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Description
This is the second meeting in calendar year 2023. Please see agenda for details.
For agenda and additional meeting information: https://www.leg.state.nv.us/App/Calendar/A/
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A
C
Yes,
thank
you,
madam
chair,
so
I
had
a
question
on
the
the
Clark
County.
It's
the
Child
Welfare
Grant
elimination
is
that
under
you.
C
D
You
and
and
thank
you
for
the
presentation
you
as
I've,
already
brought
up
about
the
Mental
Hospitals
being
closed
for
our
youth,
especially
so
it
sounds
like
it's
because
of
the
Staffing
issue.
So
with
that
I'm
going
to
actually
borrow
a
question
from
my
my
colleague.
D
What
is
what
are
the
requirements
for
these
Staffing
because
it
sounds
like
this
is
something
that
is
a
little
bit
more
than
just
hey,
you're
breathing
come
on
in
and
get
hired.
So
what
are
those
stuff?
Staffing
mechanisms?
Is
that
consistent
Across,
the
Nation
at
this
time.
A
E
Dr
Jaclyn
Wade
for
the
record
Madame,
chair
and
committee
members.
A
lot
of
these
positions
are
specialized
position,
as
we
noticed
through
covid.
We
did
have
a
shortage
of
nurses
because
they
went
to
the
medical
hospitals
or
they
were
sought
after
in
the
medical
hospitals,
so
we
had
difficulty
recruiting.
Nurses,
other
specializations
happen
to
be
clinical,
social
workers
and
other
mental
health
professionals
that
are
licensed,
and
so
we
are
having
difficulty
recruiting
specialized
Personnel
for
these
Hospital
positions.
So
this
is
why
we're
seeing
some
shortages
in
these
specialized
positions
thank.
D
A
A
It
requires
people
that
really
want
to
work
well
with
youth
that
have
behavioral
health
challenges
and
particularly
at
the
level
of
the
behavioral
health
technicians.
We
pour
a
lot
of
training
into
those
people
in
order
to
be
able
to
respond
to
to
these
youth
appropriately.
We
have
Handle
With
Care
training,
specifically
to
learn
hands-off
interventions
for
de-escalation.
A
That
is
a
challenge
to
find
it's
such
a
niche
or
Niche,
depending
on
which
area
of
the
country
you're
in
right.
It
really
is.
It
is
a
very
specialized
thing,
but
I
think
also
in
general,
through
our
state
system,
we
tend
to
lose
a
lot
of
people
that
we're
trying
to
onboard,
because
it
just
takes
so
long
to
get
from
here
to
there,
but
I
know
that
we're
all
working
together
we're
working
with
Durham
we're
working
with
the
director's
office.
D
Thank
you
and
then
I
do
have
a
my
last
question.
I
promise
sure!
Thank
you.
Thank
you
for
the
time.
This
is
a
question
from
number
10
from
slide
number
10.
You
mentioned
the
mobile
crisis
response
for
the
two
large
school
districts,
but
what
about
the
other
school
districts?
Has
there
been
any
Outreach
and
or
any
other
Communications
with
our
other
school
districts?
A
Great
question:
Dr
pitlock
through
chair
to
you,
assemblywoman
Anderson,
so
the
arpa
funding
that
we
received
specifically
for
building
out
Clark
and
Washoe
School
District
response
we're
partnering
with
Department
of
Education
and
Clark,
and
County
Clark
and
Washoe
County
School
Districts.
For
that
response.
The
rural
mobile
crisis
response
team
is
actually
under
division
of
public
and
Behavioral
Health
health
because
of
the
remoteness
of
of
all
of
rural
Nevada
right.
A
lot
of
their
efforts
are
coordinated
via
Telehealth
and
also
with
local
community
providers.
A
F
Thank
you.
Madam
chair
I
have
two
different
questions,
but
I'll.
Ask
the
person
then
ask
the
chair.
If
I
can
ask
my
second
one,
my
question
pertains
to
slide
number
six.
The
agency
challenges
mainly
Department
of
Justice
audit,
that
you
were
talking
about
from
October
of
2022.
F
I
had
pulled
that
up,
but
it
seemed
like
when
I
and
I
may
be
incorrect
and
feel
free
to
correct
me,
but
it
looked
like
from
what
the
agency
was
requesting
in
monetary
needs
was
much
higher
than
what
was
provided
in
the
governor's
budget,
and
so
I
was
curious.
If
how
that
may
impact
the
state's
ability
to
comply
with
that
audit,
especially
when
the
conclusion
of
that
audit
provided
that
some
threats
that
the
federal
government
may
take,
including
a
lawsuit
against
our
state,
for
failure
to
comply,
can
you
just
kind
of
elaborate
on
that?
A
Dr
pitlock
through
you,
chair
to
you
assemblywoman,
so
the
Department
of
Justice
response
is
really
across
all
of
DHHS
and
all
of
us
are
involved
in
creating
that
response
and
and
sprinkled
throughout
all
of
our
budgets
and
including
build
out
for
sustainability
of
new
programs
that
we're
standing
up
through
Medicaid
I
would
say
that
we
were
so
pleased
with
the
arpa
funding.
To
really
get
us
kicked
off
to
stand
up
that
community-based
service
array
and
all
of
us
together
are
working
towards
sustainability.
A
So
it's
not
just
one
piece
or
one
person
or
one
program:
that's
going
to
solve
the
problem.
It's
really
across
divisions
I
think
that
right
now,
based
on
what
we're
trying
to
build
out
we're
pretty
well
aligned
in
our
response
with
the
Department
of
Justice,
but
it
is
a
little
too
early
to
tell.
We
also
need
to
be
collecting
data
along
the
way
to
make
sure
that
these
new
programs
were
standing
up
are
really
Landing
the
successes
that
we
think
that
we're
Landing.
F
Thank
you,
I
I'm,
a
cap
attorney
for
some
of
my
pro
bono
works.
So
I
truly
appreciate
that,
because
I've
had
clients
who
have
been
subjected
to
long-term
stays
and
then
just
almost
become
institutionalized
when
they
turn
18,
so
I
appreciate
that
Madam,
chairman
I,
ask
you
a
second
question
and
my
second
question
for
you
and
I
may
have
misheard
you
when
you
were
reading
it.
You
were
talking
about
that.
F
There
are
73
youth
that
were
currently
placed
out
of
state
last
year
and
that
there
was
a
need
for
we
just
don't
have
the
resources
to
provide
for
those
who
are
juveniles,
juvenile
sex
offenders
and
also
those
on
the
high
autism
spectrum.
Do
you
kind
of
have
an
idea
of
what
the
percentage
of
those
that
really
do
need
to
go
out
of
state
are
out
of
that
73.
A
Dr
pitlock
for
the
record
through
you,
chair
to
you,
assemblywoman,
that's
a
really
good
question.
You
know
I
think
that's
where
our
data
needs
to
really
show
us
what
our
ongoing
need
is
because
remember
earlier
in
my
presentation,
we
talked
about
transition
back
to
Home
and
Community
right.
Well,
if
there's
nowhere
to
transition
and
out
of
state
youth
to
for
wrap
around
services
in
home
and
family,
you
know
how
do
we
shorten
that
stay?
Do
I
know
how
many
inevitably
really
need
to
be
placed
out
of
state.
A
A
But
some
Services
just
aren't
available
here
right
now,
like
the
juvenile
sex
offender
type
program,
but
even
for
that
type
of
a
program
when
we
do
send
a
youth
for
specialized
Services,
we
need
to
be
keeping
that
Eagle
Eye
on
how
long
the
youth
is
there
and
starting
discharge
planning.
We
always
start
as
clinicians
in
the
room
will
tell
you.
We
start
discharge
planning
before
admission
or
at
least
at
admission,
so
I'm
not
sure
I
can
give
you
a
specific
number.
B
G
Thank
you,
madam
chair
I'd,
like
to
go
back
to
the
question
that
Senator
Neal
had
asked
about
the
Clark
County
Child,
Welfare,
Grant
elimination
in
our
backup
documents.
It
appears
that
the
governor
is
recommending
a
reduction
of
8.8
million
in
federal
certainty,
Grant
funds
in
each
year
the
biennium
that
would
go
to
Clark
County
Child
Welfare.
Is
that
because
the
Federal
grant
has
come
to
an
end,
are
they
pulling
back
the
funding.
G
Thank
you
because,
further
down,
it
appears
that
there's
Federal
grant
money.
That
will
be
that
we
will
not
be
getting
for
Washoe
County,
but
in
the
back
language
or
documents
that
we
have
there's
an
ask
to
replace
that
with
general
fund
money.
But
there
wasn't
an
ask
for
the
Clark
County
money.
So
if
you
could
get
that
that'd
be
great.
B
H
A
Thank
you,
Cindy
pitlock,
through
you,
chair
to
you,
Senator
we're
we're
going
to
start
there.
There's
eight
youth,
eight
youth,
eight
female
youth.
There
now
and
by
the
end
of
the
fiscal
year
we
anticipate
16.
B
A
Dr
pitlock
to
you,
chair
through
you
to
you,
so
so
at
the
at
the
time
we
we
had
a
skeleton
staff
doing
the
best
we
could
with
what
we
had
with
three
littles
at
prtf
Enterprise.
We
moved
those
three
littles
to
prtf
North
and
what
staff
we
had
with
them
to
prtf
North.
A
It's
not
our
intent
to
keep
them
there.
Hopefully
we
can
reinvigorate
prtf
Enterprise,
there's,
there's
16
beds
there
that
are
empty,
that's
huge
for
the
Northern
Nevada
Community,
that's
a
huge
hit
for
Northern
Nevada,
and
we
are
even
as
we
speak,
working
as
hard
as
we
can
to
find
staff.
That
is
a
appropriate
for
that
facility.
So
we
can
get
any
if
I
could
get
one
bed
I'll.
Take
one
bed
give
me
one
bed,
give
me
two
I'll:
take
it
I'll
take
it.
B
Is
this
Staffing
issue
not
able
to
find
trained
staff
not
having
the
money
to
pay
that
staff
not
well
add
all
those
things
in
there?
Is
it
what
what
is
the
biggest
you
know
issue
with
finding
staff?
Is
it
just
that
we
don't
have
enough
trade
trained
people
now
or
is
it
that
we
don't
pay
them
enough?
So
they
don't
come
to
us.
A
Well,
that's
a
tough
question.
Dr
pitlock
threw
you
to
you
to
you
through
you.
You
know
I
I
think
there.
There
are
a
lot
of
nurses
out
there
that
really
can
get
a
better
rate
somewhere
else
or
can
go
to
a
county
or
through
a
staffing
agency
or
work
in
a
locums
position
and
really
do
quite
well
for
themselves
and-
and
that's
that's
really
frustrating
for
us
I
understand
why.
B
Okay,
thank
you
very
much.
You're
welcome
all
right
any
additional
questions:
Dr
Titus
or
Senator
Titus.
That's.
I
All
good,
thank
you,
I
appreciate
the
the
jumping
in
allowing
me
to
jump
here
in
here
Madam
chair,
but
it
just
raised
some
other
thought:
I
understand
the
pay
and
during
the
pandemic
a
lot
of
the
nurses,
and
certainly
my
local
hospital
chose
to
be
Travelers
because
they
could
make
three
times
as
much
and
just
move
on
with
that.
But
is
there?
So?
I
Yes-
and
you
know
that's
an
along
all
across
all
boards
in
the
state,
regardless
of
what
the
occupation
is,
what
department
we
have
staff
and
issues
and
we
recognize
they
don't
get
paid
enough
compared
to
the
private
sector
or
other
municipalities.
I
Is
there
have
you?
You
mentioned
the
specialty
staff,
and
one
of
my
concerns
is
that
we
have
too
many
obstacles:
For
Occupational
licensure
in
the
state
of
Nevada
and
I'm-
wondering
if
there's
any
reciprocity
in
some
of
those
other
fields.
Not
just
we've
tried
to
get
nursing
reciprocity
here
in
the
state,
we've
tried
to
get
other
reciprocity
in
the
state
I'm
just
wondering.
Is
it
also
a
question
that
there's
people
who
will
come
here
if
they
could
get
their
license
here.
A
Dr
pitlock
through
you
to
you,
Senator,
Titus,
yeah
I,
do
think
that
would
make
a
difference,
especially
for
licensed
professionals.
We
do
also
have
a
really
hard
time
recruiting
mental
health
techs.
You
know
a
salary
starts
at
17
an
hour,
but
I
saw
this
ad
that
you
could
go
to
Target
and
it's
24
an
hour
and
not
get
punched
in
the
face
and
thrown
to
the
ground.
By
a
kid.
That's
has
a
violent
Outburst.
A
J
Sorry
I
just
have
one
quick
question.
Thank
you
chair,
and
this
is
really
probably
more
of
a
Health
and
Human
Services
department-wide
question.
But
when
we
talk
about
the
specialized
roles
that
we
need
to
fill
I'm
just
curious,
are
we
finding
less
people
are
going
into
those
fields
as
well?
Is
that
an
issue-
and
it
may
be
different
from
Department
to
Department,
based
on
needs,
I'm,
just
curious?
If
there
is
an
issue
with
you
know,
people
actually
deciding
to
choose
the
fields,
the
the
roles
that
we
need
as
a
career
choice.
A
Dr
pitlock
threw
you
chair
to
you,
assemblyman
Miller,
perhaps
I
think
that
we
across
divisions
are
making
concerted
efforts
to
partner
with
the
universities
to
enhance
their
programs.
I
can
tell
you
as
a
clinician,
it's
extremely
challenging
to
find
clinical
sites,
and
that
can
be
quite
discouraging,
for
students
do
I
know
or
have
the
data
of
is
there
enough
coming
in
for
enough
of
an
output,
probably
a
better
question
for
enchi
or
or
one
of
the
Department
of
Ed
type
programs,
but
I
can
call
out
clinical
sites
as
being
extremely
challenging
to
find.
B
Any
additional
last
call
alrighty.
Okay,
thank
you
so
much
and
thank
you
for
all
you
do
for
our
youth.
B
K
Thank
you,
madam
chair
and
members
of
the
committee.
My
name
is
Dina
Schmidt
and
I
serve
as
the
administrator
for
aging
and
disability
services
and
to
your
benefit,
I'm.
Probably
the
fastest
talker
of
all
of
us,
so
I'll
try
to
make
this
easy
on
you
to
my
right
is
Ricky
Robb
our
Deputy
Administrator
over
Children's
Services
to
my
left
is
Tiffany.
Lewis
Tiffany,
Tiffany,
Lewis,
R
ASO
and
to
her
left
is
Jessica
Adams,
our
Deputy
Administrator
over
developmental
services,
going
right
into
the
presentation
on
slide.
K
K
Beginning
on
slide,
four
is
a
summary
of
our
operations,
including
advocacy.
Adsd
plays
a
unique
role
in
the
fact
that
we
both
Advocate
and
provide
Direct
Services.
Some
of
our
advocacy
rule
just
includes
Adult
Protective
Services,
the
office
of
consumer
health
assistance,
our
advocacy
attorney
and
our
long-term
care
Ombudsman
program.
K
Protective
Services
now
has
an
online
and
reporting
tool,
so
individuals
can
report
in
substance
or
abuse
abuse,
neglect,
occurrences,
24
hours
a
day,
seven
days
a
week
which
is
new
to
us
and
we're
very
excited,
especially
a
lot
of
our
Hospital
facilities
and
has
really
appreciated
the
ability
to
do
it.
Online
I
mean
over
the
last
couple
years
we
have
been
working
with
the
University
of
Nevada
Reno,
their
School
of
Social
Work.
K
We
have
developed
a
curriculum
aimed
at
getting
more
social
workers,
ready
for
the
field
of
geriatrics,
and
that
has
been
exciting
work
and
we've
had
some
seen
some
successes
in
transitioning
and
recruiting
social
workers
out
of
that
program
in
our
autism
and
treatment
assistance
program.
We're
excited
to
tell
that
we're
serving
more
children
than
ever
and
that
we
have
reduced
our
average
wait
times
for
services
substantially
in
our
quality
assurance
unit.
K
We
kind
of
play
a
dual
role
here:
we
have
oversight
over
quality
improvement,
but
we
also
have
oversight
where
we
try
to
do
technical
assistance,
so
we've
been
able,
through
covid,
to
bring
a
lot
of
training
to
our
provider
Network
to
try
to
help
them
with
improving
the
quality
of
their
services.
So
that's
been
an
exciting
opportunity
and
then
just
two
federal
grants
that
we've
received
one
related
to
no
wrongdoor
governance,
really
working
across
the
department.
As
Robert
mentioned
earlier.
K
He
has
the
data
system
to
try
to
do
the
no
wrong
door
efforts,
but
we're
really
looking
at
the
governance
so
that
we're
all
working
together
going
forward
on
what
a
true
no
longer
door
looks
like,
so
that
we're
excited
about
that
opportunity
and
respite
services.
This
is
a
huge
gap
that
we've
identified,
especially
for
those
children
with
dual
diagnosis
and
for
parents
of
children
with
disabilities.
The
the
amount
there's
the
respite
services
that
are
available
to
them
are
so
limited.
K
So
these
two
federal
grants
are
both
aimed
at
trying
to
address
those
issues,
and
so
we
hope
to
be
able
to
report
out
successes
in
those
programs
going
forward.
K
Moving
on
to
slide
six
is
our
agency
updates
vacancy
rates.
You've
heard
them
all
today,
I,
won't
repeat
them:
I
won't
read
them
to
you
same
idea,
we're
all
struggling,
but
just
wanted
to
call
out
some
some
high
levels
there
for
you,
our
office
of
Community
Living
highlighted
this
just
because
it
is
a
holistic
approach.
We've
during
the
interim,
we
were
approved
an
agency
manager
position,
so
we
have
combined
our
community-based
care
and
our
planning
and
advocacy
groups,
and
really
these
groups
are
now
working
together
really
looking
at.
K
How
do
we
enhance
access
to
our
services,
making
sure
that
individuals
receive
the
right
service
at
the
right
time
so
that
folks,
that
do
come
to
us?
They
may
not
be
eligible
for
the
service
they
applied
for,
but
we're
making
sure
they
get
connected
to
anything
else
that
they
are
eligible
for
and
then
our
elders
count.
This
is
a
biannual
report
that
we
put
out
that
provides
comprehensive
data
on
Nevada,
older
adults.
K
The
draft
report
will
be
posted
this
week
and
we
try
to
make
sure
this
is
available
for
legislators
as
we
go
forward
gives
you
a
comprehensive
look
at
what
the
challenges
faced
for
The
Elder
populations
in
Nevada
are,
and
we
are
embarking
again
on
our
Olmstead
planning
updates.
We
just
like
to
highlight
that
there
are
some
links
here.
You
can
get
more
information
regarding
the
process.
We
are
looking
for
as
much
Community
input
as
possible
on
that
website.
K
K
Moving
on
to
slide
seven,
it
starts
with
our
division
priorities.
These
are
the
four
areas
we
really
you'll
see
focused
on
infrastructure.
Our
agency
has
grown
substantially
over
the
last
few
bienniums,
but
we
are
as
you'll,
learn
later
heavily
based
on
caseload
and
so
we're
really
looking
for
hrit
and
fiscal
support,
maintaining
positions
we
received
through
through
the
covid
pandemic
and
then
reclassification
Equity
adjustments
and
as
director,
Whitley
and
others
have
mentioned,
provider
rates.
K
Slide
8
is
our
shows
our
budget
by
funding
source.
You
can
see
a
little
bit
of
growth
since
that
previous
by
Ending
by
the
end,
so
moving
on
to
slides
12
through
24
and
I'll
go
through
each
one,
but
these
are
really
our
caseload
projections
for
each
of
our
programs.
As
I
mentioned,
the
majority
of
our
budget
is
built
on
caseload
and
driven
by
caseload
slide.
9
is
our
family
preservation
program.
K
And
slides,
10,
11
and
12
are
the
caseloads
for
our
developmental
Services
developmental
Services
Program
provides
services
to
individuals
with
intellectual
and
developmental
disabilities.
We
currently
serve
over
7
600
nevadans,
get
Services
through
three
regional
centers,
so
there's
the
Sierra
Regional
Center
that
serves
Washoe
County
Desert
Regional
that
serves
Clark,
County
and
Rural
Regional
that
serves
all
remaining
counties
in
Nevada,
and
so
you
can
see
those
on
slides,
10.,
11.
K
K
Slide
13
illustrates
our
early
intervention
services.
These
are
Services
provided
to
Children
age
birth,
to
three
who
have
a
known
or
suspected
developmental
disability
or
delays
in
their
areas
of
cognition
communication,
physical
development,
including
their
vision
and
hearing
social
and
emotional
development
and
or
adaptive
skills.
K
Slide
14
illustrates
the
need
for
our
autism
treatment
assistance
program.
This
program
assists
parents
and
caregivers
with
the
cost
of
providing
evidence-based
treatment
to
their
children
with
autism
spectrum
disorder.
We
fund
the
treatment
programs.
We
do
not.
We
are
not
direct
service
providers
in
this
program.
K
K
K
Slide
18
is
our
Adult
Protective
Services.
They
investigate
reports
of
abuse,
neglect
exploitation
and
self-neglect.
They
work
to
resolve
the
issues
on
behalf
of
vulnerable
persons
18
to
59,
as
well
as
individuals,
age,
60
and
over
you
can
see
a
substantial
increase.
We
did
move
from
Elder
Protective
Services
to
Adult
Protective
Services
back
in
2019,
and
you
can
see
that
demand
reflected
here
in
this
chart.
K
K
Slide
20
is
our
home
and
community-based
waiver
for
the
frail
elderly.
This
whole
program
also
provides
in-home
services
to
assist
those
65
and
older
to
remain
in
their
home.
Services
include
case
management,
Homemaker
things
like
Adult,
Day,
Care,
adult
companion,
personal
emergency,
respite
services.
K
Basically,
anything
a
person
needs
really
to
remain
in
their
home
and
avoid
institutionalization
and
slide.
21
is
our
home
and
computer-based
waiver
for
persons
with
physical
disabilities
very
similar
program
variation
in
services,
but
also
all
aimed
at
maintaining
Independence
for
folks.
K
Slide
22
outlines
our
facility
population
adsd
does
operate
one
24-hour
facility.
This
is
our
Desert
Regional
Center.
It
is
an
intermediate
Care
Facility.
This
is
a
licensed
facility
that
provides
services
to
individuals
with
intellectual
disabilities,
including
active
habilitation
treatment,
to
promote
functional
skills
and
increased
Independence.
K
I
will
point
out
on
that
slide
that
we
do
have
four
new
budget
accounts
that
we'll
be
talking
about
as
we
move
through
the
session.
Those
were
created
just
really
for
increased
transparency
and
efficiency.
Some
of
our
budget
accounts
got
way
too
big,
and
so
there
was
a
need
to
break
those
out
on
slide.
24
is
a
summary
of
our
major
enhancements.
K
First
is
our
administrative
infrastructure?
These
are
requests
for
positions
that
to
support
the
growth
of
the
division,
as
I
mentioned
earlier
over
the
last
three
bienniums,
our
hrit
and
fiscal
teams
have
not
grown,
but
the
size
of
our
agency
has
grown
substantially
and
the
program
Administration
positions
that
you
see
here.
These
are
really
related
to
supporting
the
growth
of
the
complex
needs
for
the
people
we
serve.
K
We're
seeing
like
other
agencies
have
mentioned
individuals
with
more
and
more
complex
needs,
and
so
really
a
need
for
some
specialty
services
and
Specialty
positions
to
help
us
develop
plans
for
those
folks
and
make
sure
that
we're
addressing
their
needs.
K
The
third
one
on
this
slide
is
our
social
work
reclassification.
This
is
really
a
request
to
upgrade
48
social
worker,
two
positions
to
threes
and
nine
social
work
supervisor
ones
to
twos.
The
purpose
of
this
is
to
align
our
social
workers
in
Protective
Services
with
those
in
child
protective
services.
K
K
These
are
the
team
members
at
our
Intermediate
Care
Facility
that
provide
direct
support
to
individuals
residing
at
the
Intermediate
Care
Facility,
as
mentioned
earlier,
our
current.
These
are
some
of
the
lowest
paid
positions
in
our
state
agency,
and
we
often
have
people
join
us
stay
a
day
stay
a
week
and
then
leave
us
because
they
it's
a
difficult
job,
most
of
the
people
that
do
it
do
it
because
they
love
it
and
they
care
deeply,
but
they
can't
sustain
a
living
working
for
us
at
this
time.
K
So
really
we
are
looking
at
increasing
the
rate
of
this
entry
level
position
by
two
grades
in
hopes
that
that
will
help
us
recruit
and
retain
folks
to
serve
the
other
thing
to
think
about
this
one.
Is
it
really
does
put
us
at
risk
for
Staffing
ratios?
This
is
a
licensed
facility
and
we
are
required
to
maintain
Staffing
ratios
and
we,
like
everybody
else,
mentioned
we're
facing
those
same
challenges
every
day
and
the
overtime
that
we're
paying
becomes
a
concern.
K
Second,
one
on
this
slide
is
a
continuation
of
existing
positions
that
we
received
during
the
interim.
We
received
a
lot
of
older
Americans
act,
arpa
funds
into
our
agencies,
and
we
recreated
some
positions
during
the
interim
and
finance
committees
with
those
funds
and
then,
since
then,
we've
been
approved
for
more
our
projects
through
the
state,
arpa
funding,
and
so
this
is
just
a
continuation
of
those
programs
to
ensure
that
we
can
enact
all
those
new
programs
that
we
were
giving
funding
for.
K
You'll
see
several
rate
increases
across
our
array
of
services,
our
community
option
program
for
the
elderly,
personal
assistance,
Services,
family
preservation,
Services
developmental
services,
fiscal
intermediary
program
and
our
Early
Intervention
Program.
So,
though,
our
rate
increases
request
throughout
our
budget
for
all
of
those
programs
and
for
all
the
same
reasons
that
you've
heard
all
day
today.
I
won't
repeat
them.
K
K
Slide
27
is
the
two
build
draft
requests
that
we
are
putting
forward.
Sb43
is
really
just
a
kind
of
a
cleanup
build
that
allows
our
Commission
on
Aging
to
a
change,
that's
needed
to
help
fill
long-term
vacancies
for
representing
counties
and
student
governments,
the
current
language
really
limited,
who
could
participate,
and
so
we're
just
hoping
this
will
increase
our
participation
in
our
Commission
on
Aging
sb4
improves
access
to
prescription
drugs,
so
our
senior
disability
RX
program
has
a
small
limitation
on
the
funding.
We
cannot
direct
funds
service
or
we
have
to
direct
fund
Services.
K
So,
like
I
said,
I
think
I
was
pretty
fast.
I
did
give
you
provide
contact,
information
and
I
just
wanted
to
also
point
out
that
we
did
in
our.
We
did
a
include
an
appendix
a
a
lot
of
our
programs
that
we
don't
have
caseloads
for
are
very
complex
and
there's
a
lot
more
programs
that
we
oversee
and
provide
Than
People
realize
so
in
appendix
there's,
a
lot
more
detail
for
you
regarding
some
of
those
programs
within
our
operations.
So
with
that
I'm
happy
to
take
any
questions.
L
Thank
you,
madam
chair
I,
do
have
a
couple
so
there's
some
line
items
here
that
address
wait,
lists
for
several
of
the
the
services
that
the
division
provides.
I'm
curious
to
know,
with
the
increase
rates
and
funding
to
cover
the
wait
list.
Are
you
confident
that
the
the
funding
will
cover
all
of
the
people
on
the
wait
list,
or
are
we
only
going
to
address
certain
parts
of
a
waitlist,
perhaps
acuity.
K
Dean
Schmidt
Madam
chair
through
you
to
assemblywoman
Brown
May
every
session.
We're
asked
if
this
is
enough
money
to
to
address
the
wait
list
and
honestly
I
mean
I,
don't
believe
that
we
will
ever
address
waitlist
because
of
the
growing
demand
for
services,
but
secondly,
ourselves
as
well
as
our
providers,
as
you
well
know,
are
struggling
to
onboard
staff.
So
by
the
time
the
funding
hits
and
everybody
can
onboard
staff
and
get
them
trained
and
start
to
serve.
People
attrition
will
take
time
to
get
to
that
wait
list.
K
L
You
I
appreciate
that
that
Clarity,
so
that
leads
me
to
my
second
question.
If
I'm
a
Madam
chair
we
are
under,
we
have
received
a
Department
of
Justice
investigation
with
regard
to
Child
and
Family
Services,
stating
that
we
don't
provide
adequate
services
for
that
group.
Are
we
then
at
risk
for
a
similar
investigation
for
how
we're
providing
services
through
aging
and
disability
services,
or
do
you
feel
like
we
have
enough
and
feeling
is
not
the
right
statement?
Do
we
have
adequate
providers
available
in
the
community
to
stay
another
department
of
justice,
investigation.
K
For
the
record
Madam
chair
through
you
to
assemblywoman
Brown
May,
so
I
can't
speak
on
behalf
of
the
doj.
That
really
is
under
investigation
and
I
I
I'm
not
intimately
involved
in
and
can't
speak
on
behalf
of
that
what
I
can
speak
to
is.
Do
we
have
enough
providers?
No,
do
we
have
enough
specialty
providers
absolutely
not
at
this
time?
That
is
why
we
were
went
before
you
for
interim
finance
committee
to
get
arpa
funds
to
try
to
bring
in
specialty
providers.
K
So
we
received
a
rather
large
allotment
of
money
that
we'll
be
going
out
to
request
for
proposal
to
try
to
recruit
providers
who
can
serve
the
Dual
diagnosed
individuals.
So
those
are
those
folks
with
intellectual
and
developmental
disabilities
as
well
as
Behavior,
so
they're
really
behaviorally
complex.
Those
are
the
folks
that
we're
having
the
highest
challenge.
That's
one
thing
we're
doing.
K
The
second
initiative
that
we
have
is,
as
we've
done
a
rate
we
had
a
rate
increase
completed
by
a
third
party
last
year
and
what
they
did
was
help
us
establish
tiered
rate
system,
so
that
our
current
rate
structure
is
just
set
that
every
every
provider
gets.
K
So
those
are
two
of
the
major
initiatives
that
you'll
see
in
our
budget
going
forward
to
try
to
address
those
the
needs
there.
So
I.
L
Hope
that
answers
your
question.
Thank
you.
It
does
one
one
final
question:
FMA
Madam
chair.
Thank
you.
I,
just
want
to
clarify
the
one
of
the
positions
that
you
talked
about
in
your
report
is
the
developmental
support
technician
right,
which
is
at
the
Intermediate
Care
Facility
Desert
Regional
Center.
Currently,
is
that
does
that
correlate
to
Personal
Care
attendance
that
we're
hearing
about,
or
are
they
two
completely
different
positions.
K
For
the
record
Madam
chair
to
you
through
you
to
Assembly
women,
they
are
not
they're,
not
related
I,
don't
I
would
have
to
I.
Could
pull
data
to
give
you
the
the
income
levels
to
compare
the
two
but
and
I
know
that
the
personal
care
agency
rate
increase
the
Medicaid
put
forward
was
a
25
an
hour.
K
The
positions
that
we
start
with
are
much
lower
than
that,
but
I
and
I
can
provide
that
to
you
as
a
follow-up.
If
you'd
like
thank.
B
Thank
you
very
much,
I
believe
Senator
Neal
has
a
question.
C
Thank
you,
madam
chair,
so
I
had
a
question
on
Slide
19.,
so
I
was
just
trying
to
figure
out
because
I
I
see
the
gov
wreck
and
then
the
ledge
approved
and
they're
pretty
much
the
same
well.
The
ledge
approve
is
higher,
but
I
wanted
to
know.
What's
the
demographics
of
the
seniors
that
access
this
program
and
then
what
is
truly
the
effect
of
this
reduction
on
that
population.
K
Danish
Schmidt
for
the
record
Madam
chair,
Drew
you
to
Senator
Neil
great
question,
so
the
senior
and
disability
RX
program
has
the
demographics
are
two
two
populations.
One
are
individuals
on
Medicare
who
are
on
disability
or
seniors
on
Medicare,
so
the
program
currently
subsidizes
Medicare
Part
D
payments.
So
when
you're
on
Medicare
Part
D,
you
pay
a
monthly
premium,
let's
just
say
it's
fifty
dollars.
We
supplement
37
of
that
50.
K
over
time
because
of
the
donut
hole.
This
program
has
changed
substantially
and
the
demand
for
services
has
gone
down
each
year,
so
we're
really
you'll.
We
mentioned
a
bdr
one
of
the
things
that
we're
looking
at
because
you
because
of
this
exact
graph
right,
we
thought
that
the
demand
would
go
up
and
it
has
not.
It
has
continued
to
drop
off
year
over
year,
and
so
that's
what
we
have
been
looking
at
is
trying
to
figure
out.
K
What
does
this
program
need
to
look
like
in
the
future,
because
it's
old
version
doesn't
match
the
need
of
the
community?
The
need
of
the
community
is
related
to
co-pays
and
deductibles.
To
be
honest,
that's
where
people
are
having
high
out
of
packet
expenses,
it's
not
their
part,
D
plans
that
are
expensive
anymore,
it's
their
co-pays
and
deductibles.
They
need
help
with.
K
K
They
can
go,
get
a
voucher
that
helps
offset
that
cost,
and
so
that's
what
our
bdr
is
meant
to
do
is
to
change
the
way
we
can
fund
so
that
we
can
establish
a
new
program
that
meets
the
demands
and
the
needs
because,
as
you
can
see,
projected
the
way
we
currently
do
this,
it's
we're
not
projecting
to
increase
demand
and
serve
more
people.
So
we'd
like
to
switch
the
program
up
and
actually
meet
the
demand.
That's
out
there.
C
Thank
you,
madam
chair,
so
so,
okay
I
get
that
you
want
to
I
guess
reorganize
the
program,
but
the
existing
37,
it's
37
that
operates
in
the
Gap.
What
will
you
do
with
the
accrual
of
those
funds
in
order
to
flip
it
to
a
copay?
And
how
many
can
you
actually
service
within
a
copay
model?
Right
I
mean
because
I
just
keep
thinking.
C
You
know
the
older
person
is
and
using
the
Medicare
d
they
typically
do
still
need
some
prescription
coverage.
So
I'm
wondering
just
explain
to
me
how
prescription
coverage
will
continue
to
be
managed
and
if
it's
lost
and
if
and
if
it's
around
a
copay
which
could
be
the
1200
or
however,
however
many
dollars
they
have
to
pay
over
a
year.
K
Dina
Schmidt
for
the
record,
so
those
folks
that
are
now
receiving
the
37.
We
would
stop
paying
that
at
some
point
right.
We
would
give
them
appropriate
notice
and
stop
paying
the
37,
but
they
would
still
be
eligible
potentially
for
the
program
to
switch
from
paying
a
part
of
their
part
D
plan
to
actually
helping
them
pay
their
co-pay.
So
the
voucher
program
would
be
open
to
more
individuals
than
just
Medicare.
K
It
could
be
individuals
with
other
health
plans
that
don't
provide
adequate
prescription
drug
coverage,
so
it
would
expand
the
number
of
people
that
we
could
serve.
I
don't
have
projections,
yet
that's
something
we're
waiting
to
see
if
the
bdr.
If
the
bdr
passes,
we
will
start
to
work
on
that
and
create
projections
for
the
next
biennium
on
the
numbers
that
we
could
serve,
but
it
really
just
switches
from
supplementing
A
Part
D
only
to
supplementing
anybody's
needs
for
prescriptions.
C
I
mean
okay,
it
is
I
promise
you.
This
is
my
last
question,
but
okay,
so
in
this
world
of
theory,
where
you're
saying
it
could
be
600,
but
the
gov
wreck
is
way
lower
than
the
ledge.
So
how
are
you
going
to
sustain
I?
Guess
the
theory
right,
because
you're
gonna
build
your
numbers.
If
and
when
the
bill
passes.
C
So
your
your
population
or
your
caseload
is
kind
of
I
would
say
it's
it's
limited
because
you're
operating
you
should
know
what
your
caseload
is,
so
that
when
you
craft
the
bill,
you
know
exactly
what
the
appropriation
is,
that
you
need
that
you
need
right
for
the
biennium.
Isn't
it
it's
kind
of
like
the
cart
before
the
horse,
the
chicken
before
the
egg
I,
don't
know,
but
I
know
it's
that
I
know
there's
an
egg
because
for
the
chicken.
K
Dina
Schmidt
for
the
record
Madam
chair
through
you
to
Senator
Neil.
Thank
you
for
the
question.
I
think
I
understand
now.
I
apologize,
I.
Think
I
misunderstood
your
question.
So
as
we
transition
the
program,
what
we
anticipate
is,
we
will
run
out
of
money
before
the
next
biennium
right.
We
will
start
a
wait
list
because,
because
we
don't
know
what
we'll
do
originally
is
take
the
the
population
that
we
serve
now
realize
how
much
money
we
have
right
and
provide
a
voucher
system
to
those
individuals
to
support
them
through
the
biennium.
K
But
we
will
also
allow
people
to
apply
for
the
program
whether
we
have
funding
or
not,
and
we
would
create
a
wait
list
so
by
the
next.
By
ending,
we
would
actually
have
the
data
to
show
that
demand.
There's
no
way
for
us
to
figure
out
what
that
demand
is
today
without
actually
allowing
people
to
apply
for
the
service.
K
B
Thank
you
very
much,
I
believe
Vice,
chair,
Monroe
Moreno
has
a
question.
Thank.
G
You,
madam
chair,
yes,
I!
Do
it's
on
Slide
Five
of
your
presentation
and
it's
the
partnership
with
the
UNR
School
of
Social
Work
and
I
may
have
missed
it.
If
I
did
I
apologize,
how
many
students
are
currently
in
that
program
that
you're
partnering
with
and
do
you
have
any
plans
to
expand
that
to
other
institutions
within
the
state.
K
For
the
record
Madam
chair
through
you,
so
a
couple
different
things.
One
of
the
things
we
did
was
they
helped
we
helped
them.
They
allowed
us,
which
was
a
wonderful
partnership
to
help
them
develop
curriculum.
What
we
were
seeing
as
social
workers
coming
out
without
adequate
skills
to
work
with
our
populations,
and
so
we
were
involved
in
creating
and
changing
their
current
curriculum,
which
was
huge.
They
also
in
addition
to
that,
provided
in-person
training
and
created
a
staffing
curriculum
and
a
certification
program
for
our
staff.
K
So
all
of
our
staff
went
through
their
program.
All
of
our
social
workers
were
allowed
the
opportunity
to
go
through
a
two-day
I
think
it
was
two
day
or
four
day
class
where
they
were
received,
a
certification,
and
so
that
was
helpful
to
all
of
our
our
team
members
and
then,
in
addition
to
that,
we
are
working
with
them
on
internships.
I
don't
have
the
number
of
interns
or
students
in
that
program
right
now,
but
I
can
certainly
get
that
for
you
as
a
follow-up
and.
K
M
Thank
you,
madam
chair,
we're
hard
to
see
down
here
in
an
earlier
presentation.
There
was
a
note
about
a
cut
to
the
autism
rates
and
I
think
it
was
1.4
million,
something
like
that.
General
fund,
4.1
million,
with
the
match
I
just
wanted.
You
had
a
chart
there
on
autism
and
I,
want
to
know
what
the
percent
decrease
that
was
in
the
rate
and
how
you
thought
it
would
affect
Services.
Thank
you.
K
Dina
Schmidt
for
the
record
Madam
chair
through
you
to
the
Senate
to
Senator
Ganser
I
I
hate
to
talk
on
behalf
of
my
colleagues
at
Medicaid,
so
the
Medicaid,
the
the
autism
rate,
is
set
by
the
Medicaid
Division,
and
that
is
a
reduction
in
the
rate
on
their
on
their
behalf.
So
I
yeah.
Would
you
like
her
to
come
up
because
I
that
doesn't
I
don't
want
to
be
out.
M
N
Chair
Committee
Member
Stacy
weeks
for
the
record.
Yes,
the
ABA,
there
are
some
adjustments
to
the
rates,
so
there
are
some
it's
not
actually
a
one
rate.
It's
several
Services.
We
are
looking
at
and
adjusting
the
rates.
Some
go
up,
some
Go
Down
based
on
National
averages
and
adjusting
for
costs.
So
we
can
follow
up
with
the
committee
with
a
list
of
those
services
and
those
adjustments,
but
they
were
based
on
our
quadrennial
quadrennial
rate
review
process.
M
Thank
you
and
then,
in
addition
to
that,
how
you
expect
that
will
affect
services
for
those
who
are
using
them.
Thank
you.
Yes,
thank
you.
B
Thank
you
very
much
and
I
would
just
add.
I
appreciate
that
the
autism
assistance
program
has
I,
guess,
shorten
the
time
and
lessen
the
amount
of
student
or
children
and
I
hope
that
we
can
continue
to
work
on
that
as
well.
O
Thank
you
so
much
I'm
going
off
of
a
slide.
Seven,
where
it
talks
about
the
provider
rates
and
at
a
third
party
rate
study
was
conducted
for
the
increases
were
the
increases
rate
where
they
match
what
those
third-party
recommendations
were.
Or
did
we
have
to
decrease
some
of
them?
How
did
that
end
up
going
through
the
wash
thanks.
K
K
The
developmental
Services
rate
study
also
is
in
alignment
with
what
you
see
here
with
a
little
bit
of
a
tweak,
because
that's
that
one
was
conducted
and
finished,
maybe
I
think,
a
year
ago,
before
some
of
the
economic
changes
have
had
so
they
did
go
back
and
rebase
it
based
on
current
expenditures
and
cost
analysis
of
the
in
within
the
business
world,
so
that
one
has
been
rebased.
So
the
study
looks
a
little
different,
but
we
do
have
rebased
information
from
the
third
party
vendor
that
this
is
based
on.
B
All
right,
Annie
additional
questions
from
anyone.
B
B
I
once
again,
I
would
like
to
say
to
all
of
you
thank
you
for
giving
up
your
day
and
spending
it
with
us
and
preparing
all
these
documents
and
all
the
hard
work
you
do
for
the
citizens
in
Nevada.
I
know
that
sometimes
it
probably
feels
like
it's
not
appreciated,
but
it
is
so.
Thank
you
all
right
with
that.
We
will
move
to
our
last
agenda
item
of
the
day
public
comment.
This
is
going
to
be
the
second
and
last
period
of
public
comment
on
the
agenda.
B
B
669-900-6833
and
when
prompted
provide
the
meeting
ID
eight
five,
four
three
eight
one,
eight
one:
eight:
zero,
four
and
press
pound
when
prompted
for
a
participant,
ID
press
pound,
the
column.
Information
is
also
provided
on
today's
agenda
and
I'll
begin
with
public
comment
from
here
in
Carson
City.
Please
go
ahead.
P
Madam
chair
members
of
the
committee,
thank
you
very
much
for
the
record
Carter
Bundy
with
afscme.
We
do
want
to
thank
DHHS.
We
represent
members
throughout
the
state
in
different
facilities
and
different
divisions,
and
we
certainly
believe
very
strongly
in
the
mission.
We
did
have
one
concern
that
we
hope
to
be
able
to
be
a
partner
with
the
administration
on,
and
that's
the
Outsourcing
of
the
psychiatric
Residential
Treatment
Facility
here
in
Reno.
Obviously
they
perform
very
important
services
and
it's
a
staffing
issue.
P
I
think
director
Whitley
at
the
top
of
the
day,
mentioned
how
difficult
it
is
to
get
people
in.
We
would
love
to
partner
with
the
administration
to
shorten
the
hiring
time
and
the
truth
is
if
we
can
get
a
private
company
to
hire
people
to
do
this
work.
There's
no
reason
that
the
state
with
pers
and
everything
else
shouldn't
be
able
to
hire
them
as
well.
P
I
think
most
of
you
know
my
home
is
actually
in
New
Mexico
and
I
can
tell
you
that
when
Mental
Health
Services
were
widely
outsourced
during
the
previous
administration,
it
turned
out
to
be
a
total
train
wreck,
because
if
they
can't
make
money
or
it's
not
profitable
enough,
even
for
a
non-profit,
you
know
to
stay
afloat,
they
can
pack
up
and
walk
away.
The
state
doesn't
walk
away
and
shouldn't
walk
away.
So
we
hope
that
with
the
legislature
and
the
administration,
we
can
find
a
way
to
keep
that
in
the
public
sector.
Thank
you.
Q
We
are
so
much
in
favor,
we've
been
advocating
for
over
20
years
for
this
increase
in
the
reimbursement
rate
for
personal
care
services
in
our
state,
as
you
know
where
the
caregivers
were
really
in
a
crisis
situation,
because
we
cannot
find
them,
people
just
do
not
want
to
go
back
to
work
and
we've
had
a
couple
agencies
up
here
in
the
north
actually
closed.
For
that
reason,
we
heard
some
great
testimony
today
about
reimbursement
rate
coming
out
of
Medicaid,
Health,
Care
Quality
and
a
compliance,
or
rather
Health,
Care,
financing
and
policy.
Q
What
I
thought
I
just
heard
out
of
the
administrator
of
Aging
and
Disability
Services
was
that
she
hoped
that
that
25
rate
would
also
apply
to
the
waivers
I
really
hope
so
because
the
respite
it
today
is
currently
lower
than
the
minimum
wage
that
was
approved
last
year.
So,
having
said
that,
it's
hard
enough
to
qualify
for
some
of
these
programs.
You
really
have
to
be
low
income,
let
alone
qualify
and
not
be
able
to
get
the
service.
Q
B
Thank
you
very
much,
seeing
no
more
public
comment
here
in
Carson
City
we'll
go
to
Las
Vegas.
R
S
Foreign
state
legislators
good
afternoon
I
want
to
thank
the
administrative
services
for
operating
the
the
phone
line
and
enabling
me
to
speak.
I
would
like
to
speak
to
the
chair,
because
I
called
in
last
week
yesterday
would.
B
S
There's
an
old-fashioned
farmer
who
helped
men
like
that
and
he
fed
him
watermelon
for
two
for
a
month
or
two
watermelon
and
basically
I
think
what
we're
doing
is
this
I
think
this
is
a
state
border
issue
and
we
need
to
make
sure
we
have
state
checkpoints
that
there's
no
human
trafficking,
there's
no
drugs
that
are
coming
into
our
state
at
the
Border
level
and
also
I
would
like
to
see
the
Southern
Nevada
Health
District
have
a
report
on
the
vaccine.
Efficacy
rates
and
adverse
reactions,
I
beg
I.
S
T
Good
afternoon,
everyone,
my
name,
is
reason
why
I'm
calling
is
I'd
like
to
call
on
the
whole
legislature
to
show
us
proof
the
effectiveness
of
not
only
the
lockdown,
the
Mandate
social
distancing
but,
more
importantly,
the
vaccine.
The
vaccine
was
promoted
by
many
government
agencies
and
officials
throughout
the
state,
and
many
counties
we'd
like
to
see
the
effect
of
this,
whether
it
worked
or
not,
we'd
like
to
see
some
data
we'd
like
to
see
some
examples,
comparison
among
other
states
and
countries.
You
know.
P
T
To
see
whether
or
not
all
these
efforts
were
worth
it,
because
there
was
a
lot
of
changes
that
had
to
be
made
a
lot
of
livelihoods
affected,
we
just
want
to
see.
Was
it
worth
it
to
have?
A
meeting
in
the
coming
weeks
and
months
tell
us
whether
this
was
effective,
and
you
know
we
can
basically
make
a
decision
that
is
reasonable,
and
that
is
important.
T
Thank
you.
So
much
I
will
yield
my
time
and
oh
and
I
forgot.
You
know,
because
right
now
we
have
significant
High
numbers
of
inflation.
We
I
just
heard
about
that
earlier.
So
the
question
is:
would
this
inflation
situation
happen?
Had
these
events
of
the
last
three
years,
I
just
talked
about,
had
occurred,
yield
my
time.
R
Thank
you
Sarah.
The
line
is
open
and
working.
However,
there
are
no
other
callers
wait
to
offer
public
comment
at
this
time.
B
Thank
you
very
much
all
right.
Well,
I
would
like
to
thank
all
of
those
again
who
participated
in
the
meeting
today,
we'll
be
back
again
at
it
tomorrow
morning,
at
8
30
to
your
budget,
presentations
from
the
Department
of
Education
and
the
Nevada
system
of
higher
education,
and
so
this
meeting
is
adjourned.