Senate Standing Committee on Health

Senate Health Committee will come to order. Thank you for being here this afternoon. We have 21 items on the agenda. The good news is we have eight of them on our proposed consent calendar.

Item number five AB 2340 Bonta Medical EPSD services, item number six AB 2630 Bonta Pupil Health, Item number nine AB 2043 Assembly Member Boerner Medical, non medical and non emergency medical transportation, item number 15 AB 2348 Assembly Member Rodriguez Emergency medical services with amendments, Item number 17 AB 2574 Valencia Alcoholism or drug abuse recovery or treatment programs in facilities, Item number 18 AB 2680 Aguirre Curry Alzheimer's disease Item number 19 AB 2701 Vilapdua Medi Cal dental cleanings and examinations with amendments and item number 20 AB 2767 Santiago Financial Solvency Standards Board membership we allow six minutes of testimony per side.

Feel free to use that if you must. We will start as a Subcommitee with our first item. Item number one AB 1316 assemblymember Irwin Emergency services psychiatric emergency medical conditions please proceed when ready.

Thank you Mister Chair. I am pleased to present AB 1316 today. I would like to start by accepting the Committee amendments and thanking the staff for their hard work on this Bill.

As the number of Californians presenting in psychiatric in a psychiatric crisis continues to increase, hospital emergency departments have become a critical part of the safety net for individuals who desperately need psychiatric treatment.

In recent years, though, counties have instructed hospitals to hold a patient in the emergency Department if the patient is on an involuntary psychiatric hold or if the patient has Medi-Cal, leading to unnecessarily prolonged stays in the emergency Department.

In fact, data suggests that about 25% of individuals brought to the emergency Department and psychiatric crisis remain there for three or more days. This has led to valuable emergency Department space being taken up in hospitals across the state.

AB 1316 would address this issue, clarifying that hospitals may arrange a timely and appropriate transfer for patients requiring inpatient psychiatric care to the first available bed in an inpatient facility, regardless of payer preference.

This Bill also clarifies that Medi Cal managed care plans must pay emergency departments for the care they provide to Medi Cal beneficiaries experiencing a mental health crisis. This would codify an existing DHCs policy that sought to ensure hospitals are paid for for the mental health care services they provide.

I would like to note that my office and the Bill sponsor have had positive conversations with the oppositions about their concerns with the Bill and I look forward to continuing these conversations with the hopes of resolving these concerns. With me to testify in support of the Bill is Kristin Barlow.

On behalf of the California Hospital Association and Randall Hager on behalf of the Psychiatric Physicians alliance of California.

Thank you. Please proceed when ready.

Good afternoon. Kirsten Barley with the California Hospital Association, a sponsor of the Bill. Thank you for your time this afternoon. And as mentioned by our author, as many as one in five people who come to an emergency room on any given day are there actually seeking mental health crisis assistance.

And while the national standard of what any of us should expect when we go to an emergency room might be that you're in, you're able to get triaged and treated within about 4 hours.

As was mentioned before, it's not uncommon, unfortunately, for folks to wind up staying for many hours, if not even days or weeks, while treatment is sought and a placement available for someone in a crisis.

I think we wanted to really try to ensure that we have a statewide approach to how folks are being handled when they are in an inpatient, emergent or in a psychiatric emergency, and to ensure that we're treating emergency psychiatric conditions the same way any one of us would experience an emergency room visit for a medical condition, which is that you would be immediately seen, and if you can't be stabilized or treated there at that hospital, you would immediately, you know, efforts would be undertaken immediately to get you transferred under federal law.

Really, hospitals are supposed to be doing this with any patient who presents to the emergency room. And health plans or payers are prohibited from requiring that preauthorization happen for that treatment, including for anyone to be getting emergency psychiatric care.

So AB 1316 would ensure patients in hospital ers are no longer treated differently than any other type of medical emergency that presents in the ER.

And then secondly, it clears up a longstanding set of unclear guidance about Medi-Cal beneficiaries that when they come to the emergency room seeking mental health care, which system are we supposed to have pay for that service?

So it's the intent of our Bill to codify into state law a policy of the State Department of Health Care Services that our Medi-Cal managed care plans, not the county mental health system, be responsible for those emergency room services. So thank you so much for considering today.

And as was mentioned, we are talking with the opposition organization that represents a cohort of psychiatrists to try to understand and address their concerns as we can. Thank you.

Thank you, ma'am. Mister Chairman Randall Hager for the Psychiatric Physicians Alliance of California. It's really important for our physicians to ensure that there is no discrimination in any system of care, particularly in that of the emergency departments and hospitals, where they too often land.

Unfortunately, we think that this Bill does clarify that coverage for a psychiatric emergency medical condition, particularly by health plans and insurers, applies regardless of whether the patient is voluntary or involuntary, really that the legal status really should have nothing to do with whether or not they're treated, whether or not and how they're treated, and whether or not that treatment is paid for.

AB 1316 is proposed to be amended, and so it will allow, clarify that Medi-Cal will pay for all those services up to the point where they're actually admitted to an inpatient unit.

This is a long time in coming, and we're very grateful to see that our psychiatrists believe that patients with psychiatric medical emergency conditions deserve timely care and timely treatment and on the same terms and conditions as patients with other non psychiatric medical conditions. So that would include timely transportation.

But I think we're in a bad position if we're allowing healthcare plans and insurers to pick and choose patient coverage levels, reimbursement levels, or transfer options based on whether or not there's a legal status for that particular patient. It just should be straightforward across the board the same.

So it levels the playing field this Bill does with respect to those legal statuses and helps clarify that both quality and standard of care is the same for both and that hospitals get reimbursed for it either way, which is important. Thank you.

Thank you both for your testimony today. Any other witnesses in support of this measure?

Thank you, Chair. Thank you, Chair. Tim Aden, representing the California chapter of the American College of Emergency Physicians in Support.

Thank you. Next, please.

Grace Copland, on behalf of Providence in support.

Thank you, ma'am. Next, please.

Theresa Comstock with California Association of Local Behavioral Health boards and commissions in support.

Thank you for joining us. Any other witnesses in support in the hearing room, any witnesses in opposition, please step forward. Feel free to come up to the table in the well, thank you, Mister chair.

Dylan Elliott with Shaw, Yoder, Antoish, Meltzer and Lang here, on behalf of the California State Association of Psychiatrists, respectfully opposed to AB 1316 as is currently in print, would like to begin by thanking the Committee staff, author's office staff and the sponsors for the productive conversations that we've been having. Where should the Bill move today?

Looking forward to continuing those CSAPs concerns can be boiled down to, despite best intentions, a portion of the Bill that could be interpreted as relieving hospitals of their responsibility to provide assessments for 5150 individuals who present voluntarily, something that we fear could be a disaster to those individuals and the state.

Again, we're optimistic that ongoing discussions can lead us to a place that CSAP can consider removing its opposition. Want to reiterate our thanks for the dialogue and look forward to continuing those conversations. Must respectfully oppose.

Have you submitted language?

I believe so, yes, and it sounds like we're having some back and forth.

Thank you. Any other witnesses in opposition? Name, affiliation and position on the measure? Seeing none, Assembly Member. I guess you may close.

All right. Well, when the time is right, I respectfully asked for your Aye vote.

Thank you very much. Secure a quorum. We'll request a motion and take a vote. Thank you all for appearing today. Thank you.

Thank you.

Next item. Let's see who we have. We do. We have AB 1926. Member Connally, please step forward. Proceed when ready.

Thank you, Chair and Members, good afternoon. I'd like to begin by thanking the Committee and staff for their work and input on this Bill. AB 1926 would require health plans renewed on or after July 1, 2025 to cover dietary enteral formulas for the treatment of regional enteritis.

These formulas can be a successful alternative to medication treatment for several digestive diseases, including regional enteritis, which we know commonly as Crohn's disease. This therapy has substantial benefits for all Crohn's patients, but most notably pediatric patients, because they may not have access to or may not be able to use certain medications.

Additionally, patients with Crohn's disease can utilize medically necessary formulas for nutritional support and to help them achieve remission. Early treatment options for digestive diseases like Crohn's have proven to reduce harm and increase quality of life. There is no reason why Californians suffering from chronic illnesses cannot lead full and productive lives.

AB 1926 provides patients with a proven, successful alternative to certain medications, which healthcare providers may recommend when complications such as weight loss, surgery, obstruction, or severe inflammation prevent patients from getting the right nutrients. Enteral nutrition, or EN, as it's known, is a way to give the patient's body what it needs to stay healthy.

EN is usually taken in the form of nutrient rich formula, including boost, ensure and orgain. Digestive diseases like Crohn's disease affect millions of Americans with as many as 70,000 new cases of IBD diagnosed each year.

I also add AB 1926 is actually a redo of my Bill from last year, AB 620, which passed through this Committee with near unanimous bipartisan support and actually made its way to the governor's desk.

AB 620 was vetoed because, under the exclusion section of essential health benefits benchmark plan, outpatient oral nutrition, such as dietary supplements, herbal supplements, weight loss aids form, formulas, and food are listed.

However, there are exceptions to this exclusion, and after conversations we've had with the Department of Managed Healthcare, the language for AB 1926 was amended to more closely align with the language in the benchmark plan.

And to help address the veto message, I will now pass it off to my witness, Ryan Spencer, representing the Crohn's and Colitis foundation, the bill's sponsor.

Please proceed, sir. Thank you, Mister Chair. Ryan Spencer, on behalf of the Crohn's and Colitis Foundation, I think the authors he encapsulated really all the need and the intent of AB 1926. But I just want to reiterate two important points.

One is something he just concluded with, is this Bill did pass out his Committee, a version of this Bill, AB 620, passed out as a Committee with bipartisan support. It was a much more expansive Bill applied to all digestive diseases and inherited metabolic disorders.

This one, as, as the author mentioned, is more narrowly tailored and targeted toward regional enteritis and specifically states, we're talking about nutritional drinks. And the reason why that language is so narrow is because we want to more closely align with the benchmark plan, as close as we could possibly do.

The second point, I'd like to point out, has to do with cost, which always comes up with healthcare mandate bills. The chip rip report that was cited, and will be cited by the opposition when they come up, was not actually created for 1926.

It was from the previous version, AB 620, which, like I said, was a more expansive Bill. So the cost, for one, is probably larger than it would been if a new report came out specifically tailored to 1926. They cited a cost of $24 million to the overall health cost of the healthcare system.

I think it's fair to assume there will be a cost. It is a mandate. But what it fails to acknowledge, as this is a much cheaper, less expensive alternative than what currently available now, and which is typically covered, which are biologics.

So the option that is given to patients is this is you can either get particularly pediatric patients, as the cell Member said, you can put your disease in remission by using nutritional formulas, which you're going to have to pay out of pocket. It's a few hundred bucks for a case of these things, or could be.

Or you can pay a copay of $15 to $20, whatever it may be, for a biologic, which in reality could be thousands of dollars, because that's typically what's covered. So the patient is probably going to opt for the copay because it's cheaper for them out of pocket.

But for the overall health cost of healthcare system, it is a much less expensive alternative to what is offered now. And it is equally, it's proven equally effective, as he mentioned. So with that, I like to ask for aye vote at the appropriate time. Thank you.

Thank you for joining us. Any other witnesses in support, affiliation and position on the measure only, please.

Thank you Mister Chair Members. David Gonzalez, on behalf of the California Life Sciences, in support.

Thank you. Next.

Good afternoon, Mister Chair. Awad Kadani, representing the California Children's Hospital Association, in support.

Thank you sir. Yes, ma'am.

Thank you. Erin Taylor with political solutions, on behalf of the Children's Specialty Care Coalition, in support.

Thank you. Next please. Mayor Lasika, on behalf of the California Association of Orthodontists in support. Thank you.

Next please.

Thank you, Mister Chair. Alex Kahn, on behalf of the California Chronic Care Coalition, in support. Thanks for joining us.

Any other witnesses in support? Seeing none. Witnesses in opposition. Any witnesses in opposition? Let's see. Seeing. Going. Going. Gone. Okay. Seeing none. Assembly Member. You're lucky. Let me bring it back to my colleagues. Any questions, comments? Concern? A colleague? Questions, comments and concerns? Okay. It's your lucky day, sir.

Thank you, Chair. I will take that. And at the appropriate time would respectfully ask for an aye vote.

As soon as we get a quorum, we'll take a motion and take a vote. Thanks for being here. Thank you. Nice presentation. Item number three. Assembly Member Jackson, AB 1970 Mental Health Plaque, Mental Health Navigator Certification please proceed when ready, sir.

Thank you very much, Mister Chair. Senator Menjivar. The two faithfuls of the Committee want to thank the opportunity to present AB 1970, which would require the Department of Healthcare access and Information to create a black mental health navigator certification within the Community Health Worker certification program.

This Bill would require the Department to develop specific training and mental health resources, including crisis intervention training and non emergency cases, entry level assessment, navigation support and culturally specific practices relative to helping to connect individuals with licensed mental health professionals and wellness services.

It would also require to collect annual data as well, and to publish that data from individuals that earn a certificate, as well as the number of who are actively employed as community health workers. With me today, I have Dominique Paxton, on behalf of the California Black Women's Health Project, to speak on the impact of this Bill.

Thank you for joining us. Please proceed.

We have some truths to be self evident.

Let me just have you identify yourself for the record, please.

My name is Dominique Paxton, I'm the Northern California program manager of California Black Women's Health Project.

Thank you. Please proceed.

We hold some truths to be self evident, and the mental health crisis and the need for help in black communities is among those truths. It's an honor to stand here today on the behalf of Sonia Young Adam, CEO of California Black Women's Health Project, who was unable to be with us today.

Dedicated, intentional and certified behavioral health navigation is necessary to support prevention and early intervention care for the mental health barriers and gaps faced by Black Californians. We applaud Assembly Member Jackson for his boldness in bringing forth AB 1970. The proposed certification program would bring two important changes to address our community's mental health crisis.

Number one, certification equates to professionalism and knowledge and experience for those of us already engaged and committed to navigation. And number two, certification for our community in particular is a testament to the recognition that culture, heritage, history and race are social determinants of health and wellness.

California Black Women's Health Project is committed to better mental health for black women, girls, families and communities. We support AB 19 and we are committed to using our decades of experience in training health navigators, advocates and activists to provide consultation advice to any public and private agencies working to improve behavioral health care for black Calamoreans.

Thank you, Assembly Member Jackson. Thank you to this Committee for the opportunity to stand here today.

Thank you for presenting any other witnesses in support. Name, affiliation and position on the measure only, please. Thank you, ma'am.

Good afternoon. Symphony Barbee on behalf of Planned Parenthood Affiliates of California in support.

Thank you for joining us. Next, please.

Vanessa Kahina with KP Public Affairs on behalf of the California Academy of Family Physicians here in support.

Thank you. Next.

Kat Bess with the California Alliance of Child and Family Services in support.

Thank you, ma'am.

Brandon Marchy with the California Medical Association in support.

Good to see you, sir. Next, any other witnesses in support? Okay, let's turn to witnesses in opposition first. Lead witnesses in opposition if there are any, and then other opposition witnesses seeing none, let's bring the matter back to my colleague. Any questions? Comments? Concerns? Seeing none, Assembly Member. Your lucky day. You may close.

I respectfully ask for an aye vote.

As soon as we get a quorum and take a motion, we'll take a vote. Thank you both for being here. Next item, I think I thought. I see we have our Assembly health chair, Assembly Member Banta, who has several items.

We will start, if she pleases, with item number four, Assembly Bill 1975 Medi Cal medically supportive food and nutrition interventions. Chair please proceed when ready.

Thank you so much. Chair good afternoon. And Committee Member, soon to be Members. Food is life, food is sustenance. Food is medicine. Food is medicine is a priority Bill to me and is a legislative reparations priority Bill as part of the California Legislative Black Caucus.

Upon appropriation of funds, AB 1975 would make medically supportive food and nutrition intervention a covered benefit to all Medi Cal recipients when deemed medically necessary by their healthcare providers. AP 1975 would direct the Department of Healthcare Services to form a Committee to issue guidance for implementing these intervention services.

Our witnesses today giving testimony include Doctor Steven Chen, Chief Medical Officer of the Alameda County Recipe4Health Program, and Elizabeth Duran, a patient participant in Recipe4Health. Their stories will be very impactful. In addition, we have Erin Franey from the Food as Medicine Collaborative to answer any questions.

Thank you. Thank you for joining us. Let me just ask you to identify yourselves for the record before speaking. I'll let you flip a coin to see who goes first.

My name is Elizabeth Duran.

Thank you, ma'am. Do you want to proceed first?

Sure. My name is Elizabeth Duran. I live in the East Bay and I'm here to share about my experience with open source wellness and recipe for health. The pandemic caused me to lose my job of 30 years, including my health insurance. A knee injury led to surgery. I gained weight. I took medication for high blood pressure.

My Doctor of 10 years prescribed pills for anxiety. Soon after, I found myself on Medi Cal at a Taborsky Vasquez Health Center. I was terrified. My new Doctor suggested a program which would include free organic vegetables once a week, plus health and wellness coaching called Rest for Health.

He described that I would learn about nutrition and be supported by a friendly community. Within a few days, I got a phone call from the recipe for health team to enroll me in the program. What I initially envisioned as a weight loss program turned out to be much more than I ever imagined.

Not only did I receive beautiful organic greens and vegetables, I learned of their nutritional value and how to incorporate them into a healthy diet in the most affordable way. I am cooking and eating much better. Better. Today I look for new recipes online that include collard greens and swiss chard, things that used to be unfamiliar.

I learned how to incorporate different types of physical activity into my daily life. In all my years with private health insurance, no one ever asked me if I wanted to learn about healthy eating or offered resources. Open source wellness has made me feel wanted and cared for again.

When I was turned away elsewhere, my worry has become less, my sleep more. My blood pressure is at a healthy level. I am feeling happy again and not from a pill. I became so inspired that I stand as a peer leader, wanting to inspire others who may be in a dim place as I once was.

California across the state Californians across the state, like me, need these critical programs to support our health. I respectfully urge your aye vote for AB 1975, which will ensure programs like Recipe4Health becoming permanent Medi Cal benefits. Thank you for allowing me to share my experience. It has been an honor.

Thank you for joining us. Today. We eat a lot of collard greens in the south.

Yes, Doctor, thank you so much. Senate Health Committee Members. My name is Doctor Steven Chen and I am a family physician with 24 years of clinical and administrative experience in the safety net health systems.

I serve as the Chief Medical Officer for Alameda County's Food4Medicine program, and I regularly testify to congressional leaders and federal agencies about food as medicine. I'll place Miss Duran's story in context to answer the question, why support food as medicine programs through this Bill? First, Americans are sick.

Six in 10 adults have chronic conditions like diabetes or high blood pressure. And the two major drivers of these chronic conditions are an unhealthy diet, which is now the leading cause of death, resulting in 500,000 Americans fatalities per year, and food insecurity, which can double one's risk of developing a chronic health condition.

Food as medicine programs like recipe for health will address causes of root of chronic health conditions the root causes of chronic health conditions across California. In Alameda alone, we have scaled across 10 sites, 10 clinical sites and served over 6000 patients, 83% of whom are BIPOC. Imagine Miss Duran's story multiplied thousands of times in your district.

Citizens like Miss Duran will walk into your local Food as Medicine Health Centers, where a medical assistant screens them for food insecurity. A clinician then prescribes two things. Number one, produce delivered to your doorstep. Paired with number two, health coaching to sustain all of these life habit changes. So it's the food and the sustenance.

Because the produce is grown locally by BIPOC farmers, every $1 that is spent on prescribed produce generates $1.90 for the local economy. The produce is grown using regenerative and organic farming approaches, which minimize toxic pesticide residues and increase the food's nutrient density to improve health.

In fact, our evaluation team from Stanford and UC San Francisco reported the following highlights and just a few highlights. Number one, a third of our patients with prediabetes or diabetes showed a clinically significant reduction in their blood sugars. Number 22 thirds of our patients improve their cholesterol indicators, reducing heart disease risk.

Number three, emergency room visits decreased by 15%. So in closing, I urge you to make history by voting Aye on 1975 to make food as medicine a permanent covered benefit in Medi Cal and to improve the health of your constituents and the economic vitality in our communities. Thank you all so much.

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

Thank you Mister Chair. Darby Kernan. On behalf of several organizations, meals on Wheels Project Open Hand, the California Association of Food Banks and Leadingage California. Thank you.

Thanks for joining us. Yes, ma'am.

Hi, Christie Foy with Arnold and Associates here on behalf of the California Kidney Care Alliance and Fresenius Medical Care, in strong support.

Thank you. Next please. Ryan Spencer. On behalf of the American College of OBGYN District Nine in support. Thank you. Yes, ma'am.

Kelly Brooks. On behalf of the Urban Counties of California, the Rural County Representatives of California and the County Health Executives Association of California in support, thank you for joining us.

Vanessa Kahina, on behalf of the California Academy of Family Physicians, in support, thank you.

Yes, ma'am.

Christine Smith, Health Access California in support.

Thank you.

Good afternoon. Taylor Roshan, on behalf of California Fresh Fruit Association and American Pistachio Growers, in support.

Thanks. Symphony Barbee. On behalf of Planned Parenthood Affiliates of California in support, thank you.

Whitney Francis with the Western Center on Law and Poverty in strong support.

Thank you.

Brandon Marchy with the California Medical Association in support

Thanks Dylan Elliott, on behalf of the city and County of San Francisco in support, thank you.

Rand Martin. On behalf of the AIDS Healthcare Foundation in strong support. Thank you. Thank you. May I have the greatest urban support. Thank you, sir.

Good afternoon, Mister Chair. Jolie Onodera with the California State Association of Counties in support. Thank you.

Alex Kahn, on behalf of the California Chronic Care Coalition, in support.

Marvin Pineda. On behalf of the California Primary Care Association, in support. Thank you, sir. Next please.

Robert Boykin. On behalf of the California Association of Health Plans in support, thank you.

Jared Moss. On behalf of the City of Long Beach support, thanks for joining us.

Andy Nada-Riese with the Agricultural Institute of Marin in support. Thank you.

David Gonzalez. On behalf of the American Diabetes Association, in support.

Thank you, sir. Any other witnesses in support? Now let's turn to witnesses in opposition. Any witnesses in opposition? Seeing none, Madam Chair, you may close.

Thank you. This Bill has been become a heart project for me over the course of the last two years and my staff and very supportive of the idea of ensuring that California actually gets to save money by investing in healthcare preventatively.

The reality is that California stands to be able to save hundreds of thousands, if not millions of dollars if we would just do a very simple thing, which is allow people to be able to use medically supportive plans to be able to support their health conditions. With that, I respectfully request your aye vote.

As soon as we get a quorum, we'll take a motion and do that vote. Your next item is item number seven. AB 2786 certified mobile farmers markets. Proceed when ready.

Continuing with the theme, thank you, chair and Members. I want to start by accepting the Committee amendments. AB 2786 establishes a pathway for Californians to utilize their WIC benefits at mobile farmers markets.

WIC supports the consumption of fruits and vegetables through the WIC Farmers Market Nutrition program, also known as the WIC FMN FMNP mobile farmers market bring farm fresh fruits and vegetables directly to communities that otherwise lack access. The problem is that currently mobile farmers markets are not authorized to redeem WIC benefits.

To address this Bill, AB 2786 does two things. First, it creates a definition of a certified mobile farmers market in health and safety code.

And second, it directs the Department of Public Health to include certified mobile farmers markets in the state plan, which they submit annually to purchase participate in WIC FMT FMNP the state plan is approved by the Federal Government. This Bill will require DPH to authorize certified farmers markets to participate in WIC FMNP.

By allowing WIC participants to use their benefits at mfms, this Bill will increase access to nutritious food for Low income communities. With me to testify and support, I have Susie Sutphin, community food program manager, Center for Land Based Learning, and Andy Najarise, Chief Executive Officer of the Agricultural Institute of Marin.

Okay, thank you. Please identify yourselves for the record before you speak and proceed when ready, ma'am.

Good afternoon, chair Roth and community Members. My name is Susie Sutphin. I am the community food program manager with the Center for Land based learning. For more than 30 years, the Center for land based Learning has helped aspiring farmers and environmental stewards pursue careers and resources and possibilities within California's rich working lands.

In 2021, we launched a mobile farmers market as part of our community Food program. Its goal is to ensure equal access to local, seasonal, sustainably grown produce and provide innovative new market opportunities for small family farms. It serves primarily ethically diverse, Low income neighborhoods throughout Yolo county that identify as food insecure by the USDA.

We're addressing food excess challenges by not only making it affordable, but convenient. By going to the neighborhoods that need us most and have the least access to fresh healthy food. To better serve our Low income customers, we accept Calfresh benefits and provide market match so that anyone who qualifies can get $20 in produce for just $10.

We also we don't accept WIC, of course, yet, but we have privately fundraised to offer a 50% off discount to Members who have WIC. We support AB 2786 to recognize the significant role that mobile farmers markets play in improving nutrition and health for women and families who are Low income.

Mobile farmers market's mission are to support Low income communities, and it's important to note that we are not wholesalers. In the same way that bookmobiles have extended the reach of public libraries, mobile farmers markets extend the reach and impact of certified farmers markets by connecting more communities with California's small to mid sized farms.

This Bill would provide a pathway for mobile farmers markets to accept WIC farmers market nutrition benefits and in turn, allow more Californians with access to healthy, fresh food grown locally. 10 other us states allow mobile farmers markets to accept WIC. It's time for California to be the 11th.

Adequate nutrition is a key to preventing chronic conditions and reducing healthcare costs. With the passage of this Bill, California can lead the way in providing new and innovative access points to connect farmers with WIC participants. Thank you to Assembly Member Bonta for introducing this Bill. I respectively request an aye vote on AB 2786. Thank you.

Thank you, ma'am. Sir,

Sure. Andy Naja-Riese with the Agricultural Institute of Marin. I'll keep it brief. We are trying to close a loophole within California where mothers who are shopping with their WIC farmers market nutrition benefits are not able to use those at mobile farmers markets.

And we think that that a regulatory change would help to ensure that all mothers who are using WIC can shop at mobile farmers markets to get access to the best produce that's grown right here in California. So we thank Assembly member Bonta for her leadership and requestfully respect an aye vote. Thank you.

Thank you, sir. Thanks for joining us.

Any other witnesses in support? Seeing none. Any witnesses in opposition? Seeing none. Madam Chair, you may close.

Thank you, chair. When I was growing up in New York City, on every Sunday, my mother and I would have to take a bus to go to the food market to be able to get her favorite fruits and vegetables that then became mine.

This is an opportunity for us to not treat poverty as something that is suspicious, but essentially is something that we need to be able to be supportive of by allowing all of our people who are receiving WIC benefits to be able to do a very simple thing. Receive fruit and vegetables that come to their door.

With that, I respectfully request your aye vote.

We have a quorum. We'll take a motion and do exactly that. You have one more item. Item number eight. AB 3161, health and care facilities, patient safety and anti discrimination. Please proceed when ready.

Thank you chair and Committee Members. I authored this Bill because black, indigenous, and people of color communities experience a higher rates of medical misdiagnoses and patient adverse events when compared to white patients.

This Bill requires hospital safety plans to include a process for addressing racism and discrimination and its impacts on patient health and safety, including monitoring sociodemographic disparities in patient safety events, developing interventions to remedy known disparities, and encouraging facility staff to report suspected instances of racism and discrimination.

The Bill also requires hospitals to provide the Department of Public Health Health with demographic information regarding the affected patient when reporting adverse events. We cannot solve the problems of racial bias and disparities in patient safety events until we actually have real data about the scope of the problem here in California. This Bill will provide that data.

Testifying in support today is Vanessa Tahina, representing California Pan Ethnic Health network.

Yes ma'am. Please proceed.

Thank you very much Mister chair and Members, Vanessa Cajina with KP Public affairs in front of you today for the California Pan Ethnic Health Network, proud sponsors and co sponsors of AB 3161. This Bill would establish a mechanism to track racism and discrimination in healthcare while also supporting patients and accessing justice.

Racial discrimination and implicit bias persist in the healthcare industry and negatively affect health outcomes, and these challenges may lead to serious injury, misdiagnosis, or even death. Well documented national research shows that communities of color are much more likely to experience patient safety events than their white counties counterparts.

Here in California, the California Department of Public Health has oversight of facilities and is required to review adverse patient safety events. However, it is not collecting that demographic data or sexual orientation and gender identity information in connection with these events. AB 3161 creates the mechanism to collect that data so that we can understand those systemic issues.

This is problematic historically in terms of tracking who in our state is being harmed. Updating the information collected while also getting patients clear information on the complaint is currently pretty confusing, so putting this all together gives you a much better mechanism for patient safety, but then also looking at systemic information.

AB 3161 can't end racism or discrimination or implicit bias, but it will give us a much better concept of patients around the state and giving them the tools to address problematic actors. For these reasons, we respectfully ask for your I vote and thank Assembly member Bonta for her leadership.

Thank you. Any other witnesses in support? Affiliation, position on the measure only, please.

Thank you Mister chair. Alice Kessler. I'm here on behalf of Equality California and strong support.

Thank you for joining us. Next.

Sandra Poole on behalf of Western center on Law and Poverty in support.

Thank you. Yes, ma'am.

Symphony Barbie, on behalf of Planned Parenthood affiliates of California in support.

Thank you. Sir.

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

Thanks. Yes, ma'am.

Hi, good afternoon. Carol Gonzalez on behalf of Hispanas Organized for political equality and strong support, thank you.

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

Hi, good afternoon. Beth Malinowski SEO California in strong support.

Thanks.

Hello. Rachel Bhagwat, ACLU California Action in support

Thank you. Next please.

Jennifer Robles with health access California in support.

Thank you. Any other witnesses in support? Witnesses in opposition? Any witnesses in opposition? Seeing none. Bring it back to the dais, my colleagues, any comments, questions or concerns? Senator Rubio, of course.

Thank you. Thank you Mister chair. And thank you for this. I know that I was listening, I mean, not only reading, but listening to what you were saying. And already national research shows that people of color are constantly being on the losing end of this issue.

And you know, I think collecting data is super important just to really understand where the deficiencies are and we can fix the problem. So thank you both. And I want to be at it as a co author to this Bill. So appreciate you.

Thank you. Any others? Seeing no others, Madam Chair, again. You may close.

Thank you. This is just a very smart, basic Bill that allows us to be able to use the power of data to understand the extent to which bias and racial disparities impact our patients in the State of California. With that, I respectfully request your aye vote.

As soon as we get a quorum, we'll take a motion and we'll take a vote on this one as well. Thank you for joining us, Madam Chair. Nice presentations. Next is item number 11, AB 2081, Assembly Member Davies. Substance abuse recovery and treatment programs. Please proceed when ready.

Good afternoon, and thank you, Honorable Chair and Senators. I want to start off by thanking the committee staff for working with us and our stakeholders so diligently on this bill. I'm here today to present AB 2081, which relates to residential treatment facilities. My staff and I have worked hard on amendments for this bill with Assembly Committee staff, and we're happy to accept their recommendations.

This bill simply requires operators of substance use treatment facilities to include on their website and intake paperwork, a disclosure that will help lead patients to the DHCS website so they may check for prior violations or even see if their license has been suspended at one point. This can be greatly beneficial to patients.

By empowering them to look deeper into which government agencies oversee their facilities, they can learn more about treatment options and protections guaranteed to them as a patient. My bill will also empower DHCS to penalize facilities if they do not include the disclosure. The penalty would be determined by DHCS to make sure it's consistent with their fine structure.

AB 2081 is intended to further raise the level of transparency and accountability within the substance use disorder treatment system. Seeking treatment for substance use can be taboo, and as long as we continue to let bad actors run rampant and take advantages of patients in the system, it will stay that way.

There are so many stories from parents and patients about what has gone on in some of these facilities and most are utterly heartbreaking. We are elect leaders in this state and can help to prevent the loss and sadness that occurs in some of our facilities. With me today is Caroline Grinder, representing the AB 2081 sponsor, the League of California Cities. Honorable Chair and Senators, I respectfully ask for an aye vote. Thank you so much.

Thank you. Thank you for joining us. Please proceed.

Thank you so much. Good afternoon, Chair and Members. Caroline Grinder, on behalf of the League of California Cities. We are proud to co-sponsor AB 2081. This common sense legislation would require a higher standard of transparency and greater protections for individuals seeking alcohol and substance use treatment.

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

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

We have a long history at Cal Cities of attempting to pass legislation to address the concerns raised by cities about the need for increased oversight, transparency, and accountability for alcohol and drug treatment facilities operating in our communities. We believe that this is a practical step forward and we respectfully ask for your aye vote. Thank you so much.

Thank you. Thanks for being here. Any other witnesses in support? Name, affiliation, and position on the measure only, please.

Good afternoon, Mr. Chair and Members of the Committee. Sharon Gonsalves, on behalf of the City of Carlsbad, in support.

Thank you for joining us. Any other witnesses in support? Okay, witnesses in opposition, please join us in the--well--the table if you'd like.

Good afternoon, Chair and Members. My name is Trent Murphy, and I'm here on behalf of the California Association of Alcohol and Drug Program Executives. We're a professional association that represents the majority of the state's publicly funded substance use disorder treatment network. We're not necessarily opposed to the intent of the bill.

We also agree with the author that state regulations and law need to ensure that bad actors are not allowed in this space, so thank you for saying that, but we do disagree that there needs to be new regulations placed on licensed SUD services. This bill in particular is unnecessary in our opinion because current law and DHCS regulatory rules already cover the requirements outlined in this legislation.

The Health and Safety Code, specifically Section 11831.12, already mandates licensed SUD providers to disclose on their website and in any marketing of their facility, their DHCS license number and their expiration date for that license. This disclosure on the website includes a hyperlink which conveniently takes a web user directly to DHCS's full list of certified and licensed SUD treatment providers.

Additionally, the same statute mandates SUD providers to provide their license and certification information to anyone who inquires about the facility's license through any method of communication. Regarding the intake paperwork portion of the bill, Section 16,000 of DHCS's alcohol and other drug program certification standards already requires that the disclosure of clients' rights at the time of intake, which I won't give the exhaustive list, but in that client's rights paperwork, it includes the right of each person to be informed of the procedures to file a grievance or appeal a discharge with DHCS.

Current regulation states that each new client must review, sign, and be provided a copy of these rights upon admission, and these rights must be posted in a visible location for the general public as well as new clients. So it is our opinion that the current law already mandates transparency and public access to licensing information for SUD providers.

And adding another layer of requirements is redundant and imposes unnecessary administrative burdens on the SUD treatment facilities without offering any additional benefit to the public. So we respectfully ask you to reconsider the necessity of this bill and ask for your no vote. Thank you.

Thanks for joining us today. Any other witnesses in opposition? Seeing none, let's bring the matter back to the dais. Colleagues, any comments, questions, or concerns? Seeing none, Assembly Member, you may close.

Thank you. I respectfully ask for an aye vote. Appreciate it.

As soon as we establish a quorum, we'll take a motion and we will accomplish the vote. Nice presentation. Thank you for joining us. Assembly Member Maienschein, Item Number Ten: AB 2063: health care coverage. Please proceed when ready. Good to see you again.

Nice to see you again, Mister Chairman. Thank you, Mister chair. And Members, I would like to begin by accepting the Committee amendments. As detailed in the Committee analysis, AB 2063 extends the sunset date for a key pilot program delayed by the pandemic.

This pilot program integrates risk bearing providers with self funded employer plans, using capitated payment mechanisms to reduce healthcare costs. This Bill proposes a two year extension to properly evaluate the impact on service speed, healthcare costs, and patient outcomes.

The extension ensures the program can fulfill its objectives despite pandemic related setbacks, reaffirming our commitment to improving healthcare coverage, reducing costs, and meeting community needs during these challenging times.

I respectfully request and aye vote in joining me to testify and support, and also to address any technical questions are Laura Josh, the General manager of California schools VEBA, and Bill Barcelona from America's physician groups.

Good to see you both. Please identify yourselves for the record before speaking and proceed when ready. We have the same problem. Is this on?

Okay, well, red is confusing. All right. Hi, I'm Laura Josh, the General manager at California Schools. VEBA chair Roth and distinguished Members of the Subcommitee. Thank you for having us here today to talk about this important Bill.

VEBA is a nonprofit trust that was founded in 1993 as a partnership between labor and management to address the rising healthcare costs of our school district employees statewide. By law, our VIBA funds can only be used for the benefit of our trust Members. Unlike other health plans, no one's profiting.

There is no distribution of earnings, and excess reserves are not returned to the employers. They have to be reinvested into the Members of the trust program. We serve over 100,000 Members, 160,000 Members across California, which includes teachers, custodians, bus drivers and the other diverse employees who serve our communities.

We were honored to select the first of its kind pilot made possible by AB 1124, which from our perspective was a huge step forward in actually giving us transparency into our healthcare expenses. We currently spend over $1.0 billion on healthcare premiums and have limited visibility into the underlying contracts and expenses.

Under the pilot, we were able to launch a comprehensive program. It has extensive Member protections on January 1 and we've enrolled 5000 Members and their families. We're already seeing savings in the program with great outcomes and Member satisfaction has been high with no complaints received. Our launch date was delayed two years due to the Covid-19 pandemic.

So we're seeking a two year extension to ensure we can get complete data of the pilot. By granting the extension, we avoid disrupting Member care, allow evaluation of the cost savings, patient outcomes and enrollee satisfaction. So California schools VEBA supports this Bill and we respectfully request your.aye vote thank you.

Thank you sir.

Thank you Mister chair and Members Bill Barcelona with America's physician groups, we're proud to partner with Cal Schools VEBA on this pilot. I want to talk a little bit about the providers who are involved in the pilot.

In San Diego, county, for the first year of operation, we have Rady Children's Hospital and Rady Children's medical group, the largest primary care children's specialty medical group in the State of California.

We have UCSD Medical group and hospital system and we have two of the sharp groups, Sharp Restele, which has been in operation for over 100 years in the San Diego region, and Sharp Community Medical group, as well as the Sharp hospitals. These are some of the best providers in the western United States.

They're proud to participate with VEBA on this and we look forward to the transparency that this will generate around cost and quality inform our health policy in the state as we move forward. Thank you. We respectfully request your aye vote.

aye vote.

Thank you sir. Thank you both for joining us. Any other witnesses in support? Okay, any witnesses in opposition? Come on down.

Good afternoon, chair Members of the Committee, Robert Boykin with the California Association of Health Plans, regrettably in opposition to AB 2063. We greatly appreciate the author's office and their efforts to promote innovation in healthcare.

However, we continue to be concerned about allowing new risk bearing arrangements for providers outside the scope of a Knox keen fully state licensed health plan. California Knox King license health plans are tightly regulated and comply with a wide array of requirements that protect the market and healthcare service customers.

Among other things, fully licensed health plans must meet stringent solvency requirements, ensure timely access to care, implement customer grievance processes, and participate in independent medical reviews. We feel this Bill will allow an arrangement that does not provide the important consumer protections that a licensed health plan must extend their enrollees.

And for that reason, I should say, we ask you for no vote on AB 2063.

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

Good afternoon, Mister chair. Jack Yanos, on behalf of America's Health Insurance Plans, respectfully opposed. Thank you.

Next, please.

Thanks for joining us.

Good afternoon, chair Members. Matt Akin with the Association of California Life and Health Insurance Companies. In opposition. Thank you.

Any other witnesses in opposition? Okay, bring the matter back to the dais, my colleagues, any questions? Comments? Concerns? Seeing? None. Assemblymember.

Assemblymember.

Thank you very much, Mister chair Members. In closing, you know, this builds on. We passed this with AB 1124 back in, I believe it was 2020, but we just. And it was great.

Passed the Assembly, passed the Senate, signed the law, but we essentially lost two years because of COVID So for all the purposes that we as a legislative body pass this, we want to get this data. It's a pilot program. It was well enunciated by the two witnesses, but we want to get this data in.

And we lost two years through no fault of anyone, because of COVID So this will make up for that and make sure that it's rendered whole. So with that explanation, I respectfully request an aye vote.

Thank you, sir. As soon as we get a quorum, we'll take a motion and we will do just that. Thank you for joining us. Nice presentation. Is Assembly Member Lowenthal here? Item number 12, AB 2105 coverage for PANDAS and PANS. Please proceed when ready.

Thank you, Mister chair and Members, I am pleased to present AB 2105, which requires a health care service plan, contract or health insurance policy issued, amended or renewed on or after January 12025 to provide coverage for treatment of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, or PANDAS, and pediatric acute onset neuropsychiatric syndrome, or PANS prescribed or ordered by a physician or surgeon as defined by current clinical practice guidelines published in peer review, medical literature, or put forth by organizations composed of expert treating Clinicians.

I'd like to start by accepting the Committee amendments and thank the chair and Committee staff for their work on this Bill. Pandas and pans are inflammatory diseases of the brain that result in sudden onset, devastating behavioral and neurological dysfunction that usually occur after a triggering infection.

These disorders are thought to be caused by autoantibodies generated after the infection that mistakenly attacked the brain. Antibiotics and oral anti inflammatory medication help most children, but a minority needs stronger immune modulating treatments such as intravenous immunoglobulin or IVIG.

Despite published PANDAS and PANS treatment guidelines that establish the standard of care back in 2017, insurers have continued to adhere to their own policy statements forbidding authorization of immune focused treatments like IVIG, and as a result, treatments are routinely denied.

Early and expedient treatment of pandas and pans is essential in order to prevent long term and potentially life threatening impacts of these conditions. Patients seeking immune modulating treatment for acute PANDAS and PANS are frequently denied authorization for these treatments by insurers and must seek independent medical review at the Department of Managed Healthcare.

While the IMR process is effective, decisions are typically rendered within 30 days of qualification, meaning that insurers the insured must first receive a denial from their insurer, file a request for an independent medical review, and wait for a decision to uphold or overturn the insurer's denial.

Unfortunately, this timeline is simply too long for children suffering from PANDAS and PANS and is frequently leading to kids receiving treatment long after current treatment guidelines recommend according to the clinical management of pediatric acute onset neuropsychiatric syndrome, early care for pandas and pans patients is defined as receiving treatment within two weeks of diagnosis, delayed care is defined as receiving treatment within two to four weeks of diagnosis and very delayed care is defined as receiving treatment more than four weeks after diagnosis.

Based on published clinical treatment guidelines for PANDAS and PANS, denials are frequently resulting in very delayed care for pandas and pans patients, which results in worse health outcomes for patients and the need for long term care which results in greater cost to patients and their families, insurers, and to the State of California.

They say that timing is everything and in the case of PANDAS and PANS, it couldn't be more true. Early and expedient access to the treatments is crucial to the effective treatment of PANDAS and PANS in order to avoid debilitating symptoms, potentially permanent neurological damage, sometimes fatal outcomes associated with these disorders.

AB 2105 will ensure that individuals and families who are confronted with these disorders do not experience unnecessary delays in treatment that can lead to disastrous and tragic outcomes. It is my pleasure to introduce Doctor Angela Tang and Sherry Stralson, who are both mothers of children suffering with PANS and are here to testify in support of AB 2105.

Thank you. Thank you for joining us. I'll ask you to identify yourselves for the record before speaking. Try to keep it to about six minutes total. I realize you have stories to tell, and we want to hear them, so please proceed when ready.

Thank you, chair Roth and Members of the Committee. My name is Shari Strulsen. I'm a former public school teacher, and I'm also the mom of a 14 year old boy with PANS and PANDAS. Our gravity defying kid was fearless and channeled his strength, agility, intelligence, and coordination into skateboarding, parkour, gymnastics, skiing, and soccer.

His symptoms began in January of 2017, but took almost two years to diagnose and treat.

Delayed treatment caused his condition to progress to the point he could no longer tie his shoelaces, hold his pencil, finish a sentence without painful vocal tics, or walk across our hallway floor, let alone attend school, due to crippling OCD, anxiety, and cognitive declines, including impaired speech and the ability to read and write.

When Jake was younger, he dreamed of becoming an architect. But now we're unsure what his future holds after years of academic loss, there are many PANS/PANDAS survivors, stories you've heard or will hear. They are the lucky ones who receive timely treatment.

They'll go on to live normal and often extraordinary lives, the kind of life I envision for my son. His condition is now chronic and will require invasive long term immunotherapies. His physical growth has been impacted, his puberty is delayed, and hormonal intervention is required. Many times we feared we'd lose him entirely.

Insurance denials are costly if you add up the medical bills. We've spent nearly $600,000. However, our greatest expense is time. March of 2020 through August of 2023 were undoubtedly the most destructive.

When the neuropsychiatric symptoms were so severe, my son couldn't interact with any family Members, including his two younger brothers who idolized him and were robbed of their best friend. We lost 1278 days with Jake. We will never get those days back.

He will never get back the last five years of his childhood and all the friendships, religious and holiday gatherings, summer spent at camp and school promotions that come with them. At this stage of severity, experts at UCLA recommend next tier treatment, all denied by our insurance company.

After being coded as PANDAS. In my hands, I'm holding our most recent denial, dated May 7,2024 stating the member's plasmapheresis was denied in as experimental an investigation for PANDAS. Therefore, the inpatient stay for this procedure is denied as well.

In other words, our son's board certified pediatric hematologist oncologist from a renowned research University hospital in California deems this treatment a medical necessity, but our insurance company does not, which begs the question, who has the patient's best interest at heart?

Massachusetts and 11 other states list PANDAS as a covered benefit and provide the treatment my son and countless others medically need and deserve. What is a child's life worth in the State of California? Certainly the penny it would cost to enact AB 2105. Thank you.

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

Thank you so much. My name is Doctor Angela Tang. Five years ago, Pan struck down my 15 year old. My healthy soccer player could no longer walk, my straight A student couldn't write. He spat out food if intrusive thoughts struck, and he needed me at his side even during his tortured sleep.

We dropped out of school, work and life with two Doctor parents. My son got every oral medicine recommended in the 2017 treatment guidelines by experts at Stanford and Harvard and other universities. When he could no longer drink, he was scheduled for a feeding tube.

The guidelines say that the next medicine to try was IVIG, but policies by Anthem, Aetna and others say that IVIG is experimental, unproven, and not medically necessary. Luckily, I work for a large medical group, issuing authorizations and denials for the last 15 years, and my connections got him IVIG, with improvement within a week. No feeding tube needed.

Today he's off medicines and he's a college pre med nearby, and one day he may be your Doctor. My son got IVIG seven weeks from onset. According to these guidelines, past four weeks is very delayed care.

But of the hundreds of cases that I've seen, including at the Stanford Pans Clinic, where I'm now an adjunct clinical associate Professor, not one has received IVIG faster than my son. The norm is months to years of brain inflammation before insurance agrees to pay or parents sell off assets to pay, or kids get institutionalized or die.

Like the seven children whose brains are now donated to Georgetown for research, three were in the last year. While we have been working on our Bill, my opinions are my own. As an insurance insider, parenthood and PANS researcher, today I make good on the oath that I took to become a Doctor.

When I ask you to protect the youth who lack Doctor parents, some say that existing regulations where insurers use blanket policies by nameless employees who've never treated pants to automatically and universally deny IVIG plasmapheresis and rituximab are sufficient for this urgent diagnosis.

Please consider if insurer definitions of medical necessity should violate peer reviewed clinical practice guidelines by which AB 2105 defines medical necessity. Let's stop insurers passing the buck to taxpayers in special ed, unemployment and disability. AB 2105 costs $7,000 to enact and under a penny in insurance premiums.

Today I give voice to the youth whose brains lie at Georgetown and to doctors shackled in their attempts to help. Today you choose for California's kids. No, for Jake's path, or aye for my son's. Thank you very much for your time.

Thank you for joining us. You know, healthcare should not depend on who you know. Any other witnesses in support?

Good afternoon, Mister Chairman. Awad Kadani representing the California Children's Hospital Association in strong support. Thank you to the author.

Thank you Mister chair Members. David Gonzalez, on behalf of America's physician groups as well as the California life sciences and strong support.

Thank you. Next.

Thanks for joining us. Next please.

Vanessa Cajina, on behalf of the California Academy of Family Physicians here in support.

Thank you.

Mister chair. Brandon Marchy with the California Medical Association in support.

Thanks. Brandon Marchy with the California Medical Association in support. Thanks.

Brandon Marchy with the California Medical Association in support. Thanks.

Erin Taylor, with political solutions on behalf of Miller Women's and children's Hospital in strong support.

Thank you. Nora Lynn, on behalf of Children Now in support.

My name is Kelly Stevens. I'm a parent of a 10 year old boy suffering from PANDAS. In strong support.

Thank you. Thanks for joining us.

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

Next please.

Hi, my name is Jensen Tafsberger and I'm a 15 year old with PANDAS. We need your help. Please support this. Thank you.

Thank you for coming.

It's my baby. Elise Tafsberger. Mother, teacher, Engineering Empathy. My 15 year old daughter, my 11 year old son is also there suffering from PANDAS and PANS . Thank you so much. It's time for this change.

Appreciate you, thanks for coming. Yes sir.

Next please.

Jonathan Tafsberger, also with engineering empathy, parent of them. Amazing family. Thank you for your support. Thank you so much. We need it. Thank you.

Doctor Denise Caliprice. I'm a PANS researcher at Stanford and also the mother of two young men who are lucky enough to be diagnosed the day their symptoms of pans developed, treated early and who have lived largely without the disease. Now students at Berkeley and USC in strong support of AB 2105.

Thank you. Yes ma'am.

Hi, I'm April Ronet. I'm a second grade public school teacher and mom to a PANS child. I'm in strong support of AB 2105 for my son Aiden, and for all children who need access to this medication. Thank you.

Thank you. Yes, ma'am.

Hi, I'm Kelly Reilly. I am a mom to a fierce PANDAS who has been fighting this for five years of her 11 years on this earth. I am in strong support and I urge you to vote aye.

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

Thank you, Mister chair. I have to, to speak on this issue. First of all, I remember supporting this Bill. It's been before us. And, you know, hearing the stories of all children just going through this breaks my heart. Also an elementary school teacher and so I do understand the delay in education.

Just learning losses just normally is hard on kids. And now adding this to their young lives, it's even more difficult. But I think here is the key, is delayed care. I mean, for every day that goes by weeks, months, it's just so detrimental to a child.

And not only, like I said, to living a healthy life, but also, you know, their future, they're learning. And so I commend both of you as parents to really fight and continue this fight. I'm disappointed that I think we passed it and it didn't get to the finish line in previous years.

And so I'm strong support and I know how hard, because as a teacher for 20 years, I've known, I've dealt with parents, with children, with just so many other ailments and situations where it's difficult for a parent to navigate.

So I can only imagine how hard it is for both of you and as a researcher and in the throes of this issue, you know, I have to say I commend you for getting that service right away to your child because I have, remember just speaking to parents who, again, that delayed care is key here.

We can't continue to wait. Every day is just so harmful for the children. So thank you for your advocacy. And again, I want to be added as a co author. Thank you.

Thank you, Senator. Did I see someone else? Senator Menjvar.

Thank you, Mister chair. Assemblymember. I really want to commend your continuous perseverance to this.

You know, you can imagine we probably have similar bills that we continue to bring up because they're just, and they're the right thing to do and we shouldn't put a price tag as a barrier to do what is right for coverage, especially for our kids. I want to thank the advocates for coming and share your story.

I always get really upset that we force people of our most vulnerable communities to come up here and literally beg us to make sure that we cover the things that we're supposed to be at bare minimum covering. Right. So thank you so much for that.

Thank you, Senator. Senator Limon.

Thank you. And I also want to thank everybody for coming forward, for sharing their stories, but also the author. You have a great author that's not giving up. And this is some of the work that's needed in the Legislature. So thank you to the author. Thank you to each of you for sharing your stories.

This is really difficult, and certainly we appreciate that this is an effort that there's a strong commitment to.

Thank you, Senator. Any other comments? Seeing none. Assemblymember you may close.

I get a little emotional on this topic because this is such a special community of folks who have been tremendously patient with a system that has not been kind to them thus far. The most important thing that I can say to you is that we are a bit of the outlier here in California at this point.

As one of the witnesses testified to, there's already a dozen states that have this in place. As a matter of fact, it was signed by the Governor of Colorado only a week ago in that state. And there's a dozen more that have this in play. And if we look at this, by any measure, it makes sense.

These families, as you heard, are debilitated and cannot work while their children are going through these symptoms. And so they rely on state social safety net services. So we're paying, no matter what we are paying with that. Respectfully ask for your aye vote.

Thank you, sir. As soon as we establish a quorum, we will take a motion and we will take the vote. Thanks for attending and nice presentation. Okay. We will establish a quorum. Please establish a quorum.

[Roll Call]

[Roll Call]

[Roll Call]

We have a quorum. I will entertain a motion. The motion is do pass as amended. And we refer to the Committee on Appropriation. Is there a motion? I'll move the Bill moved by Senator Rubio. Please call the roll.

Moved by Senator Rubio. Please call the roll.

I'll move the Bill.

[Roll Call]

Vote is 6-0. We'll hold the row open for absent Members. Thank you all. Thank you. Next item, item number 14. Let's see, 14. No. 15,14 assemblymember Friedman AB 2297 Hospital and emergency physician Fair pricing policies please proceed when ready.

Thank you, Mister chair and Senators. Thank you. Medical debt is a significant driver of bankruptcy, poverty, and racial inequalities. Over a third of Californians report having medical debt, and hospital debt alone makes up over 70% of all medical debt. This is, of course, non voluntary debt.

It's not like people want to go to the hospital or want to go to the Doctor. It's something that you have to do to live. In 2006, California created the hospital Fair Pricing act to protect patients. And many of you might recall our recent updates to the act in 2021, including my Bill, AB 1020.

While patient protections we put into law are working, we're also learning of areas where we need to strengthen the law. AB 2297 does the it defines charity care, distinguishing it from discounted care or financial assistance. It clarifies that hospitals must review applications for charity care or discounted care without arbitrary deadlines.

A lot of times when people are deterred from the hospital, they're in bad shape, and for them to expect to know about what's available to them, maybe they find out one or two months later that they could have gotten charity care. They're low income, and the hospital says, zero, sorry, you only had two weeks to apply.

That shouldn't be allowed. It prohibits the use of liens on property to collect unpaid medical bills from financially eligible patients. And yes, people in California still can have their houses taken away because of unpaid medical debt. And finally, it eliminates the consideration of assets from eligibility, consistent with current Medi Cal rules.

It's important to remember that these patient protections apply only to uninsured and underinsured patients who have an income under 400% of the federal poverty line. So these are our most vulnerable residents with limited resources. Medical debt can be devastating, putting them at risk of housing instability and financial ruin.

As noted in the analysis on page seven, we have amendments that further clarify the assets that a hospital may consider when determining a patient's eligibility for financial assistance. This language addresses a number of the concerns outlined by the California Hospital Association.

I want to thank you, Mister chair, and your staff for your work as we've continued to refine the language of the Bill to strengthen the social safety net for patients in need. With that, I would request and aye vote.

Testifying in support today are Linda Wei from the Western center on Law and Poverty and Christine Smith from Health Access California.

Thank you for accepting the amendments. Yes, and please proceed when ready.

Good afternoon. Linda Wei with Western Center on Law and Poverty proud co sponsors of AB 2297. As a legal aid support center. Our local programs work with clients throughout the state and I'm here to share one story.

Humberto Cruz sought help from neighborhood legal services of Los Angeles due due to medical debt accrued from the birth and resulting NICU stay of his and his wife's firstborn in 2010 at Queen of the Valley Hospital in West Covina. Despite having what he believed to be adequate employer coverage, they were blindsided by expenses not covered by insurance.

The hospital failed to inform them about the option to apply for financial assistance or guidance to manage the debt, leaving them with a Bill of $19,200. Before they knew it, their account was sent to collections.

As a result of Humberto's inability to take time off from his new job to appear in court, a default judgment was entered against him. Ultimately, they were forced to sell their home to their in laws, only to discover that the property had a lien due to the outstanding medical debt.

Despite their best efforts to make payments, the collection agency seized 17,000 from the sale of their in law's home and placed levies on Humberto's personal bank account. Over the course of 12 years, the cruises paid nearly $23,000 to the collection agency, which drained their savings and resulted in credit card debt.

Humberto's story highlights the need for this Bill, specifically the provision to prohibit home liens for financially qualified patients. So urge your support. Thank you.

Thank you ma'am. Next please.

Good afternoon, I'm Christine Smith with Health Access California statewide Healthcare Consumer Advocacy Coalition. We are proud to support AB 2297 which would prohibit the use of home liens in the collection of unpaid hospital bills from financially qualified patients.

Hospitals are currently prohibited from placing liens on a patient's primary residence, but debt collectors are allowed to place liens on a patient's home to collect unpaid hospital bills. Unfortunately, property liens are regularly used to collect unpaid medical debt.

A review of assessor data found that in La County alone, over 140 property liens were placed in 2023 due to medical debt. This Bill would completely prohibit this practice against financially qualified patients, as was the intent of the original law 18 years ago.

In addition, the Bill would eliminate asset consideration and financial assistance determinations to align with current medi Cal eligibility rules, simplify the financial assistance application process, and help protect Californians savings from being depleted when seeking care. Californians need their savings to prevent property in retirement and older age, prevent poverty and retirement in older age. My apologies.

As of 2019, 7.4 million Californians ages 25 to 64 do not have access to an employer sponsored retirement plan, and nearly half of California's private sectors have no retirement assets at all.

Finally, the Bill would clarify that hospitals must review financial assistance eligibility at any time and prohibit application deadlines for financial assistance with more than one third of Californians experiencing medical debt. This Bill provides much needed relief from large hospital bills for low and moderate income Californians. We urge you. Thank you.

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

Good afternoon, John Scoglund with the County of Los Angeles in support. Thank you. Next, please.

Vanessa Cajina, on behalf of the California Pan Ethnic Health Network, here in support.

Thank you, sir.

Good afternoon, Mister chair and Committee Members Bryan Maramontez with Ask Me California in support. Thank you. Next, please.

Marvin Pineda, on behalf of the Leukemia & Lymphoma Society, in support.

Thank you. Next, please.

Hello. Rachel Bhagwat, ACLU California Action in support.

Thank you. Next, please.

Good afternoon. Beth Malinowski with SCLU California in support.

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

Any other witnesses in support?

Witnesses in opposition. Any witnesses in opposition? Lead witnesses may come join us in the well if you wish. If not,

Mister Chair And Members, Meghan Loper, on behalf of the California Hospital Association, appreciate the work of the Committee, the author, and the sponsors, and appreciate the amendments to date. We currently still remain in an opposed, unless amended position, but look forward to continued dialogue to resolve the remaining concerns. Thank you.

Thank you, ma'am. Any other witnesses in opposition? Seeing none. Let's bring the matter back to the dais and my colleagues. Colleagues. Questions, comments? Concerns? Seeing none. Bill's been moved by Senator Gonzalez. By the way, the motion is due. Pass is amended, and we refer to the Committee on Judiciary. So, madam Member, you may close.

Thank you. This will help to protect some of our most vulnerable residents. And I would urge and aye vote.

Okay, Bill's been moved by Senator Gonzalez and let's call the roll.

[Roll Call]

[Roll Call]

[Roll Call]

Current vote is four. One will hold the matter open for Absent members. Thank you both. Thank you. I see Assemblymember Flora, item number 13. AB 2198 health information. Please proceed when ready.

Thank you so much, Chair and Members, I accept the Committee amendments, but please to present AB 2198. And I certainly accept the Committee amendments.

AB 2198 exempts dental and vision plans from application programming interface requirements in California law that was meant to replicate the federal API regulations and would fully replicate the center up for medicine and medical services regulations as adopted into California law. My time is right, respectfully ask for your aye vote and here with me is Matt Back.

Mister Chairman, Members. Matt Back, representing the California Association of Dental Plans, who's the sponsor of the Bill. Assemblyman summarized it well. It's a pretty simple Bill. It just extends the deadline implementation date for us to implement these APIs, which are extremely complicated.

The Federal Government did not mandate that we do it, but California is, and we need some time to do that. We appreciate the help. Thank you.

Thanks for joining us. Any other witnesses in support? Name, affiliation, position on the measure only, please.

Good afternoon. Tim Valderrama with The Weideman Group on behalf of DentaQuest Sun Life in support.

Thank you, sir. Any other witnesses in support? Seeing none. Any witnesses in opposition? Name, affiliation, position on the measure? You may be of your lead witness.

Please come down if you want.

No, actually I'm very happy to be here. Not opposition anymore. Vanessa Cajina, on behalf of the California Pan-Ethnic Health Network, with the amendment suggested in the analysis and the patience and the work of the author and the sponsor, we can remove our opposition. Thank you very much.

Thank you for doing that. Next, please.

Christine Smith, Health Access California. With adoption of Committee amendments, we remove our opposition. And thank you for your work on amends.

Thank you, too. Next, please.

Erin Taylor with political solutions on behalf of the California Dental Association. Also look forward to reviewing the amends and anticipate removing our opposition. Thank you.

Okay, seeing no one else approaching the microphone, bring the matter back to the desk. My colleagues. Colleagues, any questions, comments or concerns. Okay, I need a. Who did that? Senator Limon motioned by Senator Limon. The motion, by the way, is due. Pass is amended and re refer to the Committee on Appropriations. Assemblymember, you may close.

Just respectfully ask for an aye vote.

Okay, please call the roll.

[Roll Call]

Current vote 7-0 will hold the roll open for absent members. Thank you, Senators. Okay, next item is Assemblymember Haney. Item number 16, AB 2365, public health.

Thank you, Mister chair and Members. AB 2365 will protect California consumers by establishing health and safety regulations for kratom products sold in the state. Kratom is a tree in the coffee family, native to Southeast Asia, and in Low doses, kratom produces can produce a beneficial stimulant effect like increased energy, alertness, concentration, physical energy and productivity.

But in high doses, kratom causes a sedative effect and other negative symptoms like nausea, increased heart rate, insomnia, and some psychotic symptoms like hallucination and confusion. Additionally, consistent kratom use can lead to dependency. However, some people consume kratom as a less dangerous replacement for opioids and opioid use disorder.

In the absence of federal action, many states, actually most states have decided to regulate kratom so that only safe and unadulterated products are being sold to consumer. However, nearly 25% of all kratom sales in the United States are in California.

And the increase in demand of kratom product and the lack of regulations can lead some manufacturers to irresponsibly create stronger and more potent kratom concentrates to put into their products. To prevent unadulterated high potency products from hurting California consumers, AB 2365 will enact robust regulations for kratom products through the California Department of Public Health.

It will ensure manufacturers are only producing safe kratom products and the consumer is able to maintain access to the benefits of them.

I'm accepting the amendments which I really want to appreciate the Committee for those which I think strengthen the Bill and I'm grateful for the work that has been done and also be working with CDPH to refine the Bill and look forward to receiving their feedback on the technical pieces.

Here to testify today is David Breger, a parent and advocate for safe kratom regulations. Doctor Aaron Berthold, an expert on Kratom.

Welcome. Please identify yourselves for the record before you speak and proceed when ready.

My name is David Breger. I'd like to thank Chairman and Members for giving me time today. Truth be told, I'd rather not be here today. I'm here to tell the story of my son Dan. He was 33 years old when he died of an overdose of kratom.

And it was one of these products that he was talking about, which is these hyper concentrated products that are extremely dangerous and they're getting more dangerous by the day, he left behind his mother, myself, and his brother. His brother, two years younger than him, not only lost his brother, but his best friend.

Losing a child is a nightmare that you wake up with every day and you go to bed with every night. Parents losing a child have an 80% divorce rate. Luckily, we're getting through it so far. But the future as you knew it, has changed forever. I'm not looking for pity or sympathy today.

I'm looking for you to pass these regulations and say aye to these regulations. Two plus years after Dan died, through a chance meeting with a Washington Post writer, he wrote an article on Kratom and told my son's story. That got me motivated to get out and try and do something about the proliferation of Kratom.

I had high and mighty ideas of banning the product in my home State of New Hampshire. Quickly hit a brick wall and a lot of frustration. Through another coincidence, I met up with global Kratom coalition and realized we had very similar goals. And I realized that significant regulations could have a much quicker result and save lives.

Through my early efforts, I also learned of the American Kratom Association, who I just found out that they are opposing this Bill, which I find incredibly hypocritical.

As in their podcasts, interviews, and their website, they speak of nothing but increased regulations for the product as deaths continue to increase, and they mostly deny the deaths that are actually taking place. The regulations that they're pushing have no teeth whatsoever. These regulations do and will go a long way. Also, please don't look to the FDA.

They're spread paper thin. People continue to die. Now is the time to act and save lives. I respectfully ask for an a vote. Thank you for your time. Love you, Dan. Forever and always.

Sorry for your loss, and thank you for joining us. Yes, ma'am.

Yes. Hello, I'm Doctor Erin C. Berthold, Kratom, researcher, educator, advocate. I spent five years studying kratom and cannabis interactions in preclinical models of pain and addiction at the University of Florida to earn my PhD. And since then, I've continued to research and advocate for the safe and appropriate use of kratom. Kratom is a fascinating plant.

It can both stimulate and sedate. I love complexity, so I was really drawn to research to try to figure out what it is that causes these dichotomous effects. The cause lies in the active constituents. They're called alkaloids, and they hit multiple receptor subtypes within the human body.

Since I began studying kratom back in 2016, consumption in the United States has rapidly increased. There were about 2 million estimated users back then, over 20 million estimated users now. Individuals use it to self treat mental health conditions, substance use disorders, to manage pain.

And this increase in the rise of use has also caused the marketplace to evolve and explode with different product formats, different product strengths. And we're relying on safety data from centuries of traditional use in Southeast Asia. But really no use in the United States mirrors traditional use.

So traditionally they take the fresh leaves off the tree, brew them for a few hours into a tea, and that's what they consume. Instead, we have dried leaf powders that are post process manufactured in different ways. And research on the long term use of these, I'd call them western or United States kratom products, is really sparse.

So in the absence of that data, we definitely need regulations while we build those safety profiles for those types of products. At the most recent meeting of kratom researchers, we had one back in February. Our Southeast Asian counterparts are very clear. Less kratom is more.

And I think we'd do really, really well to heed their cautions as there are potential negative side effects with irresponsible consumption of kratom. Regulations are necessary to protect both access and public health. Access must be maintained for those millions of Americans who are getting positive benefits from kratom.

But at the same time, the public health is threatened if these products that are available are available with no safety information, no regulation, nothing is stopping them from getting bigger, badder, stronger. Kratom is a plant.

Its potential to improve the lives of many Americans really depends on the cooperation of scientists, regulators, advocates, industry to really educate and advocate for that appropriate and safe use of kratom. Thank you.

Thank you.

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

Good afternoon, Mister chair Members Ryan Sherman. Today representing in support of the Bill, the Riverside Sheriff's Association, the California Narcotic Officers Association, the police officer associate associations of Santa Ana, Riverside, Culver City, Pomona, Corona, Nevada, upland, Arcadia, Burbank, La School Police, Fullerton POA, Murietta, Newport Beach, Palace Verdes, Claremont Placer, Deputy Sheriff's Association, California Coalition of School Safety Professionals, Riverside Police Chief Larry Gonzalez, San Bernardino County Sheriff Shannon Dicus, Riverside County Sheriff Chad Bianco, all in support of this Bill, and I'll just concur with comments the other witnesses.

Today representing in support of the Bill, the Riverside Sheriff's Association, the California Narcotic Officers Association, the police officer associate associations of Santa Ana, Riverside, Culver City, Pomona, Corona, Nevada, upland, Arcadia, Burbank, La School Police, Fullerton, Poa, Marietta, Newport Beach, Palace Verdes, Claremont Placer, Deputy Sheriff's Association, California Coalition of School Safety Professionals, Riverside Police Chief Larry Gonzalez, San Bernardino County Sheriff Shannon Dicus, Riverside County Sheriff Chad Bianco, all in support of this Bill, and I'll just concur with comments the other witnesses.

Thank you. Thank you for attending today, gentlemen.

Thank you. Next, please.

Chad Murphy with the California Association of Alcohol and Drug Program Executives and strong support. Thank you.

Chad Murphy with the California Association of Alcohol and Drug Program Executives and strong support. Thank you.

Thank you. Next, please.

Thank you. Chair Members Ryan Pierini, on behalf of Mitt 45, part of the global Kratom coalition in proud support. Thank you.

Thank you. Next, please.

Thank you. Next, please. Thank you for joining us, ma'am.

David Quintana with the Global Kratom Coalition in support.

Dion Evans. I'm a terminal patient who's used Kratom for eight years now. I'm an advocate and in full support of AB 2365.

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

My name is Julia Smith. I've been a consumer for over six years now and I strongly support this Bill.

Thank you. Yes, sir.

Victor Morphin. I'm a consumer and after my cycling accident, I support this Bill.

Thank you. Yes, ma'am.

Hi, my name is Marcel Morphin and I have been a consumer for about seven years. I'm also an advocate and I strongly support this Bill.

Thanks for joining us. Any other witnesses in support? Let's turn to witnesses in opposition. Please step forward. It.

One of the things that has not been talked about today is that kratom is actually a very effective, and its alcoholic constituents are very effective in relieving the symptoms and the effects of opioid addiction, sometimes better than pharmaceutical options that are available to patients.

I want to say from the outset that our organization thinks most of this Bill is really good, and these regulatory approaches that Mister Haney is taking are really going to be effective in California. Age gating is very important. Getting some of the heavy metals and solvents out of the product is very important.

Getting some of the other constituents out of the product is very important. The one thing that causes us concern, and why we have an opposed, unless amended position, is that the one element that does the most benefit for getting people off of opioids is hydroxymitragynine. That is one of the alkaloids in kratom.

One of the provisions in this Bill says that there shall be no more than 1% of 7-OH, which is the shorthand for that very long name. That no more than 1%.

Our members, many of whom are manufacturers, many of them who know what is happening with patients who are using kratom for these purposes, are very concerned that at that low of a level, that they will no longer have the efficacious benefits of kratom for that population.

We have suggested to the Assemblymember that a slightly higher level would be appropriate for this.

We have asked for a 2% by dry weight instead of a 1% that's currently in the Bill, we think that still keeps the Bill from being adulterated, but at the same time ensures that the kratom product is available to people in California for the benefits that this Doctor noted is very important to many Californians.

The bottom line here is that in creating a brand new regulatory structure on a product that most of us had never heard of before, Mister Haney introduced this Bill without the scientific background necessary to come to the right number relative to 7-OH.

We have to be very careful about going down that path, because we do run the risk that when this Bill becomes law, and we do hope that in a good way it becomes law, that when it becomes law, that we're not shutting down this option for many of the consumers in California who find great benefit from this product, so we encourage the author, we encourage this Committee to find a number that works so that we balance out the importance of the product, keeping the industry, the providers of this product, alive and serving Californians. Thank you.

Thank you. Any other witnesses in opposition? Seeing none. Let's bring the matter back to the dais and my colleagues. Any comments, questions, concerns? I see Senator Rubio with her hand up. Senator?

Thank you, Mister Chair. I have a lot of thoughts on this issue. Well, first of all, thank you for bringing it forward. I consider myself an educated individual, and yet this is something that wasn't on my radar as an educator, a teacher for 20 years.

You know, you hear the vaping, you hear even fentanyl has been, you know, quite publicized. But this is something that's quite new to me. So thank you for at least educating us on the topic. And just like anything else, if we don't have regulation, it tends to get out of control.

We've seen that with the fentanyl and then kids start getting creative and mixing things. And so I just want for clarification purposes, so right now there's no age limit and anybody could purchase it. So what your Bill's intending to do is cap it at no one under the age of 21, correct?

Yes. Right now there are no age limits to buy kratom in California. In most other states there are.

I think that's a very important element of this Bill, which I wholeheartedly support. But then I also heard your numbers. I'm sorry, I can't remember the researcher. You know, the number is a staggering 20 million users. Like I said, I've never heard of this. So to me, it's something that's gone under the radar.

And in any case, when something, you know, starts getting out of hand or kids getting creative and over using it and, you know, like your son, and I'm sorry, I believe it's Dan. My condolences. That's what happens when we have something that's unregulated. Correct? And it's happening with fentanyl and other things.

And so I think creating this regulatory structure is important not only to prevent these kinds of abuses and uses, but the way things are manufactured, the way things are tested, it's important. I just don't see why anyone would not be in favor of making sure that products are safe. Now, I do hear your concern. I'm sorry.

The opposition who perhaps might not be in agreement over the 1%, but you said something that it not based on scientific information, so I'm going to turn it over to the author or those that are at the table, can you share where that 1% came from?

Yeah. So the 1% is from the best research in science that we have of where to draw the line in terms of the amount. It's also reflective of what most other states are doing. Most of the other states that have set a limit or considering a limit are setting it at 1%.

This is where the best science and research is pointing us to now. We certainly could, if the California Department of Health, Public Health, has input or other thoughts on this, we would be open to that. But right now, that's where the best science is. I don't know if other folks want to, if any of the witnesses through the chair want to respond for it.

Yes, please. Yeah, I'd like to chime in first. I'd like to make it clear they're not asking for a change from 1% to 2%. Right now in the Bill, it's written as 1% of the alkaloid fraction. So it's 1% of a fraction of the product. So it's actually a big change.

It could be a 1,000% to 10,000% change they're asking for. So it's not a small change. And we put a limit on 7-hydroxymitragynine because we know it is a stronger mu opioid receptor agonist, and it should not be found in the native plant material in any sort of abundance, in any sort of quantity.

We see it in plant material. It's not produced by the plant. There's no enzymes in the plant that make it. It's a degradant of the drying process. And you usually get, like, 0.05% by weight, if that. If there's anything even detectable.

So because we know, we don't know what the limit is for it yet, but because we know it shouldn't be there in nature, and because we know it has potential, these bills are being written to make sure that no one knows this compound could be a little stronger, so they're just spiking it. I think, back in 2016 or 2018, early, early on, and we don't know if it was intentional, because at that time, we don't know that they knew.

But there were products on the market, I think Lydecker's study, that they had, like 3%, 4% or 5% of 7-hydroxy, which we knew meant they were adulterated. So we consider products like that in the industry, if they have more than 1% 7-hydroxymitragynine, that they're adulterated.

Thank you. Well, I have to admit she lost me somewhere along the line, Doctor, researcher. Yes, but that's the point. But I just want to make it clear, it was very informational. I was just kidding. Yes, some terminology is difficult to understand, but I get your point.

I just want to make sure, because when I heard it, I thought there wasn't any science behind it or, but you know, what I'm hearing is there's research, there's science. And you're basically copying this based on other research information in other states that already implemented this. Correct? So I won't belabor the point.

I just want to make sure that there was some science and information behind it. So I'll move the Bill when appropriate. Thank you. And I will add as a co-author because anything that we can regulate and make sure it's safe for our communities is important. So thank you.

Definitely. And it's also, just to the Chair, because we don't have regulations in California. We're seeing a lot more attempts to take advantage of that fact here. So you're seeing entire stores opening that are selling some of this more potent, synthetic type.

And so this is also about prevention, because if we don't do these regulations, we're going to see, if you haven't heard about it now, but, but probably next year you would have. And we want to make sure there are regulations in place to prevent some of the more harmful forms.

Do you have a response to the Senator?

Yeah, let me try. And I'm not a scientist, I'm not a researcher. I'm just a lobbyist, which is a good thing too. But I want to make a couple of points. One is, with all due respect to Mister Haney, the science is very inconclusive on this at this point.

And picking a number like 1% because some research might suggest that 1% is a good number, ignores other research that says that other numbers may be good too. The important thing is to making sure that the number is low enough that it's not adulterated.

The other point I wanted to clarify is that there are some other states that have done some legislation, some statute relative to this. Four of them have actually 2%. A couple of them do have 1%, but it is not the norm.

Many of them have no percentage of 7-OH in their law, but they have other things to try and constrain how that product is adulterated. Rhode Island, for example, just last week they had a Bill, they have a Bill that had 1% in it.

The Legislature took that 1% out and put in some other stuff that constrained the use of adulteration because they did not think that, that there was a number that was appropriate at this point because of the inconclusivity of current research.

Isn't some of the problem that dry weight is really not an indicator of what the final product looks like? You said 2% dry weight. Right. Isn't the real issue that dry weight isn't a real indication of what the final product that the user gets looks like?

Well, I think the answer to that is if we're concerned about final product, then we need to be looking at final product and what the final product has relative to 7-OH and that's, you know, dry weight, as I understand it.

Again, I'm not no expert, but dry weight is what is in the product after you take all the moisture out of it. And so it's not necessarily, it may be higher than 2%, but it's certainly not as high as some of the adulterated product that we've been seeing across the country.

And it's not an indicator of what the final product is that someone might consume. Right?

I think that it is a question about what the kratom that goes into the product looks like as opposed to what comes out at the product. Same issue we've had with hemp, as the chair knows, same issue we've had with cannabis relative to what does it look like going in? What does it look like coming out?

And we know with hemp that the dry weight is not an indicator of what comes out on the other end.

Right? Absolutely. We totally agree with you on that. And maybe that's what we should be looking at, is what comes out at the other end in terms of adulteration.

Okay. Any other questions, comments, concerns? Senator Wiener.

Thank you very much. And thank you, the author, for bringing this forward. I support the Bill, and I'd also like to be added as a co-author. I do think it's, this issue is an interesting one because it also reminds us of the complete chaos and irrationality of how we treat substances that can help people.

We have this substance, which is not regulated at all. We have psychedelics, which also can help people stop using opioids, which are blanket illegal.

Despite our best efforts over the last four years, we have some products that are maybe in some form have been narrowly approved by the FDA, but in other forms haven't and can only be used in certain circumstances. And then we have some stuff. So it's just, it's a mess, and it ends up harming people who need help. And so I think this is an excellent approach to say, let's take this and put some basic constraints around it and people can argue about what the right, you know, form of it should be.

But to me, the key step is actually bringing it into the full sunlight and getting some healthy health and safety guardrails around it. And so I thank you for bringing this Bill forward and thank you and I'm so sorry.

Okay. Thank you all. Seeing no other questions, comments or concerns. Assemblymember, would you like to close to the extent that you haven't?

Yes, thank you. And of course we'd love folks to be added as a co-author. And thanks so much, Mister Chair and to your staff. I really do appreciate the amendments and we will continue to have the conversation about the percentages and engage with CDPH around that. With that, respectfully asked for your aye vote.

Okay. The motion is by Senator Rubio. It's to do pass as amended and re-refer to the Committee on Appropriations. Please call the roll.

[Roll Call]

Current vote, 6-0. We'll hold the roll open for absent Members. Thank you all for joining us. Thank you, sir. Our final item is Item number 21, AB 3221, Assemblymember Pellerin, and its Department of Managed Health Care Review of Records. Please proceed when ready.

Good afternoon. Thank you, Chair and Members, and thanks to past efforts by the state, California leads the nation in its patient protection laws. AB 3221 will make common sense updates to the Knox-Keene Act in order to improve the Department of Managed Health Care's ability to enforce these laws and remove procedural hurdles to efficient and effective enforcement.

Under current law, DMHC can inspect health plan records, but the law does not provide for those records to be furnished electronically. AB 3221 stipulates that health plans must furnish records to DMHC in a digitally searchable format when possible.

This simple change will reduce the amount of time and effort that department staff spend reviewing records and locating relevant information when conducting surveys and investigations. Furthermore, the bill also empowers DMHC's directors to penalize plans if they fail to respond to records requests fully or in a timely manner.

AB 3221 will also make it easier for the department to seek judicial relief on a consumer's behalf by allowing the department to do so through an administrative law hearing rather than through overburdened superior courts, as is currently required.

Finally, this bill provides clear direction that when DMHC uncovers health plan violations during the survey process, they can take enforcement action immediately. So with me to testify in support of AB 3221 is Heidi Strunk, President of Mental Health America of California and Dylan Elliott, on behalf of the California State Association of Psychiatrists.

Thank you all. Please proceed when ready.

Thank you. There we go. Thank you. I am Heidi Strunk. I am the CEO and President of Mental Health America of California. We're a statewide peer-run organization that has been advocating on behalf of Californians since 1957. This bill is important to those of us to work to reform the failure-first system of care into a proactive system, a system that allows timely, appropriate access prior to reaching crisis.

My testimony today is three-pronged: as a leader of an advocacy organization, as an employer who plays premiums for staff across the state to obtain these services, and as a family member who has had a loved one denied timely access to behavioral health care. This bill would play a role in assuring timely access by closing loopholes that contribute toward delaying care.

One aspect of the bill requires plans to provide electronic searchable records, books, and papers. It is important for the department to conduct timely, efficient investigations which could lead to mitigating barriers to timely, appropriate care, as when my family member was denied care for eight months after first seeking out treatment.

This bill would also allow the department to find plans when they don't respond to requests for records fully or in a timely manner. Historically, we have seen that health plans are not often motivated by laws alone to cooperate with the department to protect consumers. History has shown us that it is often the mechanism of monetary penalties that motivates plans to adhere to the laws that do not further delay appropriate care.

By equipping the department with as many tools as possible to enforce ongoing issues of timely, appropriate care, our state's mental health crisis could be more effectively addressed and mitigate suffering which is is often exacerbated by delayed care, all of which I have seen as an advocate, an employer, and a family member. Mental Health America of California respectfully request your support of AB 3221. Thank you.

Thank you, ma'am. Next.

Thank you, Mr. Chair and Members. Dylan Elliott, on behalf of the California State Association of Psychiatrists. CSAP and its members have been at the forefront of advancing behavioral health parity nationally and in California, and are proud to co-sponsor AB 3221, which takes important steps towards parity in California.

As the author and Ms. Strunk have indicated, far too often, consumers, providers, and advocates report health plan violations that impede access to care in a timely and appropriate manner. AB 3221 simply empowers the Department of Managed Health Care to take faster and more efficient enforcement action when merited by making needed updates to provisions in the Knox-Keene Act. For these reasons, CSAP is proud to be a co-sponsor. Respectfully request your aye vote. Thank you.

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

Thank you. Vanessa Cajina, on behalf of the California Pan-Ethnic Health Network, here in support.

Next.

Mia Brittingham with Greenberg Traurig, on behalf of Equality California, in support.

Thank you.

Jennifer Robles with Health Access California, in support.

Thank you.

Julie Nielsen, representing the National Union of Healthcare Workers, sponsor of this bill, in support.

Thank you very much.

John Drebinger with the Steinberg Institute, in support.

Thanks.

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

Thank you. Next, please.

Clifton Wilson, on behalf of the California Academy of Child and Adolescent Psychiatry, in support. Thank you.

Thank you.

Meghan Loper, on behalf of the California Hospital Association, in support.

Thank you, ma'am. Any other witnesses in support? Seeing none, witnesses in opposition? Seeing no witnesses in opposition, bring the matter back to the dais and my colleagues. Colleagues, questions, comments, concerns?

Senator Grove.

It's been moved by Senator Grove. Seeing no others, Assembly Member, you may close.

Thank you so much. Improving health plan compliance with the law will not only improve health outcomes and benefit consumers financially, but will also save money by reducing the time and money needed to conduct enforcement. I respectfully ask for your aye vote.

Thank you. The motion is: do pass and re-refer to the Committee on Appropriations. Please call the roll.

[Roll Call].

Current vote, 70. We'll keep the roll open for absent Members. Thank you very much. Thank you so much. Presentation. Let's start back at the beginning. Item number. Well, it's due. Item number one. Assembly Bill 1316. Assembly Member Irwin. Emergency services. Psychiatric emergency medical conditions. I'll take a motion. The motion will be do pass, as amended. And we refer to the Committee on Appropriations. Is there a motion, Senator, by Senator Grove? Thank you very much. Please call the roll.

[Roll Call]

Current vote. 70 will keep the roll open for absent Members. Next item two. AB 1926. Assemblymember Connolly. Healthcare coverage, regional enteritis, the motion would be, do pass and we refer the Committee on appropriations. Is there a motion? Senator Mengevar moves the Bill. Please call the roll.

[Roll Call]

Current vote 50 will keep the roll open for absent Members. Next item. Item number three, Assembly Bill 1970 by Assemblymember Jackson Mental Health Black mental health Navigator certification. The motion would be do pass and we refer the Committee on appropriations. Is there a motion? Senator Rubio? Thank you very much. Please call the roll.

[Roll Call]

Current vote, 70 will keep the roll open for absent Members. Next item. Item number four, AB 1975 Bonta medically supportive food and nutritional interventions. The motion would be, do pass and we refer the Committee on appropriations. Is there a motion. Senator Limon. Thank you very much. Please call the roll.

[Roll Call]

Current vote, 70. We'll keep the roll open for absent Members. Now, let's take the consent calendar. The consent calendar consists of eight items. Item number five, AB 2340 Bonta medical item number six, AB 2630 Bonta pupil health. Item number nine, AB 2043 Assembly Member Boerner medical, item number 15, AB 2343.

Assemblymember Rodriguez, emergency medical services with amendments. Item number 17, AB 2574 Assembly Member Valencia alcoholism or drug abuse recovery or treatment programs and facilities. Item number 18, AB 2680 Assembly Member Aguiar Curry, Alzheimer's disease. Item number 19, AB 2701 Assembly Member Vilapudua Medi-Cal and item number 20, AB 2767. Assemblymember Santiago, financial solvency standards board. The motion is to the consent calendar and the floor. Is there a motion, Senator Nguyen, please call the roll.

[Roll Call]

Current vote is 80. We'll keep the roll open for absent Members. Next item is item number seven. Assembly Bill 2786. Assembly Member Bonta certified mobile farmers market. Motion would be do pass as amended, and we refer to the Committee on Appropriations. Is there a motion. So moved by Senator Limon? Thank you very much. Please call the roll.

[Roll Call]

Current vote 8-0 will keep the roll open for absent Members. Next item is item number eight. Assembly Bill 3161. Assemblymember Bonta healthcare facilities. The motion would be do pass and re refer to the Committee on Judiciary. Is there a motion by Senator Hurtado? Thank you very much. Please call the roll.

[Roll Call]

Current vote 8-0. We'll keep the roll open for absent Members. Next item is item number 10. Assemblymember Meinschein, AB 2063 healthcare coverage. The motion would be do pass as amended. We refer the Committee on appropriations. Is there a motion? Any takers motion? Senator Hurtado Okay, please call the roll.

[Roll Call]

Current Vote 9-0. Am I expecting somebody else? Current vote 9-0 will hold the row open for absent Members. Next item is item number 11, AB 2081. Assembly Member Davies, substance abuse recovery and treatment programs. The motion will be do passed and we refer to the Committee on Appropriations. Is there a motion? Senator Nguyen moves. Please call the roll.

[Roll Call]

Vote 9-0 hold the row open for absent Members. Next item is item number 12. AB 2105 by Lowenthal coverage for pandas and pans. Current vote is 60. Chair voting aye. Please open the roll.

[Roll Call]

Current vote is current vote 9-0. And that amount of that Bill is out. Item number 13. Assembly Bill 2198 by Assembly Member Flora Health information. Current vote is seven. Chair voting aye.

[Roll Call]

Is 10-0 and that matter is out. Next item. Item number 14. Assembly Bill 2297 by Assemblymember Friedman Hospital and emergency physician. Fair pricing policies. Current vote is four to one. Chair voting aye. Please open the roll,

[Roll Call]

Are we missing any?

I have no. That one can be. That one's done.

Okay, the vote is seven to two. That Bill is out. Next item is item number 16. AB 2365. Assemblymember Haney, public health, kratom. Current vote is six to zero. Chair voting aye.

[Roll Call]

Current vote is 9-0. We'll hold the row open for absent Members. And the last item. Item number 21. AB 3221. Assembly Member Pellerin Department of Managed Health care. Review of records. Current votes vote is seven to zero. Chair voting aye.

[Roll Call]

Current vote is 9-0. We'll hold the row open for absent Members. Let's go back through the items, starting with item number one. AB 1316 by Assemblymember Irwin Emergency Services Psychiatric emergency medical conditions. Current vote is seven to zero. Chair voting aye. Please open the roll,

[Roll Call]

Current vote 90 will hold the row open for absent Members. Next item is item number two. AB 1926 Assemblymember Connally. Healthcare coverage regional enteritis. Current vote five to zero. Chair voting aye. Please open the roll.

[Roll Call]

Current vote 7-0 will hold the row open for absent Members. Next item. Item number three. Assembly AB 1970 Assembly Member Jackson Mental Health Black mental health navigator certification. Current vote 7-0. Chair voting aye. Please open the roll.

[Roll Call]

Current vote is eight to zero. We'll hold the row open for absent Members. Next item. Item number four. AB 1975 Assemblymember Bonta. Medically supportive food and nutrition interventions. Current vote 70. Chair voting aye. Please open the roll.

Senator Nguyen Gonzalez Smallwood-Cuevas Wiener, aye. Wiener aye.

Vote 8-0. Hold the roll open for absent Members. The consent calendar. Current vote is eight to zero. Chair voting aye. Please open the roll,

[Roll Call]

Current vote is 9-0. We'll hold the roll open for absent Members. Next item. Item number seven. AB 2786 Assemblymember Bonta certified mobile farmers markets. Current vote eight to zero. Chair voting aye. Please open the roll,

[Roll Call]

Current vote nine to zero. Will hold the row open for absent Members. Next item. Item number eight. AB 3161 assemblymember Banta Healthcare facilities patient safety and anti discrimination. Current vote 8-0. Chair voting aye. Please open the roll,

[Roll Call]

Current vote nine to zero. We'll hold the row open for absent Members.

I think there are two. Thank you.

789-75-6789 okay Gonzalez, is that one? 9 Well, let's just recess for 10, what, five minutes.

There on Members questions in Assembly Education. Whatever you call.

Senate Health Committee will be in recess for five minutes. From our brief break. We're going to open the rolls on the Bill starting with item number one. AB 1316 Assemblymember Erwin Emergency Services Psychiatric emergency medical conditions the vote vote is 9-0. Chair voting aye.Please open the roll,

[Roll Call]

that matter is out 10-0. item number two. AB 1926 current vote is 70. Chair voting aye. Please open the roll, Senator Nguyen Gonzalez.

[Roll Call]

Vote is eight to zero. That matter is out. Next item. Item number three. AB 1970 Assemblymember Jackson Mental Health Black Mental Health Navigator certification current vote is eight to zero. Chair voting aye. Please open the roll,

[Roll Call]

Vote is 9-0 that matter is out. Next item. Item number four. AB 1975 Assemblymember Bonta medically supportive food and nutrition interventions current vote 80. Chair voting aye. Please open the roll,

[Roll Call]

That matter is out. Now the consent calendar. Current vote is 9-0. Chair voting aye. Please open the roll,

[Roll Call]

Vote is 10-0.The consent calendar is out. Next item. Item number seven. AB 2786 current vote 9-0. Chair voting aye. Please open the roll,

[Roll Call]

Vote is 10-0. That matter is out. Item number eight. AB 3161 Assemblymember Bond Healthcare facilities patient safety and anti discrimination current vote 90. Chair voting aye. Please open the roll.

[Roll Call]

10-0 that matter is out. Next item. Item number 10. AB 2063 Assemblymember Maienschein Health care coverage current vote 90. Chair voting aye. Please open the roll, 10-0 that matter is out. Next item. Item number 11, AB 2081 Assemblymember Davies Substance Abuse recovery and treatment programs current vote 90 chair voting aye. Please open the roll.

[Roll Call]

Is 10-0 that matter is out. Item number 12 is out. Item number 13 is out. Item number 14 is out. Item number 16 AB 2365 Assemblymember Haney Public Health Kratom Current vote 90 chair voting aye. Please open the roll, Vote 10-0 that matter is out. And the last item, item number 21 AB 3221 Assembly Member Pelerin Department of Managed Health Care Review of records Current vote 9-0 chair voting aye. Please open the roll, Vote 100 that matter is out. If there's no other business, the Health Committee is adjourned.