom's
lives
requires
a
policy
Road
road
map
to
Better
Health.
F
The
American
Heart
Association
recommends
policy
solutions
that
are
sustainable
and
impactful
for
prevent
for
preventing
maternal
death
and
ensuring
all
mothers
can
live
healthy
lives
before
and
after
before,
during
and
after
birth,
by
extending
postpartum
Medicaid
coverage
from
60
days
to
12
months.
Thank
you
for
your
consideration.
I
will
follow
up
with
a
letter
soon.
C
C
A
You
very
much,
and
so
now
we'll
go
on
to
agenda
item
number
three
and
we'll
be
hearing
budget
presentations
from
the
direct
from
the
Department
of
Health
and
Human
Services.
First
up
we
have
the
director's
office
and
director
Whitley
and
team.
Please
join
us
and
we
look
forward
to
hearing
your
presentation
go
ahead
when
you're
ready.
B
G
Morning,
Madam,
chair
and
committee,
my
name
is
Richard
Whitley
and
I
serve
as
the
director
for
the
Department
of
Health
and
Human
Services
with
me
today
on
my
right
is
Marla
McDade
Williams
and
she
serves
as
the
Deputy
Administrator
over
programs
and
policies
and
on
my
left
is
Stacy
Johnson
and
she
serves
as
the
deputy
over
budget.
G
Thank
you
for
the
opportunity
today
to
present
our
first
of
many
probably
appearances
before
you
to
present
our
budgets
and
we're
happy
to
be
here.
We've
as
a
department
have
been
through
a
lot
and
have
implemented
a
lot
and
we're
looking
forward
to
this
budget,
sustaining
and
and
continuing
making
improvements.
So
thank
you
for
the
opportunity,
if
you,
if,
if
I
may
just
begin
with
our
slide
presentation.
G
So
slides
two
and
three
are
the
Department's
Mission
and
organizational
chart.
If
you
go
to
slide
three,
our
our
department
is,
as
you
likely
know,
is
organized
in
divisions
and
the
are.
Our
functional
role
runs
the
gamut
from
from
eligibility
for
services,
funding,
Services
regulating
services
and
Direct
Delivery
of
services
somewhat
serving
as
the
state
Safety
Net
in
many
areas
in
Behavioral,
Health
and
other
services.
G
So
I
didn't
do
a
slide
on
challenges.
I
think
you'll
hear
from
everybody.
You
know
the
challenges
with
Workforce
I
I've
asked
my
the
administrators
to
to
specifically
speak
about
how
that
impacts,
the
programs
that
they
provide,
with
with
Direct
Services
being
the
most
difficult
and
I
think
you
know,
without
sort
of
looking
at
all
of
the
at
the
workforce.
G
In
in
specificity,
it
really
is
hard
even
just
giving
you
an
a
overall
vacancy
rate,
doesn't
really
tell
the
true
story
for
our
department
and
so
you'll
hear
from
each
division,
how
they
are
directly
impacted,
and
especially
those
that
do
try
to
provide
Direct
Services
and
where
it's
most
crucial,
then
within
there
is
in
our
facilities,
I'm
very
proud
to
say
that
all
of
our
hospitals
and
treatment
facilities
have
not
only
continued
to
provide
services,
sometimes
not
to
the
community
need.
G
But
we
have
maintained
our
joint
commission,
accreditation
and
and
certification
through
the
process.
So
it's
a
balance
of
meeting
the
community
needs
and
and
ensuring
that
we
protect
people
and
provide
quality
services.
So
I
just
give
that
as
an
as
an
overview.
But
you'll
hear
more
specifics
from
each
of
the
divisions.
G
Turning
to
page
four
just
jumping
into
the
department
of
priorities
in
a
in
a
more
of
a
of
an
overview,
I
I
really
looked
for
the
themes
that
I
think
that
you'll
see
in
our
budget,
and
you
know
in
a
budget
presentation,
you
don't
really
get
because
it's
all
categorical.
So
you
don't
really
get
to
see
the
total
impact,
but
provider
rates
it's
a
huge,
it's
probably
unprecedented,
at
least
in
my
tenure
as
as
director
and
and
as
a
division
administrator
to
have
this.
This
number
of
categorical
rate
increases
for
providers.
G
Usually
it's
a
usually
it's
a
it's
a
struggle
between
which
industry
gets
the
provider
rate
increase
and
I'm
very
pleased
that
we
were
able
to
look
in
total
at
the
impact
I.
Think
again,
you
won't
see
this
captured
in
the
categorical
funding,
but
in
Medicaid's
budget
I
think
the
the
heavy
lift
that
will
be
achieved
is
really
a
focus
on
Primary
Care,
helping
to
prevent
hospitalization
and
crisis
by
actually
investing
in
nurse
practitioners
and
services
that
can
occur.
G
You
know
in
a
in
a
physician's
office
so
again
not
captured
in
the
categorical
budgets,
but
definitely
a
theme
Here
provider
rates,
probably
our
biggest
one,
that
will
have
the
biggest
lasting
impact
on
service
systems.
As
some
of
you
know,
during
the
during
IFC
we
came
forward
nearly
every
IFC.
It
seems
like
too,
with
them
Relief
Fund
requests
to
stand
up
services.
It's
one
thing
to
stand
up
services,
but
to
actually
be
able
to
implement
them
and
sustain
them
it.
The
rate
really
is
going
to
be
transformational
across
the
board
in
in.
G
In
terms
of
this
investment,
as
I
touched
on,
though
there
are
some
some
themes:
Behavioral
Health,
certainly
I,
think
a
lot
of
improvements
have
been
made,
but
a
lot
of
work
still
to
be
done.
That's
that
Upstream
approach
both
with
children
and
adults,
where
we
could
prevent
the
when
someone
needs
to
be
hospitalized,
we
need
they
need
to
be
hospitalized
and
hospitalized
in
our
state,
but
if
it
could
be
prevented,
there's
an
obligation
to
go
upstream
and
to
prevent
those
Services.
G
You
know
in
the
least
restrictive
environment,
so
you'll
see
that
here
as
well
and
then
a
criminal
justice
piece
same
concept.
If
we
could
intervene
early
and
prevent
people
from
being
incarcerated,
we
really
should
there
and
and
getting
them
seen
so
I
I
I'm,
very
proud
of
of
the
of
the
items
related
to
behavioral
health
for
just
continuing
to
make
improvements.
You
know
this
didn't
get
much
attention,
but
the
the
national
rankings
for
States
came
out
late.
October
early
November,
but
Nevada
moved
to
to
a
ranking
of
29..
G
We
had
have
traditionally
been
the
worst
in
the
nation,
and
so
we
have
made
some
improvements.
It's
hard
when
there's
unmet
need,
though,
to
pause
and
say
you
know,
we've
we've
had
a
success,
so
you
know
if
you're
a
consumer
it.
It
doesn't
feel
like
a
success.
If
you,
if
you
have
an
unmet,
need
the
final
area.
I
think
that
that
that
is
captured
in
our
budgets
is
I
called
child
welfare,
not
not
in
the
Child
Welfare
traditional
way,
but
in
the
welfare
of
children
from
prenatal
care.
G
If
we
can
launch
healthy
babies,
you
know
they're
off
to
a
good
start.
You'll
see
that
in
in
the
budget,
as
as
a
request
you
know
about,
55
percent
of
the
bursts
in
our
state
are
are
paid
for
with
Medicaid,
so
I
think
it.
You
know
the
it's
a
it's.
It's
a
state
intervention
with
a
population
that
we
cover
those
lives,
getting
them
into
prenatal
care
and
having
those
bursts
be
healthy.
Births
is
a
priority
and
then
early
intervention
and
services
along
the
way
to
keep
children
healthy.
G
That
that's
a
a
part
of
this
as
well
so
you'll
hear
that
throughout
different
divisions
and
it
I
just
thought
it
warranted
pulling
out
and
I
in
our
subcommittee
I'll
probably
do
a
better
job
at
just
focusing
on
some
of
the
other
populations
that
truly
do
benefit
out
of
this,
because
I
I
think
it's
worth
worth
saying
and
then
it's
the
burden
is
on
us
to
then
work
with
the
provider
Network
to
make
it
easy
for
them
to
be
a
provider
of
our
services,
so
stay
on
track
with
my
with
my
presentation,
so
turning
then
to
to
slide
five.
G
This
shows
the
Department's
budget
by
funding
sources,
I
mean
so
federal
funds
requested
represent
about
55
percent
of
the
overall
Governor's
recommended
budget.
General
fund
request
is
20
of
the
total
budget
and
other
makes
up
about
25,
and
that
includes
fees
and
some
of
the
settlement.
Funds
like
tobacco
and
opioid.
The
most
significant
change
is
found
in
the
federal
funds
and
and
other
funds,
and
that's
primarily
due
to
caseload
growth,
inflation
and
the
provider
rate
increases
I
I
mentioned
moving
to
slide.
Six.
G
This
chart
shows
the
general
fund
by
division.
General
fund
requests
for
the
upcoming
biennium
is
about
four
billion
dollars
and
it
reflects
growth
of
about
693
million
or
21
from
the
previous
biennium.
G
The
largest
growth
would
obviously
be
in
Medicaid,
followed
by
aging
and
disability
services,
and
the
primary
reason
for
this,
this
increase
in
general
fund
is,
is
related
to
the
the
federal
medical
assistance
percentage
or
fmap,
and
so
as
that
with
the
public
health
emergency
going
away
and
the
the
fmap
changing
the
burden
on
state
general
fund
increases,
and
that's
that's
probably
the
largest
reason
for
for
the
increase
in
the
general
fund
request.
G
Then
that's
really
it
for
my
high
level
overview
for
for
the
budget
for
the
Department
I'll
move
in
now
to
to
the
the
budgets
that
I
directly
have
in
my
office,
which
don't
compare
to
the
divisions
really
in
in
terms
of
you
know
as
much
funding
or
or
impact.
G
So
we
have
the
role
of
oversight,
and
then
we
do
manage
some
specific
budgets.
So,
turning
to
page
nine
or
slide
nine
did
I
say
did
I
skip
it.
G
Oh
I
did
thank
you,
so
this
this
slide
is
a
summary
of
our
operations
and
those
budgets
or
those
programs
that
we
oversee.
G
Some
of
the
impact
is
really
or
or
it's
managed
in
our
office,
because
the
policy
touches
all
the
divisions
and
it
is
just
best
impacted
when
it's
able
to
work
across
the
divisions.
Others
are
funding
and
it's
an
investment
in
funding
across
the
the
divisions
and
to
the
community,
and
then
others
we
just
have
found.
Like
last
session.
G
You
approved
me
moving
all
of
our
categorical
data
analytics
into
an
office
in
in
in
in
in
my
office,
to
serve
the
entire
department
and
I
mean
if
you
need
only
look
on
our
website
and
and
go
to
the
office
of
analytics,
and
you
can
see
dashboards
that
really
show
I
mean
one
that
I'm
really
proud
of
is
discharge
planning
with
Department
of
Corrections
and
legislation
occurred
last
session
to
get
the
the
inmates
leaving
prison
enrolled.
G
The
dashboard
shows
by
prison
inmates
leaving
the
denominator
and
then
those
enrolled
in
prison-
and
you
know
it
gives
us
an
opportunity
when
you
have
that
level
of
information
to
actually
intervene
in
strategic
ways
you
don't
have
to
you,
don't
have
to
go
globally
and
hope
that
you're
able
to
effectuate
a
change,
but
it
really
identifies
where
problems
are
so
I.
Don't
we
probably
could
do
better
at
framing
some
of
our
data
to
to
to
be
able
to
make
it
more
useful,
but
it's
probably
incremental
the
first
step
was
pulling
it
together.
G
So
I'm
grateful
for
those
of
you
that
were
here
last
session
on
the
support
and
moving
that
together
together
into
our
office,
that
you
know
we
have
haves
and
have-nots
with
data.
We
have
grants
that
are
primarily
data
yeah
and
then
we
have
other
grants
that
have
no
data
but
just
programming,
and
so
we've
been
able
to
really
see
a
Synergy
in
that
office.
So
that's
that's
the
role
really
of
of
the
director's
office
for
DHHS.
Turning
to
slide
nine,
this
shows
the
the
budget
funding
for
the
director's
office.
G
The
total
revenues
are
about
205
million
for
the
biennium.
The
general
fund
is
only
about
three
percent
or
6.7
million
for
the
biennium,
and
approximately
40
percent
of
the
general
fund
is
really
recouped
through
cost
allocation
from
the
divisions
for
the
administrative
Services.
The
federal
funds
make
up
about
24
percent
of
the
revenues,
and
then
the
majority
of
Revenue
is
other
which,
as
I
mentioned
before,
is
primarily
settlement
funds
from
fund
for
healthy
Nevada
or
tobacco
settlement,
and
then
the
opioid
settlement
funds
turning
to
slide
10.
G
And
I
have
I,
have
I,
have
one
major
highlight
on
slide
12
in
this
budget
and
that's
the
fund
for
resilient
Nevada
and
it
was
established
last
session
and
it's
it's
governed
by
statutes.
It's.
It
was
set
up
similar
to
The
Tobacco
settlement
funds,
the
fund
for
healthy
Nevada.
G
G
It
provides
grants
or
will
provide
grants
regionally
to
local
and
tribal
governments
and
to
the
private
sector
organizations
who
work
in
this.
This
space
of
providing
Substance,
Abuse,
Prevention
and
treatment.
G
Statewide
met
plan
has
been
completed
and
it
is
on
our
website
we'll
be
actually
going
to
IFC
next
week
with
seeking
authority
to
to
begin
the
work
with
putting
out
the
RFP
and
awarding
funds
to
community.
As
you
might
know,
the
settlement
funds
from
the
Attorney
General's
office
were
in
reaching
the
settlement.
The
some
of
the
funding
goes
directly
to
local
government
and
some
to
the
state.
So
it
makes
it
important
that
we
really
coordinate
with
with
local
government
in
terms
of
how
we
respond.
G
Many
of
the
services
are
covered
by
Medicaid,
but
there
are
things
that
that
aren't
you
know
beyond
treatment
like
returning
to
work
or
child
care
for
your
children,
while
you're
in
treatment,
and
so
we
really
are
are-
are-
are
being
deliberate
in
making
sure
that
we
utilize
these
dollars.
I
would
in
a
way
that
fill
gaps
and
not
subsidize
existing
funding.
You
know
it's
often
easy
easier
to
get
a
grant
and
get
funding
than
it
is
to
Bill
Medicaid
you'll
hear
from
Medicaid
we're
trying
to
make
that
easier.
But
it's
still
it's
still.
G
It's
still
more
challenging
than
a
categorical
Grant,
but
you
know
with
scarce
dollars
and-
and
it's
just
the
right
thing
to
do-
we
should
help
people
to
to
appropriately
bill
for
services
and
use
these
dollars
that
have
a
margin
to
fill
gaps,
that
there
are
no
other
funding
sources
for
so
really
Dr
Woodard
couldn't
be
here
today,
but
really
she
has
worked
tirelessly
on
this,
not
only
with
the
AG's
office
and
and
achieving
the
settlements
that
that
we've
continued
to
get
and
then
on
the
planning
and
so
I
really
I
I
wouldn't
be
able
to
present
this
if
it
hadn't
been
for
the
work
that
she's
done
on
this.
G
So
next
steps
in
that
is
get
Authority
for
for
use
of
the
dollars
and
then
the
RFP
and
putting
them
out
to
communities.
Turning
then
to
slide
12..
This
breaks
out
the
fund
for
healthy
Nevada.
Again,
this
is
the
tobacco
settlement.
Funding
I
would
contrast
that
the
fund
for
healthy
Nevada,
the
tobacco
settlement,
that's
in
perpetuity,
so
there's
a
perverse
incent,
there's
a
perverse
Dynamic
here.
If
people
smoke
the
you
know
we
want.
The
impact
is
to
try
to
reduce
tobacco
use,
but
we
do.
G
We
do
receive
funding
from
the
use
of
tobacco
and
that's
in
contrast
to
the
opioid
settlement
funds
which,
which
are
are
not
in
perpetuity
they're.
You
know
settlements
that
have
occurred
and
when,
when
the
dollars
are
used
up
there,
they
won't.
You
know
we
won't
have
them
anymore.
So
just
contrast.
Those
two
they're
both
settlements,
but
they
are
their
longevity,
is-
is
different
on
the
tobacco
settlement
on
or
the
fund
for
healthy
Nevada
on
slide.
G
12.,
the
the
the
revenue
remains
steady,
some
slight
increases
over
the
past
10
years
and
it
yields
about
24
million
dollars
for
for
the
investment
in
in
this
specific
program.
The
next
slide
shows
how
the
grants
management
advisory
committee
allocates
the
funds.
G
And
so
what
you
see
in
the
budget
is
actually
what
was
spent
last
year
and
then
an
increase
in
independent
living
programs
to
address
a
broader
services
for
that
population.
The
benefits
from
from
these
resources
and
then
the
office
of
minority
Health.
It's
to
increase
funding
to
cover
the
costs
of
of
two
contract
positions,
and
then
the
administrative
funds
were
reduced
because
it's
based
on
cost
allocation,
so
it
actually
is
based
on
what
actually
is
provided.
So
that's
a
summary
of
the
a
fund
for
healthy
Nevada,
moving
to
slide
14.
G
G
Moving
on
to
to
the
next
slide,
this
slide
and
the
next
one
cover
two
programs
that
are
pass-through
funds
to
the
division
of
Health,
Care,
finance
and
policy
or
Medicaid
for
supplemental
payments
to
hospitals,
because
the
rates
paid
by
Medicaid
are
below
the
upper
pavement
limit,
which
is
the
Medicare
rate.
This
program
is
supplemental
to
those
reimbursements.
The
first
program
is
the
upper
pavement
limit,
and
this
is
a
pass-through
account.
G
As
I
said,
the
slide
shows
the
total
amount
of
contracts
and
the
amounts
that
will
be
reverted,
we're
projecting
43
contracts
and
approximately
11
million
dollars
each
year.
The
budget
includes
transfers
to
Medicaid
of
about
8
million
per
year
and
reversions
of
about
3
million.
The
federal
match
which
is
is,
is
really
the
I
think.
The
the
the
benefit
of
this
program
is
that
it
allows
Medicaid
to
make
approximately
21
million
dollars
in
supplemental
payments
each
year.
G
The
second
program
is
the
Indigent
Hospital
Care
Act.
This
program
was
established
to
reimburse
hospitals
for
uncompensated
care
and,
as
you
know,
with
the
Affordable,
Care,
Act
and
and
Nevada
participating
in
the
expansion
of
Medicaid.
Our
uninsured
rate
has
continued
to
decrease
the
the
we
probably
have
about
a
10
percent,
uninsured
rate
right
now,
or
about
350
million
nevadans
that
the
so
the
the
uncompensated
care
has
really
gone
down
in
terms
of
what
hospitals
are
able
to
get
reimbursed
for
nationally.
G
This
really
hasn't
been
addressed
by
CMS
in
terms
of
like
how
does
retool
this
program
as
a
state
we're
managing
it,
and
fortunately,
the
the
the
way
it's
set
up
is
there's
a
Board
of
Trustees
with
Naco
the
Nevada
Association
of
County
organizations,
and
they
have
Authority
for
some
decision
areas
to
to
invest
these
dollars.
G
In
you
know,
a
small
amount
goes
to
Naco
for
the
oversight
and
then
there's
the
a
traditional
accident
fund
payment
and
then
the
offset
to
County
match,
and
then
funding
is
transferred
to
Medicaid
to
be
used.
As
for
supplemental
payments,
the
board
voted
in
March
of
2022
to
continue
to
use
the
ad
valorem
property
tax
to
offset
County
match
and
the
unmet
free
care
for
supplemental
payments
to
hospitals.
A
H
This
may
not
be
a
question
you
can
answer
but
I'm
going
to
ask
it
because
you're
here,
the
opioid
settlement
funds
for
the
fund
for
resilient
Nevada,
obviously
in
favor
of
the
efforts
that
are
being
used
to
to
get
people
off
of
opiates,
the
more
that
I
read
about
you
know
the
history
of
opioids
and
how
they
were
pushed
in
this
country
and-
and
you
know,
I'm
not
going
to
single
out
any
manufacturers,
but
just
it's.
It's
really
shameful
to
be
honest
and
I.
G
For
the
record,
Richard
Whitley
and
I
probably
didn't
do
justice.
In
my
brief
overview
of
just
indicating
there
is
a
wide
margin
there
and
the
attorney
general
has
you
know
in
those
settlements.
Get
remediation
is
the
key
and
the
definition
of
that
really
is
Broad
and
you're
right.
The
the
impact
on
families
on
children.
You
know
we
have
a.
We
have
a.
We
have
a
high
rate
of
of
women
in
particularly
in
southern
Nevada,
who
don't
access,
prenatal
care,
and
some
of
the
underlying
issues
are
not.
G
They
themselves
may
not
be
a
substance
abuser,
but
their
partner
may
be,
or
they
may
be,
and
the
child
is
impacted,
and
you
know
having
getting
that
child
assessed
and
early
intervention
services
I
think
there's
some
huge
opportunity.
There
I
mentioned
the
child
care.
I
mean
we
we'll.
G
We
can
support
a
single
mom
going
to
treat
I've
heard
this
story
by
by
many
women
where
they
go
to
treatment,
they're
doing
the
right
thing
and
then,
of
course,
their
children
become
primary
importance
to
them,
but
they
can't
go
continue
their
treatment
because
of
of
their
need
for
child
care.
So
there
are
gaps
in
the
system
and
these
funds
do
have
the
the
latitude
to
address
those
unlike
Medicaid,
which
is
pretty
categorical
and
eligibility
and
then
service
provision.
G
That's
why
we
want
to
maximize
and
invest
those
dollars
where
other
funding
sources
can't
be
spent.
There's
even
the
benefit
of
these
dollars
that
the
AG
allows
us
that
if
we
did
see
a
Medicaid
service
we
could
use
and
and
CMS
allows
this
for
the
opioid
dollars
to
be
used
as
the
match,
and
you
know
honestly
I
you
know
I
could
be
criticized,
probably
for
not
moving
faster
in
getting
these
dollars
out.
One
is
I,
think
I.
G
We
really
wanted
to
be
deliberate,
but
the
other
thing
is
not
knowing
where
the
economies
was
going
to
go
just
wanted
to
make
sure
that
we
didn't
squander
that
opportunity
if
we
did
need
to
rely
on
these
dollars
for
the
state
match
for
Medicaid
for
some
of
the
crucial
services.
So
so
sorry
that
was
a
long
answer.
But
yes,
it's
a
broad
use.
I
You
chair
and
thank
you
for
being
here,
I
want
to
touch
base
on
the
tobacco
settlement
with
the
cessation
budget.
Even
though
there's
an
increase
of
almost
twenty
nine
hundred
dollars
is
pretty
much
a
flat
and
we're
and
I'm
hearing
that
there
is
an
increase,
especially
in
our
teens,
with
vaping
products,
specifically
that
they
are
increasing
usage.
So
can
you
elaborate
just
a
little
bit
on
what
that
program
looks
like
how
we're
targeting
some
of
our
more
vulnerable
teens
and
also
what
is
the
CDC
recommended
amount
for
that
funding.
G
For
the
record,
Richard
Whitley
through
you,
madam
chair,
so
I
mean
I,
actually
think
a
report
from
the
from
the
Lung
Association
came
out
yesterday
and
has
right
has
grades
for
State
we're
not
the
worst
we're
not
amongst
the
the
bottom,
but
we
did
get
an
F.
We
got
two
C's
and
two
areas
so
that
brought
us
up
and
they
really
do
break
out
and
I
don't
want
to
I,
don't
want
to
misspeak,
but
it
does.
G
If
you
look
at
that,
National
Lung
Association
report,
it
does
show
what
CDC
recommends.
That's
one
of
the
scoring
elements
when
it
comes
to
cessation.
G
This
is
one
of
those
areas
where
again
you
real
relying
on
the
funding
sources
that
are
available.
You
know
in
the
in
the
Affordable
Care
Act
there
is
a
preventive
health
package
and
it
does
include
tobacco
cessation.
So
you
know,
primary
prevention
should
be
something
that
that
these
flexible
dollars
can
can
address,
but
cessation
is
a
covered
benefit
as
as
required
by
the
Affordable
Care
Act,
and
so
you
know
like
a
lot
of
things.
We
saw
this
in
HIV
20
years
ago,
when
you
know
when
a
funding
source
gets
established.
G
Formally,
you
have
non-profits.
Sometimes
that
don't
operate
in
that
space
and
my
hope
with
Medicaid
is
that
we
could
get
more
providers
enrolled
and
really
demystify
the
billing
so
that
we
we
could
reimburse
and
then
utilize
these
dollars
in
the
flexible
ways
they're
available
similar
to
The
Narrative
I
was
explaining,
with
opioids,
probably
have
the
opportunity
to
get
that
right
from
the
beginning,
but
cessation
is
reimbursable
and
the
investment
that
I'm
not
negating
that
the
dollar
amount
we
invest
in
tobacco
prevention
is,
is,
is
low
compared
to
other
states.
A
Thank
you
very
much.
Assemblyman
Haven.
J
Thank
you,
madam
chair,
and
thank
you
guys
for
being
here
today.
I
do
have
a
number
of
questions,
but
just
kind
of
starting
out
the
opioid
I
believe
the
speaker
mentioned.
People
have
gone
to
fentanyl
now
what
other
drugs
are
we
using
those
settlement
funds
when
you,
where
you
mention
other
substances,.
G
We
haven't
used
them
yet
we
just
are
standing
up
the
program,
but
the
settlement
agreement
from
the
AG
is
Broad
to
to
substance
abuse
not
just
specific
to
opioid
but
again
in
that
same
logic
of
does
this
service
already
exist
and
is
it
covered
somewhere
else?
We
would
look
at
the
the
the
the
the
substances
being
used
and
what's
emerging
I
mean
that's
the
other
benefit
of
these
dollars.
I
think
is
the
flexibility
I
mean
I.
G
Perhaps
don't
have
to
wait
two
years
to
to
bring
before
you
that
something
is
happening
now
that
that
the
authority
to
spend
those
dollars
on
on
that
broad
array
of
substances
is
available
in
that
funding
through
the
settlement.
So
it
is
Broad
foreign.
J
And
I
don't
expect
you
to
have
this
with
you,
but
you
mentioned
the
discrepancy
between
Medicaid
and
Medicare.
J
Could
you
provide
us
with
the
surrounding
states
and
the
the
differences
between
what
Nevada's
reimbursed
what
Nevada
is
reimbursing
for
Medicaid
versus
what
you
know,
Utah
California,
Arizona,
et
cetera,
I
know
you
guys
have
provided
that
to
us
in
the
past,
and
so,
if
you
could
just
I
have
a
feeling
that'll
be
very
helpful
for
us
during
the
session.
So
if
you
could
just
provide
that
going
forward,
I'd
really
appreciate
it.
Thank
you
and
thank
you,
madam
chair.
Thank.
K
Thank
you,
madam
chair,
so
I
I
wanted
to
ask
a
question
about
the
Behavioral
Health
piece.
K
So
what
I've
been
noticing
when
individuals,
because
you
you
have
you-
have
this
program
where
you're
you're,
interacting
with
the
jails,
but
what
is
happening
when
a
Bipolar
person
is
being
picked
up
and
like
how
are
we
managing
that?
Because
what
I'm
noticing
is
that,
typically,
a
person
is
maybe
having
a
bipolar
episode,
probably
needs
to
get
medicated,
but
then
there's
also
a
conversation
that
probably
needs
to
happen
with
their
Guardian
as
well.
K
G
I'm
for
the
record
Richard
Whitley
Madam
chair
through
you
to
the
senator
I
I,
would
you
know
when
I
gave,
that
example
of
the
jail
and
that
we're
looking
at
enrollment
the
next
step
to
that
is?
Did
they
get
care?
Where
did
they
get
care?
Maybe
there
are
providers
out
there
who
do
a
great
job,
and
we
we
don't.
We
need
to
know
that
maybe
there's
a
managed
care
I
mean
you
know
we
started.
G
We
really
made
improvements
in
Medicaid
with
managed
care
with.
You
know,
pay
for
performance
and
I.
Think
the
next
phase
of
that
is
to
look
at
like
some
really
hard
to
to
serve
populations
that
maybe
move
through
systems.
How
well
do
they
do
with
that?
So
the
next
phase
of
that
is
to
actually
do
a
warm
handoff
to
a
service.
G
I
mean
the
whole
goal
of
that
enrollment
was
if
they
get
medicated
and
even
worse,
if
they're
stabilized,
while
they're
in
jail
or
or
the
Department
of
Corrections,
that
they
don't
even
get
enough
medication
to
to
last
them
until
they
can
get
an
appointment
in
the
community.
So
there's
more
work
to
be
done
in
that
area.
G
I'd,
don't
have
a
single
solution
to
it
and
you
know
in
the
jails
like
here
in
Carson
City
we
have
a
social
worker
from
our
our
Outpatient
Clinic
that
actually
works
in
the
jail,
but
that
was
because
the
sheriff
was
interested
in
doing
that.
Clark
County,
Detention
Center,
the
first
jail
that
led
our
eligibility
workers
go
in
and
actually
in
real
time,
enroll
people
before
they
leave.
So
some
of
that
is
relationship
in
the
jail.
G
G
So
there's
more
work
to
be
done
in
that
area,
so
I
don't
have
there
isn't
a
program
that
I
could
refer
you
to
other
than
to
say
I
agree
that
there
are
people
that
need
more
assistance
when
they
leave,
especially
if
they've
been
made,
helped
to
be
stabilized
while
they
were
there
or
started
on
medication
while
they're
there,
and
then
how
do
we
prevent
it?
G
That
was
the
benefit
that
some
of
our
local
jails
have
seen
is
and
honestly,
sometimes
in
with
more
direct
request
for
support
than
Corrections,
because
they
know
that
their
law
enforcement
on
the
street
are
going
to
have
to
turn
around
and
see
this
person
again
on
the
street
if
they're
not
stabilized.
So
so
it
is
Our
intention
to
do
more
in
that
space
to
be
able
to
to
and
then
to
to
measure
it
so
that
we
so
that
we
can
quantify
it
and
and
actually
make
improvements.
K
Please
so
I
the
thing
that
I
was
considering
and
wondering,
because
I
I
kind
of
sent
an
email
before
we
in
the
interim
is
whether
or
not
there's
an
ability
to
expand
the
street
teams
to
try
to
engage
in
this
work.
I
know
that
I
don't
know
how
much
coordination
is
happening
between
the
city
of
Las
Vegas
street
team
that
they
have
on
the
corridor.
K
That
only
focuses
on
a
very
small
geographic
area
and
then
the
street
team
that
we're
funding
at
the
state
level
to
try
to
figure
out
how
to
engage
in
those
high
high
zip
codes,
where
we're
seeing
more
presence
of
these
kinds
of
episodes,
so
that
the
prevention
is
happening
on
the
street
team
side
before
they're,
taken
to
the
jail
right
and
so
they're
taken
to
a
a
different
facility.
Maybe
it's
UMC,
maybe
it's
somewhere
else
in
order
to
manage
it
and
that's
what
I
was
trying
to
consider
or
think
about.
A
You
very
much
assemblywoman
haragi.
L
Thank
you,
madam
chair
and
I
have
a
couple
of
questions.
If
I
can
I
wanted,
as
I
was
going
through
the
executive
budget
and
some
of
our
backup
documents,
I
noticed
that
there's
a
closure
of
the
Northern
Nevada
psychiatric
Residential,
Treatment
Center
at
the
Northern
Nevada
Child
and
Adolescent
Services
campus,
and
if
that,
if
that's
closed
and
all
of
those
services
and
positions,
are
moved
to
the
Southern
Nevada
campus,
what
kind
of
access
to
treatment
will
Northern
Nevada
residents
have.
G
For
the
record,
Richard
Whitley
Madam
chair,
threw
you
to
the
assembly
woman,
I
I
would
defer
that
to
win
the
division
of
child
and
family
presents,
but
I
would
just
say
globally.
In
my
opening
statement
about
the
workforce
challenges
we
you
know
you
can't.
We
can't
provide
substandard
care
in
a
facility
type.
If
we
can't,
you
know
if
we
can't
staff
it
so
we
have
had
to
concentrate
our
staff
in
some
areas.
G
I'm
hopeful
with
the
the
governor's
initiative
I
mean
it
isn't
all
about
salary
either,
and
some
of
it
is
about
just
our
timeliness
to
offer
jobs
with
you
know,
believe
it
or
not.
Some
some
people
do
want
to
work
for
state
government
and
so
I'm
hopeful
that
we
can
make
some
changes.
But
that
really
is
a
staffing
issue
and
you'll
hear
more
about
that
from
Dr
pitlock
with
the
Division
of
Child
and
Family
Services,
okay,.
L
G
For
the
record,
Richard
Whitley
Madam
chair,
threw
you
to
the
assembly
woman,
I
again
well,
two
different
divisions
for
that
Northern
Nevada,
adult
mental
health
would
be
dpbh
and
then
with
Caliente
Youth,
Center,
DCFS
and
two
very
different
reasons.
Maybe
for
the
say,
the
same
strategy
of
reduction.
G
In
an
area
where
we
can
get
the
I
mean
we
can't
just
not
provide
services
when
we
have
clients
we've
taken
on
the
responsibility
for
and
so
where,
where
we
can
locate
them
to
have
a
Workforce
that
can
provide
the
Clinical,
Services
I
feel
an
obligation
to
do
and
then
on
the
on
Nevada
adult
Mental,
Health
Lisa
Sherrick
will
present
more
on
that,
but
I
you
know,
I
do
think
we
we
still
are
seeing
as
it
relates
to
the
Affordable
Care
Act
and
expanded
Medicaid,
and
this
is
a
good
thing
that
providers
are
stepping
up
and
providing
these
Services.
L
There
was
elimination
funding
for
Neurotherapy
and
biofeedback
services,
oh
Services,
as
a
treatment
for
Behavioral
Health
disorders
due
to
improper
billing.
Why
wouldn't
we
just
fix
the
issue
instead
of
eliminating
the
services,
and
could
you
talk
to
me
about
what
kind
of
services
are
actually
being
eliminated?
What
that
means.
G
For
the
record,
Richard
Whitley
Madam
chair,
threw
you
to
the
assembly
woman
again
best
addressed
when
Medicaid
provides
their
budget
overview,
but
I
would
say
that
that
is
a
service
that
is
provided.
Commercial
insurance
doesn't
cover
that
service
and
some
of
the
inappropriate
billing
or
the
inappropriate
billing
and
service
I
would
say
that
we
identified
as
some
people
with
serious
mental
illness
were
only
getting
that
service.
G
They
weren't
getting
other
complementary
services
that
you
would
think
somebody
with
a
diagnosis
would
would
should
be
receiving,
but
it
is
a
service
that
isn't
standardized
and
those
of
you
that
have
been
around
for
a
long
time.
We
we
had
the
same
thing
happen
with
basic
skills,
which
really
is
a
a
service
in
Medicaid
that
you
know
10
years
ago
that
people
found
a
way
to
bill
for
and
and
exploit.
Frankly,
the
consumer
who
that's
all
they
got
was
basic
skills.
G
So,
when
Stacy
weeks
presents
the
Medicaid
budget,
she
can
provide
more
detail
on
just
that
service
and
I.
You
know,
and
to
your
previous
question
too,
I
think
it's
important
to
put
it
in
the
context
of
everything
else.
So
what
would
like?
Even
the
elimination
of
a
service,
it
doesn't
mean
the
service
doesn't
exist.
It
just
means
that
the
state
agency
isn't
providing
it
and
we
don't
how
our
budgets
are
bills
and
how
our
caseload
is
calculated.
G
It
would
come
across
like
that
service
has
gone
away
for
the
consumer,
but
in
fact
the
consumer
made
a
choice
to
see
somebody
in
the
community
which
personally
I
think
is
a
good
thing
that
consumers
have
choice
where
you
know
again,
a
decade
or
or
20
years
ago.
They
only
had
the
state
program
to
go
to
so
I
think
we
could
probably
do
a
better
job
at
putting
some
of
these
things
in
context,
either
giving
the
denominator
of
what's
available
and
then
on
this
elimination
of
this
specific
service.
G
Putting
putting
more
narrative
around
you
know
what?
What
like
those
who
get
that
service?
What
else
have
they
gotten,
because
it's
pretty
revealing
I
think
that
we're
not
helping
people
if
that's
all
they're
getting
thank.
M
Thank
you,
madam
chair
I
had
a
couple
questions
first
was
about
so
thank
you
for
your
work.
It's
a
very
difficult
budget
in
Health
and
Human
Services,
just
to
everything
it's
extremely
complex,
so
I
want
to
follow
up
on
speaker,
Yeager's
comments
about
the
money
from
the
opioid
settlement,
so
assembly,
women's
tolls
and
some
other
folks
passed.
M
Some
legislation
to
create
an
interim
working
group,
Senator,
donate
and
I
are
on
that
working
group
and
actually
the
question
of
as
to
whether
any
money
can
go
to
victims
or
the
families
because
they
end
up
in
you
know
if
they
lose
a
loved
one.
They're
in
counseling
and
they've
spent
a
lot
of
money
trying
to
help
their
loved
one,
and
then
you
know
the
sort
of
the
aftermath
of
the
effect
of
opioid
deaths
and
Attorney.
M
General
Ford
has
has
stated
that
that
type
of
money
that
those
funds
are
not
available
for
those
types
of
services
and
so
I
just
wanted
to
confirm
or-
and
maybe
it's
part
of
how
the
working
group
was
created,
that
it
limits
what
we
can
talk
about
versus
how
those
funds
can
be
used.
So
I
just
wanted
to
get
some
information
from
you
as
far
as
whether
that
is
if
it
can
be
used
for
victims,
families
and
so
forth.
G
For
the
record
Richard
Whitley
Madam
chair
through
you
to
Senator
Ganser
that
I
would
say
my
briefing
with
the
Deputy
attorney
general
that
was
overseeing
this
broadly
laid
out
what
the
what
the
funding
could
be
used
for
to
remediate,
I,
think
cash
assistance
isn't
something,
and
it's
not
something
that
I
would
that
we
actually
are
even
equipped
to
manage
so
I
would
say
no
to
that
like
if
somebody
was
harmed
and
we're
we're
giving
them
money
for
their
I
mean
that
isn't
the
purpose
of
of
of
of
the
settlement,
but
to
be
able
to
serve
children
or
others
in
the
family
that
have
been
impacted
by
substance
abuse.
G
My
understanding
is
yes
from
my
briefing
with
the
attorney
general
that
now
we've
put
a
framework
around
this
to
prioritize
where
the
where
the
fund
needs
to
go
as
a
starting
point.
But
you
know
I
I
think
the
flexibility
is
there
to
remediate
the
Damage
Done
by
substance
abuse.
Thank.
M
You
so
it's
more
around
services
to
family,
not
cash
and
I.
Don't
I,
don't
know
that
people
were
expecting
cash
but
services
to
family
to
make
sure
that
they've
got
access
to
counseling
and
whatever
else
they
may
need,
so
so
that
that
makes
sense.
So
thank
you
for
that
and
then
I
wanted
to
skip
to
the
rate
change
for
Applied
Behavior,
Analysis
Services,
there's
a
decrease
in
the
rate
change.
M
It
says
to
the
average,
the
medium
comparable
States
so
I
just
and
it's
1.6
million
in
general
funds,
so
4.1
million
after
it's
matched,
and
so
what
type
of
percentage
decrease
is
that.
M
Get
that
back,
that's
fine,
I
just
picked
that
up
just
as
a
no.
We
we
changed,
we
added
a
Behavioral
Health
Board
and
we
went
from
about
40
registered
Behavior
technologists,
the
ruts,
the
folks
who
work
with
the
kids
in
2017
to
about
2
000
now
and
part
of
that
was
because
of
the
rate
increase
that
was
part
of
the
driver.
Really
so
I'll
appreciate
getting
some
more
detail
on
that.
Thank
you,
foreign.
N
Thank
you.
Thank
you,
madam
chair.
Thank
you
director,
Lee
first
I'd
like
to
say
thank
you
for
all
of
your
really
difficult
work
done
over
the
course
of
the
last
biennium,
in
particular
caring
for
our
most
vulnerable
nevadians
across
all
sectors.
I
have
two
questions.
First,
on
the
slide
13
under
the
healthy
Nevada
funds,
where
tobacco
monies
are
used,
I
see
a
decrease
in
the
211
supports
and
I'm
curious
to
know.
If
you
can,
you've
talked
about
your
dashboards
and
the
data
collection
that
we
have
the
utilization
of
the
2-1-1
hotline
is
it
decreasing.
N
That
coincides
with
the
decrease
in
funding.
What's
the
utilization
and
success
rate
of
2-1-1
and
then
I
see,
suicide
prevention
is
that
the
988
hotline
is
that
in
there
does
that
correspond.
Is
there
funding
relative
to
that?
Can
you
talk
a
little
bit
about
those
two
hotlines
and
how
they
work.
G
For
the
record,
Richard
Whitley
Madam
chair
threw
you
to
the
assembly
woman
I,
so
first
with
the
gosh
211..
G
No,
it
doesn't
relate
in
terms
of
it
doesn't
suggest,
there's
a
reduction
in
volume.
It's
a
diversity
of
funding
sources.
Also
you'll
hear
about
that.
Like
one
of
the
benefits
again
that
the
legislature
allowed
me
to
do,
we
I
moved
that
was
moved
out
of
my
office
to
Aging
and
Disability
Services
to
really
be
embedded
with
other
consumer
assistants
and
I.
Think
the
program
has
really
soared
under
you
know
being
placed
in
the
proximity
of
other
services
that
that
really
try
to
intervene
early
with
consumers.
You
know
to
so
it
does
not.
G
It
would
not
suggest
a
reduction
in
in
the
actual
utilization
of
that
program.
N
Thank
you
for
that
detail
and
then
just
one
last
question
in
your
presentation,
you
noted
that
fmap
increases
are
about
to
change
I'm
curious
to
know.
Do
we
know
if
the
fmap
decreases
are
going
to
happen
all
at
once
with
the
emergency
ending
or
is
it
an
incremental
decrease
that
we
can
see
over
the
biennium.
G
For
the
record,
Richard
Whitley
Madam
chair
threw
you
to
the
assembly
woman,
you'll
you'll,
hear
more.
You
know
each
F
mat
like
the
F
map
for
different
populations.
G
It's
complex
but
you'll
hear
that
in
Medicaid's
budget
detail
on
the
impact
and
what
then,
what
what?
What
that
has
on
general
fund
needed
to
match.
A
O
O
There
is
a
fairly
two
million,
some
decrease
from
federal
funds
and
I'm
just
wondering.
If,
because
I
I
figure,
our
population
is
growing,
our
need
continues
to
go
up.
Why
is
there
such
a
decrease
from
the
federal
funds.
G
For
the
record,
Richard
Whitley
Madam
chair
threw
you
to
the
assembly
woman.
You
know
I
I
can
pull
that
specifically.
But
you
know
the
the
funding
formula
for
Block
Grants
is
established
by
Congress
and
some
some
are
determined
by
population
and
are
set
so
I'd
have
to
get
the
detail
for
you
in
terms
of
each
one
that
that
we
have
yeah.
O
A
P
All
right,
good
morning,
chair
committee
members,
my
name
is
Stacy
weeks,
I'm,
the
administrator
at
the
division
of
healthcare
financing
and
policy,
also
known
as
Nevada
Medicaid
I'm
I
have
here
with
me
today.
Our
acting
Deputy
Administrator
Lynette
Aaron
she's
over
our
fiscal
unit
and
payments
unit
and
I
also
have
other
members
of
our
team
in
the
audience
here
today,
as
well
as
Grant,
saw
your
building
before
I
get
started,
though
this
morning,
I
would
like
to
take
a
moment
first
to
acknowledge
someone
who
should
be
sitting
here
with
me.
P
Our
chief
fiscal
officer,
Melissa
Lewis,
recently
passed
away.
We
wouldn't
be
sitting
here,
I
think
today,
with
this
budget,
if
it
hadn't
been
for
her
hard
work
over
the
last
few
weeks
and
she's
definitely
going
to
be
missed
and
I
just
wanted
to
note
and
express
my
gratitude
on
behalf
of
our
team
for
her
public
service.
We.
P
So
we'll
go
ahead
and
get
started
so
at
Nevada
Medicaid.
Our
vision
is,
is
pretty
simple,
and
that
is
a
lot
a
lot
of
work.
The
vision
is
to
really
promote
a
healthier
Nevada.
P
Our
mission
is
set
forth,
though,
in
statute
to
help
us
get
to
this
vision,
and
part
of
that
mission
includes
ensuring
that
our
Medicaid
Program
is
provided
in
the
most
efficient
manner
to
the
state,
and
that
includes
the
state
budget,
such
as
maximizing
available
federal
funds
for
the
state
and
also
promoting
access
to
Quality,
Health
Care
for
all
nevadans
and
restraining
the
growth
of
the
cost
of
Health
Care
in
the
state
which
we
all
know,
impacts
the
budget.
P
Thank
you.
Our
priorities
are
listed
on
this
slide
for
you
all
this
morning,
I
think
you've
seen
many
of
these
in
Prior
years
and
we
are
focused
on
promoting
Access
to
Health
Care
coverage,
specifically
Medicaid.
We
also
work
to
increase
access
to
Primary
Care
preventive
Services,
which
really
helps
get
at
lowering
costs
over
time
with
the
healthier,
healthier
population.
You
know,
and
we
can
reduce
costs
and
the
growth
of
Health
Care.
We
also
work
to
improve
access
to
and
the
quality
of
Behavioral
Health
Services.
We
also
try
and
strive
to
ensure
pregnant
women.
P
Infants
and
their
families
have
the
care
they
need
for
a
healthy
and
strong
start.
We
also
work
to
support
healthy
Aging
for
nevadans.
We
also
are
working
to
develop
a
comprehensive
strategy
for
the
coverage
and
pricing
of
prescription
drugs.
As
many
of
you
know,
that
is
a
big
piece
of
the
spending
in
our
budget.
We
also
work
hard.
P
This
slide
reflects
our
organizational
chart.
As
you
can
see,
we
have
quite
a
large
leadership
team.
We
have
four
deputies
and
they're
all
here
today,
as
well
as
our
public
information
officer
and
two
new
clinical
officers,
so
I'm
super
excited
to
introduce
them
this
morning
to
you,
there's
Dr,
rashonda
Clement.
She
is
our
medical
director,
she's
a
pediatrician.
She
just
joined
our
team
and
we
are
super
happy
to
have
her.
We
and
she
is
in
the
Vegas
building
this
morning.
I
also
have
with
me
here
today:
Dr
Keith
Benson.
P
He
is
our
Dental
Health
officer,
and
he
too
is
fairly
new.
He
comes
to
us
from
correction,
so
he
is
not
he's
very
familiar
with
state
government
but
new
to
Medicaid.
So
we're
super
happy
to
have
a
full
team.
We
also
have
two
acting
Deputy
administrators
who
are
newer,
like
myself,
Lynette
Aaron,
who
I
also
introduced
just
previously
and
Teresa
carsten.
She
is
our
acting
Deputy
over
our
Managed
Care
Program.
P
All
right.
This
slide
attempts
to
try
to
summarize
in
one
slide
all
that
we
do
I
will
say
it's
very
hard
to
summarize
all
of
our
work.
We
have
about
300
employees
who
work
really
hard
every
day
to
ensure
that
Medicaid
coverage
is
provided
to
those
who
are
enrolled
and
then
also
trying
to
assist
those
providers
that
serve
this
population.
And
so
it's
a
big
effort-
and
we
are
I,
would
say
small
compared
to
other
states,
but
we're
Scrappy
right.
P
We
work
hard
and
we
work
in
partnership
with
the
centers
for
Medicare
and
Medicaid
services
CMS,
who
is
our
federal
partner
to
provide
quality,
Health
Care
to
eligible
nevadans.
We
also
work
in
partnership
with
other
sister
divisions,
who
you'll
hear
from
later.
Today.
All
of
our
sister
divisions
we
work
closely
with
because
a
lot
of
their
services,
you
know,
inter
sorry,
inter
well,
anyways.
They
they
work
alongside
with
us.
Sorry,
it's
early.
P
So,
as
you
can
see
in
this
visual
here,
it
shows
us
all
the
key
functions
that
we
do
at
the
Medicaid
Department.
One
of
the
key
things
you
often
hear
about
from
providers
is
our
development
of
benefits,
which
includes
the
services
we
cover
and
the
rates
that
we
provide.
We
also
pay
providers
directly
through
our
fee
for
service
program
for
services,
and
we
also
pay
Managed
Care
organizations,
a
capitation
payment
to
provide
services
and
to
ensure
we
have
networks
to
serve
a
very
large
portion
of
our
population.
P
We
also
work
to
handle
appeals
from
providers
and
enrollees
around
benefits
and
payment
and
I
just
wanted
to
note
that
the
eligibility
and
enrollment
in
Nevada
for
Medicaid
is
conducted
by
our
sister
division,
the
Division
of
Welfare
and
supportive
services,
and
you
will
hear
for
them.
He'll
hear
from
them
later
today.
P
All
right
so
I
just
want
to
give
you
a
quick
update
on
some
key
Medicaid
statistics
about
912
000
nevadans
are
currently
enrolled
in
Medicaid.
That's
probably
a
lot
more
than
when
Suzanne
Biermann
sat
here
two
years
ago.
That's
one
out
of
every
four
nebadans
in
Nevada
are
enrolled
in
Medicaid.
P
I
would
also
note
that
our
population
has
grown
a
lot
because
of
the
public
health
emergency.
During
the
public
health
emergency,
we
maintained
a
continuous
enrollment
approach
and
that
was
from
the
federal
government,
so
we
can
ensure
we
got
enhanced
Federal
match
and
during
that
time
we've
seen
a
42
percent
growth
rate
in
our
population.
That's
covered
the
fiscal
year.
Spending
for
2022
was
about
5.5
billion
and
there's
a
we
cover
in
Nevada
Medicaid
covers
about
over
half
the
births
and
that's
about
19
000
births
a
year.
P
P
91
750
are
also
duly
eligible
for
Medicare,
so
they're
enrolled
in
Medicare-
and
this
is
often
could
be
our
in
just
a
disabled
population
as
well
as
our
mostly
our
senior
population
and
80
of
our
population
lives
in
Clark,
County
and
62
percent
of
all
nursing
facilities.
Stays
in
this
state
are
covered
by
Medicaid.
P
Foreign,
so
before
we
dive
into
the
budget,
I
did
want
to
talk
about
a
few
accomplishments
that
the
department
or
the
division
has
achieved
since
I
think
Suzanne,
Biermann
and
others
sat
here
before
you
last
session.
Since
then,
we
have
received
recently
Federal
approval
of
our
section
1115
waiver
from
the
federal
government.
We're
very
excited
about
this.
It
allows
Nevada
to
be
able
to
Nevada
Medicaid
to
be
able
to
reimburse
for
substance
use
disorder
treatment
in
our
institutions
for
mental
disease.
You
may
refer
to
them
as
imds.
This
is
16
more
than
16
beds.
P
P
We
hope
that
providers
once
we
get
our
implementation
plan
approved
by
CMS,
that
providers
can
start
billing
for
these
services.
In
June
of
this
year,
we
also
received
about
1.5
million
in
federal
planning
grants
from
the
federal
government.
These
grants
are
aimed
at
increasing
Behavioral
Health
provider
capacity
with
respect
to
mobile
crisis
services
and
substance
use
treatment.
P
We've
also
expanded
consumer
choice
in
our
Managed
Care
Program,
with
an
additional
fourth
plan.
This
fourth
plan
is
Molina
and
the
other
three
plans
that
have
been
in
our
program
are
hpn,
Health,
Plan,
Nevada,
Silver,
Summit
and
anthem.
We
also
in
our
Managed
Care
contracts.
We
added
a
lot
of
things
to
those
contracts,
but
one
thing
I
wanted
to
note
here
today
is
that
we
added
a
quality
incentive
payment.
This
is
it
acts
as
a
withhold.
P
A
1.5
percent
withhold
on
their
all
of
their
capitation
payments
for
the
year
and
to
and
if
they
meet
certain
quality
metrics
or
meet
certain
goals
for
our
population.
They
receive
that
funding.
If
they
don't,
they
do
not
receive
that
1.5
percent.
Many
states
are
using
this
as
a
way
to
promote
quality
in
the
program
we
also
added
coverage
of
community
health
workers
and
doulas.
In
addition
to
funding
providing
fundings
and
funding
for
the
first
tribal
federally
qualified
Health
Center,
we
also
received
54.7
million
in
American.
Rescue
plan
act,
funds
from
the
federal
government.
P
All
right,
so,
oh
sorry,
talk
too
soon,
and
we
also
wanted
to
provide
today
an
update
from
the
federal
level,
something
that
impacts
our
budget
and
coverage
for
many
of
the
enrollees
that
we
serve
today,
and
this
impact
is
the
end
of
the
federal
Public
Health
Emergency.
You
may
hear
us
call
it
the
unwind,
the
p-e-p-h-e
unwind,
and
what
that
means
is
that
we
will
be
unwinding
from
some
of
the
requirements
that
this
Public
Health
Emergency
put
upon
States,
especially
Medicaid
programs.
P
P
It's
about
making
sure
people
had
coverage
during
the
pandemic
and
they
did
not
lose
a
provider,
and
this
was
regardless
of
changes
in
eligibility
and
the
and
in
return
for
doing
that,
states
were
able
to
receive
an
enhanced
Federal
match
of
6.2
percent
and
we'll
talk
a
little
bit
about
how
much
that
is
in
a
minute,
but
in
April
of
this
year
we
start.
We
hope
I
think
we
will
be
starting
the
unwind.
P
The
federal
government
has
been
delaying
it,
but
it
does
seem
right
now
that
April
is
the
date
so
April
this
year,
states
must
begin
unwinding
from
this
phe
and
return
to
normal
operations.
This
includes
renewals
and
ending
eligibility
for
individuals.
No
longer
eligible
I
will
say
that
we
expect
anywhere
up
to
200
000
people
to
be
impacted
by
this
change.
We
are
working
closely
with
our
exchange
Partners
at
the
exchange,
as
well
as
our
eligibility
Partners
at
twist
within
our
department
to
ensure
that
nevadans
know
about
this.
P
These
changes
that
their
addresses
are
updated
and
to
ensure
that
when
they
are,
if
they
are
ineligible,
they're
able
to
find
the
appropriate
coverage
through
the
exchange
or
wherever
ever
they
may
choose
to
buy
their
coverage.
This
unwinding
process
will
take
place
over
12
months,
starting
in
April
until
eligibility
has
been
determined
for
all
enrollees
and
Medicaid.
The
enhanced
fmap
map
so
fmap
for
those
of
you
who
may
not
be
familiar
I,
always
have
to
remember.
There
are
a
lot
of
acronyms
in
Medicaid.
P
Fmap
is
our
federal
Medicaid
assistance
percentage
match,
which
really
tells
us
how
much
generally
the
federal
government
is
will
is
going
to
share
in
the
cost
of
the
program.
Generally
speaking,
if
you
want
a
nice
average,
it's
about
60
percent
in
Nevada,
the
federal
government
pitches
in
about
60
percent,
and
we
pick
up
the
40
of
the
cost
each
year.
P
This
fmap
has
been
enhanced
during
the
phe
and
that
has
been
a
benefit
to
the
state.
It's
been
about
6.2
percent
benefit
and,
as
you
can
see
in
each
quarter
this
year
it
will
begin
to
step
down
and
decrease.
We
do.
We
did
some
analysis
of
this
number
and
how
much
this
impacts
the
budget.
It
will
have
a
general
fund
impact
of
about
120
million
dollars,
increase
so
starting
January,
1
2024.
P
P
All
right
so
before
we
jump
into
some
of
our
caseload
and
our
budget
I
did
want
to
mention
some
of
our
challenges.
We
are
like
most
States
challenged
with
in
Medicaid,
with
a
lot
of
different
issues
and
I
would
say.
Probably
this
slide
represents
probably
what
most
State
Medicaid
agencies
are
facing
right
now.
The
impact
of
the
phe
unwind
does
come
at
some
cost
and
we
just
talked
about
that
to
our
state
budget.
P
It
also
comes
at
a
cost
of
people
right
right
now
think
their
coverage
is
the
Medicaid
and
for
whatever
reason,
may
not
be
eligible
anymore,
and
so
these
two
things
here
I
think
we're
very
much
focused
on
right.
Now
we
have
one
of
our
deputies
who's
really
in
charge
of
this
and
really
working
hard,
but
this
is
something
that
we
will
all
be
facing
and
making
trying
to
make
sure
that
everyone
knows
how
to
get
coverage.
P
The
second
item
here
I
think
we
all
know
and
I
think
it's
been
an
ongoing
issue.
I
will
say
in
Nevada,
it's
very
chronic.
Is
the
provider
Workforce
shortages?
This
is
an
area
I
think
our
budget
tries
to
get
at,
but
you
know
with
more
reimbursement,
we'll
talk
about
that
in
a
minute,
but
this
is
a
big
challenge.
I
think
it's
bigger
than
just
Medicaid
I.
Think
as
all
of
you
know-
and
it
is
something
we
really
do
need
to
address.
P
If
we
want
to
make
sure
that
people
enrolled
in
Medicaid
get
the
services
they
need.
Rural
and
urban
disparities
and
access
and
outcomes
is
another
ongoing
challenge.
Also
race
and
ethnicity
disparities,
another
one
that
I
think
we
see
in
the
private
Market,
but
it
still
impacts
us.
The
Medicaid
is
the
rising
cost
of
Health
Care
and
all
the
services
are,
the
costs
are
going
up
and
inflation
and
Medicaid
is
a
taxpayer
funded
program,
and
so
often
it's
hard
for
us
to
keep
up
with
those
private
costs.
P
We
also
have
chronic
gaps
in
our
Behavioral
Healthcare
Continuum
for
children
with
intensive
Behavioral
Health
needs.
We
also
are
struggling
with
children
in
our
foster
care
system
to
ensure
they
have
the
right
Services.
They
need
especially
Behavioral
Health,
Care
and
I.
Think,
like
you'll,
hear
from
most
divisions
and
agencies
over
the
coming
today
in
the
coming
days,
is
that
we
have
ongoing
State
Staffing
shortages
in
Medicaid.
We
have
about
a
17
vacancy
rate,
which
is
about
15
full-time
employees.
P
P
P
So,
as
you
can
see
in
the
last
biennium
in
the
blue
over
time,
this
is
spiked,
and
this
is
really
about
because
of
that
Public
Health
Emergency
that
I
mentioned
earlier,
where
we
were
no
longer
redetermining
individuals
to
ensure
they
had
coverage
and
access
to
care
that
is
going
away,
and
so,
as
you
can
see,
that
Spike
starts
to
drop
off
this
year
and
go
down
and,
like
I
said
earlier,
it
could
be
anywhere
up
to
200.
000
people
may
see
a
change
in
coverage,
so
I
think
we're.
P
I
would.
Oh
sorry,
I
would
also
note
that
we
did
go.
You
know
I,
think
the
program
has
like
I
said
earlier:
almost
doubled,
right,
42
increase
in
our
program
over
those
last
few
months,
which
is
a
huge
increase
for
Medicaid
right.
The
people
enrolled
this
slide
shows
our
projected
checkup
caseload
for
our
state's
chip
program.
Our
chip
program
is
our
children's
health
insurance
program,
so
it's
different
than
Medicaid
and
that
it
is
funded.
It
still
is
funded
by
state
and
federal
funds.
P
It
has
a
match
as
well,
but
this
program
is
available
to
families
with
children
to
cover
their
children
who
are
uninsured
and
when
I
mean
uninsured,
they
cannot
they're
not
covered
by
private
insurance.
They
can't
afford
it
or
they're
not
covered
by
Medicaid.
Families,
pay
a
moderate
premium,
a
quarterly
premium
in
return
for
coverage
for
their
children.
In
this
program,
and
as
you
can
see,
this
program
is
going
up
over
time
as
more
people
are
enrolling.
P
This
slide
shows
our
waiver
case
loads
and
the
projected
wait
list
for
Nevada's
three
home
and
community-based
Based
Services
programs.
These
are
optional
services,
so
we
have
to
have
waivers
to
provide
these
Services
through
our
Medicaid
Program
seems
so
Home
and
Community
Based
Services,
generally
speaking,
are
provided
in
Nevada
for
three
populations:
the
senior
population,
the
Pharrell
and
elderly
individuals
with
intellectual
disabilities
and
are
individuals
with
physical
disabilities.
These
are
three
separate
programs
and
three
separate
waivers
since
late
calendar
year,
2021,
our
waiver
case
loads
have
fallen
while
our
wait
lists,
though,
have
grown
significantly.
P
Although
funding
is
available
to
support
this
program
and
the
media,
many
of
these
Medicaid
recipients
on
waitlist
provider,
capacity
and
shortages
have
really
impacted
this
program.
So
while
people
are
covered,
they
cannot
find
this
get
the
services
they
need,
and
the
providers
you'll
hear
about
this
more
from
our
sister
division
adsd
soon
with
their
presentation.
But
our
division's
budget
does
invest
about
150
million
and
trying
to
address
this
problem
in
both
provider,
trying
to
address
the
provider
capacity
issues,
in
addition
to
paying
for
very
new
waiver
slots
to
open
those.
P
P
This
slide
here
is
the
slide
that
shows
our
funding
for
Medicaid.
So
Medicaid
has
three
buckets
of
funding,
and
this
is
our
spending
essentially.
So,
as
you
can
see
for
the
last
biennium,
we
have
the
three
buckets
of
spending.
The
the
blue,
the
light
or
the
lighter
blue
is
the
state
funds.
That's
the
portion
that
we
pay
as
a
state
for
the
Medicaid
Program,
the
darker
color.
P
There
is
the
federal
share,
so,
as
you
can
see,
it
does
grow
in
the
next
biennium
as
well,
and
we'll
talk
a
little
bit
about
that
in
a
second
and
then
the
other
category.
The
gray
is
the
other
funds
that
do
support
the
Medicaid
Program.
This
could
be,
for
example,
provider
fees,
and
we
have
one
for
nursing
facilities
which
allows
us
to
pay
them
in
supplemental
payments.
P
We
will
talk
a
little
bit
here
in
a
second
about
a
new
provider
fee
for
private
hospitals,
that
there
is
also
an
increase
for
that
funding
and
also
you'll,
see
in
here
a
local
intergovernmental
transfers
to
help
draw
down,
Federal,
share
for
counties
and
other
hospitals
that
are
served
by
the
These
funds.
So
those
are
that's
the
bucket
over
the
next
biennium.
This
budget
is
expected
to
grow
about
30
percent.
P
That
is
primarily
because
of
this
new
Private
Hospital
fee
that
we
are
working
on
with
the
Nevada
Hospital
Association
and
then
also
you
will
see.
The
state
share
portion
is
growing
as
well.
The
state
general
fund,
by
about
20
percent-
and
that
is
because
of
the
changes
in
fmap
that
I
mentioned
earlier
and
we'll
talk
about
a
look
a
little
closer
at
those
issues
here
in
a
second
but
as
you
can
see
for
the
next
biennium
like
I
mentioned
earlier,
it's
about
16.4
billion
dollars
and
I
would
know.
P
P
This
slide
here
represents
what
we
were
talking
about,
so
just
so
I
can,
let's
see
I'll
start
with
the
the
state
fiscal
year
2022.
As
you
can
see,
we
started
out
with
a
f
map
of
62.7
percent
and
then
because
we
did
The
Continuous
enrollment
under
the
public
health
emergency.
That's
in
that
green
portion.
We
got
that
enhanced
Federal
match
and
that
brought
us
to
about
69.
You
can
see
that
there
that's
increased
funding
and
that
funding
stayed
with
us
for
about.
P
P
This
slide
here
represents
our
biennium
budget.
Account
summary:
we
have
seven
accounts,
and
one
of
them
is
new.
I
just
want
to
point
out
that
3177
improve
Healthcare
quality
and
access
is
our
provider
fee
for
the
private
hospitals
that
we'll
talk
about
here
in
a
second
in
more
detail,
but
this
represents
that
new
account
where
we
would
be
collecting
the
fee
and
using
that
tip,
to
make
new
supplemental
payments
to
private
hospitals
in
the
state.
P
All
right
so
now
we're
going
to
dive
into
some
of
the
key
specifics
of
the
budget
and
some
of
the
major
enhancements.
The
first
one
I
the
governor,
recommends
improving
several
areas
that
really
get
access
to
care.
The
first
one
is
for
pregnant
women,
so
in
Nevada,
currently,
women
who
are
pregnant
are
eligible
for
Medicaid
up
to
160
65
percent
of
poverty.
This
would
expand
that
to
200
percent
of
poverty
just
for
a
little
context.
P
This
would
also
help
about
8
000,
sorry,
7,
000,
pregnant
women.
It
would
increase
coverage
for
about
seven
thousand
moms,
as
well
as
seven
thousand
newborns,
so
any
newborn
who's
born
to
a
mother
who's
enrolled
in
Medicaid
is
eligible
for
Medicaid
for
a
year
after
birth,
so
it'd
be
about
14
000
new
members.
If
you
include
the
babies
that
are
born
to
the
mothers.
P
Also
in
this
budget,
the
governor
is
recommending
about
254
million
dollars
in
rate
increases
for
providers
80.
80
million
of
that
would
be
State
share.
The
first
two
here
are
really
critical
to
our
Primary
Care
work.
You
know
and
trying
to
ensure
that
people
get
preventative,
Services
and
really
trying
to
get
at
access
and
that
that
is
our
physicians
for
five
percent
rate
increase
Dentists
get
a
five
percent
rate
increase
under
this
budget
proposal,
as
well
as
our
skilled
nursing
facilities.
P
Another
item
here,
I
just
wanted
to
mention
earlier
we
talked
a
little
bit
about
the
Home
and
community-based
Services.
This
effort
here
to
increase
Personal
Care
attendance
wages
by
42
percent,
is
really
aimed
at
trying
to
increase
that
Workforce
short
and
address
that
Workforce
shortage.
P
We're
also
going
to
be
funding
or
requesting
that
the
governor's
requesting
that
the
legislature
fund
rate
parity
for
advanced
practice,
registered
nurses
and
certified
nurse
midwives
with
Physicians.
So
that
would
bring
help
increase,
also
access
in
our
rural
areas,
who
are
having
issues
finding
Physicians
to
serve
the
population.
P
All
right
so
now
we're
going
to
talk
about
two
more
items
that
the
governor
is
recommending
that
really
are
trying
to
get
at
access.
The
first
one
is
the
new
Private
Hospital
provider
fee,
currently
under
state
law.
If
a
majority
of
medical
operators
which,
in
this
case
hospitals,
vote
and
agree
to
a
provider
fee
our
division,
our
director
can
impose
a
fee.
We
use
that
funding
under
state
law
to
pay
for
new
supplemental
payments
that
state
funding
draws
down
Federal
share.
P
If
we
do
that
tax
appropriately
under
federal
law
and
that
money
would
be
used
to
pay
private
hospitals
about
55
private
hospitals,
basically,
it
would
result
in
a
rate
increase
in
total
of
about
1
billion
dollars.
So
it's
a
big
infusion
of
funds
for
our
hospital
system.
As
we
all
know,
it's
needed,
and
this
is
a
project
we've
been
working
on
with
the
Nevada
Hospital
Association
over
the
last
six
months.
You
know
trying
to
get
this
off
the
ground.
It
is
a
big
lift.
P
The
second
item
I
would
like
to
mention
this
morning.
It's
really
trying
to
get
access
to
care.
It's
looking
at
modernizing
our
supplemental
payment
programs.
Some
of
these
efforts
include
changing
the
model
for
our
disproportionate
share
Hospital
program,
which
is
our
dish
program
and
also
changing
some
of
the
fmap
claiming
for
Clark
County.
The
goal
of
this
program
is
to
really
balance
the
needs
of
the
state
budget
in
addition
to
the
county
budget
and
ensuring
that
the
participating
hospitals
are
not
harmed
by
this
effort.
P
I
will
say
it's
a
very
it's
a
very
delicate
approach
to
try
to
address
the
county
needs
of
ensuring
it's
viable
for
them,
as
well
from
a
budget
perspective
and
ensuring
that
all
the
hospitals
benefiting
today.
The
23
hospitals
do
not
see
any
changes
in
their
payments
and
I
will
say
we
were
able
to
achieve
that
here
today,
foreign.
P
The
next
slide
here
walks
through
some
of
the
items
that
Governor
is
recommending
to
promote
Behavioral
Health
Care
in
the
state
through
the
Medicaid
Program.
I
will
note
that
this
is
about
23
million
dollars
in
the
next
biennium
and
state
share.
The
first
one
is
expanding.
The
number
of
certified
community
behavioral
health
clinics
in
the
state
from
9
to
15.,
so
ccbhcs,
is
what
you
may
have
heard
them
recall,
referred
to,
as
they
are
really
important
to
integrating
our
Behavioral
Health
Care
Services
into
our
regular
Healthcare
Services
in
these
clinics.
P
They're
specialty
clinics
that
include
substance,
use
treatment,
Mental,
Health,
Services
and
Primary
Care,
in
addition
to
mobile
crisis
and
a
lot
of
case
management
care
coordination,
all
Under,
One
Roof.
So
it's
a
really
nice
integrated
model
that
we're
trying
to
promote
and
increase
access
to
for
our
members.
This
request
includes
several
positions
that
are
needed
to
ensure
that
we
can
support
providers
and
run
this
program.
P
And
then
the
next
slide
is
a
couple
items
that
the
governor
is
recommending
around.
The
first
two
here
are
around
strengthening
our
Managed
Care
Program.
The
first
one
is
funding
the
Statewide
Managed
Care
expansion
and
making
sure
that
we
have
the
staff
and
the
contractual
support
to
do
that
effort
and
to
do
it
well
and
to
sure
that
it
works
for
everyone.
The
second
item
here
is
funding
more
expert
contracts
and
expertise,
as
we
struggle
with
Staffing.
P
Our
vendors
and
our
experts,
especially
our
contracted
actuaries
and
come
in,
are
very,
very
much
useful
to
our
work
and
we
rely
on
them
a
lot.
This
request
includes
helping
us
with
requests
for
proposals
to
make
sure
our
contracts
are
done
well,
as
well
as
supporting
our
Managed
Care
Program
and
our
rate
development
process.
P
The
last
item
here
is
around
Healthcare
transparency.
There
are
two
items,
I
would
note
today
for
you
to
look
at
and
the
first
one
is
really
looking
at
improving
participation
in
our
state,
certified
health
information
exchange
or
hie.
This
is
really
important.
If
we
really
want
to
see
providers,
do
care
coordination,
population,
Health
Management-
if
they
really
want
to
be
able
to
see
what's
going
on
with
their
patients
and
help
them
manage
their
care.
Improving
the
number
of
providers
that
participate
in
this
data
sharing
program
is
really
important.
P
P
We
also
are
asking
to
add
a
pharmacist
to
provide
the
needed
expertise
to
our
divisions,
Pharmacy
team.
This
is
a
growing
cost
driver
in
our
Medicaid
Program,
and
we
really
think
a
pharmacist
would
be
helpful
to
that
work.
And
the
last
item
here
are
just
other
initiatives.
I
did
want
to
note
I
think
some
of
these
came
might
have
come
up
earlier,
but
the
first
one
here
is
coverage
of
wearable
cardio,
defibrillators
and
supplies.
P
There's
funding
in
the
budget
for
those
items
as
well
as
continuing
arpa
funded,
the
arpa
funded
dental
program
for
individuals
with
intellectual
developmental
disabilities,
and
we
recently
got
that
funding
and
are
working
to
set
that
program
up.
So
this
funding
would
just
continue
that
funding
and
hopefully
draw
down
medicaid
share
or
sorry
Federal
share,
and
the
last
slide
here
is
the
government.
Governor
is
recommending
that
from
our
base
here
that
we
reduce
our
base
and
and
ftes
by
16..
P
P
Q
That
pay
cut
now
this
no
hi
good
morning.
Thank
you
for
that
presentation
and
thank
you.
Miss
weeks,
I
know
that
we
have
been
talking
about
the
provider
tax
for
a
very
long
time
and
you
have
been
wonderful
to
be
quite
honest.
So
I
I
have
a
couple
of
questions
for
members
here,
because
I
know
some
people
kind
of
understand
the
provider
fee
and
that
that's
just
a
I'm
doing
a
lot
of
talking,
but
you
can
respond.
Q
Hopefully,
okay
with
yes,
you're
right,
the
provider
fee
is
already
in
statute
and
has
enabling
language
is
that
the
way
it
is
currently
set
up
in
statute?
Chair
committee
members?
Yes,
okay
and
it
currently
exists
for
like
long-term
care
facilities.
I
think
you
already
mentioned
that.
P
Chair
Committee,
Member
Stacy
weeks
for
the
record.
Yes,
but
it's
a
separate
statute,
so
the
body
of
law,
that's
focused
on
the
nursing
facilities.
This
other
one
is
focused
on
a
polling
system
where
medical
operators,
by
license
type,
can
be
pulled
to
see
if
67
percent
support
the
fee
and
then
the
fee
can
be
implemented.
Q
Q
P
Chair
committee
members:
yes,
we
I
will
note,
though,
that
we
ourselves
have
to
do
the
polling
too.
They
did
pull
themselves,
but
we
will.
We
will
be
doing
the
polling
as
well
after
session
of
hospitals,
but
yes,
after
they
all.
If
the
vote
is
67
by
license
type,
we
can
move
forward
with
the
tax
and,
yes,
they
are
voluntarily,
and
that
point
offering
so.
Q
Just
to
like
dumb
this
down
for
myself
as
well
as
other
people,
I
know,
this
gets
really
complex.
Essentially
that
money
is
taken
and
it
is
matched
federally
like
at
a
three
to
one.
Is
that
about
right.
P
Chair
Committee
Member
Stacy
weeks
for
the
record,
it's
60
40,
depending
on
the
population
but
yeah,
so
we
would
be
the
revenue,
be
used
for
the
state
share
and
be
drawing
down
about
a
billion
dollars.
Okay
and.
Q
Q
P
Q
P
Q
P
Chair
committee
members
Stacy
weeks
for
the
record
at
this
time
in
the
first
year,
we're
not
looking
at
withholding
any
of
the
funds
for
Quality.
We
may
we
can,
if
we
want
to
as
a
state
in
the
future,
but
at
this
time
we'll
be
focused
on
definitely
monitoring
quality.
But
we
will
not
be
withholding
any
funds
based
on
performance
and.
Q
When
do
you
put
in
a
percentage
of
how
much
is
held
back
for
administration,
though,.
P
Chair
committee,
members,
Stacy
weeks
for
the
record,
it's
hard
to
say,
depends
on
how
big
the
payments
are.
Hopefully,
once
we
have
this
infrastructure
built
with
these
new
staff
that
we'd
be
able
to
take
on,
but
I
don't
want
to
speak
to
that
without
you
know
talking
to
my
team,
but
I
do
think
building
that
infrastructure
is
what
the
goal
of
this
is.
So
we
can
support
more
directed
payments
and
supplemental
fees
and
taxes
or
provider
fees.
Thank
you.
R
Thank
you,
chair
and,
and
thank
you
director
weeks
for
the
presentation,
as
well
as
the
cross-examination
exercise
that
was
fun
to
watch,
but
it
was
actually
very
educational,
so
really
appreciated
it.
I
do
have
a
few
questions.
I'll
try
to
make
them
just
one
or
two.
The
first
has
to
do
actually
with
a
slide
number
nine.
With
the
ongoing
challenges,
you
said
that
you
have
a
17
vacancy
rate
and
15
people,
and
then
the
last
one
of
the
last
slides
said
that
there
was
a
recommendation
for
a
reduction.
R
P
Chair
Committee,
Member
Stacy
weeks
for
the
record,
so
just
to
make
sure
we're
I
said
that
clearly
sorry,
my
throat
17
vacancy
rate
right
now,
50,
that's
50
employees,
sorry
yeah
and
the
governor's
recommending
I
think
a
production
of
16
and
those
were
positions
that
were
not
filled
before
so
the
impact
is
hard
to
know
since
we
didn't
have
them.
These
are
positions
that
were
determined
as
unnecessary,
ongoing.
R
Thank
you,
a
separate
question
chair
if
I
may
go
ahead,
please
thank
you.
This
actually
had
to
do
with
a
slide
number
four,
your
your
organizational
chart
and
there's
so
many
different
services
that
each
of
your
Deputy
administrators
have
to
utilize,
but
I
don't
see
anything
that
is
specific
for
mental
health
and
yet
you
did
mention
it
later,
and
that
is
a
huge
concern.
R
I
know
for
many
individuals
in
our
state
and
also-
and
you
mentioned
it
many
times
in
your
presentation,
so
it's
mental
health
just
use
throughout
or
is
it
under
a
different
title.
P
Chair
committee
members
Stacy
weeks
for
the
record-
that
is
a
really
good
question.
We
have
a
lot
of
really
important
Services.
You
know
we
do
have
Behavioral
Health,
though
under
Dr
caparo,
but
I
will
say
we
have
a
chief
who
is
over
that
program,
Sarah
Dearborn
and
there's
an
entire
unit
that
she
oversees
for
that
work.
But
it
does
look
buried
in
this
chart
someday,
maybe
we'll
bring
the
full
chart
for
you,
it's
pretty
large,
but
I
apologize
that
it
looks
buried.
R
Thank
you
and
my
final
question.
I
promise
you
mentioned
trying
to
do
some
different
type
of
support
systems
for
our
individuals.
I
know
that
in
Northern,
Nevada
and
I
believe
also
in
other
areas
of
the
state.
There
are
some
different
types
of
therapy,
such
as
music
therapy,
and
is
that
also
covered
under
Medicare,
or
is
that
a
Medicaid
excuse
me
or
is
that
a
different
area
of
the
health
system.
P
Chair
committee
members
Stacy
weeks
for
the
record
at
this
time,
my
understanding
is
music
therapy
is
not
a
currently
a
covered
benefit.
It
would
be
optional
that
if
the
state
wants
its
lawmakers
and
Governor
want
us
to
fund
that,
we
would
need
to
have
funding
appropriate.
The
state
share
portion
to
fund
that
service.
N
Thank
you,
madam
chair.
Thank
you
for
your
presentation.
I
just
have
two
quick
questions.
So
first
I
have
to
say
thank
you
for
answering
my
previous
question
relative
to
the
fmap
unwinding
and
what
are
the
dates
associated
with
that?
Secondarily,
it's
my
understanding
that
we
have
a
redetermination
for
all
eligibility
for
Medicaid,
and
so,
if
we
have
912
000
people
that
are
currently
covered
by
Medicaid
I
can
imagine
that
that's
going
to
be
a
significant
lift
by
the
division
to
be
able
to
do
the
redetermination.
N
P
Chair
committee,
members,
that
would
be
our
Division
of
Welfare
and
supportive
services,
so
dewist
so
I
think
they
can
speak
to
that
more
clearly,
but
I
think
we
expect
that
we
can
meet
that
time
frame.
We've
been
planning
over
the
last
six
to
nine
months
and
do
have
a
plan.
So
at
this
point
I
don't
think
we're,
but
I
would
let
them
speak
to
the
federal
match.
I
apologize,
I!
Don't
have
that
with
me.
Thank.
B
N
I
do
have
one
second
question:
there
are
a
number
of
significant
rate
increases
that
are
addressed
in
this
budget
and,
in
my
recollection,
really
unprecedented
I.
Think,
as
director
Whitley
said
earlier
today
and
I
apologize.
If
I
missed
it,
there's
one
rate
in
particular
for
Healthy
Babies.
We
talk
about
all
of
our
pregnant
moms
that
are
really
covered
by
Medicaid.
Do
you
do
you
know?
Is
there
a
neonatal
intensive
care
rate?
That's
addressed
in
this
budget
that
maybe
I
just
missed.
K
K
P
Committee
Member
Stacy
weeks
for
the
record,
it
depends
on
the
population.
So
yes,
currently
Nevada
Medicaid
does
not
cover
adults.
The
legislature
has
not
funded
that
population.
For
dental
services,
some
states
do
cover
adults
and
so
for
those
Services
it
would
be
limited
to
Emergency
Services
into
some
basic
services
and
then
pregnancy.
We
do
cover
a
broader
set
of
benefits
for
pregnant
women
and
we
do
under
federal
law
have
to
cover
children,
so
those
would
be
a
broader
set
of
services
as
well.
K
Okay
and
then
my
second
question
is
on
page
18
on
the
continuation
of
Behavioral
Health
initiatives,
so
it's
funded
with
arpa
in
collaboration,
but
when,
when
will
the
arpa
funding
end.
K
I'm
wondering
so
the
governor
has
mentioned
that
he
he
didn't
want
to
continue
over
Reliance
on
federal
funds.
So
are
you
got
what
are
you
guys
looking
at
in
order
to
offset
your
your
your
combination
here?
If,
if
there's
a
reluctance
for
federal
money
to
be
infused
or
or
are
you
guys
safe,
you're,
the
one
agency
where
you
can
go
after
the
federal
money.
T
Thank
you,
madam
chair,
for
the
questions.
I
am
a
physician,
not
an
attorney,
so
I
will
not
ask
you
the
questions
in
the
same
order
as
my
colleague
to
the
right
did
for
I
have
a
couple
questions,
but
first
a
thank.
You
you've
been
incredibly
responsive
to
my
questions
when
I've
reached
out
for
information
and
I.
Think
information
is
the
key
in
sharing
information.
It
helps
a
lot
to
dispel
myths
and
and
assumptions.
T
The
other
thing
is:
I
am
a
Medicaid
provider
and
recently
and
I've
been
a
Medicaid
provider
since
1982.
That's
how
old
of
a
doc
I
am
and
recently
I
had
to
renew
my
contract,
and
it
was
the
biggest
obstacle
I've
ever
ever
had
in
any
application
process
in
my
life,
and
so
just
so,
you
know
and
and
I
finally,
and
your
folks
that
I
finally
did
get
on
the
phone
were
incredibly
helpful.
T
T
You
mentioned
that
you're,
giving
something
like
on
page
16,
a
200
changing
pregnant
women
on
poverty
level.
We've
had
multiple
discussions
in
this
committee
and
our
health
care
committee
about
presumptive
eligibility.
T
I
I
see
the
critical
need
to
make
sure
the
babies
come
out
healthy,
not
just
take
care
of
them
afterwards
and
I
worry
that
sometimes
the
state
assumes
responsibility
just
at
the
birth
and
then
it's
a
little
bit
too
late.
So
are
we
having
any
discussion
on
continuation
of
expanding
or
encouraging
presumptive
eligibility
and
if
that
needs
to
have
a
different
discussion,
I'm
happy
to
go
there,
but
just
want
to
make
sure
that
that's
still
something
that's
really
in
mind
because
I
see
it
as
a
real
need.
P
Chair
committee
members
Stacy
weeks
for
the
record
I,
would
defer
to
my
colleague,
Dr
caparo
on
the
presumptive
eligibility.
I
want
to
say
we
are
implementing
some
efforts
around
that,
but
I
could
be
wrong.
I
want
to
make
sure
I
don't
get
that
wrong.
Dr
caparo.
Could
you
come
up?
Is
that
okay
chair?
Thank
you.
S
T
Thank
you.
You
know.
Looking
at
the
numbers
at
55
percent
of
all
births
are
covered
by
Medicaid
I
mean
I,
just
I'm,
just
so
interested,
and
it's
just
critical.
Now
back
to
some
Finance,
you
mentioned
the
F
map
and
we're
having
a
a
a
clearer
discussion
with
the
federal
agencies
on
when
that
might
end.
T
Over
the
last
two
sessions
and
during
the
covid
pandemic,
the
fmap
was
continued
way
past
what
we
thought
it
would
be
and
I'm
curious
to
see,
and
we
ended
up
with
a
surplus
at
one
point,
because
we
continue
to
have
that
fmap
extension
now
you
gave
us
kind
of
a
clearer
date
that
they're
giving
you
that
it's
going
to
end
what
was
the
Surplus
that
we
ended
up
with
and
will
that
offset
that
120
million
dollars?
You
think
that
the
general
funds
are
going
to
have
to
come
up
with.
U
T
Thank
you
because
I
think.
That's
really.
We
need
to
know
that
number
just
to
know
that
offset
of
where
we're
going
to
be,
but
we're
actually
starting
from
a
higher
Point
than
we
thought
we
would
be
because
of
the
extenuation
extension
of
the
fmap
and
then
the
next
question
and
last
question
if
I
might
I'm
sure.
T
So
this
Committee
of
people
have
been
on
this
committee
have
heard
me
ask
these
questions
in
the
past
regarding
the
number
of
Medicaid
enrollees
and
on
your
early
Maps,
you,
you
looked
at
how
we're
going
to
kind
of
unwind
with
the
Medicaid
enrollees
and
and
we
had
a
tremendous
increase
during
the
pandemic
of
people
that
enrolled.
But
I've
mentioned
and
I've
said
this
before.
V
Good
morning,
I'm
Kyra
Morgan
for
the
record
I'm,
the
chief
biostatistician
for
the
Department
of
Health
and
Human
Services
I,
don't
have
in
front
of
me
anything
that
looks
at
total,
enrollment
and
utilization.
But
what
I
do
have
prepared
is
an
estimate
of
individuals
who
we
know
are
going.
We
don't
know,
we
know,
are
likely
to
lose
coverage
due
to
excess
eligibility
and
of
those
individuals
that
we
expect
to
lose
coverage.
We
do
show
that
86
percent
of
them
have
utilization
history
in
the
last
year.
Good.
T
To
know,
thank
you
and,
along
that
same
line,
you
were
going
to
the
department,
not
you
personally,
but
the
department
was
going
to
renegotiate
because
some,
the
majority
of
it
is
through
Managed
Care
organizations
and
during
that
time,
when
they
I
think
the
Managed
Care
organizations
probably
were
one
of
the
small
niches
in
healthcare
that
made
money,
probably
with
their
enrollments
and
the
contracts.
I'm
just
wondering
have
you
renegotiated
the
contracts
along
that
line
with
the
medic
k
providers
and,
if
so,
is
that
available
information
anywhere.
P
Chair
Committee
Member
Stacy
weeks
with
a
record,
so
when
it
comes
to
our
managed
care
plans,
we
are.
We
are
currently
still
in
the
current
contract,
which
has
ends
December
31st
2025.
I
will
say
that
each
year
we
do
set
the
rates,
so
we
do
look
at
utilization
and
spending,
and
this
year
there
was
a
rate
cut
because
of
some
of
those
issues.
So
we
came
in
at
about
a
six
percent.
Sorry
yeah,
six
percent
rate
cut.
P
We
did
offer
some
incentive
programs,
so
if
they
spend
more
money
on
primary
care,
for
example
on
providers
that
we
will
give
them
a
bonus
payment
to
help
mitigate
some
of
those
impacts.
We
also
ask
that
they
spend
some
more
effort
with
their
providers
and
value-based
payment
design
and
if
they
do
meet
some
targets
around
that
they
can
also
buy
back
some
of
that
cut.
But
we
wanted
to
make
sure
that
those
issues
were
addressed,
but
the
providers
don't
see
rate
any
rate
cuts.
P
T
Thank
you
and
I
just
want
to
end
by
thanking
all
of
you
for
the
heavy
lift
that
you
have
it's
it's
frequently.
You
people
mostly
complain,
but.
T
A
You
thank
you
very
much.
I
have
one
question
and
that
is:
is
there
any
plan
to
have
any
additional
like
ccbhc
in
southern
Nevada,
where
we
have
a
lot
more
population?
Is
there
any
plan
to
to
enhance
that
or
to
make
more
centers
or
I
think?
Currently
we
only
have
one
provider.
P
A
Thank
you,
I
I
hope
that
those
more
more
across
the
state
of
Nevada
end
up
in
southern
Nevada.
Yes,
thank
you
very
much
and
back
to
the
question
on
the
those
those
that
will
be
losing
the
ability
to
have
a
provider.
Is
there
a
map
or
anything
that
keeps
that
that
we
could
look
at
to
see
where
those
people
are
going
to
be
that
that
who
will
lose
care.
P
A
V
Hello
again
for
the
record:
I'm
Kyra,
Morgan
I'm,
the
chief
biostatistician
for
the
Department
of
Health
and
Human
Services.
And
yes,
we
can
absolutely
map
those
individuals
once
we
figure
out
who
they
are.
A
Thank
you
that
would
be
helpful
and
I
think,
maybe
to
close
up
our
question
time.
Assemblywoman
Anderson
thank.
R
You
chair
for
giving
me
this
time
based
upon
some
other
questions
that
were
asked.
I
was
just
taking
a
look
at
page
16
with
the
provider
rate
increases
and
just
wondering
how
does
the
provider
rate
increase?
R
How
is
that
impacted
with
the
possible
Statewide
Managed
Care
program
that
is
mentioned
in
page
19.
and
that's
that's
kind
of
question
number
one,
but
then
also
question
number
two:
is
this
rate
increase
on
par
with
what
is
happening?
Across
the
Nation
in
this
field?
In
all
of
these
fields,.
P
Madam,
chair
Committee,
Member
Stacy
weeks
for
the
record.
Those
are
very
good
questions
so
with
the
Statewide
Managed
Care,
currently
in
statute.
So
this
was
passed
as
part
of
Senate
Bill
420
last
session.
As
part
of
that
statute,
there
is
a
provision
in
there
that
is
trying
to
get
at
the
providers
in
the
rural
areas.
I
think
that
you're
concerned
about
rates
right,
because
in
Managed
Care
managed
care
plans
set
the
rates
with
their
providers.
They
negotiate
their
rates
whereas
fee
for
service,
we
essentially
set
a
fee
schedule
or
we
do
cost
base
rates.
P
You
know
Etc,
but
managed
care
plans
have
a
lot
of
freedom
in
that
way,
but
in
the
statute
it
does
allow,
it
does
require
us
to
do
directed
payments
which
would
essentially
set
the
rates
for
many
of
the
providers
in
the
rural
areas,
especially
for
our
federally
qualified
Health
Plans,
which
are
critical
providers
in
those
areas
and
our
critical
access,
hospitals
and
I
want
to
say
the
rural
hospitals
as
well.
But
all
of
all
of
those
are
going
to
be
getting
directed.
P
Payments
through
managed
care,
which
would
be
we
could
set
the
rate
and
it's
based
on
the
current
fee
schedule,
so
it
would
not
be
going
up
necessarily,
but
it
definitely
would
not
be
going
down
from
where
they
are
today
and
then.
The
second
question
you
asked
yes,
I,
think
the
goal
of
a
lot
of
these
rate
increases
is
to
try
to
get
the
state
into
more
of
the
national
rates.
P
Sometimes
it's
hard
to
tell,
though
nationally
what
providers
are
being
paid,
but
based
on
our
quadrennial
weight
rate
review
that
our
department
does,
which
is
statutorily
required.
We
were
looking
at
other
states,
and
a
lot
of
these
here
today
are
reflective
of
those
recommendations
about
what
we
need
to
do
to
address
cost,
as
well
as
be
closer
to
other
states
in
our
region.
P
A
A
X
X
Good
morning,
Madam
chair
committee,
members
for
the
record
I'm
Robert,
Thompson
I'm,
the
administrator
for
the
Division
of
Welfare
and
Supportive
Services
I,
have
with
me
today,
Deputy
Administrator,
Kelly,
Cantrell,
Deputy,
Administrator,
Lisa
Swearingen,
and
our
agency
manager
over
Child
Care
Karissa
Loper.
As
we
go
into
our
presentation,
we've
added
on
slide
two.
Just
to
give
you
a
snapshot
of
our
mission
statement
on
slide.
Three
is
our
organizational
chart.
Our
true
organizational
chart
is
about
100
pages
long.
This
is
a
snapshot.
X
We
have
approximately
2400
employees,
so,
as
you
see
under
these
little
tiny
charts
that
that
these
ladies
run
their
units
all
day
long,
there
are
hundreds,
if
not
thousands,
of
people
in
these
little
boxes
on
the
next
slide
on
the
next
slide
slide.
Four,
we
start
talking
about
our
summary
of
our
agency
operations.
Our
primary
agency
operation
is
eligibility.
We
do
eligibility
and
payments
and
policy
for
the
temporary
assistance
for
needy
families
commonly
known
as
welfare.
X
Supplemental
nutrition
assistance
program
is
short-handed
to
snap,
but
often
referred
to
as
food
stamps
Medicaid,
which
we
heard
about
a
lot
today.
We
do
the
eligibility
for
the
Medicaid
and
we'll
talk
about
that.
A
little
bit
later.
We
do
Child
Care
development,
eligibility
and
energy
energy
assistance.
X
Within
our
agency
we
also
have
program
Outreach.
Historically,
if
a
Nevada
needed
to
access
our
services,
they
were
required
to
come
into
a
brick
and
mortar
building,
fill
out
about
25
pieces
of
paper.
That
said
their
life
story,
and
then
we
reviewed
that
it
would
that's
how
I
learned
how
to
do
the
eligibility
in
1996
and
since
then
we
have
streamlined
and
made
it
easier
electronically,
but
we
also
go
out
into
the
community
and
our
Outreach
Services
connect
our
eligibility
workers
where
we
are
needed
out
in
the
community.
X
We
send
eligibility
workers
to
mental
health
facilities,
correction
facilities,
courthouses,
where
we
are
needed.
We
actually
have
a
wait
list
for
this
program
at
this
time,
but
what
we've
really
found
is
we're
able
to
connect
where
we
needed
without
people
having
to
come
to
us.
Sometimes
the
homeless,
shelters
right.
We,
they
don't
necessarily
have
the
transportation,
so
we
Infuse
those
Services
throughout
Nevada.
X
We
do
employment
and
training.
Our
employment
and
training
is
primarily
targeted
to
our
TANF
welfare
population,
but
it
also
is
there's
an
infusion
there
with
our
food
stamp
population
also
or
somebody
that
could
potentially
be
on
food
stamps,
and
we
talk
about
that
population.
We're
able
to
get
very
creative
to
provide
employment
and
training
to
just
about
anyone
who
needs
it.
X
The
next
slide
on
Slide
Five.
We
talk
more
about
our
our
summary.
We
do
program,
oversight
and
I.
Think
it's
very
important
that
we
talk
about
in
every
program
that
we
run.
We
want
it
done
correctly.
We
are
measured
by
ourselves
and
we
are
measured
by
the
federal
government
to
make
sure
your
tax
dollars
are
spent
correctly.
X
We
do
the
eligibility
down
to
the
dollar
to
determine
how
much
someone
can
receive
whether
that's
Medicaid
food
stamps,
Cash,
Energy,
Assistance,
Child
Care,
whichever
the
program
they're
applying
for,
but
we
actually
do
more
than
just
that
individual
assessment
on
whether
somebody
is
telling
the
truth.
We
have
to
do
case
reviews
of
our
own
workers
to
make
sure
those
cases
are
correct.
We've
also
worked
with
law
enforcement,
such
as
working
with
the
FBI
when
there
is
food
stamp
trafficking
or
identity
fraud.
X
So
it's
a
huge
department
and
it's
almost
like
a
tiny
little
police
department
and
quality
Department
within
the
welfare
division.
We
do
child
support
enforcement
and
child
support
enforcement
is
just
that
children
need
to
be
supported
by
both
of
their
parents.
One
parent
is
not
receiving
their
child
support.
We
connect
with
that
parent.
They
apply
for
our
services.
We
establish
the
support.
X
We
locate
the
the
non-custodial
parent,
we
establish
financial
and
medical
support
orders
and
we
enforce
those
orders,
and
we
also
have
administrative
Services,
which
is
human
resources,
I.T
fiscal
and
that
foundation
of
the
agency
to
make
sure
everybody
is
able
to
move
forward
with
their
jobs
on
the
next
slide
slide
six.
We
start
talking
about
our
division
priorities
and
in
our
division
priorities.
We
we're
first,
first
and
foremost
we're
the
safety
net.
X
We
are
the
safety
net
for
nevadans,
who
have
food
insecurity,
who
are
not
able
to
maintain
basic
needs
for
their
children
to
keep
their
children
in
the
home
or
obtain
their
medical
need
through
our
sister
Division
division
of
healthcare,
finance
and
policy.
So
our
first
priority
is
to
be
that
safety
net,
while
maintaining
the
Integrity
accuracy
and
efficiency
and
and
addressing
that
fraud
that
we
talked
about.
X
We
work
with
collaboration
and
public
health.
We
work
as
hard
as
we
can
to
break
down
silos
between
our
agencies.
It
wasn't
necessarily
always
that
way.
Director
Whitley
is
huge
about
breaking
down
those
silos
and
not
duplicating
efforts
and
everything.
We
do.
We
work
to
make
sure
we
are
supporting
a
healthy
Nevada.
X
Our
infrastructure
is
always
in
our
in
our
priorities,
and
that
is
just
to
make
sure
that
we
are
enhancing
our
policies
and
procedures
and
we
have
a
process
that
we
call
business
process
re-engineering
where
we
are
constantly.
We
have
a
team
that
does
nothing
but
making
sure
we're
working
as
efficient
as
possible
with
time
studies
and
and
monitoring
our
staff
and
making
sure
that
everything
we
do
works.
X
We
take
up
to
it's
something
like
200
000
tasks
per
month,
that
we
work
in
our
agency
and
we've
done
touches
and
said
if
we
could
save
two
minutes
here.
What
does
that
translate
over
the
biennium?
And
we
consistently
do
that
and
we're
as
efficient
as
possible
on
the
next
slide?
We
talk
about
our
program,
accomplishments.
X
We've
come
before
you
many
times
over
many
years
to
talk
about
our
TANF
program
and
our
work
rate
participation.
Our
work
participation
rates
to
receive
our
town
of
block
grants
without
penalties.
We
are
required
to
have
a
x
number
of
our
TANF
recipients,
working
in
a
very
complex
measurement
from
the
federal
government,
and
we
weren't
necessarily
always
successful
there.
It
wasn't
that
many
years
ago
we
came
forward
to
you
and
said
we
were
facing
some
20
million
dollars
in
fines.
We
have
corrected
those
issues.
We
are
now
meeting
the
work
participation
rate.
X
We
met
the
needs
of
the
federal
government
for
our
corrective
action.
We
are
waiting
for
those
finding
letters
for
that
fine,
but
we
met
the
work,
participation
rate
for
all
family
in
federal
fiscal
year.
2021
and
all
preliminary
data
shows
that
we've
met
it
again
in
2022.
We
just
don't
have
the
4
formal
letters
yet
are
snap
accuracy.
The
federal
government
comes
in
and
measures
all
the
states
on
how
accurate
we
are
with
the
food
stamp
program.
Nevada
was
last.
X
We
were
last
in
the
nation
a
few
a
few
about
a
decade
ago
and
we
worked
very
hard
and
we
improved
ourselves
to
20.,
been
in
federal
fiscal
year.
22.
we
increa,
we
increased
our
accuracy
from
20th
in
the
nation
to
14th
in
the
nation.
So
in
my
career
in
the
agency,
we've
seen
us
go
from
the
last
to
the
14th,
so
we
want
a
shout
out
to
our
deputies
and
our
case
workers
on
all
that
work
there.
During
the
pandemic,
we
were
able
to
issue
additional
food
stamps
to
our
communities.
X
That
was
a
massive
amount
of
work
for
the
agency
to
get
those
rules
and
regulations
put
in
place
and
get
that
money
put
on
the
cards,
but
it
translated
to
almost
2
billion
dollars
in
federal
food
stamp
monies
coming
into
Nevada
families
that
translated
that
into
the
retailers
and
translated
that,
like
the
farmers,
the
cattle
everything
right,
two
billion
dollars,
two
billion
dollars
was
brought
in
during
that
pandemic.
Also,
during
the
pandemic,
we
had
a
huge
increase
in
our
child
care
and
development
programs.
X
We
increased
those
programs
exactly
child
care
and
development,
exactly
what
we
think
of
it
right.
We
need
to
provide
safe
and
reliable
child
care,
so
parents
can
go
to
work,
but
during
the
Pandemic
those
Child
Care
Centers
were
closing
down
people
weren't
going
to
to
work.
They
were
going
to
lose
their
buildings,
the
staff
they
couldn't
pay
their
staff
and
we
were
able
to
infuse
federal
dollars
into
those
Child
Care
Centers,
so
they
could
maintain
operations
even
if
they
didn't
have
children
there.
X
On
the
next
slide,
we
talk
about
our
customer
service
accomplishments
and
in
our
customer
service,
accomplishments
I
talked
about
the
targeted
Outreach
a
little
bit
and
just
to
give
you
the
number
there
we
service,
182
Community
partner
sites,
monthly.
We
go
out
into
the
community.
Some
of
those
are
full-time.
Some
of
those
might
be
half
a
day
a
month,
but
182
a
month
are
touched.
Those
are
nevadans
that
do
not
have
to
come
into
our
building.
X
We
also
went
to
183
specialized
events
over
the
radium
and
a
specialized
event
could
be
something
like
the
homeless
stand
down
and
it's
a
one-day
event
and
we
will
send
staff
there.
They
have
actually
what
we
call
office
in
a
box.
They
have
a
laptop,
a
Wi-Fi,
a
little
printer
and
they
can
get
Nevada
and
signed
up
for
Medicaid
and
food
stamps
right
there
on
the
spot.
X
X
X
X
That
increase
was
not
a
a
huge
increase
in
the
caseload
projections.
There
were
periods
of
time
in
there
where
our
application
count
increased
to
three
thousand
percent
during
the
pandemic.
When
all
the
hotels
were
laying
everybody
off,
they
were
laid
off
and
within
two
weeks
they
were
in
our
front
door
and-
and
we
were
maintaining
that-
and
we
were
dealing
with
that,
but
then
over
the
pandemic
and
the
labor
shortage
started
and
the
vacancy
rates
started
increasing
and
we
are
now
running
on
overtime.
Most
of
the
time
to
meet
this
director.
X
Whitley
talked
about
our
vacancy
rates
and
our
vacancy
rate
in
the
welfare
division
is
running
at
18
percent
and
18
is
three
times
higher
than
what
it
ever
was
when
I
was
running
field
operations,
but
when
we
dig
deeper
into
that-
and
we
start
looking
at
the
number
of
our
case
managers,
the
online
case
managers,
because
those
are
our
customer
service
staff.
Those
are
the
people
that
have
to
get
those
food
stamps,
Medicaid
and
tan.
If
approved,
it
takes
almost
a
year
to
train
them.
X
We
when
they
come
in
the
door,
we
put
them
through
a
10-week
college
course:
Academy
style,
Academy,
and
then
it
takes
another
about
seven
months
to
bring
them
up
to
speed
to
where
they
can
work
on
their
own.
During
that
seven
months
we
have
to
have
a
mentor
for
them
and
what
we
found
is
our
veteran
case
workers
our
highest
skilled
case
workers.
They
do
the
higher
skilled
cases.
They
are
doing
our
hearings.
They
are
doing.
Our
medical
institutional
cases
are
very
complicated,
they're
doing
the
testing
of
our
new
systems
they're
doing
the
Outreach.
X
So
then,
where
our
true
vacancy
rate
is,
are
those
front
line?
Entry-Level
case
workers
and
I
did
an
analysis
before
we
came
to
you
today,
while
we're
running
about
20
vacancy.
In
that
another
30
percent
have
less
than
a
year
with
our
agency,
we
have
never
been
in
a
situation
where
half
of
our
Frontline
staff
were
less
than
a
year
or
vacant,
and
so
we
are
struggling
to
train
them
struggling
to
maintain
them
and
struggling
to
get
those
benefits
out.
X
So,
while
we're
at
14
days
and
and
I
might
I
am
just
so
thankful
that
our
staff
are
willing
to
work
as
hard
as
they
are,
and
working
nights
and
weekends
to
get
that
done,
we
need
to
see
that
get
back
to
six
days.
We
need
to
see
that
get
back
to
seven
days
so
enough
on
that
that
was
my
soapbox
for
I.
I
won't
do
that
again.
I
promise,
but
I
needed
to
do
that.
During
the
pandemic
we
had
cross
collaboration
from
departments
and
it
was
unprecedented.
X
We
saw
the
department
of
employment
and
training
Rehabilitation.
We
we
saw
also
in
the
newspaper
that
they
couldn't
keep
up
with
their
unemployment
claims,
the
welfare
division,
our
directors
work
together
and
moved
magic
in
the
background.
I'm
still
not
100
sure
how
they
did
it,
but
we
were
able
to
cross
collaborate
and
the
Department
of
Health
and
Human
Services
sent
200
workers
on
nights
and
weekends.
They
did
not
take
away
from
our
productivity,
they
worked
overtime
and
they
processed
over
half
a
million
claims
and
work
items
for
the
Unemployment
Division.
X
X
Next
slide,
please,
as
we
go
into
the
caseload,
we
start
talking
about
our
projections
and
we
don't
get
into
get
into
the
Weeds
on
every
single
little
caseload
that
we
have
because
it
gets
very
complex.
So
this
is
just
very
high
level.
Our
TANF
projections.
During
the
pandemic,
this
caseload
dropped.
It
dropped
significantly
and
it
was
difficult
to
understand
in
the
beginning
because
it
was
a
nationwide
event
that
this
caselo
dropped.
While
unemployment
was
skyrocketing,
the
town
of
caseload
went
to
all-time
lows,
but
we
realized
what
that
was
happening.
X
The
child
tax
credits
as
child
tax
credits
rolled
out
people
stopped
applying
for
that
welfare,
which
makes
sense,
but
we
saw
even
our
sister
state
California,
that
town
of
kept
dropping
and
with
the
labor
shortage
has
not
started
to
grow
again.
So
we're
expecting
that
to
maintain
the
next
slide.
Please
is
our
snap
projections,
snap
caseload.
We
continued
to
work
snap
all
through
the
pandemic,
there
weren't
with
very
small
pockets
of
time.
X
X
Half
of
the
people
receiving
Medicaid
receive
food
stamps,
so
we
never
lost
contact
with
those
people
because
we
still
had
to
do
the
food
stamp
paperwork.
So
we're
talking
about
that
other
half
that
we
don't
necessarily
know
where
they
are
or
have
done
their
paperwork.
That
we'll
be
talking
about
probably
during
your
q
a
session,
but
we
do
see
that
caseload
start
to
drop
and
it
will
take
us
about
a
year
and
in
some
cases
longer
than
a
year
or
two
work
all
of
these
cases
again
with
the
redetermination
process.
X
The
next
slide
please
slide.
12
is
our
child
care
projections.
Child
Care
projections
are
doing
exactly
what
we'd
hoped
they
would
do.
They
are
increasing.
We
are
hoping
to
see
more
people
access,
child
care,
to
move
more
people,
more
working
adults
back
into
the
workforce
and
provide
that
safe
and
reliable
child
care
to
our
children
of
Nevada,
and
this
is
doing
what
we
wanted
to
do
next
slide.
Please.
X
The
next
slide
is
just
a
very
interesting
visual
that
we
like
to
give
during
these
presentations.
We
call
it
our
bubble
chart.
These
are
our
big
three
programs
and
we
call
our
big
three
programs,
snap
Medicaid
in
town
of,
and
it
shows
the
intersect
of
people
that
are
accessing
more
than
one
program.
So
when
we
look
at
this,
this
is
a
snapshot
in
time
in
August
of
22..
X
We
see
that
there
are
921
000
nevadans
receiving
Medicaid
on
this
date,
but
we
can
also
see
of
those
406
000
are
receiving
snap
and
that's
what
we
want
to
see.
We
want
to
see
people
accessing
all
the
services
that
they
can
so
that
we
can
stabilize
those
families,
not
all
states,
integrate
their
services
and
I.
Think
it.
X
That's
a
shout
out
to
Nevada
that
in
the
90s
we
started,
integrating
some
states
still
require
an
individual
to
go
to
a
Medicaid
office,
provide
their
check
stubs,
go
through
the
interview
and
do
everything
they
need
to
do
to
get
Medicaid,
and
then
they
take
a
bus
across
town
to
go
to
the
food
stamp
office
and
Nevada
Nevada
integrated
that
in
I
believe
it
was
the
early
90s.
It
was
before
I
worked
here
and
everything
we
do.
X
We
try
to
integrate
our
policies,
our
procedures,
just
to
be
as
efficient
as
possible
for
you
and
for
our
customers.
Next
slide,
please,
foreign.
The
next
slide
is
just
a
snapshot
of
our
biennium
budget.
Looking
at
Governor
Rec
governor
for
24.25
slightly
over
a
billion
dollars,
but
I
do
want
to
point
out.
This
does
not
include
the
food
stamps,
the
food
stamps.
We
are
a
pass-through
agency
from
the
federal
government.
X
The
two
billion
dollars
that
we
gave
out
in
food
stamps
is
not
listed
here
that
will
drop
that
two
billion
dollars
was
due
to
pandemic
funding.
Prior
to
the
pandemic,
we
were
giving
out
about.
We
were
approving
about
700
million
a
year,
so
I
would
say
we
could
estimate
that
to
go
back
to
the
seven
to
nine
hundred
million
Mark,
so
just
showing
that,
with
the
223
million
dollar
investment
of
general
fund,
we
then
bring
this
into
Nevada's
economy
foreign.
The
next
slide,
please,
is
a
breakout
of
our
eight
budgets.
X
We
have
eight
budgets
to
run
our
six
programs.
Some
of
our
programs
have
more
than
one
budget,
and
it's
a
just
this
an
itemized
snapshot
of
where
the
funding
will
go
per
budget
account
on
the
next
slide.
X
We
start
talking
about
our
One-Shot
initiatives
and
our
our
big
bang
for
our
bucks
is
our
computer
systems
are
Antiquated
and
they're,
starting
to
for
lack
of
a
better
word
crash,
we're
having
difficulty,
keeping
them
serviced
and
up
and
running,
and
our
three
main
requests
are
to
update
those
systems,
Hardware
software
technology,
to
support
everything
we
do
in
an
efficient
manner
when
we
don't
have
the
technology,
we
go
back
to
paper
methods
and
it
takes
five
times
as
longer
with
five
times
the
staff.
X
The
next
slide,
please
is
a
summary
of
our
major
enhancement
request
and
we
are
requesting
I,
don't
know
if
you've
heard
of
Nomads
we've
talked
about
Nomads
for
years
in
in
these
committees,
Nomads
is
an
old
green
screen
system.
It
was
never
designed
to
live
as
long
as
it's
lived
and
we
are
asking
to
update
and
modernize
that
we
have
a
no
wrong
door
project
to
integrate
Services
throughout
Health
and
Human
Services.
X
We
have
a
child
care
system,
update
request
for
eligibility
for
an
eligibility
engine
and
to
assist
our
external
partners,
and
we
have
an
access,
Nevada
system.
It
is
our
electronic
system
that
our
customers
can
apply
for
benefits
online
and
we'd
like
to
update
that
to
allow
customers
to
access
their
notices
and
documents
without
having
to
call
in
or
come
in.
X
Next
slide,
please,
as
we've
heard
from
our
other
divisions,
there
are
some
requested
positions.
We've
noticed
Through,
The
Years
through
these
sessions.
When,
when
there's
a
need
in
our
in
our
agency
to
expand
the
agency,
we
always
Target
those
case
managers.
X
We've
always
been
able
to
show
that
we
need
case
managers,
supervisors
and
managers
for
the
front
line
staff,
but
we
have
not
expanded
our
infrastructure
to
support
them
and
the
federal
government
is
putting
a
massive
amount
of
new
requirements
in
for
our
reporting
to
be
able
to
keep
accessing
Those
computer
systems
and
our
security
requirements
are
much
higher
than
they've
ever
been,
and
we
all
hear
about
that.
This
cyber
attacks
and
those
things
that
happen-
and
we
do
need
to
increase
our
our
staffing
in
the
area
of
Information
Technology.
X
We
have
almost
2400
employees
and
we
have
only
two
Deputy
administrators.
These
guys
are
getting
really
tired.
We
are
hoping
you'll
support
us
for
an
additional
Deputy
Administrator
and
on
the
next
slide,
we
see
that
administrative
services,
our
fiscal
services,
our
employment,
Support
Services,
needs
one
person
and
our
child
care
development.
That
program,
the
the
funds
that
are
moving
through
there
and
the
oversight
and
the
the
contracts
that
they're
working
on,
we
never
anticipated
the
level
of
work
that
is
coming
through
there.
X
So
we
are
asking
to
increase
our
child
care
development
program
and,
on
the
next
slide,
there's
a
snapshot
of
those
summaries.
While
we're
requesting
49
additional
positions
and
enhancements,
we
always
have
a
slight
updates
in
our
request
for
Staffing
and
field
services.
That's
tied
to
caseload,
the
governor
recommends
reducing
43
staff
from
our
Field
Services,
with
an
increase
of
49,
so
it's
overall
increase
of
six.
X
Why
we
will
open
up
for
questions.
I
do
want
to
point
out
that
we
have
a
an
appendix
with
all
of
our
acronyms.
We
are
heavy
on
acronyms
and
it
has
been
requested
in
the
last
last
couple
presentations
that
we
include
our
source
and
use
documents
for
our
town
of
block
grant
and
our
child
care.
So
we
put
those
in
for
reference,
so
you
don't
have
to
ask
for
them,
and
we
are
now
open
for
any
questions.
N
Thank
you,
madam
chair,
thank
you
for
the
detailed
presentation
and
how
we
love
our
graphs.
So
that's
what
I'm
going
to
go
back
to
if
you
don't
mind
page
13
or
slide
13
in
your
presentation
and
as
I
asked
a
little
bit
earlier
today,
the
redetermination
for
eligibility,
it's
my
understanding
that
we
are
required
to
do
that
in
order
to
continue
to
receive
those
Medicaid
dollars,
and
you
have
identified
on
your
chart.
N
X
Robert
Thompson
for
the
record,
through
the
chair
to
the
committee,
there's
very
little
risk
and
let
me
explain
why
so
of
those
921
000
recipients,
those
are
not
921,
000
redeterminations,
those
are
recipients.
Families
do
one
redetermination
for
the
for
the
family,
so
you
reduce
your
number
there
of
the
921
000
recipients.
We
never
lost
contact
with
half
of
them.
Half
of
them
are
on
food
stamps
and
we're
required
in
the
food
stamp
program
to
conduct
redeterminations
every
six
months,
and
we
never
stopped
doing
those
every
six
months
because
they
would
have
lost
their
benefits.
X
So
we
never
lost
contact.
We
still
have
their
income
resources
and
we
know
where
they
live
of
the
remainder.
We
were
very
forward
thinking,
whether
by
coincidence
or
design,
we
never
stopped
doing
our
monthly
paperwork.
We
kept
sending
it
out
and
saying:
please
cooperate
with
us
and
half
did
approximately
half
I
shouldn't,
say
half
in
a
formal
testimony
right
it
was
approximately
half,
so
that
leaves
us
with
half
of
the
half
of
the
half
right.
So
now
we're
down
to
25
percent
that
we
believe
we
we
are
not
100
sure
where
they
live.
X
We're
not
100
sure
if,
if
we
can
find
them
we're
doing
massive
Outreach
through
the
division
of
healthcare,
finance
and
policy
are
mcos
to
make
sure
that
our
customers
know
to
update
their
addresses,
so
we
can
get
their
paperwork
to
them.
We
have
a
year
to
work
those
cases
and
we
never
stopped
working
those
cases.
X
N
X
S
W
X
100
sure
that
they're
not
eligible
for
snap
I
could
not
give
you
I
can
tell
you
that
we
do
Outreach
and
when
we
do
the
interviews
and
we
meet
with
these
families,
it
is
in
our
scripts
to
say
you
appear
to
be
under
income
for
this
program.
Also,
could
we
connect
you
with
it?
We
also
go
further
than
that.
X
The
WIC
is
not
under
our
division
with
WIC
is
under
a
separate
Division,
and
if
somebody
is
eligible
for
food
stamps
and
they
meet
the
income
criteria
for
food
stamps
and
have
a
child
five
or
younger
into
the
home
or
is
pregnant,
they
would
be
eligible
for
WIC
and
we
even
connect
there.
So
it's
built
into
our
scripts
to
do
Outreach.
We
call
it
inreach,
we
have.
X
W
X
Work
under
the
we
work
under
the
ACF,
the
town
of
welfare
rules.
We
work
under
the
food
stamp,
the
food
and
nutrition
services,
Federal
rules
and
we
work
under
the
CMS
Federal
rules.
They've.
Let
us
combine
it
all
into
one
application:
we've
streamlined
our
eligibility
to
the
best
that
we
can,
but
we
do
not
have
the
ability
to
Auto,
enroll
and
I.
Think
that's
what
you're
asking
is.
Can
you
just
Auto
enroll
and
we
cannot?
They
have
to
ask
us
for
the
program
I.
K
Thank
you,
madam
chair
I
I
had
a
question
on
page
15,
the
energy
assistance
program.
What's
the
actual
caseload.
X
Robert
Thompson
for
the
record
through
the
chair
to
Senator
Neil
I,
do
not
have
the
actual
caseload
with
me
at
this
time.
We
will
have
to
get
it
back
to
you.
I
I
would
I
would
be
ballparking
and
I
don't
want
to
Ballpark
it
formally.
K
K
So,
according
to
my
notes,
it's
going
to
be
paid
for
with
Reserve
reductions
from
arpa.
How
long
will
it
take
because
this
was
approved
in
21,
the
21
20
well
22,
but
how
long
will
it
take
for
you
to
get
it
up
and
running
and
will
those
funds
be
enough
to
carry
it
to
total
completion.
Y
For
the
record,
Lisa
Swearingen,
Deputy
Administrator
for
the
Division
of
Welfare
and
Supportive
Services
through
through
the
chair
to
Senator
Neil
we
are
going
to
this
program,
is
actually
we're
doing
a
contract
Amendment
to
an
existing
contract
that
we
have
I
believe
this
is
scheduled
for
the
March
Boe
and
we
have
already
talked
with
the
vendor,
and
they
know
that
they
have
to
have
this
completed
by
June
30th
of
26
I.
Believe.
A
Thank
you,
Senator
Titus
thank.
T
You,
madam
chair
and
again,
thank
you
for
the
presentation.
I
want
to
go
back
to
page
eight,
where
you
mention
your
concern
about
the
14
days
for
the
snap
time
timeline
to
to
approve
folks
and
looking
at
on
that
on
that
same
page,
you
talked
about
targeted
Outreach
and
you
have
182
Community
Partners
I've
been
out
to
the
food
bank
in
Northern
Nevada
and
spoke
out
there
and
taken
a
tour
of
what
they
do
and
again.
T
Food
insecurity
is
a
huge
issue
and
wondering
if
part
of
that
Outreach
when
they
apply,
do
you
direct
them
to
different
food
banks
so
truly
that
Pantry's
not
empty
for
14
days
and
then
I
have
a
follow-up
to
that.
X
Robert
Thompson
for
the
record
through
the
chair
to
Senator
Titus.
Yes,
we
do
referrals
constantly
to
our
food
banks
to
clarify
on
the
182
Community
partner
sites.
Those
partner
sites
are
partner
sites
that
the
welfare
division
sends
case
managers
to.
In
addition
to
that,
we
have
partner
sites
that
we
contract
with
throughout
the
community,
such
as
the
food
bank
of
Northern
Nevada.
Who
are
able
to
do
our
interviews
for
us.
They
are,
they
are
actually
contracted
and
certified.
X
They
cannot
approve
the
benefit,
but
they
can
do
the
interview,
so
we
are
in
the
community
we
are
able
to
and
we
encourage
funneling
those
food,
insecure
nevadans
to
the
food
bank,
so
the
food
bank
will
do
the
application
for
us
start
Gathering
the
verifications
we
need
and
then
connect
them
with
those
services.
At
the
same
time,
great.
T
Thank
you
for
that,
because
that's
where
I
was
going
with
my
second
question:
do
you
have
anybody
in
your
departments
that
actually
are
at
the
food
bank
or
in
conjunction
with
folks,
into
food
banks
that
they
may
show
up
there
first
before
they
come
to
you?
So
if
somebody
might
be
hungry,
they're
running
out
of
food
they'll
go
to
the
food
bank
first
and
then
do
you
have
a
way
to
capture
them
or
netting
for
them
that
then
they
can
start
that
process
and
say
Hey.
T
X
Thompson
for
the
record,
through
the
chair
to
Senator
Titus.
Yes,
we
have
they're
called
trusted
Partners
from
the
federal
government.
I,
don't
like
that
term,
because
it
implies
our
other
partners
aren't
trusted,
but
they
are
they're,
formerly
called
trusted.
Partners
we
have
contracts
throughout
and
those
are
the
food
banks
so
that
they
can
do
that
net
right
there.
So.
T
X
Thompson
for
the
record,
through
the
chair
to
senator
Titus,
they
are
not
welfare
division
employees
they
are.
They
are
Food
Bank
employees
and
then
we
pay
them
per
application
that
they
send
back
to
us
completed
with
the
verifications
and
they
are
allowed
to
do
the
interview,
but
they
cannot
per
Federal
rules.
They
cannot
approve
the
benefit.
So
we
have
to
scan
the
paperwork
and
do
the
actual
eligibility,
but
they've
already
done
the
interview
for
us,
so
they
connect
them
with
both
services.
At
the
same
time
does.
X
I
Thank
you
chair
and
thanks
for
being
here,
you
guys
have
done
an
amazing
job
with
everything
that's
been
thrown
at
you.
I
just
was
kind
of
curious
about
the
pandemic
ebt's.
I
D
Central
for
the
record,
through
you,
madam
chair
to
assemblywoman
garlo,
so
they
will
be
wrapping
up.
However,
what
I
don't
remember
the
first
part
of
your
question:
I'm,
sorry,.
D
O
Thank
you,
chair
I'm,
looking
at
slide
number
15
of
the
budget,
account
summary
and
again
I'm
just
curious.
Under
the
the
budget
item,
child
care,
assistance
and
development
for
the
fiscal
year
2024,
it
shows
federal
funds
of
166
million,
which
is
reduced
in
25
to
93
million.
That
just
seems
like
such
a
shortage
in
supplying
needed
services
and
I'm
just
wondering
if
you
could
speak
to
why.
Why
am
I,
seeing
those
large
drops
in
the
federal
funds
for
the
next
year,
Robert.
Z
Thank
you,
Robert
Carissa,
Loper
agency
manager
for
child
care
for
divisional
welfare
and
supportive
services
for
the
record
through
Madam
chair
to
assemblywoman
kasama,
that
is
as
a
result
of
the
loss
of
the
arpa
dollars.
So
much
of
the
additional
arpa
funds
that
have
been
provided
to
the
child
care
and
development
block
grant
from
the
federal
government
will
go
away
as
of
September
30th
2024.
got
it.
Thank.
AA
Thank
you
chair,
so
I
just
have
a
couple
of
short
questions
here
regarding
page
eight
and
the
vacancy
rate
for
initially
for
my
confirmation
and
Clarity.
In
my
mind,
your
front
line
workers
must
be
licensed
social
workers
as
well
or
no
Robert.
X
Thompson
for
the
record,
through
the
chair
to
as
assemblyman
Miller.
No,
that
is
not
correct.
We
are
caseworkers,
go
through
a
college
style
classroom
that
we
provide
it's
it's
a
training
room.
Much
like
this.
These
rooms
are,
we
do
have
a
limited
number
of
licensed
social
workers
on
our
staff
to
deal
with
our
customers,
who
are
in
high
crisis,
such
as
substance,
use
disorders
or
domestic
violence,
those
High
barrier,
but
out
of
the
entire
agency,
that's
about
40.,
so
our
front
line
workers,
our
customer
customer
service
based.
X
AA
Thank
you
the
so,
what's
like
the
breakdown
of
the
from
a
number
perspective
like
how
many
when
you
say,
there's
a
30
percent
are
less
than
one
year.
How
many
people
is
that
when
we
look
at
what,
where
you
are
lacking.
X
Robert
Thompson
for
the
record,
through
the
chair
to
assemblyman
Miller,
to
get
those
specific
numbers
I'm
going
to
have
to
get
them
back
to
you.
We
have
approximately
she's
slipping
me
numbers
1251
case
managers,
but
of
those
1251
case
managers.
When
I
talk
about
our
Frontline
staff,
1251
are
not
Frontline
staff.
We
have
very
specialized
duties
throughout
the
agency.
We
are
required
to
conduct
hearings.
We
are
required
to
do
testing
of
our
systems,
the
Outreach
staff.
X
We
if
we
allow
our
staff
to
go
out
into
the
community
by
themselves,
that
has
to
be
the
most
veteran
staff
that
we
have.
They
don't
have
a
supervisor
or
lead
worker
on
hand.
So
when
I
was
talking
about
our
20
vacancy
rate
plus
30
percent
in
training,
I
was
talking
about
the
ones
that
are
specific
to
case
management
and
answering
our
phones,
and
we
can
definitely
get
those
exact
numbers
for
you.
Okay,.
AA
Thank
you
and
then
my
last
question.
What's
the
biggest
barrier
to
getting
more
folks
in
the
door
to
filling
the
vacancies.
X
AA
Okay,
thank
you
thank
you
for
the
time
and
thank
you
guys
for
doing
a
tremendous
job
with
what
you're
working
with
right
now.
Thank
you,
chair.
A
Seeing
none
thank
you
so
much
for
all
you're
doing
and
all
the
people
that
you
are
managing
and
for
those
of
you
that
are
on
the
panel
or
the
testimony
today.
Thank
you
for
preparing
that.
We
appreciate
your
time
all
right
with
that.
A
We
are
going
to
take
a
lunch
break
right
now,
so
after
lunch
we
will
do
public
and
Behavioral
Health
Child
and
Family
Services
aging
and
disability
I
hope
that
fits
within
everybody's
schedules,
but
there's
at
some
point.
We
need
to
break,
and
this
is
the
optimal
time.
So,
thank
you
very
much
and
we'll
see
you
at
12
30..
Thank
you.
A
Boy
as
a
teacher,
that's
hard
to
do
so
much
easier,
just
to
say,
welcome,
class
to
the
f
afternoon
session,
okay
I'll
bring
the
subcommittee
back
to
order.
I
hope
you
all
had
a
good
lunch,
and
the
next
item
on
our
agenda
is
division
of
public
and
Behavioral
Health
and
administrator
shirik.
If
you
will
join
us
and
begin
when
you're
ready.
AB
Good
afternoon
for
the
record,
Lisa
Sherrick
administrator
for
the
division
of
public
and
Behavioral
Health
here
with
me
today
to
my
right-
is
Cody
Finney
Deputy
over
Regulatory
and
planning
and
Behavioral
Health
policy
programs
to
my
left,
Debbie
Reynolds
Deputy
over
administrative
services,
Joe
Malay
Deputy
over
Clinical
Services
and
Julia
Peak
Deputy
over
Community
Health.
AB
AB
I
want
to
highlight
that
our
new
mission
statement
and
our
focus
on
protecting
and
promoting
and
improving
the
physical
and
behavioral
health
and
safety
of
all
people
in
Nevada,
specifically
our
focus
on
equity,
is
so
all
nevadians
can
live
their
safest,
longest
healthiest
and
happiest
lives.
Moving
to
slide
three
highlights
the
core
values
of
our
division.
AB
AB
Moving
to
slide
four,
this
illustrates
at
a
high
level
the
organizational
structure
structure
of
our
agency,
Slide,
Five
and
I
apologize.
It
is
kind
of
small
and
we
have
many
many
pages
if
you
wanted
the
whole
division.
AB
Slide
Five
provides
a
details
of
our
six
branches.
As
many
of
you
know,
dbph
is
a
complex
division.
We
operate
for
psychiatric
hospitals
throughout
the
state
and
provide
outpatient
mental
health
services
within
21
clinics
in
Nevada,
as
well
as
we
overall,
we
administer
over
50
programs
across
the
division.
AB
Next
slide,
though,
I
cannot
highlight
every
accomplishment
of
our
team
during
the
biennium
I
do
want
to
acknowledge
that
covet
has
forever
changed.
Public
health,
behavioral
health
and
our
agency
throughout
I
want
to
highlight
the
efforts
of
our
team
and
the
leadership
in
Churchill
Eureka
Persian
and
mineral
counties
who
are
developing
Nevada's.
First
rural
Regional,
Health,
District,
otherwise
known
as
the
central
Nevada
Health
District.
This
will
indefinitely
change
the
landscape
of
Public
Health
in
rural
Nevada
for
the
better,
while
much
of
the
effort
of
our
division
may
have
never
been
seen
by
the
public.
AB
AB
AB
As
for
agency
updates,
we
are
actively
seeking
accreditation
through
the
national
public
health
accreditation
board.
Accreditation
is
a
vehicle
for
transparency
and
Trust
in
public
health
to
ensure
that
we,
as
an
agency,
are
providing
foundational
capabilities
and
meeting
national
standards
for
performance
and
quality.
AB
The
division
is
also
focused
on
modernizing
our
data
systems
and
processes
to
run
more
efficiently
and
effectively.
A
key
component
of
this
effort
is
focused
on
data
security
as
the
division
houses.
Some
of
the
most
sensitive
data
in
state
government
dbph,
as
well
as
local
public
health
departments,
are
working
with
Nevada's
academic
institutions
to
develop
academic
Health
departments
to
better
connect,
public
and
Behavioral
Health
practice
with
Academia
and
training.
This
not
only
supports
Workforce
pipelines
at
pipeline
efforts,
but
allows
growth
in
the
area
of
research
and
public
policy.
AB
AB
Since
our
agency
is
so
diverse,
our
priorities
are
as
well.
We
highlight
here
some
items
that
will
be
reflected
in
our
biannual
budget
request,
but
also
in
our
strategic
planning,
Grant,
funded
programs
and
daily
operations.
Specifically,
we
must
address
and
improve
our
infrastructure
for
forensic
Mental
Health
Services.
AB
This
is
not
only
a
mandate
but
also
a
necessity
to
ensure
in
the
safety
of
our
public,
improving
the
behavioral
health,
which
is
both
mental
health
and
substance.
Use
will
be
a
topic
heard
often
during
this
session.
Lastly,
much
of
the
public
health
priorities
for
the
agency
will
focus
on
infrastructure
Improvement,
moving
to
slide
nine.
AB
Moving
to
caseload,
starting
with
our
Behavioral
Health
caseloads
on
on
slide
10
you'll,
see
our
largest
increase
in
caseload
is
medication.
Clinic
I
would
also
like
to
note
that,
while
the
governor's
recommended
budget
showed
a
decrease
in
outpatient
services
at
Northern,
Nevada
adult
Mental,
Health
Services,
we
are
now
beginning
to
see
an
uptick
in
nam's
outpatient
caseload.
AB
There
will
be
another
caseload
update
during
session,
which
happens
near
the
end
of
March,
and
we
anticipate
that's
going
to
more
correctly
identify
the
increases
that
we're
seeing
now
moving
to
the
divisions.
Immunization
caseload,
while
dbph
has
never
had
an
immunization
caseload
in
the
past
and
has
historically
budgeted
the
required
general
fund
match
for
purchasing
vaccines
for
Nevada
checkup.
In
order
to
ensure
that
Nevada
citizens
has
access
to
vaccinations,
we
are
requesting
funding
through
caseload
that
can
be
used
during
each
biannual
budget
cycle
based
on
the
Medicaid
fmap
rate.
AB
Slide
11
is
an
overview
of
the
division's
facility
populations
similar
to
the
outpatient
clinics.
During
the
early
period
of
covid,
our
census
decreased
as
emergency
rooms
and
courts
saw
fewer
individuals.
A
stay-at-home
order
may
have
played
a
role
in
these
decreases.
As
mentioned
in
the
caseload
numbers.
The
number
of
services
has
increased
over
the
past
months
in
outpatient
clinics.
However,
our
inpatient
Hospital
settings,
the
challenge,
is
a
little
bit
different
Nevada,
along
with
many
states
in
the
U.S,
are
facing
a
competency
crisis.
AB
Over
the
past
decade,
the
increase
in
the
number
of
court
orders
for
competency.
Restoration
has
been
unprecedented,
specifically,
the
competency
restoration
is
the
process
used
when
an
individual
charged
with
a
crime
is
found
by
a
court
to
be
incompetent
to
stand
trial
typically
due
to
an
active
mental
illness,
and
they
must
be
restored
to
competency
before
the
legal
process
can
continue.
This
demand
has
challenged
many
states
on
how
to
add
capacity
to
meet
the
need.
One
way
to
meet
this
demand
and
our
judicial
requirement
is
increasing.
The
forensic
bed
capacity
slide.
AB
12
outlines
our
23-25
biennium
budget
account
summary
moving
into
our
first
major
enhancement
on
slide.
13.
in
order
to
meet
the
demand
for
forensic
Services,
we
have
a
number
of
enhancements
focused
on
increased
bed
capacity
and
Staffing
of
note.
Our
forensic
Specialists
are
Category
3
peace
officers
required
to
go
through
a
formal
mental
health
certification
process,
which
includes
10
mental
health
courses.
AB
Moving
into
our
major
public
health
enhancements
on
slide,
14
first
is
the
transfer
of
the
account
for
Family
Planning
from
the
director's
office
to
the
division.
Dbph
has
worked
closely
with
the
director's
office
to
manage
the
account
for
Family
Planning,
which
has
been
effective
in
supporting
Community
Partners
and
ensuring
the
Fidelity
of
the
program.
However,
moving
the
program
fully
to
the
division
will
allow
the
program
to
operate
more
efficiently.
AB
Next
dbph
is
requesting
a
new
account
for
public
health
infrastructure.
This
budget
account
will
improve
arpa
investments
in
the
local
Health
departments,
as
well
as
data
modernization
to
the
outdated,
Public
Health
Systems.
This
includes
a
focus
on
quality
improvement
and
transparency
through
Public
Health
accreditation
and
investment
in
public
health
Workforce
projects.
AB
AB
AB
AB
AB
Slide
16
outlines
our
major
enhancements
for
Behavioral
Health.
In
the
2021
session,
SB
390
created
the
crisis
Services
fund,
based
on
a
fee
assess
on
telecommunications
and
mandated
the
creation
of
a
crisis
response
system.
This
requests
the
necessary
Personnel
to
support
and
manage
the
system
slide.
17
outlined
several
agency
level
infrastructure
requests
necessary
to
maintain
and
protect
critical
operations,
with
a
focus
on
essential
staff
support
staff
in
cyber
security
slide.
W
Thank
you,
madam
chair.
My
question
is
about
the
establishment
of
the
crisis
response
centers
and
the
collection
of
fees
from
telecommunication
agencies.
Excuse
me
if
you
could
just
give
us
a
brief
update
on
how
that's
going.
AC
Thank
you,
Senator
Harris,
through
share
to
you,
Cody
Finney,
for
the
record
as
you're
well
aware.
That
system
was
designed
between
this
body
and
with
a
lot
of
help
from
Dr
Woodard
in
the
last
session
and
the
Bureau
of
Behavioral
Health
wellness
and
prevention
has
been
working
tirelessly
on
the
implementation
of
the
system.
That
includes
the
988
crisis
line,
which
is
live
now.
The
development
of
the
regulations
and
processes
and
infrastructure
to
collect
those
fees
from
the
telecommunications
companies.
AC
I
will
say
briefly
that
being
Behavioral
Health
folks,
we
had
to
learn
a
lot
about
the
Telecommunications
industry
very
quickly
and
we're
continuing
to
do
our
best
with
that.
So
we
are
well
on
the
way
to
to
getting
those
pieces
in
place
to
make
sure
that
we
can
collect
those
funds
we
are.
AC
We
have
had
some
excellent
Communications
with
the
industry
and
some
feedback
about
what's
needed
to
make
sure
that
the
intent
of
this
body
in
the
last
session
is
in
fact
carried
out
and
we
are
in
the
process
of
working
on
those
crisis.
Stabilization
centers,
as
well
across
the
state
happy
to
answer
any
specific
questions.
I
may
not
have
touched
on.
AC
AC
They
have
expressed
to
us
very
recently
that
there
may
be
some
challenges
with
the
definitions
of
a
service
line,
and
this
is
where
I
is
probably
the
extent
of
my
expertise
that
the
definitions
of
a
service
line
may
affect
our
projections
of
what
we
can
collect
and
so
we're
working
through
that.
But
the
the
industry
has
not
expressed
any
resistance
to
us.
A
Thank
you
very
much.
Assemblywoman
Brown
may
please.
N
Thank
you,
madam
chair.
Thank
you
for
the
great
presentation.
I
just
have
a
clarifying
question
about
the
988
hotline.
I,
see
the
behavioral
health
enhancement
of
10
FTE
and
currently
we're
trained
to
a
National,
Suicide
Prevention
counselor.
Do
we
have
those
positions
staffed
in
Nevada
currently
or
are
they
staffed
nationally.
AC
Cody
Finney
for
the
record
through
the
chair
to
the
committee
members.
AC
The
question
if
I
might
clarify
is:
are
the
people
answering
the
phone
at
a
national
hotline
or
in
Nevada
we
do
have
an
agreement
with
cssnv
or
Crisis
Support
Services
of
Nevada,
and
while
calls
can
roll
over
to
a
national
hotline,
we
do
have
that
Hotline
in
Nevada.
That
is
answering
calls.
Thank.
N
A
Thank
you
very
much
as
Senator.
When
did
you
have
a
question.
Q
I
do
thank
you
just
one
question:
I
promise
with
the
there
was
a
lot
of
money
that
came
in
federally
through
those
arpa
funds
and
other
dollars
that
were
related
to
Public
Health
and
the
protection
of
those
going
forward
with
this
next
budget,
like
what
types
of
cuts
were
cut
or
not
or
not,
being
like
I
guess
renewed
now
that
we
no
longer
have
that
money.
AD
Julia
Peak
for
the
record,
I'll
I'll
start
on
that
one.
So
much
of
the
funding
that
we
received
for
public
health
varied
from
vaccination
services
to
Public
Health
preparedness
to
epidemiology.
Much
of
those
funds
have
been
given
to
us
through
a
no-cost
extension
through
June
or
July
of
2024..
So
as
long
as
funds
remain,
there
will
be
support
for
those
programs.
We
will
be
presenting
also
at
IFC
next
week
as
a
spoiler
alert.
We
did
get
a
grant
from
the
CDC.
AD
That
really
is
intended
the
best
that
Congress
could
do
to
support
Public
Health
thereafter,
and
so
it's
more
of
a
block
grant.
Looking
at
Public,
Health
infrastructure
and
data
modernization
dpbh
will
be
getting
approximately
nine
million
dollars.
Southern
Nevada
Health
District
will
be
getting
over
20
million
dollars.
It's
population-based
allocation,
and
so
some
of
the
services
will
be
able
to
be
continued
through
that
and
it
has
a
focus
on
Health
Equity.
So,
for
example,
Washoe
County,
Health
District
is
going
to
be
retaining
the
staff
working
on
Health
Equity
under
that
award.
AD
We
all
also
graciously,
with
your
approval,
have
arpa
funds
from
our
Governor's
finance
office
through
the
treasury.
Much
of
the
projects
we
ask
for
in
public
health
in
that
award
is
allocated
through
2024,
but,
as
you
are
aware,
we
can
spend
through
2026.
so
many
of
those
projects.
We
were
thoughtful
about
that
and
have
budgeted
through
2026.
R
Thank
you
chair.
Thank
you
for
the
presentation.
I
actually
have
two
questions.
If
I
may,
the
first
comes
from
slide
six,
where
you
highlighted
the
successful
partnering
with
local
officials
on
the
development
of
the
rural
regional
health
district.
Is
there
an
involvement
of
the
tribal
councils
and
or
tribal
leaderships
with
that
development.
AD
Julia
Peak
for
the
record
I'll
go
ahead
and
and
take
that
one
again
I've,
it's
been
a
pleasure
working
with
those
counties.
We
have
had
conversations
with
many
of
the
tribes
in
those
regions,
for
example,
some
of
the
things
we
were
looking
at
transitioning,
perhaps
to
the
health
district,
one
of
which
was
WIC.
One
of
the
tribes
is
able
to
absorb
another
County
in
that,
so
we
are
going
to
continue
to
work
with
the
tribes.
AD
In
that
regard,
we
also
have
through
the
grant
I'm
presenting
at
IFC
next
week,
we've
built
in
a
cultural
Navigator,
and
the
position
is
going
to
be
solely
dedicated
to
working
with
our
tribes,
because
it's
a
challenge
and
we
need
somebody
that
really
is
devoting
their
full-time
to
that
effort
and
so
they'll
be
working
with
the
other
health
districts
as
we
have
tribes
in
the
urban
areas
as
well.
So
that
position
will
be
dedicated
to
supporting
that,
regardless
of
the
health
district.
AB
And
and
if
I
may
Lisa
Sherrick
also
for
that
position,
the
key
for
us
is
making
sure
that
they're
actually
going
out
personally
working
with
the
tribes
and
individuals,
not
behind
a
desk
in
an
office
making
phone
calls.
We
understand
how
important
that
is
to
develop
those
relationships
so
that
that
will
be
a
requirement
of
the
position.
R
Thank
you
and
then
I.
I
do
have
a
second
question
if
I'm
a
chair
and
I'm
not
sure
if
it's
in
this
presentation
or
the
other
one
it
has
to
do
with
the
caseload
changes,
in
particular
the
closing
of
mental
health
hospitals,
possibly
in
the
north
I
believe
assembly
member.
One
of
my
colleagues
brought
it
up
earlier
about
the
closing
of
a
mental
health
hospital.
R
How
will
that
impact
the
individuals
from
the
north
who
need
help,
in
particular
our
youths,
our
our
individuals
under
the
age
of
21.?
That
is
one
of
my
worlds
and
I'm
very
concerned
about
their
mental
health,
as
it
continues
to
get
harder
and
harder
to
get
services
in
any
area,
but
especially
I
feel
like
in
the
rural
area,
the
Northern
Area
I'm,
sorry
in
Vegas
as
well.
So
how
does
that?
How
will
that
impact
our
mental
health
help
for
our
youth,
in
particular,.
AB
Lisa
Sherrick
for
the
record
through
the
chair
to
assembly,
woman,
Anderson,
so
dbph
outside
of
outpatient
services
in
rural
Nevada,
we
only
serve
adults.
So
I
believe
that
question
is
sorry
for
division
of
child
care,
a
child,
DCFS
Angelica,
I'm,
going
to
say
financing
and
policy.
But
yes,
DCFS
no.
A
But
it
does
warm
our
hearts
that
you
had
to
think
about
that.
Yes,
okay,
Senator
Titus,
please.
T
You
have
already
heard
me
ask
this
question
and
it's
going
to
be
on
988
I've
kind
of
been
pushing
questions
on
this
implementation
and
I
know.
Senator
Harris
had
had
asked
the
question
about
the
the
phone
companies
or
the
communications
companies.
Are
they
going
to
be
able
to
sustain
it,
but
but
it's
my
understanding
that
there
was
a
set
rate
based
on
service
lines
and
it's
already
been
accepted
that
you
already
set
the
maximum
rate
per
service
line
that
was
available
per
legislation
and
I.
AC
T
And
at
one
point
you
had
said
you
thought,
based
on
the
number
of
lines
that
there
might
be
as
much
as
15
million
dollars
per
just
do
calculating
the
math
per
service
lines,
but
today
I'm
hearing
a
little
different
that
there's
some
question
about
how
much
money
that's
going
to
be
because
I
think
one
of
the
push
on
that
legislation
was
actually
not
just
to
establish
this
988.
T
A
little
worried
that
again
do
you
have
any
idea
now
what
the
actual
budget
would
be
or
hat
you
have
to
actually
use
and,
along
that
same
line,
you
were
going
to
put
out
rfps
on
services
on
that
and
companies,
and
it
sounds
like
you've
done
that
and
you
have
some
quotes
on
that
or
where
are
we
with
that?.
AC
Thank
you,
Cody
Finney,
for
the
record
to
Senator
Titus
through
the
chair.
AC
AC
AC
This
issue
that
really
came
up
in
the
last
few
days
about
service
lines,
so
that
we'll
have
the
best
possible
projection
and
we
will
bring
that
to
this
body
just
as
soon
as
we
can
and
is
appropriate
through
all
the
processes
the
RFI
is
in
draft
form.
We
will
be
asking
a
request
for
information
to
make
sure
and
I
think
we've
talked
about
before
that
we
have
a
solid
budget
and
solid
technical
requirements
for
this
system.
There
is
an
information
system
portion
to
this.
AC
So
that
is
in
draft
form
and
will
be
released
very
shortly.
And
then
we
will
move
to
the
RFP
for
that
portion
of
the
project.
A
AE
All
right
good
afternoon,
Madam,
chair
and
members
of
the
committee,
my
name
is
Cindy
pitlock
and
I
serve
as
the
administrator
of
the
Division
of
Child
and
Family
Services.
And
let's
talk
about
kids,
the
Division
of
Child
and
Family
Services
is
the
main
child
serving
Agency
for
the
state
of
Nevada,
with
approximately
when
fully
staffed,
1119
employees
that
work
together
to
achieve
our
mission
of
safe,
healthy
and
thriving
children
in
every
Nevada
Community.
AE
We
recognize
that
Nevada's
families
are
our
future
and
they
Thrive.
When
they
live
in
safe
and
permanent
settings.
They
experience
sustainable
emotional
and
physical
well-being
and
receive
the
support
they
need
necessary
to
make
Positive
Choices.
The
covid
pandemic
was
particularly
hard
on
Nevada's
families,
further
exacerbating
a
mental
health
crisis
and
lack
of
access
to
appropriate
services
in
Nevada
We
recognize
this
emergency
is
overlaid
on
a
system
already
insufficient
to
meet
the
basic
mental
health
needs
of
Youth
and
Families.
AE
It
is
with
these
recognized
insufficiencies,
coupled
with
the
DCFS
mission
statement.
We
are
pleased
to
present
our
portion
of
the
governor's
recommends.
Budget
I
also
heard
some
of
the
questions,
as
the
committee
had
brought
them
up
and
I've
interwoven.
Hopefully
some
of
these
answers
into
my
presentation
and
we'll
leave
enough
time
at
the
end
in
case
I
didn't
with
me
today
are
Melanie
young
Deputy,
Administrator
Deputy
of
administrative
and
support
services,
Sharon
Anderson
Deputy
of
Juvenile
Justice,
Services,
John
bradkey
over
child
welfare
services
and
Dr
Jacqueline
Wade
over
children's
mental
health
behavioral
services.
AE
So
I
brought
you
my
entire
team
of
ninjas,
so
the
next
slide
represents
our
summary
of
agency
operations
and
how
we
organize
the
oversight
of
our
programs
and
Direct
Services
I'd
like
to
highlight
some
of
our
accomplishments,
some
broad
sweeping
challenges
and
then
we'll
get
into
our
enhancements.
Specifically,
there
are
a
lot
of
accomplishments,
but
I'll
try
to
narrow
it
down.
For
the
sake
of
time,
we
were
very
fortunate
to
receive
a
sizable
investment
of
arpa
funding
for
services
to
address
the
Children's
Mental
Health
crisis.
AE
Many
of
you
were
involved
in
that
through
the
interim
and
IFC
and
I
want
to
extend
my
thanks
for
helping
us
visualize.
All
of
that
we
are
working
towards
sustainability
of
those
Services.
Both
by
partnering
with
Medicaid
and
also
in
our
proposed
budget,
this
investment
includes
mobile
crisis
response
both
in
the
communities
and
in
Clark
and
Washoe
school
districts,
intensive
in-home,
Family,
Services
emergency
and
planned
respite.
AE
Both
family
and
family
youth,
peer
support,
peer-to-peer
support,
wrap
around
an
intensive
care
coordination,
Workforce,
Development,
Day
treatment
programs,
as
well
as
funding
to
replace
the
Child
Welfare
information
system,
known
as
Unity,
so
very
huge,
huge
win
for
us.
Moving
on
to
another
win,
we've
begun
a
pilot
project
of
opening
up
female
beds
at
Nevada
youth
training
center
in
Elko.
Our
goal
is
to
shorten
the
time
that
females
are
waiting
in
detention
and
give
them
the
ability
to
start
those
Services
faster.
AE
Until
now,
dcfs's
only
option
for
female
placement
was
at
Caliente.
We've
talked
about
how
extremely
difficult
Staffing
is
at
the
Caliente
area
and
Recruitment
and
Retention,
especially
for
females
in
the
Caliente
area,
to
meet
our
ratios
for
needing
those
females
to
service.
A
female
population
is
extremely
difficult.
AE
This
gives
us
an
additional
option
for
females
and
the
ability
to
be
more
Nimble
in
our
system
between
female
and
male
beds,
depending
on
where
the
needs
are
so
that
fluctuation
in
being
able
to
be
fluid
for
us
is
a
huge
win.
Another
win
Desert
Willow
Treatment
Center
is
Nevada's
only
state-run
locked
psychiatric
residential
treatment
facility
for
children.
It
has
32
licensed
beds,
that's
eight
acute
and
24
residential
as
part
of
our
goal
of
increasing
to
a
total
of
54
Beds,
which
would
be
12
acute
and
42
residential.
AE
The
division
is
utilizing
approximately
six
million
dollars
in
arpa
funding
to
improve
the
facility
to
reduce
opportunities
for
youth
to
self-harm
and
to
improve
security
barriers
for
staff
to
reduce
engines,
injuries,
specific
improvements
will
include
impact
resistant
wall
protection,
safer
ceilings
and
shower
assemblies,
new
floors
and
walls
and
protective
barriers
at
unit
nursing
stations.
This
project
is
managed
by
state
public
works
and
we're
going
to
utilize.
The
phased
in
approach
as
construction
is
completed
in
various
areas.
AE
Another
one
I'm
very
proud
of
are
infant
and
early
childhood
mental
health
program
has
succeeded
in
the
creation
of
Nevada's
first
infant
mental
health
Association.
That
will
support
the
ability
to
become
nationally
endorsed
in
the
specialty
area
of
infant
and
early
childhood
mental
health.
Talk
about
going
Upstream
right.
This
program
makes
us
one
of
the
nation's
leaders
along
with
34
other
states.
This
will
allow
us
to
have
a
specialty
endorsement,
be
able
to
participate
in
robust
training
and
Workforce
Development,
create
additional
grant
funding
opportunities
and
give
us
a
rich
training
ground
for
our
University
students.
AE
They
demonstrated
excellence
in
leadership
in
the
implementation
of
a
multi-tiered
system
of
Youth,
supports
called
positive
behavioral
intervention
and
support,
which
is
an
evidence-based,
tiered
framework
supporting
youth,
behaviorally
academically
socially
emotionally
and
with
their
Mental
Health
in
2021,
the
Nevada
Department
of
Justice
opened
an
investigation
of
our
Juvenile
Justice
services
within
DCFS,
which
focused
on
the
use
of
chemical
restraints.
You
would
know
as
OC
spray
at
the
Nevada
youth
training
center
and
also
at
Summit
View.
AE
The
investigation
has
now
been
satisfactorily
closed
by
the
doj
as
we
partnered
to
adopt
new
policies
and
practice
that
have
significantly
decreased
the
use
of
OC
spray
in
those
facilities,
so
very
proud
of
my
team
relative
to
the
opioid
opioid
I
can't
even
talk
today.
I'm
sorry,
the
opioid
epidemic
I
heard
that
come
up
a
number
of
times.
I
have
directed
The
assurance
that
all
of
our
youth
parole
officers
and
mobile
crisis
response
team
members
carry
Narcan.
So
the
boots
on
the
ground
responders
are
ready
to
respond.
AE
AE
The
report
highlighted
things
we
really
already
knew.
Nevada
does
not
provide
adequate
services
in
the
least
restrictive
setting
to
youth
with
Behavioral
Health
disabilities.
There
is
not
adequate
access
to
community-based
services
and
we
over
rely
on
institutional
settings.
We
also
over
rely
on
emergency
departments
for
screening
assessment
and
stabilization
of
our
youth
with
mental
health
issues.
Those
emergency
department
stays
are
often
for
extended
periods
of
time.
We
are
working
across
DHHS
and
with
the
attorney
general's
office
to
develop
a
comprehensive
response,
and
this
is
going
to
be
an
ongoing
project.
AE
Another
challenge
Nevada
lacks
adequate
Home
and
community-based
Services
to
help
families
receive
support
and
stay
United
in
the
least
restrictive
setting.
We
know
that
the
best
place
for
Youth
and
families
are
united
in
their
homes
and
communities.
These
services
are
also
vital
to
prevent
unnecessary
placement
in
a
more
restrictive
setting
and,
conversely,
for
step
down
back
into
our
communities
and
homes
after
an
inpatient
treatment.
AE
Another
challenge
we're
focusing
on
Nevada
in
particularly
Las
Vegas,
is
one
of
the
most
common
destinations
for
trafficals
traffickers
to
sell
children
for
sex
and
for
buyers
to
purchase
them.
The
80th
session
of
the
Nevada
legislature
in
2019
saw
the
passage
of
ab151
and
SB
293,
providing
the
framework
for
Nevada
child
welfare
agencies
to
accept
and
ensure
services
for
all
commercially
sexually
exploited
children,
which
we
refer
to
as
csec
youth.
These
bills
require
the
development
of
a
plan
to
establish
the
infrastructure
to
provide
treatment,
housing
and
specialized
Services.
AE
Basically,
we
can
no
longer
funnel
these
youth
through
our
criminal
justice
and
detention
systems.
We
need
to
focus
on
the
decriminalization
of
our
victims
and
provide
them
with
specialized
services,
including
reproductive
Health,
Services,
housing,
Mental,
Health,
Services
and
reunication
with
family.
When
we
can
another
wide
sweeping
challenge,
we'll
talk
about
a
little
bit
more,
we
lack
a
number
of
sufficient
foster
homes,
especially
for
youth
with
specialized
needs.
Both
retention
and
recruitments
recruitment
have
been
problems.
AE
AE
For
example,
Caliente
Youth
Center
has
a
47
percent
vacancy
rate,
which
represents
49
people,
Children's
Mental,
Health,
North
and
South
direct
Clinical
Services
and
approximately
40
percent
vacancy
rate,
180
people,
youth
parole
that
protects
our
communities
and
keeps
track
of
our
youth
has
a
23
percent
vacancy
rate,
12
officers
that
we
don't
have
currently
on
the
streets
and
Nevada
youth
training
center
has
a
37
percent
vacancy
rate,
which
is
about
35
people.
Child
welfare
and
administration
are
doing
fairly
well
with
about
a
20
percent
vacancy
rate.
AE
AE
AE
AE
AE
The
average
number
of
Youth
on
a
wait
list
for
specialized
Foster
placement
in
Clark
County
is
40
to
45
per
month
and
specialized
Foster
placement
in
Washoe
County
about
25
per
month
on
a
waiting
list.
Yesterday's
phone
call
told
me
that
Clark
County
has
100
youth
at
the
child
Haven
facility,
10
of
which
poured
in
the
door
in
a
23
hour
period
of
time,
supporting
our
foster
placements
in
the
most
appropriate
least
restrictive
home-like
setting
is
imperatives
for
the
physical
and
mental
well-being
of
Nevada's
youth.
AE
Our
enhancement
request,
noting
that
the
Foster
rate
structure
has
not
been
evaluated
or
increased.
Since
2008
DCFS
engaged
a
contractor
Mercer
to
conduct
a
rate
study
across
all
of
our
rate
types.
We
found
that,
due
to
over
a
decade
of
inflation
inflation,
all
rates
are
insufficient
to
meet
the
needs
of
foster
families
and
to
recruit
and
retain
families
temporarily
we
will.
We
were
able
to
bridge
this
in
the
specialized
Foster
rate
by
twenty
dollars
a
day,
and
this
expires
on
June
30th.
This
immediate
action
was
necessary
because
we
were
having.
AE
AE
The
next
enhancement
for
foster
care
decision
unit
is
pursuant
to
SB
397
of
the
2021
legislative
session,
providing
stipend
for
foster
youth
from
18
to
21
years
of
age.
This
is
so
important
to
Target
our
transitional
age
youth,
to
set
them
up
for
greater
success
and
increase
their
services
and
access
to
those
Services
during
that
transition
into
adulthood,
and
if
you
really
look
at
the
cost
savings
that
will
have
over
the
entire
service
array
of
all
of
the
divisions,
this
is
an
extremely
important
initiative.
AE
Next
problem
lack
of
sufficient
amount
of
psychiatric
Residential
Treatment
beds
in
both
locked
and
unlocked
settings.
This
level
of
care
is
imperative
for
step
down
from
higher
levels
and
to
Aid
with
smooth
transition
back
into
Home
and
Community
and
reduce
emergency
room
waiting
times.
Currently
there
are
73
youth
placed
out
of
state.
This
number
is
slightly
up
from
2019,
where
there
were
58
youth
placed
out
of
state.
AE
next
problem,
our
mobile
crisis
response
team
has
experienced
a
longer
response
team
in
the
community
due
to
increased
number
and
Acuity
of
calls,
and
also
Staffing
shortages.
We've
also
seen
increased
need
for
response
by
qualified
mental
health
professionals
in
our
schools,
which
were
in
the
process
of
partnering
with
Clark
and
Washoe
County.
For
that
school-based
response,
the
enhancement
requests
together.
These
decision
units
request
the
continuation
of
positions
to
continue
that
expansion
into
the
schools
and
also
into
the
community
Workforce
Development.
AE
This
requests
the
continuation
of
arpa
funded
positions
of
a
part-time,
Public,
Service
intern
program
to
continue
our
Workforce
Development
and
pipeline
into
state
employment
problem.
Identification
next
is
part
of
our
continuation
of
build
out
of
our
children's
system
of
care.
The
next
two
enhancements
seek
to
move.
This
one
makes
me
smile
and
tear
up
a
little
bit.
AE
AE
AE
It
will
accommodate
two
classrooms
for
additional
24
youth
in
a
true
dyadic
parent-child
service,
the
latency
age
day,
treatment
program,
requests,
arpa,
funded
positions
to
continue
for
the
Southern
Nevada
latency
age.
After
school
day,
Treatment
Center,
focusing
on
7
to
11
year
olds,
anticipated
initially
to
serve
12
to
14
Youth,
so
kudos
to
my
team
for
going
Upstream.
AE
Outsourcing
prtf
Enterprise.
Let
me
see
if
I
can
answer
some
of
those
questions
with
this
with
this
response,
so
this
decision
unit
requests
the
elimination
of
prtf
Enterprise
in
Reno
North
Reno
as
a
state-run
program
due
to
our
inability
to
staff
with
either
contractors
or
state
employees.
We
have
initiated
the
request
for
proposal
through
our
purchasing
Division
and
Contracting
process
to
Outsource
to
a
vendor
that
can
fully
open
all
16
beds.
Most
of
these
positions
are
completely
vacant,
and
rates
of
vacancies
are
so
high
across
programs.
AE
We
are
not
expecting
any
layoffs
from
this
literally
about
six
weeks
ago.
Over
the
weekend,
we
had
absolutely
no
staff,
as
in
zero
staff,
to
supervise
and
provide
services
to
the
four
youth
that
were
at
prtfu
Enterprise,
and
we
had
to
relocate
those
youth
to
prtf
North
in
order
to
provide
for
their
services
and
safety.
We
are
not
shuddering
prtf
Enterprise.
At
this
time
we
are
using
every
effort
we
can,
through
both
contract,
Staffing
and
state
positions,
to
open
up
even
one
bed
if
we
can
so
that
is
in
process.
AE
Next,
for
the
closing
of
unstaffed
Caliente
beds,
we
are
recommending
a
reduction
in
the
funding
for
Staffing
levels
at
Caliente,
Youth
Center
we've
talked
about
the
Staffing
challenges
there
and
our
ability
inability
to
meet
our
Priya
ratios
for
female
staff.
Priya
is
the
prison
rape,
elimination
act,
which
is
a
federal
law,
supporting
the
prevention
detection
and
response
to
sexual
abuse
and
sexual
harassment
within
the
facilities.
AE
Priya
requires
minimum
staff
ratios
to
keep
even
staff
safe
and
youth,
both
male
and
female,
our
average
census
in
fiscal
year
21
for
Caliente
was
59.
fiscal
year.
22
was
46..
So
what
we're
requesting
here
is
a
reduction
in
unstaffed
beds.
These
beds
are
empty.
The
overall
impact
on
wait,
lists
and
detention
that
we
have
now
is
due
to
lack
of
Staffing
across
all
of
our
facilities,
not
lack
of
number
of
beds.
AE
Problem
over
several
biennium
Nevada
has
seen
a
reduction
in
vocational
programs
offered
to
youth
in
our
Juvenile
Justice
facilities.
Trade
programs,
including
Hospitality
Food,
Services,
welding,
auto
mechanics
and
computer
technology,
can
give
youth
jobs
with
sustainable
wage
to
support
themselves.
AE
We
know
many
times,
youth
that
enter
into
our
Juvenile
Justice
programs
lack
credits
in
order
to
successfully
graduate
this
decision
unit
requests
funding
for
an
increase
to
the
Clark
County
School,
District
educational
contract
for
Summit
View.
We
contract
with
Clark
County,
School
District,
and
due
to
increasing
expenditures,
we've
had
to
reduce
the
amount
of
educational
programming.
AE
AE
Next,
youth-driven
expenses,
this
decision
you,
these
decision
units
are
for
facilities
to
comply
with
the
letter
of
intent
from
the
senate
committee
on
finance
and
the
assembly
committee
on
Ways
and
Means
dated
October
9
2021.
The
letter
required
the
separation
of
youth-driven
expenses,
expenditures
from
traditional
operating
expenditures
to
ensure
appropriate
funding
is
budgeted
administrative
transfers.
AE
AE
And
the
next
our
position
summary
the
28
additional
positions
that
you
see
with
all
the
outs
and
ends
by
the
time
you
get
down
to
the
28
is
really
mostly
the
continuation
of
positions
funded
by
arpa.
That
we've
talked
about
for
direct
direct
Clinical
Services
and
realigning
prtf
Enterprise
to
move
those
positions
down
to
Desert
Willow,
to
strengthen
that
service
array
and
two
are
for
the
victims
of
crime
program,
and
a
few
are
just
generally
realignment
a
pleasure
to
serve
Youth
and
families.
We're
here
to
answer
any
questions
you
may
have.
AE
Hopefully,
I
answered
a
few
of
them
along
the
way,
and
here
for
here
for
you,
my
team
is
here.
K
Yes,
thank
you,
madam
chair,
so
I
had
a
question
on
the
the
Clark
County.
It's
the
Child
Welfare
Grant
elimination
is
that
under
you.