Autism Spectrum Disorders Advisory Board Meeting April 22, 2026

001Good afternoon, everyone. I'm Courtney Burke, Chair of the Autism Spectrum Disorders Advisory Board, and welcome to today's meeting. This is our second meeting of the year. We have two new members joining us today. Why don't we start with the introduction with Josh first from OMH. Hi, everyone. I'm Josh Berzin. I'm a psychiatrist by training, and I am with the New York State Office of Mental Health, and I am the clinical director at their New York City field office, but over the years have taken on a role as a liaison with OPWDD and really for thinking through broader issues around people with both intellectual and developmental disabilities and mental health. And behavioral health issues, and I am taking over on the board for Sarah, who moved on within the agency into a different role and honored

002and excited to be here. We are happy to have you and 1 of the things that's really great about the autism board is that we have all the agencies at the table and it's 1 of the few forums that allows. I mean, I know there's the most integrated setting coordinating council that also has a meeting today. But this is specifically focused on. So, it's really great to have you and then we also have online Kristen Gleason. Kristen, would you mind saying hello and introducing yourself in your role? Hi there, Kristen Gleason, associate commissioner in the division of child welfare here at the office of children and family services. 1 of the groups that I oversee here is the office of children's Medicaid management. So they work closely with the. So, they work closely with our

003youth and foster care. Um. And Kim Perry has been a member of this work group, but she is happily retiring so I'm pushing in to fill in for her. Great here. Yeah, we are happy to have you. Thank you. Um, thank you. Yeah, so today for the agenda, if you didn't receive it ahead of time, we're going to have 2 updates from 2 of the state agencies. Yeah. Um, Um, um, um, um, agencies, one from the education department and the other from the Department of Health. And then I know this is not our favorite thing to do, but it's really important for us to do, and I'm glad that we are finally doing it. But we have developed bylaws that we talked about this at the last meeting, and my thanks to OPWDD primarily for

004helping pull together some bylaws to make sure that we're really being a little bit more formal and compliant in what we're doing and if there needs to be formal votes on things, that we have a mechanism to do that and so on. So we'll vote on them next meeting, but today will allow us the time to go over them and allow people to provide feedback. And then we're going to return to the discussion that we had at the last meeting on the board priority for the coming year. And then finally, we'll open up the floor to have the board raise any topics that you want to raise that perhaps we haven't spoken about recently. And before I jump into... Okay. So, the World Autism Awareness Day, I want to give a personal thanks to Josh

005Murski. I don't know if Josh is on today. Hey, Josh. JOSH MURSKI. Hey, Josh. If your ears are burning, earlier today, but I was at an event with Greg Roberts from OPWDD about autism action today, and we were giving you a shout out for your work on getting the autism, the neurodiversity flag. So April 2nd. I think it was a very exciting day. So... April 2nd. It also recently got recognized by the United States Congress. Last week, I was invited to Washington and now there's a congressional record all about the neurodiversity strength flag. And this is a historic record, if I can just share about what exactly it is. This is the first time the federal government, not state, the federal government recognized certain very serious topics. Because the whole point of the flag is

006to start conversation which brings about serious conversations which might not be pleasant. It talks about the isolation, the bullying, the suicidal ideation and everything which happens when stigmas are ramping. This is the first time the federal government has acknowledged this. And this is going to lead to some things I can't go into on here, but depending how elections go, there may or may not be certain bills being pushed about this. So this is really, really big. So... Again, this is going to be life changing for many people, this happened. So this is a first step. Also I'd like to add that the amount of conversations this has started, not even just in America, Europe. I'm seeing all the internet people talk about the flag during conversations on neurodiversity. In public, I went to the beach

007several times and saw people congregating around that sign. And I heard conversations all about what is neurodiversity. Oh, my child has epilepsy. Which is also neurodiversity. Oh, my child is autistic. Oh, well maybe we should try to get services. Things like this are all congregating in these conversations. So this is doing exactly what it's designed to do. It's making important conversations happen. Because although this board is great, what really makes change is outside of here. It's in the main public circle. It's where neurotypicals who have no clue what neurodiversity is. And they're not going to be able to get a job. They're going to be able to get a job. So they're going to have to start having these conversations. When they see red, white, gold, and from Niagara Falls to World Trade Center and

008everything, when they see this, they wonder what is red, white, gold. And I've seen conversations happen. Even I went to the gym and my screen saver is the flag. I had someone ask me what that symbol is. In the gym locker room. And then I told them and then someone said, oh, you know, that's interesting. I have ADHD, which is neurodiversity. And that started a conversation. So this is really starting a lot of really important conversations. I want to give a round of applause to this entire board for supporting this initiative, which is really important. So you've all done a wonderful job supporting this, each and every one of you. So I congratulate you all. This is a win for all of us and the entire community. And as the neurodiversity strength flag spreads, and

009it is spreading fast, I'm seeing all of our line, this is going to start those conversations, which is needed to end stigma. So congratulations to you. Congratulations to everyone. And the entire neurodiversity community, this is a massive win for everybody. Absolutely, Josh. And thank you for your advocacy and your leadership. And I love your T-shirt. I can see it on Zoom. And the hat. Yeah, you can sample plug. You can get neurodiversitystrengthplug.com. You can get your own flag and merchandise on it, too. That's great. And I think, I don't know, I know I can see a printed out slide deck. Do we actually have a photo that we want to show? Yeah. Just everybody. Just everybody. If you're not from Albany, you might have had another opportunity to see some of the lighting that we

010did on World Autism Awareness Day. But yeah, this looks amazing. I think this is the Empire State Plaza for those who aren't in Albany. I know that Kate worked to get Niagara Falls to light up in red, white, and gold. Mike got the town of Glen Park to light up. And of course, Josh, you worked with Nassau County to light the county buildings. And then the flood. The raising of the flag at Jones Beach. So those were all awesome events. So really appreciate it. Josh, anything else before we get into the presentations today? All right. And also, again, just congratulations to everybody. This is really, this is a team effort. And I just want to congratulate everybody. Mike, thank you. Kate, thank you. Yeah, we did it, guys. We're starting those conversations. You just need

011to keep the flag spreading now. And I just want to thank you, everyone. And I just want to thank you, everyone. And I just want to thank you, everyone. And I just want to thank you, everyone. And I just want to thank you, everyone. We're going to keep the flag spreading now. And we'll change the world. Great. Well, thank you. At this point, I'm going to move on to the next agenda item. And Kara Lee Kardashian is here. She's the Director of Special Education Services from the State Education Department on behalf of Chris Soriano. And she's going to be presenting. I'll turn it over to her. Great. Thank you so much. I do have a slide deck. So I'm going to attempt to share my screen. So just make sure. Okay. Let's see. Are you

012able to see my screen? Yes. And do you see the version with, do you see a normal version? Yes. Just making sure, because once I pull this up, I can't see you folks. So I just want to make sure that you're seeing what we should be seeing. Thank you so much for the opportunity to be here today and talk to you a little bit about the initiatives that are going on in the Office of Special Education. As I'm not sure who introduced me, but as that individual mentioned, my name is Carolee Kardashian. I'm the Director of Special Education Services here at the Office of Special Education in the New York State Education Department. And I'm here on behalf of Christopher Suriano, who's our Associate Commissioner and had a commitment. He was not able to be

013here today. So we appreciate this opportunity because we've got a lot of amazing things happening. Our agenda is a little bit packed. There's several hot topics in special education. That we wanted to be able to share with you. It starts with a portrait of a graduate and we'll kind of end with our IDEA determinations. We'll cover the portrait of a graduate, the blueprint for improved results with students with disabilities, pre-employment transition services, MTSSI, the dyslexia and dysgraphia area, and behavioral interventions and supports. I'm going to start off with a portrait of a graduate. In September, the Board of Regents approved the vision of a portrait of a graduate. And the portrait is defined as defines the essential skills and knowledge that every student should develop it to be successful in college, career and civic life.

014And it's about preparing that whole graduate. That with the development of real world skills, problem solving and flexibility and creativity skills, improve student engagement and motivation and an increased understanding of how different subjects relate to each other. That interconnected piece. As you can see on the screen. The portrait of a graduate has 6 attributes. And at the core is the culturally responsive, sustaining education framework. And that's really what the vision is. What is going to mean to be a graduate in New York State? Our commissioner has been really vocal about all means all. So, in that same thread, we are looking at some key regulation changes. There will be changes to diploma, instructional programmatic requirements. We'll see regulatory changes with assessments and we'll see regulatory changes that impact family and community engagement in a positive

015way. So, as we start to think about drafting and putting these forward for proposed regulation changes. One of the things that we've really thought about and we're really trying to problem solve through is how do we ensure that these new regulations are inclusive of all students across New York State. It's really important for us to be thinking about those. And once the regulatory proposed changes go to our Board of Regents, they do go out for public comment. So we would welcome you folks to make some public comment and really take a look at those under that lens of how does all mean all. When we talk about the portrait of a graduate and we talk about regulatory changes, this is one of the number one questions that come up. Will there still be state assessments

016and regents exams? And the answer is yes. There is a federal requirement under every student succeeds act that all students must be assessed. So you'll still see assessments for math, ELA and reading or math, ELA and science in three through eighth grade. You'll also still see regents exams be administered. But the key change here under the proposed vision is that students would not be required to pass regents exams to earn a high school diploma. So that has long been a barrier for students, both students with disabilities and students without disabilities across the state. And under this proposed vision, that barrier would be removed. So we are we are pretty excited about the opportunities that that is going to offer the students in New York State State high school exams. So regents exams will still be

017a way for students to demonstrate their proficiency. However, it's not a mandate in order to exit with a high school diploma under this proposed vision. When I started here in the department in July, one of the things our folks were really excited about, and under the proposed vision, was that we would be able to get students to pass the high school diploma. And that was the blueprint for improvement in the office. The blueprint for improvement in the office was the blueprint for improved results for students with disabilities. This document was initially released in 2015, and it is currently undergoing updates. And after 10 years, 2015 to 2025, a lot changes. There's a lot going on. There's a lot of moving and shaking, and it was in need of updates. However, when the Board of Regents,

018that portrait of a vision in New York's INSPIRES vision was moved forward, we took a moment to pause and really think through what this blueprint is going to ultimately look like. We wanted to make sure that there was alignment with a portrait of a graduate and the associated regulatory changes that I had referenced before. Some of the key changes that you will see reflected in this updated document once it's released is the alignment with the culturally responsive sustaining education framework, which we saw at the core of the portrait of the graduate, the expansion of career and development experiences, and a greater emphasis on student voice and student advocacy. So those are key things that we're considering as we update this document and hopefully release that in the fall. In the same area of career and

019college readiness, we want to talk a little bit or pull forward the pre-employment transition services, or what we call Pre-ETS. Pre-ETS are designed to provide early support to students with disabilities and improve their post-secondary outcomes. It's intended to get students ready for those opportunities. In the post-secondary world, whether that be college, career, or independent learning. There are five Pre-ETS, and they include job exploration counseling, work-based learning experiences, counseling on opportunities for enrollment in post-secondary education, workplace readiness training, and the instruction in self-advocacy. And if we talk with our friends in Access of ER, who's been a great thought partner in this work with us, they will share that work-based learning experiences is the most popular Pre-ETS service that is offered. Those work-based learning experiences through the Pre-ETS, which are free, provided by NYSED, and available

020to students ages 14 all the way through 22. So it starts at a little bit of a younger age, which is amazing. But those work-based learning experiences aren't just needing to occur during the school day. The work-based learning experiences can be done through the pre-ETS. They can be after school, on weekends, during summer breaks, during vacations, and can potentially be paid experiences given the right criteria. So something else that we wanted to highlight. For folks, I want to rewind just for a moment on our Multi-Tiered Systems of Support's integrated initiative here at the department. If we rewind to 2020, the Office of Special Education was granted a grant. We were awarded a grant. And that allowed us to partner with an institute of higher education, which is University at Albany. And we developed a pilot

021framework and used that pilot framework in pilot schools across the state. The 2020 grant was a five-year grant. So over the summer last year, our folks, our team came together. We applied for another round of funding. And in October, we were awarded a substantial amount of money to really move this initiative forward. It's something that we're really excited about. Because it really expands our work, not only to those pilot school districts, but to districts across the state. We are currently working on getting MLUs in place with our partners in higher education in order to get this work moving forward. But we want to expand the availability for technical assistance and support. We want to expand that professional learning and coaching capacity for folks across the state. And provide support with database decision making and using

022that culturally responsive lens. As well as maintain and build new partnerships. An update on the Dyslexia and Dysgraphia Center. So for folks who don't know, there was a law that was put in place. And that law directed the education department to establish a Dyslexia and Dysgraphia Center. With that law, currently came no funding. So we are currently advocating for the funding to make this a reality in our budget. And while we are working on that, we are also working on the implementation of the Dyslexia and Dysgraphia Center. And we are working on the implementation of the Dyslexia and Dysgraphia Center. So we are waiting to see what happens in the next couple of weeks, hopefully. We did get $200,000 in last year's budget. And we are working on hiring two Dyslexia associates who will begin

023working on the criteria of the law and what the center is intended to do. Those two folks we have interviewed, we've posted, we've interviewed. We're in the last stages of trying to get these folks hired so that we can start to build the foundation. We've also got some more funding on what needs to be done. Some of the areas that they'll work on include data analysis and collection or Collection and Analysis and starting to develop some of those tools and information for people to use out in the field. The other thing that they will start to do is look at screening tools that are available because there was a requirement to screen all students in grades kindergarten through grade five. So more to come on that and hopefully we will, we will see some funding

024once the budget comes through in order to make this a reality. We're hoping to work with a partner in higher education and to be able to help with that as well. with a partner in higher education to make this operate very similar to our MTSSI center because that structure has been so successful. I do want to share, and we've been out in the field talking a little bit about our behavioral supports and interventions within our monitoring. And sometimes in news media, we see things and we need to make sure that we remind folks about regulation and guidance that's currently out there. So in July of 2023, the Board of Regents made rules surrounding what types of interventions can be used, what kind of interventions can be used on a limited basis, and what types of

025interventions can be used or can't be used at all. They're prohibited. I will make sure that the slide deck goes to Caitlin so that you have access to this. And there are live links throughout the document. I forgot to mention that earlier. But this chart gives a summary of the regulation in terms of interventions that are prohibited, interventions that have an authorized limited use, and interventions that are authorized to be used regularly. Under the category of prohibited use, you'll see the adversive interventions, and those are interventions that are intended to cause discomfort or pain for punishment. You'll see corporal punishment, which is use of physical force for punishment. You'll see mechanical restraint, which is prohibited. There is a carve-out for students who need positioning support. You'll see students who need to use standards, gate belts,

026those types of things in order to, you know, ensure their health and safety. So there is a carve-out and mechanical restraints for that type of occupational therapy, physical therapy, that type of work with students. Prone restraint is also prohibited intervention, and that's when an individual is faced down during a physical intervention. And the use of seclusion is also prohibited, and that's when a student is confined to a space by themselves and prevented. So that's when a student is prevented from leaving, whether that be a locked space or, you know, is perceived to be unable to leave the area. Under that authorized limited use, we find two different things that are available to use on a limited basis, and that's physical restraint and the use of timeout. With physical restraint, it can only be used in

027a situation where there, you need to prevent imminent danger of serious physical harm. Physical restraint should not be on a physical basis. It can only be used when a student is in a state of emergency, or when a student is in a state of emergency, or when a student is in a state of emergency. So that's when a student is in a state of emergency, or when a student is in a state of emergency. Physical restraint should not be in a behavior intervention plan. It really is an acute use when that level of danger to themselves or others and physical harm is there. With timeout, there are two different areas where we've seen, we see that used on an authorized and limited basis. Timeout in response to an immediate concern for physical safety. So sometimes

028you'll see that as a behavior management technique that's developed as part of the behavior intervention plan, and that is allowable. However, in that category of authorized limited use, there are a number of requirements that come along with the use of those interventions. There needs to be same day notification to parents. There needs to be written notification to parents. These incidents need to be debriefed. These incidents need to be documented with specific criteria, included in the documentation, and they need to be reported. Last year was the first year that we really started to collect this data as a state. So that is a new important initiative that we are working on. And then you'll see the authorized use. The deescalation strategies, which has requirements to train all staff and all schools should be trained on deescalation.

029The multi-tiered systems of supports in that behavior lens is an authorized use, and the use of a physical escort for the purpose of getting a student out of the situation. So we're working on that. into a space where they can deescalate. And a physical escort is not where arms and legs are immobilized. It's like physical guidance to help and support a student get where they need to be to be safe. And the last category I want to touch on are the school district IDEA determinations. IDEA determinations for school districts are requirements of the Individuals with Disabilities Act. And it's part of our state's general supervision system in order to ensure that we improve results for students with disabilities. Under that general supervision, we do monitoring, we provide technical assistance, and when we find areas of

030non-compliance, we have the ability to instate some enforcement actions to make sure that non-compliance is rectified or is fixed. There are four different categories for a student to, or for a student, for a school to be, they fall in. There's one of these four buckets. So, as we look through our general supervision and our monitoring and all of the data that comes through, school districts from across the state will either meet the requirements and purposes of IDEA, they will need assistance in implementing the requirements of IDEA, they'll need intervention in implementing the requirements of IDEA, or they'll need substantial intervention in implementing the requirements of IDEA. So, they'll fall in one of those four buckets based on the requirements of IDEA. And then, the last category is the school district's requirements. And this is where

031we're going to look at the requirements based on this criteria that you can see here. So, there's performance and compliance indicators that are driven by, driven federally, that play a role in the IDEA determinations. Districts are required to submit to us timely and accurate data. So, they have deadlines for their data and they have to make sure that it's accurate before they submit it to us. The correction of identified non-compliance and other data including any relevant audit findings. If, let's say, a comptroller audit comes into a school, finds that the school's not appropriately using their IDEA funds, that could be one of the determination criteria that impacted district's determination. Currently in New York State, we have not seen that. So, that is a good thing. When I talked about performance and compliance measures, this is

032the rubric that we use, or the matrix that we use. And it is built on a point system. So, I'm going to do the the performance aspect of things. You'll see graduation rate, dropout rate, three through eight testing categories, and then the least restrictive environment categories, which is a focus for our district. The more time students spend with their peers in general education, the better, the better it is. So, we know that it's something we're watching and it's something as a state that we're working on improving. And then under the compliance matrix, these are federally driven indicators. So, they're indicators that the state reports to the federal government on, and then the districts report to us on. And that includes the timeliness and accurate data, timelines with evaluation for individual districts, suspension and expulsion, and

033disproportionate representation. The numbers and the points combined end up putting districts, depending on where they fall, in one of those four buckets, where they either meet requirements, needs assistance, need intervention, or need substantial intervention. So, that's kind of how we arrive at the determinations. We are, this is the timeline for when they are released. So, determinations are released once a year, and they are going to go out to school districts later this week. So, we are on target to do that, and those will be preliminary determinations. What that means is they have a window of time to take a look at their determinations and the data that we used to make those determinations and appeal if they need to. Districts can only appeal their determination if there was a calculation error, or if there was

034a data error, on our end. So, it is, last year it is possible. Last year we did have a couple of districts appeal, and it was granted. It was an error on our end in terms of calculation. But final determinations will be posted no later than June 30th, and they are published on the NYSED website. So, you can see all of the districts across the state, what their determination is, and what level of support that they get from the Office of Special Education. And those are, those are my mistakes. I'm going to go ahead and close the session. I'm going to go ahead and close the session. I'm going to go ahead and close the session. I'm going to go ahead and close the session. I'm going to go ahead and close the session. I'll

035stop sharing my screen. Thank you for that very comprehensive presentation, everything from updates to regulations to compliance around IDEA. So, lots of good information. I don't have any questions, but I wanted to open up to any other members of the advisory board. I just want to say that I really think that we're living in a new age full of supports. When I was growing up as a millennial, a lot of this stuff will be unheard of. Like you said, I mean, I remember throwing in the corner. I remember having counselors choke me, teachers throw glue sticks at me, stuff like that. And now we live in an age where the fact that even conversations like this are happening just show how far we as a society have gone. Now, do we still have a very

036long way? Absolutely. But we are in the right step. So thank you for presenting and showing us that. That really made me personally happy as a neurodivergent person. Thank you for that, Josh. I appreciate you. Yeah. Thanks, Josh. I think Michael Gilbert also has a question or comment. Yes. Sorry, I'm not on camera. I'm in the car. I'm on my way to the meeting a little late. In addition to being on the board and being a self advocate, I'm also a special attorney representing families. So I would love to connect. And I know, Chris, so I would love to connect with you on some of this because I can tell you where I see deficiencies in the system as somebody who who obviously represents families who are having issues with school districts. And obviously, I

037only see when things are bad. I don't get the calls when they're good. But certain school districts, I see patterns over and over or I see things that happen around the state where school districts put more money, put more focus, sorry, on saving money than complying with the idea of complying with the idea. Thank you for that. I would absolutely love to connect and I can get my information to Caitlin if she can pass that forward or you can. No. I'm not sure. Yeah, if you could have Caitlin send me your info, that would be great. I think it would be great if we could have a talk offline. Absolutely. I'd be happy to. Thank you. Ray, any other questions or comments? Mike? So I would just like to say as a former EMT and

038first responder, the fact that prone restraint is not allowed is a big deal because that is something that is not common to actually have that banned. And that's one of the things they covered. And I think that's a big part of the reason that we're doing this work is that we're not going to be able to have a lot of people who are not in the EMT school because that really does cause a lot of breathing issues and a lot of deaths. So it was nice to see that. But it's also important to kind of amplify that message to other agencies and other groups and parents and caregivers. That prone restraint really does kill a lot of people on a regular basis. And it's not talked about that much. Great, great point, Mike. I was

039just going to say that. As somebody that does some advocacy work in western New York with families, that this information is so important. There's also an organization that's called the Alliance Against Seclusion and Restraint. So for families that are listening, they have a lot of great resources there. I know that I work with families personally whose children and the parents themselves have suffered a lot of trauma because their children have been restrained in school or secluded. So it's nice to see that we're moving hopefully in the right direction. Are that concerned? Oh, sorry. One other note I want to make. Sorry, it's Michael Gilbert again. With what Kate just said, I think Kate does a lot of work with what's called floor time. And I see a lot of school districts saying it has to

040be ABA or nothing. And that's another, I think, rigidity we have in the system that schools believe is ABA or nothing. Yes, I think that it's compliance. So we focus so heavily on that. That's the only thing they can use as a methodology. So New York State uses PBIS. Can you mention some of that focus on autism? Yeah, New York State focuses very heavily on on PBS positive behavioral systems. It's embedded everywhere. And it really goes against what we know and what we're starting to learn more about when it comes to autistic people and the importance of developmental and relational model. And unfortunately, right now, ABA is the only thing that is covered in New York State by Medicaid. So it is the only I'll call it an intervention that really is recognized and the

041only one that professionals, including doctors, they'll just write scripts for ABA. So. My hope is that as we move towards away from a compliance and control model and towards a relationship and developmental based model, that a lot of these issues with seclusion and restraint will stop happening. Because what I'm noticing is when I'm helping parents rewrite IEPs so that they can be more effective for their child's nervous system, is that a lot of those quote unquote behaviors that they're seeing dissipate because the children I looked at with a different lens. So I think that's a really, really good conversation. And thanks for the tip about the resource on seclusion and restraint. Any other comments? No, I'll just make sure that the slide deck gets to Caitlin so that you can distribute it out. Yeah, that's

042great. Yeah. Thank you for presenting, Carolee. Thank you for the opportunity. We appreciate it. Absolutely. Keep up the good work. All right. We're going to turn to a presentation from the Department of Health. We have Myla Harrison, who's the Medicaid and Medicaid Director. She's the Medical Director for the Division of Medical and Dental Directors. She's going to talk about Medicaid Disability Service Improvements and the Rural Health Transformation Program. So, Myla, thank you. Great. Thank you, too. Hopefully you can hear me OK. Yes. Fantastic. Sorry. We can take this to the next slide. Just to show the agenda that I'm going to cover today, as you just heard, I will review the Rural Health Transformation Program and then some other select Medicaid program topics that I think are relevant to folks in this space. And at

043the end, we'll put an invitation or a plea for people to join the Medicaid Advisory Committee or the Benefits Advisory Council, which I'll share more information about. Next slide. So, what is the Rural Health Transformation Program? It's a new cooperative agreement. Every state has gotten funding from the federal government for rural health transformation. New York State has gotten $212 million for the first year of a five-year grant or cooperative agreement. And that funding technically started December 29th of 2025 and needs to be spent on the first year of the grant. And that's the first year of the grant in the first year, which ends October 30th of 2026. The target for these funding opportunities are counties, and this is New York's definition, counties with 10% or more of the population in rural census tracts or

044with fewer than 200,000 residents. So, that's how New York has defined rural, which means that 47 out of the 62 New York State counties, are being defined as rural. And in order to decide on the strategic direction for this program, there was input from almost 170 stakeholder organizations and community partners. So, lots of input went into deciding what was going to go into this program. Next slide. Oops. One more back. Thank you. The strategy involves a new program. The strategy involves a number of ways of approaching this work. So, the overall goal is to improve healthcare access for rural patients and communities with a set of interrelated initiatives that really leverage local assets, regional partnerships, and statewide infrastructure. So, the first item is what we're calling rural community health integration and partnerships. And what this

045means is that partnerships are not just about the rural community, but they're about the rural community. And rural partnerships will help facilitate comprehensive care coordination and enhance patient access to a wide range of providers across the care continuum to address health and social needs. And rural hospitals will collaborate with healthcare organizations to jointly build and grow these integrated health networks. The second target or pillar is to strengthen rural communities with technology-enhanced primary care. So, this idea is to improve rural patient access and utilize high-quality primary care via a program we call the patient-centered medical home model. And that leads to team-based care, patient-centered access, continuity of care, care management support, inclusive of a quality improvement process. So, that will be implemented in these areas as well. The third is really a focus on workforce. It's

046the one that's rural roots to build a sustainable rural healthcare workforce. And we will be using data to identify local specialty gaps and invest in recruiting and training more practitioners for rural areas. This will include planning, targeted education, innovative support with the aim to address immediate staffing needs for rural communities. And then the third is to build a sustainable healthcare workforce. This will include planning, targeted education, innovative support with the aim to address immediate staffing needs in addition to long-term capacity building. And then the fourth bullet is investing in technology and technology innovation and cybersecurity enhancement for the rural New York population. So, this is going to involve telehealth and using electronic consultation partnerships, care coordination alerts, strengthening cybersecurity in rural areas. And these slides are going to be available to you all. And there

047is a link at the bottom that takes you to the New York State Health Department's page on more information on this grant. Next slide. Switching away from rural health to talk a little bit about what we call population health and the Medicaid population. There's a number of proposals that we're moving forward with to enhance rates for providers of services that are in need. And one of them is to provide services that are in need of support for people with disabilities. And that's going to include services that are in need of support for people with intellectual or developmental disabilities and cross-population sorts of services. So, for instance, for people with substance use disorder, if they're going to what we call an Article 28 physical health provider, they can get an enhanced rate for seeing individuals with

048disabilities. If they're going to a substance use provider clinic, that's OASIS, the Office of Addiction Services and Supports, if they deliver physical health services in that space, they can get enhanced rates. For the IDD population, enhanced rates are available or will be available to Office of People with Developmental Disability Clinics who deliver physical health services. And enhanced rates will be available for substance use disorders. So, we're going to be looking at how we can help providers of services that are in need of support for people with intellectual or developmental disabilities. So, you can hear a theme here. We're trying to help providers of services that cross different disability areas take better care of the whole person and to incentivize them to do this so that they're not missing components of care. So, this is the

049third box on the bottom for people with serious mental illness. There will be enhanced rates for specific bundled physical health services that are delivered in the Office of Mental Health, Outpatient Treatment and Rehabilitation Services clinics. Next slide. I want to talk a little bit about dental care updates. There's a lot of words on these slides. You do not need to read these words. What I wanted to share is that there's been a lot of attention that we've taken on the Medicaid team to make sure that people with intellectual and developmental disabilities are getting their dental needs met. So, in 2024, there were about 135,000 individuals with intellectual and developmental disabilities who received the Office of People with Developmental Disabilities Medicaid funded services. And what we want to do is make sure that all those folks

050have access to dental care. And there have been a number of updates to the Medicaid funding. And there have been a number of updates to what's called the Medicaid Dental Policy and Procedure Manual with an addition of appendix, appendices that highlight where our enhanced services are for individuals with intellectual and developmental disabilities who have that designation from the Office for People with Developmental Disabilities. So, I have an example on this slide. There is a service that's called Dental Case Management. And it's for patients who have special healthcare needs. And this would be a service that goes, that can be billed above and beyond an examination code or an assessment code or a prevention dental code for people who have a certain, again, Office for People with Developmental Disability eligibility. So, whether they have a traumatic

051brain injury or have OPWDD, managed care exemption, that's called. Again, an intellectual or developmental disability. The dentist is able to claim an additional service for those people who usually need greater knowledge, skills, sophisticated equipment, extra time and personnel to feel comfortable in a dental setting. And so, it's an additional fee that gets paid on top of the normal fees for specific dental procedures. That's one example. These have been in our manual since about 2023, but we do want to make sure that people are aware of them so that they get used and are useful for the population. There is another program that is through our Medicaid 1115 waiver that's called the HEALER Program, which is Healthcare Access Loan Repayment Program. And this is a way to improve the health of your patients. And this is

052a way to improve the health of your patients. And this is a way to improve the health of your patients. And this is a way to improve the workforce within the Medicaid Services Population and strengthen New York's healthcare workforce and ability to meet certain needs, especially in high-need roles due to student debt. So, dentists, for instance, are able to apply for student loan forgiveness through this award. And if they are, they're potentially eligible. eligible if they make a four-year full-time commitment to either maintaining a personal practice panel or working in an organization that serves at least 30 percent of members, 30 percent of their members with Medicaid and or uninsured individuals. And the maximum loan repayment award for dentists is up to $100,000 per awardee. Those are, I think the deadline for that has just

053passed, and I understand there are a lot of applications. So this did get a lot of uptake, so we're really pleased about that. Next slide. The next few slides are about some wheelchair initiatives. These are very specific. I just wanted to include them so that you all could have an awareness of kind of what kinds of things do get covered in Medicaid. So this is for people who have wheelchairs. There are three new initiatives that all have to do with rate enhancement and or availability of power wheelchairs for people who use wheelchairs. So the next slide, please. Again, this is probably more information than any of you need to know, but just to give an example that in this past January, there have, there's been an increase in the fee paid for what's called wheelchair

054management. And what this means is, I think I have a slide, the next slide of what, what goes into wheelchair evaluation, please. No, I think I moved to the next topic. So essentially, this is just to show that there is a rate increase for wheelchair management. Next slide is a different topic. It's on preventive maintenance. You can move to the next slide, please. And this also was effective in January or in March, depending on if it was managed care or fee for service. This is a way to cover preventive maintenance for primary power wheelchairs that are less than five years old to allow for twice a year maintenance. And the fee here, you can see it's not necessarily relevant to most of you, but just to show that this is more frequent than it had

055been over time in the past. So we are aiming to take better care of people who are living with wheelchairs. So we're going to move to the next slide. So this is a slide that shows what preventive maintenance is. And this is, again, about a power wheelchair. It's evaluating, it's diagnosing, it's assessing if there are concerns or problems. You can see tightening bolts and screws, checking tires. Again, more information than you all necessarily need, but, you know, really paying more attention to replacing parts that are minor along the way so that you don't end up with, you know, a wheelchair. And then the next slide is about repairing backup power wheelchairs. Again, these are recently effective new codes where people who own power wheelchairs can hold onto an old wheelchair if it meets certain criteria,

056meaning it's less than five years old, and over a certain period of time, you know, won't cost so much money to repair. And I think the next slide talks about what goes into these requirements. So this is about maintaining backup power wheelchairs so that people who have a power wheelchair, if it does need to be serviced or maintained, that they have a backup. And that backup is their own wheelchair, and it was one they had used before. So this is about helping maintain backup wheelchairs. The member must have adequate storage for both their current wheelchair as well as the backup wheelchair to keep them inside and away from the elements. And again, the backup wheelchair shouldn't be used as a primary chair unless there's a documented failure of the primary chair. And the backup power

057wheelchair must accommodate the seating and positioning components of the primary power wheelchair, and those should be able to be repaired. And the backup wheelchair should be able to be used interchangeably. So again, you can go to the next slide. This is just a way to show some of the updates that have gone on in the Medicaid system for people with physical disabilities needing power wheelchairs. My last slide is an invitation to join the Medicaid Advisory Committee or the Beneficiary Advisory Council. These are both Medicaid groups, that are newly being formed again. They haven't been around in a while, but they are being reformed. And they provide critical input to help guide the development and administration of the New York State Medicaid program and Child Health Plus, and really aim to support the delivery of high

058quality, cost-effective care for Medicaid and CHIP members statewide. So there are current applications out there right now for people who are interested in Medicaid and CHIP programs. So in either one of these memberships, the Medicaid Advisory Committee is providers or administrators or even individuals with professional experience who work in community-based organizations or managed care organizations or health plans or other state agencies that serve New York State Medicaid members or CHIP members. The Beneficiary Advisory Council is really for residents, who are current or former Medicaid or CHIP members or family members and caregivers of people on New York State Medicaid. And the application is in English and 16 other most spoken languages in New York State. And when you get the slides, there is a link here if anyone is interested in putting in an application,

059either for the Medicaid Advisory Committee or the Beneficiary Advisory Council. It's not a long application, but people who become members, if they're on the Medicaid Advisory Committee, the MAC, those are three-year terms that they serve. And the Beneficiary Advisory Council serves a two-year term. There is a little bit of overlap with some folks from the Beneficiary Advisory Committee who can attend the Medicaid Advisory Committee, but that's more information than you need at this time. But at this point, there is an opportunity for anyone listening in or for colleagues, patients, caregivers, community networks, anyone who is interested in bringing some valuable perspective to the Medicaid work. And there is a mailbox link. When you get the slides, you can see if there's questions about this specifically. And I think the next slide just has links to

060if there's any questions about any of the wheelchair-specific information I shared or anything about Medicaid. And I'm going to go ahead and close this out. And I'm going to go ahead and close this out. And I'm going to go ahead and close this out. And I'm going to go ahead and close this out. The population-specific information. So again, just mailboxes where people can see concerns. So I think there's, I think the last slide isn't anything. But I don't know if anyone has any questions. I'd be happy to take them. All right, great. Hi, Myla. It's Courtney Burke. Thanks for the comprehensive presentation. I actually was listening to every word you said because access to a lot of those services, traditionally, people have been underserved who have IDD. And to see the way that it's been

061done where it's not necessarily OPWDD that's doing this, but it's agencies that are overseen by DOH, like Article 28 clinics and OASIS, that they're adding the incentives for providers to actually serve this population is a really big deal. Same thing with, you know, the presentation on access to wheelchair services. It's an essential part of people's everyday independence. And the fact that that's being recognized in the fact that you need to maintain a wheelchair in order to use it, that you can have a backup if it breaks down so you're not stranded for potentially months at a time. I mean, it's really important work. So thank you for all that you're doing. I'm going to open it up to additional questions or comments. Kristen? Thanks very much for those updates and for that information. I'm wondering

062if you have data, not today, but that you could share in the future regarding the utilization of the dental case management code that you referenced. It would be interesting to know because you mentioned you're trying to highlight and spread the word that this enhanced reimbursement code exists. So I'd be interested to know what the utilization has been since that took effect, you said in 2023. And then with regard to the wheelchair preventive maintenance and backup wheelchair, I echo what Courtney said. The Council on Developmental Disabilities had a member in the last year, so whose power wheelchair broke when she was out in the community. And it was difficult, it had to be removed from the location, which took several weeks for the wheelchair vendor to come get it. It just it stopped functioning in the

063middle of a mall. And so it sat there and eventually got moved to the security office. And then several weeks later, the provider came to pick it up. And then, you know, it was a little bit of a shock to the community. But I think it's a great way to look at how the system works. And so I think it's a great way to look at how the system works. Months later, it got fixed. And she did not have a backup wheelchair. So if you could think about what provisions are in place for people who don't currently have a backup wheelchair, she's a very active member of the community. She's employed. She's on a number of state advisory bodies. And she was pretty much confined for a period of the winter to her living situation

064because she couldn't get out because her power wheelchair was under repair for a prolonged period. Yeah, that's terrible. And in fact, you know, these initiatives are so that won't happen. But if somebody doesn't currently have a backup wheelchair, you know, that is the question. And in that person's case, if that wheelchair that is no longer functioning could become a backup wheelchair, if there's a new one, that's what this is about. And there, what I would suggest is if there's any specific questions, like what about this person or this individual situation, there were there are two email boxes in my slides. And I would suggest putting a note with information if anyone has questions or specific scenarios to the Bureau of Adult Special Populations. And that mailbox is on the slides. And you can you can,

065you know, queries can go there. The Bureau of Medical Review is the one that reviews all of the information about the power wheelchairs, but I would go to the special population, the special population team so that they can just hear the situation and scenario. It's not her situation was resolved. But but I raise it because I'm sure that she's not the only one out there who does not have a backup chair at this point. And and when the wheelchair either needs to be serviced, and it's more than a, you know, quick appointment kind of service. They're just they're stuck. So right. And may it should be more similar to, you know, if you bring your car in for repair, like, can you get a loan or car? I mean, it does get complicated, as you

066pointed out, because people have many people have special seating accommodations and other things, their wheelchairs are customized to them. So it is complicated. But I agree, if that's an area that you and your colleagues could think more about, that would be appreciated. I will pass that along. Thank you. And on your request for dental for more of the dental data, I will ask the dental team, if they have anything to say about that. And I don't know if they have anything yet to present, but I will take that back to our dental team as well. I think that's a great question. Mike. Yeah, and I just want to echo to about the the power chairs, especially, is there provisions for times of disaster, because that is one of the biggest things I've seen out in

067the field, is that folks will have their chairs destroyed by a fire or a flood. And to replace those chairs. We're trying every means possible and it takes months and oftentimes they don't have a backup or the means to to get a new chair in times of disaster. So just want to throw that out there to as to kind of build on that situation. Yeah, I can bring that back to the team. I'm not. So what I didn't cover is all that's covered for wheelchairs. I just showed some of the newer rates and a way to make some improvements, but I can take that issue back. I don't know the answer to that off the top of my head. But I do appreciate the question for sure. Jill Pettensher, you have your hand up. Yeah,

068and I don't have a question, Myla. I just want to extend appreciation. We've been working with the Department of Health and many of the principals involved in the clinic related matters and the dental matters for a number of years now. And there's been a lot of great collaborative effort made to really move this agenda forward around just the. Better partnership collaboration and increasing the knowledge, skills and bandwidth amongst all of the clinic providers to really be able to to support people with varied needs. And again, it's just great to see these initiatives really starting to take root. And with regard to the dental, there were other budget initiatives that were put in place going back to 2023. So Myla mentioned the one. But again, we have we had a lot of strong support to really

069strengthen capacity reimbursement types of billable services that were permitted and clarifying that in the Medicaid, the New York State Medicaid Dental Program Manual. So just a lot of again, great collective and collaborative partnership to really just continue doing the hard work here. There's still a lot to be done. Don't get me wrong, but we have seen some progress in this area for sure. So thank you. All right. Thank you. Yeah, no, Myla, very important work. And it's very much appreciated by everybody here. So thank you. Great. I think we're going to move on now to the exciting topic of governance issues. Thank you to the folks at OPWDD for looking at these. I'm going to turn it over, I guess, to you, Rachel. Yeah, thank you, Courtney. And I'm I'm going to try to go

070fast just to give enough time for the board to have discussion and also ask any questions. So apologies for going faster than I was previously intending. But I want to make sure there's time for everyone to talk. So the bylaws are organized into seven sections. Most of this is just based on what is in the statute and are the responsibilities of the board. We also looked at some of the bylaws from other councils and just using them as models to build this one. Same with the code of conduct and the conflict of interest. Kristen had to leave for another meeting, but we pulled heavily from the Council on Developmental Disabilities just to make sure that we were balancing both the legal and the public. And then we also looked at some of the bylaws from

071other councils and just using them as models to build this one. So those are the bylaws from other councils and just using them as models to build this one. So we pulled heavily from the Council on Developmental Disabilities just to make sure that we were balancing both the legal requirements and trying to make the language as understandable as possible. So the first section outlines the mission, responsibilities, and duties of the board. It is entirely based on the law that created the board and lists the board responsibilities that you can see on this slide here. And I'm going to ask my team that's managing the WebEx to make the slides look a little bit bigger for us. Thank you. Thank you. So it is review and study effectiveness of supports and services, identify legislative and regulatory

072activity needed to support those supports and services, improve interagency coordination, improve outreach and coordination for minority groups, and other matters deemed appropriate by the board. One question. Why are there two files that were sent out of the board? We have plain language and bylaws. Which one should we be looking at? I'm confused why there's two. Yeah, Michael. So the bylaws are what we're going through now. There's also, a code of conduct, a conflict of interest, and I think we also included a member guide. It was a lot of materials all at once. Not that this too. There's one called bylaws draft and one called bylaws plain language. Which one, Caitlin? The same? There's two files. You can look at the bylaws draft. Okay. That's what I was asking. Yep. No problem. Thank you for asking.

073The bylaws also outline the membership. This is, again, pull straight from the statute. This also pulls from the statute, which is just general information about the meetings. We have four meetings a year and the chair can call extra meetings if needed. The third section is member expectations. Just that members are expected to attend meetings in person or remotely. If you can't attend in person or remotely, you tell the chair and any support staff four days ahead if you can. That just helps us for planning for the meetings. And again, per the statute. Thank you. Thank you. Thank you. Thank you. Again, the ASD board members are not paid for the participation but can be reimbursed for some expenses. Meeting quorum. So quorum is the smallest number of board members needed to make official decisions for

074the ASD board that is half of the board members are present, or which is in person or online. If we do not have quorum, we can have a normal meeting, we can have discussions, but we cannot vote with quorum. You can have discussions, and you can have voting. It also outlines the meeting procedures, which are based on Robert's Rules of Veterans. of order which is just a standard operating procedure for public meetings anyone can attend our meetings there's provision for public comment and minutes are taken also in section three is just outloading outlining how we vote we have all done this before the chair calls for a vote members say yes or no and you need a majority to pass if people are unsure of the result you can ask for a show of hands

075or a roll call roll call vote the fourth section talks about committees committees can be formed to address a specific topic the chair can create a committee a majority of the members can vote to create one as well this is similar to the committee that formed i think last year to write the resolution for the lighting the board chair picks a committee chair this is a little more formal than we did last fall the committee chair is responsible for scheduling and running those meetings and committees can include board members and other other new yorkers who are not on the board section five is about the recommendation process any board member can make a suggestion that can turn into a recommendation that suggestion could be refined by a committee who reports back to the full board

076the board discusses the recommendation and makes any changes and then the board votes if a recommendation passes it's included in the annual report which is sent to the governor assembly and senate specific recommendations can also be sent to relevant agencies and then if a recommendation is time sensitive the board can vote to send it forward before the annual report this is what we did last year with the resolution the successful resolution to change the colors for world autism day the la the second to last section is on ethics code of conduct and conflict of interest so a conflict of interest is when a person might personally or unfairly benefit from a board decision board members complete a conflict of interest disclosure form every year and follow the code of conduct if there's any questions about

077if something is a conflict of interest you can reach out to the autism board email and we can work through that with you with our council's office so examples of conflict of interest could be an employer a family connection a financial connection and all that someone has to do if there's a potential conflict of interest is disclose that conflict of interest it's possible depending on what we're talking about in terms of recommendation that you would have to recuse yourself instead of a discussion i don't foresee that necessarily happening with the board but we just want to make sure that we're clear on on any potential conflicts the code of conduct it's very pretty simple we support the board mission act with integrity engage respectfully participate responsibly and promote a positive environment if there were any

078violations to this the chair and the member would develop a plan to avoid it happening again and if there were repeated problems the chair could request the member be removed from that committee most likely to be replaced the celle klum board admission meeting will be held on the 6th so i did want to provide a glad circle of plans for that actually to see that make sense for the board and make sure that the board is perfectly evil we support the board a wholecause and that's a team of members and we both from the board again i don't expect there to be any challenges or problems with that here but it's going to have a policy in place and then the last section just says that three quarters of board members can vote to change

079the bylaws at any time this current draft is just a draft so it is not final it won't be final until the board votes in july um and so yeah so next steps uh we'll vote at the july meeting if there anyone has any questions if they have any recommended changes um think anything needs additional clarification we probably have a little time to talk about it now but also maybe easiest to send um an email or reach out to me and caitlyn and we can talk through it with you i think that's it no that's great and i think we largely have operated under these rules yeah i would say the one exception is when we have had subcommittees we had one on housing and the you mentioned the one on lighting we didn't have

080a chair of the committee but otherwise i think that's pretty much how we've been operating and i and i can say i I haven't seen any reasons for conflicts yet, but I sit on another board where I oftentimes have to recuse myself because it's a grant making organization and I have occasionally worked with some of the grantees and I have to. So, but it's easy to do and it's sometimes it's better to be cautious and recuse yourself. So it doesn't appear that there's any conflict. But thank you for those. So we'll have time to look at them. I think the only one would be where there's much debate would be the last 1 about 3 force of the of the board to change the bylaws. That's actually seems reasonable to me, but. That might be

081something people might want to think about. So, any questions for Rachel. Before we move on, I actually went through them. Um, I won't for everyone now with what I wrote about it, um, about the bylaws. But my hope is that this can provide. A. An opportunity to really talk about, um. What an inclusive board could look like, um, as we finalize the bylaws, there were a couple things that I noted, including the 3 minute, um. The, the ability for people to only speak for 3 minutes. So, like, thinking about non speaking people or people like myself go situationally mute sometimes. What are some ways that we can embed that into the bylaws? So that people have time. To, um, to say what they need to say, if they have, like, I. Mike, and I, and

082I saw you there too Courtney were at the autism action day earlier and there were 3 non speaking individuals who spoke and it was amazing. Um, so the other thing I just want to touch on again, and I know I touched on this the very 1st time I attended a meeting is I would love to see a non speaking autistic people person on this board. And I feel like that should be 1 of our 1st things that we really need to. To focus on because we're missing a big part of the population. Um, when we don't have a non speaking person here, um, to share what their experience is like, um, because there are so many issues related to accessibility around communication that. We can certainly address, but not in a way that somebody who

083has the lived experience can address it. You know, those are absolutely perfect comments. Well taken. I think. We tend to in practice be flexible with the 3 minute timer, but you're right. We should write it down, right? What are the accommodations or accessibility needs or flexibility that we can make sure is in the policy and not just happening as part of practice. So, 100% agree and also agree on on. Board construction and membership and making sure that it's representative. Absolutely yes, I'll send that stuff to everybody to read just because I have a few things that I would love to share and, like, hopefully we can just talk about and. Um, like I said, I think this is really a great opportunity to really look at nothing about us without us. And what does that

084really mean? And how can we create that? Because. In reviewing the bylaws and in doing this, we could really create some. We could create an inclusive board that could be a model for for other boards. Yeah. Yep. Thank you. That's awesome. Awesome thoughts. Really good. Um, so we'll. See, we can do. Yeah, all right. So the last meeting, uh, we talked about the priorities for the coming year and we went through a couple of different areas and let me just. Review what they were, there was 1 area that we didn't get to, um, which was the cross system collaboration, but we did talk about, uh, so there were different areas where, um. Access to services, housing, employment, health and wellness, and then the cross system collaboration. So, in terms of access to services, and so

085glad somebody took better notes than I did, um, there was a couple of themes that came out of the access to services 1st, was that there are opportunities to better integrate with 1st responders. So they're aware of, um, the situation and people that they can speak to if they have questions. So that was a great suggestion. Um, other people talked about making public information easier to find and understand in order to. Act. Access the services to begin with, and that it can be difficult to know what the options are, or how to be eligible for the services. So the more information that can be provided, the better, and then just navigating the multiple systems and programs. Um, we actually had a presentation from from last time. That was awesome in terms of the number of

086programs that are being provided, but it was an acronym soup of sorts. And and even, um, myself. Who's who knows about a lot of the programs thought my goodness, this would be really hard for anybody to. Navigate, so I appreciated that comment as well as sort of how do we, how do we simplify it and make it available to to everybody. Um, so the 2nd area was was on housing. And we talked about how it was hard for people to find housing, but that there are opportunities to look at where some of the gaps might be more specifically in housing. So that. The agencies would know where to target their efforts. Um, there was a comment about the housing sometimes being discriminatory in terms of how the landlords operate and, um, whether we could do

087anything about that. And then also the navigation issues sort of similar to the 1st theme with accessibility is it's there's multiple housing options and it can be a little bit intimidating for anybody who's trying to navigate that. So, how do you make navigation easier? Um. The navigation. The next area was employment and the group talked about the need to educate employers to improve hiring of people with, um, uh, autism or disabilities generally, and that there were opportunities to build pathways to employment for neuro diverse people. And how would, um, you know, what were some of the ways that that that could be done to improve that and certainly increasing awareness and then increasing coordination between employment focused agencies. And again, a form like this. Is a good place for some of that coordination to happen

088at an agency level, but I think this is also down. Okay. So now you're down actually trying to get those services. How do you coordinate that? Um, you know, sometimes you have case managers or care coordinators or others who can help you, but it was identified as an area of need. And then the last topic that we talked about was health and wellness and, um, people wanting more information on health care providers, especially for mental health care. And the need to improve training for health care professionals to reduce their bias, improve the quality of interaction that they're having with people who are neuro diverse and then finally that there were opportunities for agencies to collaborate on wellness initiatives, like outdoor activities. And I know, um, at the event earlier today, when Greg was there, he

089was mentioning all of the things that are happening in collaboration on sort of these events for parks and recreation where disability is being much more incorporated into those. So, I think that's the kind of thing that we were saying would be really positive. So now we want to take a couple of minutes to talk about cross system collaboration. That's the final area that we didn't get to last time. And, um, I think just to kind of focus the conversation a little bit where do we think cross collaboration is important, um, examples of places where it could be more effective that that demonstrate exactly what agencies and why. That lack of of collaboration can be a problem. You know, if you have thoughts or other ideas on this, that would be great. I'll just start out

090by saying again, you know, I think forums like this are important, certainly at the agency level. My comment would be how do we create more cross-systems collaboration at the local level where people are actually getting their services, and what mechanisms do we have to better do that? So we'll start there. Any other thoughts? Kate? No, I was just going to say that I think this is really important. I'm in western New York, and collaboration versus people being in competition with each other is a huge thing. So my families have a lot of challenges navigating a lot of the systems because of that reason. In our area, there's certain agencies that are the only game in town, and if they're not on the ball and if they're not responsive to families, the families aren't getting the

091support that they need. I don't know if there's any comments from folks online about some of the opportunities for cross-system collaboration. Mike? Hi, Court. Oh, sorry. Well, I guess my question is, do we have like an actual inventory of all the players at the local level, like including nonprofits and other stuff in the different regions of the state? I don't know if a true comprehensive one exists. I mean, I can just say from, I guess, an analogous world, in the healthcare world and social supports, the state had to submit a waiver to really redesign all that it's doing with health-related social needs to try to get traditional healthcare providers and then transportation, housing, food services, those kinds of services to integrate better. And they had to put an entity in the middle to really help

092with that coordination between the two. So I think it's a big task, but it's potentially worthy because that's really where people are trying to navigate to get services. Yeah, because I mean, I know there's a very big difference in the autism societies that exist in the state between Western, Greater Hudson, and NASA. And there's nobody really covers New York City. So that's one of those, you know, I think that might be something important kind of for that cross collaboration, because if we don't know what's out there, there's definitely people working on the same stuff, doing, trying to do, trying to reinvent the wheel when it's already been invented. So, yeah. And I will say, I think like, for me, the most important thing is when we're talking about this is like, when we start having

093these conversations, who's at the table? Are people with lived experience? Are people with experience at the table? Because when we're brought into the conversation, mid conversation, we've missed a lot. And that isn't an individual knock on anyone. I know that's systemic. And I think it's important that as self advocates, we keep speaking to that. One of the things that I think would be really important is to make sure that every single agency that serves developmentally disabled people, in New York State, is required to employ people that are developmentally disabled. They should also be required to have people that are developmentally disabled on their board making decisions, not just a prop. So I don't know if that's something that the board could discuss. Like, in my opinion, so many things could be changed within the system

094if we actually start getting the people at the table at the very beginning, whose voices need to be heard. Great comments. It sounded like somebody online was trying to say something earlier. Hey, Courtney. Oh, go ahead. I can't defer. Someone has a strong thing you want to talk about. Oh, no. Go ahead. Go ahead. I was just going to make a comment. Yeah. No, I was, this is Jill. I was just going to just reference that we do have a lot of collaborations that we've been working on. Some of them multi-yearly. We've been working on multi-year projects with the Office of Mental Health, as well as the Office of Children and Family Services. You heard some examples of the projects we've been working on with the Department of Health. So, again, I think as at

095OPWDD, we are really working hard to increase the capacity of our, the systems that we interface with, that the people that we support are interfacing with, so that they are better equipped to support people. And so, I think that's something that we're working on. So, we're working on finding ways to better support people who have a developmental disability, whether it be when they're presenting for health services at a clinic setting or a doctor's office, or whether they have mental health needs and they're going to an OMH clinic. So that we, again, are strengthening the whole system of care as opposed to expanding up new systems within OPWDD to specifically address all of those areas because there's not enough resources to go around. So, we're trying to be more effective. with our collaboration efforts in recognition

096of the limited resources across all of the systems, but how can we all do our jobs more effectively to support everyone who's coming to our doors? So that's really been a lot of where our effort and focus has been over the past several years. Yeah, great points. And was there someone else online? Yeah, this is Mary Boatfield. I was just going to say, is there a way that we could coordinate or collaborate with the care management organizations to ensure that they have the information and resources and maybe this guide specific to the areas they serve? Yeah, I think there's a number of ways that we could coordinate with the care management organizations that would assist families, individuals to at least have the names and the numbers and the contacts at a number of these organizations.

097I'm a grandparent of a young boy with ADHD, and I know my daughter struggles with, I can find out things for her, but I can't find out what her health is. I can't find out what her health is. I can't find out what her health is. I can't find out what her health is. I can't find out what her health is. I can't find out what her health is. I can't find out what her health is. I can't find out what her health is. But I know she struggles with obtaining, you know, the info she needs. No, great points. I don't think I see any other comments on that. Anything else that the board wants to bring up today before we move on to the public comment? Oh, turn your turn your mic on. You

098just put the on the top. There's a switch. Sorry to welcome so late. I missed most of the meeting, even though it was on virtually. But one topic I wanted to raise when I'm going to say this without passing any judgment on either side, but I see a big controversy coming down the pipe in the autism world and it's in the state legislature. And that's this communication bill of rights with non-speakers. There's been a lot of drama on it. Santa Barbara has one bill. Fahey has another. And I've seen a lot of stuff on social media back and forth about this and disputes within the community. And again, as Kate said before, you know, we need people with lived experience. I don't have that lived experience. I speak too much. But... The point is that

099there are there is a divide in the community and there's the one side with Santa Barbara where they want it to be as far as I can tell, whatever communication you choose on the side with Fahey that they're saying it has to be validated and autonomous. And so there's and I've heard people on both sides and I'm going to say this without passing judgment either way. I think this is an issue the board is going to have to address because it is an issue in the state legislature and where there is division within the community and division within the state. legislature. I think that just more information about that is important. So I work with a lot of non-speaking autistic kids that are pretty complex. The lack of communication should be a human right. The

100lack of access to communication for these kids in my in my opinion and in my lived experience from from being with these kids is that there's so much trauma that these kids and their families are going to have to endure because they aren't able to speak. So and that was when I was over listening to the three speakers at Santa Barbara's event earlier. One of the young men that spoke he so he used a speller they're called so they you you touch this you touch the letters on the spell board. The person helps you. All right. So when you think about people that are autistic and you add in co-occurring conditions. So you're not just talking about the person that's autistic. You're talking about the person that's autistic. And you add in motor planning issues

101that might be happening. A person who's using using a spell board has a person that helps them spell that in that is not considered quote unquote autonomous. But it is so like I feel like the board getting more information on it right so that that we have more knowledge on it. But like the bigger issue to me is the fact that like we can't be arguing about. The board that is not using a spell board has a person that helps them spell that in that is not considered quote unquote autonomous. But like I feel like the board getting more information on it right so that that we have more knowledge on it right so that that we have more knowledge on it right so that that we can't be arguing about. What types of communication

102devices people need they need something. Like I have a 10 year old right now that I work with who is non speaking and he still doesn't have a communication device. And there's a lot of debate on both sides of this what keeps talking about with the spelling there's a lot of debate about the communication partners issue so I think this is something the board needs to. Have a position on again because Santa Barbara has one bill fee. He has an other. and nobody's even bothered to look at the governor and see where she is on this. I would love to know where the non-speaking people are on this. I really don't. That's what's important, right? Like, Fahey has her opinions and Santa Barbara has his opinions, but what are non-speaking people saying? And all I

103know is that I went to the event earlier today and I listened to three non-speaking people speak through the use of those communication boards. They're here today talking about that. I think advocating for that. And I think speaking with people that are actually using those devices to communicate would probably be amazing if we could get somebody to come to the board meeting and share. I don't know if anybody could get back in touch with Santa Barbara to see what families he had, but there was an incredible mom there and she had her two young, they were young men, her sons there that were in their mid-20s, and they were both speaking. I know them. I know them. With their letter boards. So, yes, communication, it should be a human right. And I think that's what's

104leading to a lot of issues with lack of access then to mental health services because these kids and humans can't access communication, so then they can't access things like mental health services. They go to the doctor and, you know, it's hard for the doctor to figure out what's wrong because these kids can't tell them what's wrong. Yeah. Michael, thanks for bringing it up. We as a board, haven't traditionally taken positions on specific legislation in part because members of here talk about potential conflicts are appointed by the Senate and Assembly, but I think there's nothing wrong with us as a board talking about principles that we would want to see included in a process, like for an example, making sure that there's representation, that it's truly inclusive in how it's being debated, making sure all the

105voices are heard. Personally, I'd look for common ground among the differences in the voices, but appreciate you raising it because I have heard people talking about it. And people are certainly more than welcome and encouraged to, if you have an opinion, to express your opinion, but I don't think we have taken positions in the past on specific legislation. No, my only question is, since we are an advisory board to the government, isn't this part of why we were created to advise on these kinds of issues? Certainly to be heard and to educate. You know, I did ask Rachel, I said, have we taken a position in the past? Are we allowed to? And the answer is, I don't think we actually know. So it is something I think we should get back to you about.

106But in the interim, while we research it, I would strongly suggest that people have opinions to express them. And I would say, you know, we're, as a board, supposed to be about inclusion. And I just want to make sure that the process is in fact working that way. Yeah, I believe that every person has a right to communicate and how they can communicate. Again, I would just invite Michael to do some more research on spelling. You think speller boards? And talk to people who actually use them. Because it does increase agency and independence. For people. Absolutely. 100%. That was great. All right. So I think we'll move to public comment. Usually we have a couple, one or two online. I don't know if we have anybody who is waiting for a hand or is registered

107for public comment today. Yes. So if you are interested in giving public comment, and we do have a number of hands up, you can raise your hand virtually in the meeting. It's along the bottom of your screen. It's a little hand button. The first person we have up is Catherine Wheeler. And Catherine, you are unmuted and can give your comment. Good afternoon, everyone. I am here as a mental health professional and as a parent of someone who is multiply complex with neurodivergence. I wanted to know, has there been discussion around public-private collaboration? I appreciate all of the efforts that are going in. But they all seem to be staying within government systems, within OPWDD, within OMH clinics, Article 28 clinics, versus bringing in private practice. There are so many brilliant providers who would love to

108see and serve the Medicaid population, but it's just not financially feasible. Also, is there any discussion about accessing services when you fall in that financial gap? Yes. So many of the great services require Medicaid or a waiver, which is becoming increasingly difficult to get. But people aren't actually able to independently, you know, provide these things for their families. They can't financially pay for them. Thank you. Those are really important comments. I, you know, I agree. There's always more opportunity for public-private collaboration. And there's always been a challenge with what I call the benefits cliff for different, for various purposes. And it's not just to make sure that we are doing it in a way that's appropriate for all of our programs, in addition to Medicaid. But thank you. Next up, we have Gail Bonker. You

109should be unmuted. Gail Bonker. Thank you so much for allowing me to comment on this. My comment is pertaining to what was just being talked about the Communication Bill of Rights. I work with my sister, Elizabeth Bonker, who has come up to Albany many times. who is speaking autistic woman and communicates via typing. And I wanted to express that the current bill for the communication Bill of Rights, version C, we are asking Senator Fahey to restore that bill to its previous version, version B, S7792B as in boy, because, yeah, we also believe that everyone has the right to communicate in the way that works best for them. And, yeah, this is because, you know, a lot of non-speaking autistic folks have, you know, a co-occurring condition called apraxia, which basically means that their bodies can't,

110you know, necessarily move on demand as reliably as someone who does not have apraxia. And so the role of a communication partner, you know, is to basic is a lot, a lot of it is about regulation. So basically, like helping the non-speaker, the typer to be able to communicate, the typer to be able to use their gross motor skills to point to the letters reliably. And they do do that by themselves. But it's just an issue of regulation. And so that I feel like is something that is commonly misunderstood. We need to be presuming competence. And, yeah, and I know that another, another topic is that, you know, there's a debate about if typing is evidence based, and I can tell you that it is. There was a study in from the University of Virginia

111and published in Nature in 2020. That was an eye tracking study that measured the speed, accuracy, timing, and visual fixation patterns of non-speakers as they pointed to letters that they first select with their eyes. And the study showed agency and authenticity in typer communication. Dr. Elizabeth Torres, who Elizabeth, our executive director, works with a lot, who is a professor at Rock Pierce University, has also published more than 50 peer reviewed papers. And her studies on micro movements and autism show a constant bombardment of light, sights, sounds, and smells can be dysregulating and make typing more difficult, hence the need for a communication partner for many of our non-speaking folks. That we support. And then there was also a study in Cambridge University that used portable EEGs to measure specific types of brain activity to establish

112non-speakers comprehension of spoken language. So, yeah, so just to the point about it being evidence based, it absolutely is. And so, yeah, once again, we are asking Senator Fahey and everyone who works with her to restore the communication. Bill of Rights back to version B as in boy, because that was the original intent of the bill was to declare that communication is actually a human right for everyone. So, thank you for your consideration. Thank you, Gail. Next up is Lisa Faiton. I apologize if I said your last name wrong. Hi, I've never done this before, so I just wanted to make a few comments. I think it's really important to, to make a few comments on behalf of my son who is autistic and neurodiverse and myself. I'm an autistic adult. I'm 58 and I've

113gotten through my life with a lot of help. So I didn't know I was autistic until my son was diagnosed and I was 40 and he was nine and I was also diagnosed. So I've learned a lot along the way about myself in raising my son who's now 26. I wanted to start by just addressing the restraint and seclusion and the whole presentation was wonderful. I want to thank you for that. My son, unfortunately, I'm on Long Island. He was illegally restrained and secluded. I had to sue my district for a FAPE and place him privately in another school. And what I wanted to speak about is that although I'm very grateful that you have ended seclusion because that really caused a lot of trauma to my son, you haven't ended restraint. And I just

114would like the committee to think about what restraint does to a child. And there's a lot of evidence out there that discusses this. There were times when my son at that time when he was 9, 10 and 11 years old, he was held in an instrument closet. He was not held in a timeout room, which of course is illegal. But he was not just put prone. He was also not used the CPI methodology where he wasn't hugged. He was forcibly held down by multiple people. This included teachers. This included the rest of the family. This included the guards, the security guards, the principal and many other people in the school. And just like Josh Murski has described, I actually know Josh. He went through a lot of trauma. So did my son, who now has

115permanent PTSD and anxiety in addition to all of his other comorbidities with his autism. And I would like you to really consider as an advocacy and advisory board that when you restrain a child, it instantly puts them into a trauma state. And it instantly puts them in a state of trauma. It instantly puts their brain into flight or fight, which means they try to run. They try to get away from you. And now you're holding them down in some way. Even if you're using the hug, you're still putting them into a trauma state. And there's much better ways to help a child with a behavioral issue than forced compliance, as we talked about, which AVA is recognized, is the only recognized methodology in New York State. I would really beg you to look into Ross

116Green's methodology. Which is evidence-based, collaborative problem solving, or sometimes called creative and proactive solutions. It is a wonderful methodology. It looks to positive behavioral support. There's no punishment. There's no consequences. You ask basically, why is the child behaving the way they are? You determine why they're behaving. You look at the triggers for that child. And rather than making assumptions, like AVA makes four assumptions that there's four categories of behavior. There's a lot of other reasons why they're behaving the way they are. There's a lot of other reasons why children behave the way they do. And I do believe that all behavior is communication. So I'd really like you to consider that. You want to hear from the community. I'm speaking from the community. Anyone I know who's had their child restrained has a child with

117trauma. Lifelong, permanent trauma that no matter how much therapy I do with my son, it's not enough. We've done EMDR. We've done ACT. We've done CBT. It's not enough. My son is highly functioning autistic. He used to be diagnosed, you know, Asperger's. Now it's ASD level one. And he should have been a college professor, which is what he wanted to do and teach history. My son can't be in a confined space. He tried college three times. He can't go to college. He can't write. He has dysgraphia. He has dyslexia. He has dyscalculia. So he has a lot of invisible learning disabilities that are comorbidities with his autism. So to look at him or listen to him, he speaks and he sounds like a cop. He's a college professor. But my son, now that he's been

118so traumatized, he can't always get up on time. He can't take a shower. He doesn't want to move. He doesn't want to go anywhere. Because what if? What if this? And what if that? And what if this? And what if that? This was not my child before he was restrained. My child before he was restrained was going to go to college and be a teacher. And he was going to do that very independently. And that's not the case. My son still lives at home. He's 26. He longs to live independently. But he's not ready. And I really wish that the state would consider Ross Green's methodology. The Explosive Child, the book that he wrote, is out there. And there's a lot of people, for example, Christine Keller at the Sangha Center, teaches Ross Green with

119certified teachers. And there's so many parents that use Ross Green and see such positive support. I brought it to my school district. They used it with my son. He actually was able to come back to district. My son graduated with an honors regents diploma. My son was able to get a history award. But like I said, he couldn't go to college. So now he works part time. He cannot use ComHab. Why? Because my son had an aide who tortured him in a timeout room. So he doesn't want somebody else around him. So I have to drive him everywhere. But I have a limited budget for how much reimbursement I can get. I get $3,000 for OTPS, right? I can't use IDGS for him. Because I can't use ComHab for him. So I don't get reimbursement

120for the millions of places that I take my son to because I run out of money every year in my budget. So there's a lot of room for improvement, I think, with OPWDD and I think with all of the services. And you talked about the different communication, you know, between the types of communication. We're talking about nonverbal communication. People that communicate, like myself, I'm reading from a piece of paper, like my son, when my son is shut down and he's having a really bad day and he's having anxiety attacks and panic attacks, I can't just send him to the doctor. I have to take him to the doctor. I have to be there with him at the doctor. He won't use ComHab. So that's on me. And there's a lot of people that do speak

121that still have a lot of needs. And I think that also is part of this communication bill of rights. We very much want to say that we're in support of that. And the other thing I want to say, too, is that we're in support of the ComHab. And the other thing I just wanted to mention, I want to thank Josh Murski personally. I've met him. He's an amazing young man. And we are very, very proud of him for designing the neurodiversity flag. We love it. We love what it represents. We love the colors of the gold and the red and the white. I'm very excited that we've seen it on Long Island. We've seen it in Suffolk County. We've seen it in Nassau County. We saw it at Jones Beach. And we want to really

122be in support of that. And, you know, when I first started advocating for my son and advocating for autism when all of these bad things started happening to him when he was nine years old, everyone was talking about the puzzle piece. And there was all this conflict over do we use the color blue? Do we use the color red? But I think the red and gold and white is wonderful. And Eric and I, my son Eric, we really do appreciate everything that Josh has done. And we'd love to see that flag on every building in New York State. Because it represents inclusivity. It represents our voices. And we're very, very proud of what Josh has done. And we are highly in support of that flag. So I want to thank him for that. And thank

123all of you for encouraging him and encouraging the state to really think, you know, to use this flag. Because I think it's a very important symbol that we're out there and we matter and we're part of the community. You know, people don't know I'm autistic. I don't advertise it. But I am. And I live in the same world as all the other parents that are advocating for their sons. So I really appreciate you listening to my comments today. I really hope that we can make, you know, the state do better for our kids. Finally, last and final comment on the restraint and seclusion. I worked with the New York, it's NYADD. I worked with them on getting cameras into classrooms. It was rejected by the government. I worked on getting cameras into timeout rooms. It

124was rejected by the government. I worked on getting cameras into timeout rooms. It was rejected. I worked on getting cameras into group homes. It was rejected. Why do I want cameras? And I know there's a big privacy issue. But the reason I want cameras in common areas and in timeout rooms especially is because if you're going to allow restraint and you're not going to take that off the table, anyone can abuse that. You use words like reasonable. What's reasonable? Is it reasonable to hold a kid down when he's screaming? Is it reasonable to hold a kid when he's crying? For how long? Because here's the problem, when there's abuse, people can get away with that. And there has to be a limit on how much we're going to restrain a child when they're screaming, when

125they're crying. So I would just like that to be considered as well in the discussion about restraint. I'm so thrilled that you took off seclusion. We actually, my son spoke at a committee hearing on the seclusion. But it's not enough. We really need to end restraint in New York. It traumatizes children. And I really think it's important if we're going to advocate, if you're going to advocate for our kids, you need to realize that any time you restrain a child, you're creating trauma in their nervous system. There's tons of evidence, scientific evidence about this. And it's even traumatizing for me to talk about it. After I get off the phone with you, I'm going to need two hours of quiet just to talk. Excuse me. Just to talk about what was done to my son.

126So I apologize for the tears. It's just, it's really hard. And he's 26. This happened almost 20 years ago. And it's still impacting my son's life and my life in a great way. So I just really would like you to consider that as a board that's advising the governor, that really restraint is not the answer for our kids. And that there's other ways to help them. There's other ways to help our kids besides ABA. Other ways where there's no forced compliance. There's no punishment. The reason given, by the way, for putting my son in the timeout room, which was not a timeout room, it was a music room and another room with a bookcase in it, was that he wouldn't write. He was refusing to write. He was lazy. My son has dysgraphia. He can't

127write. They knew he couldn't write. They knew he had OT and it didn't matter. He still couldn't write. He had an IEP approved lap time. He had a laptop. And it was refused. They would not give my son his laptop. So he threw a pencil on the floor because of frustration, because they forced him to write. And then they told him he violated the code of conduct by throwing the pencil on the floor. And that was the excuse that the ABA person used to put my son in a classroom, in a musical instrument room, lock him in there and sit on him. So I just would really like this. This discussion to really include my son's voice and any other voices that may come along, because I know many people who have had children that

128have been restrained that are still traumatized today, 20 years later, because they were of his generation. Thank you very much for consideration of all of my comments. This is Michael Gilbert. I just want to say as a special ed attorney, there is a lot of issue with restraint. They're only supposed to restrain a student when they're a danger to themselves or others like running in the street. The problem is there's a lot of issues with it with the school boards and lobbying legislation related to restraint. So I think it's an issue we do need to work on, but it's not a simple issue. And there was something else she said I wanted to bring up, but I don't remember what it was. Michael, there are a couple more people who want to give public comment.

129No worries. I just wanted to respond to that. Thank you. I appreciate it. I just wanted to respond super quickly to her and let this mom know about the DIR floor time bill. That's on the floor this year, has been in previous years. And DIR floor time is a relational developmental model used with children that is more child centered, more trauma informed. The assembly version of the bill is A3896 in the Senate. Bill is S5107 if that mom is interested in looking into that. But my hope is that we can expand what is covered by health insurance in New York State to include 4K. I'm not sure how we're going to do that. But I do think that the DIR will be a good tool for the development of different models, like floor time and

130other developmental relational models. Because right now, yeah, ABA is making a lot of money. Thank you. Thanks, Kate. I also just want to say I think that takes a lot of strength to be able to come out and say that, especially on a public forum. So I respect that. You're really strong for coming up with that. Thank you, Josh. I think we probably have time for one more public comment. There are two other people who have your hands raised. steve board i'll put it in the chat so you have the email um if you'd like to get your comment that way um so i think our last commenter today is going to be barbara and barbara you should be unmuted hear me yes we can awesome my name is barbara vocatus and my comment is

131going to be very short um i am an educator teaching current teachers future teachers and i also am a parent of a neurodivergent child who is 19 right now and i am here mainly to express my admiration for josh mirski i met him some time ago he's absolutely amazing and i think that the flag he has designed and now promoting doing more things with that is extremely important because we need a movement i think that right now uh yeah education and not only inclusion sometimes is a little bit theoretical as opposed to actually happening in practice. And I can speak to it again as an educator and also as a parent of a neurodivergent child. And so we need something more. We need actions that are different, that are more innovative. And I think that

132is something that Josh is representing. And by the way, the choice for the colors of the flag is absolutely amazing. That is what neurodivergent minds are. They are incredible. They are powerful. And it's just that the world needs to know more about it. And that includes also teachers. I think that in the teaching world, I don't think we still do a good job with teaching teachers. How to recognize these minds. This is a little bit more within the special education. And as someone who is representing faculty from an educational institution that is supposed to and is doing this work as well as we can, we still need a lot of improvement. And I think that Josh is doing something absolutely amazing. And again, it's timeful. It's time for a larger movement. Josh is ready. And

133we also have to be ready. But he also needs help and support from all of us. I am ready to support him. I do it any way I can. And I also thank you all for your incredible work. And thank you for giving me the voice. And have a wonderful rest of the day. Thank you very much. That's very honoring. I appreciate that a lot. You are very welcome, Josh. You deserve it. So Courtney had to leave a tiny bit early. So all of you, please come back to the stage. And I think that is the end of the session. Thank you very much. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. So that will just close us out today. The next meeting is July

13422. If you have any questions or comments, the advisory board email is now being shared on the screen. So anyone that did not have a chance to get public comment today can send a comment in writing if that works for you or join the meeting in July. Thank you all for a great meeting.