Senate Standing Committee on Health

The Committee on Health will begin in 10 seconds. Your 10 second warning. The Senate Committee on Health will come to order. Good afternoon. Thank you all for joining us. As you know, we continue to welcome all of you here in person. We will allow six minutes of testimony per side, but as usual here, you don't need to.

Feel free to use it all if you don't need to, but we allow for a full and fair hearing. So tell us what you want to tell us. One bill was pulled from today's hearing. Item number one, AB 1316. Assemblymember Irwin, emergency services psychiatric emergency medical conditions.

When we have folks here to establish a quorum, we will have eight bills on the agenda. Two of them are being are placed on our proposed consent calendar. Item number four, AB 1965 Assemblymember Blanca Rubio, Public Health Office of Tribal Affairs and Item number seven, AB 20119.

Assemblymember Weber, mental health so with that, let's start with our first item for hearing today. Item number two, Assembly joint resolution 10. Assembly Member Irwin, food date labeling. Please proceed when ready.

Good afternoon, Mr. Chair. I am pleased today to present AJR 10, which would urge our Federal Government to enact the bipartisan food Date Labeling Bill of 2023. Currently, grocery stores offer products with all sorts of different food labels, like expires on best before enjoy, buy, and sell by, to name a few.

These labels consistently mislead and confuse consumers. Sell by dates, for example, are used to show grocers when to rotate stock, and they are generally meaningless to the consumer. The result of this consumer confusion is staggering. The amount of food that is wasted is, according to one study, is as much as 20% because of confusion about labels.

At a time when prices at the grocery store have never been higher, reducing food waste is one of the best ways to ensure our constituents save money on groceries.

AJR 10 would declare California support for the Bipartisan and Food Date Labeling act of 2023, showing that our state supports putting an end to these to consumer confusion surrounding these food date labels. With me to testify in support of this Bill is Andrea Collins from the Natural Resources Defense Council and Erica Parker from Californians Against Waste.

Please come on down. You're welcome to join us at the table. Please introduce yourselves for the record and then proceed when you're ready.

Thank you, Chair and Committee Members. My name is Andrea Collins with the Natural Resources Defense Council, and we support Assembly Joint Resolution 10 because it builds on work already done by the state to address a systemic cause of food waste with implications for our health, our environment, and our economy.

AJR 10 calls on the Federal Government to mirror what we've been trying to achieve here in California. The House of Representatives version of the bill is bipartisan and already has support from five California representative co-sponsors, along with a host of support from the business community.

And right now, there's no way of knowing which dates on our food are actually safety dates and which indicate peak quality. Instead, consumers are left to guess at what info is intended to be relayed by the date on the package. And these incomprehensible date labels are a leading cause of food waste.

We need consistent date labels so that people stop tossing good food prematurely and so that we have clarity on which foods are really a health concern after a certain amount of time has passed.

Confusion over expiration dates is responsible for 20% of the wasted food in our homes, and more than 80% of Americans report tossing food because it's past date. An average American family loses about $1,500 to uneaten food, and eliminating confusion about whether that food is still good will keep some of that money in the pockets of Californians.

And ensuring that all of us understand when food is still good will help us alleviate pressure to toss food that could have nourished us. Defining a standard for consumer targeted date labels provides clarity on when food actually poses a safety risk, and it reduces the likelihood of discarding good food.

The State of California has made significant progress on the dual crises of climate change and food security, both of which are exacerbated by food waste, and both of which extend beyond our state borders, requiring that the entire nation follow our example.

So AJR 10 is a straightforward way for you to encourage further action on behalf of Californians and all Americans. And for those reasons, we're proud to support this resolution and we ask for your aye vote.

Thank you. Next, please.

Thank you.

Hi, Erica Parker with the environmental group Californians Against Waste, in support of this measure. Americans throw away nearly 66 million tons of food waste each year, and consumer confusion over date labels is a leading cause. The food cycle doesn't end at the trash can, and food waste comes with a significant environmental and social price.

There are more than 50 differently phrased labels in the US. Each term can be used to communicate different things when used by different brands, and some don't have like some date labels contain no explanation next to them at all.

Additionally, food banks and other food donation programs experience difficulty distributing food when it has an expired date on it, even if the date on the package is intended to communicate food quality rather than the safety of the food item. This keeps edible food from hungry citizens when one in eight people in the US experience food insecurity.

A major study found that standardizing date labels is the single most cost effective way to reduce food waste. As Andrea mentioned, AJR 10 comes with the added benefit of keeping money in the pockets of Californians.

The enactment of the federal Food Date Labeling Act builds on the existing efforts to reduce food waste going to landfills and protect natural resources, and for these reasons, we urge your aye vote.

Thank you very much, ma'am. Any other witnesses in support of this measure? Seeing none. Witnesses in opposition? Seeing none. Let's bring the matter back to my colleague on the dais. Colleague, any questions, comments or concerns?

I just want to thank the author for bringing this forward.

Okay, it's your day. Assemblymember, would you like to close?

Well, when the time comes, I respectfully ask for your aye vote.

And as soon as we establish a quorum, we will take the motion and we'll take the vote. Thank you for your presentation. Thank you very much. Next item, item number three, Assembly Bill 1842. Assemblymember Reyes health care coverage, medication-assisted treatment.

Thank you Mr. Chair and Senators. AB 1842 prohibits commercial health insurers from imposing prior authorization rules that create barriers to accessing medication-assisted treatment. Medications such as buprenorphine or naltrexone can significantly improve treatment for many substance use disorders by treating craving and withdrawal symptoms.

However, medication assisted treatment is underused due to prior authorization requirements, which create unnecessary barriers that delay or interrupt access to effective treatment. AB 1842 is an important first step that will reduce overdose rates and save lives.

Here to testify in support of the bill is Doctor Aimee Moulin , who is a professor of emergency medicine and division chief of addiction medicine at UC Davis. She is also the director of the California Bridge program.

Doctor, good to see you again. Please proceed when ready.

Thank you. I'm representing also 270 of the emergency departments in California that we work with through our California Bridge program. We are dedicated to providing rapid access to addiction treatment. So a patient who's suffering from opioid use disorder comes into the emergency department and we provide treatment on demand that visit.

Despite being really difficult to say, medications like buprenorphine and naltrexone are highly effective and have shown to increase recovery rates, decrease overdose death. What this looks like in the emergency department is someone will come in with an overdose, we will reverse the overdose, but at that point, we are not done.

At that moment, we now have an opportunity to get that person into long-term treatment. We will start them on buprenorphine in that ED visit. For Medi-Cal, where there is no prior authorization, we will send a prescription to the pharmacy and make sure that that person has continuous access to buprenorphine. Buprenorphine prevents withdrawal and helps that patient stop using.

What happens if you have commercial insurance? You might go to the pharmacy, bump into a prior authorization, and that prescription is no longer filled, right. Then the patient will go back into withdrawal and potentially start using an overdose again.

So in this instance, literally having those delays, even if they are short and temporary, we lose patients in that period where they go back into withdrawal and we are unable to get them into treatment. We have to wait often until they overdose and come back and then restart.

So all of that work is lost, even with a short delay. And for this reason, we're asking to remove that delay and prior authorization for the commercially insured patient population. Happy to answer questions.

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

Thank you, Chair, Members. Tim Madden, representing the California chapter of the American College of Emergency Physicians, in support.

Thank you, sir. Next, please.

Mitch Steiger with CFT, a union of educators and classified professionals, also in support.

Thank you, sir.

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

Thank you. Next, please.

Christine Smith, Health Access California, in support.

Thank you. Yes, ma'am.

Good afternoon. Elizabeth Espinosa, here today, on behalf of the Santa Clara County Board of Supervisors, in support. Thank you.

Thank you. Sir?

Thank you, Mr. Chair. Dylan Elliott, on behalf of the California State Association of Psychiatrists, California Academy of Child and Adolescent Psychiatry and the City of County of San Francisco, all in support. Thank you.

Good seeing you. Thanks for joining us. Next, please.

John Drebinger with the Steinberg Institute, in strong support. Thank you.

Mr. Chair, Members of the Committee, Brandon Marsh with the California Medical Association, in support.

Thank you, sir. Next, please.

Amer Rashid with the County Behavioral Health Directors Association of California in strong support. Thank you.

Thank you. Any other witnesses in support of this measure? Seeing none, let's turn to witnesses in opposition first. Lead witnesses in opposition, if any. You may take the table if you'd like.

Hi. Good afternoon. Chair Members of the Committee, Robert Boykin with the California Association of Health Plans. Regrettably hearing today in opposition to AB 1842, this is obviously an important issue. Health plans have heard the concerns and are constantly looking for ways to streamline the process while protecting patients and delivering high quality care.

However, this bill seeks to prohibit health plans from requiring prior authorization or step therapy for several drugs when treating someone with a substance use disorder. From our viewpoint, utilization management is necessary for patient safety and cost effective care.

Furthermore, this bill is largely unchanged from last year's AB 1288, which the Governor vetoed last year because of the importance of prior authorization, stating utilization review is an important tool for containing healthcare costs, protecting patients from unanticipated billing, and ensuring medically necessary care. Unfortunately, AB 1842 does not address any of those points raised in the veto.

But with that said, we are hard at work on some possible amendments that may move our position on the bill. We look forward to working with the author's office on a possible resolution, but for those reasons stated earlier, we are regrettably opposed to AB 1844.

Thank you for joining us, sir. Any other witnesses in opposition to this measure? Name, affiliation, and position on the measure, please?

Chair Members John Winger, on behalf of America's Health Insurance Plans, would echo the comments at CAP. Look forward to future conversations next.

Good afternoon, chair Members. Matt Akin with the Association of California Life and Health Insurance Companies. Align our comments with Kaepern opposition thank you. Thank you for joining us.

Any other witnesses in opposition? Seeing none, let's bring the discussion back to the dais. Colleague, any questions, comments or concerns? Seeing none, Assemblymember it's your lucky day. Would you like to close?

Yes. Thank you. I think it should be noted that California has already removed prior authorization for MediCal patients. There are also 17 states that have limited prior authorization.

We are asking for an opportunity to and also, I would like to note that in the governor's veto message, there was talk about fraudulent requests or abuse of drugs and specifically called out methadone. Methadone is no longer included in this bill, and that was in response to the governor's veto message.

We are, in essence, asking that you help us stop the delays and save lives. And with that, I respectfully ask for your aye vote when you have a quorum.

Thank you, Assembly Member. When we. As soon as we have one, we will take the motion. We'll take the vote. Thank you for your presentation.

Thank you.

Next item up is item number five, Assembly Bill 1977, Assembly Member Ta, healthcare coverage, behavioral diagnoses. Please proceed when ready, sir.

Good afternoon, Chair and Members of the Committee. I'm here today to present Assembly Bill 1977 which would ensure that Californians with developmental disability don't face barrier to the behavioral health treatment they need.

I want to thank the Committee staff for working with my office and I accept the Committee amendments which clarify that health plan has the ability to review a patient treatment plans are specific. Under current law, AB 1977 is a result of conversation with parents of children with autism.

Despite autism being a lifelong condition, insurance companies often require constant reevaluation every two years in order to maintain healthcare coverage. This reassessment is an extensive process involving a background questionnaire, interview, and diagnostic test which can be very traumatic for an individual with autism.

This burdensome process often result in delay or even denials for necessary behavioral health treatment if deadlines are not met. Several health plans operating in California require new autism diagnosis every two years in order for patients to receive behavioral health treatment. It is required regardless of whatever of whether patient have the previous diagnosis.

Given that autism is a lifelong condition, it makes no sense to require constant re-diagnose every two to three years in order for individual to receive necessary behavioral health treatment.

AB 1977 would put an end to this outdated practice and prohibit a healthcare service plan from requiring an enrollee, previously diagnosed with pervasive developmental disorder of autism from needing to receive a new behavioral diagnosis to maintain courage for behavioral health treatment.

We have taken reasonable amendment to AB 1977 to clarify that this Bill would not restrict a treating provider from re-evaluating an enrollee to update their treatment plan. I'm honored to introduce my witness on this Bill, Doctor Andrea Davis on behalf of California Psychological Association and Daniel Savino from Association of Regional Center Agency.

Thank you, Assembly Member and thank you for taking the proposed amendments. Please proceed when ready. Identify yourselves for the record first, please.

I'm Doctor Andrea Davis and I'm wanting to thank you Senator Roth and all the Committee Members for your service. I'm a licensed psychologist. I hold international certifications in autism and diagnosis and therapies. I'm the Chair Elect of Division One California Psych Association and President of the DIR Floor Time Coalition of California.

I own a large group practice in Pasadena, Greenhouse Therapy Center where we diagnose autism as part of our work. This Bill, though, prioritizes patient interests over business interests. The diagnosis of autism requires observation, interviewing, and administering a whole variety of one-to-one testing protocols by a psychologist or a physician.

These are detailed observation protocols requiring specialized training and credentials and certifications, not just one test. So, this takes one to two days to complete all the assessment of IQ, language, behavior, social development, attention and learning. So, you see why it's hard for families just to get a slot on the schedule for this.

And you can imagine how stressful these testing days are for children, especially autistic children.

It then requires 10 to 20 more hours of parent and teacher interviewing, school and medical records, review, complex test results, interpretation, and to justify the conclusions to write a 20 to 60 page report, a formal assessment report, and that is required by all the health plans to begin behavioral health treatment for autism.

But the wait lists for this diagnostic process are six to 12 months long. And of course, most families can't afford three to $12,000 out of pocket for such a process. So, they're forced to be on even longer waitlists for testing providers who are in network, like ourselves, or they can't find somebody in network.

So, autistic children, children are blocked right at the outset of treatment by these huge barriers of costs and wait lists. They can't afford to wait. The CDC and research says early intervention is how they achieve best outcomes, right? And autism, as the Assembly Member has said, is a lifelong diagnosis.

So, I respectfully request your, AYE vote to stop the unnecessary do-overs of a costly and stressful, and lengthy barrier to treatment. Thank you very much.

Thank you for joining us. Sir, you next.

Daniel Savino, Association of Regional Center Agencies. As the lead witness just indicated, getting that initial autism diagnosis takes a tremendous amount of time and effort on the part of families. It's a major, major barrier.

Once you have that, then there's a treatment plan and you work forward from there, building on best practices, existing skills, and work to create an opportunity for the child to attain their best developmental outcomes. That plan necessarily changes over time. As we grow, our needs change. The diagnosis does not, quite simply, a re-diagnosis is not needed.

It's counterproductive, and it's a way of creating a barrier that, as was established initially, is tremendous. It's not medically recommended. There's no basis for that. So certainly, very reasonable that a treatment plan be provided to the insurance company upon request. The Committee amendments as proposed are certainly very reasonable.

Protect the needs of the insurance company to monitor progress, but also protects the needs of the individual receiving these services and the families from potentially losing access to those services because of the barrier that a re-diagnosis would create. Urge your support.

Thank you for joining us today. Are there any other witnesses in support of this measure? In the hearing room. Please step forward. Name, affiliation and position on the measure only, please. Yes, ma'am.

Hello. Christina Tapia, family advocate here in support of this measure.

Thank you for joining us. Next, sir.

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

Thank you. Sir.

Rick Rollens, on behalf of the Autism. Business Association, in support of the Bill. As well, I'm a parent of a 35-year-old son with autism.

Thank you for joining us. Yes, sir.

Albert Camacho, I'm a grandparent of a child with autism and I'm here to support.

Thank you. Yes, ma'am.

Hollie Benincosa with the Qualified Applied Behavior Analysis Credentialing Board, in support.

Thank you. Yes, ma'am.

Marcella Costanos here from A Change in Trajectory, also in support.

Thank you.

Irene Ava, with A Change in Trajectory, also in support.

Thank you for joining us. Yes, sir.

Nicholas Dolsol, behavioral provider, in support.

Thank you.

Brandon Marchy, with the California Medical Association in support. Really want to thank the author for working with us on the amendments that are in print.

Thank you for joining us. Yes, ma'am.

Thank you. Melissa Cortez, on behalf of Autism Speaks and the Council of Autism Service Providers, in support.

Thank you.

Penny Shanken on behalf of the California Association for Behavior Analysis in support.

Thank you.

Hi, Eric Linder, representing Qualified Applied Behavior Analysts in strong support of this Bill. Thank you to the author.

Assembly Member, good to see you back. Yes, sir.

Janel Sosa, on behalf of Autism Behavioral Services and as a parent, I support the Bill.

Thank you. Yes, ma'am.

Andrea Castro, in support, especially as someone who has a brother who has autism. Thank you.

Thank you. Any other witnesses in support in the hearing room? Seeing none. Let's move to witnesses in opposition if any. First, lead opposition, come on down. Okay. If you'd identify yourselves to the record, and then you may start when you're ready.

Once again, good afternoon. Chair Members of the Committee, Robert Boykin, with the California Association of Health Plans, regrettably opposed, unless amended to AB 1977. We would like to thank the author's office for engaging with us in conversations on the issue and appreciate the overarching intent of the Bill.

As the payers in the healthcare delivery system, we have unique responsibility to ensure that premium dollars are being spent in the most efficient way possible. That oftentimes includes conducting periodic evaluations of the treatment plans to ensure enrollees are receiving the most appropriate level of care.

We feel the Bill as drafted removes that ability when it comes to people being treated for PDD or autism. For that reason, we are opposed to, unless amended on AB 1977. Thank you for your time.

Thank you, sir. Next.

Good afternoon, Chair and Members. Matt Akin with the Association of California Life and Health Insurance Companies. Regrettably, with an opposed and less amended position on Assembly Bill 1977. First and foremost, we would like to thank the author, sponsors, Committee and staff for their work on this Bill.

We've had some very productive conversations, and although we are certainly sensitive to the intent of this Bill, we would align our comments with our colleagues at CAP. Specifically, we are concerned that it's written this Bill could be interpreted to prohibit health plans and insurers from re-evaluating patients' treatment plans which could harm patients' quality of care.

Given that providers are statutorily required to review the treatment plan no less than once every six months, we believe it is imperative that health plans are clearly permitted to continue evaluating treatment plans as well. For these reasons, we are opposed unless amended on Assembly Bill 1977.

We look forward to future conversations with the author and staff if the Bill moves forward today. Thank you very much for your time.

Thank you, sir. Any other witnesses in opposition in the hearing room? Name, affiliation, position, please.

Chair and Members, John Winger, on behalf of America's Health Insurance Plans. Would echo the comments of CAP and ACLIHC, look forward to future conversations, but currently have an opposed unless amended position.

Thank you for attending, sir. Any other witnesses? Seeing none. Colleagues, back to the dais. Any questions, comments, or concerns? Yes, sir. Senator Menjivar.

Thank you so much, Mister Chair. Assembly Member, thank you so much for bringing this forward. I'm going to be casting my aye vote today from my four-year-old niece who's autistic. And I know the burden that my sister has to go through and just the constant, endless amount of testing, reauthorization approvals and so forth.

So I'm grateful that you're going to bring some reprieve to them in this process.

Thank you, Senator. Assembly Member, you may close.

Once again, I want to thank our Committee staff for working with my office and really really patient, work with my office. Really, really appreciate that. And I respectfully ask for your aye vote.

Thank you, sir. As soon as we establish a quorum, we'll take a motion and take a vote. Good presentation. You're up next with item number six, AB 2449 healthcare coverage qualified autism service providers.

Good afternoon, chair and Members of the Committee. I would like to start by accepting the Committee amendments as well as I want to thank the Committee staff for their hard work on this important piece of legislation.

AB 2449 would clarify that the Qualified Applied Behavior Analysis Credential Board is a national entity that may certify a qualified autism service provider and authorize the certification to be accredited by the Secretary of California Health and Human Services Agency.

The Qualified Applied Behavior Analysis Board of QABA was established in 2012 and is an agency whose mission is to establish highest stand up care and empower all professionals who provide behavioral care to individuals with autism.

QABA is second lecture certifying body for applied behavior analysis in the US and the lectures internationally, QABA certifications are vital to the provider community for individuals in state with large military populations. As military bases recognize Huiba for the licenses of autism service provider.

Our stay is seen and increased in a number of children diagnosed with autism, resulting in a shortage of qualified autism service providers, particularly in Low income and marginalized communities. AB 2449 seeks to meet this shortage of professional caregivers by adding an additional licensing organization that is recognized federally and worldwide for their high standard.

It will effectively end California reliance on a single entity to provide all certification by creating competition in the field. I would like to introduce Natalie Cooper, who is a parent advocate and Jasmine Gutierrez who is linishen.

Please proceed when ready.

For the past 14 years...seems unbelievable. My son has benefited immensely from applied behavioral analysis therapy. This therapy has been administered by team Members certified through the qualified Applied Behavioral Analysis Credentialing Board. The impact on my son's ability development has been nothing short of life changing. His progress in communication, socialization, and daily living skills had opened doors we once thought were closed. Parents of children with autism should have the autonomy to choose the practitioners who provide these crucial services. The success of our children's treatment hinges on the qualifications and the person centered approach of their caregivers. AB 2449 acknowledges this need by recognizing the high standards and rigorous certification process of the QABA.

Good afternoon, esteemed Members of the Senate Health Committee. My name is Natalie Cooper and I'm here today both as a parent of a child with autism and a parent advocate who assists other families navigating similar challenges. I stand before you to express my unwavering support for AB 2449.

It's not just my family that stands to benefit. The California Autism Society and its local chapters, including the Los Angeles Society, are in strong support of this Bill. They understand that the qualifications of QABA certified professionals meet the highest standards and can significantly address current workforce shortages.

In our communities, particularly among our most vulnerable populations, Many families are stuck on wait lists due to lack of qualified providers. This is especially troubling when we have practitioners already recognized in other states who could be included in the California workforce. Every day that a child with autism goes without therapy is a day lost opportunity for growth and success.

By supporting AB 2449, you have the power to expand the diversity and ability of skilled professionals in California, ensuring more children receive the help they desperately need. In conclusion, I urge you to support AB 2449 and give all families the chance to choose highly qualified QABA certified practitioners for their children. Our children's futures depend on it. Thank you.

Thank you for joining us. Next, please.

Jasmine Gutierrez my name is Jasmine Gutierrez and I am here representing the community of Merced, California. I have dedicated my career to the field of applied behavior analysis, with a particular focus on serving individuals with autism.

The treatment these individuals receive is crucial for their development and quality of life, and it's imperative that they have access to providers who are the best suited to meet their needs. I began my journey in this field in 2020, earning my behavior technician certification through the qualified applied behavior analyst credentialing QABA.

Over time, I advanced to become an assistant behavior analyst, achieving certification as a quas. Also through QABA. My training with Quaba has been invaluable, particularly because it emphasizes person centered values, autism knowledge, and comprehensive AbA techniques. However, I encountered a significant hurdle when I saw I aspired to advance further.

The QABA certification is not currently recognized at the master's level within our state statute, compelling me to switch to BACB certification. This transition, while necessary under current regulations, does not reflect my strong belief in the principles and training offered by QABA. The diversity of my community is mirrored in my professional journey.

Just as I speak Spanish and provide culturally confident care to my clients, I believe that professionals in our field should have the right to choose a certification that best aligns with their training and values.

The inclusion of QABA in our state statutes will not only validate the rigorous and specialized training it provides, but also support professional diversity and choice. Therefore, I respectfully urge you to consider the inclusion of QABA in our state certification statutes.

Such as decision would empower professionals like myself to continue delivering high quality, person centered care tailored to the unique needs of our diverse community. Thank you for your time and consideration.

Thank you. Normally, we allow two witnesses. I see that I have four in front of me.

We're just here for expert testimony. That's it. Or answer any questions Committee might have.

Thank you for joining us, and again, good to see you again.

Likewise, Senator. Always a pleasure.

Any other witnesses in support of this measure, please step forward. Name, affiliation and position on the measure, please.

Hi, my name is Christina Tapia. Family advocate in support of this Bill. I have a family Member who waited three years for autism services in East Palo Alto, California due to lack of providers. So I strongly urge you to support this Bill. Thank you.

Name, affiliation and position on the measure only, please. Please proceed, ma'am.

Doctor Andrea Davis, DIR/Floor time coalition of California and Greenhouse Therapy Center in support.

Thank you for staying.

Hi, Marcela Castanos. I'm the Director of clinical operations at an agency that provides services for kids with autism in support.

Thank you. Next, please.

Hi, Irene Nava from a Changing Trajectory as well. The lead program coordinator.

Thank you for your testimony. Yes, sir.

Next please.

Nicholas D, a BACB board Member but still in supported this Bill. Thank you.

Magdalena Camacho. I'm in support with AB 2449 since I have a grandson who is autistic.

Thank you. Next please.

Farah Shuaib. I'm a family advocate of AB 2449 with three autistic siblings who have ABA services.

Thank you.

Yes, sir. Janel Sosa. I'm coming from San Bernardino area on behalf of Autism and Behavioral Services and as a parent with a kid with autism. I support this Bill. Thank you. Next, please.

I'm Marianna Garcia. Autism behavior services in support.

Thank you. Thanks for joining us. Yes, please.

I'm Ashlynn Hawk. I am a parent of a child with autism and I'm in support.

Thank you. Yes, sir.

Hello, my name is Juan Lopez. I have two kids autismo. I support the bill AB 2449.

Thank you. Thank you. Next, please.

Mi nombre. Jessica Hernandez. Tango dos con antismo, ya por aye Bill AB 2449.

Her name is Jessica Hernandez and she has two kids with autism and she supports the Bill. Thank you for joining us. Yes, sir.

Good afternoon. Chair and Members Tyler Rinde, on behalf of the California Psychological Association in strong support. Thank you.

Thank you. Thanks for coming. Yes, ma'am.

Hi, Albert Camacho. Again, a grandparent of a child with autism and I represent also the Asian Pacific Islander Month. I'm from the island of Saipan and I support. Thank you.

Thank you.

Hello, my name is Selena Frazier. I'm the parent of a child with autism and I support the Bill.

Good afternoon. My name is Maria Aldama and I have a six year old with autism and I support the Bill.

Thank you.

Hi, I'm Karen Cabral. I'm the single parent of a child with autism and I fully support the Bill. Thank you.

Thanks for joining us. Yes, ma'am.

Good afternoon. My name is Veronica Preciado and I am the parent of a seven year old with autism, and I support the Bill.

Thank you. Thanks for joining us. Yes, sir.

Good afternoon. My name is Sergio Preciado. I came from Modesto, California. I have a son with autismo. And thank you for hearing us and. Thank you for helping us with this Bill.

Rick Rollens, on behalf of the Autism Business Association in strong support.

Thank you. Yes, ma'am.

Thank you. Yes, sir.

Thank you for joining us. Yes, ma'am.

Andrea Castro, sibling to a child with autism, in full support of this Bill. Thank you.

Any other witnesses in support in the hearing room? Let's turn to witnesses in opposition. Any lead opposition witnesses first. You may join us at the table if you'd introduce yourselves for the record and then proceed when ready.

Thank you. I will start Melissa Cortez here on behalf of the Council of Autism Service Providers. CASP is a nonprofit trade Association of Autism Service provider organizations committed to promoting and delivering evidence based practices for individuals with autism. CASP represents 54 California based organizations serving thousands of children and adults on the autism spectrum.

CASP is not anti QABA or pro BCBA. We recognize that Quaba and other certifying entities are intended to support the autism community by increasing the number of service providers. CASP is not opposed to recognizing the QABA mid tier CASP S or the entry level ABAT credential, as they are supervised by a qualified autism service provider.

However, lowering the provider credentialing standards for qualified autism service providers who design and implement treatment plans places consumers at risk. Any new credentialing considered should be, should meet or exceed the current criteria for certification. This is especially true and especially important in the absence of licensure in this state, where there is no state oversight for these providers.

QABA qualified behavior analyst or QBA Credential Lacks Sufficient educational and experiential learning requirements to ensure competence in the practice of applied behavior analysis, knowledge of the scientific underpinnings of the study of behavior, and sufficient safeguards to ensure competence to ensure no harm to some of California's most vulnerable citizens, children with autism.

To our knowledge, the QBA is only recognized in one other state. Of the 843 active QABA certificates in California, only 23 are QBAs and only six of those 23 do not have their BCBA or BCBAD, the certification that's already recognized in statute.

The QBA credential has been proposed for licensure in Texas, Georgia, Virginia, Nevada, Kansas, Washington, Oklahoma, and Oregon. Each licensing board has indicated that they will not change their licensing requirements and will not include the QBA. Citing educational and experiential concerns, CASP supports the requirements for the National Commission for certifying agencies and CCA accreditation.

This is consistent with every other healthcare certification in the business and professions code. We want to thank the chair for the amendment and thank the staff for that as well. However, we do remain opposed to this Bill today. We recognize that the amendment does improve the Bill, but we remain opposed and urge your no vote.

Thank you for your time today. Thank you, ma'am. Next, please.

Good afternoon. My name is Michelle Hyde. On behalf of the California Association for Behavior Analysis. I am a board certified behavior analyst and also a parent of a child on the autism spectrum.

Cal ABA is respectfully opposed to AB 244449 as it contradicts widely accepted standards and best practices in credentialing and oversight of practitioners in behavioral health and human services. CalABA is the nonprofit Association representing the over 29,000 practitioners of applied behavior analysis in our state.

Our concerns regarding the addition of the QABA certificates to the California statute as proposed in AB 2449 are twofold as we have concerns about QABA as an entity as well as the requirements for their certifications.

Currently, statute defines a qualified autism service provider as a person who is either licensed by the state in one of several professions or certified in applied behavior analysis by the Behavior Analyst Certification Board, which is a nonprofit organization with well established and recognized procedures for developing requirements than issuing certifications.

At present, there is no licensure for practitioners of behavior analysis in California and thus enforcement of ethical standards is essential for protecting consumers. Licensure for behavior analysts in California is a priority for CalABA as it would ensure consumer protection. The Behavior Analyst Certification Board oversees the practice of its certificants.

It has well developed ethics code and specified procedures for enforcing the code withholders of its certifications. Information about reporting possible violations are readily available to the public on the website along with information about disciplinary action taken against its certificants.

Oversight of ethical conduct of Quaba certificants is done by their board is difficult to find information on the QABA website about its ethics code, how it was developed or enforced, and there is no information about disciplinary actions available on the website that raises serious questions about protection of consumers who receive services from QABA certificates.

In addition, the QABA certification programs are substantially weaker than other programs for licensing or certifying practitioners and behavioral health professions. They contrast with those programs and entities that manage them in several important ways. Its bylaws show that the QABA board is owned and controlled by a privately held for profit company.

It appears that the Quaba board is appointed by the parent company and no information about companies, owners or investors is provided on the QABA website or in its documents. Most nonprofit, professional certifying entities make information about their governance, certification requirements and how those are developed and other standards readily available on their websites.

Parallel information is unavailable or difficult to find on the Cueba website. Individuals seeking BCBA certification and ABA must complete graduate level coursework from accredited universities. Candidates for the QABA certification for independent practitioners instead can take trainings from private vendors who are approved by the QABA board.

Candidates for licensure or certification in most professions must pass a professional exam that is administered at a secure testing center. Candidates for the QBA certification take an exam in their home or workplace that is proctored by a company examity that has been the subject of numerous complaints.

Most licenses and certifications and behavioral health professions are in the practice of that profession generally. Information on the QABA website indicates that clearly that the quaba certification is in autism intervention rather than the practice of ABA or behavioral health profession generally. We recognize and thank the chair and staff for the amendments being proposed.

However, CalABA remains staunchly opposed as we strive to ensure that state laws afford adequate protections for all consumers of ABA services. If AB 2449 were adopted, it would put healthcare beneficiaries with autism and their families at risk. In our view, it would also undermine all behavioral health professions in the state and beyond.

To avoid those problems, we respectfully ask for your no vote on 2449 today.

Thank you for joining us. Any other opposition witnesses in the hearing room? If so, please step forward. Name, affiliation and position on the measure only, please.

Penny Shanken from San Francisco, a board certified behavior analyst in opposition.

Thank you for joining us. Any other opposition witnesses in the hearing room? Seeing none. Let's bring the matter back to the dais. Colleagues. Any questions, comments or concerns?

A question, Mister chair to the opposition. I'm sorry, to the support. Can you share some response the level of training or certification that goes into the ones you're representing here today?

Senator Menjivar.

I can go ahead and answer that. So, for the QVA, it requires 270 hours of coursework of master's degree from an accredited University for higher education, 1500 hours of super field work with 5% supervision, 900 is indirect and then 600 is direct with the actual client.

So, so maybe if this is both so where because the opposition saying it's lower training or less training?

They it was increased from the other board in 2022 to 315 hours. But before that it was parallel. However, we do.

There's only a couple of hours difference or no. What am I missing here?

The. The opposition's changed their required amount of hours after we entered the market. Market.

Can I respond as well? I would like to. Yeah. Here. So one of the requirements for BCBA certification is that you have to take University coursework, including a master's degree, to receive your certification.

The QABA indicates on their website that they require coursework from an approved course sequence that's approved by their board in addition to a master's degree. But your coursework and behavior analysis can be taken from a third party vendor that's approved by their board where the BACB requires University coursework.

Got it. Thank you. So is the opposition solely on the discrepancies between the training that goes into.

So we are opposed, based on this being a lower standard for both experience and education to be certified. We also have concerns with QABA being a for profit entity who does approve their own coursework. Generally, certifying entities are nonprofit in healthcare, right?

Yeah, I saw that in the Committee analysis. Okay. Thank you, colleagues.

Any other questions, comments or concerns?

Seeing none. So, Member, you may close. Once again, I want to thank the Committee staff for patiently working with my office. Really appreciate that. And I respectfully ask for your aye vote.

At such time as we establish a quorum, we'll take a motion and a vote. Nice presentation. Thank you all for joining us. Next item is item number eight. AB 2435 Assemblymember Maienschein, California Health Benefit Exchange. Please proceed when ready. Sir, good to see you.

Thank you very much, Mister chair and Members. Since 2012, Covered California has engaged in a public process with robust stakeholder engagement when proposing and adopting regulatory changes. The Legislature has granted covert California Emergency rulemaking authority because they must must act faster than the traditional rulemaking process allows to implement changes in laws that affect healthcare access for consumers.

This emergency authority expires on January 1, 2025. Consumers will be at risk of significant delay of new benefits or protections if Covered California is not able to quickly conform to new state and federal policy.

Covered California is recently needed or will soon need to implement new subsidies to help more people afford health care, create a program to help workers who have lost their health care coverage, and revising regulations in response response to federal changes.

AB 2435 would extend Covered California's authority to implement emergency rulemaking packages until January 1, 2030 in order to adequately and promptly react to both annual and ongoing changes in federal and state rules. Once the emergency rulemaking process has been completed. Cover of California must then complete the permanent rulemaking process within five years.

This allows for another round of public engagement through comments at Board Meetings and through the regular rulemaking process. By passing AB 2435 this ensures Covered California is able to serve consumers while conforming to new state and federal policies.

Here to testify and support is Christine Smith from Health Access and Kelly Green with COVID California is also here to answer any technical questions. Thank you, and I respectfully request an aye vote.

Thank you, sir. Please identify yourselves for the record and please proceed when ready.

Christine Smith, the Health Access California thank you. We are pleased to be here in support of AB 2435. Health access has testified at every single meeting of the Covered California board since it began meeting in 2011.

Every meeting from the beginning, Covered California has had a custom that a topic is discussed at one public meeting and then voted on a month later at a subsequent public meeting.

This practice means that if any interested party has concerns about a proposed emergency regulation, then the board hears those concerns and in the intervening month, the staff of COVID California can attempt to resolve those concerns before the matter returns to the board.

In addition, cover California staff routinely meets with interested parties, including consumer advocates, who participate in public meetings. AB 2435 continues the existing law requiring this public process and facilitating the informal process of consultation.

While we are not overall fans of emergency regulations, this public process and the opportunity for public comment gives any interested party the opportunity to participate. Thank you.

Thank you for joining us.

Kelly Green, on behalf of Covered California, here to answer any technical questions. Thank you.

Thank you for joining us, ma'am. Any other witnesses in support of this measure? Any witnesses in opposition to this measure? Starting with lead witnesses in opposition, please step forward.

Mister chair. Members of the Committee, Brandon Marchy with the California Medical Association, we are here, regretfully, in opposition. Want to start by saying thank you to the author, who is also my former boss and one of my very good colleagues and friends at Covered California.

I've done my best to teach him. But we went to the dark side. He was stubborn to some of the lessons, but we'll chat afterwards.

A couple of them. Our opposition is not necessarily that we disagree that Covered California should have emergency rulemaking authority in cases of true emergencies. We do believe that they should. The bill is much more expansive than true emergencies, and we believe that that truncated timeline inhibits the public's ability to have input into making regulations.

It inhibits interested parties and stakeholders such as CMA and others. But it also prohibits and puts barriers in front of your ability to make sure that the laws that you have worked so hard to craft and pass get implemented as you saw them them and as you crafted them.

So, based off of those concerns and just the general proliferation that we have seen to the exemptions to the APA process through in other departments, we are in opposition.

Thank you and thank you for joining us. Any other witnesses in opposition, please step forward. Seeing no witnesses, other witnesses in opposition, bring the matter back to the desk. Colleagues, any questions, comments or concerns? Seeing none, Assemblymember, you may close.

The just to close on the comments my good friend Mister Marchie brought up, I do want to say that the regulation engagement process ensures the public has actually provided at least three opportunities to review and comment on proposed regulations. Ample time for stakeholders to engage with Covered California staff, whether it's to further modify or develop proposed regulations.

And then once Covered California has completed the emergency rulemaking process, they must then complete the permanent rulemaking process within five years. So we're really talking about a really significant amount of time that the public's going to have plenty of opportunity to do this.

It's important just because the complexity and to make sure that all these individuals are covered. We'll continue to work on any of those concerns. But I did want to make that clear to the Committee and with that I respectfully request an aye vote at such time.

This time as we can establish a quorum, we'll take a motion and we will take a vote. Appreciate your presentation. Thank you all for joining us. And the final item on the agenda is Item Number Nine: Assembly Bill 2995. Assembly Member Jackson, welcome. Good to have you here.

Thank you, sir. Thank you very much, Committee Members. AB 2995, which would make changes to existing law, removing stigmatizing language for people seeking alcohol or drug treatment services. The bill would replace outdated terminology with person-first language. AB 2995 currently has received bipartisan support, and with me today is our bill sponsor, Amer Rashid--all right--on behalf of the County Behavior Health Directors Association to speak on the impact of this bill.

Sir, please proceed when ready.

Thank you, Chair and Senators, for the opportunity to speak with you--excuse me--to speak with you today. My name is Amer Rashid, and I'm here on behalf of the County Behavioral Health Directors Association of California, the leaders of the public behavioral health agencies that serve the mental health and substance use disorder needs of the Medi-Cal uninsured and underinsured populations.

CBH today is here today as a proud supporter and sponsor of AB 2995, which modernizes existing law by removing stigmatizing language related to substance use disorders and associated treatments, and substitutes it with person-first language where appropriate.

Stigma surrounding substance use disorders is pervasive, a reflection of societal attitudes which can lead to an array of harmful impacts. Research shows it can lead to individuals in need to be less likely to access important and life-saving SUD treatment, or due to stigmatizing language, be less likely to continue on their path to recovery.

Stigma surrounding substance use disorder can lead to discrimination in obtaining housing, accessing health services and treatment, as well as education and employment opportunities. AB 2995's changes tackle stigma by updating existing language in law to better align with the non-stigmatizing person-first language used by behavioral health professionals across California.

This bill helps California take one important step towards addressing stigma through modernizing statute as we continue to prioritize the mental and emotional well-being of Californians. CBHDA thanks Assembly Member Jackson for their incredible work on this bill and respectfully urges your aye vote at the appropriate time. Thank you.

Thank you for joining us. Any other witnesses in support of this measure? Name, affiliation, and position on the measure, please.

Thank you, Chair Roth. Trent Murphy with the California Association of Alcohol and Drug Program Executives, in strong support. Thank you.

Thank you. Yes, please.

Kamesh Ayyagari, youth health advocate, health education startup founder and premedical student, in support of this measure.

Thank you. Yes, ma'am.

Andrea Castro, student with over--peer health educator with over eight years experience, supporting this measure. Thank you.

Thank you. Any other witnesses in support? Let's turn to witnesses in opposition. First, any lead opposition witnesses? Don't see any of those. Any other opposition witnesses? Okay, let's bring the matter back to the dais. Colleagues, any questions, comments, or concerns? Seeing none, Assembly Member, it's your lucky day. You may close.

I respectfully ask for an aye vote.

Nice presentation. Okay, let me ask for all members of the Health Committee who are not here to please report to the hearing room so we can establish a quorum and take motions and take votes on these measures.

As soon as we can establish a quorum, we will give you that.

Thank you, sir.

The Senate Health Committee will be in recess for 10 minutes. The Senate Committee on health will reconvene. Let's establish a quorum.

[Roll Call]

We have a quorum. Let's first take up the consent calendar. We have two items on the consent calendar. Item number four, AB 1965. Blanca Rubio, Public Health, Office of Tribal affairs. And number seven, AB 2119. Assembly Member Weber, mental health. Do I have a motion on the consent calendar? Okay. Senator Grove moves the consent calendar. Please call the roll.

[Roll Call]

Consent calendar has seven votes. Will hold the roll open for absent Members. Next item is item number two. Assembly joint resolution 10 by assemblymember Erwin food date labeling motion is be adopted into the floor. Please call the roll. We need a motion by Senator Hurtado. Please call the roll.

[Roll Call]

Matter has seven votes. We'll hold the row open for absent Members. Next item is item number three above 1842 by Assemblymember Reyes. Healthcare coverage, medication, assistant treatment. The motion is to pass, and we refer to the Committee on Appropriations. Is there a motion? Senator Hurtado moves the matter. Please call the roll.

[Roll Call]

Matter has eight votes. Will hold the roll open for absent Members. Next item is item number five. Assembly Bill 1977 by assemblymember Ta, healthcare coverage, behavioral diagnosis. Motion is do pass as amended, and we refer to the Committee on Appropriations. Do I have a motion? That's Senator Hurtado? Okay. Please call the roll.

[Roll Call]

Measure has eight votes. We'll hold the rope. And for absent numbers. Next item, item number six, AB 2449 by assemblymember Ta health care coverage qualified autism service providers. The motion is to pass as amended. Is there a motion so moved by Senator Grove? Please call the roll.

[Roll Call]

Matter has six votes. Will hold the row open for absent Members. Next item is item number eight. Assembly Bill 2435 by Assemblymember Meinschein. California Health Benefit Exchange. The motion is to pass and re refer to the Committee on Governmental Organization. Is there a motion, Menjivar. Senator Menjivar Muzzabill, please call the roll.

[Roll Call]

We need to recall change of vote. Grove? aye to no. No. Okay, so seven to one. Yes vote. Count on AB 2435 is seven to one. We'll hold the row open for absent Members. Last item. Item number nine. Assembly Bill 2995. Assembly Member Jackson, public health, alcohol and drug programs. Motion is do pass to the floor. Is there a motion? Senator Glazer makes the motion. Please call the roll.

[Roll Call]

Is that it for today? Do anybody miss? We're missing Gonzalez. Yeah, we're waiting for Gonzalez. The vote on AB 2995 is 100. Will hold the roll open for absent Members. Let's just go back through and pick up whoever needs to be picked up here. We're going to open the roll again and go back through the items. First, we're going to start with the consent calendar. There are two items on the consent calendar. AB 1965, by Assemblymember Blanca Rubio, Public Health, Office of Tribal affairs.

And item number seven, AB 2119 by Assemblymember Weber, mental health. The vote is seven to zero. Please call the absent Members. Chair voting aye.

[Roll Call]

I vote is 10-0. We'll hold the row open for absent Members. Let's call item number two. Assembly joint resolution 10 by Assemblymember Irwin. Food date labeling motion is be adopted into the floor. The current vote is seven to zero. Chair voting aye. Please call the absent Members.

[Roll Call]

Current vote 100 will hold the row open for absent Members. Next item is item number three. AB 1842. Assemblymember Reyes. Healthcare coverage, medication, assistant, treatment. The motion is to pass, and we refer to the Committee on Appropriations. Current vote, 80. Chair voting aye. Please call the absent Members.

[Roll Call]

Current vote, 100, a holder, open for absent Members. Next item is item number five. Assembly Bill 1977 by Assembly Member Ta. Healthcare coverage, behavioral diagnoses, diagnosis. The motion do pass as amended. We refer to the Committee on Appropriations. Current vote, eight to zero. Chair voting aye.

[Roll Call]

Current vote 10-0 will hold the row open for absent Members. Next item. Item number six, AB 2449 assemblymember Ta Healthcare Coverage qualified autism service providers. Motion is to pass as amended. Current vote, 6-0. Chair voting aye. Please call the absent Members.

[Roll Call]

Current vote 8-0 will hold the roll open for absent Members. Let's call item number eight. AB 2435. By assemblymember Meinschein. California Health Benefit Exchange motion do pass and refer to the Committee on Government organization. Current vote, seven to one. Chair voting aye. Please call the absent Members

[Roll Call]

Current vote, eight to one. We'll hold the row open for absent numbers. Should be it for everybody.

Yes, you're good. Thank you. Thank you.

Health Committee will stand in recess for five minutes. The Senate Committee on health will reconvene. And we're going to open the roll. And we're going to start by opening the roll on the consent calendar. And the consent calendar consists of item number four. AB 1965. Assemblymember Blanca Rubio, Public Health, Office of Tribal affairs. And item number seven, AB 20119. Assemblymember Weber, mental health. On the consent calendar. The current vote is 10 to zero. Please open the cure voting eye. Please open the roll for absent Members.

Please call the absent Members

Vote is 11-0. The consent calendar is out. Let's start then with next with item number two. Assembly joint resolution number 10. Assemblymember Erwin food date labeling the motion is be adopted into the floor. The current vote is 10 to 10 to zero. Please call the absent Member,

Vote is 11-0. That matter is out. Next item is item number three. Assembly Bill 1842 Assembly Member Reyes Healthcare coverage Medication Assisted treatment motion is do pass and we refer to the Committee on Appropriations. Current vote is 10-0. Chair voting aye. Please call the absent Member.

[Roll Call]

Vote is 11-0 that matter is out. Next item is item number five. Assembly Bill 1977 Assemblymember Ta health care coverage behavioral diagnosis motion do pass as amended and re refer to the Committee on Appropriations. Current vote 10-0. Chair voting aye. Please call the absent Member.

[Roll Call]

Vote is 11-0. That matter is out. Item number six. Assembly Bill 2449 Assemblymember Ta Health care Coverage qualified autism service providers the motion is do pass as amended. Current vote is eight to zero. Chair voting aye. Please call the absent Member.

[Roll Call]

That matter is out. Next item is item number eight. Assembly Bill 2435 assemblymember Maienschein, California Health Benefit Exchange the motion do pass and re refer to the Committee on Governmental Organization. Current vote is 8 to one. Current vote is eight to one. Excuse me. Chair voting aye. Please call the absent Member

[Roll Call]

Current vote is nine to one and final item item number nine. Assembly and that Bill is out. Current vote is item number nine. AB 2995 Assemblymember Jackson Public Health, alcohol and drug programs the motion do pass and to the floor. Current vote 10-0. Chair voting aye. Please call the absent Member.

[Roll Call]

Vote is 11-0. All items are out, including the last one. Health Committee is adjourned.