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Description
This is the first meeting of the 2021-2022 Interim. Please see the agenda for details.
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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A
I
don't
know
if
folks
can
tell
from
our
agenda,
but
we
put
we
put
the
mcos
on
our
list
in
alphabetical
order,
with
no
preference.
So
next
would
be
health
plans
of
nevada,
medicaid,
united
healthcare
services,
and
we
have
kelly
simonson
he's
the
president
of
that
that
nco
here
for
the
presentation,
miss
simonson.
Please
go
ahead.
A
C
B
I'm
gonna
take
myself
off,
then
the
video,
so
you
don't
see
me.
A
And
I'll
work
you
there
here.
D
Calling
with
broadcast
can
I
step
into
assist
yes,
absolutely,
okay,
perfect!
Thank
you,
miss
simonson.
Can
you
go
ahead
and
exit
the
screen
share
and
then
try
restarting
it
again.
B
A
A
B
Okay,
can
you
see
that?
No,
yes,
okay!
Thank
you
sure.
Sorry,
no
worries.
So,
as
I
mentioned,
we've
been
serving
nevadans
for
40
years
and
through
our
commercial
business
and
the
last
25
years
we
have
been
serving
the
medicaid
managed
care
population
in
nevada.
B
We
are
the
only
insurance
company
that
has
been
contracted
with
the
division
of
health
care,
financing
and
policy
since
the
inception
of
managed
care
in
1997,
and
we
joined
in
1997
at
the
request
of
then
governor
bob
miller,
because
we
knew
we
could
bring
mainstream
health
care
services
to
medicaid
recipients
in
nevada.
Just
as
we
have
been
for
commercial
members,
and
for
many
of
these
years
we
have
been
the
most
chosen
plan
by
nevada,
medicaid
recipients.
B
We've
been
able
to
be
there
during
service
area,
expansions
benefit
expansions
and
population
expansions,
and,
as
was
just
mentioned,
we
were
here
one
of
the
two
plans
during
the
medicaid
expansion
when
we
basically
doubled
our
membership
in
2014
and
then
dealt
with
the
lack
of
behavioral
health
infrastructure
that
we
were
seeing
in
our
state,
and
we
built
programs
in-patient
outpatient
and
housing
programs
to
deal
with
those
members
who
were
in
the
ers
backlogging
the
ers
at
the
time
who
had
behavioral
health
issues
and
social
needs
and
really
dedicated
a
lot
of
resources
to
decreasing
the
er
recidivism.
B
How
plano
nevada
has
been
and
always
will
be
dedicated
to
quality
for
our
members?
We
have
been
accredited
on
the
medicaid
side
since
2016
by
the
national
committee
for
quality
assurance
and
in
2021
we
were
noted
as
the
top-rated
medicaid
plan
in
nevada.
According
to
ncqa's
medicaid
health
plan
rankings
and
our
provider
network
is
really
a
significant
part
of
achieving
that
accomplishment.
B
B
In
addition,
our
company
has
made
multi-million
dollar
investments
in
communities
based
organizations
in
nevada
that
are
really
meant
to
address
social
determinants
of
health,
health
literacy
and
increase
the
the
workforce
that's
available
for
healthcare
workers
in
our
state
and
there's
a
few
there
that
are
outlined.
I
won't
go
into
those
in
the
interest
of
time.
B
Medicaid
managed
care
has
has
significant
value
that
many
are
unaware
of,
and
it
really
falls
under
these
four
tenants,
one
of
them
being
budget
predictability.
So,
at
a
time
when
healthcare
costs
continue
to
rise
and
medicaid
membership
continues
to
to
balloon,
the
state
is
able
to
transfer
the
financial
risk
of
the
mc
of
the
medicaid
plan.
B
In
addition,
there's
the
premium
tax
revenue
that
the
health
plans
pay
to
the
state
for
those
members
who
are
enrolled
in
our
plans,
I
will
go
over
health
care
improvements
in
some
later
slides,
but
focusing
on
some
member
satisfaction.
We
are
required
on
an
annual
basis
to
survey
our
members
and
determine
their
satisfaction,
and
we
are
proud,
through
lots
of
efforts
that
we've
had
to
address
consumer
satisfaction,
that
we
have
had
some
nice
achievements
in
the
rating
of
a
health
plan
on
what
we
call
the
national
cap
survey
over
the
last
few
years.
B
Our
members
receive
member
services
in
case
management
to
help
them
navigate
the
health
care
system
and,
as
sandy
previously
mentioned,
value-added
benefits
that
are
outside
the
payments
that
the
state
gives
to
us.
We
fund
those
on
our
own,
but
those
are
really
designed
to
improve
health
outcomes
and
then,
in
terms
of
access,
we
are
held
accountable
to
ensure
that
our
members
need
the
access
and
availability
requirements
in
our
contractor
that
we
need
them
for
our
members.
B
So,
at
the
time
of
the
contract,
when
we
had
308
000
members
at
the
end
of
last
year,
which
was
the
the
largest
percentage
in
the
state
of
nevada,
was
enrolled
in
health
plan
of
nevada,
and
we
were
meeting
the
access
and
availability
requirements
for
this
new
contract
for
each
segment
of
providers
between
98
and
100
of
the
time.
So
that
meant
that
98
to
100
of
our
members
that
were
enrolled
with
us
had
the
access
and
availability
to
members
in
terms
of
time
and
distance.
B
As
we
know,
we're
ranked
about
47th
in
the
country
for
physicians
per
capita
and
so
a
way
for
us
to
get
providers
to
see
more
of
our
members
is
that
we
we
engage
in
value-based
contracts,
so
we
reward
providers
for
focusing
on
quality.
A
recent
example
of
that
is
in
a
three-year
period.
We
paid
about
2.7
million
dollars
to
providers
to
focus
on
some
of
our
hedis
measures
and,
as
a
result,
we
saw
our
adolescent
immunization
rates,
increase
67
and
our
childhood
immunization
rates
increase
about
61,
and
we
do
that.
B
B
As
I
mentioned,
with
with
the
ballooning
population,
we've
really
had
to
be
creative
on
how
to
ensure
access
so
through
our
sister
company
southwest
medical
over
the
years.
They
built
some
brick
and
mortar
clinics
in
really
some
high
density
medicaid
geographical
areas.
But
we've
also
looked
at.
How
do
we
bring
care
to
the
members
for
those
that
can't
come
to
the
plan,
so
we
engaged
in
a
mobile
clinic?
We,
we
built
a
mobile
clinic
and
launched
that
in
2015.
B
Paramedicine
programs
and
house
calls
where
we
send
apns
out
to
some
of
our
chronically
ill
members
and
then,
for
about
the
last
year
and
a
half,
we've
really
been
focused
on
integrated
care
delivery
sites
where
a
member
can
receive
all
of
their
health
care
in
one
setting,
so
behavioral
medical
and
even
pharmacy
services
and
then,
through
optimum
care.
We
are
able
to
recruit
providers
to
nevada.
B
Optim
care
has
a
residency
training
for
those
in
family
practice
and
they
also
do
tuition
reimbursement
for
physician
extenders
who
go
through
that
program
and
then
are
hired
through
southwest
medical.
And
then
this
is
just
a
snapshot
of
some
of
our
value
added
benefits.
Those
continuing
in
2022
and
some
new
ones
for
2022
again
really
focused
on
improving
healthcare
outcomes.
B
Of
course,
the
increase
in
rx
and
outpatient
services
as
people
become
more
compliant
because
their
housing
is
stabilized
and,
as
we've
worked
over
the
last
few
years
in
our
last
contract,
that's
just
a
snapshot
of
improvements
in
hedis
that
we've
seen
our
focus
is
to
get
our
hedis
measures.
You
know,
between
the
50th
and
up
to
the
90th
percentile
and
from
the
beginning
of
the
last
contract.
B
To
the
end,
we've
been
able
to
see
nice
movement
there
of
49
percent
of
our
measures
being
in
the
50th
to
90th
percentile
back
in
2017
to
77
at
the
end
of
the
contract,
and
then
you
can
see
83
percent
to
movement,
to
100
for
nevada
checkup.
B
B
Many
people
before
me
have
spoken
to
this.
We
have
found
that
really
tailoring
incentive
and
initiatives
towards
that
are
culturally,
culturally
based
are
really
impactful
and
we
can
see
there
an
example
of
a
tweaking
that
we
did
to
a
maternity
program
that
has
resulted
in
significant
increases
in
prenatal
and
postpartum
care
for
african-american
women
and
then
continuing
to
integrate
health
care
services
for
for
our
members.
So
it's
really
one-stop
shopping
and
then
future
considerations
and
suzanne
spoke
too
eventually
the
ending
of
the
public
health
emergency.
B
We
know
that
will
probably
come
at
some
time
this
year
it
was
just
certainly
extended
until
april
15th.
We
believe
that
there
is
and
a
risk
that
medicaid
members
will
lose
eligibility
which
will
increase
the
uninsured
rate.
So
we
would.
We
have
some
suggestions
to
work
with
the
state
to
perhaps
give
us
more
detailed
information
on
just
enrollment
reasons,
so
that
we
can
help
members
navigate
to
other
health
care.
B
Likewise
texting
options
opting
members
into
texting
automatically
when
they
fill
out
their
medicaid
application
and
then
accepting
the
the
geographical
changes
that
we
report
on
a
nightly
basis
to
to
the
state.
And
at
this
point
it's
our
understanding
that
welfare
and
supportive
services
cannot
use
that
information
without
confirming
it
from
the
member.
But
the
members
are
calling
us
so
hopefully
we
can
find
a
solution
to
that
and
then.
B
Lastly,
just
three
areas
that
have
come
up
over
the
years
of
our
service
to
medicaid
members
in
terms
of
benefits
that
we
would
advocate
for
our
members,
and
that
is
the
expansion
of
the
heart
lung
organ
transplant
for
adults,
genetic
testing
beyond
the
bronchogene
testing,
so
that,
for
example,
people
going
through
chemotherapy,
we
can
identify
the
most
appropriate
treatment
using
genetic
testing
and
then
covering
clinical
trials
in
phase
1
and
phase
2
for
individuals
who
have
certain
diseases
that
they're
really
out
of
other
options.
A
Thank
you
so
much.
Miss
simonson,
really
appreciate
you
being
here
as
well.
Love
hearing
about
the
caring
of
our
communities
and
all
the
efforts
that
are
going
in
next
present
presentation
will
come
from
molina
healthcare
of
nevada.
This
is
our
newest
mco,
just
joined
on
in
january.
E
Okay,
thank
you
very
much,
madam
chair
committee,
members
on
behalf
of
amalina
healthcare,
we're
thrilled
that
we're
here
as
as
the
new
managed
care
organization-
and
I
really
don't
have
a
history
here
to
speak
about-
we
do
want
to
take
a
few
minutes
and
tell
you
about
moline
healthcare.
E
I
do
have
the
privilege
of
being
joined
today
by
dr
tracy
green
she's,
our
chief
medical
officer,
so
I'll
present,
a
couple
of
slides
and
she'll
present
and
and
we'll
go
through
our
our
presentation
fairly
quickly.
E
E
E
First
off
we
ensure
that
we
have
high
quality
healthcare
services
for
our
members
and
secondly,
what
we
do
is
create
a
on
the
right
hand,
side
you'll,
see
that
we
create
a
partnership
or
a
collaboration
to
deliver
a
holistic
program,
a
bio
psycho,
social
model
of
care,
and
dr
green
we'll
talk
about
that
in
just
a
minute.
What
we
do
we
we
create
these
partnerships,
you'll
see
that
we
put
this
the
member
at
the
center
of
what
we
do,
but
we
know
that's
done
in
a
in
a
vacuum
is
doomed
to
fail.
E
So
what
we
do
is
collaborate
across
the
spectrum
with
very
important
key
stakeholders
for
us.
Of
course,
we
talked
about
our
providers
who
deliver
the
high
quality
care,
but
really
community
advocates
community
stakeholders,
community-based
organizations,
government
agencies
not
just
medicaid,
but
numerous
government
agencies
that
we
partner
with
and
collaborate
with
the
serve
members
as
well
as
the
employees
that
we
bring
on
to
make
sure
that
members
are
getting
the
care
and
the
services
that
they
deserve
and
need
next
slide.
E
Molina
healthcare
was
actually
started
in
1980
by
dr
david
molina,
an
emergency
room
physician
who
was
tired
of
really
seeing
individuals
who
should
be
seen
in
their
primary
care
setting
showing
up
at
the
emergency
room.
So
he
and
his
wife
took
on
a
second
mortgage
and
created
their
first
clinic
back
in
southern
california
and
from
that
they
continued
to
grow.
They
became
a
managed
care
organization
26
years
ago
and
has
really
expanded
the
service
area
around
the
country.
So,
while
it
started
in
california,
you
can
see
here
the
number
of
states.
E
It
goes
from
one
coast
to
the
other.
Currently
we
are
19
states.
Nevada
became
our
19th
market.
These
years
we
went
live
january.
1St
and
you'll
see
here
that
we
serve
really
roughly
90
percent
of
our
members
are
served
in
medicaid.
So
really
all
we
do
are
government
programs
and
90
of
that
is
serving
individuals
with
medicaid.
E
E
I
highlight
that
across
the
country
here
we
really
do
serve
not
just
individuals
in
ten
of
chip
and
expansion
like
we
do
here
in
nevada.
We
also
serve
individuals
in
categories
such
as
aged
line
and
disabled,
manage
long-term
services
and
supports
foster
children,
individuals
with
intellectual
and
developmental
disabilities.
E
E
We
also
have
created
within
each
of
those
offices
in
reno
and
las
vegas.
What's
called
a
one-stop
help
center?
That's
really
a
physical
location
where
we
really
want
members
to
come
in
and
engage
with
us
face
to
face
where
they
can
come
in
and
get
some
extra
services,
particularly
around
social
determinants
of
health.
So
we've
hired
an
employment
specialist
we've
hired
individuals
that
they
can
come
in
and
talk
to
dealing
with
how
to
apply
for
jobs.
F
Great,
thank
you
very
much
and
thanks
for
having
us
chirp
peters
for
the
record.
My
name
is
dr
trudy
c
green
and
I
serve
as
chief
medical
officer
for
molina
healthcare
I'll
start
at
the
commitment
to
quality,
and
I
think
mike
really
hit
this-
that,
from
the
point
of
being
founded
in
1980,
molina
has
really
focused
on
quality.
We
are
striving
for
ncqa
healthcare
accreditation,
but
I
also
wanted
to
say
that
we
are
going
for
healthcare.
F
Health,
equity
accreditation
as
well,
really
believing
that
having
both
health,
equity
and
ncqa
is
critical
for
the
delivery
of
medicaid
services.
We
also
are
engaging
in
value-based
contracting,
which
is
critically
important
for
the
delivery
of
quality
services
next
slide.
F
In
addition,
we
believe
that
the
social
determinants
of
health
are
critically
important,
so
we
have
an
entire
team
that
is
molina
based
in
nevada-based.
That
will
be
focusing
on
all
of
the
issues
surrounding
social
determinants
of
health.
I'll
also
share
with
you.
We
have
a
million
dollar
investment,
around
innovation,
centers
for
social
determinants
and
I'll
talk
a
little
bit
more
about
that.
F
Molina
is
also
very
not
just
interested
in
the
medicaid
population,
but
we're
also
interested
in
nevada
and
really
impacting
the
overall
health
care
delivery
in
nevada.
So
I
just
want
to
draw
a
reference
to
three
big
initiatives
that
we
will
be
bringing
to
the
state
all
around:
a
million
dollar
investment
for
us
at
molina.
The
first,
as
I
mentioned,
is
really
looking
at
health
equity.
Innovation,
we'll
be
drawing
forth
with
our
community-based
players
to
look
at
new
and
unique
ways
to
address
not
only
care
for
food
and
nutrition.
F
The
second
is
our
sud
community
of
care,
and
this
is
a
statewide
initiative
really
looking
to
improve
the
access
to
care
and
combining
with
the
state
to
address
crisis
services
of
care
and
also
creating
not
just
our
services
but
looking
at
the
criminal
justice
system.
Looking
at
law
enforcement,
looking
at
the
jails
and
prisons,
but
also
looking
at
the
care
deliverers,
the
providers,
and
how
can
we
integrate
this
system
of
care
to
create
a
substance,
use
disorder,
community
of
care
to
be
sure
that
our
members
can
live
in
the
life
of
recovery?
F
And
the
third
is
really
a
focus
on
something
that
has
recently
come
up
in
nevada,
which
is
the
resurgence
of
maternal
syphilis
and
neonatal
syphilis,
and
so
working
in
collaboration
with
the
health
districts,
as
well
as
with
unlv
school
of
medicine
and
unr
school
of
medicine.
We're
going
to
be
working
on
the
treatment
protocols,
how
we
more
appropriately
address
our
pregnant
women
that
might
be
at
risk
for
syphilis
and
looking
at
how
we
can
work
with
our
providers
in
the
community
to
enhance
treatment
opportunities
for
syphilis
next
slide.
F
So
when
we
look
at
her
behavioral
health
program
very
similar
to
others,
ours
is
a
fully
integrated
program.
So
we
do
not
delegate
any
of
the
behavioral
health
services.
We
focus
on
a
whole
person
care
and
we
use
all
of
the
integrated
principles
that
we
have
previously
discussed,
including
early
intervention,
evidence-based
services
and
really
focusing
on
seamless
transitions
when
we're
working
with
our
individuals,
who
are
most
at
risk
with
transitions,
whether
it
be
aging
out
of
the
welfare
out
of
the
foster
system,
whether
it
be
discharging
from
the
hospitals
from
residential
facilities.
F
A
F
Well,
this
is
my
last
slide
and
really
what
I
wanted
to
say
in
this
slide
is
that
our
approach
is
one
stop
wherever
our
members
are.
We
are
fully
integrated
at
all
levels,
so
we
have
integrated
rounds.
We
have
integrated
cm
rounds
and
we're
all
focused
on
our
population
approach
so
that
we
can
overall
impact
the
health
of
our
membership
next
slide.
G
E
And
I'm
chair,
this
is
mike.
This
is
mike
yesterday
again
for
the
record.
Let
me
just
close
with
thanking
the
committee.
I
know
we'll
have
some
time
for
q
a
and
some
of
the
the
dialogue
might
lend
itself
into
this
last
slide.
So
let
me
just
say
thank
you
and
we'll
end.
Our
presentation.
A
Thank
you
so
much
all
right
on
for
our
last
presentation
today
from
silver
summit
health
plans
being
an
s
name,
I
feel
for
you
at
the
end
of
the
alphabet.
Here
typically,
I
have
nicole
king.
I
I'm
I'm
sure
that
this
is
a
double
last
name,
you
guys,
but
I'm
sorry
action,
action,
king,
sorry,
that's,
okay,
eric
schumacher.
I
H
No
problem
eric
schwacker
for
the
record
good
afternoon,
chair
peters
and
members
of
the
committee
I
do
have
with
me
this
afternoon,
nikki
king-
I
I
don't
try
to
pronounce
that
other
quarterback,
because
I
did
it
wrong
too,
but
he
is
our
vp
of
community
solutions
and
she
and
I
will
be
providing
a
presentation
to
you
all
today.
H
C
H
C
A
H
It
goes
over
there,
okay,
so
a
little
bit
about
silver
summit
health
plan.
We
entered
the
state
in
2017
and
we've
been
serving
nevada
and
nevada
medicaid.
Ever
since
then,
we
are
a
subsidiary
of
sentine
corporation,
which
is
the
country's
largest
provider
of
government,
sponsored
health
insurance.
We
operate
in
37
different
states
with
our
medicaid
and
marketplace
and
medicare
products,
and
we
ensure
one
in
every
15
americans.
H
When
we
entered
the
state
in
2017,
we
started
with
under
a
thousand
members,
but
we
have
grown
that
to
166
000
members
today,
in
addition
to
the
medicaid
program,
we
also
participate
in
state-based
exchange
with
our
and
better
product
and
also
have
our
med
medicare
advantage
product,
which
is
known
as
well
care
next
slide
at
silverstone
health
plan.
We
are
focused
on
partnering
the
state
to
achieve
the
goals
that
they
set
forth
in
the
medicaid
care,
managed
care
contract.
H
H
H
H
You
see
here
on
the
slide
a
sample
of
some
of
the
steps
we've
taken
to
ensure
a
smooth
onboarding
process
for
our
new
members.
We
have
also
taken
steps
to
modify
our
operations
and
organizational
structure
to
ensure
that
we
are
set
up
for
success
in
accomplishing
the
goals
set
forth
by
dhcfp
next
slide.
H
We
are
also
very
focused
on
working
with
our
providers,
both
the
in-network
providers,
as
well
as
the
out-of-network
providers,
to
ensure
that
they
are
set
up
for
success
in
delivering
access
to
high-quality
care
to
our
members.
We
expanded
our
medical
director
team,
our
population,
health
team
case
management,
team
quality,
team
and
provider
relations
team.
We
also
have
developed
and
put
in
place
numerous
value-based
contracts
with
our
providers,
these
value-based
contracts,
align
silver
summits
and
the
providers
goals
to
ensure
that
our
members
receive
high
quality,
primary
and
preventive
care.
H
These
value-based
agreements
also
incentivize
the
providers
to
hit
targets
on
quality
measures
and
pays
them
more
for
achieving
those
targets.
Those
dollars
that
they
can
earn
are
reinvested
back
into
their
clinics
to
expand
access
and
services
that
they
provide
in
2020
and
2021.
We
paid
out
millions
of
dollars
in
these
value-based
agreements
to
providers
next
slide.
H
H
J
Good
afternoon
and
thank
you,
madam
chair,
for
the
record,
my
name
is
nikki
atchison
king,
I'm,
the
vice
president
of
community
solutions
for
silver
summit
health
plan.
Community
solutions
is
our
latest
development
at
silver
summit.
The
goal
of
community
solutions
is
to
ensure
access
to
services
outside
of
the
provider's
office
for
our
members
and
their
families.
We
do
this
by
developing
engaging
and
contracting
what
we
call
the
community
network.
J
Also,
community
solutions
is
home
to
our
health
equity
program,
our
justice
involved
program
and
our
housing
program,
and,
most
notably,
it's
home
to
our
community
health
workers,
some
of
our
most
valued
staff
at
silver
summit
health
plan,
they're
highly
trained
and
skilled.
This
diverse
group
engages
directly
with
our
members.
Wherever
they
are,
they
locate
our
hard-to-reach
members
in
homeless,
encampments
and
shelters.
They
do
outbound
phone
call
campaigns
to
encourage
our
members
to
get
vaccinated
and
they
work
directly
in
the
detention
centers
to
develop
community
re-entry
programs
and
plans
with
our
members
who
are
currently
detained.
J
The
community
solutions,
department
and
silver
summit
as
a
whole
operates
off
of
a
member-first
approach.
Our
job
is
to
ensure
that
our
members
have
choices
and
access
and
we
honor
their
choices.
Their
personal
choice,
one
in
four
nevadans,
is
currently
receiving
medicaid
as
their
healthcare
benefit
they're,
a
central
part
of
the
fabric
of
nevada,
and
we
treat
them
with
that
respect
and
individuality
that
nevadans
love.
J
Community
investment
is
a
huge
part
of
our
approach.
We
understand
as
a
managed
care
organization
that
it's
incumbent
upon
us
to
support
the
community
network
because,
honestly,
without
them,
we
cannot
do
our
job.
You
see
there
that
in
2021
we
invested
over
2.5
million
dollars
over
a
quarter
of
that
was
contributed
to
covid
vaccination
efforts.
J
J
J
J
This
approach
is
based
on
research
that
shows
when
chil,
when
we
target
children
with
nutrition
education,
they
influence
the
whole
family's
eating
habits.
Our
vpo
quality
and
registered
nurse
is
the
executive
sponsor
to
ensure
that
the
educational
materials
that
are
developed
are
evidence-based
and
effective.
Our
senior
director
of
health
equity
ensures
the
program.
Delivery
is
culturally
competent
and
integrated
into
the
communities
we
serve.
We
look
forward
to
coming
back
and
reporting
on
outcomes
of
that
program.
J
Why
do
we
do
the
work
that
we
do,
and
why
do
we
do
it?
The
way
that
we
do
it
because,
quite
simply
it
works.
We
know
that
when
we
deploy
this
method,
community
health
workers,
investment
partnership
with
cbo's
and
providers
and
reliance
on
data
and
evidence-based
approaches,
access
to
care
goes
up
and
the
cost
goes
down.
The
data
that
you're
seeing
here
is
peer-reviewed
10
times
over
and
it
works.
J
Our
approach
to
health
equity
is
not
dissimilar
to
the
overall
approach
we
deploy
in
the
community
solutions
department.
We
analyze
data,
identify
disparities
and
then
lean
on
trusted
community
partners
and
provider
partners
to
develop
interventions.
You'll
see
here
that
we
deployed
this
and
we
were
able
to
eliminate
the
disparity
amongst
our
membership.
J
With
childhood
immunization
rates,
we
are
ncqa
accredited
and
currently
working
on
our
ncqa
health
equity
accreditation
as
well.
We
look
forward
to
a
close
continuing
partnership,
continued
partnership
with
the
state
to
reduce
health
disparities
and
improve
health
outcomes,
and
now
I'll
pass
it
back
off
to
eric.
Thank
you.
H
Thank
you,
nikki,
just
a
couple
of
other
additional
highlights
that
I'd
like
to
mention
here.
First
of
all,
we
continue
to
work
very
closely
with
immunized
nevada
and
our
provider
partners
to
host
vaccination
events
to
educate
the
community,
reduce
hesitancy
and
increase
the
uptake
of
the
cova
vaccination.
H
H
We
must
remain
focused
on
ensuring
that
nevadans
continue
to
have
health
care
coverage
for
those
that
no
longer
qualify
for
medicaid.
We
stand
by
ready
to
assist
them
in
enrolling
them
in
the
state-based
exchange
program
with
the
marketplace.
Insurance
nevada
does
still
have
a
sizable
population
that
is
eligible
for,
but
not
enrolled
in
medicaid
a
program
called
facilitated.
Enrollment
is
a
potential
solution
to
get
these
individuals
enrolled.
This
solution
was
put
in
place
in
new
york
and
has
proven
to
be
successful
in
reducing
the
number
of
uninsured
in
that
state.
H
Madam
chair,
that
concludes
our
presentation.
We
do
have
contact
information
here.
On
the
last
slide,
I
would
welcome
any
of
the
committee
members
to
reach
out
to
us.
If
they
have
questions
and
of
course
we
are
more
than
willing
to
answer
any
questions
you
all
have
today.
Thank
you
so
much
for
your
time.
A
Thank
you.
Thank
you.
Both
we
are
going
to
move
into
our
q
a
section
of
this,
this
agenda
item.
I
have
a
couple
of
folks
on
the
queue
and
I'm
going
to
go
ahead
and
start
with
a
question
that
I
have
that
doesn't
have
to
be
responded
to,
but
I'm
going
to
ask
for
it
to
to
be
followed
up
on
by
staff
and
to
get
this
information
to
us
when
you
can
to
specifically
to
medicaid.
A
Can
you
send
us
a
summary
of
the
outcome
based
metrics
that
have
have
to
be
met
by
the
mcos
during
their
contract
period?
I'm
looking
particularly
at
accessing
network
metrics,
if
they're
included
in
those
contracting
language
and
then
can
you
also
send
any
value-based
determinants
that
are
being
used
to
prioritize
or
otherwise
incentivize
each
mco?
A
C
D
C
D
Yes,
it
was
a
computer
algorithm
that
just
went
in
and
assigned
random
numbers
to
households
keeping
the
households
together.
So
it
was
actually
quite
impressive
at
how
close
we
got
to
25,
because
households
are
made
up
of
multiple
people.
It
wasn't
done
on
an
individual
member
basis,
so
yeah
it
was
a
random
selection
through
through
the
computer
system,.
A
As
a
follow-up
to
that
question,
can
I
ask
how
does
that
contribute
to
the
continuity
of
care
model
that
we
prioritized
in
this
redistribution.
D
So
the
plans
are
required
to
coordinate
care
with
each
other.
They
need
to
honor
prior
authorizations
prescriptions
things
of
that
nature
during
this
transition
period,
and
so
that's
largely
how
the
continuity
of
care
is
coordinated.
If
we,
if
we
have
faced
a
few
situations
where
there
weren't
contracts
in
place
or
care
available
that
the
member
needed,
so
we
have
authorized
on
a
case-by-case
basis,
retroactive
re-enrollment
into
their
former
plan
to
ensure
that
no
member
is
harmed
during
this
process.
A
C
Thanks,
I'm
gonna
turn
off
the
video,
hopefully
my
my
I'll
turn
off
the
video
so
that
my
sound
may
come
through.
So
hopefully
that
does.
I
have
a
couple
questions
really
and
it
really
is
a
segue
away
with
the
one
that
chair,
peters
asked
and
I'm.
I
was
really
concerned
about
the
continuity
of
care
and
if
it
was
just
arbitrarily
done,
did
you
assure
that
those
two
additional
health
plans
actually
had
the
same
providers
or
did
every
so
would
basically
be
75
percent
of
the
folks
out
of
the
100?
C
If
everybody
went
to
a
different
plan,
how
to
change
providers?
Can
you
answer
that
question.
D
So,
first
to
the
point
of
75,
we
did
not
disrupt
75
percent
of
the
membership.
It
was
somewhere
around
40.
I
believe
because
of
the
approach
we
took,
we
did
not
do
a
provider
comparison,
but
there
are
requirements
within
the
contract
that
there
is
network
adequacy
specialties.
D
C
You
repeat
the
question:
sorry,
my
concern
is
that
that
you
doubled
the
number
of
mcos
and
I
did
not
see
any
public
hearings
regarding
that.
You
split
up
a
lot
of
folks
arbitrarily
by
a
computer
network,
not
really
looking
at
the
providers
but
really
looking
at
just
did
they
have
the
same
number
of
providers,
not
necessarily
with
their
provider
on
their
new
program,
and
I
have
real
concerns
about
how
that
process
was
done.
C
You
can
maybe
address
that
offline
and
send
you
know
for
more
information,
but
the
next
question
I
have
is
these
are
negotiated
contracts
and
one
of
the
concerns
was
to
re.
Did
you
renegotiate
contracts
because
you
get
these
folks
get
paid
per
enrollee,
whether
they
are
seen
or
not,
and
so
I've
been
told
that
the
contacts
are
renegotiated
every
so
often
so
did
everybody
get
all
four
get
the
same
contracts
so.
D
Thank
you
for
the
question.
In
other
words,
are
you.
D
C
C
I
want
to
see
if,
if
more
people
are
getting
care,
because
at
the
end
of
the
day,
that
will
determine
the
success
of
what
the
state
did
by
offering
to
more
mcos
because
did
more
patients
actually
get
care
so
be
curious
in
the
next
year,
or
so
to
actually
see
those
access
data.
So
thank
you,
madam
chair,
for,
and
your
patience
with
my
internet.
A
Thank
you
for
the
question
and
I
think
that's
kind
of
in
line
with
the
request
that
I
had
for
the
metrics
that
are
included
in
the
contract,
the
things
that
are
expected
to
be
returned
as
a
product
of
those
contracts
from
the
mcos
to
as
proof
of
effort
right.
What
are
we
gonna
see
from
them?
A
So
I'm
not
sure
we
have
any
data
at
this
point
considering
how
new
we
are
into
the
into
these
contracts,
but
as
that
data
comes
in
we'd,
love
to
see
it
and
be
updated,
and
just
a
summary
of
what
you
expect
to
be
seeing
as
those
metrics
come
in
would
be
really
helpful
at
this
time.
Assemblyman
haythan
is
the
next
on
my
list.
K
Thank
you,
madam
chair,
and
thank
you
for
the
presentation
today
when
some
of
these
questions
were
coming
up.
It
kind
of
intrigued
me
that
this
was
kind
of
it
sounded
like
a
new
process
that
we
did.
K
It
just
started,
and
so
I
was
kind
of
curious
how
this
this
new
process
with
bringing
in
the
new
mco,
compares
to
maybe
what
we've
done
in
the
past
and
bringing
additional
mcos
in,
and
maybe
you
could
kind
of
explain
why
the
change.
D
Sure
so
the
goal
on
bringing
in
a
new
plan
is
to
allow
them
to
be
sustainable.
So
the
last
time
that
we
did
introduce
a
fourth
plan.
The
the
method
that
was
used
was
that
new
members
coming
in
would
be
assigned
to
that
plan
until
they
got
to
a
certain
threshold
that
was
not
successful
and
that
plan
did
have
to
exit
the
market
because
they
did
not
get
enough
members
to
be
sustainable.
So
this
approach
was
something
that
was
based
on.
You
know.
We
did
have
a
vendor
help
us
with
this
procurement
approach.
D
We
did
have
listening
sessions
that
were
held
like
public
meetings,
and
so
we
we
very
carefully
crafted
this
approach
to
ensure
that
we
were
more
successful
than
than
the
last
time
we
attempted
this,
and
it
is
based
on
other
states
experience
and
the
experts
that
helped
us
with
this
procurement.
A
And
I
I
know
that
our
mcos
are
more
than
willing
to
have
one-on-one
conversations
with
us
about
how
they're
intending
to
meet
some
of
these
metric
goals,
but
they're
all
very
invested
in
this
new
process
and
making
sure
that
the
quality
of
care
and
continuity
is
met.
So,
if
you
have
additional
questions,
please
feel
free
to
reach
out
to
those
folks
as
well.
They've
all
provided
their
contact
information
today,
but
if
you
need
some
assistance
in
that,
please
feel
free
to
utilize,
mr
ashton
and
miss
mrs
robuster
or
mr
booster.
A
I
don't
see
any
other
questions
coming
up
from
my
members,
so
with
that
I'm
going
to
thank
all
of
our
presenters.
That
was,
that
was
a
deep
presentation.
I
appreciate
everybody's
availability
and
willingness
to
dive
into
this.
This
issue
in
detail
and
I'm
gonna
move
us
along
to
our
next
agenda
item,
which
is
the
overview
of
the
status
of
the
public
health
insurance
option
to
be
established
pursuant
senate
bill
420.
A
This
is
to
be
presented
by
administrator
suzanne
biermann
again.
Thank
you
so
much
for
sticking
around
with
us
and
coming
back
for
this
particular
issue.
I'm
going
to
go
ahead
and
let
you
start
a
presentation.
G
Okay,
thank
you
so
much
chair
peters.
I
appreciate
it.
I
do
believe
that
our
presentation
is
getting
pulled
up.
So
if
you
can
just
give
me
one
minute,
I
expect
that
it'll
show
up
on
the
screen
in
just
a
second.
G
A
Broadcast
do
we
have
miss
blankenship,
don't
see?
Oh
there,
she
is
okay.
We
have
her
on
if
she
can
share
her
screen
hi,
I'm
I'm
I'm
working
on
sharing
it.
It's
just
not
showing
up
as
oh
there.
It
goes
sorry
about
the.
G
Thank
you
I
ate
it.
I
appreciate
it,
so
thank
you
for
the
opportunity
to
provide
an
update
on
senate
bill
420
from
the
2021
session.
I
will
say
this
is
one
of
I
think
about
40
bills
that
we're
working
to
implement
from
last
session
and
happy
to
to
provide
some
some
details
on
this
bill.
I
will
say
it's
really
early
in
the
implementation
process.
This
the
the
public
option
product
is
set
to
go,
live
on
january,
1st
2026,
which
aligns
with
our
managed
care
reprocurement.
G
So,
as
you
just
heard
in
the
last
presentation,
we've
just
been
through
that
process
with
the
contracts
that
went
live
on
january
1st
of
this
year
and
the
next
time
that
we'll
be
doing
that
is
january
1st
of
2026,
and
this
is
all
built
to
align
with
that
which
makes
for
a
four
year
implementation
process,
so
just
wanted
to
kind
of
level
set
with
that,
and
let
you
all
know
that
we
have
been
working
a
lot
to
meet
all
the
requirements
in
sb
420
and
to
implement
this,
but
I
also
did
want
to
highlight
that
this
won't
be
completely
up
and
operational
and
implemented
until
about
four
years
from
now.
G
So
thanks
for
that,
if
you
could
skip
to
the
overview
slide,
I
think
slide
three,
that
that
would
be
great.
So
here
just
a
recap
of
senate
bill.
420
requires
the
nevada
department
of
health
and
human
services
working
with
the
executive
commissioner
of
the
silver
state,
health
insurance
exchange
and
the
director
of
the
department
of
insurance
to
design,
establish
and
operate
a
public
option
plan
again
to
be
effective
as
of
january
1st
2026..
G
I
do
also
want
to
pause
here
and
acknowledge
that
sb420
has
a
lot
of
other
requirements
beyond
establishing
the
public
option.
Some
of
those
are
for
the
exchange
and
some
of
those
are
other
medicaid
requirements
that
are
related
to
maternal
and
child
health.
So
we
were
planning
to
focus
today's
presentation
on
the
public
option,
related
aspects
and
then
happy
to
come
back
on
the
maternal
and
child
health
date
and
provide
an
update
of
all
the
things
we're
doing
related
to
maternal
and
child
health,
including
the
provisions
in
senate
bill
420.
G
So
thanks
aida.
If
you
could
go
to
the
next
slide,
please
so
all
of
this
was
outlined
in
the
bill
itself,
but
just
wanted
to
go
back
and
highlight.
I
know
it's
been
a
while,
since
we
were
all
in
session
the
goals
of
the
public
option
product
as
outlined
in
senate
bill
420,
were
to
really
leverage
and
improve
the
state's
purchasing
power.
This
is
an
affordability
initiative
and
I
know
that's
something
that
we
talked
about
in
our
medicaid
presentation
as
well.
G
Just
you
know
an
attempt
to
address
the
rising
cost
of
health
care
that
we
know,
impacts
nevadans
and
americans
more
broadly.
So
this
is
an
affordability
initiative.
It's
also
designed
to
improve
access
and
reduce
disparities
for
historically
marginalized
communities.
So
again,
a
parallel
to
the
presentations
you
heard
earlier,
and
the
emphasis
on
health
equity
was
also
included
in
the
language
of
sb420.
G
Next
slide,
please,
okay,
so
we
mapped
out
the
requirements
of
sb420
and
one
of
the
the
primary
requirements
for
the
department
of
health
and
human
services
in
this
is
to
create
and
submit
a
1332
waiver
to
the
federal
government.
So
1332
is
the
reference
to
the
affordable
care
act
which
authorizes
what
are
known
as
state
innovation,
waivers.
Also
1332,
that's
the
section
in
the
affordable
care
act.
So
you
know
we
have
a
number
for
our
waiver
for
all
of
these
things,
going
back
to
the
medicaid
landscape.
G
We
talk
about
1115
waivers
a
lot,
and
so
that's
a
medicaid
research
and
demonstration
waiver
and
it's
called
an
1115
waiver,
because
that's
the
section
that
you
find
it
in
federal,
medicaid
law
and
similarly
the
1332
references
to
to
that.
You
know
provision
in
federal
law
that
establishes
these
state
innovation
waivers.
G
So
just
wanted
to
note
here
that
it
does
permit
states
to
request
waivers
of
certain
components
of
the
affordable
care
act,
and
one
of
those
that
is
important
for
this
project
is
what
is
referred
to
as
pass-through
funding.
G
So,
basically,
if
the
state
is
able
to
save
money
on
this
product,
which
will
be
a
qualified
health
plan
available
on
the
exchange-
and
there
are
requirements
in
this
bill
that
require
premium
reductions,
we'll
go
into
that
in
further
detail,
but
that
funding
is
what
the
amount
saved
as
opposed
to
what
the
federal
government
would
also
otherwise
be
paying
the
difference.
There
is
what's
called
pass-through
funding,
so
just
wanted
to
do
some
definitions
here
and
I
will
say,
we're
all
learning
as
we
go
on
this.
G
So
again,
you
know
one
of
the
goals
is
to
use
this
funding
to
then
have
a
pool
of
money
to
support
the
state's
affordability
initiatives
and
again
it
comes
from
money
that
otherwise
would
have
been
spent
on
advanced
premium,
tax
credits
and
the
subsidies
that
are
available
through
the
exchange
for
the
consumers
that
choose
to
buy
this
qualified
health
plan.
From
from
the
exchange
see
the
next
couple
of
slides
go
through
the
implementation
phases.
G
G
So
that
was
really
the
the
first
phase
of
this
is
to
do
some
robust
public
input
and
design
sessions,
and
when
we
finish
this
at
the
end
of
the
month,
we'll
have
hosted
six
of
those
again
much
more
information
to
come
in
this
presentation
about
what's
been
presented
where
you
can
find
it
the
the
public
engagement
process.
G
So
I
just
wanted
to
highlight
there
that
there,
but
this
is
the
phase
that
we're
currently
in
once,
we
finish
the
six
design
sessions,
we'll
move
on
to
developing
the
1332
waiver
draft,
as
I
mentioned,
that
was
one
of
the
requirements
for
hhs-
is
to
produce
this
draft
and
submit
the
waiver
to
the
federal
government
back
to
senator
hardy's
question
in
my
last
presentation.
G
There
is
an
actuarial
analysis
component
of
this
and
all
1332
waivers
so
work
on
the
waiver
draft
and
the
required
actuarial
analysis
that
accompanies
that
we'll
start
as
soon
as
we
finish
the
design
session,
so
that
is
scheduled
for
february.
G
Some
are
required
by
the
federal
government
in
terms
of
their
requirements
related
to
1332
waiver,
but
we
have
been
trying
to
have
a
very
open
and
transparent
process
where
public
comment
can
be
accepted
at
any
point
in
this
process,
so
wanted
to
flag
that
there
is
another
key
milestone
in
our
timeline.
G
All
of
this
is
somewhat
subject
to
change
but
kind
of
backward
mapping.
The
2026
state.
This
is
our
current
timeline
and
we
hope
that
we
don't
see
things
shift
considerably.
But
do
you
want
to
flag
that?
Sometimes
you
know
things
arise
that
move
dates
by
a
couple
weeks,
and
hopefully
we
don't
have
any
more
significant
delays,
but
this
is
our
our
current
best
estimate
of
this
four-year
implementation
phase,
which
is
you
know,
as
I
mentioned
before,
kind
of
a
long
time
to
to
map
out.
G
So
then
that
brings
us
to
february
2023
when
we
will
submit
the
waiver
to
the
federal
government
and
begin
negotiations,
and
then
the
next
big
milestone
is.
Can
the
process
that
we
just
recently
went
through
where
we
reprocure
the
managed
care
contracts,
but
also
this
time
in
the
next
version
of
this
we'll
be
doing
an
additional
procurement
for
the
public
option
product
as
well.
G
So
all
of
that
process
it
does
take
a
while
to
work
through
the
rfp
and
then
have
time
for
bids
to
come
in
and
then
the
scoring
process
all
leads
up
to
a
january.
1St
2026
launch
next
slide,
please,
okay,
so
here's
some
more
information
on
the
meetings
that
we've
been
hosting,
how
we've
been
establishing
opportunities
for
feedback?
First,
we
have
established
a
website-
it's
listed
here
at
dhhs.nb.gov
backslash
public
option
and
we've
really
tried
to
make
it
a
one-stop
shop
for
resources
related
to
the
public
option,
so
you
can
see
archived
design
sessions.
G
I
mentioned
that
by
the
end
of
the
month,
we'll
have
six
of
those,
so
the
ones
that
have
already
been
conducted-
the
ones
that
were
earlier
and
are
ready
to
go,
are
all
up
on
the
website
and
we
will
get
all
six
of
them
up
by
the
time
that
we're
done
with
this.
Also,
all
public
comment
that
we
are
receiving
is
posted
there.
There
is
a
mailbox,
that's
been
established
for
any
public
comments
that
come
in.
G
We
also
have
set
up
listservs
to
notify
stakeholders
of
the
design
sessions
and
all
of
the
other
opportunities
for
public
input
and
feedback,
and
also
just
general
updates
on
the
different
phases
of
implementation
of
this
project.
G
So
you
can
see
here,
the
email
address
that's
been
established
and
that's
also
included
on
the
web
page
next
slide,
please,
okay.
So
this
gets
weedy
and
I
know
it's
late
in
the
day.
G
So
I'll
go
through
some
of
this
fast,
but
when
we
think
about
the
design
elements,
what's
going
to
be
required
of
this
qualified
health
plan
just
want
to
flag
that
a
lot
of
this
is
actually
decided
and
determined
in
the
statutory
language
of
senate
bill
420
itself-
and
you
know
the
fact
that
it's
a
required
to
be
a
qualified
health
plan
means
that
it
has
a
lot
of
requirements
in
the
affordable
care
act
that
must
be
complied
with.
G
So
I
just
spent
a
couple
of
slides
here
flagging
some
of
the
the
key
design
decisions
that
were
actually
included
in
the
bill
language
itself.
So,
as
I
mentioned
before,
the
public
option
plans
do
have
premium
target
reductions-
that's
five
percent
in
year,
one
or
cumulative
a
fifteen
percent
by
year.
G
Four
again,
that's
the
idea
that
that
those
reductions
are
going
to
lead
to
you,
this
pass-through
funding
that
will
help
support
the
state's
overall
affordability
initiatives,
the
product
design
decisions
that
were
outlined
in
sp
420
again,
they
have
to
satisfy
affordable
care
act,
rules
for
qualified
health
plans
and
state
rules
for
individual
policies
of
health
insurance.
So,
as
we've
talked
a
lot
about
network
adequacy,
there
are
also
rules
that
are
established
for
all
qualified
health
plans,
and
this
plan
is
required
to
meet
those
federal
requirements
for
qualified
health
plans.
G
G
All
of
the
bidders
for
the
upcoming
to
the
next
version
of
the
managed
care
contracts
will
also
have
to
submit
a
good
faith
bid
for
the
public
option
and
participate
in
that
plan
in
order
to
have
their
proposals
for
the
managed
care
contract
to
be
considered
next
slide.
Please,
okay,
here,
additional
requirements
from
senate
bill
420
are
outlined,
as
I
mentioned
before.
The
department
of
health
and
human
services
must
operate
the
public
option
by
putting
out
a
procurement.
G
There
are
some
specific
exceptions
for
even
other
reimbursement
models
that
are
used,
such
as
federally
qualified
health,
centers
and
rural
health
clinics,
and
for
those
they
must
receive
no,
no
less
than
their
medicare
cost
pace
rates
and
certified
community
behavioral
health
clinics,
which
sandy
mentioned
in
her
presentation
earlier,
which
are
really
integrated,
behavioral
and
physical
health
clinics
must
receive
what
they
are
paid
in
in
medicaid
at
least,
and
I
will
flag
to
you
that
this
was
all
designed
to
be
a
floor
and
not
a
ceiling
provider
participation.
G
There
are
requirements
in
senate
bill,
420
that
require
providers
participating
in
the
public,
employee,
benefit
program
and
medicaid
to
also
participate
in
at
least
one
public
option
plan
and
then
the
next
set
of
legislative
requirements
outlined
here.
We
talked
a
little
bit
about
this
already
the
development
of
the
1332
waiver
application,
which
does
require
an
actuarial
analysis.
G
That
requires
the
pass-through
funds
to
be
deposited
into
a
trust
fund
managed
by
the
treasurer's
office
and
then
those
additional
funds
that
accrue
in
that
account
can
be
used
to
improve
consumer
affordability
initiatives
next
slide,
please,
okay,
so
the
the
sb
420,
the
text
of
sb420,
made
a
lot
of
decisions
about
the
design
of
the
public
option,
included
them
in
the
statute,
so
pretty
clear
on
how
all
of
that
is
supposed
to
work
there
you
know
always
are
then
more
specific
areas
left
to
the
agency
to
fill
in
some
of
those
details.
G
Some
of
those
are
determining
how
to
target
the
pass-through
funds
that
accrue
to
improve
affordability
and
decisions
around
how
to
leverage
state
purchasing
authority
to
drive
straight
state
priorities.
Again,
we
mentioned
value-based
health
care
financing
models
and
alignment
with
medicaid,
which
we've
also
talked
about
increasing
value-based
payment
arrangements
as
one
of
our
priorities
so
really
trying
to
work
on
the
alignment
between
these
two
plans
and
also
networks
and
benefit
design.
G
Next
slide,
please.
So
this
is
a
lot
of
really
granular
detail
about
the
six
design
sessions
that
I
mentioned,
which
again
are
the
primary
components
of
this
project
that
have
been
done
to
date.
So
this
outlines
the
the
meetings
that
we've
had
already
on
december,
8th
22nd
and
january
5th,
and
the
specific
topics
that
were
covered
there
are
listed
here,
as
I
mentioned,
there's
transcripts
and
videos
of
these
meetings
up
on
our
public
option
website,
in
addition
to
the
public
comments
that
we've
received
so
next
slide.
G
It
also
lists
the
the
design
session
that
we
had
last
week
as
well
as
the
one
that
is
upcoming,
the
sixth
design
session,
which
will
be
on
january
28th
and
that
will
focus
on
licensure
and
oversight
and
a
detailed
presentation
on
the
next
steps
in
this
process.
You
know
I
mentioned
that
this
is
kind
of
the
end
of
phase
one
and
so
detailed.
G
I'm
happy
to
continue
to
provide
online
updates
and
continue
to
accept
written
comments
and
feedback
from
stakeholders,
then
in
february
20
february,
so
the
next
month
we'll
be
summarizing.
All
of
that
information
and
working
on
the
actuarial
analysis
and
the
the
draft
of
the
1332
waiver
application
itself
again
august
to
november
of
this
year.
The
timeline
for
public
engagement
around
that
1332
waiver
draft
and
analysis
and
then
our
goal
is
to
submit
the
1332
waiver
to
the
federal
government
by
march
2023.
A
Thank
you
so
much.
It
was
a
lot
all
very
good
information,
though
I'm
glad
for
the
update
so
early
in
the
process.
I
do
have
a
couple
of
questions
and
the
first
one
comes
from
assembly.
Women
titus,
who
she
texts
me
the
question
because
her
her
internet
has
been
making
it
difficult
to
hear.
So
I'm
going
to
to
make
this
question
on
her
behalf.
A
So
what
have
you
heard
so
far
from
the
associations
representing
physicians,
insurers
and
hospitals,
and
how
will
you
incorporate
that
input
as
you
continue
to
flush
out
the
public
option,
so
we
don't
exacerbate
existing
access
to
healthcare
challenges
in
our
state.
We
have
heard
from
during
the
last
session,
as
well
as
in
the
interim,
that
there
is
concern
that
we
will
be
potentially
discouraging
providers
from
coming
to
nevada.
A
So
can
you
address
that,
as
far
as
you
guys
have
information
from
those
first
couple
of
design
meetings
and
what
you
expect
to
see
in
the
future.
G
Thank
you
for
the
question,
so
we
do
have
a
high
level
summary
of
the
themes
that
we've
heard
so
far.
I
will
say
many
of
the
active
participants
in
this
process
were
also
active
commenters
during
the
legislative
session,
so
have
heard
from
the
hospital
association
frequently,
as
well
as
the
association
of
health
insurance
plans.
Also,
a
lot
of
consumer
advocates
have
been
engaged
and
have
provided
public
comments
and
feedback.
So
again
it's
it's
all
posted
and
we
encourage
everyone
to
go.
Look
at
all
of
that.
G
You
know
to
the
extent
that
time
and
interest
allows,
but
I'll
just
kind
of
go
through
a
couple
of
high-level
themes.
Of
what
we've
heard
about
so
far
is
just
concern:
continuing
concern
around
the
cost
of
health
care
and
consumer
affordability
issues.
G
We
have
heard
about
the
impact
on
provider,
workforce
access
concerns
both
for
for
consumers
and
also
some
concerns
around
the
provider,
participation
requirement
and
the
concern
for
the
impact
so
related
to
the
the
question
there
also
some
additional
themes
around
the
target
population
which
segment
of
the
uninsured,
should
really
be.
The
focus
of
this
and
people
have
provided
thoughts
and
comments
on
that
question.
We
actually
have
structured
these
design
sessions
where
we
tee
up
just
a
variety
of
questions
that
we
would
like
feedback
from
stakeholders
on.
G
So
some
of
that
aligns
with
the
questions
that
we've
provided
and
presented,
and
then
there's
additional
feedback
and
comments
as
well.
So
I
did
just
want
to
flag
that
some
of
this
is
in
response
to
specific
questions.
That
is
it.
The
actuarial
analysis
needs
to
answer,
or
that
is
important
for
the
the
waiver
application
provider.
G
Reimbursement
has
certainly
been
a
common
theme
considerations
for
the
actuarial
study,
ideas
for
leveraging
state
purchasing
authority
again
some
comments
around
encouraging
and
promoting
value-based
provider
payment
models,
and
then
you
know
just
some
kind
of
more
generalized
comments
around
support
and
concern
for
the
the
market,
reform
and
implications
of
the
public
option.
So
that's
a
really
high
level
summary
and
overview.
G
I'll
also
add
that
we've
been
working
really
hard
to
get
out
questions
and
answers
or
frequently
asked
question
document
that
answers
a
lot
of
the
questions
that
we've
received
and
we
are
close
to
getting
that
posted
on
the
website
have
a
couple
of
additional
layers
of
review
but
anticipate
getting
that
additional
resource
out
for
stakeholders
very
very
soon.
So
I
hope
that
helps.
A
You
thank
you.
I
have
a
couple
more
questions
in
the
queue
I
saw
assemblyman
or
lookers
hand
up
first,
so
I'm
going
to
go
ahead
and
call
on
you
and
then
assemblywoman
gorlo,
an
assemblyman
chieftain.
K
So
I
want
to
make
sure
I
understand
the
waiver,
so
it
sounds
like
the
way
you've
described
it
that,
because
this
public
option
will
be
cheaper
than
existing
options,
that
the
premium
tax
credits
and
the
cost-sharing
obligations
of
the
federal
government
will
be
reduced
right.
K
If,
if
they're
paying
toward
the
health
plans
of
the
people
who
buy
the
public
option,
they
won't
have
to
pay
as
much
so
we'll
be
saving
hhs
a
lot
of
money
in
washington,
but
with
this
public
option
and
the
waiver
would
allow
us
to
capture
those
savings,
so
we
can
use
them
for
to
implement
this
public
option
is
that
is
that
how
this
works?
Am
I
understanding
this.
G
I
think
that's
exactly
right,
that's
the
that's
the
concept
and
I
think
that
you
know
the
impetus
for
the
1332
waiver
itself
is
to
be
able
to
capture
those
pass-through
savings,
so
I
think
you
described
that
really
well.
Thank
you.
G
So
there
are,
you
know,
general
provisions
that
are
waivable,
but
there
are
also
these
guard
rails
that
have
to
be
included,
and
the
actuarial
analysis
has
to
kind
of
ensure
that
those
are
protected
and
those
have
to
do
with
requirements
in
the
aca
around
preserving
the
number
of
individuals
covered
in
the
state,
comprehensiveness
and
affordability
of
coverage
offered.
G
So
that's
kind
of
been
parlance
called
the
comprehensive
coverage
requirement.
The
affordability
requirement,
there's
a
scope
of
coverage
requirement
and
the
waiver
must
not
increase
the
federal
deficit.
So
it
does
provide
the
ability
to
waive
other
provisions,
and
I
think
the
one
that
has
been
the
primary
focus
is
this
pass-through
funding,
but
did
just
want
to
flag
that
there
are
certain
protections
that
the
federal
government
wants
to
see
assurances
that
it's
not
harming
coverage
in
any
of
those
ways
or
increasing
the
federal
deficit.
G
So
those
are
what's
kind
of
commonly
referred
to
as
the
guard
rails
of
1332
waivers.
Okay,.
A
Thank
you
and
that's
really
important
information.
Mrs
biermann,
if
you
wouldn't
mind
sharing
that
with
us
in
a
formal
email,
so
we
have
that
what,
as
you're
giving
us
updates
on
the
process
that
would
be
fantastic.
Somebody
mentioned,
I
think
you
are
next
on
my
list.
Please
go
ahead.
K
Thank
you.
Thank
you,
madam
chair.
I
I
appreciate
staff
having
all
the
stakeholder
meetings
and
trying
to
to
be
as
transparent
and
work
this
process
through.
I,
I
obviously
still
very
confused
with
the
whole
public
option,
but
I
know
there's
a
lot
more
to
come.
One.
One
of
the
questions
that
I
had,
though,
was
it
appears
we're
going
to
be,
combining
the
risk
pools
and
under
the
established
for
medicaid.
G
Thank
you
for
the
question.
I'm
not
sure
that
there's
been
a
decision
made
on
combining
risk
pools.
Yet
so,
if
it's
okay
with
you
assemblyman
haven,
I
will
take
that
question
back
and
make
sure
that
it's
also
included
in
the
frequently
asked
questions
document,
and
I
did
just
want
to
flag
to
chair
peters
that
all
of
that
information
that
I
just
went
through
in
response
to
representative
assemblyman
orton
liquor's
question
is
also
going
to
be
addressed
in
the
frequently
asked
questions
document.
G
A
Thank
you
and
I
think
that
that
q,
a
document
is
perfect.
If
you
want
to
just
send
that
one,
it's
ready,
especially
if
it's
ready
before
the
next
couple
of
meetings
or
within
before
the
last
public
meeting.
Maybe
we
have
that
information
to
talk
to
folks
about
as
well.
C
Thank
you,
madam
chair,
and
I
believe
I
have
two
questions.
I
was
taking
my
notes
and
writing
very
very
quickly,
but
I
think
I
might
have
missed
some
information.
So
will
this
be
managed
by
the
ncos
like
medicaid,
or
will
the
state
be
managing
it
so.
G
It'll
be
managed,
like
all
other
qualified
health
plans
that
are
sold
on
the
exchange,
so
those
are
both
the
the
exchange
and
the
division
of
insurance
has
responsibilities
over
managing
the
qualified
health
plan.
So,
as
a
qualified
health
plan,
it
would
be
managed
in
the
same
fashion,
okay,
great.
C
G
I
will
try
and
I
may
have
to
call
on
phone
a
friend,
our
finance
deputy,
but
I
can't
say
their
prospective
payment
system
rates
and
I
could
get
you
more
additional
information
on
the
rate
setting
process.
As
the
state
set
up
the
certified
community
behavioral
health
services.
G
We
work
to
ensure
that
those
rates
were,
you
know,
adequate
to
cover
cost
and
it
is
paid
by
a
pps
rate
methodology,
but
I
don't
want
to
go
any
deeper
than
that.
I
don't
want
to
say
anything,
that's
incorrect,
so
I
will
see
if
phil
burrell,
our
finance
deputy,
wants
to
be
my
phone
a
friend
right
now
or
if
not,
we
can
provide
additional
information
on
how
those
ccbhc
rates
were
developed.
K
We
can
get
some
additional
information
for
you
all
suzanne
you're
correct.
They
are
established
through
pps
rates,
but
we
can
add
some
additional
detail.
If
company
would
like
us
to
do
that.
G
And
again,
just
want
to
flag
those
handful
of
exceptions
that
we
talked
about
related
to
ccbhc's
fqhc's
rural
health
clinics.
There's
things
that
medicaid
typically
pays
on
the
pps
basis,
but
the
general
rule
is
medicare
or
better.
G
Oh
sorry,
prospective
payment
system.
C
C
Are
they
going
to
be
held
somewhat
harmless
as
they
get
decreasing
premium
reduction
rates,
who
who's
going
to
be
left,
holding
the
empty
bag
that
we're
going
to
save
this
money?
For
I,
I
assume
that
we're
going
to
save
money
all
the
way
around,
which
means
somebody's
going
to
be
paid
less
and
who
is
it
that
is
left
holding
the
bag.
G
Thank
you
for
the
question
senator
hardy.
What
I
can
point
to
you
are
the
provider
rate
requirements
that
we
just
talked
about,
so
the
you
know
general
rule
of
not
less
than
medicare,
and
I
will
say
this
is
also
something
that
we
have
put
out
in
our
design
sessions
for
public
comment
and
stakeholder
feedback.
G
I
think
a
lot
of
the
ideas
are
around
savings
from
value-based
purchasing
models
and
being
more
efficient
purchasers
and
paying
for
value
and
not
volume,
but
some
of
that
again
we're
pretty
early
in
those
are
the
questions
that
we've
teed
up
in
the
the
design
session
and
some
of
the
initial
thinking
around
that,
but
did
want
to
again
highlight
that
there
are
those
provider
reimbursement
floors
that
were
outlined
in
sb420.
G
I
think
beyond
that
much
like
in
managed
care.
You
know
it's
a
negotiation
between
the
the
plans
and
the
providers,
and
I
will
also
say
that
there
are
some
incentives
or
potential
additional
scoring
points
given
when
we
get
to
the
rfp
or
procurement
process
for
those
plans
that
have
an
even
more
robust
provider
network
and
have
alignment
with
medicaid
so
just
wanted
to
flag
those
provisions.
C
Mathematics
on
that,
I
I
recognize
right
now
that
we
don't
have
enough
providers,
we
don't
have
enough
access
and
I
I'm
just
fearful
that
our
access
is
going
to
be
even
less
than
it
was
before,
and
so
I
I
would
like
to
say
that
I'm
not
optimistic
as
maybe
you
are,
that
we're
going
to
have
clean
sailing
and
do
it
cheaper
and
more
effectively
and
have
better
results
and
all
of
those
kinds
of
things
I
look,
I
would
I
will
be
thrilled
if
all
of
this
works
appreciate
it.
Thank
you.
A
Thank
you
for
the
question
and
I
also
want
to
point
out
that
I
think
one
of
the
goals
in
this
is
to
help
capture
some
of
the
uninsured,
the
folks
who
are
healthy
and
don't
have
insurance,
because
it's
just
too
expensive
to
hold
individual
insurance
and
if
we
can
absorb
some
of
those
healthy
folks,
the
potential
for
cost
savings
exists
and
that
as
well
so
there's.
A
I
think
that
the
actuarial
analysis
will
be
very
telling
as
to
what
those
numbers
look
like,
and
I
think
we
all
look
forward
to
seeing
what
they
come
up
with
when
that
comes
around.
A
A
Our
final
agenda
item,
and
which
is
our
public
comment,
we
are
going
to
take
a
short
break
to
allow
the
public
to
call
in
now
there's
a
little
bit
of
a
delay
on
this.
So
I'm
going
to
give
us
maybe
two
minutes
to
get
folks
caught
up.
I
do
want
to
note
that
there
were
a
few
folks
at
the
beginning
of
the
meeting
who
called
in
and
were
unable
to
get
on
the
line.
A
I
have
encouraged
them
to
submit
written
public
comments,
so
please
go
and
check
those
public
comment,
the
written
public
comments
out
and
make
sure
that
you
have
seen
those
on
your
time
and-
and
I
also
hope
that
some
of
those
folks
who
were
unable
to
call
in
earlier
are
able
to
make
it
through
this
time
around
so
350
we
will
get
back
going.
Thank
you
guys
for
your
patience.
A
All
right,
it
sounds
like
we
have
a
few
people
on
the
line
already,
so
we
will
get
back
started
with
the
public
comment
component
of
our
meeting
today.
Please
remember
those
who
are
calling
in
please
please
clearly
state
and
spell
your
name
for
the
record
and
limit
your
comment
to
two
minutes,
so
we
may
get
through
all
the
folks
who
wish
to
participate
in
public
comment.
Today,
staff
will
be
timing.
Each
speaker
during
public
comment
to
ensure
that
everyone's
given
an
even
and
fair
opportunity
to
speak
staff
and
broadcasting
production
services.
I
Your
decision
to
promote
a
vaccine
that
only
reduces
severity
but
is
causing
death
and
injuries
in
people
and
is
under-reported
in
theirs
back
to
the
ethics
on.
This
is
not
only
astounding,
it
is
disgusting,
especially
when
it
is
clear
that
is.
This
is
not
a
vaccine
like
those
of
the
past.
It
is,
however,
called
vaccine
to
hypnotize
those
in
believing
they
are
receiving
the
benefits
of
the
vaccines
of
the
past,
but
in
reality
it
is
a
gene
therapy.
I
In
addition,
ivor
meccan
fiber
mechanin
discussion
is
suppressed,
even
though
it
has
been
proven
to
work
as
a
therapeutic
as
a
cure,
as
well
as
a
prophylactic
laxus.
What
you
should
be
discussing
is
how
many
people
have
been
killed
using
ivermectin.
You
know
the
conspiracy,
drug
versus
rendition,
the
hospital
protocol,
and
yet
nothing.
Furthermore,
public
health
here
is
what
the
public's
responsibility
is.
It
is
to
expose
liars
frauds
and
killers,
especially
when
they
hide
behind
hot
high
dollars,
big
pharma
bad
doctors
and
tyrannical
government
officials.
I
I
I
am
personal.
I
personally
am
an
obvious
theorist,
not
brainwashed
by
agenda.
If
public
health
actually
cared
about
public
health
they'd
be
telling
you
the
11
deadly
pathogens
found
on
mass,
they
discussed
pneumonia,
hypercapnia,
hypoxia
and
immunosuppression,
but
nope.
Instead,
you
keep
doing
circles
around
trying
to
justify
your
four
healthy
practices,
saying
out
loud,
that
you
need
peer
reviewed
articles,
but
cite
none.
Where
are
your
peer-reviewed
articles,
especially
with
the
mass
importance
enforcement
in
the
state
of
nevada,
and
yet
the
surge
continues?
I
J
A
L
Thank
you
today,
I
am
stepping
in
for
landsat
vanguilder,
who
is
the
legislative
chair
for
the
nevada,
dental
hygienist
association.
L
She
was
on
earlier
and
tried
to
speak,
but
apparently
couldn't
get
on,
so
I
am
filling
in,
and
I
want
to
state
first
that
she
has
submitted
written
comments,
and
I
encourage
you
to
read
those
comments,
because
I
am
going
to
make
this
as
quick
as
I
can,
so
that
everybody
can
start
ending
their
day.
It's
been
a
long
day
for
everyone,
I'm
addressing
agenda
item
3h,
which
deals
with
immunizations
provided
by
dental
practitioners.
L
There
are
three
sections
that
I'd
like
to
point
out
in
this
regulation.
That
is
the
most
concerning,
and
that
is
that,
once
the
emergency
orders
are
lifted
and
these
particular
regulations
stay
in
place,
public
health,
public
health,
dental
hygienists
will
no
longer
have
the
ability
to
provide
immunizations
as
a
little
history.
The
governor
did
allow
dental
hygienists
to
be
providing
immunizations
for
the
past
12
months
and
have
been
doing
so
all
along
and,
I
believe,
providing
a
thousand
plus
immunizations
in
that
time.
L
L
They
have
been
endorsed
by
a
dental
board
to
practice
the
full
scope
of
their
education
and
licensure
in
public
health
and
alternative
settings
without
a
dentist
and
have
been
able
to
do
so
for
over
the
last
20
years.
So
as
drafted,
this
regulation
would
prohibit
those
public
health,
dental
hygienists
from
providing
any
immunizations
whatsoever.
A
Sorry
that
was
two
minutes.
I
do
understand
that
we
sent
you
sent
in
some
written
public
comments,
so
we
will
take
that
up
and
consider
that
as
well.
C
E
Thank
you
good
afternoon,
almost
actually
good
evening.
Thank
you,
chair
and
committee
members.
For
this
time,
I'm
pk
o'neal
assemblyman
for
assembly
district
40..
I
tried
to
speak
this
morning.
However,
I
was
never
recognized
or
able
to
actually
speak,
though
I
appreciate
this
time
now.
As
I
said,
I'm
the
assemblyman
for
assembly
district
40,
which
includes
all
of
carson
city
and
southeastern
part
of
reno,
slash
warsaw
county,
I'm
here
this
evening
to
speak
on
item
three
dot:
h
lcd
file,
r035.2.
E
E
E
E
Never
gave
me
a
call
to
seek
any
suggestions,
although
during
legislation
during
legislation,
I
tried
to
contact
him
several
times
without
a
response
back.
I
respectfully
request
that
their
measure
of
today
presented
to
you
be
rejected,
sent
back
to
allow
for
all
the
parties
involved
to
discuss,
refine
and
come
forward
with
a
proper
nac.
That's
the
way
you
wish
to
proceed
with
this,
and
I
want
to
thank
you
for
the
time
I'm
available
for
any
questions.
Thank
you
very
much
chair
for
allowing
me.
A
Thank
you
assemblyman.
I
do
want
to
acknowledge
that
we
are
not
making
any
decisions
based
on
these
regulations
today.
This
was
informative
for
our
committee
to
be
able
to
ask
questions
of
the
boards
that
were
bringing
these
these
regulations
and
where
they
are
in
their
process,
and
today
it
looks
as
though
that
particular
regulation
will
expect
to
hold
additional
work
workshops
in
february
and
march.
A
So
I
would
encourage
you
to
reach
out
to
that
board
to
talk
about
those
concerns
on
those
those
regulations,
and
I
encourage
that
of
our
committee
as
well.
If
you
have
additional
concerns
related
to
those.
A
All
right
well,
thank
you
all
for
sticking
up
with
us
today
for
this
very
long
interim
hhs
meeting.
We
learned
some
very
important
things
and
I
think
all
of
us
have
some
follow-up
that
we
are
interested
in
pursuing
so
again,
please
feel
free
to
reach
out
to
our
policy
staff
or
myself
or
the
folks
who
talked
to
us
during
this
meeting
and
presented
during
this
meeting,
and
we
will
have
our
next
committee
meeting
on
february
17th
at
9
00
a.m.