Senate Standing Committee on Health

The Senate Committee on Health will come to order. Good afternoon, everyone. Please note of the items 1 through 615 we have pulled file item 12, SB812, which will be heard in next week's hearing. We have our first author. Perfect timing, Senator. We don't have a quorum, so we're going to start as a Subcommitee. Senator Umberg, when you're ready, you can begin. Senator Umberg, the floor is yours.

Thank you, Madam Chair and Members. A particular thanks to you, Madam Chair, for working with us on this bill. You got overtime on this bill, so thank you very much. And thank you to Reyes Diaz and Melanie Moreno for their hard work on the bill. SB 35 establishes timelines for the Department of Healthcare Services to investigate allegations of licensed treatment at unlicensed sober living homes. Sober living homes typically are not licensed here in California.

And one of the things I've learned in umpteen years of working on issues concerning corruption here in the United States and all around the world is that if you don't have transparency, if you don't have accountability, and you don't have any sort of sanction for unlawful or immoral behavior, then you're going to see a proliferation of such.

One of the challenges with sober living homes, they're not licensed, and DHCS has responsibility for making sure that they're complying with the law. In other words, that they're not providing unauthorized treatment, unauthorized services. However, DHCS basically doesn't have the resources to do an adequate job of being able to respond to complaints, being able to respond to allegations of inappropriate behavior. They can't conduct site visits. They have a very difficult time, as much as they would like to do so. So that creates a void.

It creates a void in which, for example, those who operate sober living homes or those who operate treatment facilities that may have a relationship with sober living homes can engage in illegal activity. So, for example, having folks come who have 30 days of treatment, 30 days of care, get basically pushed to the street, once that is accomplished, improper treatment being conducted at some of the homes.

Now, what this bill does is this bill allows a county, a county to provide site visits, a county operating within the auspices of DCHS to be able to examine, or DHCS, be able to examine whatever operations are going on at the sober living home. Testifying here today in support we have a few witnesses. We have the Mayor of Santa Ana, Mayor Valerie Amezcua, and several Southern California residents here to discuss their experience living and working in sober living facilities.

I have two primary testimonies.

Yes. We'll start with the mayor.

Perfect. You have a total of five minutes altogether.

Thank you very much. Thank you, Senator Umberg. Good afternoon, Chair and Committee Members. My name is Valerie Amezcua, and I am the Mayor of the City of Santa Ana. Residential recovery housing provides a range of benefits to some of California's most vulnerable residents, and it is critical that their needs are prioritized over profits.

To do this, we must ensure strict compliance with state licensing laws administered by the Department of Health Care Services, which are essential to safeguarding the well beings of individuals seeking recovery. Under current law, any drug and alcohol treatment facility that provides recovery treatment or detoxification services must obtain a valid license from the Department before operating.

The Department is also responsible for receiving and investigating complaints about unlicensed facilities in violation of license or law. However, a recent state audit revealed that the Department has not consistently investigated or followed up on allegations of unlicensed facilities illegally providing or advertising treatment services.

This failure has allowed unlicensed operators to continue to provide illegal services in residential neighborhoods without state oversight or accountability for long periods of time. SB 35 would implement the Auditor's recommendation by requiring the Department to meet specific timelines for investigating allegations of unlicensed treatment services.

If the Department fails to meet these deadlines, cities, excuse me, counties, can conduct site visits and enforce license laws. This will help hold the Department accountable and enable swift action to address violations, ensure compliance, and protect public health and safety.

SB 35 also requires the Department to conduct follow up site visits to ensure unlawful activity has stopped and investigate other facilities run by the same operator to ensure those facilities are also in compliance. By strengthening state oversight, this bill helps to ensure that recovery housing meets appropriate standards of care, improving treatment outcomes and supporting healthier communities.

We urge you to support this important measure. And coming from the City of Santa Ana, my city has been impacted greatly by some of these programs, many of these programs, whether it's suicidal suicides in our community, illegal activity, overcrowding, homelessness has increased, noise, the neighbors have complained.

There's so many things that I can share with you in the interest of time that has happened in the City of Santa Ana with the many treatment programs that we have in our city that are unlicensed and that we don't have the ability to ask the county to go in and ensure that they're providing proper treatment and services. So with that, I do ask for your support for this very important measure that will not just have an impact on Santa Ana, but that will have an impact all over. So thank you very much.

Thank you.

Next witness.

Sequoyah Thiessen. I currently reside in Los Angeles, California, and I am now a student and I do historical justice work and research. However, I started using drugs when I was about 15 as an attempt to cope with child abuse I was facing. I entered rehab at 22 years old.

The word treatment now rings very oxymoronic to me. Having come from an already traumatic background that led me into addiction, I can confidently say that patient brokering was the worst thing I ever went through. I don't like the word client. It implies that we're complicit in this.

When people are suffering from addiction and are sent to drug rehabilitation, we are at our most vulnerable. I was held hostage. I was not allowed to leave, as well as my belongings. During my time in treatment, I witnessed immeasurable... Thank you. Exploitation of myself and others.

I constantly felt like a pawn, and I was forced to watch treatment owners rack up immense wealth while simultaneously destroying people's lives and sometimes ending them. I endured violence, sexual harassment, emotional manipulation, cult like environments, and grotesque living conditions. My sobriety was commodified over and over again.

I was put into stressful situations deliberately to push me to my limits. I remember telling a treatment owner that I was in an abusive relationship, thinking that they would help me if I told them the truth. Instead, it was quickly swept under the rug and covered up.

These facilities supported and funded my sickness, codependency, and regression for their own gain. I called the police on a treatment owner at a detox and told them I was being brokered, paid to be there. Not only did LAPD not know what that was, but they overlooked me and they believed the treatment owners over me.

This shows how we're treated in society. Overlooked, not taken seriously, and even blamed for the things that happened to us. Most of my, most all of my future as a human being was completely disregarded, reduced repeatedly by forced relapses and constant displacement. My trauma was exploited in my most vulnerable moments.

And against all odds, today I'm an engaged and active member of my community and I've maintained sobriety only because I have completely disassociated with all things treatment. People suffering from addiction search and yearn for purpose. Please help us find it by protecting us at our most vulnerable. I believe California has a responsibility to recognize this crisis because you're one of the most top SUD providers in the United States. I believe it's the bare minimum. Thank you.

Thank you so much. Now is the time for me... That's five minutes. Now is the time for any me toos. Any me toos in support, please step forward. Name, organization, and your stance.

Good afternoon. Dani Coze on behalf of the City of Thousand Oaks and the City of Carlsbad in support. Thank you.

Lizzie Cootsona here on behalf of the California State Association of Psychiatrists in support. Thank you.

Max Perry on behalf of the City of Camarillo in support.

Rocky Rhodes, Councilman from Simi Valley and on behalf of Simi Valley, support.

Phil Bacerra, City Council Member of Santa Ana, support.

Elaine Litster, Council Member, Simi Valley, support.

Sorry, I'm seated here. But Caroline Grinder on behalf of the League of California Cities, which is proud to sponsor SB 35, in support.

Thank you. See no others in support. Any formal opposition like to testify? I see no formal opposition. Any me toos in opposed? Name, organization. I'm sorry, it's not on. There we go.

It's on? Okay. Good afternoon. My name is Trent Murphy, here on behalf of the California Association of Alcohol and Drug Program Executives. We're the only statewide association that solely represents SUD providers. We admire and share the author's goal of ensuring that investigations are timely into unlicensed facilities, and we also think patient brokering is reprehensible.

But authorizing local governments to enforce complex state licensing laws is not the right path forward. These determinations require specialized knowledge and could lead to discriminatory actions against recovery residences protected under fair housing law. We look forward to working with the author's office on the best ways to support DHCS's implementation of the State Auditors report. Thank you.

Thank you so much. See no other me toos. Before I bring it back to the dies, Senator, are you taking the Committee amendments?

Yes, we are. And we're continuing to work on some of the details as well.

Okay, bringing it back to Committee. I can kick off conversation. Vice Chair.

I just wanted to thank the witnesses for their testimony. It's very powerful and important for you to be here and your voice to be heard. And thank you.

You know, I sympathize with the situation. We saw this very similar bill last year. We had a very colorful conversation on this last year. Other authors, I remember Senator Newman had a bill similar to this. Senator Allen last year had a bill similar to this. And this Committee a couple weeks ago heard another bill similar to ensuring that Department, DHCS was adhering it to a timeline that was, that wasn't lasting forever. We want answers. We want to make sure that you get answers. Is it within their preview, jurisdiction? Can we do something about it?

And some of the amendments that we're taking was to align the timeline to the timelines that we imposed in in another bill to stay consistent with that message. But one of the things that I was worried about, and I voiced a lot of this concern last year as a Member, was the ability of non-behavioral health individuals going into homes that are not licensed, that these are just homes that people live in because they're not licensed.

These are just homes and they have protections, additional protections that other licensed homes have. What I didn't want was city attorneys, law enforcement, individuals that have no training in this to go in homes and harass individuals. And we were trying to draw a balance there where we were looking to address and respond to the issues that you've brought up, but also to not harass individuals. I was worried that we were going to have this NIMBY approach where we didn't want these facilities anywhere.

And if we're not going to be supportive of these facilities, then we're going to have these individuals unhoused on the streets. And then the League of Cities are going to come back to us and say, well, they're on the streets. We have to have a balanced approach to that. So the amendments is looking to do that.

We want to be able to provide support to the Department if they don't meet the timeline, to then say to a local behavioral agency, okay, we didn't meet the timeline. There is substantial information here that is showing a violation. Now someone from the local behavioral agency can support the Department to go in and visit.

These are individuals that are trained in this area. This is their background, and those are the guardrails that were needed for us to feel comfortable moving this bill forward. I recognize this is a big issue for you, Senator, in your district. So this is why, yes, we did some overtime back and forth on this, but I think we found a place where we felt comfortable in drawing that balance. And that is why I am now recommending an aye vote on this bill. We do not have a quorum yet. Seeing anything else. Would you like to close?

I learned a long time ago as a lawyer, if you have a tentative in your favor, you don't try to basically do too much. So I urge an aye vote.

Okay. When appropriate, Senator, I will entertain the motion and then we'll do a vote. Thank you so much for coming.

We will be moving to file item number 15, SB 596 by Senator Menjivar. Senator, when you are ready. Just kidding.

I see an author. Senator. Sorry. The pillar there. You are recognized. When you're ready, please present file item three, SB 81.

Well, thank you, Madam Chair and Members of the Health Committee. I appreciate this opportunity to present Senate Bill 81, and I'm honored to introduce this bill. Senate Bill 81 ensures that health care spaces remain safe spaces. It requires health care providers to create non-public areas in their facilities and bars immigration enforcement from entering unless they have a valid judicial warrant or court order. This bill builds on the foundation of the California Values Act, a landmark victory for immigrant rights, codifying guidance from our Attorney General into law.

And SB 81 strengthens patient privacy protections by recognizing immigration status, whether past or present, the place of birth are confidential medical records. These are not just data points. This is deeply personal, should never be weaponized against communities. This legislation is urgent and necessary.

Health care is a human right and no one should have to choose between seeking health care and fearing deportation in California. Not anywhere in our state, not anywhere in our country. Let's be clear. Our immigrant communities are essential. They are foundational. They care for our children, grow our food, build our homes, and drive our progress.

We're bringing this bill forward not just because it's smart policy, because it's the right thing to do. This is about standing up for the people who hold this state together and making sure that when they walk into a hospital or reproductive health clinic or an FQHC in California, they are met with care and compassion and not fear and intimidation.

This bill is proudly sponsored by a broad coalition, including industry, labor, immigrant rights groups, and healthcare providers throughout the State of California, including SEIU, the California Immigrant Policy Center, the Latino Coalition for Healthy California, and the California Nurses Association. I thank everyone who has supported this bill.

With me today to testify is Vanessa Gonzalez from the California Hospital Association. And want to just lift up and thank their engagement from the very beginning in crafting this bill and ensuring that the voice of hospitals and health providers is helping shape the policies that we're bringing forward, which are really codifying the model policies the Attorney General had adopted into the law of California at a time when we know it's essential.

When Trump has rescinded the previous policy that said that sensitive places such as hospital, schools, and churches are now fair game for immigration enforcement. This is making sure that we ensure that these are safe spaces that people can get care without fear of harassment and arrest just because of their immigration status. And Veronica Palacios, an SEIU 1021 member. And I'll turn it back over to you, Madam Chair.

Vanessa, you may begin. You have five minutes total.

Thank you. Good afternoon, Chair and Committee Members. Vanessa Gonzalez with the California Hospital Association, representing over 400 hospitals and health systems in the state, here in support of SB 81. The core mission of every hospital is to provide care for all, regardless of a patient's ethnicity, national origin, or immigration status.

SB 81 strengthens protections for patients and their families against unlawful immigration enforcement actions in healthcare settings and helps maintain critical trust between a patient and their provider because no one should ever be afraid to seek care because they fear deportation. SB 81 reassures communities that hospitals and health facilities remain safe and welcoming spaces for all. We thank Senator Arreguín for his leadership on this important bill and urge your aye vote on SB 81. Thank you.

Hi. Good afternoon, Chair and Committee. My name is Veronica Palacios, proud SEIU 1021 member and Chapter President for Alameda Health Systems in Alameda County, 4,000 members strong. I'm also an eligibility specialist, and I've been an eligibility specialist for 24 years.

I am here in support of SB 81 because we need to keep the fear of ICE out of all California healthcare settings, from the ER to community clinics. As an eligibility specialist, my job is to enroll patients who come to the emergency room with no health coverage. As part of the screening process, I ask confidential questions.

When asking these questions, it is essential that my patients have confidence that no matter what information they share, their data is protected and not used against them. This helps them make decisions based on their health, not fear. This takes trust. I can assure them because of the Legislature taking place and passing SB 54, the California Values Act in 2018, which protects patients and their information. We have the responsibility to assure our community that these protections extend to all care settings.

I work with patients who are at their most vulnerable state, seeking services from heart attacks to gunshot wounds to chronic diseases such as cancer, high blood pressure, and diabetes. I connect my patients with the primary care they need so that they can get health and stay out of the emergency room. There is a fear and understood fear that our patients are facing. Healthcare workers need to feel confident when assuring our patients that ICE will not be waiting for them at their own or their child's clinic visits.

Colleagues in community clinics throughout the state are reporting to me a steep drop in patient visits because community members feel too vulnerable sitting in the waiting room. This stops them from receiving the care they need. Some are reporting that ICE is setting up operations down the street from their clinics. Imagine coming to a clinic to see an oncologist for a new diagnosis and you see ICE down the street. Patients will skip the visits and delay getting the care that they need. This fear is not only for our undocumented patients.

It's also a concern for our legal documented patients because, unfortunately, as we have seen in the news, legal residents are being detained by ICE. I'm urging you to support SB 81 because it is the right thing to do. It's not just about protecting patients regardless of their immigration status. It's about keeping our community healthy and strong enough to protect us all in times of crisis. Thank you.

Thank you for your testimony. Any me toos in support of this bill? Love to hear from you.

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

Good afternoon, Madam Chair and Members. As mentioned, we're very proud co-sponsor of the SB 81 in support.

Good afternoon. George Soares with the California Medical Association in support.

Angela Pontes on behalf of Planned Parenthood Affiliates of California in support.

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

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

Good afternoon. Alejandro Solis on behalf of California Primary Care Association and Los Amigos de la Comunidad in support. Thank you.

Good afternoon. Bryant Miramontes with the American Federation of State County Municipal Employees in support.

Rita Medina on behalf of the Latino Coalition for Healthy California, co-sponsor in support.

Anallely Martin with the California Immigrant Policy Center, proud co-sponsor in support.

Monica Madrid with the Coalition for Humane Immigrant Rights, CHIRLA, in support.

Thank you so much. Do we have any formal opposition? Any me toos opposed? Bringing it back. Colleagues, comments, questions? Senator Durazo.

Thank you very much. I just want to thank the author. This is one of the many things that we all have to do as a single community to watch out for each other. There are some very ugly things starting to happen and get away from us. And the more that we could remind our community that we are all together watching out for each other, no matter where you are, no matter what you do. It's also a way of protecting our democracy in this country because people should not feel afraid to go to school, to go to work, to go to the doctor. We need to protect that as well. So I'm really glad to see the bill, and I move the bill when it's appropriate.

Senator, thank you so much for this. I'm reminded of 2019 during the public charge conversation, and we saw a lot of individuals, our communities just stop seeking health care services. And now we're seeing that as well. I talked to providers in my district, FQHCs, they're saying our lobbies are empty. People are not coming and getting checked up.

This bill is very important to ensure everyone knows, here in California, you should be getting treated. And we're gonna put back into our motto and our message that we're gonna protect these sensitive spaces. And I thank you for bringing that to this Committee and to our body. And when we have a quorum, I will entertain that motion. You may close.

Well, we welcome co-authors, and this is an urgency bill. And I think it's absolutely critical that as this moves forward, and he thinks it's going to go to Judiciary next, that we try to move this expeditiously through the process because we can't wait. As you said, you know, enforcement actions are happening outside of health facilities right now. People are afraid to get medical care. And the fundamental principle of this bill is that health care is a human right, and people should not be afraid to seek critical emergency or medical care because of their immigration status. I respectfully ask for an aye vote.

Thank you, Senator. Thank you.

We are now going to be moving to File item number 15, SB 596 by Senator Menjivar. Senator, you are recognized when you are ready.

Thank you. After years of hearing anecdotal stories, concerns from nurses, our healthcare staff, of the lack of enforcement of nurse ratio, nurse staffing ratios, this body, the Legislature in 2019, established financial penalties specifically for nurse staffing ratio violations. So that's already in law.

However, this bill, however, that bill recognized that there are situations that are out of the control of hospitals. So it made a good faith effort to provide exemptions for hospitals who were really looking to cover and help with the staffing ratios so they wouldn't be subject to a fine.

So in order for a hospital to demonstrate in good faith that they were working to address the staffing ratios, the bill allotted the hospitals to call what's called an on call list that they can say, we've exhausted this list, we've called individuals on this on call list.

However, that bill did not define what an on call list is. And as legislators, we understand how important the details in these bills are to ensure that they're as successful as possible. Here we are for 2.0. We're looking to define what the on call list and that is what SB596 is looking to do.

We want to make sure that we have a definition of this on call list to ensure that it requires 10% of the nurse staff to be able to respond to an unexpected increases in the volume of patients, as well to cover nurses who cannot come into work for their regularly assigned shift.

The bill also makes clarifying information to the enforcement of nurse ratios, including clarifying that violations on separate days should be treated as separate cases because what we're seeing, they're being aggregated and the violations are happening on different shifts and different days and they should be treated as such individual cases.

Finally, you probably all have seen or have not a series of articles regarding the horrendous treatment of individuals in our for profit psych hospitals that have spanned for years, have resulted in deaths, have resulted in sexual assaults, and unfortunately, it's because we have not for decades now implemented a staffing ratio regulation for nurses in psych hospitals that we should have done about 20 years ago.

Now, the body is not looking to implement those regulations. We just want in this bill to give the Department Authority to do emergency regulations so that they come up with the regulations to address the horrendous situations and the lack of care of individuals in the for profit psych hospitals.

Obviously, I would love to see these be done in the budget and maybe in the May revise, we'll see this. But until then, I want to continue carrying this in my bill to let the Department know that we're taking the situation seriously and we need to make sure that that gets addressed.

As noted in the analysis, I'm accepting an amendment from the Committee to allow nurses to be to allow nurses assigned to float pools to count towards an on call list.

We took this after having conversations with the oppositions because again, we want to make sure that hospitals who are working in good faith do have the flexibility and ability to have their version of on call list be eligible under this under this bill.

I know they have additional concerns and we will continue as we have to have those conversations to address them as the bill moves forward. With that, Madam Chair, I'd like to now turn over to my witnesses.

Thank you. To our key witnesses and support. Please state your name and you each have two minutes, two and a half minutes. Thank you.

Good afternoon. My name is Joyce Powell and I'm an emergency Department nurse at Providence St. Joseph's in Burbank and I'm a proud member of SEIU. One to one RN. Today I'll be speaking about the issue that I, like too many of my fellow nurses, deal with every day and it's unsafe staffing.

I'm grateful to you, Senator Menjivar, for standing with the frontline nurses to ensure that we can deliver high quality patient care safely by raising the need for for increased transparency and enforcement in the Budget Committee last year and authoring this bill and to UNAC for joining us in this fight.

SB596 builds on our previous work for safe staffing and hospital accountability. SB227, which became law in 2019, directed CDPH to fine hospitals for inadequate staffing. But during the pandemic and with the waivers, enforcement and accountability relaxed while nurses were understaffed on the front lines today, many nurses still report the unsafe staffing.

Per SB227, fines are meant to deter hospitals from violating the staffing laws that have been on the books for 20 years. But without the enforcement, hospital administrators treat these laws as guidelines.

Hospitals are required to have appropriate staffing with a narrow exception if the fluctuation is unpredictable and uncontrollable, with prompt efforts made to maintain required staffing and if the hospital has exhausted its on call list.

Even with nurses calling out unsafe staffing, we see some hospitals failing to live up to the spirit of the law regarding an on call list. They text or calling only a couple nurses to help cover when staffing is short.

Every nurse knows that nurses have too many patients, that nurses that have too many patients mean lives are at risk. So we all try to be flexible and jump in when we can.

But if we've been just working for three days in a row or have personal commitments, we can't drop everything to make up for management's not planning. SB596 will ensure that we have a real on call list, a needed standard for patient safety with dedicated nurses who can step in when we need support.

As an emergency room Department nurse of 27 years, I accept and expect uncertainty, even chaos. Drop up your comments. Thank you. Oh, finish. Oh, okay. I'm sorry. In every shift, that's the job. We nurses are up to the challenge, but we need enough staff to do our job safely. We strongly support SB596 and urge an Aye vote.

Thank you. Thank you.

Thank you very much. Matt La Jay on behalf of SEIU, CA Our witness, our other witness was delayed a little bit, so I appreciate the opportunity to speak. I want to thank Senator Menjivar for carrying this bill and the work by her staff and the Committee staff on it.

This is a really important bill, making sure that we're tightening up a couple places in the law. Look forward to continued conversations with the hospital association about how we can implement this.

There's definitely concerns and, you know, want to work with them on that, including, you know, how does this get implemented for rural hospitals, urban hospitals and so forth. So look forward to those continued conversations and making sure that we can have something where patients are always getting the care they need.

Happy to take any additional questions that folks have if they have it. So thank you.

Thank you. We'll now move to the Committee room. Is there anyone else here in support of this bill? Please state your name, your organization and your position.

Good afternoon, Bryan Mayor Montes, with the American Federation of State County Municipal Employees in support.

Good afternoon. Monica Bustamante, registered nurse, 24 years, proud Member of SEIU 121 RN in support.

Peter Cedar, UNAC, UHCP Executive. Vice President, also a nurse for over 20 years. I stand here in support.

Thank you. Seeing no other me toos. We'll now move to any key witnesses in opposition. Thank you. Please state your name, your organization and you have two and a half minutes. Great.

Katherine, I haven't done this before. Five minutes. Katherine Scott with the California Hospital Association. Do appreciate the work of the author and staff as we've worked through this issue. Nurse staffing is A balance for our hospitals, it can be based on historical census, it can be based on anticipated surges. It's really an art and a science.

So in many cases, as we are managing multiple floors, we are often staffing below ratio actually to manage again, even just a late nurse or whatnot, you know, even breaks, et cetera. So for us it's. We always like to make sure we're utilizing our resources appropriately as well as managing healthcare costs.

I think the remaining issues in the bill really are focused on three areas.

First, we want to make sure that as we consider that 10% or what that pool looks like, when we look at the nurses, we're looking at those staff nurses, those patient nurses, not necessarily the management nurses, those nurses, it's often management is nurses who move up the ladder. Many of them have a registered nurse license.

They're required to keep that. So we want to make sure we're really focusing on the staffed beds as well. So it's really our second issue. Are we talking about the beds we're staffing? Because our census raises and fall, rises and falls. Birth is a good. I looked at the numbers last night. September, really popular month for babies.

January, February, not so much. So these are times where we may staff more in L and D, staff less in L and D. Right. So I'm betting half this room has a birthday in September, apparently. So, you know, again, really managing how we staff is important.

So when we think about what is a mandatory on call list, how we manage that list because we are paying those nurses to be on call is critical so that we can ensure we're also managing the resource. So again, appreciate the work.

No, we'll continue conversation but these are important discussions as we think about those fines on the other side. Right. So if the fine process is tightened, we're now looking at $15,000 fines for a nurse that might be late that an on callist might not have been able to manage.

And do appreciate the float pools, that's frankly where we're going is a float pool option. Our hospitals are looking at just scheduling nurses, knowing that they are, they do now knowing that they're going to be off. So what does that float pool look like?

Right, so we're not sending nurses home because we over compensated in the float pool space as well, which will equally as frustrating to those nurses who came in and then were sent home.

So thank you. Thank you. Are there any other individuals or organizations here that would like to express their opposition? If so, please come forward. State your name, your organization and your Position only. Thank you.

Good afternoon, Madam Chair. Ahwad Kidani, representing the California Children's Hospital Association, aligning our comments with our colleagues. At the hospital Association. Thank you very much.

Good afternoon. Megan Loper, on behalf of the United Hospital Association, we too would align our comments with those of CHA. Thank you.

Good afternoon. Sarah Bridge, on behalf of the Association of California Healthcare Districts here, respectfully oppose unless amended. Thank you.

Seeing no others, we will bring it back to the Committee. Senator Weber Pierson.

Thank you, Chair. Thank you, Senator Menjivar, for bringing this bill forward and allowing for us to have these conversations.

You know, we really want to ensure that above all, our patients are safe in our hospitals and that our providers, whether they're physicians or nurses or whoever happens to come in between, are not burnt out because of the amount of hours and the amount of days that they need to work.

I think this problem really needs to be fixed by increasing the number of nursing slots we have for our nursing schools in California. But that's a whole other issue.

And another Committee, I too was kind of struck by the language that said all nurses would be included in this understanding that many have stepped away from the clinical space and are more in the administrative realm and may not have even touched a patient in the last 51015 years.

And so, you know, I would be a little concerned if a nurse who has not actually been in the clinical realm was put into that pool and then ultimately in the ICU and the emergency room, labor and delivery like that just does not work.

And so, and also I'm interested to see how you will deal with the issue of the fluctuations in the hospital census and how that's going to impact the hospital call list or whatever on call list. And so I look forward to seeing what this bill will be with future amendments, you know, once it gets to the floor.

And I definitely applaud you for, for taking on this issue and trying to figure something out that works. Thank you, Senator Richardson.

Thank you, Madam Chair. Well, unfortunately, on my behalf, I've had some pretty serious family situations where my now 87 year old mother has been in the hospital multiple times. And I'm quite familiar with waiting, particularly with shift changes.

Sometimes a person will say, zero, the next person who's coming on, you know, will help you with bringing your meds or whatever. And depending upon the seriousness of that particular person, you may actually wait a little while because they may have to check somebody else who's perceived to be in a much serious situation.

So I am concerned that we have adequate nursing support and staff Staffing. I'm also equally concerned, however, and I want to ask a clarifying question that I know a lot of hospitals now, we don't have as many hospitals as we used to. Many are consolidating or unfortunately closing some of the smaller ones.

So in my district, some of the hospitals I know are using a floating pool and I think I missed the acceptance. The author, if you could.

Author and Chairwoman, could you please confirm that it is my understanding you guys are having a discussion about how to consider the floating pool similarly, as you are with the other, I guess, on. On call pool because that is used a lot in my district.

Through the chair. Thank you. No further conversation. Seated. I took the amendment, so that is going to be allowed as a eligible approach they can take.

Okay. Well, finally, I just want to say for all of us here in health care, we're lucky to have Senator Manjavar.

She works quite hard and is very concerned about the healthcare of California and so, so glad of your leadership, not only on this Committee, but your leadership and the care that you take in the legislation you bring forward. So I look forward to supporting it with that amendment being accepted. Thank you.

Thank you, Senator. To the author. I can definitely empathize with where you're coming from, your heart and your mind on this issue. You know, having been a patient myself, I was in a very severe car accident a week before my wedding and ended up fracturing seven ribs. I punctured my lung, fractured my sternum.

I was in the hospital for three weeks and really understand the difference in health care when you have available nurses. I completely understand this. However, I have some major concerns about the Bill. And is this 10% threshold arbitrary? Is it going to make it harder for hospitals and more expensive?

And right now I am solely focused on making sure that we're not increasing, increasing health care costs for patients. And I worry about our rural hospitals who this could be posed very, very challenging and thus costly. So I would like to ask one our sponsors, why the 10% threshold?

And before I can respond, I fully 100% recognize that we need to come. We need to continue redefining that 10%, 100%. And we've had those conversations with Cha on that. And in those conversations, that's how I got to the float pool of recognizing that was an issue.

We want to make sure that we allow different options for hospitals to meet. This is not a one size fits all. So on the 10% have been open door and welcome. We haven't received any language yet on what they want us to is look at for amendments. So I have nothing in place to look at.

So once we get that language, we'll be looking at it. We just didn't get it before this Committee. So I have committed to continuing to work on that once we get that. The second part you brought up is one smaller hospitals, 100% recognized it's not a one size fits all. Different hospitals, different approaches.

And once we get proposed amendments on that, we'll be able to look at that as well. Again, just haven't received anything just yet.

So to the opposition, could you speak to one how challenging this could be for rural hospitals and what the impact might be?

Sure. A couple of things. For rural hospitals they could use a myriad of different approaches, which is why it's difficult to come to a set of amendments. So you know, again, we're kind of working with the field to find a place and it's not easy. So this is not an easy approach.

You could have rural hospitals are using travel nurses and those travel nurses could be assigned working some days but then assigned to on call or could be available but not necessarily called on call.

So it's really managing that because some of our rural environments, it's really hard to attract folks to live there when they can get a higher rate someplace else or when they may have, you know, they may want to live in an urban or suburban environment. So we really struggle to get folks in rural environments.

I think you've all heard that before. So really.

And then also how we account for that 10% could be we are using managers as our on call nurses because frankly it's an environment where, you know, the nurse manager may be the one who's both the scheduler and the one who's available because there's four nurses to the whole hospital depending on the size of the hospital.

I'm thinking of one up north where literally there are four nurses. And so when one of them calls out, you know, they're calling the manager because the town is that small. So how you legislate that, not easy.

And then generally I think when we think about our rural environments, it's also are we paying for on call if you're using a manager? I mean when you're thinking about these environments where it's not one Department, you know, it's not a hospital that has seven departments because a lot of our hospitals will have seven different departments.

Your community hospital, you can kind of think through issues. But when you have one hospital with four nurses, it's a catch is catch can in some situations. So legislating that, putting that in language is not easy.

So you know, I represent what is known as a healthcare desert, you know, and our hospitals are struggling and there's been lots of conversations in this building about the looming Federal Government potential cuts to health care. And our hospitals in California are already struggling.

So I have some major concerns on whether or not this becomes even more debilitating for them if passed and implemented. So it's too far for me to support today. I'm going to oppose it, but would love for it to get to a place where I could support it. Yeah. And you may close.

Yeah. Thank you. Thank you. I've got to make it known that this is already in statute. Right. This is staffing violations. We passed this years ago and there hasn't been a heavy hand whatsoever on these hospitals at all. I mean I barely scratched the surface of healthcare worker. I'm not a physician, not an rn.

I was just a little emt. But I had a drop off patients on endless amount of hospitals in all of Los Angeles County. And holding the WA because nurses were short staffed was. I hated that time because I had a patient on a gurney for hours because there weren't enough nurses for me to give a report to.

The charge. Nurses were really spread thin. Like I've seen this firsthand. And it's not just our ERs, it's because there's no room in the ICU and you can't open up a bed in the ER. It's a domino effect. So this is a situation that impacts patient care like Senator Richardson mentioned.

And also we don't have the workforce necessary to keep up with the healthcare demands. We are, we don't have enough RNs. And I know we've. Dr. Robert Pearson talked about something that isn't within this bill but the workforce investments is really key.

But if we don't do that investment and we don't also help with staffing ratios, we are double putting pressure on our healthcare workers and not supporting them whatsoever. I want my healthcare workers to be supported. I want to make sure the hospitals have options to make them be as supportive as possible.

Because hospitals don't want to have print out nurses either because then patients don't go to those hospitals. It's a win win for everyone. And I already recognize that we do have to come back to the table to redefine the 10% and we will redefine the 10%.

I also recognize that we need to look at and I know it might be difficult but even if we don't get any proposed amendments. I'm still myself with the sponsors and the staff going to be looking to redefine and look how we can help and address the small and rural hospitals with that.

Respectfully asking for an Aye vote.

Unfortunately, we do not have quorum still. So we're going to move to File Item number 11, SB403 action. Actually, you want to move to Wahab first? Yeah, yeah. We're going to move to File Item number four, SB257 by Senator Wahab.

Moving on file item four, SB 257. Senator Wahab, you may begin.

Thank you. Chair and committee members, members of the public, I want to thank the committee staff for their help with this bill. Health insurers are mandated by the state to cover maternity health care services. But they increasingly been skirting that requirement by demanding reimbursement for that coverage by placing liens on surrogacy contracts. They collect premiums and deductibles and then turn around and pass on the financial burden onto the intended parent.

SB 257 would affirm that health plans cannot discriminate against policyholders for serving as gestational carriers, which will ensure that surrogates have access to quality health care and that surrogacy continues to be a family building option for Californians struggling with infertility.

It will also add pregnancy as a qualifying life event for health insurance enrollment so that every pregnant person can access affordable health care. Here today in support of SB 257 are Sarah Page, President of the Insurance Access and Equality Alliance and a licensed insurance agent focused on assisted reproductive insurances, and Dr. Jason Angel, Board Member of the Insurance Access and Equity Alliance and a licensed clinical psychologist.

You may proceed. You have five minutes total.

Thank you, Chair and members of the committee for the opportunity to speak today. My name is Dr. Jason Angel. My husband and I are the proud and busy parents of twin toddlers thanks to the help of an amazing surrogate.

I'm here to ask for your support of SB 257 so that families like ours don't face the same discrimination we did. We spent years of dreaming of having a family. As a same sex couple we needed assisted reproduction through surrogacy.

It was a long, emotional process. Matching with the surrogate, going through IVF, securing special insurance, all to make sure everyone would be protected. The process was remarkable. The sting of discrimination began when it came time to give birth. First, we were told we couldn't be present at our children's birth because Kaiser didn't consider us the parents.

After pleading with the medical team, they let us in moments before delivery. It was humiliating and stressful. From there, things only got worse. Starting the next morning, while caring for our newborns, the hospital's billing department called us nine times demanding payment. Even though everything was covered by insurance.

They said this only happens in these type of situations, meaning surrogacy. With surrogacy, insurers in California can demand a reimbursement from payments made to surrogates, even though all premiums and deductibles are paid. Just because she's a surrogate. This doesn't happen with any other kind of pregnancy.

Nevada has already outlawed this form of discrimination and we should follow the same steps. I urge you to support SB 257 so that all California families, including those formed through surrogacy, are treated with the dignity and fairness they deserve. Thank you.

Thank you,

Thank you, Chair and committee members, for the opportunity to speak as well. I am Sarah Paige. I'm the Chief Operating Officer of ART Risk Financial and Insurance Solutions, the nation's leading California insurance agency located in Valencia, California.

We focus on the needs of those in the assisted reproductive field, and we've been supporting over 20,000 families on their path to parenthood. I'm here today to urge you to support SB 257, which closes a harmful loophole in the health insurance market. One that allows insurers to discriminate against people who turn to surrogacy to build their families.

Here's the issue. For a pregnant woman acting as a surrogate, some health insurers demand a right to reimbursement from the surrogate's compensation and then threaten to seize it over the coverage of maternity medical expenses. Even though the insurer knew the policy was bought to cover a maternity for a surrogate pregnancy, and premiums as well as deductibles have been paid in full, creating what we consider to be an illusory benefit.

In most cases, the intended parents, who already face significant costs, are forced to pay the lien. No other pregnant woman or couple is treated in this manner. This practice is a form of discrimination based on how and why a woman is pregnant. SB 257 also asks for pregnancy to be a qualifying life event for enrollment and insurance.

Pregnancy is one of the most medically risky experiences a woman can face. While the ACA expanded coverage options for many individuals and families, some pregnant women continue to encounter barriers to accessing gaps in coverage. Passing SB 257 will help pregnant women obtain timely access to adequate health care coverage that meets their needs.

In closing, SB 257 ensures all pregnant people are treated equally under the law. Life should not begin with any form of discrimination. Again, when it comes to surrogacy, insurance companies are selling illusory benefits. The insurers are paid premiums and then repaid for the medical expenses covered by the policies that they sold. I respectfully ask you to vote yes on SB 257.

Thank you so much for your testimony. Now is the time for any me too's and support.

Good afternoon, Timothy Blood, Consumer Attorneys of California in support

Craig Pulsipher for on behalf of Equality California in support.

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

Brian Spencer on behalf of the American College of OBGYN's District 9 in support.

Lisa Stark Hughes from GS moms in El Dorado County, in support.

Robert Rettenmaier from the Law Offices of Robert Rettenmaier, in support.

Molly O'Brien with the International Fertility Law Group and a Board Member of the Insurance Access and Equity Alliance, in support.

Ethan Weisinger Principal of Bay Area Family Law Center and intended parent twice over in support.

Jessica Busman, owner of Surrogacy Partnership in Brentwood, California, two time surrogate in support.

Dawn Baker, CEO and founder of US Surrogacy LLC in Placer County, former infertility patient, in support.

Brooke Kimbrough, CEO and founder of Roots Surrogacy and former gestational carrier, in support.

Jennifer Rose, California surrogate, in support.

Melissa Bagneschi with US Surrogacy in support.

Haley Dawsey with US Surrogacy in support.

Virginia Hart, founder and CEO of ART Risk Financial Insurance Solutions in Santa Clarita, California, very in support.

Janelle Hammett, Surrogacy Journey Director for NewGen Families and two time surrogate, in support

Thank you.

And if I may, Kimberly Surratt, Vice President of Insurance Access and Equity Alliance, California and Nevada attorney who did the Nevada legislation and I'm in support.

Thank you so much. Any formal opposition please come. We can have you, Ma'am, can I have you just switch over over here so they can both sit.

Madam Chair and Members, Stephanie Watkins, on behalf of the California Associ, I almost said yours, Association of California Life and Health Insurance Companies. Regrettably, we are here today in opposition to SB257 which would make pregnancy a qualifying event for special enrollment for health insurance.

As many of you remember, in 2014 the Affordable Care Act was fully implemented in California and along with came with it many important changes in the health care market, one of which was that guaranteed issue coverage was extended into the individual market, allowing individuals and families to have full access to purchase health care without any pre existing condition limitations.

Since coverage is now afforded on a guaranteed issue basis regardless of medical history, the trade off to ensure a healthy robust market was to implement an individual mandate to have coverage and limit enrollment to an open enrollment period annually and subsequent special enrollment periods that were based on General life events.

The concern was if enrollment was available year round without limitations on coverage, the insurance market would become unstable, which is what we saw in Washington state in the 1990s. With that being said, current special enrollment periods are limited to what we call qualifying life events.

Specifically, these events include when an individual moves, they get married, they add to their family, they lose employer sponsored coverage. These types of narrow exceptions to the annual enrollment period take into account the reality of our lives while also protecting the integrity of the market.

The important thing to note is that the current special enrollment periods are generic in their application and evenly apply to all enrollees and insureds and are not tied to any one specific condition, disorder or disease, which we think is critical distinction.

Unfortunately, while we appreciate the author's intent to expand healthcare access to women when they are pregnant, we are very concerned about opening the door to creating conditions specific special enrollment periods that inevitably will favor one condition over another.

As many of you know, a critical piece of ensuring that California has access to affordable quality health care is to continue to encourage and incentivize consumers to purchase health care even when they don't need it, so that California's healthcare market remains affordable for everyone.

Unfortunately, as drafted, we believe that SB257 undermines that goal by allowing people to go without coverage until they need it. Lastly, I would like to note that the CHIPRB analysis does acknowledge that this bill would increase annual net expenditures by 69 million, potentially resulting in a $2 per Member per month impact on the individual level plans.

For those reasons, we are opposed to the bill today, but remain committed to working with the author and sponsor if the bill does move forward. Thank you.

Madam Chair and Members. My name is Olga Shiloh. And I'm here on behalf of the California Association of Health Plans, which collectively provide healthcare coverage to over 28 million Californians and are dedicated to ensuring access to high quality, affordable health care.

I'd like to align my remarks with those of my colleague from ACLI and share our perspective on the bill. We sincerely appreciate the intent behind SB257 to enhance access to maternal health care coverage. However, we are concerned about the fiscal implications of benefit mandates, and at this time, we must remain respectfully opposed.

At the time when the state is grappling with healthcare affordability and budget uncertainty at the state and federal, federal levels, we believe mandates could place additional strain on families and employers alike.

Additionally, the state is proposing a new essential health benefits package that will undoubtedly lead to increased premiums, with a potential 2% premium increase to cover these benefits, a cost that will further strain the affordability of healthcare for many Californians. While we respectfully oppose SB257, we remain committed to working with the author and the sponsors.

We welcome continued dialogue and collaboration if the Bill moves forward, forward through the process. Thank you for your consideration.

Thank you. Any #MeToos in opposition? Seeing none. So coming back, Vice Chair.

So lots of voices from Santa Clarita in the room today. Well played, Senator.

I will be supporting your bill. Thanks for bringing it forward. Thank you.

Yes, yes.

Thank you, guys. Santa Clarita residents.

You know, California has made great strides in ensuring that we provide access to health care, ACA healthcare for all through Medi Cal. And the goal is to ensure, like you mentioned, that they sign up not just when there's an illness, a disease or an injury. It's when you're healthy and it helps make the pool less high risk.

Right. I recognize that. And you mentioned that there's still some gaps that people face. I'd be naive to say that everybody in California has health care coverage, even though we've worked so hard to ensure that there's going to be ones and twos who don't have it.

And it's really unfortunate to then get pregnant and not have coverage for that pregnancy, especially when we're seeing birthing parents or breathing individuals not survive these instances. Right. We need to make sure that they have the resources necessary. We did talk to, you know, I was worried about the risk pool, had conversations with Covered California.

I was looking to see how other states fared.

I wasn't able to get information on that, but it didn't seem like the risk pool, at least for Covered California, was going to be at a level that that was going to be at a level that wouldn't allow me to support this bill with my personal work with SB729 and ensuring that fertility services was covered.

This is the next step, right? Yes. Fertility services covered, but what comes after that? Right. Once you do get pregnant, we want to make sure the next level of services do get covered. Thank you for sharing your story with me. And I want to really a special thank you to those who are gestational carriers or surrogates.

You provide a blessing to individuals that I don't think anyone can really fully thank you for that because you're allowing individuals to have a family and a child. So thank you so much for coming and providing that support on that. So I did hear some of the concerns there.

I know you mentioned EHB and the premiums that are going to be increasing there. It wasn't enough for me to not support this bill. I didn't. I think the Senator here is elevating an issue that's really important for a lot of Californians, which is why I will be supporting this bill. Yes, Senator.

It was because of something you said. Okay. So I guess I'm just wondering like we have so many people here in California who are insured. I mean, how many people are we talking about?

You know, I think it's great to throw out numbers, but how many people who are gestational surrogates are not currently having health insurance?

Sorry, I'd have to go back to the CHIPRP analysis. Does I think it's feel like it was in the 6500. It wasn't like a huge number, but the piece of it from our concern is the carving out of a condition specific special enrollment versus where does that begin? The conversation of cancer and other.

No, I completely understand that. Right. And I think that is a risk with this Bill, to be quite honest with you, especially in the, you know, federal landscape that we are in with this current Administration. Having something that specifically targets one group of people is something that our this current Administration has, you know, whatever.

But anyway, that is, that is a risk. Right. But my question was really more so 6368 how this is going to like financially impact Californians as of right now that have health insurance because we have expanded it so much. And that was something that the chair brought up. And so that's why that triggered my question.

I do this to her in sub 3. She does. She really does. Yes. Yes.

So I think the most, I mean what we look at too is the expenditures and that While it was a really small number, I think I was taken a bit by the $2 per Member per month impact to the individual market, which was much higher than we often see.

So I think the expectation is, while small number may be a large impact either way, I think our overarching issue is not necessarily with this as much.

As the bigger, the principle of it all. You're right, because I had the same exact question as if this one, then that opens the door for what about this and what about that? So you're 100% right. I think, you know, in my two years here and all the bills on mandates and so forth, there's always the number.

This is the 16th mandate Bill of the Legislature. I hear you on that. I do.

So I would love to add to that. And then now we'll turn to you for you to close. Thank you. I just wanted to address some of the questions there and I really appreciate kind of the dialogue here.

First and foremost, pregnancy is one of the only major life transitions not currently recognized as a qualifying event for health insurance enrollment. Yet almost 50% of the state has something like that or the potential to do something like that.

And it allows individuals to enroll in coverage upon learning that they are pregnant, kind of helps ensure timely access to prenatal care, reduces disparities in maternal health outcomes, and supports the health of both the pregnant individual and the baby.

I also want to highlight that this in particular, and you know, we talk about who's covered, who's not, this is about equal access, right? The mere fact that we can't, you know, prioritize just equal access for an individual who may be going through this. And I want to highlight that this is prevention and early intervention.

The cost of supporting an individual who's going through this or potentially even planning to go through this versus, let's say, a horrible outcome in the future when they don't have coverage, when they don't have the support is significantly different.

And we actually received, according to the CDC, in March of Dimes, early prenatal care can reduce preterm births, which costs roughly about $55,000 compared to 4,000 for full term births. For every person who gains timely prenatal access, there's potential for tens of thousands in savings, not just for insurers, but also for public health systems and famil.

I also want to highlight the concern about the Federal Government. I think we're concerned about everything that they're doing right now because we don't actually know what they're trying to target. 100%.

But there has been a lot of conversation at the federal level that they are trying to prioritize births, women having children, people having children, and much more. So I have no idea what they're going to do. Yes, well, you know, I don't know exactly what.

It's ridiculous what we're having to see on the, in the 21st century in the United States. Right. And I think in this state, I think all of you guys have the concerns we have. We care about maternal health outcomes. We care about people being able to start families and take care of people.

And so, you know, I'm very much committed in making sure California is, has and provides equal access to all people. And for those individuals that, you know, want to have children but wait a little bit later because the cost of living is so high. Right.

And there are so many people in my district in particular that wait till their 30s, 40s, 50s even to have a family. And as a kid in the foster care system, I do just want to highlight that this is one of the options to allow people to have the family that they are trying to build.

And I fully support this. I respectfully ask for an Aye vote and I thank you for your time.

Thank you, Senator. When we have quorum, we will entertain a motion. Thank you for your time. Thank you. Appreciate it. Senator Becker, you're up to bat file item five. SB 306.

Senator.

Thank you, Chair and Members. Here to present Senate Bill 306, which addresses a key barrier to timely medical care, unnecessary prior authorization. Doctors are spending more time on paperwork than they are with patients. A 2023 AMA survey found physicians complete 43 prior authorizations per week, spending an average of 12 hours just on that.

This red tape is preventing doctors from doing what they're trained to do, treat patients. Prior authorization delays care. 94% of doctors say it causes treatment delays. And these aren't just minor delays. The same survey said 19% of doctors said a patient was hospitalized because of these delays.

13% said a patient experienced a life threatening event or needed urgent intervention. And the worst part, many of these requests were approved, almost always approved, in fact, just days or weeks of waiting. Right now, insurers can require prior authorization if a licensed clinician determines it's medical necessary. They must follow criteria developed with input from practicing providers.

But that doesn't stop them from requiring approval for routine, commonly approved care. That happened to my own staff in a crazy incident. SB 306 says if a health plan approves a service more than 90% of the time in a calendar year, then they can't require prior authorization for that service the following year.

This creates a data driven, common sense approach. If you're approving it anyway, don't make patients' providers jump through hoops. This will free up providers to focus on patient care, reduce delays in treatment, and allow health plans to concentrate the review process where they're actually needed.

SB 306 is a simple step with a big impact. Cuts red tape for providers, reduces unnecessary delays for patients, and still lets plans review care when appropriate. Let me conclude by thanking the Committee for working with the bill sponsors and my team on the current bill and print. I'm aware the Committee analysis suggests one additional amendment which would apply the bill's provisions to in network providers and who submit prioritization requests electronically.

I am willing to accept the amendment to focus on in network providers, but given the known glitches in electronic PA request systems and availability of such software, particularly in smaller rural practices, I would like more time to figure out if we can craft such a requirement in a manner that doesn't delay necessary health care for the second part of that. With that, I respectfully ask your aye vote and have some excellent witnesses here today.

Go ahead. Both have a total of five minutes.

Awesome. Good afternoon, Chair and Members. My name is George Soares with the California Medical Association. We're the proud sponsors of SB 306 by Senator Becker. We want to start off by thanking Senator Becker for authoring this critical measure in the Prior Authorization Reform Legislative Package.

We also want to thank Chair Menjivar and her staff for the long hours and work on this over the past few weeks. This is not a new issue in healthcare or for this Committee, but California's patients and physicians need prior authorization reform now more than ever. This bill is a straightforward approach that will require health plans to remove prior authorization and prior notification from any service or prescription that is approved at 90% or higher.

Prior authorization was originally intended to ensure appropriate use of services and control healthcare costs, but in reality it has become an administrative roadblock that delays necessary care, increases physician burnout, and frustrates patients by prioritizing health plan profits over patient care. Physicians routinely spend hours, sometimes days, navigating complex, inconsistent authorization requirements that often override clinical judgment.

We're not suggesting prior authorization is not appropriate in some circumstances, but the current system needs to be drastically overhauled. As the Senator mentioned, an AMA survey found that 43 prior authorizations a week is average for physicians and 12 hours each working week on paperwork rather than treating patients.

This time spent on inefficient and burdensome tasks comes at the expense of treating patients and eats away at time physicians could be spending with patients in the exam room, coordinating care for patients with chronic diseases, and increasing access to care for new patients. For physicians, prior authorization has been and remains a major source of burnout.

Physicians and their staff spend hours each week, often unpaid, dealing with paperwork, phone calls, and redundant requests for information. I'll close by saying that patients and physicians are burdened by prior authorization requests for services that are approved at a high rate. In many cases, these services are reoccurring or routine, yet still critical in providing timely care.

The overall volume of prior authorization requests is drastically slowing down the delivery of care across the healthcare delivery system, and this bill will directly address that issue. For those reasons, we urge your support of this critical reform to the prior authorization system that will result in greater access and healthier Californians. Thank you, and we're happy to answer questions.

Good afternoon. Sheirin Ghoddoucy on behalf of the California Medical Association. Here for any technical questions.

Thank you so much. Any me toos in support?

Good afternoon. Lizzie Cootsona here on behalf of the California State Association of Psychiatrists and the California Academy of Child and Adolescent Psychiatrists as well. Thank you.

Christine Smith, Health Access California, in support.

I'm Fred Noteware representing Stanford Health Care in support.

Shira Spector for Stone Advocacy on behalf of the California Orthopedic Association in support.

Mari Lopez, California Nurses Association, in support.

Ryan Spencer, California Podiatric Medical Association, in support.

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

Angela Pontes on behalf of Planned Parenthood Affiliates of California in support.

Tim Madden representing the California Society of Plastic Surgeons and the California Chapter of the American College of Cardiology in support.

Cher Gonzalez on behalf of the American Diabetes Association in support, as well as the Association of Northern California Oncologists and the Medical Oncology Association of Southern California. All in support.

Sara Noceto on behalf of the California Chronic Care Coalition and ALS Association in support.

Vanessa Gonzalez, California Hospital Association, in support.

Meghan Loper, United Hospital Association, in support.

Clint Hopkins, owner and pharmacist at Pucci's Pharmacy in Sacramento and Eddie's Pharmacy in Los Angeles. Strong support.

Thank you so much for me too in support. Any formal opposition to this bill? When ready, you might begin.

Thank you, Madam Chair and Members. Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies. I'd first like to thank the author and the sponsors for their willingness to talk with us over the last several years about this proposal, as well as the Committee staff for the most recent amendments. Regrettably, while we appreciate the open dialogue, we remain opposed unless amended to the bill in print today.

As many of you know, health plans and insurers work diligently to ensure that enrollees and insureds are getting the right care at the right time from the right provider. Medical and utilization management tools like prior authorization are key to promoting safe and effective care for all enrollees and insureds.

To that end, health plans and insurers act as stewards of the premium dollar, and therefore have an obligation to invest those dollars in proper and effective care. In recognition of the need to streamline the process, many of our health plans and insurers are currently implementing their own enhanced prior authorization programs to help ease the burden on providers and enrollees.

Understanding the goal, we appreciate the recent discussion we've had around this issue and believe that SB 306 as drafted is missing some key elements that are critical to ensuring that plans and insurers can uphold hold the right care, the right place, the right time approach.

For these reasons, we have come together collectively to highlight some of the issues we think need to be addressed in the bill in order to ensure this proposal is successful in achieving the goal of reducing administrative burden on providers, providing immediate relief to all enrollees and insureds, while also protecting the integrity of the healthcare system as a whole.

With that, we had a few suggestions, and I know that we provided them. I'll just briefly, in the interest of time, just touch on them. But most of them are to clarify that the statute only deals with services versus prescription drugs, inpatient or outpatient. To set a standard approval threshold of 95% versus 90%.

I think the important thing to know is with all the work with OHCA, we think that the 10%, the 90% could potentially impact our ability to meet the thresholds that OHCA has put forward. Create a standard threshold for what services the plans insurers must review. Establish a process for plans and insurers to disqualify specified services.

There are some services for which there is a minor number of services that are provided in general, or so sophisticated that even if they meet that threshold it would never be appropriate to remove prior authorization. Do establish a process of rescinding prior authorization exemptions specifically in fraud or abuse situations where we see significant upticks that is concerning to the marketplace.

Create a format for evaluating prior authorization exemptions on a year over year basis, and require DMHC and CDI to review the policy three years post implementation to access patient safety and cost implications. We believe the suggested changes we have outlined will help achieve the goals as stated by the author. And for those reasons remain opposed unless amended, but look forward to working with the author and sponsor if the bill moves forth today. Thank you.

Good afternoon. Bill Barcellona with America's Physician Groups. We're also in an opposed amended position as well. We are thankful for the amendments that have been taken today and our conversations with the author's office. The 200 capitated delegated medical groups in California stand in the middle of this situation, between independent providers and health plans, because our groups are delegated for UM responsibilities as well. They have a high level of automation already in this process.

They have very low rates of denials. But they do serve an important place in the medical community in terms of oversight for low value care that is medically unnecessary or referrals to out of network physicians. So we're hopeful that we can continue with discussions on this bill as well with the plans, the CMA, and the author's office to work out an acceptable solution. Thank you very much.

Step on up for me toos in opposition.

Good afternoon, Chair and Members. Kelli L'Heureux with Resilient Advocacy on behalf of the California Chamber of Commerce, also in opposed unless amended position. Thank you.

Nick Louizos, California Association of Health Plans, also opposed unless amended. Thanks.

Thank you so much. Seeing no other me toos, going to come back. Some of the opposition concerns came a little later and require a lot more conversation, which is why we didn't touch them. Because I know you have to dive into more of them. We were able to address one of them, the in network one and, you know, we talked about the electronic submissions.

But I think after having conversations with the author that there needs to be more tweaks to it because of some smaller providers not having access, cyber attacks, the lack of systems always being up and running. And I think more conversations need to happen on that. We just felt what the amendments that we provided were some that we can get to a point right now, and I know the author is going to continue having those conversations with y'all. Senator.

Thank you, Chair. Just really want to thank the author for picking this up and running with this issue. It's a huge, huge issue in the healthcare space. Not only one that we physicians feel, but oftentimes if there's a prior authorization, our nurses are the ones that are constantly sending stuff in and having to deal with this. It is something that has come up pretty much every year since I've been here.

And so my hope is that, seeing that this is a significant issue and it is something that generally gets to the Governor's desk every time, that we're able to actually get him to sign it because it would really not only help out providers but significantly help out the patients that we're trying to serve. So thank you so much, and I would love to be a co-author on this bill. Thank you.

Senator, are you a provider? Is this going to help? Seeing no other conversation. Senator, you may close.

Thank you. I think that was a, that will suffice as my close, that comments from Dr. Weber. Do appreciate, Dr. Weber Pierson. I do appreciate the opposition for working with us. As was stated, this is, this has been an issue every year. It's an issue nationally, and really hope that we can thread the needle and find a way to lead here in California. I respectfully ask for an aye vote.

Once we get a quorum, Senator, we will entertain a motion. Until then, we will continue. You have another bill, Senator?

I do in fact. Have my joint author present with me.

Not allowed. Come on in, Senator Jones.

Good afternoon. Chair here with my joint author, Senator Brian Jones with a, you know, with, I won't say a rare, but I think an important partnership here. Welcomed. Welcomed. On an important topic, one that I don't think is not new to this body and we hope that we found the right approach this year.

This bill establishes a five year pilot program to study the benefits of using psilocybin to treat mental health conditions in veterans and inactive first responders. First, I want to thank, we want to thank the chair and Committee staff for their work on the bill.

We will be accepting the Committee amendments suggested in the bill analysis today that add important safety guardrails to this research. SB751 responds to crisis we cannot ignore Every day, an average of 17.6 veterans die by suicide.

Every day, first responders, those who run towards dangers to protect the rest of us, are more likely to die by suicide than in the line of duty. These are individuals who've experienced repeated trauma and too often our existing mental health treatments simply don't work for them.

Many are turning to underground or unregulated sources of psilocybin or even traveling abroad to seek relief. That not only places them at risk, it signals a serious gap in our system of care. This bill is a step towards addressing that gap responsibly and safely.

The pilot program will be up to five counties to provide psilocybin treatment in regulated clinical settings such as community health clinics, veterans facilities and hospice centers under the supervision of trained medical professionals. It will be overseen by the University of California system, a first for this approach and adheres strictly to FDA and DEA regulations.

California currently is no state led effort to study this therapy, despite its growing youth reuse and a lot of research going on at our UCs and despite the risk associated with unregulated access.

The bill also establishes dedicated fund to support treatment, staff training and rigorous research and includes a comprehensive reporting system through 2030 so we can evaluate the results and decide where to go from here. I want to address specifically a concern raised by Dr. Weber about protecting pregnant women and nursing women from this research.

We are fully committed to adding provision to this bill that precludes any of this research from being conducted on such individuals. With that, let me turn it over to my doctor and offer thank you.

Madam Chair, Members, I want to thank Senator Becker and his entire team for two years of solid partnership on this issue. I think two years ago if you would have asked either one of us would we be involved in advocating for the use of psilocybin, you would have called both of us crazy.

I know our my staff would have for sure. I don't want to speak for Senator Becker's staff and I would have called you crazy for thinking I was going to do it.

But as the walking through this process over the several years and different bills that have come forward on this issue and then working with veterans organizations specifically in my county, I've come to the realization that there is some hope, some potential for these compounds to be used in treating veterans and inactive first responders on helping them get healthy.

Our veterans and our first responders are owed a debt of gratitude which we can never really be able to fully repay. But if we can help them in some small way, I say shame on us for not doing so sooner.

Our veterans and first responders are asking for this treatment to be made available to them and we owe it to them to at least give it a try in a controlled, limited way utilizing qualified medical professionals and researchers at the world's leading institutions of higher learning, an institution that we all highly revere, respect and trust.

The University of California system, California happens to be home to both and we ought to take advantage of the fact of passing this bill. With that, I'd like to hand it over to our witnesses and provide their testimony on our bill.

When you're ready, Madam Chair, Members, veterans, first responders and guests. My name is Jason Moore Brown. I'm a California resident, I'm a father of five and a grandfather of one very spoiled granddaughter. I'm a former army officer that's deployed three times in support of the global war on terror in a four year span.

I conducted over 300 combat missions and was twice awarded the Bronze Star. I'm a beneficiary of the program that the bill sponsor Heroic Hearts Project offers to veterans. My wife Sharon is also a beneficiary participating in the Heroic Hearts Veteran Spouses program. She went to Mexico, I went to Peru.

Our treatment saved our lives, our marriage, and has kept our family intact. It's an understatement. I can't really like explain explain how significant it was for us.

The Legislature and advocates like my colleagues and myself have been fighting to get California's veterans and first responders access to research backed life saving emergency therapies like those in SB751 for five years. For those of you new to this issue, this is the third iteration of this bill and the most restrictive.

We passed a much broader bill with bipartisan support out of the Legislature three years ago. In the five years we've ridden the political merry go round, approximately 30,000 veterans have committed suicide since 911. Approximately 185,000 veterans have committed suicide. We haven't had one year since 2001 where veteran suicides have dropped below 6,000. Clearly nothing has worked.

California has the largest veteran population in the US and according to the Va, California continues to maintain a disproportionately high rate of suicide, veteran suicides when compared to other states. The research this bill will facilitate may be the breakthrough veterans like me have had to leave the US to utilize.

If we save one life, if we keep one family intact, isn't it worth exploring? Don't veterans and first responders deserve the right to explore all, any and all options? One of the things that we rarely discuss are the second and third order effects of suicides in families. And I know that's not really talked about often.

There's not a lot of research behind it that I found at least. But one statistic that I found is that in 2022 they looked at the total cost of suicide in the US and it was over $500 billion.

So whatever we appropriate to this in the State of California, I mean we need to look at the second and third order, not only appropriations and expenses, but how that impacts California families for decades and generations to come.

So I encourage you strongly today to vote aye on SB 751 to give veterans and first responders an opportunity to access the research that will come from this bill. Thank you.

Go ahead. Thank you all for allowing me to speak today. My name is Angela Graham. I'm a retired firefighter of almost 20 years and co founder and Executive Director of the Siren Project. We are co sponsoring this bill.

We're a non profit funding and facilitating retreats in Mexico for first responders using entheogenic medicines, also known as psychedelics, to treat symptoms of post traumatic stress. My husband and I started this after having to navigate the system in search of my own mental health treatment when all modalities had failed.

Fortunately, we had a friend who was a veteran, to help us connect with trustworthy providers. Soon after, I got on a plane to San Diego, met up with a group of strangers and we smuggled ourselves across the border into Rosarita to do drugs.

I'd gotten to the point that I was having so many breakdowns and angry outbursts, I felt I needed to take extreme action to protect my son from all I was exposing him to. After my experience with these medicines, I was able to calm my anger and find peace like never before.

Nothing had given me such immediate and comprehensive relief from my symptoms. I was finally able to be the mom my son deserves. Today, the fire service is more accepting of mental health issues than ever before. I personally had access to more therapy and therapeutic mentalities in the last few years than when I started.

Yet suicide rates are climbing. The suicide rate for firefighters is 500% higher than it was 20 years ago. We are three times as likely to die by suicide than on duty activities. Not to mention the generational trauma being created and passed on. This is all despite more acceptance and available therapy.

Clearly, what is legally available is not enough. Now, before we fall further behind, California needs to set the standard for safe, effective access to these crucial resources. These medicines may not be safe for everyone. It also takes a lot of work and support before and after a journey to see the benefits of these therapies.

For these reasons, safeguards like medical screening and properly trained space holders are needed. This Bill is not perfect, but is much needed. Step in the right direction as we keep going back and forth over the details. People are waiting and suffering. Please show your support for all the first responders in your communities by supporting this Bill.

SB751, thank you for your time.

Thank you so much. #MeToo's in support. Please step on up.

Madam Chair, and Senators. Anthony Molina, on behalf of the Law Enforcement Action Partnership another co sponsor of this bill, in support. Thank you.

Thank you.

John Madden, former IAFF Local 1171 President and retired Deputy Chief for City of Santa Clara and Siren Project participant and support.

Thank you so much.

Bonnie McKeegan, licensed clinical social worker from Grass Valley. I am a former Healthcare Medical Trauma center social worker who acquired PTSD on Father's Day in 2011. I strongly support thank you so much. Rob.

Dr. Catherine Sonquist Forest, Former Chair of the Department of Family Medicine at Stanford and caregiver for 15 of the first responders in the VA post their treatment in the first trials of these medications. In strong support of us pursuing this as a state. Thank you.

Any formal opposition, come on up, sir.

We have two. Okay. Gentlemen, you have a total of five minutes together.

Great. Chair Members, my name is Greg Burt with the California Family Council, here to express opposition to SB751. Let me begin by affirming our deep respect for California's veterans and first responders. These men and women have sacrificed much for our public safety. And that's precisely why we are concerned about this Bill.

It proposes a state run pilot program that would use these heroes as subjects in an experimental initiative centered on psilocybin, a powerful psychedelic listed classified as a Schedule 1 drug under the federal law and state law, which means that it has no medical utility and a high potential for abuse. Now, why?

Psilocybin has been designated as a breakthrough therapy by the Food and Drug Administration for certain conditions. This is not an endorsement. It's just a way to speed up research, not a substitute for full approval. In fact, the FDA's guidelines for psychedelics are just in draft form, highlighting how unsettled the regulatory landscape is.

And yet SB751 moves forward without requiring FDA or Federal Drug Enforcement Administration oversight. It claims federal compliance, but mandates no actual review by those agencies. This sets up a troubling precedent for drug makers who may want to bypass established FDA safety standards and come to California for approval instead.

And more concerning, the Bill grants the California Health and Human Services Agency broad authority to create Psybin service hubs in five counties with minimal detail on oversight or access. This isn't a limited trial. It simply lays the groundwork for commercialization. Veterans and first responders deserve better care rooted in science and not in politics.

And we respectfully urge a no vote. Thank you.

Briefly, Madam Chair. Briefly, Madam Chair, Ryan Sherman with the California Narcotic Officers Association. We got our letter in late, but we did get it in. Just wanted to briefly touch on a couple points about our opposition. One was a point that was already made about using veterans and first responders as psychedelic guinea pigs.

We think that there's nothing in the Bill yet that really delineates who is going to qualify for these programs, what conditions they are hoping to have treated, what diagnoses have been conducted. There's a lot of unknowns in here. Instead, it just talks more generally about there's some qualifying illnesses.

I think PTSD is mentioned, depression is mentioned throughout, but it's not actually listed as one of the concerns to be treated with the mushroom. So because of that and some other definition problems that we have throughout the Bill, it's in our letter. We remain opposed and look forward to working with the author and Committee.

Thank you. Me too. Is in opposition to this Bill. Okay, colleagues, any questions? Senator, Dr. Weber Pierson.

Well, this is interesting to see the two of you together. It would be nice if we all worked closely like this on a more regular basis. Want to appreciate the Bill that is before us today. There have been many different iterations of this Bill of which I have had strong issues with all of them in the past.

Definitely understand that this has been shown to have benefit in certain populations. Our veterans being one, firefighters, you know, other first responders as well. You know, we've spoken about the carve out for pregnant patients. Look forward to seeing what those final amendments would look like. And just really appreciate the Bill that you've brought before us today.

Thank you.

You don't have to.

Vice Chair. Well, I want to thank the bipartisanship. That both the Senators have worked together to present this. And at the end of the day, our veterans, our public servants, have given. So much to our community, to our. State, to our nation. And because there's so much evidence that proves that these psychedelic treatments are transformative.

I think we owe them the right to try. And so I'm going to be supporting this today. And I will add that it is very untypical for me to support anything. Along these lines, but I've heard personal stories of how this transformed the lives of veterans suffering from severe ptsd, and. They deserve the right to try.

This is the third version of the Bill that I've seen in my short time here. And like the Doctor, the previous versions caused a lot of heartburn and concern. And, you know, it was very hard for me to get to the point of supporting the other bills. And each time it was decreasing and getting a little better.

And when I saw this Bill, I was like, well, I really have to work on it now as chair. Right. And we've had several conversations. Staff has worked very hard on this. And I wanted to make sure, like you mentioned in your opening statement, Senator, that there were guardrails here.

While I'm not a huge, huge fan and it's very atypical for me to support these kind of bills, I do recognize that we are moving in this direction.

The Veteran affairs, they themselves have already announced that they're going to be looking into doing work in this space to address the needs of our veterans, because what we don't want is just a bunch of drugs. Here, take this pill. Take this pill. That's usually, that's always been the VA or even in the service.

Right here is ibuprofen. And dry socks and I hope you're okay. And that's really. It never served as a firefighter, but I can imagine any paramilitary organization is going to be very similar experiences to what veterans or military service Members have experienced.

I don't, you know, I don't need to be convinced that ptsd, severe mental health is real in these kind of first responder kind of jobs and in the service. I understand that 100%.

This Bill, I think draws a very fine line in providing guardrails that are spelled out that we define who gets to participate because the original language had the possibility of VFWs and any other kind of organization to be participants and without having a licensed clinical expert.

And so the amendments that we provided is to ensure that we honed in on who was eligible to oversee them. And we're not creating service hubs. The Department is not creating service hubs across the, across the state. It's just saying that the UCs can work in this pilot in five different counties.

I appreciate the point of excluding certain individuals and who's appropriate to be the to participate in this. We added amendments to ensure that there's peer advocate and counseling and mental health services for individuals who want to participate on a volunteer basis is a volunteer basis of these pilot programs.

And we ensured that we provided guard roads to the UC systems and how to approach this because we didn't want to just leave it as a free for all for them to decide how it was going to be approached. We're going to be getting a report back. The Federal Government is working on this.

There's a lot of movement in this space. I do recognize the Federal Government is slow at times to get this moving. And I think I've heard we've been speaking on this for like three years almost now.

And I recognize that we need to get moving because in the past three years that we had conversation, nothing has happened in any other different level. So I am thinking thankful that you two came together on this.

I'm thankful that you took the amendments to provide the guardrails, which is how I got to a point of being able to support this Bill and recommending an aye vote. Gentlemen, Senators, you may close.

Thank you. I'm going to try to be brief and I think regarding the opposition's concerns, I think most of the concerns are addressed by those guardrails. Madam Chair, that you're speaking about.

One point of opposition I want to personally point out because it personally offends me when you say as opposition presents that we're using these Veterans as guinea pigs. That personally offends me. My grandfather was a POW from 1943 to 1945 and he had PTSD until the day he died in 1999.

My son in law is a police officer. My son is a firefighter. I serve on the board of a nonprofit called Cover Now Fund that stands beside families when they're left behind by suicide from a law enforcement officer.

Just since December this year, we've had seven female law enforcement officers across this country commit suicide, most of them with children to come to this Committee and say we're using these veterans after we've asked these veterans in their service to go into 300 combat missions. We've used them in 300 combat missions.

We've asked firefighters to run into fire, we've asked police officers to run into bullet fire. And some of them don't come out healthy when that happens. These veterans currently are seeking this treatment in third world countries. They're flying into the jungles of Central America. They're going into shanties in Mexico.

They're going to other places to find this treatment because it's the last resort for them. And somebody's come beside them and said, hey, try this. It might work. It is time for California to recognize that we are the leaders in the world on medical treatment.

It is unconscionable that we would send our military folks into battle across the world, have them come home and we not take care of them and they're having to choose to go across the world to get the treatment that they need. We should be doing it here. We should be finding the solutions here in California.

We should be coming up with the answers here in California. I thank you for your support and ask for each one of you for your aye vote. Thank you very much.

I will let my joint author's eloquent. Words stand as the close. I just want to thank our veterans and first responders for their service. Chair, thank you for your service. Respectfully ask for an aye vote.

When we have a quorum. We'll entertain a motion. Thank you so much. Thank you for the testimony. Thank you. Senator Cervantes, thank you for your patience. Is your time to shine. File number eight will be discussing SB313 now.

Thank you, Madam Chair and Committee Members for the opportunity to present Senate Bill 313. I One moment. Excuse me. I want to thank the Committee staff for their support on this bill. I am accepting the Committee amendments on pages 3 and 4 of the Committee analysis to be taken in the Senate Judiciary Committee.

SB 313 is a vital step towards protecting the privacy and security of California families. It makes a straightforward but important change. It moves the birthplace of a child's parent from the publicly accessible to port portion of a birth certificate to the confidential section accessible only to authorized individuals. This is more than an administrative fix.

It's a matter of personal privacy and data security, especially in a time when sensitive information is too often weaponized. What might seem like a small detail the birthplace of a parent can be misused to target, profile or discriminate.

Current law requires each live birth to be registered with the local register of births and deaths for the district in which the birth occurred and prescribes specific information to be listed on a certificate of live birth, including the full name, the sex of a child and the full the birthplace as well as the date of birth of each parent.

This bill does not interfere with data collection or public health reporting. SB313 simply ensures that information such as a parent's birthplace is treated like other sensitive personal data, kept confidential but still available to authorize public health officials and researchers as needed.

The California Department of Public Health already maintains a confidential section of each birth certificate for public health purposes. This bill moves the birthplace information of the parents to that protected section, aligning with the best practices for data privacy.

It is important to note that this bill does not limit the Department of Public Health or the Office of Vital Records from verifying documents or authenticating certificates. It preserves our authority while enhancing legal safeguards around personal information. The birth certificate is one of the first and most important legal documents a person receives.

It is used to obtain a passport, enroll in school, apply for a job, apply for other benefits and more. Birth certificates are issued by individual states, which are required by law to report annually vital statistics data to Federal Government.

Within each state, the management of birth certificates can be further decentralized with data collection and certificate issuance occurring at the county or municipal level. SB 313 is about balance. It's about preserving the integrity of public health data while fiercely protecting personal privacy.

It upholds our values and reflects our responsibility to defend every Californian's right to dignity and security. It is narrowly tailored approach that balances transparency and privacy. I respectfully ask for an Aye vote.

Thank you Senator. Any witnesses? Any #MeToos in support of the bill? Do we have any formal opposition to the bill? #MeToos opposed? Bring it back Senator, I love this bill. I actually would love to be added as a co author.

I think that's a great and creative approach to take in combating what's going on on the Federal side, Senator. Dr. Weber Pierson.

Thank you. Thank you, Chair. Everything's great. So, just had a question.

Give me one second. We have quorum now and I don't want to lose it. Let's establish quorum Committee.

Assistant, if you can call the roll, please.

[Roll Call]

Perfect. We have quorum. Senator, please proceed.

Thank you. So, just had a question and a little concern about who would be privy to this information if it's only on the confidential portion of the birth certificate form.

The same individuals, Public Health Department, folks who already have, that are already privy to everything else, such as Social Security information and other sensitive information. It doesn't change who is privy to it.

Right.

And I think that's one of my concerns because I was just looking at the kind of overview of the bill, and it said that confidential information for public use is typically not included on routine copies unless specifically requested by a person either named on their certificate, the parent who signed it or if no parent, signed, the mother.

So those are the only ones. The birth mother.

Yes, the birth parent. The birth person who. Yes.

So what if it's an adopted child? Or what if it's a. Well, you know, if same sex, which is not a female, or what if the mother has passed, so then the father doesn't have access to it. So I think there may be some unintended consequences by restricting that information, Senator.

And so you brought up the adopted. Those who petition to adopt are also eligible to request that information.

Okay, that's on page two of the analysis. Okay, so what's on the. So it's more than just the parent who signed it, the mother and the individual whose name is on the birth certificate.

It's the registrant, the parent who signed the certificate, or a person who has petitioned to adopt. The person.

Okay, so if the father hasn't signed it but isn't actually adopted, does he have access to it? And that's. I mean, that's current law now. Well, no, because right now the information is on the birth certificate.

Right. For private information. Yes, for private information. It's just the people that currently is in statute now. So the other parent by statute wouldn't be eligible.

The other parent by statute would not be eligible.

Yes, because that's. That bill's not looking to change that part.

I think that might be another bill that you all currently heard. That's.

No, this is. This is your bill. Okay. So because what we're talking about, who has access to that confidential section.

Right. But both parents can sign certificates.

They can. It doesn't always happen. Right. And so just wondering who would have access, Would someone who should have access to that information still have access to that information if they wanted it, since we're now putting it under that confid, or this bill, excuse me, would put it under that confidential section.

So I just think that might be something to kind of look at and see if it. Just to ensure that it covers the ability for all parents to have access to that information. If we're now moving it over to the. The confidential section.

Certainly happy to take a deeper dive on your concerns around that. Yes, thank you.

Thank you. Thank you, Madam Chair. And just a follow up, just so everybody's clear, I recently had a constituent that brought some information to me that on an adopted child that was given up at birth, the father did not sign the certificate and the mother did pass away for drug use.

Senator Grove.

And so then who has access? And I'm hoping that's where you're going, or did I misunderstand you? And that was just a perfect example of what happened. And we, you know, I don't know, we were able to get it easily because they came to us to do it.

But I just didn't know if this bill, if the concerns is this bill would limit that from happening. Just I think that's where she, the our colleague is going with it.

No, I certainly understand. We certainly have to do a little bit more work and having discussions on that front. But at the end of the day, this bill is just simply making sure that we remove the birthplace of origin from the parents where you actually have. I could give you a current example right here.

When you do fill out, this section here would be removed from just public view, and so it would just be listed as confidential. That is the meaning of this bill today. But we'll certainly look into what you just raised via your constituent that came to you and what, of course, Senator Weber alluded to.

Okay. I just wanted to say that I concur with what Senator Weber Pearson is saying because it does happen. I mean, it's rare, right? How many kids do you adopt where both parents are happening? You know, but it could happen, and then that creates a problem.

Through the Chair, if I may, the bill, I do want to say, doesn't change who has access. It's whatever's in statute that is, that remains. But we will get more clarity on that front.

Vice Chair.

So you know, obviously I've had a daughter signed a birth certificate. My mom passed away, needed to get a copy of her birth certificate. Is this going to prohibit people from accessing information, family from accessing information? It's not going to. Absolutely not, no.

Absolutely not. So again we're simply just addressing moving this information to the confidential portion. It doesn't reform birth certificates. So no, that will not happen. Okay, thank you.

Yeah, thank you for that clarity, Senator. Seems it's very simple the what's in statute now who can access confidential information is not being touched. Who signs the birth certificate is not being touched. Who is eligible to sign. The only thing is removing one thing from the public facing birth certificate to the confidential sector.

And again doesn't touch who is eligible to request that confidential information. But I think the author has annotated and taken into account a scenario that still exists. Whether this bill moves forward or not would still exist in this world. Now with that I'd like to give you opportunity.

Thank you for the comments from my Senate colleagues. I look forward to having continued discussion and hope I can count on your aye vote today.

We do have a quorum like to move the bill. Thank you. Moved by Senator Richardson. The motion in front of us is do pass and we refer to the Committee on Judiciary. Committee Assistant, please call the roll.

[Roll Call]

Senator, that has a 3 to 2. We're gonna leave it on call for right now. Thank you so much, Senator Cabaldin. Senator, when you are ready, you can start.

Thank you. Thank you. Madam Chair, I'm here to present SB339 and first I want to acknowledge and thank the Chair for collaboration to improve the Bill as well. California is in the midst of an STI epidemic and I wish this were just a rhetorical statement. Flourish. It comes directly from CDPH.

Over the past decade, California has seen a sharp rise in STI rates. In Los Angeles County alone, gonorrhea rates have risen by more than double and syphilis rates now have increased threefold. As of 2023, the county ranked sixth highest in the state in terms of per capita chlamydia cases.

And if we look to San Francisco, they've seen chlamydia and gonorrhea cases increase by 30% among men and early syphilis rates increase. By 120% among women aged 15 to 25. These increases are definitely not spread evenly throughout California or through about communities or evenly through communities of color. We're seeing massive equity gaps throughout the state as well.

What we know is that the best way to lower SDI rates is through access to testing into treatment. Yet as STI rates have been rising so dramatically in the past decade, we've been lowering the Medi Cal reimbursement rates for every single STI clinical lab test.

When providers can't afford to accept Medi Cal patients due to those rates, vulnerable populations lose access to STI testing, worsening the epidemic. SB339 would keep access to of those clinical health care services for low income Californians by restoring rates for STI clinical lab tests back to 100% of Medicare.

And it would also increase transparency for the triennial review by requiring the data set used for that purpose to calculate the rates to be published. So I respectfully urge an aye vote on SB339 and would like to, with the Chair's permission, turn to our lead witnesses from.

Thank you. Good afternoon. Angela Pontes, on behalf of Planned Parenthood affiliates of California, representing these seven Planned Parenthood affiliates across the state, serving patients from every county through 115 community health centers here today in support and as A sponsor of SB339, California Planned Parenthood health centers serve over 80% Medi Cal beneficiaries and our health centers alone provide over 2 million STI tests each year.

We are the number one provider of STI testing in the Medi Cal program. As the Senator said, STI rates in California have been increasing. We've reached epidemic levels increasing over the last five years. At the same time, the triennial review process at DHCS has resulted in multiple reductions to STI testing rates.

For example, in 2024, the review resulted in an 18% cut in MEDI Cal to STI testing codes and that was retroactively implemented to July 1, 2023. These cuts harm medical providers like us in two ways. Cutting the funding moving forward and also the clawback of the funds back to the retroactive date for Planned Parenthood.

This has resulted in reimbursement, reduced reimbursements by $7 million each year. In addition to that clawback, further, the data that is collected and the calculations used in the triennial review to establish these rates is not made public like is done at the federal level. This means that providers are unable to verify how the rates are calculated.

SB339 will help planned Parenthood and other medi Cal beneficiaries to stabilize their budgets and continue to provide timely STI testing and treatment for our state's most vulnerable patients, all while addressing the STI epidemic. We respectfully ask for your aye vote.

Are you here for technical support? Okay, Moral support. Any me toos in support of this Bill?

Good afternoon. Christy Foy here on behalf of the California Clinical Laboratory Association. In support. Thank you.

Craig Pulsipher on behalf of Equality California.

In support, Rosetta Lopez with UC Santa Cruz Planned Parenthood Generation Action. In support, Rylan Richmond with UC Santa Cruz Planned Parenthood Generation Action. In support, Valeria Barrera Verdusco from UC Santa Cruz Planned Parenthood General action. Elizabeth Molina, San Jose, California. I'm with Planned Parenthood Advocates, Marmonte and I'm in support Rochelle Rufo.

I'm with San Jose State University, Planned Parenthood in Action, and I'm here for support.

Thank you. See no other MeToos in support. Do we have any formal opposition? I see none. Oh, yes, there we go. If you're formal opposition. No. In support. You're wearing pink. .

Hi, my name is Iraya Gallegos. I'm part of UC Merced and I wanted to show my support for SB339. Yes, thank you.

Here we go. Yeah, we got room. We got time.

Sorry. Ryan Spencer with American College of OBGYNs and the California Society of Pathologists in support.

Any runners behind you? No. You didn't see any? That's it. Okay. Any formal opposition? I don't think I saw any. Any me toos. Opposed? See none either. Bringing it back. Colleagues. Good. It got moved by Senator Dr. Weber Pierson. Senator, you may close.

Just to say thanks to the the Generation Action young people from Santa Cruz, Merced and San Jose State and ask for, respectfully ask for an aye vote. Thank you.

Motion in front of us is do pass. And rerefer to the Committee on Judish. Please call the roll Committee Assistant.

[Roll Call]

Senator, that's four to zero. We're going to leave it on call for the rest of our colleagues to come back. Thank you so much for your time. We have no other authors, so we're going to turn to Committee authors. Calling on any other author who's presenting in Health Committee to please come on down. For now, we're going to turn to file item 14, SB 796.

Well, good afternoon, everyone. I almost feel like I should say good evening. First of all, I want to start off by thanking the Chair and staff who worked with myself and my team on this very important bill for all of us. Thank you for helping us to craft legislation that can be helpful not only to our first responders who are out there doing the work, but to the benefactors of those who receive the services. So let me start off by talking a little bit about this bill that we have before us.

When you look at the bill, the objective of SB 796 is to ensure that it reflects the critical importance of first aid and CPR training of California first responders. I hereby want to officially accept the Committee's amendments. SB 796 ensures that all state employees, excuse me, not all state employees. That all state employed peace officers, firefighters, and lifeguards have access to CPR and first aid training that meets the standards of the California Emergency Medical Services Authority, hereby named Cal EMSA.

By clarifying California's EMSA's role as the approving agency and establishing quality assurance requirements, this bill promotes safer and, most importantly, more consistent life saving practices across California's emergency workforce. And with that, I'd like to highlight a few key points about this bill.

SB 796 enhances emergency preparedness by allowing state employed peace officers, firefighters, and lifeguards to receive optional scope CPR and first aid training authorized directly by the California Emergency Medical Services Authority, ensuring that consistency, I mentioned, the high quality and instruction across all departments. SB 796 directs California EMSA to implement quality assurance and improvement measures to ensure training programs remain effective, evidence based, and aligned with current emergency medical standards.

Currently... Excuse me. Currently, state agencies such as CHP, CAL FIRE, and California State Parks employ first responders trained in public safety first aid, also known as PSFA, which requires a minimum of 21 hours of instruction. To operate a public safety first aid program, agencies must receive emergency medical services authority.

EMSA may also expand their programs by including the optional scope life saving skills such as Narcan for opioid overdoses, oxygen therapy, and gas exposure antidotes based on agency needs. So that's one of the additional things we want to make sure is available is the optional scope.

Again, that provides life saving skills such as Narcan, which many of us are learning about for opioid overdoses. Excuse me, too much cough medicine. Oxygen therapy and gas exposure antidotes. It is important to note California and Colorado, and this is a real key point for all Members.

It's important to note that California and Colorado are the only states that delegate EMS oversight to county level local EMS agencies, also known as LEMSAs. Unlike centralized models used in the other 48 states, LEMSA is a decentralized structure, which creates barriers such as state agencies must obtain separate approval from each local EMS agency to use optional scope skills even when those skills are identical across counties.

So envision this, authorized state employed peace officer, CHP, having to get approval from Long Beach, from Manhattan Beach, from any communities all along the way. And meanwhile, they can't provide these much necessary services that our community needs. Employees must reapply while transferring between counties, leading to delays and inefficiencies.

SB 796 removes these redundancies by granting EMSA the authority to approve statewide use of optional scope skills for state employed PSFA providers. This ensures seamless, consistent care across jurisdictions and eliminates unnecessary reapplications. By equipping first responders with EMSA backed portable training, SB 796 strengthens California's emergency response system and improves outcomes in life threatening situations.

SB 796 legislation underscores California's commitment to public safety and the workforce. It's not enough just to call 911. We got to give them the tools to be ready to help us. And that readiness is making sure our first responders have the tools, the training, and the flexibility they need to save lives where every second counts. With that, I'll pause for a moment to hear if you have any other witnesses who'd like to participate. Because I'm bringing this forward on behalf of the administration, I won't have the law enforcement testify.

Okay. Thank you. Any me toos in support? Okay. Do we have any formal opposition? Me toos in support or formal opposition? Come on. Okay, sure.

Hi. Darby Kernan. I represent the EMS Administrators Association of California. We are in opposition, but do believe the amendments that I believe are being taken help move the bill a long way. We've been meeting with the Senator's office and staff and had conversations with CHP.

And while we think the EMDAC and regulatory process is a way to go about this, we do understand that it takes some time to contact all of the different LEMSAs, and so we understand why they're doing legislation. We still think the process that exists today does work and is sufficient, but we understand why you're doing the bill. And while we're opposed, we're working with the office. Thank you.

Me toos in opposition? Coming back to the Committee. One second. I've learned I can't recognize the editors. Senator, thank you so much for bringing this bill forward. I 100% agree with you. If a CHP officer is going up and down a highway crossing various counties, that would be very frustrating to get 44 different LEMSAs approval for additional training.

I hear you with that. I didn't recognize. I think it was a good example talking about our state lifeguards, that one lake in particular could be surrounded by three different counties and would need three different LEMSAs to approve the certification.

I think it's good to have EMSA take the lead if this is a state employee and have the state overhead lead take the lead there as well. Thank you for taking the amendments to strike out the licensed individuals because that's additional training like the EMTs, paramedics, and I think that addressed some of the concerns of the opposition. Seeing no other conversation, I'll let you close.

Well, thank you for assisting me in closing there. To summarize, as our very fine Chair said, this is an issue with individuals who work in multiple counties, and we also must recognize that there is tough, we're having a very tough time fielding enough officers, CHP officers, lifeguards, and so on. And so adding this additional difficulty really means that the difference between someone who may need that care, and we need people trained and we need them trained now. And we need them trained.

We don't want to also lose sight that it's important to have the consistent training so that everyone is up to speed and has the best skills to be helpful. So with that, I respectfully ask for your aye vote and for us to give the confidence to all of our state employed law enforcement associates the opportunity to be fully equipped to do their job.