Senate Standing Committee on Health

And so if now we got a competition, well, Senator, Assembly Member Wood, I saw him. He was sitting here, but then you walked in. All right. She's first. She's first and she has two.

Good afternoon.

Good afternoon.

We'll start AB 254 1st. Does that work? Okay.

Thank you.

Madam Chair and Senators. Senator. Senators look two. Three well. Madam Chair and Senators.

Zero, it's okay.

You were the chair.

Senator Wood, would you like to go?

AB 254 is a common sense measure to protect reproductive health information. Nearly one third of women use reproductive and fertility tracking apps to guide them through their lives and their pregnancies for menstrual cycle tracking. One of the first questions users are forced to answer when seeking the app services is often are you pregnant? These apps are capable of recording when pregnancies begin and when they end. In their current form, the apps offer little in the way of data protection.

A Consumer Report study found that none of the leading menstrual tracking apps offer transparency about who they share the data with. This study found that a majority of the apps use third party trackers. It's unacceptable, especially in a post row world, to sell data revealing reproductive care that could result in arrest, and not to mention just that we deserve privacy in our reproductive lives.

AB 254 protects this data by adding CMIA protections the California Medical Information Act, to reproductive and sexual health information collected by these digital services. With me today in support of AB 254 is Janice Gonzalez with the Lieutenant Governor's office and Becca Kramer with the ACLU.

Please, first supporter, go ahead.

Hi, Becca Cramer Mowder, matter on behalf of ACLU. California action and support. Given the national climate, reproductive and sexual health information is becoming even more valuable and poses an even greater risk to users when shared without their consent. As states across the country criminalize people for receiving reproductive health care, it becomes even more important that California does more to protect against digital tracking.

The lax data security of apps that track menstrual cycles or pregnancy means this data could easily be acquired and used as evidence to criminalize pregnancy loss, abortion, or gender affirming care. The data collected by these apps is extensive. Ads for reproductive health services may take a user directly to a survey that tracks family medical history, mood, medications, pregnancy status, and other sensitive information.

Unlike a Doctor's office, this information is not covered by HIPAA or CMIA because it is considered health information rather than medical information, a distinction that carries a huge difference in legal obligations and protections, but which is meaningless and nonsensical to the average user. The data sharing provisions and enforcement mechanisms governing health information do not provide adequate protection.

This Bill makes those claims of privacy protections real by adding the information collected to CMIA, providing users with the medical privacy protections many wrongly assume reproductive or sexual health app information already has. We therefore request an aye vote on AB. 254. Thank you.

Thank you very much. Next person speaking in support, please.

Hi there. Thank you. Madam Chairman Members, I apologize. Ran down those stairs, so a little out of breath

I'm Janice Gonzalez, Legislative Affairs Specialist, here to speak in support of AB 254 on behalf of Lieutenant Governor Eleni Kunawakis.

Going back up, so tougher part, no?

Okay, good way to use pauses with your breath.

It's happened to a lot of us. We're with you.

Thank you. The Lieutenant Governor is a proud sponsor of AB 254 and is grateful to the author for bringing this Bill forward. Under current law, data collected on an app regarding a user's sexual reproductive health is not sufficiently protected. Since the overturned a row 11 states have criminalized abortion and many more considering doing the same.

As more and more Californians place their personal health data on tracking apps, there is no guarantee that their information is safe. AP 254 extremely extends the safeguards of California's medical privacy law, CMIA, and the federal medical privacy law, HIPAA to the data gathered by digital services that offer sexual and reproductive health care. With AB 254 users can be assured that sensitive digital information about their reproductive and sexual health will have the same protections and privacy as other medical information.

AB 254 protects Californians and continues to be a beacon of hope and a safe haven in a post row world. We respectfully ask for your aye vote AB 254. Thank you.

Thank you very much. Now others speaking of support just come forward now. Name and affiliation.

Karen Stout on behalf of the California Nurse-Midwives Advisors Association, as well as Neighborhood Approach California. In support.

Crystal Kidos here on behalf of the city and County of San Francisco. In support

Ryan Spencer on behalf of the American College of OBGYN's, District Nine. In support.

Taylor Jackson with California Health Plus advocates representing California's Community Health centers here in strong support.

Thank you. Anybody speaking in opposition to this Bill today? None listed. Right. Seeing none. Lead opposition? Is there just some people who would like to speak and say they don't like it? Seeing none. We'll go to the phone lines. Moderator, are you there? We have anybody on the line for AB 24?

Yes, Madam.

Okay.

Yes, Madam Chair, we do have a comment from line 96. Your line is now open and if you would like to comment, please press 10. Line 96 your line is now open.

Hi, my name is Raquel I'm with the National Association of Social Workers California chapter in support of this Bill.

Thank you. Next caller, please.

Good afternoon, Ken Cutler on behalf of the Health Officers Association of California in support thank you.

And we are waiting, okay then, the next question. The next comment is from line 92. Your line is now open.

Thank you very much. Next caller, please.

And there are no more comments Madam Chair.

Thank you very much. Now's the time we'll turn it back to Committee Members. Questions, comments? It's pretty straightforward Bill. Would you like to close?

When the time is right, I respectfully ask your aye vote.

Thank you very much. We don't have a quorum for a motion right now, but when we do, we will get there. Now, moving on to AB 1720.

Thank you, Madam Chair and senators. I want to start by thanking the committee staff for their help on this cill and the chair herself. Ultrasound, AB 1720 is a simple bill to ensure ultrasounds are provided in licensed settings or by medical providers. Ultrasounds are some of the most intimate and revealing medical tests an individual can receive. They often reveal for the first time a serious medical issue or the development of a fetus. A misread ultrasound can therefore be utterly devastating.

Unlike other states, ultrasounds in California do not require a specific certification or licensure. Unlicensed ultrasound providers do not use insurance which puts uninsured patients at disproportionate risk, since they may seek what should be medical care from unlicensed centers. We are taking amendments and Senate Judiciary Committee to expand exemptions to all licensed providers, and I'm committed to continuing to work with stakeholders to ensure the bill is restricted to unlicensed ultrasounds only. With me in support is Ryan Spencer with the American College of Obstetricians and Gynecologists.

Mr. Spencer.

Thank you, Madam Chair and members. Ryan Spencer on behalf of the American College of OBGYN's, District Nine, in support of AB 1720. Our providers utilize ultrasounds to monitor pregnancy as well as diagnose and monitor medical conditions that are not related to pregnancy, such as causes of pelvic pain, abnormal uterine bleeding, or infertility. They are an essential part of health care and should be treated as such.

Staff who utilize ultrasounds at unregulated and often nonmedical facilities have no legal obligation to provide pregnant people with accurate information and are not subject to HIPAA or required by law to maintain client confidentiality. Equally concerning is the use of ultrasounds to emotionally manipulate and shame pregnant people under the guise of informing or diagnosing them. Additionally, while there is currently no evidence that ultrasounds are harmful to a developing fetus, it is possible that effects could be identified in the future.

Therefore, casual or nonmedical use of ultrasounds during pregnancy should be avoided and performed only for medical reasons by qualified healthcare professionals, and AB 1720 can help provide these necessary protections by ensuring ultrasounds are performed only in regulated medical facilities. For these reasons, ACOG is pleased to support AB 1720 and ask for your aye vote. Thank you.

Thank you very much. Anybody else speaking in support of this bill? Want some just eyes? Okay, nobody. Anybody speaking in opposition to this bill today? Okay. Seeing seeing none. We'll go to the phone lines.

If you would like to comment on AB 1720, please press one zero. And there are no comments, Madam Chair.

Okay, thank you very much. And we'll now be bringing it back here. And I just want to clarify, we have some mockup of amends that it was too late. You're double-referenced. So you're going to take these amends in judiciary kind of just cleaning up the language. Making sure people who should be giving ultrasounds, doctor's office, and such, can all do their work?

Yes, Madam Chair.

Okay, very good. Okay. Anybody else? I think we're not quite at a quorum yet. We need one more. Okay, thank you very much.

Thank you. Again, when the opportunity arises, respectfully ask your aye vote. And thank you, Madam Chair, for allowing me to go.

Thank you very much. All right. Assemblymember Wood.

Thank you very much, Madam Chair.

Yes, sir.

Sometimes it's lonely at the end of the alphabet. So Madam Chair and senators, thank you for the opportunity to present AB 1092. This bill builds upon my prior legislation, AB 595 on health plan mergers to ensure that health plans acquiring a physician group are subject to regulatory review. Studies show that mergers and acquisitions in healthcare are not lowering costs for anyone but the entities doing it. And there are real concerns about how these mergers could reduce or limit access to certain healthcare services.

This bill ensures that the regulators have the authority to review such transactions and their impact on consumers. The bill also authorizes the Department of Managed Healthcare director to review competition in health systems and provide this information to the Attorney General. Recent technical assistance from the Department of Managed Healthcare clarify that these transactions include those of a health plans affiliate. I respectfully ask your aye vote.

Thank you very much. First person speaking in support.

Good afternoon, Madam Chair. And Senators. I'm Katie Van Deynze, a policy and legislative advocate with Health Access California, and we are proud to support AB 1092. Health Access, sorry, Health Access sponsored AB 595 by Dr. Wood, which the Legislature passed back in 2018 to give the Department of Managed Healthcare the authority to approve or deny mergers or approve mergers with conditions to protect consumers.

AB 595 required that when two health plan merged or another entity acquired a health plan, they seek the approval of the department. Under the law, the department reviews the merger for the impacts on consumers, purchasers, quality, and costs, and holds a public meeting on a major transaction which affects a significant number of enrollees or will have a significant impacts.

AB 1092 closes the critical gap in that legislation in this oversight authority by requiring that when health plans acquire other entities, like physician groups, there is that same oversight. Since the passage of AB 595, a trend that we've been seeing is health plans buying or investing in physician groups. For example, Optum Health, a medical group owned by UnitedHealthcare, recently bought two of the largest physician groups in Southern California. UnitedHealthcare, a health plan, may today be the largest employer of physicians in the United States.

Like health plan mergers, eliminating or lessening competition among providers, insurers, and health plans can lead to increasing costs for consumers and less competition for quality and types of services offered. An insurer buying a doctor group raises important questions about quality, and this committee has heard lots of bills this year about protecting consumers by respecting the professional judgment of doctors. This is why requiring that all kinds of health plan mergers have this state review for impacts is so critical to protecting quality and affordable health care. Thank you, and I respectfully ask for your aye vote.

Thank you very much. Is somebody else speaking as lead supporter today? Okay. Seeing none. Just others wanting to chime in on this bill, please come forward at this time. Name and affiliation.

Beth Malinowski, the SEIU of California, in strong support.

Thank you.

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

Thank you.

Hello. I'm Karen Stout with California Nurse Midwives Association, as well as the NARAL Pro-Choice California, in support.

Thank you.

Afternoon, Chair and members. James Michael Powell with AFSCME California, in support.

Thank you very much. Okay, lead people speaking in opposition today, please come forward.

Hello, good afternoon. Thank you, Madam Chair and members. Nick Louizos on behalf of the California Association of Health Plans, and we are in a respectful opposition of 1092, which from our perspective, will only make healthcare more complicated, more expensive, and less efficient. Members, the DMHC already has the authority to impose requirements on health plan transactions, and the department is not shy at all about using its authority.

AB 1092 places even more conditions into existing law that will ultimately give the government more leverage to demand expensive undertakings from our members. And the amendments that went into the bill last week unfortunately make the bill worse. Just as one example, the language stating that acquiring an entity is further defined as including the acquisition of an entity by a corporate affiliate of a health plan if the agreement or transaction will impact enrollees of the healthcare service plan in the state is particularly problematic from my member's perspective.

This language about corporate affiliates could cast a very wide net and incorporate activities that we don't think are intended in the scope of this bill. One of my members offered one example. If the parent company of the health plan, for instance, acquired a corporation that provides, like, printing services, let's say, and those services are used for patient materials, employee materials, and for materials intended for the health plan enrollee, then it could conceivably trigger all of the review requirements of this bill.

And we're not sure that's intended because the transaction would impact enrollees of the healthcare service plan as stated by the language, because the plan documents would be produced by that service and the transactions would be considered a major transaction since all of the health plan enrollees would be impacted by that. I'm not sure that's the intent, but if a plain reading of the language seems to indicate that, that could conceivably happen.

Additionally, the newly enacted Office of Healthcare Affordability, of which Dr. Wood was a champion of and conceptually, we'd like to see, take aim at the underlying costs of healthcare. But the office also takes aim to take a comprehensive approach to addressing rising health care costs. And as part of its mission, the office is required to monitor the impact of consolidations and promote competitive markets in a manner that's supposed to be supportive of the AG's activities and of the Department of Managed Healthcare.

This involves analyzing transactions and reporting on anticipated impacts on the healthcare market. Considering this, it's not entirely clear why this bill is needed. During a recent board meeting of the office, it said it would be reviewing over 100 transactions in the healthcare industry. So layering new layers of review upon the ones that already exist, we think is onerous on our members. I'll just leave you with this. California's market, particularly compared to other states, is pretty competitive. It's a bellwether of competition and choice, providing millions of access to affordable health care. Now, we agree ensuring that we have a competitive market and a healthy market is definitely something that policymakers should strive for. We just think this bill is unnecessary and could harm the market. Thank you.

Thank you very much. Next person speaking in opposition.

Good afternoon, Madam Chair. John Valencia, representing Vision Service Plan, VSP, headquartered in Rancho Cordova. We're the nation's largest not-for-profit insurer of vision care. We insure over 14 and a half million Californians and over 93 million Americans with a network of 45,000 providers. To distinguish from my colleague's position, our concern is about the same language, but for a different reason. VSP has a subsidiary, a corporate affiliate entitled VSP Ventures.

Using the mechanics in the Business and Professions Code, Section 655, we are investing in community-based optometric practices, basically to keep them in existence and keep competitive against retail-oriented types of providers of optometry. The way we do it is simple. We invest in a professional corporation, which is the only type of healthcare corporation that in turn can invest in optometric practices. We take away the concerns of the provider, leases, practice management, and the like, and those providers become practitioner employees of that professional corporation.

We provide the financing so that new docs who are both in debt and not necessarily inclined to follow the old model of practice acquisition, have an opportunity to stay in the community in which they want to practice. In terms of market domination, Business and Professions Code, Section 3077, if I remember correctly, limits optometrists to no more than 11 offices, and that's any combination of the number of optometrists. We've advanced corrective language to the author spoken with Dr. Wood. We intend to keep working on that, but we would ask for your consideration of our request. Thank you.

Thank you very much. People just speaking in me toos for opposition.

Madam Chair and members, John Wenger on behalf of America's Health Insurance Plans. Apologies for not getting a letter in on time, but we do have an opposed position.

Thank you very much. Okay, going to the phone lines now. If we have anybody in support and or opposition to AB 1092.

If you'd like to speak to AB 1092, please press one zero. Our first comment is from line 90. Your line is now open.

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

Thank you. Next caller, please.

Okay, the next comment is from line 86. Your line is now open.

Good afternoon, Faith Borges on behalf of California Agents and Health Insurance Professionals, in support.

Thank you very much.

And there are no more comments at this point, Madam Chair.

Thank you very much. Now we'll be bringing it back to the committee. Senator Rubio.

Thank you, Madam Chair. Thank you to the author. I want to address some of the comments that were made by the opposition. I completely understand why you want to move this bill forward, but if you don't mind addressing what Mr. Valencia just stated in terms of how it impacts their business, as well as Mr. Louizos'. I know that there's a lot there and a lot of comments were made, but if you can synthesize, I think it's based on the corporate affiliate word. So if you can address that, that would be great. Thank you.

Thank you, Senator, for the question. We're still looking at the VSP issue, but I think they have 14 million enrollees in the state, and I think their desire is to keep that pool by supporting other entities in practice out there. And that's fine, I guess, from my perspective, as long as it actually benefits consumers and not necessarily benefits VSP or others. The purpose of this bill is to make sure that if we have consolidation or acquisitions, that they actually benefit consumers.

So I did anticipate some of the questions from the opposition. We have no interest in printing businesses. That's not it at all. But more and more, we're starting to see affiliated entities entering into the healthcare space, For example, and while it doesn't apply specifically to this bill, we're seeing in the skilled nursing facility space where companies own more and more related entities that seek to maximize profit, while in some cases putting less and less money towards the actual care of the patient, some of our most vulnerable citizens.

This bill we don't believe is going to increase costs. Basically, we're looking at the acquisition of physician groups, which has been the next frontier, so to speak. You heard that Optum acquired has been an acquisition. They are now the largest group that owns, not owns well, hopefully they don't own physicians. But you have a large acquisition there and I think that that is a challenge. I don't think that that necessarily leads to increased consumer benefit there.

Let me see, there were a couple of other things. We don't believe this makes this anything any more expensive. It's a review. DMHC would look at the data. In 30 years, DMHC has not denied a merger or an acquisition in California. What they have done is add some conditions to that to make it more consumer-friendly. And we saw that in the last year with AB 595 and two health plans that emerged and there were some conditions to that that helped to make this more consumer-friendly. So OHCA doesn't have, the Office of Health Care Affordability, doesn't have the authority to do that. They're tasked with gathering market data to see whether or not there is a market influence there. So appreciate the opposition. I think they're conflating some things here that really don't go well together. And I just will reiterate we have no interest in printing businesses.

May I just do a real quick follow-up? And I want to thank you for that. But again, there was a lot of that was stated by some of the opposition that probably requires to go a little deeper. But at the end of the day, I think all of us want the benefits to go to consumers, but we also don't want them to be so bogged down with the processes and policies that they're not actually providing those benefits to our consumers. I just want to encourage, if you can just give it some more thought in terms of how do we make sure that there's not unintended consequences, I would appreciate that, but thank you. I know that you tried to explain as best you could with everything that was said. That's all I was going to say. Thank you.

Thank you, Senator. Senator Roth.

Thank you, Madam Chair. I'm just curious on the physician group acquisitions, Optum, for example. Is this a traditional acquisition where Optum buys the assets and the liabilities or acquires the stock in a corporation and then the physicians become employees and or are there other arrangements where a physician group tires of dealing with the administration of a medical practice and contracts with, on some basis on Optum or some other group to come in and run that piece of the operation as the physicians practice medicine? Would that, for example, I'll ask a better question. Would that situation fall under this bill?

I think the difference is right now you have physician groups that exist and they exist for economy of scale to share administrative burdens, to share office space, a variety of things. What we're seeing here is that the health plan is actually acquiring the physician group very different than the physician group operating as an independent entity. And that is where we have concerns. The more you see in the marketplace, the more consolidation you see in all of healthcare is not leading to a consumer net benefit. We're actually seeing increases in costs. As far as your specifics about every acquisition is going to be different, and what is acquired and what is not acquired as part of that is going to be different based on each transaction. So it's hard for me to say exactly what each transaction would include.

Thank you, Madam Chair.

Thank you.

Thank you, sir. Senator Nguyen.

Thank you. Thank you, Madam Chair. I've got a few questions or two. One, is there a time frame on how long the department has to be able to approve or disapprove?

I believe it is. I can't remember offhand. I'm sorry, we don't have that. I apologize.

Okay. Because we looked through and we couldn't find it. The reason why I bring this up is we've had a lot of problems with the length of time in terms of hospital being acquired. And because of that, obviously, in a business decision, it needs to move faster than slower. And then we end up a lot of these hospitals shutting down because they can't be acquired.

And when I was a county supervisor, we went through the process of Hoag and St. Joseph merging in Orange County, and it took quite a process. And so I just want to make sure that there is some kind of timeline, so know as they're looking at the business decision and also the consumer side of it, that the length doesn't get too long or that there's unlimited time. The other one is diving deep into the information of the provider. Does that include confidential attorney-client privilege information? Is that going to all be exposed or how does that work?

That's not our intent. And if there's something in the legislation that asks for that, that's not our intent, we would address that.

Okay, thank you.

I appreciate your leadership in this space. Whether we like it or not, we have a for-profit healthcare system, right? So that's the name of the game, right? Companies merge to be able to maximize profit, but somebody needs to be looking out for the consumers as well. And I think that's what our job is, is to make sure as companies grow and get bigger and eat up more components of the part that you could only see the name Monopoly, right? That game, right?

You shouldn't be able to run the board. And I think that's what you're trying to get at with this. And so I appreciate that effort. We were trying to look at the timeline issue also, and I think it potentially could get bogged down so that might be an area where we take a little look because it's not delineated out. It's just a part of a merger. Although I don't think it's the same as a hospital, because a lot of times hospitals are precarious, whereas oftentimes doctors groups or insurance groups are not. So it's a different type of transaction. Okay. Would you like to close, sir?

Thank you for the questions, and we will look at the timeline. I appreciate that as well. I don't take this lightly. I owned my own practice for many years. I didn't really like a lot of incursions into what I was doing. And I get it, so I do get it. But I think it's our job to look out for consumers.

We continually hear the cost of health care continues to rise and is rising, as I've said, multiple times, at nearly twice the rate of inflation at times. And a factor in this is consolidation in the marketplace. There is no question about that. And there's a lot of academic studies to support that. So we're not saying you can't consolidate. We're just saying it should be reviewed and it should benefit consumers. And there are examples where consolidation does benefit consumers.

We've got a hospital in my district that was part of an operating agreement with another health system, allow that hospital to stay open, benefit to everyone, and the economy of scale they were able to bring, it doesn't appear to have caused an increase in costs, but we're watching that. But it troubles me that now we're moved beyond hospitals, we've moved beyond health plan mergers. We're now having health plans acquire physician groups. It's continuing to go because these acquisitions happens because there are resources to be made. So with that, I didn't mean it was a big soapbox. I appreciate the opportunity. I respectfully ask for your aye vote when the time comes.

Thank you very much. We'll get a motion when we get there. I see Mr. Rodriguez here, and we need one more senator for a quorum.

Close enough.

I'll stay put.

All right. You have more than one bill ahead of in front of us today, Mr. Rodriguez.

Yes, I got a couple trying to make them quick.

All right. Oh, okay.

Try.

So, let's start with AB 379.

Thank you, Madam Chair, Members. Thank you for allowing me to present AB 379. Thank you for allowing me to present and accept the Committee's amendments. AB 379 would create a number of planning and transparency requirements for the local emergency medical service agencies, also known as LEMSAs, and the California Emergency Medical Service Authority EMSA. To increase transparency, the Bill would require both LEMSAs and EMSA to post approved annual plans on the websites within 30 days of approval.

LEMSAs would be required to include in their annual plans their corresponding budget and list of exemptions given to providers for failing to meet 911 response times in the previous year. LEMSA would be required to approve or request amendments to annual plans within 90 days of receipt to ensure that LEMSAs operate on up to date plans. Additionally, this Bill required that LEMSAs develop policies and procedures for calculating and reporting ambulance patient offload times, better known as APOT.

Finally, this Bill would direct LEMSAs to develop an audit tool for ambulance patient offload time, APOT data, with validation from ambulance providers and hospitals. LEMSA has coordinate emergency response throughout California, and it is imperative that the public and lawmakers can see how local agencies are planning for care. All too often, we are left wondering why timely 911 response times are not being achieved, and APOT is exclusively long.

For more than 30 years working in the field as an EMT, I can tell you that I've had to wait at hospitals thousands of times, and I can attest that this has also resulted in me being late on many 911 responses. This bill increases transparency on how LEMSAs operate and compels EMSA to work more quickly to correct and approve annual plans so that local agencies can operate up to date plans. Thank you. I respectfully ask for an aye vote.

Thank you. First person speaking in support of this Bill. Do you have any lead supporters? This is your bill, sir? Yes. Okay. Anybody speaking in opposition to this bill today, please come forward.

Good afternoon, Madam Chair and Members. Sean Henschel here on behalf of American Medical Response, California's largest provider of 911 private emergency services. Regrettably, they are opposed unless amended to AB 379. According to the author's statement, the bill seeks to increase transparency, and AMR is actually in favor of that goal. The issue, however, is that it's not being applied equally here. Respectfully, AMR respectfully requests that it also include public agencies as response times and standards for the reporting.

Additionally, to establish a standard definition for what is a response time, the 911 exemption provisions target private ambulance response times with no accountability to the response times for public agencies, which make up a majority of the EMS providers in California. This is because public providers don't have to report response requirements, so the bill would unfairly paint privates as not medium response times, and there's no comparable information for public providers. This, unfortunately, would create a double standard within the law.

Finally, AMR argues that there should be a base measurement or a definition response time to ensure equitable comparisons. The term can be vague, as not all providers start their dispatch clock at the exact same time. Incrementalism certainly has its place, of course, where some improvement would be better than other than none at all. However, that's not the case when you're dealing with data collection and reporting.

What you would end up resulting is, unfairly misleading data that would be egregious towards a public versus a private and respectfully request an amendment. Thank you.

Thank you very much. Anybody else speaking in opposition to this bill today? Anybody on the phone lines wishing to speak in support and or opposition to this bill?

If you would like to speak to AB 379, please press 1 0. And there is a comment from line 94. Your line is now open. Line 94, your line is now open. Please unmute, if you're muted at this time.

There are no further comments at this point, Madam Chair.

Thank you very much. And we'd bring it back to the Committee at this time. And just to make the comment, I hear AMR, but there's no 911 time limit for public agencies. So maybe that can be a Bill that somebody does another time. But that's not what this Bill is trying to do. Senator Roth.

Thank you, Madam Chair. And I do understand that. I was just curious of the author, why not include the public agencies that actually provide and staff ambulance, pre hospital transport services?

Well, they unfortunately operate a little differently under exclusive operating agreements, better known as EOAS. So that's some separate. But that's something I entertain to look out for next year. But specifically, this Bill is catered differently. But I'm open for that. But unfortunately I didn't have that discussion with AMR until just recently about that. So obviously that's something definitely we're working on for next year because I think you're right, everybody should be held accountable whether you're a private sector or the public sector. Correct.

Thank you. I appreciate that. I'm sure they appreciate it too. So look forward to that. Thank you, Madam Chair.

Yeah, excellent. But that's the same thing I was going to say it's different. I see. It's good for the goose. Should be good for the gander too, because otherwise the hospitals are the ones holding the bag.

Correct.

Whereas you got multiple parties feeding into that system. Okay. And I believe we have enough to call for a quorum. That secretary, if you could call the role Senators.

Eggman. Here. Eggman? Here. Min? Here. Glazer. Gonzalez. Gonzalez? Here. Grove? Grove? Here. Hurtado? Limone? Menjivar. Menjivar? Here. Roth? Roth? Here.

Rubio, Rubio?

Rubio, Rubio? Present. Wahab? Wiener?

At seven. We have a quorum. Thank you very much. Seeing. No other questions, Senator Grove.

Thank you, Madam Chair. I do have a question. Again, it appears, and forgive me, I was in rules governor's appointment, so I came down here to give the chair a quorum and ask this question. So I apologize if this has already been asked, but it appears to me that it's providing kind of a double standard by targeting private ambulance holders or operators. And there's no accountability with the public agencies or public organizations that provide the same services as private organizations.

But yet we're only going to penalize or require this from the private providers. Is there a reason why or am I incorrect?

One reason is they operate a little bit differently under EOA's exclusive operating agreement. So that falls in a different category. But the opposition is right. It needs to be fair across both sides. But unfortunately, this Bill is just catered this way. AMR came to me kind of late regarding this discrepancy and like I said, it's a little too far too late. But that's something I'm willing to entertain with them for next year because that right, everybody should be held accountable on both sides.

I appreciate you at least acknowledging the fact that everybody should be held accountable regardless if it's public or private. I think one of the biggest frustrations I have in this Committee is the way that we treat either state policies, like, take Medi Cal policies, and then our plans that are private know, we require so much of them, but we don't require it for the poorest people in our community. And then here we have an ambulance service provider.

Know, again, this Bill targets the private providers but lets all the public providers off the hook when there should be an accountability for service to the person who's requiring the service, if that makes sense. But thank you for answering that question. I appreciate it.

Thank you.

I asked. Senator Roth asked.

No worries.

No, it's okay. It's important. It's an important point. And I was talking about that in all of our briefings leading up to this. And there's not even, like, a timeline established for private ambulances. There's a timeline established, which is what he's trying to get at, is like, what are the exceptions to going over that timeline? They're not even established for the public agencies. So I think somebody should do that next year.

Thank you. Look forward to it.

That was your closer.

Yes. With that, I respectufully ask for an aye vote.

Okay. We have a motion on this Bill moved by Senator Rubio. Secretary, please call. The roll is due pass as amended and referred to the Committee on Appropriations.

Senators Eggman Aye Eggman aye Min Glazer Gonzalez, Gonzalez aye Grove, Grove not voting Hertado limone. Menjivar, Menjivar aye Roth, Roth aye. Rubio, Rubio aye Wahab Weiner.

Bill has five votes. We'll hold it on call for the absent Members. And now you have next up, AB 616. And I'll just say on this Bill, before you get started, I just want to kind of make a statement for my Committee Members. I understand that there was a lot of negotiations last year and that there was a deal struck and nobody here was a party to that.

And now one of the groups has come back to try to get what they didn't quite get last time. And I'll say I wasn't part of that politics. And this policy seems to uphold the same policy for everybody, which seems fair. So on that basis, I've recommended an aye vote on this and understand if people feel differently because of things that were established last year. I just want to say that. Okay, go ahead, sir.

Thank you with that. Thank you, Madam Chair and Senators. Thank you for allowing me to present AB 616, which would remove the exemption for public disclosure on financial data reports for large medical groups and medical groups that take on delegated risks from health plans. First, I'd like to start by thanking the Committee staff for working with my staff and sponsors on amendments to clarify the Bill and ease implementation.

Regarding RBO's reporting to DMHC, the Committee recommended we simplify the process DMHC will use to make information publicly available in order to better align the process with DMHC's disclosure process for health plan and audited financial statements. Amendments would also ensure that the information made public would not include individual plan specific rates.

Regarding other medical groups reporting to HCAI, that Committee recommended we separate the provisions dealing with physician organizations that are part of a fully integrated delivery system and other large medical groups. This change is intended to be clarifying. Finally, the Committee recommended the outlines of types of information that will be collected and made public.

The information will be treated in a similar manner as hospital information will not include individual plan specific rates. I accept the Committee amendments and agree to take them in Judiciary Committee. According to the Senators, I'm just going to go to this.

AB 616 would create greater accountability in the healthcare delivery system and close a gap and publicly assess financial data by making public the financial data already reported to DMHC and making public the financial data soon to be collected by HCAI for other large medical groups.

With me to provide testimony are Beth Malinowski, who is a government affairs associate for SEIU California, Katie Van Deynze, who is a legislative advocate for Health Access California, and Joan Allen with SEIU UHW, who is also available for technical questions. Thank you.

Okay, you have six minutes total per side.

Madam Chair and Members, Beth Malinowski with SEIU California, proud sponsors of AB 616. And as the Assemblymember noted, we work closely with the Chair and staff on common sense amendments that really do all in the type of information that will be made public and appreciate that work. On that note, I'd like to offer some brief remarks on SEIU's perspective on the importance of this Bill.

We might not say this enough, but every worker, regardless if they clean schools, care for the elderly, or take care of our airports, they are healthcare consumers too. And healthcare costs are rising out of control. The cost of health care has been rising above inflation for years, taking larger and larger chunks out of workers' wages and destabilizing family budgets. Every dollar workers put into a copay is one less dollar they can reinvest in their communities.

For SEIU members at the bargaining table, health care coverage and costs are the number one issue. Employers faced with these rising costs either seek to reduce health benefits or push more of the costs onto the workforce, leaving less of their paycheck for rent or putting food on the table. It's a losing proposition for California's workforce. SEIU has for years advanced efforts to rein in healthcare spending and coalition with consumers, labor and purchasers.

The job of addressing the underlying costs in our healthcare system is far from over, but we cannot address what we cannot measure. To tackle this issue, we must create a more transparent and accountable healthcare system with public access to more data. AB 616 does just that. As Assemblymember Rodriguez noted, the Bill will close a significant and remaining gap in financial data that is publicly available, creating parity across the healthcare delivery system so that medical group data is treated the same way as hospital, health plan, skilled nursing, and other data sets.

The Medical Group Transparency Act would remove the existing Public Records Act exemption for financial data that physician organizations are already required to report to DMHC and HCAI, thereby creating a pathway for purchasers, researchers, policymakers and advocates to access this information.

As healthcare increasingly moves towards outpatient settings operated by physician organization, as ongoing provider consolidation increases the market power of large physician organizations, it's appropriate to bring the same level of public scrutiny to physician organizations that already exist for other types of providers and for health plans. Thank you in advance for your aye vote today and I'll hand it over now to my colleague, Katie Van Deynze over at Health Access. Thank you.

Thank you, Ms. Van Deynze.

Good afternoon again, Katie Van Deynze with Health Access California, and we are here in proud support of AB 616, a pro consumer measure to help us better understand what's causing rising health care costs. Health Access has been advocating for medical group financial transparency since the 90s, when we support it as part of a package to create the Department of Managed Health Care and Regulation of medical groups that take risk.

The Office of Healthcare Affordability requires cost growth targets for the healthcare industry and additional categories of physician organizations to report financial data to inform the setting of those cost growth targets. Yet that information is exempt from public disclosure. This decision was a carryover from a compromise back in the 90s, keeping medical group information from the public, and this compromise was bad for consumers then and it is now. This transparency is even more critical now as providers continue to consolidate, driving higher healthcare costs.

Based on recent rate review filings, we can see that 20% of some health plan premiums go to physician services, but we do not have the most basic information about medical groups. How financially solvent are these groups? Do they have $1 in reserves? Are there reserves as ample as health plans and hospitals that we have this information for? Or do medical groups rely on affiliated entities like Kaiser, Sutter and Sharp for their reserves? As providers continue to consolidate and increase their market power, these are all reasons why medical groups should have the same transparency as health plans and hospitals do under existing law.

Consumers are struggling to afford their health care, and more than half of them are delaying or skipping care because of these rising health care costs. And AB 616 is an important measure to help us understand cost drivers and address these rising costs for consumers. Thank you, and I respectfully ask for your aye vote.

Thank you very much. Now, people just speaking in general support? Name and affiliation.

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

Thank you.

Good afternoon, Madam Chair and Members. Jessica Hay with the California School Employees Association in support.

Thank you. Here comes our leader.

Tracy Custodio, Kaiser Folsom in support.

Thank you.

Malia Chu. I'm the daughter of a Kaiser Roseville healthcare worker, in support.

Thank you.

My name is Tammy Chu. I'm a Kaiser Roseville employee and a proud SEIU union member, and I'm in support.

Thank you very much.

My name is Jvonne Christian. I work for Kaiser Sacramento and I'm in support of AB 616.

Thank you.

My name is Donna Young. I'm a Kaiser employee, desktop medicine, and I'm in support of AB 616.

Thank you.

Deshauna Dasher, a nurse at Kaiser Permanente, in support of 616.

Thank you.

Hello. I'm Tracy McCreary. I work at Kaiser Sacramento. I'm also a nurse, and I am in support of 616.

Thank you very much. Okay, now we'll move to the opposition. Mr. Marchy.

Madam Chair, Members of the Committee, Brandon Marchy with the California Medical Association, with the utmost respect for the author. Unfortunately, we are opposed to the Bill. Also, I know you gave an opening dialogue to it, Madam Chair, but unfortunately, we are extremely disappointed that we are here today talking about something after years of negotiation.

And after less than one year after the office was signed into law and an agreement was made and everybody engaged in good faith negotiations on this monumental legislation, we are here talking about proposals that did not make it into that final agreement. This is not how good faith negotiations should be conducted or honored afterwards.

California's regulatory entities, such as the Financial Solvency Board, such as the Department of Managed Healthcare, such as the Health Payments Database, such as the Office of Healthcare Affordability, have access to this information and can take regulatory action and administrative action should they find some inconsistencies or something wrong with this data.

Rather than better informing or protecting the public, this Bill will be used for political purposes and would give private equity, venture capital, and other interests a blueprint and roadmap to continue their predatory acquisition practices of medical groups in the state and even from entities that are not based in California. Madam Chair, we just heard about from a Bill earlier today that these entities are now moving from the hospital space and health plan merger and acquisition space into medical groups.

Why would we want to give them more of a roadmap, more of a blue print into these types of transactions? AB 616 raises significant antitrust concerns and will have significant implications, excuse me, on the state of consolidation in the State of California and will harm our ability to recruit and retain providers, not just physicians, in communities that need care most. With that, I respectfully request your no vote.

Thank you.

Good afternoon. Madam Chair and Members. I'm Hiliga Gonzalez with Kaiser Permanente. We are also respectfully opposed to AB 616, which again would reverse an agreement made just last year when establishing OHCA. It took well over two years of stakeholder negotiations to pass this legislation, and it is monumental legislation.

We agreed to a compromise on last year's Bill to submit the provider group financial information to OHCA if that information was kept confidential. That was a key provision for Kaiser Permanente to go neutral on the Bill from last year. That language ultimately removed our opposition. This was a compromise language with stakeholders, the Legislature, and the Governor's office, which ultimately came SB 184, which nobody opposed.

So, the public release of this information, we believe, would have many unintended consequences. Mandating disclosure of competitively, sensitive information, particularly in the healthcare sector, will allow sophisticated entities to manipulate that information. We believe it will impact healthcare markets. This information would be available to not just the public, but to large, sophisticated healthcare corporations and private equity firms outside of California.

Healthcare is a highly competitive industry. Disclosure of this compensation information, hiring strategies that these reports contain, for example, would have unintended consequences in recruiting and retaining physicians in California. We believe that AB 616 is troubling in that it reverses the outcome of good faith negotiations less than a year than when they were passed. For these reasons, we are respectfully opposed to AB 616. Thank you.

Thank you very much. Other people speaking in opposition now. Just name and affiliation.

Alchemy Graham on behalf of the California State Association of Psychiatrists, in opposition.

Thank you very much.

Taylor Jackson with California Health Plus Advocates representing California's Community Health Centers in opposition.

Thank you very much. Okay, now we will go to the phone lines. Anybody speaking in support and/or opposition to AB 616? Name and affiliation and position.

If you'd like to speak to AB 616, please press one zero. The first comment is from line number 90.

Good afternoon, Madam Chair and Members. This is Sandra Poole with Western Center on Law and Poverty in support.

Thank you. Next caller, please.

Line 95. Your line is now open.

Good afternoon. Thank you, Madam Chair Members. Bryce Docherty on behalf of the California Society of Anesthesiologists and California Ambulatory Surgery Association in opposition. Thank you.

Thank you. Next caller, please.

Line 93. Your line is now open.

Good afternoon. This is Kelly McMillan calling on behalf of Memorial Healthcare System in opposition.

Thank you. Next caller, please.

Line 94. Your line is now open.

Madam Chair and Members, Caitlin Vega for the California Labor Federation in support.

Next caller, please.

Line 101. Your line is now open.

Hi there. Bianca Blomquist, Policy Director for Small Business Majority, in support.

Thank you. Next caller, please.

Line 100. Your line is now open.

Thank you. Madam Chair, Adam Zarrin with the Leukemia and Lymphoma Society in support.

Thank you, next caller.

Line 98. Your line is now open.

Madam Chair and Members, it's David Gonzalez on behalf of America's Physician Groups in opposition. Thank you.

Thank you. Next caller.

And there are no more comments, Madam Chair.

Thank you very much. At this point, we will bring it back to the Committee. Senator Roth.

Thank you, Madam Chair. You know, when I first took a look at this Bill, since we're dealing with physician groups, I was concerned about the privacy aspects of the disclosure, particularly to the extent that individually identifiable information, whether it's regard to physician compensation or nurse compensation or staff compensation, would be disclosed, would be contained in the information that's disclosed.

Having managed law firms before, I probably would have been offended if somebody wanted me to turn over my audited financial statements for the firm, although I recognize that in the healthcare arena, we're not law firms. We're dealing in a much different sandbox where there needs to be transparency and it's important to make sure that consumers are protected and that the rates stay as low as possible for the health care that people need.

But having looked at some of the sample disclosure forms that were provided to me, it appears that the information in various categories, the ones that I would be most concerned about, salaries and benefits and things like that, is aggregated information. And so I'm not necessarily sure I understand completely what the problem is with the public release at this point of the information that's on file.

And having listened to some of the opposition, I guess my comment is if there are specific reporting categories that are problematic from the standpoint of predatory takeovers of physician practices, it would seem to me that that sort of information, those problematic reporting categories, either should have been or should be identified so that we can consider whether to redact that information prior to the public release of the information, if it's appropriate to do so, and if it doesn't terribly damage our ability to do the analysis that we need to do on the data. So I guess I'm standing by to hear about that, and in the interim, my concerns have been satisfied, and I'll be supporting the Bill. Thank you, Madam Chair.

Thank you.

Thank you very much. I made a statement in the beginning, and this is just the same application that goes to every other health agency, hospitals, everybody else. Nobody else wants to speak on this. Then would you like to close, sir?

Thank you very much for the robust discussion. I respectfully ask for an aye vote.

Thank you. We don't have a quorum right now. Oh, we've established it. That's right. We have a motion. Alright, been moved by Senator Menjivar. Secretary, please call the roll. And you are taking no amendments. That's right. So the motion is due pass and refer to this Committee on Appropriations. Judiciary.

I'll take the amendments in Judiciary. Thank you.

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

That's four. We'll hold that roll open, and now your last one is AB 1392.

Thank you. I'll make this one quick.

Okay.

Thank you, Madam Chair and Senators. Thank you for allowing me to present AB 1392 which would strengthen the hospital supplier diversity program. This bill would require hospitals with expenses over 50,000, 500,000--I'm sorry--to submit a plan to the Department of Health Care Access for Information, HCAI, to increase procurement from minority women, LGBT, and disabled veteran-owned businesses and enterprises.

In 2019, AB 962 created the Hospital Supplier Diversity Reporting Program to require hospitals to submit an annual report to HCAI on their prior supplier diversity efforts. AB 962 recognized that increasing procurement diversity is not just a social mission, but also a business strategy that widens the supplier pool to mirror the patient population they serve. However, in the most recent report, diverse procurement spending only accounted for two percent of the total supplier spending. Our disadvantaged communities deserve more dollars.

This bill will strengthen the program to align more with two successful supplier diversity programs from the California Public Utilities Commission and the Insurance Commission. Specifically, the bill uses the following strategies from the state's existing programs: requires the Department to provide outreach and assistance to both hospitals and businesses, adds a representative from a group purchasing organization to the Commission. Lastly, the bill allows HCAI the flexibility to adopt any additional requirements or programs to strengthen the intent of the bill.

These strategies from existing programs have been largely successful. For example, insurance companies have increased their diverse procurement dollars from 930,000,000 to 3.1 billion from 2012 to 2021. Large utilities report that 31 percent of their total procurement came from diverse suppliers, surpassing the agency's goal of 21 percent. With me to testify in support and provide testimony is Manny Diaz representing the California Hispanic Chamber of Commerce, and Darrel Sauceda, Chairman of the Los Angeles Latino Chamber of Commerce. Thank you.

Thank you very much. Mr. Diaz.

Good afternoon, Madam Chair and Members. Manny Diaz representing the California Hispanic Chambers of Commerce. Madam Chair, we're a proud co-sponsor of this legislation. We think that what's being proposed here is very reasonable. It's not about a report. It's really about a plan, a detailed plan for the large hospitals to put together. The opposition will state that they need more time. Well, we think it's very doable. There's already best practices right now with the other supplier diversity programs.

Assembly Member Rodriguez mentioned the utility industry, the insurance industry. Very successful. So there's a lot that the hospitals can use from their best practices from the other supplier diversity program. We think it's time when 40 percent of our population here in California is Latino, and that's just the Latino part of it, and only two percent goes for procurement for everybody that's in diversity pool.

We think something's wrong here, so we ask for your support to really come out with a detailed plan here, and I know that the California Hispanic Chamber, we've been working with the other supplier diversity programs, with PUC and the utility industry for many years and also with the insurance industry. So this is nothing new for us, and we'd be more than happy to also work with the hospital groups. So we're here to ask for your support. Thank you.

Thank you very much. Next person speaking in support.

Good afternoon, Madam Chair and Committee. So my name is Darrel Sauceda. I'm representing the Los Angeles Latino Chamber of Commerce. We have over 900 members, and we've been diligent trying to work with the Hospital Association for the last two years, trying to get where we're at right now. As a small business owner myself, I've tried to work with the Hospital Association, and we just keep getting roadblocks by the GPOs.

It just seems like it's just another layer of trying to frustrate us to not apply for this kind of work, but I believe that AB 1392 strengthens the Burke Bill from AB 962, which was in existence since 2019, so I don't understand why they need more time to look at this. I mean, I know we had the Pandemic, but as a business owners, we all have different areas where we have experts that continue on and move the business.

So I just believe that additional time is just--I just think it's unacceptable. We're wasting time. We need to put our local businesses back to work. I mean, they're part of their membership. We're providing the bottom line to these hospitals. So I'm in support. I'm hoping that we get your vote. Thank you.

Thank you very much. Others speaking in support now? Just name and affiliation.

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

Thank you. People speaking in opposition to the bill today, now would be the time to come forward.

Good afternoon, Chair Eggman and Committee Members. Vanessa Gonzalez with the California Hospital Association representing over 400 hospitals and health systems in California, here with an opposed unless amended position on AB 1392. CHA is not opposed to the intent or to the new requirements in AB 1392. However, in light of efforts that are currently underway related to diversity procurement from previous legislation, we are requesting a delay in implementation.

Back in 2019 when AB 962 was signed into law, this was the first time that there were state requirements on hospitals related to diversity procurement and it was something completely new for many of our hospital members. The purpose of the original piece of legislation was to lay the groundwork, collect the data, find out where hospitals are in the diverse city procurement space, and assess which diverse vendors are available and can meet the needs of hospitals.

Due to delayed implementation of 962 because of the Pandemic, hospitals didn't submit their first year of reports until July 2022, and the second year reporting was due just last week. Additionally, AB 962 also created the Hospital Supplier Diversity Commission which was tasked with providing recommendations to the state on how hospitals can increase their diverse procurement. The group didn't meet until March of 2021 and has only issued one set of recommendations.

In order to allow AB 962 to mature and to do what it was intended to do, CHA is requesting that the requirement that hospitals develop detailed and verifiable plans be delayed for five years. This would allow HCAI to collect five years of data from hospital reporting and give the Hospital Supplier Diversity Commission time to evaluate and develop additional recommendations for the state's consideration.

Additionally, we're also requesting that the plan submission requirements be changed from annually to every three years, similar to community benefits assessments as there is not much change year over year. Hospitals are committed to supplier diversity and are doing a lot to meet the requirements of AB 962. With that, respectfully request your no vote. Thank you.

Thank you very much. Next person speaking in opposition.

Good afternoon, Madam Chair and Members. Connie Delgado on behalf of the District Hospital Leadership Forum and would like to align my comments with those of the California Hospital Association. Thank you.

Thank you very much. Anybody else just wanting to speak against the bill now? Just name and affiliation. Seeing none, we'll go to the phone lines now. If there's anybody on the phone line speaking in support or opposition to 1392.

Thank you, Madam Chair. If anyone would like to speak on Bill AB 1392, please press one then zero at this time. Again, that is one then zero at this time.

Madam Chair, at this time, we have nobody queuing up.

Thank you very much. Okay. Would you like to close, Assemblymember? Oh, Senator Menjivar.

Thank you, Madam Chair. My question to Vanessa, if you could come back up. Thank you. You mentioned, you know, the California House for Diversity program, recommendations came out in 2021, and I was reading through these recommendations. Have any of them been implemented since?

Yeah. So the HCAI is actually tasked with reviewing those recommendations and implementing either through regulation or through legislation.

So they're currently going through the process right now?

Yes, exactly.

My question to you then, Assemblymember, you know, I can see both. I think, 100% we should be putting a lot of pressure to ensure that procurement is as diverse as California. But I'm also seeing some of the groundwork, some of the foundation that has been in place already. 2021, these recommendations came out. I just heard HCAI is going through them.

What do you say to them potentially having this start in three years versus I mean, pushing back the implementation just to.

Well, I just think, I know one of the requirements is five years, right? But there's no guarantees that they'll really do it, right? Even though we'll look at it for five years, but is there a guarantee that they'll do it? And for once, since the CPUC already is doing insurance commission, does it basically mimicking what they're doing, it's very simple, easy process.

So that's why I see that now is the time to do it. Whether delaying it more, we're just delaying our communities that are vulnerable, that do really need this help and support. So once again, I don't know why we want to wait longer. It's already being done in two other organizations, and there's no guarantee. Once again, if they want to wait another five years, will they really implement the recommendations or just this obstacle of delaying it more and more?

So what would you say? So HCAI is going to come out and either validate these recommendations from 2021 or say, "hey, these are the ones that should be implemented." Would your Bill then trump what HCAI is looking to push forward once they're done with their evaluation of?

I would think so, as long as it mimics the same thing was doing with the CPUC.

So would it halt their work right now?

I'm not really too sure on that. I can get back to you.

And then my second question is, how would you respond to--I think I'm not sure if the second opposition said something around an annual report versus three years, saying that in one year, maybe not much is happening, versus maybe in two to three years, you're going to see more changes?

You know, I think part of that is that report that you talk about every three years is a very comprehensive report that has more details to it. This one doesn't.

Once again, if the CPUC Insurance Commission can do it within a year, I don't see why they can't. Once again, it's basically mimicking them. And once again, the report they talk about every three years is a very comprehensive report. And we're not looking at that right. This is a more simple report. That to us feels like it should be done sooner rather than later.

Because the hospitals are already doing the groundwork. They're already doing the list.

So this just says, along with that list, let's get a plan. What are you doing with that list? Is there a plan to go along with it?

Correct. Once again, it's a basic plan.

Right, thank you.

Senator Rubio?

Thank you, Madam Chair.

And, you know, I don't want to repeat everything that my colleague just stated right now, but it is one of these situations where I can see both sides as well, because I understand that we have these recommendations and sometimes we could get ahead of some of the work that's already been done. But on the flip side, I also understand our local communities who are struggling to also stay afloat because the pandemic just really stifled everyone's ability to get ahead.

And putting forward this plan, I think would help local communities and not only local benefit, but also local jobs, which I think all of us are wanting in our local communities. So like I said, I do understand both sides, and I understand the hospitals just sort of concern about having already these recommendations. So it's a little bit interesting how I can see clearly how both are torn here.

But at the end of the day, for me, I understand that it's a win-win in terms of local benefits, local jobs to our communities. And also, I'm sure that, because I trust the author as well, that I hope you can continue to have these conversations and see where we can find common ground. But for me, it's having that diverse pool is smart business.

And for me, just considering the insurance companies are doing it, as well as the California Utilities is doing it, and I think you pointed out some of the financial benefits in terms of numbers. You know, we need to ensure that diversity is represented. So at this point, I will support it. But I hope that you're open to continuing conversations to make sure that some of the concerns that my colleague just stated are acknowledged.

Yes, definitely. I look forward to continue the discussions.

Senator Menjivar?

Sorry, Madam Chair.

You know, I'm always wary of implementing something where something hasn't fully been developed just to ensure that, you know, we're not pulling our capacity or we never see something grow. Could you just explain to me a little bit more? I'm going to go back to this diversity program thing. Okay, so recommendations are in place, and understand your Bill is to actually implement those recommendations. Don't just do a report, what are the actions?

Are we going to be getting a new set of recommendations, or is your Bill going to build off of these recommendations and just do a plan for implementing?

Pretty much the plan, kind of mimicking, once again, what they're doing at the CPUC and Insurance.

So we're not going to be looking to find new recommendations because that work already has been done.

Correct, it has.

But, you know, we're always open to see what the best impact that we're going to have once again for our minority-owned businesses in the areas that hospitals are located at, right? It's very complex, the state is, right? And so let's look at who we can work with in those areas that would be a diverse group of individuals or businesses in this point.

Okay, that is all. Madam Chair.

Thank you. A lot of us were out and about yesterday at events, and I happened to see a constituent who told me she was getting ready to retire from our prison healthcare facility that we have in town in Stockton. I was on the City Council when the state wanted to build the fourth prison in my district. And we asked them for local hire and local procurement.

And they explained to us that they didn't have to do that because they were the State of California, they didn't have to do that. And then we explained to them that they did need water and sewer hookup. And so we were able to get local procurement and local hire. And I just saw somebody who's getting ready to retire with 12 years in with that state job. So it makes a difference, I think, in people's lives.

And if there's going to be good employers in our communities, they should be employing and partnering with our local diverse communities. Would you like to close, sir?

I respectfully ask for aye vote. Thank you.

Thank you very much. Did one of the questioning Senators want to make a motion? Thank you, Senator. Bill is moved by Senator Rubio, and that is do pass and we refer to the Committee on Appropriations. Secretary, please call the roll.

Senators Eggman? Eggman aye. Nguyen? Glazer? Gonzalez? Grove? Grove no. Hurtado? Límon? Menjivar? Menjivar aye. Roth? Roth aye. Rubio? Rubio aye. Wahab? Wiener?

Roth? Aye. Roth, aye. Rubio? Aye. Rubio, aye. Wahab? Wiener?

Four to one. We'll leave the roll open. Thank you, Assembly Member. I think your work here is done. How about a motion on the consent calendar? So moved. Alright, that is consent calendar day AB 461, AB 608, AB 847 with amends, AB 915 with amends, AB 1110 with amends, AB 1005, AB 1125, and AB 1471. Okay, Secretary, please call the roll. Motion by Senator Roth.

Senators Eggman? Aye. Eggman, aye. Nguyen? Glazer? Gonzalez? Grove? Aye. Grove, aye. Hurtado? Limon? Menjivar? Aye. Menjivar, aye. Roth? Aye. Roth, aye. Rubio? Aye. Rubio, aye. Wahab? Wiener?

That is five/zero, and we'll hold the roll open for absent Members. Okay, we're looking for presenters here. We need Assembly Member Ramos? No? Not Ramos. We need Boerner and Jones-Sawyer. I saw Jones-Sawyer here before and then he disappeared. How about--did we get a motion on AB 379? Okay, we did that one.

Item Number Four: AB 254 by Bauer-Kahan. We don't--moved by Senator Roth. That is 'do pass and re-refer to the Committee on Appropriations.' Secretary, please call the roll.

Senators Eggman? Aye. Eggman, aye. Nguyen? Glazer? Gonzalez? Grove? Hurtado? Limon? Menjivar? Aye. Menjivar, aye. Roth? Aye. Roth, aye. Rubio? Aye. Rubio, aye. Wahab? Wiener?

Four/zero. We'll hold the roll open for absent Members. You need a minute, Assembly Member? We'll call the roll on our next one. Okay? AB 1720: Bauer-Kahan. We need a motion. So moved by Senator Roth.

Secretary, please call the roll.

Senators Eggman? Aye. Eggman, aye. Nguyen? Glazer? Gonzalez? Grove? No. Grove, no. Hurtado? Limon? Menjivar? Aye. Menjivar, aye. Roth? Aye. Roth, aye. Rubio? Aye. Rubio, aye. Wahab? Wiener?

Four/one. We'll hold that open, and now we have before us AB 716 by Assembly Member Boerner. Welcome.

Okay, thank you so much, Madam Chair and Members. First, I'd like to accept the Committee Amendments and would like to thank the Chair and your Staff for working with us on this bill.

AB 716 quite simply seeks to prevent consumers from being hit with surprise bills for ground ambulance services. California already has strong protections in place for surprise medical bills, but there remains a loophole for ground ambulance bills. Under this bill, patients with insurance will only be responsible to pay the in-network cost sharing amount.

Those without insurance will be charged no more than the Medi-Cal or Medicare rate for that service, whichever is greater, and this bill would require that absent a contract between an ambulance provider and the health plan, the health plan pays the ambulance provider the locally set local emergency medical authority, the LEMSA rate for ambulance services, meaning that our local firefighters, our paramedics, are compensated for the heroic work that they do.

This issue is also personal to me. My daughter had to take an emergency trip to the hospital my first year when I was in the Assembly, and we received a surprise bill despite having excellent insurance.

When calling an ambulance, the last thing anyone, any mother, any spouse, any child should have to do is thinking about the life saving ride will result in financial hardship. AB 716 is a common sense solution, and I hope all my colleagues will join me in the Legislature in supporting this bill. I'll continue working with all stakeholders to ensure we address any unintended consequences. I respectfully ask for an aye vote.

I have here with me today Jennifer Reese, who will first share the story of what happened to her when her daughter was injured, and we also have Katelin Van Deynze--I think--Policy and Legislative Advocate for Health Access California, the sponsors of this bill.

Thank you very much. Next person, please. First person.

Good afternoon, Madam Chair and Senators. My name is Jennifer Reese and I live in Fresno County. I am here today in support of AB 716. I hope that after you hear my story, you will understand why an aye vote is so important for all Californians. Just over a year ago, my daughter, a 21-year-old college student, sustained serious injuries due to being kicked multiple times in the chest by a horse.

After she was kicked, she fell to the ground, unable to move or speak. The Apple Watch that she was wearing immediately activated and called 911. An ambulance arrived at our home and transported her to the nearest hospital five miles away. While there, she was diagnosed with four broken ribs and a partially collapsed lung. The seriousness of her injuries prompted her to be transported again by ambulance to a Level l trauma center twelve miles away.

She spent three nights in the hospital. A month later, she received a bill from the ambulance company totaling 4,600 dollars. My daughter is covered by my employer-sponsored health plan, but our insurance company paid less than half of the bill, leaving my daughter responsible for 2,400 dollars. She was distraught because she didn't know how she was going to pay for this bill.

Initially, I thought my insurance company was processing the claim incorrectly, but after many hours on the phone with them, I found out the 2,400 dollars was billed because the ambulance company was out of my insurance plan network. I also discovered that all Fresno County 911 calls are handled by this ambulance company, and this company chooses not to contract with any employer-sponsored health plans.

This choice makes them out-of-network for all Fresno County residents with employer-sponsored health insurance plans. With a million residents in Fresno County, that's a lot of people receiving surprise ambulance bills. To make matters worse, four months after receiving the first ambulance bill and despite knowing I was working to resolve the claim with my insurance company, the ambulance company sent my daughter to collections.

To provide perspective, the total bill for the three day hospital stay was 57,000 dollars. My insurance covered all but 1700 dollars. Basically, my daughter owed three percent of the hospital bill, but more than 50 percent of the ambulance bill. I'm actively fighting to prevent other Californians from enduring the struggle I have endured over the last year.

Ground transportation ambulances should be stopped from surprise billing for critical emergency services. I urge you to vote aye on AB 716. Thank you.

Thank you very much, and I hope your daughter's doing better. Next person, please.

Good afternoon again, Madam Chair and Senators. Katie Van Deynze with the Health Access California and we're proud to sponsor and support AB 716. AB 716 will close a glaring gap in consumer protections against surprise bills for ground ambulance transport, ensuring that consumers will only pay their in-network cost sharing.

This bill also places a cap on what uninsured Californians can be charged for ambulance services, ensuring they're not being charged an inflated rate. A surprise bill happens when a consumer does the right thing by going to the emergency room or the hospital, but through no fault of their own, seeing an out-of-network provider. In the case of ambulances, consumers have no control in whether the ambulance that shows up is in their network, resulting in many surprise bills.

A study found that 73 percent of ambulance from Californians with large employer coverage include an out-of-network charge. And for an ambulance ride, consumers can often receive a bill of 1,000 dollars or even more than 2,000 dollars which can be financially destabilizing for Californians, especially those with low and moderate income who might not have savings.

We hear from Californians across the state that they might not even call the ambulance out of legitimate fear of the bill, putting their health at risk, and you'll see in the handout that we have with the community members, stories from Californians across the state about their experience with surprise medical bills with some saying that they either had a bill at one point and then decided not to call the ambulance the next time they were in emergency.

If there is no contract between the ambulance provider and the health insurer or the health plan, the bill requires that the insurer, the health plan, pay the locally set rate under the existing local rate setting process, and again, this takes the consumer out of the middle, ensuring they only receive that in-network cost sharing. AB 716 also includes consumer protections against debt collections, including against wage garnishment that is identical to what it was included in AB 72 that prohibited surprise billing for out-of-network health professionals authored by our Attorney General, Rob Bonta.

Thank you very much.

Oh, thank you. I respectfully ask for your aye vote on AB 716.

Okay. Other people speaking in support of this today? Come forward; state your name and affiliation.

Good afternoon once again, Madam Chair. Mari Lopez with the California Nurses Association in support.

Thank you.

Good afternoon again. Beth Malinowski, SEIU California, in support.

Thank you. Anybody speaking in opposition to this bill today?

Thank you, Madam Chair. Cliff Berg here on behalf of the California Association of Collectors. We generally applaud the author for this bill. We think all the provisions that you have heard about are excellent and have no concerns regarding them. The one provision in this bill which we think is over broad and needs work is an absolute prohibition on the use of wage garnishments.

While it is true we agreed in the Bonta Bill relating to hospitals to include a ban on wage garnishments, we did not agree to every subsequent health care bill that comes through the Legislature, and since the passage of the Bonta Bill, we have seen and agreed upon legislation by Senator Wieckowski which substantially limits the use of wage garnishments in California based upon income to protect low and moderate income Californias.

So given the passage of the Wieckowski Bill limiting wage garnishments, we think an absolute prohibition on wage garnishments for a particular type of debt makes no sense. In reality, wage garnishment is a post judgment tool which means that the bill has gone through the collection process. It's gone to court because it was triaged and someone felt it was worth suing on. A judgment was attained, collection was tried again, and the individual still refused to even work out a payment plan.

So only as a last resort is a wage garnishment ever used post judgment in California and it's severely limited by the Wieckowski Bill. We think this language is over broad and would ask the author to consider narrowing the language or taking out the prohibition. Thank you.

Thank you very much. Others speaking in opposition today? Two Cliffs. It makes a hill.

That is true, Madam Chair. Cliff Costa on behalf of the California Creditors Bar Association. Would like to associate my comments with Cliff Berg, the other Cliff, and respectfully ask for a no vote today, but understand it's on that limited perspective. Thank you.

Thank you very much. Okay. Others just wanting to speak in opposition in general? Okay, no. Let's go to the phone lines. Anyone speaking in support and/or opposition to AB 716?

Thank you, Madam Chair. If anyone would like to speak on AB 716, please press one then zero at this time. Our first comment comes from line 86. Please go ahead.

Good afternoon, Chair and Members. Faith Borges on behalf of California Agents and Health Insurance Professionals in support.

Thank you very much.

Our next comment comes from line 89. Please go ahead. Line 89, your line is open. 89, if you would like to comment, now is your time. Moving on, line 105, your line is open.

Chair and Members, Jonathan Feldman on behalf of the 911 Ambulance Alliance. Didn't have a position at the time the bill was being prepared for an analysis, but through negotiations, we are moving to support, so I just want to thank the author, staff, and the sponsor for negotiating all year with us and look forward to supporting the bill from here on out.

Thank you very much. Next caller, please.

Line 104, your line is open.

Hi, Chair and Members. Maxine Mantell on behalf of the National Multiple Sclerosis Society in support of the bill. Thank you.

Thank you. Next caller, please.

At this time, we have nobody else in line, Madam Chair.

Alright, we're going to bring it back now. Senator Wiener.

Thank you, Madam Chair. First of all, thank you for bringing this bill forward. It's so long overdue. First of all, I'd love to be a co-author of the bill. This is just one of those areas; it's like the Wild West and people are like literally are living in fear of calling an ambulance, and it's been that way for a long time. I don't think it used to be that way.

It used to be like the Fire Department would send out an ambulance for you, and I remember when I was in the San Francisco City Attorney's Office, and I defended the city when it got sued, among other things and tort claims, and so we would get the complete medical record including the ambulance, and the ambulance bill would usually be like 300 dollars or maybe 350 or 400.

And now it's just thousands and thousands and we need to be very clear that this industry has transformed in a negative way and private equity is now in the house and so it's viewed as a cash cow, and so there's no reason why ambulance rates need to be as high as they are, but if that's where the industry is going, that's the current state of affairs, but we certainly don't need to upend people's lives because of--it's just outrageous for ambulance companies to even just refuse to be a network for anyone because they know that they'll just go after the patients.

This is a really great bill. I'm happy to move it, and I apologize if--I was presenting another bill so I missed your opening. If you already addressed in your opening, I don't want you to repeat it. Just responding to the garnishment issue.

Yeah. So the prohibition on wage garnishment that's in 716 is identical to all the wage garnishment prohibitions that we have in every other surprise medical bill. This bill was actually brought to us three years ago by my fire chief in Oceanside, and I had no idea that when the surprise bill we got from my daughter, I thought it was like an insurance error. I was like, 'why do we have this?'

It was so crazy because we had no control of who was going to transport her from Scripps to Rady's when she had orbital cellulitis and almost lost her eye, right? And it was the week after spring recess, my first year. Do I go back? How do we handle all these things? So we didn't have that, and we didn't know and when he brought it to us, he made clear most insurers do not contract with cities that provide ambulance services.

So when you think about wage garnishment and you think about really how this industry is impacting real Californians and being able to pay, it is appropriate that you'd have the wage garnishment prohibitions in surprise ambulance bill like you have for every other surprise medical bill, and so that's why we did not take those amendments. Yes.

Senator Roth?

Thank you, Madam Chair. Obviously, this is a critical bill, and this is, as my former colleague, Senator Herzberg used to say, 'an elegant solution to a serious problem.' I'm a little concerned on the wage garnishment piece because obviously we're limiting the amount that can be charged, we have uninsured people, we're going to have to pay, and it seems to me that at some point, if we control the cost that's being charged for those folks who choose not to pay the bill, there needs to be some recourse for the company who provides the service, however limited.

And if the prior limitations on wage garnishment that our bankruptcy expert former colleague put through the Legislature are not sufficient, then maybe we need to revisit that. So obviously that's not going to happen.

I just ask you to continue to take a look at that because if there's no ability to do any sort of wage garnishment and if an individual, for whatever reason, maybe intentional, maybe not, chooses not to pay for the services, how do you recover for the services? The cost of the services provided? And that's rhetorical.

Okay.

I appreciate your work.

Thank you. I will point out, and I believe it's Encinitas, I might have the city wrong, the locally negotiated LEMSA rate for ambulance service is 400 dollars; in Poway, it's 4,500 dollars. So just because we're using the LEMSA rate doesn't mean that this is going to be a really low cost share for the patient and I think when people are making a good faith effort to pay their medical bills, we know medical bills are one of the reasons people end up going on that precipice of homelessness.

We know that, right? That's not something we don't know as legislators. We know that and having that wage garnishment for people who are especially low income or middle income, I don't think it an appropriate thing. We should have all surprise medical bills in the same kind of situation because I think medical bills are a different category than other wage guarders.

This eliminates the surprise piece of the medical bill, right?

It does, but the locally negotiated--the LEMSA rate can vary widely from jurisdiction. Like San Diego County doesn't have a countywide LEMSA rate, so it goes to the municipalities, and the municipalities, as I gave the example, one city is 400, one is 4500.

But in terms of service providers, we're dealing with service providers who don't have any alternative but to provide the service.

Yes.

So we need to provide a way for those who are providing a service to those who choose not to pay with the ability to recover for the cost of the services.

I hear you. I hear you. Thank you.

Okay. Anybody else want to speak on this bill? Okay. Yeah. I think it's a legitimate issue. We went around and around on the wage garnishment in the office also and kind of landed on this side maybe because I had to call 911 twice in a week. I don't know. Right? I don't know. Surprise bills may be coming, but it is a time when people are incredibly vulnerable, when they have to decide whether to call 911 or not. Would you like to close?

Respectfully ask for an aye vote.

Okay. Was there a motion on this bill? Senator Wiener moved it. Okay, and it is a 'do pass as amended and re-referred to the Committee on Appropriations,' and folks saw the mock up that there were some technical and clarifying amendments made to the bill, and you were accepting those amendments?

I accept those amendments.

Okay. Thank you very much. Secretary, call the roll.

Senators Eggman? Aye. Eggman, aye. Nguyen? Glazer? Gonzalez? Grove? Hurtado? Limon? Menjivar? Aye. Menjivar, aye. Roth? Aye. Roth, aye.

Okay. Madam Chair, Members first, I'd like to accept the Committee amendments and would like to thank the chair and your staff for working with us on this Bill. AB 719 would require medical managed health plans to reimburse transportation operators for non-medical transportation and nonemergency medical transportation services.

All right. 5-0. We'll hold that open for Assembly Members and then moving on to AB 719 non-medical and non-emergency medical transport back to transporting. Go ahead.

These are services that are federally mandated under the Americans with disability act to provide and include travel to doctors appointments, physical therapy, and other medically necessary services. AB 2394, signed in 2016, had the unintended consequence of removing the incentive for medical managed care plans to contract with transit agencies. As a result, medical managed care plans retained funding that should have been used to reimburse public transit agencies for services they were providing for medical clients.

AB 719 simply ensures that the public transit agencies are reimbursed for eligible medical trips by requiring plans to contract with transit providers. I respectfully ask for an aye vote. And I have with me here today Alchemy Graham, legislative advocate for the California Transit Association, the sponsors of this Bill, and on the phone line, I have Vanessa Rauschenberger with Gold Coast Transit Districts to answer any technical questions. Thank you very much. Please proceed. Thank you.

Madam Chair and Senators, Alchemy Graham, legislative and regulatory advocate with the California Transit Association, and on behalf of our more than 220 Member organizations, I'm here today to voice our support for and proud co sponsorship of AB 719. As Assembly Member Boerner mentioned, AB 719 would require medical managed care plans or MMCPS, as I will refer to them in my testimony to reimburse public transit operators for the non medical and nonemergency medical transportation, NMT and NEMT, respectively, the services that they provide.

And as the Assembly Member mentioned before, AB 2394 by Assembly Member Garcia was passed in 2016 medical directly reimbursed transportation providers when they offered these services to medical customers. When AB 2394 was signed into law, it had that unintended effect of cutting transportation providers out of the reimbursement loop by providing state and federal funding directly to the MCPS for transportation services. This disincentivizes MCPS from contracting with public transit agencies as they're not required to reimburse them for the services that they provide.

And as a result, public transit agencies have seen reductions of hundreds of thousands to several millions of dollars in reimbursement funding while MCPS continue to receive transportation funds and pocket them. Since this Bill was heard in the Assembly, we've received some opposition from MCPS, who have made several claims, including the following that this Bill will drive. Up transportation costs for MCPS, and customers already have access to public transit without a contract between the MCP and transportation provider.

I'd like to clarify that this Bill would not require any additional funds from MCPS. It would simply ensure that the funds that they currently receive for transportation are used for their designated purpose. While it is true that customers can access fixed route public transit for transportation services because it is a public service, transit agencies do not receive reimbursement for fixed route services. They only receive reimbursement for paratransit services, as clarified in the author's most recent amendments.

That said, this Bill does not apply to fixed route services, nor does it qualify reimbursement for public transit fares, as these are not eligible NEMT or NMT services. AB 719 will ensure that public transit agencies are reimbursed at reasonable rates for eligible medical trips, remedying the unintended consequences of AB 2394, and providing customers with reliable and accessible transportation services. With that, we respectfully request your support. Thank you.

Thank you very much. Anybody else speaking in support, come forward now. If you just want to say you like the Bill, come forward now. Name an affiliation.

Good afternoon. Steve Wallauch on behalf of the Alameda Contra Costa Transit District and the California Association for Coordinated Transportation in support.

Thank you very much. All right, anybody speaking in opposition to this Bill today? Now would be the time to come forward.

Good afternoon, Madam Chair and Committee Members. Rebecca Sullivan with Local Health Plans for California. LHPC represent the 17 not for profit, community based health plans, medical managed care health plans. Excuse me. So we have had some great conversations with the author's office and the sponsors, but unfortunately, we are still opposed as of today due to the contracting mandate.

There are a number of valid reasons that plans or even public transit operators may not choose to contract with one another. And the language of this Bill is very strict. Some of those reasons could be medical appropriateness or service provision reasons, quality of care provisions or others. And just this strict mandate really doesn't account for any of that. So we look forward to and hope to continue to have conversations and would be open to having conversations, softening that language, something like a good faith effort. So thank you so much.

Thank you very much. Anybody else speaking in opposition to the Bill today?

Madam Chair, Members of the Committee. Jedd Hampton with California Association of Health Plans. In the interest of time, we would align our comments with our colleagues from the local Health plans California about concerns with the overarching mandate for medical management health plans to contract specifically with local Trans agencies. So thank you. Look forward to working with the author moving forward.

Okay, thank you very much. Anybody else wanting to speak? Say they don't like it? No? Okay, let's go to the phone lines. If you're in support and or opposition to AB 719. Moderator.

if you'd like to speak to AB 719, please press one and then zero. We have a comment from line 99. Your line is now open.

Hi, this is Vanessa Rauschenberger, General manager for Gold Coast transit district, and I'm speaking to support this Bill. This is an important Bill for Gold Coast Transit to help us cover the cost of services we're already providing, and we urge the Committee to support this Bill. Thank you.

Thank you very much. Any others speaking in support? That was one of your witnesses? That was my witness. Okay.

And there are no further comments at this point, Madam Chair.

Okay, bringing it back to the Committee now. Questions? Comments? The Bill has been moved, and I didn't quite realize that health plans were, like, using Uber and stuff to pick people up, which seems like this would be a very good way to use our transit districts who have struggled and have lifts and have all the things to be able to go around and pick folks up and go to the doctors. Would you like to close?

Respectfully, ask for an aye vote.

And we have a motion. We have a motion from Senator Wahob. Let's call the roll. And that motion is do pass as amended and rerefer to the Committee on Appropriations. Secretary.

[Roll Call]

80. We'll hold that open for absent Members. Thank you very much. Thank you very much. Now, our final presenter of the day, Assembly Member Jones Sawyer.

Thank you, Madam Chair and Members. I would like to start by accepting the Committee's amendments. I am proud to present AB 1510, the Fighting Fentanyl Bond Act of 2024. As the Chair of the Assembly Public Safety Committee, I have heard my colleagues concern for their communities, and I considered bills that attempted to combat the fentanyl crisis from numerous angles. However well-intentioned those bills may have been, it became clear that they were not going to address the root causes behind the crisis.

I recognized that this issue deserved more attention than a Policy Committee hearing could offer. That is why I was proud to co-host the informational hearing on the fentanyl and overdose crisis, where we heard from the impacted families, public health experts, and individuals working on the front lines. Over and over again, we heard about the need for a public health response.

Experts stressed the importance of addressing the underlying causes of drug use and overdose, and presented the data and evidence to support policies that expand services and eliminate suffering. The punitive policies from the war on drugs failed to support Californians who lack access to services and stigmatize those who are struggling with addiction. Leaving the informational hearing, I saw an opportunity to correct the mistakes of the past and prevent further harm to our communities.

The Fighting Fentanyl Ban Bond will make underrepresented investments, unprecedented investments in public health intervention programs that increase access to substance use and treatment, medication, assisted treatment, harm reduction programs, fentanyl tested strips, and Naloxone education awareness so that people understand the risks, learn how to administer Naloxone, and know how to protect themselves and their loved ones. Focus deterrence and violence prevention, because individuals who have been impacted by the carceral system have limited access to services and are 40 times as likely to die from an overdose.

And research on emerging illicit drugs so that we can stop playing catch up and instead be prepared to take on Xylazine, commonly known as Tranq, and prevent future crises. The Fighting Fentanyl Bond was developed in partnership with experts in addiction medicine and public health, as well as leaders in a drug policy, human rights and law enforcement. I am extremely proud of this bipartisan effort to provide the public with an opportunity to make a real investment in public health and drug treatment.

Together, we hope to abandon the divisive rhetoric that has led nowhere and unite the fight against fentanyl. With me is Dr. Keith Humphreys, Professor at Stanford School of Medicine and a Stanford Health Policy associate. I'm also joined by Glenn Bacchus. Members, I respectfully ask for your aye vote.

Thank you very much. Doctor?

Chair Eggman, Vice Chair Nguyen, thank you for a chance to speak to you today, and thank you, Assemblymember Jones-Sawyer for your leadership. It's an honor to testify alongside you. As was said, I'm a Professor at Stanford Medical School. I've been working in the addiction field for 35 years, and I strongly support this for the simple reason that I've never seen a drug epidemic this bad in my life. 50% increase in fentanyl deaths in California in 2020, again in 2021, perhaps again in 2022.

And that's just one of the drugs we are suffering from. Also methamphetamine, tranq and so on. And there has to be resources to do that. Because I just have a very short time, I'm just going to just give an example of one thing we could do that's hard to do otherwise, and that is make an investment in kids around prevention. Prevention has come a long way from when it was maybe cops trying to scare kids about cannabis.

There's really good evidence-based programs that bring communities together to equip kids with emotional skills, social skills, pro-social connections in the community, and the most rigorous studies we have randomized clinical trials, which is what we love to see as scientists.

Programs like this, like Communities That Care, which is done in hundreds of cities around the United States, shows that not only do kids use less drugs, they also smoke less, they use less alcohol, they're more likely to graduate school, they're even, 12 years later, more likely to graduate from college. It's very hard to get a standing support for prevention and investment in kids. It's not health care, so it's not covered by Medi-Cal. It's something we have a hard time doing, oftentimes thinking ahead.

This is one of the many things you could support with this Bill. So that's why I'm strongly in support of it and thank you for your time very much.

Thank you very much, sir. Mr. Bacchus?

Good afternoon. Glenn Bacchus for the Ella Baker Center for Human Rights in strong support. There's a humanitarian crisis happening in our homes and in our streets. Nothing short of a humanitarian crisis. Our own neighbors are now displaced refugees in their own country and our children are living in a world of escalating danger. The causes are myriad interlocking crises of homelessness caused by the lack of affordable housing and widespread economic disparities, the crises of untreated mental illness and untreated substance use disorders.

This Bill, this bond measure, is part of the solution to those interlocking problems and it's well past due. The United States has never taken drugs seriously. If we'd taken drugs seriously, then we would have invested in better treatments and in evidence-based prevention and evidence-based efforts to prevent death. This ballot measure will ask voters if they're ready to take drugs seriously and invest in primary prevention, secondary prevention, and ongoing treatment and management of chronic relapsing disease.

Primary prevention, by investing in young people and educating them about the risk of fentanyl and providing them pro-social options. Secondary prevention, which is the prevention of overdose, HIV, hepatitis C, heart conditions and other conditions associated with drug use. In the context of drugs, secondary prevention is often called harm reduction. It's working with people who are expressing symptoms of a medical condition in order to prevent the further death, disease or disability.

A comparison might be with diabetes in which you work with a patient to prevent loss of eyesight or loss of limb. This Bill will help us invest in treatment for substance use disorders. We need to invest in what works, such as medically-assisted treatment and contingency management. And we should also invest in research into what can work better for the treatment of opioid use disorders and stimulant use disorders. The US is woefully behind in this research because of a preference for punishment over science and healthcare.

If voters support this investment in this time of crisis, the additional benefit is there would be greater interest from private industries in treatment and cures for substance use disorders, including stimulant use disorders for cocaine and methamphetamine, opioid use disorders for heroin, fentanyl and other drugs, and the treatment of tranquilizers, benzodiazepine, sedatives and other drugs. But we can't wait for the federal government or private industry to bail us out. Californians have to help Californians. This Bill is a strong step in the right direction.

It's worthy of your support and the voter support. Thank you.

Thank you very much. Other speakers in support of this today?

Good afternoon. Jeannette Zanipatin on behalf of Drug Policy Alliance in strong support.

Thank you very much. Anybody else speaking in support? Seeing none. Anybody speaking in opposition to this Bill today? Seeing none, we'll go to the phone lines. Anybody speaking in support and/or opposition today?

If you'd like to speak to AB 1510, please press 1-0 at this time.

And there are no comments queuing up, Madam Chair.

Okay. Now would be the time we'd bring it back to the committee and I'm assuming, Assemblymember, you're going to work a lot as far as an actual plan and working with leadership and the administration to actually get something on the ballot.

Yes. Not only that but obviously trying to come up with a number and working with not only administration, Department of Finance, and others. What makes sense? Because you want to make sure that the funding goes to specific public health policy groups that actually are successful at drug treatment. Because we want to take this very seriously and make sure that not only are they funded, but there's a provision in there to ask to look at accountability, and so that we see successful programs that we can hopefully keep funding over and over again.

Okay. Before it moves off the floor, hopefully most all those things will be in place so we can actually know what we're going to be sending to the vote.

I think that's the most important to know what works.

Exactly. Okay. Anybody else? Questions, comments on this? Seeing none. We have a motion and would you like to close, sir?

Respectfully ask for aye vote.

Thank you very much. Motion on this? Senator Hurtado moves the bill and it is a do pass as amended and re-refer to the Committee on Gov and Finance. Secretary, please call the roll.

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

Seven, zero. Thank you very much. We'll hold that open for absent members.

Thank you, Committee.

Okay, item 14. Do we have a motion so moved by Senator Hertato? If I can get back to my sheet, that motion was do pass and refer to the Committee on Judiciary. Senate Member Wood secretary, please call the roll.

[Roll Call]

That's all of us, right? 71. So we'll close the roll. Who are we missing? Okay, we're going to leave that the roll open on that. Okay, let's move on to back up and file. Order to file. Item number one AB 379. The motion is due pass as amend and re refer to the Committee on Appropriations is by Rodriguez. AB 379. Secretary, did we get a motion on that? Rubio moved that Bill. Secretary, please call the roll.

[Roll Call]

Will hold the roll open. Moving on to AB 616, also by Rodriguez and that is due pass and re refer to the Committee on Judiciary. Secretary, please call the role. It was moved by Menjivar.

[Roll Call]

Okay, moving on. We'll leave the roll open on that. AB 1392 Rodriguez motion is do pass, and we refer to the Committee on Appropriations. Secretary, please call the Roll.

[Roll Call]

Seven to two. We'll leave the roll open for absent Members. AB. 254 Bauer-Kahan. That was moved by Roth. The motion is do pass, and we refer to the Committee on Appropriations secretary Senators.

[Roll Call]

Moving on to Bauer Kahan AB 1720 moved by Senator Roth that motion is due pass and re refer to the Committee on Judiciary Secretary

[Roll Call]

We'll hold the roll open. Moving on to AB 716 by Boerner that is due, passed as amended and Reefer to the Committee on Appropriations, moved by Senator Weiner. Secretary, please call the Roll

[Roll Call]

7-0. We'll hold that open. Moving on to AB. 719 Boerner. The motion is due, pass as amended and re refer to the Committee on Appropriations moved by Senator Wahab secretary, please Call the Bill

[Roll Call]

8-0. We'll hold that open. Let's see the consent calendar again. Secretary, please call the roll.

[Roll Call]

We'll hold that open waiting for Glazer to get here and okay, let's see. For Senator I think I missed a couple. I think.

Yeah. AB 616. Item two. That motion is do pass and re-refer to the Committee on Judiciary secretary please call the roll. Moved by Senator Menjivar.

[Roll Call]

Okay, 1392 Rodriguez do pass and Refer to the Committee on Appropriations moved by Rubio

[Roll Call]

We'll leave that open. AB 254 by Bauer Kahan, do pass and refer to the Committee on Appropriations moved by Roth.

[Roll Call]

10-0 we'll hold that open and then AB 1720, Bauer Kahan, do pass and Refer to the Committee on Judiciary moved by Senator Roth. Secretary Senator Glazer, this is Bower Kahan 1720.

[Roll Call]

All right, that's 102. That Bill is out. The roll is closed. Okay, let's move on to AB 716. That motion is to pass and refer to the Committee on Appropriations as amended. Secretary.

[Roll Call]

10-0 all right, we just go back in order for all right. To call the roll on the consent calendar.

[Roll Call]

Roll is closed. That Bill is out. AB 379 Rodriguez do pass as amended and re refer to the Committee on Judiciary. Secretary

[Roll Call]

It's eight to one that rolls closed. That Bill is out. Moving on to 1392 Rodriguez. Do pass and re refer to the Committee on Appropriations having to do with procurement.

[Roll Call]

That Bill is out. The roll is closed. Moving on to 254 Bauer Kahan confidentiality. Do pass and rerefer the Committee on Appropriations.

[Roll Call]

Okay, let me just double check it's. 11-1 rolls closed. That Bill is out. Moving on to AB, 1720. Bauer Kahan. Do pass and refer to the Committee on Judiciary. 1720 is out. 1720 is out. 716 by Boerner, maybe 716. Do pass and refer to the Committee on Appropriations.

[Roll Call]

That Bill is out. The roll is closed. Moving on to AB 719 Borner, also having to do with non medical transportation and contracting with local transit districts. Secretary

[Roll Call]

12-0. That Bill is out. AB 1092 by Assemblymember Wood do pass and refer to the Committee on Judiciary.

[Roll Call]

The final bill of the day is AB 1510. Do we want to say out on 1092. 92 is 92. That Bill is out. That role is closed. AB 1510. Jones Sawyer. That is do pass as amended and rerefer to the Committee on Government Finance.

[Roll Call]

Thank you. And that concludes this Committee meeting.