Thread by @woodrumlaw

ADSD budget presentation to the Health and Human Services Subcommittee getting started. You can watch online here: nvleg.granicus.com/MediaPlayer.ph…

Public comment starting with Las Vegas (Grant Sawyer Building). First comment regarding the Autism Treatment Assistance Program. They are included in our fact sheets, downloadable here: adsd.nv.gov/uploadedFiles/…

Comment now regarding Home Delivered Meals - sometimes generally called "Meals on Wheels" which has become a proprietary eponym (en.m.wiktionary.org/wiki/proprieta…)

Home Delivered Meals can connect seniors to their community, help avoid isolation, and more per commenters.

Further comment regarding the Autism Treatment Assistance Program and Early Intervention Services. Public comment now closed. Presentation starting.

Dena Schmidt, Administrator at the table with Deputy Rique Robb, Children's Services, and Melissa Lewis, Fiscal.

Moving providers to Medicaid offerings as well as Medicaid eligible children to those offerings lessens the burden on state general fund per ADSD. Fluctuations do exist related to parent choice.

On to budget accounts, starting with the donut hole (gap) that Senior and Disability Rx address for Nevadans in the program.

Data has been affected for this program related to federal movement in prescription drug coverage. Possibly a goal to do a premium subsidy program in future to adjust to changing conditions. Two decision units for caseload growth. Pausing for questions.

Assemblywoman Carlton remarking on Donut Day, asking if there are any other federal changes to be aware of. Response: Not at this time. Senator Kieckhefer asking at what points do we cover? Answer: premium subsides and gap coverage.

Question from Assemblywoman Spiegel about the impact of manufacturer coupons on the Senior/Disability Rx program. Response that follow-up will be provided.

On to two increases for the next account. 11 new long term care ombudsman positions and increase related to Home Delivered Meals and goal to eliminate wait list for that program.

Questions on 3151, Chair Sprinkle appreciating concise presentation, asking for rationale of reorganization and walk through of goals. Response that the goal is to make 3151 a true administrative account. Q of how this will be beneficial. Response: cost allocation, tracking.

Further response that some programs get lost in mixed budget accounts and separating them out will give complete picture on costs of programs. Sen. Kieckhefer asking about Home Delivered Meals and costs per meal diverging between providers. What is increased funding doing?

Response that some funding addressed equipment but even so, demand in Las Vegas has gone up even in the face of investments in infrastructure. Question about maintenance of effort, are we supplanting funding into programs? Response: more data being gathered.

Q: what is the backlog on eligibility determinations? A: about 500 waiting to be assessed. As of November, 97 in Las Vegas with City of Henderson and Catholic Charities. Q: how quick do you get through that backlog? A: will follow up with that information.

Q from Assm. Thompson: addressing wait-list and future growth? A: request is aimed at list and caseload growth will funding will address the growth projection. Q: is waitlist a person in the community or have they gone through screening first? A: the 500 have requested service.

Q: what is the real waitlist if they have not been determined eligible yet? A: we use the actual waitlist when building a budget, we don't just look at applications, we look okay those who are eligible and waiting for the actual service.

Q from Chair Sprinkle: with additional 11 long term care ombudsmen, what work is going to be addressed? A: we do quarterly visits but monthly are more ideal for larger facilities and this will address that.

On to budget account 3266 - Home and a Community Based Services budget. This includes personal assistance, community options, and homemaker services for seniors. M205 is the request for a phased in approach to the ATAP waitlist. M206 is elder protected services caseload.

Request for legislative authority to expand to Adult Protective Services, accompanying budget BDR has been submitted to expand to 18-59 year olds individuals with disabilities.

Additional accounts to address waitlist. E227 request related to further interpreter support because of need for ongoing communication access.

Slide 25, request for funds from Healthy Nevada and TANF funds to support the Autism Treatment Assistance Program.

Slide 26, series of transfers to address appropriate budget accounts. Slides 27 and 28 transfer ATAP to its own budget account, 3209. Slide 29, transfers related to communication access program to 3206, a dedicated account. Further changes to make a true administrative acct.

Committee questions solicited. Chair Sprinkle: asking about telephone/communication surcharge funding, will that address waitlist (E227)? Answer: there is no waitlist for these services.

Asking now about projection for caseloads in communication access. A: 15% increase in last biennium so that is what is being anticipated in future. Q: how will you fund that? A: could be a waitlist for service delivery, we work with Deaf Centers of Nevada as a grantee on this.

Sen. Denis asking about M205, wanting an update on ATAP community providers and if encouraging the providers to become Medicaid providers has been successful? A: working with them directly on their service delivery model and how to bill directly. 29 to 49 now.

Q: How has that been helping? A: provider capacity and diversity in case mixes. We do case planning with those children on Medicaid and provider bills Medicaid directly. Q: what is the projection for future waitlists? A: hope is to eliminate waitlist, 32 children since Jan.

Q from the Chair, do you characterize the Medicaid strategy as really getting services to children? A: yes, we are able to serve those children. Some challenges on availiability based on age of child, behavior of child, and family preferences. Also provider participation.

Q from Chair, why are you going in this direction on revenue streams? A: TANF reserves is a new approach, ATAP meets the goal of families maintaining employment while children are served so that was the connection. Q: do these reserves take the place of other funding? A: yes.

Sen. Denis asking about Adult Protective Services program and the statutory changes, will you have enough staff? A: the request does include VOCA and ACL grant monies plus caseload growth. 100% staffed in Las Vegas right now. First time since 2014.

Assm. Carlton asking about personal care attendants and the way the hourly rate is structured, people reporting there's more need than just the four hours allotted. Two constituents go back and help additional unpaid hours because they care, per Assm. Carlton.

She is now asking if companies are rationing time and also if provider rates trickle down actually to the attendant? Remarking that it is important to grow staff in this field with incentives to grow staffing. Why 56 cents an hour?

A: social workers do an assessment of a person's needs and hours are set by that assessment, people can request reassessment. On rate increase, no way to ensure it goes to the individual. Up to agencies to pass that along. Agencies report trouble with retention.

Regarding 56 cents, Medicaid presentation addressed their view of this service, this seeks to align the rates. Follow up requested about the reassessment/appeal process by Assemblywoman Carlton.

On to presentation regarding Early Intervention Services. Two decision units regarding caseload growth. Elimination of 4 Developmental Service positions (currently vacant) and replace with 3 Management Analysts for data transition and tracking costs and business models.

Transfers related to cost allocation. 3208 questions starting. Chair stating that since his freshman year in 2013, he's been hearing about this budget account. Concern back then about shifts in direction, what is going on right now, are there growing concerns about this model?

Deputy Robb talking about how we are digging in deep since the last legislative session, with new data system we can really look at data and models. We've been working to determine what the needs are, are we meeting them, and doing that in best quality way?

$302 per child per month on the state model, whereas the cost is $565 per child on community model. Goal is to use management analysts to understand current needs and good decision-making going forward.

One of our challenges is that we're not telling our story very well and we need data to support that. Assemblywoman Carlton asking if these changes will affect programs because so much is going on. Wants answer on the record.

Answer: slides 36-39 have a transfer crosswalk.

Assemblywoman Carlton: "That's exactly what I need on Friday morning, where's my donut?"

Answer: one employee possibly in another budget.

Q: no impact to children?

A: no

Sen. Kieckhefer asking about impacts to families. A: new system will be online regarding full system with case planning and future goal of billing component inclusion. Consistency will be achieved, collaborative through part C. We do need family permission to bill insurance.

Sen. Kieckhefer: I just don't believe the caseload data, it is flat. I don't know if that is outeach to community regarding NICU or other kids. I said that in pre-session as well.

Chair asking also about flat caseload projection, impact on waitlist?

A: federally mandated to not have a waitlist. Will have new projections for March as well.

Q: a child is not on waitlist if they are receiving at least one service?

A: to be compliant, active IFSP (individual family service plan) is needed so they could be getting one therapy but need another. Part C does monitor closely.

Chair saying they could be waiting for services that must be provided in 30 days?

A: under part C, need active IFSP and case management, we do have children waiting for some specialty services where there is no provider capacity in community. That is the service waitlist.

Q: What would it take to address service waitlist?
A: Provider capacity for specialists.
Q: Question re: part to full time position
A: Pediatric physician position was part time contact position. 20 yr physician served until Feb '17. Hard to fill the role, people want benefits.

Q: any increase in Medicaid revenue for this position?
A: based on our billing system, not a good data analysis to answer fully but we do believe it will help us with providing the services directly with children should increase Medicaid revenue.

Q re vacant positions. A: should not negatively affect operations to eliminate those. Physician will be a positive.

Q from Assm. Carlton regarding market rates for physicians, will anyone apply that we would like to have?

A: Would be unclassified, belief it's comparable.

Hearing closed, opening for final public comment.

Follow-up comment from Catholic Charities in Las Vegas, 90% on waitlist get approved. 340 on list right now, 10% approved each month.

Assm. Carlton: true waitlist or waiting for eligibility?

A: true waitlist as of today: 340

Comment from UNLV, remarking on policy papers from the University, let points: Autism on the rise, 1.5-2.5 million cost over a lifetime for Autism including lost wages per commenter who is also a parent of a child with Autism. She remarks she is emotional over urgency in care.

Comment in Carson City, further regarding Autism services. 2014 study shows 1 in 59 children are identified with Autism Spectrum Disorders before age 8 per commenter.

Comment now regarding aging services and needs in that arena. View by commenter of ADSD as a wraparound service that prevents institutionalization and helping people stay in their communities and homes. Remark about real progress on waiver waitlist.

Commenter commending the staff of ADSD for their service provision for a "massively growing population." Leading into the waitlist for frail elderly waitlist/waiver. Numbers affected by limits on funding per commenter. Thanking for the personal care attendant rate increase.

Remark that there is a caregiver shortage where managers at fast food restaurants make more than some caregivers.

.@MLiveratti talking about wait time versus wait lists and significance of what that feels like for people who are waiting. Referrals go up when people realize that waitlists are starting to move. "Getting services to people is what really counts."

@MLiveratti Community provider in early intervention field remarking on importance of data system coming online. Remarking also on rates of reimbursement to hire, train, and maintain quality people to provide services. Tuition costs have gone up and workers need more funds as a result.

@MLiveratti Further comments about Autism Treatment Assistance Program and questions about funding sources in that arena. Comment period now closed.

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