Senate Standing Committee on Health

The Senate Committee on Health will begin in 30 seconds.

The Senate Committee on Health will come to order. Good afternoon, y' all. Our first order of business is the most important order of business. We are going to say happy birthday to our Senator, Dr. Weber Pierson here. Happy birthday. She asked me to do this. She wanted this. She wanted this. Loves this.

Okay, we have one Bill that was pulled from today's hearing. That is file item 9, AB 1460. Now, that leaves us with 16 bills on the agenda for our proposed for consent. We have an author to kick us off on file number one. AB310, Assembly Member. Step on up.

All right, thank you. Thank you, Madam Chair and Senators. Happy birthday, Senator. By the way, I appreciate the opportunity to present AB 310 today, which is a continuation of the work that my team and I have done on increasing the safety on youth sports.

I want to begin by accepting the Committee's amendments as described in the Committee's analysis. I've provided copies for your reference today. I also want to extend a special thanks to the Committee and staff. Thank you for all the time and work on the bill and I appreciate the engagement with the chair as well.

AB 310 aims to extend protections for children in youth sports by building upon the success of the Nevaeh's Youth Sports Safety act, which we passed in 2023. Since then, we've made great strides in learning from experts about how best to support youth sports programs and coaching staff in providing safe and accessible sports programs in their communities.

As you may know, sudden cardiac arrest is the number one killer of student athletes. According to California Interscholastic Federation, or CIF. If not properly treated within minutes, SCA can be fatal in 92% of the cases. In these situations, timely intervention is critical.

That is why, through Nivea's law, we established a new standard of safety around youth sports by ensuring these athletic programs provide our young athletes access to an automatic external defibrillator, also known as an AED.

During both practices and matches, parents and kids should never have to question whether the coaches and staff have the equipment or the training to administer life saving care in an emergency.

AB 310 further achieves this by requiring youth sports organizations to have a written emergency response plan that includes the location of an AED and outlines safety procedures in the event of a cardiac emergency. The bill would also ensure proper maintenance and testing of automatic external defibrillators and requires coaches to be recertified on these devices every two years.

With me today in support of AB310 is Greg Hurner, representing the sponsor of this bill, Save a Life Foundation.

Madam Chair Members Greg Hurner, on behalf of the Eric Peredes Save a Life foundation and more importantly, Eric's parents Hector and RHNA, that lost their son to the preventable tragedy of sudden cardiac arrest and who have dedicated their lives to keeping other families from experiencing the same tragedy.

The Nevia Youth Sports Safety act was passed last year because 10 year old Nevia Grace Johnson collapsed at an athletic practice and an AED was steps away, behind a locked door and inaccessible to those attempting to save her life.

The bill mandated that by 2027, California's youth sports teams must make an AED accessible to athletes during practices and matches. This provision is being delayed by one year in AB 310. The reality is that SCA is the number one killer of student athletes. 90% of SCA victims die because emergency intervention was not delivered within minutes of collapse.

AB 310 updates the Nevaeo Youth Support Safety act to clarify that anyone can use an AED. They are simple to operate and use voice commands and sound commands to coach the person through their use. In fact, they can't be misused as they will not administer a shock if the heart's electrical pulses don't indicate the need.

AB 310 also takes steps to save more lives by requiring planning and education including the certification of coaches or on CPR and AED. Importantly, a youth sports organization would be required to have a written emergency response plan that is reviewed annually for the coach, Administration and athletes, so the plan is familiarized with those closest to respond.

We appreciate the author and the Chair's support in keeping these requirements to 2027. In asking for your support, I will note that schools with interscholastic athletic programs have been mandated to have AEDs and emergency action plans since 2019.

So while we are disappointed in the delay of the existing law requirement for youth sports organizations until 2028, we remain committed to supporting efforts to find additional ways to get AEDs in the community. I'm happy to answer any questions about costs or anything else about AEDS and would like to thank Dr.

Weber for sponsoring our recent youth screening event in San Diego.

Thank you so much. Any #MeToos in support of this bill, please step forward.

Madam Chair. Chris McKealy on behalf of the American Youth Soccer Organization, AYSO in support of the bill and happy birthday Dr. Weber Pierson.

You're going to get that all day. Dr.

Afternoon, Madam Chair, Members. Alex Alanis, on behalf of the on behalf of the Upper Lake Tribe in support.

Thank you Madam Chair Members, Tim Madden representing the California chapter at the American College of Cardiology and support.

Thank you so much. Do we have any formal opposition, any #MeToos opposed to this bill? Vice Chair Birthday woman.

Thank you. Chair. Really want to thank the author for this bill. You know, I am a mom of two young boys that are very active in sports. And you know, as was stated, we just had an event in my district.

One of the other organizations that I'm a part of just sponsored an event because one of our youth who had moved to the east coast but was very, very active in soccer actually had one of these events and is only alive today because of the fact that there was an AED and no one knew that he had any issues.

He'd been playing soccer his entire life and then all of a sudden he just collapsed on the field. You know, luckily he is alive, he's thriving, he's back to playing soccer, he's in college now.

But this is extremely, extremely important for people to be trained, for people to have access to it and at some point for, you know, all of our youth to actually be screened. One of the things in the program was actually a screening program.

So all of the kids that were there got a chance to come and get an eeg and for the those that were a little higher risk actually had an echo right there on site. So, you know, really appreciate you continuing to push this very, very, very important issue and this truly, truly does save lives.

So thank you so much and would love to be a co author.

Thank you, Vice Chair.

Yes, I just want to echo the sentiments from a Senator from San Diego and thank you for your voice and for being up here and advocating and also the author for bringing this forward.

It's important for our athletes and as a parent, knowing that one more person is trained, whether it's for my child or another child, is really important. So I just want to say I'll be supporting this Bill. Would love to be added as a co author if you're having me as well. Thank you.

Thank you colleagues. Assembly Member I used to be one of these kids that did a lot of these sports and I had one incident, then ambulance had to come and get me, but it wasn't cardiac. It was more felt really hard playing basketball. So I recognize the need for this.

As a previous emt, you know, I've had to take various CPR courses. I know we had a lot of dialogue on whether it should be hands on or just strictly online.

I think CPR instruction in person is important, but I also Recognize that a lot of these people are volunteers, that they're not getting paid for this and they're just being there to ensure that their kids have a coach there present.

So recognizing that, we don't want to add additional barriers for people to be able to provide some training for the kids. So we were able to land on that to bring some flexibility for that. This Bill is really important to protect our kids, even professional.

I remember during NFL's last season there was a player that out of nowhere fell and had to get surgery. But they have access to AEDs and so forth. So I don't think just because you're a professional, you should be able to have that access to treatment.

It's regardless of who you are, if you're five to five years old, you should have access to that life saving technology. So with that I'd give you an opportunity to close.

Thank you. And thank all of you for those words. And it makes us feel better when we do a bill like this to try and help our youth. And my kids are all older now and I have grandkids. I have one that's seven who I'm sure is going to be playing sports real soon also.

But just to know that I know like if you go to a football game, you see an ambulance parked there, so you're like, okay, I feel a little bit better, the ambulance is there.

But to know now that we'll also have an aed, which technology just keeps advancing and we have it, so why don't we make sure it's available? So I think this bill will help us, take us to where we are.

And as you guys know, as a former law enforcement, you know, safety was the core of what I wanted to do. I wanted to make sure that we do protect and I continue to protect here in this Legislature. And that's again what this bill is doing. And at the end of the day, it's all about the kids.

So we want to make sure that we're doing that. And so I respectfully ask for an Aye vote. Thank you.

Once we have quorum, Assembly Member, I'll entertain a motion. Thank you for your presentation. Thank you.

Thank you. Happy birthday again.

All day. Assembly Member Krell, you are up with file item 3 AB 4610. Team Member, you may begin. Assembly Member.

Good afternoon, Senators, and happy birthday. I come to you with Assembly Bill 416 today. This is a bill that would authorize emergency room physicians to put patients experiencing behavioral health crises on 5150 holds. Currently only law enforcement and the county designee has the authority to do this.

This is an important bill that would alleviate overcrowding in our ER departments and also help patients who are experiencing behavioral health crises transition quickly to a place where they can get the kind of care that they need.

With me today to support this important bill is Tim Madden, representing the American College of Emergency Room physicians and also Dr. Ellen Schenck, an emergency room physician here at UC Davis Health. Short and sweet. Thank you Assembly Member.

Thank you Madam Chair. Tim Madden representing the California Chapter of the America College of Emergency Physicians. And I must also wish a happy birthday to this fine Senator as I missed my earlier opportunity, but if I come up again, I'll do it once more. With that being said, representing the emergency physicians, we're the sponsor of AB416.

Would love to thank the Assemblymember for bringing this important issue forward. I will defer my testimony to Dr. Schenk to talk more about the need for the bill but available to answer any questions.

Thank you.

Good afternoon Chair and Committee Members. I'm Dr. Ellen Schenk and I'm a practicing emergency physician here in Northern California. I am also a fellow with the California Chapter of the American College of Emergency Physicians, the sponsor of this bill. As the analysis points out, one in six patients that comes into the ED has a behavioral health diagnosis.

I treat these patients every time on one shift. Some of them I can stabilize and discharge and some of them need to be transferred to an inpatient facility. For those who are voluntarily seeking care, we can immediately begin looking for placement.

But there are also patients who are danger to themselves or others and need to be placed on a 5150 hold to ensure they remain safe and to get additional care at an LPS designated facility. I can keep them safe by holding them in the ED under Section 1799 of the Welfare and Institutions Code.

But we can't start looking for an available bed and an LPS facility until the patient is placed placed on a 5150 which in some places can take many hours, even days. So this patient who's in crisis, who's a danger to themselves or to others, is just stuck waiting. This happened recently on one of my shifts.

I work primarily at an academic center but also at a small rural hospital in the Sierra Nevada foothills. When I was on shift at the rural site, a 17 year old female had run away from home and was brought in by an ambulance after trying to kill herself after overdosing on her side psychiatric medications.

During her ED stay, she metabolized the medications and wanted to leave because she was a danger to herself. We wanted to place her on a 5150 hold, but it was a holiday weekend. We had no one working in the ED who was certified to place 5,150s.

It took three days before we were able to find someone who could come in and officially place her on the hold that we already knew she needed.

Meanwhile, this poor girl had to stay in the ED that whole time under fluorescent lights listening to us run codes when she should have been promptly referred to mental health facilities that became much needed therapies on her journey toward healing. I went into emergency medicine because I wanted to help people when they're in crisis.

One of the most frustrating parts about my job is when I can't get my patients the care they need in a timely manner. That 17 year old girl, if she had shown up at my primary academic site, she would have been placed on a 5150 hold immediately when she was medicated cleared.

However, there's a wide disparity in resources available to providers and to patients. Depending on the county, the time of day, even the day of the week that they are in crisis, this should not be the case. Emergency physicians are always in the ed.

We ask that you empower us to take care of our patients and vote yes on AB416. Thank you.

Thank you so much for your testimony. Me-too's in support of this bill? Name organization and your stance, please.

Claire Sullivan, on behalf of the California Association of Psychiatric Technicians and the City of Bakersfield in strong support. Thank you.

Nisette Short, on behalf of Adventist Health, Loma Linda University Health, the Alliance of Catholic Health Care and St. Agnes Medical Center in support. Thank you.

Good afternoon, Christy Weiss, on behalf of the California Hospital Association in support.

Thank you so much. Formal opposition to this bill. Please step forward, ladies. You'll have a combined five minutes. Combined time of five minutes.

Good afternoon, Chair and Committee Members. Karen Vaccary, Director of Public Policy, Mental Health America of California. We are a peer run organization and I'm a person with lived experience and a family member. I'm here today to respectfully oppose AB416.

This bill is unnecessary because ER physicians are already eligible for county designation as a professional person designated by the county. However, by specifically stating that ER physicians are eligible for designation, the bill is intended to encourage ER physicians to seek designation, thus expanding the pool of those authorized to place holds and thus expanding involuntary commitment.

By specifying ER physicians as a professional person in statute, we are opening the door for a myriad of other classes of professional persons to also be added to statute in the future. Where will it Stop? Counties vary widely in their training of designated individuals.

ER physicians treat a broad variety of ailments, but they have varying levels of experience and are not specialized mental health practitioners. By increasing the number of designated ER physicians, we risk inappropriate transfers to psychiatric facilities. There is also value in an ER physician calling a third party in for an evaluation.

Both county staff and crisis response teams are already connected to lower levels of Service. When an ER physician calls them in for a 5158 evaluation, they will link individuals not eligible for 5150 to appropriate community based voluntary services. ER physicians in General Acute Care Hospitals do not always have this linkage to community based services.

For the past three years, California has steadily increased involuntary treatment with bills like SB43. At a time when California is experiencing severe workforce challenges, serious fiscal concerns, and a rising rate of individuals with mental health challenges, we should be expanding cost effective voluntary services, not costly inpatient care.

We already have mechanisms in place to help individuals in an emergency. What we don't have are investments to keep people out of crisis. I respectfully request your no vote. Thank you.

I'm Dr. Lynn Rivas, Executive Director of the California Association of Mental Health Peer Run Organizations. Since 2011, we've been dedicated to empowering individuals who receive mental health services, peer support specialists, and peer run organizations.

As someone with a severe mental health disorder myself, and over 15 years of experience in the field, I have heard from many individuals who have experienced involuntary institutionalization. They consistently describe these experiences as traumatizing and demeaning. We oppose this bill for three main reasons. 1.

Trauma from involuntary institutionalization so evidence shows that psychiatric institutions often cause trauma rather than providing effective treatment. A recent expose in the San Francisco Chronicle highlighted the inadequacies and dangers of private psychiatric hospitals in California. 2. Costly response the bill promotes the most expensive response to mental health crisis while ignoring less costly, more effective alternatives. 3.

There are effective alternatives peer run respites offer a voluntary option for those in crisis, emphasizing rights, community support, and personal empowerment. Unlike traditional psychiatric crisis services and often pathologize behaviors and focus on symptoms, peer run respites view emotional crisis as a universal experience.

They recognize that crisis can arise when individuals lack the resources or support needed to cope with overwhelming circumstances. Instead of imposing solutions, peer staff empower guests to explore their options, practice self care, and align the recovery with their values. Recovery cannot occur through forced treatment. Expanding the use of 5,150s is not the solution. Thank you.

Thank you so much. Anyone would like to record their me-too and opposition, please step forward.

Good afternoon, Madam Chair. Malik Bynum with the County Behavioral Health Directors Association in respectful opposition, but thank you. Thank the author and the sponsors for continued discussion on amendments. Thank you.

Kelly Brooks, on behalf of the Urban Counties of California and the Rural County Representatives of California. We also have an opposed position and are continuing to think about potential amendments and look forward to working with the author, this Committee and Senate Judiciary. Thank you.

Thank you.

Thank you. Good afternoon. Trent Smith, on behalf of the California State Association of Public Conservators, Public Guardians and Public Administrators in opposition.

Good afternoon. Anthony [unintelligible] Live LGBTQ Inclusivity, Visibility and Empowerment, as well as Kayan California Youth Empowerment Network in opposition.

Good afternoon. Danielle Bradley, on behalf of the California State Association of Counties. Also in respectful opposition, but would like to also express our gratitude to the author and Committee for continuing discussions around amendments that will remove our concerns. Thank you.

Thank you so much. Bringing it back. And you know, just to flag that, the only amendments that we did get was late last night and it was from rural counties. No one else has offered any amendments for the Committee to review or the author to review.

So there are no Committee amendments because we didn't have anything to discuss.

And just to clarify, just to add a little bit more context to the opposition regarding the lack of experience or expertise on mental health, law enforcement currently can place people on hold right now and they don't have any mental health background whatsoever and they don't get any training to put people on hold.

In fact, this would require the ER, dogs, who have more experience in mental health to even get trained to put people on hold. So this is an additional layer of training that a lot of individuals who are right now designated don't even do.

And if we're putting, if counties are putting barriers that a requirement that people have to be placed on a hold to be transferred to the correct facility for treatment, then that we need to address that barrier.

Because if they have to be on a hold and no one is there to put them on a hold, then we need someone there to be placed on a hold and not have the experience that the Doctor just shared here. Colleagues with. Any other comments, Vice Chair?

Yeah, so I will be supporting this. I'm struggling a little bit because, I mean, I do understand from the bigger picture that so much more needs to happen and needs to be done. You know, I have a niece who has had.

She wasn't diagnosed bipolar until she was older, but she started having episodes where she attempted suicide at 13 years old. And by the time she was 16 years old, she had been on over 65150.

She'd been in 72 hour holds, 14 day holds residential for, I think, three months at 1 and 4 months at another point. There is a being heavily involved in all of that through her life, knowing that it was always difficult to find a bed. Always difficult to find a bed. We're facing a workforce shortage as well.

So this is a really big issue. But I do see that this is an important component and we can do and need to do all of the above. And I agree with the chair 100% that I think ER doctors are more qualified than law enforcement to help make these really important decisions.

So we have a lot more work to do. I'm going to be supporting this. I want to thank you for taking on this piece of it, Senator.

Dr. Weber Pearson. Thank you, Chair. I want to thank the author for bringing this book forward so we can engage in this conversation. You know, completely understand what the opposition is kind of getting at.

I do think it's a little confusing in the opposition letters and also in your statement when you say ER physicians can already do this when they technically cannot do everything that you need to do for a 5150.

But I'm just wondering from the opposition, what would be your recommendation for the solution for the scenario that our physician mentioned for those who are in smaller areas, rural areas, maybe don't have the ability to have someone come in immediately like you do at some of the larger hospitals or academic centers?

Having a patient sit there for, you know, hours or days waiting for someone to come in to evaluate them for 5150 itself could be traumatic.

The one of the problems with police and emergency room doctors is that they don't have training in community alternatives. Because a lot of people that end up being institutionalized don't need to be involuntarily institutionalized. They can be directed to community resources.

I mean, I'm really serious about the fact that everyone I've spoken to is traumatized by their experience being institutionalized. And I think that rather than helping people's mental health, we're literally hurting people's mental health.

Understand that? And that's why I think this is not the answer for every situation. It is the answer for some situations. So my specific question was really around the scenario that was presented by the physician who was working in a rural area. There was someone that needed to be placed on a 5150.

I'm assuming when the person eventually came out to evaluate the person, they were put on a 5150. So it was a valid concern. What would your recommendation be if we were not to do something like this?

To ensure that patients in areas that don't have access to someone to come and evaluate them quickly, that they're not caught in an emergency room or kind of like in the in between situation.

I have two comments. First, I'm not the right person to speak with this, but I do know there are ER physicians designated by the counties, by some counties. So at least in some counties they are eligible for designation. And under the way the statute is written, they should be eligible.

But we would say, you know, with 988, the state is building a really robust crisis response system and crisis response teams are the ideal teams to do this work because they have the linkages, because they know how to talk with people, because they know how to evaluate people.

And so instead I would say let's invest in those crisis response teams around the state that will be vital in addressing this issue and other mental health issues.

I'm not sure if a crisis response team would be the person to put someone on a 5150.

So to the author, as you continue to work with opposition and other stakeholders, one of the thoughts may be to really focus on those areas that don't have immediate and that may be within, I don't know1224 hours of someone to actually come and evaluate a patient that those providers that work at those places actually get this training.

Just, you know, just a suggestion to kind of talk with the opposition. Because there are places that do not have all of the resources that you find in the larger cities, in the larger academic centers.

And those patients that are seen in those areas should not have disproportionate care just because they are in a rural or in an inner city hospital that may not have those immediate resources.

And so we need to ensure that their care is just as equitable as someone that may end up going to UC Davis or UCSD or UCSF or, you know, one of the more prominent, wealthier hospitals that where they have all of the resources, resources, there should not be desperate care just because of where you happen to go.

So just a thought, as we continue to look at all other ways in which we can provide these services, but understand that there are some patients that need to be put on a 5150 and it should not be upheld based on the area or the hospital that you go to. Thank you.

I think you're right. On the crisis response investment that has to happen. I think they should be responding to calls versus law enforcement, but that's out in the field. And there are scenarios where individuals are inappropriately being sent to eds. And what do you do in those cases? We want to prevent that. Right.

We want to have the right team out in the community going there. But there are going to be people that are being transferred to eds and what do you do with them there at that position? And this bill just is, it is not an absolute. As soon as this passes, everyone is designated an ER physician.

That just says whenever a county puts together their next policies and procedures on training that they have to include ER physicians. The other issue is that while some counties may do it, I think you share that some counties do designate. Some counties are also imposing barriers to their own will.

And so I think [unintelligible] you had another bill where, where we were talking about county issues and the difference in counties and we want to bring some standardization to that. But 100% agree more needs to be done. 988 investment, mobile crisis.

But for the people that fought through the cracks, we need to ensure EDs, they know where to be sent and to send them and transfer them to a facility that could actually connect them to the community resources. Right. Because this could just be a 72 hour hold.

It's not in a 10 day and at that facility facility that will make that determination because they are the experts in that and we just want to get them out of the EDS for that purpose. Assemblymember, please close.

Thank you so much and thanks to the Senators for the robust discussion here. Appreciate the points raised by the opposition. And you know, to be clear, I think, you know, I agree that involuntary institutionalization does cause trauma. I think it's a really important point. I think it should be avoided whenever possible.

But we do have some situations where it's necessary. And so the question when voting on this bill is who you think should be in the best position to make those, in some cases life or death decisions. I would argue that it's emergency room physicians who are seeing these patients in increasing numbers.

And right now the ER departments are overcrowded. 25 to 50% of those patients, even at the larger hospital, are waiting to be placed on 5150 holds for those evaluations. There's actually three counties right now where ER docs are designated. That's Ventura, San Diego and Santa Clara.

This bill would enable the rest of the counties to have physicians trained and authorized to make the decisions. I think the chair made a really important point that now this is in the hands of law enforcement sometimes in the field and in fact some law enforcement departments are pulling back.

They're not responding to calls of mental health crisis because because it puts officers in danger and it can put the patients in danger. A lot of people have made really valid points about law enforcement not being the best suited people to respond.

I would argue that ER docs are the best suited people to respond and that's why I think it's really important to give them that training and that authority. So that's what this bill is about. Appreciate all the comments and respectfully urge your aye vote.

Thank you. Some Member don't have a quorum yet. Can do a motion. Thank you for your presentation. Thank you. Some Member Chen, you are up sir. We are now on file, item 6 AB 460.

Thank you Madam Chair for your time. If I could have a quick point of privilege. Happy birthday Dr. Weber Pearson, one of my favorite people in the world and also you've gone above and beyond as always and the Honorary Chair of the on-time caucus back in the assembly. So, we miss you.

Thank you Madam Chair for that point of privilege. Want to thank you so much for the committee and the committee's hard work. We were taking all the amendments and want to thank you so much for making the bill better.

Current law stipulates the supervision requirements for radiologic technicians who administer contrast materials to patients, which has created delays and barriers in access to care.

This bill updates that definition of direct supervision to include an immediately available physician who is available via sound, audio and video with the supervising physician also having real time access to the patient's medical records.

Additionally, we've included a stipulation that the facility should have personal on site with appropriate license who are capable of responding to any adverse events during the contrast.

This change will ensure patients receive timely and high quality diagnostic care, align us with federal CMS standards and will help with the backlog of patients that has caused delays in patient care. With my witness testimony today, we have Ryan Spencer representing the California Radiological Society who can help speak to the need of this bill.

Thank you Madam Chair Members, happy birthday, Dr. Weber. Ryan Spencer, on behalf of the California Radiological Society, sponsor of AB460. AB460 simply modernizes California supervision laws by allowing radiologists to provide real time remote supervision via audio and video with technologists diminishing contrast for imaging. That's it. Same procedure, same safeguards just modern tools. Here's a core issue.

Ryan.

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

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

These states recognize that radiologists can be readily available remotely while properly trained technologists carry out their duties under strict protocols and importantly, AB460 maintains and strengthens patient safety.

The bill now requires that qualified personnel be physically present on site during the contrast administration to monitor patients and, as just amended, has the proper license to respond to any adverse reaction. This ensures that if the radiologist is remote, there's always somebody on site to react immediately.

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

Thank you so much and would any like to record their me too, in support of this bill. Do we have formal opposition here? Me toos opposed? Quick and easy, colleagues. No questions, no comments. Great. My job here is done. assembly member, you may close.

Madam Chair, you're the best. Respectfully, ask for an aye vote.

All right, you heard it here. All right, thank you assembly member. We don't have a quorum yet. No motion yet, but thank you. Thank you. Presentation. Calling all authors. We need authors in room 1200, health, Senate Health. The on time caucus is waiting for you. And we also need members to establish a quorum. Absolutely.

Madam Chair, may I have permission to play while we.

While we wait, what? Senate Health Committee will recess for now. Now you can play.

Health will reconvene.

Okay, great. We have an author here. We have file item eight, AB573, assembly member Rogers.

Well, I'm sorry to interrupt the dance party. Good afternoon, chair members. I'm here today to present AB 573. This bill would improve the enforcement for our state's flavored tobacco ban and protect kids and adult consumers from these highly addictive products.

CDTFA is responsible for ensuring the tax that the tobacco retailers comply with the state's tobacco excise tax and licensing laws. There are approximately 30,000 tobacco retailers in California, and currently CDTFA only inspects about 3,300 a year. That's about 11% of the total retailers.

Unfortunately, this is clearly not enough enforcement to keep these dangerous products off the shelves and protecting our kids. Illegally flavored e-cigarettes still compromise nearly 40% of the total e-cigarette sales in California. Disposable e-cigarettes represent 90.9% of sales of prohibited flavored e-cigarettes in California.

Last year, California tobacco retailers still sold tobacco to underage buyers at a rate of almost 20%. Without additional funding of the state's tobacco license, these inspection numbers will continue to decline.

As CDTFA has noted, AB 573 would increase the fees that tobacco retailers pay each year from $265 a year to $600, or up to $600 to maintain and enhance enforcement operations at CDTFA. Increasing the fee would provide more support for CDTFA's efforts to identify bad actors in the retail landscape and to target its enforcement efforts more effectively.

Additionally, AB 573 commissions a study of the tobacco retail enforcement landscape to make recommendations for better coordination among the various enforcing agencies as well as an appropriate fee to ensure maximum compliance of all California's retailers. More effective retail licensing enforcement will reduce the availability of flavored tobacco products.

You'll note from the analysis, many of the retailers actually are supportive or neutral on the Bill. They understand that bad actors create a bad environment for everybody and want to make sure that there's appropriate enforcement. We have two witnesses with us today. We have Alexandria Felton. She's a regional advocacy Director for the Campaign for Tobacco Free Kids.

We have Daphne Perez Ruiz, a student from Santa Rosa with the Latino service providers, and I will turn it over to them.

Ladies, you have a total of five minutes, okay?

Okay.

Alexandria Felton with the Campaign for Tobacco Free Kids.

As a proud co-sponsor of AB 573 and in strong support of the bill, I'm here to answer any technical questions, but I will say just in the outset, I joined my fellow co-sponsors at the American Cancer Society, Cancer Action Network, the American Heart Association and the American Lung Association to urge your support of this critical legislation.

Our goal is to ensure that the state law that ended the sale of most flavored tobacco products lives up to its promise. Essential to this is maintaining effective enforcement and removing products from the shelves so that we can reduce flavored e-cigarettes use among youth.

So thank you for your consideration today and we ask for your aye vote.

Good afternoon, Chair and members. My name is Daphne Perez Reese and I am a rising junior at Sonoma Academy High School. I'm here to testify in support of AB 573 because I've seen firsthand how easy access of tobacco and vaping products is destroying the health and futures of young people in my community.

I want to share a story that's personal to me. A few years ago, I was surrounded by a group of friends who felt like family. We'd spend long nights talking on the phone, hanging out, attending parties, all of us proud to be nicotine free.

We used to look at the older teens who smoked and drank and promised ourselves we would never be anything like that. But everything changed when we got into high school. One of my closest friends who was part of the racial minority at our school, began feeling isolated.

He didn't have many other guys he could relate to, and he noticed that the only way to fit in with some of those groups was by doing what they were doing smoking, vaping and drinking. What makes this even more painful is that no one ever pressured him directly.

He made that choice on his own because he felt like he didn't have any other option. Since then, he hasn't been the same. The friend I once knew is now addicted. I've tried to help him, and he wants to stop, but he's terrified of losing the friends he's made, even if those friendships are built around bad habits.

It's heartbreaking to see so many of my other classmates in the same situation. They struggle with mental health, but instead of seeking help from a counselor or trusted adult, they turn to vapes because it's the easy way out. They're cheap. It's scary how normal it's become.

I see students who can't run for a few minutes in PE or during sports without uncontrollably coughing and the worst part, is how easy it is for them to get these products. That's why I strongly advocate for AB 573.

Increasing the annual licensing fee for tobacco retailers will help the Department of Tax and Fee Administration, conduct more inspections and hold stores accountable. Right now, only about 11% of retailers get inspected each year and that's simply not enough.

We need to protect young people from falling into addiction by making it harder for them to get their hands on these products in the first place. AB 573 will help by increasing inspections and cracking down on illegal sales to youth.

I respectfully ask for your support of AB 573 to safeguard the health and futures of students like my friend, my classmates and myself. Thank you so much for your time and consideration.

Thanks for coming up. Was this your first testimony? Yes. You did really great. Thank you. Me toos, in support of the bill?

Good afternoon. Jamie Morgan, on behalf of the American Heart Association, proud co-sponsor and supporter.

Thank you. Good afternoon. Kisa Bruce, proud co-sponsor with the American Lung Association here in support.

Good afternoon, chair and Members. My name is Bria Arriaga. I'm a rising junior and I testify in support of AB573.

Good afternoon. Sol Rodriguez. And I testify in support of AB 573. Great.

With the Trans Latino Coalition and strong support of this initiative. Thank you.

Thanks, Bambi. I don't think we have any formal opposition on this bill. Any me toos against this. Good, ecause she was going to stare you down. Bringing it back, colleagues, I just want to thank you for coming up for being a leader for your generation. I think you're right.

You know, a lot of individuals your age group right now are turning to this. It's saddened, I'm saddened to see that, but it takes leaders like you to come champion this bill with the assembly member to let us know that something needs to be done in this space. Assembly member, you may close.

I don't think I can say it any better. I think just thank you to Daphne and others from Latino service providers and our coalition for pushing this bill forward. I ask for an aye vote.

Great. Once we have a quorum, we'll get a motion going. Okay. Thank you so much.

Thank you.

All right. You're pinch hitting for Assembly. File item 7, AB546, Assembly Member.

And hopefully you won't kick me out before my own bill right after this, right? No, I won't. Okay. Thank you so. Yes. Thank you. Madam Chair and Members. I'm here to present AB546, the Clean Air for All Insurance Coverage Requirements act by Assemblymember Caloza, who regrets not not being able to be with you today.

And I want to thank the Committee staff for their work on this bill and say that the Assembly Member does accept the suggested amendments.

So what this bill does is it would require it will require health care service plans to provide coverage for effective HEPA purifiers for enrollees who are pregnant, diagnosed with asthma or have COPD after Wildfire and as you yourself know, the January wildfires in LA County severely worsened air pollution and released dangerous pollutants like lead, asbestos and silica, all of which cause long term respiratory harm in 2024.

There was a study on California wildfires from 2008 to 2018 and that study pointed out that over 55,000 premature deaths are attributed to wildfires with an economic burden of up to $456 billion.

And research from the CDC or the Center for Disease Control and Prevention and UCLA confirmed that the effects of wildfire smoke can last weeks or months.

So Assemblymember Close's office has moved with urgency for weeks to assist her community and deliver hundreds of water bottles and masks to various shelters, businesses, senior centers and families in dire need of supplies. And I know we all thank the Assembly Member for her work on the LA fires and the community there.

The thought of wildfire smoke has pushed her 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 homes.

So 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. And today to testify we have Sophia Rafikova with the Coalition for Clean Air.

Good Afternoon Chair Menjiver and Committee Members and Happy Birthday Senator. Sophia Rafikova with the Coalition for Clean Air. We're 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, paints and building materials can cause a variety of health impacts ranging from headaches and irritation to respiratory and heart disease and cancer. Additionally, during wildfires, smoke can enter indoors through windows, doors and ventilation systems, increasing exposure to particulate 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 health care service plans to include coverage for a high efficiency particulate air purifiers, also known as HEPA, 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 not only for 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 breathing struggling to breathe to feel safe inside their homes. We urge you to vote aye on AB546. Thank you.

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

Thank you. Vanessa Kahuna on behalf of the California Academy of Family Physicians here in support.

Thank you.

Good afternoon Madam Chair and Members. Happy Birthday, Senator. Marty Lopez with the California Nurses Association in support.

Thank you.

Good afternoon. Symphony Barbee with Planned Parenthood Affiliates of California in support.

Thank you.

Good afternoon Chair and Members Jennifer Tannehill with Aaron Reed and Associates on behalf of the California Society for Respiratory Care in support.

Thank you. Form opposition I was looking for you behind the pillar.

Good afternoon Chair and Members. Olga Shiloh on behalf of the California Association of Health Plans, we recognize the importance of air quality in communities affected by wildfires. However, we must respectfully express our opposition to AB546 that's currently in print. CAP generally opposes mandates because they increase the cost of coverage for consumers.

This bill is unique in that it requires coverage of household appliances like air purifier. This sets a concerning precedent for health plans to cover non medical equipment and extends beyond the traditional health care services. AB546 also selectively offers additional benefits only to individuals residing in counties affected by wildfires. It unintentionally creates new inequities and worsens disparities.

The Bill limits these benefits only to large group contracts, CalPERS and CalSTRS, but excludes MEDI Cal and individual enrollees. Furthermore, defining eligibility by county is overly broad as California counties can be large and not uniformly affected by wildfires. For these reasons, we remain opposed but are committed to working with the author if the bill moves forward.

Thank you.

Me-toos in opposition.

Good afternoon Chair Members. Matt Akin with the Association of California Life and Health Insurance Companies. We would like to align our comments with our colleagues at CAP. Respectfully in opposition thank you.

Thank you so much. Bringing it back. I agreed with, you know, some counties are really big and one of the amendments that was important was that we wanted to dwindle it down a little bit more.

For example, in LA County where the most recent fires are, LA County goes all the way to Lancaster, Palmdale, it's about 90 miles. And I felt like, well, maybe, you know, the fires not maybe are not going to be impacting those people.

So the amendment we took to have minimum a prescription from the Doctor was the Committee in the chair's weight ability to refine it a little bit more. I do also have the concerns that this is asking for the coverage of state employees to get this and not people on Medi Cal. There is.

I did have concerns on that, on the equitable piece there, recognizing that perhaps they would be needing the assistance more. The assistance more compared to other individuals. That's not to say that low income people can't be on a large commercial, but more than likely are going to be on Medi Cal.

But I do also recognize the importance to bring in some relief to individuals that are impacted by the wildfire smoke, having been in those areas, having been in LA County and always around the fire.

So we were trying to balance that, which is why you see some of these amendments, but do echo some of the concerns you did bring up. So Member, please close.

Well, I want to thank the Committee for hearing this bill and just also thank Speaker Rivas for being a principal co-author and respectfully ask for your aye vote.

Once we get quorum Assembly Member. All right, you have your own bill. File item 17, AB 1487.

Thank you, Madam Chair. As our witnesses are coming up, I will start today. I'm here to present AB 1487, which makes important changes to the Transgender, Gender non-conforming, and Intersex World Wellness and Equity Fund. And I'd like to start by saying that I do accept the Committee amendments.

In 2020, California established the first of its kind Transgender Wellness and Equity Fund to ensure sustained investment in programs that provide health care, housing, support and community resources to what is called the TGI community or the Transgender, Gender, Non Conforming and intersex community community.

All told, the fund has distributed $13 million to programs that support the TGI community. However, this community still experiences more negative health, social, and economic outcomes than the General population. And given the recent attacks from the New Federal Administration, California cannot be complacent.

So the TGI Wellness and Equity Fund is a valuable tool that could be doing even more to support additional individuals that are known as two spirit individuals coming from Native American populations. AB 1487 will rename the Fund to provide representation and support and to add in the two spirit community.

It will expand eligibility to include programs that provide workforce development training, resettlement and social integration for asylees and immigrants, as well as diversion programs and outreach to transitional age youth. The Bill will expand the definition of healthcare to include mental health care, which is critically important in these times.

Together, these changes will ensure that more2TGI individuals have access to life saving services, economic stability and pathways for social integration. And joining me today in support are Bamby Salcedo, President and CEO of the TransLatin@ Coalition, and Diana Feliz Olivia, founder and CEO of Casita Feliz.

And we also have Jacob Fraker from the California Legislative LGBT Caucus in case there are additional technical questions. So I'll turn it over to our witnesses.

Ladies, you have a total of five minutes combined. Okay, thank you.

Good afternoon. Thank you so much for the opportunity to be here. Thank you so much. As I, Assemblymember Addis, for your courage to include this Bill in the Legislature. My name is Bamby Salcedo and I do have the privilege to be the President and CEO of the TransLatin@ Coalition.

And I'm here to let you know that I am a 55 Trans woman who transitioned back in the 80s and back in the 80s, there was not any type of support or services for any of us. And the fact that right now we are experiencing political attacks from our Federal Government.

This Bill will support the livelihood of our community. In addition to that, it will also support the infrastructure development that needs to happen in organizations that serve this community.

And it's critically important that we continue to provide the services and support that all of our communities who are trans, gender expansive and in success and two spirited identified receive, particularly in this critical times. We are seeing a migration of trans people coming from other states due to the continuous political attacks in other states.

And so we want to make sure that we support and provide the services that those communities need as well. I think this is also important for young people, particularly transitional age youth who don't have the services that they need.

One example that I could give specifically is the closure of Children's Hospital Los Angeles Center for Trans Youth Health and Development. And so the services for young Trans people are being limited. And this Bill will definitely support. You. Know, young people to continue to be who they are and continue to thrive in our society. I ask for your vote yes on this Bill. I appreciate the opportunity to be here with you today.

Good afternoon. My name is Diana Feliz Oliva. I'm the founder and CEO of Casita Feliz Latina LGBTQ center in Fresno, California. And I'm here today on behalf of this Bill, AB 1487. Plus my sister here to my left, Bamby Salcedo. Whatever she says I do, I do.

And more importantly, after studying the Bill as a social worker, I have an MSW from Columbia University. And as a Trans Latina, there's not many of us with an Ivy League education. And so when I have bills that come across my desk that I want to support, I really kind of get into the meat of the Bill.

And I'm super excited that the expansion of this Bill moving forward will include mental health services. We all know here this afternoon that the political government that we currently exist and reside in is attacking, eliminating and trying to eradicate Trans lives. And this Bill expands the services to include mental health services in all its prisms.

So it talks about not only the traditional mental health scope, but also therapeutic art programming, spiritual meditation, writing, dancing, painting, and more than ever, we need to operate not only using a model of scarcity with our programming throughout the State of California, but we want to operate using a model of joy and liberation.

We want to focus on our strengths and this Bill allows funding to increase for Trans serving organizations across the strait to operate in that manner.

We want to be intentional with this Bill and making sure that the monies from the State of California go intentionally to the populations that are suffering the most when it comes to disproportionately impact of HIV, substance use, housing poverty and intimate partner violence. So I respectfully ask for you to support this Bill of AB 1487.

All right, come on up. Me too is in support, Chair, Members.

Kathy Mossberg with San Francisco AIDS Foundation. APLA Health, and on behalf of my colleague Craig Pulsver with Equality California who. Couldn't be here today, all in support, thank you.

Madam Chair and Members. Paul Yoder on behalf of the California Academy of Child and Adolescent Psychiatry in support, thank you.

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

Malik Bynum with the County Behavioral Health Directors Association in support, thank you.

Elijah Joseph on behalf of Live LGBTQ inclusivity, visibility and empowerment and support, thank you.

Hello, Chair Members. Symphoni Barbee on behalf of Planned Parenthood Affiliates of California in support, thank you.

Good afternoon. Alejandro Solis on behalf of CPCA Advocates in support, thank you.

Good afternoon. Lang Le from Asian Americans Advancing Justice Southern California in strong support.

Aubrey Rodriguez with ACLU California Action, and proud support.

Anyone opposed? I don't think we have formal. Okay, formal opposition. Please come on up.

Good afternoon, Senators. My name is Emmett Adams. I'm 18 years old, an Oakland resident, a gay man, and I voted in my first election this April, and I'm speaking today on behalf of Cause Californians United for Sex Based Evidence in Policy and Law. The support here said we should not Fund this Bill with a scarcity mindset.

But California is facing a $12.0 billion budget shortfall. To address this, we're freezing Medi Cal enrollment for undocumented immigrants and borrowing billions to keep essential programs afloat. And yet, in the middle of this, AB 1487 seeks to expand a nebulous Fund to finance therapeutic arts and painting classes.

This Fund has already allocated millions of taxpayer dollars to various nonprofits since 2021 with zero accountability. Tell me, do we know where this money is going? One grantee, Alianza Translatinx, went from just $3,000 in annual revenue to 1.51 million one year later. In 2022, this nonprofit spent only $60,000 on client services and over $380,000 on salaries. Worse.

In 2023, TGI gave money to the Transpower Project, whose CEO was indicted last October on 53 felonies, including stealing over $900,000 in public funds. This Fund is a sinkhole for taxpayer dollars, and it is being funded for purely ideological reasons.

Democrats are losing young men, and this Bill is emblematic of why we are throwing away our future in the name of homophobic gender politics, self congratulatory slogans, and slush funds of the politically connected. When you're in a hole, stop digging. Vote no on AB 1487. Thank you.

Good evening, Senators. My name is Michaela Swaney, and. And my pronouns are Zir/Zim. I am in opposition to AB 1487 because this Bill does not go far enough. I was born a CIS woman, which means, you know, I've committed a crime being born a female. And, you know, I have ovaries and all, but I like whiskey neat.

I use power tools, and, you know, if I skip my wax appointment, I start growing a mustache. Wait, does that make me gender non conforming? Can I get a grant? Because apparently, if you say you're two tgi, I mean two spirit, transgender, non conforming, you can qualify for taxpayer funded dance classes, spiritual care, and guided meditations.

There's even money for writing and painting classes like art therapy. So can my wine and art nights with the girls. I mean, can I? It's therapeutic, you know, especially after reading bills like this. Oh, and hey, I identify as cat gender, so can I get a litter stipend too? That's a serious question.

Speaking of, I also want to advocate for my furry friends. Not the cats and dogs, but my actual furry friends. You know, like the ones you see prancing around at the private I'm strategic.

To what the Bill we're having.

Oh yeah, no, I most definitely nowhere.

In the Bill does it talk about animals. So I respectfully ask you to stick to those comments of the Bill.

Yeah, no, I'm speaking of opposition because I feel like there's a lot of genders that aren't included. Like we have the neutros, you know, the maps, you know, those minor attracted people, sworn virgins, all real, all marginalized. But they're not in the Bill.

You know, that's why I'm speaking in opposition is because we're missing so many people in this. Oh, and the detransitioners as well, you know, no one is more marginalized than them. You believe that they don't exist despite that they're there. Like Chloe Cole, Layla, just standing breathless right in front of you, you know.

All right, so this Bill isn't about public health. It's cause play with a budget line. It's taxpayer funded identity play. And if you vote for it, don't worry because I identify as somebody that will not forget. Thank you.

I'd like to record any me toos in opposition of this vote, please step forward.

Meg Madden, I represent cause Californians United for Sex Based Evidence in policy and law. In opposition.

Jean Chadbourne, lifelong Democrat, Member of Women are Real. In opposition.

David Bollog representing Serving Family Values Alliance, Informed Alhambra and Taxpayer Oversight for Parents and Students. We are in opposition. Opposition. Thank you.

Hebron Ferrier with California Family Council. In opposition.

Thank you. Bringing it back to the dais. Assembly Member, like to first apologize on behalf of human beings for what we had to sit through. I do, I think I encourage. Maybe you should participate in those therapeutic courses. Might be beneficial. So we recognize that the budget already passed. Allocations have been sent already.

This is not asking for additional money. This is to change the name of the Fund that already exists, that is eligible for grants and to expand what you're already doing to include two spirit. Additionally, we account for every dollar that gets sent out. It's contracted out. So we know exactly where the dollars are going. With that, Assembly Member, please close.

Thank you. Madam Chair, I do want to reiterate that this is a policy Bill. The policy process is separate from the budget process. The budget has been signed by the Governor. But that's not what I'm here for today. I'm here for a very simple policy Bill.

I think the opposition has made our case for us around what transgender people face every single day, what two spirit people face every single day, what intersex people face every single day. And I think they've proved the point of the need for this Bill. And so I want to thank the Committee and respectfully ask for your Ivo.

Thank you. And you're right, I should apologize to you and not the author. But thank you for coming up. Thank you for civically being engaged. I suppose when we have a quorum, I'll entertain a motion, Assembly Member.

Thank you.

Assam Member Garcia, I know you've been waiting. zero, wait. I think the other assignment left. So I think you're up. I thought I saw some Member Banta. No. Okay. Some Member. Garcia, you are up. Thank you for patiently waiting. We are on to file item 10, AB843. Your show, Assembly Member.

Good afternoon, Madam Chair and Senators. I'm pleased to be presenting AB 843, safeguarding language access Programs. First, I would like to thank Committee staff for working with us and just want to note that I will be accepting the Committee's amendments.

Currently a quarter of California's residents, over 6 million, have lived in the US for less than five years and have limited English proficiency. These individuals disproportionately experience gaps in health insurance coverage and are three times more likely to be uninsured than those who speak English proficiently.

Those with limited English proficiency are proven to be at risk for longer hospital stays, surgical delays, and greater chance of hospital readmission as a result of poor communication. Patients have no choice but to depend on their children, other family or friends to translate critical medical information.

ABA 43 will align our state laws with Affordable Care Act's language access protections to ensure language accessibility and improve overall health care outcomes for California's diverse communities. This bill is sponsored by our Insurance Commissioner and has received bipartisan support on the Assembly floor. Here with me to testifying support is Miguel Bastidas from the California Department of Insurance.

Good afternoon, Chair and Committee Members. My name is Miguel Bastidas. I'm the Chief Deputy Legislative Director for the California Department of Insurance here on behalf of Insurance Commissioner Ricardo Lara.

As a proud sponsor of AB843, Insurance Commissioner Ricardo Lara, I would like to thank us and Member Garcia for his leadership and authority in this important health care access measure.

Also, as a proud son of immigrants who personally understands the barriers to health care access for those with limited English proficiency, Commissioner Ricardo Lara is honored to sponsor AB843. Children bear the enormous and unfair burden of translating complex insurance paperwork and sensitive medical information.

At its best, this practice leads to imperfect translations and potentially embarrassing situations related to sensitive health information. At its worst, this practice leads to miscommunication and potential adverse health outcomes. Additionally, as a result of the lack of language assistance, individuals may struggle to understand insurance options, compare plans, or enroll in coverage by providing language assistance services.

Insurers can help alleviate this problem by helping individuals with LEP or limited English proficiency understand, obtain, and appropriately use health insurance that they are paying for. The federal regulations that were adopted in 2024 were based upon extensive research and stakeholder feedback. AB843 seeks to modernize California's language access laws to align with federal regulations.

Because the current Administration has a history of substantially weakening similar regulations issued by past administrations, we anticipate that it will again act to undermine the current rules. This is why it is imperative that California adopt these updated federal requirements into state law. California's health care system is stronger when everyone has equitable access to health care coverage.

AB 843 will diminish barriers and improve health outcomes by expanding access to health care for Californians with limited English proficiency. On behalf of Insurance Commissioner Ricardo Lara, I respectfully ask for your aye vote. Also with me today is Gabrielle Lazard, an attorney four with our Health Equity Access office for the Department here to answer any technical questions.

zero, great. Okay. Just here for technical. Me too. Is in support of this Bill.

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

Thank you.

Vanessa Kahina, on behalf of the California Academy of Family Physicians. Here in support.

Mari Lopez, California Nurses Association in support.

Paul Yoder, on behalf of the California Academy of Child and Adolescent Psychiatry and support.

Very subtle.

Whitney Francis with The Western Center on Law and Poverty and support. Thank you.

Jennifer Robles with Health Access California and support.

Dorena Wong, Asian Resources, Inc. and strong support.

Symphony Barbee on behalf of Planned Parenthood Affiliates of California in support.

Lang Lei on behalf of Asian Americans Advancing Justice Southern California and strong support.

Thank you. Formal opposition. Please step forward. Any #MeToos? Opposition? Surprise. Okay, bringing it back. No questions. No technical support needed. Assembly Member, you may close.

Thank you so much. Members of the Committee, thank Senators. And I respectfully ask for an Aye vote.

Thank you. So, Member. Once we get a quorum, once my colleagues come down, please. Colleagues. Madam Chair, you are up. We are going backwards. File item two now. AB 350.

Rare. Good afternoon, Chair and Members. I would like to start by accepting the Committee amendments. I'm proud to present AB 350, the respecting fluoride for Kids act, which will improve oral health outcomes for children throughout the state. A cavity is the most common chronic childhood disease and one of the leading reasons children miss school.

AB 350 will ensure that children under the age of 21 enrolled in Medi Cal and commercial health plans receive the benefits of fluoride varnish, a topical form of fluoride known to help prevent or stop the progression of cavities. AB 350 accomplishes two main things.

First, it expands the coverage of fluoride varnish to more youth enrolled in Medi Cal and commercial health plans. This benefit is already available to young children ages 0 to 5. This bill would ensure fluoride varnish is available to all children under the age of 21 when prescribed by a medical or dental professional.

Second, AB350 clarifies that when a person in a public health setting applies fluoride varnish as directed by a medi Cal provider, that the provider can receive reimbursement for the service. This will enable children who face barriers accessing dental care and traditional health care settings to receive fluoride varnish in schools, preschools, home visiting programs and other locations.

As the Chipper analysis highlighted, there is a strong evidence that the fluoride varnish is effective in improving oral health outcomes such as the prevention of tooth decay and dental cavities. Compared to no fluoride varnish, AB350 is especially timely and critical given the threats at the federal level to remove fluoride from community water systems.

Fluoride varnish has been used for years and is considered safe for children and adults and is an effective tool for preventing tooth decay, especially those at high risk.

Senators Our children have yuck mouths and there's nothing more beautiful than a smile that we know has been taken care of so that that child can go into a classroom, learn, smile at their parents and be assured that they will have the tooth that they need, the teeth that they need to to be able to smile for their lifetime.

With me today to talk more about that are Eric Doughty, Senior Legislative Advocate for the California Dental Association, and Dr. Paul Glassman, associate Dean for Research and Community Engagement at the College of Dental Medicine at California North State University.

Thank you, Madam Chair Members. Eric Doughty, here on behalf of the California Dental Association, representing more than 27,000 dental professionals, CDA is a proud CO sponsor of AB 350. As Assemblymember Bonta mentioned, cavities are the most common chronic, yet largely preventable condition experienced by children.

Untreated cavities can cause pain and infections that may lead to problems with eating, speaking, playing and learning. Research shows that children with poor oral health status were nearly three times more likely than other students to miss school because of dental pain and were more likely to perform poorly in school.

Fluoride is a mineral proven to repair and prevent damage to teeth. Unfortunately, in California, less than half of children in the Medi Cal program have annual dental visits where fluoride varnish could be applied. Primary care and public health settings such as schools offer additional access points for the application of fluoride varnish for children enrolled in medi Cal.

Further, we are concerned about the recent statements of the Federal Administration that threaten community water fluoridation with the United States Centers of Disease Control and Prevention has previously named as one of the 10 greatest public health interventions in the 20th century because of the dramatic decline in cavities since community water fluoridation started back in 1945.

AB 350 would expand coverage and access to fluoride varnish by requiring Medi Cal and commercial plans to cover fluoride varnish in primary care settings in children under 21 years of age, as well as requiring Department of Healthcare Services to create a Medi Cal policy governing fluoride varnish application reimbursement for personnel working under the contract under contract with Medi Cal enrolled providers, allowing more children to benefit from fluoride varnish will lead to overall improved oral health outcomes for a higher number of children and youth and keep them in school ready to learn.

We ask for an Aye vote.

Thank you, Chairman of our Committee Members and Assemblymember Bonta. Thank you for the opportunity to say a few words. I'm Dr. Paul Glassman, Associate Dean for research and community engagement at California North State University. And I also serve as the chair of a statewide coalition working with the California Department of Health to implement California's oral health plan.

I always find it interesting that many people who have easy access to dental care actually don't realize how difficult it is to get dental care for so many Members of our society, particularly those in the Medi Cal program.

And in fact, if you look at the numbers, a significant amount of the money we spend in the Medi Cal program is spent on repairing the consequences of this eminently preventable disease. Dental cavities is one of the most preventable diseases that of any and yet we have huge expenditures for repair of neglected disease.

And as you just heard, with the increasing federal misinformation about fluoride and now it decreased use and more people concerned about it, it's really critical that we think of some other way to be able to protect children's teeth. And a very effective and low cost alternative is fluoride varnish. It's applied directly to the teeth.

It doesn't get into the rest of the body, so people don't have the same kind of concerns about its use. And it's safe, highly effective. And there are estimates saying that if we were to have widespread use of fluoride varnish in California, it would significantly decrease the Medi Cal program.

Millions of dollars could be saved in what's now spent on reparative disease. Also, as you heard, legislation in 2009 allowed non health licensed people to apply it, but there's currently no payment mechanism. AB350 would create the payment mechanism and allow expanded use of fluoride varnish among the various population groups who don't have access to good dental care.

Now it'll have children, be able to start school with healthy mouths and be able to grow into adults who can be productive Members of the society. So thank you. And I respectively urge your aye vote on this important solution to our current costly and and expanding and I refer to it as epidemic of dental disease. Thank you.

Thank you, gentlemen. The line's getting ready. Step on Up Me too is in support.

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

Thank you Chair, Members. Chris Scroggin with Capital Advocacy on behalf of Children's Choice Dental Care and support.

Andy Liebenbaum, LA County and proud support.

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

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

Kathy Mossberg, Delta Dental in support.

Tony Anderson, Association of Regional Center Agencies in support.

Chair, Member. Jarl Dentas with FUMA and Strategies on behalf of Alameda County in support.

Jennifer Tannehill on behalf of the California Dental Hygienists Association in support. And we appreciate the work of the Committee and Dr. Glassman as well.

Monea Jennings on behalf of the California Association for Orthodontist in support. Thank you.

Symphony Barbee on behalf of Planned Parenthood Affiliates of California in support.

Nora Angeles with Children Now proud co sponsor and strong support.

Kenneth Wilkerson on behalf of Northeast Medical Services in support.

Gary Cooper representing the California Academy of General Dentistry in support.

Dorena Wong, Asian Resources, Inc. and strong support.

Julia Liao, Asian Health Services in support.

Thank you so much. Form opposition.

Hi. And I'll be as brief as possible. My name is David Bollog. I'm representing Fluoride Action Network. We are a group of activists and advocates who throughout the years, I'm going back to 1975 when we outlawed water fluoridation in the City of Los Angeles. We've been working together in various groups. We are now under Fluoride Action Network.

We do find that fluoride to be actually toxic, causing thyroid problems, various cancers, bone embrittlement, lower IQs. And I can understand why you would not take take my opinion over the doctors over here.

But I do want to let you know Food and Water Watch actually did start a complaint process under the Toxic Substance Control act that was back in 2016 and went through the whole process of actually making the complaint and then not liking the way the EPA responded and then taking the EPA to court.

And the final judge ruling on that is from Judge Edward Chen, a district judge, federal district judge in California who was a President Obama appointee.

And what he ruled is that the plaintiffs had proven by preponderance of evidence that water fluoridation, the level of 0.710 mg liter, the prescribed optimum level of fluoridation in the United States, which our City of Los Angeles does, presents an unreasonable risk of injury to health and Environment finding that a 1.0 drop in IQ of a child is expected for each 0.28 milligrams a liter of fluoride in a pregnant mother's urine.

Now, I know we, the type of treatment that this is for is for topical treatment. And I would say if that's the only treatment that you're going to do or that you wanted to do, that's what I'd say would be the least harmful because it's just going on the teeth and then you rinse it out.

But the reason I bring up water fluoridation is because already in most water providers in California, they already provide water fluoridation, so they're already getting that optimum amount. So to put this is like another form of toxicity. And I know you're pointing, you know this is aimed at people that are of lower income.

Nobody needs any more toxicity in their body, especially people of lower income. So with that we ask that you reject this. Thank you.

Any other forma #MeToo's in opposition.

Good afternoon, Chair, Members. Matt Akin with the Association of California Life and Health Insurance Companies. Respectfully in opposition. Just while we're going through the EHB process, you know, we just, you know, any mandated benefit bill, we think there should be a pause on those as the new HB proposals would increase premiums for Californians.

Just in the essence of, excuse me, healthcare affordability. Thank you.

Olga Shiloh with the California Association of Health Plans. I want to align my comments with my colleague from aclic and we respectfully oppose the bill. Thank you.

Bring it back. We are quiet today. Vice Chair.

Yes.

So I just want to thank the author for bringing this forward and make it clear while I know that there is some national and public controversy about fluoride right now, this is about a topical fluoride that is covered. And I'm sure that if the, or rather there is a question here.

It's my understanding this is about topical fluoride treatments and where the real danger exist when it comes to other fluorides is when you're ingesting that. But the way that I brush my teeth is I brush, I rinse and I spit. I don't actually ingest it. Can you just speak to that a little bit for clarity?

Yeah, no, absolutely. You're absolutely correct about that, that the fluoride varnish is painted directly on the teeth. There are many studies that look at does it show up in the bloodstream? Is it in the other part of the body? It doesn't. It's very clear that it's it stays only on the teeth.

And so although there's some controversy, certainly much of it by misinformation, but certainly a lot of concern about fluoride in other forms that gets in the rest of the body. Fluoride varnish absolutely does not. And that's what this bill is about. It's about fluoride varnish. It's absolutely safe.

Thank you. And because I understand the importance of it and Americans are known for having great teeth. Right. Fluoride treatment's gonna help that. Thank you for bringing this bill forward. Madam Chair. You may close.

Thank you so much to just address some of the opposition's comments. And thank you Senator Valadares for asking your question which I think resolves that issue. You and I Chair, both have EHB bills that are focusing on reestablishing that the total premiums paid by employers and enrollees according to the CHIPRP analysis that would was released is a .002.

Oh, excuse me. It's .0002% of costs that would be created with this piece of legislation. With that I respectfully request your Aye vote.

Thank you, Madam Chair. Once we have quorum we'll entertain a motion calling all Members of the Senate Health Committee to come down. Please help us establish quorum. Assembly Member Elhawary, you are up. Moving on to file item 12, AB 1037.

Good afternoon Madam Chair and Members. I would like to start off by.

We have a special delivery. Special delivery everybody.

Happy birthday.

Very sweet. Good spouse. Did anyone get a video? Very sweet. Happy birthday. Back to you as I remember.

I feel like we need to take that in. That's the kind of husband I want to manifest. All right. Good afternoon Madam Chair and Members. I would like to start off by accepting the Committee amendments. I am here to present AB 1037 which updates outdated substance use disorder laws to reflect what actually works.

Evidence based compassionate care that meets people where they are. California is moving forward in how we treat behavioral health. We've passed big reforms and created new ways to reach more people. But our laws haven't kept up. They still carry outdated language and barriers that do real harm. I represent skid row.

I see what happens when systems fail people, when treatment is out of reach, when stigma is written into law and when the only door left open is jail or death. AB 1037 helps remove those barriers.

It gets rid of language that shames people, updates policies to reflect current best practices and makes sure our laws support healing not punishment. People don't need more judgment. They need care services and a path forward. Whether they're just starting to seek help or have been trying to get support for years.

The fact that this Bill touches so many parts of statute shows how broken and inconsistent the system is. We have a real opportunity to bring clarity, compassion, and consistency to how we treat substance abuse in this state.

With me today is Dr. Gary Tsai, Director of LA County Substance Abuse Prevention and Control Program, and Malik Bynum with California Behavioral Health Directors Association to testify and support.

Gentlemen, you have five minutes.

Thank you very much. My name is Dr. Gary Tsai. I'm the Director of Substance Use for Los Angeles County. I'm a board certified physician and in psychiatry and addiction medicine as well as someone with lived experience as a son of a mother with schizophrenia who struggled to navigate the behavioral health system consistently.

Data tells us that only about 5% of people with substance use disorders are accessing treatment. The other 95% oftentimes report not wanting services or not thinking that they needed services. We know that we have to do better.

And to do better, we have to take a fundamentally different approach to substance use care by ensuring that programs are designed not just for the 5% of people who are knocking on our treatment doors, but rather the 95% of those who are not as well.

Today, throughout California, someone can not be admitted to a substance use facility if they've consumed a substance within the past 24 hours. If they relapse, they can be removed from the program. These policy barriers are counterproductive. These are exactly the types of individuals that we want within our treatment doors.

Nowhere else in healthcare do we ask someone to address the symptoms of their condition before they can access services. If someone has diabetes, we don't ask them to lower their blood sugar until it's below 200 before we can accept them into clinic.

We accept them in care even if they just ate a donut and their sugar spiked to over 500 that morning. AB1037 looks to strengthen proven efforts that will better serve our clients. They center services around their needs and increase access to those services.

It helps to address bottlenecks, to increase the supply of residential settings that offer evidence based treatments like medications for addiction treatment. And they make laws clear around naloxone now that it's over the counter. This Bill seeks to communicate through words, policies and actions that people with substance use are worthy of our time and attention. And we respectfully request your aye vote. Thank you.

Good afternoon, Madam Chair and Members of the Committee. Malik Bynum with the County Behavioral Health Directors Association representing all 58 counties in two cities and their behavioral health agencies serving the mental health and substance use disorder needs of California. Here in proud support of AB 1037.

The SUD modernization act established by this Bill proposes a package of solutions to correct historical stigma pertaining to SUD treatment as well as outdated statute presenting barriers to those who want and need substance use recovery assistance.

As we know, California's behavioral health system is undergoing several programmatic changes including LPS expansions, Prop 36 implementation, as well as the many BHSA requirements coming down as a result of Prop1.1 consistency throughout all of that is at the core of county BH is the array of SUD treatment services we provide as a safety net for all Californians.

AB 1037 aligns current law with best practices identified by SUD subject matter Experts such as Dr. Tsai and aligns with the direction California behavioral health programs are trending when it comes to SUD treatment. In addition to the abstinence piece that Dr.

Tsai mentioned, a critical piece of this Bill is updating state law to reflect the over the counter status of Naloxone nasal spray, a life saving opioid antagonist used to reverse overdoses.

As we know, in 2023 the US Food and Drug Administration approved Naloxone for over the counter non prescription use and this is because Naloxone is both immediately effective and easy enough for anybody in this Committee hearing to use.

Of course, most first responders arriving on the scene of an overdose are sure to have Naloxone on hand, but we also know that there are times where this response is unfortunately just too late. With Naloxone more readily available, California will be better equipped to save the lives of more individuals experiencing opioid overdoses.

And while this is just one piece of the comprehensive overhaul of the SUD treatment system proposed by this Bill is an essential one that gives Californians a tool to respond to the opioid crisis currently plaguing our state. AB 1037 is good focused policy with purpose.

The provisions in this Bill would improve access and delivery of SUD treatment at a time where California needs it the most to ensure timely interventions and to save lives. With that, I respectfully ask for your aye vote and support on this Bill today. And of course Happy birthday Dr. Weber.

Thanks Malik. Please step on up to recognize record your B2 in support of this Bill.

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

Andy Liebenbaum, County of Los Angeles, proud sponsor of this Bill

Paul Yoder right now on behalf of the City and County of San Francisco and the California State Association of Psychiatrists. Good to see Dr. Tsai here. Urge your aye vote. Thank you.

Hello. Danny Fisher on behalf of the Commission for Behavioral Health in support.

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

Thank you.

Kevin Guzman with the California Medical Association in support.

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

Good afternoon. Trent Murphy with the California Association of Alcohol and Drug Program Executives in support. Thank you.

Thank you. Turning over for any formal opposition in the room. Me toos opposed to this Bill. Okay. Bringing it back.

Chair so first of all, I understand what you're trying to accomplish here, and I'm struggling with my vote on this. My family has not escaped, you know, addiction, facing addiction in our family. And I understand that so much needs to be done in this space.

However, I have major concerns with this Bill and I'm just going to kind of read off from the California Narcotics Officers Association. Their major concern, and for me as well, is in their letter, they say that this Bill removes testing equipment from the definition of drug paraphernalia.

The result which will allow narcotic traffickers to openly possess drug testing equipment they use maximize profits. This change runs counter to the negotiated agreement reached between CNOA and the Substance Use Disorder Advocates last year, which culminated in the passage of AB 2136.

I have a hard time when something was negotiated in good faith just a year ago making significant alterations to that Bill and that good faith intent here. That's probably one of the major reasons why I have concerns about supporting this.

I will say that I really love the provision in the Bill that would remove the mandate that you be sober for 24 hours because some people just can't make it to that point when they're dealing with addiction. And I completely understand that, but I'm not going to be able to get there on this Bill.

I don't know if you are taking amendments, if you could continue to work on this, but for this reason I cannot support it. And I just wanted to let you know that.

Thank you. And I'm going to have our witness also respond to your concern because it's not in the.

I'd love to. Clear. Yeah, yeah, yeah.

So just, just to clarify, I think the, the portion that you had highlighted was actually removed after amendments through the Assembly that pertains to syringe service provisions that are not no longer a part of this Bill.

Yep. Okay.

Yeah. And the opposition has not removed their letter, even though we removed that in the first Committee in our first hearing. In the Assembly.

Okay, so then what I'll do is I'll lay off today. I'll take a deeper look on this. And again, I'm gonna. If there are still some of the significant issues, then I'll make that call on my vote on the floor.

Thank you.

Okay. So, Member, thank you so much for bringing this forward. I think when we look at our systems, what outdated models do we have that we need to remove?

I think I love this kind of legislation that looks at things, that removes red tape that is outdated and how we can ensure that we're actually not creating more barriers, but removing them to get help to individuals with that. Please close.

I just want to share that this Sunday marks one year since the passing of my cousin Mido, who overdosed on fentanyl.

And I think it's really important that as we think about how to best support folks who need the care, who need behavioral health supports, that we're really thoughtful in how we really look at updating outdated laws and really ensure that our folks have the access that they need, building a system that saves lives, because we don't want to wait until it's too late for other folks.

I respectfully ask for your aye vote.

Thank you, Assembly Member. Once we get quorum, we'll get a motion going.

Thank you and happy birthday.

Assemblymember. Pellerin, I see you. zero, nope. So there we go. You were hiding. Assemblymember Bennett, you're up. File item 13, AB 1041, whenever you're ready, sir.

Thank you very much, Madam Chair. Members, good afternoon. AB 1041 is an attempt to try to address a problem that we have, and that is it's taking physicians a long period of time to get credentialed by health insurance plans. And I have two great witnesses here.

So rather than me spending a lot of time explaining the bill and then them repeating what the bill is going to say, I'm going to let them explain the bill and I'll fill in any of the holes that I think need to be filled in after that. But we do need to streamline.

Physicians are waiting months and months. Oftentimes they have multiple different forms that they have to deal with. They don't know for sure where they are in the process oftentimes. And with that, I'd like to introduce my two witnesses, Christy Weiss and Flo DiBenedetto.

Good afternoon, Madam Chair and Members. Christy Weiss, on behalf of the Physician Association of California, we're really pleased to bring this bill forward.

The Physician Association of California is focused on supporting small independent physicians and has done a deep dive with the Members of the Association to really identify what are some of the barriers that physicians are facing in their day to day practices and what are some of the challenges that are taking them away from the time that they need and want to spend on patient care.

One of the number one issues that was raised are the challenges that physicians experience when they're going through the credentialing process with the health plans. There's a lot of red tape in this process and in many cases, a lot of duplicative processes that the physicians have to go through.

So we've been working on this bill with Assemblymember Bennett and working, you know, with this, with the opponents to come up with a solution that will work that will streamline the credentialing process. With me today we have one of our subject matter experts, Flo DiBenedetto.

And I'd like to cede the rest of the time to her to share some more. Thank you.

Thank you, Christy. Good afternoon, ladies and gentlemen. My name is Flo DiBenedetto. I'm currently the CEO of a company called DiBenedetto Solutions. But I'm also a health care attorney, and I've been a health care attorney in California for over 40 years.

I spent 28 years in private practice and most recently 15 years as the General counsel of Sutter Health. Credentialing happens to be one of my specialties, and I've represented physicians seeking to be credentialed, and I've also represented plans who are doing the credentialing for physicians. So I've been on both sides of this equation.

As Christy alluded to, before a physician can treat a patient enrolled in a health plan or an insurance company, he or she has to be credentialed, which is a process designed to assess their qualifications, do they have the qualifications and are they safe to treat patients? Health plans and insurance companies have their own credentialing forms.

There's no standard form that any of these payers are required to use. So over and over again, physicians are filling out different forms but providing the exact same information to the plans and the insurance companies.

And it's PAC's position and the author's position that having, and I agree that having a standardized form required to be used by health plans and insurance companies would go a long way to reducing the burden on these physicians and many of the delays in the credentialing process.

Larger medical groups have the resources to take on this kind of divergent and differentiating paperwork, either because they're large enough or many of them are affiliated with large health systems who do that work for them. Independent physicians don't have those resources.

Putting timelines on health plans and insurance companies to expeditiously complete the credentialing process is also an imperative. These organizations can hold a physician's credentialing form for weeks or even months before it tells the physician that the form is for one reason or another incomplete and won't be processed.

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

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

Thank you so much. #MeToo's in support of this bill?

Doug Kessler on behalf of Cse Puydi, Fresno Tulare Kings and Kern.

Good afternoon. Estea Kessler with Central Valley Mayors and Elected Officials and we support this very much.

Good afternoon Members of the Committee. Happy birthday Dr. Weber. Esther Flores on behalf of the California Farm Worker Foundation in support.

Good afternoon. On behalf of the California Hispanic Chambers of Commerce in support. Thank you.

Thank you. For opposition. Please come on up.

Thank you. I'll be brief. Chair and Members, Nick Louise. On behalf of the California Association of Health Plans, we've moved from an opposed to an opposed and less amended position.

And a lot of that has to do with the open door policy that the author and his staff and the sponsors have shown us in discussing the practical issues that we have with the bill. Conceptually, you know, there's no issue. It's more of an implementation element for us.

We think additional conversation needs to happen around the provisional approval component of the bill and the provisions of the bill that limit the ability of the plan or carrier to ask for additional information throughout the process. We think those are important patient safety issues.

And so we look forward to further conversations with the author's office and the sponsors. But at the current time, we remain opposed unless amended. Thank you.

Should have sat down, Nick. I'm going to pause public comment for right now. We are going to establish quorum. Secretary, please call the roll.

[Roll call]

We have quorum. Great. Please continue.

Thank you, Madam Chair. Members. David Gonzalez, on behalf of America's Physician Groups, also with an opposing, less amended position, we are reviewing the amendments. I want to thank the author and his staff for the dialogue and look forward to those continued conversations. Thank you.

Good afternoon, Chair Members. Matt Akin with the Association of California Life and Health Insurance Companies and would like to align our comments with our colleagues at CAP, also with an opposing unless amended position. Thank you.

Chair and Members. Kathy Mossberg with the Local Health Plans of California. We also have an opposed unless amended position and look forward to continuing conversations. Thank you.

Kevin Guzman with the California Medical Association. We're in respectful opposition. Want to align our comments with APG. And just want to say thank you. To the author as well.

Thank you so much. Okay. Bringing it back, Senator Grove.

Thank you, Madam Chair. I understand rural communities. We want to certify and credential these doctors. And so I get the issue, but I do understand the opposition on, you know, gateway of just requiring to take providers that maybe don't meet the standards that they have and sometimes that takes longer than 10 days.

I know that you have been so graciously working with the opposition. Are you going to continue that dialogue?

And try to resolve that issue with them?

Absolutely.

Absolutely.

Thank you, sir. Appreciate that.

We recognize we see a lot of bills that talk about sometimes administrative burdens. Some are necessary and other times important, but other times they're incredibly burdensome. And you're looking to standardize and streamline the process for plants or credential health providers.

Because if we don't, we're not going to have enough of the workforce to be available to see patients. They just want to see the patients. Now, this bill came a long way. Originally. You were prescribing what form to use.

Now with the amendments, we're asking the departments to come together and put that form to put that form instead of telling them exactly what form to choose from. I think that makes sense. So thank you so much for taking those amendments. You may close. zero, did you take the amendments?

Yes. Great. Thank you. Yes, I do accept. Accept the amendments. Appreciate the ability to work with your staff on these amendments. Also, I appreciate being able to work collaboratively with everybody, the sponsors and people that are. That are here. This is good government when people do that. And so I both respectfully asked for an aye vote. And.

And also now that when you took roll, I was able to identify who that was behind the flowers over there. Wish Senator Weber a happy birthday.

Incognito today. A motion on this bill. Can I entertain? I need a motion. Will anyone. Okay. Senator Durazzo moves the bill. The motion in front of us for AB 1041 is due. Passes, amended and reaffirm the Committee on appropriation. Secretary, please call the roll.

[Roll call]

Assembly currently has a vote of 5 to 0. But we don't have enough Members here. We'll keep it on call.

Thank you very much.

Assemblymember Pellerin. Wait. Nope. Sorry. Yes. There we go. I. I knew you came in. That's the second time I've done this to you. I apologize. We're on file number 14. AB 1242. So Assemblymember Nguyen

Thank you. I wasn't going to fight it if you called Assemblymember Pellerin. I'm a team player. But then you corrected and so I guess I'll have to come up. Good afternoon, Madam Chair and Senators. I want to start by agreeing to take the proposed amendments in the next Committee. And I would also like to thank the chair and Committee staff for their work on this Bill.

AB 1242 is an important Bill that increases meaningful access to critical state services for California's vulnerable limited English proficiency populations by designing a language access Director within the California within the California Health and Human Services Agency to coordinate and oversee language access efforts, ensuring there's human review when California Health and Human Services uses AI for translation or assistance, and by improving the process for determining which languages are covered by state and local agencies for their language assistance services.

Doing so, AB 1242 increases access to health care and social services for limited English speaking communities throughout the state. In my prior work to coming here as a Director for a nonprofit organization, I served many communities that were limited in English.

And I can tell you how many times throughout the day that we would have community Members come in and they would give me a letter that they received from the state and not only was it inaccurate, but it was also confusing and many times they did not receive a qualified interpreter when needed.

So this Bill is hoping to address that and to fix that. AB14 1242 helps eliminate avoidable disparities in health care, improve overall health outcomes, and reduce costs across the health care system. Here to testify and support are Julia from Asian Health Services and Doreena with Asian Resources.

Ladies, you have five minutes total. Make sure you put. Yeah, once it's read, you're good. Push it.

Oh, got it. There you go.

Good afternoon, Chair Menjivar and Senate Health Committee Members. My name is Julia Liou, and I'm the CEO at Asian Health Services, and here to express full support of AB 1242 Asian Health Services. We are a community health center that provides medical, dental and behavioral health care to 50,000 low income patients in 14 languages.

We started 50 years ago because we saw that language was a key barrier to healthcare access. Language barriers continue to hinder community Members with limited English proficiency from accessing critical information. Most recently, Mr. Lee, a disabled Chinese senior, was in great need of home care assistance and support.

He was unable to navigate or access the state level programming and at the Department of Aging in his language and remained in isolation for months on end, exacerbating his health issues. It was only recently, with the help and navigation of one of our affiliate partners, that Mr.

Lee was able to gain access to the support and care for his physical and mental health. Accessing supportive health care services earlier could have reduced costs and prevented Mr. Lee's health care issues from worsening.

On March 1 of this year, Executive Order 13166 Improving Language Access for persons with limited English proficiency was revoked and replaced with Executive Order 14244, which designates English as the official language of the United States.

While this order alters federal language access directives, it is important more than ever for California to uphold federal language access rights in health care.

According to a recent study by the California health care foundation, 23% of California residents with LEP were aware of their right to an interpreter and nearly 1/3 who received help understanding their Doctor reported using a family or friend. 29% of individuals with LEP in California still do not have a usual source of care.

So it's even more critical than ever that AB 1242 be passed to reduce racial and ethnic health disparities in our state. Thank you Chair Menjivar and Members of the Committee for your time today.

Good afternoon Chair Menjivar and Committee Members. My name is Doreena Wong and I'm the Policy Director at Asian Resources Inc. A proud co sponsor of the Bill since 1980, ARI has provided direct services and advocated for increased cultural and linguistic access to health and social services programs for thousands of Asian American, Native Hawaiian and Pacific Islanders, immigrants and limited English proficient or LEP populations in the state.

Like ahs, we have seen firsthand the serious consequences of language barriers faced by our LEP clients, like very long wait times to get an interpreter just to apply or renew for MediCal resulting in the loss of coverage for our clients.

Loss of Health Coverage Better language services are even more important now than ever, especially with the attacks on immigrants and including the cruel immigration raids in our communities and the severe cuts to medical and other critical programs. Many research studies have documented that language barriers have led to health disparities, adverse consequences, and significant harm to LEP patients.

AB 1242 would contribute to improved communication and it would reduce overall health care costs to the state and by reducing avoidable clinical costs, costly corrective measures and costly medical conditions, as well as reducing the pain and suffering of LEP patients. AB 1242 would contribute.

First, it would codify the California Health and Human Services Agency's Language Access Program by designating a Language Access Director to oversee language access plans and coordinators. Second, it would create community level mechanisms for greater accountability. Second, it would ensure human review of machine and AI translated, interpreter and translation services.

Third, it would update the Daimley Alatoria act by allowing the use of the U.S. census and other relevant data sources, community level input and other relevant factors. Therefore, we urge your vote in support of AB 1242 to address the current systemic health inequities of LDP populations in California. Thank you.

Thanks for your testimony. Stepping up for me toos and support.

Crystal Straight with Bright Light Strategies Representing the co sponsors of the Language Access Task Force and always also asked to voice support from the Lao Seri Association, the the Pacific Islander Collective of San Diego and the Samoan Community Development Center.

Thank you.

Johnny Pineda with the Latino Coalition for Health California in support. Thank you.

Twee Du with the Southeast Asia Resource Action Center in strong support. Thank you.

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

Chair and Members Jael Dentas with Full Moon Strategies on behalf of Unlimited County in support. And Happy birthday, Senator.

Hello. Ana Thaokolo with Empowering Pacific Islander Communities, otherwise known as EPIC. And strong support. Thank you.

Good afternoon. Zhong Vu with Asian Resources here on. Behalf of the Asian Pacific Islander Moving. Forward Black alliance for Just Immigration and Healthy Health. Mercedes, thank you for all strong support.

Hi, my name is Annabelle Tong. I'm speaking on behalf of Pacific Asian Counseling Services, the Korean Community Center in the East Bay and Asian Pacific Partners. For Empowerment, Advocacy and Leadership. In strong support.

Good afternoon. My name is Janice Park and I'm here on behalf of American Community Media, Taulama for Tongans, and Cambodian Community Development Inc. Thank you.

My name is Samuel Yip. I'm expressing support on behalf of the center at Sierra Health Foundation, Southern California Pacific Islander Community response team and SAHAs for cost. Thank you.

Good afternoon. I'm Olivia Lee on behalf of Asian. Inc. Rams Inc. California Healthy Nail Salon and Regional Pacific Islander Task Force in strong support.

Good afternoon. My name is Sean Kim and I'm here on behalf of Vietnamese Family Service Center, Southeast Asian Development Center and Courage California in strong support.

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

Good afternoon. My name is Pai Zong on behalf. Of the Hmong Culture Center of Butte County. We strongly support.

Good afternoon. My name is Lang Lei on behalf of Asian Americans Advancing Justice Southern California in strong support.

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

Beth Montowski, the SEO California in support.

Good afternoon. Kenneth Wilkerson on behalf of Northeast Medical Services in support.

Good afternoon. Sydney Fong on behalf of Asian Americans and Pacific Islanders for Civic Empowerment, AAPI Force in strong support.

Hi, Andrew Menorah with Asian Resources Inc. Expressing support on behalf of two of our co sponsors. Fellow co sponsors, Centers for American Center for Asian Americans in Action, Orange County Asian Pacific Islander Community alliance as well as two partners, Nico's Chinese Health Coalition and Asian Pacific American Public Affairs. Thank you.

Good afternoon. My name is Nip Lam from Asian Prison Support Committee and strong support.

Hi everyone. Ben Wong with Asian Health Services in strong support.

Thank you. Don't think there's any formal opposition of any formal opposition in the room. Me too. Is opposed to this Bill coming back. Okay. We got moved by Senator Grove. Assigned Member. You may close.