Assembly Standing Committee on Health

Good afternoon and welcome to the Assembly Health Committee hearing for April 29th. Before we begin, I want to make sure everyone understands our Committee rules to ensure we maintain order and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time.

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

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

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

As a reminder, primary witnesses in support must be those accompanying the author or who otherwise have registered a support opposition with the Committee and the primary witnesses in opposition must have their opposition registered with the Committee. All other support and opposition can be stated at the standing mic.

When called upon to simply state your name, affiliation and position. Additional testimony will also be in person and limited to name, position and organization. If you represent one. All testimony comments are limited to the Bill at hand. Some Housekeeping Items I would like to note that AB916 Lee has been pulled from today's hearing by the author.

Additionally, the following bills are proposed for consent for today's hearing. Any Member of the Committee may remove a Bill from consent on consent. We have item 5.

AB447 Mark Gonzalez with a motion of do pass as amended to Appropriations Item 10 AB585 Patterson with a motion of do pass to Appropriations Items item number 11 AB 682 by Ortega with a motion of do pass to Appropriations Item number 12 AB 725 Solache with a motion of do pass as amended to Appropriations Item number 14 AB886 Krell with a Motion of Do Pass to Appropriations Item 21 AB 1161 Harabedian with a Motion of do pass as amended to Appropriations Item number 23 AB 1199 Patterson with a motion of do pass as amended to Appropriations Item number 29 AB 1495 by Valencia with a motion of do pass to Appropriations with that when we have an author we shall start as a Subcommitee for this hearing.

Our Committee Member, Mark Gonzalez, Assembly Member, is going to present item number eight, AB554 thank you Assemblymember.

Thank you, Madam Chair and Members. I'm proud to present AB554, the PREPARE act in partnership with Assembly Member Matt Haney. I want to begin by thanking the Chair and the Committee staff for their thoughtful work and their collaboration.

AB 554 at a time when the Federal Government is actively working to roll back fundamental health care protections, California must continue to lead and AB554 does just that. AB554 protects and expands access to HIV prevention medications like PrEP, ensuring that patients and providers have the flexibility to choose the option that best meets their needs.

This includes expanding access to injectable prep, which studies show improves medication adherence and significantly reduces the spread of of HIV. The Bill also streamlines reimbursement for small community based clinics, the front lines of care for many and for the most vulnerable individuals. Under current practice, these clinics face major, major barriers in getting reimbursed for providing injectable prep.

A single vial can cost around $4,800, a prohibitive amount for many small clinics in my district and across the state, and often discouraging them from offering this vital prevention tool.

Join me today to highlight the impact of AB554 are Craig Pulischer with Legislative Director of Equality California, Miguel Miguel Batistas, Chief Deputy Legislative Director for the California Department of Insurance and to help answer any technical questions. I think Kate Fisher is on her way, so she's with the California Department of Insurance Office of Health Equity Access. I'll let one of you guys take it away.

Given the current composition of the Subcommitee. I think we will be okay without that testimony. Please go ahead.

Thank you. Good afternoon. Craig Polsberg on behalf of Equality California, Proud co Sponsor over the last several years we've been proud to work with this Committee and the Legislature to expand access to groundbreaking and highly effective HIV prevention medications, also known as Prep and PEP.

In 2019, California became the first state in the nation to prohibit prior authorization and step therapy requirements for these drugs except in very limited circumstances. We've since partnered with CDI and DMHC to ensure those protections are fully implemented alongside federal and state laws requiring non grandfathered health plans to cover preventive services like PREP without cost sharing.

But that progress is currently under threat. The Trump Administration is slashing federal funding for HIV prevention and the US Supreme Court is currently weighing whether to limit the authority of of the USPSTF to make preventive service recommendations. AB554 is a straightforward response to clarify and strengthen protections in existing law.

First, the Bill builds on existing protections prohibiting prior authorization or step therapy by applying these protections to all drugs approved by the FDA or recommended by the CDC. It also recognizes that several new injectable prep drugs are in the pipeline and makes clear that injectable medications of different durations are not therapeutically equivalent and must be covered accordingly.

Second, it codifies the existing requirement that non grandfathered health plans cover PREP without cost sharing and expands that requirement to grandfathered plans. And finally, the Bill includes a small but important change to improve reimbursement for injectable prep drugs.

To be clear, the vast majority of health plans in California are already in compliance with AB554 under existing law and regulations. The Bill simply shores up California's existing safeguards to ensure uninterrupted access to PREP for LGBTQ people, communities of color, and others who remain disproportionately impacted by the epidemic. And I respectfully urge your aye vote thank you.

You'll have two minutes.

Good afternoon Chair Committee Members. My name is Miguel Bastidas with the California Department of Insurance here on behalf of Insurance Commissioner Ricardo Lara.

As a Proud sponsor of AB 554, Commissioner I would like to thank Assembly Members Gonzalez and Haney for their leadership in authoring this critical measure with tremendous While tremendous progress has been made in reducing HIV transmission, HIV prevention activities have stalled in high risk communities.

We must ensure effective HIV prevention reaches all communities, especially those disproportionately affected by HIV, like communities of color. AB554 would eliminate barriers to these necessary and life saving medications. This Bill would expand access to HIV prevention in California while similar coverage is in peril for many others throughout the country due to the pending Braidwood decision.

It is vital that we lead the way and stand on our values by reducing barriers to life saving medications for all Californians at risk for HIV. On behalf of Commissioner Ricardo Lara, I respectfully ask for your aye vote thank you.

Thank you. Are there any others in support of this measure? Please come forward. State your name, affiliation and your position on the Bill only.

Thank you. Madam Chair Ryan Spencer on behalf of the American College of OBGYN's District 9 in support

Lang Lei Policy Advocate for Asian Americans Advancing Justice Southern California and strong support

Jennifer Snyder on behalf of the California Life Sciences in support

Good afternoon. Farrah Mc Daid Ting on behalf of the County Health Executives Association of California in support

Katie Van Dynes with Health Access California and support thank you.

Andy Stone with San Francisco AIDS foundation and on behalf of APLA Health and strong support. Thank you.

Thank you. Are there any primary witnesses in opposition? Please come forward. Thank you. Each have two minutes.

Thank you. Good afternoon. Chair Members. Matt Akin with the Association of California Life and Health Insurance Companies, regrettably with an opposed position on AB554. While we sincerely appreciate the intent of the Bill, our concern is focused on the impact this Bill would have on healthcare affordability.

According to the chiBIRP analysis, a AB 554 would increase premiums by nearly $136 million in year two at a time when California is grappling with rising health care costs. As many of you know, OHCA was established in 2022 in part to ensure healthcare is accessible and affordable for Californians.

In April of last year, OHCA's board approved approved a statewide spending target of 3% phased in over the next five years starting this year. We feel that adding expensive new mandates at this time could disrupt efforts to make healthcare more affordable and make it very difficult for health care entities to comply with the spending target.

For these reasons, we are opposed to AB554 today. But we do look forward to future conversations with author and staff if the Bill does move forward. Thank you.

Thank you. Are there any others who would like to. Oh, I'm so sorry. Please go ahead.

Thank you. Madam Chair. Members, my name is Olga Shiloh and I'm here on behalf of the California Association of Health Plans. I'd like to align my remarks with those of my colleagues colleague from ACLI and share our perspective on the Bill.

While we appreciate the goal of improving HIV prevention methods, we have concerns about the fiscal implications of benefit mandates at a time when the state is grappling with healthcare affordability and budget uncertainty at the state and federal levels.

Additionally, authorization for care and utilization review are fundamental tools to ensure that patients receive safe, high quality and affordable care. At this time, we must respectfully remain opposed to AB554. If the Bill moves forward, we are committed to continuing the dialogue and working with the author. Thank you for your consideration.

Thank you. Are there any others in opposition, Please come forward as me too. Seeing none, I will. Oop. Sorry.

Apologies. I'm not in opposition. I'm actually, actually here in support. Kelly Brooks, on behalf of the County Board of Supervisors of Santa Clara County. Just running between committees today.

Thanks. Thank you. Ms. Brooks. Seeing no others in support or opposition on this Bill, I'll bring it back to the Committee for comments or questions. Assembly Member Patterson.

Thank you. Just question, what is the Federal Government and Trump Administration doing to. Can you say that part again?

Yeah, so. So the piece I mentioned was the federal cuts to HIV prevention. So the Trump Administration just proposed, I think it was, you know, tens of millions of dollars in HIV prevention that were just slashed. The other piece that I mentioned was a case that's currently before the U.S.

Supreme Court that threatens the constitutionality of the U.S. preventive Services Task Force that makes recommendations on preventive services. And so essentially what we're doing, this Bill is codifying some of the protections that are in federal laws to make sure that regardless of what happens, the Trump Administration, the U.S. Supreme Court, those protections remain intact.

Okay. Yeah, I'm very familiar with the task force. I have legislation on that pass out of this Committee regarding colon cancer. And I think that's the much bigger threat to preventative services that we have in California. A very similar Bill like this was done last year. Trump wasn't President.

So, you know, we recognize the need for this service, irrespective of who's in the Administration. But I look forward to supporting this Bill again once again this year. Thanks.

Thank you. Assemblymember Patterson, seeing no other comments from the Committee. Assemblymember Gonzalez, I saw your head nod when we heard from the opposition on this Bill. I know that moving forward, you'll continue to make sure that we have an opportunity to protect HIV and AIDS preventative care as it is so incredibly crucial.

In your closing, would you like to perhaps address some of the comments offered by the opposition?

Sure. Without. And I appreciate you. Thank you, Madam Chair, and thank you, Members. I think there was kind of two different opinions by two different departments as to what the cost was and what was associated with overall people who have HIV, or was it categorized as other people who preventative pieces to it.

So I think we're going to figure that out together. I know you guys are part of that conversation as well on the insurance side. But basically, if the Bill helps prevent just 132 additional HIV infections in one year and 160 additional infections in two, the estimated cost would be completely offset.

So that that sort of offsets that piece of it in that conversation. But again, we are going to have a continuous dialogue on this piece about that today. But just to close out, we want to be clear that HIV remains one of the most prevalent sexual transmitted infections in California.

While medical advances have made HIV largely preventable, far too many individuals continue to be left behind. In 2022 alone, 57% of all new HIV diagnoses in California were among Latino individuals, a stark reminder that the epidemic still hits our communities of color the hardest. This is not just a challenge for the LGBT community.

HIV does not discriminate by zip code, background or identity. But unfortunately, our systems often do through limited access, outdated policies and financial barriers. AB554 is about changing that. It's about giving people real choices, equipping small clinics with the tools they need to protect lives, and ensuring that California continues to put public health over politics.

This Bill reaffirms California's commitment to ending the HIV epidemic for everyone everywhere else. I respectfully ask for your aye vote and for your partnership in the light to end HIV once and for all.

Thank you so much, Assemblymember and thank you for pointing out that the CHBIRP analysis, the kind of independent analysis that is done does the analysis based on the Bill as written. And I think in this instance there was a. There's obviously a component that's related to HIV prevention and another component that's related to AIDS prevention.

So I think moving forward, we will have to address that should your Bill get out of Committee with that, we don't have the ability to have a motion or a second at this time. And so thank you for your presentation. We will consider the Bill when we have quorum.

We're going to move on now to item number nine, AB577 by Wilson. And for those Members who are watching right now or their offices, Health Committee goes in file item order. And so if you see somebody that is presenting who is before you in file item order, you should come and hustle down. Thank you, Assemblymember Wilson. Whenever you're ready.

I think. There we go. Yes. Thank you. Madam Chair and Members, I'm pleased to speak with you today regarding AB577, a critical measure to put medical decisions back where they belong with physicians and their patients.

This Bill protects the right of physicians to administer and dispense vital medications, including injections, infusions and oral drugs, directly to their patients when deemed medically necessary. I would like to thank both the chair and the Committee staff for their diligent work on this Bill and confirm that I will be accepting all Committee amendments.

AB577 ensures that parents I'm sorry patients can receive timely, safe and personalized care from their trusted doctors. It strengthens patient safety, preserves continuity of care and recenters medical decisions between doctors and patients. Across California, we are seeing a troubling trend.

Health plans, insurers and pharmacy benefit managers are increasingly imposing policies that prevent doctors from administering medications directly in their offices. Policies that force vulnerable patients to travel to infusion centers or wait for home deliveries, delaying urgent treatments.

Imagine a cancer patient sitting in their Doctor's office prepared for a critical injection only to be told the drug can't be administered today because because of insurance rules or a senior with a history of severe allergic reactions to a variety of drug therapies being sent to an infusion pharmacy away from a Doctor who knows that patient's early sign of anaphylaxis.

Or an elderly cancer patient with poor eyesight who must drive to the health plan's vertically integrated pharmacy to pick up two anti nauseam pills simply because their physician isn't allowed by the health plan to dispense the necessary drug on site prior to the Administration of chemotherapy.

This is not patient centered care and this is not how we protect vulnerable communities. AB577 restores the role of the physician in making decisions about where and how a patient should safely receive treatment.

We have met with and listened carefully to opposition's concern and in response to this Bill now includes clear amendments to ensure that this Bill applies only to in network providers, requires patient consent, guarantees cost transparency and exempts hospital outpatient facilities. Additionally, we look forward to continuing engaging in conversations with all relevant stakeholders.

I would like to now introduce my two witnesses, Dr. Anthony Padula, a rheumatologist in private practice in Walnut Creek, California, and Cher Gonzalez with the Association of Northern California Oncologists and the Medical Oncologists Association of Southern California. We also have another witness who's available for expert testimony if there are any questions. Thank you.

You'll each have two minutes.

Thank you. Thank you for the opportunity to address you today. I sit before you as a physician who has cared for Californians over two decades. I've done this in a private, independent rheumatology practice in Walnut Creek, and I have the scars to prove it. Today I'm speaking on behalf of both my patients and my colleagues.

I'm here to express strong support for AB577. Every day in exam rooms across our state, we witness firsthand challenges facing our healthcare systems, hastened struggles to access care, affordable treatments and navigating complex insurance systems. Meanwhile, physicians battle administrative burdens that pull us away from what matters most time with patients.

One of the most concerning Trends is what AB577 addresses the practice of steering patients away from receiving medications in their physician's office to health plan owned infusion centers or pharmacies. This practice disrupts continuity of care, creates unnecessary boundaries, especially for vulnerable patients and prioritizes profits over patient well being.

I'm here to ask for your support of AB577 and your partnership in addressing multiple critical areas. First, we need to protect clinical decision making. AB577 properly recognizes that physicians should determine the most appropriate setting for a medication Administration based on the medical necessity, not the financial incentive for health plans.

The Bill ensures patients can receive injected or infused medications in their physician office when medically appropriate for medications that patients are self administered home, regular check ins with their physicians or medical staff provide crucial opportunities to address questions such as reviewing lab monitoring requirements, discussing safety practices, monitoring side effects.

PBMs simply do not provide this level of care. I've personally reached out to every pharmacy benefit manager over the years regarding concerning practices only to be told they have zero responsibility to the patient beyond their initial medical review. They don't ensure patients follow through with lab monitoring. They don't discuss the patient's underlying condition.

They merely read standardized medical information, typically delivered by representatives without significant medical qualifications, before directing their patient to call their Doctor with any questions. All while these PBMs earn more profit from dispensing a single medication to one patient for one month than I do in providing comprehensive care to that patient over five or 10 years time. That represents profit, not including the cost of the medication itself.

Thank you, I appreciate that.We'll move on to your testimony. Please.

Cher Gonzalez on behalf of my clients, the Association of Northern California Oncologists and the Medical Oncology Association of Southern California, which is just a very long way of saying I represent California's oncologists, I'm also here. They are the sponsors along with the rheumatologists of the Bill.

But I'm also here on behalf of my patient advocacy clients, the American Diabetes Association and the Hemophilia Council of California, who are also in support of the Bill. But I think even more importantly for me, I'm actually here as a patient. I'm here to advocate for myself today and I never get to do that.

So this is a lot of fun. I live with a very, very rare inflammatory disorder which causes me to go into anaphylaxis. And I actually go into the most serious form of anaphylaxis known as anaphylactic shock. And I've been seriously impacted by these PBM and health plan policies over the years. So I'll just leave it at that.

And if you have any questions about what it's like from the patient's perspective, because the good Doctor can answer all the questions about what it's like to be a Doctor and to fight for your client's life and run into a wall when it comes to these policies.

But I can answer any questions you might have about what it's like to be a patient and have to live with these policies. Thank you.

Thank you. Are there any others in support? Please come forward.

Angela Hill, the California Medical Association in support.

Ryan Spencer with the American College of OBGYN, District 9 and the California Podiatric Medical Association both in support. Thank you.

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

Thank you. Madam Chair John Wenger here on behalf of America's Health Insurance Plans. We do have an opposed position on the Bill, but want to thank the author for the initial conversations. And I'm sure there's more to come.

But as many of you know, specialty drugs are a significant driver of increased drug costs which are now 24 cents out of every dollar of premium. Physician offices play a role in the rising prescription drug prices.

Data shows that on average, the physician markup for specialty drugs ranges from $277 to $4,937 more than what a specialty pharmacy charges. On average, a physician Office charges about 23% more than specialty pharmacies for the same drug.

These significant and ever increasing markups are why employers and health plans have been looking for innovative ways to save patients money while protecting the patient care. Specialty pharmacy programs are developed and designed to avoid any delays in care.

Not all clinician administered drugs are eligible for these programs as they must be able to meet safety and distribution and Administration requirements. Specialty pharmacies have a myriad of safety guidelines that they must meet and they are developed to avoid the very delays in care that we are discussing today.

And we understand the author's concerns about policies that would prevent physicians from dispensing certain oral medications, such as anti nausea medication prior to administering an infusion. However, the provisions of the Bill are pretty broad and would impact all oral prescription medications, which is undermining pharmacy networks and we believe driving up costs.

Self administered oral prescription medications should not be treated the same way as injected or infused medications. If providers mark up these medications in the same way they do for the infused medications and patients and plan sponsors will have to bear that cost.

We recognize that the patient care is of the utmost importance of this Committee, as it should be. But we also need to recognize that we do have the Office of Healthcare affordability and a 3% growth target, and we do have to also meet that. And so unfortunately today we think the Bill is extremely broad.

But we do have a commitment to work with the author and discuss potential amendments on maybe finding a better balance. But as of today, we are opposed.

Thank you, Madam Chair Member Steffanie Watkins. On behalf of the Association of California Life and Health Insurance Companies. In the interest of time and given the long agenda, we'd like to align our convers our comments with ahib.

I think our primary concern really centers around what we've seen abuses of using these opportunities as a profit center, which I don't think serves patients or the system in total.

We would like to have those conversations going forward and see if there's a possibility and a pathway forward to see if we can narrow the Bill a bit and ensure that the patients are getting access to important medications, that we're ensuring that relationship with their provider at the same time that we're ensuring that the cost of the drugs that they're being provided are consistent with what we can otherwise provide through our specialty pharmacies.

So with that we would currently are opposed to the Bill, but look forward to conversations if the Bill moves forward today. Thank you.

Thank you. Are there any others in opposition? Please come forward.

Kelly Larue with resilient advocacy on behalf. Of the California Chamber of Commerce in. Opposition to the Bill in print. But look forward to reviewing the Committee amendments. Thank you.

Thank you.

Alison Ramey on behalf of the Pharmaceutical Care Management Association, also opposed.

Thank you. Seeing no other opposition or positions on the Bill, I will bring it back to the Committee for comments or question. Assemblymember Patterson

I just wanted to hear a response to the opposition, if you don't mind. Actually brought up some good points about raising the cost of pharmaceuticals which I think we share don't necessarily want to happen. So just would be interested in your response to that.

Agreed. Absolutely don't want that. I'll turn it over to the expert.

I think the numbers are specifically inaccurate. Costs from Medicare and medicines are APR plus 6% for administrative fees. If there is other gouging in the system that should be addressed. I've been in my practice 20 years and it's been that standard across all. Rheumatology practices across the state. I welcome them opening their books and showing the numbers.

And I do think and we'll go, we'll hear I'll go ahead and then I'll add on go ahead.

The FTC. Found in their investigation and I'm quoting the three big three PBMs marked up numerous specialty generic drugs dispensed at their affiliated pharmacies by quote, thousands of percent. I just don't think it's accurate.

And I think there's an opportunity as you know, type of Legislator that I work with opposition to address those justifiable concerns. So I think there's an opportunity there needs to be narrowing to ensure that we don't have, we don't Trade one Center for another. Happy to do that.

All right. I want to also just clarify that you've already taken significant amendments to narrow the Bill, as has indicated. Absolutely. Are there others that you just. If you want to be more specific about the amendments taken.

I think so. The amendments that have already been taken through this Committee fully support and justifiable.

What I'm saying is that I'm still having ongoing conversations with opposition and if they bring up something that I think is worthwhile to put into the Bill as we, if we have the opportunity to proceed, of course I will absolutely consider it.

I consider as a part of the legislative process to have that open door all the way through and we'll continue to have that stance as it relates to this Bill.

But I appreciate the amendments that have already been taken to address quite a bit of concerns, including concerns from this Committee and happy that they are included and we're accepting them fully today.

And just to clarify, it is one to make sure that we are focusing on applying Bill only to in network providers, contracted services and covered prescriptions, requiring the healthcare provider to determine that it's medically necessary as defined in existing law, and then also requiring healthcare provider physician's office to ensure that they're obtaining consent from the patient and disclose a good faith estimate of the enrollees. Right.

And the cost transparency. Did you mention that?

I didn't, but yes. Yeah, that was welcome. Thank you. All right, thank you so much. With that Assembly Member, would you like to close?

Thank you for the question. Thank you for the experts who are doing this work and those even receiving care. And to the opposition, I appreciate your goal in order to provide a patient centered care.

And this is, I think the goal of every everyone to be able to do that in a way that's transparent and truly benefits our patient. What I would say is by passing AB577, we affirm a California health care system that is patient first, physician guided and rooted in sound medical judgment.

Ultimately, this Bill is about standing up for patients and their right to timely care from the doctors they trust. At the appropriate time. I would ask for an aye vote.

Thank you, Assembly Member. At the appropriate time. You shall get a motion in a second on that. With that, we will move on to our next Bill item, which will be item number 7. AB546 Coloza. After Assembly Member close this Bill, we will be taking up the special order of business. Item number one. Button. Button.

Oh, button. It's on. No. Let me try that again. Good afternoon, Madam Chair Banta and colleagues I'm here to present AB546 or as I like to call it, Clean Air for All, which would require healthcare service plans to provide coverage for effective portable HEPA purifiers for our most vulnerable Members of the community.

I'm also proud to share that Speaker Rivas is also a principal co author of this Bill. I also want to thank Rosalynn Pullmano from the Speaker's Office for all her hard work on this.

I also wanted to share that I would like to thank the Chair and all of the Health Committee staff for all this their work on this Bill. I accept the amendments to narrow the scope of this Bill.

The recent wildfires in Los Angeles County have severely worsened air pollution and released dangerous pollutants like lead, asbestos and silica, all of which cause long term respiratory harm. I have experienced firsthand the health effects of wildfire smoke.

When I visited many of my constituents and surveyed the impact of the LA wildfires, my team and I moved with urgency for weeks to assist my community and delivered hundreds of water bottles and masks to assist various shelters, small businesses, senior centers and families in dire need of supplies, all while coping with the intensity of the situation.

Although I had my N95 mask to get me through the weeks that followed, the thought that wildfire smoke may have pushed my constituents with asthma, COPD and those who are pregnant to visit the emergency room to seek additional prescribed medication due to the unlivable conditions of the air quality in their own home really troubles me.

A 2024 study on California wildfires from 2008 to 2018 pointed out that over 55,000 Premature deaths are attributable to wildfires with an economic burden of 432 to 456 billion. The Medi Cal program recognizes that asthma remediation under CALAIM and coverage of asthma preventative services avoids unnecessary hospitalizations, emergency Department or urgent care visits or other high cost services.

As a California Health Benefits review program indicated, AB546 could lead to the following an improvement in respiratory health status for enrollees with asthma and a significant reduction in the use of steroids and inhalants an improvement in respiratory health status and quality of life for 2,600 enrollees with COPD, including nearly 500 fewer urgent care visits and an improvement in fetal growth and cognitive development for babies born an estimated 8,200 homes with pregnant enrollees.

So with that, AB 546 would ensure that our most vulnerable populations like pregnant women and people suffering from respiratory issues during a declared State of emergency can receive the essential devices that they need. And with me today to testify is Sofia Rafikova from Coalition for Clean Air.

Good afternoon, Chair Bonta and Committee Members. I'm Sofia Rafikova with the Coalition for Clean Air, and we are a statewide nonprofit working to protect public health, improve air quality and prevent climate change. When we think of poor air quality, we often think of outdoor air.

However, indoor air quality can often have a much more significant, if not greater, impact as Californians spend 87% of their time indoors, where the air can be up to 100 times more polluted than outdoor air.

Indoor air pollution emitted by cooking appliances, fireplaces, cleaning products, paint and building materials can cause a variety of health impacts ranging from headaches and eye irritation to respiratory and heart disease and cancer. Additionally, during wildfires, smoke can enter indoors through windows, doors and ventilation systems, increasing exposure to particular matter pollution inside.

This pollution is especially harmful for elderly people, pregnant women and children.

With studies showing that exposure to particulate matter can increase the risk of preterm birth and exasperate asthma and cardiovascular disease, this Bill offers a simple solution for protecting our most vulnerable populations from wildfire smoke exposure by requiring healthcare service plans to include coverage for high efficiency particulate air purifiers, also known as HEPA purifiers, for those who are pregnant or diagnosed with a respiratory disease.

These purifiers are able to remove 99.97% of microscopic particles floating in the air, hence why they're called highly efficient. HEPA purifiers are crucial for not only helping reduce asthma attacks and providing allergy relief, but also for protecting people from breathing smoke and soot inside their homes during a wildfire emergency.

In order to allow those struggling to breathe to feel safe in their homes, we urge you to vote Aye on AB546. Thank you.

Thank you. Are there any others in support of this measure? Please come forward.

Alan Abs with the Bay Area Air Quality Management District in support.

Kelly Brooks, on behalf of the County Of Santa Clara in support.

Thank you. Are there any primary witnesses in opposition?

Madam Chairman, Members Stephanie Watkins, on behalf of the Association of California Life and Health Insurance Companies. Regrettably, we are here today in opposition. While we very much appreciate the most recent amendments are in the process of discussing those with our Members, we remain concerned with the precedent the Bill sets.

Specifically, as drafted 546 not only exceeds the existing EHBs, but it appears to set a new standard for coverage tying access to specific disaster designation. While we certainly appreciate the author's intent, as many of our Family and friends have been impacted by the devastating wildfires California has experienced over the last decade.

We remain concerned that expanding coverage outside of the current essential health care benchmark conversation undermines the work we are currently doing. We believe that focusing on updating the essential health benefits allows for a more comprehensive and thoughtful approach when determining benefits while we continue to grapple with the rising cost of health care and budget shortfalls.

For those reasons, we are opposed to the Bill in print, but remain committed to working with the author and the sponsor if the Bill moves forward today.

Thank you. Thank you. Are there any others in opposition? Please come forward as metoos.

Olga Shilo. On behalf of the California Association of Helplines. And we are opposed.

Thank you. Seeing no other opposition, I'll bring it back to the Committee for comment or question. Assembly Member Kos, I know that you are are working very hard to be able to serve your district and as a part of the co the Members who are part of the Southern California California delegation.

I know that you care deeply about wanting to make sure that we are doing our basic need to make sure that we have clear air quality and that we're addressing the toxic air that comes after our wildfires.

And with that, I want on behalf of your constituents and our California constituents, I want to thank you for doing that.

And of course you have the co authorship of the speaker on this Bill and also want to recognize you for making being responsive to the chip work analysis which indicated that it was very helpful to relook at the scope of this Bill. With that, would you like to provide any closing comments?

Thank you, Madam Chair, for just your leadership on this Committee and you know, looking forward to hopefully getting this Bill out of Committee. There's a lot of people depending on us to ensure that they have coverage for the things that are most essential to them. And we can't wait until another disaster happens to take action. So respectfully ask for your aye vote. Thank you.

Thank you. And when we have quorum we will do that. Although do is there a motion in a second that we can entertain right now, Gonzalez and Patel, that we will hold when we have quorum. Thank you. Okay, we are going to move now onto the special order of business. Item one. AB224. Thank you Committee Members.

I'm very pleased to present AB224. The Affordable Care Act requires health plans sold in the individual and small group markets to offer a comprehensive package of items and services known as essential health benefits or EHBs.

Under the federal legislation, each state has the authority to choose its benchmark EHB plan, which details the EHBs that must be included in the scope of benefits for each health plan. California's current EHB benchmark plan does not include coverage for a variety of benefits such as hearing aids, infertility treatment, or durable medical equipment.

In order to change California's EHBs, the state was required to update its existing benchmark plan through a review process, which included an actuarial analysis and stakeholder process. That process began in June 2024 when the Department of Managed Healthcare held their first public meeting.

The process included an actuarial analysis, subsequent public meetings, a legislative hearing, and a public comments period. California has completed its review process and is now in the process of submitting a proposal to the Federal Government to CMS to add hearing aids in fertility treatment and durable medical equipment to California's EHB benchmark plan.

In order for new benefits to be in place for the 2027 plan year, the state must now notify the Federal Government of its proposed plan by May of this year. This Bill will codify these new HBs in that if that proposal is approved.

With me to testify today are Mary Watanabe, Director of the Department of Managed Health Care, and we also have Sarah Ream, Chief Counsel with D DMHC for any technical questions.

Thank you. You may proceed.

Good afternoon. Mary Watanabe, Director of the Department of Managed Healthcare over the last year, the Administration and Legislature have worked collaboratively on a process to up the state, update the state's benchmark plan, and expand the services included in California's essential health benefits, or what we Refer to as EHBs.

The process has included a series of public meetings and opportunities for public comment. As noted, we held public meetings on June 27th of 2024 and January 28th of 25. The Legislature held a Joint Hearing on February 11th of 2025.

Through the public meetings and subsequent public comment, we have narrowed the list of benefits to add to California's benchmark plan. The final benefits, selected by both the Administration and the Legislature include services to evaluate, diagnose and treat infertility.

This includes in vitro fertilization and artificial insemination, an annual hearing exam, and one hearing aid for each year every three years. And we're proposing to expand the durable medical equipment benefit to include coverage for mobility devices such as walkers, manual and power wheelchairs, scooters, hospital beds, portable oxygen and augmented communication devices.

On March 28th of this year, we released the draft documents that we plan to submit to CMS to update the California's Benchmark plan. For one final comment period. Based on the comments we received, we are making two non substantive updates to the documents.

We will update the actuarial report to clarify that fertility services will cover donor sperm and eggs for both artificial insemination and in vitro fertilization.

We will also update the summary document to clarify that health plans are required to cover behavioral health services when provided by physicians or other providers who are licensed healthcare professionals acting within scope of their license. The one modification is that this will include trainees and associates who provide services under supervision.

The DMHC has the Administration support to move forward with submitting California's application to CMS by May 7th. Just next week, the Legislature will need to codify the new benefits and statute which is the subject of AB224. If approved by CMS, the new benchmark plan would take effect January 1st of 2027. Thank you.

Okay, next. Now we'll go into public comment. Witnesses to testify in support. Just please state your name, your organization and your position only. Come on up.

Good afternoon chair Members Sandra Poole, Western Center on Law and Poverty and support .

Good Afternoon chair Members Beth Malinowski, the SEIU California in support

good afternoon. Dr. Ruben Alvero from the American Society for Reproductive Medicine in support

good afternoon. Christine Smith, Health Access California in support.

Alice Kessler on behalf of Equality California. Also on behalf of Resolve, the National Infertility Association and the Alliance for Fertility Preservation. Thank you.

Elise Borth here on behalf of the California Academy of Audiology and support.

Nora Angeles is with Children Now in Support.

Allison Ramey on behalf of the California Dental Association with the support if amended position looking that dental be included. Thank you.

Johanna Wonderly parent here in support. Captain. Wonderly support My name. Kaitlyn Wonder and. Support. My name is Kara Wonderley and. This I support.

Caprice Schuler in support.

Ryan Spencer, on behalf of the California Association Of Medical Product Suppliers and Support.

Dream.Org I support.

Good afternoon. My name is Jamir Watson. I'm an advocate for disabilities and I'm deaf and I strongly support this. Thank you.

My name is Scotus. My brother Jalen. We strongly support Every kid should be able to hear. Thank you.

Hello. George Villa with motivating individual leadership for public advancement and full.

Hi, my name is Claudia Garcia and. As parent of twins I support.

Ronald Coleman Baeza here on behalf of the California Pan Ethnic Health Network. CPEN we have a supportive amended position but appreciate the author for bringing this forward and would have hoped to see dental included. Thank you.

Thank you. Are there any other witnesses in support? Any other witnesses in support? Okay. With that, are there any witnesses in opposition to testify? Are there any other opposition witnesses to testify? Okay, seeing none. Are there any additional opposition witnesses just to say their name or organization and position? Okay, seeing none.

I'll bring it back to the Committee. Any Members have any questions for the author? Ms. Patel, the floor is yours.

As a school board trustee, I am really grateful that you've brought this former school board trustee, that you've brought this build forward. I can't tell you how many times I've heard about children needing to be able to hear to access their learning in the classroom.

In fact, it was years ago when I wrote a letter of support to a Bill just addressing hearing aids. However, I am very thankful to see you making the approach through this pathway and when the time is appropriate, I would like to make the motion to approve. Thank you Mr.

Patterson. Great, thanks. Appreciate the opportunity. You know, I supported last year, particularly the legislation to require hearing aid coverage for children. And you know, unfortunately that was vetoed by the Governor and so we're left with no other choice but to go this route. I think that's what his veto message said.

But regarding federal subsidies that go to our coverage here in California and you know, a lot of talk here about the questions about, you know, exactly what the Federal Government's going to do and what would we do if subsidies are reduced and it forces, you know, less people are able to afford Covered California, for example, what's the plan if that happens?

Should we, does this, should this Bill happen this year or should we wait for some certainty from the Federal Government?

Yeah, I appreciate both your former legislation last year Assemblymember that was very happy to support. And the question, you know, I think we have been operating for a while under this, the specter of the many variables associated with the Federal Government's approach to funding our health care system.

And as we were thinking about moving forward with providing the benchmarking plan this year in legislation, it really came down to ensuring that we would have an opportunity to be able to submit benchmarking proposal to CMS this year, recognizing that it wouldn't go into effect until 2027. So there is a delay associated with delaying even further.

So there's a legislation moving forward on the Senate side as well as the Assembly side. And we've had a lot of conversations with DMHC and the Administration to really think about how to approach this question, which is very legitimate in terms of what might happen.

We will always have the opportunity to submit this and, and then we will have to wait for a response from the Federal Government. And certainly there will be consequences to this particular benchmarking plan as there will be consequences with whatever decisions are made about the waivers to the ACA and quite frankly as you know also Medicare. Medi Cal.

Yeah. Is there. Well thank you for that. I really appreciate it. Have we yet had or DMHC had conversations with the Federal Government yet? Do we know Is there any insight from the Federal Government? Have conversations occurred?

Yes, we've been having conversations with them. On an informal basis. We've asked them for input on the template forms that they're using, confirming that the templates that are online are the templates that are still valid, letting them know that we are going to submit.

They seemed they expressed pleasure that they heard when we were we were going to submit. But we won't know exactly what the process will be until we submit those documents to them next week.

Great. Thank you.

Any other questions from any Members commentary? No. Okay. See none. Bonta you may close.

I respectfully request your aye votes.

This is a a Bill that we have worked a lot on across the both the Senate and the Assembly with also consideration from our respective budget sub chairs on this and very much appreciate as well the Speaker's engagement in Speaker's office engagement in this as well and very thankful for DMHC and the guiding both technical assistance and willingness to make sure that we had an opportunity to have a very robust stakeholder process to be able to shape the ultimate benchmark marking plan.

So I want to thank you all for your service and your work as well. With that I respectfully request your aye vote.

Vote thank you so much and we will take that up as soon as we have quorum. Thank you.

I think the only other author in. The room is Mr. Haridian on AB 1032. You could take the mic, please. And if you have any witnesses in support of your.

I do. And she's making her way up. Should I wait for the real chair to take the. To take the chair or. No, I will just go. I'm being much nicer. Yes, I know. Well, maybe I would first just like to thank Madam Chair for all her support with this Bill. The Committee staff work on the Bill.

I will be accepting the amendments and really for the chair's work from the day that the wildfires happen to support this effort and really talking me and everyone involved through a lot of the challenges that a lot of the victims of the wildfires had on the mental health and behavioral health front.

So personally, I just want to thank you, Madam Chair, for your efforts and just your care. I want to thank the speaker as well and his staff for their partnership as they are a joint author of this Bill. AB 1032 wildfires in California leave more than physical destruction, they cause lasting emotional and psychological harm.

The fires in Eaton and Palisades have claimed 30 lives, destroyed over 18,000 buildings, and caused nearly $30 billion in damages, leaving thousands in crisis.

The California Department of Health reports that emotional recovery following a wildfire is especially challenging, with studies showing a significant increase in emergency room visits for anxiety, depression, PTSD and substance use disorders in the aftermath. Yet in these moments, access to behavioral health services is often severely strained.

We saw this on the ground during just one week in January following the year's wildfires. California Parent and Youth Help Hotline saw a dramatic increase in calls for help. Overnight calls surged by 366%, live chats increased by nearly 70%, and text message pleas for help rose nearly 50%.

AB1032 responds directly to this need by ensuring access to care for those recovering from wildfire trauma. AB1032 helps those coping with the aftermath of wildfires by requiring healthcare service plans and insurers to reimburse eligible enrollees for for up to 12 additional visits per year with a licensed behavioral health provider.

This applies on or after January 12026 if the enrollee is in a county where a local or state emergency has been declared due to wildfires. AB1032 also specifies that an enrollee is entitled to these benefits until one year from the date the local or state emergency is lifted. There's always a question of need.

Is this actually needed? There was a survey of over 10,000 CalPERS Members and it revealed that more than half considered seeking behavioral health care. Among those who received care, 61% were unable to get in plan treatment within two weeks, and 46% identified difficulty finding a provider as the biggest barrier to care.

More than half received care outside their health plan. As noted in the CHERB and Committee analysis, enrollees in commercial and CalPERS policies captured under this Bill do have coverage for behavioral health visits, regardless of whether or not there is a wildfire.

None have coverage, however, that allows them to see any licensed behavioral health provider contracted with their plan or not and be reimbursed for that visit. This Bill fills that gap. It removes barriers and expands access to timely trauma informed care from any licensed behavioral health provider, not just those in network.

AB 1032 provides a vital lifeline, ensuring survivors get the help they need to heal, rebuild, and move forward. Here with me to testify and Support is the CEO of the California Behavioral Health Association, Dr. Leandra Clark Harvey.

Good afternoon, chair and Members. I am Dr. Le Ondra Clark Harvey. I'm a psychologist and I'm the CEO of the California Behavioral Health Association. We represent mental health and substance use disorder organizations across the state that provide services to 2 million Californians each year.

Of our Members in the LA metro areas that were impacted by the most recent fires, 71% lost property, 30% of their clients lost property, and 43% of the agencies had some type of major disruption in service because of this tragedy. That's why I'm here today to express strong support for AB 1032.

We believe that this Bill offers clear, narrowly tailored solution that is focused on ensuring timely short term behavioral health care while communities rebuild their lives. This is so important because when wildfires tear through our communities, we often focus on what we can see. The homes that were lost, the neighborhoods that were changed.

But for thousands of Californians, the harm that we don't see is just as, if not more devastating. Fear, trauma and grief. These experiences leave deep emotional scars that don't disappear when the fires are out. The impact of this trauma can last for months and sometimes years.

Research from UC Davis and the California Department of Public Health show that mental health demand in affected counties surged for at least a year after the 2018 camp fires. And the American Psychological Association has similarly found that wildfires lead to significant behavioral health impacts in communities, especially for people who lose homes or have prolonged displacement.

So AB 1032 acknowledges this truth. It ensures that after a wildfire emergency is declared, individuals can access visits with a licensed behavioral health provider not months later, not after jumping through hoops. But when they need it most, mental health shouldn't be secondary to physical safety. Survivors deserve easy access, not delayed care during these moments of incredible vulnerability.

We believe that this Bill ensures that when our communities face the worst, we are ready to respond with compassion and urgency. So on behalf of the California Behavioral Health Association and all of those affected by California wildfires who will better be served by this Bill, we respectfully urge you to support AB 1032. Thank you.

Thank you. Are there any others in support of this measure? Please come forward.

Thank you. Madam Chair. Eduardo Martinez on behalf of AltaMed Health Services and strong support.

Good afternoon. Angie Minetti with the Steinberg Institute in support.

Good afternoon. Omer Altamimi at the California Pan Ethnic Health Network in support.

Hi. Julie Nielsen with the National Union of Healthcare Workers and also for the Kennedy Forum And support.

Jorge Cruz with the California Behavioral Health Association and support.

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

Thank you, Madam Chair. Members, my name is Olga Shilo. I'm here on behalf of the California Association of Health Plans. We recognize the behavioral health impacts that wildfires have on affected communities. However, we must respectfully express our opposition to AB 1032 as currently in print.

California and federal law already required that mental health, health and substance use disorder services be covered at parity with physical health care, and medically necessary behavioral health services must be provided with our arbitrary limits. Furthermore, existing law already provides mechanisms to support displaced enrollees and ensure continuity of care.

Unfortunately, this Bill appears to undermine existing protections and introduce unnecessary complexity into well established standards. The bill's selective benefit structure could inadvertently worsen disparities.

AB 1032 limits behavioral health benefits only to individuals in counties affected by wildfires, benefits only those who already have insurance coverage and the means to access care, while at the same time exempts medical enrollees. AB 1032 risks layering on complexity, disrupting existing protections and unintentionally creating new inequities.

For these reasons, we remain opposed, but are committed to working with the author if the Bill moves forward. Thank you for your consideration. Thank you.

Madam Chair and Member Steffanie Watkins, on behalf of the Association of California Life and Health Insurance Companies, we too are regrettably here in opposition. While we appreciate the intent and understand the impact that wildfires have had on our communities, we again are concerned about setting a precedent where we're tying specific access to a specific disaster designation.

As my colleague mentioned, under AB 2941, California currently requires plans and insurers to file a notice with the regulator anytime an emergency declaration has the potential to displace any enrollees or insureds.

Specifically, this notification must include information demonstrating that enrollees insureds have access to medically necessary health care in affected areas, including how we will provide displaced insureds with access to medically necessary health services, how we will ensure access to medically appropriate care from a qualified provider, and if care cannot be provided within the network.

The insurer must arrange for available and accessible providers outside the network with the patients responsible only for the amount equal to in network cost sharing. The insurer's plans for communicating with the insured have to be enumerated regarding options available during the emergency, including providing a toll free telephone number.

Because of the nature of these emergencies, we must file these notifications within 48 hours of a declaration by the Governor understanding what is currently required we are confused as to the problem this Bill is intending to address.

In addition to this Bill seems to want to treat one type of disaster differently than all others which creates a concern with respect to equity and access. For those reasons we are opposed to the Bill today, but do look forward to having continued conversations if the Bill moves forward today. Thank you.

Thank you. Are there any others in opposition? Please come forward. Seeing none. I'll bring it back to the Committee for any questions or comments. First Assemblymember Harabide and I just want to recognize you and the work that you have been able to do to support your community.

I don't know a first time first four week Assembly Member who has had to take on the challenge that you have in support of your constituents and our collective constituents in Southern California in Eaton with the Eaton fire and also the Palisades fire.

So I want to appreciate you for moving very quickly into response mode and then also foresight mode to be able to really consider this second phase of recovery where we are going to have to grapple with the ongoing mental health concerns for not only the survivors but the first responders who are really struggling in this moment.

As to your witnesses point have been devastated. There's a collective community devastation that's layered into this. So I want to thank you for bringing forward this very thoughtful Bill. I know mental health is an area of passion and interest for you as a Legislator and bringing forth this Bill along with the co authorship of the Speaker.

In so doing I do want to just give you an opportunity to address the opposition's concerns about the the reality of this being something that is impacting a specific moment in time and segment of the community for our consideration.

Thank you, Madam Chair. I couldn't have said it better than what you just summarized. So thank you for that. And I would say on a few of those points, One, we obviously believe that access to immediate behavioral health services and care should be given to all patients in all disasters.

So the obvious conclusion for one of the points of contention is to expand this and make it bigger and obviously have any type of disaster applicable. If the plans and the providers are willing to do that, we would love to see it.

I would also say that this idea that it's a solution looking for a problem, I hear every day, and I know many of you do, from Members of our communities who cannot get behavioral health services under their plan without constant delay, barriers to that care. And it is a problem in the best of circumstances.

When there is a disaster like a wildfire, it is life altering. And I think the problem that we're trying to solve is very clear. People who aren't able to access this care in a week, in two weeks, three weeks or a month are left in dire consequences.

And frankly, the cost of that delay is much bigger than the cost that Chaburb has identified. So I think that we will continue to work with the other side. I think we are all on the same page that we want to get any patient who needs behavioral health services the care they need quickly.

And it's just a matter of doing it in the most efficient way. So I appreciate them being here and we'll continue to work with them.

Thank you. And can we use that as your close Assembly Member?

I would, I would respectfully ask for an aye vote. Thank you, Madam Chair.

Thank you so much. Appreciate it. And can I have a motion and a second contemplated for future Moved by Gonzalez, seconded by Crell. Thank you. And with that, Assemblymember, thank you so much for the presentation and the commitment. And we will move on to our next item, which will be Assembly Member Soria, item number 13, AB849.

Thank you, chair and Members. AB849 requires healthcare facilities to provide trained chaperones for ultrasound examinations of sensitive areas and establishes the facility's responsibility to educate chaperones on how to identify and intervene against abusive behavior. Under current law, health facilities in California are not required to offer chaperones for any sensitive examinations.

Many facilities have established their own internal policies for when and if chaperones are required or suggested, but specific details vary widely. Even in facilities that have formal policies, chaperones are not always provided with instruction on what to look out for and what to do if they witness something concerning.

I was motivated to author this Bill after hearing the horrific stories of women from my district who came forward to share their accounts of an ultrasound technician praying on them while they were most vulnerable, and who is now on trial for their alleged crimes.

Over a period of years, at least 10 women have reported being sexually abused by this man under the guise of medically necessary ultrasound examinations.

In several cases, chaperones were were present, but they later testified that they received no training on issues as fundamental as where to stand, what to look out for, and what to do if they noticed something was wrong.

On other occasions, the ultrasound technician was allowed to dismiss the chaperone midway through the examination, leaving no third party to observe or intervene. And of course, there were also cases where no chaperone was present, nor was the patient ever afforded to have one provided.

These profound betrayals of the sacred trust that patients place in those who are supposed to heal and care for them can have devastating and lasting consequences.

One of the women who was allegedly preyed on by the ultrasound tech in my district was so deeply traumatized that she could not bring herself to go back to her city's only hospital to receive the treatment for an underlying health issue and so died as a result.

AB849 requires a patient to be provided notice that a trained chaperone is available upon request to be present an ultrasound examination of certain sensitive areas.

It further requires that staff who may serve as medical chaperones must be educated by their facility on appropriate techniques to observe the examination, when and how to intervene when they identify concerning acts and the procedures to report any inappropriate behavior.

AB849 provides vital safeguards during highly vulnerable examination to protect patients and ensures that the relationship between patients and medical providers is one of trust and transparency that promotes healing and safety.

Here with me to testify in support of AB849 is Sally Gonzalez, a survivor of the abuses at Los Banos at the Los Banos Hospital, here to let to share with you her story.

Thank you. You'll have two minutes. Good afternoon, chair and Members. My name is Sally Gonzalez. Back In May of 2020, I had gone to Sutter Health Memorial Hospital emergency room for lower abdominal pain. The that had lasted for several days, so a vaginal ultrasound was ordered. Instead of getting help, I was sexually assaulted by the ultrasound tech.

My mind was racing and I began questioning myself. I was frozen, unable to utter a sound. All I could do was search with my eyes for the female chaperone who was in the room, hoping she'd notice what he was doing to me.

But she was facing away from myself and the ultrasound tech, entirely engaged in her phone and completely oblivious to what was happening. Later, I learned that in that hospital, chaperones aren't required to receive any actual training on what to do or look out for other than being physically present in the room. They had no responsibility.

Chaperones like herself need to receive proper training so that they know where to stand and what to look out for. They need to have the knowledge of proper procedure for these types of ultrasounds. If the chaperone in my room had been given proper training or any training at all, maybe she could have helped me and stopped him.

And if the man who assaulted me knew she was trained to notice and prevent acts like his, maybe he wouldn't have felt like he could have gotten away with it with violating myself and others like me. I know we can't always stop men like him from violating women like myself.

But what we can do is make sure we aren't alone and are protected during these vulnerable moments. For these reasons, I strongly urge your aye vote on AB 848. Thank you.

Thank you so much for the testimony. Are there any others in support of this measure? Please come forward. Are there any primary witnesses in opposition? Any metoos in opposition? Seeing none. These are me toos in opposition.

Vanessa Gonzalez with the California Hospital Association here with an opposed unless amended position. I would like to thank the author for working with us to address several of our concerns. However, we do remain concerned with the increased staffing challenges that will result from this Bill and that our hospitals won't have enough staff to meet the requirement.

However, we are we do remain committed to working with the authority. A workable solution. Thank you.

Thank you.

Thank you, Madam Chair. Member Sarah Bridge, on behalf of the Association of California Healthcare Districts, also here. Respectfully, oppose unless amended, echo the comments of those made by the California Hospital Association. Thank you.

George Soares with the California Medical Association. No official position today, but just some. Concerns with the recent amendments.

With that, I will bring it back to the Committee for any questions or comments.

I just want to thank the author for bringing this Bill. It's really important. I appreciate it. I support it and would love to. Be added as a co author.

Well, I want to thank Assemblymember Soria for your bringing for this Bill and I just want to acknowledge the testimony offered by your witness. I know that it's incredibly challenging to be able to be here and to speak to the incredibly the hardship and the experience that you had and I want to thank you for being here.

It's always very powerful and I know Assemblymember you are seeking to be able to address something that is hitting your district as you always do, providing legislation that comes straight from the needs of your district and your constituents.

And I want to thank you for that as well and for really trying to strike the balance between what you heard from opposition in negotiations around the potential impact on providers, but also wanting to ensure patient safety throughout the experience. So with that, would you like to close?

Thank you so much for the comments and I respectfully ask for an aye vote.

Thank you. Is there anyone who will motion and second CRE and Stephanie, thank you. When appropriate. Thank you so much.

Thank you.

We're going to move be moving on to item 22, AB 1196. Assembly Member Gallagher zero, perhaps not. One moment please. While we are waiting, I want to encourage all authors to come to the hearing room.

We are moving at a very good and steady clip in Assembly health here and would very much appreciate having authors to be able to have this Committee review your very well thought and hard fought pieces of legislation. Thank you. Minority Leader Gallagher, whenever you're ready.

Thank you Madam Chair. I appreciate your patience and want to make sure I got our witnesses here and I also want to thank the chair and the Committee for working with us on this Bill and we will be accepting the Committee's amendments that I think help get to the strike the right balance and help get us to the solution here.

So I'm proud to present AB 1196. You know, extracorporeal bypass is what I've learned is a process sometimes used during heart surgery that allows a CPB circuit, also known as a heart lung machine, to take over and functions as the heart and lungs.

This is done when surgeons need the heart and their lungs to remain still during surgery. So it's a very specialized procedure.

But current California regulations require this kind of surgery to be performed with three surgeons present and is not always possible and it takes up a lot of time, certainly a lot of doctors that we need in hospitals. So it can be burdensome when in many cases it may not be necessary.

So this regulation dates back to the 1970s and the heart lung machine began to be semi regularly produced in the 1960s and has continued to grow in safety and effectiveness ever since. And despite this, we still use the same regulations when we're doing this procedure.

California is the only state right now that requires three surgeons for this surgery. Most states don't even require two. California regulations also require only one of the three surgeons to be a heart surgeon. This made sense when several decades ago the idea of a heart surgeon or any specialized surgeon was a new idea.

But now it seems unnecessarily burdensome to require surgeons, often of other specialties to be present for a heart surgery when a physician's assistant or registered nurse is just as qualified to assist.

I'm sure we're all aware of the staffing shortages that California hospitals are dealing with, and so we want to update these regulations to really help provide for that flexibility and for the technology that's come and the specialties that we have.

Many hospitals don't have three surgeons at their facility full time and need to bring in a second and third surgeon from a different hospital you can imagine in some of our rural hospitals. So AB 1196 would require the Department of Public Health to update these regulations. And that's the compromise that we came to with the Committee.

Update those regulations, make that a priority, and the Department must complete this update within three years. So I think it's a reasonable measure to help with this procedure and to help save us staff and surgeon time in our hospitals that are already very overburdened at this time. So as for your aye vote.

And with me to testify today is Mike Wiltermood, the CEO of Enloe Health, and Vanessa Gonzalez with the California Hospital Association.

Thank you. You'll each have two minutes.

Well, thank you. At the risk of repeating everything Assemblyman Gallagher said, I just want to reiterate that this is a section of Title 22 that is in desperate need of revamping. And so we fully support the provisions of AB 1196.

You know, we believe that advancements in surgical techniques, technology and medical management have dramatically improved since the 60s and 70s. And we've got as opposed to 50% mortality rates in the 60s, we now have less than 2% nationwide.

We requiring the additional resources that are unnecessary not only puts a financial burden on the health system but potentially limits access. As Assemblyman Gallagher pointed out, where every physician is a precious commodity, particularly in rural areas, these physicians, when they're on call, are unable to provide other services.

We believe that requiring the California Department of Public Health to update this regulation based on current professional standards is a simple and thoughtful solution that incorporates the expertise of today's medical community. And I respectfully urge your aye vote on AB 1196, and I'm happy to answer any questions.

Vanessa Gonzalez with the California Hospital Association and I think the minority leader and my colleague from Enloe did a great job summarizing the need for the Bill, so I'll keep my comments brief. As noted in the Committee analysis, 48 hospitals currently receive this program flex from the California Department of Public Health.

And we think the Committee amendment is a practical solution to updating these regulations to reflect today's advantages in medicine as well as current clinical standards. So respectfully request your aye vote. Thank you.

Are there any others in support of this measure?

Sarah Bridge, on behalf of the Association Of California Health Care Districts and support. Thanks.

Thank you. Any primary witnesses in opposition?

Madam Chair, Tim Madden, representing the California chapter of the American College of Cardiology. We have currently an opposing unless amended position. I just wanted to thank the author and his staff for the thoughtful conversations. I haven't heard any concerns from my folks in terms of the amendments and going to DPH doing the regulations.

I just don't have an official position. I just want to thank everyone for their work on it.

Thank you. Any other MeToos in opposition? Seeing none. I will bring it back to the Committee for question or comment. Minority Leader Gallagher, I want to thank you for bringing forward this Bill.

In my very first weeks in the Assembly, I had an opportunity to visit paradise and your district and was just one very taken by the incredible knowledge that you have and that your community Members have of you and, and, and similarly.

And I know that you fight very hard to make sure that rural communities are supported in the way that they should in the healthcare space as well.

And want to thank you for bringing forward an approach that would allow us to be able to accept the amendments, which basically puts this in the hands of our agency to get clear on the science and the practice that's required, while giving us an opportunity to be responsive to your community. With that, would you like to close?

Thank you, Madam Chairman. I appreciate the cooperation on this and, you know, your willingness to really understand, you know, these issues as you have over the years. So thank you and ask for your eyebow.

Thank you. Do I have a motion? In a second. Steffani moved. Seconded by Krell. Thank you. With that, when we have an opportunity, we will vote on the Bill. Thank you. We're going to move on now just to give a little bit of a roadmap for folks.

We're going to do item number 26, Erin's, followed by Baynes, 27 and 28. And then we were going to move back and file item order to item number eight. Item number 19, AB 1113. Assembly Member Aarons.

Thank you so much, Madam Chair and Members. As COVID 19 showed, wearing a mask is an important public health tool. However, currently there is no codified right to wear a mask for immunocompromised individuals like my late twin brother.

This Bill codifying the right to wear a mask for health reasons is critical because even a cold can be deadly for vulnerable people. Today, local governments and businesses could attempt to ban mask wearing without statutory protections, individuals are left vulnerable to questions about bodily autonomy. And this important public health tool.

This Bill applies broadly to public spaces, including businesses, schools, workplaces and healthcare settings. There are limited exceptions, such as temporary removing masks for identification purposes. AB 1326 affirms the right to wear masks in public for health protection.

I'm proud to have the support from the Health Officers Association of California and Disability Rights California and respectfully ask for your aye vote.

Thank you Assemblymember. Are there others in support as primary witnesses or as metoos?

Thank you. Isabella Argueda with the Health Officers Association of California and support thanks.

Thank you. Are there any primary witnesses in opposition or me toos in opposition seeing none. I will bring it back to the Committee for questions or comments.

I want to thank you, Assemblymember Aarons for working with the Committee to help to make sure that we were clear enough on this Bill to avoid any unintended consequences as it relates to public safety issues more broadly and want to thank you for bringing forward this measure. I know it is very personal to you. Thank you.

And with that I respectfully ask you to close

Thank you Madam Chair. I respectfully ask for your aye vote today.

Thank you. Do we? Thank you Assemblymember Krell seconded by Gonzalez. Thank you. When we have an opportunity we will get to vote on the Bill. Thank you Member we're going to move on now to item number well, Assemblymember Bains, whichever you'd like to proceed with first, are we starting with 1386? Item number 27 AB 1386 by Bains.

All right, ready. Thank you Chair. Members AB 1386 would add perinatal care to a list of services all General acute care hospitals must provide.

My goal with this Bill is to bring all stakeholders to the table, including Administration, hospital hospitals, nurses, OB GYNs and health plans to figure out what needs to be done to ensure every community has access to labor and delivery care.

In the past decade, California has closed more than 50 hospital maternity wards precipitated by low delivery volumes, workforce shortages and hospital financial instability. Annual births have declined dramatically over the past decade and hospitals struggled to recruit L and D support staff, which has left eight counties with no licensed OB GYNs and 11 with only a handful.

Maintaining a fully functional L and D unit at a hospital with low to no monthly births places a financial strain on a hospital kin to staffing a fire Department when there's no fires to extinguish.

There may not be a fire every week yet we are sure glad that they are ready to to respond when a fire does occur. Just as the Legislature is considering staffing CAL FIRE year round, we also need to rethink how we Fund and support L and D during this challenging period.

LD unit closures don't affect all areas of the state equally.

They have disproportionately affected women in low income areas, women in communities of color, black women who die from pregnancy related causes at nearly four times the rate of white women and women in my San Joaquin Valley where we see the highest rates of maternal deaths in the state.

Things are bad and it's getting worse as we continue to lose access to vital care in these vulnerable communities.

More than 50 years ago, at a time when there had never been more than three women in the California State Legislature and women of color had only just been guaranteed the right to vote, the Legislature wrote A list of 8 basic hospital services without including a single dedicated women's health service.

Hospitals have been required to provide those services ever since and the list has never changed.

AB 1386 is intended to change while providing the necessary resources to support these services, including supporting workforce and reimbursements Health care is a mess in the United States and there is no one boogeyman you can blame for all of our problems, although the President is making a very strong case for himself.

I represent a community where 335,000 people are enrolled in Medi Cal. That's nearly 70% of my constituents. Add in the Medicare population and it's hard to find someone who is not on a public health insurance plan.

As a Legislature, we've underinvested in reimbursements for our constituents, we failed to train and recruit an adequate workforce to service them, and we've created a system that grants access to healthcare infrastructure based on your zip code instead of your needs. I do not believe in promising simple solutions to complicated problems.

It would be easy to simply demand that we add perinatal services to the list of required services and wash my hands of the complicated conversations we must have to make that happen.

The current version of this Bill makes our goal clear, but it cannot go into effect until we decide how to effectively support hospitals and providers to ensure services can be safely supported in the communities across the state.

I have asked the California Hospital Association to engage with me and the California Nurses Association to figure out how to turn this aspiration into a reality. Cha has been an honest and productive stakeholder in our conversations.

They have submitted a good faith proposal that has the potential to lead to a comprehensive Bill that will ensure access to perinatal services in a financially responsible way, address our chronic workforce shortage, and prioritize care in vulnerable communities.

If the Bill moves out of Committee today, I will be amending it to address These and other causes of closures. We must get this right. And I am committed to doing the work required to get this right. I respectfully request the Committee provide the opportunity to do just that by advancing the Bill out today. Thank you.

Thank you. Are there any others in? Sorry. Please go ahead.

Good afternoon, chair and Members. I'll be brief to yield some time to registered nurse Ann Caputo Pearl. I'm Carmen Comsti, Assistant Government Relations Director of the California Nurses Association. Proud sponsor. 98% of births take place in hospitals.

But when the list of basic required hospital services was established in the 70s, maternity services was not included and not, shockingly, there were only three women in the Legislature. AB 1386 would correct this glaring omission.

Without safeguards under California law, our maternal health infrastructure has unraveled deepening health disparities, particularly for low income families, rural regions and communities of color. By reclassifying perinatal services as a basic hospital service, this Bill ensures that all patients, all communities, can access high quality perinatal care.

And through our compliance plans, this Bill aims to chart a path forward to bring maternity services back online at hospitals throughout the state. All communities must have equitable access to hospital maternity services. It will save lives and improve health outcomes. And with that, I'll yield the rest of my time to Anne.

Good afternoon, chair and Members. My name is Ann Caputo Pearl. I've been a labor and delivery nurse for 22 years. I'm a Member of the California Nurses Association, and I'm here to speak in strong support of AB 1386. Every day I care for patients during one of the most vulnerable and transformative moments of their lives. Childbirth.

And I can tell you from experience, labor doesn't always go according to plan. A healthy pregnancy can turn into a medical emergency in an instant. A sudden drop in blood pressure, hemorrhaging, a baby in distress, Placenta Previa, an urgent need for a life saving cesarean section or an emergency abortion. When these moments happen, you need a hospital.

You need trained staff, surgical teams, NICUs and resources ready 247 to save lives. That's why hospital based maternity care isn't just an option. It's the foundation of a safe maternity care system. It's also the safety net for birthing centers and home births if complications arise. They rely on hospitals to take over care quickly and effectively.

But this safety net is rapidly disappearing. With shrinking access to hospital labor and delivery units, patients end up in emergency rooms that are unequipped for obstetrical care. That's not just inconvenient it's dangerous, and it's costing lives.

I see the impacts of this every day at my hospital in downtown Los Angeles, where we care for an entirely low income, underserved population, including unhoused individuals, immigrants and families on medi Cal. Many of the patients who come through our doors haven't had access to prenatal care.

And it can be the first time anyone has assessed their health, ever. And that's when everything surfaces. Uncontrolled diabetes, hypertension, infections, untreated mental health conditions, chronic substance abuse, undiagnosed complications. This is where the art and science of perinatal care matters most.

It's knowing how to recognize subtle changes in a fetal heart rate tracing before it becomes a crisis. It's managing a shoulder dystocia in seconds to prevent brain injury. It's controlling a postpartum hemorrhage to save a mother's life.

Thank you.

In short, as a nurse, I just want to say I'm committed to advocating for the health and dignity of every mother, birthing parent and newborn. And I respectfully urge you to vote aye on AB 1386. Thank you.

Move the Bill. Moved by Aguiar Curry, seconded by Steffani. Are there any others in support?

Good afternoon. Roxy Ortiz from the Association of Regional Center Agencies in support.

Good afternoon. Elmer Lizardi here on behalf of the California Federation of Labor Unions. In support.

Good afternoon. Omar Altamimi on behalf of the California Pan Ethnic Health Network. In support.

Thank you. Are there any primary witnesses in opposition? Please come forward.

Good afternoon. Vanessa Gonzalez with the California Hospital Association here with an opposed unless amended position. And I want to begin by thanking Dr. Baines and her staff for the thoughtful discussions. Cha is committed to continuing to work on this important issue.

Our primary concern with the Bill currently in print is that it doesn't address the factors that are leading to labor and delivery unit closures. And as Dr. Baines noted, declining birth rates, workforce shortages and financial instability have left some hospitals with no other choice but to close their maternity care services in order to keep their doors open.

This is a significant concern and we need all stakeholders working together to look at how we can preserve and expand access to labor and delivery care and work together to develop new models that meet the unique needs of communities. Cha remains committed to working with Dr.

Baines, providers, health plans and other partners to address these challenges and find solutions.

Thank you. Thank you. Any others offering a me too in opposition? Seeing none. I will bring it back to the Committee for comment or question. Assemblymember Patel.

Thank you for bringing this Bill forward. Assemblymember Dr. Bains, I did have a maternity Ward in my community closed. One of my healthcare district hospitals had their maternity Ward closed. When we look at hospitals that are in distress, how can we provide them support to keep that maternity Ward open or to reopen their maternity Ward?

There are two other hospitals in San Diego, one another public health care district that had its maternity ward close, and the other healthcare district just closed their whole hospital down due to lack of being able to provide the services due to Medicare reimbursement rates. So I just want to make sure we can implement this. I want it to be successful and want to partner in a way that we can make this successful.

Sure. You know, as a physician that's been working in the healthcare system, I have, you know, knowledge not just only in this area, but that the biggest issue that we're facing is our federal Medicaid cuts.

I think we are all very concerned and grappling with what's going to happen when those cuts happen and what are we going to do to protect our hospitals forever. Over a spectrum of years, you had increasing cuts to Medicaid, and we're about to get a really, really big one. So I do worry about that.

And that is why I'm committed to working with everyone at this table to make sure that we do everything right, that we provide the care that's needed. At the same time not creating a financial burden on hospitals as well, but at the same time addressing what's coming down the pipeline at the Federal level as well.

I mean, shutting down the entire Medicaid system is not an answer, and that is inappropriate at the federal level.

Assemblymember Carrillo, did you have a follow up?

Yeah, one more question. Another one related to my own life experience. I did have an emergency C section with my first baby. It was a very dramatic situation. I had planned to have a midwife birth, and I was very fortunate that there was a that could take care of the complications that I was experiencing at the time.

Having a hospital that delivers a certain number of births every year keeps people trained, keeps people primed and ready to go. And I keep hearing from our Members, from the Hospital Association that that's something that's leading to the closing down of maternity wards.

Is there another way that we can work to make sure our workforce stays adequately trained and ready to go for all the complications that come up during childbirth?

Yeah. I mean, as a physician that provides perinatal care, as a person that has been in those rooms, of course, making sure that we work to have more physicians, making sure that we expand our workforce, that's what I did as a Commissioner on the Song Brown Commission.

I was the chair of that Commission prior to being in the Legislature. So that is why workforce is of utmost importance to me. And I agree with you. A physician has an expanded access and scope of practice. As a family doc, we provide care.

Not only do we deliver babies, we are working in the hospitals as well and, you know, making sure we expand that and addressing all of the cuts to Medicaid at the same time.

Thank you, Assembly Members. Assemblymember Carrillo.

Thank you, Madam Chair. As Dr. Baines noted, hospitals have been closing for decades now across the state, and those that are still open are struggling because of many requirements that they have to comply with, are retrofitting in other ones.

So with this policy that you're proposing now and the conversation that has happened, obviously, with what's happening at the federal level too, having those cuts coming our way, and with this now, I don't see any provisions or mechanisms that this will allow any help, additional help for those hospitals who implement this policy.

Yeah, no. We're working on a list that the Hospital Association has submitted, and that is what I'm committed to working on to make sure that we address everything that is needed to keep our hospitals open as well.

Look, I was right there when the Tulare Hospital shut down and we worked hard to get that reopened way before when I was a medical student, actually. So I understand the complexities of rural health care. I'VE been at the table to help reopen that hospital and I will continuously be at the table to make sure that we do all we can.

Let's do all we can because those hospitals in rural areas like the ones that I represent also are struggling with so many other different issues, as you know. But I hope that we can continue those conversations.

So are our pregnant women that need access to vital care. Thank you.

Assemblymember Patterson.

Great. Thank you. Chair well, you know, I don't like to make it a habit to vote against bills from Dr. Baines especially. Well, you're so nice. But if I do vote against a Bill doesn't mean that person's not nice. Just sometimes it happens. It is for me.

So, you know, well, I like to say all the time is obviously we don't know what's going to happen with Medicare yet. I mean I think there's probably going to be some cuts and I happen to sit on that Budget Committee as well and I think we'll have some things to sort out.

You know, and I always put the forward the reminder of California's unfunded Medi Cal for decades now. And just last year, you know, the Governor proposed cutting, you know, taking the MTO tax right. And balancing the General Fund from it. So we have our own self inflicted wounds here in California.

California that we have to address ourselves, you know, but also obviously we got to look at whatever the Federal Government's going to do. That said, I do have I know you obviously don't want maternity or hospitals to close.

I don't think anybody here in the Legislature has taken a pretty active stance and not that, but I do have concerns about fortunately I represent one of, you know, at least one hospital that you know, on Oka's list of or was on, it's not anymore having to stay at, you know, 1.8% or whatever.

And so I do have concerns that this could make things a little bit more difficult for hospitals to stay open. But I also recognize the need of having maternity service as a father for, you know, this accessible and everywhere, everywhere we can. And so we have to look at other solutions.

But you know, so I'm going to lay off today because I do have some concerns about, you know, whether this will make could potentially make an issue worse. But I know that you don't want that to happen.

So I assume you'll keep working on it to make sure this is paired with policy that helps those hospitals stay open.

Thank you so much with that. Assemblymember, would you like to close. Yes. Look, sorry. Before you do, I really apologize, but there is a. An anomaly in your Bill that I want to just make sure we're clear about.

The Health Committee is moving forward, proposing to move forward with this Bill with a blank on the timelines associated with establishing the perinatal services as a basic service, and then also for DPH to establish a process to approve. I just want to.

That is very unusual for this Committee in particular, and I know that you will be working very hard to make sure that by the time this Bill gets to the floor, should it move there, that that will be filled in.

Should that not be the case, we will likely need to bring this Bill back to the Committee for Review. So just wanted to acknowledge that. And with that, Assemblymember, please close.

Thank you. I understand it might be anomaly. Look, uncertain times calls for uncertain meas. I wholly thank the California Nurses Association and the California Hospital Association to get at the table for some difficult discussions and be open at it at the same time. We gotta do everything that we can to save our hospitals.

We gotta do everything that we can to save our women that are dying in childbirth.

As a physician that provided care in Taft, which the closest hospital was about an hour away, there were times where I had to decide if the women that showed, the woman that showed up contracting was going to deliver in my clinic or on the way to the hospital.

And I had to make these difficult decisions on whether I'm going to hold the woman in the clinic to give birth in the clinic or let her go in an ambulance because it's better that I'm there and the baby gets delivered by a Doctor versus in the ambulance on a one road, 12 way road on the way to the hospital.

That could take 440 to maybe two hours. These are decisions that I had to make in that time that I was in Taft because there was no hospital there. It shut down several years prior and the closest hospital was 40 minutes away. These are not easy conversations and they will continue to not be easy.

But that doesn't mean that we fear it and run away and don't get to the table and provide solutions. Our constituents want solutions. They don't want us to just sit here and do nothing. They want us to see that we're working towards something. And as I said, I'm committed to working with everyone on this. Respectfully. Ask for your aye vote, thank you.

And we are going to establish quorum right now so that we have an opportunity to vote on this Bill. Secretary, please call the roll.

[Roll Call]

We have a quorum. We have a motion and a second on this Bill. So with that, Secretary, please call the roll.

[Roll Call]

That measure is on call. Thank you, Assembly Member. We're going to move on now to item number 28. Your second item of the day. AB 1429.

Awesome. Thank you, chair Members. AB 1429. For the past 20 years, DMHC has routinely cited Kaiser for violating mental health parity and timely access laws.

In 2005-2009-2013-2015, 2017, 2023 and now again in 2025, DMHC has imposed a $50 million fine against Kaiser, the largest in the department's history, and reached a settlement which required a $150 million investment in behavioral health services. We are in the midst of a mental health crisis in the United States.

One in five Americans will need treatment for a mental health condition this year. And we have passed new laws to make it clear that mental health care is equally important as physical health care. Our clinical providers know this better than anyone.

And as usual, they are the tip of the spear advocating for better conditions for health care workers and high quality patient care for all of us. Let's be clear about the scope of the problem. With more than 9 million enrollees in California, Kaiser has a 40% share of California's health insurance market.

The simple truth is that when Kaiser provides better care, California does do better. Bringing Kaiser's mental health care on par with this excellent physical health care would be game changing. Unfortunately, despite repeated enforcement actions and citations, Kaiser's efforts have been insufficient to meet the behavioral health standards required by state and federal law.

DMHC has right to level the largest fine it's even imposed ever imposed against Kaiser. And I'm confident Kaiser's 150 $1.0 million investment in its network will make an incredible difference. But what are we doing to help patients in the meantime who struggled and continue to struggle to access care during years of non compliance?

For years these patients have been promised a better system with better access to care. And yet they are still waiting. Just last month, DMHC released a follow up report that found Kaiser has remedied just one of the 20 violations, one of the 20 violations that DMHC found in 2022. This is where AB 1429 fits in.

The Bill offers a practical patient centered solution to bridge the gap as network improvements are made. The Bill requires Kaiser to reimburse patients for out of pocket behavioral health costs when they seek care from non Kaiser providers because they could not access appropriate care from Kaiser itself.

Reimbursements would cover expenses such as CO payments, deductibles, prescription medication costs and provider fees directly related to obtaining behavioral health care. This requirement would remain in effect only until DMHC certifies that Kaiser has completed its corrective work plan. I want to note for the Committee that Kaiser's settlement agreement describes a similar reimbursement process, but without any details.

That process is being developed by Kaiser to be submitted to dmhc. The public and the Legislature have no access or opportunity to provide input during the development of the process.

As lawmakers, we will not see that plan until it's already finalized and DMHC has confirmed the Department will not have any power to force Kaiser to modify it once it's approved. It sounds likely that plan will be approved by the end of the legislative year.

If that is true, I look forward to reviewing it and I am certain it will inform our deliberations at that stage. In the meantime, AB 1429 represents a balanced approach that focuses on patients needs.

It acknowledges the reality that implementing comprehensive changes to a behavioral health system takes time while ensuring that patients do not go without care in the interim. This is not about penalizing Kaiser. This is about upholding our commitment to mental health parity, ensuring all Californians can access the behavioral health care they need so vitally and deserve. And I respectfully request an aye vote.

Moved by Arambula, seconded by Gonzalez. You'll each have two minutes.

My name is Monica Whelan and I'm here as a parent whose child was unable to get timely and appropriate mental health care from Kaiser and who was forced to pay thousands out of pocket for care we had already paid to receive. My child suffered from depression, which became worse during COVID on Memorial Day Weekend 2020.

I discovered a photo where my child had carved the word fat into his arm with a knife and referred to himself by a different name. He needed immediate help, but Kaiser told me that there was a long wait for therapy. It took a month to get an appointment.

Then when my child didn't connect with the therapist, he was offered group Therapy due to a shortage of therapists. He did not feel comfortable there and continued to deteriorate. I reached out to Kaiser again and was told that there could be a two month wait for an appointment. This was unacceptable as my child was having suicidal thoughts.

I contacted Member services and was finally connected to a therapist. The therapist. The therapy was outsourced to an external contractor. After a few virtual sessions, the therapist said she could no longer see my child as his case was too severe. My child ended in the ER with suicidal thoughts.

There he spoke to a therapist via an Ipad and was released. I was told to lock up all the knives in my home. It was not until six months later. After this ER visit, my child was able to meet with a Kaiser therapist for severe depression.

Still only once a month unless there was a cancellation as a shortage of therapists at Kaiser made more frequent appointments impossible. His condition continued to deteriorate and he ended up hospitalized at Hillside's residential program there. Thankfully he improved and he was released with a recommendation that he received therapy weekly.

Yet we could still not get an appointment with Kaiser's therapist until almost six weeks later. I was not going to risk my child's help health with Kaiser's broken system again. So we began to provide out of pocket care.

To date, my Child has received 54 private out of pocket individual therapy appointments costing over 8,000 along with family therapy costing over 3,000. This is the care we pay Kaiser for but are not receiving. I'm not alone. I know that other parents and patients have suffered after decades of Kaiser citations and fines.

AB 1429 will ensure that Kaiser remains under a plan of correction for severe behavioral health failures. Families who will have an easier path to get the care they need. Thank you so much. Thank you.

Fred Seavey National Union of Healthcare Workers. Ms. Whelan's experience is not unusual. According to the California Department of Managed Health Care, Kaiser has been repeatedly cited for understaffing his behavioral health services, illegally delaying patients access to care and thereby forcing patients to self Fund care. As Dr.

Baines noted, DMHC cited Kaiser for these and other violations in 2005-2009-2013-2015201720212023 and so far twice in 2025. In 2023, DMHC imposed the largest state behavioral health fine in our state's history on Kaiser. And currently Kaiser is under a two year corrective action plan to fix the violations.

When patients can't get timely care, Kaiser instructs them to file a grievance with Kaiser's Member services system. Investigators, however, found that Kaiser's grievance system is, quote, overwhelmed.

They examined nearly 30,000 grievances filed by patients regarding behavioral health services during a two and a half month period and found that Kaiser failed to resolve nearly one third of those grievances within the maximum 30 day time frame allowable in state law.

Last Friday, DMHC cited Kaiser again and fined Kaiser another $820,000 for its timely grievance handling failures. And in another violation just two months ago, DMHC cited Kaiser for 20 violations of health health care lies behavioral health laws, including failing to provide patients with timely access to care.

According to investigators, Kaiser forced children to wait upwards of four months for autism services, which they said, quote, was far in excess of the 10 day timely access timeframe in California law. After 20 years of citations and fines, Kaiser still hasn't fixed its broken system of health care. Patients shouldn't have to pay the price. We respectfully request. Urge your aye vote for this Bill. Thank you.

Thank you. Are there others in support of this Bill? Please come forward with your name, affiliation and your position on the Bill.

Good afternoon. Linda Nguy with Western Center on Law And Poverty and support.

Good afternoon. Elmer Lizardi here on behalf of the California Federation of Labor Unions and support.

Good afternoon. Madam Chair. Malik Bynum with the County Behavioral Health Directors Association in support.

Good afternoon. Omar Altamin with the California Pan Ethnic Health Network in support.

Thank you.

Eric Payne, Executive Director of the Central Valley Urban Institute in support.

Are there any primary witnesses in opposition? Please come forward.

Good afternoon. My name is Angelica Gonzalez. I'm with Kaiser Permanente. First off, I'd like to acknowledge our Members and the challenges she faced and I appreciate her testimony today.

Before I speak to our opposition of the Bill, I just want to acknowledge the analysis and the excellent work that they did summarizing our settlement agreement and our Corrective action work plan.

As you have read in the analysis, we have been working to transform our behavioral health delivery system to improve our Members care experience and evolve our operations, processes and procedures to better help Members with accessing care.

Just to be clear, while the settlement agreement and corrective action work plan was posted last month, we that work has started well before we posted the the agreement was posted by the Department of Managed Healthcare. Additionally, we are meeting with the Department of Managed Healthcare quarterly to update them on our progress.

We had a recent quarterly meeting with them and the results of that should be posted in the next few days. Again, we want to thank the author's office for reaching out to us to work on possible changes to the Bill to address some of our concerns. Those concerns are we have some concerns on the Bill.

The Bill does not explain explicitly require that our enrollees attempt to access care within our network first before they go to a non Kaiser provider or pharmacy.

Allowing our Members to go outside to non contract provider creates several issues including care fragmentation, increased costs and it undermines our ability to contract with external providers to achieve that broader access that we know our Members need.

And if our Members are allowed to seek care without going to Kaiser Permanente first, we won't know nor will our regulators know if we are meeting those access requirements Last, I did want to note that medication access has not been an issue or noted deficiency for us.

We have systems in place to review and fill prescriptions from external providers and so we are unclear why that provision is necessary in the Bill. However, we really do appreciate Assemblymember Baines and her staff for reaching out to us with amendments to address our concerns with the Bill.

While we have not yet been able to agree with language because it's it was new and we're still reviewing it, we look forward to working with her and her office to continue a constructive dialogue to explore a potential path forward. Thank you.

Thank you Madam Chair Members Stuart Thompson on behalf of the California Medical Association, we did some concerns with the Bill in print about the confusion it might cause among providers about whether a service is covered and who exactly to Bill but want to just appreciate

Dr. Bains and her recent engagement on those Amendments, we really look a step in the right direction. We look forward to being part of the dialogue going forward.

Thank you. Are there others in opposition? Please come forward.

Kelly Larew with Resilient Advocacy on behalf of the California Chamber of Commerce, in opposition.

Nick Louisos on behalf of the California Association of Health Plans, in opposition.

Thank you. Assembly Member, have you accepted the amendments from the Committee? Yes. Thank you. I'll bring it back to the Committee now for any questions or comments. I did want to just ask the opposition a question. What is the current status of the proposed claims reimbursement process and when do you expect to launch that?

Yes. I don't have specific details as those are still being worked out with the Department of Managed Health Care, but we do expect that to be finalized and notices going out to affected Members by the end of of the second quarter of this year.

And is there anything in the settlement agreement that's keeping you from soliciting stakeholder feedback before you finalize the reimbursement process.

That I don't have an explicit answer to? That might be something that we would have to ask the Department of Managed Healthcare.

Thank you. Assembly Member, perhaps in your close seeing. No. Oh, Go ahead. Assembly Member Patel.

Thank you, Madam Chair. Thank you for bringing this Bill forward and drawing some light and attention to this issue. I do have Kaiser, Kaiser Hospital and several offices in my district. This issue is important to me and my constituents as well. Just trying to get some further clarification on a few lingering questions for me.

One is that in this, with your Bill, a patient would be able to seek outside care if they weren't getting care provided by Kaiser? Is there a provision to ensure that medical records are also available so that there isn't conflict in delivery of treatments or conflicting treatments or something like that?

Medical records are always available.

Okay, wonderful. And it's just the patient themselves or their guardian can have that.

Now, the way the process works is you can request medical records from any office as a patient, as a medical institution, as a physician. I get multiple requests for medical records daily.

Excellent. Thank you for that. My next question is related to are there any guardrails around the outside providers or the treatments they offer such that they are licensed in California, they're practicing in California so that people aren't seeking care that might not be permitted in the State of California.

I understand your concern. However, they would have to go to a licensed physician for it to be reimbursed by the medical system itself. So that should already be as status quo.

Okay. Thank you. And that includes telehealth. That's the same.

It should be certified telehealth.

Okay, thank you.

Thank you. Assemblymember. Perhaps in your close you addressed in your opening the potential where we might have a timing issue in terms of this legislation and having the full breadth of the corrective action work plan established and in place in terms of what will happen there. Can you share with us how you plan to address that?

Yeah. You know, since the start of this Bill, we were able to see that there was a plan that was submitted as was stated.

It's on the website now as of a month ago, they actually handed me the entire thing and I read it while I was providing healthcare to clinics in Delano and on my way back here to be in Committee. And there's a lot of things that are missing from that.

And I look forward to those being addressed and I look forward to the work that's being done. Again, look, these are difficult conversations. Our constituents, our patients. My patients need us to show action on this. And I'm glad that a work plan was created.

There's a lot of work to be done and I look forward to it being resolved by the end of this year. And, you know, looking at that timeline and how it works, again, this is about working together.

This is what happens in the Legislature is we're so afraid to address things that we just don't want to address it. And guess who suffers? People suffer. People's mental health suffers. And yes, this creates difficult dialogues. It creates uncertainties. But again, I applaud everybody at the table that wants to work together on this.

This is about working together to make sure that patients are being taken care of. And I feel that everybody in this room wants to make sure that everybody has access to the highest level of patient care. That's. That's why I became a Doctor. And that's what I'm always going to be committed towards.

And I am committed towards making sure that difficult discussions do get addressed and we do take action for our not just constituents, but my patients as well. So respectfully ask for your aye vote.

Thank you. We have a motion by Orembula seconded by Gonzalez. With that secretary, please call the roll.