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assembly committee on commerce and labor mr secretary will you please take the role assemblywoman carlton here assemblywoman considine present assemblywoman dickman here assemblywoman duran here assemblyman flores assemblyman fryerson here assemblywoman hardy here assemblywoman martinez present assemblywoman marzola here assemblyman o'neill yeah assemblywoman tolls here here thank you mr secretary please indicate that all members are present before we begin i will go over our housekeeping items please remember all exhibits written testimony and amendments must be submitted by noon on the business day prior to the committee meeting people who wish to provide testimony or attend the meeting virtually must pre-register online by visiting the legislature's website help the public is strongly encouraged to submit written testimony in advance of the meeting zoom chat is reserved for committee business only members please remember to keep your camera on at all times this will ensure that we have a quorum unless you are stepping away for non-committee-related business members and presenters please remember to be muted at all times just unmute yourself prior to speaking and then promptly mute yourself when you are done thank you to everyone who is here and we can get started with our agenda items we have three bill hearings on our agenda for today i will be taking the items out of order and i will be starting with assembly bill 91 i will now open the hearing on assembly bill 91 and i believe i have the majority leader benitez thompson present to presents that along with kathy denauer of the state board of nursing and mike hillerby representing the nevada state board of nursing majority leader are you present i am hello welcome and you can get started when you are ready thank you for joining us thank you so much good afternoon uh chairwoman and members of the assembly committee on commerce and labor i'm theresa benitez-thompson representing assembly district 27 and i have the pleasure of sponsoring assembly bill 91 which seeks to add an advanced practicing registered nurse to the state board of nursing a quick history of how we got to today's bill request the aprn licensing designation was authorized in 1987 and allowed an aprn to provide some diagnostic and treatment work with patients well under the supervision of a physician by 1991 there were 1991 licensed active aprns in nevada conversation and interest about increased responsibility for the profession began to grow many of these attempts have been successful but it's taken some time in 1991 there was a failed attempt to allow aprns to prescribe controlled substances it would be a decade before the measure was eventually advanced by the legislature in 2001. in 2011 senate bill 205 required aprns to obtain certification from a nationally recognized board bringing nevada into compliance with the national council of state boards of nursing in 2013 the legislature allowed aprns to practice independently free from the requirement to work with the collaborating position this was a significant policy shift allowing the profession to flourish from 760 licensees to 3 300 licensees in 2015 assembly bill 292 allowed aprns to offer certain services via telehealth and in the last two legislative sessions their scope of work has increased as well they can now sign death certificates they can write provider orders of life sustaining treatment which is a pulse and also write orders for home health care the next evolution is for them to have a seat at their professions governing board the state board of nursing consists of seven members and assembly bill 91 seeks to make one of those members an advanced practicing registered nurse i'll now defer to kathy dinauer the executive director of the state board of nursing for comments thank you thank you very much uh assemblywoman benitez thompson and thank you so much for your support of this bill i'm kathy dinauer and i'm the executive director for the board of nursing and as assemblyman assemblywoman benitez thompson said we have over 3 200 nurse practitioners in our state and we do not have a mandate to have an aprn on our board we have been fortunate that over the last 10 years by sort of the luck of the draw we have had an aprn who is on the board but it is not something that has been mandated and currently two of our rn members happen to be aprns and aprns represent a very significant population of nursing in our state and have and having representation on the board would really complement the current makeup ab-91 would not increase the number of board members but would require that one of the rn members be an aprn and i've provided the committee with a map of states that require an aprn to be on their board and as you can see on the map most states do require between one or more aprns to be on the board there's only a few states nevada being one that does not have that requirement so that's what we're seeking with ab91 and i'll answer any questions thank you mr nauer um majority leader benitez thompson was mr hillary going to be presenting with you as well i think we have them available just to help answer uh questions but i think mr hillary did you have prepare comments michael hillard before the record no matter majority leader do not here to answer questions okay thank you members do you have any questions okay i see assembly woman kasama assembly member kasama thank you chair um my question and that certainly i'm in favor of that that sounds um like a good idea to put that into um statute what the practice is i just had a question on section that would be section one number five where we had before no member of the board may serve more than two consecutive terms for the purpose of the subsection service of two or more years and filling an unexpired term constitutes a term and then i noticed that's being removed without anything replacing it is is the intention that there would be no term limits now for any person appointed that they could serve as long as they wanted and what would be the reasoning for that assembly assemblywoman michael hillerby on behalf of the state board of nursing that in 2017 the legislature added a general provision in nrs 622.207 that unless specifically identified otherwise all title 54 boards and commissions members are subject to three term limits to three terms so in while drafting legal made the recommendation that we remove that language so that we were consistent with the legislature's most recent intent in 2017 and i will tell you that language dates back to at least 1947 so predates even me uh i've been around here a while so we don't really have the history on why there was originally uh that particular limit put in but again and thank you for that question because we do want to make sure that it's noted for the record that we did have a conversation around that point with the board and during the drafting process and as mr hillerby stated we could find no specific reason why we wouldn't want this provision of this chapter to be in conformance with 622 and in that effort to make sure that all boards had some similar language in them so i'm i'm glad you asked that because we get a chance to put our thinking on the record there yes it seems very reasonable thank you members any other questions for our presenters okay seeing none i am going to move into testimony and support of assembly bill 91 i believe we do have some people signed up who would like to give testimony on video do i have paige barnes with the nevada nurses association okay she might be on the telephone line do we have jennifer podego with okay i think that's actually everyone we had signed up um broadcasting can we go to the telephone line to see if we have anyone signed up to testify in support yes sure to testify in support of ab9191 please press star 9 now to take your place in the queue again to testify in support please press for ab91 please press star 9 now to join the queue caller with the last three digits two zero two please slowly state and spell your name for the record you'll have two minutes and maybe again now thank you madam chair and members of this committee my name is paige barnes t-a-i-g-e-d-a-r-n-e-s i am here on behalf of the nevada nurses association in support of ab-91 we believe this bill will provide the needed representation on the nevada state board of nursing thank you for your time caller with the last three digits 4 zero zero please slowly state and spell your name for the record you'll have two minutes and may begin now good afternoon sharon members of the committee my name is cameron duncan c-a-m-e-r-o-n-d-u-n-c-a-n and i am a practicing primary care and psychiatric mental health nurse practitioner in reno nevada and i'm also the vice president of the nevada advanced practice nurses association i'm providing the statement in support of ab91 on behalf of nasa dr cindy pitlock our president has also submitted a written statement into the record since 2013 when full practice authority was provided the number of aprns in the state has increased exponentially and this has provided nevadans with increased access to quality healthcare across the state because of this increase apr ends in the state it's ever so important for the aprn to have a permanent place on the nevada state board of nursing aprns practice in many different specialties including mental health women's health primary care and others and having an aprn on the board will provide for a more clear understanding of the scope of practice of nurse practitioners and other aprns across the specialties they will advise the board on prescribing standards and they're also able to provide expert in case review and decision making on disciplinary cases which is important to protect all nevadans across the state it's also important to note that nevada state board of nursing is a member of the national council of state boards of nursing this council is responsible for implementing policies and setting licensing standards for nurses and therefore it's essential for nevada aprns to have a voice at the national level to advocate for aprns in our state so we can continue to provide high quality excellent care to our patients and to showcase the ways that aprns contribute every day to the health and well-being of all nevadans once again on behalf of nafna the nevada advanced practice nurses association we are in strong supporter of assembly bill 91 thank you thank you for your testimony we are currently on support of ab 91 if you recently joined the call and would like to testify in support please press star 9 now to join the queue chair there are no more callers in support at this time thank you i will now hear testimony in opposition of assembly bill 91 i have two people signed up for video is miss sonia rich mazzeo from the alma clinic on with us do i have katie ryan with dignity health okay broadcasting can we move to the telephone line to see if there is anyone in an opposition thank you to testify in opposition of ab91 please press star 9 now to take your place in the queue again to testify in opposition of ab-91 please press star 9 now to take your place in the queue chair there are no callers in opposition at this time thank you broadcasting i don't have anyone signed up to testify in neutral on video can we check the phone lines to see if there's anyone on the phone to justify a neutral thank you to testify in neutral on b 91 please press star 9 now to take your place in the queue chair there are no callers in neutral at this time thank you broadcasting majority leader benitez thompson would you like to give any closing remarks i appreciate that chair reagan i just want to thank the committee for their time and of course make sure you know that i'm available to have any additional conversations if you have a thought later today or the next couple of days um anything that you want to talk about feel free to reach out and i'll look forward to hearing from you thank you for your time thank you i will now close the bill hearing on assembly bill 91 and the next item on our agenda is assembly bill 101 i believe i have assembly member stephen you're here to present the bill assemblyman good good morning madam chair members of the assembly committee on commerce and labor my name is steve yeager and i represent assembly district 9 in southwest las vegas it's my pleasure this afternoon to present assembly bill 101 to you it's nice to be back in front of this committee i enjoyed serving on the committee last session so i i miss all of you and it's a pleasure to be back here this afternoon madam chair with your permission uh what i would like to do is just make some very brief introductory remarks and then i would like to hand it over to the experts who can kind of talk about the bill and how it might work in the real world those include jennifer pedego executive director of the state nevada board of veterinary medicine excuse me the state the nevada board of veterinary medical examiner i think she is on the zoom with us and we might also have i'm not sure if it's on the zoom or by phone but dr stacy hosking veterinarian who is also on the board and then after that we would be happy to answer any questions that you might have so if that's acceptable uh madam chair i'll go ahead and make some brief remarks and then ask if ms patago can take over from there does that work for you madam chair absolutely right thank you so much so again steve yeager for the record assembly bill 101 seeks to ensure that we are able to utilize all available options to care for our pets cbd for pets is not necessarily a new idea but it's one whose time i believe has come for the state of nevada the bill is not thankfully not not very long and not incredibly difficult but with that madam chair i would like to hand it over to miss pedego and i hope i haven't been butchering your name to go over the the bill and help answer any questions welcome ms pedego when you're ready i thank you uh chair hardagey um and thank you assemblymanager jennifer pedego executive director of the nevada veterinary board for the record um good afternoon so the board office over the years has received quite a number of inquiries from professionals in the public confused about their ability to have these conversations and discuss the use of cbd there isn't a lot of clarification in the state and especially from the federal government however with the increasing use of and prevalence of cbd products that are available to pet owners one of the most fundamental reasons for this bill is to allow practitioners who are informed about the risks and benefits of cbd be able to make recommendations and have discussions about product safety and applicability for their animals and treatment and have that relationship with the pet owners about this product um and as uh assemblyman yeager stated we do have uh dr stacy hosking who is a veterinarian as well as an internal medicine specialist uh veterinary obviously and she is probably maybe on the phone line or in the the public comments i'm not sure but she should be available to answer any questions about the science related to treatments um with cbd that's her specialty so i'd be happy to answer any questions members of the committee any questions for our presenters okay i'm gonna do one check of chat really quick okay vice chair carlton thank you very much uh madam chair so i guess i just want to understand um so you they wouldn't actually be prescribing this this would be uh considered a therapy um where do we think the veterinarians are going to be getting the the cbd hemp um what whatever they're going to be using how are we going to know it's been tested i mean there's a lot of criteria around this product that we have in the state so i'm just curious how that will integrate in a veterinary setting oh thank you vice chair carlton um i think dr hoskin can speak specifically about types of products but typically in the uh sale of this and you're correct there is no prescription uh it's it's a recommendation now by the definition of this um that is in this bill which is the threshold of thc less than 0.3 percent that is the threshold of the federal farm bill which uh stipulates that that is considered a hemp pro uct so the testing of these products which is i i don't uh there there is an issue with the federal testing obviously the fda does not test these like they do with other supplemental products but we do have testing capabilities here in nevada and a lot of these independent companies do test independently and from what i understand in discussions with board of pharmacy uh the stipulations of the practitioners have to be that they have at least investigated the efficacy or the testing parameters of these products so that you know we're not getting a snake oil issue here um but in terms of a regulatory framework um that only exists so insofar as it already does exist i guess i would say and again i don't know if dr hosking is available or if if she's on the public line but she might be able to expand more on that dr husky do we have you on the line did you want to provide additional comments madam chair this is steve yeager i don't see that she's on the zoom with us but i suspect she may be on one of the call-in lines or else maybe she had a technical difficulty but might i suggest for questions like those when we go to supportive testimony i think if she's on the phone she'd be able to answer them and if for some reason she was not able to join us today i'm taking notes of all these questions and i certainly can circle back and get those answered for committee members okay sounds good i do have other members in the queue assembly member dickman thank you so much madam chair i just wanted to thank assemblyman yeager so much for bringing this bill um about three and a half years ago i had a yorkie who was treated by actually um dr hoski and she had several tests done nothing was conclusive but it was a respiratory thing and i asked about cbd treatments and of course they could not guide me because it was illegal so i did it on my own and not that i think it would have saved the dog but i think her last days would have been far more comfortable if they had been able to guide me so thank you so much appreciate it much needed thank you assembly member for your um comments i have assembly member considine next thank you madam chair and thank you for the presentation my question might be one that requires um some follow-up afterwards but we've mentioned veterinarians who are informed our veterinarians have that have investigated the cbd and how to to to work with it my question is are there any training or education that veterinarians who are not familiar with this can get or is there some way for them to find more education more information about it i didn't quite get contact with them you button thank you for the question uh assemblywoman considering um so yes uh short story or you know short short form uh there are um continuing education courses that are available both from a scientific and treatment perspective and using it as a therapy and then also from a product safety and efficacy standpoint we don't have specific or at least our board does not have specific requirements of requiring that but there is that information available to practitioners thank you very much and thank you madam chair for allowing the question thank you for your question any members any other questions for our presenters assembly member o'neill thank you madam chair i apologize i'm having internet issues also um i just need some explanation if they could on section one two where it reads the board shall not take any disciplinary action against a licensed veterinarian etc etc engages in the practice of medicine solely for administering or recommending the use of products pursuant to subsection one so the only thing the vet is working on is cbd only can you explain that where that would be in the practice thank you assemblyman o'neil um i don't know if i specifically understand your question the inclusion of that was to ensure that and again the the very specific nature of that statement is the solely so it's an additional protection for practitioners to understand that the board is not interested in disciplining just for administering cbd but any other clinical decision making any requirements for testing or use or communication with the owner informed consent about risks and dosages that all pertains to actions that are overseen by the board it's just the sole act of administering it would not be considered disciplinary a basis for disciplinary action i don't know if that yes i appreciate that because i read it differently than that because this is higher practice was now yeah it's cbd it's just this particular act and um in that respect if i may have a secondary question madam chair yes assembly member o'neil thank you how prevalent is the usage of cbd with treatment in veterinary medicine right now and what do you think this may expand too thank you uh assemblyman o'neill and i i do think that would be i can get about halfway to that question um and dr hoski may be able to answer it further we don't have information on how it's being used now in veterinary practices because as far as we know it's not being discussed or used in veterinary practices because of the lack of this protective layer at least for those discussions in the human in the pet owner avenue i imagine that it's a very big industry just on the basis of the prevalence and saturation of these products that are available either online or in um in just the general marketplace so i do foresee it being a decent market it does have limits if it's used you know when used appropriately it's um and advertising obviously for um scope of this of this treatment for you know it's not going to cure cancer at least as far as we know based on medical evidence from veterinary studies that have been done but it does have great um potential for use in pain management um there's studies being done for epilepsy and again that's information dr hosking could speak to but uh given the current market for pets in general um there is a large basis for which this could be used there's a lot of interest out there i appreciate that thank you very much thank you madam chair for the time members any other questions okay seeing none we are going to move into testimony and support do i have miss sonia rich mazeo okay broadcasting can we check the telephone line to see if there is anyone signs in in support the testify in support of av 101 please press star 9 now to take your place in the queue again to testify in support of ab101 please press star 9 now to take your place in the queue chair there are no callers in support at this time thank you broadcasting and it looks like i did have dr stacy hosking signed in in support she might have just had significant technical difficulties and not been able to get on video okay i don't see i have anyone signed in on video for opposition can we check the phone line to see if there's anyone on the phone line for opposition to testify in opposition of ab101 please press star 9 now to take your place in the queue chair there are no callers in opposition at this time thank you can we check the phone line for anyone in neutral to testify in neutral for a v 101 please press star 9 now to take your place in the queue chair there are no callers in neutral at this time thank you broadcasting assembly member yeager would you like to give any closing remarks thank you so much madam chair steve yeager for the record um certainly apologize we didn't have dr hosking with us today i suspect there were some technical issues but i'm going to circle back with her to get answers to vice chair carlton's question and also assemblyman o'neill's question and then you know perhaps ask her to just probably put something in writing that can give a little more detail on the appropriateness of cbd and i'll make sure that that's distributed to you madam chair for for further distribution to your committee i want to thank you for hearing the bill i think what we're trying to do is make sure that uh veterinarians aren't punished for um either administering or recommending this kind of treatment because in some cases it will be appropriate and right now it's really um just kind of a a gray area i guess because it's not really enumerated in the statute so again i'll get that additional information for the committee and i thank you so much for hearing the bill this morning and you know madam chair if you would allow i would like to hand it over to miss pedego to provide any further concluding remarks for the bill thank you assembly member jaeger miss pettigo do you have any questions you would like to give um no i just wanted to thank the committee today for hearing this bill and i did confirm with dr hosking she was hitting the buttons as much as she could and wasn't getting through so i will make sure to get follow-up from her so thank you for your time i appreciate it thank you everyone i will now close the hearing on assembly bill 101 our last bill for the afternoon is assembly bill 81 i will now open the hearing on assembly bill 81 i believe i have assembly member haven here to present the bill assembly member hayfin welcome to the committee and when you're ready you can get started thank you and uh good afternoon chair howdy and members of the assembly committee on commerce and labor i am gregory hayfin ii representing assembly district 36 and it is my absolute honor and i am very grateful to be presenting assembly 81 today for your consideration existing law which is codified in nrs 629 or 50 currently prohibits health care providers who have not actively practiced their profession continuously for the immediately proceeding three years from providing voluntary health care services an association with a sponsoring organization such as the remote area medical or ram program this statute prohibits volunteers specifically recent graduates of health care from providing essential medical dental vision and other services to rural parts of nevada i'd like to provide a quick example of how this prohibition has negatively impacted health care services in rural nevada recently a unlv dental provider who previously had volunteered for the ram program as a dental student came back after graduating to volunteer with the ram uh program however he did not meet the requirements under the existing law and the department of health and human services had to decline his services as they noted residents throughout nevada especially the rural areas benefit from these free pop-up medical clinics in trump a citizen came to a free pop-up clinic sponsored by ram to receive gentle work she had kidney failure and was in need of several extractions prior to obtaining transplant approval for the kidney transplant a dental provider with the ram program was able to address potential needs and she now has been placed on a transplant list without this voluntary health care work she may not have been able to have this opportunity further i have met with the department of health and human services the deputy directors deborah hassett and beth handler they have no issues or concerns and remain neutral on assembly bill 81 several health care related agencies and organizations support assembly bill 81 including but not limited to amr and medic west ambulance culinary health fund desert view hospital dignity health healthy communities coalition the nevada state society of anesthesiologists nevada orthopedic society night community coalitions county manager tim sutton and the state board of ophiopastic medicine and then touching on the bill section subsection 2c of section 1 of the bill removes the restriction the provider of health care who has not actively practiced his or her profession continuously with immediately proceeding three years from providing voluntary health care services by removing this restriction it all ultimately allows qualified healthcare providers to voluntarily volunteer their services in association with a sponsoring organization with the help of these volunteers nevada rural residents have an opportunity to receive the care they desperately need in order to live a healthier life then i wanted to touch on nevada revised statute 629-430 as a few questions have come up uh relating to medical professionals who are retired and have not practiced within the most recent three preceding years and the possibility of them practicing in a hospital setting and possibly doing surgical procedures this statute defines sponsoring organization as an organization that one organizes or arranges for the provision of voluntary health care service in association with one or more providers of healthcare and two is registered with the division of pursuant to nrs62946 i have caroline deberry the chief external officer for ram uh here to touch a little bit further on that but before i turn it over to her um i am proposing a very minor amendment um that i'm very happy to do as this was a pre-filed bill i have a number of uh senators and assembly members that have asked to co-sponsor this bill with me senators hardy and senator orrinshaw and assembly members hanson hardy leavitt matthews wynn o'neil orton liquor titus torres and tolls would all like to be added as co-sponsors to this bill and as i stated previously today caroline deberry is here to provide some additional information to the committee and at the end of her testimony we will both be available to answer questions of the committee caroline i'll turn it over to you good afternoon to share how to geek and members of this mr barry we can barely hear you can you try getting closer to your microphone yes ma'am i'm sorry about that is this better politely yes okay i apologize i is hopefully this is even better all right uh good afternoon chair having members of the assembly committee on commerce and labor for the record i am caroline deberry chief external affairs officer for remote area medical or ram i am honored to be here today to support assembly bill 81 thank you so much for this opportunity the healthcare crisis facing our world today requires an all hands on deck approach to our problems and ab-81 allows for just that assembly bill 81 would increase access to free health care by empowering even more providers to offer these crucial free services the law currently allows providers with out-of-state licenses to provide volunteer free quality health care with a sponsoring organization such as remote area medical assembly bill 81 would broaden this important law by removing the law's current restriction that requires any such volunteers to have been actively practicing for at least three years before providing these health care services promote area medical wholeheartedly supports this legislation because it would increase the number of volunteers who can provide desperately needed free healthcare services throughout nevada remote area medical is an international non-profit that has been providing free dental vision and medical pop-up or mobile clinics for over 35 years ram relies on its thousands of volunteers with unencumbered licenses from all over the nation to provide these free services in the last several years ram has held 14 such weekend clinics in nevada such as in perron for our clinics in perum ram has worked with his partner the nye communities coalition to ensure a list of volunteer providers is submitted to the department of health and human services the department then completes a thorough vetting of the volunteers even before the pandemic ram witnessed firsthand the crisis our nation was already facing we saw the growing underserved population and growing shortage of healthcare workers now during and after the pandemic the needs are and will be greater than ever the three-year requirement currently in statute reduces the amount of free health care nevadans can access assembly bill 81 removes the unnecessary requirement and ensures that every qualified health care provider available from anywhere in the united states can come and volunteer to help the citizens of nevada the national council of state boards of nursing and the federation of state medical boards have helped write and have endorsed federal legislation that would incentivize similar volunteer laws without including such a three-year requirement supporting assembly bill 81 gives the hope of relief and help to those most in need remote ar a medical thanks you for your support of this critical legislation this concludes my presentation madam chair thank you again for allowing me to be here today thank you caroline um and this is again assemblyman gregory hey from the second for the record and i wanted to just add um two quick things uh one um the other thing that one of the other things that this bill does is brings us further into compliance with a recent bill that was passed in the congress it's called it's hr 2216 and this bill provides an appropriation of 56 million dollars to help assist the um the programs and the volunteers uh throughout the nation um and so there's there's federal dollars that are available to to assist in addition to that the federation of state medical boards fully supported h.r 2216 as written which there was no restrictions placed on the length of time that the medical provider had to be practicing having said that madam chair and committee thank you for this time and caroline and i would be more than glad to answer any questions you may have thank you assembly member hey finn i am going to check with committee members to see if there is any questions committee members any questions vice chair carlton here we go uh thank you madam chair and uh good afternoon mr apen so um i guess one of the things i'd i'd like to clarify though is you read off a list of folks that were in support but only some of those i have letters on so if they're listed on another document as in support i'd like to get a copy of that because i see that you do have some of these other letters here but you listed some that weren't so if those are available somewhere and i've missed them i'd like to be sure and get a copy and this is basically um a changing assembly bill 228 from the 2013 session that i worked on with uh then assemblyman tom grady on this issue and he did a very good job of trying to address an issue that had come up and being able to get and this was really more focused on volunteers coming in from outside the state rather than from inside the state there was never talk of recent graduates really we were looking at experienced medical providers being able to come in and volunteer in the state to give these services and um in go going back and and rereading it to make sure that i remember correctly we specifically put that three years in because we wanted to make sure that folks had some experience and knew what they were doing and we also wanted to be able to take a look at their record in case there had been a problem in another state we didn't want someone who was having issues coming to nevada this is of course all about public safety you want to give people health care but you want to make sure that you've got the appropriate person giving the health care especially since the way nevada has it structured is that if it's volunteer health care you're protected by the good samaritan law so the the patient has no recourse if any harm is done so that that was one of the issues that he and i had spoke about talked with the sponsors of the bill back then and in 2013 and and they were very comfortable in having that three years so i have concerns about eliminating the three years i think it's very important to make sure that the practitioners that come into this state or have graduated from a practice have a basis of experience to be able to provide these services assembly member haven do you yes uh through you chair to assemblywoman carlton i would be more than glad to provide you with copies of the letters of support um it was brought to you by attention uh during this committee hearing that some of the letters of support for some reason were not able to be uploaded to nellis and i guess that's been an ongoing problem with our virtual um committee hearings and part of the issues of trying to zoom everything um but i would be more than glad to address that in regards to the previous legislative intent not being for recent graduates i greatly appreciate you bringing that up we've run into this the last two years with the ram program and we have extensively talked to the department of health and human services and legal counsel for the lc at the lcb because i too did not believe that that was the intent of the laws to prohibit recent graduates from providing voluntary services however lcb was not able to find that legislative intent and then therefore recommended that i carry this bill draft to try to correct that issue and madam chair i want to make sure something's perfectly clear i wasn't saying that i agreed with mr hafen i was stating that the three years was put in there for protection purposes so we because of the three years we never discussed the other side so i'm not saying that i agree and or support this particular provision i have serious concerns about allowing someone who has not been in practice on their own uh being able to do this this but the original bill was aimed at folks coming in from outside of the state so i believe allowing recent graduates is a totally different conversation when it comes to that and my biggest concern is when you eliminate this from the bill we will not be able to look at those people coming in from outside the state and they could have a current malpractice suit or be under some type of discipline from another board in another state and there's nothing we'll be able to do about it because we will have eliminated that three years so that's my biggest concern thank you madam chair thank you vice chair carlton um i believe speaker fryerson you madam chair um and thank you so much uh and thank you for getting back to me you uh provided us with a copy of the bill and my question uh and i addressed it with you was actually looking at the three-year provision differently just correct me if i'm wrong my reading is that by removing it there is no time requirement or limitation so it could also go the other way and was it contemplated that someone could not practice for 20 years and be able to provide this service uh so it's kind of the opposite end of the spectrum of of a new practitioner uh if uh if that was contemplated and and i believe you uh well you addressed that i think it'd be important for it to be on the record um how that is if that's taken into consideration thank you uh through you chair to uh mr speaker um and i appreciate the question and it brings it back to assemblywoman carlton's question as well and the department of health and human services does an extensive betting program to ensure that every professional that comes into this state and is going to be providing services is fully vetted in addition to that in a hospital setting which this bill doesn't really affect the hospital settings they would have to go through the privileged program our process which is a six to eight month process of vetting the individuals and and i do have um mr berry here that can hopefully further expand on how the vetting process goes so we can we do ensure that everyone that comes here to practice doesn't have those outstanding malpractice concerns um and is fully qualified to do so i'm caroline deberry through you chair uh to assembly member hatha i thank you so much for this opportunity to clarify i so so again uh and i'll lean closer to the microphone again so again i'll use the param clinic examples those are our most recent nevada clinics we work with our partner to submit a list of volunteer providers to the department of health and human services and as assembly member hayfin was saying the department does a complete thorough vetting of the volunteer providers and then gets back with her bae you know making sure that that these are providers that they trust to handle this properly uh the other key piece of that is ram of course also does our check to make sure that there is no unencumbered license to in so to an earlier comment or concern uh if someone is a recent graduate so you know they're they're fully licensed provider they can go to any doctor's office dentist office whatever and practice freely without any uh any challenges or restrictions uh that same provider then can if this requirement is removed can go ahead and then provide their same quality free services at our clinics as opposed to only in a paid environment so that's really the only difference here is trying to remove that three-year requirement that's not imposed on them if they're getting paid it removes it so that then they can still do the same quality work just in a free environment providing it as on a volunteer basis uh you know at these clinics and so then also and i mentioned this earlier but i want to kind of reiterate that uh and kind of bouncing off of or going off of what assembly member haven said uh there is federal legislation that has been introduced in the past couple of congresses and has gained some interest even from central schumer's office and others and this legislation would incentivize states to pass laws similar to nevada's and it was partially written it's called the healthier act and the last congress it was h.r 2216 has been very bipartisan and even prior congresses and the national council of state boards of nursing and the federation of state medical boards worked to help write that legislation and that legislation does not include a three-year requirement they had no concerns there uh as to whether someone had been practicing for a year or two years you know just graduated again as a fully licensed provider only a month or two before i hope that's helpful thank you very much madam chair if i can follow up just just a little bit uh it is helpful um i think it would be helpful for this committee to get some backup support from the department about that vetting that takes place um to make sure that i i think to my colleagues satisfaction having been a bill that she worked on some years ago that number one folks are qualified number two their background is being looked into and for me number three that they're not stale that that they're not someone who has been out of practice for 20 years and is coming in providing some type of service that you know maybe technology has left them maybe advances since they last practiced have left them and what that process is but i think it would be helpful for the committee if we could get some information excuse me some information from the department about that vetting process to give some folks in comfort that we're not um uh you know putting some folks in in in more harm's way uh than not and i don't obviously that's not the intent so um i think that the information from the department would be helpful thank you speaker members any other questions for our bill presenters assembly member hardy thank you madam chair um for the question and thank you assemblyman hafen for bringing this forward um my questions are just a little bit different so she mostly talked about the the ram organization so is it would it be primarily limited to rural areas or it could be throughout the state um and then if you could just talk a little bit about the specifics as to what these volunteer um providers could do like you know you mentioned dental some vision is it like just routine physicals i'm assuming like they're not going to be doing anything extensive so if you could just talk a little bit about those two items thank you um chair through you to assemblywoman um party um this program has actually been used currently throughout the entire state um so this this legislation change would affect the entire state um and and i'll let uh mr berry uh kind of uh elaborate a little bit more on how that works thank you very much caroline deberry through you chair to the assembly member uh yes that is correct this would apply to throughout the state this is not exclusive to rural uh as a little background remote area medical was founded to really address rural regions but a lot of times the requests that we have actually do come as well from metro areas and so on is really wherever there's a health care shortage need and yes we do very primary care type services and we're certainly not going to be trying to do some complex surgery like brain surgery or anything like that we usually set up in a location such as a fairgrounds gymnasium so on we have bring in the necessary equipment make sure everything is sterilized and so on uh and the format for these are yes basic dental procedures we actually have more requests for dental extractions than almost any other dental procedure but also cleanings and so on and then again typical checkups helping provi you know helping our patients recognize that they have diabetes or you know different things like that and then trying to connect them with the nearest local resources that may be available i hope that answers your question thank you very much yes thank you i appreciate that that gives some um clarity and you know i too agree that we want to make sure that these the people that we are volunteering they're properly vetted and you know so that we have that security and safety is and to the these folks that are providing services so thank you i want to follow up on assemblymember hardy's question and you might have answered and i just missed it but is there a list of services that can be provided in a list of services that can't be provided at these affairs this is caroline deberry to the chair i believe that question was directed to me if that's correct uh but yes uh we can certainly provide a list of the services that we do provide uh that is not something i have submitted for the record but i'm more than happy to share that later on uh and then of course also we work with the state to make sure we're aware of what services are able to be provided and so on yes if you could mr berry if you could provide that list to our committee manager so she can distribute it to the committee i'd like to see a list of what uh services are approved for the fairs and what services what services are approved yes ma'am and i would assume that services not listed on there cannot be performed at the fairs um i have assembly member dickman next thank you so much madam chair um i just wanted to say it with the critical medical shortages that we have in our state and especially in the rural areas it just seems to me that this we really need this badly as long as the the providers are um vetted and qualified so i was hoping to be able to sign on to the bill mr people is that possible at this point uh chair through you to assemblywoman dickman uh first and foremost i would be more than glad to add additional uh co-sponsors and it's an honor to be here today and to in order to have as much support as i do um and then i did want to just touch on on what you just stated um because i i do agree with the governor's recent executive directive that is actually doing exactly what you just said it's allowing medical professionals that are licensed in any state to come in here and actually work whereas my bill is just opening up the voluntary voluntary portion of this and so um i think many of us know that the governor and i don't always agree on things but this is one thing that i do agree with him and think that he's done an excellent job on thank you and thank you madam chair thank you members any other questions for our presenters okay seeing none i am going to move into testimony and support of assembly bill 81 i believe i have a few people signed up on video so i'm going to start from the top do i have mark fiorentino on do you give testimony and support on behalf of knight county okay do i have ryan muchio katie ryan with dignity health st rose and i'm assuming these people might be on the telephone line we will to them i'm just going to finish on the video let's do i have broadcasting can we check the telephone line for people who are signed up to testify and support yes chair to testify in support of ab 81 please press star 9 now to take your place in the queue again to testify in support of ab-81 please press star 9 now to take your place in the queue caller with the last three digits zero eight one please slowly state and spell your name for the record you'll have two minutes and may begin now thank you chair and members of the committee for the record this is dylan keith k-e-i-t-h with the vegas chamber we are in support of ab-81 as it has long been a priority of both the vegas chamber and the southern nevada forum to fix the doctor shortage that we have in this state we believe this is a step in the right direction especially for our medically underserved commit communities thank you very much for your time we urge your vote on this caller with the last three digits five five nine please slowly state and spell your name for the record you'll have two minutes and may begin now thank you chair how did you and to all the committee members my name is ryan luccio r-y-a-n-m as in mary u-c-c-i-o i'm the co-chair for the from promo area medical events as well as the secretary of the board for the nia communities coalition which is the sponsoring organization for the ram clinic the past six years i'm calling today to voice my support for ab-81 as i have personally witnessed over the past six years how counterproductive the portion of the law in question has been to the ability to our ability to serve individuals who otherwise would not be able to access quality health care as assemblyman hayfin mentioned during the 2020 ram event we met a lady who was not able to receive a kidney transplant until she cleared up infections in her mouth fortunately because of our partnership with unlv dental students and other dental providers last year we did have enough dental providers and were able to provide care for her and she was able to make it onto the transplant list without an event like this there's no telling what the outcome would have been on behalf of our entire ram committee and the citizens who have received care from our clinics i would greatly appreciate your support of ab-81 thank you for your time and consideration caller with the last three digits one two two please slowly state and spell your name for the record you'll have two minutes and we begin now again caller with the last three digits one two two my apologies i'm here good afternoon madam chair members of the committee for the record my name is katie ryan k-a-t-i-e-r-y-a-n and i'm system director of nevada government relations for dignity health saint rose dominican i just wanted to briefly call in to lend our support and acknowledge that we have provided a letter of support to the committee on behalf of saint rose of which i noticed our letter was one of those that hadn't been added to the exhibits for this hearing so i will send around the letter to the committee members once again for your viewing after this and then i also wanted to put on the record that dignity healthmate rose dominican is in support of 80 91 not on opposition as mentioned in the first bill hearing i'm not sure why my name was listed as someone who's going to testify in opposition but i just wanted to clarify her position thank you and i'm available to answer any questions perfect thank you caller with the last three digits four nine two please slowly state and spell your name for the record you'll have two minutes and we begin now madam chair members of the committee it's mark fiorentino last name is f-i-o-r-e-n-t-i-n-o thank you for the opportunity to speak uh briefly i do represent nye county and i am calling to express our support of this bill as you as you've heard obviously there are a number of people in nye county especially in perup and i suspect in many other areas of the state who depend on these volunteer services to obtain medical care in fact many of them probably would have no access without the volunteer so we're supportive of the bill and i am offering my services to assemblyman hafen and you madam chair and the committee members it seems like the concerns that have been raised about making sure that professionals are vetted and qualified and up to date on knowledge is something that we can work through and i'm happy to work with the sponsor of the bill and the committee to to help get us there and be happy to answer any questions that you have you should have as part of the record a letter from tim sutton who is the night county manager if not i'll make sure that you get that and we can include it in the record thanks again thank you mr do we have anyone else on the line chair there are no more callers and support at this time okay thank you i am going to move into opposition now do i have a stephen cohen on video broadcasting can we check the telephone line for anyone who has signed up in opposition to testify in opposition of ab 81 please press star 9 now to take your place in the queue chair there are no callers in opposition at this time thank you broadcasting i am going to move into testimony in neutral do i have melinda southam yes hi madam chair the members of the committee thank you this is melinda southard with the nevada division of public and behavioral health and um i did want to just mention that we do have processes um to vet all of the volunteers that we receive information for we fully ensure that they have a current license and have no outstanding malpractice or um motions against their license of any sort and would be otherwise well qualified to practice in the state and i'd be happy to send um documentation that provides support of our our processes to the committee managers for your review thank you thank you miss heather broadcasting do we have anyone on the telephone line who wishes to provide testimony in the neutral position to testify in neutral on a b 81 please press star 9 now to take your place in the queue again to testify in neutral for a b 81 please press star 9 now to take your place in the queue caller with the last three digits three four three please slowly state and spell your name for the record go up two minutes and maybe again now hello thank you for this opportunity committee chair and assembly members my name is stacy smith s-t-a-c-y-s-m-i-t-h i'm the ceo of nine communities coalition we serve the counties of nye esmeralda and lincoln nye communities coalition has hosted the remote area medical for the last six years and has collaborated on a variety of other volunteer medical events in our rural frontier communities for many years a key issue in our area and across the state is our access to medical dental and vision care much of the state is identified by the hersa and the usda as medically underserved areas the volunteer-based events are so important to our community members and they give us this opportunity to get access to the medical dental and visual care that many of them would not have the process established through the registration of the sponsored free health care events that miss southard was just speaking for allows the state of nevada and the host agency to screen those health care providers to ensure that the medical professionals are going to provide quality safe care to our communities i participate in this process every year and engage with the division of health to ensure that the professional volunteers are qualified and able to safely serve our community members they're going to be referred back to the staff at night communities coalition for follow-up they're going to be contacting us so i'm going to want to make sure that these people are receiving the best possible care they're my neighbors there's my friends they're my clients and i'm going to be interacting with them for years to come removing the restrictions on the years of practice will allow us to increase the number of community members served while continuing to deliver those quality services during the 2019 ram event and prompt one community member told me this was the first dentist that she had seen in more than 15 years every year we run into those kind of scenarios and every year we are unable to meet the full needs of our community and we would really appreciate your efforts to help us increase the number of people that we can serve thank you chair there are no more callers in neutral at this time thank you broadcasting assembly member haven would you like to give any closing remarks thank you madam chair and committee members um i greatly appreciate the opportunity to present today and um as promised i will i will provide you with a couple of the letters of support that for some reason did not make it up on nellis and we will work on getting you some additional information on the vetting process as well as the list of services that are approved um having said that i thank you so much for this opportunity and look forward to answering any further questions you may have thank you thank you member and yes it was the list of services provided at the fairs what type of vetting is done and then also just the documentation on how you address the point that speaker fryerson made as well on a practitioner who might be licensed for 20 years but has been out of the practice for 20 years making sure that they're still that they're not stale to you thank you i will now close the hearing on assembly bill 81 members this brings us to our last item on the agenda public comment i do not see anyone signed up on video for public comment so we can go to the telephone nines lines while we give people who might be listening over the internet time to call in i will go over some quick um reminders when it comes to public comments i would like to remind those who will be testifying under public comment or giving providing public comment that this is an opportunity to discuss general matters that fall within the purview of this committee the public has already given has been given time to support or oppose a specific legislation and we open and close hearings on bills so that we establish a record of the public testimony on the bill therefore public comment is not intended to be a continuation of a bill hearing broadcasting can we check to see that there um did you check to see if there are members or public on the telephone line to give public comment to take your place in public comment please press star 9 now to join the queue chair the public line is open and working there are no callers for public comment at this time okay thank you let's give them another minute to see if anyone is i'm going to sign up for public comment thank you broadcasting okay thank you broadcasting can we check to see if anyone has signed it up for public comment yes chair to take your place in public comment please press star 9 now to join the queue chair the public line is open and working and there are no callers for public comment at this time thank you okay thank you members that concludes all of our agenda items for the day our next meeting will be on wednesday at 1 30. we are adjourned you