Senate Standing Committee on Health

The Senate Committee on Health will come to order. Good afternoon everyone. It's been a busy day. We're going to be running back and forth from the Capitol. There's a lot of committees going on. We originally had eight items on the agenda. We pulled one and held it over to the next hearing.

File item 3, SB339 was pulled from today's agenda in hearing. That leaves us with seven bills on the agenda and two are proposed for consent. That's file item one, SB223 and and file item five, SB246 we will start with as a Subcommitee.

Thank you Vice Chair, for joining me this afternoon and I see we have one author that is ready to go. We're going to be kicking off with file item two, SB228 by Senator Cervantes. Senator, when you're ready.

Thank you so much, Madam Chair, for allowing me to present Senate Bill 228 which will enhance the oversight of the Comprehensive Perinatal Service Program which was established in 1984.

I want to start by thanking the Committee staff as well as Madam Chair for your all the diligent work in working with my team on this Bill to address the concerns from opposition. I want to begin by accepting the Committee amendments clarifying the intent of the Bill.

As you know, in 1984 the Legislature established a Comprehensive Perinatal Service Program, otherwise known as CPSP, which provides eligible pregnant and postpartum people under MediCal for conception to 60 days postpartum. The program is provided to eligible pregnant and postpartum MediCal Members. It seeks to reduce parental, maternal and infant illness and death in California.

Patients receive enhanced services in other areas such as health education, nutrition education, mental health assessment and intervention. Under existing law, CPSP is jointly administered by the California Department of Public Health and the Department of Health Care Services.

While CDPH has authority to monitor the perinatal program through Fee for Services, DHCS is responsible for dealing with MediCal in managed care plans which cover 99% of MediCal customers. In February 2024, the California State Auditor published a report focusing on the oversight of CPSP.

The report highlighted the lack of available data regarding the use of CPSP services by MediCal customers. This lack of data was so significant that the report was only able to assess the perinatal program's usage for 414% of MediCal patients in 2022.

And according to the Auditor, although DHCS requires the managed care plans it oversees to conduct CPSP related reviews of primary care providers, once at least every three years. In 2022, only 45 of those approximately 2,600 provider reviews included an assessment of the use of the perinatal program services.

Meanwhile, CDPH delegated its oversight of the perinatal program to local health jurisdictions, but did not require that those jurisdictions complete quality assurance chart reviews. The State Auditor surveys of the California 61 local health jurisdictions found that 22 of those jurisdictions did not complete the chart review required by law.

Additionally, while California has one of the lowest maternal mortality rates in the country, health experts say that the number of deaths is unacceptable, which is really high. By these estimates, 80% of maternal deaths in the state are preventable.

My Bill, SB228 will implement several recommendations made by the California State Auditor report of 2023 to the CPSP by enhancing the monitoring and oversight of the program. The recommendations include reinstating that DHCS is primarily responsible for the delivery of the CPSP program and should collaborate with CDPH when appropriate.

Specifically requires DHCS to collaborate with CDPH on updating regulations related to CPSP.

This Bill will also require that a report be submitted to both the Assembly Health Committee and the Senate Health Committees every three years, disclosing which programs, which providers conducted reviews of the services that are already required to be published, that are already required by law to be published.

Among other things, at the end of the day, we want to make sure that we are promoting healthier outcomes for mothers and infants across our great state. And we believe that this is the best approach in doing so.

A lot of acronyms in there. How Senator?

Yes, there is.

Senator, do you have any lead witnesses in support?

Not today.

Okay. This is. See no lead witnesses in support. This is a time for any #MeToos in support of this item, please step forward. Please state your name, the organization you're with, and your position.

Omar Altamimi with the California Pan-Ethnic Health Network in support. Thank you.

Thank you. Seeing no other #MeToos in support. Are there any lead witnesses in opposition? There are no lead in opposition. Any #MeToos in opposition? Please step forward.

Nicole Wordelman on behalf of the Children's Partnership as well as Maternal and Child Health Access, we appreciate the author's work on the measure as well as the Committee staff. The amendments appear to be going in the right direction. They just want to see them in print. And we'll review then. Thank you.

Perfect. Thank you so much.

Seeing no other #MeToos in opposition. Bringing it back to the Subcommitee. Nothing further. Senator, I think you know, having audits and reports provide us an opportunity to look at programs and fix them, address them. And I commend you for looking at this, a program that is really important.

Given this issue and ensuring that individuals going through pregnancy and postpartum and everything under that umbrella are giving other resources necessary. Thank you for working with my Committee and getting to your goal of fixing this program. When we have a quorum, we will call for a motion. Thank you for your presentation.

Thank you so much. Appreciate an aye vote. Thank you.

Oh yeah, I didn't give you an offer. Please Senator, you may close.

Thank you for the thoughtfulness of the staff and working with us. And I certainly look forward to continuing our work with the concerns that were shared with the opposition and certainly eager to keep this Bill moving and respectfully ask for an aye vote when appropriate.

Thank you, Senator. Calling all other authors. We can get through this Committee pretty quickly if we get authors. If not. Madam Vice Chair, I'm going to present my Bill to you.

Let's do it. We're now moving to file item 8, SB324, Menjivar Medical Enhanced Care Management and Community Supports. Senator, the floor is yours.

Thank you, Madam Chair. I'd like to first state that I will accept the Committee amendments imposed on myself, by myself, to myself. Just kidding. Thank you for the Committee. You're working with me. Members, in 2022, California implemented the Advancing and Innovating Medi-Cal CalAIM initiative to create a more coordinated and equitable Medi-Cal system.

Two initiatives within CalAIM came out of that. There were the Enhanced Care Management, ECM, and Community Supports. ECM includes comprehensive care management to help Medi-Cal enrollees coordinate their physical health, behavioral health, dental, and social services.

Community Supports are services to address enrollees' health related social needs, such as services to secure a bunch of different things like housing, modifications in their homes, housing deposits, and so forth. A key concept in developing these initiatives was the idea that the care should be done in the communities by their neighbors of where the individual lives, breaking down the traditional walls of healthcare.

However, what we're seeing is that the community providers who offer the support struggle to enroll with Medi-Cal plans due to burdensome paperwork, administrative requirements, and competition from large for profit providers who are not based in the community and oftentimes are headquartered in other states.

Additionally, a 2023 study found that more than half of the Medi-Cal plans analyzed opted to contract with national for profit companies to offer these services and there were few smaller nonprofits in the provider pool despite their experience, cultural competency in offering social services to individuals. Another more recent analysis found that for profit companies will receive an estimated 67% of the total spending for these services, including the 50% makeup that I just mentioned that are from out of state companies.

Despite contracting with national for profit companies, utilization of the services is still low considering the needs of the Medi-Cal population. So my bill would do this. It's going to require, It's asking to require Medi-Cal plans to contract with company community providers if they are available in the county and have experience providing the services. Got to be mindful of smaller, more rural areas.

We're asking to require DHCS to standardize and streamline templates used by Medi-Cal plans to contract the community providers. Removing some red tape, we're asking to require DHCS to issue guidance to clarify how community providers may issue, may use an intermediary to assist with plan contracting and claims, better known as community hub models. And finally, we're asking DHCS to publish additional data about ECM and Community Supports provider. Madam Chair, I now like to turn to my witness my testimony in support of this bill.

Thank you. Thank you and welcome to our witnesses in support. You will each have two minutes of testimony. I'll let you go a little longer if you need to. You're free to begin.

You can make it, get it closer to you. It's on with the red light. Yeah.

Good afternoon, Chair and Members of the Committee. My name is Kelly Bennett. I'm the CEO at Community HealthWorks, a Sacramento nonprofit dedicated to improving access to health care for historically underserved communities right here in Sacramento.

Since 1998, we've used a community health worker model to serve our region's most vulnerable, including people experiencing homelessness, those transitioning from incarceration, living with severe mental illness, or frequently relying on emergency room departments to receive their care.

As an early adopter of CalAIM, having helped pilot whole person care in our county and the Health Homes Program, we, as well as many like us, demonstrated that community based organizations, CBOs, can in fact meet Medi-Cal provider standards.

Today, as a provider in a geographic managed care county, Sacramento, we contract with not 1, 2, or 3, but actually 4 managed care plans to deliver enhanced care management and the full range of housing related community supports. Our impact is clear. Last year, we placed over 600 individuals into housing with support from CalAIM, reducing emergency department visits and improving long term health outcomes.

Yet despite these successes, major challenges threaten our ability to sustain this work. The current reimbursement rates do not cover the true cost of care, including administrative overhead, field based outreach and travel, each essential to serving individuals with complex medical and social needs. The administrative burden in CalAIM is what we call the hidden cost as each managed care plan imposes different requirements and processes.

This plan by plan variation creates inefficiencies that divert resources away from direct patient care and services, making it harder for organizations like ours to focus on serving people. Smaller community based organizations struggle to participate in CalAIM due to barriers to entry in the contracting process.

Allowing subcontracting within provider networks would create opportunities for organizations to reach more marginalized populations in need of services. Community based organizations with direct experience in service delivery must have a voice in shaping CalAIM's future. Our on the ground expertise is invaluable in ensuring the state policies and program guidelines remain practical, effective, and responsive to real world needs.

If you could wrap up your comments.

For these reasons, I urge your support of SB 324. Investing in rate stability, administrative simplification, and CBO participation will strengthen our ability to deliver person centered, results driven care. Thank you. I welcome any questions.

Thank you.

Good afternoon, Senators. I'm Graciela Anaya. I'm the Director of Community Health with Central California Asthma Collaborative. We are an asthma remediation community supports provider currently contracted with managed care plans in the State of California.

Since our founding in 2011, CCAC has been dedicated in serving residents of the San Joaquin Valley, a region with a high prevalence rate of asthma, serving communities of color, underserved populations, LGBTQ plus, individuals with disabilities, and those living in rural and economically disadvantaged areas.

I come to you as an organization that has been providing asthma remediation services for the last three years under CalAIM, having served over 5,000 Medi-Cal recipients and throughout the San Joaquin Valley and has contracted with six managed care plans in 13 counties.

In the early stages of contracting, we faced several challenges due to the differing processes among the plans, including variations in application requirements, documentations, and timeline for completing the contracting phase. For us, it took up to 12 months. The sheer capacity and willpower necessary to do this often leads to CBOs just giving up.

By January 2022, we finalized contracts with three MCPs and established infrastructure needed to begin offering our services. However, we did not receive a single referral in the first quarter after the launch of AIM, CalAIM. We received our first referral by the end of the second quarter.

At that point we began working with the plans to provide leads and engage Medi-Cal members ourselves. We know that many of our CBO partners aren't as lucky and aren't always able to keep their own self generated referrals. During this time, we were awarded capacity building funding from funds from the incentive payment program and PATH CITED grants.

Without these funds, the lack of referrals would likely have prevented us from moving forward and continue to provide the services and be able to be as successful as we are today. Although updates to the community supports programs are underway, CBOs still lack direct involvement in policymaking, leaving these issues unaddressed.

These ongoing challenges are in reality the reality for most CBOs. To ensure sustainability of the programs and better serve Medi-Cal members, we are advocating for this bill to increase collaboration between DHCS and the CBOs and improve and sustain CalAIM program among many of its amendments.

Not only have we experienced firsthand these challenges, but we have also experienced growth throughout CalAIM and know that it can be a possibility for many of our local CBO partners to find and find success with the passing of this bill. Thank you.

Great timing. We'll now move to those who are also here in support. Please state your name, your organization, your name, and your position.

Good afternoon. Darby Kernan on behalf of LeadingAge California in support of SB 324.

Good afternoon, Senators. My name is Aria Russell. I represent Community HealthWorks, CalAIM, both CS and ECM, and I support this bill. Thank you.

Nicole Wordelman on behalf of the Children's Partnership in support.

Good afternoon, Senators. My name is Will Akins. I'm a reentry community health worker with Community HealthWorks, and I support this.

Good afternoon. Ryan Souza on behalf of Ceres Community Project, a lead organization in the CBO Medi-Cal Coalition, and Project Open Hand, a member of the Food Is Medicine Coalition, both in support. Thank you.

Good afternoon. My name is Chris Baker. I'm with Community HealthWorks, also under the CalAIM initiative, and I'm here to support SB 324.

Good afternoon, Senators. My name is Daisy Velasquez on behalf of Community HealthWorks. I support this bill.

Good afternoon, Chair and Members. Jennifer Fearing on behalf of the California Association of Nonprofits, or CalNonprofits, a policy alliance of more than 10,000 nonprofits statewide, in strong support.

Good afternoon. Adrienne Shilton on behalf of the California Alliance of Child and Family Services, proud co-sponsor in support.

John Drebinger with the Steinberg Institute in support.

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

Good afternoon. Kim Lewis representing Aspiranet and the California Coalition for Youth in support.

Good afternoon, Madam Chair and Members. Awet Kidane with the California Children's Hospital Association in support in concept. We thank the author. Look forward to working with the author on making sure that our nonprofit children's hospitals are also prioritized. Thank you so much.

Good afternoon. Lindsay Gullahorn on behalf of Mom's Meals. We don't have an official position, but really do appreciate the recent amendments to the bill and look forward to continuing to work with the Chair and sponsors. Thanks.

Good afternoon. Ted Jackson with the Marin Center for Independent Living. We are the CalAIM vendor and the first independent living center in the state to start doing ECMs, and we're in strong support.

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

Good afternoon. Yasmin Peled on behalf of Justice in Aging in support.

Good afternoon. Jorge Cruz with California Behavioral Health Association in support.

We'll now move to any witnesses we have in opposition. Seeing none. Is there any organizations or individuals that would like to express opposition? Great. We'll move this to the Committee. Committee Members? Senator Rubio.

Well, I'll move the bill whenever appropriate. I just think it's always good when you have collaboration between those that actually know what's going on, and especially to improve care. So I'll move the bill. Thank you.

Any other Committee Members? No. I just like to say at a time when access to care is really hard to come by, this bill really seeks to improve that. And thank you for keeping in mind our underserved and our rural communities in this important work. Thank you. So we have, Secretary, we have a motion from Senator Rubio to move the bill. We don't have a quorum, so you can close.

Thank you so much, Madam Chair right now. Yes. To clarify, we don't want to exclude Children's Hospital of LA or similar entities like that. I know that was voiced during the public comment. It's our intent to make sure that they're not excluded, that managed care plans can reach out and contract with them. Additionally, you know, and I skimmed through when I accepted the Committee amendments, the Committee amendment I took, and, you know, it's a difficult one to take, but it was around rate, Medi-Cal rate guidance.

And I think it's important during this time right now, as we're talking about just the amount of money that we are in debt or in the hole for Medi-Cal, that we are seriously looking at our policy and not adding further compounded issues to our Medi-Cal situation. Which is why I decided and put collaboration with the Committee that it was better to strike out the Medi-Cal rate reimbursement guidance in my bill and just to be mindful of the situation. With that, respectfully asking for an aye vote.

Thank you. And since we do not have a quorum just yet, we will move to file item number seven, Weber Peirson. While I hand the gavel off here.

We are stretching our legs. We are moonwalking. This is good. This is part of the new thing. Before you present a Bill. Good. At this time, I'd like to ask my colleagues to come to Senate Health so we can establish a quorum. We have three more bills to go through, and then we will be done. I'd like to give credit to the ones that are here.

In front of the Senate Health Committee, we have file item seven, SB646. Senator Dr. Weber Pierson, you may proceed.

Thank you, Madam Chair. Good afternoon, Chair and Members of the Committee, I'm here to present SB646, which would help safeguard maternal and fetal health from toxic heavy metal and prenatal vitamins. By implementing mandatory testing and public disclosure, California can ensure that pregnant individuals receive safe and high quality prenatal nutrition.

Prenatal vitamins are essential for supplementing the nutritional needs of pregnant individuals, helping to prevent birth defects, low birth weight and pregnancy complications. While a balanced diet is ideal, many Americans, including Californians, do not consume adequate nutrients.

This is even more challenging for pregnant individuals who are eating for two. Prenatal vitamins commonly contain things such as folic acid, iodine, iron and other essential nutrients.

For a pregnant individual, it is critical for both women and their physicians to know and trust the supplements they are taking and recommending are safe and do not contain dangerous amounts of any substance or metal. However, recent studies highlight concerns over toxic element contaminants in prenatal vitamins with lead, arsenic, cadmium and mercury.

A Government Accountability Office study found lead and heavy metals with no safe level of exposure and half of the prenatal vitamins, with some independent studies finding contamination exceeding California's Prop 65 limits.

Given the risk associated with heavy metal exposure and the absence of federal or state regulations to specific prenatal vitamins, legislative action is needed to enhance transparency, which allows consumers to make more informed choices. It also incentivizes companies to reduce toxic element contamination and, if needed, provide a basis for setting safety standards.

This Bill would require testing of prenatal vitamins in order to determine how much toxic elements are in the product and they, upon request of an authorized agent, will provide the results of the test. This Bill enforces that the manufacturer, start on or before January 1, 2027 post the product toxics each level of each batch on their website.

It would also enforce the manufacturers attach a QR code to the product showing the test results and a link to the FDA website where consumers can learn about the health effects of toxins on fetuses, infants, children and individuals who are pregnant.

Lastly, no person nor entity shall sell or distribute prenatal vitamins in the state that do not fall under specified descriptions. Keeping consumers in the dark makes this problem worse, not better.

Given the disturbing levels of toxic elements that testing has found in some supplements, providing consumers with toxic element testing will give them more confidence in the safety of prenatal vitamins. Transparency increases trust. Trust increases compliance, and compliance leads to healthier moms and healthier babies.

In closing, this Bill would prohibit the sale and manufacture of prenatal vitamins that aren't up to standard. This way, people who are trying to get pregnant or who are pregnant are not exposed to heavy toxins. With me to speak and support is actress Hilary Swank.

Hillary has long been an advocate for safer consumer products for mothers and babies and even works with a company that produces products that are high quality and low in toxins. Hillary will speak on behalf of EWG. She will join Dr. Danielle Vachon, who will speak on behalf of ACOG, a fellow OB GYN from San Diego.

And Scott Faber is here who is the Senior Vice President of Governor Affairs for EWG. He will be available to answer any technical questions thank you.

Perfect. You may begin.

Thank you for the opportunity to testify here today. My name is Hilary Swank and I am proud to support SB646, which I know will ultimately reduce the presence of heavy metals and prenatal vitamins. I'm testifying today on behalf of the Environmental Working Group, a National Environmental Health Group committed to protecting women and children's health.

As a mom and entrepreneur, I am deeply committed to protecting my family and your families. We know prenatal vitamins are essential for maternal and fetal health, but recent studies show that far too many contain heavy metals that can harm developing babies. I am the mother of twins who just turned two and they are beautiful.

When I discovered I was pregnant almost three years ago, the guiding light in my life evolved into educating myself on the healthiest things I could put into my body to nurture myself and my babies both during and after my pregnancy. In addition to seeking out the good, I also edified myself on the bad.

I extensively research products, foods and vitamins I should avoid due to their harmful impact on my and my baby's well being.

While I'm not a scientist or a doctor, I am a well informed mother and I can't help but feel greatly concerned when I read studies that tell us that exposure to heavy metals, even at low levels, can negatively impact a woman's ability to create life and for a baby's brain and body to develop optimally.

My research for what's best for my babies led me to become the Chief Innovation Officer at Healthy Baby. Healthy Baby is a safety first mom and baby product company dedicated to the health of our babies where developmental and neurological health is at the center of everything.

They screen their ingredients before and after production to meet rigorous standards and I believe all prenatals can and should do the same. Testing and transparency should empower consumers while giving companies a framework to do better. Raising the bar for maternal and infant health. There is no question that this should be an industry wide standard.

We should expect full transparency in healthy products from companies that sell supplements for the well being of women and their babies. All companies making products for a mom and baby have the responsibility to do the utmost to protect their health within the scientific guidance.

I am proud to support SB646 because I am committed to protecting my family and your families from dangerous toxins. The health of our next generation begins with the choices we make today. Every decision is an investment in building a stronger, brighter and healthier future for our children. Thank you again for the opportunity to testify.

Thank you Ms. Swank. Like to turn over to our next lead testimony.

Hello Madam Chair and Members. My name is Dr. Danielle Vachon and I'm an OB GYN here today on behalf of the American College of Obstetricians and Gynecologists, ACOG District 9, in strong support of our sponsored Bill SB646, a critical measure to protect maternal and fetal health by ensuring transparency and safety in Prenatal vitamins.

As a physician, I routinely counsel my patients on the importance of prenatal vitamins, which are essential for fetal development and maternal well being. These vitamins provide vital nutrients such as folic acid, iron and other micronutrients that help reduce the risks of birth defects, low birth weight and pregnancy complications. They're a cornerstone of prenatal care.

Speaking as a mother, I took prenatal vitamins for months before pregnancy and diligently throughout pregnancy and postpartum. While breastfeeding, I carefully avoided high mercury foods I love like tuna, only to later learn that I may have unknowingly ingested some of these toxic elements through my prenatal vitamins.

When I make recommendations to my patients, I need to be certain that what I advise is both effective and safe. It's a matter of trust between physician and patient. That's why SB646 is so important. Recent studies have revealed deeply troubling realities. Toxic elements including lead, arsenic, cadmium and mercury have been found in prenatal vitamins.

These aren't negligible contaminants. Even low level exposures to these heavy metals can be harmful to a developing fetus, increasing risks of complications such as low birth weight, preterm birth and neurodevelopmental disorders.

Given these risks, both patients and providers must have access to accurate, timely information about what's in these products before a recommendation is made or a purchase is completed. This Bill is simple. It demands transparency. It requires manufacturers to test their products and to disclose the results so people can make informed, safe decisions.

We cannot allow the very vitamins intended to protect maternal and fetal health to become a hidden source of harm. SB646 ensures that when we recommend a prenatal vitamin, we do so with the confidence that it's truly helping and not hurting our patients.

For these reasons, ACOG urges you to support SB646 to empower consumers and protect table future generations from preventable toxic exposures. I appreciate your time and I'm happy to answer any questions.

Thank you so much. Now is the time for any #MeToos. Any individual wish to record their support for this Bill, please let us know your name, what organization you're with and your position.

Good afternoon, Senators. Thank you very much. I'm Dr. Jeanne Conry. I'm a board certified obstetrician gynecologist from California. I'm past President of the American College of Obstetricians and Gynecologists, past President of the International Federation of Gynecology and Obstetrics, and I fully support this Bill. Thank you.

Good afternoon. I'm Dr. Kelly Mchugh an OB GYN out of Davis, California and also a fellow of the American College of OBGYNs and fully support this Bill.

Thank you.

Good afternoon. I'm Dr. Juliana Melo with ACOG District 9 and I fully support this Bill as well.

Thank you.

Shilpa Mathew, a Doctor practicing in Sacramento here and I fully support this Bill.

Thank you.

Good afternoon. Kim Lewis, representing Children Now in support.

Good afternoon. Symphoni Barbee, on behalf of Planned Parenthood affiliates of California in support.

Good afternoon, Dr. Bolton. I'm an OB GYN in Oakland and I support this Bill.

Hello, I'm Dr. Middleton. I'm a OB GYN in San Francisco. And I support this Bill.

Hello, I'm Dr. Desjardins. I am an OBGYN practicing in Santa Maria and I am in support of this Bill.

Good afternoon. I'm Dr. Kenya Holmesley, an OB GYN practicing in Oakland, California, and I'm in full support of this Bill. Thank you.

Good afternoon. I'm Maya Zapata, I'm an OB GYN in Los Angeles, ACOG Fellow and I'm fully in support of this Bill. Thank you.

Good afternoon. Dr. Morgan Mandigo. I'm an OB GYN in Orange County. And an ACOG fellow as well. In full support of this Bill.

Good afternoon. I'm Sophia Alvarado, an OB GYN in Sacramento, and I'm in support of this Bill. Thank you.

Madam Chair, Members. Andrew Antwih with Cha Yoder Antwih Schmelzer Lang. Here on behalf of the California Medical Association support. Thank the author.

Good afternoon. Dr. Jocylen Glassberg. I work in Sacramento as an OB GYN in full support.

Dr. Hayley Miller. And I'm also a fellow of ACOG and I support this Bill.

Good afternoon. I'm Dr. Caroline Knorr. I'm an OB GYN physician in San Francisco and I fully support this Bill.

Good afternoon. I'm Dr. Ivonne Verduzco. I'm a OB GYN in San Francisco and I fully support this Bill.

Good afternoon. My name is Dr. Schyler Edwards. I'm an OB GYN resident practicing in San Francisco and I fully support this Bill. Thank you.

Good afternoon. I'm Dr. Emily Chin. I am a physician in San Francisco and I fully support this Bill.

Good afternoon to all. My name is Dr. Sloan Brezina. I'm an OB GYN. I practice here in Sacramento. In full support.

Hello, I'm Dr. Kaylee Cox. I am a resident down in Los Angeles and I fully support this Bill.

Hi there. I'm a practicing OB GYN up in Chico, California, and I fully support this Bill. Thank you.

Good afternoon. I'm Lee Ann Serrano, an OB GYN resident in Los Angeles and I am in full support of this Bill.

Good afternoon. I'm Dr. Nawal Siddiqui. I'm an OB GYN in Los Angeles in support of this Bill.

Hi, Good afternoon. I'm Dr. Alena Cave. I'm an OB GYN resident in Bakersfield, California, and I am in support of this Bill.

Hi, I'm Dr. Caitlin Esparza. I'm an OB GYN resident in San Francisco and I support this Bill.

Good afternoon, Senators. My name is Larry. I'm a fourth year medical student in support of this Bill.

Thank you so much. So amazing to see all the women in white coats. What a great turnout.

Yeah.

See no other #MeToos in support. Do we have any lead testimony in opposition of this Bill? Please come forward. Yes, please. We might need to go on that side, sir. Please. Thank you.

Thank you. Chair, Members. Anthony Samson with Samson Advisors here on behalf of the Council for Responsible Nutrition. CRN is the leading trade Association representing dietary supplement and functional food manufacturers and ingredient suppliers. While we very much appreciate Senator Weber Pierson's intent with SB646, CRN is opposed unless amended for several reasons.

First, manufacturers do not add these elements into prenatal vitamins. Rather, many of the ingredients in prenatal vitamins come from natural sources in soil where these elements are ubiquitous. The same is true for fruits and vegetables, many of which contain trace levels of elements due to soil uptake.

But all health experts agree that despite the presence of these elements, we should not dissuade consumers from eating fruits and vegetables in the same way as we should not dissuade expectant mothers from taking prenatal vitamins. Our concern, however, is that 646 in its current form would do just that.

Second, the elements specified in 646 are on California's Prop 65 list. Prop 65 requires manufacturers, including manufacturers of prenatal vitamins, to provide warnings to consumers if the product would expose consumers to carcinogens or reproductive toxicants at a level set by the Office of Environmental Health, Health Hazard Assessment or OEHA without getting into the minutia.

The warning threshold set by OEHA are known to both be the most health protective in the world. So if a warning is provided on a prenatal vitamin label, then the consumer can choose not to purchase that particular product.

If a warning is not provided but should be, then recourse is available under Prop 65 as it is heavily enforced by both the Attorney General and private plaintiffs.

Third, 646 does not take into account existing federal testing requirements, which, among other things, require manufacturers of prenatal vitamins to ensure their products are safe and accurate through testing for identity, purity, strength and composition following good manufacturing practices outlined by the FDA.

Despite these concerns, we believe there is a viable path forward that would ensure consumers are not dissuaded from taking prenatal vitamins at a high level. Manufacturers could perform finish bulk testing on prenatal vitamins on a quarterly basis.

If those tests reveal the presence of these elements above Prop 65 warning threshold or as established through consent decrees through Prop 65, then those manufacturers would need to submit those results to the Department of Public Health.

If those tests are below those levels and the manufacturer would submit a certificate of compliance to DPH while giving DPH the ability to verify those results. We look forward to working with this Committee and with the Senator on this alternative path moving forward. Thank you.

Madam Chair, Senators. Don Gilbert, on behalf of the Consumer Health Care Product Association, we also have an opposed unless amended position on the Bill. We certainly appreciate the Senator's intent with the Bill. We don't oppose the goal of the Bill we're just looking to improve the Bill.

The Committee analysis summarizes a number of studies that talk about the or analyze the importance of prenatal supplements to both expectant mothers and new babies.

And so we want to make sure that nothing in the Bill inadvertently limits prenatal nutrients supplements, and also that consumers are not left in position to try to analyze the results of a test on their own, which could lead to misunderstandings and so on. So we again, want to align our, our testimony also with Mr. Sampson and the solutions that he's proposed. Thank you.

Thank you so much for anyone wishing to do a #MeToo in opposition.

Madam Chair and Senators. Anthony Molina, on behalf of the Natural Products Association, in opposition. Thank you.

Thank you so much. Seeing no other individuals for #MeToo. Bringing it back to the dais, I think. Senator, you had a question, correct?

Yeah. Thank you. Thank you, Madam Chair. Well, first of all, thank you to all the people that provide such an important service. And of course, our colleague Weber Pierson, who also does that on her spare time. She's already a superstar. But I do have a couple of questions.

And clearly for me, prenatal care is the first step to a healthy society. And as an educator for 20 years, I also have seen, you know, the effects on the other side when people don't take care of themselves. But there's a few questions that were raised.

You know, I do appreciate the comment that the gentleman just made about analyzing test results. You know, it is a complicated issue. But when I go back to the QR code, I'm sorry, I'm asking. Our authors here, is there a way to access information in a different language?

Because we have to take into consideration that we have a lot of mothers, even those that speak Spanish and other languages. What can someone with a different language expect to see?

Thank you so much for that question, Senator Rubio. And yes, you know, the goal would be to provide the information in languages that everyone would be able to understand and be able to read.

And also, one of the things I was looking at or thinking about yesterday was just, do we need more than just the QR code to be quite honest? Because that is becoming an issue with certain people who don't have, who aren't as savvy in technology.

And so we will be looking at those things, but ensuring that when they're able to pull up the information, that it is available in multiple languages.

Thank you for that. And again, taking into consideration what was said right now about the federal requirements already in place and Prop 65, I just want your last narrative, what is that one top line issue that makes this absolutely necessary in light of the federal requirements and Prop 65, the ability to use that.

So I will pass it on to our expert, but want to, as we're moving the mic over to him. There is the FDA does not regulate prenatal vitamins. Right. That is not something that they do. And with Prop 65, which is great, I'm glad that we have that, but it does not require warning.

In all cases, we're on prenatal vitamins. Additionally, what we're looking for is not to dissuade people from taking prenatal vitamins, but allow them to have the information that's there so that hopefully the products that are put out will eventually be the safest and the healthiest.

Understand what was stated by the opposition about contaminants and however, there is a difference in products right now as far as the toxins that are there.

And so even though it may be something that you, you know, is in the soil, there are other companies that are ensuring that their soil is as free as these contaminants as possible.

So we don't want people, of course to not take prenatal vitamins, but it is the right to understand what is in those vitamins that they're taking.

And along the lines of Prop 65, we all see the warning labels with Prop 65, this may have X, Y and Z, but it doesn't actually tell you what X, Y and Z is, nor the level. And so those are things that we need to keep in mind when we're dealing with Prop 65.

But I will turn it over to our expert witness.

Thank you. Thank you, Senator. Thank you for the question.

Let me just pick up on something that Senator Weber Pierson just said, which is that while we know that these ingredients are being contaminated because of how they are sourced, we also know from the testing that has been done that some companies are avoiding those contaminants when they look for those ingredients.

So it is possible for companies to source their ingredients in ways that avoid the likelihood of contamination. Just yesterday, a new study, an academic study was released showing that 83% of the more than 150 prenatal vitamins that were were sampled had levels of lead that were detected.

15% of those were above the levels that are required would require a warning under Prop 65. So we know there's a lot of variability when it comes to the presence of these metals in the marketplace, which tells us that some companies are really working to avoid them more than others.

The other thing I just wanted to say about the federal requirement is supplements are regulated as a subcategory of foods. There are no requirements under the good manufacturing practices that are issued by Fda. I should mention I teach food law at Georgetown Law School in addition to working at Ewg, and I used to represent the food industry.

I was the head of government affairs for their trade Association, the Consumer Brands Association. There's no requirement under federal GMPs or good manufacturing practices that companies test for the presence of these metals, these contaminants in prenatal vitamins. Essentially, they police themselves. They decide which things to look for.

In particular, they might choose to look for primarily microbiological contamination, pathogens, things like that. Then they choose how to look for those contaminants. They do not have to report those results. They don't have to certainly report them to consumers or to the FDA. So it's not exactly right to say that there are federal requirements in place.

And as Senator Weber Pierson noted, Prop 65 enforcement depends on trial lawyers and the extent to which government officials have the resources to test to see whether warnings were warranted. They're not. Now, I will say good companies are certainly testing. All companies should be testing on their own. We don't know that they are.

All we're asking them to do if they are testing is to share the results with consumers so that not only we will know, but they will engage in a race to the bottom, in a good sense, in the sense that they will look for ways to avoid having those contaminants in their products.

Thank you. Well, I just want to thank you for that information because I know that the safety standards of care for these prenatal medicine for infants and mothers is critically important.

And you know, and I do hear the industry, I know that it seems like there might already be something in place, but I think we can never be too safe when it comes to children and mothers. So when appropriate, I'd like to move the Bill. Thank you.

Thank you. Senator Rubio, you addressed one of the questions I had. Dr. Weber Pierson, I have one additional question for you, and you kind of touched on it. Do you think this will limit.

If a consumer comes in and a lot of the options or inventory available in front of them has a label and QR code, they freak out. What are the options? Or is enough inventory for them to choose another item?

You know, it's interesting. If you had asked me this question maybe 1015 years ago, my answer may have been different.

But the inventory is so vast today as far as the options for different prenatal vitamins, I do not see that as being a deterrent for them to be able to get the nutrition that they need for themselves and their babies during a very, very delicate point in their lives.

And something that's necessary. Like you mentioned, you're going to recommend to your patients or even your patients that you take this as a requirement. And I think it's imperative to when someone is there's no other option. You must take prenatals to be as successful as possible that we look at what's inside and provide the consumer protections.

I know some of the amendments from the opposition, some of them were probably a little difficult for the author to take because it completely gutted their bail. But I know the doctors. The end goal is to make it successful, that we can actually get to the goal that it's not a headline.

And I'm assuming you will be continuing conversations with the with opposition. Additionally, this Committee passed a similar Bill last year and the way we're looking at this Bill is very similar to that Bill that we the Committee passed out last year, which is why I will be supporting this Bill.

And when we have a quorum, we'll be able to coffer or address the motion that you introduced. Thank you so much. It wasn't as dramatic, I think. I don't know if you've been watching the Federal Government, but we're not super dramatic over here.

It was dramatic.

Okay. Well, thank you so much for coming and sharing your perspective and story with us. With that, I'd like to turn over to the Senator for her closing. Thank you.

I want to both thank both of my witnesses who came to testify and all of my fellow ACOG Members who also came to support as #MeToo. This is a very important Bill. We'll definitely continue working and having conversations with, you know, with the opposition. We've worked well before on some, some bills that I've had.

But this is a very important issue because we are talking about the health and safety of our future even before they are actually born. And so we, we have to get it right and we have to be the lead for the rest of the country to be able to follow.

And with that, I respectfully ask for an aye vote on SB646 at the appropriate time. Thank you.

Thank you, Senator. Dr. Weber Pierson. We are looking for authors of our two remaining bills.

Senate Health would take a quick recess.

The Senate Committee would reconvene in 30 seconds.

Senate Committee on Health has reconvened. We just had quorum. zero my goodness. In the meantime we will continue as a Subcommitee. We are now moving on to file item 4, SB40. And Senator Wiener is is getting ready. Senator Wiener, you may begin when you're ready.

Thank you very much, Madam Chair. Thank you for hearing this. Thank you—thank you for hearing this Bill today. And thank you to you and your staff for working with my office here to present Senate Bill 40.

The Insulin Affordability Act is part of a package of a few bills that I'm authoring that we'll see in this Committee, I hope in the coming weeks.

It's like 10, right Senator?

Just three, maybe four. Actually, a fourth one now just got referred apparently.

And I'll be accepting the Committee Amendments to delay implementation for Covered California by one year, and to allow a health plan to use Step Therapy as long as one insulin—one type of insulin for each drug—one insulin for each drug type is covered, similar to what is in statute around antiretrovirals for HIV.

So, thank you for working with us on those amendments. SP 40 caps insulin monthly co-pays at $35 and restricts—or limits—step therapy requirements for insulin. We know that so many people rely on insulin to stay alive. It's not an optional drug.

It's not the type of drug that if you don't take it, you just won't be as healthy. If you don't take it, you will not be able to survive. It's critically important. And there are too many people in California who struggle to afford insulin. We know that Congress created a $35 co-pay cut for Medicare recipients.

We should do the same thing here in California for the plans that we regulate at the state level. We know that, in this country right now, health care access is at risk, and health care affordability is something we need to embrace in every way possible. And this Bill will help to do that.

So, I respectfully ask for your "Aye" vote. With me today to testify is Dr. Bindlish, who is a Diabetologist and an Internist. And Christine Fallabel, Director of State Government Affairs and Advocacy with the American Diabetes Association, our sponsor. Thank you.

Thank you. You have a total of five minutes together.

Good afternoon, Madam Chair and Committee Members. Thank you very much for the opportunity to speak here today. I am Dr. Shagun Bindlish. I am a board certified Diabetologist and Scientific and Medical Director of American Diabetes Association. And I'm very honored to be present here for testifying the very important SB 40 Bill.

Insulin is, as we all know it, is just—my first patient, actually, this journey, my journey from fellowship to now as a practicing physician, has been not only very rewarding, but was very emotional. The first patient I saw as diabetes fellow was a two-year-old child.

And the family was very overwhelmed with the new diagnosis of the child, with Type 1 Diabetes. They were also struggling with the emotional and financial burden that comes with this lifelong disease. So, it's very emotional to in—throughout this many years, we have been actually addressing multiple effects and impacts of this disease, plus the complications.

I have had patients who rationed their insulin to make it through the month. Others skip dosages, they risk hospitalization or develop several severe complications, because they simply can't afford what keeps them alive. One of my patients, a 28-year-old patient, told me he sometimes chooses between paying rent and buying insulin.

That should never be a reality in a country with medical advancements. As we all know, we have come a long way in the advancement of insulin and the medications for diabetes treatment. SB 40 addresses this crisis head on. It aims to cap insulin cost. And insulin is both long-acting and short-acting insulin.

And it makes it easier for people to access essential medications without going into debt or risking their lives. This Bill is about dignity, it's about equity, and it's also about preventing suffering we have power to stop. So, as a physician, a scientist, and an advocate for my patients, I urge you to support SB 40.

Affordable insulin isn't just a policy, it's a matter of life and death.

Before you continue, it looks like we have quorum. Committee Assistant, can you please establish a call? Attendance, or roll.

[Roll Call]

We have a quorum. You may proceed with your testimony.

Thank you. Madam Chair and Members of the Committee. My name is Christine Fallabel, and I'm the Director of Government Affairs and Advocacy for the American Diabetes Association. We stand in strong support of Senate Bill 40, to make insulin more affordable for Californians who need it.

Diabetes is a growing epidemic in the U.S., as well as here in California, where more than 3 million people live with the condition. And I, myself, have had Type 1 Diabetes for 25 years. The cost of managing it can be unsustainable. People with diabetes have medical expenses approximately 2.3 times higher than those who do not.

When people with diabetes are unable to manage the disease and access the insulin they need, it increases the risk of developing costly and burdensome complications, including diabetic ketoacidosis, increased risk for infections, increased hospital visits, cerebral edema, and premature death. And over a long period, insulin rationing can lead to heart disease, kidney failure, amputations, and even blindness.

A recent study showed that between—in—1 in 6 people with diabetes ration their insulin due to cost alone. That's because in recent years, the cost of insulin has tripled and the price for the newest, fastest-acting insulins has continued to climb.

To fight this crisis, 26 states and Washington, D.C. have passed laws to limit monthly out of pocket spending for insulin, and Medicare beneficiaries have their out-of-pocket monthly spending for insulin capped at $35. But California is yet to join them.

When people cannot afford the medication necessary to manage their diabetes, they scale back or forego the care they need to manage their health, exposing themselves to complications. Or they are forced to choose between paying for their medication or rent, utilities, and other necessities to live.

Senate Bill 40 offers a solution to ensure that people with diabetes can afford the medication they need to survive. By capping co-payments people with diabetes pay for insulin, we can ensure that Californians with diabetes are healthier, and that our state, as a whole, can thrive. Thank you for your time.

Thank you so much. Now is the time for anybody who'd like to do a "Me Too" in support of this Bill. Name, organization you're with, and your position please.

Good afternoon. My name is Mark Pasos. I'm a resident of Pleasanton who has been living with Type 1 Diabetes for 49 years, and I thank you for your support of SB 40.

Thank you.

Good afternoon. My name is Rhea Binlisch. I'm a junior in high school and the President of Dublin High's chapter for American Diabetes Association, and I stand here today to support SB 40.

Thank you, Madam President.

Jennifer Robles with Health Access California, in Support.

Good afternoon, Chair and Members. Beth Malinowski, SCU California, in strong support.

Good afternoon, everybody. Matt Diamond. I'm a CPA based out of San Francisco, California. I've been a Type 1 diabetic for more than 30 years, and I wholeheartedly. support the Bill here today. Thank you.

Good afternoon, Madam Chair and Members. Alex Kahn, on behalf of the California Chronic Care Coalition, in support.

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

Madam Chair, Members. Andrew Antwee, on behalf of the California Medical Association, in support.

Thank you. Do we have any lead opposition—like to provide testimony? Any—anybody—like to record their "Me too" in opposition to this Bill? Senator Wiener, this is abnormal.

I have some non-controversial bills.

Let's bring it back to our colleague Senator Rubio. Kick us off.

Thank you.

Well, first of all, I'm proud to be a principal co-author on this Bill, and I think that this is one of those important bills that we hear from our constituents constantly, just how they are dealing with the high cost of living already, you know, struggling to pay bills, as you mentioned, rent, gas, everything else.

And I think this is just such an important part of, of you know, providing relief to our constituents, especially when it comes to staying healthy. And I agree with you. I've heard stories from our constituents where they just don't take the proper dosage and they're trying to cut corners.

And it's just so sad to me that that's a choice they have to make, especially when we know that some end up just not being healthy for the rest of their lives. So, I just want to say thank you to the author, and I think that, again, this is something we all need to do.

I appreciate you and with that I'll move the Bill. Thank you.

Senator, Dr. Weber Pierson.

Good afternoon. Senator Wiener. I just want to thank you for, once again, introducing this Bill. This is truly a lifesaving Bill. I was extremely disappointed last year when I saw the governor's veto message and you know, understand that we are in this space with CalRx and, you know, California trying to create its own insulin.

However, we are not there. And in the meantime, while we continue to wait and talk about what may happen in the future, there are people who really need this now. And so, I really just want to thank you. I'm also a proud, you know, co-author of this Bill, and just look forward to supporting it again. Thank you.

Senator Grove.

Thank you, Madam Chair. There are very few times that myself and the Senator from San Francisco agree on things, but this is definitely one of them. And I know I supported this Bill in the past. I have seniors, I have individuals that are really struggling with the cost of insulin.

I think insulin is something that should be provided at a lower cost. And I supported this Bill last time and I was looking briefly why you are back here. It's because it was vetoed. Better luck this year and I am glad to support the Bill this year.

Thank you Senator. Senator Richardson.

Thank you, Madam Chair. I'd also like to join in commending the author on this very important topic. Both my father and mother were diagnosed with diabetes.

I didn't know my mother had diabetes, and she hid it from me because she didn't want to worry me about, you know, oh, here's something else I have to think about, and I think a lot of that is because of misinformation, concern of cost, and all the additional questions, sharing of medication, and so on.

And so, I just think it's really important to eliminate cost as being one of the factors, but there are many factors that individuals with diabetes face on a day-to-day basis and certainly, the cost should not be one of them.

This is a very key disease that many people face in this country, and there's no reason why the cost should be more than what is reasonable, compared to other medications available. So, thank you for your work.

Vice Chair.

Thank you. So, Senator, I can definitely appreciate the goal of SB 40 and making insulin affordable. It is much needed. However, I'm also aware of the CalRx Program, overseen by the Department of Healthcare Access and Information, and the Program's effort to develop and manufacture low-cost, biosimilar insulin products in California.

Unfortunately, the LAO reported in February 2025 that, "It is unknown when the new product will enter the market." HCAI recently reported to our office that manufacturing has started, but they have not yet received the final federal approval, and I know you've mentioned a lot of this.

The LAO also reported that HCAI indicated that it could not provide an estimated timeline to receive federal approval to sell the product. So, however, for just the sake of argument here, if HCAI announced in July—or HCAI announced in July that the biosimilar insulin product has been federally approved, how what would become of your Bill?

Are we being duplicative?

Thank you for the question. I also want to just appreciate the broad bipartisan support this idea has always had. In fact, Senator Bates had pursued this Bill before I did, so it's always had great bipartisan support. It's always good to look for those opportunities in this divisive moment in time.

I think the two are—they're not mutually exclusive in any way. And I, I've, you know, I—we—held an oversight hearing in the Budget Committee on CalRx and insulin. CalRx has produced methadone, generic methadone, which is great. Insulin has been delayed, as you know, and so, it will be it could be quite some time before we have that.

If CalRx, if it magically happened tomorrow, the two built—the two would just coexist. You would have an additional source of insulin that would be very inexpensive. And for anyone who was obtaining insulin through their insurance, regulated by the state, it would be capped at $35.

I hope that we get to the point where insulin is so cheap that $35—that that would become an irrelevant cap. But that would be the worst thing that would happen, if everything got so cheap. And I don't think that's going to happen in the near future.

Then, you would just have a cap that, effectively, people would be paying less than that, which is fine. So, the two coexist, I think, very well. They don't, they don't—they're not mutually exclusive.

It's one of the reasons, just, respectfully, to the Governor when he vetoed the Bill in 2023 and cited CalRx, I never really—I just didn't agree with that message, because CalRx and a co-pay cap are different things, and they don't conflict with each other.

So.

Go ahead, Senator.

So, she wants to weigh in. That's, that's fine. Okay. Yeah.

I'm sorry, didn't mean to interrupt. But only one thing I want to add, which is very important information for the CalRx, is it is only for long-acting insulin. It's not a short-acting insulin.

And for Type 1 Diabetes patients, and even for a lot of Type 2 Diabetes patients, they are dependent on both long-acting and the short-acting insulin. So, this has to be really, I think, addressed very importantly, even if, even magically, if it happens tomorrow, it is still going to be a biggest challenge.

Thank you. So, I'll just add that I don't have any faith that CalRx is going to deliver on this. So, I do see the need for this and for this now.

Question though, I mean we have a veto-proof Legislature at this point, if this were to be vetoed again, is it something you might consider bringing back to the Body?

That's a really good question, Senator. I could go on for a long time about my views, about the fact that a veto hasn't been overridden since...

Senator and I have had a conversation on this, yes.

That is, you know, we are co-equal branch of government, and I do believe we should act fully like a co-equal branch of government.

So, thank you.

Seeing no other question.

But I will also just say, I'm an eternal optimist and I—my goal is to convince the Governor that he should sign this Bill. So, that is my goal.

Another Member wishing to speak out. Just some remarks. Thank you for accepting those three amendments. I know we didn't land the plane on the other two, but you're waiting for some technical assistance on some departments, and we know that conversation is going to be ongoing, as you go through the process—process here.

And I don't think anyone here disagrees. It's really expensive. We need to cap it. But even with the delay with Covered California, we're going to have to have those conversations of cost sharing and how other people's premiums will go up, while people on insulin cap will be at $35. Other Members will have to pay for it.

But that's a greater conversation to our healthcare system and how expensive things are. With that, Senator, you may close.

We've had a great conversation. So, I respectfully ask for an "Aye" vote, and I appreciate everyone's comments and support.

Since we do have a quorum, I need anyone—I need a motion on File Item.

Rubio made a motion. Senator Rubio, motion in front of us is do pass as amended, and we refer to the Committee on Appropriations. Committee Assistant, please call the roll.

Rubio did.

[Roll Call]

It currently has eight to zero. But we're gonna put that Bill on call. We still have some Members that aren't here. Our final Bill today is before that. Senator, I'm going to take up the consent calendar moved by our Vice Chair. We will now consider the bills on the consent calendar. Their items number one, SB223. And file item number five, SB246. Motion made by our Vice Chair, Committee assistant, please call the roll.

[Roll Call]

I'm gonna. For the Members that have been here, we're gonna open the roll on some on all the bills so we can get some Members out of here. We're gonna start with file item 2, SB228. Senator Limon, if you give us a couple minutes here. Committee assistant, please call the roll.

Well, I need a motion to file item 2, SB228, moved by Senator Wiener. Motion is due. Pass as amended. And we refer to the Committee on Appropriations. Committee assistant, please call the roll.

[Roll Call]

We're gonna hold that item open. Moving on to file item four. We did that. Moving on to file item seven. SB646. Need a motion. Senator Rubio makes a motion. Motion is due. Pass. And we refer to the Committee on Environmental Quality. Committee system. Please call the roll.

[Roll Call]

Going to hold the roll open. Final item 8, SB324 and we'll make a motion. Move our Vice Chair. Motion is due. Passes amended and we refer to the Committee on Appropriations. Please call the roll.

[Roll Call]

Gonna hold that item open. Senator Limon. File Item 6. SB386.

The floor is yours.

Dental plans often contract with third party companies to issue provider payments to dental practices with virtual credit cards. However, accepting this form of payment charges the dental office processing fees 2% to 5% of the total payment amount and in addition to the standard merchant transaction fee, for processing the payment through their credit card terminal.

This leaves providers with two options—either process the virtual credit card and accept high fees, or spend administrative time continuously opting out of virtual credit cards when accepting their payment. This Bill requires dental plans and virtual credit card companies to provide notice of any fees associated with payment, along with details on alternative payment method—methods.

SB 368 provides the ability to opt in, with authorized consent, to receive virtual credit cards. This Bill does not apply to health plans that have a direct contract with a dental provider that allows that provider to choose their form of payment for services rendered.

Today, I have with me in support of the Bill, Lawrence Gayden, Policy Director for the California Dental Association.

Please proceed.

Thank you. Good afternoon, Chair and Members. Lawrence Gayden, with the California Dental Association, here as a proud sponsor of SB 386.

The growing use of virtual credit cards has been a long-standing concern for CDA Members. The shift to electronic payments were meant to streamline and modernize the healthcare delivery system, but instead, has created challenges for dentists who are paying up to 10% in fees, just to access their payments owed to them by the plan.

SB 386 would ensure that there are guardrails to protect providers and allow them to explicitly exercise their choice of payment method, by creating an opt-in requirement for any fee-based payment models used by dental plans and their vendors.

Rather than being defaulted into payment methods that nickel and dime them, SB 386 will ensure that there's an option for a non-fee-based payment method and gives dentists the choice to express which option works best for their practice. We appreciate the collaboration with the plans on this to get us the language we've adopted today.

Ultimately, these predatory fees shift funds away from the healthcare system that could have been used to improve patient experience and ultimately, patient access. For these reasons, I urge an "Aye" vote on the measure.

Thank you so much. Now, it's time for "Me Toos" in support. Name, organization, and position.

Good afternoon, Chair and Members. Jennifer Tannehill, with Aaron Read & Associates, on behalf of the California Dental Hygienists Association, in support of the Bill. And we support the amendments that are in the analysis provided by the sponsor.

Thank you so much. No other "Me Toos" in support? Any lead witnesses in opposition? Step on up. You can come.

Kristy Wiese, Capital Advocacy, on behalf of the California Association of Dental Plans. With the Committee Amendments, we're happy to remove our opposition.

Oh, I'll be short and sweet.

Okay.

Really want to thank the Senator, and the sponsor, and the Committee, for working—working through these issues that we had. Obviously, it's important that the plans and the dentists collaborate together. We have a symbiotic relationship and we, you know, need each other to be successful and serve consumers. So, happy to remove our opposition, and really appreciate everyone's collaboration.

Thank you so much. Any Me Toos in opposition? Bringing it back to my colleagues. Questions, comments? Moved by Senator Rubio. Senator, you got to like 95% of the—all the stakeholders' wants—so, I want to commend you on this. With that, please close.

Thank you.

Well, thank you again to the Committee staff, to the Committee for this, and I respectfully ask for an "Aye" vote.

Great. Moved by Senator Rubio. Please call the roll. The motion on the Bill is "Do Pass" as amended and re-referred to the Committee on Appropriations.

[Roll Call]

Senate Health Committee will be in recess.

Senate Committee, Committee on Senate health will convene in 32nd. Committee is back in session. We're going to be opening up the roll. We're going to start with file item one. We're going to start with file item two. SB228. Committee Secretary. Please call the roll.

[Roll Call]

Currently 9-0. We're gonna keep that item open fire. Item four, SB40. Please call the roll.

[Roll Call]

That has has 9-0. Putting it back on call. Moving on to file item 6. SB386. Please call the roll.

[Roll Call]

Gonna put the item back on call. Fire item 7. SB646. Please call the roll.

[Roll Call]

Keeping the item on call. Fire item 8. SB324. Please call the roll. Gonzalez.

[Roll Call]

We're gonna put put that item back on call. Committee assistant. Please open the roll on the consent calendar. That's going to be for file items 1 and 5. SB223 and SB246. Please call the roll.

[Roll Call]

Gonna put the consent calendar back on call. Thank you Senator. Grove Committee Secretary , we're going to go through the items again. Can you open the roll on the consent calendar that has file item 1 and 5, SB223 and SB246. Call the roll. G. We are almost there. We're going to put that back on call. Please open the roll on. Please open the roll on File Item 2, SB228.. Putting the item back on call. Please call the roll on SB40. File 4. File 4 is back on call. Please open the roll on file. Item 6. SB386.

[Roll Call]

File item 6. SB386. Senator Limon.

[Roll Call]

We have 9-0 on the item. We're going to place it back on call. Please open the roll on fire. Item seven, SB646.

[Roll Call]

Going to put fire item seven back on call. Please open the row of fire. Item 8, SB 324. We're gonna put the item back on call. Senate Health will take a recess. And I asked Senator Durazo. I don't know if she's gonna come back. Okay. She's the only one on that other Bill, right? Everyone else is good. No, but he is not. Right. But for everybody that was here, yes. Will reconvene in 20 seconds. Senate Committee on Health is back in session. We're going to be opening the roll call on file. Item 6. SB386. Committee Assistant, please call the roll.

[Roll Call]

We're going to put that item back on call. We are. We are gonna open the roll on the consent calendar that is file item 1 and file item 5, SB223 and SB246, respectively. Please call the roll..

[Roll Call]

That's 11 to 0. Consent calendar is adopted. Please open the row on Fire. Item 2. S.B. 228.

[Roll Call]

With 11-0. That item is out. Please open the roll on file. Item 4. SB 40,

[Roll Call]

That has the 11 to 0. SB 40. Item 4 is out. Please open the roll on file. Item 6. SB 386. With a 11 to 0. Item 6 is out. Please open the roll on file. Room 7. SB 646.

[Roll Call]

That has 11 to 0. The Bill is out. Final item on the agenda 5, item 8. SB 324. Please call the roll

[Roll Call]

The item has 11-0 and it is out. The Senate Committee on Health has adjourned.