Assembly Standing Committee on Business and Professions

Welcome to today's Business and Professions Committee hearing, where we'll be hearing bills back on concurrence that have been substantially amended in the Senate, even if they were just substantially amended to shrink what we had already passed five months ago.

We have four bills on today's agenda, and there is no consent calendar today, which is unfortunate, as we have a motion, though, as always, for each measure being presented today, we will be allowing primary witnesses here in the room today to speak for up to two minutes each, with up to two primary witnesses per side. Any additional witnesses will be limited to name position on the Bill and the organization they represent, if any.

For those wishing to provide further comments, we are accepting written testimony through the position letter portal on the Committee's website. With that, we'll get today's hearing started. And I have asylum. Member Patterson Asylum Member Patterson, would you like to present agenda item number one? AB 633, which I was notified by my Vice Chair, is a support support recommendation. And I have a motion, it sounds like, and I have a second. We are clicking on all cylinders, but we don't have a quorum, so we can't take a motion yet.

That's all right.

Ready when you are sir.

So, first of, thank you for the opportunity to present first of all, we know that the State of California has a severe nurse shortage. And I want to present AB 633, which would offer retiring nurses a reduced fee to keep their license active, particularly at this time. We want to ensure that all willing and able registered nurses are eligible to serve their communities even after they've retired.

AB 633 will allow a retired nurse to renew their license for a substantially reduced fee, so that they may offer their services in a voluntary capacity, either on a regular basis or in emergency. The State of California already offers this same benefit to other healthcare professionals. The Medical Board allows retired doctors to renew their licenses at a reduced rate, and the Dental Board offers the same benefit to retired dentists. This Bill has enjoyed unanimous bipartisan support. It has no opposition.

And when you have a quorum, I'm asking for your support. Thank you.

Perfect timing, Assembly Member, because it looks like we have a quorum. Madam Secretary, can you please call the roll?

Berman, Flora, Alanis, Alvarez, Bains, Bonta, Chen, Dixon, Gipson, Grayson, Irwin, Jackson, Lee, Lowenthal, McCarty, McKinnor, Nguyen, Joe Patterson, Ting.

Great. We have a quorum. Do we have any primary witnesses in support? That's all we need. That's all we need any primary witnesses in opposition to the Bill? Seeing none. Are there any folks in the audience who want to add on in support of the Bill?

Mr. Chair and Members Monica Miller on behalf of Alameda County and the California Association of Nurse Anesthetists in support of AB 663. Thank you.

Thank you.

Good evening, chair and Members, Rachel Mueller with the Weideman Group on behalf of California Society of Health System Pharmacists in support. Thanks.

Thank you.

Good evening. Jenny Trice with the County of Santa Clara in support.

Thank you.

Mr. Chair, Members, Paul Yoder on behalf of the City and County of San Francisco and Mayor London Breed, got here as fast as I could, sponsor of the Bill. Urge your vote. Thank you.

Thank you. Wait, so I'm not sure if people are presenting for the right Bill. There's 633 and 663. So this one is 633. It sounds like maybe on the board we've got the wrong Bill up. I can't see that screen on our end. It's actually black, which is not helpful.

Mr. Chair, I'll take all the support I can get.

So we'll be at that Bill in a minute. Anybody who wants to add on in support or opposition to AB 633 by Assembly Member Jim Patterson? Maybe Phil Chen, but he hasn't decided yet. Seeing none. We've got a motion and second. Is that right? Now? That was a motion in second for 633. Good. Any comments or questions from colleagues? Seeing none. Mr. Patterson, would you like to close.

The opportunity to present I think this is a very common sense and affordable way to frankly say thanks to the retired nurses for coming back into the profession. And we want to put those barriers down as low as we can get because we appreciate that we need them now more than ever. Ask for your aye.

Thank you, Assembly Member Patterson. Bless you. Thank you for your work on this Bill. I'm absolutely sympathetic to the varying levels of nursing shortages around the state, and this is an opportunity to help with that. I'm happy to continue to support this Bill. Madam Secretary, please call a vote.

AB 633, Jim Patterson. The motion is with recommendation that Senate amendments be concurred in. Berman aye, Flora aye, Alanis, Alvarez aye, Bains aye, Bonta, Chen aye, Dixon, Gipson aye, Grayson, Irwin aye, Jackson aye, Lee aye, Lowenthal aye, McCarty, McKinnor aye, Nguyen aye, Joe Patterson, Ting.

That bill is out. Thank you very much. Next, we'll move on to agenda item number four, AB 1070. Assembly Member Low. Have a bipartisan, tripartisan, multiple motion and second. We can't even do tripartisan anymore.

Thank you very much to the chair and colleagues for allowing me to present Assembly Bill 1070. I respectfully ask for aye vote.

Thank you very much for that very thorough presentation, Assembly Member. Any primary witnesses in support of the bill?

Hi. Tish Rylander. On behalf of Signify Health, I'll keep this pretty short. AB 1070 defines what takes place during an in home evaluation and authorizes a physician and surgeon to supervise up to eight physician assistants at one time when the PA's are performing very specific in home health evaluations. This Bill only increases the ratio for PA's performing very limited services and that require minimal supervision. The flexibility provided by AB 1070 is critical to address workforce shortages and helps to increase access to care for many vulnerable patients.

We respectfully ask that the Committee concur in these Senate amendments. Vote aye on AB 1070. Thank you to the Committee and to the author for working with the various stakeholders as well to reach this agreement.

Thank you very much. Any primary witnesses in opposition to the bill? Seeing none. Any folks want to add on in support of the bill? Either in favor or support name organization you're with and position on the bill? This is for AB 1070. Seeing none. We've got a motion and second. Colleagues, comments? Dr. Baines.

Can you hear me now? I just had a question about the opposition from the medical board. If you can address that, please.

Chair. Through the chair. If the witness testimony can address that.

Yeah, thank you. I think it's important to note that under the flexibility of AB 1070, PA's are not practicing to the full extent of their scope. Physicians can supervise less than eight physician assistants. And speaking on behalf of Signify, we have a robust process of training, monitoring, and providing compliance oversight. We have the highest standards of clinical accuracy and patient satisfaction. I think those points address the board's opposition.

Originally, the bill would have allowed for doctors and physicians to use their discretion as to how many PA's they would supervise. We heard their concerns and along with other stakeholders and limited, put a cap on that to eight.

No, actually, the letter says they wanted to clarify how these home health evaluations should be documented.

Yeah. And in that, that's why we've taken the amendments to further define what takes place in home health evaluations, to make sure that it was very narrowly crafted so that this increase would only apply to a very limited in scope in home health evaluations.

Okay, so those were addressed, is what you're telling me?

Yes, absolutely. Thank you.

Any additional questions or comments? Seeing none. Assembly Member, would you like to close?

Respectfully, ask for a vote?

Thank you. Madam Secretary. Thank you for working with us on this bill. The Senate amendments narrowed the bill, further addressing concerns that have been raised about supervision. With that, I'm happy to continue to support the bill today. Madam Secretary, please call the vote.

AB 1070 Low. The motion is with recommendation that Senate amendments be concurred in. Berman? Aye. Berman aye. Flora? Aye. Flora aye. Alanis? Aye. Alanis aye. Alvarez? Aye. Alvarez aye. Baines? Aye. Baines aye. Bonta? Chen? Aye. Chen aye. Dixon? Gibson? Aye. Gibson aye. Grayson? Erwin? Aye. Erwin aye. Jackson? Aye. Jackson aye. Lee? Aye. Lee aye. Lowenthal? Aye. Lowenthal aye. Mccarty? McKinnor? Aye. Mckinnon aye. Wen? Aye. Wen aye. Joe Patterson? Ting?

That Bill is out. Congratulations. Thank you very much. And not seeing Assembly Member Haney, who I know a lot of people are excited to see when he gets here. Assembly Member McKinnor, would you like to present agenda item number three AB 782? Got a motion, got a second.

Mr. Chair Members, I respectfully ask for an aye vote.

Erin Norwood on behalf of Flavor RX. In light of the motion and the second, I will keep this very short. Just want to thank the author and the co author, Ms. Irwin, for their work on this Bill. I am here to answer any questions you may have and urge your aye vote. Thank you.

Thank you.

Mr. Chairman, Members, Joe Lang, representing Jordan's Guardian Angels. As a special needs father, I can tell you how important it is to have this service continue. Most of the time. Special needs children have a variety of medications they have to take. Sometimes swallowing and other things are challenges. And our pharmacy is part of our healthcare provider system, and they help. And this Bill will just allow that to continue. And we urge your aye vote.

Thank you very much. Any primary witnesses in opposition to the Bill?

I think there was more support, though.

We'll get there. Okay. Don't worry.

I'm jumping the gun.

Any folks want to add on in support or opposition to the Bill? Let's just let everyone do it at once. Name, organization you're with, if any, in position on the Bill.

Hello again. Rachel Mueller with the Weideman Group on behalf of California Society of Health System Pharmacists in support. Thank you.

Thank you.

Hello, Ryan Allain on behalf of the California Retailers Association in support. Thank you.

Thank you very much. Any additional witnesses in support or opposition? Seeing none. Bring it back to colleagues for questions or comments. Seeing none. Some of the Member, would you like to close?

I respectfully ask for your aye vo.

Thank you very much. I want to start by recognizing the author for taking on this Bill. Making sure parents can get their kids to take their medicine is important. I also want to acknowledge the position this Bill is putting the board in. And I do express some sympathy for their opposition. Given my understanding that the USP has defined compounding to include flavoring for nearly 20 years, it shouldn't have been a surprise that legislation passed back in 2019 would have resulted in where we are today.

It seems like that should have been plenty of time for a Bill to be introduced through the regular process, which would have allowed for more discussion. Unfortunately, because we're hearing this Bill for concurrence only the Committee's ability to seek out some compromise or agreement is very limited. With that in mind, I'll be voting in favor of recommending concurrence today. Madam Secretary, please call a vote.

Thank you. AB 782 McKinnor. The motion is with recommendation that Senate amendments be concurred in. Berman aye, Flora aye, Alanis aye, Alvarez aye, Bains aye, Bonta, Chen aye, Dixon, Gipson aye, Grayson, Irwin aye, Jackson aye, Lee aye, Lowenthal aye, McCarty aye, McKinnor aye, Nguyen aye, Joe Patterson aye, Ting.

That Bill is out. Congratulations.

Thank you very much.

Thank you. Assembly Member Haney, if you'd like to present a lot of folks are excited for you to present item number two, AB 663.

I missed something.

You did have a motion and a second and someone who is grateful that you are in better physical health than a month ago.

Thank you. Can I start?

Thank you. Mr. Chair, Members, I'll be brief. AB 663 is back for concurrence. When allowed mobile pharmacies to dispense medications for opioid addiction treatment, this Bill passed unanimously out of Committee earlier this year. There were some amendments in the Senate that clarify that a local government can operate more than one pharmacy.

Yes, please.

Allows the pharmacist in charge to determine how many mobile pharmacies are appropriate, allows a local government to set up a mobile pharmacy on a quicker timeline, and provides a deadline to inform the Board of pharmacy when a local government decides to open or close a mobile pharmacy. Thank you for your time, and I respectfully ask for your aye vote on concurrence.

Thank you. If you have a primary witness, please go ahead.

Mr. Chairman and Members, nice to see you again, Paul Yoder still on behalf of the city and County of San Francisco, sponsor of the Bill. This is one of the most important strategies for Mayor Breed and the city in addressing Fentanyl it sensibly builds on recent legislation. Urge your aye vote. Thank you.

Thank you very much. Any primary witnesses in opposition to the Bill? Seeing none. Anybody wants to add on in support or opposition again, but this time to this Bill, please go ahead.

Mr. Chair and Members. Monica Miller, again on behalf of the County of Alameda and the California Association of Nurse Anesthetists in support of AB 663.

Thank you very much.

Chair and Members. Rachel Mueller with the Weideman Group on behalf of California Society of Health System pharmacists in support of 663. Thank you so much.

Thank you.

Jeff Neal on behalf of the County of San Diego Gratefully in support.

Thank you.

Hello, Genesis Gonzalez, on behalf of Lieutenant Governor Eleni Kounalakis in support thank you.

Thank you very much.

Hi. Jenny Trice with County of Santa Clara in support.

Thank you. Any additional witnesses in support of opposition? Seeing none. Bring it back to colleagues for questions or comments. There's a motion to close debate. Second, I'm not sure what the protocol is here, but we're just going to give you the opportunity to close.

Assembly Member well, on behalf of myself and my doppelganger Mr. Patterson, was it Mr. Patterson?

And this Patterson missed it, so I'll explain it to him later.

Respectfully ask for your aye vote thank you.

It takes a village, Assmebly Member Haney. Thank you to the author for bringing this Bill forward. I was happy to support the Bill earlier this year, and I'm happy again to support recommending concurrence in the amendments. Madam Secretary, please call the vote.

AB 663. Haney the motion is with recommendation that Senate amendments be concurred in. Berman aye, Flora aye, Alanis aye, Alvarez aye, Bains aye, Bonta, Chen aye, Dixon aye, Gipson aye, Grayson, Irwin aye, Jackson aye, Lee aye, Lowenthal aye, McCarty aye, McKinnor aye, Nguyen aye, Joe Patterson aye, Ting.

The author was so confident he's already gone. But congratulations to him on the Bill getting out with that for folks to add on, let's run back through the agenda. And if you do have a Member who's on this Committee who isn't here yet and you're watching the hearing right now, please go get your Member and bring them to 1100 so they can add onto the bills. Madam Secretary, please go ahead.

AB 633 Jim Patterson. Alanice? Aye. Alanice aye. Bonta? Dixon? Aye. Dixon aye. Grayson? Mccarty? Aye. McCarty aye. Joe Patterson? Aye. Joe Patterson aye. Ting? AB 663 Haney. Bonta? Grayson? Ting? AB 782. McKinnor? Bonta? Dixon? Aye. Dixon aye. Grayson? Ting. AB 1070 Low. Bonta? Dixon? Aye. Dixon aye. Grayson? McCarty? Aye. McCarty aye. Joe Patterson? Aye. Joe Patterson aye. Ting?

So we'll keep the roll open for, let's say, five minutes to allow folks to come over to add on. Madam Secretary, please, we're telling stories. Run through the agenda so members can add on.

AB 633 Jim Patterson. Ting? Aye. Ting aye. AB 663 Haney. Ting? Aye. Ting aye. AB 782 McKinnor. Ting? Aye. Ting aye. AB 1070 Low. Ting? Aye. Ting aye. Thank you.

Madam Secretary, please open the roll for members to add on.

On AB 633 Jim Patterson. Grayson? Aye. Grayson aye. On AB 663 Haney. Grayson? Aye. Grayson aye. On AB 782 McKinnor. Grayson? Aye. Grayson aye. On AB 1070 Low. Grayson? Aye. Grayson aye.

Madam Secretary, please open the roll or run through the agenda for members to add on.

AB 633 Jim Patterson. Bonta? Aye. Bonta ate. AB 663 Haney. Bonta? Aye. Bonta aye. AB 782 McKinnor. Bonta? Aye. Bonta aye. AB 1070 Low. Bonta? Aye. Bonta aye.

We are adjourned. I should say we are adjourned for the year.