Assembly Standing Committee on Health

If you represent one, all testimony comments are limited to the Bill at hand. We also welcome any comments or letters of support or opposition to our Health Committee portal as well. Today we have several bills proposed for consent for the hearing. Any Member of the Committee may remove a Bill from consent. Proposed post for consent today is item number one, AB 517, by assemblymember Soria. Item number two, AB 551 by Assemblymember Bennett, with amendments item number 16, AB 1131 by Assembly Member Garcia.

Item number 20, AB 1478, by assemblymember Cervantes. Item number 28, AB 798, by Dr. Weber. Item number 29, AB 915, by Dr. Aramula. And item number 30, AB 1325, by our Vice Chair, Waldron. And item 32, AB 614, by me Wood. So our custom is we do not start until we have representation from both parties. So we are missing our Republican Vice Chair. So as soon as we have a Member of the other party, we'll be able to start. Actually, we can start now. I appreciate.

Like, they're on queue. It was amazing. With that, I thought I saw Ms. Irwin, would you be ready to. You're not quite ready. Okay, you know what? In view of that, I have a Bill. I'll go ahead and present my Bill. Would you like to take over for me, Mr. Mccarty? Where's my little cheat sheet? Okay. False alarm. Mr. Low is here to present item number 21, AB 1577. Whenever you're ready, sir. A classic example of the early bird gets the worm. Well done.

Well, Mr. Chair, thank you very much for accommodations and allowing me to present in kindness and respectfully ask for. I vote. When you've established a quorum with respect to Assembly Bill 1577, which helps to ensure that we increase access with respect to health care. And I have two witnesses here in support to also testify as well. I respectfully ask for. I vote when you have a statue of quorum. Thank you.

Good afternoon. Thank you, chair, wood and Members of the Committee for Considering AB 5077. And thank you, Assemblyman Low, for your unwavering support of nurses. My name is Charmaine Morales, President of United Nurses Associations of California Union of Healthcare Professionals. California is facing a nurse staffing crisis never seen before. And the recent pandemic shed light on the nursing shortage, which was exasperated by the poor working conditions, burnout, and a lucrative nurse travel registry industry.

While the nursing shortage discussion has been ongoing and well documented, it is important for the State of California to intervene and implement a plan to save nursing immediately. UNAC UHCP recognizes the nursing challenges that have been outlined by the state for the past five years, and we feel it is important for California to act swiftly and solve the crisis. AB 1577 is an important component of solving the crisis by requiring hospitals to provide more clinical placements to community colleges as they grow their nursing programs.

Community colleges are best positioned to help resolve the staffing crisis, and we need to ensure that as students move through nursing programs, bottlenecks are not created, thus impeding nursing school completion. I am a graduate of Los Angeles Harbor College and completed my clinicals at Kaiser in Harbor City. And once I passed my boards, I went to work for the same hospital where I completed my clinicals. This is the perfect match for hospitals. Train the nurse and hopefully hire them.

AB 1577 will be a game changer for California, and I want to thank all of the stakeholders for working together to find solutions. UNAC UHCP appreciates all the recommended amendments, and we look forward to continuing to work collaboratively with CHA. Thank you. And I respectfully ask for your aye vote thank you.

Elizabeth Hawkins from United Nurses Association of, California, Union of Healthcare Professionals. I've been in the nursing profession for 38 years, and precepting is important and it also keeps nurses in the community in which they went to school because they tend to stay where they have done their clinical rotations. Thank you. I ask that you support this Bill.

Thank you very much. Others in support of the Bill.

Good afternoon. Chair, Committee, staff and Members, Christoph Mair with the American Federation of State, County and Municipal employees and strong support.

Thank you very. Actually, is there opposition to the Bill? My apologies. Aye was so excited. We were on a roll there. And before we have opposition, aye'm going to have Madam Secretary call the roll. We have a quorum it Wood here. Waldron. Aguirre. Curry. Arambula? Burner? Wendy Carillo? Flora? Vince Fong? Maienschein? McCarthy? Joe Patterson? Rodriguez? Santiago? Villapudua? Weber. Thank you. Thank you very much, Members. You have no idea how happy you've made me today.

And those of you in the audience may not understand, but trust me, this is a good thing to have a quorum. So thank you so much. And I just recognize, I hope to Members of the audience, this is an extremely busy week for us and today is an extremely busy day. So you're going to see Members coming and going. It's just the nature of what's going on today.

And so I'm really grateful the Committee Members to come and help me establish quorum so we can continue on. So please, our opposition witness. Thank you.

Sorry about that. Thank you, Mr. Chair and Member Sarah Bridge, on behalf of the Association of California Healthcare Districts here, respectfully opposed to AB 1577. I will note that our opposition originally hinges on the original iteration of the Bill, and we are excited about working with the author and the sponsors on potential amendments. I want to start by recognizing as well that we share the goal of increasing our healthcare workforce.

However, we disagree with an approach that hinges hospitals ability to provide care on clinical placement slots. Our primary concern revolves around the penalties and the threat to hospital licensure. District hospitals are some of the smallest rural and remote facilities in the state where clinical placement slots may not be appropriate or as robust districts are public hospitals, meaning they operate largely on public dollars and are owned by the constituents they serve, penalties come at a direct cost to the public and public funds.

ACHD supports a collaborative approach with community colleges to identify gaps that could be appropriately filled. However, the requirement that hospitals then meet a demand identified by the community college goes too far. Training students is incredibly costly and hospitals may allocate their clinical placement slots to fill particular specialties their hospitals or regions needs. Specifically, when the cost is financially insurmountable due to other financial considerations, hospitals must have the flexibility to change, adapt or eliminate these slots.

While we appreciate the intent of AB 1577, it simply goes too far at the sake of hospitals at a time where many district hospitals are struggling financially. We look forward to working with the author and the sponsors moving forward on an appropriate solution to address the workforce crisis. However, at this time, we would respectfully request your no vote. Thank you.

Okay. Thank you very much. Are there others in opposition? Seeing no one. We'll bring it back to the. Sorry. I'm sorry. I apologize. It's okay. Christy Weiss, on behalf of the California Hospital Association, we are in a position of concerns. Look forward to working with the author and the sponsors as amendments move forward. Thank you. We're all about health and fitness. I just didn't mean for you to have to run, but thank you. Questions? Mr. Flora? Thank you, Mr. Chair.

Mr. Low, always good to see you. And I am really, really wanting to support this Bill today, but I absolutely understand from a district hospital perspective the concerns that how these fines and potential loss of licensure, based on a community college's opinion or not ability to get slots. Can you address that concern? Because I do, because I think this Bill is righteous and we need to get more students in a clinical time. We absolutely agree with that.

But I do think that potential fines and loss of licensure is a problem. Can you address that for me. Thank you very much. Through the chair. Thank you very much. Mr. Flora. Specifically presented before us, too, in the analysis, and I forgot to mention that, like to accept the Committee's suggested amendments as well, which just simply addresses that of the fines we took out the removal of licensure, so that of the fines.

But ultimately, it's to help increase the type of access and making sure that the implementation also works, too. So I share that concern, too, and deeply committed to helping making the impact implementable as well, too, while also recognizing the potential concerns that you've had as well. No, and I appreciate that, and I am going to support the Bill today, but I will be checking with my district folks, because I don't want to do anything that's going to hurt my district people as well.

And hopefully we get that sorted out before floor. Thanks. Thank you, Mr. Floor. Mr. Fong, not to belabor the point, but is it my understanding that and reading the analysis that it authorizes but does not require a fines or a license to be revoked if they fail to meet, is that correct? So it does authorize one, but it doesn't require it. Correct. Not mandatory, but authorizes. Okay. But not mandatory. All right, thank you. Thank you. Any other questions or comments, Ms. Waldron?

So, just to clarify that the amendments also included that it only applies to hospitals near a community college that has an approved nursing school? Yes. Yeah, because not all hospitals have that. Thank you. Great. Thank you. Anyone else seeing no one Bill does enjoy a do pass recommendation. Would you like to close, Mr. Lowe? Just simply that committed to also working with Members of this Committee that expressed some of the concerns moving forward should this pass. This Committee, I respectfully ask for. I vote very well.

Thank you. Is there a motion on the Bill? The motion by Mr. Rodriguez, a second by Mr. Santiago. The motion is do pass as amended, to appropriations. Madam Secretary, please call the roll.

Wood? Aye. Wood, aye. Waldron? Waldron, aye. Aguliar-Curry? Aguilar-Curry, aye. Arambula? Berner? Wendy Carrillo? Flora? Flora, aye. Vince Fong? Vince Fong, not voting. Maienschein? Mccarty? Mccarty, aye. Joe Patterson? Rodriguez? Rodriguez, aye. Santiago? Santiago, aye. Villapudua? Weber? You have seven votes. You're trending in a positive direction.

We'll leave the Bill on call for you. Thank you very much. Mr. Connolly is up next. Before we. He can kind of wander up here, but we do have a consent calendar. If someone wants to make a motion on the consent motion by Ms. Seguer. Curry, a second by Mr. Mccarty on the consent calendar, which is item numbers 121620282930 and 32 diagonal. Bingo. There. Madam Secretary, please call a roll on the consent calendar. Wood. Aye. Wood. I. Waldron. Waldron. I. Aguyakuri. Agyar. Curry.

Arambula? Berner? Wendy Carrillo? Flora? Flor, aye. Vince Fong? Vince Fong, aye. Maienschein? Mccarty? Mccarty, aye. Joe Patterson? Rodriguez? Rodriguez, aye. Santiago? Villapudua? Weber? We have seven on the consent calendar. We'll leave that on call. Mr. Connolly, you have two bills. Let's start with AB 620.

Thank you, chair. Let's do that. And thank you again. And to Members. I'd like to begin by thanking the Committee and staff for their work and input on this Bill. And I will be accepting the Committee's amendments. AB 620 would require health plans to cover medical nutrition therapy. Medical nutrition therapy in the form of nutritional formulas can be a successful alternative to medication treatment for several diseases, including Crohn's disease.

This therapy has a particular benefit for pediatric patients because they may not have access to, or may not be able to use certain medications. Additionally, patients with intestinal bowel disease, or IBD, specifically Crohn's disease, can utilize medically necessary formulas for nutritional support to help them achieve remission. Early treatment options for metabolic and digestive diseases like Crohn's have proven to reduce harm and increase quality of life. There is no reason why Californians suffering from chronic illnesses cannot lead full and productive lives.

AB 620 provides patients with a proven, successful alternative to certain medications, which healthcare providers may recommend when complications such as weight loss, surgery, obstruction or severe inflammation prevent patients from getting the right nutrients. Exclusive internal nutrition, or even as it's known as a means to induce remission, is safer, improves growth and encourages healing in children over steroid therapy. Internal nutrition, or en, is a way to give the patient's body what it needs to stay healthy.

Enteral means passing through the intestines when nutrition is taken either orally or through a feeding tube. Enteral nutrition is usually taken in the form of a nutrient rich formuLA and some common formulas include boost, ensure and organ inherited metabolic disorders and digestive disease. And including IBD affects millions of Americans with as many as 70,000 new cases of IBD diagnosed each year. AB 620 will allow Californians suffering from these disorders to have greater access to nutritional support in addition to medication by expanding health insurance coverage.

To quote, medically necessary foods which have proven to reduce symptoms and improve quality of life, I will now pass it off to Dr. Sindhura Batchu, pediatric gastroenterologist. I think I said that right at UC Davis and I respectfully ask for an aye vote. Welcome Doctor.

Thank you chair and Members of the Committee, thank you for giving me the opportunity to speak today on behalf of our pediatric patients with inflammatory bowel disease. My name is Sindhura Batchu and I am the pediatric gastroenterologist, UC Davis. I come here to voice my support for AB 620, the prevalence of IBD is about 77 out of 100,000 children, and more recently, the number of children with IBD is increasing.

IBD, which includes Crohn's disease and ulcerative colitis, are progressive chronic intestinal conditions characterized by inflammation in various parts of the gastrointestinal tract. The progressive nature of this disease can lead to irreversible damage and, if not treated in a timely fashion, surgical removal of the diseased bowel. Current treatments can vary from five asas, steroids, immunomodulators and biologics, which works towards rerouting our immune system and decreasing inflammation. However, these treatments are not perfect.

A subset of our patients fail need dose escalation and more importantly, these medicines come with adverse side effects including infection, malignancy, autoimmune sequelae that need to be closely monitored. Another concern for patients with IBD is malnutrition. Many patients may experience weight loss due to their symptoms and pediatric patients are at risk for delayed growth and puberty development. This central issue in IBD impacts patient outcomes as well as quality of life, emphasizing the need for dedicated dietetic care for patients with IBD.

Medical nutritional therapy has been used in various forms of IBD since 1970s. Exclusive internal nutrition, or EEN, is defined as Administration of 100% of the body's estimated caloric needs by liquid nutritional formulas. Nutritional therapy targets our gut microbiome instead of our innate immune system to lower inflammation.

In our American Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines, it is an actual recommendation treatment for induction of remission of inflammatory bowel disease and given that there are no side effects, it is truly an appealing option in a select cohort of our patients. Supplemental nutrition can also increase energy and promote growth for those children that present with growth failure. Unfortunately, many of our family's internal nutritional therapy is not an option as it is not covered by insurance.

When I meet a family for the first time diagnosed with IBD, I see a sick child in a distressed family. My job as a physician is to set them on the best trajectory of gut healing wellness and avoid need for surgery. Providing them with any less desirable options, I feel is medically incorrect IBD treatments are already so limiting to begin with. An added barrier of insurance approval really limits a family's options.

A teenager who recently came to a practice with a new diagnosis, inflammatory bowel disease, he presented with a stricture. Okay. Given the extent of the disease and stricture, he was started on dual induction therapy with internal nutrition and biologic. The family was dedicated to do nutritional therapy. This would mean patient x would need to take seven to eight cans of pediature a day. Imagine having to do so and not feel great and worry about insurance coverage.

I can tell you I've had many families where this is not even a viable treatment option, and there was a lapse in insurance coverage. On behalf of our patients, I stand in front of you to urge to support AB 620 to allow all treatment options to be available to our pediatric patients with this chronic and very serious illness. Thank you.

Thank you very much.

Ryan Spencer. On behalf of the Crohn's and Colitis foundation, they are the sponsors of this measure. It was stated in the analysis and also reiterated in the Chaburp report. But I think it's worth restating that this is currently covered by Medi Cal through Medi Cal RX. And so what this Bill simply does, it applies it to commercial plans as well. And so I'm also here to answer any technical questions you may have and ask for your support. Thank you.

Thank you very much. Others in support. Okay. Is there opposition to the Bill? Uh, good afternoon, chair Members of the Committee. Robert Boykin with California Associate of Health Plans. Regrettably, in opposition to AB 620. We respect and understand the intent of the Bill. However, we are opposed because according to the Chaburp analysis, the annual health plan premium increase will be 24 million. But we do understand that the amendments will help maybe lower that cost.

But also keep in mind that this is one of 23 mandate bills this year that, when combined, are set to increase annual cost by more than 1 billion. So we've spoken with the sponsors in the author's office of the Bill and look forward to work with them as the Bill moves forward in a process. Thank you. Thank you very much, Mr.

Chair Members. Stephanie Watkins. On behalf of the Association of California Life and Health Insurance Companies, we do have an opposed, this is on the mandate list. But we do appreciate the constant dialogue with the sponsors and the author, appreciate the amendments that were taken and worked out with Committee. And so we'll continue that conversation as the Bill moves forward today. Thank you.

Thank you. John Wenger. On behalf of America's Health Insurance Plans, will just echo the comments of Stephanie Watkins.

Okay, thank you. Anyone else bringing back to the Committee for questions or comments? Any questions or comments? No, actually, Mr. Rodriguez is here, so there's three of us. The Bill does enjoy a do pass recommendation. Would you like to close, Mr. Connolly? Yeah.

I appreciate the consideration, the ongoing dialogue, and respectfully ask for an aye vote.

Wood? Aye. Wood, aye. Waldron? Waldron, aye. Aguilar-Curry? Aguilar-Curry, aye. Arambula? Berner? Wendy Carillo? Flora? Vince Fong? Maienschein? Mccarthy? Joe Patterson? Rodriguez? Rodriguez, aye. Santiago? Villapudua? Weber? We have four votes. We'll leave the Bill on call for you. Thank you very much to your witnesses. And you have another Bill.

Thank you very much. Motion by Ms. Aguirre. Curry. Second by Mr. Rodriguez. Thank you very much. The motion is do pass as amended to appropriations. Madam Secretary, please call the roll.

Thank you, chair. Another Bill? We're excited about AB 119. I want to start again by thanking you, the Committee staff, for the work on this Bill, and will be happily accepting the Committee's amendments in this case as well. I'm pleased to present AB 119 today, which restricts the online sale of sodium nitrite to minors and caps of purity, at which it is allowed to be sold at 10%.

Sodium nitrite is an inorganic compound and hard to believe this, but has become a frequent item used by teenagers to take their own lives at Low levels of purity 10% and below. Sodium nitrite is commonly used as a food preservative. However, consuming the compound in high levels of purity can cause fatal poisoning. While there is no real world application for sodium nitrate in concentrations of purity above 10%, major online retailers have been selling it at levels of purity up to 99%.

Because a chemical can easily be purchased in highly pure forms and delivered directly to an individual's residence, it has become a tragically frequent method of committing suicide. Shockingly, poison control centers throughout the country have reported a 253% increase in self poisoning with nitrites and 166% increase in fatalities in 2021 in comparison to 2018.

Assembly Bill 119 would address the ease of access to this dangerous chemical by prohibiting online retailers from selling sodium nitrite to miners, and prohibit the sale of sodium nitrite in concentrations greater than 10% to a person over 18 years of age. The Bill also specifies that retailers and online marketplaces must implement an effective age verification system and includes an exemption for legitimate business entities. This Bill has no opposition, and I respectfully ask for an aye vote.

Thank you very much, Mr. Connolly. Others in support of the Bill. Thank you. Yes. Mr. Chair Members Bryce Doherty, on behalf of.

The American Academy of Pediatrics, California, in strong support.

Thank you. Thank you. Anyone else? Is there opposition to the Bill? See, no one will bring it back to the Committee for questions or comments. Any questions or comments? We do have a motion by Ms. Aguirkuri, a second by Ms. Waldron. Bill does enjoy a do pass recommendation. Would you like to close?

Thank you. Again, I respectfully ask for an aye vote.

Thank you very much, Mr. Connolly. Madam Sec. The motion is do pass as amended. Madam Secretary, please call the roll. Wood? Aye. Wood, aye. Waldron? Waldron, aye. Aguilar-Curry? Aguilar-Curry, aye. Arambula? Berner? Wendy Carrillo? Flora? Vince Fong? Maienschein. Mccarty? Mccarty, aye. Joe Patterson? Rodriguez? Santiago? Villapudua? Weber? That Bill has four votes. We'll leave it on call. Thank you, Mr. Connolly. Ms. Irwin?

You bring gifts or props?

I could bring gifts, but that's probably not the goal.

We couldn't get skittles out of Mr. Gabriel, but we tried.

Good afternoon Mr. Chair, members, I would like to begin by accepting the Committee amendments and thanking the Committee staff for their hard work. I'm pleased to present AB 660 today. For too long, Californians have been misled by unclear labels on food. Stores offer products with all sorts of different labels, like expires on Best Buy, enjoy buy, sell by, to name a few. These labels consistently mislead and confuse consumers.

Sell by dates, for example, are meant to show grocers when to rotate stock and they are meaningless to the consumer. The result of this consumer confusion is a staggering amount of food waste, with one study attributing as much as 20% of food waste to these labels. This ultimately costs consumers money at the grocery stores and Addis to climate change as wasted food rots in landsfills. AB 660 would end this confusion.

It takes the industry's own adopted standard and requires food items that use date labels to use the standard items like we have on this milk bottle. Best if used by to indicate the quality of food or used by to indicate the safety of food. I would like to express my continued appreciation to the industry for engaging in productive conversations with our office. We will find a path forward with this Bill.

Recent author amendments to the Bill were made to address certain industry concerns and they are reflective of my commitment to continue to work with all stakeholders on this Bill. With me to testify today in support of this Bill are Nicole Curryan, representing Californians against waste, and Andrea Collins, representing the Natural Resources Defense Council.

Good afternoon chair and Members Nicole Curry and with Californians Against Waste, we are proud to co-sponsor AB 660, which will streamline expiration date labels by requiring the use of consistent terminology next to an expiry date to indicate the quality and safety of a food product. A study by Refed found that standardizing these labels is the single most cost-effective way to reduce food waste. Data also shows that households make up a whopping 43% of food waste, by far the largest category of food waste.

When broken down by supply chain stage, this is more than grocery stores and restaurants combined at 31%. As I'm sure you're aware, consumers are bombarded with all types of expiration date label formats. Each term can be used to mean different things when used by different brands, and some expiry dates have no phrase next to them at all. In 2017, the industry's two largest trade associations released a joint statement announcing that they would implement uniform date labeling using the recommended quality and safety date phrases.

They promised large scale adoption by the following summer and committed to 100% implementation by 2020. The Legislature then codified the industry's proposed terminology in 2017 with AB 954 as a voluntary standard and directed CDFA to promote the use of these terms and discourage the use of consumer facing sellby dates. AB 954 also established separate definitions for a quality date, safety date and sellby date and statute, and this Bill passed with no opposition.

However, if you've recently stood in front of your fridge or pantry and squinted at a label, you know that voluntary implementation is clearly insufficient. Further consumer education as to what phrases on which foods mean, what isn't possible until we streamline these labels, wasted food is a societal, economic and environmental problem.

As a state, we throw away 6 million tons of food every year, releasing methane emissions that have a climate impact 86 times greater than co2, not to mention the amount of money spent on food that never gets eaten and the costs of dealing with this excess waste passed on to ratepayers. AB 660 simply requires all brands to use the same terms that they themselves have identified to reduce consumer confusion and that the state has adopted as a voluntary standard.

This small change will have huge ramifications and for this region, we urge your aye vote on this Bill. Thank you.

Thank you. Please go ahead.

Thank you chairwood and Committee Members. My name is Andrea Collins with the Natural Resources Defense Council and we support AB 660 because it addresses a systemic cause of food waste with implications for our health, our environment, and our economy. Too many of us look at a container of milk, see that the date has passed, and decide to dump it rather than risk getting sick.

However, the date on milk, whether it uses those words or not, is likely a sell by date, meant to help grocery stores with stock rotation and many of the other dates on food are intended to be an indicator of peak quality. In fact, there's no way of knowing which dates are actually safety dates and should tell a consumer not to eat the product.

Instead, consumers are left to guess at what information is intended by the date on the package, and more than 80% of Americans report tossing food simply because it's past date. We need consistent date labels so that people stop tossing good food prematurely, and also so that we have more clarity on which foods are really a health concern.

Confusion over so called expiration dates is responsible for 20% of the wasted food in our homes, and Americans spend one $300 on discarded food every year, eliminating confusion over whether food is still good will help keep some of that money in the pockets of Californians. We have enough food. Yet 8 million Californians face food insecurity and food packaging dates are a challenge for food banks and pantries that help ensure that our seniors, families and folks in need of emergency food assistance have enough to eat.

People who receive food from pantries may be reluctant to take those items that are near or past date because they believe that the item is unsafe after the date. Whether or not that's the case, the need for food assistance in our state is immense, and food insecurity is detrimental to the physical and mental health, with outcomes that include diabetes, hypertension, behavioral challenges in children. And these negative ramifications should make any attempt to improve food security a priority for public health.

Additionally, people in food deserts or food apartheid regions, which are largely indigenous, black, Latino and rural communities, and those who are dependent on the emergency food system are purchasing or receiving food that's closer to the date on the label, meaning that they're more often plagued with the question as to whether or not to toss food past date, making this a significant equity concern. And a larger percentage of their budget is spent on food.

So the consequences of tossing that food make a bigger dent on their household incomes and finances. Ensuring that all of us understand when food is still good to eat will help alleviate pressure to toss food that could have nourished us. And defining a standard for consumer targeted labels clarifies when food actually poses a safety risk and reduces the likelihood of discarding good food. So for these reasons, we're proud to support and sponsor this key legislation. Thank you.

Thank you very much. Others in support.

Rebecca Marcus, representing Kalperg in support.

Thank you.

Izzy Swindler from Shah Yoder, Antwi Schmemzer and Lang representing a few different groups. California Product Stewardship Council, National Stewardship Action Council stop waste in support. Thank you.

Thank you.

Amara Ager on behalf of Rethink Waste, California Compost Coalition, five Gyres Institute and Plastic free future in support.

Thank you. Anyone else see? No one will go to opposition.

Good afternoon. Dennis Albiani testifying on a couple of different entities that have varying different ranges of positions. So I'll explain that as we go. So I represent consumer brands Association, and we, along with the Food Market Institute, actually developed, did significant research and developed the terms that are outlined in this Bill. Also worked with Mr. Chu when the Bill went through 954 and spent a lot of time in this area.

It's actually some of our own reports that have been used by the proponents to justify the Bill. And we are supporting federal legislation and we think that is by far the best way to do this. Single state legislation is very challenging. It's a concern to us that when you mandate something, it brings along liability, whether it's 7200 liability, unfair business practices of those.

So that's a concern to the consumer brands Association that has been very involved in this and has been moving this forward and making great progress. Although admittedly not 100% compliance as discussed, there are some other issues with some of the smaller food manufacturers, out of country, out of state manufacturers and how they would comply. I think that's a concern that needs to be further discussed. And the real issue is consumer education.

Regardless what the terms are, we need to be able to educate them so that some of the concerns of the proponents, which are very valid, are able to be recognized. Now. On behalf of the Pacific Egg and Poultry Association and the associated California egg farmers, we are concerned and need to believe that eggs should be removed from this Bill. And we've testified several times, had several conversations with the author. The eggs are governed by a whole USDA structure of regulations, significant state law.

It's actually codified in state law, it has been for years. And how we do that. And so we're a little bit concerned, and I'll just say this, that I think consumers, and I think most people, I was just at the farmers markets this Saturday, consumers have a very different relationship with their eggs than they do with their pancake mix. And I think I knew they'd get at least a good smile. I think that's very real.

And they demand certain things and they want the dates on there and they want to know what's going on with their eggs again, crackers, pancakes, different things and different standards. So we believe that eggs should be removed from this and we'll continue to have that position. So with that, we are working with the author, work with the staff, keep working on the opt in, appreciate some of the amendments that they're bringing forward, and look forward to working on that issue as it progresses. Thank you.

Thank you. Others in opposition. Hello, Ryan Elaine on behalf of the California Retail Association, we have no formal position. We're working and committed to working with the author. There's initial concerns, but just want to let everyone know that we're going to work those out. Thank you.

Hi, Margie Lee. On behalf of the California League of Food Producers with some concerns but appreciate the author.

Thank you. Anyone else? Any questions?

Excuse me. I'll make a comment. As a consumer, I get so confused by these sell by, do, buy whatever on the packaging. So I applaud you for working on this. I know you'll continue to work on it because there are some issues. Those of us that are in ag have some concerns about it, but I do think we need to hone in on it. I know the Federal Government's working on this as well, but how long do we wait? And the waste is just incredible.

So I'll be supporting the Bill today. I would hope that you'd continue to work with the opposition.

Thank you. Anyone else? I want to thank the author. I supported this in the Ag Committee, and I remember supporting 954 back in 2017, and it is confusing. I mean, Mr. Albani, what is the designation on eggs? What does a carton of eggs say?

Sell by dates. Well, it says sell by on 30 days, and it's codified in law. That's what's required.

And so what does sell by mean?

It means that the folks need to sell it within 30 days, and then after that, you have time. But eggs do start to, their quality greatly diminishes after about 40 to 45 days, and you'll start seeing to where the yellow starts blending into the white. And it really degrades over time pretty quickly after the 30 days.

So the sell by is 30 days, but it can go for 45. And you just illustrated the challenge that consumers have when you says sell by. I don't know what that means. And so I think it's an expiration date. So I've probably thrown a whole lot of eggs away that I could have used with my pancake batter or whatever else. And I appreciate the conundrum, I really do. But I think you all know that California doesn't always wait for the Federal Government.

If we did, my goodness, the number of things in the healthcare space, we'd be stuck in the mud. Our Bill that we did to protect consumers from surprise medical billing was passed in 2017 or 2016, I believe, and it took the Federal Government six plus years to catch up with California. So we're not going to wait. And actually, I would just say, know, people selling food products, why not follow a standard that we set in California? Why wait for the Federal Government moving forward?

So I don't think we need to. We had this similar discussion around the dancing arrows on recycling of plastics and things like that. Nobody wants to have different labels for different states, so why not just do the right thing and do it quickly and let the Federal Government catch up five or six years from now and let us as consumers know what we're eating, what we can use in our pancake batters, and what we can't in a more accurate way.

And I would just say the Bill was passed in 2017. Here we are six years later, and we took it on faith that the industry was actually going to do more than has been done. So I think in response, we're kind of tired of waiting, quite frankly.

Sure.

And the 25 top producers who signed on to the MOU have evolved, as we mentioned, some of the smaller ones, some of the other entities don't. I did want to address that. Just one issue. I generally agree, but I do want to say, do you prefer to have a date or no date? I'm using on eggs and I think consumers do prefer a date and would prefer that.

And I think if we didn't do that, we would get, and I'm pretty positive this is how it works. I know the egg industry, we would become the dumping ground of eggs from repackaging out of other states that have tighter dates. So this is a walk, and I appreciate your points and we talked about it. We do need to be very careful about how we handle this. And then I think we are making progress. Appreciate that we're working with the folks and we'll continue to.

But I do think there is a difference when you look at eggs and even dairy.

I think we want a date and we want to know what that date means.

Sure.

That's the bottom line.

We agree 100% on that.

So how do you envision the label on eggs?

I would keep it with what the consumers are currently familiar with, which is sell by, and that's been codified and kind of standardized throughout the country. But again, we can have that conversation. But if we don't standardize it across the country, I think it's going to be very difficult for people to do that type of education that's required. Well, I don't remind, but just want to say there is likely to be very major federal food and agricultural legislation passed this year. It's called the farm Bill.

They do it every five years. And it's kind of like our budget. You put in a Bill and it gets into the budget. You put in a federal Bill, which we're supporting and you play that out. So we're working on.

And then my final question. I like this Bill. That's why I'm talking about it so much. So what does the egg industry do to educate consumers about what the sell by date means? Because I didn't know. I just assume when it says sell by. That means that it's an expiration date. So what will the egg industry do? Sell by and goodbye. How do I know? Because I didn't know until you just told me today.

So the proposal would put best if used by. And I think that's on an egg carton. And I think that has a similar undefined at this point, I guess the idea would be post the Bill being passed that then there would be some consumer education element to it. But I think there is an equivalent amount of, if there is confusion, equivalent amount of confusion on many of the terms.

I think that's why the entities got together and did a whole lot of consumer review and trying to figure out what they could promote. As this moves forward, I look forward.

To learning how to take care of my eggs because my dog gets a lot of them rather than throwing them away. So anyway, thank you.

Fair enough.

He survives. So I guess they're okay. You may move the Bill. I'd be happy to second the Bill, Ms. Erwin. The Bill enjoys a do pass recommendation, but there is a sell by date. So would you like to close?

Okay, I won't make it too because you've already made most of my arguments for me. And we do want to reduce consumer confusion. And I will state again, we will continue to work with Mr. Albiani and the industry, but when we talk about zero, California should slow down, we're slowing down on what already is a national voluntary program.

And if the farm Bill passes, I would be pretty certain that they would use the same standard that the industry has come up with, which is again best if used by, if it is to indicate the quality data food or used by, to indicate the safety of the food. And we have dairy that's already doing it. We have enjoy by which doesn't. We don't know what that means.

We're not sure what this date means, but we do have the Julian date on here, which I think we were talking about in Ag. So let's reduce consumer confusion and work to reduce our effects on climate change by putting less food into the landfills. And with that, I respectfully ask for your vote.

Well, thank you very much, Assembly Member Irwin. I know you'll continue to work through with the opposition on this. And yeah, it would be really great to see that we aren't wasting as much food as we currently do. And then there are issues that will impact the Department of Public Health, which we hope that you'll continue working with the Committee here as we finalize this piece of it. So we have a motion in a second. The motion is do pass as amended to appropriations.

And I want to thank the opposition, too. This is difficult, I recognize. Maybe we can have breakfast someday.

Yeah, exactly. Steak and eggs. We'll go for it.

Madam Secretary, please call the roll. Do pass as amended to appropriations. Wood, aye.

Wood, aye. Waldron? Waldron. Not voting. Agar Curry. Agar Curry, aye. Aramula. Verner, Wendy. Carrio. Flora, Vince Fong. Maienschein. Mccarty, Joe. Patterson. Rodriguez. Santiago Villapudua. Weber. Weber, aye.

That's 30. We'll leave the Bill on call. Thank you very much. Looking around, Ms. Schiavo, whenever you're ready. You have AB 710. We'll start with that one, if that's okay.

Yes.

Thank you so much. Thank you, Mr. Chair and Members. And I'd like to begin just by saying I accept the Committee's amendments and am appreciative of the staff for working with us to make improvements on the Bill. We are all aware of the crisis facing abortion rights in America at this time.

I am passionate about bringing to light the issue of deception that constituents in all of our districts encounter at a critical time when they're faced with a very difficult decision, something personal to them, to their bodies, and to their health. Across California, crisis pregnancy centers outnumber abortion clinics by 20%. These clinics use deceptive practices targeted at vulnerable populations to draw them in by claiming they provide abortion services when they have no equipment nor capacity to provide abortions.

These crisis pregnancy centers shame, intentionally mislead and lie to women about their reproductive health care options to block them from accessing abortion care, and are confusing a lot of people in our community. As a nurse advocate who worked with nurses on ensuring safe access to health care, I see it as extremely dangerous that these fake pregnancy centers present themselves as medical clinics. To be clear, they are not licensed medical clinics.

While women are in their most vulnerable state, working to get reliable medical information and possibly referrals for or abortion care, they instead are met with shaming and fear tactics and Fed misinformation about abortions, leading to infertility, depression, and higher suicide rates. All misinformation. AB 710 will deliver accurate information about how these fake women's healthcare centers operate and what options are available for people.

This legislation would prompt the launch of a public awareness campaign to communicate the facts about actual pregnancy care and abortion services being provided at primary care specialty clinics. When women need to access health care, it's critical the information they get is factual and that the providers have your best interest in mind, not an agenda to discourage you from seeking abortion care with AB 710.

Factual information will be delivered to the General public as well as those in the healthcare space to ensure anyone seeking abortion care would know where they can get medically accurate, comprehensive and unbiased information. Timely reproductive health care is essential and must be met without delay. The delay that these fake healthcare centers can impede a pregnant person from making the choices that's best in their families and their healthcare needs. Rest assured, California will continue to lead by protecting women's health care, including abortion care.

I have with me today as witnesses Shannon Hovis, Director of NARAL Pro Choice California, and Dr. Kelly Pfeiffer, Executive Director of ARIA Medical. Thank you.

Good afternoon, chair and Members. My name is Shannon Olivieri Hovis and I'm the Director of NARAL Pro Choice California, representing NARAL's 4 million Members nationally who are fighting for reproductive freedom. Reproductive freedom means that every individual has the ability to make personal decisions about their reproductive lives, free from government interference and free from any form of oppression or coercion. California law strongly protects reproductive freedom, including the right to access birth control, abortion care, prenatal care and more.

And since the Supreme Court overturned Roe v. Wade nearly one year ago, California has taken additional steps to ensure that Californians and those forced to travel here understand their legal rights to access abortion care, including by creating abortion CA Gov. But the reality is that California must do more to ensure that all communities, including immigrants, LGBTQ plus, foster youth, people experiencing homelessness and more, have access to medically accurate and comprehensive information about services available. Abortion services, in particular, available in our state.

Fake health centers, sometimes called crisis pregnancy centers, threaten reproductive freedom and prey upon our most vulnerable communities, frequently targeting people of color and pregnant people with Low incomes. Fake health centers are run by antichoice organizations that intentionally lie to shame and mislead pregnant people seeking an abortion in order to block them from accessing care. These groups provide few or no real medical services, mislead people about the services they do provide, exaggerate the likelihood of miscarriage in early pregnancy.

To downplay the urgency in seeking abortion care, push health disinformation, like emphasizing non factual relationships between abortion and infertility as well as breast cancer, to dissuade pregnant people from accessing abortion, and have been shown to delay access to medically legitimate prenatal and abortion care. Alarmingly, as Assembly Member Shivo said, the number of fake health centers in California is 20% higher than the number of health centers that provide abortion.

Everybody deserves to have access to the medically accurate, comprehensive and unbiased information they need to make personal decisions about their lives. AB 710 will complement abortion CA Gov by establishing a public awareness campaign to communicate the facts about pregnancy care and abortion services being provided at primary and specialty clinics in California. This Bill reflects one of the recommendations of the California Future of Abortion Council, and I urge your. I vote. Thank you.

Thank you. I'm Dr. Kelly Piper. I've been an abortion provider for over 25 years, and I currently practice in rural California, Arizona and Kansas. And I recently started a medication abortion clinic in Kansas. Every day I see people who've been harmed by these fake clinics. Many patients are made to go through later, more complex procedures because they went to a fake clinic thinking they'd get the abortion pill.

They're told they're too early to come back repeatedly, and then they are too late in any other part of medicine. When I get a test result from another Doctor or clinic, I trust it.

When I get an ultrasound from one of these clinics, I have to repeat it, because we've had cases where people have been given the wrong image, to be convinced that they're too far along when they're really too early or when they're convinced they're much earlier, just to run out of time, always to make sure that you can waste time until someone no longer has that option.

My patients have no idea that their information is not private, that these are not real medical clinics, and that people can share their private data with whomever they want. I see teenagers who will be profoundly harmed if their families found out they are pregnant. And these centers have no obligation of confidentiality.

I see patients weeping because they fear they will never be able to have a baby again, that they're going to get cancer, that they're going to get some terrible things that they've been told, and they're desperate to have their abortion. They come anyway, but they're terrified of what they're doing to themselves. All of these things that they walked out of this clinic believing they were true, but they are not true in any other part of the healthcare system. This would be inconceivable.

Can you imagine going into a cardiologist and be given a fake result to convince you that you're about to have a heart attack, to trick you into surgery? This happened in Redding, California. It was criminal and it was shut down. But in fake clinics, people get this information that affects them profoundly false information, and there are no consequences. Californians deserve to be informed. They have the right to medical care without being tricked. I urge you to support AB 710 and thank you for inviting me today.

Thank you others in support. Thank.

Thank you.

Chair and Members Erin Evans on behalf of the California Nurse Midwives Association in support, thank you. Good afternoon. Molly Robeson with Planned Parenthood affiliates of California in support, thank you.

Good afternoon. Ryan Suez, on behalf of Essential Access Health in support, thank you.

Veronica Villalobos with the California Latinas for Reproductive Justice in support, thank you.

Thank you.

Dr. Taiwo, midwife with Black Women for Wellness and Black women for Wellness Action project strongly in support of this Bill.

Thank you. So opposition to the Bill please come up.

Mr. Chair and Members of the Committee, it is an honor to be before you today. Hello, my name is Heidi Matsky and I'm the Executive Director of Alternatives Pregnancy center in Sacramento. I oppose AB 710, a Bill that defames and falsely accuses licensed medical clinics like ours. This Bill, as defined in the fact sheet, also seeks to derail women's access to comprehensive health care provided through pregnancy centers like ours.

At Alternatives Pregnancy Center, underprivileged women receive pregnancy tests, ultrasounds, prenatal care, full service gynecological care and treatment, abortion pill reversal services and post abortive care at no charge, nearly $1.5 million worth last year. Our website, signage and phone personnel clearly state that we do not perform or refer for abortion, and instead we provide unbiased, peer reviewed education on abortion procedures so women can make informed choices regarding their pregnancies and their reproductive health.

The doctors, nurses, nurse practitioners, medical assistants and phlebotomists at alternatives are all licensed medical professionals. Many have experienced or performed abortion in their past and are compelled to help others. Atoria is a patient of alternatives who was faced with domestic abuse, homelessness and an unplanned pregnancy, only to be handed the abortion pill as Planned Parenthood's only option. Instead, at Alternatives Pregnancy Center, Atoria was provided abortion pill reversal services, prenatal care for her healthy baby, financial support, housing support and emotional support.

Shannon is one of 177 women in the last two years who was denied care at Planned Parenthood because they would not choose an abortion and then came to alternatives for comprehensive medical care. Kelly was told by Planned Parenthood that abortion was her only option, but was never educated on the different procedures or how they would impact her long term. They provided her with five abortions, and it was years before she found healing through post abortive classes offered for free.

At Alternatives Pregnancy Center, Ariane was pregnant, struggling with addiction and homelessness. Alternatives provided comprehensive care and housing for her. Now she has a healthy daughter, has recovered from her addictions and is mentoring other women. After living as a man, choosing to detransition, Jess sought us out a place that wouldn't shame her, but instead provided the gynecological care she needed as a woman would the medical team and staff of Alternatives Pregnancy center please stand right now. Who was there for these women who needed comprehensive medical care?

Who was there when they wanted to practice their full right to choose? Alternatives Pregnancy center was the licensed medical facility that was there for every one of them, as many pregnancy centers throughout California are, I am grateful for our God who has made the work of alternatives possible, for we love because he first loved us. Now that the facts and the truth have been presented, you must recognize that this Bill seeks to discredit the very facilities that women deserve to have access to.

So I'm asking you to respectfully oppose AB 710.

Okay, thank you. Please, no applause. And we don't know, no expressions one way or the other. No applause, no booze, no anything. So thank you. Next witness, please.

My name is Atoria Foley, mother of a daughter born after two successful abortion pill reversals. I stand here today in full opposition of Bill AB 710, AB 710's manipulative verbiage begins with describing pregnancy care clinics as fake, intentionally misleading, even going far enough to state that pregnancy care centers shame pregnant women. In all actuality, I would describe my experiences with Planned Parenthood as fake, shameful, and intentionally misleading.

AB 710 also claims that those seeking abortion services are derailed by the number of pregnancy centers in California. Yet here in downtown Sacramento, two Planned Parenthood locations sit a mere eight minutes apart. There is no shortage of abortion accessibility in California as a result of the openly biased and disprovable statements used in Chiavo's summary of AB 710, the deceptive nature behind this Bill is revealed immediately, refuting the claim that, quote, accurate and unbiased information would be distributed through this campaign.

Instead, what AB 710 will accomplish is the intentional swaying of a vulnerable population of women and men towards seeking abortion services through limited and biased information. Misinformation. Misinformation that holds the power to end the life of an unborn baby, a child whose life may be preserved if their mother has full access to comprehensive medical care, as I received at Alternatives Pregnancy center and truth regarding abortion. Truth such as the validity behind abortion pill reversals. Truth that a reversal does not harm a developing baby.

Truth that my daughter is a living testament to after two attempted abortions and two successful reversals within one pregnancy. A truth that AB 710 seeks to silence. It is absolutely crucial that people receive unbiased care and information when considering abortion, including information about reversals at Planned Parenthood. I did not receive that. As I sat in fear and regret asking how to reverse my abortion, I was told that I safely could not. That was a lie.

I found myself repeatedly apologizing to the nurse as she increasingly grew in her annoyance. Annoyance at my hesitancy, annoyance at my tears, annoyance about my questions about abortion, pill reversal. I look back on myself that day, and I am saddened at who I was. I was scared, sad, lost and afraid to speak up for myself. But I am no longer that version of myself today. And today I will not be afraid to speak up. I will speak up for women in my past shoes.

I will speak up for God, the author of Life, to speak up for those who cannot yet speak for themselves. Lastly, I will speak up for what is wrong. And AB 710 is deceitfully, intentionally wrong. It is my hope that you will speak up and stand with me in opposition. Thank you.

Thank you. Are there others in opposition? So just your name and organization if you represent one.

Sophia Laurie with young women for America, California Family Council, and relative to a woman who was lied to by planned parenthood.

Just your name and position, please.

Pastor Brandon Campbell with the California capital connection for Independent Baptist churches. In opposition. Thank you. Shannon Gale. I'm a mother, and I'm in strong opposition.

Thank you.

Susan Goslin. I'm a nurse practitioner at alternatives Pregnancy center, and I strongly oppose. Thank you.

Hi, I'm Jess Rose. I was born a woman, transitioned to male and identify now as a woman. And I oppose this Bill. Thank you.

Arianne Clark, resident of California and a mother. I oppose this Bill. Thank you.

Lisa Eichinger, Alternatives Pregnancy center. I strongly oppose this Bill.

Thank you.

Alina Vancouver, a sac state student, and I oppose this Bill.

Thank you.

Diana with alternatives Pregnancy center. As a licensed phlebotomist, and I strongly oppose this Bill.

Thank you.

Rebecca Lathrop, with alternatives Pregnancy center. And I oppose this Bill. Thank you.

Nellie Vasilkov with city Bible. And I oppose this Bill.

Thank you.

Nikki Detner. And I oppose this Bill.

Thank you.

Aksana Pisariva, registered nurse, strongly oppose this Bill.

Thank you.

Charlene Bellamide, a phlebotomist and mother of five. I oppose this Bill.

Okay, thank you.

Dr. N. Almanji Obijivayn. I strongly oppose this Bill. I'm a medical Director of Alternative Pregnancy center.

Thank you.

Rainy day Garcia, Alternatives Pregnancy center. And I oppose this Bill. Thank you. Hello, Committee. My name is Robert Bird. I'm a Bay Area resident, political independent. And I urge you to vote no on this Bill. Thank you.

Thank you, chair and Members. My name is Jonathan Keller, President of California Family alliance, also speaking on behalf of the California Southern Baptist Convention. And there are 2000 churches respectfully opposing the Bill. Thank you.

Anne Bray Dean, representing 45 day, 40 days for life. And I strongly oppose this Bill.

Thank you.

Kelly Bradford, multiple post abortive woman. And I oppose this Bill.

Thank you.

I'm Olga Herman. Reverend Olga Herman.

I'm with JC Resource center and I represent life teams and the Prayer Council of the United States. And I oppose of this Bill. Please.

Thank you, Greg Burt with the California Family Council in strong opposition. Thank you.

Thank you.

Amy Sherchlick, volunteer at Sarah Pregnancy plus health in Roseville. And I strongly oppose this Bill.

Thank you.

JC Carpenter, and I am a founder of life love leader with 40 days. For life and three time post abortive woman. I staunchly oppose this Bill. Thank you. Bob Simmons with alternatives and adoptive father. I strongly oppose your Bill. Thank you. Dr. Vanson Wong, Obgyn, in opposition to this Bill. Thank you.

Jackie, the street preacher of Kingdom Roar. And I strongly oppose this Bill as an adopted daughter.

Thank you. Anyone else? Clifton Billings, 74 year old Vietnam veteran, born FDA microbiologist. I strongly oppose this Bill. Thank you. Seeing no one else, we'll bring it back to the Committee. Questions or comments? Dr. Weber.

Thank you to the author and to the opposition and to the supporters. I actually had not planned on speaking on this Bill, but the statements from the opposition has compelled me to speak and to ask a few questions. Are your physicians board certified and Members of ACOG?

Yes, they are.

So do you align your principles and policies with the American College of Obstetrician Gynecologists?

Our policies and procedures? I would have to ask them for that.

Okay, well, I'm looking at them in the audience and they're not saying anything. So what randomized control trials have validated the abortion pill reversal services?

I don't know that there has been. I know that the FDA, there was a trial that was being done in Southern California, but I don't know how that trial ended. What I do know is for the last four years, alternatives pregnancy center has been doing abortion pill reversal services and there have been at least 100 women who have had babies as a result of it.

Have you put those into actual, like a paper or an article or peer review so that it could be evaluated?

No, I have not.

All right. And the reason why I ask is you've said a lot about abortion pill reversal services. There was testimony that was very moving about the fact that you had not been counseled on that as a possibility. And I am an Ob GyN and a Member of ACOG and I'm board certified. And ACOG states, facts are important, which is true. Medication abortion reversal is not supported by science. Facts are important, especially when it comes to policies and discussions that impact patients claims regarding abortion reversal.

Treatments are not based on science and do not meet clinical standards. The American College of Obstetrician and Gynecologist ranks its recommendation on the strength of evidence and does not support prescribing progesterone to stop medication abortion. A 2012 case series reported on six women who took mifristone and were then administered varying doses of progesterone. Four continued their pregnancies. This is not scientific evidence that progesterone resulted in the continuation of those pregnancies. These case control series with no control groups are among the weakest form of medical evidence.

Can I ask a question?

A 2020 study intending to evaluate medication abortion reversal in a controlled IRB because the initial one was not IRB approved, the initial one that had six people, the study was not supervised by an institutional review board, IRB, or an ethical review Committee required to protect human research subjects, raising serious questions regarding the ethics and scientific validity of those results in 2012.

So a 2020 study intending to evaluate medication abortion reversal in a controlled IRB approved setting, that's probably what you were referring to a couple of years ago, was ended early due to safety concerns among the participants. So I ask if your practitioners are Members of ACOG, are board certified, and align their policies with ACOG, because this is important if patients are coming to you or your facilities, wherever they may be, in a very vulnerable state. Right? Pregnancy, sometimes it's a surprise for people.

There's a lot of different emotions going on. It's extremely important that they are counseled properly on medically found information.

As an OBGYN Doctor, what would make you not want to allow a woman to have a second chance at life to save her baby as that has happened time and time and time again at alternatives?

As a physician, all physicians went to save lives. That is what we go to medical school for.

Why would you be in opposition to what we are doing?

This is not a back and forth.

So that is what we go to medical school for. That is what we do our residencies for. And for those of us who go on, like myself, to do a fellowship, to do extra training, that's what we do it for. We all want to save life, but we also know that we have to provide correct information and not factual information. So I wholeheartedly support your Bill.

I was not going to speak today, but learning what is being put off as factual information is very concerning and very disappointing. Not only as an obgyn, but as a woman and a mother of two children. If I went to one of your centers and was given this factually, medically incorrect information, I would be very upset. Thank you.

Thank you. Anyone else? Mr. Patterson?

Thank you. First, I want to say I have a great deal of personal respect for the author of this Bill, and I did warn her last night that I have a different perspective on this particular topic. I want to thank the moms and the beneficiaries of these services and the medical professionals that are here because of conversations like this. I think crisis pregnancy centers have wrongly been targeted for violence. These centers have had to shut down because of security concerns. I'm thankful for these centers.

I'm not a scientist. I can't really debate the reversal medication situation. I really don't know. All I know is I've met a lot of these women and these families that have benefited from their services, and I take complete offense to calling them fake health centers. I take offense to you calling the licensed doctors, the nurses, and other medical professionals as fake.

The women who had abortions and have gone through these centers and have used services of Planned Parenthood and the crisis pregnancy centers, and attacking them is not appropriate. It's false. They cannot provide data with whomever they want.

Just heard a Bill in privacy just now where I serve as the Vice Chairman, and there's actually legislation up right now to make California's already strong privacy laws that are landmark legislation, even stronger to protect women who are coming in from out of state and deciding have an abortion here. And so it's not accurate to say that they can share personal information, and if they're doing that, that's a violation of already existing law. You just described an example of situation in reading.

I don't know anything about it. I tried to Google it, couldn't find anything about it. But let's assume it's true. And it sounds like to me if it was shut down, that the law took care of it. There are bad actors in a lot of fields of study, a lot of different kind of situations.

And I'm not going to paint a broad brush, but very soon I'm going to an event in my district with literally hundreds of families that are going to be supporters of one of these centers in my district. And it isn't because they're fake. It's because they're actually benefiting my community and women who've benefited from this service. And so I wrote my comments as I was sitting here listening to this, because I think the mischaracterization of these centers throughout the country has been really problematic to me.

I've seen what they've done. I've seen the women who've benefited from them. And if we want to have a discussion about the types of things that they can do, I think that that's fine. But this legislation, in my opinion, paints them with a broad brush, and I definitely cannot support this legislation as a result.

Okay, thank you. Anyone else see? No one. We have a motion by Assemblymember Agar Curry, a second by Dr. Weber. Motion is to pass, as amended, to appropriations. Would you like to close up?

Okay. You're still off.

It's like blinking at me.

I'm not touching it, and it's working. Yes.

Okay.

Okay.

So, thank you so much, chair and Members, and appreciate everyone's comments today and insights. I think the alternatives pregnancy center is not the norm. It is the exception. They are actually medically licensed, but it is rare, and the majority of them are not. And as we've heard today, even in the case of a licensed center, they're not providing medically accurate or factual information to people, even when they are here in front of a legislative body.

And I'm glad I didn't wear pink today, because we all know that's what abortion rights activists have been wearing and even visually confusing people. And I think it's emblematic of what's happening within these centers. This is simply a public information campaign. This is not restricting them in any way. It is making sure that anyone who is pregnant knows where they can get certain kinds of information. If they want factual information, medically based information about abortion, they should know where they can get it.

Right now, I happen to have the website from the Alternatives Pregnancy center, and this is what you find on their website, which talks about abortion. These are questions to ask yourself. Is abortion the right decision for me? Would I consider parenting or adoption? Will I regret having an abortion? Do I have a strong personal or religious belief about abortion? Would my family, friends, and partner support me in this decision? Am I feeling pressured to have an abortion?

Would having an abortion change my life in a negative way? Would I receive the support I need if I decided to parent a child now, I would not say that this is comprehensive of abortion information. When people are seeking information about abortions, and this is on their website, they're not even hiding this. So we are just suggesting and moving forward the idea that we need to make sure that people know solid information when it comes to what their options are around abortion.

If people want to keep their children and they provide the kinds of services they're talking about, that they want to keep that baby, fine. That's great. That's wonderful. And that should be clear. But it is not a place where you get a referral for abortion or real medical advice around abortion options. And that should also be clear. We should make it clear where you can get that information.

So when people are at this moment, when it is so hard, when it is such a difficult moment, for people to go and be shamed and confused and misled at that vulnerable moment, to me, is unconscionable as a mom who, I have two daughters, and I am very happy that I was able to choose when I had a baby at a time where I could support my daughter.

And I think that everyone needs to be able to make that decision on their own without pressure and shame and embarrassment. This is simply public information. And if what you're doing, you're proud of, this should not scare anyone and there should not be opposition to it, I respectfully ask for your vote. Thank you.

Thank you. Mishava. The motion is do pass as amended, to appropriations. Madam Secretary, please call the roll. Wood, aye.

Wood, aye. Waldron? Waldron, no. Aguilar-Curry? Aguilar-Curry, aye. Arambula? Berner? Wendy Carillo? Flora? Vince Fong? Maienschein? Mccarty? Joe Patterson? Joe Patterson, aye. Rodriguez? Santiago? Villapudua? Weber? Weber, aye.

It's three to two. We'll leave the Bill on call. Thank you very much. You have a second? You have an AJR? Okay, get started if you want.

Hello? They are. Go ahead. Whenever you're ready.

Okay, number two. So, chair Members, thank you so much. Happy to present AJR four, which is a joint resolution requesting the Biden Administration dissolve the Accountable Care Organization's, or ACO REACH program. The ACO REACH is the Biden administration's attempt to rebrand a Trump Administration global professional direct contracting model. This model was intended to further privatize traditional Medicare by enrolling millions of Medicare recipients in private direct contract entities, or DCEs, without consent.

Our nation's Medicare program has kept eligible seniors and people with disabilities from dying and out of poverty for close to 60 years by providing guaranteed health care. When first established, Medicare allowed patients to see a physician and accept Medicare and kept administrative costs at a minimum. Medicare, for example, has an administrative percentage of 4%, 2 to 4% versus insurance companies, which have administrative levels of around 16%. Since the mid 1960s, the Federal Government has increasingly used Medicare to pay private insurers.

In the 90s, it was called Medicare Part C and now often referred to as Medicare Advantage to administer our county's Medicare program. Many of the providers of the ACO reach are sometimes private equity firms and are rushing to exploit and undermine Medicare's solvency by over diagnosing and inflating billing practices. Privatizing Medicare funding has created a three hundred fifty-billion-dollar market, undermining Medicare solvency and putting critical care decisions for patients in the hands of insurance companies rather than medical providers.

California is most vulnerable because we house 27 of the 132 nationally approved ACOs. We are one of the states that has close to 20% of the nation's ACO reach providers. Joining me today, I have Dwayne Camp, state policy Director for California Alliance for Retired Americans, to testify and support, and also have two physicians here to answer technical questions if needed as well.

Thank you.

Can you hear me okay? Yes, we're good.

Sorry.

So, you're impacting me. Well, good afternoon, Chair Wood and esteemed Members of the Committee. My name is Dwayne Camp and I'm humbled to speak on our resolution. Today I have the privilege of working for the California Alliance for Retired Americans. We are a statewide nonprofit senior and disability advocacy organization representing over 1 million Members.

Through our over 300 affiliated organizations, many of our Members are Medicare beneficiaries, and upon their enrollment, they made a conscious choice about their preferred model of care, traditional or fee for service, Medicare or Medicare Advantage or part C. In addition to deciding on which supplemental plans best fit their needs, over 6 million Californians have been faced with that same choice.

And as this Committee is well aware, our state is on the precipice of the largest demographic shift in history, as older adults and seniors are projected to comprise at least 25% of California's population by 2030. For nearly 60 years, Medicare has provided health care coverage to tens of millions of Americans. However, in the last decade, Medicare incurred billions of dollars in overpayments to Medicare Advantage insurers.

As a result, in part of the proliferation of privatization in Medicare and through the systematic exploitation of Medicare advantages loopholes such as risk score gaming and upcoding, these overpayments are consequential as models project, the Medicare Hospital Insurance Trust Fund is projected to hit insolvency as early as 2028. Direct contracting, now rebranded as ACO REACH under the Biden Administration, automatically aligns or enrolls traditional Medicare beneficiaries into an ACO, an accountable care organization based on their physician's affiliation with an existing ACO network.

These ACOs essentially operate as a managed care plan, most backed by private insurers, many of which are investor controlled. Additionally, under the REACH program, ACOs are only required to spend as little as 60% of their Medicare payments on patient care, leaving the remaining 40% to keep s profit and or cover Administration and overhead. By comparison, traditional Medicare spends 98% of its funds on patient care, and Medicare Advantage is required through the ACA to spend 85% on patient care.

2.1 million Americans have been aligned into ACO REACH thus far, and while CMS has indicated program expansion is momentarily capped, we have Members who are receiving 30-day notices about their reach alignment as recently as March of this year. Once enrolled, the only way for a beneficiary to remove themselves from a REACH program is to change primary care providers. And in closing, ACO REACH is the pathway to privatize the entire traditional Medicare population.

Private equity groups are racing to invest in primary care practices and health plans. In fact, over about over the last 15 years, Medicare Advantage plans have been the most popular form of health insurance startups. But Cora is not alone in her condemnation of this program. Members of Congress, including prominent leaders from California's congressional delegation, advocacy organizations and others, have expressed their opposition to ACO REACH.

And while CMS has taken steps to address some of the concerns, removing a few bad actors or insurers with a documented history of Medicare abuse doesn't solve the programmatic flaws in REACH's design, nor does it address the substantive concerns about consumer choice. ACO REACH threatens to undermine the great work of this Legislature to improve access, affordability and quality of health care. Traditional Medicare, which remains the most popular cost-effective healthcare program for seniors, deserves and requires us to protect it.

And we should be taking steps to ensure we are hitting our solvency numbers and that every senior or sorry, as every californian ages in this state, that they have equitable access to Medicare, traditional Medicare, or at least be able to direct their choices for Medicare coverage. Thank you. And with me, sorry to clarify, we have Debra and Mark Dolman, who are from Napa, and they have been aligned into an ACO.

Thank you. Okay, others in support.

I'm sorry, I was confused. I thought we just had one witness speaking. So he went well, over time.

They were just asking if they should speak in support.

Oh, yeah. Absolutely.

I'm Deborah Dahlman and I represent physicians for National Health program, Healthcare for all California and Healthy California now coalition. We are all in solidarity with Cara and we strongly support AJR four, as I'm directly affected by ACO Reach. I'm also available for questions.

Yeah.

Okay, yeah. And just a name and position.

Mark Dahlman. I'm with healthcare for all California in strong. You. Thank you. Anyone else? Is there any opposition to the Bill? It's an AJR. It's not a resolution. No one. Bring it back to the Committee for questions or comments. I think there was a motion by Ms. Aguiar-Curry. No questions or comments. I will second. The motion does enjoy AB adopted recommendation. Would you like to close, Ms. Schiavo?

Thank you so much and encourage an aye vote. Thank you.

Okay. Thank you. Madam Secretary, please call the roll.

Wood? Aye. Wood, aye. Waldron? Waldron, aye. Aguilar-Curry? Aguilar- Curry, aye. Arambula? Berner? Wendy Carrillo? Flora? Vince Fong? Maienschein? McCarty? Joe Patterson? Rodriguez? Santiago? Villapudua. Weber? Weber, aye.

Okay, thank you. That's 40. We'll leave the Bill or the AJR on call. So thank you. Thank you very much. Mr. Lowenthal, you're up next. Mr. Lowenthal has AB 907.

Thank you.

Mr. Chair. And Members, I am pleased to present AB 907, which requires a healthcare service plan, contract, or health insurance policy issued, amended or renewed on or after January 1, 2024, to provide coverage for treatment of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, or PANDAS, pediatric acute onset neuropsychiatric syndrome, or PANS, prescribed or ordered by a provider. PANDAS and PANS are inflammatory diseases of the brain that result in sudden onset, devastating behavioral and neurological dysfunction that usually occur after a triggering infection.

These disorders are thought to be caused by autoantibodies generated after the infection that mistakenly attack the brain. Antibiotics and oral antiinflammatory medication help most children, but a minority need stronger immune modulating treatments, such as intravenous immunoglobulin or IVIG. I always screw that up. Sorry.

Despite published PANDAS and PANS' treatment guidelines that established the standard of care in 2017, 6 years ago, insurers have continued to adhere to their own policy statements forbidding authorization of immune focused treatments like IVIG, and as a result, treatments are routinely denied without routine consideration. When a prescriber or a family appeals, insurers typically uphold their denial, claiming, quote, a lack of medical necessity or that, quote, the treatment is experimental. Unfortunately, most reviewers working for insurers lack experience in this complex, uncommon, and devastating disorder.

A typical delay in receiving IVIG due to insurance denials is usually measured in months, if not years. Meanwhile, most PANS and PANDAS sufferers cannot attend school or require intensive academic accommodations such as home hospital school. They may be hospitalized medically or psychiatrically, resulting in more cost and unnecessary suffering as a result of delays in treatment. Individuals suffering from PANS and PANDAS may accumulate permanent neurological damage. Their parents are often unable to work and may require state unemployment or family medical leave benefits.

Children lucky enough to have parents with the financial wherewithal to pay out of pocket or the savvy and persistence necessary to battle the protracted appeals process typically recover well with the appropriate treatment. Yet families who lack these resources often endure financial ruin, possible child abuse allegations, police quote unquote wellness checks that go awry, and even suicides.

This last tragic fact has led to the establishment of the pond brain bank at Georgetown University, where the brains of three deceased young PANDAS and PANS patients are now contributing to scientific knowledge. Community physicians are often reluctant to treat this disorder due to its intensity, its complexity, its relative rarity. With the added burden of lengthy insurance appeals, the pool of willing treating physicians shrinks even further. In addition, insurers often restrict and delay access to out of network specialists with experience and expertise in this illness.

This Bill seeks to alleviate these barriers by directing insurers to follow treatment guidance put forth by University level multispecialty experts in the field. As indicated in the CHBRP analysis and reflected in the Committee analysis, the increase to total net annual expenditures if AB 907 were enacted is relatively low, constituting a .002 increase for enrollees with DMHC regulated plans.

With regard to the conclusion in the CHBRP analysis that the evidence of the efficacy of treatments is insufficient or inconclusive, I will say the following we are fortunate that PANDAS and PANS are relatively rare.

However, that means that there are not many individuals who will require the treatments that are commonly prescribed for these disorders, and unfortunately, that means that the sample sizes are very small and as a result, there is not much data available on the efficacy of the commonly prescribed treatments, but that does not mean the treatments are ineffective. Additionally, and perhaps most importantly, because this is usually a pediatric diagnosis, there is not the same drug or treatment trial data available as there typically would be for adults.

This, combined with the limited occurrence or rarity of these disorders, make it difficult to provide conclusive evidence. However, from the perspective of the pediatricians and physicians who are treating kids with PANDAS and PANS, the treatments are extremely effective and the earlier they receive treatment, the better the outcome for these patients. Early and expedient access to the treatment is crucial to the effective treatment of pandas and pans.

In order to avoid the debilitating symptoms, potentially permanent neurological damage, and sometimes fatal outcomes associated with these disorders, AB 907 will ensure that individuals and families who are confronted with these disorders do not experience unnecessary delays in treatment that can lead to disastrous and tragic outcomes. I am very pleased to be joined by constituents, stakeholders of the 69th, April Renee and Dr. Tempeh Chan, who are here to testify in support of AB 907.

Hi, I'm April Rone. Thank you for allowing me to speak. My beautiful son Aiden was a healthy, vibrant eight year old when he got pneumonia nine years ago. He woke up a completely different child. Afterwards, suddenly consumed by OCD, hallucinations and extreme separation anxiety. He couldn't leave the house or play. He raged and threw things at his baby brother. He stopped sleeping, refused to eat, and couldn't do any schoolwork. What happened to my son? Four months later, Aiden was diagnosed with PANS.

He started antibiotics and in days we had our son back. For years, his occasional flares were managed with antibiotics, steroids and nsaids. Unfortunately, at the age of 14, a simple flu plunged Aidan back into severe PANS. This time, antibiotics didn't work. He lost all quality of life, and I stopped teaching to become his caretaker. Desperate, we found specialists from our local children's hospital and UCLA. My son's new doctors, gravely concerned, prescribed IVIG, which is a standard of care for more severe pans, according to published guidelines.

That is why we were shocked when our insurance denied Ivig, saying it was not medically necessary. Two years into this horrible flare, Adam was hospitalized for severe stomach pain. By now, he was 16 and still waiting for treatment in the hospital. Aidan finally received IVIG with immediate relief. His Doctor called his recovery miraculous and recommended another infusion to solidify gains. We were asked to keep a journal of Aidan's improvement for proof of positive outcomes. I journaled as he began to eat again, gaining weight.

His joints stopped aching. He slept through the night. Anxiety, OCD and short-term memory loss melted. My entire family started to heal until we opened another denial letter, this time claiming IVIG as experimental. Sadly, my son's health began to deteriorate from the inability to get medicine. Our task of documenting Aidan's miraculous recovery turned into the heartbreak of documenting his decline. Months later, I got a letter saying IVIG had finally been approved. No explanation was given.

By now, our son had unchecked brain inflammation for two years, three months, and 24 days. Today, Aidan is 17. He is 80% healed. With Ivig and I can finally return to work. But the 20% he lost to insurance delays left a mark. He has fatigue like never before. He now needs therapy for residual OCD and tutoring. Paid out of pocket. The consequences of denials are tremendous. Families choose between paying their bills and their children's health. Desperate, some families sell homes to buy medicine.

Some just lose their children forever. Enough PANS children have committed suicide that there's a brain bank at Georgetown to study kids like Max Wallace. Max killed himself the day before Christmas 2016 while waiting for treatment. He was just 13. Right now, 10 states have laws like AB 907. A dozen more states introduced bills this year alone. Meanwhile, California families still can't access lifesaving medicine, despite having two leading PANS clinics, UCLA and Stanford. It's time for California to protect its children.

On behalf of all California families impacted, I respectfully urge aye on AB 907.

Good afternoon. My name is Dr. Tempe Chen, and I'm a practicing pediatric infectious disease physician at Miller Children's and Women's Hospital in Long beach. Treating California kids with pandas and pans, which are forms of autoimmune encephalitis. When pans strikes, a child's brain is attacked by misguided antibodies. Overnight, a child can be devastated by what looks like psychiatric disease, with the illness destroying an entire family's ability to function. I am the only Doctor treating PANS at my hospital. Others are uncomfortable managing the complex disease.

While many will turn away these patients for another reason, they've encountered too many insurance denials, and it's awful facing desperate families with our hands tied. Large randomized trials are not possible when a disease is rare. We have eight small trials showing great benefit and one small, flawed trial showing none. In treating PANS, I follow the published expert consensus guidelines, establishing standard of care that were developed by experts from the NIH, Stanford, Harvard, Georgetown, and other academic centers of excellence.

Yet almost every request for IVIG gets denied. Insurers shamelessly post IVIG policies, claiming it's not necessary for PANS. I spent hours on the phone citing the treatment guidelines to insurance representatives with no experience in this field. I sent in reams of appeals paperwork, to no avail. The only way to get an approval is to endure multi-level rote denials, then file a grievance with regulators like DMHC. Most recent DMHC decisions overturn the IVIG denials. So why do insurers deny this important treatment?

According to a recent ProPublica report last month, Cigna knows that only 5% of denials are appealed, and insurers are banking on families to simply give up. I've seen the dramatic recoveries from IVIG. I fear that the lack of coverage may result in permanent harm to young, developing brains. Keeping a kid in special ed or locked in a psych Ward while their caregiver parents can't work is much more expensive than just treating promptly and correctly.

Right now, only the most educated, persistent, and wealthy families get the medicine they need. We don't need a research study to prove that health care inequity and societal damage is happening here. This Bill would save California money. Even CHBRP's estimates, which ignore societal cost, figure that AB 907 would increase insurance premiums by zero point 16%, less than $0.01. Giving a Pans family the chance to rejoin productive California society is truly priceless, and the choice is crystal clear to me.

In desperation, I've referred patients to UCLA, thinking they'd have better success with insurance. But they don't either. I'd like to read a statement from my colleague at UCLA, rheumatologist Dr. Patrick Whelan. I care for almost 400 families with pans from all over California. Time is of the essence in treatment, and the situation is dire.

Anguished parents with screaming children sit in my office day after day, and it's agonizing for families and providers locked in a relentless battle with insurers for months over treatments that often bring rapid relief. California kids deserve the legal protections that already exist in 10 other states, not unconscionable delays. A dozen more states have introduced PANS bills this year, and it's clear that the situation will not improve without AB 907. Please help me heal these struggling children. Thank you.

Thank you, others in supporting my name is Sherry Strollson. I'm a mom of a PANS child, and I strongly support AB 907.

Thank you.

My name is Dr. Angela Tang. I'm an adjunct Professor with Stanford PANS Clinic. I urge you to support AB 907.

Thank you.

My name is Riley Spray. I have PANS, and I strongly support this Bill.

Thank you.

My name is Rachel Spray. I'm a registered nurse and a mom. My daughter was recently denied. IVIG. I strongly support this Bill.

Thank you.

Kevin Riley, father of a PANDAS child. I support this Bill. Thank you.

Jen Jobart, mother of two children with PANS. I strongly support AB 907.

Thank you. Hi, Danny Rone. I am a father. And for my son Aidan, I strongly support AB 907. Thank you. Paul Murphy. On behalf of the Alex Manful Fund, we support this legislation. Thank you. Thank you. Opposition to the Bill.

Good afternoon, Mr. Chair and Members of the Committee. Jed Hampton, with the California Association of Health Plans here representing 43 health plans covering nearly 28 million lives. Regrettably here in opposition to AB 907 today, first want to take some time to thank the witnesses in support and the other witnesses here today. Obviously, it's a very challenging disease. We want to acknowledge that first and foremost, as I mentioned, PANDAS and PANS is very challenging to definitively diagnose.

It's a very controversial diagnosis, and there are not specific diagnostic tests to confirm a diagnosis for pandas or pans. And generally, Clinicians use different diagnostic processes to not only confirm a diagnosis, but also to rule out other conditions with similar symptoms, such as OCD and the like. As the Committee analysis points out, an ICD 10 code does exist for pandas.

We want to acknowledge that under the definitions of disorders involving immune mechanisms, but generally speaking, national billing codes do not exist to reimburse for these specific services currently. In fact, this Bill requires the health plans to actually accept a different billing code for a different, albeit similar, condition in the absence of nationally recognized billing codes for pandas and pans.

Ultimately, our concerns lie in the fact that the Bill would broadly require the plans to cover all treatments for these conditions without meeting the critical clinical and medically necessary guidelines set forth in current law, which is probably most concerning from our Members perspective. It would also prohibit health plans from imposing any limitations on the volume of treatments and alters benefit design by limiting cost sharing and copayments for these treatments.

As you've heard previously, and we'll probably hear later, this is just one of 23 individual mandates that have been introduced this year. And while we will certainly acknowledge that this particular Bill is not the most expensive of mandates, we do have to look at these mandates cumulatively in terms of their total impact across the board. And just for context, Members. Last year, there were 13 mandates that were introduced in the Legislature last year that had a total cumulative impact of $1.5 billion in premium increases.

So with 23 mandates, again, we do have to look at all of these in context, but do want to thank the author and the witnesses for being here today, but we are regrettably opposed to the Bill.

Mr. Chair, members, Steffanie Watkins, on the behalf of the Association of California Life and Health Insurance companies, we, too, are regrettably here in opposition. I think our hearts go out to those who are here today that have been impacted by this. Unfortunately, I think one of the things I'd like to highlight is the removal of the medical necessity standard. That's a ubiquitous standards that we see all through the codes that helps guide and direct those services that are provided to enrollees and insured.

And there is certainly a concern by our members to set a precedent to remove that standard from this. So, for those reasons, unfortunately, we are opposed today. We look forward to continuing conversations if this Bill moves forward today.

John Winger, on behalf of America's health. Insurance plans, to just echo the comments. Of CAP and ACLHIC. Anyone else in opposition say no to bring it back to the Committee. Any questions or comments? Dr. Weber.

Thank you so much to the author and to the families and to the physicians who've come to speak on this Bill and also to the opposition. You talked about the removal of the medical necessity. Is there any particular reason why that was not a part of this Bill?

Unfortunately, as the disease is rare and every patient is different, there's not one cookie cutter description or treatment plan for every patient. So one thing may be medically necessary for one patient and not as medically necessary for the other. So we tried to leave it broad because there is active, ongoing research into the condition and its treatments.

This is a tough one because I'm sure you can understand it's hard if there is no standard for medical necessity. It's hard to say that a provider is doing what he or she should be doing before going to another treatment. We have treatment guidelines, and if there is ambiguity there, it's also a little concerning because one child can get one treatment with someone and a completely different one with another provider. That's a little concerning for me.

But this is a very rare and very debilitating condition. And I understand what the health plans are saying, and I know that you've got a lot of bills. I've got one, too. But I think that if we don't do something, we can have long term devastating impacts, not only on the family, but the individual child. I usually like to go where the data goes, but in this situation, it is so rare and so devastating that I will be supporting your Bill today.

Thank you very much. Dr. Weber, I would like to comment.

No, unless she's asked a question.

I'm sorry.

That's fine. Thank you, Ms. Waldron.

Thank you. As co chair of the Rare Disease Caucus, understanding the issue of rarity is something that we grapple with all the time. The number of studies, sample sizes.

Put up a barrier to trying to figure out, a, how many people are affected, b, what's the chance that this could be PANS or PANDAS? And we have to look to the providers that are familiar with it, because, as in rare diseases in General, there are a lot of providers who are not familiar with the signs. And sometimes it could take years and years to get a diagnosis. But looking at this, we're dealing with children, and any delays increase the risk of a long-term problem.

We can't conscionably say that we can delay treatment or in this case, prolong suffering.

We need to be sure that families, one of the things I've always felt as sitting on this Health Committee now for six years, that I want to be sure that every person, mom on Medicare or Medi-Cal who can't speak English can get the best treatments available for their, you know, if there's a treatment that the provider, in their knowledge, thinks could give relief, maybe not, maybe so, but in their experience could, I think we ought to be able to give them a try.

So, speaking as a mom, and I think it's important that we do so I'll be supporting the Bill today.

I want to thank you, Mr. Lowenthal, for bringing the Bill forward, and thank your witnesses as well. Obviously, rare diseases pose real challenges in the delivery of health care, and oftentimes coverage lags significantly in catching up with that.

I would note that, obviously, in our analysis, there are 10 states now, including that, mandating at least temporary coverage here, and none of those appear to be California, which is kind of shocking in many ways, considering the research and medical research and the facilities, the care we can actually provide in the state. So the Bill does enjoy a do pass recommendation. And I would just note to the opposition, yes, there were 23 mandate bills, but not all of those bills moved.

So we will be far short of the $1.5 billion that scares the industry as bills move forward. And as such, I want to give you an opportunity now, Mr. Lowenthal, would you like to close?

Simply want to say thank you for the very thoughtful comments, Dr. Weber, Ms. Waldron and Mr. Chair really appreciate them and respectfully ask for your aye vote.

Thank you very much. We have a motion by Ms. Aguirre Kirby, a second by Dr. Weber. Motion is do passed to appropriations. Madam Secretary, please call the roll.

Wood? Aye. Wood. aye. Waldron? Waldron, aye. Aguilar-Curry? Aguilar-Curry, aye. Arambula? Berner? Wendy Carillo? Flora? Vince Fong? Maienschein? McCarty? Joe Patterson? Rodriguez? Rodriguez, aye. Santiago? Villapudua? Weber? Weber, aye.

As 50. We will leave the Bill on call. Thank you very much. Mr. Rodriguez, are you. I don't see another author. Are you ready with your Bill? Okay, please go ahead.

Thank you. Okay, you have AB 55 whenever you're ready, sir.

Thank you, Mr. Chairman, Members, thank you for the opportunity to present AB 55, which create a workforce adjustment program which serves as a supplemental payment for ground ambulance transportation providers that provide their employees a wage increase. I would like to start by accepting the Committee's amendments to limit the state share of payment not to exceed 80% of the Medicare payment level benchmark. California provides approximately $110 per ground ambulance transport, which ranks 46 in the United States for Medicaid reimbursement.

California has failed to provide medical base rate increases for ambulance services since the last increase in 1999. When adjusting the current rate for inflation and cost increases, the reimbursement rate should be about $60. This is about $60. In comparison, the national average is 260, Florida's rate is 200, Texas rate 300, and Arizona is 375. As you can see, California has fallen behind. Now it's time to sound the alarm because the loan reimbursement rate is threatening the stability of our emergency medical response systems.

Providers are ending emergency and nonemergency contracts because of their inability to recruit employees, increasing expenses, and low reimbursement rates. As someone who spent over 30 years working as a first responder in emergency medical services, this issue is very personal to me. According to the Bureau of Labor Statistics, the median pay for an EMT is about $17 an hour, or 36,000 per year. That's less than some fast-food workers.

Because of the low wage, my colleagues and I would regularly work multiple 24 and 12 hour shifts just to make ends meet. In fact, it took me about 25 years to start making about $20 an hour. As you can imagine, I miss birthdays, anniversaries and other family events to support my family. For that reason, I'm proud to author AB 55, which has the support of the providers and the labor unions who represent frontline essential workers. With that, let me turn over to my witnesses in support.

Jimmy Pearson, President and CEO of Medic Ambulance Service and President of the California Ambulance Association, and Jimmy Webb, representative of the International Association of EMTs and Paramedics, SCIU Local 5000.

Jimmy, Chairman Wood and Members of the Committee, good afternoon and thank you for the chance to speak today in support of Assembly Bill 55. My name is Jimmy Webb and represent EMS professionals across the State of California on behalf of the International Association of EMTs and Paramedics, SCIU Local 5000. I'm not only an EMS advocate, but I'm also a lifelong EMS professional.

The Bill before you for consideration today, AB 55 presents the legislative body with the opportunity to impact the EMS profession across California in a monumentally positive fashion. The current version of AB 55 allows for a critical increase in revenue for private sector EMS providers, while also taking the historic step of guaranteeing these increased revenues would directly and positively impact the wages of all private sector EMS professionals.

Today, EMS professionals employed in the private sector provide the vast majority of all EMS services in the State of California. Unfortunately, it has been well over a decade since this industry has seen support in the form of a reimbursement rate increase, resulting in the state reimbursing its private sector responders at some of the lowest rates in the US. When combined with the historic rising costs of doing business in 2023, California EMS providers are faced with a perfect storm of problems.

I am proud to stand here in partnership with the California Ambulance Association and our private sector partners as we urge your support for AB 55. While it is true that our members historically fight with management, I can attest to that too in the public eye to gain fair wages and benefits in the workplace, today we are standing with them and asking for your help. The industry is at a tipping point and the time for acting together is upon us.

By passing AB 55, we are guaranteeing that EMS providers can afford the resources they need to keep crews responding to patients in a safe and timely manner. This goes beyond wages and includes safe equipment, improved training and so much more. When our providers are properly reimbursed and funded, then our EMS professionals can reach fair contracts that help ensure the EMS system continues to thrive throughout the future.

There's no downside to increasing the reimbursement rate for private sector providers in the same manner by which public sector providers have seen their reimbursement rates increase during recent years. Simply put, this is a promise to private sector first responders that their industry will be funded fairly and that their wages will be impacted positively as a direct result of swift legislative action. Our actions together today can help build the EMS industry we all deserve tomorrow. Thank you for the opportunity to speak today.

Thank you. Good afternoon, Chairman Wood and Members of the Committee. My name is Jimmy Pearson and I'm the President and CEO of Medic Ambulance Service. Medic was founded by my grandparents and uncle who immigrated to California from Italy in pursuit of their American dream. Medic started in a house on Nebraska street in Vallejo, California with four employees and two ambulances. Today, medic employs over 450 dedicated employees and operates over 100 ambulances that serve Solano, Sacramento, Yolo, placer, Napa, Sonoma and El Dorado counties.

I'm here today on behalf of the California Ammo Association, where I serve as the President to respectfully request your abode to support AB 55 and the thousands of private sector EMS workers who stand to benefit from this Bill, all of whom are chasing their American dream. AB 55 requires increased medical payments to improve EMS worker wages. This Bill directly impacts the lives of those who take care of our loved ones and in their time of need.

Private sector EMS workers provide about three fourths of all ambulance services in California and are called on to provide care and transportation to more than 10,000 times every day, often for unimaginable situations and in the worst conditions, possibly at the worst times of the day, EMS workers are truly the answer to a prayer. Imagine a job where every day, in most cases, someone is literally praying that you walk in the door and handle their difficult situation.

Yes, without a doubt, our EMS workers and our employees are heroes. Yet when they get their paycheck into the week, many EMS workers don't feel like heroes. They struggle to make ends meet on a meet on wages, and some are barely above minimum wage. This isn't how we should reward heroes. I love EMS. I love being a paramedic. I've been a paramedic for nearly 20 years and love being an EMS clinician like Assembly Member Rodriguez.

I have a deep, profound of appreciation for what EMS workers do and desperately want to see our industry across the board pay them what they deserve. The single greatest challenge we face is shamefully low Medi Cal reimbursement. Low medical reimbursement makes it difficult to recruit and retain EMS workers. It also puts at risk sustainability of the ambulance industry, especially the equitable delivery of services to rural and disadvantaged communities.

We have already seen several ambulance companies go out of business in recent years, due in large part to low medical reimbursement. Private sector ambulance providers have waited nearly a quarter century for an increase in medical reimbursement. We are probably the healthcare provider type that has waited the longest for an increase.

You may wonder how we've been able to survive in an industry, and it's because amazing workers like Jimmy right next to me and the ones that we have across our profession, they have worked smarter and harder to get the job done. Even when strained by Covid and responding to natural disasters brought on by climate change. I don't think we can reasonably ask them to work harder than they already have.

I respectfully ask you for your Committee to vote a for AB 55 so we can improve the wages and benefits for AMS workers. Thank you, sir. Thank you very much. Others in support of the Bill. So just your name and organization, please.

Priscilla Kudos. On behalf of the City of Santa Monica in support.

Thank you.

Christoph Mair, with the American Federation of State, County, and Municipal Employees, in support.

Thank you, chair Members. Jonathan Feldman with the 911 ambulance alliance, in support. Thank you, Mr. Chairman. Michael Cohen, on behalf of medic ambulance, in support. Thank you. Brian Meter. Strongly support medic ambulance service thank you. Aaron Walden. Medica ambulance in support.

Thank you.

Shelby Hindel. Medic ambulance and I support thank you.

Kevin Simon. Medica ambulance. I support thank you.

Lisa Curley, Medica ambulance and I strongly support thank you.

Tom Argel. Alpha One Ambulance Medical Services, in support.

Thank you.

Michael Jones. Alpha one ambulance in support thank you. Michael Courtney. Westside Community Healthcare District, in support. Thank you.

Melissa Harris, President, CEO of Ambuserve Ambulance and I support thank you.

Is there opposition to the Bill? Seeing none. We'll bring it back to the Committee. Questions or comments? Any questions or comments from the Committee? None. Is there a motion from the Committee? Motion by Dr. Weber. A second by Mr. Villapudua. Motion is do pass as amended to appropriations. Would you like to close, Mr. Rodriguez?

I respectfully ask for aye vote. Thank you.

Thank you very much. It does enjoy a do pass recommendation. I thank you so much for working with the Committee, Madam Secretary. Please call the role. Wood, aye.

Wood, aye. Waldron? Waldron, aye. Aguilar-Curry. Arambula? Berner? Wendy Carrillo? Flora? Vince Fong? Maienschein? McCarty? Joe. Patterson? Rodriguez? Aye. Rodriguez, aye. Santiago? Villapudua? Villapudua. Aye. Weber? Weber, aye.

You have five votes. We'll leave the Bill on call, and I need to turn this over to our Vice Chair. I've got to go present a Bill and another Committee, so I will be back quickly. Thank you.

We have item number 11, AB 1048, by Assembly Member Wicks. You may start when you're ready. Good afternoon, chair Members. First, I want to accept the Committee's proposed amendments and thank their staff for their work on this Bill. Even in a state that has embraced the Affordable Care Act, dental insurance plans have operated with much less oversight and regulation than full-service health plans.

Regulatory exemptions have allowed dental plans to restrict patient benefits with arbitrary waiting periods, deny coverage of preexisting conditions, and increase patient premiums without increasing benefits. These exemptions critically hurt patients denied coverage due to or prevented from receiving meaningful value for their dental premiums. This is especially important as out of pocket expenses for dental services are continually on the rise. 16% in 2021 alone.

And a new California Healthcare Foundation survey found that 38% of Californians have a family Member who skipped dental care last year due to high costs. As amended, AB 1048 will establish essential patient protections and create accountability through prohibiting large group dental plans from implementing arbitrary waiting periods on patients, prohibiting dental plans from denying claims related to preexisting conditions, and requiring an annual review of dental health plan premium rates.

As you will hear shortly, the dental plans are opposed to my Bill saying that it would raise premiums by 45% to 80%, while an independent analysis of chiburp estimated that the increases would be between one and 4%. I've accepted the chair's amendments to exclude the individual and small group markets from the ban on waiting periods, addressing the primary driver of the estimated cost increase. Also, adding rate review aligns dental insurance with other types of insurance, including medical, homeowners and pet insurance.

It is time for dental plans to be held accountable and to ensure consumers receive value for their premiums. If we can't regulate dental insurance the way we regulate other types of insurance, we need to stop calling and thinking of it as insurance. Testifying in support with me today are Dr. John Blank, President, the California Dental Association, and Jessica Moron, legislative advocate. California Dental Association respectfully asked for an I vote.

Good afternoon chair and members. My name is Dr. John Blake. I'm a practicing dentist in Long Beach with 35 years of experience and currently serving as the President of the California Dental Association. I'm here today speaking on behalf of CDA and our 27,000 Members throughout the state in support of Assembly Bill 1048. Since the implementation of the Affordable Care Act, we've seen significant reform in health insurance plans with the elimination of waiting periods, preexisting condition clauses, and establishing a premium rate review process.

However, dental insurance plans were largely left out of these provisions, which allows these plans to continue to operate with much less regulation than full-service health plans. Every day, my colleagues and I see countless patients forego care or have their claims denied due to lack of patient protections and transparency in dental insurance. Dental insurance plans still impose waiting periods on patients denying coverage for services such as fillings, root canals or crowns for six to 12 months, all while the patient is paying their monthly premiums.

These waiting periods leave patients with two options, delay care until the waiting period is over and risk the condition getting worse or pay for the services out of pocket. Dental insurance plans also regularly deny claims for enrollees with preexisting dental conditions. This usually shows up when a dental plan will not cover bridges, dentures or implants for a tooth that was lost, either due to trauma or genetic reasons, before an enrollee enrolled in that plan.

The most egregious example of this is a patient who needed to replace their dentures that had switched plans since they received their last pair years ago. The new dental plan refused to cover the pair of dentures since the patient was considered to have a preexisting condition, which happened to be having no teeth. These prohibitions and coverage beg the question as to the value of dental insurance plans. What are they actually providing to enrollees if they will not cover dental procedures when they are needed the most?

AB 1048 would also require dental insurance plans to go through a premium rate review process. My colleagues and I have seen the value of dental plans to offer our patients continue to erode as dental premiums go up, while the annual maximum of the plan that we pay hasn't risen in decades and plans hold steady or even cut provider rates. As dentists, our ultimate goal is to provide quality care to all patients.

If dental plans can deny coverage for arbitrary reasons, how can we provide the necessary care for our patients? We all know that the mouth is connected to and integral to the body. Thus, oral health care is interrelated to physical health. Dental insurance plans should recognize and support the prevention and maintenance of oral health and not dodge coverage through fixable technicalities. I respectfully ask for your iboat. Thank you.

Good afternoon Chairman, Members Jessica Moran here with the California Dental Association here as the sponsors of AP 1048. I'd just like to quickly wrap up our comments by saying that our opposition is going to come up here and likely say that dental plans cannot be held to the same standards as medical plans because dental is different.

Members, I'd like to ask instead as to why we continue to be okay with treating medical insurance differently than we treat dental insurance when we know how integral your dental health is to your overall physical health. We've seen how successful these patient protections have been on the medical side, and California has the opportunity, with this Bill to be the first state to implement, to start raising the bar on dental insurance and make sure that consumers are receiving real value for the premiums that they are paying.

I urge your aye vote today. Thank you.

Thank you. Are there other witnesses in support? Please come forward. Name organization position good afternoon chair and Members Jennifer Tannehill with Aaron Reed and Associates on behalf of the California Dental Hygienist Association in support. Thank you.

Good afternoon. Carly Myers on behalf of the National Health Law program in support.

Good afternoon, Mel Assagai for the California Association of Orthodontists we didn't get our letter in, but we're in strong support. Thank you.

Good afternoon. Marty Lopez, California Nurses Association, in support. Good afternoon. Beth Bonoski with SEO California, in support.

Christoph Mair with the American Federation of State County and Municipal Employees in support.

Diamond Kim, on behalf of Children's choice, in support.

Good afternoon. Chair Members. Jose Torres with health Access California in strong support.

Nora Lynn with Children Now in support. Thank you. Any witnesses in opposition, please come forward.

Of the California thank you. Association of Dental Plans. We are in opposition today in spite of the comments made by the sponsors about the validity of dental insurance. We believe that we share the intention of both the sponsors and the author, which is to make sure that individuals have access to coverage. Access to dental insurance. Dental insurance is different.

We talk about it all the time in this Committee, and the measures in this Bill are levers that are used primarily in the individual market to keep the premium costs down and make sure that consumers who do not have employer sponsored coverage can still access dental services. So we very much appreciate that the author has taken the Committee amendments. We remain opposed to the Bill right now, but look forward to continuing conversations as the Bill moves forward. Thank you.

Are there additional witnesses in opposition? Please come forward.

John Winger, on behalf of America's health insurance plans, would just echo the comments at. Kathy, look forward to future conversations.

Faith Borges, on behalf of the California agents and health insurance professionals very appreciative of your agreement to take those amendments and look forward to reviewing the Bill in print.

Thank you. Preston Young from the California Chamber of Commerce here today in opposition to the Bill as it appears in print due to the cost-based concerns. Thank you.

Thank you. Do we have any comments, questions from the Committee? Seeing none. Ms. Wis, if you'd like to close disrespectfully, ask for an ivote. Thank you. Do we have a motion? We have a motion and a second. Madam Secretary. Please call the roll. The motion is do pass as amended to appropriations.

Wood. Waldron? Aye. Waldron, aye. Aguilar-Curry? Arambula? Berner? Wendy Carrillo? Flora? Vince Fong? Maienschein? Mccarty? Joe Patterson? Rodriguez? Rodriguez, aye. Santiago? Villapudua? Villapudua, aye. Weber?

Right now it's three - zero. Your Bill is on call. Thank you.

So going in order here, our next Bill, AB 1470, item 19 by Assembly Member Quirk-Silva. And you may proceed when you're ready.

Good afternoon, Madam Chair and Members. First, I want to thank the Committee Consultant for all of her work on this Bill with my office and I accept the proposed Committee amendments. Members, AB 1470 is a result, or lack thereof, of an issue that has been raised for almost a decade, reducing the unnecessary paperwork burden to allow mental and behavioral health providers to concentrate on their primary mission, improving patient outcomes.

In 2014, in lieu of a bill, the Department of Health Care Services and stakeholders agreed to a third-party review of the department's documentation requirements. In 2016, the report, based on a sample of six California counties, compared data to New York and Massachusetts statewide.

Standardized documentation requirements in an effort to identify redundancies and methods that could be more efficient, was completed in its findings and recommendations released. There were a number of recommendations.

However, not much has been done to reduce redundant and unnecessary paperwork so that providers can focus on minimum standards, meet audit requirements, and spend more time treating patients and families. Our vulnerable workforce depends on it.

Because one of the primary reasons clinicians are leaving the public and mental behavioral health sector is excessive paperwork. AB 1470 requires DHCS to develop standard forms by January 1, 2024 relating to medical necessity criteria, mandatory screening, transition of care tools and documentation requirements for mental and behavioral health services provided under the Medical program.

This includes specialty mental health services, non specialty mental health services, and substance use disorder services.

It is time to stop kicking the can down the street. With me today to testify in support and answer any questions Committee Members may have is Al Rowlett, President of the California Council of Community Behavioral Health Agencies as well as, CEO of Turning Point Community Programs and Victoria Kelly, Chief Executive Officer of Redwood Community Services.

Thank you, Chair and Members of the Committee. Again, my name is Al Rowlett and I'm the President of the California Council of Community Behavioral Health Agencies, President and CEO of Turning Point Community Programs, an organization that is privileged to provide services in 10 Northern California counties.

I'm also a licensed clinical social worker serving in this field for over 40 years. Though the topic of reducing redundant and unnecessary paperwork is not the most exciting issue, it is necessary and important, and I enthusiastically ask for your support of AB 1470.

CBHA has long advocated, as said earlier, for the reduction of paperwork evening, supporting the Commission of a study in 2015 that found that it takes California clinicians five times longer to complete paperwork than clinicians in other states.

I estimate that clinicians at turning point at our crisis residential and urgent care programs spend 40% of their time, on average, completing paperwork. Many times, clients will refer to us to the other paperwork that they've already filled out and state, I've already answered these questions.

It's in my record. I appreciate the department's effort to improve the behavioral health delivery system through CalAIM, but California continues to grapple with severe shortages and mental health and substance use professionals, as stated earlier. It is time for transformation.

Burdensome and unnecessary paperwork prevents us from immediately ameliorating the crisis that many of the individuals that we're privileged to serve present us with, when we see them. I ask for your support of AB 1470.

Good afternoon. Chair and Members of the Assembly Health Committee. I'm Victoria Kelly, Chief Executive Officer at Redwood Community Services, a multiservice organization serving individuals across the lifespan in rural Northern California, including Mendocino, Lake, and Humboldt counties.

We provide mental health and substance use disorder services, foster care, housing and homeless services, and school based support. I am here today to urge your support for AB 1470 to streamline the documentation expectations throughout California's medical behavioral health system. Our current system is at a critical breaking point.

This Bill will have beneficial effects on workforce retention and recruitment of qualified providers during an incredibly challenging time by reducing burdensome documentation standards on providers and increasing the focus on life changing services to our most vulnerable populations.

In my organization alone, we witnessed too many of our providers leaving due to the overwhelming paperwork demands as opposed to the quality services and impact on their clients and communities.

We too, estimate that the paperwork consumes 40% to 50% of our providers time and is even higher for multicounty providers such as ours, where each county behavioral health department have differing standards and interpretations.

For example, our current assessment recently went from 14 sections to complete to 21 sections for a provider to complete. In substance use disorder residential services.

We are going back to a daily note and a weekly note, which means a provider will have to complete eight notes per client per week instead of one note per client per week. All our providers say the same thing. We want to change lives. Providers want to engage in documentation that shows the impact of the work on the lives of their clients and families.

They want to know that the time they are spending in their profession is first and foremost about direct client care that positively impacts and changes lives and is not ruled by documentation.

We ask that you support AB 1470 to address a behavioral health workforce crisis and free up precious time and resources for providers to do what they do best, serve client needs, and empower communities for long term success.

Thank you. Thank you. Are there additional witnesses in support? Please come forward.

Tom Renphrey, on behalf of the California Association of Alcohol and Drug Program Executives in support. Thank you.

Rebecca Gonzales, National Association of Social Workers California Chapter in support.

Good afternoon. Adrienne Shilton with the California Alliance of Child and Family Services. Proud co-sponsor and support.

Taylor Jackson with the California Primary Care Association in support.

Amy Blumberg, on behalf of the California Children's Hospital Association, in support.

Corey Hashida, on behalf of the Steinberg Institute, in support.

John Drebinger, California Council of Community Behavioral Health Agency. CBHA, co-sponsor and in support.

Matthew Madaus, on behalf of Behavioral Health Collaborative of Alameda County in support.

Thank you. Are there any witnesses in opposition, please come forward.

Lisa Gardner with the County Behavioral Health Directors Association. We represent the leaders of the public behavioral health safety net in 58 counties and two cities. We have a position of concerns on this legislation.

We recognize, like everyone does, that over time, County Behavioral Health Agencies have been overburdened by paperwork that has led people to treat the chart rather than the patient. And we also agree that more should be done to put patients first.

However, we felt that this legislation did not reflect the significant work that's being done through the CalAIM program to reduce documentation that work is underway. We appreciate the amendments offered by the Committee and look forward to reviewing them and working further with the author. Thank you very much.

Thank you. Any other additional opposition? Seeing none. We'll bring it back to the Committee. Comments? Motion in a second. Would the author like to close?

Just as we know time is precious and the belief that most of the time that a clinician is working with a patient should be working with the patient versus filling out paperwork. All of us have seen a doctor at some point and I know for sure. I noticed they're often typing away, putting in information as they're trying to treat the patient.

And I know that is because of their responsibility to make sure paperwork is done, but I think the effort to really focus on the patient is very important. With that, I respectfully ask for an aye vote.

Thank you. We have a motion do pass as amended to appropriations. Madam Secretary, please call the roll.

[Roll Call]

30. Your Bill is on call. Thank you. Thank you, Members.

Okay, next. In order, item 22. AB 1645. Assemblymember Zburr, please proceed when you're ready. Thank you.

Thank you Madam Chair and members of the committee. I'll start by extending my thanks to you and the committee's staff for your engagement on this bill, and I'd be happy to accept the committee's proposed amendments. Today, I'm proud to present AB 1645, which is sponsored by Insurance Commissioner Ricardo Lara, Equality California, APLA Health, Los Angeles LGBT center, and the San Francisco AIDS foundation.

About a month ago, you may have seen headlines about a federal judge in Texas who struck down national protections for preventive care benefits under the Affordable Care Act. While we do have protections in California, some of them are based on these federal protections. So there's concern now that this Texas case may put the federal preventive services requirements on which our state relies into peril.

Among other things, AB 1645 will codify in California law existing federal guidance to ensure that consumers can still access preventive care and all the necessary services for delivering that care without cost sharing, should this federal law ultimately be struck down on appeal. So this bill is about protecting Californians from the sweeping health care rollbacks we're seeing coming out of courts in Texas and elsewhere. Every Californian deserves access to preventive health care that is comprehensive, inclusive, and affordable.

Californians most affected by STIs include people of color, young people aged 15 through 29, LGBTQ-plus people, and people who use substances. Underlying these disparities is a lack of primary and preventive health care due to a range of factors, including family rejection, unemployment, homelessness, or lack of access to culturally competent local services and providers. Comprehensive, inclusive, and affordable preventive care is critical to identifying and addressing health challenges before they become serious, particularly for marginalized populations.

Our sponsors who are with me today have dedicated themselves for years to strengthening access to PrEP, a life-saving HIV prevention medication because they understand that comprehensive coverage for preventive health care is critical to maximizing utilization and preventing HIV. The same can be said for the other preventive care that falls under this bill.

Barriers to preventive care can force people to choose between preventing expensive and devastating health care problems before they occur because they have to pay money for something in which they're not ill yet and choose between doing that or putting food on the table for their families. In essence, this bill is about ensuring that low-income people have access to the same comprehensive and affordable preventive health care as everyone else. I ask for your aye vote at the appropriate time.

Today with me I have Josephine Figueroa, who is the Chief Deputy Legislative Director for the Department of Insurance, and Reina Hernandez, Associate Director of PrEP and HIV Navigation Services at the San Francisco AIDS Foundation. And to answer any technical questions you have, here is Jessica Ryan, attorney with the Health Equity and Access Office for the California Department of Insurance. Josephine.

Good afternoon, Madam Chair and members of the committee, Josephine Figueroa, Chief Deputy Legislative Director for the Department of Insurance, here on behalf of Insurance Commissioner Ricardo Lara. Commissioner Lara is a proud co-sponsor of AB 1645. First, I want to thank Assemblymember Zbur for authoring this important measure. AB 1645 would remove barriers to accessing $0 preventative care under the Affordable Care Act and add CDC-recommended screening for sexually transmitted infections to the list of preventative care benefits.

The incidence of STIs have been growing over the last 20 years and impacts historically disadvantaged communities, including people of color, youth, and the LGBTQ-plus community. By strengthening existing law and requiring STI screening to be covered without cost sharing, AB 1645 will improve health by identifying STIs and other illnesses early, allowing STIs to be managed more effectively and to be treated before they develop into something more complicated and debilitating condition. We also know that even small amounts of cost-sharing lead to reduced care.

Studies demonstrate that rising cost-sharing may worsen disparities and adversely affect health, particularly among patients living in low-income areas. Further elimination of cost sharing in preventative services was found to reduce disparities in accessing to it. AB 1645 eliminates loopholes that allow cost sharing for using recommended $0 preventative care benefits. Finally, it codifies certain federal guidelines for coverage of preventative services without cost sharing, which is particularly important given continued attacks on the ACA preventative services in federal courts.

Insurance Commissioner Lara has been committed to fighting for affordable health care and more equitable access to health services during his time in the California State Legislature and now as insurance Commissioner, he continues this effort. We must ensure that California can continue to provide fair and equitable access to branded care for all as potential continued changes by some federal courts may attempt to curtail access to these essential services. On behalf of Insurance Commissioner Ricardo Lara, I ask for your aye vote.

Good afternoon. I would like to thank the Assembly Health Committee for allowing me to testify today in support of AB 1645. My name is Reina Hernandez and I'm currently the Associate Director of PrEP and HIV Services at the San Francisco AIDS Foundation where our mission is to promote the health and wellness of the communities most impacted by HIV and AIDS.

We provide comprehensive free and HIV and STI testing, HIV treatment, PEP and PrEP, and I am here to express support for AB 1645 because I firmly believe that everybody deserves equitable access to no-cost-sharing, comprehensive preventative services, regardless of their race class, gender, or financial status, and ability to do so.

AB 1645 would strengthen current state law and close loopholes to ensure that the people we serve, the LGBTQ community, youth, and communities of colors of color, have access to critical preventative care and STI screening, including all of the services and office visits that are necessary to deliver that care without cost sharing. By way of example, in our experience, office visits continue to remain as a roadblock for many of our privately insured clients who are using PrEP and accessing STI services.

We serve over 20,000 individuals in any given year, and one-third of those individuals are privately insured. I would honestly like to think that the main reason why people come to our clinic is because we're LGBTQ-friendly. It's a judgment-free space and provider service delivery model and our harm reduction approach. But when we ask clients about their choice in providers, their response is almost the same as to why they come to us. Because I don't have to pay a copay for my visit.

And upon further discussion, concerns about the cost of living come up and it becomes clear that if they would receive care from their primary care provider that they would receive primary care from their providers if it was not for the financial cost of doing so. An AB 1645 would ensure that people would not be charged a copay for office visits associated with preventative care, regardless of how they are billed.

Another important provision of this bill that has direct impact for our clients is a requirement for state-regulated plans to cover STI screening that is recommended by the CDC at no cost. Current law prohibits cost sharing for screening recommended by the USPSTF, but the task force recommendations don't always align with the best clinical practice. Currently, clients using their insurance run the risk of being charged a copay for a screening that is recommended for them and important for their health.

And AB 1645 would close this loophole and ensure equitable access to STI screening. This important bill ensures that people will be able to have access to comprehensive STI care regardless of the political and judicial attacks on the Affordable Care Act. And I would just like to say that we have all of the tools necessary to prevent HIV and STI infections and get to zero. We just need people to have access to them.

Thank you. Are there other witnesses in support? Please come forward. Name, organization and position only.

Good afternoon. Katie Van Deynze with Health Access California in support. Thank you.

Good afternoon Molly Robson with Planned Parenthood Affiliates of California in support.

Good afternoon Anne Donnelly with the End Epidemics Coalition in California and also on behalf of CalHEP or California Hepatitis Alliance in support. Thank you.

Good afternoon. Ryan Souza, on behalf of Essential Access Health and APLA Health in support. Thank you.

Good afternoon. Craig Pulsipher, on behalf of co-sponsors Equality California and the Los Angeles LGBT Center. Also here on behalf of BNIstar, the California LGBTQ Health and Human Services Network, SF HEP B Free Bay Area and Justice and aging.

Good afternoon. Carly Myers, on behalf of the National Health Law Program in support.

Good afternoon. Sandra Poole, Western Center on Law and Poverty in support.

Rand Martin, on behalf of the AIDS Healthcare Foundation in strong support. Thank you.

Thank you. We'll return to the committee for any questions, comments? Oh, opposition. I'm forgetting about opposition. Is there any opposition to this bill? 11

Good afternoon. Chair and Members of the Committee, Robert Boykin with California Association of Health Plans. We respect, sorry, in opposition regretably in opposition to EB 1645. We respect and understand the intent of the bill.

However, we are opposed because this removes cost-sharing on services that are covered by health plans. According to the California Health Benefits Review program, this will increase annual costs by 20 million for all Californians. Once again, keeping in mind that this is one of 23 mandate bills this year that, when taken altogether, are set to increase annual costs by more than 1 billion on all Californians. Thank you for your time today.

Mr. Chair and members, Steffanie Watkins, on behalf of the Association of California Life and Health Insurance Companies, is also regrettably opposed. We did have some conversations to kind of work through some of the proponents of the bill. We do better understand, based on some of the judiciary action, some of the concern about preventative services no longer being included, or at least the risk. We'd like to continue those conversations with respect to the CDC guidelines and potentially implementing those earlier than we normally do the task force.

So with those, we hope to look forward to continuing those conversations with both CDI and the author of the bill. Thank you.

Other witnesses in opposition please come forward. Thank you.

Preston Young from the California Chamber of Commerce here in opposition because of the premium impact.Thank you.

Seeing no other opposition now, we'll bring it back to the committee for questions, comments, motion, and would the author like to close?

Sure. So first of all, let me thank the committee again and the staff for the hard work on this bill. Just want to reiterate that 1645 is not a mandate bill. It waives cost sharing for integral services provided by federal law. They're at risk of going away. And for CDC-recommended STI screenings, which are already basic health care coverage, the costs of the bill, as estimated by CHBRP, are minimal. It's literally a little more than 100th of 1% in terms of the cost increase for the preventive care. So I proudly want to thank my sponsors and the folks that are here today and ask for an aye vote.

Thank you. The motion is due pass as amended to appropriations. Madam Secretary, please call the roll.

[Roll Call]

Your bill has five votes. We'll leave the bill on call.

Thank you very much.

Believe Ms. Reyes is next. Whenever you're ready.

Thank you. Mr. Chair Members, thank you for the opportunity to present AB 1288. The Bill prohibits commercial health insurers from imposing prior authorization rules that create barriers for medication assisted treatment. Medications such as buprenorphine, you can call suboxone, too. Methadone, or long acting naltrexone can significantly improve treatment for many substance use disorders by treating craving and withdrawal symptoms. However, medication assistant treatment is underused. Almost two thirds of commercially insured persons in California with drug or alcohol dependence do not initiate treatment.

Prior authorization requirements create unnecessary barriers that delay authorization requirements that delay or interrupt access to effective treatment. Skyrocketing overdoses represent a public health emergency, demanding new strategies of response, including the removal of unnecessary barriers to effective treatment. AB 1288 is an important first step that will reduce overdose rates and save lives. Here to speak in support of the Bill is Dr. Aimee Moulin, Professor of emergency medicine and Division Chief of addiction medicine at UC Davis and Director of the California Bridge Program. Thank you.

I'm an emergency physician. I also work with a network of over 279 emergency departments which are providing addiction treatment in the emergency Department. And what we can tell you is that medications for addiction treatment, particularly opioids like fentanyl, are very effective. And our challenge is getting medications to people in a timely fashion. And when we encounter delays or patients have difficulty accessing medications, we lose them and we lose an opportunity to save lives and get people into treatment.

I really want to thank assemblymember Reyes for bringing this Bill forward, because I believe it will save lives. Thank you.

Thank you very much. Others in support.

Thank you, Mr. Chair. Tim Madden, representing the California chapter at the American College of Emergency Physicians, in support.

Thank you.

Carly Myers, on behalf of the National Health Law program, in support.

Thank you.

Brandon Marchy with the California Medical Association in support.

Thank you.

Dr. Neal Mehra with California Society of Addiction and Medicine in strong support.

Thank you.

Taylor Jackson with the California Primary Care Association in support.

Thank you.

Hi. Tiyesha Watts with the California Academy of Family Physicians in support.

Thank you. Anyone else? Is there opposition to the Bill? Okay, see no opposition. Any questions or comments from the Committee? Motion by Ms. Aguiar Curry, a second by Mr. Villapudua. Motion is do pass to appropriations. Madam Secretary, please call the roll.

[Roll Call]

You have five votes. We'll leave the Bill on call. Thank you. Thank you very much. Next up, Dr. Jackson. I believe.

So you have AB 1451. Whenever you're ready.

Thank you very much, Mr. Chair and Committee Members. I would like to start by accepting the Committee's amendments to AB 1451 to thus removing the requirement for pre-authorization for treatments of urgent or emergent mental health or substance use disorders. As we know, we are in the midst of a mental health crisis, and there's not very many tools that we have to really deal with the crisis at this time.

And so this bill is designed to ensure that we create as many opportunities that while someone is willing to receive the help necessary, that there are less barriers in making sure we can serve them in a quicker and more efficient way. Obviously, we have seen too many circumstances, and for those who don't know how mental illnesses sometimes work, is that sometimes you only have a brief period of time in which someone is willing to accept treatment or accept any type of help.

So the longer we wait, the less likely someone will be served, and this bill does that. Unfortunately, the health care industry workforce is impacted. We have a workforce shortage. And so facilities that actually have the professionals there, facilities who actually have everything that they need to be able to serve someone, we must continue to break down as many barriers as possible.

And certainly, just waiting for an authorization to receive services is something that we cannot afford to continue to accept at this time during such a crisis. And so with that, I want to thank the Committee for working with us on this bill and respectfully ask for an aye vote.

Thank you. Support.

Good afternoon. Mari Lopez, California Nurses Association, in support.

Thank you.

Carly Myers, on behalf of the National Health Law Program, in support.

Thank you.

Hi. Tiyesha Watts with the California Academy of Family Physicians, in support.

Thank you.

Taylor Jackson with the California Primary Care Association, in strong support.

Thank you.

Izzy Swindler with Shaw Yoder Antwih Schmelzer and Lange with a few clients in support, California State Association of Psychiatrists, and California Academy of Child Adolescent Psychiatry as well, both in support. Thank you.

Thank you.

Mr. Chair and Members, Brandon Marchy with the California Medical Association, in support.

Thank you.

Rebecca Gonzales, National Association of Social Workers, California Chapter, in support.

Thank you.

Mr. Chair and Members, Tim Madden, representing the California Chapter of the American College of Emergency Physicians, in support.

Thank you.

Hello. Molly Robson with Planned Parenthood Affiliates of California, in support.

Thank you. Is there opposition to the bill?

Good afternoon, Chair, Members of the Committee. Robert Boykin with the California Association of Health Plans. Regarding in opposition to AB 1451, we respect and understand the intent of the bill. Health plans currently cover the treatment and care for mental health and substance use disorders. However, this bill seeked to remove prior authorization. We understand there are amendments before us, and so we'll make sure to take a look at them. But that was one of the reasons.

Removing prior authorization gets rid of the guardrails that help keep healthcare premiums stable. That, plus the lack of cohesive definition for behavioral health crisis, is why we are opposed. But once again, we have reached out and spoken to the author's office, and we look forward to work with them as this bill moves forward during the process. Thank you for your time.

Thank you.

Mr. Chair, Members. Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies, we too have an opposition on the bill. We look forward to continuing those conversations and seeing the amendments as the bill moves out today.

Thank you. Anyone else? Okay. See, no one will bring it back to the Committee for questions or comments. Our Vice Chair, Waldron.

Thank you. Having done quite a bit of work in the mental health space, I want to thank you for bringing this forward. We talk about mental health parity with physical health, which we achieved with Senator Weiner's Bill 855 a couple of years ago. So when we look at this, if a patient is in for treatment, I mean, would we consider not beginning treatment or starting a referral process if a heart condition was discovered or any other physical condition, if they were identified at the time of the appointment, for a separate condition?

So when we look at parity and mental health, also to send them home at a time when maybe they're most ready to receive treatment would not only be inefficient, but it will also, in the long run, be more costly or far more detrimental. So I'll be supporting your bill.

Thank you. Anyone else? Is there a motion on the bill? A motion by Mr. Villapudua, second by Mr. McCarty. Does enjoy do pass recommendation? It's do pass, as amended to appropriations. Would you like to close, Dr. Jackson?

Once again, Mr. Chair, thank you and the Committee for your help with this bill. Obviously, this is just one bill amongst many that will help to put together the pieces of how we can truly treat mental health as the crisis it is. And I know this Committee doesn't need to understand that this is a crisis, but certainly for those listening, it is so important to understand just how much of a mental health crisis California has, and particularly with our young people as well. And so I respectfully ask for an aye vote.

Thank you very much. Madam Secretary, please call the roll.

[Roll Call]

You have six votes. We'll leave the bill on call. Thank you. Seeing no other authors present, I'm going to go ahead and present my bill. So I'll turn this over to our Vice Chair.

Okay, we are moving to Item 33: AB 1331. Dr. Wood, proceed when you are ready.

Thank you very much, Madam Vice Chair. California has a fragmented and decentralized health information exchange network with areas of the state with no health HIE--we'll call it eighth entity--and limited participation by major types of providers. This limits the ability of patients, health care providers, and public health departments to use data to improve health care quality and care coordination.

In 2021, the California Health and Human Services Agency created a data sharing agreement defining the parties that will be subject to new data exchange rules and setting forth a common set of terms, conditions, and obligations to support secure, real-time access to an exchange of health and social services information in compliance with applicable federal, state, and local laws, regulations, and policies.

This bill establishes the next step by creating a board to ensure that the Data Exchange Framework is successful in achieving the exchange of information to ensure that California achieves its health care access, equity, affordability, public health, and quality of care goals. I respectfully ask for your aye vote.

Thank you. Are there witnesses in support?

Good afternoon, Madam Chair. Katie Van Deynze with Health Access California. We have a support if amended position and look forward to working with the author as the bill moves forward. Thank you.

Good afternoon. Sandra Poole, Western Center on Law and Poverty. We also have a support if amended.

Good afternoon. Johan Cardenas with the California Pan-Ethnic Health Network, in support.

Thank you.

Move the bill.

Are there any witnesses in opposition? Seeing none, we'll bring it to the Committee for comments, questions. Okay. Would the author like to close?

Respectfully ask for your aye vote.

Thank you. The motion is 'do pass to Appropriations.' Madam Secretary, please call the roll.

[Roll Call].

Your bill has six to zero; it will remain on call.

Thank you, Madam Vice Chair. And we are waiting for authors, so we'll wait for authors. We can go through the roll since we're just sitting here. Madam Secretary, please lift the call on the consent calendar.

[Roll Call].

The consent calendar passes 8-0. Item number three, AB 620. Please lift the call and call the absent Members.

[Roll Call]

And then we were all here for AB 1331 by me. We are about as caught up as we could possibly be. So we're just going to wait. There are authors, please. Authors who have bills before the Health Committee. Please come on down. Ms. Ortega, you have two bills before us. Thank you. Whenever you're ready.

All right. Thank you, Mr. Chair, for the opportunity to present to you today AB 1060. As a mom of four and a Legislator, this fentanyl crisis keeps me up at night. The numbers are shocking. Over 150 people per day are dying in the United States from opioid overdoses, with fentanyl being the deadliest. Over 6000 people in California died from overdoses in 2021. Even more troubling than that, it's what it's doing to our kids. Fentanyl is now the leading cause of fatal poisoning among children under five.

This bill will make Narcan available to all Californians by requiring private insurers and Medi-Cal to cover the total cost of over-the-counter Narcan. Narcan is a life-saving drug that quickly reverses fentanyl overdoses and is an effective tool in preventing deaths. While Narcan is extremely effective, it is also expensive. Out-of-pocket cost for Narcan can be over $100, depending on the dosage, which is unaffordable to most families who can barely make ends meet today.

AB 1060 will ensure that Californians have access to this life-saving drug. Today, testifying in support is Dr. Neal Mehra with the California Society of Addiction Medicine. And testifying in support is Marika Cole, a mom who lost her son due to fentanyl poisoning.

Good afternoon, Members of the community. Hello, I'm Dr. Neal Mehra, and it's honor to speak on behalf of California Society of Addiction Medicine. I specialize in addiction medicine. I'm medical Director of two prominent nonprofit organizations in Sacramento. We treat both patients that have opioid addiction as well as patients that do not have addiction but need help in taking prescribed opioids more safely. When we think of overdose, we often equate this with people with addiction.

However, it is also exceedingly more common that people without addiction are unknowingly exposed to high potency synthetic opioids such as fentanyl. As noted in your reports, bystanders were present but unable to provide life-saving measures in approximately 3300 unnecessary deaths in California just in 2021 that could have been prevented simply by the bystander having access to Narcan. This is a critical reason why everyone needs Narcan.

While opioid addiction is very prevalent, now is an especially unprecedented time when people without addiction are unknowingly and unwillingly exposed to high potency and lethal synthetic opioids such as fentanyl and analogues, including carfentanil. The first illustration I'd like to share is with children and young adults that are not addicted, but may be experimenting with drugs and alcohol for the first time. It is extremely easy for kids to order drugs over the Internet and have them delivered directly to them.

In many cases, the illicit pills arrive with variable amounts of fentanyl that is 100 times more potent than morphine or carfentanil that is 10,000 more times more potent than morphine. This has led to the phenomena where one pill can kill, perhaps the very first pill they try. Having any cost barrier to Narcan would deter and make it even more likely that parents, friends, and others would not prioritize obtaining it and thus not be prepared in case of a fatal overdose.

A second increasingly common example is a consequence of most providers being fearful of prescribing opioids, even for appropriate reasons. As a result, many chronic pain patients, including the elderly and veterans, are getting abruptly cut off from their medications and are going through withdrawal and high levels of pain. Many of these patients depend on opioids but are not necessarily addicted and are reluctantly resorting to buying pills off the streets. Again, many of these people are unknowingly buying fake pills that contain lethal doses of fentanyl.

These people need and deserve people around them to have easy access to Narcan to save them in case of an overdose. Greater access to Narcan will not only save lives, but it could also potentially reduce some costs of EMS response and ER visits, as some people that receive Narcan do not need further intervention. Everyone needs a low barrier access to Narcan, as any of us at any time may encounter a person of any position in society that may be experiencing a lethal overdose.

I could continue with my experience, but I want to encourage you to ask me questions to clarify if there's anything I could do to explain this tremendous importance for ensuring Narcan is available to everyone. Thank you.

Thank you. Please.

Hello, my name is Merika Cole, and I'm here today to ask you to support AB 1060 and to share my story to illustrate why it's so important. My son Merrick was 25 years old when we lost him. He loved skateboarding. He didn't drive. He had autism, and he didn't really talk, but he was incredibly bright. He was a polyglot. That means he knew various languages and he could read and write Russian fluently. He could speak Spanish, and he knew American Sign Language.

He loved playing video games, like most people that are on the spectrum. When he was playing, I would hear him speaking other languages, but he couldn't socialize very well and he was way too trusting. So he needed conservatorship, which I obtained, and I was his conservator. When a person has autism, they just want to make friends. One day, Merrick asked me if he could go to his friend's house, and he only had three, so I said yes.

He promised to be back within an hour because he was looking forward to me combing his hair, which was rare. He had difficulty with having his hair combed because he had sensory issues. And I promised him a new pair of Nike Slides, which were slippers, which he was really excited about. When he came home from his friend's house and I left to go shopping, I was gone for about 45 minutes.

When I came back and went into his room to show him his slippers, I found him unresponsive. I had bought two doses of Narcan previously because we have homeless in the area, and I thought maybe I could save a life, just in case. So I had those two doses of Narcan to give him, but I only had two. It was too expensive for me to buy, and I wish I would have bought more. I tried giving him both doses that I had, but it wasn't enough.

I administered CPR and called 911. The paramedics came pretty fast, and they gave him IV, which had Narcan in it, but it wasn't enough. An autopsy later found that he had fentanyl and carfentanil in his system, and that's why the dosages were futile. He was among the first overdose in this area, in this region involving carfentanil. So the paramedics had no idea why he wasn't responding.

Since then, I've done a lot of research and learned that Narcan can save lives at the right dosage and at the right time. If it had been more affordable, I would have had more, because I'm about trying to save someone's life when I started studying about this. And if it had been more affordable, I definitely would have bought more. Definitely.

We need Narcan to be made affordable and available to everyone, not just in schools and other public places, but to everyone so people can carry it around and be ready. We need Narcan to be--well, we know that fentanyl is a poison, and it will kill. We need to provide parents, caregivers, and neighbors this tool so that we can save lives. I ask the Committee to please vote yes on AB 1060 and help save more lives. It would definitely have saved my son's life.

Thank you. Others in support?

Good afternoon. Justin Rausa, office of Attorney General Bonta, in support. Thank you.

Thank you.

Good afternoon. Mari Lopez, California Nurses Association, in support.

Thank you.

Kelly Brooks, on behalf of the County Health Executives Association of California, here in support.

Thank you.

Sandra Poole, Western Center on Law and Poverty, in support.

Thank you.

Carly Myers, on behalf of the National Health Call Program, in support.

Thank you.

Lisa Gardiner, with the County Behavioral Health Directors Association, in support.

Thank you.

Tasha Henneman, PRC, a behavioral health organization in San Francisco, in support.

Thank you. Is there opposition to the bill? Seeing none. We'll bring it back to the Committee for questions or comments. Any questions or comments? Dr. Arambula.

I want to thank the Assembly Member for bringing this bill forward and for Merrick's mom for testifying here today. By increasing access to Narcan, we have a greater chance of saving lives and just appreciate the bill and look forward to supporting it.

Thank you, Dr. Arambula. Anyone else? Dr. Weber.

Thank you so much. How do you envision this bill actually being implemented? So if it's over the counter, how would patients not have to initially come out of their pocket to get it actually covered by their insurance?

Yeah. We just have received a report from the California Benefits Health Review Program, and that was one of the things they brought up. They suggested that people would initially might be able to have to pay out of pocket and then send in their reimbursements receipts. So it's something that I'm going to work on as we move this bill forward to make sure that there's a way to make sure that everyone gets it and it's free and there's no other barriers to get in the way of making sure that they can get it.

Thank you.

Anyone else? Your bill has a motion by Ms. Waldron, second by Dr. Arambula. Enjoys a do pass recommendation, is do pass to appropriations. Ms. Ortega, would you like to close?

Yes. Thank you, Committee Members and Chair, for allowing me to present AB 1060. While I recognize that this Committee is about policy, I do want to mention that the cost of this bill is about $9 million. I just received the report, and I started to do the math. And according to the California Benefits Health Review Program, an estimated 78,000 people will obtain Narcan under this bill. If we assume the same rate of usage as the state's nonprofit distribution program, this bill will reverse about 5,000 overdoses.

That's 5,000 life saved. If I do more math, that's $1,800 per life saved. Do we get to save 5,000 lives a day for one $1,800? Not really. Right now, the average cost of a visit to the California ER is $2,900. So this bill will cost far less, save thousands of Californians from fentanyl poisoning, and more importantly, save many more lives. Thank you. I respectfully ask for your aye vote.

Thank you very much, Assembly Member. The motion is due pass, due appropriations. Madam Secretary, please call the roll.

[Roll Call]

Your bill has eight votes. It's out of Committee.

Thank you. And you have one more bill.

Thank you.

Yes, I do.

AB 1157.

Thank you, chair Members, for the opportunity to present AB 1157 before you all today. This Bill would clarify that durable medical equipment, or DMEs. DMEs, are covered essential health benefits and individual and small group health plans when medically necessary and prescribed by a healthcare provider. Durable medical equipment, such as wheelchairs and ventilators, enables individuals basic functioning, such as mobility, breathing, and communication, as it's primarily used by people with disabilities in chronic conditions. Yet private health plans in California generally do not provide adequate coverage of DME.

Many health plans completely exclude most DME items like wheelchairs, hearing aids, and ventilators. Other plans impose $2,000 annual limits on DME items, which only covers a fraction of cost of most DME. AB 1157 provides a solution that will help ensure that all Californians have access to durable medical equipment they need to live fulfilling lives.

Today, I have with me Carly Meyers, Staff Attorney at the National Health Law Program, and Jim LeBrecht, a longtime board Member of the Disability Rights Education and Defense Fund and founder of two organizations advocating for greater inclusion of people with disabilities.

Thank you. Good afternoon. My name is Carly Myers and I'm with the National Health Law Program, a nonprofit public interest law firm that protects and advances the health care rights of low income individuals and families. We strongly support AB 1157 and believe it will play a vital role in improving access to the healthcare devices that people with disabilities need to leave their homes, maintain their health, and participate fully in community life.

Currently, many Californians do not have access to the wheelchairs, hearing aids, ventilators and other durable medical equipment, or DME, that they need. Private health plans offered in California's individual and small group markets regularly exclude or severely limit coverage of this equipment. Without adequate coverage, many people go without medically necessary devices. They obtain inferior ones that can put their health and safety at risk, or they turn to publicly funded programs such as Medicare and Medi Cal, which do cover DME for help.

This gap in private health insurance occurs despite the Affordable Care Act's clear mandate otherwise. The ACA requires plans to cover certain essential health benefits, or ehbs, including rehabilitative and habilitative devices. States have some flexibility in defining the content of the ehbs. However, pursuant to federal law, the design of the EHB benefit package must not discriminate on the basis of disability or health status. DME devices, which are essential for the basic functions such as mobility, breathing and communication, are primarily used by people with disabilities.

When DME is excluded or severely limited from health plan coverage, it creates an access barrier for the adults and children who rely on this equipment but who cannot afford it out of pocket. Further, home use rules, which limit coverage to only the devices that an individual needs inside their home to the exclusion of devices they may need to travel even 10ft outside, serve to further segregate and isolate people from their communities. This Bill will help address this inequity.

AB 1157 clarifies that medically necessary DME is a covered essential health benefit in the State of California, and it will stop the discriminatory exclusions and limitations that people with disabilities have endured for decades. With greater access to DME, more Californians will have the tools that they need to pursue education and employment, to take care of their families, and to do whatever else a person may need or want to do.

13 years after the passage of the Affordable Care Act, it is no longer acceptable that health plans continue to exclude devices as foundational as a wheelchair. California now has the opportunity to correct this injustice, and we urge you to take it. Thank you.

Thank you.

Hi, my name is Jim LeBrecht. I'm grateful for this opportunity to speak to you today in support of AB 1157. I'd like to share my lived experience of what it's like and what it means to me to live with the current dollar caps and home use limits of DME coverage under private insurance coverage. I've been using a wheelchair. Using a wheelchair has been part of my life since I was two years old. I was born unable to walk because of Spina Bifida.

When I first understood that my insurance would only pay for DME coverage for items used in the home, I was outraged. That this was the law told me all I needed to know about how most of society and many elected officials thought of me and the disabled community. Why wouldn't they pay for a wheelchair that would allow me to travel away from my home? Why wasn't it considered necessary for people like me to have access to the world around us?

Fresh air, sunny days, visiting family and going to work. It was about painfully Low expectations for us. The message I took from this was that society and the law only thought of the disabled as sick people who were only able to live at home and not hold jobs. We were insignificant, disposable, and not valued as human beings like others. I wish I was being melodramatic here, but I'm not. I mean, what would you assume? It was unthinkable.

Was it unthinkable that I might be able to contribute to society in a meaningful way? That I could start a small business and employ people in meaningful, creative jobs? The reality is that I did start an audio company and hired several employees. I and my company paid taxes and provided an affordable and needed service to the local film industry.

And when the opportunity arose, I and dozens of people were employed over five years to create the documentary crip camp, and we paid for services from at least a dozen companies. I don't like equating someone's value to economics, but I am telling you that the benefits of this Bill far outweigh the cost. And I don't feel as though I need a spreadsheet to back up this assertion. On a more basic level, when we allow seniors or the disabled to fully participate in daily living, everyone benefits.

It's not a one way street. Grandparents can babysit children after school so a single parent can hold down a full time job. This is just one example I could tell you about. This Bill isn't charity or something nice to do for the less fortunate. It's about correcting a policy that devalues us. It's about allowing us the same freedoms that everyone else takes for granted. This is about human rights, this Bill. Anyone willing to say that it's too expensive?

I don't believe really believes in freedom for all. All of us want to have a full life, a life of one's choosing. But when you can't afford the essential items that the current regulations state are nonessential health benefits, you are keeping us shut away in our homes, out of sight. It makes me wonder if that might have been the intent all along. Thank you.

Thank you. Others in support.

Good afternoon. My name is Dan Okenfuss, representing the California Foundation for Independent Living Centers here in support. Thank you.

Thank you.

Katie Van Deynze with Health Access California, in support. Thank you.

Matt Lege. On behalf of SEIU, California in support. Thank you.

Johan Cardenas with the California Pan-Ethnic Health Network in support.

Good evening. Alex Khan, on behalf of the ALS Association in support.

Sandra Poole, Western Center on Law and Poverty. We're a co sponsor of this Bill and in strong support. Thank you.

Stewart Ferry with the National Multiple Sclerosis Society in support. Thank you.

Dave Butler on behalf of the California. Association of Medical Product Suppliers, in support.

Thank you.

Nora Lynn, with Children Now in support.

Thank you. Is there any opposition to the Bill? Seeing none. We'll bring it back to the Committee for questions or comments. Any questions or comments? We have a motion by Ms. Aguiar Curry, a second by Mr. Villapudua. Would you like to close?

Thank you for allowing me to present today's Bill and respectfully ask for your. aye vote.

I just want to say thank you for bringing the Bill forward. It does enjoy a do pass recommendation. Thank you to your witnesses. Very much appreciate testimony. The motion is do pass to appropriations. Madam Secretary, please call the roll

[Roll Call]

You have seven votes. We'll leave that Bill on call. Thank you. Thank you. Thank you. And Ms. Bonta.

Okay. AB 921.

Thank you, Chair and Members. Good early evening. AB 921 requires the Department of Health Care Access and Information, or HCAI, to establish the Behavioral Health Community-Based Organization Mentorship Program, connecting students with CBOs and providing them with resources, work experience, and a pathway to sustained employment as a behavioral health professional. Our behavioral health crisis is real and felt in homes, classrooms, on the streets, and in our community throughout the state.