Senate Standing Committee on Health

The Senate Committee on Health will come to order. Good afternoon, y'all. We are back. Second half of the legislative session. For everyone's awareness, two bills were pulled from today's agenda. That's going to be File Item 3 and 9, AB 54 and AB 536. So, we have 11 bills on today's agenda. Six of them are proposed for consent.

We'll be hearing five bills today. We just missed Assemblymember Bonta. So, Assemblymember Krell, we'll have you come up first and present. Assemblymember, this is your first time here. Members present from over here. We bring you in, we make you stand instead of sitting. First up, File Item 4, AB 348. Assemblymember, go ahead.

Hi. Good afternoon, Senators. My name is Maggie Krell, Assemblymember representing the 6th district here in Sacramento. I am pleased to present you today with Assembly Bill 348. Assembly Bill 348 actually streamlines some of our most vulnerable patients in California who are cycling between homelessness, severe mental illness, and even incarceration.

Currently, there's often delays that lead—that undermine—our ability for these very vulnerable patients to access care. And so, what 348 does is it streamlines their access to care by creating presumptive eligibility based on these criteria. With me today is Sacramento's forever Mayor and former Senate Pro Tem, Darrell Steinberg from the Steinberg Institute, along with Tara.

You'll see that this Bill has a broad coalition of support. It made its way through the Assembly with bipartisan support, and I think you'll agree that this is a really important Bill to streamline care for some of the most vulnerable patients in California who are cycling through homelessness, incarceration, and institutionalization.

So, without further ado, I'd like to turn it over to former Senator Steinberg.

Thank you, Assemblymember. For the two witnesses here, you have a total of five minutes. It's up to you how you want to break up that time.

I'll speak fast, Madam Chair. Madam Chair and Members of the Committee, thank you so much and thank you, Assemblymember Krell, for championing this Bill and this cause. And I am joined by Tara Gamboa-Eastman, the Legislative Director for the Steinberg Institute, and Karen Larsen, our CEO, I think, is in the audience here as well.

As you know, I'm Darrell Steinberg. I was the founder of the Institute and Former Senate Pro Tem and former Mayor of Sacramento. Our Institute is a nonprofit organization singularly focused on breaking cycle of homelessness, incarceration, and repeated hospitalization—people living with severe mental illness—and I'm here today.

Our Institute is the proud sponsor of AB 348 and this Bill, it builds on a journey that began for me more than two decades ago when I was a freshman Assemblymember in 1998. I introduced AB 34, which launched a groundbreaking $10 million pilot program, we came to call "Whatever it Takes Care."

The idea was simple. Assertive outreach, case management, whatever it takes to people living with severe mental illness on the streets. And over the course of five years between AB 34 and 2034, we demonstrated huge decreases in hospitalization, jail time, days of homelessness, exactly what people need and what the people of California expect.

It led then to my having this wild idea to put this program and this system on the ballot in 2004, which led to Proposition 63, the Mental Health Services Act, the 1% tax on millionaires, which has now become the Behavioral Health Service Act.

The Cornerstone of Prop 63 was and is what we did under AB 34, in 2034. Full-service partnerships—programs designed to meet whatever it takes for people, to get them off the streets and into more stable settings, and to begin a recovery towards living in our community.

By the way, the promise that was made by our forebears in the 1960s and 70s when they shut the state mental hospitals and promised a decent system, acute mental health care. Prop 63, by the way, has generated 31 plus billion dollars of funding for public mental health since 2004. It's in part helped save the system.

And yet, it still has a lot of work to live up to its promise, which is why we did Prop 1 Back in March. Here's the problem. 20 years later, the promise of whatever it takes is faltering.

Even though these full-service partnerships were originally created to serve people experiencing homelessness with serious mental illness, today, only about 40%, I repeat that, only about 40% of FSP slots go to that population. The very people these programs were created to serve are still languishing without the care that they need.

I'm all for local discretion and control, but there is no state standard in California about who gets admitted to care with these precious dollars. And as you know, because we all have experienced it and at every political level, it dominates our discourse. One quarter of California's unhoused population is living with serious mental illness.

That number, I think, is low. And they're cycling through our emergency rooms, our jails, our streets, disconnected from care that can transform their lives. There are thousands of people that have gotten wraparound care and whose lives are better. So, this Bill sets a standard.

It says to the counties and other providers, if somebody meets objective criteria, they're living on the streets, they've had a number of 5150s, they're coming out of jail or prison, that they're eligible and they're enrolled. Presumptive eligibility is what we call it.

It would allow the provider, without the consent or permission of the county, to enroll somebody, while all the eligibility issues are being worked out. By the way, there's little time to waste, right, for somebody who's out on the street and who is really sick. Not two weeks from now, not a month from now, but they can enroll people today.

This aligns with Prop 1 because Prop 1 really happened with the Governor's leadership, of course, and Legislature's leadership, because we were frustrated, despite all the successes of the Mental Health Services Act, with the fact that these FSPs and the money was not focused enough on people who are the sickest of the sick.

This is a big bill in my view, not just because we're sponsoring it, but I think it will begin remedying a problem and get us back to our original intent.

Thank you. You heard the click. Thank you, sir. Now, turning to any "Me Toos" in support of this vote. Please step forward. Name, organization, and your position, please.

Angela Hill, the California Medical Association, in support.

Tessa D'Arcangelew Ampersand, Smart Justice California, in support.

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

Shira Spector, Intern with Stone Advocacy, on behalf of the California District Attorneys Association, in support. Thank you.

Caroline Grinder, on behalf of the League of California Cities, in support.

Madison Whittemore, on behalf of Vera Institute for Justice, Smart Justice, and Sacramento County Probation Association, in support.

George Cruz, on behalf of the California Behavioral Health Association, proud co-sponsor, in support.

Natalie Spivak with Housing California, in support.

Max Perry, on behalf of the Big City Mayors Coalition. Also, in support.

Leah Barrows, on behalf of California Hospital Association, in support.

Sharon Gonsalves, on behalf of the City of Bakersfield, in support.

Charles Wright, on behalf of the California Association of Veterans Service Agencies. In support.

Omar Altamimi, on behalf of the California Pan Ethnic Health Network, in support.

Monea Jennings, on behalf of the Greater Sacramento Urban League, in support. Thank you.

David Bollog, Serving Family Values, in support. Thank you.

Rainer Apostol, on behalf of Drug Policy Alliance, in support.

Michelle Nottingham, on behalf of the Commission for Behavioral Health, in support.

Matty Hyatt, California Civil Liberties Advocacy, in support.

Thank you so much. Now turning for any formal opposition. No. Okay. Seeing no formal opposition, but now I'd like to turn over to "Me Toos" in opposition.

Thank you. Senator, my name is Amer Rashid, on behalf of the County Behavioral Health Directors Association of California, unfortunately with an opposed unless amended position. Have been grateful with the conversations we've had with sponsors and the authors but certainly have some concerns we hope to continue to work on. Thank you.

Kelly Brooks, on behalf of the County of Los Angeles. We have an opposed position and we're looking forward to meeting with the author next week. Thank you.

Thank you. See nothing further, bringing it back to my colleagues for any questions that they may have. I do recognize that there are some concerns, but I think you—Senator Durazo, go ahead.

I just wanted to—it sounds like there's a legitimate issue of the opposition with regards to, if I understand this correctly, is how it sort of makes it more difficult to handle all the possibilities, all the cases, all the people who do need these services to put others, you know, up front.

So, I just urge you, you don't have to answer right now, but just urge you to address the county's concerns. Thank you.

Thank you, Senator. In—you're right, Senator, Mayor Pro Tem. There is no standard across California and what we're seeing, and we've heard, is that unfortunately, even LA County in particular is waiting 90 days in what I'm calling this version of a step therapy, where they're saying you have to do this first before you get FSP.

That's 90 days that we could be preventing from really doing a wraparound approach for an individual that might need it. So, I think it's beneficial that we have a standardized approach to this. I do recognize there is no amendments proposed from the opposition on this. There's no Committee amendments on this.

I know conversations is still happening, but we didn't have anything to work with in terms of what we can mend. Other exclusions of 5150 were really hard to take because that's the whole intent of FSP, is to prevent people from getting on 5150.

So, if we were to exclude that, we would, by default, negate the whole intent of FSP. So, I know we're trying to get people to get access, full wraparound access, sooner rather than later. There's great intent behind this Bill. Thank you, Assemblymember, for bringing this forward. I'd like to turn over to you to now close.

Sure. Thank you so much for your comments, Senators. It's a really important Bill. It will streamline access to health care for our neediest patients.

I think we see a lot of examples of that in Los Angeles County and with all respect to the opposition, and we'll certainly continue those conversations, but the 90-day delays are just unacceptable when you're talking about patients who are homeless, who are cycling in and out of ER rooms, and even in and out of jail.

So, this will really prioritize the neediest patients with the exact type of care that's been proven to be effective. And with that, I respectfully ask for your "Aye" vote.

Assemblymember, we don't have a quorum yet, so when we do, I'll entertain a motion. For now, thank you so much for your presentation.

Thank you.

Going to be moving back up to File Item 1, AB 40, fellow Chair.

Assemblymember, when you're ready, you can move forward with AB 40.

Good afternoon Chair and Committee Members. AB40 simply clarifies that state law defining emergency services includes reproductive health services, including abortion.

Sadly, earlier this month the Trump Administration removed guidance telling health care workers that provide abortions in order to save their patients lives that they are protected under federal law with the rescission of the Emergency Medical Treatment and Labor act, or emtala.

This bill says simply makes it very clear for California providers that the state version of EMTALA requires hospitals to provide the care, treatment and surgery necessary to relieve or eliminate an emergency medical condition, including reproductive health services. This bill just makes that very clear in California law.

I want people in California to understand they will not be turned away from an emergency Department when they are in an emergency, when they are in the middle of the worst day of their lives, potentially losing the pregnancy they wanted so very much.

They should not have to also fear for their lives because they are being denied care. Recent federal actions make it very clear that it is very important to take this action now to ensure state law is clear.

About 50,000 people in the US develop life threatening pregnancy complications each year, including major blood loss, sepsis or or the loss of reproductive organs. And in rare cases, doctors might need to terminate a pregnancy to protect the health of the pregnant person, especially in cases where there is no chance for the fetus to survive.

Unfortunately, there have been instances even here in California where parents in the middle of a miscarriage or a pregnancy related or other critical emergency have been turned away from the emergency room and told to go to a different facility.

No one facing an emotional, vulnerable and potentially life threatening emergency should be denied care, told to go home or forced to drive to the next hospital. Abortion is health care, including emergency care and this bill makes it clear in California we treat it as such. Testifying in support today is Angela Hill with the California Medical Association.

Angela, you have five minutes.

Thank you. Madam Chair, Members of the Committee, my name is Angela Hill with the California Medical Association and we're in support of AB40. Physicians must be able to provide timely evidence based emergency care to stabilize patients and prevent avoidable harm in emergencies involving miscarriage, ectopic pregnancy, severe Preeclampsia or sepsis.

Any delays in care, including an emergency abortion, can result in permanent injury, a loss of fertility, or even death to the the pregnant person. Denying life saving abortion care in these situations contradicts decades of emergency medicine standards and it undermines the trust that patients place in their physicians in the healthcare system.

CMA opposes policies that override clinical judgment of trained physicians at the expense of patient health and safety, especially when it's driven because of religious beliefs. I'd like to also address a concern raised by opponents.

If a medical condition is such that the pregnant patient and the fetus need care, medical professionals are going to provide emergency care to stabilize both the patient and the fetus. And not every pregnancy related emergency is the same. And AB40 does not require physicians to perform emergency abortions.

It just ensures that they can provide medically necessary care in cases where fetal viability is no longer possible. And based on a patient's unique medical condition and their ethical duties, pregnant patients should not be forced to travel longer distances or to access the care that they need in emergency settings.

AB40 upholds medical standards while protecting life by allowing doctors to use their expertise when they are acting to save a patient's life or when their health is at risk. On behalf of over 55,000 physicians of CMA, we respectfully urge your aye vote and we thank Assemblymember Bonta for her work authoring this bill and bringing it forward.

Thank you. Now is the time for the me toos in support of this bill.

Thank you. I'm Dr. Kelly Peifer. I'm a senior advisor with Access Bridge, which works on reproductive health access and emergency departments. Strong support. Thank you.

Ryan Spencer with the American College of OBGYN's District 9. In support.

Angela Pontus on behalf of Planned Parenthood Affiliates of California. And strong support.

Tim Madden representing the California chapter at the American College of Emergency Physicians. In Sport.

Vanessa Hina on behalf of the California Academy of Family Physicians. In support.

Jennifer Robles with Health Access California in support.

Maddie Hyatt, California Civil Liberties Advocacy, in support.

Good afternoon, Madam Chair and Senators. Rosanna Carvacho Elliott here on behalf of the City of Alameda, also in support.

Thank you, Chair and Members. Kathy Mossberg, Central Access Health in strong support.

Omar Altamimi with the California Pan Ethnic Health Network. In support.

Miranda Pond on behalf of Reproductive Justice, Reproductive Freedom for All California, in strong support.

Mitch Steiger with CFT, A Union of Educators and Classified Professionals also in support.

Kimberly Robinson with Black Women for Wellness and Black Women for Wellness Action Project in support.

Tori Sumbler with Black Women for Wellness in support.

Adriana Benedict on behalf of Hey Jane. In strong support.

Thank you. Do we have any lead witnesses in opposition? Please come on in. Yes, you can sit down here, sir. You have a total of five minutes once you begin, Madam Chair.

Thank you. My name is John Girardi. I'm an attorney and I'm the founder of Advocates for Women's Health, which is a nonprofit OBGYN clinic serving lower income women in the City of Fresno, California, a place that desperately needs better prenatal care for lower income women. I'm here in opposition to AB40.

I believe AB40 raises a number of troubling issues that I believe would render it unnecessary at best and harmful at worst. AB40 singling out of one kind of procedure, abortion.

While witnesses have stated that obviously it's not prescriptive requiring abortion, I think the singling out of abortion could give the appearance of being prescriptive and pressuring towards physicians towards abortion.

The point of EMTALA and other kinds of laws for one of the many points is to help facilitate the best judgment of medical providers in providing the necessary emergency care for a given situation. Unlike emtala, which contains explicit considerations for emergency care to stabilize both the mom and the child.

I know we've heard that emergency care will provide for the child, but that language is not in the bill. AB40 contains no provision discussing the importance of maintaining stable situations for mom and child. We believe that existing protocols already exist to address Life saving medical interventions for women in critical situations, including the existing emergency services law.

There's also concern regarding whether not all abortions are emergent situations. Is this going to clog up emergency rooms with situations that are less than emergent? A couple of questions as I wrap up and thank you for your attention to this. One is a question of whether this would be in violation of the Federal Weldon Amendment.

Federal Weldon Amendment, which prohibits various forms of discrimination against hospital systems, et cetera, on the basis of failure. On the basis of failure to provide abortion services.

And secondly, to ask what evidence there is that existing hospitals, what kinds of hospitals are not already sort of in compliance with the need to provide emergency care services in these kinds of situations. Obviously there were some tragic circumstances that sort of helped prompt this bill with an instance of a mother was pregnant with twins.

Whether that was indicative of religious practice or instead indicative of just negligence on the part of one hospital I think is up for debate. So with that, that's my testimony and opposition. Thank you so much.

Like to turn over to any metoos in opposition, please.

David Bollog, representing Serving Family Values. We are in opposition. Thank you.

Thank you so much.

Seeing no one else, bringing it back to my colleagues, Madam Viceroy, I just, I'm a little perplexed because I thought this is already happening in, in hospitals. Are there, to the witness through the chair, are there hospitals in California that are not performing emergency reproductive abortion when the mother's life is at risk?

I don't have data at my fingertips. However, I can point to, I think it was just a few weeks ago there was a press piece done on this very issue and it did highlight the journey of a mother who was turned away from a hospital up north in California.

And it was a very much emergency situation where her health was at risk and she had to travel very far. She did have some issues and ultimately there was a very traumatic experience for her that she really had to undertake when the fetus tragically, as the author explained, these are often situations where there's no viability.

But I don't know if you have any other data.

Thank you, I will. I just want to first clarify for the Committee that EMTALA is still a federal law that is in effect. I misstated my opening comments on this. I think, Senator, to address your concerns, there have been several instances. It did prompt this. It did prompt this piece of legislation.

But more importantly, what prompted this legislation was that there is confusion now amongst health care providers around what guidance to follow when the Federal Government decides To. To remove guidance around ensuring that it's very clear that EMTALA is enforceable and needs to be protected under federal law. It does leave California providers with an unfortunate open question.

So the intention of this bill is to just make it very clear that California also has mirroring language to be able to support the fact that providers need to provide care in emergency situations, including reproductive health care, which could potentially also include abortion care.

So then are those cases. I mean, I would assume it's malpractice. If it's.

There are instances and evidence of that already happening. So we do need to clarify in the State of California, out of concern for patient care, that we make sure that it doesn't happen here.

Okay. So that Eureka case is not going to.

Is not a malpractice case that was just recently reported. And I'm actually unclear. We haven't directly communicated with that family that was highlighted in the story regarding what legal remedies they could be seeking. But I do know that it was really highlighting an issue where a physician's judgment. Right. Was being ultimately overridden over a policy.

Whether would any other. Can I respond to the question? Well, I just want to make sure the Senator had a question for the witness. I just want to make sure. If the Senator has a question to the author, then I would. She would, yes.

You please let her respond. Okay. Yeah. Thank you. Appreciate that. Senator, I think the concern is that malpractice, quite frankly, whether or not that particular case. Case. There was a claim of malpractice brought is irrelevant because any of that would be ex post.

Like the remedy is ex post past the point of urgency, past the point of emergency, past the point of somebody losing potentially their lives and losing potentially their fetus. So I think it makes sense for us to be able to move forward with a bill that ensures that we have clarity around this in the State of California.

So the reason why I'm asking is I'm just trying to understand if this is actually necessary, because if there are legal remedies and emergency care is not being given at a hospital when the mother's life is at risk, then if there are already legal remedies and those past cases have ended in malpractice, then I don't understand the need for this bill.

So I don't know that we're going to get the answer here today. I was just trying to get some clarity on it.

Yeah, I appreciate that, Senator. However, the fact that there are legal remedies to a harm is irrelevant to the fact that what we are trying to do is ensure that providers have clarity around the type of care and that they are responsible for providing care at the point of emergency.

And for those reasons, it is actually necessary to ensure that we have that clarity. In the State of California, particularly given the fact that the Federal Government has provided very confusing guidance that controverts the outstanding existing EMTALA law.

Well, I would just think that legal decisions would give physicians hospitals that clarity if they're malpracticed. So no more, as does legislation.

Turn it up to Senator Richardson.

Madam Chair, I'm going to speak a little more graphic than the Assembly woman so we might have clarity and be able to move forward on this bill.

As I understand what the Assembly woman is saying, if I went to the hospital and if I was pregnant and I was in the process, unfortunately of losing a child, if I go to a hospital where a Doctor is unclear their protection, if they're protected by actually performing that service, then that Doctor may say, you know what, I'm sorry, I can't help you to move forward.

This isn't, I think it's a poptic, whatever it's called, pregnancy. You're going to lose the baby. That Doctor may say, hey, I'm not willing to do it because I'm not willing to risk my license. I'm not willing to make the hospital vulnerable.

And so what the Assembly was woman is saying is that it really doesn't matter after the fact if the woman loses the baby. If the woman dies, sure, her family may have legal recourse, but that has nothing to do with that very moment when the woman is seeking the care.

And what I understand the Assembly woman is trying to clarify is by us clarifying the legislation, then the doctors will know, yes, I can provide this service without being in risk of losing my license, losing my job, causing the hospital to have problems. So it's not that it's not helpful ultimately to have.

It's that at that moment when a person is losing a child, is bleeding is all the things that are happening, they need the physician to be able to say, yes, I can provide the service right now. And that's what I understand the author is saying. And the difference? Yes, yes, ma' am.

I see no other questions. Madam Chair, you know, we don't want to wait till legal recourse to take action on things.

We want to be preventative as much as possible because then if we're reactive, that could put someone's life at danger and we can't fix that from then on So I know your intent is to make sure we put prevent these kind of cases. Bring clarity to this very supportive your bill. Give your opportunity to close.

Lawsuits are great. Life is even better. With that I respectfully request your aye vote Ma'am.

Sure. We don't have quorum just yet. Once we do, we're entertain a motion to move forward calling rest of health chair Members to come. We have two Members short today. We will be losing another Member.

We need to get quorum so we can get some votes on the books for any other Senator that could come and just establish quorum so we can quickly vote on the two items. We're going to be very short today in Committee with Members Majority Leader step on up.

Moving on To File Item 5, AB 2260 this monster of a bill.

Majority Leader, well good afternoon Madam Chair and Members of the Committee. First, I'd like to thank the Chair and the Committee staff for all your work on this Bill. I will be accepting the Committee's amendments today. AB260 is an important proposal to protect safe and legal reproductive health care here in California.

Access to reproductive health care, including abortion, continues to be under threat across the nation. Since the Dobbs decision, other states have been restricting or banning abortion care and people's ability to make decisions over their own bodies.

The Federal Government has already made cuts to critical funding for family planning in an effort to further restrict the ability of states to provide essential health care. You know, just a few weeks ago, the U.S. health and Human Services Secretary said he directed the FDA to re evaluate its approval of safe abortion medications.

So AB260 is in response to these very real threats to protect the this Bill protects access to medication abortions here in California. Specifically mifepristone, a common medication abortion drug that was first approved by the FDA in 2000.

Medication abortion is safe and effective and it's at the least invasive option for abortion care based on decades of FDA research. Access to full scope of reproductive health care is critical for Californians and their health care providers so they can make decisions that are best for their health and their families.

This is especially true for people living in the areas with few providers or for those who have to travel long distances to get care. This Bill also provides critical protections in California for medical professionals who are helping their patients get the health care they need and the patients themselves.

Specifically, this Bill protects healthcare providers, pharmacists, clinics and hospitals from disciplinary action or licensee impacts that are legally provided. Legally providing Mifepristone following the passing of a Similar policy in New York State. This Bill allows reproductive health care providers names to be removed from medication abortion prescription labels.

Health plans will be required to continue covering medication abortion, making sure this essential care remains affordable for those who need it. Finally, this Bill also expands access to telehealth services, making sure more people, especially our folks in rural and underserved areas, have access to safe, reliable, remote health care.

Senators, the Federal Government has already shown us its intent to roll back access and funding for reproductive health health care. It's more important than ever that we stand strong in protecting the rights of Californians and their health care providers.

This is a proactive step to make sure our people can keep accessing reproductive care, regardless of changes at the federal level. Affirming access to reproductive health care not only secures a person's right over their own body, but it fosters the health and well being of our communities across the state.

State with me today to testify and support are Dr. Kelly Pfeiffer, a clinician providing care to patients from states with abortion bans, and Miranda Pond, a practicing attorney with reproductive freedom for all. We've also requested Angela Pontus with Planned Parenthood Affiliates, who is also in the room, to answer any technical questions if needed. Thank you, Majority Leader.

Before we go, your witnesses. We have quorum, so we're going to do a couple of housekeeping keeping things before we move on. Okay? Thank you. Secretary, please call the roll.

[Roll call]

Can I do consent? Yes. Yes. Thank you. That's okay. The items on consent today are Item 2, AB55, Item 6, AB463, Item 8, AB708, Item 11, AB583, Item 12, AB627, and Item 13, AB870. Motion was moved by OR Vice Chair. Secretary, please call a roll.

[Roll call]

We're going to put the consent calendar on call. It currently has a vote count of six. Sero. Secretary Cub. Yeah.

You're Senator, can you hold? You have two more?

Yes, I do. I'm going to open the roll call, but we're going to put it on call if you want to come back. Secretary, can you please call the roll on file item two. Sorry. File item 11 AB40. File item one, AB40, please. And can I get a motion first? File item one moved by Senator Richardson.

The motion in front of us is do pass and we refer to the Committee and appropriations. Please call the roll.

[Roll call]

Current vote count of 4 to 0. We're going to put that on call. Like to move file item 4, AB348. If I can get a motion moved by the Vice Chair. Motion is due. Pass. Secretary, please call the roll.

[Roll call]

With the current vote count of six is there. We're going to put the item on call now. Coming back to you. You have a total of five minutes. It's up to you how you want to split up that time. Please proceed when you're ready.

Hello, I'm Dr. Kelly Peifer. I'm a family medicine physician and it's an honor to be here, Madam Chair. Thank you. I've been providing abortion care in California for over 25 years alongside my work in primary care and policy.

I'm grateful that everything about everything California has done to protect the right to abortion, including enshrining this right into the Constitution and protecting the Clinicians who provide this life saving care from other states. I also run a medication abortion clinic in Kansas where I've worked for since 2017.

The patients we see primarily travel from states that ban abortion. Under our shield laws. California licensed clinicians can serve those travelers and we're protected against prosecution or civil actions from being brought home. And that's allowed us to serve thousands of patients without worry. But we can and must do more.

AB260 will help by protecting access to the medications we use for abortion. Data from 40 years around the world clearly show that abortion pills are safe and effective. And in light of the situation at the Fda, it is urgent to assure that California Clinicians and pharmacists can prescribe and deliver mifepristone to the patients who rely on us.

This Bill will allow us to continue to treat our patients even if politicians in Washington act against the science. To Further limit MifePro AB 260 will also allow Californians covered by Medi Cal to access medication abortion through telehealth and for those who live far from Clinicians who provide abortions in person.

For those who can't leave their jobs or can't find childcare for people of limited mobility due to transportation or disability, abortion pills can be delivered with the same rates of safety and efficacy as in clinic care.

Studies from the Guttmacher Institute show that since Dis Dobbs allowed states to ban abortion clinics, the rate of abortions has actually risen and medication by telehealth is the reason around the country and here in California, access to vital care has improved. For those who struggle to make to clinics because of telehealth.

I hope California will continue to lead in this public health crisis and I strongly urge a yes vote on 260. Thank you.

Thank you. Good afternoon Madam Chair, Chair and Members of the Senate Health Committee. My name is Miranda Pond and I'm here on behalf of Reproductive Freedom for All California, a proud co sponsor of AB260. Reproductive freedom for all is the nation's largest organization dedicated to protecting and expanding reproductive freedom for all people.

For over 50 years we have fought at both the state and federal levels to ensure access to essential reproductive health care including abortion, birth control, pregnancy and postpartum care and paid family leave.

We are powered by more than 4 million Members across every state and congressional district, united by the shared belief of the 8 in 10Americans who support legal abortion. In California, that belief is more than a value, it's a constitutional right. That's why we're here in strong support of AB260.

This critical legislation ensures that California protects access to medication abortion regardless of any regressive federal actions. It codifies the existing evidence based standard of care that has been safely used for more than 25 years, protecting providers, patients and access to essential care. As the courts threatened to restrict mifepressone nationwide. California must stand firm.

AB260 guarantees that our state will not allow political interference to roll back access to citizens safe effective medication abortion. It also protects the use of telehealth, ensuring that people in rural and underserved communities continue to receive care with dignity and respect.

We are grateful to Assemblymember Aguiar-Curry for her leadership and we respectfully urge your aye vote on AB260. Thank you.

Thank you so much. Step on up if you want to record a me too in support of this bill.

Ryan, specifically on behalf of the American College of OBGYN's District 9 in support.

Angela Hill with the California Medical Association in support.

Angela Pontus on behalf of Planned Parenthood Affiliates of California, co-sponsor in strong support.

Madam Chair Anthony Molina on behalf of the Abortion Coalition for Telemedicine in support. Thank you.

Good afternoon. Tiffany Brokaw here on behalf of Attorney General Rob Bonta, Proudcoin's father sponsor this bill. Thank you.

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

Kelly Brooks on behalf of Los Angeles County here in support.

Kathy Mossberg, Central Access Health co-sponsor in support.

Durazo Manning on behalf of California State Treasurer Fiona Ma, pro co-sponsor of this bill.

Thank you.

Genevieve Schweitzer on behalf of Lieutenant Governor Eleni Kunalakis as a proud co-sponsor in support. Thank you.

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

Thank you.

Craig Polster on behalf of Quality California in support.

Adriana Benedict on behalf of Hey Jane, proud co-sponsor in support.

Kimberly Robinson with Black Women for Wellness and Black Women for Wellness Action Project and support.

Tori Semler with Black Women for Wellness in support.

Maddie Hyatt, California Civil Liberties Advocacy in support.

Yesenia Jimenez in support. Thank you.

Jackie Valdez in support.

Moving on to lead witnesses in opposition, please step forward. Any anyone opposed would like to record their MeToo in opposition. Bringing it back to my colleague. Great moved by Senator Richardson. Majority Leader. Please close.

I'm going to make this easy. I respectfully ask for. I vote and I want to just acknowledge all the people that are in support of this Bill for the women of California and hopefully across the nation eventually. Thank you.

You got five supporters for each provision of the 21 provisions in the Bill. Thank you very much. Thank you, Majority Leader. Secretary, please call the roll. Motion was made by Senator Richardson. Motion is is due, pass is amended and we refer the Committee on Business, Professions and Economic Development.

[Roll call]

Well, they'll come. But for right now it's on call with a current vote card of 2 to 0. We see another author. Thank you. Assembly Member Valencia. When you're ready, please present file item seven, AB four and 92.

Thank you, Madam Chair. Good afternoon, Members. As good of an afternoon can be having considering everything going on in our state.

But that's another topic here to present AB 492 that will require the Department of Health Care Services to notify local governments when they issue a new license for an alcohol drug abuse recovery or treatment facility that will operate within their jurisdiction.

The written Notification will include the name and the mailing address of the licensee and the name of the facility. With me to provide testimony is Caroline Grinder, the legislative advocate for the League of California Cities.

Caroline, you have five minutes. Great. Good afternoon, Chair Members. Caroline Grinder. On behalf of the League of California Cities, we're Proud to sponsor AB492. Alcohol and Drug treatment facilities provide a vital component of California's behavioral health continuum, providing stability and support to people on their path to recovery.

However, cities have significant challenges in communicating effectively with the Department of Healthcare Services and receiving accurate and timely information. Cities are often the last to know about a new treatment facility that's licensed in their community, often only learning about these new facilities when residents call with concerns about operations.

AB492 would hope to address this issue by requiring the Department to notify cities when a new license is approved. This assures that cities receive timely information about the new facility and allow them to proactively coordinate local resources and better address communities community concerns.

Cities are already expected to manage a wide range of data on properties in their communities. This includes the names of all property owners, which are kept through the county recorder's office, and then also records of regulated businesses through city finance departments. There's already state programs with similar notification requirements, including liquor licenses, cannabis businesses, and syringe exchange programs.

California has made it really clear through recent policy funding decisions that addressing homelessness and behavioral health is a crisis that requires coordination at all levels of government. And this includes our cities. With billions in the pipeline for behavioral health housing, we must ensure that local governments are equipped to be effective partners.

We think that by enhancing communication between the Department and local governments, we could strengthen our behavioral health system, improve outcomes for individuals in treatment, and build healthier, safer communities. For those reasons, we urge your support for AB 492.

Thank you so much. Please step forward if you want to record your Me too, In support of this bill, please.

Good afternoon, Madam Chair. Jonathan Clay, on behalf of the City of Encinitas, in support.

Nicole Wertleman on behalf of the Orange County Board of Supervisors, in support.

Good afternoon. Kiara Ross, on behalf of the cities of Glendale and San Marcos, in support.

Dylan [unintelligible] on behalf of the California State Association of Psychiatrists, in support. Thank you.

Sharon Gonzalez on behalf of the cities of Carlsbad and Thousand Oaks, in support. Thank you.

Mike Shreve on behalf of the City of Anaheim, in support.

George Cruz, on behalf of the California Behavioral Health Association, in support.

I'd like to turn to if there's any lead witnesses in opposition. Any me toos opposed? Okay, bringing it back. Assemblymember, I, I provided a non-reco on this bill and Members are going to be able to vote how they want to um want to vote.

But the reason why it was a non-reco because this Committee has seen a lot of bills related to this specific entity coming from Members of a specific area, the O.C. County. And it's really prevalent to see that it's a constant bullying and harassment of these facilities.

And the examples that were given from the witnesses are examples like liquor stores and cannabis that are not where people. These are stores and they're businesses. It's not a facility that has people living in there. There is no other license facility under health that has to give a heads up to a county once they license an entity.

If this was about collaboration, then the bill would be I want every single licensed entity to tell the county that we just license an entity. But it's a specific focus on one specific type of licensed facility that has people living in there.

Additionally, every single kind of new business that comes to a county, the counties already know fire has to get involved. The local business permit has to be given out. So counties are aware and it's also published on the website of every single type of license they give out.

Again, I thought this bill was once again putting or just putting a limelight on an entity that just is housing people. And if this facility didn't exist, we would have these individuals living on the street. For those reasons, I cannot support this bill. Any questions or comments from my colleagues?

Assemblymember, you may close. Thank you. And I hear your perspective loud and clear. I'll speak on behalf of my district, the most diverse district in Orange County, proudly. So we actually are home to 60% of all the unhoused resources and facilities that are intended to treat people that have this need.

My intent with this bill is not to stigmatize or point out this specific industry, more so to ensure that there's collaboration and communication of information amongst all levels of government so that we can better treat our constituents.

Again, my district has the highest concentration of need and I think this would be a vital tool so that our cities who are being the most proactive in Orange County, have the information they need to provide for the residents, whether they're homeowners or individuals living in these types of homes. With that, I respectfully asked for yes vote.

Thank you. Assembly Member motion. zero, he. He just closed. I can answer a question.

Just kidding.

Okay, great. I just want to make sure we're following the.

Yeah, it wasn't illegal. The author. Would you be willing to as if you get to the next step, are you willing to continue to work with the community Committee maybe on some amendments that they might have? I know the bills are kind of crossing pretty quickly right now.

I mean we just finished our first house of origin and now, you know, within a couple days we're already viewing your bills. So if you would be open to continuing to work with the Committee as you hopefully go on to the next one. I'll make a motion to move your bill.

Thank you. Absolutely. You have my commitment in doing so. Again, all this does is we'll have the state send an email snail mail to the city letting them know the name, the mailing address of the licensee and the name of the facility. That is all it's doing.

So happy to consider any amendments that this Committee has and work through that process as well.

I do also want to make it clear, you know, the reason why there's no, there wasn't a no recommendation is because there's no amendment that was provided by the Committee.

And it wouldn't have been fair if I provided, if I gave a no recommendation without an amendment, which is why it was a none due to the fact that on just it was going to be really hard to provide an amendment. It was just going to gut the bill.

So this is why no amendment was provided by the Committee. So I don't want to give a false promise that the Committee is going to work on other amendments because just on its face, no other entity has to provide any notice, any Committee County across California and this would just pick on one entity.

So to provide an amendment would to just say don't do this notification. So I just want to make that clear.

Thank you.

I'm still absolutely great. I'm a person of great hope. So potentially you guys will be able to work it out and also as you go to other communities as well willing to give you a shot.

Moved by Senator Richardson. Motion is do pass and we refer to the Committee on Appropriations. Secretary, please call the roll.

[Roll call]

Assignment currently is a 2 to 0. But you see most of our Committee is missing. So we'll open it back up. Thank you so much for your presentation. Thank you. We're going to put that item on call. I thought I saw some Member. Yes, I did. Assembly Member Gonzalez, you are up you represent file item 10, AB574.

Ready when you're ready. Good afternoon. Thank you, Madam Chair. Thank you to Committee Members. First, I want to say thank you to the Committee, to the staff, for their work on this bill. And we'll be accepting the Committee amendments. The sponsor, I know, and us, and many conversations that we've had with the Committee staff.

Yes.

So thank you all so much for coming to those agreements. I'm here to present AB574, which will allow patients to access up to 12 medically necessary physical therapy sessions without prior authorization for a new condition. AB574 ensures that patients can get critically early treatment without unnecessary barriers, helping them recover faster and avoid worsening health conditions.

Prior authorization requirement currently create delays that make it harder for patients to access the care they urgently need, often prolonging patients pain and dependence on medications like painkillers. Health plans and insurers frequently require doctors to submit detailed paperwork to prove the need for physical therapy. And the process varies widely depending on the insurer.

A survey by the American Physical Therapy Association found that over 75% of physical therapists reported that prior authorization decisions took three or more days. When patients are left waiting in pain, these delays are harmful, particularly for patients suffering from chronic conditions who may experience worsened outcomes while they wait for approvals.

I know firsthand how frustrating and exhausting these delays can be. My mother's care. As my mother's primary caregiver, I've been one who's made the calls scheduling the appointments and navigating the complicated approval process. And I know my experience is not unique.

When she had her stroke about three years ago, you finally start to recover, you figure out those pieces to it, you finally get the authorization, which is two. I took it to her first appointment and, and it was like, well, this is just the evaluation for the first one. The second one you have to come back for.

And then that's the first sort of therapeutic session that we'll give you. And then you gotta wait for more authorization to come back. That's assuming they mail it out, send it out. And so two weeks later we got the other one.

She could have made much more progress in those first two weeks, should we had prior authorization in the first place. But instead the first authorization was just simply an evaluation. So for us, that delay is what causes not just my mother, but many people the ability to recover faster because of bureaucratic paperwork.

So this bill, AB 574, will ensure that patients are informed about potential out of pocket cost before starting treatment. If the coverage is denied and require the clear consent and disclosure if the provider is out of network, which is also very key. To be clear, this bill does not apply to Medi Cal managed care plans.

This afternoon, two individuals who are our primary witnesses of support. Dr. Oscar Gallardo, CL Clinic specialist in neurologic physical therapy with LA County, and Dr. Rick Katz, President of the California Physical Therapy Association. Take it away, gentlemen. You have five minutes total.

Thank you. Hello. Madam Chair and Members of the Committee, My name is Oscar Gallardo. I'm a doctor of physical therapy and a board Member of the California Physical Therapy Association.

I have dedicated my entire clinical career to serving patients through the Los Angeles County Department of Health Services, where I work primarily with individuals recovering from complex neurological conditions such as spinal cord injury, stroke and traumatic brain injury. These are not just diagnoses. These are life altering events that affect real people throughout the state.

And for these patients, access to timely and uninterrupted physical therapy is not a luxury. It is an urgent medical necessity. Unfortunately, under the current system of prior authorization, this access is routinely delayed, interrupted or outright denied. I've witnessed firsthand the harmful consequences of these administrative barriers.

Patients often begin therapy only to have it abruptly halted after a few visits. While they wait, sometimes weeks, for a new authorization, a patient who begins to regain strength and function suddenly loses ground due to forced pauses in care.

When they finally return to therapy, we often spend valuable sessions just trying to get them back to where they were rather than continuing their progress. This stop start cycle is essentially damaging for patients with neurological conditions. Interruptions in therapy can cause permanent setbacks and significantly reduce the patient's overall potential for recovery.

Worse still, these delays can lead to preventable complications, hospital readmissions and increased long term healthcare costs. AB574 addresses this problem directly by eliminating unnecessary prior authorization barriers for the initial 12 sessions of a physical therapy plan of care.

The bill ensures that patients, especially those with neurological needs, receive the continuous medically necessary care that they need and that they pay for as part of their health plans. California must do better. For these patients, neurological rehabilitation cannot be subjected to bureaucratic delays.

I urge your support on AB574 so we can remove harmful barriers to care and give patients the best possible chance of recovery. Thank you to Assemblymember Gonzalez for championing this important legislation. And thank you to the Committee for your time and consideration.

Thank you. Hi, my name is Rick Katz. I'm a doctor of physical therapy and the President of the California Physical Therapy Association. And we represent more than 10,000 Members, we are seeing trends of arbitrary limits and interruptions placed on patients patients access to care.

A review of about 1.2 million cases from the nation's largest physical therapy provider showed that the standard number of visits when approved through a computer algorithm was about 3.8. However, if those visits then went through a physician or a healthcare provider, they approved 12 visits on average.

That indicates that the care that was originally requested was medically necessary and that the arbitrary limits replace on the patient's care by the health plan. Just this year, UnitedHealthcare implemented a prior authorization policy that interrupts physical therapy care at six visits and requests records be sent in to establish medical necessity for continued care.

This occurs regardless of the patient's condition, regardless of what the referring physician requests, and ignores the plan of care that's actually established between a physical therapist and the attending physician.

If you question insurance companies, you'll find that there are minimal denials for appealed physical therapy which indicates that the original care requested was medically necessary and denial simply interrupted needed care. The opposition to the bill states that this bill will create unfettered access to physical therapy, which implies they're fearful of increased costs.

The opposite is actually true and that dozens of studies show that early and uninterrupted access to PT can reduce costs by as much as 75% by reducing downstream care costs.

This bill will not limit an insurer's ability to establish benefit policies that limit the number of annual visits and can mandate that a physician be involved in the care early on prior to the onset.

This bill does not restrict the ability of a payer to provide perform retrospective utilization review or their ability to exclude overutilizers over providers or over utilizers from their network.

So I want to thank the Committee Chair and Assemblymember Gonzalez for working with us to modify the language of the Bill recently and to address the excuse me, the concerns that you had and I urge you to vote yes on the Bill. Thank you.

Thank you so much. Any anyone here from me too in support? Do we have any lead witnesses in opposition.

It's very quiet in here today. Ooh, it's the Senate.

I didn't even know this room existed. Ladies, you have a total of five minutes.

Madam Chair, Members, Stephanie Watkins, on behalf of the Association of California Life and Health Insurance Companies, first and foremost, we would like to thank the sponsors and the author's office. We have had multiple discussions over the last couple years with respect to the spread.

Unfortunately, as many of you have heard before, prior authorization serves a critical function within the healthcare system as it allows health plans and insurers the opportunity to evaluate specific services and ensure that they are not only medically necessary, but are consistent with appropriate clinical care guidelines.

Regrettably, AB574 would undermine that process by allowing physical therapy providers to provide their patients with up to 12 visits without any oversight or review by the patient's health plan or primary care physician.

In essence, this policy change restricts the health plan insurer's ability to determine if the treatment visits are medically necessary or follow the standard care clinical care guidelines. Without this assessment, we are concerned that patients may receive unnecessary treatments or therapies that are not tailored to their specific needs.

Regrettably, we believe this bill unnecessarily increases administrative costs, decreases affordability, and potentially leads to unneeded or unnecessary care and delivery for our Members.

As many of you know and we've been here, we are currently working on several bills that we have an opposed, unless amended position on dealing with a more holistic, broad based review of prior authorization and changes that we'd like to see and help facilitate in that area.

So, unfortunately, today we are opposed to this bill, but we do look forward to having additional conversations if it does move forward. Thank you.

Thank you, Madam Chair and Members. My name is Olga Shiloh. I'm here on behalf of the California Association of Health Plans. I'd like to align my remarks with those of my colleague from ACLIQ and share our perspective on AB574. We recognize and value the important role physical therapy plays in patient recovery and well being.

However, authorization for care is a fundamental tool to ensure that patients receive safe, high quality and affordable health care. This process facilitates adherence to evidence based medical guidelines, protecting individuals from unnecessary procedures, excessive costs, and potentially harmful treatments. This process is not about denying care.

It's about ensuring the right care at the right time from the right provider. I would also like to reiterate that while it is incredibly important to maintain appropriate checks and balances in health care, we are also continuously working to improve the authorization for care process altogether.

If this bill moves forward, we are committed to continuing the dialogue and working with the author. However, at this time, we must respectfully remain opposed. Thank you.

Do we have any me toos in opposition? Okay. Colleagues, do you have any questions for the Assembly Member? Okay. I do recognize it's a good, valid point. There are other bills that are looking to address on the bigger picture. I know those conversations are going to collide at some point.

As for right now, most likely this bill will make it out of Committee and those conversations will continue as they move along. Assemblymember, I give you the opportunity to close now.

Thank you, Madam Chair. Thank you to everybody on the dais today and for the ongoing conversations that we've had about this with the opposition. Thank you, Dr. Gallardo and Dr. Katz, for sharing your experience today on the floor. This bill received 73 to 1 out of Appropriations 14 to 0 and Assembly Health 16 to 0.

So it is going along the right trajectory, I think, because this prior authorization relates to everybody, not just those of us who are here serving in office, but everybody. AB574 is our promise that healing in California begins with compassion and not paperwork. By removing needless delays, we turn barriers into bridges.

We transform waiting rooms into recovery rooms and pain into progress. Let's stand together for every patient in need. Ensuring care comes swiftly and hope for patients reigns. I respectfully ask for your aye vote.

Can I entertain a motion moved by Senator Padilla? The motion in front of us is do passed as amended, and we refer to the Committee on Appropriations. Secretary, please call the roll.

[Roll call]

As a Member that currently has a vote count of five to zero, we're going to put it back on call. Thank you. Thank you for your presentation. There are no presentations left in the Senate Health asking the rest of the Members to come. But right now we're going to open the roll. Go down the list.

Secretary, please open the roll and file item one. AB40.

[Roll call]

Putting that back on call, but currently has a vote count of five to one. He opened the rope the consent calendar and call the absent Members.

[Roll call]

Putting the consent calendar back on call. Current vote count seven to zero. Call the absent Members for file. Item four, AB348.

[Roll call]

Putting it back on call. Vote count 7 is 0. Please call the absent Members on file, item 5. AB260.

[Roll call]

Please call the. Please call the absent Members on file item 7. AB492.

[Roll call]

Putting back on call with a vote count of 5 to 0. Please call the absent Members and file item 10.

[Roll call]

Let's go through the roll again. Please call the absent Members of file item 1.

[Roll call]

Please call the Absent with the Putting it back on call with 61 vote count. Please call the absent Members on the consent calendar.

[Roll call]

Consent calendar back on call with the 80 vote count. Please call absent Members on file item 4.

[Roll call]

File item 4.

[Roll call]

Back on call with the vote count of A to 0. Please call the absent Members on file item 5.

[Roll call]

Placing that item back on call. Vote count of five to one. We're going to take a quick recess until the rest of the Members are back to close out the vote.

Back in.

I mean, Senate Health is back in.

One more time, please. Please open the roll on file, item one.

[Roll call]

That bill is out with the vote count of 7 to 1. Please open the roll and call the absent Members on the consent calendar.

[Roll call]

On the nine to zero consent calendar is adopted. Please call absent Members on file item four.

[Roll call]

That bill is out with the vote count of nine to zero. Please call the absent Members and file item five.

[Roll call]

That bill is out with the vote count of six. Six to one. Please call the absent Members on file, item seven.

[Roll call]

With the vote count of six to zero, that bill is out. Please call the absent Members on file, item 10.

[Roll call]

The vote count of 7 and 0. That bill is out. That concludes the business for today's Senate Committee on Health. We are adjourned.

Sam sat.