Nevada



center-17145000RICHARD WHITLEY, MSDirector BRIAN SANDOVALGovernor525780026670Dena SchmidtAdministrator00Dena SchmidtAdministratorDEPARTMENT OF HEALTH AND HUMAN SERVICESAGING AND DISABILITY SERVICES3416 Goni Road, Suite D-132Carson City, NV, 89706Telephone (775) 687-4210 Fax (775) 687-0574 Minutes Name of Organization:Nevada Commission on Services for Persons with Disabilities (CSPD)Date and Time of Meeting:May 3, 20189:00 a.m. Videoconference Location:Aging and Disability Services (ADSD)3416 Goni Road, Suite D-132Conference Room HCarson City, NV 89706 Videoconference Location: Desert Regional Center1391 S. Jones Blvd. Training RoomLas Vegas, NV 89146To join this meeting by phone dial 1-888-363-4735, then enter Access code 1228133 when prompted. AgendaWelcome and Introductions Brian Patchett, Commission ChairpersonMembers in attendance: Brian Patchett, Cyndy Ortiz-Gustafson, David Daviton, Charlene Frost, Jim Osti, Nicole Schomberg, Dora UchelMembers excused: Shelley HendrenMembers absent: N/AGuests: Eli Schwartz, Mike McMahan, Dr. Tedoff, Jamie Hutchinson, Erik Lovaas, Ella Philander, Beverly Ghan, Kristen Shelton, Jeff Duncan, Lorraine Belt, Rosana Woomer, Anil Manocha, Kim Johnson, Padima, Samantha Jaime, Jody Patton, Debbie Bowman, Brook Adie, Ellen Wilcox, Rosana Woomer, Crystal WrenCart Provider: Becky Van AukenPublic Comment (No action may be taken upon a matter raised under public comment period unless the matter itself has been specifically included on an agenda as an action item. Public comment at the beginning and end of the agenda may be limited to three minutes per person at the discretion of the chairperson.? Members of the public may comment on matters not appearing on this agenda or may offer comment on specific agenda items.? Comments may be discussed by the Board, but no action may be taken.? The matter may be placed on a future agenda for action)Dr. Tedoff owner of Applied Behavior Analysis, we’re a group of five licensed behavioral analysts who provide autism treatment in Las Vegas. We serve about 65 children and their families, through mostly Medicaid and ATAP funding and I’m concerned with the changes in ATAP funding. Earlier this week ATAP announced to providers they will no longer be able to support Medicaid eligible children and providers will have to direct bill to Medicaid. When Medicaid became a funding source for autism treatment their reimbursement procedure proved to be way too difficult to navigate to make it a reliable funding source, and ATAP has been a reliable funding source. As you know cash flow is critical to a business existence, ATAP recognized this barrier to the provision of services and credentialed themselves as a Medicaid provider, thereby assuming the task of billing while continuing to fund the provision of services to eligible families. Another barrier to the provision of autism, treatment here in the State of Nevada is the requirement that behavior technicians working under the supervision of licensed behavior analysts must be registered behavior technicians with their own NPI numbers to be eligible for reimbursement. As of this morning, there are 666 registered behavior technicians in the entire State of Nevada and the last estimate I heard was about seven thousand five hundred kids in the state with autism. If each RBT works with 2 children, it leaved over six thousand children without services because of a lack of provider. If we as a state are serious about providing research-based autism treatment for Nevada residents there are two issues that must be recognized. The first is billing Medicaid and getting reimbursement, that must be efficient and timely. The other one is there must be a mechanism in place to support the development of an RBT workforce. I would request that these items be placed for discussion on a future agenda.Erik Lovaas, under the CLEO overview second-to-last page of the handout, on the waitlist question one says why are people waiting and most likely waiting for ATAP, and the answer ATAP has always had a wait list number of referrals exceeds number of new children funded each month, provider capacity is limited, and services exceeds funding. I would like to add the reimbursement rate is the problem.Brian – Yes, thank you for sharing that, anyone else?Approval of Meeting Minutes from February 8, 2018 (For Possible Action)Brian Patchett, Commission ChairpersonKim Johnson ADSD staff interpreter states she was not the interpreter for the last meeting. Cyndy Gustafson made a motion to approveChar Frost – secondAll AyesNo opposed – Motion carriedPresentation and Discussion about Nevada Budget Process ADSD Fiscal Department – Anil ManochaMy name is Anil Manocha, I’m the Administrative Services Officer at Fiscal ADSD. I’m going to be presenting today the budget process overall. We have in the State of Nevada a Biennium budget and will go over how we go through the agency submission all the way to legislative approval. (See Handout) Vegas didn’t have the handout, so we took a moment to get those to the Vegas people, and introduce all non-commission members.Brian – we want to make sure we understand the process because there’s been some confusion about the process, we want to understand the different steps, and when is it in fact the point where there is no more discussion. I believe now we’re in a discussion period up until the budget is submitted to the Governor’s office. Anil – Page one is just the budget overview and page two starts with budget process timelines. We basically have three steps in the budget process overall. First one is the agency request when we submit the budget to the budget office and it goes to the second phase of the recommendations and then it goes through the legislator’s approval. Those are the three basic steps we follow every biennium. Budget kick off meeting was on February 27th, that’s usually in February every other year when we start the budget. From there we go to the agency preplanning phase which is March to April, we meet with program staff and gather the information and data we need and their basic needs we need to put together and from there start building the budget due August 31st, this year. After we submit that agency request to the budget office the budget office works to review those request, revise it, make recommendations to the coordinator that takes from September to December. During that period, we go back and forth on recommendations, we submit what they need as backup documents, as required. Then it goes from the recommendations to the legislature after the state of the state address in January, the legislative money committee hears the budgets and makes changes from February to May of the next year, which will be 2019. After that the budgets are approved by the end of the legislative session, which is 120 days. The base budget structure is actual expenditure for the base year of SFY2018 with payroll costs calculated by nabs. Any changes to the base are adjusted for one-time expenditures and partial year cost through the units are called adjustment to the base. We go the next level, decision units, they are a standalone mini budget. It’s a balance budget request that displays revenue and expenditures with the new programs, if we have additional programs other than the existing programs, we would increase that through a decision unit, or if there is any decrease to the existing program, we’ll have a standalone decision unit for that as well. Then we have some other maintenance decisions for continuing existing services and some enhancement decision units used for the new program or new services we have. If you follow through page four, there are some budget structure units that we commonly use as maintenance units M100, M101 and M151. M100 is a statewide inflation and M101 is agency specific inflation, some of the maintenance decision units we don’t have any control of those as an agency. These are controlled based on how the economy is doing, they are controlled by the Governor’s office and budget office. M150, M151 are the adjustment to the base and similarly we have some specific to the cost allocation, either a statewide cost allocation or Attorney General cost allocation. Those units are controlled in M800 maintenance units, and again we don’t have any control over these, they’re adjusted and run by the budget office. On page 5 you can see there are some common enhancement decision units. Those all start with E, which stands for enhancement, and they’re grouped and categorized from E125 to E150, which if the sustainable economy. I would like to mention that these enhancement units are based on the Governor’s strategic priorities. Since taking office in early 2011, Governor Sandoval focused to create the new Nevada in leading the state out of the Great Recession. In the 2015 legislative session, the Governor laid out his five-year strategic framework to achieve his long-term vision to provide the outcome the citizens demand. It’s important to remember in planning for the 2019-2021 biennium that we’re going to be electing a new Governor in November 2018, who will likely bring new priorities and fresh ideas on how the state should operate. For the existing strategic priorities, we have E125 to E150 for the sustainable economy. E225 to E250 Efficient and responsive State Government, E275 to E300 Educated and Healthy Citizenry, E350 to E375 Safe and Livable Communities and E550 to E559 Technology Investment Requests. Page 6 we have other common enhancement decision units as you read through, E490 through E900. As the agency prepared their budget request, the Governor has asked all agencies to consider some of the following considerations, what activities does our agency perform that you would stop doing if you could? What result could be obtained by reprioritizing those resources? Also, what new initiative would you propose, what results would they achieve, how would success be measured? While we build the budget, we keep all those priorities in mind. Page 7 as you see it’s a Pre-Planning phase, we are in this phase right now, during this phase we schedule meetings with the program staff that should start no later than March to give adequate time for planning. We also determine the two times cap for the next biennium based on the state general fund for the odd fiscal year which is 2019 and multiply that with tow for the next biennium and talk about new programs, and changes to the existing programs, we work with the program staff to complete the budget planning summaries to prepare for the meetings with the director’s office and schedule those meetings in April. We make sure program staff are working on getting the performance measures data updated and provide all the information to fiscal in a timely manner. Last sheet you see is the timeline we follow to as we go This is the timeline for fiscal ad starts from February 9th with all the deadlines we have until August 1st. August 1st is the date given by the director’s office to us to submit our budget to the director’s office, so they can review before we submit to the budget office on August 31st. That’s all I have Debbie and I are here to answer questions.Brian – Thank you for that presentation. There seems to be confusion, and I know the answer, but I want to make sure we get to hear the answer about blackout periods when comment is over, and my understanding that once it’s submitted to the governor’s office. Tell me when that starts, when comment ends, when people who are not in the state can continue to comment and work with State leaders, when does the blackout start?Anil – My understanding is as soon as we submit the budget to the budget office, we don’t have any control after that, we can’t go back and make changes or even ask the budget office for changes.Debbie – That’s correct, once it’s submitted.Brian- Right, so that was my understanding. I clarified that with the governor’s office. There was some discussion that we were in that blackout period which is not true, and I just hope that everybody here understands that too, because I was just surprised to hear somebody try to say that was the case a few months ago. In fact, this is the time when people can comment and can work with state leaders to look at what priorities are in the budget and I know that we’re in the middle of an interim. This is when the interim committees of the legislature meet. When you talked about the Governor’s priorities, what he was looking at, one of the things he said sounds like, are there things we should stop doing, why, and what could we do that would be more efficient, that’s one of his driving principles for his budget, correct?Amil – Yes, that is correct.Brian – The new Governor take office when?Amil – JanuaryBrian – January 19th, so between January 19th and the beginning of the session he/she must make any changes, correct?Amil – CorrectBrian – Thank you, so this apparently a critical time. Those involved in this meeting are listening in, if you have questions, some were brought up in public comment this is a good time to be asking and looking at some of these items. I know there have been some meetings I’ve been involved with relating to autism and the RBT rate. There have been some meetings related to increasing the rate for jobs and day training and supportive living arrangements for people with intellectual developmental disabilities. There have been meetings to look at some of those budget items, and I’m sure there are lots of other going on, those are two that I’ve been involved with. I’m hoping that some of those things end up in the Governor’s budget. If there are other items, this is a good time to reach out, to state leaders that are making these decisions and make sure that we’re being heard. If it is an issue like was state earlier in a comment where there’s an RTB rate issue or with JDJSI, feel free to contact me or members of the committee on those issues. Thank you very much for your explanation.Update and Discussion on the 700 Hour ProgramBeverly Ghan, Supervisory Personnel Analyst, DHRM, 700 Hour ProgramHello everyone, my name is Beverly Ghan and I’m with the division of Human Resource Management. I’ll present an update on the 700 Hour Program. The 700 Hour program is a program implemented by the Department of Employment Training and Rehabilitation. The rehab specialist meets with clients and assist them in filing out applications and determining what types of positions they may qualify for based on any limitations. A list of those positions for each client is sent to us and if they are approved, meet minimum qualifications, we’ll put their names on an eligible list referred to as the 700 Hour eligible list. Effective January 01, with the passing of assembly bill 192, state agencies are now required to use the 700 Hour list when it’s available. When filling a vacancy, they must first contact the persons on that list and if someone can perform essential functions of the job, the employment offer is made to that person. Since January 1st, 37 – 700-hour clients have been hired with the state. The positions that they’ve been hired are admin aide, accounting assistants, and administrative assistants. So, the grade ranges up to about grade 25. The agencies that are using the positions vary and are healthcare financing, welfare, child and family services, aging, public behavioral, taxation, agriculture, environmental protection, highway patrol and employment security division. When a 700 Hour client is hired the agency has the option at the end of the term to release that person or move them into a permanent position. If they’re moved into a permanent position, the initial hours go towards their probationary period. If the client has not hired on they can request to be put back on the 700-hour list and start the process over again. Brian – Wonderful. What is the probationary period for the state new hires?Beverly – Typically one year.Brian - Do you know any demographics as far as those individuals, these 37 who are employed, do we know if they have intellectual, developmental or physical disabilities? Beverly – No, we don’t get into that with the clients.Brian – I wasn’t sure. I’m so happy there’s been 37. It sounds like the process is that most of the people come to you through vocational rehabilitation, is that correct?Beverly – That’s correct, they go to them and sign up for different programs.Brian – Okay, and just to remind this commission, as part of what we do is have responsibility over the ten-year plan for employment of people with intellectual disabilities. That came from the Governor’s task force that created the document that we’ve been working through for the last couple of years. The bill that was referred to and was passed in the last session, sponsored by Assemblyman Sprinkle was trying to focus on getting more people with intellectual, developmental disabilities into the state system. One of the priorities that is listed in the ten-year plan is for the state to be the leader in employing people with intellectual and developmental disabilities.That’s why this is relevant to us as a commission. Other questions, people may have?Cyndy – How many people are on the 700 Hour list?Beverly – The total varies because once they get hired, they’re removed from the list. Cyndy – Even a running average is fine, thank you.Beverly – I’m going to say at least 50 right now, quite a bit. When they apply, when we get the document from them, they’re not looking to get into just one position, we get a list of positions for them, so their options vary.Cyndy - So 37 being placed with a running average of 50, it’s pretty good? Beverly – Yes, it’s very good, typically, last year, if were to look at those numbers we would hire maybe one or two.Cyndy – Excellent Char - My understanding is you said that when people are hired they come off a list and we have placed 37 so that mean that 50 that we currently have on the list is in addition to the 37 that have been placed. Beverly – That’s a total average, I’m going to guess that’s a low average. It’s probably quite a bit more. Char – If we could just get more accurate numbers for the next meeting, that would be great. Brain – She said she would provide those for us, she’ll have them to us today and we’ll send them out to the commission. Beverly – And to answer her question, once someone is hired, they are removed from the list. So, I would say an ongoing 50 at this point and that doesn’t include the 37 that got hired. Brian – Thank you. I appreciate the presentation, I think going forward rather than having you come here, you could just provide the numbers for each meeting and we can keep track of what that is. Beverly – We provide numbers monthly to DETR, so we could copy you.Updates Regarding the Nevada Commission for Persons Who Are Deaf, Hard of Hearing, or Speech ImpairedEli Schwartz, Guest Commission ChairpersonEli – We had a meeting on April 11th, and it was an interesting and successful meeting. During public comment we had many public comments regarding the deaf center of Nevada, how deaf people needed this service. Last year we worked with the $1,447,265, the program is currently under RFA which can give up to $1,579,855 approved by the Governor. This has been a community not receiving the support they needed from other state-run entities and DCN fills those gasps. The following agencies were mentioned: public schools, vocational rehabilitation, and NEIS, the public thought that ADSD was going to cut funding in half next year. Cheyenne Pasquale reported on the funding piece early in the meeting explaining the program and the request for the RFA for the next two years. The commission discussed changes to the NRS 427A.750 in the following areas. What we think the commission should look like and the responsibilities and functions of the commission and a possibly paid director. Looking at the paid director I believe last week Senator Spearman had the opportunity to request a discussion whether we should have a paid director and the funding going to come from. I had the opportunity to be there and worked with Senator Spearman trying to address the needs of the commission. We also discussed further funding for the commission as it was only funded for 18 and 19. Another thing we discussed the director would do is to help us update the plan and act on it, connect with other commissions and other states, help us with legislative responsibilities’, and do research into commission goals. We have decided to change the Name to the Nevada Commission for the persons who are deaf and hard of hearing. And the other thing we discussed was to update the number of commissioners from 9 to 11, with one position going to a specialist for children age 0 to age 5 and the second being a parent of a child 0 to 3. That was one of the main concerns and that’s where we really get in the beginning of the child education.Brian – Thank you very much, Eli. I appreciate that. I wanted to come back to one of the first things you said. I’m aware that there is a need to look at funding as it relates to the services that you mentioned at the beginning, for the centers that are providing those services. It appears that as we’ve seen those services become more available and the quality and quantity are improving, it appears that there are a lot more people that need those services that even go beyond what the PUC has used related to telecommunications and technology. I think that it’s a good discussion that you’re having. Trying to look at how do we expand that funding to more people and look at not just the technology but going beyond that. I think as you look at enhancing that commission, obviously you’re talking with Senator Spearman, you gave public comment in the last health meeting and you gave a presentation there and I hope that will help the situation. I also understand that the public comment at the last meeting, there were a lot of people there and some people felt like they weren’t heard. So just if you maybe look at your format and see if there’s a way to make it easier for everybody to comment at your meetings.Eli – Thank youChar – You said that you wanted to update the current number of commissioners, the parent of 0 to three?Eli – CorrectChar – I know our kids especially once they get into school they really struggle. I would suggest you expand that to parents that have kids who are deaf, hard of hearing, we must take care of them for the entire lifespan.Eli – RightChar – So anybody who has a child who’s older deaf, hard of hearing potentially dealing with that from zero to three and have that experience as well.Eli – We did update the number of commissioners. So, we now have 11, we’re looking for people to fill those positions. Update, Discussion and Make Possible Recommendations on ADSD Caseload Evaluation Organization (CLEO) Numbers (For Possible Action)Jeff Duncan, Unit Chief - Planning, Advocacy, and Community Services (PAC)Jeff – I’m going to go over the attachment for the CLEO overview and I’m going to touch on the four different programs and talk about each meeting specifically, and the developmental services and go through each question on the left side and we should have team members here to answer questions. This data is for March of 2018. The first question is ATAP the number of individuals waiting for services. They had 600 children waiting for an average of 390 days. We already had public comment on the next question, why are people waiting for services. We already had public comment about the reimbursement rate impacting it. ATAP has always had a wait list, number of referrals exceeds the number of new children funded each month. Provider capacity is limited and the need for services exceeds funding. The third question is, are they getting some services but not others? That’s not applicable for ATAP. The last question is about the budget caseload to actual. Our budget is 785 and the actual caseload is 714. I believe Brook is there to answer questions.Brian – Brook, if you want to come to the table that would be great. We’ve heard and we’re aware of the challenges that exist, can you clarify some of this. I know the RBT rate is a challenge in my other life with Easter Seals we’re a provider of these services and I know it’s a challenge. Second thing is that we know there is a large wait list according to the State Department of Education. That number has been thrown around somewhere over 7,000 kids that they’ve identified, and so we know we’re just making a dent or not even making much of a dent in these services. There’s also the challenge as was mentioned, with the RBT’s getting them credentialed, turnover, all that. And that’s something that I will be talking about in another section, but I am going to be formally addressing it in a hearing with the interim committee on health. I’m also addressing that with the federal government at this point too. There are a couple different levels I’m looking at some of this stuff at. The reality is ATAP and the community providers are pretty much in the same boat right now and ATAP’s funding, why don’t you talk about that and why Brook, why ATAP had to finally say we can’t pay you guys for three months while you’re trying to get your RBT’s credentialed. Brooke Adie for the record – We still are allowing the 90-day certification period, but what we’re doing is for the Medicaid children, we’re starting the transition process for the providers to direct bill Medicaid. Over the next several months what we would do is say okay, as the child’s prior authorization expires then the provider will submit a prior authorization directly to Medicaid as the servicing and billing provider and ATAP will no longer be providing payment to the providers and then seeking reimbursement from Medicaid. We’re hoping by November 1st all these children will be transitioned, but of course it’s not our intent to have children go without therapy. We will be working with and talking to providers and helping them overcome any struggles or barriers they’re having to get the kids to be able to direct bill Medicaid. We want to work with providers in making sure the priority authorizations are filled out the way that we fill them out in order to get them reimbursed, we’re going to help with claims to make sure that you guys have the information you need to fill the claims out the way we’ve been able to get reimbursement for, and then because during the 90-day period is not reimbursable by Medicaid, then we’re still going to allow ATAP families to do that. If there are children that have private insurance or are receiving straight ATAP funding that 90-day training period is still going to be an option. Brian – Who’s here from Medicaid?Jamie – Jamie Hutchison and Jody Patton, are on the callBrian – Jamie and Jody, as you know, we met several times talking about the RBT rate. And I know you’re looking at a rate increase there. Do you have any comment as to where all that’s at?Jody – We have collected information from our community providers and this is not something we can do directly but we have drafted internally and sent forward to the administration for the Governor’s office and the legislative session to determine which of those concepts to move forward with.Brian – I believe you gave three different options as far as raising that, correct?Jody – Correct, we appreciate everybody’s input and diligence in getting us that information so that we could move it up the road on the budget concept papers. Brian – There are three different levels proposed as far as rates, please correct me if I’m missing any. The low one moved it to $33, $35 was mid-range and $38 was the high, is that pretty much ballpark for what we ended up with as that RBT rate? Jody – I don’t have the exact numbers in front of me but that sounds like what we are looking at. Brian – That’s the proposal, so what I suggest we do now is lobby for the higher rate. I know some providers put forward several $45 and we looked at the rate being provided by other providers like military insurance which was $42. Char – Brian, can you remind me what the current rate is?Brian – $31.30 Char – I just want to comment that, for example, my son’s ADA provider specifically does not take Medicaid. When he was young I just paid out of pocket. I just had a discussion with his office the other day, and they have been very clear that the Medicaid rate is not high enough for them to even meet with Medicaid, for lack of a better phrasing. I would be very interested to find out if the ADA providers believe that 35 is enough.Brian – As one provider I will say no, it is not, any rate increase is welcomed, but we really wanted to see it at a minimum of $45, Erik do you want to comment on that?Erik- That’s not going to be enough, I really encourage people to look at national averages for Medicaid reimbursement rates, today we are second or third last in the nation and coming up 10 percent isn’t going to do it. I think California which has a very strong insurance backing from the state, they are very actively getting people insured, they have a $40 reimbursement rate. People there can get their children enrolled and insured very quickly with plenty of providers there and are doing private insurance so there is an offset, even the national rate is above $40.Brian – Thank you for sharing, I know Utah is about that. Dr. Tedoff if you would like to comment?Dr. Tedoff – An increase in rate would be helpful in terms of retention, and retention is critical because what I’m not hearing in this conversation is a nine-alarm fire, 666 RBT’s with 7,000 children that need services. Increasing the rate will help with retention. To expand on that a little, you must understand that most kids who are eligible are over the age of 7 and at 7 they are required to go to school, therefore they are only available from 4 to 7 pm or 3-hour shifts. It’s a hard sell to recruit somebody to say if you go through these hoops of fire become an RBT, a 40-hour class, national exam, on site assessment, you can make $20 an hour, three days a week, 3-hours a shift. That’s a very hard sell. So, any increase in rate is going to be helpful with retention.Brian – I appreciate that, and that is the challenge. Do you want to add anything? Brook, on that?Brook- We find that the RBT population does have a very high rate of turnover and so we find that the providers are frequently hiring new RBT’s needing that training time. I think Dr. Tedoff highlighted some of the training, the 40 hours class and a national exam and they need to have a lot of practical experience. We really want to make sure that we’re getting good qualified people out there providing the high intensity frequency of services. These are the people that are in the homes the most, providing the most amount of therapy. He was accurate in saying that most of them are school aged and a lot of the therapy happens after school.Brian – It does, and a lot of it is happening in centers now too because of supervision. Thank you for sharing, supervision is a challenge. The ratios that exist nationally between DCBA and people and the RBT’s is tough. There’s no other service we provide at Easter Seals that has that the second is the credentialing, it’s a huge issue. When you look at credentialing, many states don’t require the credentialing of an RBT. I would really like to see our state go to that. We’ll talk more about that in the legislative stuff. I think credentialing of BCBA is appropriate but given the turnover we have and how difficult it is to get RBT’s and retain them, it means that sometimes we’re waiting as much as six months to get an RBT credentialed especially when you start talking about Medicaid HMO’s, especially Amerigroup. It’s like the nine-alarm fire, I keep saying we’re in a Medicaid crisis right now in Nevada. The rate we’re going within the next year or two we may not have any providers left here and I think that’s the reality of this. The reality is that our policy in Nevada the way it is and I’m not blaming any individual at all here, we need a better way of doing this, and the way it works with Medicaid insurance the message we’re sending is that we do not want to serve children with Autism. It is clear that’s what the state is doing.Erik- I’m connected with national in Reno and I’ve been doing this a long time with a lot of people from other states and there’s no schedule for providers or BCBA’s or RBT’s to come to this state at this rate. At the rate that is being offered, it’s a clear signal to kids with autism in the state that nothing is going to help.Brian - I agree, Eric, and I think we provide those services at Easter Seals because we provide a lot of other services and we get some donations. It must be tough out there for private providers given what we have unless you’re using a model that I think we just decide I’m not going to take Medicaid and then it becomes expensive for the parents. Any other comments on this item.Cyndy – I have a question on developmental services.Brian – We’ll go into that, anything else on autism? I think we know what the challenges are with ATAP. Jeff the next item, please. Jeff – We’ll go to early intervention, fist question, number of individuals waiting according to the last report, 0 children waiting to initiate services according to our fact book, there were 3 children waiting for 3 individual services over the time-period and this was without a parent exception, but all three have since been initiated. As to why they’re waiting, the children show as waiting due to reasons such as but not limited to availability of partners, parent exception, and date of entry errors or timeliness. Other services, some individuals may be receiving services per their IFSP but waiting for other services. The last part is the breakdown of the budget caseload versus the actual caseload. We are budgeted for 3,831 and we currently have 3,583 enrolled. For referrals it’s 669 budgeted with 661 being the actual referrals. I believe Fatima is on the phone to answer any questions.Brian – Any questions for Fatima? I have a pretty good understanding of what’s going on. We’ve had some great meeting with the providers in the last month. There’s a lot of work being done here. I just announced they are looking at new software and a new tracking system, and we are looking forward to the ability to gather better data about the kids being served with more consistency and so forth. These also been an increase in the amount of oversight of all the providers in the state that provide services, and so the quality assurance unit is geared up to do more in making sure we’re providing good quality services across the state. Jeff – Thank you Fatima for being available. We’re going to move to the ageing and physical disabilities waivers for the first question about the total number of people waiting, in March 2018 we had 454 people waiting for an average of 164 days. For the physical disabilities waiver, priority 1 there are 2 individuals waiting for an average of 235 days. For priority 2 there are 15 people waiting an average of 163 days and for priority 3 there are 190 people waiting an average of 338 days. There is a note here I want to make sure we get, that starting in 2018 the number of days waiting is counted for the date someone expressed interest in the program. Why are the individuals waiting? People are waiting for waiver slots and they are waiting for all waiver services. The third question is not applicable. For the budgeted caseload versus actual caseload, we have 2,211 budgeted frail elderly, with an actual caseload of 2,118 at a 96% capacity with 93 slots open. And with the physical disability budgeted caseload of 826 and actual caseload of 794 again at a 96% capacity with 32 open slots. These are March 2018 numbers and in April we had a big push so I’m happy to say that our May reflection should show that we are closer to 99%. I don’t want to guarantee 100% as that is unattainable with the nature of the programs. We are looking at filling these open slots between the FE and PD waiver and again we should see those reflections at the next meeting in August, that should show a better reflection of our current structure with the waivers. Brian – Great, Any questions?Cyndy – I have a question for clarification, you have probably explained this before, but does the number of slots ever go up?Jeff – With each legislative session we request the number of slots based on population growth. Also based on the Olmstead act, those waiting over 90 days, we identify both sets of numbers within our wait list to capture that data. We all know the population is growing and every time we go to the table it is based on population growth. The 90-day Olmstead change was new in the last session, so we got two different sets of slots that were for all three waivers. The ID waiver was put in there as well, it was a true reflection based on the current numbers at that time. With our population growth and demonstrating that we will be at full caseload, a 99% rating, I’m hoping to gain more slots, at least ask for additional that will be a true representation of our population and those waiting over 90-days.Brian – Any questions on this? I know that the 90-day Olmstead thing was something former members of this body were very involved in helping to make that happen and we are very appreciative of it happening.Jeff – Moving to developmental services, we’ll start with the waiver there were 589 people waiting for an average of 686 days, for SLA there were 220 people waiting for an average of 279 days, for JDT there were 157 people waiting an average of 558 days and for TCM there is no wait list, everyone who applies receives services if they are eligible. As to why they are waiting, they are waiting on waiver slots for a provider or the right placement match for the SLA and JDT. The question about are individuals getting some services but not others, yes about 62% are on the waiver wait list are receiving some services. The budgeted caseload for TCM is 6,995 with 6,910 actual cases, Waiver caseload is 2,314 budgeted with 2,168 actual with 151 pending, with an average of 11 terminations a month. For SLA there are 2,653 budgeted with 2,388 actual for a 90% capacity, and then JDT has a budgeted caseload of 3,226, with 2,512 actual for a 78% capacity. One note here for the record the reasons for SLA and JDT being under capacity is waiting for all billing to completed in the harmony database system, identifying, approving and setting up qualified providers, vacancies and low provider rates. If you have questions I’ll do my best to take them back and get you answers.Brian – All right, I was waiting to hear that harmony was a part of this challenge, and rates I appreciate that. I think that the harmony transition was rocky, I think there are still some challenges, but I think a lot of that has been addressed and smoothed out over time, so I would hope that these numbers will improve over the next month or two. It’s concerning to see SLA numbers JDT at 78% and SLA at 90%, and the waiting list is a lot lower than it was last time we had this report, I’m not sure if we can get an accurate number with the new software. Jeff, do you have any thought on that, I know for a little while we were really concerned about the numbers from harmony, I don’t know if we still have those concerns or not? Jeff – I can’t speak for the database, but I’ll follow up and we can have a better report next meeting. Brian – Okay, I know Cyndy had a question. Cyndy – My question was about the 78% capacity and the JDT what specifically was contributing to that? That we kind of asked but I don’t know if there’s any more clarification on that one. Jeff – I can find out and get you a response. Brian – Let’s find out because that is low, and it should not be that low, especially in SLA or JDT. There’s been some expanding of ability of providers, I know we had a provider close last year and there was a transition that took place. I know of at least two, maybe three providers who opened additional space to provide these services. We have people waiting a long time for services especially with the discussion about the Olmstead act. We still have quite a bit of turnover with case managers and that with the rate issue is always a challenge, which is being addressed. I appreciate all the work Dena and her team, and Richard and Mike in the Governor’s office have done. A lot of people have been involved in this discussion with us, and there is a proposal going forward to the next IFC meeting to look at an increase now and we are looking for a significant increase in the Governor’s budget. Because the rates are abysmal, when you compare these rates to the RBT rates, the autism project is a much more expensive service to provide but rates are a lot better for autism than they are, it’s bad. Some organizations who had the ability to raise the rates, what they’re paying their staff, have done that out of contributed dollars that they have, but most are struggling with rates. We’re excited to see an increase and hope that will help us address the turn over within the community providers as well. Any other questions?Char – Last time we were here I had asked a question about applications and how those were being processed and if they were using the new definition that was changed from related conditions to developmental disabilities, which included a new definition for that population. I was told at that meeting, that yes, that was happening. Since then I attended a public hearing on March 20th for proposed changes to the NAC related in part to 224 and Tracy from Opportunity Village submitted some questions on November 30th, they provided answers to those questions that I just want noted that ADSD sent out the answers to these questions and specifically included the terms persons with related conditions in lieu of the new language. So, I’m really concerned that applications are not being reviewed based on that new definition of developmental disability and I just wanted to get that on record. Jeff – I will follow up with Lisa and have that conversation with her and have her come to the next meeting. Brian – Jeff if Lisa wants to put together just the answers to that and we can send that out to the commission members and put it on the website. Char – I was going to bring this up during the next section, but my other issue is that going through these regs, the questions were not answered at that public hearing. They were answered after the fact. It sounded like they were not planning on coming back for another public hearing and there have been more questions raised based on these answers.Brian – Let’s see if we can get some answers, I agree we need to understand how that’s being implemented. I know that they were working on it but if the language isn’t correct we need to make sure it’s been fixed and that we’re following through on what should be implemented from AB224. Updates and Discussion Regarding Interim Legislative Activities Brian Patchett, Commission ChairpersonBrian – There were three interim committees that we talked about last time that we need updates on. The three committees are, Seniors, veterans and adults with special needs, the second is the interim committee on health and then the interim committee on education. I’m going to start with education, I requested through the Chair that we be permitted to have a couple items in the next meeting, I worked with the staff, and so we’re going to be addressing special education. I am looking for people who would like to join main a panel discussion, there are three areas of discussion, one is school to work transition, second is IEP’s, challenges with IEP’s, I’m hoping someone form Nevada PEP might be interested in helping with that one and third is assistive technology and challenges with assistive technology in the school districts. Those are the three items on that agenda. The meeting is coming up in the next couple of weeks. I’m going to be sitting in on all three of those items, but I would love to have people joining me. I know on the transition Tracy from Opportunity Village is going there as well. I’ve had contact with CCSD to be there and I’m looking for people who might be interested in sitting at the table with me on these. Anyone interested?Char – I can make sure that we have somebody from PEP, if not me then someone.Brian – I also chair the Commission on assistive technology, and there is going to be a parent talking about assistive technology and maybe one other individual, speaking on the challenges there. We’re not doing a great job on all three of these items anywhere in the state. There is a lot that needs to be done with the transition from school to work and when it comes to IEP’s we are still getting IEP’s handed to parents and said sign this without any discussion. With assistive technology, unless you go to fair hearing, you probably won’t get what your child really needs. That is the reality with assistive technology, that’s where we see a lot of generic IEP’s or something minimal being provided. The other commission that I chair has spent time basically listening to groups of parents over the last couple of months, and it is just incredible. When I talked to the districts, they say oh, we’re providing assistive technology, that’s not what the parents are saying.Char – What we’re hearing is that parents are going in and asking for assistive technology and they’re given offers that the district possesses and if they ask for something outside of that, they’re being told no.Brian – Totally contrary to law, no actual evaluation or assessments are being done. The parents don’t even know they can request an outside assessment. I got to the point with the Clark County School District where I thought we were going to make progress on that and then was told that they were providing assistive technology to everybody, after six months of being told they were not. These are the items that are critical to a child receiving a free and appropriate public education, and it is not happening. Then you get into the bad stuff where Clark County schools decides they want to use special education dollars to cover their deficit and of course all the stuff in the newspaper last year about Washoe County school districts. It seems like we never did get to the point of really addressing these real issues. The core is what is in an IEP, what are we doing about transition and technology and we’re not doing that, once you get something in an IEP we can talk about do they have the capacity to offer those services, in some cases they don’t have the capacity. If you think of anyone else that should be involved in that discussion during the interim committee, please let me know. Marsheila Lyons just joined us, thank you. We just started our discussion about interim committees and were talking about education, and we talked about what we’re going to do with autism. If you want to give an update, where you are at with the committee on health.Marsheila – The legislative committee on healthcare heard testimony at the last meeting and we’ve heard testimony throughout the interim on empaneling providers in general and then specific to the issue of providers to work with children with Autism. The chair has asked me to put together an agenda item for our next meeting, which is June 17th, (corrected later in the minutes to July 17th) to have insurers and advocates discuss some of the issues that we’re having with empaneling providers and she wants a piece of that to be focused on autism providers. I’m hoping to work with Brian and others to put together the appropriate people on that panel to meet with Medicaid and the Department of Healthcare Finance and Policy to get representation from the three managed care organizations as well as probably some of the private insurers separate from that to be a part of that panel to discuss the issue.Brian – I appreciate that, Marsheila is a staff for that committee and the chair is Senator Pat Spearman, I appreciate her interest and when this issue comes up, when she talks about empaneling, we’re talking about credentialing and the issues brought up in public comment in this meeting. I have reached out to two lobbyist, who represent the insurance side, and I’m going to be doing some meetings with them and I think they will be providing people for that panel as well. We want to really look at how can we address that, it’s not just Medicaid, there are some medical providers who this credentialing challenge that we’re having applies to as well. We’re hoping to have some people from Medicaid to also talk about this as it is a crisis. Marsheila, one of the providers who is on the phone described the situation as a nine-alarm fire that we’re in right now. We’re in the position right now if we don’t get some of these things corrected as relates to autism, we may not have any autism providers left in Nevada in the next year or two. When I brought this up with legislators, especially legislators involved in the medical community, they say the issue in not just an autism issue, it’s an issue across the board and really it is an issue of getting people credentialed through Medicaid and trying to figure out why it is such a challenge in Nevada to do that. Erik – I dug back as of February 3rd, I was putting data together on reimbursement rates for Medicaid, and Nevada at $31.31 was the fourth lowest in the nation, there were three states that were lower. The national average was $44 an hour, and I know that cost of living was one of the drivers for reimbursement rates, and we have a great cost of living here in Nevada. States like Louisiana, New Mexico, Wisconsin, Texas, North Carolina are at $50 an hour up to $74 reimbursement rates. I know Nevada can do better, and I’m not going to stop pushing for a better environment for our kids, that’s what we do, that’s who we are. Brian – Easter Seals looked at that and we found that several states don’t require credentialing of the RBT’s at all.Erik – Minnesota recently and some of the other states moved quickly where there were problems like this and they got rid of the RBT credentialing and allowed the agencies to be the governing body on quality of work being provided, it’s a stop gap. It’s obviously an RBT problem but it hinges on the reimbursement rate I would say. One more thing I want to say, University of San Francisco came out with an article today that EEG was highly accurate predicting autism by nine months of age and that was correlated with ADOS given later in life. We’re seeing progress in early identification, but we can’t kick the can down the road, we must move on this. We pay now, or we pay later, that doesn’t include quality of life, something must be done. Brian – I agree, thank you for sharing that. The reality is, you can make the most progress between the ages of birth and five. If we don’t have enough providers because of credentialing and rates and those things, it really creates a situation that we are in where it is a crisis. How much time do you think we’ll have for that panel, Marsheila?Marsheila – I don’t know just yet, I think it is going to be an extensive discussion. I do know that the chair wants me to do quite a bit of work before the meeting since we have so much time in between. That will be our third meeting and we’ll have two more, meetings after that. Being at a place where we’ve done enough work in between that time, that we potentially have possible recommendations or things for the committee to start thinking about whether they would like to put them forward as recommendations to the full legislature to consider. Brian – Excellent, so people know, Marsheila, how many bill drafts does this committee have?Marsheila – TenBrian – Ten, so if this is something that is determined by the chair and the members of the committee as being critically necessary and that they want to use as a bill draft to make corrections, they can do that, or they can also make suggestions to the full legislature as they come into session this next year. This is a great opportunity to do this, we’ve been successful doing this in the past when Kristen was working on one of the committees. As we get closer I would ask for input and invite folks to give public comment as it relates to this in that meeting. Anything more to add, Marsheila?Marsheila – I’ll be reaching out to folks and if there are elements that have not come up in the public discussion, that I need to be aware of, make sure I know to reach out to those people as well.Brian – I will give you a list of some of the providers that have been with us on the phone today, so you know who they are. The other committee that we wanted to talk about is Seniors, veterans and adults with special needs. The discussion that is going on in that committee is dealing with rates as they deal with JDT, SLA types of things and big discussions going on in that committee and in the health, committee as well are discussions on Behavioral and mental health. There are a lot of issues related to living conditions as well, a couple of months ago we had a woman who went to a living arrangement in Southern Nevada and died there because the conditions were so bad. This has become a big part of the discussion on Seniors, veterans and adults with disabilities. There is an ongoing discussion about supported living, with a presentation about supported living arrangements through regional centers, and developmental services as compared to what’s going on in mental health and behavioral health. I know that the issues of credentialing and quality of services are both critical in the behavioral health area is what they’re talking about. That’s what I know is going on in the three committees, I try to attend those as much as I can or watch them if I’m not there. This is an opportunity to get the conversation going, and it is helpful when we get to the legislature if we have a bill draft coming from one of these committees, or a recommendation coming, or even a letter from the chair is helpful. If she were to say these are the issues and we’d like to see them addressed by the legislature during this session. Jeff – I do have the written testimony submitted by Mindy martini, principal research analyst for LCB on the legislative committee for senior citizens, Veterans, and adults with special needs or SVA, that I will read.Legislative Committee on Senior Citizens, Veterans, Adults with Special NeedsMindy Martini, Principal Research AnalystResearch Division, Legislative Counsel BureauThe SVA Committee is authorized to meet four times during the 2017-2018 Interim.? To date, the SVA Committee has met two times.? As one of the Committee’s requirements this Interim, pursuant to Assembly Bill 299 (2017), it must complete a study to determine standards of training for persons who are not providers of health care, but who provide care to clients.? As part of the study, the Committee must also study the creation of a competency evaluation that each provider must take and successfully complete.? The study must be completed, with a final report to the Director of the Legislative Counsel Bureau for submission to the next legislative session.? In addition to carrying out the study, the Committee has received presentations on veteran’s programs, including the Adopt a Vet Dental Program.? The Committee has also received an update on the audit of the Adult Mental Health Services Community-Based Living Arrangement Homes (Legislative Auditor Report #LA18-13).? For the upcoming meeting of the Committee on June 19, 2018, it is anticipated that the agenda items will focus primarily on issues relating to senior citizens and adults with special needs.? Items may include:? a) Review of independent living for adults who are visually and/or hearing impairedb) Vocational rehabilitation and employment for persons with disabilitiesc) Update on private and public funding for schools for the deaf, hard-of-hearing, and speech impaired individualsd) senior citizen needs, including care giver supports and guardianship issues.? The final meeting of the Committee on July 19, 2018 will include a work session to determine bill draft requests to be forwarded to the 2019 Legislature.Thank you for your interest in the SVA Committee.? Mindy MartiniBrian – I requested those items related to the disability stuff in a conversation with Mindy and was given a presentation at their first meeting, and I’m glad to hear those items are going to be on that agenda, at least tentatively, looks like I need to do some follow up. As far as folks with visual disabilities, this is dealing with the independent living program, and goes back two sessions ago, we passed a bill to research enhancing those dollars, so we could provide more services for people in those categories who are not ready to go into employment. I’m glad we’re having that conversation.Marsheila – I want to clarify, I think I said June 17th and it’s July 17th, for the next legislative committee on healthcare meeting. Making sure we have the right date.Brian – July 17th, next committee on health. That gives us some time to put together some good information. Thank you, Marsheila for being with us. Discussion and Make Possible Recommendations Regarding Subcommittees of the CSPD for Employment and Wavier for Persons with Intellectual and/or Developmental Disabilities (For Possible Action)Brian Patchett, Commission ChairpersonBrian – I was hoping we would have a signed letter from the Governor, there was a discussion that took place maybe a month and a half ago to form a subcommittee of the CPSD to focus on waiver-related issues and what proposed changes that the Governor can address to that waiver. I know that Kristen is here and certainly she gave a good presentation as they went around and id the public comment. We have opportunities to make changes coming into the legislative session is my understanding, correct? There was a discussion with the Governor’s chief of staff, myself and a couple of other providers and the head of Aging and Disability Services sitting around the table and it was suggested we would like to provide more flexibility and scope especially as relates to employment and maybe some other things within the Medicaid waiver for home and community-based services. The suggestion was why don’t we form a subcommittee of the CSPD to inform the Governor by the first of August. We’re just waiting right now for the Governor to give us and official signed letter that we drafted with some language for them saying this is what I would like to have happen, and then we can do that. I am hoping we do this very soon, we were hoping to have it a month ago, and my understanding is that the Governor could make suggestions and changes to the waiver at any time. Is that correct?Kristen – Correct, we are currently in process to renew the waiver, which is just a logistics with CMS as far as inputting information in their portal. What we can do is that we’re not properly prepared to make any changes to the wavier at this time, but we can always do an amendment. I think it would be appreciated to have that ongoing conversation. I set up a public workshop at the end of March to solicit recommendations and was grateful to have a lot of stakeholders participate in that, but that was just one point of discussion that we had to receive information on desired changes to the wavier application. Going from there to have a more ongoing conversation I think it would be helpful to have a subcommittee of the CSPD. I commit to have in attendance between myself and our new waiver supervisor Ellen, who joined me today. We can make changes, it would be instead of through an application, it is through an amendment. I think our goal is to make sure that our waiver services that are being offered, are really meeting the needs, we want to make sure that as we administer the waiver and ADSD operates the waiver, we really work closely with them to try to make sure we are meeting the needs. We try to be a part of the discussion as much as possible, even after we have officially approved our waiver for CMS and submitting the document and uploading it to the system, doesn’t mean that it is set in stone for five years. We will absolutely continue the discussion and can do an amendment at any time. Brian – For those that have been on the commission know that we worked with Kristin on legislative things a few years back, Health and Interim committee on seniors. I was thinking while she was talking that there’s nothing that prohibits me from appointing a subcommittee now. I don’t want this subcommittee to be more than 10 -12 people at the most. Let’s make a list there are some people not on this committee that I want to make sure are represented. I want to make sure there is a representative from Opportunity Village, probably Tracy and/or Bob, I would say someone from UCP, let them decide who they would like there/. Monica or one of her staff, I will be there in this capacity, and we would like to reach out to some parents who have children and/or individuals with intellectual development disabilities as well. I’m open to recommendations there and I would be open to anyone on the commission who would like to volunteer.Char - I’d like to participate on that subcommittee.Cyndy – I’ll do it too.Brian – Char and Cyndy, excellent, anyone else want to volunteer? We will request Kristen and her staff be there with us. If you have suggestions of individuals with intellectual developmental disabilities and/or parents, or other providers, I’m going to reach out to a couple of other provider and see if they want to be a part of this discussion. I think one of the guiding principles in all of this is how do we make changes to the waiver that allows us to employ more people with intellectual developmental disabilities. That will be one of the items.Cyndy – What about someone from the NCED?Brian – Good idea, do you have someone in mind?Cyndy – I doBrian - That takes us to about half the committee and we could probably appoint another five or six. We should call it the committee on the home and community waiver amendment, something like that. All those in favor of this committee as I’ve outlined?Cyndy – So movedChar – SecondBrian – Any further discussion? All right. All those in favor please indicate by saying Aye. Any Opposed? Any Abstentions? So, moved. Thank you very much.Discussion on Nevada participation in the National Disability Compendium (For Possible Recommendation)Brian Patchett, Commission ChairpersonJim Osti, Commission MemberJim – I’d like to update you on a few things that have been happening. I’m a little bit concerned that we can’t do this on a statewide basis currently. The health district is getting ready to do its three-year community health assessment. It is a very long and involved process where we look at all the health needs of our community, and we’ll develop health focus areas, those health focused areas will lead into our community health improvement plan, where we’ll strategize with our community partners on ways that we can improve the health of all the citizens of southern Nevada. Part of our activities to do that is to develop data and we do have a data website that we’ve been using for the last four years, it’s called Healthy Southern Nevada. If you typed that in, it’s easy to find. That website has a lot of data indicators, and I’m very pleased to say that through our discussions with our national vendor for that website we have been able to add ten disability indicators to the website. I wish it was a lot more but before we only had one. I made the request and we surprised when the responded positively to that request. I feel good that these indicators are available for people to go in and do an analysis of the data. The indicators are listed by county, by census place, by zip code and by census track. The ones that are available to us currently from the American community survey, you can do a quick analysis of that data. This is what I would call the prototype of what I’ve been describing as a compendium for the State of Nevada. I would be an opportunity for the state to pull down the latest data from several curated national websites as well as to input some of its own data for a way to look at disability that yields information that helps with a number of our tasks as a community. One is eliciting funding, if you have evidence of need, obviously that’s one area that you might be able to improve funding. The compendium for Nevada for disabilities would also highlight what trends are existing. I have been working with another group called the Clark County Children’s Mental Health Consortium. Something I observed when looking at the national data, is a serious increase in the number of children under age 5 with disabilities as defined through the American community survey. I’m hoping we can dig into this data a little more closely, because for 2016 we are ranked in that American community survey as the top state in the entire country for prevalence of disability under the age of five. That one, unfortunately, is not in our website, but it is in the American community survey, and it’s in the National Disability Compendium which is published through the University of New Hampshire. I come to this commission with an appeal, that we really look hard at getting all this data together in one place. I mentioned to the Children’s Mental Health Consortium that a decade ago, we were all sitting around the table complaining and concerned that we don’t have enough data. I would suggest to everybody now that with the technology changes that we’ve been seeing and the incredible increases in capacity of our systems, that we’re moving toward having too much data that we need to be looking at. We need assistance from technology and from individuals who are trained to look at and review data to help us develop this information so that we can use it as a Commission to the benefit of our constituency. I’m hoping that I can move this needle a little bit in the right direction, if you have questions for me I would be glad to answer them.Cyndy – Thank you for this, I think it’s important. I agree with you 100% that we have a lot of data, but we’re not using it the right way. In working with some national groups around data including prosperity, ow a former CFED, which is the community, corporation for enterprise development they are just now in the process of adding some disability indicators to their national data as well. I think the fact that it was just on your website, the fact that you’ve put that together is great. One of the things that comes up a lot of times when talking with national partners is that in addition to local data which any of them can’t get, policy recommendations around data are important to be looked at. We’re pulling all this data, starting to get a better sense of issues like poverty, educational attainment for people with disabilities, I’d really like us to be using that to make policy recommendations not just in Nevada but nationally, because we have a lot of national partners asking for recommendations based on our data. I know that’s kind of convoluted, but I think beginning to use some of this like Jim said, to make the policy recommendations and to make sure that we’re using that data to tell Nevada’s story nationally. Brian- Absolutely, I think it’s important.Jim – I would add to that, Cyndy, one of the things that we’ve done with our website is that we purchased the data from all the national sites, and our company utilized, and our company does a great job of getting that data posted, but we have a personal responsibility as an organization to provide local data to the website as well. We have over 80 indicators that the Southern Nevada Health District is providing to our website. It is not only national data, but it is local data as well that we’re publishing, that’s the model I would hope for a Nevada disability compendium. You would draw down the national data and add the local data whether it be on a statewide basis or even down to a zip code level or beyond. Cyndy – I agree one hundred percent, thank you.Brian – At this point Jim, are we ready to look at approaching a legislator, where we would request a bill draft to create a statewide compendium? You’ve said there is not one. With legislation we could create on if it was just one person monitoring this statewide as a beginning perhaps, what do you think?Jim – I think that would be a great step, we need to enlist the aid of our universities in this project. They generally have the talent or expertise and are looking for funding to so some of these types of activities. So that would mean perhaps UNLV or UNR would come to the table with a discussion about what they might be able to provide.Brian – Or maybe both. I do have a question, maybe you or Cyndy would have some idea on this, sounds like we have the highest per capita of prevalence for children with disabilities according to this data, any sense on why that is? Anyone drill down to see what that is?Cyndy – I’d like to ask Jim if he could send that site to us, I’d like to see that too. You know one other thing that’s interesting, working in the veteran’s base, there was a bill passed two sessions ago, that required every state agency to report on the number of Veteran’s they served. That data was aggregated and sorted by department. I’m not saying that we do that right now, but I think it is an interesting idea to try to get a sense of prevalence numbers of people who are veteran’s in this case, that were hitting each one of our agencies. It might be something to think about down the road, every agency is already collecting this information. As to Jim’s concept about a compendium it doesn’t live anywhere right now where you can see, for example, the percentage of children that are in DCFS that have a disability or that are using social services or things like that. Something to think about when we’re looking at data we might want to look at prevalence data in our programs, and it is possible, we have done it in other sectors. Another avenue of opportunity for us may be the new analytics section that Richard Whitley has developed. They would be drawing from a lot of different data sources and might be able to help with building a compendium for Nevada.Brian – Good Idea, do you want to have that conversation, Jim, and/or Cyndy, with Richard?Jim – I don’t have a vehicle for having that conversation with Richard, but maybe Cyndy does.Cyndy – Yes, absolutely, I’ll try to get something set up.Jim- I would be glad to support that conversation in any way I can.Brian – We’re going to ask for a motion for Cyndy to go and have a conversation about the compendium with the head of Health and Human Services Richard Whitley. Motion to approve that.Jim – I’ll make the motionCyndy – I’ll second the motionBrian – Any further discussion? All right, all those in favor Aye, any opposed? Any abstentions. Motion carried. Report, Discussion, and Make Possible Recommendations for Recruitment to the Commission per NRS427A (For Possible Action)Brian Patchett, Commission ChairpersonBrian – Jeff, what are the positions that are open? Do we know what positions those positions are? Jeff – I do not have the specific ones that are open, I believe we have three opening, but we do have some terms expiring soon as well and Wendy is not here, and Dawn is on medical leave, so I wasn’t able to follow up, to get what has been sent over for approval for the members who are new and the ones returning now. I wanted to bring that to your attention because according to the information I have Brian your term is ending 6/30 and others also look to be expiring. Brian – I think we may need to do another meeting before 6/30/2018 to do something, we don’t want to lose a bunch of members and not have people on here. I’m going to purpose to the director that we extend this term a little bit, we’ve done this once before, because if many of us leave the end of June we are going to have low numbers on here. Jeff will you investigate that and see if we can extend the term a little bit?Jeff – Will doCyndy – Would we make recommendations then next time when we have the information?Brian – Yes, Absolutely, there have been some names put forward and with vacations we don’t have that information and we must make sure we have that information because we need to get these people on this commission. Discussion and Make Possible Recommendations regarding Nevada Commission on Autism Spectrum Disorders (ASD) (For Possible Action) Brian Patchett, Commission ChairpersonBrian – The Autism, commission meeting was a couple of weeks ago and it is sunsetting at the end of the year December 31st. One of the ideas was that we would initially appoint a subcommittee of the CSPD for autism just to keep that going through the legislative session. Then perhaps proposing a bill along the lines of what we’ve talked about with the commission for people who are Deaf and Hard of Hearing, we would create additional slots on the CSPD for folks representing autism, whether that be a provider, a parent and/or person with autism. Those were what was presented, I haven’t been able to talk to Dr. Gaspar since then and there is no one form that commission here to affirm that, we’ll table this item till next meeting.Discussion and Make Possible Determination of Issues and Agenda Items to be Considered or Deliberated at the Next Meeting (For Possible Action)Brian Patchett, Commission ChairpersonBrian – We always have the standing items, the legislative item, at this point we are talking about interim committees. We’ll invite people to come back and present information for our next meeting. We always have the report Jeff has been giving related to numbers, and statistics, that we get across the programs and services from ADSD, let’s see if we can get Lisa and the others here next time. There should always be an item that relates to the ten-year plan, this time it was the 700-Hour program that item addressing employment for people with intellectual and developmental disabilities and our responsibility as a commission. We need to act on new membership for this commission and transition, what is that going to look like, we may need to do a bill again with this combine it with what Eli said related to folks who are deaf and their commission.The deaf commission has a standing report. The compendium, the statistics that we gather statewide with Cyndy and Jim. I would like to have an item for Medicaid, because it always seems to come back to them. An item with Medicaid specific to disability and autism, talking about some of these issues of credentialing. Anyone else?Char – At our last meeting we had some WIOA numbers, can we bring that back?Brian – Yes, we were supposed to at this meeting, but the director Shelley Hendren was unable to be here today. All right if you have any thoughts on the next agenda, please let us know as we need to have it prepared about two weeks before the meeting and approved by our DAG and post it appropriately. Confirm Dates for Future Meeting (For Possible Action)Brian Patchett, Commission ChairpersonBrian - With the term expirations should we have another meeting before August one before the term expires on June 30th?Jeff – Yes, I think we can get the agenda items locked up in a month and a half if you want to meet before June 30th. I’ll get everything firmed up and talk to Rich to see about an extension. Brian- How does the 21st sound for most folks?Char- Works for meCyndy, Jim, - Works for meBrian – Anyone on the phone that it doesn’t work for?Okay, then we will try for the 21st of June for the next meeting. The next meeting date is tentatively scheduled for June 21, 2018 at 9:00 am. Public Comment (May Include General Announcements by Commissioners) (No action may be taken upon a matter raised under public comment period unless the matter itself has been specifically included on an agenda as an action item. Public comment at the beginning and end of the agenda may be limited to three minutes per person at the discretion of the chairperson.? Members of the public may comment on matters not appearing on this agenda or may offer comment on specific agenda items.? Comments may be discussed by the Board, but no action may be taken.? The matter may be placed on a future agenda for action)No Public comment. AdjournmentBrian Patchett, Commission ChairpersonCyndy – Moved to adjourn meeting Jim – Second the motionBrian – All in favor –Committee – Aye’s Brian – Any opposed? Meeting adjourned at 11:26 pm. Commission on Services for Persons with Disabilities MembersBrian Patchett (Chair), Cyndy Ortiz-Gustafson (Vice-Chair), David Daviton, Dora Uchel, James Osti, Charlene Frost,Nicole Schomberg, Shelley HendrenNOTE: Agenda items may be taken out of order, combined for consideration, and/ or removed from the agenda at the Chairperson’s discretion. The public body may combine two or more agenda items for consideration. The public body may remove an item from the agenda or delay discussion relating to an item on the agenda at any time. The public body may place reasonable restrictions on the time, place, and manner of public comments but may not restrict comments based upon viewpoint.NOTE: We are pleased to make reasonable accommodations for members of the public who have disabilities and wish to attend the meeting. If special arrangements for the meeting are necessary, please notify Lorraine Belt at (702) 486-4307 as soon as possible and at least ten business days in advance of the meeting. If you wish, you may e-mail her at lorrainebelt@adsd.. In accordance with NRS 241.020, supporting materials for this meeting are available at: 3416 Goni Rd, D-132, Carson City, NV 89706 or by contacting Lorraine Belt at (702) 486-4307 or by email at Lorrainebelt@adsd.NOTE: In an effort to provide a safe environment for Aging and Disability Services Division meetings, please refrain from wearing perfume, scented hairspray, cologne, essential oils, scented deodorant, aftershave or any other scented products when you attend.?Scented products contain chemicals which can cause migraines, nausea and even breathing problems for people with asthma, allergies, and environmental illness.No Scents is Good Sense! If you are unsure if a product is safe to wear, a good rule of thumb is to just not wear it.Agenda Posted at the Following Locations:Aging and Disability Services Division, Carson City Office, 3416 Goni Road, Suite D-132, Carson City, NV 89706Aging and Disability Services Division, Las Vegas Office, 1860 East Sahara Avenue, Las Vegas, NV 89104Aging and Disability Services Division, Reno Office, 445 Apple Street, Suite 104, Reno, NV 89502Aging and Disability Services Division, Elko Office, 1010 Ruby Vista Drive, Suite 104, Elko, NV 89801Nevada Community Enrichment Program, 6375 West Charleston Boulevard, Ste. L200 Las Vegas, NV 89146Southern Nevada Center for Independent Living, 6039 El Dora Street H-8, Las Vegas, NV 89101Disability Resource Center, So. E. Greg St., Suite 102 Sparks, NV 89431 Nevada State Library and Archives, 100 North Stewart Street, Carson City, NV 89706Desert Regional Center, 1391 South Jones Boulevard, Las Vegas, NV 89146Sierra Regional Center, 605 South 21st Street, Reno, NV 89431Rural Regional Center, 1665 Old Hot Springs Road, Carson City, NV 89706Northern Nevada Center for Independent Living, 999 Pyramid Way, Sparks, NV 89431Dept. of Health and Human Services, 4126 Technology Way, Carson City, NV 89706Early Intervention Services, 2667 Enterprise Road, Reno, NV 89512Notice of this meeting was posted on the Internet at: and ................
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