Assembly Standing Committee on Health

Good afternoon. We will start the April 2 hearing of the Assembly Committee on Health today. So thankful to be here today. Before we begin, I would like to make a statement on providing testimony at this hearing. We seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California. All witnesses will be testifying in person. We allow two main witnesses for a maximum of three minutes each.

Additional testimony will also be in person and limited to name, position, and organization if you represent one. All testimony comments are limited to the bill at hand. I would also like to welcome Ms. Assemblymember Kate Sanchez. The speaker has appointed Assemblymember Kate Sanchez to the Health Committee. Welcome, Assemblymember Sanchez. We'll move on now to, we'll move on as a Subcommittee because we don't have. Because we don't have the full Committee with us. The following bills are proposed for consent for today's hearing.

Any Member of the Committee may remove a bill from consent. Item two, AB 1943, Weber with amendments and referred to the Committee on Privacy and Consumer Protection. Item 17, AB 2703. Aguiar-Curry. Item 19, AB 2841 Waldron with amendments for third rating. With that, we will begin with item number one, AB 1926 Connolly. Mr. Connolly, please come forward.

Thank you, Chair and Members, good afternoon. I would like to begin by thanking the Committee and staff for your work and input on this bill. Very much appreciated. AB 1926 would require health plans renewed on or after July 1, 2025 to cover dietary enteral formulas for the treatment of regional enteritis. These formulas can be a successful alternative to medication treatment for several digestive diseases, including regional enteritis, also known as Crohn's Disease.

This therapy has substantial benefits for all Crohn's patients, but most notably for pediatric patients patients because they may not have access to nor be able to use certain medications. Additionally, patients with Crohn's disease can utilize medically necessary formulas for nutritional support and to help them achieve remission. Early treatment options for digestive diseases like Crohn's have proven to reduce harm and increase quality of life. There's no reason why Californians suffering from chronic illnesses cannot lead full and productive lives.

AB 1926 provides patients with a proven, successful alternative to certain medications, which healthcare providers may recommend when complications such as weight loss, surgery, obstruction, or severe inflammation, prevent patients from getting the right nutrients. Enteral nutrition, or EN, is a way to give the patient's body what it needs to stay healthy. EN is usually taken in the form of nutrient-rich formula, including boost, ensure, and orgain digestive diseases, including Crohn's, affect millions of Americans with as many as 70,000 new cases of IBD diagnosed each year.

I'll also add AB 1926 as a redo of my bill from last year, AB 620, which passed through this Committee with near-unanimous bipartisan support. AB 620 was vetoed because under the exclusion section of nutrition or excuse me, exclusion section of essential health benefits benchmark plan, outpatient oral nutrition, such as dietary supplements, herbal supplements, weight loss, AIDS, formulas and food are listed.

However, there are exceptions to this exclusion, and after conversations with the Department of Managed Healthcare, the language for AB 1926 was amended to more closely align with the language in the benchmark plan. And to help address the veto message, I will now pass it off to my witnesses, Kelly Isaacson, a clinical dietitian at Cedars-Sinai Medical Cente, and Ryan Spencer, representing the Crohn's and Colitis Foundation, sponsors of the measure. Thank you.

Thank you. Good afternoon, Madam Chair, Vice Chair and Committee Members. My name is Kelly Isaacson. I'm a Registered Dietitian at Cedars-Sinai and I'm also a national board member for the Crohn's and Colitis Foundation. In my practice, I see children and adults suffer from malnutrition caused by their inability to tolerate or absorb nutrients due to their disease. Many patients may experience weight loss during flares, and pediatric patients are at risk for delayed growth and pubertal development.

Malnutrition is associated with poor outcomes in IBD, including reduced response to medications, higher rates of ER visits and hospitalizations, increased need for surgery, and poor quality of life. Current treatment for IBD can vary from aminosalicylates, stage steroids, immunomodulators, and biologics, which work by reducing inflammation and or modulating the immune system. However, these treatments are not perfect. A subset of patients don't respond or they need dose escalation. Further, these medications come with adverse effects, including bone disease, infection and malignancy that need to be closely monitored.

Enteral nutrition formula is a medical food and it's been used in various forms to treat IBD since the 1970s. Providers prescribe enteral nutrition to patients who are malnourished to optimize nutrition. They can see that it helps to augment response to medications like biologics, and we even use it to optimize patients who are going for surgery. Exclusive enteral nutrition, or EEN, is the current standard of care for pediatric patients. EEN refers to a treatment where a person's entire diet comes from a medical formula.

A patient may ingest these formulas by mouth or through a feeding tube, and when followed for two months, 80% of patients with active IBD will go into remission. This is slightly better than response to steroids, but we also see gut healing with enteral formula, which we don't see with steroid therapy. Without this medically necessary food, patients risk malnutrition, inadequate growth, cognitive impairment, surgery, and repeated hospitalizations.

At around $1.80 per bottle, a 12-year-old patient may need six to eight bottles of enteral nutrition daily, amounting to a total cost of around $800 for this therapy. Unfortunately, medical formula is not covered by health plans and for many of my patients, the cost of this therapy is unaffordable. Families should not have to reconsider perfectly viable and possibly even superior treatment options because it's not a financial realistic for them.

I'm hoping that we can overcome this barrier to safe, effective therapy and expand coverage of nutrition formulas so that health and nutrition care is more equitable. Thank you.

Ryan Spencer on behalf of the Crohn's and Colitis Foundation, they are the sponsors of the measure. Just simply ask for your aye vote in support. Thank you.

Thank you. Do we have any other witnesses in support? If so, please state your name, organization, and position.

Samaya Nahar here on behalf of the Children's Specialty Care Coalition, in support.

David Gonzalez on behalf of the California Life Sciences, in support.

Mel Assagai for the California Association of Orthodontists in support.

Good afternoon. Alex Cohn, on behalf of the California Chronic Care Coalition, in support.

Okay, do we have any primary witnesses in opposition?

Good afternoon. Chair Members of the Committee, Robert Boykin with California Association of Health Plans. Regrettably, in opposition to AB 1926, we respect and understand the intent of the bill. However, we oppose primarily based on the fact that this bill, AB 1926, will increase premiums on all consumers. According to Shabirp analysis from last year's AB 620, a bill largely similar to this bill, it is likely to increase premiums on Californians by 24 million.

AB 1926 is just one of many mandate bills introduced this year that, when taken collectively, will substantially increase premiums for all our enrollees. While all are well intended, each of the mandate bills will only increase costs and make healthcare less affordable for everyone. Thank you for your time today.

Thank you. Stephanie Watkins. On behalf of the Association of California Life and Health Insurance Company, we too are here in opposition today. We do like to thank the author and sponsor. You know, we've had a lot of conversations. If the bill does move forward today, we'd like to continue those in an open dialogue to address our concerns. Thank you.

Any additional witnesses in opposition, please state your name, organization and position.

Thank you Madam Chair. Jack Yanos on behalf of America's Health Insurance Plans in respectful opposition. Thank you.

Thank you. I'll bring it back to the Members of the Committee. Any questions? Thank you. So we'll hold the move the bill by Majority Leader Aguiar-Curry, seconded by Doctor Weber. That bill- We're meeting at Subcommitee and we'll be on call. We'll move on to AB 1965. Blanca Rubio. Put your mic on. There we go.

Thank you, Madam Chair and Members, for the opportunity to present AB 1965. I want to begin by accepting the proposed Committee amendments, which would clarify specific duties for the liaison. And I want to thank the Committee staff for their hard work in ensuring the measure meets its intended goals. AB 1965 would establish the Office of Tribal Affairs within the Department of Public Health, led by a tribal health liaison, to address health disparities experienced by our tribal communities. The Members on this Committee are all too familiar with the health disparities experienced by the California native population.

Cardiovascular disease, opioid overdose, cancer, infant mortality. The list is unmatched by any other population in California. This measure would take the meaningful steps of having an established representative and office within the CDPH to coordinate on reducing these disparities. The tribal liaison will serve as the main resource, advocate and communications link between the Department of Public Health and the federally recognized tribes and their direct or indirect public health services in the state.

This measure places a focus on engagement between the Department, Native American communities and their public health services in California. The position shall promote and coordinate collaborative efforts between the Department and tribes to improve the availability and accessibility of quality healthcare affecting the tribal populations in California, as liaisons already do in other states such as Nevada and Utah. An additional focus will be stimulating engagement between the Department and the Native American communities to enhance access of quality care affecting Native American communities.

This direct coordination is essential to remedy the disparities facing our tribal communities at the moment. In addition to the Committee amendments, I welcome further conversations with Members here today on specific professional requirements for the liaison, which do not violate Prop 209, as well as guardrails, ensuring the office meets its required duties. Here with me today to testify and support is Doctor Mark LeBeau, CEO of the California Rural Indian Health Board, the sponsors of this measure.

Thank you, Assemblymember Rubio. Go ahead, you'll have three minutes. Thank you.

Thank you. Chair, Committee Members and Assemblywoman Blanca Rubio. On behalf of the 59 fairly recognized tribes and 19 tribal clinic systems that are part of the California Rural Indian Health Board where I work, I want to thank Committee for consideration of AB 1965. Committee Members in 2011, Governor Brown issued Executive Order B 1011, requiring at the time all State of California agencies to encourage communication and consultation with California tribes.

On June 18, 2019 Governor Newsom issued Executive Order N-15-19 which reaffirmed and incorporated the principles outlined in Governor Brown's Executive order. At that time, multiple state agencies and departments issued tribal consultation plans and policies.

Examples include the Department of Healthcare Services Tribal Engagement Plan, which was approved in 2012, the California State Transportation Agency's Tribal Consultation Policy adopted in June of 2014, the California Government Operation Agency's Tribal Consultation Policy adopted in March of 2016, Health and Human Services Tribal Consultation Policy finalized in January of 2017, Department of Social Service Consultation Policy in 2017, Public Utilities Commission Tribal Consultation Policy adopted in 2018, California Environmental Protection Agency's Tribal Consultation Policy adopted in 2020, Committee Members there is a need for the California Department of Public Health to develop and establish its own tribal consultation plan and policy.

A political article noted in 2020 noted that both federal and multiple state health agencies across the US refused to provide tribes and their organizations access to data showing how the coronavirus was spreading across their communities, potentially widening health disparities and frustrating tribal health leaders working to contain the pandemic. On behalf of the California Rural Indian Health Board and the tribes and the tribal clinics that I have the honor and privilege of working directly with, I want to ask for support for AB 1965.

It definitely is in line with the governor's administrative orders. It is important for tribal governments and state governments to come together and work collaboratively to protect all citizens within the State of California. Thank you.

Thank you so much. Are there any other witnesses in support in the room?

Good afternoon. Alex Alanis, on behalf of the Kaweah tribe and the Habematolel Pomo of Upper Lake, in support. Thank you.

Thank you. We'll move on to any primary witnesses in opposition. Any additional witnesses in opposition? Seeing none, we'll bring it back to the Committee. Doctor Weber.

Good afternoon. I really just want to thank the author and the sponsors for this bill. It's definitely long overdue. And if you would be, I would be so honored if you would allow me to be a co author on this very important measure. So thank you.

Assemblymember Waldron.

Thank you. I too want to thank the author for this bill. I represent a district that is extremely rural. In fact, my district houses all 18 tribal governments that are located in San Diego County. And we see there's a stark lack of services, you know, ranging from all of the issues regarding health, not only just the substance use and the diabetes and all those things that we know of, having the clinics available, having the diagnostic tools available, the access to be able to even get to a center, very lacking.

But as well as the fact that we want to have culturally sensitive, you know, ways of addressing the needs of the tribal communities with that access of care they definitely have, the tribal governments are all different. We can never assume that one is the same as the other.

I've, you know, gotten to know over the years now, 12 years here representing that district, that the needs vary from one place to the other, and that access is very important, but their unique needs need to be integrated into the public policy and the protocols of our state. So thank you.

Assemblymember Haney.

Thank you, Chair. And I wanted to thank you both for your leadership on this and bring another issue forward that I hope can be a part of the conversation as this moves forward, which is how we are working intentionally and collectively with urgency towards addressing the challenges around fentanyl and drug overdose and drug addiction. We worked with a number of tribes in having a hearing on the Ajas land around the particular impacts and particular challenges of fentanyl and drug overdose as it impacted tribal communities.

And one of the challenges that we had when we did that is it felt that there was not the level of focus and collaboration that should be there from our state in confronting these issues together with tribes and this compact and this effort and the broader focus that this can bring, I hope, can also extend to those challenges.

There are very high rates of overdose, and I think some of the particular challenges around public health and health as it relates to accessibility of treatment and care and clinics, and also some of the particular challenges that can exist with coordination with the Federal Government and some of the opportunities that exist with clinics and otherwise that we can use as a benefit to in accessing resources. And so I hope that all that can be there as well.

It was really an eye opening experience for me, not only in the challenges, but also in some of the missed opportunities, because we don't have this level of communication and coordination and intentionality as it relates to that particular, most deadly of health and public health epidemics that we're facing as a state. So thank you. I would also love to be added as a co author, and thank you so much for your leadership.

Majority Leader.

Thank you for bringing the bill forward Miss Assemblymember Rubio. I'd like to be added as a co author. Got me.

Would you like to close?

Thank you. And I want to thank the Committee again for their hard work. And the Chair, I know it was a little bit difficult trying to make sure that we got the language correct. I'm still hoping that if there's any additional changes, we can continue working on it. With that, I respectfully ask for an aye vote.

Thank you. I appreciate it.

Thank you. I appreciate it. We are still a Subcommittee right now, but I want to thank you for bringing this bill forward. I think it certainly addresses some of the incredibly critical health disparities that we know exist in the tribal communities, and so thank you for bringing forward the bill. And if possible, I'd love to be considered as a co-author as well. We will move on to Item Number Five: AB 2081: Davies. Please go ahead. Thank you. I think your mic might not be on.

There we go. Thank you. Good afternoon. Thank you, Honorable Chair and Committee Members. I want to start by thanking the Committee staff and our stakeholders for working with us so diligently on this bill. Under current law, substance abuse disorder facilities cannot operate without first obtaining a license from the Department of Health Care Services. This only matters for treatment centers with more than six beds. After receiving certification, should a treatment facility receive a violation that affects the status of their certification, it is posted to the DHCS website.

This is a resource that many people look for treatment, even knowing--excuse me--this is a resource that many people look for treatment don't even know about when they're trying to decide on a course of treatment. There is such a lack of transparency for those looking for treatment, and it's heartbreaking to hear some of the stories about these places. What my bill AB 2081 does is it begins to peel the veil back from these facilities so patients can start to have a sense of control in their choices.

AB 2081 will have certified substance abuse facilities include a disclosure on their websites and on any intake forms that links to the DHCS website. AB 2081 will also require these establishments to pay a penalty if they are found to not have provided the disclosure to potential patients. In 2023, it was found by the OC Register that some of these treatment facilities were intentionally encouraging patients in relapsing during their treatment. They did this to ensure patients stayed with them to continue treatment for longer.

Some of these fraudulent facilities that promised care will sell their patients through referral programs in order to get kickbacks. This lack of transparency from care providers is what led us to where we are right now. These are taking advantage of patients and using their insurance providers as personal banks. AB 2081 is a common sense measure that protects our patients in our communities and brings accountability back to the conversation of substance abuse treatments.

Here to testify with me is Tamara Letourneau, the City Manager for Laguna Niguel, and Caroline Grinder from the League of California Cities. I respectfully ask for an aye vote. Thank you.

Thank you. You'll each have three minutes.

Thank you so much. Good afternoon. It's an honor to be here and to speak on this important legislation. As the Assembly Member Davies said, my name is Tamara Letourneau. I'm the City Manager for the City of Laguna Niguel. I'm a proud public servant with an over 36-year career serving California communities. I have extensive experience dealing with extremely well-operated recovery treatment facility operators, as well as those that find it challenging to follow any rules and laws.

It is these operators who find it challenging to follow the rules that create serious issues for patients they serve and the communities and neighborhoods that they reside in. The abuses in the recovery home industry are rampant and well-documented and included such things as those setting up fake homes to falsely charge insurance companies without providing real patient care to those recovery homes who employ untrained and unlicensed individuals who harm patients, and those are just a few examples.

The list of ways patients are harmed is endless and is vastly in this vastly unregulated industry, which includes a lack of transparency regarding operations and patient care. AB 2081 puts critical regulations in place where legal, disciplinary, or other enforcement actions by the Department of Health Care Services on an operator would be required to be disclosed, and a violation of these regulations would result in penalties.

It is critical for patients and their families to know when they are seeking a treatment program that they are getting reliable and a reputable operator who puts patient care first. For the protection of the current and future recovery home patients, it's critical that recovery home operators be held accountable for their actions and the public should be able to easily access--have access to confirmed said violations so the patients and their families can make informed decisions regarding their care. It is for those reasons I respectfully urge you to support AB 2081. Thank you.

Thank you. Next witness.

Good afternoon, Chair and Members. My name is Caroline Grinder, and I'm here on behalf of the League of California Cities, which is proud to co-sponsor AB 2081. This is some common sense legislation that would require a higher standard of transparency and greater protections for individuals that are seeking alcoholism and substance use treatment.

Specifically, AB 2081, as amended, would require a recovery or treatment facility to provide a disclosure to those seeking care that they can check the Department of Health Care Services website to confirm the facility's compliance with state licensing laws. Compliance with state licensing laws administered through the Department of Health Care Services, is essential to safeguarding residents' well-being and maintaining quality care.

This measure would ensure that those seeking treatment easily know what violations, if any, have happened at that facility and would hold providers accountable by making those violations more easily accessible. By making this information more accessible, AB 2081 empowers patients to make informed decisions about their care. Residential recovery housing provides a wide range of benefits to some of California's most vulnerable residents, and it's critical that their needs are prioritized over profits.

Cal Cities has a long history of attempting to pass legislation to address concerns raised by cities about the need for increased oversight, transparency, and accountability for drug and alcohol recovery facilities. AB 2081 is a practical step forward in protecting residents and upholding the integrity of the residential treatment facility model. We urge the Committee to support this legislation. We believe it's good for cities, good for the neighbors, and most importantly, good for those that are seeking treatment and care. Thank you.

Thank you. Are there any additional witnesses in support in the room? State your name, organization, and position, please.

Nicole Wordelman, on behalf of the Orange County Board of Supervisors, in support.

We'll move on to opposition. Primary witnesses.

Really brief, my name is Trent Murphy. I'm with the California Association of Alcohol and Drug Program Executives. We've been working really diligently with the author's office on amendments on this bill. We were opposed to the previous version, but we're looking forward to revising and reviewing our current position.

Thank you. Any additional witnesses in opposition? Seeing none, I'll bring it back to the Committee. I just want to clarify, Ms. Davies, are you intending to accept the amendments of the Committee?

We actually did, yes.

Okay, great. Thank you. Any other questions from the Committee? Ms. Schiavo?

I want to thank you for bringing this bill. I actually heard an investigative report about a treatment center that was charging for patients they didn't have--double charge--double billing for services they were providing. And, you know, at the end of the day, these are taxpayer dollars a lot of times that are paying for these programs, too, or definitely some of these programs.

And I just wanted a little bit of clarification, if you could clarify what the amendments are, and then also, I was curious if there is a timeframe. It looks like they have to post violations on their website indefinitely forever. I was just curious if it was kind of a forever situation or if there's a certain point when they get back in compliance, they can take things off.

The amendment we made is, to begin with, we're going to have that the treatment home would actually have the violation itself on their website, but working with DHCS, it'll be on their site. However, they will have a link that--the treatment center will have a link on there saying this is where you can go to see if there are any violations. So we changed that to go--and also I think they also have ten days to 14 days I think already in order to make sure it's up there.

It also removes the civil penalty.

Okay, thank you.

Any other questions or comments from the Committee? We're still operating as a Subcommittee, but I will accept a motion and a second. Oh, okay. We'll do it again.

Thank you so much.

This will be on call.

Appreciate it.

Mr. Berman. Item Six: AB 2154.

Good afternoon, Chair and colleagues. I'd like to begin by thanking Committee staff for their work on this bill. I will be accepting the Committee's amendments described in the analysis. AB 2154 would ensure that if a person is involuntarily detained under the Lanterman-Petris-Short Act, then a family member of the person detained would be provided a copy of the Department of Health Care Services Patients Rights Handbook.

This bill would provide family members with valuable information and resources, including definitions, to understand the terminology to enable them to support their loved ones during a mental health crisis. In addition, by understanding the rights of their loved ones who have been involuntarily detained, family members will be better equipped to ensure that their rights are realized. In particular, I want to thank the California Hospital Association and Disability Rights California for working with my office and the Committee on the amendments to maintain patient confidentiality.

I'm glad we were able to address concerns and look forward to continuing conversations with these stakeholders, and this bill came out of discussions with family members who want to improve our mental health system based on the experiences of their loved ones.

And I'm really honored to be joined by two of them today, Laura Parmer-Lohan, who's a friend and also of a parent who inspired this bill after sharing her son's experience during a mental health crisis, and Jenny Traub, parent of two daughters with severe mental illnesses and a 10 year volunteer for NAMI Parents and Youth and Young Adults support group. With that, I'll turn it over to them.

Thank you. You each have three minutes.

Honorable Chair Bonta and Health Committee Members, thank you for your leadership and your service. I also want to thank honorable State Assemblymember Mark Berman for his leadership. I experienced anguish when the emergency department team responsible for stabilizing my son during his mental health crisis told me to go home and refused to tell me to which facility he was going to be assigned.

Luckily, I glanced at Find My Friends on my iPhone app and was at the right time and monitored his transport from the emergency department to the facility. Upon arrival, the facility staff refused to confirm or deny his presence. Despite that, I held power of attorney for his care should he become incapacitated, which he was, my access to him was denied.

It was not until after the initial 5150, a 72 hours hold, had expired and several days after the extended hold that I was allowed to speak with these treating physicians. As a result, they had no information about his clinical history and what transpired in the months, weeks, days or hours before his crisis. In the absence of information, several different medicines had been prescribed to him rapidly.

When I saw him, I was shocked to find that his condition had worsened considerably and he was in a catatonic state. His hospital stay lasted more than six weeks. Later, I learned that this is much longer than a case such as his. Had we understood his rights, we would have been able to provide invaluable clinical history to his treating physicians, which in turn could have sped up his stabilization and recovery.

Clinical data show that 80% of patients want family members involved and recovery is expedited and more robust with family support. Please support AB 2150. Providing families with information is a simple and powerful step. Thank you.

Thank you. You can go ahead.

Madam Chair and Committee Members, I'm Jenny Traub. After my 15 year old daughter's suicide attempt, she was placed under a 5150 involuntary hold. Unlike Laura's situation, my daughter was a minor, so we were able to communicate with the care team. Yet still it was a traumatic experience and a 5150 was foreign to us, as were the rights of our daughter.

Under this bill, we would have received a copy of or access to the existing California Department of Health Care Services Handbook explaining the rights for individuals in mental health facilities. In that stressful situation, we were not prepared to understand what was happening and more information would have been better. The handbook includes critical involuntary hold education and definitions, as well as rights regarding visitation, telephone access, and the ability to have a patient's right advocate and more.

Having access to this material would have helped us better understand and navigate through a devastating situation for the successful treatment and care of our daughter. And this is not only personal for me. For the past 10 years, I've been a volunteer for NAMI, the National Alliance of Mental Illness. I co-facilitate a support group for parents of youth and young adults up to the age of 26. I met Laura while facilitating the support group.

Hers is one of the numerous stories I hear of parents finding themselves unexpectedly plunged into the dire situation of having their child or young adult 5150'd. I see their shock, hear their trauma, feel their pain, and listen to their frustration in trying to help their child or young adult. Family members eager to support their loved ones deserve to be educated on the involuntary hold process and definitions as well as the rights of their loved ones, regardless of the age.

And absolutely more can be done in sharing existing non-HIPAA violating resources with family members in their greatest time of need. Providing access to information and resources is a first step at helping family members support their loved ones and improve their and outcome. As a parent of two daughters with severe mental illnesses and a NAMI support group facilitator. I wholeheartedly support AB 2154 and request your aye vote. Thank you.

Thank you so much for sharing your testimony. Are there any other additional witnesses in support?

Danny Offer with the National Alliance on Mental Illness, also known as NAMI California, in strong support. Thanks.

Thank you.

Arlene Rusche, as a concerned parent.

Kathy Palmer Lohan, another concerned parent. Thank you.

Are there any primary witnesses in opposition? You can come forward to the table.

Can you hear me now? All right, awesome. Good afternoon, Madam Chair, Committee Members. Deb Roth with Disability Rights California. We are California's federally mandated protection and advocacy agency.

We have an Opposed unless Amended position, and I feel awful coming up here after Assemblymember Berman just talked about working with us, and I do want to acknowledge that his staff and Committee staff worked with us, and there's just one little thing left, but it's kind of important. And I want to say that we support the intent of the bill, and I hope I'm not botching your name, Miss Parmer-Lohan.

That's awful, what you experienced, and I don't know if this bill will help you for all of the things that you experienced, but we definitely support having more information out there. This is a public document. It is available digitally as well as in a hard copy. And we know families want to do all that they can to help their loved ones. So our problem that's left over is kind of central to the Patient's Rights handbook, and it's about patients.

Existing law gives patients the right to the handbook upon admission to a hospital, but not before. And that's when family members would get a copy under this bill when the patient is detained. So we were pleased to see a reference, and it's in comment 6b, in the analysis that there are organizations that provide resources specifically for those on an involuntary hold. We're aware of one in each county, and that would be the official patient's rights advocate.

Unfortunately, they tell us it's very difficult to get copies of the handbook. The advocate in San Diego told us they used to receive them upon request to the State Department of Healthcare Services, but that stopped about six months ago. We do understand the author is willing to continue to work on this, and we hope we will be able to remove our opposition. Thank you.

Thank you. Are there any other additional witnesses in opposition in the room? If not, I will bring it back to Committee for comment or question. Miss Waldron.

Thank you, Madam Chair. I have found that every time I am in the district and give an update to various groups-- it doesn't matter if it's a Chamber of Commerce or just a parents group or students. It doesn't matter what group it is-- When I give an update on the things we're working on in Sacramento, inevitably I'll get into the discussion of mental health because it's so important and it affects everybody.

And I found that every single time I speak, people come up afterwards. A lot of times they're parents of adult children who are, you know, 22 or 25 years old who are, you know, that's that window right there where, I mean, they're still children to us, you know, and they still have lost their way in many ways. Time and time again, is parents, they don't know where to turn.

Unfortunately, many of the cases that adult child has either committed suicide or overdosed or whatever, by the time they were able to even locate them. There's so many issues with HIPAA and privacy and all of these things that as a parent or someone who really is involved in, a stakeholder in that person's life cannot get to them, cannot be able to help to--

Having the information is so vital because you're going against this bureaucracy and just being able to know that the patient's rights are realized and being able to make sure that they receive the appropriate treatment is so critical. And it's always timely, timely, timely. So thank you for bringing this forward. I think it's very important. I would love to be a co-author if I could. I think it's a very important message that we're sending.

Thank you very much, Vice Chair.

Ms Schiavo.

I want to also thank you for bringing this bill forward and thank you for sharing your story. It's heartbreaking. And just wanted to ask to be a co-author on the bill as well. Thank you.

Really appreciate that. Thank you.

Well, thank you. I know that ensuring that a family is equipped to be able to support and advocate for their loved ones is absolutely critical. And we want to make sure that no family member has to endure what you all did. And also recognize that the author is going to continue working with, with the advocates from Disability Rights California to try to make sure that there's a full implementation that will meet and address their needs.

So with that, we are still a Subcommitee, so we will hold this bill open. But thank you so much.

Thank you, everybody. Really appreciate the conversation and the early support before your full Committee.

Thank you.

Thanks.

We will move on to item number seven. AB 2156 Blanca Pacheco. Please go ahead whenever you're ready?

Thank you. Thank you, Madam Chair and Members, I want to start by thanking the Committee staff for all their hard work on this bill, and I will be accepting the Committee amendments. Today I am pleased to present AB 2156, the Identity Integrity Act. This bill would allow for the use of diacritical marks on vital documents, such as birth certificates, death certificates, and marriage licenses.

I have worked with California Department of Public Health to keep this a low-cost bill and fine-tuned language to address any potential concerns. Other states, like Texas, Illinois, Kansas, Hawaii, North Carolina, Oregon, Alaska, and Utah, have all passed laws allowing for the use of diacritical marks on vital records. In fact, just 38 years ago, California, too, allowed diacritical marks on vital records.

But after the passage of Proposition 63 in 1986, English was declared the official language of California, and this was lost, minimizing the rich, multicultural heritage of California residents. As the most populous and diverse state in the nation, California should not change the spelling and pronunciation of people's names on vital records by omitting accents, tilde,s and other diacritical marks. In some cases, the exclusion of a diacritical mark changes the meaning of a name.

For example, the last name Pena, without the tilde, or also known as the ene. This would be Pena, which translates to shame in English. Even superstar Beyonce has a tilde on her name on the e. California should reflect the actual names of residents, reflecting parental and individual rights, preserving cultural and artistic identity as expressed in names. This bill simply seeks to restore what was once previously allowed while preserving one's cultural identity.

And with me today to testify is Nancy Chaires Espinoza, mother of seven-year-old Nicolas, who inspired this bill, and his name has tilde making it Nicolas versus Nicholas. So I have here my witness who will be testifying today.

Thank you. You have three minutes.

Thank you, Madam Chair. Wrong one. It was. I'm sorry. Thank you, Madam Chair and members, Nancy Chaires Espinosa. In 2016, my son Nicolas made his debut into the world in the aftermath of an emergency C-section.

And in the midst of making a multitude of medical decisions for a baby who would spend weeks in the NICU, I was informed that the State of California would not allow me to give my son the name that his father and I had so thoughtfully and lovingly chosen for him. The state's denial of the tilde, one type of diacritical mark in my son's name, changes its pronunciation and strips it of its cultural heritage. My grandfather attended segregated Mexican schools in this state.

He then worked the fields from Calexico to Lakeport with my father. My parents came of age at a time when students were often punished for speaking their home languages at school and when educators would arbitrarily anglicize names that they didn't want to learn how to pronounce. I'd like to think that today we know better, that we understand that acknowledgement of someone's name is the starting point for inclusion, that even if we can't pronounce it perfectly, that acknowledgement matters.

Look at what a lovely job the previous author and some of the speakers did in demonstrating that for us, doing otherwise sends the message that shedding off parts of oneself is still the price of admission in our society. AB 2156 advances some of our most treasured freedom, self-determination, parental rights, and the vision of California for all and basic respect for the multitude of cultures that make this such a special place to live.

This bill gives you the opportunity to say to my son and to all of those with diacritical marks in their names that they are as worthy of being seen and addressed by their correct names as their friends and classmates. The English-only initiative and the state's overzealous interpretation of it which produced this prohibition are products of a shameful period during which prominent Californians led a xenophobic movement which they then exported across the country.

This Committee and this Legislature did not create the discriminatory practices in place today, but you did inherit them. Ask yourselves whether the prohibition of diacritical marks on the government documents that literally identify us reflects who we are as a state today and whether it aligns with the future that we're all trying to build. I respectfully request your aye vote.

Thank you. Do we have any other witnesses and support in the room?

Connie Chan, on behalf of California State treasurer Fiona Ma in support. Thank you.

Do we have any primary witnesses in opposition or other witnesses in opposition? Seeing none, I will bring it back to Committee. I will just go ahead and thank the author for bringing forward this bill as an individual with an apellido that is villafane.

The tilde on my end, I'm very thankful that I had a birth certificate in New York City that had that, and it was very much a part of my identity growing up, to be able to inform and teach people how to be able to say my name always correctly. So it's very powerful. I'm glad that your son will have that opportunity. We are still meeting as a Subcommittee, so, Author, if you want to close, go ahead.

Thank you and thank you again for this opportunity to present my bill when the time arrives, I respectfully ask for an aye vote. Thank you.

Thank you, Miss Pacheco. We will move on now to item number eight. Mister Lowenthal, AB 2175.

Looking for my backup?

Here he comes. All right. Please go ahead. Whenever you're ready, Mister Lowenthal.

Thank you, Madam Chair and Members very pleased to present AB 2175 which requires the state to create hospital capabilities database that is accessible to hospital staff and includes a contact number for the interfacility transfers, a list of specialties on the hospital's physician call panel, and whether or not their services are available seven days a week. I would like to start by accepting the Committee amendments. Very thoughtful amendments. And I'd like to thank the Committee for their work on this Bill.

Currently, there are no database or source of information that lists what on call specialists are available at any given hospital. The database would be searchable by location and specialty, making it faster for providers to identify the closest facility with the capability to care for their patient. It has become increasingly difficult to transfer patients to other hospitals needing a higher level of care.

Physicians and staff in the emergency Department are spending valuable time calling surrounding hospitals, trying to find a hospital that may have an on call specialist to treat a patient. AB 2175 will provide emergency physicians and staff with a valuable tool to help reduce the amount of time it takes to find a hospital that has on call specialists to treat a patient needing a higher level of care, thereby streamlining access to care.

I'm pleased to be joined by Tim Madden, representing the California chapter of the American College of Emergency Physicians, who is here to testify in support of the Bill.

Thank you. You'll have three minutes. Thank you.

Madam Chair and Members Tim Madden, representing the California chapter of the American College of Emergency Physicians. Proud sponsor, sponsors of AB 2175 Assemblymember Lowenthal did an excellent job at outlining what the Bill does, as well as the need for the Bill. I'm more than happy to answer any questions or provide examples around the need for the Bill.

I'd also like to thank Committee consultant for her help on the amendments, as well as our conversations with the California Hospital Association, which I think had been productive with that. I respectfully ask for your aye vote.

Thank you. Are there any other witnesses in support?

Madam Chair, Members of the Committee. Brandon Marchy, with the California Medical Association, in support.

Good afternoon, Madam Chair Members. Dylan Elliott, on behalf of the California State Association of Psychiatrists, in support. Thank you.

Thank you. Are there any witnesses in opposition?

Good afternoon. Vanessa Gonzalez with the California Hospital Association here with an opposed, unless amended, position. Appreciate the recent discussions with the author and sponsors. We just want to make sure that hospitals will not be required to submit duplicative information, as hospitals already provide information on the supplemental and specialty services that they provide. So look forward to ongoing discussions with the author and sponsors. Thank you.

Thank you. Seeing no other opposition, I'll bring it back to Committee for comment or question. Doctor Weber.

Good afternoon. Thank you so much for this Bill. And thank you for accepting the Committee amendments that would remove the actual provider's information and just focus on the specialty that you're looking for. Do have a question based on the concern from the opposition? When I'm looking at the analysis that was done by the Health Committee, the current hospital data collected by HKI includes types of services available on premises.

Would that not encompass the information that you. That you're looking for or no?

Thank you for the question. We're not sure at this point, and that's part of the conversations we've been having with the Hospital Association. It's unclear, for example, if we're in need of an ophthalmologist, if that would be covered under that list. Now, if it was a supplemental service, if it was a neonatal unit or a burn unit. So that tells us one piece of information, but it may not have all the other on call specialists listed on it.

So we've had multiple conversations with the hospital Association. I think we're making some progress. But at this point, it's not quite 100% clear if that would be included. If it is, great. We agree with the hospital Association. We're not looking for them to report duplicative information. We just want to be able to know what of those on call specialists are available.

Mister Lowenthal, you can close now if you'd like.

Respectfully ask for your. I vote.

Thank you. We are still a Subcommitee, so we will hold this bill and we will move on to your second bill now. Item 13 AB 2402. And we have a quorum, so we will go ahead and call the roll. Apologies for the moment. We'll take care for the Committee.

[Roll Call]

Mister Lowenthal, we're going to go ahead and vote on consent now. Aguiar-Curry makes a motion seconded by Doctor Weber. Please call the roll.

[Roll Call]

That's a vote of 9-0. That is out. And we'll move now to item number one. AB 1926. We had Connolly, we had a motion earlier Agar Curry. Seconded by Doctor Weber. The motion is do pass to Appropriations. Please call the roll.

[Roll Call]

That's a 9-0. That vote is out. That motions out. Item number three. AB 1965. Blanca Rubio. Due pass as amended to Appropriations. Aguiar-Curry moves, Doctor Weber seconds. Please call the roll.

[Roll Call]

That's 9-0, that measure passes as well. We'll move on now to item number five. AB 2081 Davies. The motion is due pass as amended to Judiciary. Thank you. Aguiar-Curry, seconded by Schiavo. Please call the roll.

[Roll Call]

That has 9-0. That motion passes as well. Measure passes. Item number six. AB 2154 Berman. The motion is do pass as amended to Appropriations. So moved by Aguiar-Curry. Seconded by Schiavo. Please call the roll.

[Roll Call]

That measure passes 9-0 and is out. We'll move on to item number seven. AB 2156 Pacheco. The motion is due passed as amended to Appropriations. Please call the roll. Moved by Schiavo. Seconded by Sanchez. Please call the roll.

[Roll Call]

That measures is out with nine to zero. We'll move on to item number eight. AB 2175 Lowenthal. The motion is due pass as amended to Appropriations by Aguiar-Curry. Seconded by Schiavo. Please call the roll.

[Roll Call]

[Roll Call]

That measure is on call. We'll move on now. Thank you for the patience to item number 13. AB 2402. Mister Lowenthal, you can begin.

Thank you, Madam Chair and Members, I would like to start by thanking the Chair and the Committee staff for the proposed amendments to transfer responsibility of the awareness campaign and the safe bar program from the Department of Public Health to the ABC. I accept the amendments and will take them up prior to the Bill being heard in the Governmental Organization Committee.

I am so pleased to present AB 2402, which is part of a larger package of bills that I'm carrying, to address the ongoing and underreported issue of roofy-ing that is taking place across California, across the United States, and across the world. This is about sexual assault. Roofy-ing, or drink spiking, occurs when perpetrators incapacitate their victims through the use of a date rape. Drugs such as Rufinol, GHB, and ketamine. Typically, drink spiking is not an independent crime.

Rather, it is done in order to make other horrific crimes, such as rape, sexual assault, easier to commit. And while anyone can turn victim to roofy-ing, it's women and Members of the LGBTQ community that are targeted the most. And dare I say, it is sexism and discrimination by all of us that have allowed this problem to proliferate this long. Drink spiking can take place anywhere. However, the most common places are restaurants, bars, and nightclubs where alcohol beverages are served.

When someone has been roofied, not only do the drugs cause memory loss, but also pass through the body extremely fast, making it very difficult for the victim to seek justice after the fact. This is why pervasive measure preventative measures, such as those in this Bill, that this Bill establishes are especially important when seeking to tackle this issue. AB 2402 requires that the California State Department of Public Health establish two programs.

One, a public awareness campaign on this issue, and two, a safe bar program to better educate and prepare restaurant, bar and nightclub employees on preventative measures and how to handle drink spiking should it occur in their place of employment. By the way, I liken this to where we were with drunk driving 30 years ago and how we had to educate and really tackle it as a village to prevent it. Once somebody is already drunk and get behind the wheel, it's too late. And the same thing.

It's the same phenomena with roofy-ing. Once it's taken place, it's too late. We have to prevent it from happening. It takes a village approach. Through a public awareness campaign, the State Department of Public Health will increase awareness about the dangers of drink spiking, the resources available to the public to prevent these crimes, and how the unfortunate event that someone has had their drink spiked.

This will not only help facilitate safer social environments, but also deter perpetrators from attempting to engage in this criminal activity in the first place. Secondly, through the establishment of the safe bar training program, modeled after Tennessee's state Bar, the State Department of Public Health will create an optional program for restaurants, bars and nightclubs to participate in to better educate their employees on preventative measures as well as how to handle drink spiking should it occur in their place of employment.

Increased training and awareness of employees at the institutions where drink spiking commonly occurs will help promote a safer and more alert atmosphere with fewer accounts of roofing and in turn, sexual assault and rape. As a restaurant and bar owner myself, I'm extremely sensitive to this issue, and I know just how important it is to be able to provide a safe and inclusive environment for our guests.

Increased awareness and training will not only help combat these crimes, but can also increase business as people will be more willing to go out and be social with a strength strengthened sense of security. I'm very pleased to be joined by West Hollywood Mayor John Erickson, as well as Raul Verdugo, Advocacy Director for Alcohol justice, who will be testifying in support.

Thank you. I just want to ask a question of the author. Are you agreeing to take the Committee amendments on this?

Yes, I opened my statement agreeing to the amendment.

Thank you so much. Appreciate it. And I'm going to pass the mic over to our Vice Chair Waldron, but please go ahead.

Thank you. Thank you so much. Honorable Chair and Members of the Committee, my name is John Erickson. I have the great privilege of serving as the mayor of the great City of West Hollywood. West Hollywood is home to more than 200 entertainment oriented businesses such as restaurants, bars and nightclubs. In 1.9 sq. miles. In February 2022, the West Hollywood City Council unanimously approved an item that I authored for the purchase and and distribution of drink spike testing strips at bars and nightlife establishments.

In cooperation with the Los Angeles LGBT Center's Weho Life program, the City of West Hollywood distributed more than 30,000 test strips in the first 10 months of our operations. The city continues to promote drink spike test strips as an important and life saving tool. As part of our work to support and educate safety at entertainment venues, the City of West Hollywood provides education about drinks, bike test strips and our required bystander intervention training program in which more than 2000 West Hollywood employees have participated.

We also collaborate with the City of Los Angeles, the County of Los Angeles Sheriff's West Hollywood stations entertainment policing team, a team of deputies specifically focused primarily on our entertainment and alcohol related law enforcement and issues like, simply put, drink spike testing strips and other ways we can educate the community to save lives. We are happy to see expanded educational opportunity statewide for patrons to access drinks, bike testing strips and continued educational outreach that is so needed.

West Hollywood became the first city in California to pass an ordinance in late 2021 to require bystander intervention training for personnel and business establishments that serve alcohol for on site consumption. The Bystander Intervention training program launched in March of 2022. Provided by the Rape Treatment center at the UCLA Santa Monica Medical center. The training is an educational course that addresses the issue of drug facilitated assaults and date rape drugs.

The training also promotes the proactive role that on site alcoholic beverage sales can take in the prevention of sexual assaults. Since the program's inception, again, more than 2100 employees have participated in this educational campaign. Additionally, as the mayor of the city, I am also a victim of this exact crime. And so if it can happen to the mayor of a city, it can happen to anyone going out there on a Saturday night trying to have fun with their friends.

I respectfully thank Assemblymember Lowenthal for authoring this and other likewise important bills, and I thank you all for your time and attention. And ask for an aye vote.

Hi, my name is Ronald Verdugo, Director of Advocacy at Alcohol Justice, and today I'm speaking on behalf of the California Alcohol Policy Alliance, a project of Alcohol Justice. We're a statewide alliance representing 50 organizations with a mission to unite diverse communities to prevent and reduce alcohol related harm. We support AB 2402 in the effort to initiate a campaign that will shine a light on this vastly underreported issue, informing the public on how to prevent drink spiking and what to do if it occurs.

Depending upon the survey, any survey, 6% to 20% of respondents report having had their drinks drugged and or spiked. Prevention is always the best course. Preventing it from happening may reduce the chance that people will try it in the first place. Requiring the ABC to administer a safe bar training program will ensure that every licensee has the incentive to train their respective staff while informing our communities throughout the state with the information needed to protect public health.

For these reasons, we support AB 2402 and thank Assemblymember Lowenthal for bringing this legislation forward.

Thank you. Are there additional Members in support in the audience? Please come forward. Seeing none. Are there witnesses in opposition? Seeing none. Questions from the Members of the Committee? If you would like to close.

I respectfully ask for your aye vote on this very important issue affecting millions of Californians.

Thank you. Do we have a motion? Okay. The motion is due pass as amended to governmental organization. Madam Secretary, please call a roll.

[Roll Call]

We need one more, so your Bill will be on call. Thank you.

We will move to item nine, AB 2250. Doctor Weber, you may proceed when you're ready.

Good afternoon. Chair and Members of the Committee, I am here to present AB2250 which will require health plans and insurers to include coverage for social determinants of health screening and access to community health workers.

Social determinants of health is commonly defined as the conditions in which people are born, grow, work, live and age in a wider set of forces and systems, shapes the conditions of daily life and affect health functions and quality of outcomes and risk. Social determinants and health impact about 80% of your health risk, health outcomes and unfortunately, your life expectancy. It is horrific that in this country and in this state, your zip code determines your life expectancy.

Social determinants of health screening tools and clinical practice help identify the social and economic risks of patients that are usually unknown to us who are healthcare providers. But they are a critical piece and often the missing link to successfully presenting, preventing, or managing health conditions. For example, if I as a provider know that you live in a food desert because I've screened for that during the social determinants of health assessment, then I need to alter my nutrition recommendations to ensure that you would be successful.

Or if I know that you live in a neighborhood that is unsafe because of violence, then I'm not going to recommend that you walk your neighborhood at night to get exercise to manage your obesity. Or if you come in with a chronic cough and I know that you work or live in an area with extreme air pollutants, then I would put lung cancer higher on my deferential, despite the fact that you are a non smoker.

But I know that your risk for developing lung cancer is higher than my previous patient who is also a nonsmoker and the same age as you. But you live or work in an area that is high risk because of the toxins that you are exposed to every day.

These social determinants of health are extremely important to screen for, and this information can lead to healthcare teams linking patients to community resources, or discussions about changing patient treatment plans to mitigate social needs to improve health outcomes for all Californians. Unaddressed social determinants of health exacerbates existing health disparities and increase healthcare costs. AB 2250 serves as a proactive solution to these challenges and helps to address gaps in healthcare by requiring coverage and reimbursement for social determinants of health screenings and access to community health workers.

While a similar bill was vetoed last year, despite what the Governor said in his veto message, this bill is not redundant to federal initiatives nor our adverse childhood experiences, also known as ACE screenings, the same as social determinants of health screenings. These new efforts by the centers of Medicare and Medicaid services are only within the Medicare system and do not conflict with AB 2250, which targets the Medi-Cal and Covered California population.

And while ACEs can be considered as one aspect of social determinants of health, they represent a specific subset of adverse childhood experiences that can influence health outcomes. Social determinants of health, on the other hand, encompass a broader range of social and environmental factors that influence health and well-being throughout a person's entire life. By requiring coverage for screenings and access to community health workers, AB 2250 ensures that Medi-Cal beneficiaries benefit from these essential services.

Additionally, it extends support beyond the Medi-Cal population to include other vulnerable groups such as those under Covered California who also face social needs but may not have access to such services previously. With me here to speak in support of this bill is Tiyesha Watts, legislative and policy advocate and Dr. Scrubb.

Thank you to the chair and committee members. My name is Adia Scrubb and I'm a family medicine physician from Oakland practicing in Solano County.

I learned early on from my mentors in medicine that a community physician must also consider the factors beyond the clinic walls to make an impact in someone's care. I respectfully ask for your aye vote on AB 2250 because it will ensure that the healthcare providers have the resources to better understand factors impacting our patients health both inside and outside of the clinic. Screening for the social determinants of health is critical to developing a treatment plan that is best for my patients.

If I am informed that a patient doesn't have reliable transportation, then I try to select medicines that require less follow-up and monitoring. If I am informed that I have a patient who is an unhoused diabetic that doesn't have access to refrigeration for their insulin, then I have to maximize treatment with oral medications. However, there is a need to do more than just screen because there are obstacles outside of the clinic that interfere with a patient's ability to complete treatment.

This bill will provide the linkage between the healthcare team and community resources through community health workers or social workers. They can ensure that patients are receiving the direct assistance they need to access food, transportation, housing, and health care. At the end of a visit, I have been able to provide the patient with a warm handoff to the community health worker and clinic to continue the discussion of their specific needs or to ensure that they will have follow-up soon after.

When my patient with depression and uncontrolled diabetes expressed that she needed assistance at home with taking her medications, I was given her permission to directly discuss her difficulties with my clinic social worker right after the visit. The social worker then later called the patient to assist her with enrolling in in home supportive services. Afterward, my patient's sugar levels and depression significantly improved after being matched with a part-time caregiver.

My family medicine colleague had difficulties with getting an unhoused patient a much needed surgery because he did not have the address where he could be discharged to after the surgery. A social worker would have been able to assist the patient with navigating and obtaining at least some type of temporary housing to be able to move forward with the surgery. I respectfully ask for your aye vote on AB 2250. Thank you.

Good afternoon, Madam Chair and Members of the Committee.

Thank you for the opportunity to address this critical issue impacting our healthcare system. My name is Tiyesha Watts, representing the California Academy of Family Physicians. While progress has been made in addressing social determinants of health through initiatives such as the community health worker benefit under Medi-Cal, and inclusion of Social Determinants Health codes under CalAIM, there are still gaps that persist that AB 2250 seeks to fill. One of the primary challenges lies in data collection and documentation for social determinants of health.

Primary care providers often face barriers in screening for social determinants of health, which is essential for documenting patient needs such as housing, food insecurity and transportation. Without proper resources and reimbursement, primary care providers are unable to conduct screenings efficiently and connect patients with the necessary resources to address their social needs. As the first and often most consistent point of contact in the healthcare system, social determinants of health screenings are typically conducted by primary care physicians.

However, Medi-Cal does not currently cover or reimburse these services. By covering screenings in the primary care setting, AB 2250 empowers primary care providers to efficiently screen for social needs and closes the referral loophole. Enhancing healthcare and accessibility AB 2250 builds upon existing initiatives, such as the community health workers' benefit within Medi-Cal to strengthen integration of primary care with the crucial role that community health workers play in facilitating access to essential social services.

This legislation fosters collaboration between primary care providers and community health workers, bridging healthcare gaps to enhance health outcomes and ensure greater equity and access. Significant investments and efforts have enhanced the community health worker benefit, such as the workforce, in prioritizing recruitment and training, certification to improve access to care in California communities. Health plans and insurers also play a crucial role in providing access to community health workers through contracting with community based organization or direct employment.

In closing, AB 2250 is a crucial step towards addressing social determinants of health and advancing health equity in our communities. I respectfully ask for your. I vote and I'm happy to take any questions or concerns.

Move the bill. Thank you. Any other witnesses in support, please come forward. State your name, organization and position only. Thank you.

Good afternoon, Madam Chair. Justin Fanslau, on behalf of DaVita, California Association of Nurse and Anesthesiology and Findhelp, all in support. Thank you.

Madam Chair and members, Rand Martin, on behalf of the AIDS Healthcare Foundation, in support of this very essential bill. Thank you.

Madam Chair and members, Tim Madden, representing the California chapter of the American College of Emergency Physicians in support.

Madam Chair and Members, on behalf of Western Center on Law and Poverty in support. Oh, Sandra Poole.

Meron Agonafer with California Black Health Network, co-sponsor and strong support.

Brandon Marchy with the California Medical Association in support.

Good afternoon, I'm Liz Helms, California Chronic Care Coalition, in very strong support of this important bill.

Jennifer Robles with Health Access California in support.

Kristi Foy, on behalf of the California Kidney Care alliance in strong support.

Chris Scroggin, on behalf of Children's Choice dental care in support. Thank you.

David Gonzalez with the California Life Sciences in support.

Taylor Jackson with the California Primary Care Association, proud cosponsors.

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

Sumaya Nahar with the Children's Specialty Care Coalition, in support.

Erin Evans on behalf of the San Diego Housing Commission, in support.

Kelby Lind with Planned Parenthood Affiliates of California, in support.

Ryan Spencer on behalf of the American College of OBGYNs, district nine, in support.

Hi, Kim Robinson, on behalf of Black Women for Wellness and Black Women for Wellness Action project, in support.

Marcel Reynolds, on behalf of California School-Based Health Alliance, in support.

Thank you. Are there any witnesses in opposition? Please come forward. We allow two witnesses, three minutes each.

Good afternoon, Madam Chair, members of the Committee. Jed Hampton with California Association of Health Plans. CAP does not have a position on the Bill at this time. We certainly support the intent of the bill, have had discussions with the author's office and the sponsors. We do have a couple of questions that we would like to continue to engage with the author's office on, namely around the health plan requirement to provide adequate access to community health workers.

We do have a couple of questions that we wanted to work out there, but again, we don't have a position on the bill at the time. We are appreciative to the author's office and the sponsors for chatting with us and look forward to engaging with you all in the coming weeks. Thank you.

Thank you. I will bring the discussion back to the Committee. Any questions? Miss Aguiar-Curry?

I love this bill, so thank you for bringing it forward. I'd like to be a co-author.

Any other comments? Mr. Patterson?

Great, thank you. Remember this bill last year? Thanks for bringing it back again. Commend anybody who just keeps trying to bring the bills back. I have one that I brought back as well this year, but you know, I've thought about it a lot since last year and I thought the examples that you use were really good. When I was growing up, me and my brother, my mom didn't have a car.

So the actual example you used kind of resonated with me. But can you help me understand what these screenings look like or how they take place?

Yes, so depending on the screening method utilized. So currently there are various validated and evident based tools that are being utilized. So the CMS, on the federal level, they have a screening tool that most practices are using, as well as within the FQHC center, they have the prepare tool that they're using.

So on a day to day, for example, when a physician is meeting with their patient, they try, these are sensitive questions. So you can't just outright ask them, are you homeless or are you food insecure? So within the primary care setting, these physicians typically build that relationship with them. So it's more of an informal conversation that starts first. And while they're also documenting, using the, the tool, so it would use, do you have access to healthy foods?

Do you live in an area that is, that has violence? Do you live next to adequate resources for food? Or do you have adequate access to shelter?

So first they will start off informally to build that trust, and while they then will document that, and then with the patient's permission, obviously, if they would like to have a follow-up to get those resources, then that's when we would bring in the community health worker or social worker to close that gap and then to have a healthy send off so that they can connect them with the needed resources that were identified during that visit.

So kind of, you have children?

Yeah. So kind of think of it similar to what happens when your child goes to his or her annual visit and you fill out a form and it may ask you something like, you know, how many hours? Does your child have screen time? Does your child wear a helmet? Do they wear seatbelts? So it's similar to that at getting at what other kind of resources, what kind of education, what other kind of tools may you or your family need?

Yeah, I feel like those questions when I go to the doctor are very judgy, by the way. So, okay. On these questionnaires, and because this is Medi-Cal, and I think we, we have some type of deficit in this state that starts with the b, many billions over.

But let's say, you know, I go to one clinic and I have developed this relationship, or maybe I haven't, but through the course of that particular visit, this screening takes place, or a portion of it, and then I end up, you know, going somewhere else or how exactly is that going to work? Because in the private insurance, that kind of information, with the prior authorization, that whole thing, it might transfer over, might be able to transfer to new provider.

But in the medi Cal System, where, let's say I go to one clinic, I do the screening, and then maybe I'm go to another provider some other day, does that new clinic have to redo the screening or is there going to be some kind of system where this is meshed together?

Right. So your medical record is your medical record, and if the two systems align, then you'll be able to see what's in that medical record. It has nothing to do with your insurance.

You can have private insurance. Right. And, for example, in San Diego, and you go to Scripps and then you choose to get a Doctor at Sharp. The question is whether or not those two systems can automatically see each other. It has nothing to do with their insurance level and so, or whether or not you have commercial insurance or Medi-Cal. And that is an issue that we need to, a separate issue that we need to address within the state.

But people in those situations can ask for a copy of their medical records. So it's not insurance dependent. It's whether or not the systems or the clinics that you are going to can actually have access to the other systems information.

I guess we just want to make sure, obviously, that Medi-Cal wouldn't pay for this twice or something like that, right.

Well, so this is a screening tool, right? And just like you have annual screening tools for your child when they go.

The judgy ones?

Well, you may think it's judgy, but it is important for physicians to know whether or not there are things that your child or family may need or other education that they may need. It's not. I wouldn't say that it's judgy. However, you know, just because you screened me today and I have a job and I have a home, that may not necessarily be the case in a year.

So this is not meant to be a one time thing, because we understand that people's lives and circumstances, unfortunately change. Sometimes it stays the same, sometimes it gets better, but unfortunately, sometimes it gets worse. And so it's not like you get this screening. You're good, because this is how you will always be. This is something that needs to continually happen.

Okay. Thank you.

Any other comments, questions from the committee? I just wanted to say that, you know, we know that now.

We know that environmental and social factors can affect health, just like physical or genetic in many ways. An existing law requires plans to cover screenings for adverse childhood experiences. The ACEs. But there's no requirement for screening for social determinants of health, which really goes hand in hand with identifying a lot of the traumas that we're finding now affect people even later in life.

And then we're dealing with issues in crisis, especially, as we know, mental health, especially substance use, especially in the criminal justice system, and all those things where now we're having to deal with things that, if we could just work on early intervention and prevention, would make such a difference. So we always talk about that, needing early interventions, but we need the data in order to be able to do that.

So that's what this bill is trying to do, to get at more of the data, and it would also allow us to really do a better job at individualizing care for people. So I'm very supportive of the Bill. Thank you for bringing it forward. Do we have a motion? We do. We just need a second. Okay, we have a motion. And second do pass to appropriations. Okay. Would you like to close, madam?

Thank you, chair. And thank you for those remarks, because essentially what this bill is, is really trying to get at not only getting the data, but making sure that we are intervening early to not only help individuals health, their families health, but also to ultimately reduce the care of healthcare in this state. It's a lot easier to prevent things like diabetes, high blood pressure than to chronically treat them later on for the rest of someone's life.

Thank you. Madam Secretary, please call the roll.

And so, you know, providing coverage for social determinants of health screening and access to community health workers facilitates the early identification of risk factors. It enables timely interventions leading to improved patient outcomes, reduced hospitalizations, and better management of chronic conditions. This bill advances health equity and makes real impact, like I said, in reducing healthcare cost. And with that I respectfully ask for your aye vote on AB 2250. Thank you.

Bonta? Waldron? Waldron aye.

[Roll call]

Your bill is on call. Thank you. We can move ahead to to item 10. Assemblymember Wilson.

Good afternoon, Madam Vice Chair, Members. I am pleased to present AB 2300, a bill that will ban DEHP form use in IV bags and, in certain cases, tubing.

DEHP belongs to a family of hormonally active industrial chemicals called- and I actually didn't look up how to say this- phthalates. Thank you. Which are used to make plastic soft and pliable and can be found in a myriad of products ranging from garden hoses to shower curtains to vinyl flooring and building materials, particularly those made from Polyvinyl Chloride which we call PVC plastics.

DEHP impacts the thyroid and immune system research indicates that DEHP promotes drug resistance and inhibits the effectiveness of breast cancer drugs, interferes with the ability of chemotherapies to fight breast cancer, and that patients with higher level of DEHP in their system had higher rates of relapse and mortality. DEHP is commonly used to impart flexibility to IV bags and IV tubing. Some IV bags and tubings can contain up to 40% DEHP by weight.

DEHP has been shown to leach out of the iv bags and tubings and into medications and other fluids being infused into the bloodstream of patients. The good news is that safer alternatives exist and are already being used in FDA-approved DEHP-free IV bags. For example, B. Braun and Fresenius Kabi already exclusively manufacture DEHP-free IV bags and their competitors Baxter and ICU Medical also offer a large portfolio of FDA-approved non-DEHP IV bags.

Together, these four companies make and sell the vast majority of the IV bags purchased by healthcare systems in California. Many companies also manufacture IV tubing free of DEHP, but because this sector of the industry is more complicated, we have given these manufacturers seven years to comply with the bill's required phase out of DEHP in IV tubing. My office has also taken amendments to exclude human blood and blood production, product collection, processing and storage bag, including integral tubing.

This amendment was taken after concerns are raised about there not being alternatives to non-DEHP bags. I would also like to thank all of the stakeholders for their robust conversations that we've had over the last few weeks. Happy to continue these conversations if AB 2300 moves forward.

Now with me today is Dr. Lisa Bailey, who retired in 2022 from a 40 year surgical practice where she specialized in breast cancer surgery, and Tracey Woodruff, PhD, MPH, the Director of the program on Reproductive Health and the Environment and a Professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. They will speak more on the importance of AB 2300 and to help answer any questions you may have.

My name is Dr. Lisa Bailey and I'm pleased to be testifying today in support of AB 2300. First, do no harm. This is from the hippocratic oath that I swore to when I graduated from medical school. I recently retired in 2022 from a 40 year medical practice where I specialized in breast cancer surgery.

I currently serve as the Chair of the Board of Breast Cancer Prevention Partners, and I'm also an active member of numerous medical associations, including the California Medical Association and the American Society of Breast Surgeons. My job as a breast cancer surgeon is to remove the cancer from a woman's breast and lymph nodes. I've performed thousands of these types of surgeries and have counseled even more women regarding their risks of breast cancer and breast cancer recurrence.

I've also placed thousands of catheters in women whose recommended treatment was chemotherapy. The tip of the catheter is placed just above the right atrium of the heart. The IV fluid and chemotherapy then go through the catheter into the heart and then to the rest of the body. There is evidence that DEHP, which is a neurotoxin, may cross into the brain, though the chemotherapy typically does not.

IV bags and tubing that are used for this therapy, if they contain DEHP, then carry this hormonally active chemical throughout the woman's body. I was trained to save lives, so you can imagine how outraged I was when I learned that research conducted in December of 2021 and published in the Journal of Biomedicine and Pharmacotherapy showed that DEHP not only promotes drug resistance and inhibits the effectiveness of breast cancer drugs, it interferes with the ability of chemotherapies to provide breast cancer.

My patients would always ask me if the treatment was successful and if they were cancer free and not at risk for future cancer. And I now learned that their risk of cancer recurrence is higher because of their exposure to the DEHP in the IV bags and tubing used as part of their surgery and other treatments. In fact, DEHP has been shown in laboratory studies to increase growth of human breast cancer cells and decrease the efficacy of Tamoxifen, a drug commonly used to treat breast cancer.

The scientists found that DEHP turns on a gene known to promote proliferation, invasion, metastasis, and drug resistance in human breast cancer cell lines. When DEHP is used in IV bags and tubing to deliver chemotherapeutic agents to women with breast cancer, the very act of delivering the medicine weakens the treatments. Representing an organization committed to breast cancer prevention, I want you to know this is simply not okay, especially when safer alternatives to DEHP exist and have been used in medical devices for well over four decades.

This new research confirmed that patients with higher levels of DEHP were more likely to develop breast cancer again, and they were more likely also to die. I do not know how many of my previous patients fell into one of these two categories, but you can imagine how frustrated that makes me feel as a medical professional wondering if the medical treatment that I authorized might have inadvertently worsened their disease. 20 years ago, the FDA sounded the alarm but did not act to address this problem.

AB 2300 gives California the chance to do so. Given the well established health concerns associated with exposures to DEHP, I urge you support of this common sense healthcare protective legislation. Thank you.

Good afternoon. My name is Tracey Woodruff. I'm a Professor and Director of the program on Reproductive Health at UC San Francisco. My research focuses on how chemicals impact health, particularly during pregnancy, and how that affects fetal and child development and health inequities.

I'm pleased to speak about AB 2300 and its proposed ban on DEHP and regrettable substitutes from IV bags and tubes. This ban is important for everyone who is a patient in a hospital, and particularly for newborn babies and patients who live in communities that are more burdened by environmental exposures. Chemicals like DEHP disrupt hormones and are known as endocrine disrupting chemicals, and newborns are more susceptible to harmful impacts of exposures to these types of chemicals.

Developmental exposures to DEHP can pose a greater risk to developing fetus, child and pregnant parent, and cause a host of adverse health effects, including incomplete formation of male reproductive systems, lower sperm count, and preterm birth. Science also suggests DEHP can increase risk of neurodevelopmental harms such as lower IQ and ADHD. DEHP exposure can increase the risk of other diseases, including metabolic disorders, such as diabetes.

Finally, phthalates can also undermine the immune system, which has been discussed, so people battling cancer or other illnesses are at particular risk. And I want to note that all of these diseases are greater in Hispanic and black populations. And we know that exposures to DEHP are occurring from medical devices to newborns. For example, studies show infants in neonatal intensive care units who are often preterm, where there is more intensive use of DEHP containing medical devices, have higher exposures to DEHP because of this.

Life stages such as pregnancy, fetal development, pre-existing conditions and stress due to poverty and food insecurity can make people especially vulnerable to adverse health effects from chemicals, and people are exposed to multiple chemicals, which can also increase risk. Consequently, research shows there is no risk free level of exposure to these chemicals across the population. Studies show that over 95% of pregnant people across the US are exposed to DEHP along with dozens of other chemicals. Exposures are also distributed unequally.

Studies of over 6000 pregnancies found higher levels of these phthalates in black and Hispanic participants compared to whites. That's contributing to environmental injustices. Research and health care practitioners are concerned that exposures to EDCs like DEHP from medical devices adds to existing exposures to EDCs from other sources and are unnecessary. This is particularly concerning for patients who come from highly polluted areas, including places like Fresno and the Central Valley. There is no safe level of exposure. And so this is why this bill is very important for the patients in the State of California.

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

Good afternoon, I'm Jelica Gonzalez with Kaiser Permanente, in support.

Hi, Janet Nudelman with Breast Cancer Prevention Partners. We are one of the sponsors of this bill, in strong support.

Veronica Gonfer with California Black Health Network, one of the co-sponsors in strong support.

Good afternoon. Whitney Francis with the Western Center on Law and Poverty, in support.

Good afternoon, I'm Alicia Kerry Mica with B. Braun Medical. We're a manufacturer for the devices addressed in this legislation with a major plant in Irvine and we strongly support this legislation.

Ryan Spencer with American College of OB/GYNs. We actually have a support if amended position and just like the ban on tubing to be included in all settings, not just the three in the bill. Thank you.

Laura Gillen, on behalf of Clean Water Action and Keep A Breast, in strong support.

Thank you. Are there witnesses in opposition? Please come forward.

Vice Chair, members of the Committee, my name is Darbi Gottlieb with AdvaMed. We are the largest trade association representing medical technology manufacturers.

We have over 450 members nationwide and California is home to over 240 member company sites. We currently have an opposed unless amended position on the bill, but appreciate the productive dialogue with Assemblymember Wilson's office and look forward to continuing conversations to address our outstanding concerns. As currently drafted, we are concerned the bill could cause major supply chain challenges for California health systems and negatively impact patients who rely on these products. Our primary concern is the implementation timeline.

We believe a more appropriate phase out date for both tubing and solution containers is 2035. Changing or substituting product materials is a highly complex process and subject to strict regulatory requirements. The FDA oversees the full product lifecycle from the methods and facilities for the design and manufacture of the product to the distribution and post market surveillance. This is to ensure that products are safe and effective for patients.

To abide by these standards, switching the materials for a single product takes you years of extensive validation, biocompatibility and performance testing and AB 2300 will impact hundreds of products. Though DEHP is being phased out in other countries, it's important to note that the manufacturing processes, products and supply chain are different based on the company and location and whether suitable alternatives are readily available in the different jurisdictions. Last year, the EU extended the DEHP phase out by another five years, totaling 13 years of implementation.

We would also like to see a threshold added to the definition of "intentionally added DEHP". This will allow manufacturers to test product compliance while insuring companies are not penalized for trace amounts that may be out of a manufacturer's control, which is consistent with other jurisdictions like Europe and Canada as well. Again, I appreciate the opportunity to provide comments and want to thank the author's office for the continued dialogue.

We look forward to continuing to work with the office and the Committee as the bill moves through the process. Thank you.

Good afternoon. Erin Friday, Protect Kids Ballot Initiative, Our Duty. We oppose this bill unless amended to also prohibit puberty blockers, cross sex hormones and gender surgeries for minors like Sweden, the UK, Finland and France are doing. Testosterone in female bodies causes liver cancer. Puberty blockers cause brain development and weakness and bones. Please check out the WPATH expose from Michael Shellenberger. Thank you.

Thank you. Are there other witnesses in opposition? Please come forward.

Chair, Members, this is Dean Talley with the California Manufacturers and Technology Association. We have opposed unless position. Thank you.

Good afternoon, Chair, Members. Obed Franco, on behalf of the American Chemistry Council. We have an opposed unless amended position.

Good afternoon, Madam Chair and Members. Moira Topp, on behalf of Biocom California, with an opposed unless amended position.

Meg Snyder, on behalf of the Vinyl Institute, opposed.

Nicole Young, part of Protect Kids California, opposed unless amended. Erin Friday's amendments. Thank you.

Yvette Corcoran, a registered nurse and opposed this bill unless amended to Erin Friday's request.

Thank you. Other questions or comments from the Committee?

Assemblymember, I appreciate you brought this bill forward for numerous reasons, being a woman, and we've all had our issues as well, little bit disturbed at the moment from comments that have been made.

I just wanted, I know that you're going to continue to work on this bill, and I know we're at this first Committee that you've heard, so I encourage you to continue to do so, and I'll be supporting your bill today.

Thank you. I appreciate that support. And just if the Chair wouldn't mind, I'll note that, you know, we are working with opposition in regard to timing. There's lots of it as it relates to not disrupting supply chain as well as, you know, FDA approvals.

And so we'll figure out what the great landing spot is. And so, and we, we are dual referred. And so we'll make sure we get those changes in by the next Committee well before we get to the floor.

Any other comments?

I will just make a comment-- I want to just clarify and quite frankly, apologize to the author, but clarify that the intention of the bill is to really remove DEHP from these nutrition infusion. The blood bags, right?

Not the blood bags, the IV bags, tubing. We took out the blood bags in particular because there is no way right now, scientifically or technically, to be able to have a replacement type bag for blood.

You won't be able to, we won't be able to then do blood infusions if we got rid of DEHP.

So one of the things I know that you're going to continue to work on is just to ensure that the technology will be able to catch up with the requirement.

Absolutely. Because we don't, you know, these are life saving medications. You know, had to deal with this issue last year personally and was thankful that on this particular issue, as it relates to DEHP, I didn't, my particular provider, healthcare provider, had already transitioned to the new bags. However, I have friends who are receiving care and they are part of healthcare providers who have not transitioned.

And so this is to be able to allow them to, you know, get care without having to worry about this issue and then allow technology and supply to catch up in all aspects, whether it relates to blood bags or to just the standard bags that we use or tubing.

Thank you. Any other comments from the Committee? Author, you may close.

All right. With that, I respectfully ask for your aye vote to ensure that these vulnerable populations receive the life saving care that they need without endangering their lives in the future.

Aguiar-Curry moves the bill. Dr. Weber seconds. I just want to thank the author for bringing this forward. And I know that given the concerns around manufacturing that you have noted that you'll continue to work with the opposition to consider adjusting the implementation timeline of the bill and including a threshold to allow manufacturers to test compliance.

That measure is on call. We will move to item number 11, AB 2319.

My recommendation on this is an aye. With that, the motion is due pass to Environmental Safety and Toxic Materials. Please call the roll.

[Roll call]

Arthur, you can go ahead whenever you want. Thank you.

All right, we got the full squad here ready to go.

Thank you Madam Chair, Members. I'm pleased to present AB 2319 a bill that aims to reduce the alarming and disproportionate maternal mortality rate of black women and other pregnant persons of color by ensuring successful implementation of SB 464 by then Senator Mitchell, the California Dignity and Pregnancy and Childbirth Act, I mean act of 2019. A recent study by the California Department of Public Health found that women of color, in particular black women, die of pregnancy related complications at a much higher rate than white women in California.

This disparity exists across all income levels. Evidence suggests one key cause of this disparity is the implicit bias of healthcare providers. A provider's level of bias, whether conscious or unconscious, can influence their interactions with patients and their diagnosis and treatment of the patient's pain, and can undermine patients trust and engagement in care.

To address this, the California State Legislature passed the act in 2019, which requires hospitals, alternative birth centers and primary care clinics, which are the facilities covered under the act, to conduct evidence based implicit bias training for all health professionals who provide care during a patient's pregnancy, childbirth and immediate postpartum period. In August 2021, the Department of Justice launched an investigation to ascertain compliance with the act.

While some facilities went above and beyond the requirement of the act, there is still work to be done to ensure full compliance. DOJ's investigation revealed that there is a need for an enforcement mechanism, public transparency of compliance data, firm compliance deadlines, and additional specificity and clarity so that facilities are better equipped to know which providers need to be trained. I am a mother, grandmother. I have sisters, aunts, nieces and friends that look just like me. And as black women, these statistics hit too close to home.

They acknowledge the sobering reality of being a pregnant woman of color in the state and highlights the need to correct the course we are on. This is why the California Legislative Black Caucus, in its entirety, have signed on as co authors to this bill, including Doctor Weber, who is a joint author. With me today is Tiffany Matthews from the Attorney General's Office and Gabrielle Brown.

Gabrielle Brown, maternal and infant health program manager at Black Women for Wellness Action Project, to speak more on the importance of of this bill and answer any questions you may have.

Go ahead. You have three minutes each on the support.

Good afternoon. Chair and Members, my name is Tiffany Mathews, Deputy Attorney General and legislative advocate at the California Department of Justice. I'm here today on behalf of Attorney General Rob Bonta who is a proud sponsor of AB 2319 along with our co sponsors, Black Women for Wellness Action Project, Western Center on Law and Poverty, Reproductive Freedom for All, the California Nurse Midwives Association, and California Black Women's Collective.

We'd like to thank the authors, Assemblymember Wilson, and Doctor Weber, and the Legislative Black Caucus for their leadership in carrying this important piece of legislation. The United States has the highest maternal mortality rate in the developed world. In California, people of color, particularly black women, continue to die at three to four times the rate of white women.

AB 2319 aims to reduce this alarming disparity by ensuring that healthcare facilities comply with the anti bias training requirements set forth in the California Dignity and Pregnancy and Childbirth act. As Assemblymember Wilson mentioned, in August of 2021, DOJ launched an investigation to ascertain compliance with the act, and once DOJ began its investigation, compliance improved from 17% to 81%. We, along with all the other stakeholders involved, want to get that number to 100%.

So to better equip healthcare facilities to comply with the requirements set forth in the Act, AB 2319 would provide clarity on which healthcare facilities need to administer these trainings it would provide clarity on which employees need to be trained it would establish deadlines for which trainings need to be completed and it would confer enforcement powers to the California Department of Public Health and the Attorney General.

Here with me from DOJ is Carly Eisenberg, supervising Deputy Attorney General who is part of the DOJ investigation, to answer any technical questions that you may have. We thank you for your time and respectfully ask for an aye vote.

Good afternoon and thank you, Madam Chair and Committee Members. My name is Gabrielle Brown and I am the Maternal and Infant Health Program Manager at Black Women for Wellness. We are a reproductive justice community based organization committed to improving the overall health status and well being of black women and girls. I am honored to appear before you today to express our strong support for Assembly Bill 2319.

This bill is of paramount importance as it addresses the critical issues necessary to improve black maternal and infant health outcomes by ensuring the successful implementation of Senate Bill 464. SB 464 represents a significant milestone in our state's efforts to improve maternal health outcomes by requiring hospitals to implement implicit bias trainings, the minimum effort with tremendous promise to address an established root cause of disparities in maternal health outcomes. However, the success of this legislation hinges upon the compliance by covered facilities.

Without the proper oversight and accountability measures in place, the intended benefits of SB 464 may remain unrealized, leaving countless mothers at risk of preventable harm. The urgency of this situation cannot be overstated. We know that in California, black women are three to four times more likely to die from pregnancy related causes than white women. These disparities persist across income levels and educational attainment, highlighting the pervasive nature of implicit bias within healthcare.

Findings by maternal mortality review committees reveal that the majority, more than 80% of these deaths are preventable. This is both devastating and unacceptable. Working in a community where black maternal and infant health disparities are prevalent, I have seen the devastating consequences of implicit bias in healthcare. Within the first three months of last year, within Los Angeles County alone, April Valentine and Bridget Cromer died tragically when in the hospital to give birth.

The tragic stories detailing the preventable deaths are stark reminders of the profound and devastating impact that implicit bias can have on the lives of black women, birthing people and their families through my interactions with their partners, I've witnessed firsthand the immense burden placed upon them as they assume the sole responsibility for their family's well being, navigate through grief and trauma, and strive tirelessly to seek accountability and justice for their loved, beloved spouses.

These experiences have fueled my commitment to advocating for policies that address the root causes of these disparities. The passage of AB 2319 is a matter of life and death for countless mothers and families across our state. By supporting this bill, you have the opportunity to make a tangible difference in the lives of mothers and infants, ensuring that all mamas and birthing people receive the quality care and support they deserve before, during and after childbirth. Thank you for your time and consideration.

Thank you. Are there any other witnesses in support? Please come forward. State your name, organization and position only.

Debra Roth, Disability Rights California and support.

Good afternoon. Sandra Poole, on behalf of Western Center on Law and Poverty, co sponsor and in strong support.

Hi Carol Gonzalez here on behalf of HOPE, Hispanas Organized for Political Equality, and strong support. Thank you.

Dylan Elliott on behalf of the Board of Supervisors of the city and County of San Francisco and the California State Association of Psychiatrists, both in support. Thank you.

Nora Lynn on behalf of Children Now in support.

Meron Agonafer with California Black Health Network in strong support.

Jennifer Robles with Health Access California and support.

Erin Evans, on behalf of two proud co sponsors of this important Bill, both Reproductive Freedom for All, which is formerly NARAL Pro-Choice California, as well as the California Nurse-Midwives Association. Thank you.

Michelle Teran-Woolfork with the California Commission on the Status of Women and Girls in strong support. Thank you to the author.

Craig Pulsipher for Equality California in support.

Kelby Lind with Planned Parenthood affiliates of California in support.

Kimberly Robinson with Black Women for Wellness and Black Women for Wellness Action Project, who is also a co sponsor, in strong support.

Thank you. Any witnesses in opposition? You'll have three minutes, and the comments obviously need to be pertinent to the bill. Thank you.

Chair and Members. My name is Sophia Lorey and I'm with California Family Council. According to this Committee bill's analysis, AB 2319 seeks to reduce the effects of implicit bias in pregnancy, childbirth and postnatal care, and that the Legislature recognizes all birthing people, including nonbinary persons and persons of transgender experience. Yet how is it implicit bias to believe only women can give birth? The biological scientific truth is only women can give birth.

During childbirth, the cervix expands so the baby can travel from the uterus through the vagina. A man does not have a cervix, a uterus or a vagina. How could a man get pregnant? How would a baby come out of a man? The bill analysis accidentally acknowledged this in a section titled Maternal and Infant Health outcomes in California. It doesn't say paternal health, but maternal health. Sounds like your Committee staff knows only women can give birth. Does your staff need implicit bias training, too?

Women are not birthing people as the bill states, and we must stop using belittling language to erase the reality of things only women can do. Lastly, the AB 2319 fact sheet discusses how implicit bias is causing an increase in the black maternal mortality rate. I believe we all want to see the black maternal mortality rate decrease, but we must unite in a search for the real causes.

A 2019 Harvard study found that over the past decade, implicit bias based on race has decreased by 17% and explicit bias has decreased by 37%. If this implicit racial bias reported in the Harvard study were the sole cause of maternal mortality, we would expect pregnancy related mortality in the black community to decrease. That is not what is observed nationally. It is time to look deeper at the factors that may be unique or overrepresented in black communities to discover the sources of the disparities.

This bill needs to explore other reasons besides implicit bias to explain black maternal mortality rates. And it is not implicit bias to know that men cannot get pregnant. It is a fact. For these reasons, I urge a no vote on AB 2319. Thank you.

You have three minutes.

Thank you. Good afternoon. Erin Friday lawyer, Executive Committee for Protect Kids California ballot initiative Democrat and mother of a daughter who used to believe that she was a boy but with love and compassion embraced her female body. AB 2319 before speed medical professionals lunacy. Women cannot change into men. Daughters cannot become sons. Birthing people are women. Non binary is a fiction. Humans are a sexually dimorphic species. The Legislature continues to promote a new religion, the religion of transgenderism.

That one has an ethereal, fluid, internal sense of self, a gendered soul, if you please. That must be accepted by all, even though there is no scientific basis for its existence. This bill requires that anyone who might interact with a pregnant woman be educated, that women can become men with syringes of testosterone or a slice of the scalpel to the breast. It mandates that corrective measures be employed. If the employee believes in biological reality, what does corrective measures mean?

It sounds like re education camps, termination, or perhaps the gulag. Now for the punishments against a medical provider for not complying with the forced transgenderism training. It shall be punished pursuant to the health and Safety Code, section 1280.3, upwards to a cool $75,000 for the first infraction and 125,000 for the second. That's right. If a medical provider does not punish an employee for misgendering a pregnant woman or refusing to believe that males have vaginas, it can be out $75,000 or more.

With the passage of this bill, California will be one step closer to erasing women, forcing a new religion on the medical community, and ripping away First Amendment rights. So I ask you and urge you to vote accordingly.

Are there any other witnesses in opposition in the room? Seeing none, I will bring it back to the Committee for comment or question. Doctor Weber.

Good afternoon. I want to first start by really thanking our Attorney General for doing what many of us talk about, which is oversight and holding accountability. Oftentimes we pass bills and we're not even sure if they actually go into effect.

And so the fact that the Attorney General office actually looked to see if providers and hospitals were doing this implicit bias training and finding that the vast majority of them were not, and understanding that we need to go back and strengthen the language of the original bill, I just really want to acknowledge that and thank him for that. I also want to thank the staff on this bill.

I know my office has reached out many times to really make sure that we get that medical wording correctly, because that is so very important to me. And I want to thank my co principal author for presenting this and all of the other co authors. And I want to address the issue that one of the people who spoke in opposition said, yes, you are correct. Implicit bias is not the only reason for the increased morbidity and mortality that we see in African American birthing people.

And that's why I talk so much about social determinants of health, one of which is racism. And what you see with racism is that black women bodies are weathered due to the constant microaggressions that we have to deal with on a daily basis. So that when we become pregnant, our bodies are already tired and worn down.

But where the implicit bias comes in is when we go into that delivery room, when we go to that hospital, when we go to that clinic, and as a board certified OB/GYN, I am actually there and understand what happens. But when we go there, it's that implicit bias that when they say, I'm in pain, something is wrong, people do not listen to them. So, no, this is not the only reason, but it is a major reason.

And this bill will help prevent that from happening, so that at least when they come in, even though their bodies are weathered, and we will deal with that to make sure that no woman, regardless of your race, will come in having a different stamina than others. But once they come into that hospital, that everyone is listened to, everyone is respected, regardless of their race, their gender. And that is what this bill is doing.

So I want to just thank the Committee for allowing it to be heard, and I would like to move it at the appropriate time.

Thank you so much. Any other comments? Mister Jones-Sawyer.

And I want to thank Doctor Weber, Attorney General Bonta, and really the black caucus for taking this up. We've talked about this for far too long. I was here with Senator Mitchell, Assemblymember Mitchell. Oh, my God. When she brought this up and was trying to make this happen.

And so as someone that wanted to definitely make sure we support Black Caucus and black caucus priorities, I think it's very important that we do that and that we move forward as a body to make sure we protect all African Americans, no matter what. And I'm not really understanding what the opposition is, but I'm going to go ahead and vote today for this bill. And thank you for bringing this forward.

Thank you. Do we have a motion? Sorry, apologies. I was chatting over here. Author, would you like to close?

I would just like to thank the Attorney General, as was stated by Doctor Weber, the accountability oversight to ensure that a bill that was put forth from this body with the full support at that time of the Black caucus was looked at and determined that there were aspects of that bill that were not being handled correctly and that it needed to be more robust to ensure not only that, the maternal health of black folks in California was taken care of, but really all because implicit bias is not just about racism, it's about all things.

And so I'm really thankful for that. I'm thankful for the Black Caucus continued support on this, and I respectfully ask for an aye vote.

I want to thank the author for bringing forward this legislation. As a Member of the Black Caucus and you, as Chair of the Black Caucus, very thankful that you are ensuring that we continue to mitigate the effects of implicit bias and explicit bias in healthcare.

Madam Chair, can I forgot to state one statement? Is that okay? Yes, go ahead, ask. And I would just like to note and just state for the record, because I firmly believe it, and I think it's important to be said in this moment that non binary people and men of the transgender experience give birth.

Thank you for stating the obvious, but it did need to be said with that, please call the roll. The motion is due pass to appropriations.

[Roll Call]

That measures on call. While we wait. Oh, there we go. Ortega's here.

We will move to item number 15. Ortega, AB 2446. You may proceed, assemblymember.

Thank you, Madam Chair and Members, for the opportunity to present AB 2446 today. This Bill will provide medically necessary diapers through Medi-Cal to children 21 years and younger, as mandated by the federal early and periodic screening, diagnostic, and treatment program known as EPSDT. The Bill will also expand the current restrictive medical necessity definition and California statute stating that only children over five years can have access to prescription diapers if they suffer from incontinence. Sorry. I apologize.

This Bill intends to bring California into alignment with federal law under EPSDT mandate. According to the National Diaper Bank, California has one of the most restrictive state definitions of medical necessary. This restrictive definition conflicts with federal law and leaves children under five vulnerable to illness caused by diaper need. The average cost of diapers in California can be as high as $100 per month per child, with many low income families simply cannot afford.

Expanding access to prescription diapers to medical patients will not only eliminate the conflict between California and federal law, but will lighten the financial, physical, and mental cost of diaper needs for millions of Californians.

As a young mother who had two little boys by the time she was 21 years old, I understand the need for diapers, and having to make that difficult choice of whether to buy formula or a diaper is one that our mothers or fathers should not have to make in the fifth largest economy in the world. Today, I have a witness testifying on behalf of this Bill. Miss Becky Silva from the California Association of Food Banks.

Moved by Arambula, seconded by Rodriguez. You have three minutes. Thank you.

Thank you, Madam Chair and Members of the Committee. Becky Silva with the California Association of Food Banks. Currently, a quarter of California households with children are food insecure, with deep disparities for Black and Latinx households. And we know that households that experience food insecurity also face barriers in affording other basic necessities.

If you're wondering why the California Association of Food Banks is so passionate about this issue, it's because diapers are one of the most common non food products requested by families who visit food banks, pantries, and other community organizations. Diapers are not merely essential to keeping infants healthy and safe. Most childcare facilities actually require parents to provide diapers for any children left in their care.

According to the National Diaper Bank Network, close to 60% of parents reported missing an average of four days of school or work in a month because they didn't have enough diapers to leave with their child care providers. This forces families deeper into poverty. Every dollar a family has to spend matters, especially at a time when almost 60% of families in California live paycheck to paycheck and really struggle to make ends meet.

The decision for families to choose between putting their money towards paying rent, food, or buying diapers for their child is a decision that no caregiver should have to make. There are real and painful consequences for the baby when parents can't afford enough diapers, but this issue impacts the entire family.

The inability to adequately diaper an infant or toddler has been found to increase rates of family hunger overall and diaper need is linked to maternal depression, stress, and anxiety, which can lead to health problems for the parents, like high blood pressure and heart disease. So for all of these reasons, we're really proud to support this Bill, and we urge your aye vote today. Thank you.

Thank you. Do we have any other witnesses in the room in support? Please state your name, organization and position.

Good afternoon. Josh Gauger, on behalf of the California Association of Diaper Banks in support.

Good afternoon. Whitney Francis with the Western Center On Law and Poverty in support.

Ryan Spencer, on behalf of the California Association of Medical Product Suppliers in support.

Thank you. Do we have any primary witnesses in opposition? No witnesses in opposition. We will bring it back to the Committee at this time. Dr. Weber.

Good afternoon. Thank you so much for this very, very important Bill. When I was reading it, I was struck by the fact that urinary tract infections and colic were specifically listed as conditions that would be covered. And I was a little confused by that because colic isn't really something that is known to cause, like diarrhea or anything. It's usually gas and wasn't really sure why specifically that.

And then with urinary tract infections, some of it could be due to hygiene, but it could be other reasons in infant and toddlers, such as reflux and things that has absolutely nothing to do with diapers. So breaking those two things out specifically was a little confusing for me and was thinking that it might be better to just kind of word it as any condition, not necessarily of the skin. You have the skin.

You know that in the judgment of the clinician, it's related to inadequate diaper hygiene, at risk of reoccurrency. You know, what you have down there, because the colic and the UTI, I was really trying my hardest to understand that. So as you're going forward, as you're moving this Bill forward, you might want to just kind of tweak that a little bit. But thank you.

Absolutely. Thank you for that. And, yeah, we'll definitely continue to work on it. My goal here is to make sure that as many babies and children have access to this critical need, but definitely we'll continue to work on it. Thank you.

With that, I think we have a motion and a second. I want to thank the author for bringing forward this Bill. It's absolutely critical to have the kind of coverage that will ensure that people don't necessarily need to have a critical thing like diapers not provided for them. Author, would you like to close?

I respectfully ask for your aye vote.

Thank you. Motion is do pass as amended to appropriations. Please call the roll.

[Roll call]

That measure has ten votes to zero. It is out. Thank you. You have a second Bill, item number 18 AB 2753. Please go ahead and present. Thank you, assemblymember Jackson, for your patience.

Thank you, Madam Chair and Members, for the opportunity to present AB 2753 before you all today. This bill will clarify that durable medical equipment, or DME, is covered essential health benefit in individual and small group health plans when medically necessary and prescribed by a health care provider. Durable medical equipment enables an individual's basic functioning, such as mobility, breathing, communication, and it's primarily used by people with disabilities and chronic conditions.

With access to DME, people with disabilities can maintain their health, pursue education and employment, and participate fully in community and family life. Yet currently, private health plans offered in California generally do not provide adequate coverage of DME. Many health plans completely exclude most DME items like wheelchairs, hearing aids, and ventilators. Other plans impose a 2,000 dollar annual limit on DME items, which only covers a fraction of the cost of most DMEs.

Without adequate coverage, many people go without medically necessary devices and obtain inferior ones that put their health and safety at risk. With me today testifying on behalf of AB 2753 are Carly Myers with the National Health Law Program, and we also have Jim LeBrecht, a consumer who has experienced firsthand issues with DME denial.

Thank you. You'll each have three minutes.

Thank you. Good afternoon. My name is Carly Myers, and I'm a Staff Attorney with the National Health Law Program, a nonprofit public interest law firm that protects and advances the health care rights of low-income and underserved individuals and families. Many Californians do not have access to the wheelchairs, hearing aids, ventilators, and other durable medical equipment that they need. Private health plans in California's individual and small group markets regularly exclude or severely limit coverage of this equipment.

These policies disproportionately harm people with disabilities. Without access to the devices they need for the basic functions such as breathing, communication, and mobility, a person's health, independence, and livelihood is compromised. Children are unable to attend school and may face developmental delays. Adults are unable to work, travel to the doctor's office, or support their families. Some Californians have been forced to quit their jobs or take reduced salaries in order to qualify for Medi-Cal, which does cover comprehensive DME.

Others have been institutionalized because they cannot function in their own homes without needed DME. Further, pervasive home use rules, which limit coverage to the devices and individual needs inside their home to the exclusion of devices that they may need to travel even ten feet outside, serve to further segregate people with disabilities from their communities. AB 2753 would correct this injustice.

It would clarify that medically necessary DME is a covered essential health benefit in California and it will stop the discriminatory policies that have isolated and devalued the lives of people with disabilities for decades. This bill would be cost-neutral to the state. When an essential health benefit is added for the purpose of complying with federal requirements, including federal nondiscrimination law, then the state is not responsible for defraying the cost of that benefit.

This bill falls within that exception to defrayal, providing the state a timely and prudent vehicle to correct this inequity. With no impact on the state budget and a tremendous impact on the lives of the children and adults that need durable medical equipment to function and live full lives with equal opportunity, we strongly urge your support of AB 2753. Thank you.

Thank you. Please go ahead.

Madam Chair and everyone else, I'm especially happy to be here as one of your constituents today. I'm really grateful for this opportunity to speak in support of this bill. I'd like to share my lived experience of what it's like and what it means to me to live with the current dollar caps and home use limits of DME coverage under private insurance coverage. Using a wheelchair has been part of my life since I was two years old.

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

I had to assume that it was the powers that didn't value my community's quality of life and that they didn't believe that the cost to make sure we could leave our homes was justified. Does our society only think of the disabled as sick people who are only able to live at home and not hold a job? Do you think we are insignificant or disposable? Was it unthinkable that I would be able to start my own company and create jobs?

Do you value us as human beings like everybody else? My lived experience is this: I started an audio company and hired several employees. I and my company paid taxes and provided an affordable and needed service to the local film community. And when the opportunity arose, I and dozens of people were employed over five years to create the Oscar-nominated documentary 'Crip Camp.' And we paid for services from at least a dozen companies. I'm talking about well over one million dollars.

I don't like equating someone's value to economics, but I am telling you that the benefits of this bill far outweigh the cost. When we allow seniors and disabled to fully participate in daily living, everyone benefits. It's not a one-way street. One example is that grandparents can babysit kids so a single parent can hold down a full time job. My wheelchair is four years old and has several breakdowns due to wear and tear.

If I was getting my insurance from a private insurer who operates under these caps, I would be in danger of losing my freedom and my independence if I could not afford to pay for an inferior, low-cost wheelchair. You want me and my community to thrive, create jobs, and bring their vigorous spirit out in the open. Push back on this horrible false stereotypes of people like me, and champion this bill. This is not charity.

Why do I have to come before you and convince you that I and my community should be afforded the resources that allow us abilities you enjoy by default? Thank you so much.

Thank you for that. Any other witnesses in support, please come to forward. State your name, organization, and position.

Sandra Poole, on behalf of Western Center on Law and Poverty, co-sponsor and strong support.

Debb Roth with Disability Rights California, in strong support. Thank you.

Dan Okenfuss, California Foundation for Independent Living Centers, in support.

Christine Smith, Health Access California, in strong support.

Kim Rothschild, California Association of Public Authorities for In-Home Support Services, in support.

Adam Zarrin, Leukemia Lymphoma Society, in support.

Ryan Spencer, on behalf of the California Association of Medical Product Suppliers, in support.

Sumaya Nahar, with the California Children's Specialty Care Coalition, in support.

David Gonzalez, California Life Sciences, in support.

Josh Gauger, on behalf of the County Health Executives Association of California, in support.

Nora Lynn, on behalf of Children Now and Let California Kids Hear, in support.

Thank you. Are there any witnesses in opposition? Thank you. You'll have three minutes each.

Madam Chair and Members, Steffanie Watkins, on behalf of the Association of California Life and Health Insurance Companies, unfortunately here in opposition today. I think all of our hearts go out to many of the stories we hear, and this is one of many mandates that you will see this year come before you for consideration.

I think, just as kind of--to go down--history, many of you may remember in 2012, as the ACA was first being adopted into California, we did choose the Benchmark Plan and the Kaiser 30 Plan. That was something that was highly debated, discussed. It was before the Legislature. CHBRP and Milliman did a extensive studies on what that benchmark plan would look like. It was never meant to be the ceiling, but always meant to be the floor, as affordability and access was always clearly important to individuals.

As we moved on several years later, we readopted that and made conforming changes related to habilitative and rehabilitative services to ensure that the plan conformed to the federal guidelines. With that, we are here today. We absolutely understand that this is a broad discussion. We've seen bills before on hearing aids and other DME. We think that that is a valuable conversation to have, but one that should be had in a broader perspective.

Senator Roth, the Chair of Health Committee, does have a bill this year to revisit that discussion of the Benchmark Plan, and we think that this would be better suited to have that in that broader conversation, especially as you will see many other mandates that are critical to individuals that they feel very passionate about that should be considered and discussed as well.

So unfortunately, while we are in opposition to the bill before you today, we are in support and concept of looking at the Benchmark Plan in totality and considering that as it moves forward out of the Senate. Thank you.

Good afternoon, Chair and Members of the Committee. Robert Boykin with the California Association of Health Plans. We would like to align our comments with ACLHIC's testimony on the bill, regrettably in opposition to AB 2753. We respect and understand the author's attempt to include durable medical equipment under the Essential Health Benefits Benchmark Plan.

As noted in the analysis and as mentioned earlier, Senate Bill 1290 was introduced this year and expresses the intent of the Legislature to review California's EHB Benchmark Plan and establish a new benchmark plan for the 2027 year. We look forward to that discussion and feel that any new mandates that currently exceed the EHBs, which will leave the state on the hook for the defrayed cost, should be left for discussion on a possible new benchmark plan. For these reasons stated, we respectfully ask for a no vote. Thank you for your time today.

Are there any other witnesses in opposition? Please come forward. State your name, organization, and position.

Thank you, Madam Chair. Jack Yanos, on behalf of the America's Health Insurance Plans, in respectful opposition. Thank you.

Thank you. With that, I will bring it back to the Committee for comments or question. Mr. Jones-Sawyer.

And I want to thank you for bringing this. I mean, I probably mentioned this a million times to this Committee and to other committees that my brother is blind, and when he was in elementary school, he was told he couldn't bring his CNI dog. We reversed that. Then he needed braille. They told him they wouldn't provide braille in the DC school system. We reversed that. When he got to college, he needed readers in the Maryland University system. They refused to do that.

We sued; they got him that. They provided him transportation and some other things. Today my brother as a PhD from the Maryland, the University of Maryland, he's getting ready to retire from the DC school system as an assistant principal, and he's provided a value to students in the DC school system because he's very keen at listening and he's the Dean of Student Discipline and he finds out what's going on and people tell them what's going on.

So when the kids come in and say, 'hey, you know, I haven't done anything; you can't see me,' he'll say, 'well you're in a red jacket and I know you were smoking dope behind the, behind the bench,' but the thing that really gets those kids is when they start crying about, you know, 'dog ate my homework, I can't get to school on time,' you know, 'I have problems at home and everything.' My brother will say, 'well I'm blind and have a PhD. What's your excuse?'

So there's another value to people who have disabilities moving into the mainstream because we always mainstreamed him in the system and insisted on that, and I think he's become a very valuable commodity. And that's just a teacher and not a film producer, but a teacher, somebody that I think all students should see that and should know that because you have a challenge, a physical challenge, that doesn't stop you and that we should provide all the necessary tools.

Because if he didn't have any of those tools--think about it--anywhere along the road you didn't have any of those tools, I don't think he would have made it where he is. So I'm voting for it today. Thank the author for bringing this forward.

Mr. Patterson.

Thank you. We had a, well, exchanged a couple messages on this. You know, I think it's--I've supported in this Committee in the past, like for example, children with hearing aids, you know, because if a kid can obtain a hearing aid, you know, when they're younger--or if they don't, their ability to have all sorts of other, you know, be able to hear the teacher, their anxiety in school and things like that, you know, prove obviously if they have a hearing aid.

And so we've had bills come through here and you know, pass, go all the way to the Governor and get vetoed, and I just look at that as like one example in this bill that is a really good thing. Obviously, I think people having wheelchairs and--I mean it's pretty important and necessary, and it is kind of crazy to me to think that that's not available for some people.

I think I'm not quite there yet, only because--I'm not gonna oppose the bill, I'll tell you that--I think where this is going, this is definitely something I'm interested in continuing the conversation. You know, it's obviously very--it's very broad, and I want to understand that a little bit more, you know, as it smooths through the process.

But I think there are definitely things out there that are necessary for life that, you know, we have to continue those conversations, you know, not only in this, in this body, but to say that, hey look, we're just, you know, we're not gonna, we're not gonna do anything about that is a little interesting. So your bill is very broad and I think that's a good thing.

Hey, you know, why not? Go shoot for the stars, you know, and kind of see where it goes, but look forward to the discussions, you know, as we move forward. So, thanks.

I want to thank the author for bringing forward the bill and recognize that we need to be able to codify that DME coverage without this limitation to ensure that individuals with disability receive coverage to comply with federal and state requirements of non-discrimination protections is very critical. I appreciated the testimony around this bill essentially in that regard being cost-neutral because it allows us to be able to conform to the federal requirements.

And I just want to thank my constituent and the superstar that we have here today just in pointing out that sometimes we need to be very thoughtful in what we're calling 'medically required' in order for people to have a full life and all that they need and the durable medical equipment that will allow them to be able to do so. So thank you for that. With that, Assembly Member Ortega, would you like to close?

I respectfully ask for your aye vote.

Thank you. The motion is 'do pass to Appropriations.' We need a motion. Thank you, Dr. Arambula and Majority Leader. Please call the roll or do pass to Appropriations.

[Roll Call].

That measure has ten votes and it is out of Committee. Thank you. We will move on to Item Number 16: AB 2556, Mr. Jackson.

In 2022, the US Preventative Service Task Force recommended screening for anxiety in children and adolescents aged 8 to 18 years old. Also, according to the CDC, early identification and expanded evidence based prevention and intervention strategies are critical to improving pediatric mental health. But despite these recommendations, in California, 114,000 youth were not treated for their major depression and only 28% of youth with severe depression received some consistent treatment.

AB 2556 works to combat the lack of information regarding mental health screening in an attempt to make it more accessible and less stigmatized. I respectfully ask for an aye vote.

Thank you. Any other witnesses in support?

Kelby Lind with Planned Parenthood Affiliates of California in support.

Madam Chair, Members of the Committee, Brandon Marchy with the California Medical Association. I want to thank the author for working with us on the amendments that he accepted today, and with that, we'll be moving to a support position moving forward. Thank you.

Thank you. Any witnesses in opposition?

Good afternoon, Chair and Members of the Committee. Robert Boykin again with the California Association of Health Plans, regrettably in opposition to AB 2556. We understand and appreciate the author's intent to help drive an increase in behavioral health and wellness screenings, especially among today's most in-crisis and vulnerable youth. However, we are currently opposed to the Bill in print, as much of what is proposed seems to be duplicative of existing law.

Additionally, we have been working with the author's office with some clarifying language to ensure that health plans can fully comply with the intents of the Bill and be responsible partners in this space. We are currently reviewing your proposed amendments outlined in the analysis, which do seem encouraging. We look forward to engaging in engaging in further discussions with the author's office as the Bill moves forward. Thank you for your time today.

Thank you.

Steffanie Watkins, on behalf of the Association of California Life and Health Insurance Companies, regrettably here in opposition as well, I think we look forward to working with the author of the Bill moves forward today. I think there are some concerns with respect to legal guardian versus policyholder. We wouldn't necessarily know who the legal guardian is of a child. Our fiduciary responsibility and duty is with the policyholder is the individual that we normally would notify of any EOCs or changes.

So we look forward to having those conversations if the Bill moves forward today. Thank you.

Any other additional witnesses in opposition?

Thank you, Madam Chair. Jack Yanos on behalf of America's Health Insurance Plans in regretful opposition. Thank you.

Thank you. Seeing no other opposition or witnesses, I'll bring it back to the Committee for questions or comments. Dr. Arambula moves the Bill. Dr. Weber seconds. Dr. Jackson, you may close.

Thank you very much. I've had some great discussions with both those in support and opposition. Obviously, as we know, we cannot forget, even though we've made some great gains in terms of mental health, the crisis is not over and we must continue to keep our foot on the gas to address it. Many of us receive our annual text message or email saying, get your flu shot.

All we're asking is, is if a parent has a child, that not only do they get a notice about a flu shot, but they say, hey, come get your wellness screening for your children. We've got to get are young people screened and we're going to try any way and every way. I'm going to be back here again next year about trying to do something again. Right. But the idea is we can't give up.

We must continue to improve the way we serve our young people and set them up to be able to thrive. I respectfully ask for an aye vote.

Thank you, Doctor Jackson. Certainly appreciate your leadership always in this particular space around mental health and wellness for our children. With that, the motion is do pass as amended to appropriations. Please call the roll.

[Roll call]

[Roll call]

That measure has thirteen votes to zero and passes through Committee. Thank you. Our next Bill is item number four, AB 2052, Jones-Sawyer. Moved by Rodriguez, seconded by Sanchez.

Oh, this is short and sweet. Good morning, Chair and Members. I present AB 2052 that strengthens the public health center support program, support funds that continue to reach students who experience the difficulty accessing medical care. I would like to accept the Committee amendments.

School based health centers give students who would not otherwise have access to physical and behavioral health services the opportunity to lead healthier lives and have shown to increase attendance, academic achievement, and improved school climate.

AB 2052 will continue to strengthen the reach of school based health centers, requiring the Office of School-based Health to coordinate with the grant administrator, the California Department of Public Health, align grant recipient preference with existing definitions in education code, and prioritizing school based health centers that increase access to care for California's most underserved students and communities. In many communities, school based health centers are the only source of healthcare a student can access.

Funding is limited this year, but this Bill will set up school based health centers to receive funding in future years and use those funds effectively and efficiently. With me in support is Rachel Reynolds and Amy Blackshaw on behalf of the Bill sponsor, the California School-Based Health Alliance.

Thank you. The Bill has been a motion and seconded already. You have three minutes.

Good afternoon, Chairperson Bonta and Members of the Health Committee. My name is Amy Blackshaw and I am here today to advocate for AB 2052, the School-Based Health and Education Partnership program. I'm currently the Behavioral Health Project Director at the California School-Based Health Alliance, and prior to that, for nearly 10 years I worked at La Clinica de La Raza, a federally qualified health center where I manage the operations of eight school based health centers in Alameda County.

In that role, I experienced the power of the education and health sectors coming together to build partnerships that leverage resources to support students and their families. I witnessed the impact of culturally competent, youth centered, accessible healthcare that resulted in improved student health outcomes and and improved academic outcomes. School-based health centers are where young people feel comfortable getting their needs met, from mental health care, primary care, reproductive and sexual health care, and in some cases, dental and optometry services.

Students depend on school based health centers for health information that they understand and supportive youth focused programs such as such as peer support groups that strengthen their connections to their school community and build their sense of belonging, as well as mental and physical wellness. AB 2052 is an important step in the right direction because it helps our state's Department of Public Health and Education improve their coordination to strengthen the state's efforts to advance school-based health centers.

I respectfully urge your aye vote to enable these state agencies to collaborate more effectively, empowering them to better support the vital work that's carried out by school-based health centers throughout California. Thank you so much.

Thank you.

Honorable Chair and Committee Members. My name is Marcel Reynolds. I'm the Director of Communications and Strategic Membership at the California School-Based Health Alliance. The California School-Based Health Alliance supports around 400 school-based health and wellness centers in K through 12 schools across California. School based health centers provide medical and behavioral health care, and many also provide dental care, optometry, and other ancillary services, all of which are youth centered. Almost all care provided is reimbursed through Medi-Cal.

Research shows that school based health centers have a positive impact on absences, dropout rates, disciplinary issues, and other academic outcomes. School-based health centers enhance access to healthcare by bringing medically accurate, age appropriate care to where kids spend the most time: in school. School based health centers are an investment in the well being of youth and their community. With AB 2052, California has the opportunity to update our state structure for providing support to school=based health centers.

Recognizing the critical role the California Department of Education and the California Department of Public Health play to bridge both health and education to fully support student well being and success. California is the state with the highest number of school-based health centers that does not provide dedicated state funding to support them. Among other provisions, AB 2052 strengthens the capacity of our state to coordinate grants to support the establishment, expansion, and operational sustainability of school based health centers in the future when our state's budget allows.

AB 2052 better positions our state to support the critical role that school based health centers play in California's efforts to ensure access to health care for all. Thank you for your time, and I respectfully urge your aye vote.

Thank you. Any other witnesses and support? Name, organization.

Thank you, Madam Chair and Members. Dylan Elliott, on behalf of the California State Association of Psychiatrists in support.

Kelby Lind, Planned Parenthood Affiliates of California in support.

Thank you. Any witnesses in opposition? Seeing none. We can bring it back to the Committee. I think the Bill was moved and seconded already. Author, you may close.

Respectfully ask for your aye vote.

Thank you so much. I look forward to seeing this Bill around a critical issue related to school-based health centers continue to go through the legislative process. And with that, the motion is do pass as amended to Education. Please call the roll.

[Roll call]

Thank you, Chair and Committee.

That measure passes eleven to zero. Mr. Jones-Sawyer.

Thank you. Majority Leader Aguiar-Curry will be presenting file item 12, AB 2339. You're welcome.

Good afternoon, Chair and Members. When I authored AB 32 in 2022, my clear intent was to increase patient choice in access to care via all forms of Telehealth services. The intent of my past legislation was for Medi-Cal to cover Telehealth services equally, including mobile apps through asynchronous messaging. These apps are important because working families can access medical care on their own schedule without having to take time away from work or their families.

Because AB 32 became law, Californians who have private insurance benefits from these types of convenient apps because asynchronous Telehealth is covered under private health plans. However, Medi-Cal beneficiaries are allowed asynchronous Telehealth options only under certain circumstances, which creates barriers to the equitable care. Health care providers are prohibited from establishing a new patient relationship with Medi-Cal beneficiaries via asynchronous or other virtual communication modalities unless a patient requests an audio only modality or a test that they do not have access to video.

This particularly impacts the ability for Medi-Cal beneficiaries to access sexual and reproductive healthcare services that can be appropriately provided using asynchronous modalities like apps. AB 2339 will expand access to sexual and reproductive healthcare services that can be provided using asynchronous modalities for Medi-Cal beneficiaries. Allowing Medi-Cal beneficiaries to access this form of care will provide equal access to asynchronous Telehealth services and give Medi-Cal beneficiaries the same convenient care as their peers with private insurance.

With me today to speak in support of this bill is Doctor Jennifer Yager with the Bixby Center for Global Reproductive Health, and Kelby Lind, Vice President of Regulatory Affairs at Planned Parenthood affiliates of California.

Welcome, Doctor Yager. You'll have three minutes.

Good afternoon, Chair Bonta and Members, my name is Jennifer Yager. I'm an assistant professor at the University of California, San Francisco in the Philip R. Lee Institute for Health Policy Studies and the Department of Epidemiology and Biostatistics. I am here to support Assembly Bill 2339 which will improve Telehealth access for Medi-Cal beneficiaries across California. Numerous studies have shown that Telehealth offers a safe and effective way to provide sexual and reproductive health services.

Telehealth can enhance access to care, especially for rural and underserved populations, by eliminating the need for transportation, childcare, and extra time for in person visits. In our research with young people, many also valued the privacy that Telehealth visits offer and feel more comfortable communicating with their provider and asking questions compared to in person visits. However, our survey of over 1,000 young adults revealed barriers to phone and video visits.

Nearly one quarter said that it would be difficult to use phone or video visits for contraceptive services. Food and housing insecure young adults were more likely to report difficulty using phone or video visits. Lack of privacy at home was a common barrier among young adults, who often live with family members. Asynchronous Telehealth can ensure access to care for these patients, and to illustrate, I want to share the experience of a 23 year old woman from Los Angeles who I recently interviewed.

She developed symptoms of a urinary tract infection, or UTI, but couldn't take time off work from her job at a coffee shop in order to get care. Her UTI progressed to a kidney infection causing serious illness and she lost her job. Since then, she has had recurrent UTIs and prefers asynchronous care, which she has found available through an online Telehealth company because it works better with her schedule. She has to pay out of pocket, but feels that this is the best option given her time constraints.

Notably, studies focused on UTI care have found no differences in quality of care or patient outcomes across asynchronous Telehealth phone or in person visits. AB 2339 ensures that Medi-Cal beneficiaries have the choice of an asynchronous visit, which may be the only way to access care for young people and other vulnerable populations. I respectfully urge your support for this bill today. Thank you.

Thank you. Three minutes.

Thank you. Good afternoon, Chair Bonta and Members of the Committee. My name is Kelby Lind, Vice President of Regulatory Affairs at Planned Parenthood Affiliates of California. We're a proud co-sponsor of AB 2339 representing seven affiliates that provide comprehensive sexual and reproductive healthcare, gender affirming care, and behavioral health services throughout California. I want to begin by thanking the author for her continued dedication and leadership on Telehealth.

When the COVID-19 public health emergency began four years ago, Planned Parenthood moved quickly to implement secure Telehealth appointments for sensitive services such as birth control, STI treatment, pregnancy counseling, prep and pet follow up, and gender affirming care. Today, Telehealth continues to be a popular choice for Planned Parenthood patients, even when in person appointments are available.

Thanks to the Legislature's leadership, since the onset of the COVID-19 public health emergency, Planned Parenthood patients continue to have a choice to access crucial services via Telehealth without having to worry about the additional time and resources necessary to make it to an in person appointment. Importantly, previous legislation by the author, AB 32, ensured that Medi-Cal patients can choose to see a Planned Parenthood provider via synchronous Telehealth when it is appropriate for the patients presenting concerns.

AB 2339 will ensure Medi-Cal patients have the same protected access and choice for asynchronous modalities, including when they need access to a Planned Parenthood provider for birth control or treatment of a UTI. More than 1 million Medi-Cal patients are seen by a Planned Parenthood provider every year, comprising 80% of all Planned Parenthood patients in California.

In serving a patient population that is disproportionately low income and historically underserved, Planned Parenthood strongly believes that Telehealth, including asynchronous Telehealth, is critical to address health inequities and improve access to healthcare services. Medi-Cal patients deserve equitable access to the same healthcare options afforded to commercially insured patients. Full Stop.

AB 2339 is of utmost importance to Planned Parenthood because it will ensure Medi-Cal patients have equitable access to healthcare, establish consistency in state law with existing protections for synchronous Telehealth, and AB 2339 will preserve a patient's right to choose a new provider for sensitive services via secure asynchronous Telehealth platforms. I respectfully urge your aye vote on AB 2339 today. Thank you.

Thank you. Do we have any other witnesses in support?

Brandon Marchy with the California Medical Association in support.

Ryan Spencer with American College of OBGYNs District Nine and OSHA in support.

Vanessa Gonzalez for the California Hospital Association in support.

Carolyn Veal-Hunter on behalf of Teladoc Health, in support.

David Gonzalez with America's Physician Groups in support.

Thank you. Do we have any witnesses in opposition?

Good afternoon, Madam Chair and Members. Unfortunately, with much respect to the author, Mari Lopez with California Nurses Association, we must oppose the bill. We are dead set against mobile app replacing in person healthcare. As mentioned earlier by witnesses on another bill, on a previous bill. It's really important that in person care maximizes the potential of providing everything that a patient needs.

We feel that this is continuous moves by big tech and AI and hedge fund corporations to move into healthcare to maximize profit with delivering a little as, as far as patient care is concerned. Thank you.

Thank you. Seeing no other opposition to the bill, I'll bring it back to the Committee. Dr. Weber moves. Ms. Schiavo, seconds. Thank you so much, Ms. Aguiar-Curry. Would you like to close?

I would. You know, I sit here and I think about when we did AB 32 and how it was controversial because it was Telehealth and it's changed the world. It's changed how we deliver health and having access to everything. As much as you want to do the perfect bill, there are certain things that kind of go through the cracks, and this is one of the things.

And so AB 2339 simply conforms coverage for app based Telehealth services for Californians on Medi-Cal with those who have private insurance. Essentially colleagues, you are voting on whether or not Medi-Cal beneficiaries can have the same access to sensitive services that you all have with your private health insurance provider today. Further, this bill also aligns with California's emphasis on patient choice in Telehealth and further statewide efforts to expand access to sexual and reproductive health care. I respectfully ask for your aye vote.

Thank you. Majority Leader Aguiar-Curry. The motion is do pass to Appropriations. Please call the roll.

[Roll Call]

That measure passes 12 to zero. Thank you, majority leader.

Thank you very much.

And not last, but definitely not least. No, sir. One more. We have item number 14, AB 2435. Mr. Maienschein.

My 12th year. I'm getting the hang of this microphone thing. Thank you very much, Madam Chair and Members. Since 2012, Covered California has engaged in a public process with robust stakeholder engagement when proposing and adopting regulatory changes. The Legislature has granted Covered California Emergency Rulemaking Authority because they must act faster than the traditional rulemaking process allows to implement changes in laws that affect healthcare access for consumers. This emergency authority expires on January 1, 2025.

Consumers will then be at risk of significant delay of new benefits or protections if Covered California is not able to quickly conform to new state and federal policy. Covered California is recently needed or will soon need to implement new subsidies to help more people afford health care costs, create a program to help workers who have lost their health care coverage, and revising regulations in response to federal changes.

AB 2435 would extend Covered California's authority to implement emergency rulemaking packages until January 1, 2030 in order to adequately and promptly react to both annual and ongoing changes in federal and state rules. Once the emergency rulemaking process has been completed, Covered California must then complete the permanent rulemaking process within five years. This allows for another round of public engagement through comments at board meetings and through the regular rulemaking process.

By passing AB 2435, this ensures Covered California is able to serve consumers while conforming to new state and federal policies. Kelly Green and Allison Peace with Covered California are here to help answer any technical questions. Thank you. And I respectfully request your aye vote.

Thank you. You'll have three minutes.

Thank you, Madam Chair and Members, I'm Kelly Green with Covered California, joined by Allison Pease, our Assistant General Counsel. We're not the sponsor of this legislation, but we are here to provide technical assistance to the extent that the chair or the Members have any questions.

Thank you. Any additional in support?

Faith Borges with Act EM on behalf of California Agents and Health Insurance Professionals in strong support.

Christine Smith, Health Access California in support.

Good afternoon, Chair, Members. Beth Malinowski, STIU California in support.

Thank you. Any witnesses in opposition? You'll have three minutes. Thank you.

Thank you, Madam Chair, Members of the Committee, Brandon Marchy with the California Medical Association, regretfully here in opposition and unfortunately, next to my former boss, so I doubly regret it. Our concern is not necessarily that we do not believe that Covered California should not have emergency rulemaking authority. We actually very much agree that they should in order to be in compliance with federal law. Our concern is actually with the broad, blanket sort of ability for them to do emergency regulation packages that are not necessarily emergencies.

Right. The emergency rulemaking process has its place. We believe that it does, but it significantly undermines the public's participation in this process. It significantly undermines stakeholders participation in this process. And finally, it undermines your ability as legislators to have input in the rulemaking process, to make sure that they are implementing laws and that you guys have passed. You, excuse me, you legislators have passed. It cuts the window down from about 75 days to about 10 days.

That is not a lot of time for anybody to respond to very important regulatory packages. So that is the reason for our opposition. Again, I have great respect for the author and great respect for Covered California as well. They've been amazing partners since their inception, but do believe that the emergency rulemaking authority should only be used when absolutely justified and should be appropriately narrowed to true emergencies. Thank you.

Any other opposition to this Bill? Seeing none, we will bring it back to the Committee for question or comments. Dr. Weber.

Good evening. Early evening. Thank you so much for bringing this Bill forward. I think you know what I'm going to ask because we talked about it before. So first of all, I want to thank the opposition for already answering one of my questions because one of my questions had to do with the notification and the timeframe difference for public input. So without emergency, it's 75 days. With this emergency rulemaking it's 10 days. So my question is for Covered California.

Completely understand and agree with the need to move quickly for federal changes. But why do we need this to be so broad, to essentially kind of give Covered California a blank check to do anything under the emergency rulemaking? Why is this Bill not narrowed to specifically refer to the things that we know that we need in an emergency situation, which is to change it for federal guidelines?

Thank you, Assemblymember Weber. So we do appreciate Brandon and CMA's points raised. First, with regard to your question, we do need to have broad emergency rulemaking authority in order to be have the ability to adapt to federal rules which do change on an annual basis.

We also need the emergency rulemaking authority to be able to adapt to state law changes so that can include items that Assemblymember Maienschein mentioned, such as state subsidies, for example, in which we have had to leverage the emergency rulemaking process due to budget augmentations made to help support Covered California enrollees with additional state subsidies. So the broadness of the rulemaking does allow us the flexibility that we need to keep pace with federal and state law changes.

We have, since our inception, been devoted to transparency, to public engagement, and we absolutely respect oversight of the Legislature and of the public generally. We have a robust stakeholder engagement process and a public process by which our rulemaking packages are put forward and voted on by our board.