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Description
This is the eighth and final meeting of the 2021-2022 Interim. Please see the revised agenda and "Work Session Document" for details.
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
Videos of archived meetings are made available as a courtesy of the Nevada Legislature.
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Closed Captioning is Auto-Generated and is not an official representation of what is being spoken.
A
F
C
A
Here,
thank
you.
So
much
will
you
please
mark
assemblyman,
hayfin
absent
excused
from
today's
meeting.
I
am
down
here
in
las
vegas
to
kick
off
this
last
meeting
with
my
colleagues
down
here.
I
wish
we
could
all
be
together,
but
knowing
certain
circumstances,
we
are
still
entertaining
this
three-modal
model,
just
a
couple
of
housekeeping
items,
as
we've
done
every
every
committee
meeting,
so
everyone's
on
the
same
page.
A
First
I'd
like
to
remember
remind
everyone
to
please
silence
all
of
your
electronic
devices.
I
think
I
have
to
do
my
own
here
too
yep
for
members
joining
online.
Please
mute
your
microphones
when
you
are
not
speaking
and
leave
your
cameras
on,
so
we
can
ensure
you're
there.
Additionally,
I
ask
our
presenters
on
the
zoom
video
call
to
leave
your
cameras.
Often
microsoft,
microphones,
muted,
until
I
call
up
the
agenda
or
work
session
item
under
which
you
will
present
or
if
I
direct
any
questions
to
you,
the
zoom
video
call
has
a
chat
feature.
A
However,
this
feature
is
only
to
be
used
for
technical
assistance.
Any
links
or
information
that
you
would
like
to
share
during
your
presentation
should
be
stated
verbally
on
the
record
and
follow
up
with
an
email
to
staff
agenda
items
may
be
taken
in
a
different
order
than
listed
two
or
more
agenda
items
may
be
combined
for
consideration.
A
A
A
If
you
do
not
testify,
you
may
also
want
to
sign
in
there
so
there's
a
record
of
who's
in
attendance
and
who's
in
interested
in
a
particular
topic
and
in
the
event,
the
content.
The
committee
needs
to
contact
you
later
when
testifying
in
person.
Please
turn
the
microphone
on
to
speak
and
off
to
listen,
because
we
have
other
listeners,
others
listening
to
and
viewing
the
meeting
in
las
vegas,
sorry
in
carson
city
and
online.
A
We
do
get
some
reverb,
so
this
is
something
I'll
remind
you
about.
If
we
have
any
issue
with
it
and
with
that
we're
going
to
go
ahead
and
move
into
agenda
item
number
two
public
comment:
is
there
anybody
in
las
vegas
who
would
like
to
public
comment?
Please
come
to
the
table.
Public
comment
will
be
limited
to
three
minutes
per
speaker
staff.
Will
time
each
speaker
during
public
comment
to
ensure
everyone
has
a
fair
opportunity
to
speak.
We
also
ask
that
you
do
not
repeat
what
a
previous
commenter
has
stated.
A
An
additional
opportunity
to
make
public
comment
will
be
available
at
the
end
of
the
meeting,
since
we
will
be
having
a
work
session
today.
I
encourage
individuals
to
address
any
item
on
the
work
session
during
this
first
public
comment
period.
This
does
not
preclude
me
from
requesting
clarification
if
the
committee
has
reque
questions
regarding
specific
items
in
the
work
session
document,
therefore,
to
ensure
that
you
have
an
opportunity
to
present
your
views,
you
may
want
to
address
items
in
the
work
session
during
your
first.
A
I've
already
asked
if
there
was
anyone
in
las
vegas
for
public
okay,
we
have
someone
coming
up
to
the
table
and
we
will
go
to
carson
city
and
then
our
virtual
folks,
who
may
be
calling
in
please
state
your
name
and
spell
it
for
the
record
and
proceed
when
you're
ready.
Thank.
G
You
chair,
peters,
bradley
mayor
partner
with
argenta
partners,
b-r-a-d-l-e-y-m-a-y-e-r,
I'm
here
today
on
behalf
of
the
southern
nevada
health
district,
and
I
wanted
to
specifically
call
out
item
l2
that
we
are
in
support
of
you
know.
These
kind
of
non-categorical
dollars
are
critical
to
improving
nevada's
population
health.
G
You
know
the
threats
in
public
health
are
changing
all
the
time
and
so
having
the
ability
to
address
chronic
disease,
health
disparities
and
emerging
threats,
and
the
like
through
this
proposal,
is
critical,
and
so
we
urge
your
support
and
we
thank
you
for
considering
it.
Thank
you.
A
Thank
you
for
your
comments.
Is
there
anyone
else
in
las
vegas?
Who
would
like
to
provide
public
comment?
Seeing
none
we'll
go
ahead
and
go
to
carson
city?
I
can
see
in
the
reflection
that
there
are
a
couple
people
at
the
table.
So
please
turn
on
your
mic
state
your
name
and
spell
it
for
the
record
and
proceed
when
you
are
ready.
H
I'd
like
to
refer
you
to
a
fact
sheet
that
was
in
your
meeting
materials.
It
was
distributed
to
you
in
advance
and
I'd
like
to
highlight
a
few
points
on
the
fact
sheet
for
your
consideration.
As
you
go
into
your
work
session
today,
I
want
to
point
out
that
the
generic
and
biosimilar
drugs
provide
one
of
the
top
value
propositions
in
health
care
and
here's
some
statistics
to
support
this
statement
in
2020
health
care
spending
in
the
u.s
reached
4.1
trillion
dollars.
H
That's
2.6
billion
dollars
when
talking
about
prescription
drug
spending
nationally
new
data
for
2021
shows
generic
drugs
now
represent
92
percent
of
all
prescriptions
filled,
but
account
for
only
16
percent
of
all
prescription
drug
spending.
The
data
shows
even
more
savings
compared
to
2020
when
these
numbers
were
90
percent
of
all
prescriptions
and
18
of
all
spending.
This
means
that
even
as
more
generic
drugs
are
being
dispensed,
the
share
of
the
overall
cost
continues
to
drop.
H
H
According
to
a
recent
aarp
study,
they
reported
that
the
cost
of
the
390
most
commonly
used
generic
drugs
by
seniors
has
fallen
by
9.3
percent.
It's
important
to
note
that
generic
and
both
similar
drugs
have
entirely
different
economics
than
brand
drugs.
Generic
drugs
are
a
commodity
market
and,
as
a
result,
profit
margins
are
smaller
and
distribution
is
largely
handled
through
three
major
wholesalers.
H
H
I
Good
morning,
chair
peters
and
members
of
the
health
care
committee,
this
is
joanna
jacob.
I
am
government
affairs
manager
for
clark
county.
I
was
supposed
to
be
joining
you
today
in
grant
sawyer,
but
got
stuck
here
in
carson
city
last
night,
so
very
happy
to
be
here
in
carson
city
and
testifying
today
on
item
d1
in
your
work
session
is
an
item
that
clark
county
did
submit
for
consideration.
So
we'd
like
to
thank
you
for
including
it
on
today's
work
session.
I
The
intent
of
this
request
really
is
to
provide
a
path
forward
for
child
welfare
agencies
to
build
federal,
4e
dollars
for
a
model
of
care
that
is
emerging
from
the
family.
First
prevention
services
act
that
is
called
a
qualified
residential
treatment
program,
and
some
of
the
guidance
that
is
coming
down
from
the
federal
children's
bureau
really
showed
us
that
there
may
need
to
be
some
updates
to
the
nevada,
rai
statutes,
and
that
is
to
align
with
that
guidance
to
provide
that
path.
I
We
intend
to
bring
you
a
consensus
product
really
to
say
that
to
move
us
forward
to
provide
this
path,
it's
tremendously
important
for
clark
county,
because
the
federal
guidance
states
that
we
will
no
longer
be
able
to
build
4e
dollars
for
this
group
home
kind
of
model
of
care
unless,
beyond
14
days,
unless
we
have
certain
exceptions,
one
of
which
is
this
qualified
residential
treatment
program,
which
the
federal
guidance
also
tells
us
needs
to
be
licensed
by
the
state
as
a
child
care
institution.
I
And
our
definition
in
nevada
did
not
match
the
federal
guidance
and
that's
the
intent
of
the
bdr.
So
I
wanted
to
say
that
that
we
will
work
with
our
child
welfare
agency,
colleagues
and
our
state
colleagues
on
this
bill
and
want
to
thank
you
for
including
it
today
for
action
and
ask
for
your
support.
Thank
you.
A
D
D
Good
morning,
chair
peters
vice
chair,
donate
and
members
of
the
committee,
my
name
is
jimmy
lau,
first
name
j-I-m-m-y
last
name
lal
lau
and
I'm
the
vice
president
of
ferrari,
reader
public
affairs
representing
dignity,
health,
st
rose
dominican
on
behalf
of
saint
rose's,
non-profit
acute
care
hospital
system
in
nevada.
We
want
to
thank
the
committee
for
diligent
work,
this
interim
and
offer
comments
in
support
of
two
items
on
the
committee's
work
session
document
first
we'd
like
to
offer
our
support
for
item
l,
specifically
the
creation
of
a
public
health
infrastructure
and
improvement
account.
D
This
item
will
provide
ongoing
support
for
nevada's
public
health
infrastructure.
Complementing
the
work
of
community
stakeholders
across
our
state,
st
rose
is
proud
to
be
a
part
of
nevada's
public
health
infrastructure,
offering
many
free
and
low-cost
programs
through
its
foundation
and
wellness
centers,
to
address
social
determinants
of
health
for
nevada's,
most
vulnerable
and
disadvantaged
residents.
D
Second,
we
would
like
to
offer
our
support
for
item
k
related
to
community
health
workers.
Sam
rose
has
supported
legislation
in
previous
sessions
related
to
community
health
workers,
recognizing
the
substantial
value
they
provide
to
the
communities
they
serve.
Expanding
access
to
community
health
workers
will
provide
an
immense
benefit
to
nevada's
residents
and
we
are
hopeful.
This
provision
to
the
existing
statutory
authorization
for
community
health
workers
will
allow
saint
rose
to
bolster
its
work
in
providing
high
quality
and
accessible
services
for
nevadans.
We
look
forward
to
working
with
the
legislature
on
these
measures
in
2023.
D
Good
morning
show
peter
the
members
of
the
committee.
My
name
is
megan
kamlasi
and
I
am
the
associate
director
of
the
center
for
public
health
excellence
within
the
school
of
public
health
at
unr.
First,
I
want
to
thank
senator
donate
for
all
the
time
and
work
he
and
staff
put
into
the
sb
209
study.
Through
it.
D
He
received
a
significant
amount
of
feedback
that
the
results
of
which
are
reflected
in
the
work
session
today
for
many,
the
coven
19
pandemic,
provided
the
first
concrete
example
of
what
the
public
health
sector
does
and
underscored
the
importance
of
robust
public
health
systems.
It
also
highlighted
the
consequences
of
chronic
underfunding,
workforce
shortages
and
outdated
infrastructure,
which
limited
the
state's
capacity
to
respond
to
public
health
challenges
before
the
pandemic
and
exacerbated
them
during
the
crisis.
D
The
proposal
before
you
in
item
l
in
the
work
session
document
regarding
public
health
modernization
represents
a
significant
step
toward
improving
the
ability
of
public
health
practitioners
to
prevent
and
respond
to
health
crises
in
the
state.
It's
ongoing
flexible
funding
that
will
be
a
perfect
complement
to
the
historic
investment
and
public
health
infrastructure
that
the
interim
finance
committee
approved
yesterday.
D
As
you
consider
these
proposals
today,
I
think
it's
just
important
to
remember
that
there
are
hard-working
public
health
professionals
who
are
currently
stretched
thin,
who
are
doing
the
best
that
they
can
with
the
funding
and
the
staff
and
the
capacity
that
they
have,
and
this
non-categorical
funding
will
just
enable
them
to
address
whatever
the
public
health
issue
is
of
the
day
and
respond
to
the
needs
of
the
residents
and
the
communities
you
serve.
Thank
you
for
your
time.
D
Yes,
chair
one
moment
if
you
would
like
to
offer
public
comment
for
today's
meeting,
please
press
star
9
now
to
take
your
place
in
the
queue
over
the
phone
or
raise
hand
inside
the
zoom
client,
once
more.
That's
star
9,
now
over
the
phone
or
ray's
hand
inside
the
zoom
client
to
participate
in
public
comment.
D
J
Hello,
this
is
jay
colbert
clauselle
for
the
record
from
the
nevada
community
health
worker
association.
Thank
you,
chair,
peters,
and
members
of
the
committee
for
having
us
today.
I
will
be
available
to
answer
questions
when
item
k
comes
up,
but
on
behalf
of
the
chw
association.
Please
consider
a
one
word
addition
to
the
recommendation.
J
Chw
is
a
very
broad
title
and
there
are
chws
who
do
not
have
certification
and
have
staff
funding
sources
that
do
not
require
it.
Employers
have
been
supporting
their
staff
to
pursue
the
requirements
and
we
believe
that
this
should
be
left
to
market
forces
to
reward
chws
and
employers
who
pursue
training
and
certification.
J
J
So
with
all
that
in
mind,
the
one
word
addition
is
to
add
the
word
certified
so
holding
himself
or
herself
out
as
a
certified
community
health
worker
in
this
state
before
in
the
state,
be
certified
as
a
community
health
worker
by
the
nevada
certification
board
and
I'll
repeat
that,
since
I
fumbled
so
require
that
any
person
holding
himself
or
herself
out
as
a
certified
community
health
worker
in
this
state
be
certified
as
a
community
health
worker
by
the
nevada
certification
board.
Thank
you
very
much
for
your
time.
A
Thank
you
so
much
for
those
public
comments.
I
made
notes
on
that
suggestion.
Are
there
other
callers
for
public
comment.
D
D
D
We
saw
the
consequences
of
underfunding
of
our
public
health
infrastructure
during
covet
19
and
I'm
sorry.
We
saw
the
underfunding
of
public
health
and
the
impacts
during
covet
19..
We
had
health
inequities
that
were
magnified
and
disadvantaged
populations
were
severely
affected.
The
lack
of
resources
to
work
with
the
disadvantaged
communities
on
inequities
and
health
priorities
prior
to
the
pandemic
left
us
ill-equipped
to
work
with
these
communities
to
provide
the
support
and
access
to
services.
D
D
Funding
system
we
operate
in
is
ineffective
and
unsuitable
for
meeting
our
public
health
responsibilities
like
going
to
a
doctor
who
takes
you
but
not
weigh
you
at
your
pulse
and
oxygen
levels
or
have
you
stick
out
your
tongue
and
look
down
your
throat
categorical
funding
issues,
chronic
underfunding
of
public
health?
I
urge
you
to
approve
the
bdr
for
public
health.
Modernization.
A
A
D
Thank
you.
Apologies
thank
you
for
the
opportunity
to
comment
on
the
proposed
public
health
infrastructure
and
improvement
fund
under
item
in
in
the
work
session
document.
D
Finally,
the
proposed
funding
and
associated
investment
provides
a
real
opportunity
to
diversify
funding
for
public
health
programs
in
nevada,
which
we
know
would
really
alleviate
some
of
the
reliance
on
federal
financing,
which
could
lead
to
the
dismantling
of
programs.
After
that,
funding
has
been
exhausted
if
sustainability
has
not
been
able
to
be
attained.
So
often,
the
very
restrictions
that
come
with
federal
funding
can
often
lead
many
of
our
most
vulnerable
communities
without
access
to
adequate
services.
D
Therefore,
providing
the
opportunity
for
non-categorical
and
flexible
funding
will
really
ensure
fundamental
public
health
services
are
in
place
and
can
certainly
respond
to
current
and
emergent
public
health
needs,
as
well
as
improve
the
health
of
all
communities
in
nevada
and
then.
Finally,
on
behalf
of
our
organization,
I
also
echo
some
of
my
colleagues
on
the
line
and
also
would
like
to
submit
our
support
for
the
community
health
workers.
As
we
know
that
investments
there
will
also
improve
our
health
care
impact
and
outcomes
overall.
Thank
you.
A
D
D
Good
morning,
chair
peters
and
interim
health
committee,
for
the
record,
my
name
is
joelle
gutman
dodson
and
I'm
the
government
affairs
liaison
for
the
washoe
county
health
district
kevin
dick.
The
health
officer
of
washoe
county
health
district
was
on
the
phone,
but
you
guys
were
having
trouble
hearing
him.
So
I
will
read
what
he
would
have
liked
to
said
to
have
said
into
the
record
so
we're
here
in
support
of
the
public
health
infrastructure
and
improvement
fund.
D
The
lack
of
resources
to
work
with
these
communities
historically
on
inequities
and
health
priorities
identified
in
our
public
health
needs
assessment
left
us
ill-equipped
to
work
with
these
communities
to
provide
the
support
and
access
to
services
they
so
desperately
needed,
and,
as
you
know,
we
are
always
at
risk
of
a
new
public
health
crisis
or
emergency
right
now
we
are
facing
monkey
pox
and
again
are
hindered
by
the
lack
of
adequate
and
flexible
public
health
funding.
I
wanted
to
give
you
a
couple
examples.
D
The
current
funding
system
we
operate
it
in
is
ineffective
and
unsuitable
for
meeting
our
public
health
responsibilities.
It's
like
going
to
a
doctor
who
could
take
your
temperature,
but
not
weigh
you
check
your
pulse
and
oxygen
levels
or
have
you
stick
your
tongue
out
and
look
down
your
or
look
down
your
throat,
but
not
not.
Look
at
your
ears.
We
need
to
fix
this
categorical
funding
issue
and
the
chronic
underfunding
of
public
health.
Thank
you.
A
Thank
you
for
those
those
comments.
Bps
were
you
able
to
connect
with
that
other
caller.
D
F
F
F
To
compound
an
already
simmering
public
policy
time
bomb
elders
count
indicates,
nevada
has
been
and
will
continue
to
experience
an
aging
tsunami.
Nevada's
population
has
increased
by
more
than
11.42
percent,
while
the
65
and
older
population
increased
by
40
nevada's
growth
rate
for
age,
85
and
older
is
double
the
national
rate.
F
There
are
approximately
13
000
personal
care
aides
who
assist
elderly
and
physically
disabled
nevadans
with
a
daily
living
test,
such
as
bathing
eating
toileting
and
mobility
in
their
clients
home.
This
workforce
is
disproportionately
women
of
color,
who
are
currently
paid
an
average
only
of
eleven
dollars
an
hour
with
few
to
no
benefit
close
to
half
of
the
workforce
relies
on
some
form
of
public
assistance
because
of
low
wages
in
inconsistent
hours.
F
Home
care
workers
play
a
critical
role
in
keeping
seniors
and
adults
with
disabilities
out
of
expensive
and
less
desirable
care
settings.
For
example,
nevada
saves
an
average
of
seventy
thousand
dollars
a
year
for
every
senior
who
has
served
through
the
frail
elderly,
home
and
community
based
waiver
program
instead
of
a
nursing
facility.
F
Despite
the
important
role
that
home
care
workers
play,
which
has
been
made
all
the
more
evident
during
the
covid
pandemic,
the
home
care
industry
suffers
from
over
50
percent
turnover
rate
due
to
the
lack
of
compensation
and
respect
afforded
to
these
women.
Lastly,
the
vast
majority
of
home
care
in
nevada
and
nationally
is
delivered
through
medicaid.
F
F
I
would
like
to
commend
you
and
the
2021
legislature
for
having
the
foresight
to
enact
legislation
to
immediately
address
these
critical
issues,
and
I
am
speaking
to
item
m
and
asking
for
your
support
of
the
recommendations
that
have
been
adopted
to
date
by
the
workforce.
Employment
board,
deputy
administrator
cody
finney
has
been
tasked
to
chair
the
home
care
employment
standards
board,
and
I
know
she
will
be
available
to
answer
any
other
questions
during
that
item.
Thank
you
very
much.
I
appreciate
your
time.
A
Thank
you
miss
lockhart.
We
appreciate
you
calling
in
to
give
us
a
brief
update
on
that
the
status
of
that
committee
and
we
look
forward
to
hearing
more
about
those
recommendations
in
the
coming
session
as
well.
Are
there
any
other
callers?
I
don't
see
anybody
coming
to
the
tables
bps.
Do
we
have
anyone
else
on
the
public
comment
line.
D
A
A
A
A
A
A
If
you
have
a
greater
interest
in
participating
in
the
development
of
these
regulations,
the
process
can
be
found
on
the
lcb
website
or
you
can
reach
out
to
our
staff
for
additional
assistance.
Committee
review
is
an
important
process
for
follow-up
on
bills
that
we
have
passed
in
the
last
couple
of
sessions,
but
we
will
not
be
taking
any
action
on
these
items
today.
A
A
G
Yes,
eric
robbins
for
the
record
from
lcb
legal,
so
there
are
six
regulations
that
the
committee
is
considering.
Today
there
is
lcb
file,
r010-2
and
lcb
file,
r094-22,
both
of
the
state
board
of
health.
There
is
r026-22
which
is
being
considered
by
the
state
board
of
oriental
medicine.
There
is
ro57-22
of
the
board
of
examiners
for
marriage
and
family
therapists
and
clinical
professional
counselors
and,
lastly,
two
regulations
of
the
state
board
of
pharmacy,
r085-22
and
r086-22.
A
K
Thank
you,
madam
chair.
I
appreciate
the
opportunity
to
ask
a
brief
question
on,
and
this
is
in
regards
to
ro
r010-22
of
the
state
board
of
health,
and
I
was
just
wondering
the
penalty
fees
wondering
how
they
were
set.
If
someone
doesn't
report,
this
is
regarding
the
cancer
reporting.
C
A
This
is
andrea
gucci.
I
am
the.
C
D
Just
a
clarification
to
what
is
already
currently
in
regulation.
C
So
working
with
our
stakeholders,
including.
C
Quite
a
bit
of
confusion
as
to
what
those
fees
were,
because
we
also
have
in
regulations
and
abstract
copy
that
was
placed
there.
You
know,
prior
to
even
looking
to
amend
these
regulations.
K
K
This
is
on
zero,
nine
four,
two
two
on
the
music
therapy
and
I'm
just
wondering
why.
Why
is
there
an
issue
with
this?
Has
it
been
abused?
Why
are
we
again
regulating
music
therapy
and
is
it
because
they're
billing
for
their
services,
so
it
requires
regis?
You
know
some
regulation
and
certification.
K
I
just
think
we
have
so
many
licenses
that
we
require
in
our
state
it's
more
of
a
hindrance
to
care
than
helpful
care.
So
can
you
explain
me
just
briefly
perhaps
why
this
was
recommended
where's
the
problem
we're
trying
to
solve.
D
Hi,
this
is
letitia
matherell
for
the
record,
so
the
licensing
of
music
therapists
is
actually
a
statutory
requirement,
so
we
have
to
license
music
therapists.
D
One
nrs640d.100100,
the
legislative
declaration
notice
that
the
practice
of
music
therapy
is
hereby
declared
to
be
a
life
learned,
ally,
health,
profession
and
its
need
to
protect
the
public
from
the
practice
of
the
public
or
the
practice
of
music
therapy.
So
that's
why
we
license
them,
because
it's
in
statutes.
We
have
no
choice
as
far
as
the
regulations.
D
That
was
ad330
that
I
believe
passed
in
the
last
legislative
session
that
applied
to
occupational
licensing
boards
and
since
music
therapist
was
an
occupational
licensing
board.
It
also
applied.
D
K
A
Thank
you,
dr
titus,
for
the
questions
and
on
the
music
therapy
piece.
I
had
an
opportunity
to
go
and
visit
with
the
notables
in
reno.
If
you
are
up
in
that
area
and
would
like
to
get
a
perspective
on
what
music
therapists
do
and
how
they
impact
our
community,
I
would
encourage
you
to
reach
out
to
them
and
see
about
a
visit
and
a
chat.
A
And
move
on
to
our
first
presentation
agenda
item
today:
agenda
item
five
presentation
regarding
priorities
and
recommendations
of
the
regional
behavioral
health
policy
boards
during
the
2021-22
legislative
interim.
We
have
one
two,
three
four,
let's
forget
five
five
boards
to
present
on
their
bdr
ideas.
Today
I
believe
we
we
have
one
up
in.
I
was
going
to
start
with
clark.
Are
you
okay,
perfect?
Okay,
please
go
ahead,
introduce
yourself
and
proceed
when
you're
ready,
thank
you
intros
and
carson.
Thank
you.
So
much.
E
Thank
you,
chair
peters
and
members
of
the
committee
for
the
record.
This
is
valerie
haskin
rural,
regional
behavioral
health
coordinator
bear
with
me
for
just
a
moment.
While
I
get
the
presentation
up
and
running.
E
So
thank
you
for
this
opportunity
to
speak
to
you
today.
I'm
going
to
open
our
series
of
presentations
with
a
brief
description
and
overview
of
the
regional
behavior
health
policy
boards
to
provide
some
context
for
the
following
presentations
from
each
of
the
coordinators.
E
The
regional
behavioral
health
policy
boards
were
established
during
the
2020
2017
legislative
session
by
ab366
and
in
2019
ab-76,
further
divided
the
state
into
five
behavioral
health
regions.
This
was
done
to
ensure
that
regional
boundaries
were
based
on
common
access
to
services
and
needs.
Each
regional
behavioral
health
policy
board
consists
of
7
to
13,
volunteer
members
and
represents
a
broad
group
of
stakeholders
from
local
communities,
including
law
enforcement,
human
or
social
services,
behavioral
health
providers,
the
criminal
justice
system
system,
consumers
or
family
members,
insurers,
emergency
services
and
others.
E
Due
to
time
constraints,
I'm
not
going
to
go
into
great
detail
regarding
the
duties
of
the
boards.
However,
the
board's
duties
do
include
advising
the
nevada
department
of
health
and
human
services
and
all
of
its
subdivisions,
as
well
as
the
commission
on
behavioral
health
regarding
the
needs,
assets
and
progress
related
to
behavioral
health
in
each
region.
E
The
policy
boards
also
provide
state
agencies
with
local
insight
to
help
them
prioritize
funding
in
a
way
that
may
have
the
greatest
positive
impact.
The
boards
also
provide
additional
insight
as
to
any
obsolete,
redundant
or
otherwise
problematic
legislation
or
public
policy
that
creates
barriers
or
other
challenges
to
improving
the
behavioral
health
system.
E
E
Now
I
would
like
to
take
a
couple
of
moments
to
introduce
each
region
and
their
respective
coordinators
and
chairs
the
washoe
regional
behavioral
health
policy
boards
region
includes
washoe
county.
Only
their
chair
is
julia
raddy
and
their
coordinator
is
dorothy.
Edwards,
the
northern
regional
behavior
health
policy
board
service
area
includes
carson
city
story,
churchill,
lyon
and
douglas
counties
and
is
chaired
by
taylor.
Allison
sherilyn
roller
wood
recently
joined
our
ranks
as
the
coordinator
for
the
northern
board,
replacing
jessica
abras.
E
E
E
Last
but
not
least,
we
have
the
southern
regional
behavioral
health
policy
board,
which
serves
mineral
esmerelda,
lincoln
and
northern
nye
county
kim
donohue
is
their
coordinator
and
their
chair
is
currently
pending.
Their
first
meeting
is
scheduled
for
next
week.
So
there
are
some
exciting
things
to
come
and
to
expect
from
the
southern
board.
E
So,
in
conclusion
of
this
very
brief
overview,
much
more
detail
regarding
the
boards,
their
priorities
and
their
respective
bdr
topic
areas
will
be
given
within
the
presentations
to
follow
additionally,
more
details
about
the
boards,
their
roles
and
activities
can
be
found
in
the
handouts
provided
to
support
this
in
the
region-specific
presentations.
Thank
you.
A
Thank
you
for
the
brief
presentation
I
have
to
say
I
I
serve
on
the
washoe
regional
behavioral
health
policy
board
and
I
I
really
love
the
work
that
we
do
and
the
group
of
folks
that
have
brought
are
brought
together
through
these
boards
and-
and
I
just
wanted
to
share
that.
I
think
we
have
a
couple
of
folks
on
the
committee
who
serve
on
these
boards.
So
thank
you
for
being
here
today.
I
will
go
ahead
and
let
you
proceed
with
the
next
part
of
your
presentation.
N
A
N
N
A
N
Again,
michelle
bennett
for
the
record.
Thank
you
for
the
opportunity
to
present
today
on
the
clark
region.
The
clark
board
is
currently
filled
with
all
positions
and
a
strong
representation
of
professionals
in
this
region.
In
addition,
board
members
participate,
in
addition
to
their
day
jobs.
They
volunteer
their
time
and
participate
in
various
coalitions,
committees
and
boards
across
the
entire
state,
and
bring
that
expertise
to
tackle
the
complicated
issues
in
behavioral
health.
I
am
pleased
that
the
board
members
possess
a
high
level
of
cooperation
and
teamwork.
N
N
This
has
resulted
in
an
acceleration
of
existing
challenges,
and
this
board
will
reevaluate
priorities
during
the
september
board
meeting,
for
the
exception
of
the
last
priority,
to
identify
wraparound
services
for
individuals
experiencing
homelessness
and
mental
health
crisis.
All
other
priorities,
pre-date
kova
challenges.
N
N
Some
of
the
regional
challenges
clark
faces
echo.
Many
of
what
the
state
challenges
are.
This
is
just
brief
bullet
points
of
some
of
the
challenges.
Clark
is
currently
the
second
largest
county
to
experience.
It
has
a
high
percentage
of
severe
depression
and
frequent
suicide
ideation
and
that's
among
all
other
u.s
large
counties,
workforce,
sorted
shortages,
which
you
will
hear
throughout
the
presentations
of
my
co-workers
and
other
coordinators,
is
a
common
theme.
N
This
affects
access
to
care,
treatment
and
proper
diagnosis.
Clark,
county
detention
center
is
the
largest
mental
health
provider
by
patient
in
volume
they
average
about
21
000
inmate
populations
with
a
behavioral
health
need.
However,
there
are
some
positive,
some
positives
being
done,
and
I
want
to
highlight
las
vegas
metro.
They
are
probably
the
first
to
be
to
bring
somebody
into
the
system
and
they
are
doing
their
best
to
reduce
arrest
and
get
people
into
the
proper
treatment.
N
Some
of
their
attempts
are
the
creation
and
facilitation
of
hot
teams
which
provide
outreach
to
individuals
who
are
experiencing
homelessness
and
connecting
them
to
resources
a
lot
of
times.
This
is
the
first
point
of
contact
that
somebody
in
our
community
will
have
into
entering
the
system
cit
crisis
intervention.
They
are
actually
doing
some
great
stuff.
N
They
are
working
with
clark,
county
social
services,
so
many
acronyms
working
with
social
workers,
so
these
social
workers
are
going
out
with
police
officers
and
they're
responding
to
crisis,
calls
it
reduced,
arrest
incarcerations
and
helps
those
in
suffering
from
mental
illness
to
get
into
services
that
they
need,
and
then
finally,
I
want
to
highlight
the
lima
program,
the
law
enforcement
intervention
for
mental
health
and
addiction.
N
This
is
through
the
office
of
community
engagement.
This
is
a
diversion
program.
It's
a
9
to
12
month,
pre-booking
program
that
is
geared
towards
helping
people
with
low-level
drug
offenses.
The
key
thing
about
this
is
participants
must
have
a
chemical
dependency
but
they're
willing
to
engage
in
treatment
so
throughout
their
participation
in
lima.
They
are
connected
with
resources,
skill
levels,
sometimes
even
a
re-evaluation
of
what
their
job
skills
are,
and
this
program
currently
has
300
referrals.
N
They
have
60
graduates
to
date
and
their
recidivism
rate
for
their
graduates
is
only
3,
so
they
are
doing
good
work.
One
of
the
main
challenges
that
all
of
these
programs
are
reporting
back
is
a
lack
of
affordable
housing
and
mental
health
facilities
to
treat
this
population
left
with
no
other
options.
Many
times
these
individuals
either
disappear
from
contact,
or
they
repeat,
offenses.
N
So
they've
achieved
remarkable
success,
but,
along
with
along
with
numerous
community
partners,
they
need
help
which
leads
me
to
the
clark
regional
behavioral
health
policy
board,
bdr
concept
for
the
upcoming
session
in
july,
the
board
voted
to
approve
the
development
of
a
supportive
service
transformational
fund.
N
A
key
component
of
this
is
supportive
housing.
So,
since
many
of
these
individuals
are
trying
to
get
into
treatment
or
unable
to
sustain
themselves,
they
often
need
a
third
party
to
help
them
sustain
whatever
goal
or
mental
service
that
they
need.
So
supportive
housing
is
a
concept
that
engages
rental
assistance
and
supportive
services
wrap-around
services
that
can
help
with
case
management
care
coordination
in
order
to
get
somebody
in
a
place
where
they
can
function
at
the
most
successful
rate.
N
In
order
to
encourage
a
cohesive
service
system
across
service
sectors
and
maximize
available
resources,
it
is
important
to
align
services
across
the
range
of
providers
that
includes
intellectual
and
developmental
disabilities,
the
justice
system,
aging,
homeless
response,
behavioral
health,
child
welfare
and
youth.
All
these
linkages
to
affordable
housing
are
alternatives
to
facility-based
care
and
will
maximize
dollars,
because
individuals
are
tapping
into
one
source
and
not
having
to
go
across
multiple
sources
to
get
their
housing
completed.
N
That's
all
I
have
for
today.
Thank
you
for
letting
me
present.
A
A
Oh
great,
we
look
forward
to
hearing
more
about
how
you
guys
build
that
out
and
what
we'll
look
at
what
it
will
start
to
look
like
before
session
starts.
Are
there
any
questions
from
the
committee
for
clark,
regional
behavioral,
health
policy,
brain.
A
Right,
thank
you.
I
think
that
we're
okay
right
now,
if
you
want
to
stick
around
to
the
end
in
case
questions,
come
up
based
on
these
other
ones.
That
would
be
great.
I
think
our
next
presenter
looks
to
be
the
northern
regional
behavioral
health
policy
board,
I'm
not
seeing
them
in
las
vegas,
they're.
D
A
M
Good
morning,
madam
chair
peters
and
members
of
the
committee,
as
valerie
mentioned
in
the
introduction,
my
name
is
sheridan
rorwood
and
I'm
the
northern
regional
behavioral
health
coordinator.
Thank
you
for
the
opportunity
to
provide
my
presentation
on
agenda
number
5b
regarding
regarding
priorities
and
recommendations
of
the
regional
behavioral
health
policy
board.
Today,
I'm
in
my
ninth
week
on
in
this
position.
So
I
apologize
up
front
if
I
miss
anything
that
should
be
reported
to
the
committee,
please
note
chair
and
committee,
I
can
supply
any
further
necessary
information
if
needed.
M
A
little
bit
about
the
northern
region,
as
valerie
said
it
consists
of
carson
churchill
douglas
lyon
and
story
counties.
The
current
population
is
estimated
to
be
reaching
200
000..
The
total
area
is
approximately
8049
miles
of
rural
and
frontier
and
in
actuality
the
area
is,
is
eleven
thousand
nine
hundred
and
seventy
six
point
nine
ninety
five
square
miles.
I
just
recently
learned
this
when
looking
at
the
ethnic
makeup
of
the
northern
region.
M
Seventy
four
point:
one
percent
of
the
re
residents
in
the
region
are
white
out
of
hispanic
origin,
16.6
are
hispanic,
3.2
percent
of
the
population
are
native
american
2.4
asian
and
1.9
percent
of
the
population
are
black
or
african
american.
Looking
at
the
age
differential
5
percent
of
the
population
is
under
5
years.
22
percent
is
between
the
ages
of
5
and
24
years,
23
between
the
ages
of
25
and
44
years,
28
between
45
and
65
years
of
age,
and
then
23
percent
are
of
65
and
older.
M
M
M
So
looking
at
some
of
the
board's
areas
of
discussion
and
support,
our
behavioral
health
workforce
across
the
northern
region
is
lacking.
I
believe
the
consensus
on
this
topic
is
that
it's
a
hot
one,
statewide
you're,
going
to
hear
that
a
lot
today,
probably
from
each
coordinator,
regional
board,
infrastructure,
the
security
and
sustainability
of
it.
The
insufficiency
of
coordinated,
behavioral
health
responses
to
those
in
crisis
training,
crisis
planning
must
be
continued
to
be
developed
and
providers
trained
crisis
response.
988
are
building
are
being
built
up
upon
to
help
close
these
gaps.
M
While
we
are
a
few
years
away
for
more
optimal
services,
these
deficits
to
the
crisis
response
model
need
to
be
addressed
now,
access
to
care
for
all
ages
and
levels
of
treatments.
This
will
continue
to
be
a
problem
if
the
workforce
is
issues
aren't
resolved
as
well
as
transportation
issues
within
my
region.
Lack
of
behavioral
health
supporting
houses
for
smi
and
sud
population
board
will
continue
to
reach
across
the
county
lines
to
work
on
this
statewide
issue.
M
As
we
move
forward
transportation
in
accessing
medical
care
and
mental
health
crisis,
transportation
is
a
gap
and
a
huge
barrier
throughout
our
great
state
and
that's
another
hot
topic.
You're
going
to
hear
talked
about
quite
a
bit
and
finally
consistent
community
awareness
or
knowledge
of
state
and
local
programs
across
the
entire
region.
M
That
being
said,
there
is
always
hope
so
I'd
like
to
focus
on
some
positive
assets
of
the
northern
region.
As
the
newbie
I've
been
in
awe
at
how
these
counties
truly
come
together.
The
resiliency
from
the
northern
region
is
unwavering
and
I
would
be
remiss
if
I
did
not
highlight
some
of
the
successful
projects
and
programs
that
reign
in
the
northern
region.
M
We
have
our
most
teams,
our
moba
outreach
safety
teams
and
we
have
those
in
carson
douglas
and
lying,
and
they
are
growing,
bigger
and
better
and
stronger
as
988
and
the
crisis
response
model
gets
built
up.
We
regional
fast
programs,
those
are
multi-disciplinary,
forensic
assessment
service,
triage
teams
and
they
work
with
incarcerated
individuals
being
released
by
offering
alternative
ways
for
treatment,
services
and
resources.
M
Cit
program,
our
crisis,
intervention
training
that
occurs
in
most
of
our
northern
counties,
with
our
community
partners
and
law
enforcement,
and
I
am
blessed
to
be
able
to
train
within
some
of
those
cit,
trainings
and
great
great
response
and
are
our
are
for
our
from
our
law
enforcement,
multi-disciplinary
teams
or
mdts
for
individuals
with
smi
cases
that
struggle
with
regular
traditional
services.
These
teams
are
vital
when
it
comes
to
our
most
severe
smi
population
working
together.
M
M
I
have
had
the
honor
of
sitting
in
on
a
couple
of
the
county's
meetings
and
so
far-
and
I
would
say
these
are
vital
in
bringing
a
nice
array
of
partners
from
their
surrounding
communities
and
counties
together
at
the
same
table
using
their
voices
to
talk
about
current
issues
and
the
surrounding
areas,
giving
updates
on
the
old
and
new
resources
and
programs.
Things
of
this
nature
very
informative
and
active.
M
So
thank
you
for
the
pleasure
of
giving
of
allowing
me
to
give
you
an
idea
of
the
assets
that
I've
learned
from
this
region
as
I'm
settling
in.
Lastly,
here's
a
bit
of
the
board's
recent
history,
as
well
as
the
focus
of
their
bdr
concerning
legislative
priorities
impacting
behavioral
health.
The
board
has
been,
and
will
continue
to
provide,
support,
testimonies,
intra
regional
legislative
support,
education
and
advocacy
advocacy
as
always
and
ongoing.
During
the
81st
legislation
session,
the
board's
bdr
was
rewriting
the
ns,
the
nrs
433
language
and
changing
not
only
the
legal
holds
titled.
M
M
The
board
is
in
the
works
of
writing
the
language
for
the
bdr,
so
I
can't
elaborate
too
much
but
to
say
that
there
is
a
bit
there's
a
little
bit
of
the
y
on
the
one
pager
that
I've
provided,
and
I
noted
the
other
bdrs
on
the
boards
with
a
focus,
and
I
apologize
dorothy
that
I
forgot
to
put
your
your
bdr
on
there.
I
I
know
my
bad.
In
conclusion,
I
want
to
thank
you
for
all
the
time
today
and
hearing
what
is
happening
with
the
behavioral
health-wise
in
northern
region.
A
Thank
you
so
much
for
the
presentation.
Are
there
any
questions
on
the
northern
regional
behavioral
health
policy
board?
So
many
acronyms
you
guys,
I
don't
see
any
questions
coming
in
from
committee
members.
Thank
you
so
much
for
the
presentation.
We
look
forward
to
seeing
how
you
flush
out
that
bdr
language
and
it
may
be
worth
coordinating
a
little
bit
based
on
some
of
our
work
session
documents
today
on
that
language.
O
Is
the
insurance
companies
are
in
the
process
of
trying
to
say
that
we
don't
we're
not
allowed
to
bill
for
the
treatment
of
anxiety
and-
and
so
I
think
that
one
of
the
challenges
that
we're
going
to
see
is
we're
going
to
see
more
people
trying
to
be
less
anxious
without
the
help
of
their
insurance
and
therefore
they're
going
to
be
looking
for
other
sources
to
be
able
to
treat
anxiety.
O
So
I
I
don't
know
if
that's
playing
a
role
that
people
are
seeing
in
northern
nevada,
but
it's
obviously
concerning.
If
we
see
their
greatest
diagnosis
of
anxiety
and
on
some
circles,
we're
not
allowed
to
treat
it
or
get
paid
for
it.
Rather
has
that
been
something
that
we
see
up
there.
M
K
M
Sheryl
and
ron
for
the
record
senator
hardy.
I
can't
speak
to
that
answer
right
now.
I
haven't
really
looked
into
that
recently
nine
weeks
on
the
job,
but
I
can
go
ahead
and
do
some
research
on
that
and
get
back
to
you
if
necessary.
A
Thank
you
for
that
question,
and
that
is
disturbing
to
hear
considering.
I
think
many
of
us,
particularly
of
my
generation
anxiety,
is
one
of
the
only
things
that
takes
us
into
our
doctor's
offices.
So
I
think
there's
some
there's,
probably
some
like
work
to
be
done
around
that.
Thank
you
for
bringing
that
to
our
attention
as
well.
Are
there
any
other
questions
for
the
northern
regional
behavioral
health
policy
board?
I'm
not
seeing
any.
A
Thank
you
so
much
if
you
don't
mind
again
sticking
around
for
a
little
while,
in
case
questions
arise
from
these
other
presentations.
That
would
be
fantastic.
I
have
next
on
my
list.
Miss
haskin
with
the
rural
regional,
behavioral
health
policy
board.
It
looks
like
you
are
in
carson
city.
Please
introduce
yourself
and
proceed
when
you're
ready.
E
Hello
again,
chair
peters
and
members
of
the
committee
again
for
the
record,
valerie
haskin,
rural,
regional
behavioral,
health
coordinator,
and
now
it's
my
turn
to
give
you
a
brief
overview
of
the
rural
board's
priorities
and
bdr
topic
area.
I'm
not
going
to
go
into
any
detail
regarding
the
demographics
of
our
region,
just
for
the
sake
of
time,
but
that
information
can
be
found
on
the
handout
that
was
provided
for
2022.
E
Tier
two
priorities
are
those
that
are
important
but
are
seen
as
heavily
affected
by
changes
in
tier
one
priorities.
The
rural
board's
tier
2
priorities
include
improved
care
transitions
and
communication
among
providers
across
the
statewide
behavioral
health
system,
improved
safeguards
to
ensure
that
the
care
provided
to
our
communities
is
of
high
quality
and
improved
access
to
mid-level
care,
which
seems
to
be
a
statewide
gap.
E
Tier
three
priorities
include
improving
access
to
care
for
active
duty
service
members
veterans
and
their
families,
or
smvf
expanding
the
availability
of
culturally
appropriate
and
respectful
services
and
programs
leveraging
tele-behavioral
health
care
for
services
as
appropriate
and
finally,
stigma
reduction
for
more
detail
regarding
these
priorities.
Again,
please
see
the
handout
provided.
E
Oh
probably
be
helpful
if
I
put
this
in
the
right
format
there
we
go
all
right.
At
its
june
meeting,
the
rural
regional
behavioral
health
policy
board
voted
to
adopt
the
building
of
a
robust
pipeline
to
bolster
nevada's
behavioral
health
provider
pool
as
its
bdr
topic
for
the
2023
legislative
session.
E
These
slides,
as
I
move
forward,
will
say
draft
as
these
concepts
are
currently
subject
to
change
upon
board
approval
at
its
meeting
next
week.
The
ideas
presented
here
have
been
developed
through
conversations
with
stakeholders
across
the
behavioral
health
system
and
are
advised
by
the
work
of
dr
sarah
hunt
at
unlv,
who
has
committed
a
great
deal
of
time
researching
these
pipeline
models.
E
This
nevada
pipeline
would
be
based
upon
successful
models
from
nebraska
and
illinois,
and
it's
my
understanding
that
other
states
are
also
looking
into
adopting
similar
models.
Like
these
other
states,
the
nevada
pipeline
model
would
likely
include
the
launch
of
a
behavioral
health
workforce
pipeline
center,
which
would
collaborate
with
and
help
expand
upon
existing
successful
programs.
So
there's
no
desire
to
create
any
sort
of
duplication
of
efforts,
but
would
introduce
new
programs
and
connections
across
the
educational
system
and
occupational
licensing
works
going
from
k-12
education
through
professional
practice.
E
E
The
first
component
of
the
behavioral
health
workforce
pipeline
is
k-12
education.
Here
the
board
and
its
stakeholders
would
love
to
see
expansions
of
career
and
technical
education
programs
across
the
state
to
be
consistent
and
robust,
regardless
of
location
and,
of
course,
to
include
opportunities
for
students
to
learn
about
behavioral
health
professions.
E
Additionally,
the
center
would
collaborate
with
successful
programs
such
as
the
area,
health,
education,
centers
or
ahex,
which
provide
support
and
guidance
to
high
school
and
college
students
who
want
to
pursue
health
careers.
Here,
the
center
would
support
the
ahex
across
the
state
in
expanding
their
efforts
to
include
behavioral
health
professions.
E
E
A
Thank
you
so
much
for
the
presentation.
Can
I
just
summarize
this
that
you
guys
are
looking
at
an
like
a
pipeline
support
center
and
partnering
with
other
agencies.
Is
that
kind
of
the
intention
of
it
you
kept
saying
center,
so
I
was.
E
Yes,
for
the
record,
valerie
haskins,
relational
behavior
health
coordinator,
so
the
models
from
nebraska
and
illinois
both
focus
on
having
a
center
that
is
housed
within
the
one
or
more.
I
think
it's
two
or
three
for
both
of
them
and
institutions,
of
higher
education
within
their
respective
systems
and
with
that,
it's
kind
of
I
don't
want
to
say
forcing,
but
it
kind
of
like
pulls
the
different
programs
at
all
of
the
different
locations
of
the
ng
system.
E
One
of
the
big
pieces,
is
looking
at
that
internship
piece
so
that
we
can
make
sure
that
people
who
are
graduating
have
internships
to
move
on
to
which
is
a
major
issue
that
we've
seen
as
that
my
board
has
seen
and
that
I
have
also
seen
as
the
regional
coordinator
with
people
trying
having
a
difficult
time
finding
placement
so
that
kind
of
within
graduate
school
to
postgraduate
and
licensing
would
be
the
major
focus
again.
We
wouldn't
want
to
duplicate
any
efforts,
but
kind
of
really
need
to
pull
all
of
these
different
agencies
and
organizations
together.
K
You
thank
you
for
opportunity
to
ask
a
question.
Thank
you
for
your
presentation,
just
some
clarification.
K
So
I
was
a
product
of
my
county,
paying
my
way
through
school
went
back
after
medical
school
and
had
medical
students
and
residents
rotate
with
me
from
the
very
first
day
I
opened
my
doors
and
continued
for
about
38
years.
But
again
you
mentioned
about
duplication
of
efforts
and
how
much
time
have
you
invested
in
our
meeting
with
the
school
of
medicine's
residency
program
in
winnemucca?
E
For
the
record,
valerie
haskin,
the
school
of
medicine,
no,
not
necessarily
simply
because
the
professions
that
are
focused
on
here
are
outside
of
the
scope
of
the
medical
board
of
medical
examiners,
except
for
psychiatrists,
which
is
a
new
professional
focus
for
my
board.
We
have
previously
focused
on
clinical
social
workers,
mfts
cpcs
and
drug
and
alcohol
counselors.
E
E
I
it
seems
as
though
there's
just
less
knowledge
among
students
about
the
opportunities
there
are
to
access
these
programs
that
can
help
them
and
then
one
of
the
issues
there
is
that
I
believe
I've
heard
from
mr
ackerman
is
that
they
aren't
given
any
funds
for
marketing
and
so
having
the
center
would
kind
of
help
fill
in
the
gaps
between
the
professionals
within
each
particular
program,
because
people
get
busy
and
they
get
focused
on
their
work.
And
that
happens.
K
Thank
you
for
that,
and
the
fact
that
you
have
gerald
ackerman
involved
gives
me
much
comfort,
because
gerald
knows
his
his
job
out
there
and
has
done
tremendous
job
further
roles
and
understands
the
layers
of
all
the
healthcare
folks
needed.
Have
you
talked
to
the
superintendent
of
schools
school
districts
out
there
for
that
pipeline
of
students
to
get
interested?
I.
E
Have
been
working
my
way
through
my
email
list
this
last
week
to
get
emails
out,
I've
also
reached
out
to
the
ng
system
of
higher
education,
perfect.
K
So
I
certainly
like
the
concept
and
again,
the
fact
that
gerald
is
involved
gives
me
some
good
confidence
that
that
you're
going
to
have
some
good
direction
on
how
to
do
this,
and
not
just
it
always
sounds
great,
but
then,
when
it
comes
to
fruition
or
trying
to
implement
it
and
not
repeat
stuff
and
look
for
money
for
that
and
using
the
nevada
health
core,
as
part
of
that
program,
would
be
good
if
we
can
get
that
funding
so
anyway.
Thank
you.
Thank
you
for
what
you're
doing.
Thank
you.
Thank
you.
Manager.
A
Thank
you
so
much.
It
looks
like
you
have
a
couple
of
folks
in
the
senate
this
time
around
who
are
invested
in
this
bill.
So
I'm
looking
forward
to
those
conversations
and
hearing
how
this
pans
out
for
you
any
other
questions
saying
none.
Thank
you.
If
you
don't
mind
sticking
around
for
a
little
bit
we'll
move
on
to
our
next
presentation,
I
have
the
southern
regional
behavioral
health
policy
board,
miss
donahue
and
it
looks
like
you
are
in
carson
city.
Please
introduce
yourself
and
proceed
when
you're
ready.
B
I
apologize,
I
am
not
finding
my
presentation.
A
Oh
and
we
should
have
staff
in
the
room
who
can
help
you
with
that?
Oh
there
we
go.
B
B
I
believe
it
is
important
for
me
to
stop
and
make
note
that
the
southern
regional
behavioral
health
policy
board
is
not
at
the
same
level
of
the
other
policy
boards.
It's
important
for
me
to
mention
that,
in
the
introduction
from
my
counterpart
that
the
policy
board
for
the
southern
region
was
developed
in
the
2019
legislation
and
this
position
had
been
vacant
for
over
three
years
before
resuming
this
role,
the
board
had
not
been
able
to
successfully
form
a
full
board
and
hold
a
quorum
in
the
past.
B
B
B
So,
there's
a
little
bit
of
it's
hard
because
nye
county
is
divided
between
two
coordinators
between
myself
and
the
clark
regional
behavioral
health
coordinator.
So
with
having
that
county
divided,
it
does
make
those
populations
and
those
that
I
serve
and
the
square
mileage
a
little
difficult
to
narrow
down
precisely,
but
I
have
done
my
best.
B
The
ethnicity
breakdown
has
also
been
provided
to
best
understand
the
community's
makeup
that
encompasses
the
southern
region
on
july
28th
of
2022
from
9
a.m.
To
around
11,
the
southern
regional
behavioral
health
policy
board
met
to
hold
the
first
scheduled
policy
board
meeting.
We
had
30
online
and
50
in
person
in
attendance.
B
However,
due
to
a
technical
difficulty,
the
deputy
attorney
general
respectfully
requested
the
meeting
be
ended
in
order
for
us
to
comply
with
open
meeting
law.
We
then
rescheduled
our
meeting,
and
so
I
do
have
seven
board
members
appointed,
and
I
would
like
to
announce
that
franklin
kachke,
our
public
defender
out
of
lincoln
county,
has
been
assigned
to
the
board
sheriff
carrie
lee
out
of
lincoln
county.
B
B
I
have
missy
rowe
she's,
the
ceo
administrator
of
one
of
the
hospitals
in
my
region,
that's
grover,
c
dill's
medical
center
in
lincoln
county.
I
have
stacy
smith.
She
is
the
nye
communities
coalition
executive
director
and
will
be
filling
the
role
of
our
drug
and
alcohol
facility
administrator
representative
and
lastly,
I
have
chief
scott
lewis
out
of
the
pahrump
valley,
fire
and
rescue
services.
B
B
At
this
on
the
august
22nd
board
meeting,
we
will
be
voting
in
the
open.
The
seven
board
members
will
be
voting
in
the
six
open
appointed
positions.
B
I
would
also
like
to
point
out,
madam
chair
and
members
of
the
committee.
I
do
have
one
position
that
does
remain
open.
We
are
looking
for
candidates
to
fill
the
private
or
public
insurer
representative
position.
This
coordinator
has
requested
through
medicaid
to
help
identify
a
representative
that
covers
the
southern
region.
B
B
It
makes
it
extremely
difficult
and
provides
a
lot
of
barriers
for
my
board
members
in
the
southern
region,
so
we
use
zoom
and
in
person
the
unr
extension
office
gracially
holds
in
person
the
insight
for
the
board
meeting
for
those
that
would
like
to
attend
in
person
the
regularly
scheduled
reoccurring
board
meetings
have
been
scheduled
for
the
fourth
thursday
of
every
month
from
9
00
am
to
adjournment,
so
we
will
have
our
first
board
meeting
the
22nd
followed
by
thursday.
The
25th
will
be
our
second
board
meeting
on
the
august
25th.
B
B
As
the
southern
regional
behavior
health
coordinator,
I
will
be
repres,
I
will
be
presenting
to
the
board
members.
My
findings
that
I
have
gathered
over
the
last
eight
months
in
conducting
needs
assessments
and
swot
analysis.
Swot
analysis
is
identifying
our
strengths,
weaknesses,
opportunities
and
threats
within
the
communities
I
serve.
B
B
I
also
have
met
with
all
of
my
ems
fire
services,
emergency
directors,
county
managers,
the
statewide
coordinators,
school
superintendents,
principals,
school
counselors,
our
human
service
directors,
community
stakeholders,
our
tribal
partners
and
many
other
statewide
agency
partners
across
the
state.
These
findings
will
help
educate
and
contribute
to
the
board
members
areas
of
focus
when
determining
the
board's
priorities
and
possible
bill
draft
request.
Selection.
B
Another
gap
identified
is
behavioral
health
workforce,
which
you
will
hear,
and
you
have
heard
this
is
a
common
thread
across
the
state
to
increase
behavioral
health
providers
and
workforce
available
to
treat
patients
living
in
rural
frontier
regions
across
nevada,
and
I
would
like
to
note
that
I
feel
that
most
of
my
region
is
very
frontier
in
encompassing
the
southern
region
also
to
identify
the
process
to
improve
licensure
reciprocity
for
mental
and
behavioral
health
providers,
and
also
to
increase
youth
access
and
visibility
to
well-defined
career
paths
and
mental
behavioral
health
in
the
public
health
fields.
B
Another
gap
identified
is
youth,
elder
and
family
services,
the
awareness
connection
and
support
of
programs
addressing
youth,
behavioral
health
in
schools
and
at
home.
The
awareness
of
connection
and
support
for
programs
addressing
elder
behavioral
health
awareness
connection
and
support
for
new
and
existing
programs
that
may
support
wrap-around
services
for
individuals
and
their
family
members
who
might
be
experiencing
mental
behavioral
health
challenges
and
increasing
access
to
programs
and
services
for
individuals
with
substance
use
and
opioid
use
disorders.
B
In
my
southern
region
I
have
walker
river
paiute
tribe,
which
falls
in
mineral
county.
I
have
the
duckwater
shoshone
tribe,
which
falls
in
northern
nye
county,
and
I
have
the
yamba
tribe,
which
falls
in
northern
night
as
well
to
improve
access
to
our
state,
federal
and
local
programs
and
services
to
improve
the
overall
health
and
well-being
of
nevada's
indigenous
population.
B
I
wanted
to
kind
of
end
with
assets
because
being
the
positive
person,
I
think
we
have
focused,
we
always
focus
on.
What's
broken,
some
of
the
negativity,
and
I
really
would
like
to
draw
on
some
of
the
assets
and
strengths
across
the
southern
region.
Resiliency
top
number
one
for
my
frontier
communities.
B
They
have
demonstrated
incredible
resiliency.
The
fast
team
we
have
now
community
coalitions
has
some
drivers
that
have
really
been
supporting
our
fast
teams,
which
encompasses,
as
previously
mentioned
by
my
other
counterparts.
B
Taking
our
cit
crisis
intervention
training
are
most
teams
expanding
that
also
trying
to
make
those
more
statewide
instead
of
regional,
making
that
more
statewide
and
standardized
language
and
processes
and
procedures
mdt,
multiple
disciplinary
teams.
I
have
also
found
with
my
location
in
the
southern
region.
B
I
am
positioned
to
utilize
many
of
our
state
agencies
and
programs,
both
with
our
northern
teams
and
our
southern
teams.
So
I
am
supported
by
the
southern
regional
mdt
teams
and
also
northern
and
southern
our
coalitions.
I
am
very
lucky
to
have
several
coalitions
in
the
southern
region
I
have.
That
is
where
I
have
found
a
lot
of
the
strength
and
a
lot
of
our
boots
on
the
ground
and
been
able
to
have
incredible
visibility
and
identification
of
the
strengths,
weaknesses
and
opportunities
across
the
southern
region.
B
B
B
A
Thank
you,
miss
donahue.
You
have
taken
quite
the
effort
over
there
and
really
brought
in
a
wealth
of
information
for
being
there
for
eight
months.
So
congratulations
on
pulling
together
your
committee
looking
forward
or
your
board
looking
forward
to
seeing
how
you
guys
flush
things
out
next
month
and
and
look
forward
to
seeing
if
you
guys
come
up
with
a
bill
are
thank.
A
On
thank
you
on
this
raw
behavioral
health
policy
board.
A
I
don't
see
any
okay,
we'll
move
on
to
the
next
one,
the
last
but
not
least,
washoe
regional
behavioral
health
policy
board,
miss
edwards
believe
in
carson
city
to
present
on
on
the
board
I
serve
on,
so
I'm
looking
forward
to
for
everyone
else
to
hear
what
we're
trying
to
do
with
that
board.
Please
introduce
yourself
and
proceed
when
you're
ready.
L
Good
morning,
madam
chair
members
of
the
committee
staff
and
guests,
I
am
dorothy
edwards,
the
washer
regional
behavior
health
coordinator.
I
also
submitted
a
summary
that
provides
a
bit
more
explanation
of
what
I'll
touch
on
this
morning.
I
ask
your
forgiveness,
I'm
going
to
read
from
notes
to
stay
on
time
and
on
task.
L
The
responsibilities
as
you
heard,
along
with
the
criteria
for
board
composition,
are
outlined
in
nrs
433,
but
you
can
see
we
have
a
strong
composition
of
subject
matter
experts.
The
board
is
currently
chaired
by
former
senator
giuliarati
in
her
current
role
as
director
of
programs
and
projects
for
the
health
district.
The
vice
chair
is
steve.
Shell,
who
serves
as
the
vice
president
of
behavior
health
at
renowned
health
and
then
we're
honored
to
have
the
fabulous
assemblywoman,
sarah
peters,
as
our
legislator.
L
You
can
find
a
much
more
detailed
breakout
of
data
and
policy
development
in
the
annual
report
and
the
behavioral
health
profile
that
we,
as
coordinators,
do
each
year
developing
a
crisis
response
system
has
been
washo's
largest
area
of
attention.
Frankly,
for
the
last
several
years,
we
know
that
people
are
experiencing
challenges
to
mental
and
behavior
health
on
a
daily
basis.
L
Additionally,
covet
19,
it
has
impacted
not
only
the
economic
and
physical
well-being
of
communities,
but
the
mental
health
of
individuals
and
families
across
the
country.
A
robust
crisis
response
system
ensures
that
every
person
in
crisis
receives
the
right
help
at
the
right
time
in
the
right
place.
Far
too
often,
and
probably
repeating
what
you
know.
L
This
has
been
an
amazing
collaboration,
because
what
you
don't
see
too
often
is
what
we
are
now
experiencing:
collaboration
and
leadership
at
the
table
from
city
and
county
law
enforcement,
emergency
responders
and
other
behavior
health
professionals.
We
have
subject
matter
experts,
technical
advisory
committees,
all
following
samsha's
guideline
for
behavioral
health
crisis.
L
So
just
to
remind
you
before
I
move
on
the
three
prongs
or
legs
of
a
crisis,
now
well
can't
say:
crisis
now,
anymore.
That's
copyrighted!
I
think,
but
the
cop,
the
crisis
response
system
is
first
someone
to
talk
to
and
that's
represented
by
our
crisis
support
services
call
center
a
call
line,
also,
of
course,
enhanced
now
by
our
988
call
center
ability,
then
someone
to
respond,
so
this
will
be
a
mobile
response
team
composed
of
a
peer
and
a
mental
health
clinician.
L
This
does
not
take
the
place
of
the
higher
level
most
team,
which
is
comprised
of
law
enforcement
and
a
higher
level
clinician
when
law
enforcement
is
necessary,
but
most
of
the
time
we're
finding
that
that
would
not
be
the
case
and
then,
thirdly,
it's
some
place
to
go,
and
that
is
the
crisis
stabilization
center,
and
this
is
what
washer
county
we're
currently
working
to
roll
out.
I
couldn't
give
you
a
date.
L
We
spent
last
year
on
our
implementation
plan
and
now
that
we've
perhaps
identified
a
vendor
in
a
location
we're
hoping
this
next
year,
so
to
actually
roll
out
an
opening
I'll.
Keep
you
informed
so
another
subject
that
we
considered
a
priority
over
the
last
couple
years
was
the
equitable
focus
on
substance
use
disorder.
L
We
actually
were
able
to
address
that
in
our
last
legislative
session,
bdr,
which
was
senate
bill
69
and
that
actually
addressed
several
areas
around
substance
misuse
and
I
have
provided
some
bullets
there.
I
won't
read
to
you
but
priorities
for
the
board.
This
outlines
some
of
the
additional
areas
the
board
has
identified
this
year.
L
We
also
host
the
ambassadors
and
thank
you
to
the
state
for
helping
with
that.
That's
a
group
of
paraprofessionals
who
have
reached
out
to
every
individual
who
has
agreed
that
has
tested
positive
for
covid
19,
provided
daily
a
list
by
the
health
district
and
to
offer
help
and
support.
I
should
have
brought
the
data
I
did
not.
I
can
provide
that,
but
we
have
had
thousands
of
contacts
and
it
has
just
been
phenomenal
what
these
people
have
been
able
to
help
these
individuals
just
get
resources.
L
Sometimes
they
don't
need
anything,
but
sometimes
they
need
someone
to
talk
to.
I
was
contacted
last
week
to
see
if
we
could
provide
some
resources
to
those.
Fortunately,
small
handful
of
individuals
have
texted
positive
with
monkey
pox
and
we
have
been
able
to
provide
some
assistance
there
as
well
diversity
and
inclusion.
The
behavioral
health
needs
of
minority
communities
have
been
historically
and
disproportionately
underrepresented.
L
L
So,
lastly,
our
legislative
priorities
over
the
last
biennium,
I
mentioned
the
2021
bdr,
which
was
born
as
sb69
that
was
passed
and
then
this
year
so
give
me
some
grace.
Last
just
last
week
our
board
voted
on
our
concept
and
you
might
be
surprised
because
we
have
been
all
about
crisis
response
in
our
county
and
around
our
board.
So
you
might
be
surprised
to
hear
that
our
bdr
is
also
focusing
on
an
component
of
workforce
development.
It
was
a
unanimous
vote
by
our
board,
but
really
the
reality
is.
L
We
can
have
a
beautiful
crisis
center,
a
nice
building
with
all
the
bells
and
whistles.
We
can
have
policies
in
place.
We
can
have
a
robust
plan,
but
if
we
don't
have
staff
to
address
the
behavioral
health
crisis
before
during
and
after
it's
all
for
naught
waste
of
money
time,
and
so
we
realized
that
we
have
to
also
forge
ahead
with
pushing
workforce
development.
Now
again,
our
concept
is,
I
have
a
couple
sentences
to
describe
it.
L
We're
still
fleshing
it
out,
we're
anxious
to,
of
course,
work
with
our
rural
regional
board
and
then
any
other
supporters.
Frankly,
of
legislation
that
has
to
do
with
workforce
development,
but
our
current
concept
will
focus
on
increasing
and
retaining
our
behavioral
health
workforce
through
more
graduate
medical
education
slots
slots,
such
as
psychiatry,
aprns,
we're.
Looking
at
advancement
in
the
other
licensure
areas
as
well
we're
looking
into
the
need
for
more
support
for
organizations
and
individuals
who
supervise
residents
and
interns,
and
ms
haskins
gave
us
a
great
overview
of
that
need.
L
So,
as
I
said,
we're
just
now
exploring
we've
got
meetings
scheduled
next
week,
we're
working
with
hospitals,
unr
and
some
of
our
other
partners
to
sort
of
really
fully
flesh
out
the
concepts
so
that
we
can
support
it
to
lcb
by
our
deadline.
So
that
gives
you
an
overview
of
what
washoe
county
is
busy
doing.
I
invite
you
to
attend
the
meetings
if
you'd
like,
and
certainly
reach
out
to
me,
if
you
have
any
further
questions.
A
A
A
Thank
you
all
for
sticking
around
appreciate
your
time
today,
looking
forward
to
seeing
these
bdrs
gets
fleshed
out
and
working
together
on
them
in
this
coming
next
coming
legislation
legislative
session,
I'm
going
to
go
ahead
and
close
out
that
agenda
item
and
move
on
to
agenda
item
6.
an
overview
of
the
patient
protection
commission
department
and
health
and
human
services
and
its
work
during
the
2021-2022
legislative
interim.
A
C
C
Today
I
will
be
giving
you
an
overview
of
the
patient
protection
commission
or
ppc,
as
well
as
the
priority
focus
of
the
ppc
over
the
past
year,
the
healthcare
cost
growth
benchmark
and
then,
finally,
a
brief
overview
of
the
three
bill.
Draft
requests
or
bdrs.
The
commission
will
put
forward
to
the
legislative
council
bureau.
C
C
C
These
included
the
commission's
membership
additional
responsibilities
and
topics
for
review
assigned
to
the
ppc
movement
of
the
ppc,
from
the
governor's
office
to
the
department
of
health
and
human
services
required
the
ppc
to
adopt
bylaws
and
designated
the
ppc
as
the
sole
state
agency
responsible
for
managing
nevada's
participation
in
the
peterson
millbank
program.
For
sustainable
health
care
costs
and
we'll
talk
a
little
bit
more
about
that
piece
later,
the
current
makeup
of
the
ppc
is
as
follows.
C
C
The
recurring
goal
the
ppc
wholeheartedly
agrees
on
is
doing
what's
truly
best
for
the
patient.
I
see
this
reflected
in
their
work
and
recommendations
in
this
short,
while
I've
been
with
the
ppc
since
april
of
this
year,
as
codified
in
nrs,
the
ppc
is
charged
with
systematically
reviewing
issues
related
to
the
healthcare
needs
of
residents
of
nevada
and
the
quality,
accessibility
and
affordability
of
health
care,
including
prescription
drugs,
most
notably
for
the
primary
focus
of
the
ppc.
During
the
interim,
this
review
includes
examining
the
cost
of
health
care
and
the
primary
factors
impacting
those
costs.
C
This
executive
order
was
in
conjunction
with
nevada's
acceptance
into
the
peterson
millbank
program
for
sustainable
health
care
costs.
Back
on
march
1st
of
2021,
the
ppc
did
not
meet
from
june
through
september
due
to
membership
constraints.
Therefore,
after
the
executive
order
was
signed
in
december,
the
reconstituted
ppc
revisited.
This
topic.
C
The
ppc
also
created
a
stakeholder
advisory
subcommittee,
initially
developed
in
2021
to
advise
the
ppc
on
all
matters
relating
to
the
peterson
millbank
program
for
sustainable
health
care
costs.
Since
its
inception,
the
subcommittee
had
21
members
all
appointed
by
the
ppc
and
has
truly
served
its
purpose
over
the
past
12
months
in
reviewing
strategies
associated
with
the
healthcare
cost
growth
benchmark.
C
C
The
work
associated
with
the
peterson
millbank
program
for
sustainable
healthcare
costs
has
been
the
primary
focus
of
the
ppc
over
the
interim.
The
technical
assistance
awarded
to
nevada
and
associated
with
this
program
will
currently
expire
after
december
31st
2022.
However,
the
work
will
continue.
C
The
cost
growth
benchmark
is
one
of
the
first
steps
in
helping
to
make
health
care
more
affordable
and
transparent
in
nevada.
To
support
the
statewide
effort.
With
the
peterson
milbank
program,
governor
syslak
had
requested
assistance
of
the
ppc
to
provide
recommendations
specifically
to
develop
a
statewide
healthcare,
cost
growth,
benchmark,
calculate
and
analyze,
statewide
healthcare
cost
growth
and
to
analyze
the
drivers
of
healthcare
cost
growth
per
this
request.
The
ppc
has
been
hard
at
work
with
the
peterson
milbank
and
baylet
health
to
provide
these
three
recommendations
to
the
governor.
C
So
what
is
a
health
care?
Cost
growth
benchmark,
so
the
official
definition
is
that
it
is
an
annual
rate
of
growth
benchmark
for
healthcare
costs
in
a
given
state.
I
also
provided
some
national
statistics
here,
so
you
can
see
between
2015
and
2019,
the
average
per
capita
healthcare
cost
growth
was
4.1
for
those
same
years.
C
Some
key
points
to
keep
in
mind
about
a
health
care
cost
growth
benchmark
are
setting
a
a
public
benchmark
for
a
healthcare
spending.
Growth
alone
will
not
slow
the
rate
of
growth.
A
cost
growth
benchmark
serves
as
an
anchor
establishing
an
expectation
that
can
serve
as
the
basis
for
transparency
at
the
state,
insurer
and
provider
levels.
C
Here.
I'd
like
to
share
with
you
the
visual
model
associated
with
explaining
what
a
cost
growth
benchmark
is
and
the
alignment
with
the
focus
and
activities
of
the
ppc
over
the
interim.
First,
we
start
with
measuring.
We
have
to
first
measure
performance
relative
to
the
anchor
or
the
benchmark.
Next,
we
analyze.
Okay.
So
we
see
that
our
performance
either
falls
above
or
below
the
benchmark
for
a
given
year.
Now,
let's
do
a
deeper
dive
into
that
data.
C
To
find
out
why
what
specific
factors
relative
to
health
care
costs
are
driving
those
costs
higher
or
lower
in
a
given
category
after
the
analysis
phase
is
complete.
We
then
report
on
the
findings.
Here's
what
we
found
out
as
to
what
specific
factors
are
driving
up
health
care
costs
in
the
state.
It
is
also
important
to
note
here
that
the
findings
will
be
shared
with
the
health
care
and
insurer
industry
prior
to
being
publicly
released,
so
the
industry
can
additionally
validate
the
findings
for
accuracy
and
be
well
poised
for
public
release
of
the
report.
C
After
reporting
out
on
the
analysis,
we
would
then
have
conversations
within
healthcare
industry
experts
in
nevada
to
identify
those
opportunities
and
potential
strategies
to
help
slow
healthcare
cost
growth
in
the
state
in
a
collaborative
and
effective
way.
Lastly,
of
course,
we
work,
together
with
our
partners,
to
implement
those
cost
growth
strategies.
C
A
few
points
to
highlight
around
executive
order,
number
2021-29
for
the
nevada
healthcare
cost
growth
benchmark
are
that
this
executive
order
established
the
healthcare
cost
growth
benchmark
for
years
2022-22,
and
this
set
a
benchmark
of
3.1
3.19
percent
cost
growth
for
year
2022
when
compared
to
prior
year's
spend.
The
intent,
of
course,
is
to
help
curb
those
climbing
healthcare
costs,
because
this
work
has
been
the
primary
focus
of
the
ppc
over
the
interim
I'd
like
to
further
highlight
some
recent
ppc
activities
with
regard
to
the
benchmark.
C
C
This
data
was
presented
at
the
monthly
ppc
meeting
on
april
20th,
which
is
archived
on
the
ppc
website.
If
you're
interested
in
viewing
the
cost
growth
benchmark
program
will
assess
healthcare,
cost
growth
for
all
nevada
residents,
with
commercial,
both
insured
and
self-insured,
medicaid
and
medicare
coverage,
or
who
receive
health
care
through
the
veterans,
health
administration
and
the
state
correctional
system,
health
care
cost
growth
at
the
state
level
is
measured
using
total
health
care
expenditures,
which
includes
claims
spending,
non-claims
based
spending,
consumer
cost
sharing
and
ensure
administrative
costs.
C
First,
just
some
brief
background.
Nrs218D.213
authorizes
the
ppc
to
request
the
drafting
of
not
more
than
three
legislative
measures
which
relate
to
matters
within
the
scope
of
the
commission.
Since
march,
the
ppc
has
been
having
a
more
focused
discussion
on
potential
bdr
topics
for
the
2023
session.
C
A
total
of
16
topics
were
initially
brought
forward
for
consideration,
which
truly
is
an
impressive
number
for
such
a
young
commission
with
one
topic
being
withdrawn,
a
total
of
15
topics
have
been
up
for
consideration
for
a
few
months.
Now,
after
much
deliberation
and
discussion,
the
ppc
has
reached
consensus
on
its
final
three
bdrs
in
support
of
the
charge
of
the
ppc.
C
C
Additionally
of
note
for
this
item,
the
ppc
also
voted
yesterday
to
include
this
topic
in
a
letter
to
the
legislature,
noting
full
recommendation
and
support
of
the
ppc
for
this
topic
being
put
forward
during
the
2023
session.
I
will
be
drafting
the
document
and
posting
for
consideration,
approval
and
signature
of
the
ppc
anticipated
during
the
september
meeting.
C
A
K
So,
thank
you.
Thank
you,
madam
chair,
for
the
question,
and
thank
you
for
your
presentation.
I
definitely
you
have
perked
my
interest
in
your
potential
3bdrs
and
I
definitely
want
to
hear
more
about
them
because
of
potential
positive,
but
also
significantly
negative
impact.
K
If
that
bdr
as
a
primary
care
provider,
we
were
mandated
that
we
go
to
electronic
medical
records,
but
we
weren't
mandated
that
to
communicate
with
each
other,
so
everybody
started
their
own
medical
records
and
then
it
really
has
been
a
problem.
Unfortunately,
the
cost
of
doing
all
that
to
the
providers
has
been
tremendous
and
I'm
concerned
that,
although
the
it
may
be
well
intended,
it
may
have
significant
negative
impact.
K
So
as
that
particular
one
moves
forward,
I'd
love
to
have
some
more
information
on
that
as
you
and
your
board
meet,
I
appreciate
what
you're
trying
to
do,
but
again
sometimes
you
know
the
pathway
to
you
know
where
is
paved
by
good
intentions,
and
so
I
it
just.
I
have
big
concerns
about
that,
so
I
would
appreciate
some
follow-up
on
that.
K
As
it
moves
forward,
I
am
also
somewhat
concerned
about
your
first
and
second
third
bdr
drafts
and
would
love
to
be
involved,
as
as
you
me
and
your
meeting
again
in
september,
to
kind
of
kind
of
sort
some
of
this
out
on
what.
But
those
are
the
three
potential
bill
drafts
you
might
throw
others
in
or
those
are
what
you're
going
with.
C
Melinda
sidler
for
the
record,
so
these
three
bdrs
that
I
presented
today
will
be
the
three
bdrs
that
the
commission
is
decided
to
put
forward
to
the
legislature.
Good.
K
And
then
so
you're
going
to
do
that
you're
going
to
send
that
forward,
but
obviously
the
the
language
isn't
has
been
developed
at
this
point
in
time.
These
are
conceptual
so
if
to
whatever
extent
possible
before
they
are
submitted
as
final
draft
to
the
legislature,
I'd
love
to
be
able
to
support
them,
but
it
helps,
if
I
know
what's
in
them
beforehand,
so
that
I'm
not
testifying
against
them
when
I'm
in
the
senate.
So
I'd
appreciate
your
reaching
out.
Thank
you.
C
A
Assemblywoman
for
just
a
little
longer
just
a
little
bit,
thank
you,
melinda
and-
and
I
think
this
is
a
a
kind
of
an
important
point
to
make
that
these
bdr
wrecks
are
are
conceptual
at
this
point
and
that
they
are
getting
flushed
out
through
the
research
and
development
process
up
until
they
are
introduced
in
session,
and
then
we
still
have
the
entire
legislative
session
through
stakeholder
working
together,
stakeholders
working
together
prior
to
and
beyond
the
initial
hearings
and
voting
on
on
these
bills
in
both
houses.
A
So
the
the
process
is
not
complete.
It
is
really
just
the
beginning
of
a
vast
process
through
getting
these
bdrs
to
into
law.
Anyways.
Thank
you
for
your
presentation.
I
don't
see
any
additional
comments
coming
up.
We
look
forward
to
seeing
these
flesh
out
and
and
receiving
some
of
those
letters
you
mentioned.
Thank
you
so
much
for
being
here
today,
miss
sutherd.
A
A
A
A
All
right
we're
going
to
get
started
here
if
folks
can
turn
their
cameras
on
and
get
back
in
their
seats.
I
wanna
call
us
back
and
take
our
convening
and
open
up
our
agenda
item
seven,
which
is
our
work
session,
hope
everyone
has
their
work
session
documents
in
front
of
you.
We've
had
some
suggestions
on
language
changes
that
we're
gonna
go
through
as
we
as
we
go.
I'm
gonna
ask:
let's
see
I'm
going
to
go
back
to
my.
O
A
Is
ready
for
his
last
his
last
committee
meeting
to
be
done?
We
so
in
most
cases?
Yes,
I
would
say
the
same
thing
and
I've
asked
staff
for
their
input
on
the
importance
of
some
of
these
language
changes
that
have
been
suggested.
There
are
a
couple
where,
as
we
saw
from
judiciary
interim
judiciary
committee,
they
adopted
a
measure
that
was
included
in
one
of
ours.
A
I'm
looking
at
that
as
if
we
don't
include
certified
in
this
bdr
draft
language,
we
may
be
looking
at
some
significant
fiscal
notes
on
it.
So
we'll
change
that
and
then
we
happen
to
have
one
extra
bdr,
and
so
I
was
going
to
to
ask
to
split
one
of
these
out.
So
we've
just
got
a
couple
of
things
to
go
over,
not
big
modifications
to
language
at
all,
but
just
some
things
to
clean
these
up
before
we
hand
them
over
to
the
drafting
process.
A
Okay,
so
moving
on,
we
have
the
work
session
members.
The
work
session
document
is
posted
on
the
committee's
meeting
page.
There
are
also
hard
copies
over
here
if
you'd
like
on
the
tables
in
the
committee
rooms,
if
you'd
like
to
grab
one,
it
contains
a
list
of
proposed
recommendations
related
to
child
welfare,
the
coven
19
health
crisis,
interim
study
and
multiple
other
matters
in
the
purview
of
our
committee.
A
P
P
P
P
Thank
you.
We
will
begin
with
a
recommendation
a
regarding
commercially
sexually
exploited
children
or
csg,
which
you
can
find
on
page
two
of
the
work
session
document.
This
recommendation
was
proposed
by
bridget
duffy
chief
deputy
district
attorney
at
the
clark
county
office
of
the
district
attorney
during
the
april
21
2022
hhs
meeting.
P
Stakeholders
indicated
these
misdemeanor
offences
are
more
likely
to
bring
victims
of
commercial
sexual
exploitation
to
the
attention
of
law
enforcement,
chair,
peters
and
committee
members.
I
want
to
note
that
last
friday
the
joint
interim
standing
committee
on
judiciary
voted
to
draft
legislation
that
is
similar
in
its
request
to
item
two
of
the
csec
recommendation,
which
is
the
requirement
to
use
c-sec
screening
methods.
P
A
Thank
you
so
much
patrick,
mr
ashton.
I
would
like
to
ask
for
questions,
but
I
want
to
just
reiterate
that
this
is
not
the
forum
for
debate
on
these
these
bills.
These
are
not
bills.
These
are
bdr
ideas.
So,
if
you
have
questions
related
to
the
ideas
we
do
have
experts
in
the
room
are
there
any
questions
from
the
committee.
A
Thank
you
so
much
senator.
I
have
a
motion
to
approve
the
recommendation
with
the
removal
of
a
number
item
number
two
on
our
recommendation
list.
A
K
Yeah
I
I
am-
I
I
tried
to
grab
my
microphone
before
when
there
was
a
discussion,
so
I'm
sorry
that
I
didn't
get
that
in
I'm
going
to
support
it,
but
I
want
to
do
with
the
caveat
that
the
ultimate
final
bdr
I
may
not
be
able
to
support
until
I
see
it,
so
I'm
going
to
support
it
absolutely
to
get
it
out
of
this
work
session.
Thank
you.
A
Well,
I
appreciate
that,
as
always,
this
is
not
a
commitment
to
a
vote
during
session.
I
appreciate
your
discretion
in
that,
but
I
and
and
also
appreciate
you
helping
us
move
this
forward
with
that.
The
motion
carries
with
those
in
attendance.
A
A
We
will
make
note
of
your
support
of
the
work
session
document
in
the
session
I'm
just
kidding.
We
won't
hold
you
to
that
all
right.
I
think
we
could,
if
that's
all,
I
just
want
to
check
in
and
make
sure
we
follow
the
process.
Everything's
clear,
we're
good
to
go.
We're
going
to
move
on
to
work
session,
item
b.
P
Thank
you,
madam
chair,
for
the
record
of
patrick
ashton.
Next
is
recommendation
b
on
homeless,
youth
and
young
adults
under
25
years
of
age
who
are
experiencing
homelessness,
which
you
can
also
find
on
pages
two
and
three
on
the
work
session
document,
and
this
recommendation
was
developed
by
chair
peters
in
consultation
with
committee
staff.
P
The
division
shall
collaborate
with
the
dmv
to
facilitate
this
additional
outreach
service.
Now.
Moving
to
item
2
of
this
pdr
recommendation
require
a
county
with
a
population
of
100
000
or
more
residents
to
develop
a
strategic
plan
to
address
homelessness
by
the
respective
governing
bodies
of
the
county
and
the
cities
within
the
county.
P
The
strategic
plan
shall
contain
the
sub
items
a
through
e,
as
outlined
in
the
work
session
document
on
page
three.
Each
such
county
shall
develop
a
strategic
plan
on
homelessness
and
present
it
to
the
joint
and
term
standing
committee
on
health
and
human
services.
Next
legislative
interim,
madam
chair.
O
A
O
I
think
I
moved
to
approve
this
as
a
bdr
and
as
much
as
its
committee
bdr.
I
recognize
that
we
aren't
held
to
what
is
actually
going
to
be
in
the
verbiage,
nor
are
we
held
to
that
we're
actually
going
to
support
it
during
the
next
legislative
session,
but
this
will
obviously
my
emotion
will
include
it
to
be
a
bdr
which
will
be
discussed,
debated
and
dissected
during
the
session.
A
Thank
you
for
that
any
other
discussion,
seeing
none
all
those
in
favor,
please
signify
by
saying
I
are
raising
your
hand.
A
Any
opposed
motion
passes
with
those
in
attendance.
P
Thank
you,
madam
chair,
for
the
record
patrick
ashton
committee
policy.
Analyst.
Now
we
are
moving
to
item
c
behavioral
health
care.
On
pages
four
and
five
of
the
work
session
document.
This
recommendation
was
developed
by
chair
peters
in
consultation
with
committee
and
dhhs
staff
in
response
to
various
testimony
at
the
march
24th
hhs
meeting.
P
There
are
two
items
under
this
recommendation
for
bdr.
The
first
item
relates
to
a
regulatory,
clinical
oversight
of
behavioral
health
care.
Specifically
number
one
require
dcfs
and
dpbh
dhhs
to
each
formulate
and
operate
a
comprehensive
statement
for
behavioral
health.
Clinical
standards
of
care
for
children
and
adults.
P
Either,
division
shall
review
the
applications
and
advise
the
applicants
concerning
the
applications
item
4
require
each
division
to
certify
or
deny
the
certification
of
behavioral
healthcare
programs
based
on
the
standards
established
by
either
dcfs.
If
relating
to
programs
treating
children
or
the
state
board
of
health.
P
The
second
item,
under
this
bdr
under
this
bdr
recommendation,
relates
to
cost
savings,
reinvestments
and
children's
behavioral
health
systems
of
care.
The
bdr
would
define
the
children's
behavioral
health
system
of
care,
as
outlined
in
sub
items
a
and
b
of
item
six
item.
Seven.
It
would
require
a
commission
on
behavioral
health
dpbh
dhhs
to
track
the
spending
of
federal
funding
in
the
children's
behavioral
health
system
of
care
to
account
for
costs
avoided
across
the
child.
Serving
systems
within
dhhs
item
a
to
require
dhhs
to
establish
an
evidence-based
methodology
to
quantify
averted
expenses.
P
Cheer
peters
dr
woodard
and
dr
petlock
are
available
for
questions.
Madam
chair.
A
A
Is
there
any
discussion
on
the
motion
seeing
none
all
those
in
favor
say
I
or
raise
your
hand,
I
any
opposed,
nay
seeing
none.
The
motion
carries
with
those
in
attendance.
Thank
you
so
much
this
is.
This
is
a
big
lift,
but
I'm
very
I'm
very
excited
for
the
future
of
nevada's
behavioral
health
systems.
P
P
P
The
recommendation
is
to
request
a
bdr
to
revise
the
definition
of
child
care
institution
and
nrs-432a
o245
to
include
qrtps
pursuant
to
the
family.
First
prevention
services
act.
The
qrtps
should
be
able
to
provide
services
for
up
to
25
children
different
from
a
child
care
institution
which
provides
services
to
16
or
more
children.
We
have
trainer
checo
present,
as
well
as
several
representatives
from
dhhs
to
answer
questions
madam
chair.
A
Thank
you
so
much,
mr
ashton.
Are
there
any
questions
from
the
committee
seeing
none?
I
would
entertain
a
motion
to
approve
the
recommendation.
A
motion.
I
have
a
motion
from
vice
chair
donate.
Do
you
have
a
second
from
assemblywoman
gorilla,
any
discussion
on
the
motion
before
we
vote
all
those
in
favor,
please
signify
by
saying.
I
are
raising
your
hand.
I
any
opposed,
nay,
the
motion
passes
with
those
in
attendance.
Thank
you
so
much.
Please
go
ahead
to
agenda
item
eight.
P
Puerto
rico,
patrick
ashton,
committee
policy,
analyst
recommendation
e,
is
on
fetal
alcohol
spectrum
disorders
or
a
f,
a
sd
which
you
can
find
on
page
five
and
six
of
the
work
session
document.
This
recommendation
was
proposed
by
the
corante
gift,
autism
foundation,
children's
advocacy
alliance
and
the
nevada
chapter
of
the
american
academy
of
pediatrics.
During
the
solicitation
of
recommendations
period,
the
recommendation
is
to
request
a
pdr
to
add
fetal
alcohol
spectrum
disorder
to
the
definition
of
developmental
disability
set
forth
and
nrs435007.
P
And
revise
nrs-44203
to
read:
fetal
alkyl
fetal
alcohol
spectrum
disorder
instead
of
fetal
alcohol
syndrome
and
make
corresponding
changes
throughout
nrs
committee
members
we
have
several
representatives
present
from
the
entities
that
made
this
recommendation
as
well
as
dhhs
subject
matter
experts
the
workstation
document
also
contains
a
brief
intent
of
this
recommendation.
Madam
chair.
A
Thank
you,
mr
ashton.
Are
there
any
questions
on
this
item?
Seeing,
oh
see,
sorry,
I
thought
dr
titus
was
reaching
forward
for
her
her
mind.
Isn't
seeing
none
I
was
there.
I
would
entertain
a
motion
by
sure
donate.
Thank
you
a
second
from
assemblywoman
gorlo.
Thank
you.
Is
there
any
discussion
on
the
motion
before
we
vote
seeing
none
all
those
in
favor,
please
signify
by
saying
I
are
raising
your
hand
aye
any
opposed,
nay,
nah
motion
passes
with
those
in
attendance.
A
Thank
you
so
much
we'll
go
ahead
and
move
on
to
bdr
recommendation
f.
P
P
This
includes
to
evaluate
the
need
for
an
on-site
laboratory
review.
The
requirement
for
school
board
approval
if
the
school
based
health
center
is
near
school
and
not
on
school
grounds,
review,
medicaid
reimbursement
rates,
consider
opportunities
to
incentivize,
school-based
health
centers
and
also
then,
to
submit
the
study's
findings
and
recommendations
to
the
joint
interest
standing
committee
on
health
and
human
services
by
december
31st.
P
2023
number
two
requires
dhhs
to
develop
a
resource
office
to
help
providers
with
the
certification,
medicaid
enrollment
and
billing
for
school
health
services
and
certified
school-based
health,
centers
or
other
alternatives
such
as
such
as
a
satellite
clinic
for
those
currently
able
to
build
medicaid
through
physician
provider,
types
and
number
three
ensure
school-based
health
centers
are
enrolled
in
medicaid,
manage
manage
care
provider
networks
by
requiring
medicaid
managed
care
organizations
to
contract
with
all
school-based
health
centers.
By
designating
the
school-based
health
clinics
as
essential
community
providers
for
the
medicaid
managed
care
programs,
chair,
peters
and
committee
members.
P
A
A
K
Please
go
ahead.
Thank
you
so
whoever's
here
to
to
answer
those
so
school-based
health
centers.
I
take
it
already
exist.
K
A
That
is
a
great
question.
The
point
of
this
study
is
to
review
the
requirement
for
a
school
board
to
approve
how
much
that
is.
An
issue
to
date
is
not
clear,
but
it
is
important
to
assess
that
as
a
potential
barrier
to
access
to
off-campus
school-based
health
centers,
which
essentially
would
be
community
health,
centers.
K
So
just
thank
you
for
that,
so
clarification
do
have
have
all
17
different
county
school
boards
in
any
of
those.
Are
the
regulations?
Do
you
we
don't
know
if
there
are
any
regulations
that
limit
them
off?
You
know
off
campus
from
the
school
boards.
I
mean.
I.
A
Do
we
have
I'm
trying
to
remember
who's
on
our
call.
O
Obviously,
you
have
to
have
all
sorts
of
things
that
the
center
has
to
be
able
to
qualify
for
medicaid
reimbursement
as
well
as
the
provider,
and
so
the
study.
As
I
see
it,
is
putting
together
what
it
would
take
to
have
a
either
on-site
or
off-site.
O
Provider,
ship
and
a
provider
in
order
to
qualify
for
medicaid
reimbursement,
which
is
problematic
and
I'm
sure
somebody
has
done
it
somewhere,
but
it
is
something
that
would
be
a
new
preacher.
As
I
understand
it
could
have
a
lot
of
hoops
to
jump
through,
and
I
think
this
study
is
trying
to
figure
out
what
those
hoops
are.
So
they
could
do
it
and
I
don't
think
that
maybe
all
school
boards
are
going
to
be
able
to
adjust
to
it.
But
I
think
that's
why
we
study
it.
O
A
Thank
you
for
that.
I
believe
that
miss
ives
with
dpbh
was
on
unwilling
to
jump
in
on
this
one.
Please
proceed.
D
D
A
Thank
you,
and-
and
I
want
to
be
clear
on
the
point
of
a
study,
dr
titus.
We
we
have
this
ability
to
pull
together
school-based
health
centers.
It
exists,
we
don't
have
very
many
and
it
seems
like
low-hanging,
fruit
for
access
to
children
and
their
families
on
creating
relationships
with
primary
care
providers
and
with
other
providers.
We
have
private
partners
such
as
community
health,
I'm
sorry
communities
in
schools
and
I
think
family
first
in
las
vegas
does
this
as
well,
where
they
act
as
kind
of
care
managers
and
coordinators
for
kiddos
in
schools.
A
So
we
are
already
trying
to
piece
parts
of
this
together.
This
bill
is
really
trying
to
pull
everyone
into
the
same
room
to
talk
about.
How
does
it
work
on
the
ground?
What
works
for
everybody
and
what
doesn't
and
how
can
we
make
sure
that
we
are
getting
kids
the
best,
the
best
carrot
that
we
can
where
they
are,
which
you
know
because
school
is
mandated
in
schools.
A
K
Up
right,
so
I
so
I
do
and
thank
you
for
that.
I
do
appreciate
the
concept
just
want
to
make
sure
that
is
this
really
do
we
need
a
bdr?
Do
we
need
a
a
law
a
bill
to
address
this
is
or
is
it
something
we
can
do
outside
that
scope?
K
You
know
perhaps
through
the
division
of
healthcare,
but
it
sounds
like
it's
kind
of
forcing
folks
to
communicate
with
each
other
and
sometimes
that's
what
our
job
is
making
this
thing
happen,
so
I'm
supportive
of
the
concept,
but
the
next
question
I
also
had
was
the
number
three,
which
was
the
ensure
that
they're
enrolled
in
medicaid
managed
care
provider
networks,
certainly
out
in
the
rurals
in
many
areas,
our
hospitals,
our
fee
for
service
and
those
kind
of
things
and
met
and
mandating
that
they
are
enrolled
in
medicaid
will
be
an
interesting
concept,
especially
if
they
have
to
in
the
managed
care
provider
network,
so
I'll,
be
interested
to
see
how
this
progresses
and
how
that
communication
happens
and
some
of
the
information
we
get
for
it.
A
Thank
you
for
that
you're
asking
a
lot
of
the
questions
that
I
think
will
be
have
to
be
flushed
out
before
session.
Obviously,
so
I
look
forward
to
continuing
to
talk
about
what
our
different
needs
are
in
the
communities
based
on
this
all.
Right
with
that,
I
would
entertain
a
motion
to
approve
the
recommendation.
O
A
Chair
donate,
oh
thank
you.
So
much.
I've
got
a
second
from
senator
hardy.
Is
there
any
discussion
on
the
motion
before
we
vote,
seeing
none
all
those
in
favor,
please
signify
by
saying.
I
are
raising
your
hand.
I
any
opposed,
nay
motion
passes
with
all
those
intendents.
Thank
you
so
much
go
ahead
and
move
into
bdr
item
g.
P
P
This
recommendation
was
developed
by
chair
peters
in
consultation
with
committee
staff,
in
response
to
testimony
provided
by
dhhs
staff
of
the
pharmaceutical
drug
pricing
transparency
program
at
the
july
21st
hhs
hhs
meeting.
The
recommendation
is
to
request
the
pdr
to
require
dhhs
to
license
and
regulate
pharmaceutical
sales
representatives
who
are
operating
within
the
state
and,
if
he's
collected
from
the
licensure
of
pharmaceutical
sales,
representation
shall
be
accounted
for
separately
in
the
state.
P
A
Thank
you,
mr
ashton.
Are
there
any
questions
on
this
recommendation,
seeing
none
I
would
entertain
a
motion
motion
from
the
vice
chair,
donate
you'll
have
a
second
from
assemblywoman
gorlo.
Is
there
any
discussion
on
the
motion
seeing
none
all
those
in
favor,
please
signify
by
saying.
I
are
raising
your
hand.
I
any
opposed,
nay,
raise
your
hand.
A
Is
that
titus
I
mean
I
can't.
Can
you
confirm
please
verbally,
which.
A
P
P
This
recommendation
was
developed
by
chair
peters
in
consultation
with
committee
staff,
in
response
to
testimony
provided
by
dhhs
staff
of
the
pharmaceutical
truck
pricing
transparency
program
at
the
july
21st
meeting.
The
recommendation
is
to
request
a
pdr
to
require
pbm
operating
within
the
state
to
obtain
a
license
from
dhhs
item.
P
Number
four
establish
a
fiduciary
responsibility
for
a
pbm
to
a
third-party
payer.
The
benefit
of
the
payer
is
the
primary
and
sole
interest
of
the
fiduciary
and
any
conflict
with
that
role
must
be
disclosed
and
avoided
and
number
five
prohibit.
Pbn's
medicaid
managed
care
plans.
Medicare
party
plans,
including
medicare
advantage
party
plans
and
private
health
insurers
to
the
extent
authorized
under
federal
law
from
reimbursing
less
for
prescription
trucks
because
they
were
purchased
under
the
federal
340b
truck
pricing
program,
which
is
also
called
discriminatory,
contracting,
see
also
attachment
h5
in
the
workstation
document
committee
members.
P
P
We
have
again
we
have
dr
slamo
with
as
the
dha
dhhs
subject
matter
expert,
as
well
as
representatives
from
the
nevada
primary
care
association
to
respond
to
any
questions
you
may
have.
Madam
chair.
A
Thank
you.
So
much
are
there
any
questions
from
committee
members
on
this
item.
K
Manager,
please
go
ahead,
thank
you
and
thank
you
for
bringing
this
forward.
I
think
it's
something
every
we
do
need
to
address.
There's
many
states
or
several
states
that
have
actually
passed
some
of
these
laws
and
other
states
that
the
laws
were
presented
but
didn't
pass
and
do
we
have
any
idea
what
we're
being
encouraged
to
model
california's
didn't
pass
arizona
passed,
a
program
that
may
or
may
not
work
in
nevada.
A
G
Yeah
eric
robbins
lcb
legal
for
the
record,
so,
basically,
under
current
law,
pharmacy
benefit
managers
are
drafted
or
are
they're
licensed
or
certified.
I
don't
remember
off
the
top
of
my
head
what
the
credential
is,
but
they
they
have
to
be
go,
go
through
some
sort
of
registration
process
with
the
division
of
insurance,
and
so
what
this
bill.
G
What
sb
392
did
proposed
to
do
last
session
was
to
take
that
out,
while
still
leaving
all
of
the
provisions
that
currently
apply
to
pbms
as
administer
administrators
and
basically
re-enacting
them
in
a
different
chapter
and
having
them
be
licensed
by
the
department
of
health
and
human
services
other
rather
than
the
division
of
insurance,
and
then
it
added
in
some
of
these
additional
provisions
about
prohibiting
spread
pricing
requiring
a
the
pbm
to
allow
a
client,
full
audit
rights
and
establishing
a
fiduciary
responsibility.
G
Currently,
a
pbm
has
a
duty
of
good
faith
and
fair
dealing,
so
it
would
change
that
verbage
a
little
bit,
but
there's
not
a
model
from
other
states.
It's
just
kind
of
trying
to
keep
what
we
have
an
existing
law
regarding
their
their
licensure
as
insurance
administrators
and
shifting
that
process
over
to
dhhs,
rather
than
doi.
A
Are
there
any
other
questions
from
the
comedian
this
item,
seeing
none,
I
would
entertain
a
motion
from
vice
chair,
donate
in
a
second
from
assemblywoman
gorilla.
Any
discussion
on
the
motion
before
we
vote
saying.
A
I
can
appreciate
that
all
those
in
favor,
please
signify
by
saying
aye
raising
your
hand
all
those
opposed.
Please.
O
K
Yeah
yeah,
I
I'm
a
yes
on
this
one
and
and
again
we'll
we'll
have
to
continue
the
discussion
further
down
the
line,
but
I'll
support
this
today.
A
P
P
The
recommendation
was
developed
by
cher
peters,
in
consultation
with
comedy
staff,
in
response
to
testimony
provided
by
various
stakeholders
at
the
february
17th
and
may
19th
hhs
meetings.
This
recommendation
was
also
recommended
by
belton
case
government
affairs,
representing
shatter
proof
and
on
behalf
of
the
nevada
collaborative
collaborative
care
model
coalition,
the
bdr.
P
The
recommendation
is
to
request
the
drafting
of
a
legislative
measure
to
amend
the
state
plan
for
medicaid
by
adding
a
coverage
requirement
for
mental
behavioral,
health
and
substance
use
services
and
that
are
delivered
through
evidence-based,
integrated
behavioral
health
care
models
such
as
the
collaborative
care
model
and
members.
We
have
dhhs
representatives
and
subject
matter
experts
from
the
entities
who
submitted
this
recommendation
present
to
respond
to
any
questions
that
you
may
have.
Madam
chair.
A
Thank
you,
mr
ashton.
I
want
to
just
apologize
earlier.
I
think
I
called
mr
robbins,
mr
eric.
It's
been
a
long
couple
of
days.
I
apologize
for
that.
Are
there
any
questions
from
the
committee
on
this
item?
A
Seeing
none
I
would
entertain
a
motion.
Vice
chair
donate
a
second
from
assembly
woman
gorlo.
Any
discussion
on
the
motion,
seeing
none
all
those
in
favor,
please
signify
by
saying
I
or
raising
your
hand
any
opposed,
nay
motion
passes
with
those
in
attendance.
Thank
you
so
much
we're
going
to
go
ahead
and
move
into
agenda.
Bdr
item
j
recommendation
day.
P
For
the
record,
patrick
ashton
comedy
policy
analyst
item
j
is
on
medication,
assisted
treatment
for
substance
use
disorder,
and
you
can
find
this
recommendation
on
page
eight
and
nine
of
the
work
session
document.
It
was
developed
by
chair
peters,
in
consultation
with
comedy
staff
in
response
to
testimony
provided
by
various
stakeholders.
At
the
february
17th
hhs
meeting,
the
recommendation
is
to
request
a
bdr
to
number
one.
P
I
require
any
health
care
provider
who
is
authorized
to
make
a
diagnosis
of
opioid
use
disorder
to
provide
information
and
counseling
on
evidence-based
treatment
options,
including
controlled
substances
used
for
medication,
assistant,
treatment
of
opioid
use
disorders,
approved
by
the
fda
to
a
patient.
The
provider
has
diagnosed
with
an
opiate
use.
Disorder
number
two
required
a
health
care
provider
to
prescribe
an
fda,
approved
medication
for
the
treatment
of
an
opioid
use
disorder
at
the
patient's
request.
As
long
as
such
such
a
medication
has
no
contraindications
for
the
patient.
P
If
a
person
is
incarcerated
in
a
jail
or
transferred
from
a
jail
to
a
prison
and
has
already
received
medication,
assistant
treatment,
the
jail
or
prison
must
facilitate
a
continuation
of
this
treatment.
The
child
or
prison
must
also
take
reasonable
measures
to
facilitate
continuation
of
medication
assistant
treatment
upon
release
members.
We
have
dr
woodard
from
dhs
dhhs
present
to
respond
to
any
questions
you
may
have.
Madam
chair.
A
Thank
you
so
much.
It
was
brought
to
my
attention
yesterday
that
some
of
this
language
in
item
two
did
not
get
directly
at
the
point
and
purpose
and
assemblyman
orrin
liquor
has
been
working
to
address
that
language.
Would
you
like
to
present
your
suggested
revision,
assemblyman
or
liquor.
F
Yes,
thank
you
so
yeah.
We
rather
than
saying.
O
A
Thank
you
that
does
get
to
the
intent
of
this
bdr
recommendation
as
we
worked
on
it,
so
I
would
be
happy
to
to
well
first
take
questions.
Are
there
any
questions
on
the
bdr
recommendation
as
presented
assemblywoman
titus?
Thank.
K
I
I
have
concerns.
Thank
you
first
for
that
clarification
on
number
two,
because
I
had
real
concerns
that
they
we
must
do
something.
This
state
has
been
actively
and
aggressively
going
at.
I
feel
opioid
addiction
for
a
number
of
years
now,
at
least
since
2015
in
my
first
session,
there's
been
rules
rightfully,
so
our
opioid
addiction
and
overdose
is
incredibly.
K
To
yet
add
more
regulation
when
we
have
seen
and
had
testimony
in
this
very
committee
that,
despite
all
of
that,
we
as
providers
have
done
a
better
job,
we
are
not
prescribing
the
medication
as
we
have
in
the
past.
The
state
was
successfully
involved
in
a
lawsuit
to
the
drug
companies
to
prevent
the
drug
companies
implications
and
the
providers
implications,
we've
all
stepped
up,
and
but
yet
we're
still
seeing
a
dramatic
increase
of
opioid
deaths.
K
We
all
know
where
the
the
drugs
are
coming
from
illegally
is
the
real
problem
and
we're
not
really
addressing
that
in
any
of
these
bdrs.
K
So
I'm
just
frustrated
that
this
is
the
opiate
bdr
that
we're
coming
up
with
and-
and
I
just
can't
support
yet
more
regulations
on
healthcare
providers
when
what
we
have
done
has
been
excellent
and
it
still
has
not
affected
the
outcomes
that
I
can
see.
So
I'm
just
a
bit
frustrated,
certainly
appreciate
the
dr
orton
lakers
addition
and
clarification
about
mandates
and
I'm
just
very
concerned.
Thank
you.
I
know
the
intent.
I
know
we
still
see
huge
numbers,
but
I'm
not
sure
this
is
the
solution.
O
I'm
going
to
echo
what
the
other
doctors
are
saying
and
then
add
to
that
when
we
require
medication-assisted
treatment,
that
includes
methadone
and
methadone
may
be
more
problematic
in
some
cells
or
some
jails
or
some
prisons
than
it
is
in
others,
and
sometimes
we
have
what
we
call
a
therapeutic
discharge
when
we're
dealing
with
somebody
who's
using
or
abusing,
and
when
we
start
to
say
you
have
to
do
something,
then
it
overrides
the
medical
judgment
and
I
think
that's
a
dangerous
position
for
us
to
be
in,
and
certainly
for
the
physician
who
may
find
him
herself
in
a
very
difficult
position
to
be
able
to
have
a
defense.
A
Thank
you
for
both
of
your
concerns,
I'm
going
to
ask
if
dr
woodard
is
online.
If
she
can
talk
a
little
bit
about
the
intent
of
this
bill,
that
it
was
it's
not
intended
to
direct
folks
who
are
already
providing
this
kind
of
opioid
treatment
service
to
do
more.
But
it's
more
intended
to
address
the
community
understanding
of
the
access
to
treatment.
But
dr
woodard,
if
you
would
please
go
ahead
and
explain
a
little
more
on
the
intent.
Q
And
thank
you
chair
and
committee
member
stephanie,
woodard,
department
of
health
and
human
services,
senior
advisor
on
behavioral
health
for
the
record,
so
chair
you're,
absolutely
correct,
and
I
would
like
to
just
go
back
to
what
assemblyman
or
licker's
comments
were.
So
the
intent
here
is
actually
very
similar
to
some
of
the
language
that
was
added
in
eb
474
and
the
controlled
substance.
Abuse
prevention
act,
and
you
know
the
goal
would
be
to
preserve
the
patient
and
prescriber
relationship.
Q
There
should
never
be
the
mandate
in
law,
in
my
opinion,
to
mandate
the
practice
of
medicine,
and
so
the
goal
here
is
to
ensure
that
we
have
the
education
for
individuals
who
have
been
diagnosed
with
an
opioid
use
disorder
on
the
availability
and
the
effectiveness
and
efficacy
of
medications
for
opioid
use
disorder.
I
would
agree
with
senator
titus's
comments,
especially
around
the
work
that
prescribers
have
done
to
this
point.
Q
They
have
carried
a
lot
of
weight
when
it
comes
to
rectifying
some
of
the
over-prescribing
that
we
were
seeing
of
prescription
opioids
in
the
past.
So
what
we're
trying
to
do
here
is
address
the
other
side
of
the
issue
and
we
do
have,
unfortunately,
very
low
rates
of
medication-assisted
treatment
being
offered
to
patients.
Very
rarely
are
they
even
aware
that
they
have
options
for
medications
available
to
them,
and
so
the
goal
really
is
to
ensure
that
individuals
who
are
receiving
that
diagnosis
are
being
offered.
Q
O
If
dr
woodard
could
address
the
issue
of
methadone
in
all
facilities
where
a
person's
confined
when
we
talk
about
offering
medication
assisted
treatment,
are
we
doing
methadone
in
all
facilities,
or
are
we
capable
of
doing
all
that?
Do
we
have
not
just
waivers
but
licenses
for
everyone
to
be
able
to
do
that?
Do
we
have
enough
physicians
who
are
able
to
do
that?
Q
Through
your
chair,
stephanie
woodard
for
the
record,
so
currently,
we
do
have
some
jails
that
are
actually
offering
methadone
to
individuals
who
are
already
on
methadone
as
a
maintenance
drug,
where
we
also
have
some
jails
that
may
not
be
offering
that
same
connectivity
to
treatment,
even
if
the
individual
has
previously
been
maintained
on
that
medication.
O
Q
So
stephanie
woodard
for
the
record.
We
would
have
to
reach
out
to
each
of
the
jails
and
department
of
corrections
in
each
of
their
affiliated
prisons
to
determine
if
they
had
the
capacity.
We
do
know
that
we
have
demonstrated
capacity
in
some
of
the
jails
across
the
state,
so
that
would
be
around
looking
to
see
if
they
had
the
capacity
potentially
with
community
partners
to
be
able
to
provide
methadone.
Q
I
think
part
of
the
the
issue
here
also
is
the
the
language
that
really
just
describes
making
sure
that
they
are
able
to
provide
a
treatment
for
opioid
use
disorder
in
the
same
manner
and
to
the
same
extent
as
other
forms
of
health
care.
Q
So
I
I
would
ask,
perhaps
if
we
need
some
additional
clarification
on
that
language,
that
we
would
not
be
providing
an
undue
burden
by
a
mandate
that
would
fall
potentially
outside
of
what
we
would
consider
the
same
manner
and
the
same
extent
of
other
forms
of
health
care.
G
Yes,
eric
robbins
for
the
record.
I
just
wanted
to
kind
of
clarify
for
the
purposes
of
the
initial
drafting
of
the
bill,
with
the
proviso
that
this
could
change
before
that
the
bill
is
introduced
and
certainly
after
the
bill
is
introduced
through
the
amendment
process.
G
But
with
regard
to
one
and
two,
the
way
I
read,
the
any
provider
who
is
authorized
to
make
a
diagnosis
of
opioid
use
disorder
would
be
would
mean
that
it
would
apply
to
first
of
all
the
prescribers,
so
the
physicians,
physician
assistants
and
advanced
practice
registered
nurses
and
then
the
mental
health
providers,
the
psychologists,
mfts
clinical,
professional
counselors,
social
workers
and
alcohol
and
drug
counselors,
and
that
the
prescribers
obviously
would
would
prescribe
if
it's
appropriate
and
that
the
mental
health
providers
would
refer
to
a
prescriber
to
prescribe
if
it's
appropriate-
and
I
just
wanted
to
make
sure
that
was
okay.
G
A
I
appreciate
the
comment
and
the
opportunity
for
the
committee
to
make
the
initial
decision
on
who
to
include
in
the
bill.
To
me,
this
list
sounds
like
a
great
starting
point
and
I
appreciate
the
the
point
that
it
can
be
refined
through
the
drafting
process
and
within
the
legislative
session
through
amendments.
Are
there
any
other
comments
or
questions
on
the
bill?
Bdr
recommendation
is
presented.
O
I'll
be
voting
no
as
a
red
flag.
You
know,
I
probably
have
talked
about
substance
use
disorder,
probably
more
than
anybody
else
around
town,
and
I
I
believe
in
treating.
I
think
this
has
dangerous
implications,
but
we're
putting
ourselves
in
my
impossible
positions
to
do
something
that
we're
not
able
to
do
so.
I
think
it
needs
to
be
more
encouraging
than
mandated
on
lots
of
different
levels,
but
I
will
be
voting
no
as
a
red
flag.
O
A
Thank
you
we're
still
on
the
comment.
Sorry,
the
questions
portion
of
our
voting
press
procedures,
so
I
would
go
ahead
and
take
a
motion
with
the
suggested
revision
on
an
item
two
from
presented
by
assemblyman
orrin
liquor.
I
have
a
motion
from
vice
chair
donate.
I
have
a
second
from
assembly
woman
gorlo.
Any
other
discussion
on
the
motion.
A
Saying
oh
excuse
me.
I
have
a
question
from
mr
ashton.
P
For
the
record,
patrick
ashton,
just
to
clarify
item
two
here,
would
it
the
changes
that
you're
requesting
is
that
a
healthcare
provider
should
offer
information
about
fda,
approved
medication,
assisted
treatment,
but
not
be
required
to
prescribe
it
when
requested
by
a
patient?
Is
this
the
intent.
A
A
K
A
Thank
you.
We
have
two
nays
senator
hardy
and
assemblywoman
titus
the
motion
passes.
Thank
you
so
much
go
ahead
and
move
on
to
bdr
recommendation
item
k.
P
For
the
record,
patrick
ashton,
committee
policy,
analyst
item
k
is
in
regards
to
community
health
workers
on
page
nine
of
the
workstation
document.
This
recommendation
is
from
jay
culver,
klausel
program
manager
of
the
nevada
community
health
worker
association
and
was
provided
during
the
july
21st
hhs
meeting.
Their
recommendation
is
to
request
a
bdr
to
number
one
revise
nrs422722
by
authorizing
dhcfp
to
promulgate
policies
regarding
who
may
supervise
community
health
workers
who
provide
services
to
medicaid
patients.
P
My
practice
under
supervision
and
be
reimbursed
by
medicaid
such
as,
for
example,
behavioral
healthcare
settings
that
have
licensed
clinical
social
workers
as
the
supervising
entities
and
number
two
require
that
any
person
holding
himself
or
herself
out
as
a
community
health
worker
in
the
state
be
certified
as
a
community
health
worker
by
the
nevada,
certification
board
and
committee
members,
jack
colbert
klausel
is
present
to
answer
any
questions
that
you
may
have.
P
They
also
mentioned
that
the
word
certified
should
go
in
sub
item
2
before
community
health
worker,
so
that
it
would
require
that
any
person
holding
himself
or
herself
out
as
a
certified
community
health
worker
in
the
state
be
certified
as
a
community
health
worker
by
the
nevada
certification
board.
That
was
provided
during
public
comment
earlier
today.
A
Thank
you,
mr
ashton.
Are
there
any
questions
regarding
the
recommendation
with
that
requested
revision
to
include
certified
before
cert
the
first
certified
community
health
worker
on
item
two
seeing
none.
K
Of
that
entertainment,
I'm
sorry!
Yes,
yes,
I
apologize
a
little
delay
here.
I
just
have
some
concerns.
I
certainly
absolutely
support
community
health
workers,
so
I
I
support
the
most
of
this
proposal
or
this
bdr
with
the
exception.
I
I
having
them
work
under
a
licensed
clinical
social
worker
in
a
healthcare
kind
of
setting.
I
have
some
concerns
about
that,
and
so
I
I
can't
support
this
draft
as
as
presented.
Thank
you.
O
I'm
intrigued,
I
I
think
we
need
the
concept
of
the
community
health
workers.
I
think
we
need
the
certification
of
the
community
health
workers.
O
When
we
talk
about
health
or
a
community
health
worker,
I
I
think
sometimes,
if
we're
listening
to
the
words
we
we
think
they're
going
to
be
taking
blood
pressures
or
making
sure
the
person
takes
their
medicine
or
keep
helping
them
with
their
rehabilitation
and
and
now
I'm
going
to
have
them
under
social
workers.
O
So
is
there
a
sub
certification
of
community
health
workers
that
works
under
social
workers
that
are
more
prone
to
let's
talk
about
it
versus
the
community
health
worker?
That
says
this:
is
the
medicine
you're
supposed
to
be
taking?
Because-
and
this
is
your
nutritional
need-
and
this
is
the
thing
that
you
have
to
do
to
avoid
getting
sick
and
you
have
to
make
sure
that
your
blood
pressure
is
taken.
So
I
think
I
I
think
the
the
flexibility
that
we're
talking
about
may
be
one
of
those
questions
that
has
to
be
worked
out.
O
I'm
just
kind
of
curious.
What
do
we
have
subsets
of
community
health
workers,
because
it
would
be
unusual
for
a
community
health
worker
who's
under
a
social
worker,
to
pretend
that
they're,
the
community
health
worker,
who
should
be
supervised
under
a
doctor
or
a
nurse
practitioner
or
ba
question
mark
question
mark
question.
One.
A
Thank
you
for
the
questions
and
we
do
have
jay
colbet
clauselle,
I'm.
So
sorry,
if
I
said
that
inaccurately,
would
you
mind
talking
a
little
bit
about
the
current
certification
process,
how
that
was
developed
and
what
we're
asking
for
here
and
if
there
is
a
state,
a
common
certification
process
throughout
the
country.
A
And
can
you
also
speak
a
little
bit
to
what
the
scope
of
the
workforce
is
for
community
health
workers.
J
Jay
colbert
clasell
for
the
record,
chair,
peters
and
committee
members.
There
is
not
a
national
certification
for
community
health
workers.
There
is
a
national
association,
but
the
growth
of
the
certification
has
been
market
driven
and
and
also
led
by
the
states.
So
each
state
has
developed
their
own
certification
process.
The
state
of
nevada
collaborated
with
the
state
of
washington
and
the
state
of
massachusetts,
primarily
when
developing
their
certification
system
through
dpbh
and
that
was
launched
in
january
november
of
2018.
J
I
believe
the
nevada
certification
board
reviews
those
applications
for
the
dpbh
approved
curriculum
that
covers
13
competencies
over
an
eight-week
period.
The
next
part
of
the
question
is
on
the
scope
of
work
and
I'd
like
to
start
by
saying
there
is
no
such
thing
as
a
medical
community.
Health
worker
that
is
out
of
the
scope
of
what
a
community
health
worker
is.
A
medical
service
should
be
provided
by
somebody
who
has
the
the
training
and
or
and
or
licensing
required
for
that,
so
taking
a
blood
pressure.
J
If
they,
if
the
community
health
worker
has
the
training
to
do
that
work,
then
then
they
could
do
that
assisting
with
medication.
J
They
can
read
the
bottle
to
the
client,
help
with
translation,
help,
give
all
those
reminders
so
that
the
the
client
can
understand
the
the
method
that
or
the
way
that
they're
supposed
to
be
taking
their
medication,
but
a
community
to
to
go
on
to
that
broader
level.
J
One
of
the
specific
things
that
I
like
to
tell
social
workers
is
a
community
health
worker
should
not
be
asking
things
like
the
miracle
question
like
if
you
as
because
that's
crossing
over
into
therapy
where
you're
asking
the
client,
if
you
could
have
you
know
the
world
that
you
wanted,
you
know
what
would
your
perfect
life
look
like?
That's
not
the
community
health
workers
role,
a
community
health
worker
is
there
to
help
the
client
understand
the
options
that
are
in
front
of
them
from
a
culturally
competent
standpoint.
J
O
J
So
a
j
colbert
claselle
for
the
record.
We
do
have
an
extended
program,
so
the
college
of
southern
nevada
takes
13
weeks
to
go
through
the
curriculum.
They
also
add
in
some
hipaa
training
and
a
mental
health
first
aid.
The
truckee
meadows
community
college
also
has
an
approved
training
through
dpbh
that
I
I
don't
remember
their
exact
number
of
weeks,
but
it
covers
all
the
same
competencies.
J
Our
curriculum
is
eight
weeks
that
we
spend
with
the
client
and
and
we
kind
of
teach
them
the
roles
and
boundaries.
So
that's
part
of
it,
because
a
lot
of
community
health
workers
are
already
out
there
they're
already
doing
a
lot
of
work,
but
maybe
they're
not
referring
as
much
as
they
should
be,
and
they
need
to
have
stronger
connections
with
those
licensed
providers
in
both
behavioral
health
and
in
you
know,
physical
health.
O
J
Jay
colbert
class
for
the
record
through
you
chair.
They
should
not
be
operating
autonomously
in
some
of
our
rural
areas.
There
are
no
other
services,
and
so
they
they
end
up
in
difficult
positions
where
they
just
try
to
do
the
best
for
the
client
and
that's
something
that
we'd
like
to
remove
and
mitigate
by
encouraging
them
to
form
one
of
these
contracts
with
a
license
provider
and
really
fall
under
or
go
under
the
the
social
services
that
we
have
in
the
state.
O
Madam
chair,
I'm
going
to
be
supportive
of
this
and
recognizing
that
we
have
this
huge
need,
but
I
think
we
need
to
put
some
boundaries
on
this
in
the
legislative
session
that
are
inviting
for
people
to
become
one
and
then
number
two:
how
they're
getting
paid
and
number
three
what
their
results
are
and
do.
We
have
any
way
to
be
sure
that
the
scope
of
practice
is
safe,
but
I
will
be
reporting
supporting
this,
at
least
if
you're
ready
for
emotional
issues
with.
A
Thank
you
so
much.
I
had
one
more
clarification
from
staff
on
the
first
point
about
the
authority
for
medicaid
to
kind
of
set
supervisory
roles.
Mr
ashton,.
P
P
This
year
is
really
something
that
the
community
may
decide
to
strike
from
the
language
here
from
the
work
session
document,
the
intent
is
to
give
nevada
medicaid
the
flexibility
to
decide
within
their
own
policy
authority,
who
can
be
an
appropriate
supervising
entity
in
any
setting
medical
setting,
behavioral
health
care
setting,
and
this
is
the
flexibility
and
the
intent
of
it,
as
I
understood
it,
from
conversations
with
nevada
medicaid.
P
So
the
committee
can
decide
to
take
out
a
licensed
clinical
social
workers
here.
That
was
merely
in
here
as
an
example
and
limited
to
say
that
medicaid
will
have
this
flexibility,
and
I
also
want
to
state
this
is
for
medicaid
reimbursement
so
because
the
issues
as
alluded
to
in
earlier
presentations
were
that
right
now,
it's
limited
to
physicians,
physician
assistants
and
advanced
practice,
registered
nurses,
who
can
be
a
supervising
entity.
This
really
would
expand
that
and
give
the
flexibility
to
medicaid.
Thank
you,
madam
chair.
O
So
I
mean
that's:
one
of
my
concerns
is
medicaid.
It
probably
would
require
us
to
have
a
waiver
to
have
medicaid
apply
for
a
waiver
for
medicaid
to
cover
a
community
health
worker,
separate
and
distinct
from
somebody
who
already
has
the
ability
to
be
covered
by
medicaid
for
what
they
do.
Am
I
correct
in
that.
D
O
D
D
O
D
Provider
type
which
is
outlined
in
our
state
plan
amendment,
so
it
would
really
be
changing
those
requirements
which
would,
of
course
require
federal
approval
for
this
from
the
centers
for
medicare
and
medicaid
services
to
further
expand
the
types
of
providers
that
would
be
allowable
for
reimbursement
as
community
health
workers.
O
And
so
I
would
ask
the
obvious
question
for
their
services:
what
are
their
services
that
the
people
in
the
federal
government
would
say?
Oh
yeah,
that's
a
medicaid
service
that
they
need
to
do,
because
I'm
not
sure
what
the
nebulous
description
is
that
you're
going
to
put
in
your
application.
But
that's
just
me
again.
A
I
appreciate
your
comments
and
I
think
you're
getting
at
some
of
what
the
work
is
to
be
done
between
now
and
session
and
even
within
session,
on
fleshing
out
the
language
to
be
included
in
the
in
the
legislation.
So
are
there
any
other
questions
saying
none?
I
would
entertain
a
motion
and
sent
vice
chair
donate
in
a
second
from
assemblywoman.
A
Is
there
any
discussion
on
the
motion
saying
none
all
those
in
favor,
please
signify
by
saying
I
am
raising
your
hand
any
opposed.
Please
say,
nay,.
C
A
We
have
one
name
from
dr
titus.
The
motion
passes.
Thank
you
so
much.
We.
That
brings
us
to
bdr
recommendation
item.
L.
P
For
the
record,
patrick
ashton,
committee
policy,
analyst
members,
the
following
three
recommendations
under
item
l
were
developed
by
vice
chair
donnata,
in
consultation
with
committee
staff,
in
response
to
several
roundtable
discussions
and
stakeholder
input
during
the
covit
19
health
crisis,
interim
study
pursued
to
sb209
from
the
2021
legislative
session.
After
each
recommendation.
I
will
hand
it
back
to
the
chair
and
the
committee
for
further
discussion
and
potential
action.
I
will
start
with
the
recommendation
on
public
health
modernization
which
you
can
find
on
page
10
of
the
workstation
document.
P
The
fund
shall
appropriate
general
funds
of
15
million
each
fiscal
year
for
fiscal
years,
2023
to
2024
and
2024
to
2025,
and
then,
additionally,
the
following
provisions
apply
as
outlined
on
the
work
session
document
from
a
to
f,
chair,
peters
and
committee
members.
We
have
julia
peak
dpbh,
deputy
administrator
and
megan
komlossi
associate
director
of
the
center
for
public
health
excellence.
Unr
president.
To
respond
to
any
questions
you
may
have
adam
chair.
A
Thank
you,
mr
ashton.
Are
there
any
questions
from
the
committee
seeing
none?
I
would
entertain
a
motion
from
vice
chair
donate
in
a
second
from
assemblywoman
corlo.
Any
discussion
on
the
motion
before
we
vote.
Seeing
none
all
those
in
favor,
please
signify
by
saying
aye
raising
your
hand,
I
I
any
opposed
motion
passes
with
those
present.
Thank
you
so
much
we're
gonna
go
ahead
and
move
on
to
the
next
recommendation.
Under
this
item.
P
P
There
are
much
more
items
under
this
study
requirement.
All
of
it
is
outlined
in
the
work
session
document
and
committee
members.
We
have
also
david
ferguson,
chief
of
the
division
of
emergency
management
and
homeland
security
and
allison
genko
public
health
resources
officer
in
the
office
of
the
governor
present.
To
answer
questions
madam
chair.
A
Thank
you,
mr
ashton.
Are
there
any
questions
from
the
committee
members
on
this
item
seeing
none
I
would
entertain
a
motion
from
vice
church
on
yate
and
a
second
from
assemblywoman
gorlo.
Is
there
any
discussion
on
the
item
before
we
vote,
seeing
none
all
those
in
favor,
please
signify
by
saying.
I
are
raising
your
hand
all
right.
A
P
For
the
record,
patrick
ashton
comedy
policy
analyst.
Next,
we
have
a
bdr
recommendation
related
to
telehealth
reimbursement
parity.
The
workstation
document
contains
a
summary
on
senate
bill
5,
which
passed
during
the
2021
session
on
page
11
and
12.
among
other
provisions,
sb5
prohibited
various
third-party
payers,
from
reviews
refusing
to
pay
for
services
provided
through
telehealth
because
of
the
technology
used
and
categorizing
telehealth
services
differently
than
services
provided
in
person
for
purposes
related
to
coverage
or
reimbursement.
P
In
addition,
sp5
required
third-party
payers
to
cover
telehealth
services
and
the
same
amount
as
services
provided
in
person
or
by
other
means,
except
for
services
provided
through
audio,
only
interaction.
These
reimbursement,
parity
requirements
for
telehealth
services
were
temporary,
facilitating
access
to
telehealth
only
for
the
duration
of
the
covet
19
public
health
emergency.
P
A
K
I
certainly
appreciate
telehealth
and
and
especially
in
rural
areas
and
if
anything,
coped
brought
out,
that
the
access
to
care
can
be
tough,
but
I'm
concerned
about
the
parity
of
reimbursement
now
with
those
who
might
have
brick
and
mortar
buildings
in
the
state
and-
and
I'm
not
I'm
going
to
not
support
this,
because
I'm
anxious
about
how
it's
going
to
turn
out
as
as
it
final
finalizes
and
again
making
certain
other
requirements
for
telehealth,
and
so
I
won't
be
able
to
support
this
at
this
time.
Thank
you.
D
Thank
you
so
much
chair
peters.
I
just
want
to
share
one
sentiment,
which
is,
I
think,
that
the
field
of
telemedicine
or
telehealth
and
the
umbrella
is
still
very
new,
and
there
is
research.
That's
coming
out
determining
the
efficacy
of
one
mode
versus
the
other.
D
My
understanding
is
that
cms
right
now
is
collecting
feedback
from
providers
nationwide
to
see
if
audio
services
can
relate
to
an
in-person
visit
and
what
the
nuances
are
covering
that,
but
a
lot
of
that
will
be
we'll
learn
as
we
continue
moving
forward
throughout
the
kova
19
pandemic,
as
it
turns
to
an
endemic
and,
of
course,
with
other
public
health
crises
that
come
about.
D
So
my
hope
is
that
when
this
bill
does
come
out
during
the
legislature
that
we
can
have
those
conversations
and
debates
as
to
what
requirements
do
come
forward
during
a
public
health
emergency
similar
to
covid19
or
if
we
want
to
make
them
permanent
to
entice
digital
health
companies
to
come
to
the
state
or
what
that
looks
like.
So
I
think
that's
the
intent
of
this
proposal.
A
Thank
you
so
much,
and
I
want
to
take
a
moment
to
just
discuss
that
during
the
legislative
session
when
we
decided
to
put
these
sunsets
on
in
committee,
we
did
make
a
commitment
to
come
back
around
to
assess
the
requirements
for
parity
with
telemedicine,
and
so
I
feel
like
this
is
a
good
starting
point
with
that.
But
again
the
bill
ends
up
going
through
a
process
and
we
are
just
at
the
beginning
of
that.
So
any
other
comments
or
questions
from
the
committee
saying
none.
A
C
A
A
nay
from
assembly
woman
titus,
the
motion
passes
we're
going
to
go
ahead
and
move
on
to
bdr
recommendation
item
m.
I
didn't
skip
one
right
m.
P
For
the
record,
patrick
ashton
committee
policy
analysts,
these
are
now
recommendations
to
draft
letters
we
are
on
under
item
m.
This
is
a
recommendation
was
developed
by
chair
peters
in
response
to
a
recommendation
provided
by
marlene
lockhart
from
the
service
employees,
international
union,
local
1107.
P
During
the
solicitation
of
recommendations
period,
the
recommendation
is
to
draft
letters
to
the
senate
and
assembly
health
and
human
services
committees
and
the
director
of
dhhs
expressing
the
committee
support
of
further
recommendations
identified
by
the
home
care
employment
standards
board
created
by
sb
340
last
session
and
committee
members.
We
have
cody
finney
present
from
dhhs
and
she's.
Also
the
chair
of
the
home
care
employment
standards
board.
She
could
respond
to
any
questions
you
may
have.
Madam
chair.
A
A
Seeing
none,
I
would
go
ahead
and
accept
a
motion
from
viceroy
donate
in
a
second
from
assemblywoman
gorlo.
Any
discussion
on
the
motion
seeing
none
all
those
in
favor,
please
signify
by
saying
I
or
raising
your
hand.
I
any
opposed,
nay
motion
passes
with
those
present.
Thank
you.
So
much.
Please
proceed
with
a
letter
item
n.
P
P
A
Thank
you.
So
much
are
there
any
questions
from
the
committee
seeing
none,
I
would
entertain
a
motion.
Senator
donate
second
from
assemblywoman
gorlo,
or
is
there
any
discussion
on
the
item
with
seeing
none?
I
would
all
those
in
favor
please
signify
by
saying
aye
raising
your
hand,
I
any
opposed.
A
May
no,
the
motion
passes
with
those
present.
Thank
you
all
so
much.
I
believe
that
brings
us
to
the
end
of
our
work
session
agenda
item.
Please
correct
me
if
I'm
wrong
good,
okay,
we're
going
to
close
that
item.
Thank
you
all.
So
much
for
your
input
and
questions
always
appreciate
the
discussion
and
look
forward
to
future
discussions.
As
we
move
through
the
legislative
session,
I'm
going
to
open
agenda
item.
K
Madam
chair,
I
just
want
to
acknowledge
the
committee's
hard
efforts
and
work
and
all
the
hearings
and
folks
that
have
contributed
to
improve
the
health
of
all
nevadans
throughout
our
state.
So
it's
been.
This
is
our
last
meeting
in
this
committee
and
and
the
time
that
has
been
spent
has
been
impressive
and
I
think
we've
gotten
some
good
things.
Moving
forward.
Looking
forward
to
further
conversations
and
thank
you
to
all
committee
members
and
workers,
and
especially
madam
chair
for
taking
on
these
tasks.
A
O
A
Much
for
that
go
ahead.
Senator
hardy.
O
Thank
you
appreciate
what
you've
done
and
our
staff
and
I'll
call
him
eric
there.
I
go
mr
robbins
and
patrick
who
have
been
personally
helpful
to
me
and
in
my
position,
and
I
appreciate
the
opportunity
to
have
served
on
this
committee
and
these
long
years
and
I
look
forward
to
continuing
good
relationships
with
all
of
you.
A
A
I've
appreciated
all
of
the
effort
put
in
by
the
entities
who
have
come
before
us
and
those
who
have
shared
their
opinions,
their
expertise
and
their
life
stories
on
these
really
important
issues,
but
I
also
want
to
take
a
moment
to
extend
our
appreciation
to
you.
Senator
hardy,
it's
been
a
really
a
a
pleasure
serving
with
you
in
this
capacity.
I
don't
think
we've
served
on
a
committee
together
before
and
this
being
your
last
committee.
A
It
really
feels
like,
like
I
missed
out
on
a
little
bit,
not
having
served
with
you
previously
to
this.
We
want
to
wish
you
best
luck
in
your
next
chapter.
You
will
be
missed.
Thank
you
so
much
for
all
of
your
service
and
the
concern
for
your
community
and
your
willingness
to
always
come
to
the
table
and
have
discussions
on
these
really
important
issues
to
our
community.
So
thank
you
for
your
service
senator
hardy.
We
are
looking
forward
to
seeing
how
things
go
in
the
next
chapter
of
your
life.
A
A
You
guys
have
helped
keep
us
reined
in
and
coordinating
with
with
our
stakeholders
and
with
our
agencies,
making
sure
that
I
have
notes
drafted
in
ways
that
are
helpful
to
getting
us
through
committees.
I
just
you
are
invaluable.
Thank
you
so
much
for
your
help
and
for
the
work
that
you
do
and
I'm
going
to
move
us
into
a
public
comment
with
that,
and
this
is
our
last
public
comment
of
the
interim.
A
They
we
have
physical
locations
and
online
I'm
going
to
go
ahead
and
ask
folks
to
please
continue
to
limit
your
comments
to
three
minutes.
Is
there
anybody
in
las
vegas
who'd
like
to
come
up
for
public
comment
at
the
time?
This
time
not
seeing
anyone
in
las
vegas
approaching
for
public
comment
in
carson
city
is
there
anybody
who
would
like
to
approach
for
public
comment?
A
A
D
Thank
you
so
much
chair
peters.
Before
we
conclude,
I
just
want
to
express
my
gratitude
to
you,
of
course,
for
bringing
me
alongside
the
decision
making
process
and,
of
course,
to
the
unsung
heroes
of
some
of
the
bills
today,
which
were
the
biggest
tasks.
I
think
the
code
19
bills,
our
committee
staff,
guided
us
throughout
that
process.
I
I
know
that
we
didn't
get
a
lot
of
it
into
those
bills,
but
hopefully
we're
just
getting
started
on
some
of
those
processes
and,
of
course,
doc
hardy.
D
I
think
a
lot
of
us
share
the
same
sentiment.
You've
been
very
gracious
to
work
with
sir,
and
it
was
such
an
honor
to
have
the
ability
to
work
with
you
in
the
senate.
D
I'm
truly
going
to
miss
you,
and
I
hope
that
in
in
this
respect,
I
think
the
the
city
of
the
folks
of
boulder
city
are
lucky
to
have
your
servicer.
So
thank
you
so
much
for
serving
and
for
your
expertise,
and
I
look
forward
to
hopefully
still
pulling
you
into
this
committee
meeting
at
some
point
in
the
future,
for
your
expertise.
So
thank
you
so
much,
sir.
A
Thank
you.
I
was
remiss
on
all
of
your
effort,
also
acknowledging
all
your
effort
on
that
covid19
study
really
bringing
some
amazing
stakeholder
groups
together
and
talking
about
these
dynamic
issues
and
also
for
serving
with
me
and
helping
make
these
hard
decisions
like
I
don't
know
how
folks
do
this
by
themselves.
It's
really
it's
really
a
group
effort
and
we
had
an
amazing
one.
You
guys,
I'm
really
really
proud
of
the
work
we've
done
in
this
committee
with
that.