Senate Standing Committee on Health

We have eight bills on today's calendar, plus one special order item. Eight of the bills are being are on our proposed consent calendar. Item number two, Senate Bill 910 with amendments. Item number four, Senate Bill 963 with amendments. Item number six, Senate Bill 1082. Amendments will be taken in human services. Item number 11, Senate Bill 1252. Item number 12, Senate Bill 1257 with amendments. Item number 13, Senate Bill 1319. Item number 14, Senate Bill 1320 with amendments. And item number 16, Senate Bill 1442.

With that, we have an item on special order. It's item number one, Senate Bill 1290 by me, by Roth. Healthcare coverage essential health benefit. I'm going to turn the gavel over to my Vice Chair, Senator Nguyen.

Thank you, Mr. Chair. At this time, we will start with our special subcommittee since we don't have a quorum, and I'm asking for Senator Roth to present SB 1290.

Thank you, Madam Chair. This bill sunsets California's current essential health benefits benchmark plan. The benchmark plan is the plan that is the marker for the health plan and insurance policies that are sold in California's individual and small-group health insurance markets. According to the Affordable Care Act, which includes the plans available through Covered California, federal rules allow states to update their benchmark plan after undergoing a stakeholder process. Federal rules also establish a ceiling and floor for the changes that can occur.

This bill is meant to kickstart the stakeholder process. My hope is that at the end of the process, we will be able to amend this bill to incorporate the changes that come out of that process in terms of expanding or changing essential health benefits in the benchmark plan. I have witnesses who will be providing technical assistance and who can explain more about this process. Our first witness is Garen Corbett, California Health Benefits review program. And our second witness is Mary Mary Watanabe, director of the Department of Managed Health Care, and Sarah Ream, chief counsel to DMHC.

Thank you. Who would like to go first? Garen?

Good afternoon. Good afternoon. Can you hear me? Thank you for having me again. My name is Garen Corbett. I'm the director of the California Health Benefits Review Program. I've been director since 2011. Again, I'm happy to be here as a technical resource.

So back way back in the mist of time, back in 2011, each state was notified by the Federal Government to choose their respective EHB, their EHB benchmark plan that would define the standard set of benefits that must be covered by plans in that state. Moving forward, starting in 2014, insurers in every state were required for the very first time to offer plans with benefits that were substantially equal to those found in the state's benchmark plan.

Importantly, the EHB benchmark defined only what benefits must be covered, not what the cost-sharing levels were to be. Anyway, states had to select their first EHB benchmark by the end of September of 2012, which would again define each state's EHBs for 2014 and 15. This benchmark included coverage for state mandates that were enacted before December 31 of 2011 and complied with the Mental Health Parity and Addiction Law of 2008.

These comments are based on my notes of conversations with legislators and key legislative staff at that time. Some of the key considerations in the previous deliberations were one being quite mindful of which regulated market the state was selecting its benchmark plan from. General consensus was that it was important that California choose a plan regulated by DMHC. Why? DMHC-regulated plans were subject to the Knox Keene Healthcare Service Act of 1975 that requires coverage of medically necessary basic healthcare services.

Therefore, medically necessary basic healthcare services are indeed a part of the EHB coverage requirement in California. Now the landscape is different today. At the time, the comprehensiveness of DMHC plans felt meaningful for the purposes of establishing California's benchmark plan. For example, DMHC had longstanding requirements that abortion had to be covered by health plans. That said, there was also consideration of affordability and widespread support of Covered California.

Because the benefits provided by the benchmark would become mandated benefits, there were discussions and trade-offs at that time that were evaluated and considered. Abortion and a few other areas were prioritized over things like chiropractic care, for example, and pediatric hearing aids. So California's selected EHB benchmark, the base benchmark plan California selected for 2014 was the Kaiser Small Group HMO 30. That was the largest plan by enrollment in one of the three largest small-group insurance products.

California chose to supplement this plan with the pediatric dental benefit from its separate chip program and the pediatric vision benefits from the federal employee vision program. And to create the overall EHB benchmark plan for California. We also here in California chose to define habilitative services under the same terms and conditions applied to rehabilitative services. When we again revisited the benchmark in 2015 for the 2017 year, the Brown Administration had feelings that we should not change the plans at the time and the Legislature agreed.

Medical trend was running at about 7% that year. In plan years 2014, 15, and 16, the base benchmark plan was a plan that was sold in 2012. While in plan years 2017 through 2024, the base benchmark plan was a plan that was sold on the market in 2014. As no new base benchmark plan or supplements were submitted to CMS, the Kaiser Health Plan Small Group 30, or the HMO 30 plan, plus those identified supplements continue to serve as California's benchmark plan today.

Now going forward, HHS established new rules providing states with new flexibility for selecting a benchmark plan. California may choose now choose to do one of three things. Select a benchmark plan from another state used for the 2017 plan year or California can replace one or more categories of EHBs under its benchmark plan used for the 2017 plan year with the same category or categories of EHB from the benchmark plan that another state used for the 2017 year.

Or option three, otherwise, select a new set of bench of benefits that would become the state's new HB plant. By selecting some or all categories from another state's benchmark plan or adding to the base of benchmark to the base benchmark plan, California could include new services not currently covered under our benchmark plan.

There are three specific benefits that are covered by the majority of other state benchmark plans, but that are not included in the current Kaiser Small Group 30 Plan. Chiropractic care services, hearing aids, and infertility services and treatments. The committee's analysis of SB 1290 is excellent and comprehensive. I wish to close with a brief call out of a couple of comments to remind committee members of some important considerations and context to the state's selection of its EHB benchmark plan.

The ACA requires coverage of EHBs for almost all enrollees in the individual and small group markets, both inside and outside of Covered California. Inside Covered California, all qualified health plans, known as QHBs, are required to provide coverage of EHBs, while outside Covered California non-grandfather plans and policies in the individual and small group market are required to cover EHBs. However, large-group, self-insured, and grandfathered plans and policies are exempt from EHB requirements.

For 2024, CHBRP estimated that 12.1% of Californians are enrolled in commercial health insurance that must cover EHBs. Medi-Cal, California's Medicaid program, is also required by the ACA to cover a set of benefits referred to as EHBs, but those are separate from and function independently from the EHBs that commercial health insurance can be required to cover under the ACA.

So, in closing, a reminder that California must submit any proposed modified benchmark plan it selects by the first Wednesday in May 2 years prior to the effective date of the new benchmark plan. So in early May 2024 for plan year beginning in 2026 and early May 2025 for plan year beginning January 1, 2027. Thanks for having me here today.

Thank you, sir. Next please. Miss Watanabe.

Here we go. All right. Good afternoon. My name is Mary Watanabe. I'm the director of the Department of Managed Health Care. With me I have Sarah Ream, our general counsel is here to help answer some of the more technical questions if needed. Just to provide some quick background about the department, the Department of Managed Healthcare our mission is to protect consumers' healthcare rights and ensure a stable healthcare delivery system. We currently license 143 plans that provide coverage to nearly 30 million Californians in the state.

This means that we regulate about 96% of state-regulated commercial and government insurance offered in the state. My colleague did a really good job providing some overview of the process in the background. I think I'll really focus on the timeline here.

So before we submit the filing to CMS with our the Legislature's new selected benchmark plan, if we go down that option, we really need to consider some of the options and the Legislature would need to consider and adopt the newly selected benchmark plan by amending state statutes. We foresee the administration partnering with the Legislature to hire a consultant to assist with the analysis of California's benchmark plan and evaluating these options to include additional benefits.

The consultant would also prepare the actuarial analysis to support the selection of a new benchmark plan and the application to CMS. We are currently exploring options for funding this work, primarily with support from a foundation, and anticipate this analysis will take approximately six to eight months. Once we have identified several options for a possible new benchmark plan, we anticipate a stakeholder process to provide input on the options.

In addition, there will likely be additional opportunities for stakeholder input through the informational hearings or other hearings related to the legislation codifying the new benchmark plan at a later date. And again, just a reminder about that critical date that we do need to file by May for it to take effect two years in the future. So it would be May of 2025 for this to take effect in the 2027 benefit year. So I think I'll pause there and Sarah and I, of course, would be happy to answer any questions.

Thank you. Comments? Any questions for the?

Madam Chair, I think there may be some stakeholders in the audience who wish to comment.

Before them though, can I call and ask if there's any witnesses to support or oppose? Witnesses to support and oppose, not the stakeholders.

Diana with Health Access, and we are in support. We are in support of SB 1290 and believe that this re-examination of the benchmark plan is timely, necessary, has the potential to reduce health inequities and increase access to care. Thank you for authoring.

Thank you. Any other witnesses to support or oppose? Seeing none. No more. At this time, I want to call for the stakeholders, if you can come up. Do you with want me to call everybody by name or you know who you are? You want to come up? Please state your name and the organization that you're with and you have one minute each, please.

Oh, awesome. One minute. I thought I had 15 seconds. I am Kasey Cain.

Five now. I meant five minutes. Just kidding.

I am a parent of a deaf and hard of hearing child. I'm also an audiology graduate student and the board president for California Hands and Voices. I highly support this bill.

And your name?

Kasey Cain.

Thank you.

Thank you, Madam Chair and Senator Roth. Mr. Chair and members, Nick Luizos with the California Association of Health Plans. We issued a support and concept letter on this bill and we're supportive of the bill moving forward. Certainly, California's current essential health benefits, or EHBs, as you heard a moment ago, were determined after a pretty robust discussion and analysis, balancing consumer accessibility to healthcare services and affordability.

That process, and the process that's envisioned by SB 1290, is encouraging and certainly preferable to the current approach, at least in our view of haphazardly considering one-off benefit coverage bills in the policy committees that inflate healthcare premiums for all Californians. Just to contextualize that, last year, California lawmakers introduced a batch of mandate bills that would have increased premiums in the first year by nearly $1.0 billion.

And we are grateful that, at least on the Senate side, there are a minimal number of mandate bills that have been introduced, but several have been reintroduced this year nonetheless. While reopening California's essential health benefits is not without its challenges and pitfalls, it offers policymakers the opportunity to engage in a more thoughtful discussion of coverage, again, balancing affordability and accessibility.

If we do go down this path, we would strongly suggest that a moratorium be placed on the consideration of any new individual and one-off benefit mandate bills while this process plays out. We would also ask policymakers to keep in mind that there is work being done at the Office of Healthcare Affordability, which is currently considering a statewide spending target. CAHP is in support of a multi-year spending target and in any case, this should not conflict with whatever work is being done at that level. We'd love to be an integral part of the conversation. Thank you.

Thank you. Next.

Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies. In the interest of time, I will align my comments with my colleague at CAHP. We are supporting concept and look forward to the conversation as it moves forward. Thank you.

Thank you.

Good afternoon, Craig Pulsipher on behalf of Equality California. Strongly support efforts to ensure that not only LGBTQ, but all Californians can access the healthcare services they need. Also here today, representing a coalition of organizations working to expand coverage for infertility treatment. We recognize infertility is a disease as defined by the AMA, the WHO, and the American Society for Reproductive Medicine. As such, we believe treatment for infertility should be covered in the state's benchmark plan, just like all other diseases for which treatment is medically necessary.

Unfortunately, while the state's current benchmark plan covers a wide array of reproductive health services, it does not include coverage for fertility care, a glaring omission given that this care is an essential component of Reproductive Healthcare. At the same time, the current benchmark plan leaves out LGBTQ people who rely on access to fertility treatments to start a family. Just last year, the ASRM published a new, more inclusive definition of infertility that reflects the lived experiences of LGBTQ people.

And we strongly support efforts to ensure that California's benchmark plan includes equitable and inclusive coverage for standard fertility services, including diagnostics, medically indicated preservation, artificial insemination, and IVF. Lastly, I would just note that California, which holds itself out as a leader in reproductive freedom, is currently lagging behind several other states that already include fertility services as an EHB. And at a time when IVF is under attack across the country, it's now more important than ever to ensure that Californians have access to the full spectrum of reproductive healthcare. Thank you.

Thank you. Next.

Good afternoon. Jessica Moran with the California Dental Association. Appreciate the opportunity to give comment on SB 1290. This is especially timely as just last week, CMS finalized and published their rule for 2025 plan designs, which include the opportunity for states to open up their EHB benchmarks to include routine non-pediatric dental services. While data indicates that 88% of Californians have some form of dental coverage, with about 50% of that being employer-sponsored coverage, there is significant variation across the dental market for services that are covered in plan policies.

For example, there's no minimum standard or floor required for dental coverage. Most dental plans have annual maximums and no cap to patient out-of-pocket spending. These factors leave consumers to purchase inadequate dental coverage that's inappropriate for the dental needs or simply receiving low to no value for the premium dollars that are being spent.

May I ask you to wrap it up, please?

We urge the committee to amend SB 1290 to include adult dental services. And additionally, when designing the benefit, we request the Legislature to include a separate dental deductible for embedded dental services. No annual lifetime minutes, no annual lifetime limits on dental coverage services, and are receivable out of pocket maximum. California has the opportunity to be the first state to implement this, so we look forward to continue working with the Legislature. Thank you.

Thank you. And if I'm just as a reminder, one minute please, so that we could allow everybody else to have some time to speak.

My name is Stuart Steene-Connolly. I'm a board member for the Hearing Loss Association of America and father of two young girls who share my hearing loss. I wanted to give a personal effect to what this bill means to a lot of us. As you probably know, there's an epidemic of untreated hearing loss in this country due to the cost families choose to live with poor hearing or the wrong equipment for far too long, which leads to other lost opportunities.

Recently, my two girls and I needed to upgrade our aging hearing aids. Our bill was over $20,000 after our top tier insurance deducted only $1,500 per hearing aid because they deemed our upgrades as an elective and not the true medically necessary equipment they are. We had to pass on keeping those hearing aids that were already fitted to them. This is the reality for myself and for thousands of families like mine in California.

The HAACP program that was supposed to fix this is woefully ill equipped to handle the true need of our community. There isnt a single provider on your site that serves Sacramento within 100 miles and the insurance companies that are supposed to cover our equipment for what we pay them, but they wont because they need to save a profit. Please hold them accountable by passing this bill.

Thank you.

Hello. I'm Nora Lynn with Children Now, and I'm here with our partner, Michelle Marciniak from Let California Kids Hear to speak strongly in support of a policy solution that will permanently close the coverage gap for children in need of hearing aids. According to pediatric experts, failure to give appropriate early intervention to deaf and hard-of-hearing children leads to speech, language, cognitive, educational, and social-emotional deficits, and permanent and preventable delays.

32 states have recognized this and require health plans to cover children's hearing aids, but California is not one of them. Over 20,000 children in California are stuck in this coverage gap, and their families face difficult choices about affording healthcare. It's time to fix it. This, and I will pass to Michelle.

For over the past two decades and more recently under this administration, several attempts have been made to address this developmental crisis, all of which Governor Newsom has blocked due to the precedent it would set to go above and beyond the essential health benefits. The governor's alternative program, after three years and millions invested, is not working, with less than 2% served.

By adding hearing aids to the EHB, this bill addresses the governor's stated concerns and addresses this developmental emergency that's been unfolding for years in the State of California. As a mom with a child who is hard of hearing, the story that haunts me most is children showing up at centers across the state at the age of five, unable to say their name because they have never had access to sound. I urge the administration to act with urgency on this. It's time to let California kids hear.

Thank you.

Good afternoon. Lloyd Friesen, representing the California Chiropractic Association, also known as Cal Chiro, and we support the provision of SB 1290 to review the essential health benefits and benchmark plan. Specifically, we're asking that the new benchmark plan include chiropractic services specifically as it relates to chiropractic manipulative therapy. That therapy has been shown to be one of the top treatment interventions with the conservative management of neck, back, and headaches. California is one of only four states that does not include chiropractic services as a benefit.

And so, again, we would ask the State of California, in their review of the benchmark plan, include that again, the scientific literature shows the importance of that service. And again, we support the activity of this legislation. And thank you, Senator Roth, for your leadership in this. Thank you.

Thank you. Next.

Thank you, Madam Chair. Thank you, Senator Roth. I'm Ryan Spencer, on behalf of the Crohn's and Colitis Foundation. Over the past several years, the foundation has been working on improving coverage benefits for patients with inflammatory bowel disease, IBD. Specifically, they've been working to ensure coverage of dietary enteral formulas for patients diagnosed with Crohn's disease. These drinks have been clinically proven to treat patients and to keep them remission the same way as a more aggressive and more expensive biologic drugs. Ironically, the biologic drugs are typically covered.

The enteral dietary formulas are not. Avoiding more expensive biologics and using enteral formula can reduce overall cost to healthcare system and still effectively keep IBD patients, particularly children, in remission. Last year, ABC 1620, by Assemblymember Connolly, which would require coverage of dietary enteral formulas, was vetoed by the governor, citing the belief it was not included in the benchmark plan and therefore exceeded the definition of EHBs. There was no dispute on the treatment or its efficacy. It was merely because it was not in the benchmark. So I ask, when the state does implement a new benchmark plan, please ensure the inclusion of coverage of all dietary enteral formulas prescribed to treat digestive disorders. Thank you.

Thank you. Seeing no more, no other witnesses or stakeholders at this time, I would like to pause who establish a quorum. Madam Clerk, can we please call roll?

[Roll Call]

Thank you. That's six members. We have a quorum at this time. I'm going to bring it back. Colleagues, members, any questions? Comments? Senator Menjivar.

Thank you so much, Madam Vice Chair. I am really excited about this bill, Senator Roth. There are two items that I'm especially excited about the potential of including as a benefit. One of them, you heard a lot from stakeholders today.

Let California Children Hear, an effort that stakeholders have been working on for over 20 years, but somehow we can't get it right here in California. We've attempted various times, and I attempted last year as well, and unfortunately, we got vetoed. We are failing our kids who are unable to hear, hard of hearing. And the story you heard of one of the stakeholders is a familiar story to so many individuals. I want to echo the urgency behind ensuring that we submit a plan.

And my question in all this is, Senator Roth, do we think we can get there by May of next year in submitting that? I mean, if it was up to me, I wish we could do it in this May, in less than a month, but what do we need to do to ensure that we submit by next May?

Well, you heard the timeline outlined by the witnesses. The key is that if we're going to make a change in the essential benefit, adopt a plan, make the change in the essential benefits, and want it effective in the 2027 policy year, we have to have the, I won't be here, you all will have to have this done by May 2025. So it would certainly be, I would think, if you're interested, significant for those here this year to move this along as far as possible.

If not, get it done during this session. There's some actuarial work that needs to be done. You know, the actuary needs to compare our current plan against other plans. Then we need to do an actuarial analysis and cost analysis of the individual benefits options that could be included in the plan and then make some decisions as to what should ultimately be included as essential benefits.

Put that in a bill, get the bill through, and if I can, Madam Chair, may I use this as an opportunity to sort of explain the process? This is not your typical bill, where the bill is filled up and we all know what we're voting on. This is a bill to start the process and have a conversation. But that's how we have to do this. We have to have a conversation as the actuarial analysis is moving forward as to which benefits to put in the bill.

So if it leaves here and it goes to the Senate, it's going to go over the Assembly and all through that process, the actuarial work continues. Decisions are made, working with stakeholders as to which benefits, essential benefits should be included, what should be changed, bill takes form, voted on over there, comes back here. In the meantime, I will be scheduling another informational hearing to keep you apprised of developments and the timeline, and how we're moving forward.

And if we get it done this year, we'll come back here to the Senate Committee for a vote on the bill with everything fleshed out, because I know those are typically, some of you are typically concerned about that before it moves forward. That could conceivably happen before we end session this year. If it does not happen, the actuarial work can continue and the work outside the building here can continue.

But you'll start over with a new bill in January of 2025, and you'll need to move that bill through both houses of the Legislature before May 2025 in order to provide the appropriate notification to health and human services. So I share your interest. If that's an interest of yours, and it's the interest of other colleagues in the Legislature, then maybe we can speed up the process. Does that answer your question, Senator?

That does. Madam Vice Chair, I have another question for the witness. Sir, I forgot your name, but.

Garen Corbett.

You gave some options that we can take and I think there were three options. There were two that I wanted clarification. We can submit a new set of benefits or we can just replace some of them, correct?

Yes. Using other states.

Is there a max amount of benefits we can include?

That's a fantastic question. I don't think so. But I'll turn it over to.

I'm Sarah Ream, I'm the chief counsel for the DMHC. So there's not a maximum amount of benefits, but there's a generosity limit. There's a set of benefits when taken together. There's a floor which is set by looking at the least generous plan in typical plan in the state. And then there's a ceiling which is the most generous typical plan. So the value of your benefits has to fall within that range. You can't. And the purpose of that? Congress did not want a state adopting a plan.

That is garbage. Nor did they want, they were mindful of cost and premiums and premiums rising. So they also did not want a benefit plan that just was the sky's the limit. So you have parameters and you have movement within those parameters, but you have to stay within those parameters.

Okay. And then you mentioned Kaiser. Is that one of the lower?

It's a fairly generous plan, but that's our current benchmark. It's been our benchmark.

Got it. Okay. Well, I just, you know, for the record, I know I mentioned hearing aids. Infertility services, I would, we need to include that. We're so behind, it's discriminatory. We're behind 14 other states on coverage, expansion of coverage of this. So three things I want to say that I would push for and are the three items that you mentioned today that isn't covered by Kaiser. It's chiro, hearing aids, and fertility services. But if I were to rank them, hearing aids would be number one. And then infertility and then chiro. Those are the things I would put my hat on to ensure that we include in benefits.

Thank you. Any other comments, members, colleagues? Seeing none, Senator, Mr. Chair, would you like to close?

Well, let me just say I'm committed. As we move through the process and we have the stakeholder conversations and conversations with the administration and the Assembly on the contents of this bill to keep members of this Health Committee specifically apprised of what's going on and what the timeline is, we will have an informational hearing assuming the bill moves forward and there's something to report.

And at the end of the process, if it's during my term here, we will bring the bill back to this committee so that you'll have another look at it with more information in it, and you'll have another opportunity to vote either up or down or not vote. And that's my commitment. So at this point.

Senator Menjivar?

She's gonna make my clothes for me, Madam Chair.

I just think I want to make sure we all understand how important this is. This is so huge. I think Nick, you know, mentioned this, that we always bring up bills of added mandates and one-offs. This is our opportunity to really look at all these issues that we've looked to create mandates and to group under these new EHBs. Yes. I just want to make sure everyone really understands. I wish the whole committee was here to really hear this, because this is a great opportunity for us to close the gaps on a lot of benefits. I just want people to really understand how important this matter is.

Is that you're close?

Madam Chair, I could not have done a better job of closing. That's why I love my Budget Subcommittee Chair. Respectfully ask an aye vote at the appropriate time.

Thank you. Is there a motion? Motion by Senator Menjivar. This is do pass and refer to the Committee on Appropriation. Please call for a vote.

[Roll Call]

Six, zero. We'll keep the roll call open.

Thank you, Madam Chair and members.

Let's go ahead and take up the consent calendar. Consent calendar is. Item number consists of item number two, Senate Bill 910 with amendments. Item number four, Senate Bill 963 with amendments. Item number Senate Bill 1082, amendments being taken in human services. Item number 11, Senate Bill 1252. Item 12, Senate Bill 1257 with amendments. Item 13, Senate Bill 1319. Item number 14, Senate Bill 1320 with amendments and item number 16, Senate Bill 1442. Is there a motion? Senator Glazer moves the bill. Please call the roll.

Senator Hurtado.

Oh, excuse me. Let's correct it. And Senator Hurtado moves the bill. They're fighting over it now. Please call the roll.

[Roll Call]

Consent calendar. The vote is 6-0. Will hold the roll open for absent members. Senator Umberg, you are here on item number three, Senate Bill 913, substance use disorder treatment facilities. Please proceed and ready.

Thank you Mr. Chair and members. And a special thank you. You and I have engaged on this and to Reyes Diaz also for your assistance. Let me begin by saying that we are taking significant amendments, most significantly, the portions of the bill that respond to sober living homes and facilities that has now been struck from the bill. We are committed to taking other amendments as this bill should proceed out of this committee. With respect to, for example, who can make a site visit.

We originally said city attorneys. As district attorneys, we eliminate district attorneys. These amendments are taken in response to concerns raised by the committee. So what this bill now concerns are substance use disorder treatment facilities. This is a particularly acute issue in Southern California in an area known as the Rehab Riviera.

I think members may be familiar with the issue concerning rehab facilities that engage in patient brokering, engage in recruiting folks to come to that treatment facility and once their insurance runs out, going ahead and releasing them basically to the street. SB 913 would augment substance abuse treatment regulation efforts by licensing efforts, licensing by requiring the Department of Healthcare Services to adopt a process that would allow cities to request approval to conduct site visits.

In other words, the Department of Healthcare Services would need to provide its consent for a city attorney to make a site visit to see whether or not that facility is engaged in unlawful activity, for example, patient brokering. It would also allow a site visit so that the city attorney and or DCH CH can determine whether or not there are other violations. We would not permit the city attorney to inspect. Search any area where an individual resident has an expectation of privacy.

This does not grant any additional authority to a city attorney that is not already held by the Department of Health Care Services. We will continue to work on amendments, and with that, I urge an aye vote. We have our witness.

Senator, as she is coming forward. You know my policy here is the committee votes on the bill in print. So is your opening describing the bill in print, or is it describing what you're going to do with it?

It's describing amendments that we are committing to take should this bill move out of committee.

Okay. And you know the. Let me just say this. What we vote on here is the bill imprint. But it's okay to tell people what you're going to do with it, and that's fine. It's tough to analyze it when we don't have an opportunity to look at it. But.

Yes, and I understand that, and I'm grateful for the committee's staff and their flexibility. I recognize that we may have created some confusion, and to the extent that we have created any confusion by reference to, for example, sober living homes that are licensed or unlicensed, as you point out, Mr. Chair earlier today, that, by definition, sober living homes are not licensed.

Thank you. I didn't mean to interrupt, ma'am. Please identify yourself for the record, and please proceed when you're ready.

Thank you so much. 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 sponsor SB 913. 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. That's why compliance with state licensing laws administered to the Department of Healthcare Services is essential to safeguarding residents well being and maintaining quality care.

SB 913's intent is to enhance the oversight and enforcement of state licensing laws for alcohol and drug treatment facilities with cities as partners. Specifically, 913 would augment state licensing efforts by requiring DHCs to adopt a process that would allow cities to request approval to conduct site visits and enforce existing state licensing laws. Cities would be able to request this approval based on the city's reasonable belief that the facility is operating out of compliance with state licensing laws.

To be really clear, SB 913 would establish a process for cities to work with the department to ensure compliance and would require the department's approval prior to any inspection or enforcement action. In no way do we intend for SB 913 to allow cities to conduct these site visits or take enforcement action without the direction and approval of the department. This measure also does not create a new process outside the scope of what DHCs is already authorized to do.

Cities are the closest level of government to the constituents they serve and are therefore well positioned to respond promptly to emerging issues and concerns in their communities. Allowing cities to partner with the state to conduct these site inspections and enforce state licensing laws will ensure swift action to address violations, ensure compliance, and protect public health and safety. By collaborating with cities, the state can supplement its regulatory efforts by leveraging local resources.

According to DHCs, the average amount of time it takes to close a single complaint is around four months, and they receive nearly 600 of these per year. As the number of facilities continues to rise in California in response to the state substance use crisis, the Department faces a major hurdle in being able to monitor and regulate these facilities. Cities can be a valuable partner in ensuring that the Department is aware of violations and ensuring swift action is taken.

For those reasons, we believe 913 would help meet our shared goals of ensuring treatment facilities meet standards for patient care, which is a central part of effective treatment outcomes and community well being. Calcite has a long history of attempting to pass legislation to address the concerns raised by cities about the need for increased oversight, transparency and accountability for drug and alcohol recovery facilities. Cities are focused on enacting legislative solutions that safeguard every person's well being and care.

We believe that 913 is a step forward in protecting residents and upholding the integrity of treatment facilities. We commit to continuing to work with the author and any opposition to address any concerns that are raised. I think we share the same goal of ensuring that bad actors are unable to subvert state oversight to take advantage of vulnerable populations. So with that, we urge the C\committee's support of this legislation so we can continue to have those conversations this year. Thank you.

Before we start with the other support witnesses, let me just get some clarification. I realize I said we're going to vote the bill in print, and we are. And the bill in print includes sober living facilities. But for the moment, I'm going to ignore that. Does the league contend that since we're authorizing as a state, in other words, delegating enforcement authority to local officials, a city attorney or a District Attorney, whatever, of health facilities?

Because that's what we're talking about here, that if we have neighborhood or client customer patient complaints about snfs, skilled nursing facilities, or patient complaints about hospitals, that the natural course of action here would extend also to authorizing city attorneys or district attorneys to conduct enforcement inspections of other types of health facilities.

I think our intention here is that that process would be through the department. Right. So I don't think we're anticipating that cities would want to take on that enforcement action for all types of different kinds of group home facilities, but that cities could partner with the department where there is an enforcement process to ensure that we're responding swiftly and ensure that we are available as a resource to the Department when there's difficulty doing these inspections and providing that oversight.

We feel there's an acute problem with alcohol and drug treatment facilities, but I think that we foresee that if there were other processes to work with departments.

We'd be open to that and to the authors. Since we're talking about residential treatment facilities where treatment's ongoing and it's a health facility, don't you anticipate problems associated with HIPAA violations? You're dealing with patients and patient records. And the old purpose for going in, I assume, would be to determine the nature and the scope of the treatment provided and whether it's within the license.

And in doing so, wouldn't you be of necessity, requiring the look of the use of and the review of patient records in these treatment facilities?

So a couple points. One is that whatever authorization is, the authorization that the Department of Healthcare Services currently has, so to the extent the Department of Healthcare Services prohibited, for example, from examining patient records, examining areas where there's an expectation of privacy, those prohibitions would apply to the city attorney, for example, on a site visit.

But that's the whole, that's everything inside the residential treatment facility other than the administrative office, because you're dealing with patients, right? Patient identity, patient situation, patient treatment course of action.

So if, for example, you see that there are 20 patients in a place that's authorized to treat six, that's not an invasion of, for example, an individual's privacy interest is contained in HIPAA, number one. Number two, if you see, for example, that there's drug use, that there's needles being strewn about, that is, you have no expectation of privacy if you leave needles somewhere on the premises. So if you see that folks are actively using drugs, you don't need to invade their privacy.

But if you can see that that's going on, then that bears further investigation. And so I take your point, and we'll make sure, Mr. Chair, that any site inspection is within the bounds of what's currently authorized by DHCs to inspect or visit.

And I assume then your bill, whether the one in print or the one that you think is going to be in print, would be permissive. So if you made a request, I assume the Department of Healthcare Services could deny the request without recourse.

That's correct.

Okay. Well, let's continue the process. Sorry, colleagues. Let's take the support witnesses. I apologize. Support witnesses, please.

Nicole Wordelman, on behalf of the Orange County Board of Supervisors, in support of the bill in print. And they will evaluate the bill as it may be in print at a future date.

Thank you, ma'am. Any other support witnesses? Any opposition witnesses?

Good afternoon, honorable chair and Member Sheri Daly with the California Consortium of Addiction Programs and Professionals here today in respectful opposition to SB 913, which aims to share state authority for regulating alcohol and drug treatment programs with local governments. Happy to hear that there has been some movement on changing the direction of the business Bill. Haven't seen anything in print, so unfortunately I will have to go with what is in print.

Regarding my comments today, after what I considered a fruitful conversation with the bill's sponsors, we were unable to come to a court regarding how to improve enforcement against unlicensed provision of addiction treatment services in the Orange County area. Although we provided several specific sets of language to remedy some of the loopholes we see in statutes with regard to licensing of treatment programs to the league, none were accepted.

We believe that although Senator Humberg has safety and consumer protection at heart, we do not believe the sponsors do. What they want is to appease NIMBYs in Orange County who have waged a legal and public relations battle against recovery residences, otherwise known as several living for over 10 years. In December, the League of Cities announced it supported the governor's Proposition, one, which aims to expand wraparound services, including housing for people with mental health and substance use disorder diagnoses.

Following the league's support of Prop one, elected officials in Newport Beach, Huntington Beach and Orange opted to withdraw their city's membership in the league, and others are considering doing so as well.

Lo and behold, we now have a rash of anti sober living bills put forward by the league to appease their Members and bend to the will of those who strive to discriminate against those in recovery, the very people who have done the hard work of learning how to live differently and to become contributing Members of their communities.

My organization advocated for clear guidance from the Department of Housing and Community Development concerning group living homes and the increasing harassment we are seeing from the entities who are now here today asking you to give them unprecedented authority to invade people's homes and impose judgment on what they think they have found within them. That guidance was released in a technical advisory that is referenced in the analysis for the Bill.

It specifically states that local government cannot require recovery residences to obtain permits to be regulated in any means that is not applied to other single family households in a jurisdiction. Essentially, this guidance barred local government from regulating recovery housing out of existence. In response, SB 913 proposes a new way to allow local government to infringe on the housing rights of people protected by the Americans with Disabilities act.

It would allow local government officials to make unannounced visits to private residences they believe are in violation of licensing laws. This would be equivalent to allowing warrantless searches of people's homes. HCD has been very clear on what cannot be done with regard to group homes. Yet these local governments throughout Orange County continue to harass citizens and thumb their noses at state laws and the Constitution.

Simply put, their track record on this issue proves that these entities would ignore any rules presented to them and continue down a path of discrimination, but with the state's blessing, should this measure pass. In addition to the inherent discriminatory nature of this policy, last year's budget actions make it unwarranted. The Department of Health Care Services asked for and received 12 additional permanent positions for ongoing and corresponding statutory changes to strengthen compliance overseas oversight for substance use disorder licensure enforcement.

Just last year, the request included an addition of a field office in Santa Ana, which adds additional staffing to work in Southern California to enhance oversight in the region. It includes an AGPA in the new office to speed the complaint response and funding to post all complaint and compliance reports on the DHCs website. The new office will achieve the stated goals of the Bill without creating invasive local government involvement over licensing investigations.

As always, I thank Senator for his continuous efforts to make alcohol and drug treatment more accessible and higher quality, and I look forward to working with him and his staff on future legislation in this area in the coming months. We are totally on board to work on any legislation that addresses the acute problem of patient brokering. Unfortunately, this Bill does not in its current form. Thank you.

Thank you, ma'am. Any other opposition witnesses?

John Drebinger with the Steinberg Institute in respectful opposition.

Any other opposition witnesses? Seeing none. We'll bring it back to the dais and my colleagues. Let me just start off with the league, you know, and the author since 2021. It appears to me, looking at budget change proposals, that we, as the state, have invested about $5 million or more in additional resources, I assume primarily directed to Orange County to deal with investigation of complaints licensing issues.

We don't license sober living facilities, but we do respond to complaints of unlicensed activity there and anywhere else, frankly, in this space. Is it the league's position that the. And it's also my understanding that there is a satellite office of DHC D. Yeah, the Department of Care. DHCs, right. Department of Health Care Services. I'm tired in Santa Ana with inspectors there.

Does the league contend that the inspection of licensed residential treatment facilities has been inadequate, as opposed to the continuing debate and concern over sober living facilities?

I think we believe that those investments in the opening of that office are in response to the fact that there is a disproportionate amount of these facilities within Orange County and Southern California generally. The fact that a lot of these staff were located in Sacramento for years created real inefficiencies in the process. We're happy to see that there's a recognition of that in this investment.

But I think it doesn't change the fact that in 2023, we're still facing these really lengthy timings to close out these inspections. And I think that that continues to allow people to fly under the radar. And our goal is just how do we ensure that that enforcement is adequate.

But one of the issues is if the city attorneys or the district attorneys are limited in terms of what they can look at, patient records, treatment, you know, profiles and the like, because of HIPAA, which they are.

We recognize that we have no intention of cities being in any kind of violation of HIPAA. Our goal is that the Department would set up a process that cities would have to adhere to. So whatever the Department would determine that cities were or were not allowed to do, we want cities to have to comply with that. And the goal is not to, as the Senator mentioned earlier, set cities up in a position to be in violation of individuals rights.

Well, and the author and I, and I'll direct this to the author who've had this conversation. I'm not on the Judiciary Committee, but I once was a lawyer. It seems to me that if the state, through Department of Health Care Services, designates and authorizes someone to act on its behalf, that they become the agent. And so the author is going to have to work out if this Bill moves some sort of immunity situation.

So if the local agents, whether it's a city attorney or a District Attorney, violate the rules, whether they're federal or state, and somebody gets sued, it's Orange County or the city or both, not the State of California.

If that's a request, yes, Mister chair.

It is.

To the extent that someone who is conducting a site visit exceeds their authority, it is my view that they should be on the hook and the state should not be on the hook for it. We'll make that clear. If you'd like, I'd respond to some of the other points that have been raised.

Please feel free. And I want to make sure I allow questions by my colleagues. Stop dominating the conversation. That's me. Stop dominating the conversation.

I'll respond. So, first of all, let me address the point with respect to sober living homes and facilities and the opposition did not have an opportunity to be able to respond as to the amendment because this is of recent vintage, number one. Number two is that there may be some factual dispute as to what the existence is of the department's facility in Santa Ana. We're informed that there's been no permit issued in the last couple years for any facility.

And we're informed that while there may be additional personnel, two additional personnel, they're located here in Sacramento. But I don't think that anyone would dispute the issue that there's been virtually no enforcement. I think that the Department would agree that their resources are completely inadequate, at least as to our part of the state, that there's been virtually no site visits. And also, just to be clear, this doesn't just pertain to Orange County, this would be a statewide enforcement and would apply statewide.

Well, that's even more concerning to me, but that's okay. I mean, we're dealing with a demonstrated need, and that's one, for the state to delegate authority in a particular area, that's one thing. But to pass a Bill, and I don't know what Bill we're passing, but to pass a Bill that authorizes statewide cities and counties to come to the Department of Healthcare Services and request authority to take over the state's authority for enforcement of state laws and regulations, that's problematic, but that's okay.

Well, to respond, Mister chair, is that it's not the intent that the cities, for example, take over the responsibility. The Department has responsibility to the extent that the Department does not have adequate capacity and they provide their consent to, for example, a city attorney, to make a site visit with the proper direction from the Department. That is the intent.

So that we're all clear, and this is an issue that doesn't just pertain to Orange County, I'm informed that there are many areas of the state where there are issues with respect to these treatment facilities.

Does your Bill provide a process? In other words, what happens when the, let's say, a city attorney exceeds the city attorney's authority under the delegation? What's the remedy?

Well, the remedy would be just like any other, you know, for example, 1983 action. You can't fire them if the if. Well, it's just like any other 1983 action. If a governmental entity invades the civil rights of an individual, that individual has certainly recourse. And as I indicated before, we'll make clear that that recourse would pertain to the entity that's conducting the site visit.

So, for example, to your point, whether the state would be responsible for a rogue city attorney, they should not and would not be responsible. It would be the city's responsibility.

Colleagues, I'm going to shut my mouth and allow you all to have questions, comments or concerns. Please direct them to the author or the lead witness, Senator Nguyen.

Thank you, Mister chair. I want to first say thank you to Senator Humbert for putting forward this Bill. This has been an ongoing discussion, not just in Orange County. Orange County. Of the 200 plus facilities in California, 61 of them are in Orange County, 61 of them are in Los Angeles County as well. So you're looking at two counties, and Orange County is only 3.2 million people. This has been the number one issue that local government in my district. I represent half of Orange County cities.

This, it could be coastal, it could be inland, doesn't matter. This has become a saturated problem in Orange County. We cannot get the Department to listen to us, to hear from us. They're not coming out. We can complain. We can complain. I mean, even the fact that, you know, when you're talking about the health code section of 1502 a states that, you know, the whole idea of over concentration within 300ft, it's not even being looked at. There's facilities within, and there's multiple facilities.

And so these facilities has been. This issue has been ongoing for almost 20 years, not just in Orange County. And so, you know, bringing this forward, we allow a full discussion in the state legislative body. That has never been. That has not happened for us. And so I urge a support of this so that we can continue that discussion.

You know, I do also want to make another comment is that I know that one of the opposition witness said something about the League of cities, and I'm not here to defend the League of cities, but you mentioned my cities, Newport Beach, hunting Beach have all just left League of cities. Let's stick to one issue at a time. That was because of something else. It's not because of the rehab, because if it was the rehab, all the cities would have left 20 years ago.

You know, there's. So let's stick to that reason. And that's what those cities have stated was because of Prop one issue, not because of not doing the rehab. So I think that's really unfair to make that comment against the league of cities. So I actually. My question, Mister chair, is to the league or the author or the Senator is, can you kind of give us a rundown of what happens when a city five complaints?

Because I want people to know, what are we doing with, why do we even need to have this discussion here. I mean, if Garden Grove, Stanton, whatever, city files a complaint to the Department, where does that go and what does that happen?

I realize this sounds facile, but pretty much nothing.

Thank you.

Can somebody tell me what type of complaint? I mean, I think we need, we're talking about residential treatment facilities, at least in what you propose to be the amended Bill. And so is the complaint that what, what's going on? That there's something other than licensed residential drug treatment going on in the facility, Senator, or is it something else?

Well, I think there's a variety of complaints. One is that they're recruiting, for example, patients from beyond 125 miles, which is current state regulation, recruiting them to come to the facility to basically use up all their insurance and then they boot them out. I think that's the most common complaint. There are other complaints about the facility having way, being way over capacity. That's another common complaint. Other issues are, for example, besides the marketing, the false marketing complaints, for example, drug paraphernalia being left around the area.

There are, because these are treatment facilities, these are not needle exchange facilities. There should not be any drug use in and around the area. So if needles are found in the neighborhood, then there's reason to believe that there's something gone awry in the facility.

I just. Thank you. And that's what I wanted people to hear, is that what does happen to these complaints and why we are where we are today? Because if you think about it, in your own neighborhood, I have 11 year old and a 13 year old. I don't have a facility in my neighborhood, but I don't want my children to be surrounded by needles all over the neighborhood.

Or even incidences in Newport Beach, where someone at 02:00 in the morning ran to someone's home because they were delusional, they needed the help. And we're not here. Any of our cities and the local elected are not here to not support this. The people need help and we are here and ready to help. But there needs to be order.

There needs to be some help for also neighborhoods and residents who live there, who has young children who are older, who needs the help themselves in other ways.

And so this is really going to, is having that discussion and allowing cities to work with the state, not take over the state, because I know none of the city wants to take over the state's responsibility and the healthcare facilities, but this is about allowing local government to respond to their constituents just like any of us when they call their city. The city says, I can't do anything about it, the city calls us Legislator and we go, well, we try. We call, too. We're not hearing.

And that's why we are where we are today. And so, you know, I think going back to, I just want to say thank you for allowing us to have this discussion because this is happening all over the state. A lot of it is concentrated in Orange County. Mainly it's because we have 41 miles of the coast. But like I said, though, it's not just the coast anymore. It's now also facilities who are inland and next door to the coast and all of Orange County.

So with that, thank you, Mister Chairman.

Thank you, Senator. Any other questions? Comments? Senator Menjivar.

I recognize that we do need to have accountability, but Senator Umberg, that's exactly what I'm worried about. The comments from Senator Nguyen, that's what we're going to be hearing and it's going to be weaponized just like that. That is my biggest concern. The Nimbys are going to come out even more. The fear mongering that you just heard is what's going to happen if we don't amend this Bill.

And that was a perfect example of my number one concern of this Bill because I hear it, too in my district. I have some in the residential areas of my district. But, you know, we had a conversation that I'm worried that this avenue will be weaponized. And I understand that we are here to adhere to our constituents, but at times we are boxed in. We don't want these in our neighborhoods, but we also don't want homelessness. We need a, we have to balance that.

And I'm not here to say that we should have indecent XYz happening in our neighborhoods. I like to take walks around my neighborhood and I want to make sure that it's clean. Great. But we're seeing that all over California, right? And if we're pushing an amount of certain areas, one, they're going to be concentrated in other communities, predominantly that look like mine, or we're just not going to have these entities, and then we're going to be going backwards instead of forwards.

And how we're going to address the different kind of issues we're having in California. The new satellite office, how long has it been in place for us to even see if it's had an impact on some of these issues? Do we know? I don't know how long.

So that may be with, I'll address the first part of your question, but as to the second part of your question, I am not aware of any permit being issued in Santa Ana for a satellite office. Let me ask Miss Greendor.

We've been unable in our local area and regional representatives to be able to ensure these people are actually there and have no evidence of that yet, but I'm happy to continue to try to find that. Yeah.

And Mister chair, if I might respond. All right, so your concerns are legitimate, and we have a state interest in making sure that they're adequate, or at least as best as we can do, recovery facilities. And we also have an interest in, for example, making sure that a rogue city attorney doesn't just become the agent of a few disgruntled neighbors.

And that's why we will amend the Bill to make it very clear that the city attorney may only operate under the authority and with the consent of the Department. So to the extent that the Department, which still has primary responsibility, feels as though there are either complaints that are not worth investigating or unwarranted complaints, they withhold consent. So we're not relinquishing our responsibility. We're simply adding another component to the Department to be able to enforce the law.

What would be the first step? The Department asks the city to step in or the city asks the Department for them to step in?

Well, I suppose it go either way, but my guess is that, that the city would be asking the Department most.

Often, does the Bill for future print? Would it be specific to say that the state can come? I would, and I don't know if that's in place right now, that if a Department does need help, which we recognize there are, you know, overcapacity and several issues that they reach out to the city on issues.

So the Bill does not preclude the Department from asking a city and giving authorization and consent to a city.

It can go either way even without this Bill. Can the city, can the Department ask for a city for assistance?

Well, I'm sure the Department can ask the city for assistance. The Department right now cannot, so far as I know, deputize the city to make a site visit.

Does your Bill allow for that? Will your Bill allow for that?

We certainly can do that. I would expect that to the extent that the Department wants to give consent and authority, that they certainly could, and we'll make sure that that's included in the Bill. As I said at the outset, I think the most common occurrence is going to be a city asking the Department to provide consent and authority, and the Department can certainly proscribe that authority, authority in whatever way it sees fit.

And, Senator, can you clarify in the beginning you said you're going to be only doing residential facility treatments, no longer.

Sobering centers, no longer sober living homes.

That's correct. Okay. And you know, Senator, you know, I'll echo what we talked about. A lot of concerns with the Bill. Respect you as an author, and I know you're dedicated to ensuring that your work is fluffed out. I will be voting this Bill out, but I will be reserving my right because I still have some outstanding concerns. And hopefully by the time it gets to us again, it's flushed out.

Thank you. Thank you, Senator.

That's right. Senator Limon, thank you for keeping me on track.

Thank you. So thank you to the author and to the chair. I think that this Bill has generated a lot of robust conversations. So for clarity of amendments as this moves forward, no sober living facilities, period.

Sober living homes, right? Correct.

No sober living homes. But you are including residential.

Well, what is included are.

I just want to know all of the things you're moving forward. Sorry.

Licensed substance use disorder treatment facilities, which are sometimes referred to as recovery centers, but these are not. So to distinguish, it is my understanding that a sober living home is not a licensed facility, and it is a place where individuals reside where they may be getting treatment somewhere else. And so to the extent that a sober living home wishes to establish itself in virtually any neighborhood, this bill does not prescribe that or prohibit that, nor does it authorize a city attorney to make a site visit.

Okay, so it will include recovery centers but not the unlicensed sober living homes.

Yes. And I created some confusion, I think, by designating them as unlicensed sober living homes because as the chair pointed out to me earlier today, by definition, a sober living home is unlicensed.

Okay. But those, as you move forward, will be amended out.

From this and any other things that you can speak on. Sorry, I just want clarification on what the amendments are in addition to this.

Correct.

There are no amendments.

Well, what

I just, I want to remind everyone this Committee does not negotiate amendments from the dais and will not recess to do a bullet point. The bill could have been put over to clarify amendments. So when you vote, you're voting on what's in print, and if for some reason and it doesn't wind up ultimately that way, in the final version of the print in another Committee. You just want to make sure you understand.

Thank you. Sorry. And I just wanted just to take the word of the author in terms of what the. I guess I shouldn't use the word amendments, but I appreciate the clarity. Amendments or amendments? I should use the word of just kind of the issues you're going to work on. Is there anything else that you are going to be working on as this bill moves forward?

So that when I do take a vote, I'm just clear that these are the issues you're going to be working on, but they are not amendments?

Sure. Let me just, as chair points out, I am informed that there's no hearing next week in Senate health. Is that accurate?

We're not going to hear. We don't want to have a hearing on the 17th, we have a hearing on the 24th. And on the 22nd, actually, we have my matter specially set on the 22nd.

Unfortunately, this is double referred. So in that there's not a hearing next week, there's not an opportunity then for the bill to be heard then in Senate judiciary before it can pass on to the appropriations.

I'm not objecting to the conversation. I just want to make sure the record's clear because of problems that we've had in other committees in prior years.

That right. I'm trying to respond to your concern as to why we wouldn't put it over. And I think that's a reasonable suggestion. It just doesn't, because of the timing, because of the fact it's double referred, it doesn't work. In essence, putting it over kills the bill. No, I understand that, Mr. Chair, in response to Senator Limon's question, yes.

We want to make it clear that in the bill, what it pertains to, what it does not pertain to, to address the questions of the Chair, that whomever is conducting the site visit is the entity that is responsible to operate within the bounds of the law. So to the extent that somebody operates outside the bounds of the law and subjects themselves to, you know, civil rights actions and those kinds of things, that would obtain. Two, to use the most common example to the city, number one.

Number two is that this is only with the consent of the Department, and only within the bounds, is authorized by the Department. If the Department should refuse the consent, then there is no authority to make a site visit. And so to be clear, the responsibility for that consent and the primary responsibility for the enforcement of law is the Department.

So if the Department potentially said, we do not consent to X, but we consent to Y, that would be adhered by through the city, potentially, the city.

Only would be authorized to operate within the bounds of the consent, and the authorization of the Department, should they exceed it and cause harm, then that whatever remedy would be enforced upon the city.

Okay, so along those lines, if there is a discrepancy in what an inspection, the interpretation of something that is seen or heard or done or experienced in an investigation, and if there is a disagreement between that interpretation between the city or the state, which supersedes if they are not aligned?

Well, that would be a factual question for a court. So, for example, if the city arguably exceeded its bounds in terms of authorization. So just to use an example, as the chair pointed out, HIPAA. So let's say the city inspected a site and then entered into one of the rooms and decided that they needed to go through an area they thought was a public area. Turns out to be a private area, foot locker or something like that.

Turns out it's a foot locker and that there's an invasion of privacy and that the individual whose privacy is invaded then sues the city and the state for this invasion of privacy, that the court would have to determine what the bounds were of the authorization and whether the city exceeded those bounds. If the city exceeded those bounds, then they would be responsible. If the state was negligent that didn't actually use due diligence in authorizing the city, then there could be other liability.

But that's true of anything. I mean, that's basically true of any. So, for example, in law enforcement, there are often joint task forces between the state, the Federal Government, and a local city. And if there's a violation, if someone commits a civil rights violation, then it's up to a court to, in a finder of fact, a jury to, for example, make a determination as to who is responsible.

And I appreciate that. And I think one of the concerns I heard from the chair and that I share as well is if there are ways that this law can, you know, should it move forward, be written in such a way that it makes it easier for the court to determine and not hold the state liable for, you know, where appropriate, the issues between the city and the state. And I think that that's one of this.

And I appreciate that part of this discussion has generated that there is a higher concentration in certain parts of our state. Therefore, you see a lot more engagement and feedback. And really, you know, I think we've given Orange County as the example, and so there's just more experiences there. But at the same time, this is statewide, and this will have statewide implications.

And my concern is not, you know, not just putting it on the state, because the balance and the weight of what it feels like is probably different in all 58 counties. I mean, the examples that were given is that two counties primarily are bearing, you know, kind of the brunt of this or half, right. And so I want to be respectful of something that's. That's, you know, again, going to have an implication for the entire state.

And I would agree that if there are ways that this law can be written to make that clarity and make it easier for the court to determine that the intent was for, if a city does it, a city has to take kind of ownership of this right. That that would be something that would be, of course, that I would support. But you know, I don't know how others will weigh in.

So, Mister Chair, if I may respond.

Of course.

So we will make it clear that the city or whatever entity is authorized, is only authorized to perform its duties within the bounds of that authorization, and should they exceed it, that they will bear responsibility. I also would expect, although this is a law that applies to statewide, that in counties that don't have any of these facilities, you're not going to hear, there's not going to be complaints. And so to the extent that there are counties that have zero facilities, you will have zero issues, right?

Yes. So I will be supporting this today. I think it's an important issue. Certainly. I heard from you as the author how important this is. I think, like others, supporting it with some concerns and some pause and not knowing if this was the right step. I share, you know, some of the concerns that our chair has expressed, and I hope that as it moves forward, there will be ongoing conversation.

I know you know you're going to work on that, but this is a difficult one to be able to vote on today. But I understand how important it is to at least attempt to do something and have a bill imprint that requires legislative conversation, with input, with analysis, for purposes of the district.

Thank you, Senator Rubio.

Thank you, Mister Chair. This is very difficult for two reasons. Let's just start with the author and the chair. I respect the chair so much, and, you know, and I know it's very thoughtful. Every time we come here, you know, the amendments he takes on any bill, I tend to almost agree 100%, because, you know, that's how much time it takes to get to a good place. And at the same time, I respect the author.

I know that when you engage in legislation, you're always looking at it not only as a Legislator, but your legal mind as well. And so it's difficult because we were told not to, as the chair put it, negotiate from the dais. And I actually have personal experience of letting a bill out, someone not keeping their commitments. That was very, I think you all remember that.

And there was, you know, I had to pay a price for it in my district, but because it is difficult, it is double refer. I know you're trying to get to a good place, but I want to consider it. But I have a couple of questions, and I'm sorry, I did walk in a little late. I was working on another Committee. You have language here that says unannounced site visits. Can you tell me if you address that? Is there any change in that language?

So currently the Department can make announced or unannounced site visits. And to the extent that they are conferring authority and permission on a city attorney, they can restrict that if they wish. The Department can say only announce visits or both.

But right now, we're giving a little bit more, I guess, authority to the cities, right. We're letting them sort of take control of this issue, as they were putting it. Right?

We are not giving any additional authority to cities at all. The authority that exists is not expanded by this bill. The authority that exists currently resides in the Department. So to the extent the Department, in essence, provides some authority and some consent, they cannot give more authority than the authority they currently have. So, for example, if the Department does not have the right to invade someone's HIPAA's HIPAA, invade HIPAA rights, the Department doesn't have that right.

And if the Department said city, have at it, go through any record you like, that would be beyond the authorization. And to Senator Limon's question, yes, if, if the Department did that, they would probably be also jointly and severally liable with the city if they simply authorized the city to do something that they weren't authorized to do.

You know, and I'm trying to understand the issue. This is not something that I deal with every single day, but I do have a little bit of reservation in terms of something that I saw in my own district, you know, where the neighboring city neighborhood was complaining about certain facilities, and it almost became almost like a mob mentality where they kept harassing, you know, people in these facilities.

And so I almost, you know, when I hear things like, you know, unannounced site visits, you know, I just remember how hard my community worked to try and get these, some of these facilities out. It was just constant harassment. So I want sort of clarity, and perhaps I'm not understanding the post, so that's probably my fault that I need to, I would like to see, I do want to support in the sense that I know it needs to happen.

I really hesitate because I always refer to the chair, and I know how strongly we feel about having things done before they come to committees. But this issue kind of doesn't sit well with me because I just remember the harassment of these facilities constantly by some of my community members. They just, they could have done anything, but they just wanted them out. So they were always being harassed.

And when it says unannounced site visits, I like to see some kind of guidance or some reasonable cost to visit and continue to, you know, to be present. That's because there's reasonable cost to believe that something is not in the up and up. So I don't want to repeat what everyone says. You know, I've heard the entire debate, and, and I just go back to what Senator Limon stated.

We need a little bit more clarity because then you're trying to point the fingers and see who's at fault or who do you blame. And that's an area that you need to tackle. But I do want more time to talk to you about it. I know we attempted several times, and it's just been crazy. As we can all attest, we're juggling 34 different committees. But I will, you know, again, with hesitation support the bill.

And my apologies to the chair, because I always refer to the chair. But I want a more in depth conversation, and I hope that we can get to a place that all the concerns are answered. And if you're okay with that, I will be supportive.

Let me. I'm sorry, Mister Chair.

Thank you, Senator Rubio. No apology necessary. I don't ask people to vote any particular way. And I thought I made that clear. So don't worry about it. Senator, you had something to say?

I was going to say that these are fair points to the extent that, for example, there appear to be harassment by individual neighbors, by multiple complaints, certainly the Department should take that into consideration. I would expect would take that into consideration in granting consent and authorization. To the extent the Department says, look it, you can make only announced visits or you could make an unannounced visit between the hours of 10:00 a.m. And 2:00 p.m. They certainly, they have the ability to do that.

This bill doesn't give any additional authority, so they can do that. And, you know, just like in all cases where we expect the state law enforcement or other state entities to act with reason, we would expect them to act with reason. And if they demonstrate that they don't have judgment, then it's our responsibility to come back in and restrain their judgment.

Yeah, thank you for that. And my apology to the chair. He never does tell us how to vote, but just out of respect, you know, I do value his thoughtfulness, and I know that when he speaks, it means something. And when he's not on board on something, there's a really good reason. So I do take that very seriously. But thank you for answering my questions. I will be supporting it today.

Thank you, Senator. Senator Grove, you're up at bat.

Thank you, Mister Chair. First, just on a side note, I'd like to thank the chair. That speaks volumes for integrity, because that is not always what happens in committees. When the chair says no, it's a no go. And so that is a man of honor sitting to my right that allows opposing conversation to take place in his Committee and support of a bill that he is opposed to. And I just want to recognize that. I've been listening to the conversation.

I understand where my colleagues are coming from in the questions that they want answered. I think the chair brought up some really good questions. But the way I read this, and I'm just, and I went through it because I heard, you know, not the scuttlebutt, but the way the Committee could go. So my understanding is, and again, just correct me if I'm wrong, you're aligning, you're aligning these facilities with adult treatment court, best practice standards. No?

I don't know. I suppose I can ask if it, if it is aligned. Exactly. Adult treatment court. Is that okay?

Got it. I got it. Okay. I apologize.

Different bill. Okay. All right.

Okay. I wasn't here. I had separate committees.

No, no, I, listen, I do that all the time. I.

Okay

I just pray for when I present the right bill when called upon.

So that's okay. I have my notes on this one too. So I'm like looking best practices. But I apologize. And I apologize, Mister Chair, for not having that. So I have a treatment facility in the Central Valley area. Not, I only have one or two. I don't have a lot. So I have a treatment facility and I do get calls from my office. Look, they're in my front yard. It's 03:00 in the morning. What can I do?

And because do there are sober living homes, unlicensed that are constitutionally protected under that issue or that standard, there is not a lot that can be done. And then there was one time where I talked to the law enforcement individuals and they were saying there was a huge altercation because the neighbor had just had enough. So I get what you're trying to do. Again, I don't have the majority. My colleague, the Vice Chair said that they have 61 of these facilities in Orange County.

I don't have those. But I do think that obviously local ordinance, they allow these homes to be there. I think these homes are significant. They need to do that. We used to have them go to our, I mean, realistically, before propositions were passed in this state, they'd be arrested, you know, put in jail for 30 days, get wrap around treatments. They'd solve the problem in an isolated facility that didn't do this. But now we have a different compassion, I guess, for individuals in this.

And correct me if I'm wrong, but I do think that the people who live next door to them or down the street from them or on the way to that facility have rights as well. And I think bringing some clarity into the regulatory piece of this makes sense, specifically just from life experiences where I've had people call my office regarding this. Again, nothing against the chair I loved. I understand what he's saying.

I listened to the arguments here, but I just wanted to make that statement that that's what I thought it was. Is that accurate, like.

Well, yes, it is accurate that we are focused on the licensed substance. I want to be sure that I don't create additional confusion here. Licensed use disorder treatment facilities, sometimes referred to as is recovery centers. So the confusion, I hope I've eliminated at least some of it by eliminating the portion of the bill that made reference to sober living homes.

So this doesn't deal with sober living homes. That may be an issue for another day, but this doesn't deal with those.

Yes.

Yes. It's licensed treatment facilities in a neighborhood.

That's right.

Basically.

Well, wherever.

Wherever, wherever. Thank you, sir.

Thank you, Senator Grove. Senator Menjivar.

On that same point, Senator, recovery centers, I thought we had heard a bill here. Recovery centers aren't all licensed.

So this would only apply to those that are licensed.

Got it. Thank you. And who currently inspects these facilities under DHCS?

No one. I mean, that's. I can defer to the league, but there's virtually no enforcement going on. So that's what the challenge is.

There is a way to file complaints with the Department, and then they have inspectors who will do inspections, do unannounced site visits, and take enforcement action.

What title do they have or background?

I'm not an expert on that.

Meaning, we're asking attorneys to inspect. Do they have the expertise, like the inspectors under the Department to inspect? Do they know what they're looking for? Is this going to require extra training of these attorneys?

So. Well, one, it doesn't necessarily need to be an attorney, number one. It would be, the bill would envision that, for example, a city attorney's office would have then been authorized to perform a certain site visit. And your point's well taken is that the Department is required to basically establish the policy and the qualifications of those who would be conducting the site visit. So it would be, and I was a bit facile before, but the enforcement is negligible. So when I say none. It's just negligible.

But in theory, if the program was working well.

Well, the program is, I don't believe, the one thing I do believe is the program that the Department is, does not have the capacity to basically enforce the law today. And thus, if it is being enforced, it is negligible.

I know, Senator, we've given you a laundry list of things that your staff is jotting, and I'd like to add one more final thing. If we can look at the titles or the experience of the individual, should this bill make it of who it's going to inspect and what knowledge that individual is going to have of these facilities?

So to your point, I am not an expert in this area. I believe that the Department, they should, and I think they do have expertise in this area. So I would require them to actually develop the criteria and the qualifications for both the site visit as well as the criteria and qualification for those who conduct the site visit.

We would expect, to the chair's point earlier, if the Department simply says, you know, you can have anybody conduct a site visit, and it turns out that you have unqualified people who are running roughshod over people's rights, that that could iner to the state's liability. But I do have confidence that the Department could create the guidelines so that the city attorney then could enforce those guidelines.

So, for example, if the Department says everyone must have the following qualifications and the city simply ignores that and operates as a rogue agency, that they then assume whatever liability might occur.

Okay, thank you.

Any other questions? Comments? Senator Nguyen.

Thank you, Mister Chair. There was a comment from my colleague in Los Angeles earlier in response to my comments, I just want to make it clear we are not here from Orange County saying we don't want any. That's not it. We know that every one of us are responsible and need, and there's individuals out there who needs the help. Facilities should be open.

What we're asking for is just to allow us to partner with the state agency to give us their guidelines to help us work within our communities. That's it. We're not asking for anything more. We're not asking, you know, to completely say, shield Orange County from ever having facilities again. No, that's not the comment that I made at all.

This is about being good neighbors and also being good citizens working together in the community, whether that's the facilities and the neighbors, and that's what it really comes down to right now. Cities feel that they're handicapped. They call and cry and scream and no one is hearing and the state's not hearing. There's no enforcement. And if there is, you know, as the Senator, the author stated, that it's probably very sparse or not in existence.

And so, you know, I just want to make it clear that again, we in Orange County want to be there. We're here to help, but we also want some help. We need to be able to work with the Department and allow us to answer to our constituents as well.

Thank you, Senator. Just for the record, the statistics that have been provided to me between fiscal year 2018 and 2022, DHCS averaged 595 complaints annually for about 1750 substance abuse treatment facilities. And the average time to close a complaint has dropped in the last two years from 245 days to 114 days.

Just for the record, for people who don't think the Department of Health Care Services is doing anything. You know, Senator, as you move your bill forward, and I'm sure there'll be a motion and it'll move forward in looking at your bill, what happens after the site visiting.

So, for example, if there's an enforcement, actually, they find out that there's a violation of the law at that point in time, again operating within the authority of the Department, then whether the Department authorizes the city attorney, for example, to take that facility to enact exact, whatever remedies currently are available in the law, that's what would happen. Or the Department could do that. But again, ultimately, it resides in the Department to enforce the law.

Well, the way the bill is currently drafted, as I read it in Section 11834.01, it authorizes nothing beyond a site visit. So should this pass in its current form, all that's authorized, if the Department authorizes it, per a request, is to allow a city or county to conduct an unannounced or announced site visit. And frankly, the bill currently authorizes that. It looks like only with respect to unlicensed sober living homes.

So I guess what I'm telling you are suggesting or saying is, to the extent that this bill has substantially changed in the Judiciary Committee, I don't know what the Health Committee may choose to do. Because if there's substantial change from the current language in the bill that enhances the activity of a city attorney or a District Attorney beyond a site visit, since we haven't seen any language, we may have to look at it again.

And I understand that Mister Chair, and let me again, sort of underline a point that was earlier made. I know that you, Mister Chair, and I know your staff takes a great deal of pride in the work that they do, and when there are significant changes made without the opportunity to fully analyze, it puts you in a bind and puts your staff in a bind. And I am sorry for that. One of the reasons is that we could not put the bill off.

Number two is that, and many of these changes are responsive, either the Committee's concerns, which were legitimate, or to individual Member's concerns. And so, again, to the extent that the chair looks to see what the bill looks like in print when it comes to Judiciary Committee, then if the chair has continuing concerns and wishes to bring it back, of course, you know, we defer the chair's prerogative.

I have a good relationship with the chair of judiciary, and I think I can commit that Committee to make sure that we provide you whatever information.

I just wanted to point out to you, I don't think your language does what you're talking about, and you may want to take another look at it.

No, I think you're right.

Because you'll be back in the 114 days to complaint resolution.

I think you are correct that we. That the bill has significant amendments and significant, significant changes. And what I've tried to do is I've tried to express to the Committee, before the Committee votes what my intent is in terms of those future amendments. I understand that it's certainly appropriate for you and your staff to review in writing what those amendments are so that you can analyze whether it's consistent with your concerns.

Any other questions, comments? We have certainly taken the time with this one, but it deserves the time. So, Senator, great presentation. May I have a motion, please? It's been moved by Senator Nguyen. Please call the roll. Oh, the motion on the bill is do pass and re refer to the Committee on Judiciary.

[Roll Call]

The bill has five voted. We'll hold the roll open for absentee Members.

Thank you, Mister Chair.

Senator Becker, item number 10, Senate Bill 1120.

Good afternoon, Chair and members. I'm here today to present SB 1120, the Physicians Make Decisions Act. This is a bill that takes a critical step forward in ensuring fair and accurate healthcare decisions for patients in California. I'd first like to thank the Chair and committee staff for their work on the bill. I will be accepting minor technical amendments from the committee today.

Put simply, this bill requires physician oversight when algorithms are used to decide on healthcare providers' requests to offer medical services. This is a necessary safeguard to address the growing use of artificial intelligence in health insurance processes, such as claims and prior authorization requests. With me today, I have Doctor Anna Yap at UC Davis Health Emergency Medicine, and we also have George Soros from the CMA available for any technical questions. Thank you.

Good afternoon, Chair and members. I am Doctor Anna Yap, here today, representing the California Medical Association as the proud sponsor of SB 1120 relating to artificial intelligence in healthcare. We want to thank the Committee for hearing this bill today and a special thank you to Senator Becker for authoring this important measure.

Artificial intelligence is a popular topic that has grown immensely over the past couple of years, but in the practice of medicine, we have been using AI for years to assist with diagnosis and testing, which is why the physician community often refers to artificial intelligence as augmented intelligence. In general, physicians are enthusiastic about the potential of AI in healthcare, but we also want to guarantee it's done in a safe, responsible, and ethical manner for our patients.

SB 1120 takes a step in the right direction by requiring that any denial or modification of care in a health plan prior authorization process must be overseen by a human physician and that any AI tool that is used to support physicians in utilization review processes must comply with federal standards for freedom from bias. This includes excluding biases that discriminate against an individual based on their gender, race, or other identities.

AI can be a powerful tool for supporting physicians in making clinical decisions, but we must be aware that they can be deeply flawed. AI models used by physicians to deduct diseases such as cancer or suggest the most effective treatment are evaluated by the Food and Drug Administration.

But the AI tools targeted in this bill, which are used by insurers in deciding whether those life-altering treatments should be paid for, are not subjected to the same scrutiny and have little independent oversight, even though they also influence the care of our nation's sickest patients. No matter how smart the technology is, it is dependent on the underlying data sources that it learns from. If those underlying sources are flawed or biased, it can create disaster outcomes for our patients.

That's why we need the knowledge and experience of a physician to make the final decision. This bill builds on other similar efforts at the state and federal level. In a final rule issued earlier this year called HTI-1, the Federal Government put rules in place for certified health information technology tools to ensure that they are free from bias. Several bills currently in the assembly call for transparency around data sources and algorithm and data sources.

SB 1120 guarantees that incredibly important and sensitive decisions are made by a human physician. This is a key piece of legislation to allow us to provide some important specific rail guards as AI develops in healthcare. As the leaders of the healthcare team, we bear the ultimate responsibility for the treatments that are administered. And it is important that physicians, not computers, can make sure that our patients get the care that they need. Thus, I respectfully request a vote on SB 1120, the Physicians Make Decisions Act.

Thank you all, and I'm happy to answer any questions.

Thank you very much. Next, please.

Perfect. Are there any other witnesses in support? Name, affiliation and position on the measure, please.

Just here to answer any technical questions, George Soros is with the California Medical Association.

Thank you, Chairman. Members: Tim Madden, representing the California Rheumatology Alliance in the California Chapter of the American College of Cardiology and support.

Thank you, sir. Next, please.

Good afternoon, Chair and members. Kim Stone. Stone Advocacy, on behalf of the California Orthopedic Association, in support. Thank you.

Thanks for coming. Next, please.

Leah Barros, on behalf of California Hospital Association, in support.

Thank you. Next, please.

Grace Copeland, on behalf of Providence Health and support.

Thanks for coming. Next, please.

Jennifer Snyder, with Capitol Advocacy on behalf of the California Life Sciences, in support.

Thank you. Next.

Sara Noceto, on behalf of the ALS Association, in support.

Thank you, ma'am. Next. Yes, sir.

Randall Hagar, on behalf of the Psychiatric Physicians Alliance of California, in support.

Thank you. Any other witnesses in support? Okay, let's move to witnesses in opposition first. Any lead witnesses?

Sorry, our position is a concerns position right now. So, Robert Boykin. Good afternoon, Chair and members of the committee, Robert Boykin, with the California Association of Health Plans here today in the concerns position. We would like to thank the author's office for early engagement on the bill.

However, the bill has changed substantially since it was introduced in February. We're still reviewing the most recent amendments and may update our position should the bill move forward today. Our main concern is that the current language appears to be overly broad and not easily applicable in the healthcare space. Additionally, we are concerned with the provision of the bill requiring that our AI systems and software be open to inspection.

Our concern here is that the bill does not clearly define who could access and inspect these systems, which could create potential privacy and proprietary concerns. But let's be clear. We want to note that currently, health plans use automated tools to assist in decision-making, reduce administrative burdens, and increase efficiency, and do not solely rely on these tools to make healthcare decisions. There is and will always be human involvement when making these decisions.

We look forward to further conversations as the bill moves forward with the author's office and other stakeholders. Thank you for your time today.

Thank you. Next please.

Steffanie Watkins: on behalf of the Association of California Life and Health Insurance Companies, I'd echo my colleague's comments in the interest of time. We, too, have a concerns on the position on the bill. We do have some additional points that we'd like to discuss with the author about some of the most recent amendments regarding how providers can review the prior authorization requests, and we look forward to those conversations if the bill moves forward today. Thank you.

Thank you. Next please,

Mister Chairman and members: John Winger. On behalf of America's Health Insurance Plans, also have a concerns position, but look forward to the conversations. Thank you.

Thank you, sir. Any other witnesses in opposition or concerned? Okay, seeing none. Let's bring the matter back to the dais and my colleagues for questions, comments, or concerns. Senator Grove.

Thank you, Mister Chair. You know, AI technology is pretty cool when you use it and scary at the same time. And I know that it saved us time in the real world. I'm a business owner, and we write policies a lot, and you can plug some stuff in, and the policies come out, and they're, you know, we had them first checked by our legal team, and they're like, "Yeah, they're perfect." And it saved hours and hours of time.

That's way different than having a doctor, a computer talk to you about your physical or your medical issues or anything like that. So just like, you know, self-driving cars, I think that's a great new technology, but I want somebody behind the wheel. I like the AI situation. I think it's pretty beneficial in some areas. But I want a doctor looking at me, my family, and I'm assuming, you know, overseeing what's going on. So honored to support the bill today.

I think it's common sense, and I think that next year, we'll probably see a lot of AI bills as fast as that piece of technology is moving. Thank you, sir. Thank you, Mister chair.

Thank you, Senator. Any other questions, comments or concerns? Okay, Senator, you may close.

I appreciate those comments from the Senator and respectfully asked for an aye vote.

Okay. The motion is do-pass as amended, referred to the Committee on Appropriations. Please call the roll.

[Roll Call].

Bill has four votes. We'll hold the roll open for absent Members. Thank you, Senator Becker. Senator Min, you are here on item number five, Senate Bill 1078, language access. Please proceed when ready.

May I proceed, Chair? Mister Chair. Thank you. Chair Roth, Committee Members, before I start, I just want to make clear that I'm accepting the prose Committee amendments and want to thank the Committee staff for their work on the Bill.

SB 1078 would create an office of language access within the California Health and Human Services Agency, CalHHS. This office would provide oversight, accountability, and coordination across CalHHS's departments and offices to ensure individuals with limited English proficiency have meaningful access to its programs and services. For the nearly 6.4 million Californians who have limited English proficiency, language barriers pose a significant challenge to their ability to have access to quality healthcare coverage and services.

Studies show the absence of culturally and linguistically appropriate healthcare services have negative health outcomes for individuals in this situation, including longer hospital stays and higher likelihood of hospital readmissions. These avoidable clinical costs can be significantly reduced with improving interpretation and translation services. And while California has long recognized the importance of providing in language resources, this often doesn't get translated within our significant bureaucracy and have not been implemented in an effective way.

SB 1078 would help ensure implementation and monitoring of existing federal and state language access laws and close an existing gap for those seeking access to the broad spectrum of health services. Today, I have with me Julia Liou from Asian Health Services and Doreena Wong from Asian Resources, Inc. to testify in support.

Please proceed.

Good afternoon, Chair Roth and Senate Health Committee Members. My name is Julia Liou. I'm the CEO of Asian Health Services and one of the co sponsors of SB 1078. Asian Health Services- we're a community health center that provides medical, dental, and behavioral healthcare services to 50,000 low income patients in 14 Asian languages. We started 50 years ago because we saw that language was a key barrier to healthcare access.

Many of our patients, they travel 30 to 50 miles just to access our services because of the language barriers that they experienced. My own grandfather was also a community health center patient, received services in in his own language and avoided a lot of ER visits because of that, because of his health issues. When we saw that California embarked on the broadest distribution of COVID vaccinations, we saw how language barriers really hindered community members with limited English proficiency from accessing life saving vaccines.

The state's vaccine website had a lot of translations full of errors. Mass vaccination sites promised translations for languages beyond Spanish, but our own staff and our own community members were unsuccessful in getting interpreters in Asian languages. We were able to stand up our multilingual multicultural testing site in 10 Asian languages, but we saw overall how the impact of lack of language accessibility just really challenges with individuals with LEP.

They were three times more than likely to test positive for COVID, and those who were hospitalized were 35% more likely to suffer health outcomes compared with English speakers. These health inequities could have been mitigated. There's been a lot of challenges, and we'd like to avoid that moving forward. We've been very encouraged by the Governor's 2022 executive order that directs CalHHS to develop language access plans to improve access to their services.

Yet there's no mechanism or entity charged with oversight and accountability for the development and implementation of these plans. There lacks transparency for the public to know how and when these plans are developed and what progress has been made. With recent data indicating that 29% of individuals with limited English proficiency do not have a usual source of care, it's even more critical that SB 1078 be passed to ensure greater accountability and accessibility to CalHHS programs and meaningfully reduce racial and ethnic health disparities in our state.

SB 1078 currently has over 70 organizations representing Asian American, Native Hawaiian Pacific Islander, African American, and Latinx communities in support of this Bill. Thank you, Chair Roth and Members of the Committee for your time today.

Thank you. Next, please.

Yes, hi, good afternoon, Chair Roth and Committee Members. My name is Doreena Wong. I am the policy director at Asian Resources, Inc. We ask for your support of SB 1078, which will improve language access for limited English proficient, or LEP, Californians. Since 1980, ARI has provided over 30,000 direct services to Asian Americans, Native Hawaiian, Pacific Islanders, immigrants, limited English speakers every year in our offices in Sacramento and LA. We also advocate for increased cultural and linguistic access to health and social services programs.

Like AHS, we have seen firsthand the serious language barriers that our clients face. Our staff has seen long wait times, sometimes over an hour or more, when they try to talk to the county eligibility workers during the Medi-Cal renewal process, especially during the Department of Healthcare Services public health unwinding. So this has caused Medi-Cal terminations and loss of health care coverage and Services.

So these language barriers, as you have heard, can cause health disparities, adverse experiences, and significant harm, and has caused significant harm to our LEP community members. So SB 1078 will contribute to improved communication and, as Senator Min and Julia has pointed out, can avoid costly healthcare costs. The Bill would also bolster the federal and state statutory language requirements by codifying CalHHS language access policy and the language access plans.

Currently, as Julia pointed out, there is no mechanism to require or monitor the plans to coordinate the language services across the agency or enforcing the provisions of the plans. So this will create a centralized office that would monitor the effective implementation of those plans and issue corrective action plans for those noncomplying. It would also provide and inform LEP communities about critical CalHHS's resources on its public website and allows smaller language populations to request the translation of vital documents upon a written request.

And then finally, there would be increased accountability of CalHHS by requiring regular reports to the Legislature about its progress and also to create a language access advisory stakeholder group so that they could provide community input. So, in conclusion, for all those reasons, we think that the 1078 will improve, will address the current systemic barriers that many communities face, and urge your support of SB 1078.

Thank you, ma'am. Any other witnesses in support? Name, affiliation, and position on the measure, please.

Abby Alvarez with the Regional Pacific Islander Taskforce, the Center for Asian Americans in Action, and the Orange County Asian Pacific Islander Community Alliance.

Thank you. Next please.

Rebecca Gonzales, Western Center on Law and Poverty in support.

Thank you.

Hello. Faith Lee with Asian Americans Advancing Justice, Southern California. We're in support. Thank you.

Thank you very much. Next, please.

Hi. Mar Velez with the Latino Coalition for a Healthy California in strong support.

Good afternoon, Mister Chair and Members. Dennis Cuevas-Romero with the California Primary Care Association Advocates in support.

Thank you. Next.

Thank you. Yes, sir.

Kevin Aslanian, Coalition of California Welfare Rights Organizations, strong support. Thank you.

Thank you, sir. Any other witnesses in support? Let's turn to witnesses in opposition. Any other opposition? Any witnesses in opposition, lead or otherwise? Seing none. Let's bring the matter back to the dais. My colleagues, questions, comments, concerns? Anyone? Senator Nguyen.

Thank you, Mister Chairman. Senator, I appreciate the Bill, and I will be supporting it. One thing, I hope the new office of language access also consider the different languages within that community. For example, within the Vietnamese American community, those who were educated prior to 1975 understands different language and different wording.

And so we actually been having a lot of difficulty with a lot of state booklets and manuals of Vietnamese that a lot of our older generation cannot understand because the translation right now that's being used tend to be more of a Google translation, and it's so not the same. And those who are educated after 75 has a different education and in terms of the language of the Vietnamese language than those who are older.

And so I hope that the new office would take that into account and making sure that we have the language so that those who most likely need, or the older generation, would be able to read and understand what our intent is or trying to explore whatever that program is or if there's a test to it as well. So I will be supporting, and I hope that as we move forward, that that's taken into consideration. I don't know about the other languages. I'm just more familiar with the Vietnamese language. So thank you.

Thank you for the comment, Senator. And I think one of the reasons we're trying to put this together is to ensure that there is culture, as they say, culturally competent programming available. It's not just Google translate at the end of the day.

Thank you.

Thank you, Senator. Senator Menjivar.

Senator, thank you so much. I know that the Department has tried and put some action plans together, and your Bill is going to complement the efforts of the Department. I really appreciate you bringing this Bill forward.

Thank you, Senator.

Thank you, Senator. Any other questions, comments, concerns? Seeing none. Senator Min, would you like to close?

I respectfully ask for your aye vote.

And who moved? Senator Menjivar moved the Bill. The motion is do pass. Re-refer to the Committee on Human Services. Amendments being taken in Human Services. Please call the roll.

[Roll call]

Well, that's four votes. We'll hold the row open for absent Members. Senator Eggman, Senator Wahab has been sitting here for a while. You have more than one Bill. Would you mind if we take Senator Wahab? Why don't you flip a coin? Thank you, ma'am.

Rock, paper, scissors.

So, Senator Wahab, I guess that means you have to speak quickly. This is item 15. Senate Bill 1355, Medi Cal in home supportive services. Redetermination. Ready. Please proceed when ready. Yes.

Thank you. Thank you to Senator Eggman for giving up her spot real quick. Chair Roth, colleagues and Members of the public, I thank the Committee for their Amendments and thank Chair Roth for his support of the Bill. I'm here to present SB 1355, which extends the eligibility of medical benefits for in home support services recipients to every three years instead of annually. Every year.

The most vulnerable of an already vulnerable population lose benefits because they did not submit their information in time or lack knowledge, access, and assistance with an administrative process they may find intimidating and cumbersome, especially monolingual individuals, immigrants, and others. Extending the eligibility period will ensure that the public population who rely most on it will see fewer interruptions of their benefits. Long term care and aging experts agree that any changes in income for medi Cal beneficiaries on ihss are too significant to warrant yearly applications.

SB 1355 is modeled after existing law, which allows continuing Medi Cal eligibility for children up to five years of age without conducting redeterminations during that period. It its use with other medi Cal populations has already proven it is possible to conduct redeterminations without yearly applications by Medi Cal beneficiaries on IHSS.

I specifically want to say that IHSS has the lowest threshold for people to be able to partake in that program, specifically selecting somebody that can provide culturally competent care, especially to our immigrant communities, our lower income communities, and we, again, have an aging population. And this is one of the safety net programs that so many people rely on. So I would like to introduce my witness, Kevin Aslanian, Executive Director with the Coalition of California Welfare rights organizations.

Good afternoon. My name is Kevin Aslan Kohler, California Welfare Rights Organizations, and we work with a lot of IHS clients who have very often have problems with this enrollment. And the DSS. Department of Healthcare Services publishes reports about enrollment. And during January of this year, 108,000 Medi Cal recipients were disenrolled because they did not complete their renewal. 42% of those disenrolled during a survey done by Department of Healthcare Services said that they never got the renewal form. So how could they re enroll?

64% of them completed the form and sent it back to the world, to the system. It got lost in the system. It's kind of nutty. 35% of them tried to call up and go through the renewal system, and they couldn't get the call center, just drop their call. And the major victims of these are mostly Hispanics that this happens to. So this Bill basically would just give people three years. And most of the people on fixed income, you know exactly what they have.

And the med system shows if there's a COLA increase, it's there. The government knows that there's nothing to look at. And I urge you, I vote. Thank you. Thank you very much, sir. Any other witnesses in support, please step forward. Name and affiliation and position on the.

Measure, please chair Kathy Mossberg with the local health plans of California in support.

Thank you. Any other witnesses in support? Now let's take witnesses in opposition. Are there any opposition? Witnesses in the hearing room seeing none. Bring it back to my colleague. Senator Grove moves the Bill. Senator Wahab, would you like to close?

I respectfully ask when I vote.

The motion is do pass as amended. We refer to the Committee on Government Organized Governmental Organization. Please call the roll.

[Vote]

Bill has two votes. We'll hold the roll open for absent Members. Senator Eggman, thank you very much for your patience. You're here on two measures. First is item number seven, Senate Bill 121238. Lanterman, Petra, short act designated facilities.

Thank you very much. I hope it wasn't something I said that all the Members left.

It was something I said, Senator.

Was it earlier on, and this has to do with the subsidies disorder treatment centers, but not related to the earlier one which was presented here. I am presenting SB 1238, which you might remember, last year we passed SB 43, which redefine what it means to be gravely disabled in the State of California. Since then, we've been, you know, well, realizing that there's going to be some cleanup legislation that's going to have to happen.

And so we're here today with the first thing that we've heard that has become a real issue is the issue around facilities, of course, and we know we're building them out. We have six round, I think, of b chip Prop one pass. More will be coming, often being able to designate which ones that people can go to.

Since a standalone subsequent diagnosis is now eligible for that kind of admission, the criteria at the facilities and what is allowed through the Department does not quite track with that. So what this is, is going to allow different sorts of facilities that the county can designate. In each county. No county will be required because, like a SNF may be able to do it in one county, but in another county, that might be totally inappropriate.

So this all goes through the county designation of which facilities they think will be that place that will take that patient who might have a standalone substance abuse disorder diagnosis trying to come out of the ER to be able to get then into our system. With me here today is the head of the emergency room Association, Doctor Gertz, like Hertz.

Sir. Doctor, please proceed.

Hi. I'm Michael Gertz. Thank you for having me. I'm an emergency physician in the Antelope Valley. I'm also the President of California ACEP, a cosponsor of the bill. This Bill is about creating options and flexibility to counties to identify and develop safe therapeutic places for people with severe substance use disorder to recover. As noted by Senator Eggman, the population eligible for involuntary treatment has expanded. It now includes people with just substance use disorders and no comorbidity of mental health disease.

Otherwise, this population deserves access to dedicated treatment facilities. The ED should not be the only option for people at highest risk for substance use disorder. Our eds have done a lot of work over the past few years to become a welcoming place for patients with substance use disorders to begin treatment. As emergency physicians, we are passionate and dedicated to providing 24/7 open door access to everyone in our communities. But recovery takes time and space. 72 hours is too long for anyone to stay.

In an emergency Department, we are always open, which means the lights never go off, the alarms never stop ringing, and the ambulances never stop rolling in. Sleep deprivation, overstimulation, none of these are helpful for people looking to find recovery with serious substance use disorders. Counties need the flexibility to identify options so patients can have a safe, quiet space to recover and so that we can keep our emergency departments open 247 and have access to everyone. Thank you, sir.

And also today with me is Randall Hagar with the Psychiatric Physicians Alliance in California.

Sir. Thank you, Senator Eggman. Thank you, chair, for allowing me to give testimony today when AB, I'm sorry. SB 43 was enacted. We did a survey of our membership across the state, and we do have Members who are medical directors and facilities of all sorts. And the feedback we started getting was that there was a particularly vexatious issue in the local counties with the passage.

They were kind of freaking out, if you will, about the whole issue of how you deal with substance using individuals who have become greatly disabled. Local officials were not sure where to send them, what kind of authority would be found locally to effect transports and treatment. But what we did find is that many of the licensed facilities that are currently certified by counties and approved by the state in local jurisdictions are already treating this population in a very special respect.

In that respect is that they have co occurring disorders, they have a severe mental illness, and they also have their substance use issue on board. And those people do get access to the treatment facilities that are certified to allow treatment and evaluation for people with severe mental illness. So in a sense, that gave us the idea that maybe what we needed to do, because there's still a population, population out there that has a sole diagnosis of severe substance use disorder.

And what we needed to do was create the capacity for counties to be able to certify facilities for the treatment of them. What we did find in our efforts to look for a solution was that there are several kinds of facilities where regulations specifically prohibit the admission of people with the sole substance, substance use disorder. And so it seems simplest to basically to think about conferring discretionary authority on counties to do designation of those kinds of facilities. It is permissive.

They're not forced to designate any particular facility, but if they deem that that's appropriate, they can do that. We think that this is a very modest start to address the issues as some of the facilities and treatments that will be enabled by Proposition one can come online in the intervening years. But this does move us forward a bit. It does address the institutional issue of the door is closed to you if you're solely substance use disorder diagnosed. Thank you. Thank you sir. Other witnesses in support?

Name, affiliation, position on a measure only, please. Good afternoon, Mister chair Members. Dylan Elliott, on behalf of the California State Association of Psychiatrists, additional co sponsor and in support. Thank you. Thank you. Next please. Jeff Neil, representing the County of San Diego, also in support. Next please. Thank you, sir.

Leah Barrows, on behalf of California Hospital Association, in support.

Thank you Mister chair.

And Members, Moira Topp, on behalf of San Diego Mayor Todd Gloria, as well as the full Big City Mayors Coalition, which is the coalition of mayors of the 13 largest cities in California, all in strong support.

Thank you Mister chair.

Members of the Committee, Brandon Marti with the California Medical Association in support.

Thank you. Any other witnesses in support? Witnesses in opposition please. Any witnesses in opposition? If you lead, you may step up and take a microphone.

Please identify yourselves for the record and you may proceed when ready.

Thank you, Mister Chair and Members, Michelle Cabrera with the County Behavioral Health Directors Association of California with an opposed, unless amended, position on this bill. First, we want to appreciate the Senator for her work in trying to address what is indeed a conundrum that we face in trying to implement SB 43. County behavioral health departments were immediately getting to work once this bill was signed to try to identify what kinds of changes would be necessary in our system to faithfully implement SB 43.

And the LPS system as we know it had historically, for the, since its inception, been built around a system of care to address mental health conditions and the treatment of those conditions,

And alcoholism.

As well as alcoholism. However, with respect to alcoholism, well, I won't take for my time in addressing that, but I'm happy to in the Q&A. So what we're concerned about here is that this bill actually does not solve the problem that it purports to try to address in a way that we believe supports the welfare, the safety, and the treatment outcomes of the expanded population that we need to serve under SB 43.

And it would create a perception that counties have viable options to treat substance use disorders only without actually making the necessary changes to the treatment facilities to do so. And that that will create both public pressure and concern at the local level, as well as confusion as to why we're not using the authority that's granted to us under this bill to then designate, for example, a psychiatric health facility for substance use disorder only treatment. Let me give you an example.

The regulations for psychiatric health facilities today say that we may not treat SUD only. Why is that? Because those facilities are not required to have the kinds of services or staffing that would ensure that those needs would be adequately met. They are appropriate for individuals with co occurring conditions, and so, in the short run, DHCS has already clarified in guidance that they may be used as such.

We believe that a more helpful track, and this is the amendment that we've proposed, would be to have DHCS convene stakeholders to identify what kind of staffing services would be necessary to adapt our current locked LPS facilities to safely and appropriately treat their substance use disorder or co occurring medical needs, and then to put us on a track to make changes to licensing and regulation standards, which would also require, potentially changes in reimbursement.

But that's gonna take some time to figure out, and so we're asking for an amendment to put us on track to make some of those changes. Without that, we're concerned about the safety of these facility types for individuals with SUD only in particular, and the quality of care. We think that the bill won't result in the outcomes that the author and the sponsors ultimately want. For these reasons, we respectfully oppose unless amended. And again, thank you to the author for being open to discuss our concerns.

Thank you, ma'am. Sir?

Thank you, Chair and Members, for allowing me to speak in opposition of SB 1238. My name is Samuel Jan and I'm with Disability Rights California. We are the designated protection advocacy system for our state. SB 1238 is a follow up to SB 43 last year, which expanded civil commitment criteria to include individuals with substance use disorder for the first time in over 50 years, SB 1238 seeks to answer the question of where these individuals will be held.

We continue to raise concerns with the expansion of an involuntary commitment and the specific impact on the substance use disorder population. We also echo the concerns of the Behavioral Health Directors Association that the manner in which SB 1238 implements the tremendous changes stemming from SB 43 is not comprehensive and could lead to significant issues. Involuntary commitment is extraordinarily expensive and often causes increased harm. It pulls resources from upstream and downstream services that could be used to avoid hospitalization and keep people stable long term.

The research on involuntary commitment of individuals with substance use disorder is clear. It's less effective than voluntary treatment, and it significantly increases risk of post commitment overdose. SB 1238 would allow full implementation of SB 43 in a manner that that will harm Californians with substance use disorder. Our state should instead focus on increasing access to voluntary substance use disorder treatment services, particularly in underserved communities. SB 1238 is a mistake for California, and we urge your no vote.

Thank you, sir. Any other witnesses in opposition? Seeing none. Let's bring the matter back to the dais and questions, comments, concerns? Senator Menjivar.

Mr. Chair if you could allow the Senator to respond to some of the issues the opposition has brought up.

Yes, thank you very much. You know, and I thank the federally funded Disability Rights for coming here today to object to the work we did last year and continue on this year. We have a difference of opinion, and then I appreciate, and we have been working and you're going to sit up here on my next bill. We're going to continue this relationship. But it sounds to me like basically what you're asking us to do is not do this because it would put pressure on counties.

We feel pressure every single day to be able to get something done. My office has had so many conversations with local counties, with hospitals about the need to clear up these regulations, the need to be able to designate certain facilities so that the ERs aren't backed up. I understand that it's going to be more work. I understand counties are going to have to look at their own, what they need.

And again, when we just also passed Prop 1, and that said, we're going to do a real inventory of everything we have, and we know that we don't quite have enough. That's why we're putting it all on. That's why it's all being built. And we also know that there are facilities that are eligible now to be able to do this kinds of treatment. Again, different facilities have different capacities. We are forcing nobody to do anything.

We're saying counties who would like to do it can designate other facilities that then address that issue from the 1967 rule about mental health issues only. Good answer from you, Senator.

Further questions, Senator? Any other questions? Members? Seeing none. Senator, you may close.

Thank you very much. Again, this is an important piece of follow up again last year, and I thank you all for your support in passing SB 43. We know that we didn't get a lot of cooperation from a lot of departments because folks didn't think we could do it. They doubted you all. We did it. And now we just really need to be able to fix the little problems that might exist, because we, you know, we had to pass it without a lot of guidance before.

We're sure getting it now, and we're taking all of it and putting it into policy. And I ask for your aye vote.

Thank you, Senator. Is there a motion?

Move the bill.

Senator Grove moves the bill. Please call the roll. And the motion is. Thank you. The motion is, do pass. And we refer to the Committee on Judiciary.

[Roll Call]

Bill has five votes. We'll hold the row open for absent Members. Senator, you have one more item, item number nine, Senate Bill 1397, behavioral health services coverage.

Thank you very much. Nice to have Ms. Cabrera. Thank you. Thank you to the Chair and Committee for hearing this bill. I want to start by saying I'll be accepting the Committee amendments. SB 1397 will require health plans and insurers to pay the greater of the Medi-Cal Specialty Mental Health rate for a contracted service that the county health agency is providing.

So, again, you know, we've done a lot of work towards parity of making sure that private insurances pay their fair share in treating folks, especially if they're covered under their plan, treating mental health issues. We also know, and we heard last year through the passage of SB 326 and redoing of the Mental Health Services Act, that a lot of times counties are just providing this without getting reimbursed.

So this bill says counties or private health care insurances are welcome to let counties provide the service, the specialty service. And of course, this is a full service partnership we're talking about. But if they ask the counties to do that, then they must be reimbursed at the Medi-Cal rate to said county. That way we're saving our county dollars for those who really need it, who are on Medi-Cal.

We are pulling down the dollars from private insurances who should be covering this and making sure that there's no break in services. And with me here today I have Michelle Cabrera, who is Executive Director of the County Behavioral Health Directors Association, as well as Susan Holt, County Behavioral Health Director of Fresno.

Please proceed.

Mr. Chair and Members, Michelle Cabrera with CBHDA, and we are proud to support this bill, which would require commercial insurance plans to reimburse county behavioral health for individuals who are served in our full service partnerships. And I would like to take the remaining time that I may have and give it to our County Behavioral Health Director from Fresno.

Thank you, ma'am. Please proceed.

Thank you very much, Mr. Chair and Members. My name is Susan Holt, and I am representing my colleagues with the County Behavioral Health Directors Association. I'm the Behavioral Health Director in Fresno County. And, as you heard from our author, Senator Eggman, this bill is quite important to us because it would require that reimbursement from the commercial insurance plans full service partnerships also, we call these full FSPs.

They provide a whatever it takes unique approach to behavioral health care, and they provide highly intensive mental health services with multiple service encounters per week. This includes two populations ranging from children all the way to older adults. Recent policy changes will require county behavioral health agencies to focus our resources on those members who are Medi-Cal beneficiaries, including focusing our FSP efforts. And that requires us now to really carefully consider and reevaluate when and how we can provide services to the broader community.

In Fresno County, we have seen consistently requests for FSP services from individuals with commercial insurance. Typically, these referrals come through our crisis continuum, but, also, these referrals even come from those commercial plans and their network of private providers. There's a variety of reasons for this. One of those reasons is that FSPs through county behavioral health systems provide psychosocial intensive mental health treatment services that are community-based, meaning that we quite literally go where people are. We meet them where they're at.

We also assign a personal services coordinator to every single person in a full service partnership program, and that client has access 24 hours a day, seven days a week, to a of their multidisciplinary team who knows them personally so that they can not rely on the public crisis system when they have an episode that needs attention. Post-pandemic, we are seeing increased acuity across all payer sources.

Individuals across California, whether they have Medi-Cal or not, are seeing higher and higher levels of acuity. That's hitting the county behavioral health crisis continuum and inpatient services. So because of that, we anticipate increased referrals to the county behavioral health system for the full service partners level of care.

Sadly, in my community, numerous individuals who have private insurance have reached out to me to tell me they feel that they need to quit their job so that they can enter into poverty, so that their loved one will qualify for Medi-Cal, so that they can have access to these very important full service partnership programs. We have in Fresno County attempted to bill commercial insurance.

The vast, vast, vast majority of the time those claims are denied, and overall, we receive less than 1% of the cost of the care for those privately insured individuals. We're quite grateful to the Legislature for your commitment to parity, in particular, Senator Wiener and others who have been pushing for expanding parity laws and enforcement to ensure greater coverage, and very grateful to Senator Eggman for authoring SB 1397. On behalf of my colleagues, County Behavioral Health Directors across the state, we strongly support SB 1397 to ensure access to full service partnership care, and we respectfully request an aye vote.

Thank you, ma'am. Any other witnesses in support? Name, affiliation, and position on the bill, please.

Good afternoon, Mr. Chair and Members. Jolie Onodera on behalf of the California State Association of Counties, as well as the Rural County Representatives of California and the Urban Counties of California, in strong support.

Thank you very much. Next, please.

Chair and Members, Samuel Jain with Disability Rights California. We're in support.

Thank you. Any other witnesses in support in the hearing room? Okay, how about witnesses in opposition? Any witnesses in opposition? Last call. Okay, seeing none. Back to the dais. Colleagues, questions, comments, concerns? Been moved by Senator Menjivar. Senator Eggman, would you like to close?

I would just thank you all very much and thank our witnesses for testifying and really laying out, I think, the perverse incentive that we've made for people to leave their job in order to be able to get coverage. That's wrong. Let's try to fix it. I ask for your aye vote.

Okay. Great job. Motion is do pass as amended, re-refer to the Committee on Appropriations. Please call the roll.

[Roll Call]

Bill has four votes. We'll hold the row open for absent Members. Thank you. Senator Gonzalez. Do I see Senator Gonzalez?

Nope.

Okay.

You want to do your bill?

We'll do...

I'll go back to you.

We'll do my bills 18 and 19. If she comes, we'll stop.

At this time, we will move into Bill SB 1042 from Senator Roth.

Thank you, Madam Chair. Members, the bill requires all nursing programs in the State of California to report their clinical placement needs to the Board of Registered Nursing. The bill will also require health facilities and clinics to report on clinical placement slots for nursing students to the Department of Health Healthcare Access and Information, HCI.

The bill would also authorize the Board of Registered Nursing, upon request by a nursing school or program, to assist in finding and securing clinical placement slots to meet the clinical placement needs of that particular school or program. As you may know, one of the major bottlenecks to growing capacity in our nursing programs is the challenge of locating and securing the clinical placement slots necessary to provide the clinical training required to obtain a nursing degree.

There was a 2020 State Auditor report on the Board of Registered Nursing that found that due to a lack of reliable data, the board lacked critical information about the location and availability of clinical placement slots to make enrollment decisions.

Therefore, the State Auditor recommended that the board require nursing programs to annually update information about the clinical facilities they use for student placements and that compiling this information and comparing it with other available information about existing facilities would allow the board to identify clinical facilities that programs do not currently use for placements, which could help nursing programs find additional slots for their students.

This bill does just that by collecting data on nursing program's clinical placement needs and collecting data from health facilities and clinics on their clinical placement slots. The board would then have the necessary information to properly match scarce clinical placements with the nursing students that need them. The information will also assist the board in working to identify additional clinical placement slots in a broader range of healthcare facilities and clinics, not just hospitals. At the appropriate time, I'd respectfully ask for your aye vote.

Thank you, Mister Chairman. Do we have any witnesses in support? Please come forward.

Hello, Daniel Pearl. On behalf of the American Federation of State County Municipal Employees, as well as the United Nurse Association of California, Union of Healthcare Professionals, and strong support.

Thank you.

Samuel Jain with Disability Rights California, we are in support.

Thank you.

Matt Lege with SEIU California in support.

Thank you. Do we have any lead witnesses in opposition or anyone in the room who wants to voice in opposition? Seeing none, bring it back to my colleagues. Questions? Comments? There's none. Would you like to conclude?

Yes for an aye vote. Thank you, Madam Chair.

Thank you. Is there a motion? Oh, Senator? Motion by Senator Wiener. This is a do-pass and referred to the Committee on Business, Professions, and Economic Development. Please call for the vote.

[Roll Call]

The vote is 4-0. We'll hold the roll call open.

Thank you, Madam Chair.

And we go now on to SB 1385.

Thank you, Madam Chair. This Bill happens to be part of the Senate Democratic Caucus's Safer California Policy platform, which includes bills to address both retail theft and the fentanyl crisis. This particular Bill allows the substance abuse navigators placed in emergency departments to Bill the Medi-Cal program under the newly implemented Community Health Worker Benefit, the California Bridge Program. CalBridge recognizes the important role that hospital emergency departments can play in linking patients with opioid use disorder to treatment and in preventing fentanyl overdosed deaths.

CalBridge accomplishes this by combining immediate access to medication for addiction treatment with support from a substance abuse counselor, or navigator, who links the patient to ongoing care. What began as a pilot program using federal funding in 52 hospitals is now a program that has been implemented across 276 hospital emergency departments. In order to sustain these programs, however, a funding source is needed, and this Bill creates the funding source by allowing the substance abuse navigators placed in emergency departments to build a Medi-Cal program. With me today to speak to the success of the program is Doctor Aimee Moulin, an ER Doctor at UC Davis and one of the principal founders of the CalBridge program. Hope I didn't butcher your name, Doctor.

You did a fantastic job. Thank you very much.

I am excited to have an opportunity to talk to you about the transformative power of our substance use navigators. We literally call them suns because they bring the sun into our emergency departments. We started at UC Davis with a single substance use navigator who was grant funded. His name's Tommy Trevino.

Please, Doctor.

He has changed the way that we take care of patients in the emergency department from a fast, a problem that was intractable and unsolvable to a place where we can have a huge opportunity to change people's lives. That is what he did. We have now substance use navigators in emergency departments across California doing similar work, but they are grant funded. This program needs to be embedded in the Medi-Cal program because one it needs to continue but extend.

If you can imagine the transformative power that one human can have in an emergency department that sees over 100,000 people annually. Imagine I need an army of sons in my emergency department who can identify the unmet social needs in my patient population, help overcome them and link them to treatment. I appreciate so much, Senator Roth, bringing this forward because it has been a transformational program for emergency departments and patients in California. Thank you very much.

Thank you. At this time, let's hear from other supporters.

Thank you. Chair Members Tim Madden, representing the California chapter of the American College of Emergency Physicians. And we recently just come on as a sponsor of this Bill. So proud to support the effort. Thank you.

Thank you.

Good afternoon. Glenn Backes for the Yellow Baker Center for Human Rights and the Prosecutors Alliance of California in support.

Thank you. Any other, do we have any witness in opposition? Seeing none. Bring it back to my colleagues. Comments? Questions?

Senator, can you clarify something for me, please? The Bill, the way I understand it, is for mental health services in the capacity of the fentanyl drug addiction and things like that. Like, similar to that. It's mental health services though, right?

It's substance abuse.

Substance abuse.

So to the extent that I guess that involves mental health, I suppose, but it's primarily substance abuse counselors to transition individuals with substance abuse from the emergency department on a continuum of care basis. I think I - did I say that correctly, Doctor?

Yes, you did. However, I will say, you know, people with substance use disorders rarely have an isolated substance use disorder. There's often co occurring PTSD, depression, anxiety. And our substance use navigators help navigate people with those issues as well. Exactly. Yeah. They'll look at the whole person, look at those needs and address them as they come.

Okay. Okay, thank you.

No more comments. Would you like to close?

Ask for an aye vote. Thank you for your patience.

Is there a motion. Moved by Senator Menjivar. Madam Claire, please call the roll. Oh, I'm sorry. And it's do pass and rereferred to the Committee on Appropriations.

[Roll Call].

4 to 0. We'll keep the roll call open.

Thank you.

I'm so sorry, Mister Chairman. And at this time, we're waiting for a Senator. We're waiting for one more author.

Okay. We're waiting for Senator Gonzalez. We're going to open the roll for those members who've joined us. We're going to start with the consent calendar, and on the consent calendar, we have number two, SB 910, with amendments number four, SB 963, with amendments number six, SB 1082. Amendments are going to be taken in human services. Number 11, SB 1252. Number 12, SB 1257, with amendments. Item 13, Senate Bill 1319. Item 14, Senate Bill 1320, with amendments. And item 16, Senate Bill 1442.

Current vote on the consent calendar is 6:0 chair, voting aye. Please call the roll.

[Roll Call]

Current vote is 9:0. We'll hold the roll open for absent members. Calling item number one, Senate Bill 1290 healthcare coverage, essential benefits. Current vote is 6:0 chair, voting aye. Please call the roll.

[Roll Call]

Current vote is 11:0. And just.

That's out, right?

That matter is out.

[Roll Call]

Current vote 9:0, hold the roll open for absent members. Senator Gonzalez. Item number 17, Senate Bill 1016, Latino and Indigenous Disparities Reduction act. Please proceed when ready.

Thank you, Mr. Chair and members. I want to begin by accepting the committee amendments described on pages 5 and 6 of the analysis and would like to thank the committee staff for their work on this. I'm here to present SB 1016, which will help uncover trends and disparities that are often hidden in aggregated health data for Latinos and indigenous Mesoamericans. Latinos make up 40% of California's population. However, within the community, there are several ethnic groups that have diverse health outcomes.

SB 1016 will address these shortcomings by requiring the Department of Public Health to collect and release disaggregated data for specified Latino subgroups, including Mexican, Salvadoran, Guatemalan, each major mesoamerican indigenous nation, as well as others testifying in support of this measure. Today I have Genevieve Flores-Haro with the Mixteco Indigena Community organizing project, as well as Erica Librado with Centro Binacional Para El Desarrollo Indígena Oaxaqueño, and with that, I respectfully ask for an aye vote on SB 1016.

Thank you, please proceed.

[Spanish] SB 1016 is the first step in making that possible at the state and local levels. Therefore, I respectfully ask for your vote in favor of SB 1016.

Thank you, ma'am. Next, please.

And I'll just be repeating the first part of my colleague's comments in English. So, good afternoon, members of the committee. My name is Erika Librado, I'm from the Triqui community. My family is from Cruz Chiquita, Oaxaca, and I speak tricki, Spanish and English.

I'm the Greenfield program manager with Centro Binacional Para El Desarrollo Indígena Oaxaqueño, an organization created by and for indigenous communities to organize and to make sure our community's culture, languages, and knowledge are recognized and respected by systems and institutions that impact our lives. CBDIO is a proud co sponsor of SB 1016, authored by Senator Lena Gonzalez. One of the teams that I support is our maternal mental health program, where CBDIO provides support groups that we call platicas for indigenous mothers in Misteco and Triki.

In our program, we have seen mothers with years of trauma after difficult migration experiences, past abuse and postpartum depression, or other mental health issues. Yet, when mothers come to us in crisis, we struggle to find assistance for them, especially assistance that can be provided in their languages. For example, a tricky mother asked us for help with her Calfresh case.

She had been denied benefits because she could not read the papers they sent her, and she could not communicate with a social worker in Spanish, and the county office would not provide her assistance with an interpreter. We translated the document for her and helped her call the Calfresh office. Without our help, though, she and her children would have been denied Calfresh. Without the data to show our presence and how important it is to provide services in indigenous languages, our mothers and families will continue to suffer.

And that's why I'm here today for our indigenous mothers and families, I believe that it is important that the presence of indigenous communities are counted and that our voices and needs are heard. SB 1016 is the first step in making that possible at the state and local levels, and therefore, I respectfully ask for your vote in favor of SB 10, and then I'll just switch over to my comments.

That's fine. Thanks.

Thank you. And then for me, so good afternoon, chair and members of the committee. My name is Genevieve Flores-Haro, and as was mentioned, I'm the associate Director for the Mixteco/Indigena Community Organizing Project, or MICOP. MICOP is a proud co sponsor of SB 1016. Authored by Senator Lena Gonzalez, SB 1016 aims to collect demographic and language data for California's Latin A subgroups and indigenous mesoamerican nations.

This data will be disaggregated to provide a more detailed understanding of the needs and experiences of these communities. California has a rich diversity of indigenous mesoamerican communities, each with our own languages, our own cultures, and our own customs. However, these communities have often been told that were too small to be counted. Though the 2010 Indigenous Farmworker study indicated that more than 60% of farmworkers on the California Central coast are indigenous, our communities continue to be ignored.

Since that report released over 10 years ago, SB 1016 aims to identify and decrease health disparities among Latin and indigenous communities in California. Research indicates that collecting more detailed and accurate demographic data is crucial to effectively addressing the health needs of diverse populations. In 2023, MICOP, in collaboration with the local health public health department researchers and our community Members, conducted the San Luis Obispo Indigenous Demographic study. The study revealed that San Luis Obispo county in particular is home to over 8000 and indigenous community members.

Of those surveyed, 57% speak only their indigenous language, Mixteco. Other indigenous groups that we found in the county are Tlapaneko, Amusco, Triki, and Nahuatl. 95% work in agriculture, 87% of children under 564 percent struggled to find food in the last year, 85% lack health insurance, and only 46% reported ever receiving a physical exam. The study highlights the importance to include all community members and data collection to understand their needs and to create systems that can be more responsive.

Responsive Latinos are not a homogenous group and Latino that dangerously erases indigenous mesoamerican identities. SB 1016 is a step towards recognizing and valuing our differences and ensuring health equity for indigenous and Latin communities in California. And we respectfully request your aye vote. Thank you.

Thank you. Thank you both for coming. Any other witnesses and support? Name, affiliation and position on the measure, please.

Rebecca Gonzales, Western Center on Law and Poverty, in support.

Thank you, ma'am. Next please.

Doreena Wong, Asian Resources, Inc. In strong support of SB 1016.

Thank you. Next please. Thank you. Thank you. Gracia. Thank you.

Mar Velez with the Latino Coalition for a Healthy California, a co sponsor and in strong support.

Good afternoon. Geronimo Aguilar here on behalf of All of Us or None, Todos o Nadie, Sacramento chapter in strong support. Thank you.

Thank you. Any other witnesses in support? Any witnesses in opposition? Seeing none. Let's bring the matter back to the dais. Colleagues, questions, comments, concerns. Senator Limon.

Thank you. And I just want to thank the author and the presenters also from the district that I represent. So great to see the work that you are advocating for with the author and respectfully move the bill when appropriate.

Thank you, Senator Limon. Any other hands up? No other, Senator.

I just want to say thank the author for bringing this and thank you so much for sharing your stories and making this important demand. We need to respect our indigenous communities who are feeding our families across the state and know MICOP work very well and excited to see you all here representing on this issue.

Thank you. Okay, would you like to close, Senator Gonzalez?

I would just like to thank Genevieve and Erika as well as the many organizations who've been working on this. This is our second year conducting this organization and pushing this bill. And I would like to respectfully ask for an aye vote.

Okay. The motion's by Senator Limon. The motion is to pass as amended. We refer to the Committee on Appropriations. Please call the roll.

[Roll Call]

[Roll Call]

That matter is out. Miss anything? Looks like we've concluded our agenda today. Thank you for your participation. This session of the Senate Health Committee is adjourned. It.