Assembly Standing Committee on Health

Good afternoon and welcome to the Assembly Health Committee hearing on Tuesday, April 12025. Happy April Fool's Day.

Before we begin, I want to make sure everyone understands our Committee rules to ensure we maintain order and and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time.

We seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California.

Rules of conduct by Members of the public include no engaging in conduct that disrupts, disturbs or otherwise impedes the orderly conduct of this hearing Engaging in personal attacks of Members of this Committee, authors, staff or other witnesses talking or loud noises from the audience.

Please be aware that violations of these rules may subject you to removal or other enforcement processes. If you are providing witness testimony at this hearing. All witnesses will be testifying in person. Main support and opposition will be allowed to two main witnesses for a maximum of two minutes each.

Additional testimony will also be in person and limited to name, position and organization. If you represent one. All testimony comments are limited to the Bill at hand. We have several items on consent. The following bills are proposed for consent for today's hearing.

Any Member of the Committee may remove a Bill from item number three, AB242 burner with motion of do pass to appropriations. Item number nine, AB618 crel, with a motion of do pass to Appropriations. Item number 10, AB627, Stephanie, with a motion of do pass as amended to Appropriations.

With that, we will be hearing items in file order and our Committee Members will go last and we will begin with the first author that we have in file, item, which is item number eight, AB583 Pellerin. We will begin as a Subcommitee, not having established quorum yet.

Thank you, Assemblymember Pellerin. Begin when you want. Good afternoon, Chair and Members. First, I want to thank Madam Chair and your Committee staff for working with my office on clarifying amendments to the Bill, which I do accept. In many settings, nurse practitioners are the primary providers that care for a patient prior to and up to their death.

However, they lack the authority to sign a death certificate and instead must delegate that task to a physician who may have never cared for or seen the patient prior to their passing. This extra step means that it is possible for families to wait days or weeks before receiving a death certificate.

AB 583 will authorize nurse practitioners to sign death certificates. Currently, 40 states plus Washington, D.C. allow nurse practitioners to sign death certificates with no restrictions with Me to testify and support this Bill are Sarani Kwan, a nurse practitioner at West County Health Centers, and Christy Wiese, on behalf of the California Association of Nurse Practitioners.

Good afternoon, Madam Chair and Members. Christy Weiss with capital Advocacy, on behalf of the California Association for Nurse Practitioners. I'm just going to give my time to Sarani, our nurse practitioner, who's here today to share a bit of why. This is so important. And we hope you'll support the bill.

Good afternoon, everyone. Thank you so much for your time. 2023 was a particularly difficult year for my practice. I've been in practice for 23 years at a very rural clinic in Sonoma County, and I happen to have three wonderful patients pass away from a variety of reasons, mostly cancer.

And in 2023, when those patients all died, I was their primary caregiver for many years, each one of them, and I was not able to sign their death certificates.

And the reason that this became an issue was because I am often the only healthcare provider working in that clinic, in some cases, four weeks at a time, depending on the schedule of the two physicians that work in that clinic.

And I had multiple conversations with our local mortuary, and they were very frustrated with me because they just said, why can't you just get a physician to sign? And I kept explaining to them, there just isn't a physician who can sign these death certificates. I'm sorry. And it really came to a head for me this year.

I just lost a beloved patient that I'd been caring for for the past couple of years. She had a number of health issues and. And her family was on the other side of the country when she passed away. I, of course, was sent the death certificate to sign.

And I again explained to not only my whole staff, but also her funeral home that I was not able to sign her death certificate. Here I am educating them on the law of California, and they said, then you need to change the law. This is not okay. And the family has flown from the East Coast.

They want to do the services. They can't apply for any of her death benefits because they don't have a death certificate. And I said, well, I am sorry that there's nothing I can do, but there is hope in the future because we have this Bill that I hope you will support.

It will make a huge difference to the care of our patients in the communities that we serve all over California. I know I am only one nurse practitioner out of thousands in the state that have this problem every single week.

So I hope that the Committee will see the reasons for this to be supported and happy to answer any questions. Thank you.

Are there any other witnesses in support? Seeing none. Are there any primary witnesses in opposition? Any metoos in opposition?

Good afternoon, chair and Members. George Sores with the California Medical Association. No official position. I just really appreciate the sponsor and the author on working through some amendments that we look forward to agreeing to in the coming weeks. Thank you.

Thank you. I'll bring it back to the Committee for comment or question. Thank you, Member Carrillo, at the appropriate time. Shiavo, thank you. We don't have any comments on this Bill. Assembly Member Pellerin, thank you so much for bringing this Bill forward. It gives nurse practitioners the ability to sign death certificates.

40 other states allow this and I'm supportive of California doing the same. Giving nurse practitioners the ability to sign death certificates will bolster the ability of families to receive death certificates in a timely manner, as was stated by our witness that you offered.

Allowing them to make arrangements and handle other legal matters, which is so important during a family's time of grief.

With that, would you like to close? I appreciate that. So, Members, this Bill is personal to me. My family and I were unable to have a proper funeral for my father when he passed because of the delay in obtaining his death certificate. And as such, we were.

We had a celebration of life, but without his body, without his ashes. And sure, many of you have had personal experiences as well. Our witness as well. And so I respectfully ask for your I vote when you have your Committee together. Thank you, Assembly Member Pellerin.

We'll move on now to... Hi Tomasa. We will move on now to item number seven. AB492, Valencia. Please go ahead. Whenever you're ready, Assembly Member.

Thank you, Madam Chair, and muy buenas tardes Members, AB492 seeks to improve communication between the Department of Health Care Services and local governments. Specifically, it will require the Department to notify local jurisdictions when a new license is issued for an alcohol or drug abuse recovery treatment facility that will operate within their jurisdiction.

The written notification to the cities and counties will include key details, such as the name and mailing address of the licensee and the name of the facility. A recent state audit revealed that Orange County has more beds for for treatment facilities per 10,000 residents compared to other counties in California.

By providing timely information to local agencies, we can empower communities to stay informed and better support recovery and treatment initiatives. With me to provide testimony today is my good friend, Ms. Norma Campos Kurtz, Anaheim City Council Member.

Please go ahead. You'll have two minutes.

Chair Bonta, Committee Members. My name is Norma. Thank you, Kurtz. And I'm a Council Member in the City of Anaheim. Across our city, we continue to see a growing number of residential recovery housing emerge in our neighborhoods. These facilities, when properly implemented and operated, provide a wide range of benefits to some of our most vulnerable residents.

But when they're not, there is an immeasurable impact on our residents and on us as a city. If today, a recovery housing facility pops up in Anaheim, we as a city may not know about it, potentially, until something bad happens and a resident calls us. AB492 would change that.

This reform would provide us with necessary and timely information, notifying us when a new facility is approved in Anaheim. That would allow us to better integrate the facility into our neighborhoods and to communicate proactively with our residents. It arms us with the tools we need to continue building trust transparency in our community.

Currently, we are aware of 22 licensed facilities operating in Anaheim. However, we know there are many more that are not licensed. Among these are unregulated, unlicensed sober living homes, transitional housing, group homes, and others. I hear from my constituents often with stories detailing the impacts these facilities are having in our communities.

Frequent calls for police in the middle of the night. Drug and mental health related disturbances that their kids have to witness. Residents in those neighborhoods say the kids spend less time playing in the front yard. Elderly loved ones are retreating behind locked doors. People are anxiously monitoring the security cameras instead of chatting with neighbors.

Then of course there's the pressure these facilities put on our already strained housing market. When these well funded for profit and nonprofit operators outbid our working class families. The once single family homes, turn into revenue generating facilities and our hard working residents are left out of the housing market.

Then there is a domino effect on our local school enrollment numbers, our tax base and our city's overall stability and vibrancy. This Bill is a first step in changing that with with AB492 and early notification.

It will bring our city an opportunity to not only respond more effectively to community concerns, but more importantly, we can prevent some of them. This Bill will help us ensure the safety of both our residents and the patients in the facilities. And I know our city will be the better for it. Thank you.

Good afternoon Chair members. Caroline Grinder. On behalf of the League of California Cities, which is Proud to sponsor AB492. We know that alcohol and drug treatment facilities are a vital part of our behavioral health continuum. Happy to answer any questions on this proposed Legislation. Thank you.

Thank you. Are there any other witnesses in support? Any witnesses in opposition? Oh- In support.

Good afternoon, Madam Chair, Members of the Committee, Cher Gonzalez, on behalf of the City of Carlsbad, in support. Thank you.

Thank you. Any other primary witnesses in opposition? Any me too's in opposition? Seeing none. We'll bring it back to the Committee. Thank you so much, Mr. Valencia, for bringing this Bill forward.

It requires, very simply, the Department of Healthcare Services to notify local governments when they issue an initial license for a new alcohol or drug recovery or treatment facility. It's a very narrowly tailored bill around transparency for our community members and local partners.

I want to appreciate the author for bringing forward something that is just a make sense opportunity for us to be able to both have the care that we need within our communities, as well as ensure that our community members know what's going on in their neighborhoods. With that, we... We have a comment from...A question from assembly member Patel.

Hi, thank you for bringing this Bill forward. Appreciate it. One clarifying question. It's just to inform you there's no back and forth on whether it will get approved, not approved, anything like that.

Now, it's, as the chair stated, a very narrow bill. Simply allows and mandates the Department to notify the local municipality of this facility being provided a license. That's it.

Thank you. We're going to take roll call. Oh sorry. Assembly member Rodriguez

Thank you.

If I could please clarify? I understood from the witness that this. Is in an effort to potentially also stop some projects. Did I misunderstand that?

Assembly Member, my read of this Bill and working with Committee is that that was perhaps an overstatement of the confines of this Bill. It really is just a noticing Bill.

Okay. Thank you for the clarification.

Assembly Member, would you like to close?

Appreciate the consideration from this Committee. I want to also thank Cal Cities for collaborating on this Bill. And I respectfully ask for a yes vote.

Thank you. We need to establish quorum, so, Secretary, please call the roll.

Bonta, here. Chen. Addis. Aguiar-Curry, here. Arambula. Carillo. Flora. Gonzalez. Krell. Patel, here. Rodriguez. Sanchez. Schiavo. Sharp-Collins. Stefani.

We have a quorum. We also have a motion from Assembly member Carrillo. Do I have a second on this Bill? Assembly member Krell on the end is a second. And with that, Secretary, please call the roll.

The motion is due. Pass to appropriations. Bonta? aye. Bonta, aye. Chen? Addis. Aguiar-Curry? Aguiar-Curry, aye. Arambula? Arambula, aye. Carrillo? Carrillo, aye. Flora? Gonzalez? Gonzalez, aye. Krell? Krell, aye. Patel? Patel, aye. Rodriguez? Rodriguez, aye. Sanchez? Schiavo? Schiavo, aye. Sharp-Collins? Stefani?

That Bbill is out. Thank you very much, Assemblymember. We're going to move now to the consent calendar moved by Aguiar-Curry, seconded by Carrillo. This is items 3, AB 2242, item 9, AB 618, item 10, AB 627. Secretary, please call the roll.

[ROLL CALL]

The consent calendar is out. Seeing no non committee authors in the room. I'm going to ask if Assemblymember Aguiar-Curry, majority leader, can go. It's item number four. AB 280.

Good afternoon, Madam Chair and Members. AB280 will fix a basic but important issue making sure health plan provider directories are accurate and up to date. So right now, too many patients struggle to find in-network doctors because directories are full of errors. This leads to delayed confusion and unexpected out of network costs.

Existing law already requires health plans to keep their provider directories updated and accurate. This law has been on the books since 2015. Yet many plan directories still have significant error rates. For certain specialties, like mental health, these error rates are still as high as 80%.

When people are looking for a doctor or healthcare provider of some kind, they call through a list of providers they got from their health plans. They find that many of these providers aren't reachable, not taking new patients or aren't in network. So many of you have experienced this yourselves. I have.

In fact, almost every member of my staff has two this year. Now imagine you're a single mom with two jobs or someone with language barriers or disabilities who already face challenges accessing care. Are you ever going to actually access the health care you or your employer is paying for?

The state has done so little enforcement, only five small penalties in nearly a decade. There's virtually no incentive for health plans to fix this problem. AB280 addresses this decade long problem by requiring health plans to verify provider information on a yearly basis. It also requires plans to meet increasing accuracy benchmarks, reaching 95% by 2029.

This Bill sets meaningful penalties for non compliance so health plans take seriously the accuracy of the provider directories. AB 280 would authorize health plans to use a central third party database to help reduce administrative burdens on providers and improve the accuracy of these directories.

If a consumer relies on inaccurate directory, the health plan must arrange care and cover any out of network costs. Members, this is already existing law.

For 10 years, health plans have been required to ensure the provider directories are updated, but without real ways to hold health plans accountable, these directories remain inaccurate and consumers are still struggling to find care. AB280 will ensure provider directories are reliable so Californians can access the care they need without delays.

With me today to testify in support are Katie Van Deynze with Health Access California and Sarah Soroken, a licensed clinical social worker from Solano County who has experienced with dealing with the real life consequences of ghost networks on their patients. Welcome.

Hi. As a mental health therapist, I have seen firsthand how inaccurate provider directories harm patients. In my six years as a triage and crisis therapist at Kaiser, it was a rare day that I did not speak to at least one patient reporting they had called through a provider list without success.

All the while the patient's distress or mental health condition had worsened. These were patients experiencing anxiety disorders, depression and post traumatic stress, among many other mental health concerns. They were expected to call through provider Lists of 25, 50 or more in an attempt to get connected to treatment, even though their symptoms made doing so extremely challenging.

Frequently, patients who have the means end up paying out of pocket for psychotherapy due to these ghost networks and barriers of getting out of network coverage. Coverage or coverage approved and those without means go without care, leaving us with a two tier health care system in which inequities are exacerbated and reinforced.

Some patients experience severe negative outcomes as a result of these ghost networks. As an example, I have evaluated a patient in an emergency department who had attempted suicide after calling through a list of 50 providers without success, losing hope and spiraling deeper into depression.

This patient now has the traumas of a suicide attempt and having been harmed by our health care system to add to their treatment needs. We would be negligent if we didn't do everything in our power to ensure patients get the health care they need, pay for and are legally entitled to. Thank you.

Good afternoon, Madam Chair and Committee Members. I'm Katie Van Deynze with Health Access California. We are proud to sponsor AB280. A decade ago, Health Access co sponsored the law that the author was talking about to require health plans to update and maintain accurate provider directories so that provider. So that consumers can find the care that they need.

Consumers deserve accurate provider directories but as you just heard, despite health plan's responsibility to maintain these accurate directories, these directories are failing consumers with real impacts for their access to care and their health. California, on paper, has one of the strongest laws in the nation on provider directories.

Yet some directories are 80% inaccurate for psychiatrists, while most health plan directories are a quarter or a third inaccurate for all their contracted providers. These inaccuracies are the worst for behavioral health providers, where there are already significant barriers for consumers both seeking care and accessing care. And AB280 takes important and urgent steps to help address this problem.

First, it gives regulators the authority to require plans to use essential utility. And essential utility is a database where providers can go to update their information once for all of their contracted plans, and that accuracy is regularly checked for that information.

And second, AB 280 sets clear enforceable standards, starting with a 60% accuracy requirement and going up to 95% accuracy in the next five years.

Right now, when consumers go to trying to find a provider, they are met with a wrong phone number, a wrong address, the provider's not taking new patients, the provider is out of network despite being in the health plan provider directory. And on and on these inaccuracies go.

Despite being law for a decade, health plans have failed to uphold their responsibilities to maintain these directories. And both plans and providers have shifted blame, failed to find a workable process for consumers, and left consumers with a mess every time they tried to find a health care provider.

We asked with this Bill that create concrete, enforceable standards for accurate provider directories. We respectfully ask for your aye vote. Thank you.

Thank you. Any other witnesses in support, please come forward. State your name, affiliation and position only.

Carli Stelzer, California Behavioral Health Association, in support.

Sandra Poole, Western Center for Law and Poverty, in support.

Kim Lewis with Children Now in support.

Julie Nielsen on behalf of the National Union of Healthcare Workers, in support.

Good afternoon. Chair Bonta, Committee Members. Bryant Miramontes with the American Federation of State County Municipal Employees, in support.

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

Hi. Good afternoon. Liz Oseguera with the California Alliance of Child and Family Services also in support. Thank you.

Good afternoon. Omar Altamimi with the California Pan-Ethnic Health Network also in support.

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

Tara Gamboa-Eastman with the Steinberg Institute and support.

Hello. Good afternoon, Members. Kevin Guzman with the California Medical Association. We're here in a tweener position working on the Bill. Thanks to the author and sponsor for working with us.

Eric Doughty with the California Dental Association in the same situation as CMA. We're looking forward to working with the author and sponsors on the Bill.

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

Madam Chair Member Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies, first and foremost we'd like to thank the author and sponsor. We've had over the last couple years some really productive conversations and with the new staff that's dedicated toward this, we look forward to those conversations going forward.

Unfortunately, today we are we have taken an opposed position on AB 280. While we appreciate the intent of the Bill and share the author's concerns about maintaining accurate provider directories, provider directories act as an essential guide and health plans and insurers rely upon them to help our enrollees and insureds access timely and appropriate care.

We uniquely understand the frustration that can arise from inaccurate information being listed in the provider directories and have spent a substantial amount of time over the last several years engaged in working toward a solution.

That being said, we do believe that AB280 addresses does not address the root causes of the issue and instead simply places the full responsibility of the database accuracy on health plans and insurers without fully appreciating that this endeavor was always intended to be a shared responsibility between contracted providers and health plans and insurers.

In the simplest terms, our concerns are that the proposal does not appear to take into consideration that the accuracy of each individual provider directory is solely reliant upon practitioners and medical groups maintaining their own accurate records, providing that information to plans and insurers in a timely manner, and informing plans and insurers in real time of any relevant changes when they are made.

Without the consideration being included in the Bill, plans and insurers will continue to struggle to meet the expectations set forth by the Legislature. Currently, commercial health plans and insurers spend over $2.1 billion annually to maintain provider databases, clearly demonstrating the commitment health plans insurers have to support accurate provider directories.

We certainly appreciate that the Bill acknowledges the need for a central utility to collect the necessary information for accurate provider directories. However, without provider buy in and participation, we will ultimately be in the same situation where health plans and insurers are struggling to collect the necessary information to update the provider directories.

Our collective Members plans have dedicated substantial time and resources towards implementing 137. We look forward to these future conversations if this Bill moves forward today, and look forward to the time that we will all be able to collectively offer completely accurate and up to date provider directories with the partnership of our provider groups and plans. Thank you.

Thank you, Madam Chair Members Nick Louizos with the California Association of Health Plans in opposition as well, I Do want to thank the author's office and the sponsors. We had a good conversation last week about this Bill. Of course, everybody wants accurate provider directories, but unfortunately this Bill doesn't do the trick.

In summary, penalizing our plans for things that to a certain extent are outside of their control doesn't do much except increase the cost of healthcare and make it more administratively burdensome.

And in the end, the directories will not be much more accurate than they were before, you know, unless the providers are made to be a part of the solution as well. Now, I will just add that the Department of Managed Health Care is working on regulations that are set to be finalized this summer.

They deal with a whole host of issues, including directory updating, provider listings, product and network identification related issues, and directory searches. And we're currently providing comments as part of that regulatory package. You know, a couple of other things.

The author mentioned that the Bill requires plans to use a third party centralized administrator or vendor to do the provider directories. But you know, the Bill doesn't shield a plan that uses that third party centralized system from liability from the penalties. So, you know, we think that's a problem in the Bill.

And then, you know, I will just, you know, mention the behavioral health provider situation. I know that was touched upon in some of the testimony. That is a problem. It's a real struggle for health plans to get behavioral health providers into their networks. A lot of behavioral health providers prefer to do one off letters of agreement instead.

And, you know, some of our plans have told us that behavioral health providers have actually asked to be removed from the provider directories in some cases. And so, you know, that's definitely an issue that transcends this Bill.

But in any case, you know, if this Bill moves forward, you know, we do want to have further conversations, you know, with the supporters and the author's office, of course. But as it currently stands, we're in opposition. Thank you.

Thank you. Are there any others in opposition? Please come forward. Name, affiliation and position

Chair Members Kathy Mossburg with the Local Health Plans want to thank the author's office and the sponsors. We've had good conversations. We do have an opposed position, but look forward to further having further conversations.

Thank you. I will bring it back now to Committee Members for questions. Assembly Member Schiavo.

I want to thank the author for this Bill. You know, I know it's a huge, huge issue. And I've also heard, I mean, I feel like this is an issue where there's an incredible wide variety of experiences and just a lot of inconsistency Right.

Because I've also heard from a therapist in my district who talks about getting called multiple times a month by each of the insurance companies that he accepts to confirm his information or over and over and over.

And then sometimes the same insurance company who already confirmed it will have someone else call and confirm it again with him and he's like, I need to be talking to patients and not spending my time. So there needs like this.

It feels like there needs to be a much more streamlined process for providers to confirm their information and not have to confirm with every single insurer that they accept. Also.

And you know, and I think that, you know, this along with not increasing rates for mental health providers in many years, most insurance companies is probably why it's harder to get mental health companies or mental health providers in insurer, you know, accepting insurance, which we all know is a huge problem as well.

So I just, I just wanted to kind of see if you have any reflections on how we get to that point, bigger picture to address a more streamlined approach for providers to be able to more easily confirm their information and you know, and how and I feel like that would be an important step or piece of the solution that you're proposing here today.

Thank you for the question, Assemblymember Schiavo. And that is what we're trying to get to with the central utility that's in the Bill. This Bill gives the Department of Managed Healthcare and the Department of Insurance the authority to acquire health plans to participate in the central utility.

And with that database, providers are able to update their information once for all their contracted plans that are participating in that system.

And so I think like there is the, the technology to address that problem, to try to streamline it, because that is, that is an issue that we, we had heard over the years since the existing law back in 2015 was passed, was there's all this different outreach for health plans to try to ensure they're remaining the responsibilities under SB 137.

And I think with the requiring the health plans to participate in the utility and the providers updating that information, it'll be more streamlined. And that's the goal with that provision.

Seeing no other comments or questions, I'll just share. Majority Leader, that I want to thank you for introducing this very necessary Bill. Provider directories are such a critical tool that patients rely on in order to meaningfully access the care they are entitled to under their insurance policy and state law.

If they don't have the ability to know what provider they can see, then that's not really. Access health plans hold a duty under law to provide and maintain an adequate network of providers so that people who rely on their coverage to stay healthy can access necessary care in a timely manner.

It's been 10 years, 10 years since our state enacted a provider directory requirement, and we're still not seeing the kind of accuracy rates that we need in order to be able to ensure that we're providing the kind of information that our healthcare patients and consumers need.

And really, there is no excuse for why people across the state are spending countless hours navigating inaccurate provider information and and ultimately ending up delaying or foregoing critical care because their health plan is not holding up their end of the deal. I just want to make a couple of notes that I think is important for the Bill.

The first is that the Bill isn't even requiring that a health plan maintain 100% accurate provider directory. Instead, it's giving plans an additional four years to incrementally ensure their directory is 95% accurate. Asking for 95% compliance with state law 14 years after implementation is an incredibly generous ask.

I'm glad to be able to support this Bill today and thank the author and sponsors for their commitment to ensuring consumers have meaningful access to the care that they need. Majority Leader, would you like to close?

I would, and thank you very much for your comments. I really appreciate it. You know, there's nothing more frustrating than when you're in your office here in the building and you have six employees that are trying to get go to the Doctor and they feel like they've been ghosted. They can't get from one place to the next.

They can't get their health care taken care of. And so this Bill really kind of got me right between the eyes saying why is reweighted since 2015 and we're still struggling to get there. So let's just remind everybody that we have timelines for this. 60% accuracy by July 1, 2026. 80% accuracy by July 1, 2027.

90% accuracy by July 1, 2028. 95% accuracy by July 1, 2029. How much longer are we going to wait? Members, I respectfully ask for your aye vote.

Moved by Arambula. Seconded by Krell. Secretary, please call the roll.

[Roll Call]

That bill's out. I believe I saw Assemblymember Ortega. Your file item is next. AB636, item number 11.

Go ahead when you're ready. Thank you, Madam Chair and Members for the opportunity to present AB 636 today. AB 636 would provide medically necessary diapers through Medi Cal to children 21 years and younger as mandated by the federally Early Periodic Screening Diagnostic and Treatment Program.

The bill would also expand the antiquated medical necessity definition and Medi Cal provider manual, which states that only children five or years older can have access to prescription diapers if they suffer from incontinence.

According to the National Diaper Bank Network, California has one of the most restrictive state definitions of medically necessary and is only one of only three states that restrict the age of access to five years old and above. Children are considered potty trained at the age of three.

California's definition leaves children from three to five years old who still need diapers for various reasons unable to access the medically necessary necessary diapers they're entitled to under the federal program. The average cost of diapers in California is as high as $100 per month per child, which many low income families on Medi Cal simply cannot afford.

By passing AB636, California would join the many states that include New York, West Virginia and Idaho that define medically necessary diapers as beginning as beginning at age 3, aligning with the realities of child development. With me testifying in support is Gabby Davidson, policy advocate for the California Association of Food Banks.

Thank you, have two minutes.

Thank you. Chair Bonta and Members, Gabby Davidson with the California Association of Food Banks. So currently over a quarter of California households with children are food insecure, with deep disparities for black and Latina Households. And we know that households that are experiencing food insecurity are also facing barriers to meeting their other basic needs.

Diapers are one of the most common non food products requested by families who visit food banks, pantries and other community based organizations, which isn't surprising given how expensive they are. On average, diapers and wipes cost about $80 to $100 per month.

And if you have multiple children, like my mom did raising triplets on her own, you're spending much more. And in rural areas with fewer retail options, cost for diapers can be even higher. Every dollar a family has to spend matters.

The decision for families to choose between putting their money towards paying rent, food or buying diapers for their child is a decision that no parent or caregiver should have to make. Unfortunately, many families are forced to make this decision given the high cost of living in California.

This financial strain often has serious consequences for families as a whole. Diaper poverty can lead to diapers being kept on longer than suggested, which can lead to painful rashes for babies. It is also linked to maternal depression, stress and anxiety.

AB636 by Assemblymember Ortega is a practical, much needed step to expand access to diapers for low income Californians. CFP is proud to co sponsor and we urge your I vote. Thank you.

Thank you so much. Any other witnesses in support please come forward.

Thank you. Chair Members, Chris Scroggin with Capital Advocacy on behalf of the San Diego Food Bank in support.

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

Kathy Mossberg with Grace and Child Poverty in support and a co-sponsor.

Tony Anderson the Association of Regional Center Agencies in support.

Good afternoon Chair Members. Jonathan Munoz on behalf of First Five California. In support of the bill.

Moved by Aguiar Curry, seconded by Addis. Are there any witnesses in opposition? Seeing none. I'll bring it back to the Committee for any comments or questions.

Majority Leader, thank you very much for. Bringing the Bill forward and particularly the testimony from food banks. I am so worried about my food banks right now and this is just another thing that we have to fix and to make sure our children are taken care of.

And so I appreciate that you've come forward with this Bill and to all the food banks out there, go get them.

Thank you.

Assemblymember Ortega, this has been an area of incredible leadership and advocacy for you since you joined the Legislature focusing on diaper need for those of our constituents who, you know, have to potentially suffer the sacrifice, shame and stress and the impacts on their daily lives to not be able to have a simple thing to be able to take care of their babies.

I want to thank you for your leadership and authorship of this and I know that it will address the the coverage of diapers when there is a medical need which doesn't address all the diaper needs in our communities.

But it will also hopefully be a step forward for the most vulnerable families who struggle to afford enough diapers to keep their kids healthy. With that I will ask the Secretary to call a roll. zero Assembly Member, would you like to close?

Respectfully ask for your I vote. I cannot see you Madam Chair, but thank you.

[Roll call]

That bill's out. Thank you. Assemblymember. We'll move on now to item number 14 AB 1041. Bennett.

Thank you. Assembly Member Bennett, whenever you're ready.

Nice to see you have a face and move that Chair Madam Chair and Members AB 1041 will streamline the provider credentialing process for doctors by establishing requirements that promote accountability and transparency and ease credentialing burdens on independent physicians without jeopardizing patient safety. Why is this important? You might ask?

This will improve access to health care by cutting through administrative red tape and expediting physicians ability to be added to health plan networks and begin seeing patients enrolled in those plans. AB1041 would take important steps to improve the credentialing process.

Specifically, this bill would require health care service plans and health insurers to adopt a single uniform credentialing form which would eliminate the redundant paperwork that exists in the current credentialing process. 2. It would establish firm deadlines for the credentialing process requiring that a health insurer has 90 days to review a credentialing application.

If the healthcare service plan or insurer does not meet the 90 day deadline, the applicant's credential shall be conditionally approved unless specific conditions apply and provide clarity and accessibility to the credentialing process by requiring insurers to provide the applicant with contact information for the individual assigned to review the applicant's application.

In Ventura County, like many places in California, there are shortages of physicians and delays in the credentialing process further exasperate this problem. This Bill is a modest step in an effort to expand access to care. With me today are Flo, Flo DiBenito and Dr. Join Lu in support.

I ask for your aye vote and look forward to hearing from my witnesses.

Thank you. Elite of 2 minutes.

Distinguished chair and Members of the Health Committee, Good afternoon. My name is Dr. Joanne Liu. I'm a practicing radiation oncologist in Eureka, California. In Humboldt County and like many rural areas, we face a persistent shortage of physicians. My own small four person practice is deeply embedded in the community.

When a patient calls our office, they don't get routed to a call center. They get my front desk to answer the phone and I can talk to my patients directly. That's one of the reasons I've been there for almost 18 years.

But in a health professional shortage area, the last thing we need is slow and inefficient credentialing leading to delays on onboarding physicians. These delays can last four to even six months.

I've experienced firsthand how a flawed credentialing process has resulted in a panel of patients being canceled that were scheduled to see a new physician or a physician that couldn't attend a scheduled conference because the physician who was supposed to cover for them didn't get credentialed in time. This isn't just an inconvenience of paperwork.

It's a barrier to healthcare access and adds to the burnout among physicians. The credentialing process should be as streamlined and efficient as possible. AB1041 creates a standardized credentialing process requiring plans to make timely decisions. The status quo is not working. That's why I ask Those who oppose AB1041 is the current credentialing status quo acceptable?

You know how bad it is, so why didn't you bring up with a solution? So I urge your support for AB1041. Let's remove the barriers and let more doctors take care of patients without delay.

Thank you. Good afternoon. My name is Flo DiBenedetto. I'm the CEO of DiBenedetto Solutions, which is a healthcare consulting firm. I'm also a healthcare attorney and I've practiced in California for over 40 years, both in private practice and most recently as the General counsel of Sutter Health.

Credentialing is one of my specialties, and I've represented both physicians seeking to be credentialed and the organizations doing the credentialing. Before a physician can treat a patient enrolled in a health plan or insured by an insurance company, he or she must be credentialed, which is a process designed to assess their qualifications.

Health plans and insurance companies have their own credentialing forms. There's no standard form that these payers are required to use, so over and over again, physicians are filling out different forms but providing the exact information to multiple organizations.

Having a standardized form required to be used by health plans and insurance companies would go a long way to reducing the burden on physicians and some of the delays in the credentialing process.

Larger medical groups have the resources to take on this paperwork either because they're large or because they are affiliated with the health system which completes the paperwork for them. Independent physicians don't have that. Putting timelines on health plans and insurance companies to expeditiously complete the credentialing process is an imperative.

These organizations can hold a physician's credentialing form for weeks or even months before it even tells the physician that the form is incomplete and won't be processed.

Health plans and insurance companies have the resources and the staff to devote to processing these credentialing applications in a Far more timely manner manner in this, in the system as it operates today. When physicians are delayed in credentialing, it's the patients who suffer because they can't access their physician for care.

AB 1041 will establish some long needed transparency and accountability by standardizing the forms and creating a reasonable 90 day review period. The law will not reduce standards, it will reduce waste by streamlining this process and I respectfully urge your I vote to make credentialing more efficient to better serve patients. Thank you.

Thank you. Any other witnesses in support, any primary witnesses in opposition, please come forward. Thank you. You'll have two minutes.

Thank you. Madam Chair. Members, Nick Louiseos with the California Association of Health Plans. First let me start off by, you know, thanking the sponsors of this bill. They did reach out to us and we had a good conversation about, you know, what they're intending to do with this measure.

And so we'd like to thank the author as well for that. You know, we certainly appreciate the intent of the bill. You know, as our Members believe that a streamlined credentialing process will be beneficial to both plans and providers, we commend the author for his desire to decrease administrative burdens in the system in a common application.

You know, certainly a good idea. Many plans already use them, particularly the one that's NCQA accredited, because if providers did use a common application, submitted their supporting documents on time through electronic means in particular, and attested periodically that their data was accurate, that that would be a good thing.

And plans could certainly process those applications better than the timelines associated with this Bill as currently drafted, though we don't think the Bill entirely hits the mark.

The main reason for delay in credentialing providers, and this is very similar to the provider directory that we just Bill that we just heard, is the back and forth necessary to get updated and accurate information. Because many providers unfortunately are not responsive and do not maintain current information in their applications.

And this Bill doesn't do very much to fix that particular problem. Conditionally approving applications with the wrong information we think is ill advised. And we also have issues with the limitation on our plans to make follow up inquiries to the providers.

So you know, if this Bill passes the Committee, you know, we are open to having further conversations with the author, but, but in its current form, we don't believe the Bill entirely achieves its goal. So thank you. We're opposed.

Any other witnesses in opposition, please come forward. State your name, affiliation and position only.

Stephanie Watkins. On behalf of the Association of California Life and Health Insurance Companies, we'd like to align our comments with our colleague at CAP and look forward to working on the bill if it moves forward today. Thank you.

Kevin Guzman with the California Medical Association. Just wanted to say we appreciate the author's willingness to take on this issue. We were fortunately opposed. Unless amended, the bill is largely model of a CMA sponsored Bill from last year that the author held in order to work with stakeholders to find a solution.

We believe that this bill should undergo similar stakeholder process with the groups that have been working on this the last few years. Thank you very much.

Assembly Member, do you accept the amendments that were offered by Committee? Yes, I do. Okay, thank you. Any other comments or questions from the Committee?

Assembly Member Patel, thank you for bringing this bill forward. I have just a question. It's a clarifying question. Is there any guidance, I didn't see any guidance in this language about whose version of the form or which content would be considered a priority in getting. Into this new form.

Are you leaving that up to the departments in question to come up with that by the deadline?

Yes. Although I might point out here, I think it's appropriate to answer. There are a number of things that no Bill is ever perfect when you first bring it forward in front of Committee.

I think there are a number of things that we look forward to working with everybody on and new information to me that there is a second application process out there that that is being being recommended. So certainly from the author's point of view, willing to have conversations about all of those things.

Wonderful. Thank you.

Thank you. I just want to thank Assemblymember Bennett for bringing forward this bill today. I think we were actually looking at a similar Bill early on in this in the session. I'm glad that you were able to move forward with this with our Committee amendments and just want to echo what you said.

The provider credentialing process is important, but it's a process that has become increasingly burdensome, timely and confusing for providers to navigate. Just today I had a group in my office that said that it took them eight months to get credentialed. When we so desperately need different kinds of health care workers, all kinds, that's really not acceptable.

I've been hearing about these issues from a far range of wide range of providers. Physicians, nurses, midwives, doulas, Community Healthcare workers. We have a lot of work to do.

I just want to also note that the former chair of this Committee worked with the California Medical Association on a substantially similar Bill proposal and I'm glad to see that it's been reintroduced and we can move it forward again today. And I also note that CMA did not introduce a letter in opposition to this at this time.

So I'm hopeful that you can continue to make progress on this and I'm happy to support it as it moves out, should it move out of this Committee. With that, Secretary, please call the roll. Would you like to close?

I appreciate the comments of the chair. I know that you have intimately been involved in this effort and many other efforts to try to improve health care. And so I respectfully ask for an aye vote.

Thank you. Assemblymember, I need a motion and a second Arambula and Stephanie. With that, please call the roll.

[Roll call]

That measures out. Thank you, Assembly Member. We'll move on now to item number 12. AB787 Papan.

Please go ahead. Whenever you're ready, Assembly Member. Thank you, Madam Chair and Members. I'm happy to accept the Committee's amendment. So let me start there. I'd like you all just to take a second and think for a moment if you were sick and not feeling well.

But then it's going to be compounded by having to spend hours on the phone trying to find a carrier. Excuse me, trying to find a provider that's in your network. Maybe they're no longer practicing. Maybe they're no longer affiliated with your. With your carrier. Or maybe they just aren't taking new patients right now.

And I can tell you from firsthand experience, it happened to me. But of course, I had enough savvy to ask my carrier to find me somebody that was covered. But that was after I probably spent about four hours on the phone trying to find a provider.

And I think for too many patients, this reality isn't just a hassle, it's really a crisis. Studies show that approximately half of provider directory listings are inaccurate. And some plans have error rates that are as high as 98% at that point. Why even have a directory?

Patients pay for their health insurance, and part of what they're paying for is access to an accurate, reliable provider directory. Instead, these broken systems create confusion, delays and unnecessary frustration, all when people need care the most.

The problem hits hardest for our vulnerable communities, people with disabilities, low income families and communities of color who already face significant barriers in accessing care for these groups. Inaccurate provider directories don't just cause inconvenience. They compound existing challenges by leading to surprise or coerced billing.

Patients may unknowingly receive out of network care based on faulty directory information and face massive and unexpected bills. Or they may feel forced to pay for costly out of network treatments because, try as they might, they just can't find an in network provider accepting patients. A directory error shouldn't mean financial devastation for someone who did everything right.

That's why we need AB787. It's going to help shepherd you through this process. It requires health plans to clearly inform patients that they can contact their health plan for help finding an in network provider.

It also holds health plans accountable, requiring them to respond to patient requests for help within one business day and provide a list of available providers who are actually accepting patients within two business days. The result? Faster access to care, fewer unnecessary EBAR visits, and a system that actually works for patients.

Bottom line, no one should have to call dozens of providers just to get the care they're already paying for. AB787 ensures patients get the right care quickly, accurately and fairly through the assistance of their carrier. It really lets us make healthcare work for the people who need it most.

With me today to testify in support of the Bill is Katie Van Dyens. She is senior policy and legislative advocate for Health Access California and Sarah Sorokin, who is associate Member of the National Union of Healthcare Workers.

As a licensed marriage and family therapist, I've frequently seen patients struggle to find available mental health Clinicians on their health plans. Provider directories, patients struggling with symptoms of panic, social anxiety, depression, post traumatic stress, psychosis and more are expected to call through these inaccurate lists even though their symptoms and distress make it incredibly difficult to do so.

When I was employed in the UC system, we would call through health plan provider lists for students in order to sift through inaccurate lists and increase students chances of getting linked to mental health care. While employed at Kaiser, I took calls every day from patients unable to find available therapists on the lists given to them.

Patients with means would resort to paying out of pocket for care. And patients without means who are disproportionately people of color, would either experience significant delays in getting connected to needed care or go without care altogether.

Delayed or denied care risks, worsening mental health symptoms, the development of comorbidities, the need for more intensive and expensive care, interference with functioning and family roles and at work, and increased disability and need for public assistance. Delayed and Denied care can also lead to suicide attempts.

And I have assessed a young patient in the emergency Department who attempted suicide after calling through an extensive list of in network mental health therapists without success. Healthcare saves lives and health plans can and should do more to connect their patients to care. Thank you.

Good afternoon, Madam Chair and Members. I'm Katie Van Dyens with Health Access California and we're proud to support AB787. We support this Bill because it'll help ensure that consumers can access care through their provider directories. And they know that when they call their health plan, they'll get access and to a list of providers in a timely manner.

As you heard, Health Access California, we co sponsor the law to require provider directories. But unfortunately that law hasn't insured accurate provider directories leading to these barriers in access to care.

In one case, a consumer seeked help, called 73 doctors and found that some had retired, others were not accepting insurance, some had a disconnected phone number and even some had passed away. It should not be on the consumer to call through all these providers to navigate the productory on their own. And that's why AB787 is so important.

With this Bill, we can ensure that when the consumer calls their health insurer, they can get some assistance and they have that support to be sure that they can find a health care provider in a timely manner. This will ensure that providers. Sorry, excuse me.

Consumers can find access to care in a timely manner and reduce barriers to care. And we respectfully ask for your. I vote. Thank you.

Thank you. Are there any others in support of the bill? Please come forward. State name, affiliation and position.

Tara Gimbo Eastman with the Steinberg Institute in support.

Carly Stelzer with the California Behavioral Health Association. In support.

Sandra Poole with Western center on Law and Poverty. In support.

Julie Nielsen with the National Union of Healthcare Workers in support.

Kevin Wispan on behalf of the California Medical Association in support. And apologies for not having the letter in on time.

Lizo Seguero, the California Alliance of Child and Family Services also in support.

Are there any primary witnesses in opposition? Seeing none, we will have any me toos in opposition. The Bill has been motioned by Arambula, seconded by Addis Assembly Member. Would you like to close? I disrespectfully question. I vote. Thank you. Thank you. With that secretary, please call the roll.

[Roll call]

That bills out. Thank you. Thank you Madam Chair. We'll move on to file items 1 and 2, starting with AB4 or Assembly and Member Arambula. Your dealer's choice, AB4 or AB29.

We'll start at the top of the file order, if that works for you.

Top of file order file item 1. AB4, Arambula.

Thank you Madam Chair and Members for the opportunity to present Assembly Bill 4 which directs Covered California to expand access to affordable health care coverage to all income eligible Californians regardless of their immigration status.

The historic exclusion of undocumented individuals from the health care system threatens the well being of individuals and families within every one of our communities. Hard working, tax paying undocumented individuals are still restricted from purchasing their own coverage on the Covered California marketplace.

By removing immigration status as an eligibility barrier to Covered California, we can continue to build a more universal, equitable health care system for all who live in California. It is time that we recognize that health care access as a human right and remove exclusions to vital health care access.

With me testifying in support is Ana Alvarez with Health Access California who will be reading testimony of an impact impacted individual. We will hear from Beatrice Hernandez, an impacted individual in their native language of Spanish which Anna will be translating and available for any questions will be Chloe Steck, Hermosia with the California Immigrant Policy Center.

Good afternoon Chair Bonta and Members. My name is Beatrice Hernandez and I'm a resident of Sacramento here in strong support of AB4. As someone who is ineligible to purchase health insurance through Cover California due to my immigration status. When I was five, I lost my seven year old sister to cancer.

Her passing broke our family and we immigrated to the US when I was 12 years old. Growing up I only had access to emergency medical and when I got to college I paid out of pocket for the UC sponsored health insurance which was wonderful but made it difficult to make other ends meet.

Thanks to the Medi Cal expansion, I was able to stop paying out of pocket. However, now as a working professional and a sole proprietor, I earn above the Medi Cal Threshold and I'm still locked out of COVID California because of my immigration status.

As a working professional, I want to stay healthy and continue to shape the social and economic landscape of our state. Without access to coverage, even small health issues can become big setbacks. That's true for thousands of others working across California. Health care is a human right and as someone who has paid thousands in state and federal taxes.

I should have access to our state's health care system. To our health care system. When one of us lacks care, it impacts all of us. We appreciate the Legislature and the governor's work to expand Medi Cal. But even with those gains, over 500,000 Californians still lack access to comprehensive coverage.

Thus, thousands of people who could avoid ER visits, stay healthy and keep working, all while saving the state money in the long run. More than 100,000 Californians are already buying coverage at full price and could benefit from the options to access Covered California. But I'm not just a number. I'm a Californian. I pay taxes.

I contribute to my community, and I need access to care just like anyone else. Please support AB4. Thank you.

Thank you.

Hello, my name is Ana Alvarez and I'm one of the organizers of the Health for All Coalition. We advocate for quality, affordable health care for all, regardless of their immigration status. I'm here today to share the testimony of one of our community Members who would benefit from access to Covered California.

She's a resident of the City of Southgate and has lived in the US for 18 years and is the parent of two daughters. These are her words translated into English. Today I want to share the harsh reality that thousands of immigrants face by not being able to access affordable medical care.

And I I prefer to do so anonymously due to all of the attacks that are occurring against the immigrant community, something that I consider inhumane. Health should not depend on immigration status because we are all human beings and we all deserve to live with dignity.

Living in the United States as an undocumented person is difficult enough, but when it comes to health, the situation becomes even more worrisome. As immigrants, we come to this country in search of a better future, working hard to support our families. For many of us, getting sick not only means pain and worry, but also fear.

Fear of an unaffordable medical Bill. Fear of losing our job because we cannot get care in time. Fear that a minor health problem will become a crisis because we have no options. No one should have to choose between their health and economic stability.

I've heard too many stories from families, including my own, who have had to choose between paying rent or a Doctor's appointment. No one should have to live with that fear. Having access to health insurance allows us to receive timely care, prevent illness, and care for our loved ones without the worry of unpayable debt.

This lack of access affects us deeply. Parents who avoid going to the Doctor because the cost is too high. Children who grew up without regular checkups. Adults who ignore their symptoms until it's too late. Health shouldn't be a privilege reserved only for a few.

We all contribute to this country with our work effort and dedication, and we deserve the opportunity to take care of ourselves and our families. It's time to expand options so more immigrants can access affordable insurance. Because health care is a right, not a privilege.

If this change were to become a reality, it would mean peace of mind, security and hope. It would mean no parent would have to choose between paying for a Doctor's appointment or feeding their children. It would mean we could prevent illnesses before they become emergencies. Thank you. Would meet. Thank you.

Thank you. Are there any other witnesses in support Moved by Addis, seconded by Carrillo.

Sandra. Poole on behalf of Western Center on Law and Poverty. Also a Member of the Care Health for All Coalition.

Eric Doughty with the California Dental Association. In support.

Christine Smith, Health Access California, proud to be a co sponsor with the California Immigrant Policy center. Also doing a MeToo for SDIU California chair and Committee Members Bryant.

Mayor Montes with the American Federation of State County Municipal Employees in strong support.

Hi, good afternoon. Carol Gonzalez on behalf of East Binas. Organized for political equality and support. Thank you.

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

Monica Madrid with Coalition for Humane Immigrant Rights, also known as CHIRLA, in support.

Christopher Sanchez on behalf of Carrez and the Central American Resource Center. And strong support.

Omar Altamimi, California Pan Ethnic Health Network in support.

Eric Paredes on behalf of the California Faculty Association in support.

Kelly Brooks on behalf of the County Welfare Directors Association here in support.

Thuy Do with the Southeast Asia Resource Action Center in support.

Thank you.

Julie Nielsen, National Union of Healthcare Workers in support.

Tim Madden representing the California chapter of The American College of Emergency Physicians in support.

Kevin Guzmano with the California Medical Association in support. And apologies again for the letter.

Good afternoon. Dennis Cuevas Romero with the California Primary Care Association Advocates in strong support. Thank you.

Are there any primary witnesses in opposition? Seeing none. Are there any me toos in opposition? Seeing none. I'll bring it back to the Committee for questions or comment. Assemblymember Carrillo, thank you.

I just want to thank the author for being a champion in this space. Many of you know my story. Came here at the age of 15.

In search of the American dream and somehow I made it here and I fully understand the comments on how people leave scared and afraid of what's what could potentially happen here to support the. Bill and thank you. For keeping a champion for this space.

Thank you, Assemblymember, for bringing this Bill forward and for your ongoing commitment to ensure that all Californians, regardless of their immigration status, have access to quality, affordable health care.

I know that there is still some work to be done on this Bill, and I appreciate the work that you've done so far with this Committee to ensure that we're investing appropriate resources to create actual, affordable coverage options and that we're safeguarding the sensitive information of our immigrant communities.

But I'm confident that you, as an author and with your sponsors, will continue to fine tune this Bill to ensure we're building this program right. With that, would you like to close?

Thank you, Madam Chair, for the opportunity to present and I respectfully ask for an aye vote.

Thank you. There's been a motion in a second Secretary, please call the roll.

[Roll call]

That measure's out. Thank you. And we will now move on to your second, the second file item, AB 29 by Arambula.

Thank you, Madam Chair. I want to start by thanking the Committee for their diligent work on this bill. All Californians should have access to trauma informed screenings by health care providers that they trust. Because community health workers and doulas are the trusted providers for many, AB 29 authorizes them to receive Medi-Cal reimbursements for conducting ACEs screenings.

ACEs, or Adverse Childhood Experiences, are traumatic childhood experiences like abuse, neglect, or exposure to violence, mental illness, divorce, substance abuse, or criminal activity at home. Individuals with multiple ACEs are at risk for toxic stress physiology and often face significantly increased risk for leading causes of death such as heart disease, stroke, cancer, diabetes, and more.

While not eligible for Medi-Cal reimbursement, community health workers and doulas are uniquely positioned to conduct ACEs screenings because they are seen as a highly trusted provider who emphasizes the two generation approach. This is crucial because ACEs can follow a pattern of intergenerational trauma where children of parents with ACEs can be at greater risks themselves. This bill will ensure more equitable access to trauma informed screenings. Testifying in support of AB 29 is Hollye Jenkins, community health advocate from the Black Wellness and Prosperity Center.

Thank you, Madam Chair. Thank you, Committee Members. Good afternoon. My name is Hollye Jenkins. I am a community health worker and certified black lactation educator. I work with Fresno based CPO called Black Wellness and Prosperity Center.

Thank you for the opportunity to be here today and for considering your support of AB 29, a bill that has the potential to facilitate timely interventions and mitigate the long term negative health outcomes associated with Adverse Childhood Experiences, ACEs. Adverse Childhood Experiences can have a long term negative impacts on health, opportunity, and well being.

We know that certain groups experience ACEs are at proportionately higher rates. The clients at BWPC and other CPOs in the Central Valley and across the state focus on serving black and BIPOC individuals with a focus on pregnant persons and among those affected by trauma.

I know this not because of the research but also through my daily work as a community health advocate with Black Wellness and Prosperity Center. And I also know that my clients entrust me and their live with their lived experiences including childhood traumas as I provide care and help them to improve their health outcomes.

Doulas and community health workers working with CPOs often come from very come from the very communities we serve. This gives us a unique insight into the realities of our clients' experiences. Culturally centered, trauma informed trauma informed care is the core of our work.

We spend significant time building relationships, understanding our clients' backgrounds, and providing person centered holistic care. Community health community based organizations, doulas, and CHWs are trusted sources of information on health topics ranging from pregnancy complications to mental health outcomes. Our deep connections with the community makes us uniquely positioned to support the individuals in need.

Allowing CPOs, doulas, and CHWs to receive training, recognition, and reimbursement for conducting screening screenings will help break cycles of trauma, connect clients to critical care, and improve health outcomes for children, pregnant persons, and families in our community. Thank you so much for your time and your consideration, and I hope you will consider consider supporting AB 29. Thank you.

Thank you. Are there any others in support?

Tara Gamboa-Eastman with the Steinberg Institute in support.

Carli Stelzer with the California Behavioral Health Association in support.

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

Omar Altamimi, California Pan-Ethnic Health Network, in support.

Kelly Brooks on behalf of the County Health Executives Association of California in support.

Nicette Short on behalf of the Alliance of Catholic Health Care, Adventist Health, Loma Linda University Health, and Saint Agnes Medical Center in support.

Thuy Do with the Southeast Asia Resource Action Center in support.

Good Afternoon, Chair and Members. Jonathan Munoz on behalf of First 5 California in support.

Thank you. Are there any primary witnesses in opposition? Or me toos in opposition? Seeing none. We have a motion by Sanchez, seconded by Addis. I'll bring it back to the Committee for questions or comment. Seeing none. I want to thank you, Assembly Member, for working with our with our team in the Health Committee to make sure that you were able to take author amendments prior to the hearing to ensure that these community based providers who are making such important connections and appropriate referrals are doing so based on a screening that we've developed in a model that has been quite effective.

And we know that it's very difficult to make sure that we are not re traumatizing patients to have to continue to discuss their trauma with that. So it's incredibly helpful to be able to pull in our very capable doulas and healthcare workers help to be able to do that. So with that, I am making an aye recommendation, and I will ask the Secretary, after your close, to call the roll.

Thank you for the opportunity to present. I respectfully ask for an aye vote.

The motion is do pass to Appropriations. [Roll Call]

That bill's out. Thank you. We'll move on now to item number five, AB 416, Krell.

Whenever you're ready, Assembly Member. Please press the button.

Thank you. Good afternoon, Members, and thank you, Madam Chair. AB416 removes an unnecessary bottleneck in California's behavioral health system. Patients in crisis shouldn't have to wait days for care when trained Emergency physicians are available 24/7 to help. This Bill is a common sense solution that will improve patient care and reduce ER overcrowding.

Right now, when somebody comes to an ER and is in crisis, emergency room physicians do not have the authority to authorize 5150 holds. Instead, sometimes patients are forced to wait hours and even days to get these patients the care they need.

Not only can this be catastrophic for the patient, but this also results in more delays in ERs that are already overburdened and overcrowded. In fact, in some ERs, they're over 50% over capacity. And this is creating an unnecessary bottleneck.

Emergency room physicians are really well positioned to make these important decisions to determine whether a patient can take care of themselves or others or is severely disabled to the point that they are unable to function without a medical intervention. So this is a really important Bill.

It will help streamline medical care to vulnerable people who need it most, and it will help relieve some of the pressures that these emergency rooms are currently facing. With me today in support are Dr. Graham from the American College of Emergency Physicians, and then also Randall Hagar with the Psychiatric Physicians alliance of California.

And I'm not sure who wants to go first.

Thank you. I'll each have two minutes.

Thank you, Madam Chair. Tim Madden, representing the California chapter of the American College of Emergency Physicians, were co sponsors of the Bill. And I'm going to defer my time to Dr. Graham and let her tell you a little bit more. Thank you.

Good afternoon, chair and Committee Members. My name is Dr. Camara Graham, and I am a practicing emergency physician here in Sacramento. I also sit on the board of directors for the California chapter of the American College of Emergency Physicians.

As noted in the analysis, one in six patients who present to the emergency Department have a behavioral health diagnosis. I therefore have the honor of caring for these patients on every single shift. Many of these patients will present to our emergency Department voluntarily.

Some of these patients I am able to safely treat and stabilize and send home after some medication adjustments or interventions. Some of these patients require additional resources, and I can work with our social workers to get those outpatient behavioral health resources to them. Some of these patients also require transfer to an inpatient psychiatric facility.

And when they present on a voluntary basis, I can immediately start working on getting them to the care that they need.

There is a smaller number of patients who present to the emergency department, however, who are in acute crisis. Who are a danger to themselves and to others, and need a 5150 hold so that we can ensure that they are safe while we work on arranging additional transfer to an LPS designated facility.

The problem is we cannot start working on getting them to that facility until a 5150 has been placed. And depending on where you practice in our state, this could take several hours or many days. I can help keep these patients safe in our emergency Department by holding them under Section 1799 of the Welfare and Institutions Code.

But in order to transfer, an LPS facility requires either an attestation that they are presenting voluntarily or a 5150 hold. These patients, therefore, are stuck sitting in our emergency Department until someone shows up to write that 5150. I became an emergency physician because I want to help patients who are in crisis.

And one of the most frustrating pieces of my job is when I can't get care to the patients that need it in a timely fashion. As we discussed this as a board, it became very apparent that there are a lot of discrepancies in what resources are available to our patients and to providers in our regions.

There's also a significant difference in the amount of time that patients spend waiting to be able to get to the care that they need. This really shouldn't be the case. Emergency physicians are in our emergency departments 24/7, 365.

Our ask is that you help enable us and empower us to take care of our patients and vote yes on AB416. Thank you.

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

Yes. Mr. Chairman, Members of the Committee, Randall Hager, for the California alliance of Psychiatric Physicians. Want to thank the author for bringing this Bill forward. This is an area I've worked in a lot. I think it's worth noting that it has an outside significance because we are at a turning point.

After decades of reductions in the numbers of psychiatric beds, we're beginning to see some of those come back through the granting program, through BCHIP and other programs. We also have a workforce crisis here, and we need people to be able to deliver the care, to connect the care. And I think this Bill does that.

We are talking about individuals, just to switch gears here real quickly, who are very ill, often very disabled, often psychotic. And those individuals need the very best that we can give them. They show up in our emergency rooms and they need our help.

And we need to give them what they need so that they can stabilize and step on the road to recovery. So for those reasons, the Psychiatric Physicians alliance is very, very pleased to co sponsor this Bill and we commend it to your support. Thank you.

Thank you. Any others in support, please come forward with affiliation, name, and position.

Tara Gamboa-Eastman with the Steinberg Institute in support.

Good afternoon. Angela Hill with the California Medical Association. We just submitted our letter and are in strong support.

Good afternoon. Delilah Clay on behalf of the California Hospital Association in support.

Nicette Short on behalf of the alliance of Catholic Healthcare, Advantus Health, Loma Linda University Health, and St. Agnes Medical center in support.

Thank you. Are there any primary witnesses in opposition? Thank you. You'll have two minutes.

Thank you. Chair Members Samuel Jan with Disability Rights California. We are here in opposition to AB416. We appreciate all the engagement from the author, staff, and the sponsor on this Bill. Everyone who works in mental health knows how big of an issue people in mental health crisis getting stuck in emergency departments is.

We really agree with the author about how serious of a problem this is. AB416 is the wrong solution. It proposes to provide all emergency physicians the ability to write involuntary holds without any oversight from the county. AB416's solution would be to send all of the people stuck in EDS to locked psychiatric facilities.

That's going to result in a lot more unnecessary hospitalization and significant expense for the state and counties. It's over $4,000 a day to hold people in some of these facilities. The SF Chronicle recently reported on the big increase in for profit psychiatric facilities in the state.

They reported on the bare bones staffing levels that's resulted in incredible profit margins for primarily out of state corporations. The human cost is that people are dying, they're being re-traumatized, and many are not actually getting the help that they need. AB416 would allow all emergency departments to transfer patients directly to these facilities.

They would be able to do that without any oversight from the county in determining whether these individuals actually need involuntary hospitalization and without a thorough assessment of whether their needs could be met at a lower level of care.

AB416 will increase unnecessary hospitalizations, put more people at risk of harm in deadly for profit locked facilities, and result in tremendous expense for the state. We oppose AB416 for these reasons. Thank you.

Thank you. Any others in opposition, please come forward. State your name, affiliation, and position.

Marona Goneifer with Cal Voices in opposition.

Good afternoon Madam Chair, Malik Bynum with the County Behavioral Health Directors Association in respectful opposition. But we look forward to further discussions with the author. Thank you.

Thank you. Seeing no other opposition, we'll bring it back to the Committee for questions. Assembly member Addis.

I want to thank the author for bringing this forward. It's a huge issue for our emergency rooms and I absolutely agree that we need to solve this and also share some of the concerns that have been brought up, particularly around lack of county oversight, private for profit psychiatric facilities, which is not necessarily the focus of this Bill;

But I do share the concern around folks being sort of shuffled into those facilities, while also seeing that there is a place for 5150s. We absolutely need that and our emergency departments are not the places to be able to serve those folks.

So just wondering your thoughts on how you'll work with opposition if you're working with opposition, how you'll work with opposition moving forward to sort of fine tune this to get it right, really.

Thank you. Assembly member Addis. I agree that the concerns here are really valid. We need to be protecting the very vulnerable folks who end up in ER in this situation in the first place. The status quo right now though is that it's up to law enforcement to place people on 5150 holds.

This would allow emergency room physicians, the authority not just to place people on 5150 holds, but also in practice, to be able to remove these holds. I think this is an improvement over the current status quo because doctors are really well positioned to make these difficult medical decisions.

You know, I don't see any evidence that this would result in more 5150 holds. I think this would result in people who need this level of care to receive that care more quickly and in a more streamlined way.

Assembly member Schiavo.

So I also appreciate this Bill. I know this is a challenge. You know, I worked with nurses for 13 years and heard about hospital after hospital after hospital closing psych wards and or psych units. And so I know that, that people being stuck on 5150s in the emergency Department is a huge, huge issue.

And I met with some physicians recently who are raising this concern. And their concern was more around that when they receive folks, so there's a couple issues, right? There's not enough places for people to go; treatment facilities, mental health facilities, that are available. This specific provider was in Humboldt County, so definitely in more rural areas, that's even more of an issue.

And then the other issue that he raised was around that when taking people off of 5150s has also been a challenge. When they establish that people have maybe de-escalated, or whatever the issue is, and they should be able to be released, there's no one because it's only county, not just law enforcement, but county officials.

Right? But if they're not working on the weekends and it's the weekend, then they have to stay in the emergency department in a hallway with lights on 24/7 and people walking around, which is not conducive to someone who was probably just 5150ed.

So, I guess, you know, my question is how does this Bill address that issue? Or if you're expanding who's authorized to put someone on a 5150, are those people also able to remove them from a 5150, if that is also the what's needed at that time?

Yes. Assembly member Schiavo, my Bill doesn't have that precise language, but my understanding is how this works in practice, is that the authority, which also comes with a level of training as well, would grant the power not only to place someone on a 5150, but also to remove it.

And again, I just point out that the emergency room physicians are used to giving 24 hour care, so they're really well positioned to be immediately responsive to the needs of these patients.

Can the opposition also just expand a little bit more around your concerns about transferring people into institutional settings that maybe it's not appropriate? Can you explain how you kind of see this happening or see this working on the ground?

Absolutely. Thank you, Assembly member. So under current law, counties do have the ability to designate emergency physicians to write these holds. Some counties do that, some counties don't. In the counties that don't, it's psychiatric evaluation teams that come in and provide that assessment.

And those teams have a lot of ability to facilitate warm hand offs to lower levels of care. There's no requirement that the emergency departments have, conduct these assessments and actually do a thorough assessment of whether those individuals can be met at a lower level of care.

So this Bill would no doubt increase the number of people that are transferred to locked psychiatric facilities.

And when counties designate physicians to be able to put people in psychiatric holds, are they also, if you're designated to be able to put people on holds, can you also take them off?

Yes. Yes, I believe that's correct.

Okay. And do you know, is LA County a county that does not allow for this?

I'm not sure about specifically LA County.

Okay. Okay. I do have some concerns about this Bill. I hope that you can have some more conversations with the opposition and address some of the concerns that they're raising today. And I'll, you know, support it at this time to allow that conversation to move forward.

Appreciate that Assembly member Schiavo. Just to answer your question, Santa Clara, Ventura and San Diego counties are the three that currently authorize emergency physicians. And also as the Committee Analysis, which is really thorough and I appreciate, points out, the County Behavioral Health Department would still have supervision. Even if this authority is granted, the county would maintain supervision.

Dr. Arambula.

Thank you, Madam Chair. And thank you Assembly member, for bringing up this much needed legislation. Having practiced for 10 years in an Emergency Department, I know the unique role that we play in helping to determine the acuity that our patients are facing.

That position and that lived experience allows me to speak about how important it would be for us to have this authority that's being discussed before us. It would allow us to ensure that we were getting the appropriate treatment at the appropriate time for the patients who needed it.

It would also allow us to remove that requirement to see anyone who didn't need to be on a 5150, if you were granted this authority. When the time is right, Madam Chair, I'd like to make a motion for this Bill as this is a much needed piece of legislation. And thank you for bringing it forward.

Time is right now. Assembly member, is there a second? Thank you. So seconded by Stefani; And Dr. Patel has a question.

Yes. Thank you for bringing this Bill forward. I have heard, I'm from San Diego County, and heard from many providers as well as firefighters that this is a pressing issue and definitely needs to be addressed. My couple of questions, one is actually a clarification...

Can you please clarify what the process is for the training or the certification and confirm that this is exactly what law enforcement currently goes through and has the authority to do?

Actually, I'll defer to the expert witnesses on what the training consists of.

My understanding is that the training varies from county to county. There are some very broad parameters in the law that provide counties some overall guidance, but the specific content and how they go about doing the process of training and educating and certifying people is almost as various as our 58 counties.

My scientific mind loves consistency and I struggle with that. But I'll save that conversation for another day. My other question is, when counties do authorize physicians, do they authorize them currently with a team as the county would with a behavioral specialist team or is it as an individual physician?

Assembly member, they're currently for the emergency physicians, at least, they're approved as they work in the emergency Department. So a little bit different than what was described as a part of the psychiatric evaluation team. But the process is the same in our Bill points to that process. For those counties who are not allowing emergency physicians to be designated.

They have to go through the application process through the county. They also have to go through the same training program than any other designated individual will have to go through. So there is consistency from that standpoint. And that's also why we believe, as pointed out in the analysis, the county does have some oversight in this process.

So it's not necessarily a rubber stamp type of a process, different than what the police officers, what authority they're allowed, under existing law.

Thank you for that further information. I do have some concerns, but I'm also willing to vote for this to get it out of Committee, as I am learning that things continue to get worked on as they move out of Committee.

I hope that your Assembly Member Krell able to work with opposition and maybe try to sure up some of the concerns, but definitely see the need, and thank you for trying to take this on. It's critical.

Well, thank you, Assembly member. I think what I appreciated about this piece of legislation is that it does include the reality that our ER doctors would need to complete training in order to be able to be qualified to issue the 5150.

And I do think that some of the concerns raised by the opposition are somewhat out of the scope of the immediate problem you are trying to solve, which are the wait times and response times within our ED departments that will continue to get more crowded as we have difference of opinions in our law enforcement sector about how to address the issue of people who are experiencing mental distress.

With that being said, I do think that some of the issues raised by the opposition essentially kind of fall outside of the scope of this legislation.

They have to do a lot more with the capacity issues and the fact that we haven't really built out the infrastructure to be able to deal with some of these pinch points, if you will, that will prevent people from having to not receive the care that they need in a timely and appropriate manner ,and in the least restrictive setting possible.

So I know that if not with this Bill, others you will continue to work on that issue. With that, I am supportive of this Bill and I think we have a motion in a second on this. Would you like to close?

I respectfully ask for your aye vote.

Thank you, Secretary. Please call the roll.

The motion is due pass to Judiciary Committee. Bonta? Bonta, Aye. Chen? Chen, aye. Addis? Addis, aye. Aguiar-Curry. Arambula? Arambula, aye. Carrillo? Carrillo, aye. Flora? Flora, aye. Gonzalez? Gonzalez, aye. Krell? Krell, aye. Patel? Patel, aye. Rodriguez? Rodriguez, aye. Sanchez? Sanchez, aye. Schiavo? Schiavo, aye. Sharp-Collins.Stefani? Stefani, aye.

That bill's out. Thank you, Assemblymember. We'll move on to item number six. AB460. Chen.

Thank you, Madam Chair, for allowing me to present AB460. A special thank you for your Committee and your Committee staff for their diligent work on the Bill. We will be setting all the Committee amendments.

Current law requires on site supervision for radiologic technologists who are administering contrast materials, which has created significant delays and barriers in access to care. This Bill redefines a supervision requirement to include an immediately available physician who is available via audio and video, with a supervising physician also having real time live access to the patient's medical records.

Additionally, we've added a stipulation that the facility shall have personnel on site who are capable of responding to any adverse effects during contrast and we are committed to ensuring that this is clear in the language.

The change will ensure patients receives timely and high quality diagnostic care and aligns with federal CMS standards, will help the backlog of patients that has caused delays in patient care. Today we have witness testimony from Ryan Spencer representing the California Radiological Society could help speak to the need for the Bill.

Thank you. Please go ahead.

Good afternoon, Madam Chair and Members. Ryan Spencer, on behalf of the California Radiological Society, sponsors the AB460. AB460 simply modernizes California supervision laws by allowing radiologists to provide real time remote supervision via audio and video when technologists administer contrast for imaging. That's it. Same procedure, same safeguards, just modern tools. Here's a core issue.

Current law requires radiologists to be physically on site. But in many rural and community hospitals, having an on site radiologist at all times simply isn't possible. This results in patients experiencing delays in cares, sometimes in urgent or emergency cases, not because of lack of equipment or trained technologists, but because of an outdated supervision rule.

AB 460 fixes that. It aligns California law with federal CMS policy, which since 2020, has allowed virtual direct supervision through real time communication. This policy has proven safe and effective and is currently in place through 2025. More than a dozen other states, including Texas, Florida, New Jersey and Alabama, have already adopted similar approaches.

These states recognize that radiologists can be readily available remotely while properly trained technologists carry out their duties under strict protocols. And Importantly, as the CIM Member mentioned, AB460 maintains and strengthens patient safety.

This Bill was recently amended to require that qualified personnel be physically present on site during the contrast administration to monitor patients and respond immediately to any adverse reactions. This ensures that even if the radiologist is remote, there's always somebody on site ready to act.

In short, AB460 improves access without compromising safety, reduces unnecessary delays, relieves strain on the radiology workforce, and brings California in line from on a practice. With that California Logical Society respectfully asks for your aye vote. Thank you.

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

George Soares with the California Medical Association and support. Thank you.

Any primary witnesses in opposition or #MeToos in opposition? Seeing none. I'll bring it back to the Committee for question or comment. Assemblymember Schiavo, moved by Flora, seconded by Sanchez.

Can you please explain? Just explain to me just so I have a better understanding of how this works remotely. Can, can the person who is remote, can they see what's happening or are they on the phone? Like, how did. How does that work? How can they monitor or engage with what's happening on the ground remotely?

Thank you for your question. Assemblymember Schiavo. There's a multiple way for telemedicine to utilize. It can be done where they can be seen via telephone or where they can have. Where they have a network in which they can be seen via video as well.

We have seen the utilization of telemedicine from areas as far as Catalina Island to reach patients in Palmdale, Lancaster, an area that you're familiar with. With that, I'll give some of the additional details to my key witness.

Typically, the reason why a radiologist needs to be on site is to answer any questions. There's really no other reason why they need to be there. And so right now, the Bill was recently amended to require there also be audio and video. So it would be a video component.

And so effectively what this does is it removes the responsibility for the radiologist to have to be next door. And every time the RT has a question like, you know, is contrast needed? What type of contrast, what type of precautions are needed? They don't have to say, hey, can you.

Can, you know, can you come in here and talk to me? Or basically even pick up the phone and call the radiologist who might be in the next room. They can just access them through video teleconference. Through telehealth and be able to answer that questions.

If there is an adverse reaction, which I know is the concern of Members of the Committee, including the chair, there will be somebody on site physically to be able to respond to the adverse reaction.

And so if the remote radiologist can give feedback to tweak the process as it goes along during the procedure?

The Bill requires they have to be readily available at all times to be able to respond to any questions that the RT has.

Are there any limitations on where this radiologist could be? Could they be in India or China or Europe or anywhere?

They would still be a licensed physician in the State of California. But in terms of the. Yeah, that's required. That's we're talking about here. We aren't talking about somebody based out of you practice medicine in California. You're going to need to be licensed in California. But no, there aren't. That's that is the law.

But there's no, there's no nothing in the Bill that says that the person has to be a certain radius from the clinic.

Okay, but licensed in California.

That's correct.

Okay. Okay. Thank you.

Assemblymember Patel.

Appreciate you bringing this forward and making sure that our patients get the care they need when they need it. Being the mother of three athletes, we have need a radiologist several times. So I can see the need for this.

My question is, when it's done via telehealth, is there a requirement or any sort of assurance that these will be secure lines, secure communication channels as it is health data? I do have concerns just around, you know, data security and privacy and also, you know, people interrupting the calls or listening in, so to speak.

Thank you so much for your question. It's my understanding the lines are very secure. It's not a line in which it can be interrupted in a way that it can be listened upon. Also I have my key witness expand upon that.

The answer is yes. I mean, the Bill doesn't specifically specify that, but anytime that you're using a telehealth network, it has to be. That's been. Since we started using telehealth. That has been a standard bearer.

So just to clarify. So this isn't just going to be somebody's cell phone that they're using FaceTime with?

Correct.

Thank you.

As long as it's secure.

Seeing no other comments from the Committee, I think we have a motion and a second. Assemblymember Chen, you can close.

Thank you so much for your questions. I really appreciate that. I respectfully ask for your aye vote.

Thank you. Motion and second. Secretary, please call the roll.

Motion is due Pass to Appropriations. [Roll Call]

That bill's out, Assemblymember.

Madam Chair, we saved the best for last. At your pleasure.

Good, because this one's riveting. Thank you, Members, for your consideration of AB789. The Affordable Care Act expands access to quality, affordable insurance and health care for millions of Californians. It also includes provisions to control consumer costs, for requiring transparency and oversight of premium rate increases.

Most of the ACA's provisions have been codified in the California statute, which ensures that the protections and processes it provides will remain in place even if the federal law were to be repealed or altered. However, the definition of unreasonable rate increase in state law is still tied back to the federal law. This Bill is very simple.

It removes the tieback of the definition of unreasonable rate increase to federal law, securing the ability of state regulators to review and protect consumers from unreasonable and unjustified rate increases. With me in support, I have Katie Van Dyne, Van Dynesee, Van Dines with Health access.

Thank you, Mr. Vice Chair and Committee Members. Katie Van Dynes with Health Access California. We're here in proud support of the Bill and appreciate the chair for championing this issue and ensuring that this definition is protected in state law. I'm just here if there is any or any questions on the Bill. Thank you.

Additional Members and support.

Chair and Members. Nick Louise, on behalf of California Association of Health Plans, we don't have support. Or oppose on the Bill. We did issue a concerns letter to the authority about some ambiguity in the approach. We've already had conversations with Committee staff about how to possibly tighten up the. Language moving forward so that the Bill.

Doesn't lead to any unintended consequences. So we look forward to those conversations. Thank you.

Julie Nielsen, National Union of Healthcare Workers, in support.

Good afternoon. Matt Akin with the Association of California Life and Health Insurance Companies would just like to align our comments with CAP and look forward to continue conversations on the bill. Thank you.

Do we have any key witnesses in opposition? Any Members in the audience that would like to say me to and for opposition with that? I'll bring that to the Chairwoman. I apologize. Any questions from the Committee Members with that?

Madam Chair, I respectfully request your aye vote.

[Roll call]

Madam Chair, that Bill is out. Thank you very much.

Thank you, Mr. Vice Chair. We will now go back to the file items so that people can add on. If you are on the committee and you have are not here, note that we will not be holding open the roll for more than two minutes after we conclude these set of votes. We'll start with the consent calendar.

Secretary, please call the roll.

[ROLL CALL]

The consent calendar is out. We'll move to item one, AB 4, Arambula. Lifting the call for add ons.

[ROLL CALL]

That's still out. Item number two, AB 29 for add ons.

[ROLL CALL]

That measure is still out. Item number three, AB 242 Burner oh is on consent. Item number four, AB 280 Aguiar-Curry.

[ROLL CALL] AB 280.

Item number four.

That measure is still out. Item number five, AB 14- 416 Krell.

[ROLL CALL]

That measure is still out. Item number six, AB 460 Chen.

Sharp-Collins.

Item number six, AB 460.

Sharp-Collins, aye.

That measure is still out. Item number seven, AB 492 Valencia.

492 do pass to appropriations. [ROLL CALL]

That measures out. Item number eight, AB 583 Pellerin. Oh, this was actually the first bill that we heard. So we had a motion of with Carrillo seconded by Schiavo. Secretary will call the roll.

[ROLL CALL] 583.

This is AB 583. Item number eight.

[ROLL CALL]

That bill's out. Items number 9 and 10 were on consent. Item number 11, AB 636 Ortega.

[ROLL CALL]

That measure still out. Item number 12, AB 787 Papan.

[ROLL CALL]

That measure still out. Item number 13 we just voted on. Sharp-Collins.

[ROLL CALL]

Item number 14, AB 1041 Bennett.

[ROLL CALL]

That bill's out.

AB 416, do pass to judiciary. [ROLL CALL]

AB 583.

[ROLL CALL]

And AB- that bill is still out.

AB 680. 636.

[ROLL CALL]

You are. You are whole. Thank you. We are adjourned.