Senate Standing Committee on Health

The Senate Health Committee will come to order. Good afternoon. We continue to welcome the public in person and via our teleconference lines. We will allow six minutes for in person testimony per side. Don't feel obligated. Individuals wishing to provide public comment via phone today, while we still do that, the Assembly does not. So we'll see how much longer we do it. It is 877-226-8163 and the access code is 736-2834. Okay, today we have eleven bills on our agenda. Eight of those bills are on proposed consent. So let's call the roll just to establish that we do not have a quorum.

Senators; Eggman, Here. Nguyen, Here. Glazer. Gonzalez. Grove. Hurtado. Limon. Menijar. Roth. Rubio. Wahab. Wiener.

Okay, Senators, take that as your roll call and come on down. All right, first up we have Assembly Member Gibson. Welcome. And you are presenting to us today AB 632 healthcare coverage for prostates.

Thank you very much, madam Chair and Madam Co Chair. And thank you very much for allowing me the opportunity to present Assembly Bill 632. Assembly Bill 632, which seeks to prohibit cost sharing for prostate screening for insurers enrollees who are either 55 or older, 55, 55 or at least 40 years of age considered as high risk. Wait a minute, I fit in that number.

Okay, I want to first thank the committee for working with my staff diligently and working on making and strengthening this Bill, making this Bill better. I will be accepting the committee recommended amendments. Prostate cancer is the second most common cancer in America, affecting one in every eight men. Wow, I fit in that category. Over 25,000 people will be diagnoesd with prostate cancer in California this year. And over 4000 people watch this, will die of this disease.

African Americans are at a higher risk to develop prostate cancer, which, the demographics being 60% more likely to develop prostate cancer than other races. Wait, I fit in that category. Other at risk factors includes increasing age, genetic mutations, and having a first degree relative with prostate cancer. My dad died of prostate cancer. Prostate cancer screenings are easy and fast and can be detected easy and early, most treatable stages, which lowers the mortality rate of this very curable underscore curable disease.

Currently, the cost of screenings deferred people from finding out from finding prostate cancer at an early age. Assembly Bill 632 aims to reduce the barriers of receiving these life saving screenings, which would help reduce the number of people who die from this disease. Here with me to provide supporting testimony is a very compelling gentleman who comes from Folsom. I will ask him to please come and please self introduce. He testified previous at previous committee and also Courtney Brandt. She is the zero prostate Cancer Pacific Northwest Chapter Director, who will also testify in support of Assembly Bill 632.

Thank you. First person, please.

Yeah. Major brain brain excuse me. Major fatigue, brain fog, muscle loss, huge loss of strength, higher cardiovascular risk, a higher risk of osteoporosis, an additional 7500 a year in medical expenses, a lifespan most likely cut short and emasculated daily from the inside out with other side effects. I'm sure you do not see this with me standing here as an advanced prostate cancer patient speaking in support of AB 632.

In fact, my prostate cancer was diagnoesd at age 53 because of a self procured lab test that included presa screening, a screening denied as preventative care by my healthcare provider. I went back to my doctor with elevated PSA results and I was diagnoesd with prostate cancer two months later. I'm now 55 and in treatment for advanced prostate cancer. I wish I had no more. I wish my doctor had no more. I wish my healthcare provider prioritized prostate cancer screening as preventative care.

Then maybe I would have caught it earlier when the disease is easier to treat. And maybe I wouldn't be living with the side effects of treatment for advanced disease as I described just a moment ago. My name is Jeff Mayhak.

I am from Folsom, and this is why I am here in support of AB 632, I have made it a priority to spread the word about screening in the community and among friends, including a family friend, an African American man who is diagnoesd and treated for high risk disease one year after me. I appreciate the opportunity to help make changes on a larger scale.

And AB 632 is one step towards making screening and early diagnosis easier for those at high risk, especially African American men and active duty and retired military men that I hope won't have to face the same challenges I have. AB 632 ensures that prostate cancer screening is available to those who need it, free from unnecessary barriers between a man and a future free from prostate cancer.

Thank you, Assembly Member Gibson, for your leadership on this issue and to the chair and Members and the committee for your time and consideration.

Thank you. Thank you for sharing your story with us. Next supporter, please.

Hi, my name is Courtney Brandt, and I would like to give my time. Over to Dr. Peter Batan, a urologist who serves patients in a safety net. Hospital in Santa Cruz County. Dr. Batan?

Thank you. Madam Chair. Madam Vice Chair, Assemblymember Gibson, thank you all for the opportunity to present this life saving Bill Today and to support it. I'm Dr. Peter Breton. I'm past President of the California Urologic Association, and I'm testifying for all California urologists and their patients. I'm also past President of the California Medical Association. I'm a practicing urologist at three safety net hospitals in the Salad Bowl of America, Santa Cruz and Monterey counties, and I treat primarily farm laborers and non English speaking patients.

I speak in vigorous support of this Bill because it will help lives, as Assembly Member Gibson has said. By a. Timely and early diagnosis of prostate cancer screening. A simple, very simple blood test. I wish women had this blood test for breast cancer. My mom died of breast cancer to be performed in high risk patients, as Assemblymember Gibson Zed said, and also veterans and specific age group high risk patients, many as I see in my indigent population that I serve. Thus, the proposed elimination of just simple copays will benefit marginalized groups and even greater will help benefit them the best.

Most importantly, it will prevent metastatic disease and subsequent greater costs of delayed care. This is a cost effective Bill. Doesn't cost the state anything as well. So I thought it was ingenious the way Assembly Member constructed this Bill. Thus, it's a very cost effective and efficacious healthcare method to serve our indigent high risk population, especially in this time of cost cutting.

While I understand the profit motives of the insurance companies that have resist this Bill to date, but based on my personal experience and more importantly, the experience submitted from data from the California Urologic Association and our National American Urologic Association and the Cancer societies, they have verified that lack of PSA screening because of some recommendations in the past past five years. We are seeing increased metastatic disease. We are seeing needless deaths. So please, this is a very cost effective Bill.

It'll prevent metastatic disease and loss of lives. Help us help you save patients in our great society here in California because we have expanded Medicaid medical more than any other state. And I'm proud with what our Governor has done with healthcare and inching closer to universal health care more than any other state in the union. So please share with me Assembly Member Gibson's view. Thank you very much.

Thank you. Okay, anybody else in the room speaking in support today? Now is just your name and affiliation position on the Bill.

My name is Dr. Alexandra Johns and I'm a General surgery resident here in Sacramento. And on behalf of the National American College of Surgeons and all three California chapters of ACS, we are in support of this Bill.

Thank you.

Thank you. Okay, seeing no others approaching the mic at this time now, anybody speaking in opposition to this Bill today, now is the time to come forward. Seeing none, we'll go to the phone lines. Moderator is there anybody on the phone wishing to speak in support or opposition to AB 632, thank you.

For support or opposition to AB 632, please press one and zero. At this time we'll go to line 183.

Good afternoon, chair and Members my name is Sandra Poole on behalf of Western Center on Law and Poverty in support of this Bill.

Thank you. Next caller.

Madam Chair, no further comments in queue at this time.

Okay, thank you very much. Now would be the time to bring it back to the committee. Any questions, comments? Senator Grove?

Thank you. Thank you, madam Chair, thank you for bringing this Bill forward. I do have a couple of questions. Just because of the witness that you brought forward, the urologist that treats an indigent population, as he says, and I believe you said specifically farm workers and those underserved. This item is covered by Medi Cal, correct?

Yes.

And is there an adequate reimbursement rate for this, or is that something that needs to be addressed?

And this Bill does not reflect anything to do with Medi Cal. It's just not forcing, but requiring the plans to provide it at a no deductible.

Yes.

That is correct.

Okay, thank you. Just briefly.

Yes. By removing the copay, the indigent population would rather have dinner that day than pay $20 to $40, maybe $80 for a prostate cancer screening Bill. You're asking them to give up future life or possibility of a meal that day. I think that's unjust. This doesn't cost the state.

Thank you very much. That's not the question I asked. I asked if the Medi Cal reimbursement rate was adequately reimbursed for you to provide that service to people who don't have insurance or insurance plans.

As you know, Madam Chair, this medi cal is grossly underpaid. But we do it, and we do it to cover everything. We pick it up. We ask for subsidies. Medical all I can answer to that was a generalized question. Medical is paying about 30% what Medicare pays. That should say enough.

Yeah. Thank you, sir.

Sure.

Trying to make a point in someone's Bill, but I love your Bill, so I'll move your Bill when the appropriate time comes.

Thank you very much.

Sorry, I want to make my point. Would you like to close, Mr. Gibson?

Yes. Thank you very much. I want to thank our witnesses and also Mayhek for his testimony. Heart moving testimony. Again, when I was reading this Bill and when I came up with this Bill, I followed these demographics and certainly to removing the cost barrier will go a long way for people who are struggling to make ends meet.

If you have to get a second or any other kind of test, you would think twice because a lot of people don't have disposable income to sitting around in order to pay for it. And so I think we should go a step further to, one, making sure that we can provide the resources or remove barriers for this treatable and curable disease. I respectfully ask for an aye vote.

Thank you very much. Very important issue, and we will take that up when we have a quorum. Thank you so much very much. Oh, I see Ms.. Erwin here. Let's move on to AB 931. You can see we don't have a quorum, but we are encouraging Members of the Health Committee to come to the Health Committee room.

Well, good afternoon, Madam Chair and Members. I am pleased to present AB 931 today. I would like to begin by accepting the committee amendments. As a patient looks to get physical therapy treatment their doctor has prescribed, a frequent barrier that they run into from their insurer is delay for prior authorization. A survey by the American Physical Therapy Association saw that over 25% of therapists regularly wait for over a week for prior authorization decisions from the insurance companies.

These delays can leave patients suffering from pain and reduced mobility while they wait for their insurer to grant them the care they need to find relief. Patients in chronic pain often are forced to continue the use of painkillers as they wait for prior authorization, and other patients may give up on their course of care immediately, entirely.

AB 931 would avoid these negative outcomes for patients by preventing insurers from requiring prior authorization for the first twelve physical therapy visits related to a new episode of care. In doing so, this Bill removes unnecessary restrictions created by the denial of care and constant reviews for medically necessary physical therapy treatment.

I would like to express appreciation to all of the stakeholders for engaging in productive conversations with my staff on a path forward with this Bill, and I look forward to continuing those discussions. With me to testify today in support is Rick Katz, President of the California Physical Therapy Association, and Paul Gaspar on behalf of the Independent Physical Therapist of California.

Thank you. First Member, please.

Hi. Good afternoon. My name is Rick Katz. I'm the Doctor of Physical Therapy and President of the California Physical Therapy Association, and we represent over 10,000 physical therapists, physical therapist assistants, and physical therapist students enrolled in PT programs. And AB 931 improves access and reduces delays in care through patients receiving physical therapy.

In recent years, we've seen increases in healthcare review decisions done via computer algorithms that do not properly recognize the training and opinion of physicians and other health professionals to assess the need for the duration of care based upon initial evaluations. In fact, a data review from 1.2 million cases from the nation's largest electronic medical records provider for physical therapy showed that the standard approval rate was 3.8 visits per each request, and this was done via a computer program, not by individuals reviewing that.

While there was a standard approval of over ten visits when a review was done by an individual provider, the opposition to this Bill states that it is necessary for the insurers to be involved early in the authorization process to ensure the proper care is delivered. They are essentially stating that the insurer needs to establish medical necessity based on the computer algorithm because a physician and a doctor of physical therapy are unable to make that determination on their own.

A patient who has a defined physical therapy benefit and the opinion of multiple healthcare professionals should not be denied care or have care delayed because of a computer algorithm is in place. The repeated submission of authorization requests delays care, creates great frustration for the patient provider, adds to administrative burden. This Bill will not limit an insurer's ability to remove a provider from their network for demonstrating patterns of overutilization. This Bill allows care to be delivered without these unnecessary delays.

Published studies in Musculoskeletal Medicine show that costs can be as much as 75% higher when access to physical therapy is delayed. These added costs are attributed to increased opioid use, surgeries, diagnostic testing, and additional physician visits. An attempted rollout of one of these restrictive utilization management programs for physical therapy in California back in 2019, resulted in 51 patient complaints to the department managed healthcare before the insurer had to pull back implementation of the program, and this occurred within a very short period.

The plan rollout showed that 100% of the requests for care were reviewed. Which basically says that the physician and the physical therapist couldn't determine what the frequency and duration of care should be. The payer approved an average of 3.8 visits per request. The only impact to this was a delayed in access to care and patient complaints. And note that these requests for care received reviews were not performed by a peer provider. They were done by a computer algorithm.

Allowing a payer to ration a patient's benefits does not ensure that they receive appropriate care. It just contributes to them not receiving the care that has been deemed medically necessary. The opposition also states this Bill would allow for unfettered access to care. Seeing a patient for twelve visits is far from being unfettered access. Our goal is to treat patients and get them as independent as possible, and then discharge them and have them manage their condition on their own.

We have dozens of patients waiting in our waiting room to have care, so there's no incentive for us to continue to see a patient if they don't need care. It does not make any sense to have a PT who is treating a newly injured individual with a spinal cord injury to have to submit requests for care for every three visits. And this is a case that's occurred in some of the rehab hospitals in California.

CPTA has engaged the DMHC in conjunction with our colleagues from the Independent Physical Therapists of California to help address the issues that exist with delayed access and delayed reauthorizations. But their abilities are limited based upon current law. This Bill diminishes the need for a patient to file a complaint in order to access care that is medically necessary and covered in their benefit plan.

Doctor, you're leaving your colleague less than a minute to testify.

Then I am done. I urge you to support AB 931, and I appreciate Assembly Member Irwin bringing the Bill forward.

Thank you very much. About 40 seconds left.

Yes, Dr. Paul Gaspar from the Independent Physical Therapist of California. I'm here today because I was the one to help mine the data regarding the constraining of the physical therapist services, sometimes known as rationing. My opinion is overall that CPTA is pretty much over the target with the twelve visits asked. The standard deviation with the average visits is really high, though.

So some practices, like mine see 14 or 15 visits on the average because we treat a lot of very involved patients, underserved patients, patients with very complex conditions, things like that. And so what we're trying to do here is trying to make sure that physical therapists and doctors are the ones that are making the call, not computers, and not just the same number of visits rationed out every few weeks.

Okay. Thank you very much. Anybody else speaking in support of this measure? Now's the time to come forward. Just name an affiliation.

Paul Smith, practicing physical therapist in Fresno, California.

Thank you. Speaking in support?

Absolutely. Thank you.

Thank you very much. Okay, seeing nobody else. Anybody speaking in opposition to this Bill today?

Good afternoon, Madam Chair, Members of the committee. Jedd Hampton with California Association Health Plans with an opposed unless amended position on the Bill. California Association of Health Plans represents 44 health plans across the state, covering nearly 28 million people. We do sincerely want to start by sincerely thanking the author, the sponsors, the author's staff, and the committee staff. We've had ongoing conversations on this Bill and some really productive conversations.

So we're very appreciative of the author willing to engage with us on some of our concerns and hope to continue those conversations moving forward. However, we are opposed, unless amended, AB 931, principally because this Bill will exempt certain providers from seeking prior authorizations for physical therapy services for up to twelve visits. As you know, Madam Chair, there's been a lot of discussion in this committee this year around prior authorization as a whole.

We really appreciate your work and consideration of the issue and know that we're going to be working on it some more moving forward. But ultimately, we do believe that prior authorization services are critical function within the healthcare system as it allows health plans and ensures the opportunity to evaluate specific services and ensure that they are not only medically necessary, but consistent with appropriate clinical care guidelines.

As with all bills seeking to remove prior authorization or other utilization controls for a particular service, we are concerned that this Bill may result in patients receiving unnecessary or inappropriate care and potentially driving up costs within the healthcare system. So for these reasons, we are opposed, unless amended to the Bill. But again, look forward to working with the author to address our concerns moving forward.

Thank you. Thanks very much. Next.

Stephanie Watkins on behalf of the Association of California Life and Health Insurance Companies, I'd like to echo my colleagues comments in the interest of time, but also thank the author and sponsor and the committee for working on some amendments to address the out of network piece that's generally a big concern. So with that, we look forward to any future conversations. Thank you.

Thank you very much. Anybody else speaking in opposition at this time come forward? Seeing none, we'll go to the phone lines. Moderators or anybody on the phone lines.

Thank you for support or opposition of AB 931, please press one, then zero at this time. Go to line 186. And 186, please go ahead.

Thank you. This is Liz Helms, President and CEO of the California Chronic Care Coalition. In support.

Thank you. Next caller.

One moment, please.

Maybe lay off?

One moment please.

Are you hunting for somebody?

189, please go ahead.

Okay.

And 189, your line is open now.

Maxine Mantell on behalf of the National Multiple Sclerosis Society. In support of the Bill.

Thank you.

Thank you, Madam Chair. No further comments in queue at this time.

Thank you very much. We're going to bring it back to the committee now. And we had asked you about six visits versus twelve, and you said twelve, although I don't know if you've been to physical therapy before, but I haven't. Who does twelve?

Well, this is basically what the data came up with from the physical therapists, that they thought twelve was the average amount of appointments that were needed. And obviously the opposition is looking for a different amount. As you heard from the opposition, we have been working diligently with them, and we have taken a number of amendments, and we're still working on perhaps a happy medium between the insurers and the physical therapists.

Okay. Ms. Grove wants to negotiate from the dyess and say so. Nine? Did I hear nine? But I trust that you'll continue to work on this issue. And the other thing that we did, just to add a concern that there's got to be some kind of notification when somebody says, okay, I'm going to get it without prior auth, that you may not get the authorization, and then a client is potentially on the hook for that.

And we appreciate those amendments. And as I mentioned, we are taking all those amendments, and that's along the lines of the out of network issue that we think that has been resolved.

Okay, thank you. Any other questions, concerns?

I also want to echo the chair. I think there can be a happy median. I think twelve is probably more of the serious cases. Not everybody has all those serious cases. My son just went to physical therapy for his elbow because of pitching. I think he did, like, three or four visits. So I think there could be a happy median somewhere. So I hope that you continue to work on it and consider it.

Absolutely. We all have a lot of anecdotal data, and we just need to look at what is the average amount. But the main thing is that there are large costs to delaying care, and so we want to make sure that the PTs are able to start their care right away and then figure out what a good number is there.

Yeah, no, I'm totally in agreement with you on that. The delay, even a couple of days or several days is not good for the patient, so I completely understand that part. But like I said, it's going back to I think twelve might be more of a serious case that's going to last a lot longer than most of the average cases or injuries. I shouldn't say cases, injuries.

And we'll definitely continue to work on that.

Thank you. Okay. Would you like to close?

Just respectfully ask for your aye vote.

Okay. Will still don't have a quorum yet. Is there a motion for when we do have a quorum? Senator Weiner moves. So when we do have a quorum, we have a motion. Thank you very much.

Thank you very much.

Now we're looking for Assembly Member Maienschein as well as the rest of our Assembly Health Committee Members. Senate. Senate looking for Assembly Member to present, Senators to serve.

Maienschein is presenting in Government body right now. And we're working on getting at least one of the Members so we can get your forum going.

Okay.

He's presenting. I'll be right back.

Senators; Glazer. Gonzalez. Grove, here. Hurtado. Limon, here. Hurtado. Here. Menjivar. Roth here. Rubio. Wahab. Wiener, here.

And right on time. Here comes our last presenter. And we have established a quorum. Welcome.

Thank you very much, madam Chair. I was presenting a Bill. I want you to know I was not sitting around waiting. I was presenting a Bill. And I want to begin by accepting the amendments as listed in the analysis. AB 1085. And I ran here. So that's why I'm a little out of breath. It's not my Bill that how far was it? How far? It was far enough that I think it's legitimate. I'm out of breath.

Okay. I was checking on that.

I'm not overly concerned that I'm out of breath.

Called stress tests. Health committee.

But I will check my fitbit. AB 1085 requires the Department of Healthcare Services to seek any necessary federal approvals for a medical benefit to cover housing support services. Homelessness dramatically impacts health outcomes, costs, and access to care. Health costs for Medicaid beneficiaries experiencing chronic homelessness averages over $33,000 a year and over $100,000 per person for frequent hospital users. Housing support services help people access housing, remain housed, and are essential for individuals experiencing homelessness to access meaningful care.

Two years ago, DHCS shared an intent to make housing support services a medical benefit for Californians experiencing homelessness by 2024. AB 1085 requires the Department to begin the process to make this benefit a reality. With me to testify. In support are Linda Nye from the Western Center on Law and Poverty and Nor Kasur from EAH Housing. And I respectfully request your aye vote first person, please.

Good afternoon, Linda Way with Western Center on Law and Poverty, proud co sponsors of AB 1085, which builds upon the investments to homelessness through help dollars by making housing support services a medical benefit. Housing support services include services that connect individuals to housing, one time deposits, and tenancy support services to keep people stably housed. Currently, Medi Cal plans may offer a range of housing support services to people experiencing or at risk of homelessness.

Under Cal aim, this plan option can make both eligibility and actual services inconsistent and inequitable, difficult to administer, and often time limited. This Bill would make housing support services a medical benefit, which would reduce the variation by setting a standard eligibility criteria applied statewide and allow providers to more easily access a stable, sustainable source of funding for housing support services. This Bill would also open the doors to significant federal funds with up to a 90% match rate that we are currently leaving on the table.

A benefit is an approach that has already been proven effective in 20 other states, and I urge your aye vote on this Bill, which has enjoyed bipartisan support on the Assembly. Thank you.

Thank you very much. Next person, please.

Good afternoon. My name is Noor Coster. I am a Business development manager for EAH Housing. EAH Housing is one of the largest affordable housing, nonprofit development, and management organizations in the western United States. Our affordable and supportive homes serve more than 25,000 seniors, families, veterans, students, people with disabilities, and people who are experiencing homelessness. We provide services in our affordable developments to match the needs of the residents, including supportive services for the formerly unhoused residents and people at risk of homelessness and with disabilities.

Over the last five decades of developing and managing these communities, eh has found that residents are able to maintain a stable home and their overall well being when the community includes supportive services. Eh thus partners with experienced service providers who understand each community's needs and offer everything from medical case management and healthy food programs to financial literacy and job training to our residents.

One of the biggest barriers for EAH Housing to successfully build and provide more homes with supportive services statewide has been the lack of reliable, sustainable services funding. In fact, access to services funds, whether through a city, county, housing authority, or other entity, is one of the key determinants for whether we decide to propose a new supportive housing development in a locality.

The political will, the land, and even the construction capital may all be there, but we have actually had to reconsider moving forward when we can't find the services needed or the funding needed to support the future residents. Our state development programs for supportive housing requires us to find sources of services, funds that will continue for as long as the residents need those services. Eh is supporting AB 1085 because the benefit would bring additional federal dollars to California.

It would offer a predictable, reliable, sustainable source for funding for Eh to use with our service providers across the state and will help us create more supportive homes with these affordable housing funds. Ultimately, it would allow us to move more people off the streets and into stability. Thank you.

Thank you very much. Anybody else speaks in support? Now is the time to come forward. Just name an affiliation at this point. In support.

Good afternoon, Madam Chair and Members. Mark Farouk on behalf of the California Hospital Association. In support.

Andrew Dawson on behalf of the California Housing Partnership. In support.

Good afternoon, Madam Chair. And Senators Andres Ramirez. On behalf of all home. In support.

Thank you. Good afternoon. Yasmin Pellet. On behalf of justice and Aging in Support thank you.

Izzy Swindler with California State Association of Psychiatrists in Support. Thank you. Thank you.

Hi, I'm Mari Castaldi with Housing California in support.

Thank you.

Good afternoon. Jamie Velasco with the Steinberg Institute in support.

Thank you very much. Anybody speaking in opposition to this Bill today, now would be the time to come forward. Seeing none. Moderator we'll go to the phone line, see if there's anybody on the phone wishing to speak in support and or opposition. Thank you.

For support or opposition, AB 1085, please press one, then zero. At this time we'll go to line 187 good afternoon,

Sharon Report with the Corporation for Supportive Housing, proud co sponsor of AB 1085 in support. Thank you very much. Anybody else?

Madam Chair. And no further comments in queue.

Thank you very much. Now would be the time to move it back. We have a motion on the Bill. Senator Grove, did you want to ask a question or speak?

I do, Madam Chair.

Okay, please.

Thank you, Madam Chair. I appreciate the Bill. I do. I live out off of the 80 business route where they have that golf course where there's this like, skid row, right? Hundreds of trailers and stuff. And so I just have a huge concern right now. We're grappling with hospitals that are financially distressed and closing medical providers, medical providers leaving the network, not providing services to those that get Medi Cal. How do you propose, I guess, the pathway?

I know this is just a study to request the information and then if the information comes back viable, then we would request it from the federal government. But where does the rest of the resources come from?

Well, I do think you've hit the nail on the head. This is the first step towards determining what those resource sources could ultimately be and how they would best be used. So it is going to be a balancing act at some point. I think this is money that's going to be very helpful. If you talk about that level of match 90% match, that is a lot of money that California could have access to. I'd note CHA was here too in support of that as well.

So I do think the issues that you raise are legitimate mean. We do have to figure out how assuming this is something that's doable how that money ultimately gets spent is something that the Legislature is going to have to grapple with.

I appreciate that. And like I said, again, I think about it and I think would I love to have them in housing? Yes. Am I concerned about what happened a couple of days ago at that particular encampment that didn't even make the news and probably just got barely on the radar because the fire Department had to put out the burning women that were was? I get it. I think there needs to be housing available. We struggle with housing, housing projects.

I worked with my colleague from San Francisco on a couple of bills just this week or last week for housing projects because we need more housing. I just am very concerned that we can't even provide the adequate reimbursement rates for our medical providers and the hospitals. And I'm very concerned about this, again, catastrophic event that could possibly take place. But I appreciate the concept of the Bill and we're moving it to provide housing for people that are and the.

Idea would be this house. And the idea would be this would give more money to do that, to reimburse those hospitals, to reimburse those providers. So the idea is to access more money for California to do the type of things that we need to do to get these individuals in house.

I get it. Yeah. Thank you, sir. Thank you, Madam Chair.

Thank you. And thank you for your longtime dedication to trying to serve the unhoused population. Yeah, and I think we need more so that when people come into the ER so we don't have the backup, we can get people back out as quickly as possible. And we know where reimbursement goes. Oftentimes buildings follow. So would you like to close, Mr. Maienschien?

Thank you very much. Madam Chair, Members respectfully request an aye vote.

Okay. Thank you very much. That Bill was moved by Limon. Senator Limon. And the motion is due pass as amended and referred to the Committee on Appropriations. Secretary, please call the roll.

Senators. Eggman, aye. Nguyen. Glazer, aye. Gonzalez, aye. Grove. Hurtado, aye. Limon, aye. Menjivar, aye. Roth, aye. Rubio. Wahab, aye. Weiner, aye.

That's nine. And we'll hold that open for absent Members, thank you very much. Could we get a motion on the consent calendar? And on the consent calendar, there is AB 48, AB 70, AB 332, with amends, AB 405, AB 5952, AB Eleven. Or 1325, with amends, AB 1462, AB 1696. So moved by Senator Grove on the consent calendar. Secretary, please call the roll.

Senator Eggman.

Aye.

Eggman aye. Nguyen.

Aye.

Nguyen aye. Glazer.

Aye.

Glazer aye. Gonzalez.

Aye.

Gonzalez aye. Grove.

Aye.

Grove aye. Hurtado.

Aye.

Hurtado aye. Limon.

Aye.

Limon aye. Menjivar.

Aye.

Menjivar Aye. Roth.

Aye.

Roth aye. Rubio. Wahab.

Aye.

Wahab aye. Weiner.

Aye.

Weiner aye. Eleven.

It was eleven. We will hold that roll open for a few minutes for absent Members. I think Senator Rubio is the only one missing right now. Okay, now, moving on to AB 632, Assembly Member Gibson. The motion was due pass as amended and rereferred the Committee on Appropriations. I believe we had a motion by Senator Grove again. Secretary, please call the roll.

Which one?

The prostate one.

Yes, I did.

I did.

The vice chair was saying, I didn't move it. I was just making sure that I was correct.

Senators Eggman.

Aye.

Eggman aye. Nguyen.

Aye.

Nguyen aye. Glazer.

Aye.

Glazer aye. Gonzalez.

Aye.

Gonzalez aye. Grove.

Aye.

Grove aye. Hurtado.

Aye.

Hurtado aye. Limon.

Aye.

Limon aye. Menjivar.

Aye.

Menjivar aye. Roth.

Aye.

Roth aye. Rubio. Wahab.

Aye.

Wahab aye. Weiner.

Aye.

Weiner aye. Eleven.

All right, now moving on to AB 931. Erwin do pass as amended, and Ruby referred to the Committee on Appropriation. Senator Weiner made that motion. Secretary, please call the roll.

Senators Eggman.

Aye.

Eggman aye. Nguyen. Glazer.

Aye.

Glazer aye. Gonzalez.

Aye.

Gonzalez aye. Grove. Hurtado.

Aye.

Hurtado aye. Limon.

Aye.

Limon aye. Menjivar.

Aye.

Menjivar aye. Roth.

Aye.

Roth aye. Rubio. Wahab.

Aye.

Wahab aye. Weiner.

Aye.

Weiner aye.

Eleven, nine to zero. We'll hold that open for absent Members. Senator Rubio, if you could come on down. Thank you, Members, very much. We're going to have, like, a three minute recess while we wait for Senator, who is presenting in another committee to come over here for final votes before we close a roll to move to the consent calendar. I will read it off again. AB 48. AB 70. AB 332 with amends. AB 405. AB 5952. AB 1325 with amends. AB 1462. AB 1696 is a consent calendar. Secretary, please call the roll.

Senator Rubio.

Aye.

Aye.

Rubio aye.

Okay. Now we're moving on to AB 632 by Assembly Member Gibson. The motion was do pass as amended and rereferred the Committee on Appropriations Secretary Senator Rubio.

Rubio aye.

12 0. That Bill is out. AB 931. Senator Assembly Member Erwin do pass as amended and referred to the Committee on Appropriations. Secretary.

Senator Nguyen. Grove. Rubio.

Aye.

Rubio aye. Ten zero.

Ten zero. That Bill is out. And that concludes the Senate Committee on Health.

Thank you.

Thank you. Thank thank you.