Senate Standing Committee on Health

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The Senate Committee on health will begin in 30 seconds.

The Senate Committee on Health will come to order. Good afternoon everyone. Beautiful day. Nine days till summer recess. I'm not counting. We have one bill that was pulled from today's agenda. That's going to be file item three. That's AB 387 by Assemblymember Alanis. So that brings us to 11 bills for presentation today.

Three on 11 bills on agenda, three on consent. And we have two wonderful authors who are ready to go. Going to start in file order with file order number one, our Majority Leader on the Assembly side. Whenever you're ready. Great.

Good afternoon, Madam Chair and members. Thank you to the committee staff and Chair Menjivar for all of your work on this bill. I will be accepting the committee amendments today which reflect our conversations with the plans, the providers, consumer advocates, the chair and committee staff to strike a balance on accountability for all parties involved.

AB 280 will fix a basic but important issue making sure health plan provider directories are accurate and up to date. Right now, too many patients struggle to find in network doctors because directories are full of errors. This leads to delayed care, confusion, and unexpected out of network costs.

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

When people are looking for a doctor or other healthcare provider, they reach out to a list of providers they get from their health plans. They find many of these providers aren't reachable, aren't taking new patients or aren't in network. Many of you have experienced this yourselves. I know I have.

In fact nearly every member on my staff and has gone through it in this year alone. Now imagine you are a single mom with two jobs or someone facing language barriers or living with a disability. You already face challenges to accessing the care you need and finding a provider in network becomes a huge task.

Are you ever going to be able to access the health care you or your employer are paying for? Or when you can't find an available provider in your own network. AB 280 addresses this decade long problem by ensuring provider directories are up to date so consumers can access care more easily.

This bill accomplishes the goal by creating accountability for both the plans and the providers. AB 280 requires plans to meet increasing accuracy benchmarks reaching 95% by 2029. It creates, excuse me, creates timelines for providers to respond to plans requests for information so the plans have the information they need to make the directories accurate.

It also allows plans to note when they have not received information from providers so consumers are aware when provider's information has not been updated. AB 280 will also allow the department to require health plans and providers to use central third party database to streamline access to provider information.

To ensure accountability, this bill allows the Department of Managed Health Care to set penalties for non compliance so health plans take the accuracy of the provider directories seriously. If a consumer relies on inaccurate directory, the health plan must arrange care and cover out of network costs. Members, this already exists in law.

For 10 years health plans have been required to ensure the provider directories are updated, but without real accountability measures, these directories remain inaccurate and consumers will still struggle to find care. AB 280 ensures provider directories are reliable so Californians can access their care as they need it without delays.

With me today to testify in support are Katie Van Deynze with Health Access California and Sarah Sora Okun, a licensed clinical social worker from Solano county who has experience dealing with the real life consequences of ghost networks on her patients. Thank you.

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

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

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

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

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

Good afternoon Madam Chair and Senators, I'm Katie Van Deynze with Health Access California, and we are proud to sponsor AB 280. Health plans and insurers, as the author noted, have been required for 10 years to maintain and update their directories for their contracted providers.

Consumers deserve accurate directories, but as you just heard, these directories are failing consumers and these inaccuracies are creating barriers just accessing care. In theory, California has the strongest law in the nation on provider directories.

Yet without law in effect for a decade, recent studies have found that these directories, for one for psychiatrists, was 80% inaccurate, and most health plan directories have inaccuracies of a third or a quarter of contracted providers.

These inaccuracies, as you just heard, are the worst for behavioral health providers, creating significant barriers in an area where there's already significant barriers to accessing care. AB 280 takes important and urgent steps to address this issue with new requirements for plans and providers.

First, it gives the Department of Managed Healthcare and the Department of Insurance the authority to require the use or designate its central utility database. We've heard for many years from providers that there are issues with receiving so many different contacts from the health plans asking for them to verify their information through phone call, through email.

Using this technology to be able to update once using the central utility is a way to streamline that process, and AB 280 gives the department the authority to require the use of that central utility, one or more of the central utilities, and allow for input in the process from providers, health plans, and consumers.

In addition, this bill also sets clear and enforceable standards for accuracy annually increasing benchmarks starting at 60% next next year and 95% by 2029. We've heard from both providers and health plans reasons why the other is at fault for these inaccurate directories.

And with AB 280, we take amendments from both of these parties to ensure a balanced and effective solution for consumers. We've integrated required provider timelines to update their information and allowed health plans to know the directory when a provider hasn't been responsive to verify their information.

This bill gives health plans more tools to ensure timely response from providers and holds health plans accountable for their directories to ensure they're accurate for consumers.

When consumers go to call providers that are listed in their directories, the phone number is wrong, the provider is not taking new patients, the provider says they're not in network, and on and on these inaccuracies go.

We ask with this bill that Senators create an enforceable standard for accuracy so that consumers can find the care that they need. Thank you. We respectfully request your aye vote.

Thank you for your testimony. Now is the time for those who would like to record their me toos in support of this bill.

Madam Chair and members, Bob Draw, on behalf of the National Union of Healthcare Workers in support.

Nora Angeles with Children Now in support.

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

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

Annie Thomas on behalf of the California Alliance of Child and Family Services in support.

Good afternoon. Linda Way with Western Center on Law and Poverty in support.

Andrea Peters, on behalf of the California Public Employees Retirement System in support.

Adam Zarin, the Leukemia Lymphoma Society in support.

Melissa Cortez, on behalf of Autism Speaks in support.

Shayla Silva, on behalf of the California State Retirees and the Association of California State Supervisors in support.

Good afternoon Beth Malinowski with SEO California in support.

Sherry Daley with the California Consortium of Addiction Programs and Professionals in support.

Hi, I'm Dr. John Valley on behalf of the 3.5 million Californians who are AARP Members, we offer our support.

Thank you so much. Now is the time for formal opposition.

Hello. Thank you. Chair and members, Nick Louizos, on behalf of the California Association of Health Plans. We have an opposed unless amended position on the bill in print. We know that significant amendments are going into the bill today.

So we want to thank the authority, her staff, the sponsor, the chair and committee staff for the open door policy and the level of dialogue that we've had regarding this measure. The modifications to the penalty structure in the bill are a significant step forward, as are some of the provider accountability measures which were suggested by our membership.

We did receive the language later in the evening last night, the specific amendments. And so, you know, we do need some time to sit with the language in order to provide the most constructive feedback to the author about where we're going with this bill.

But then again, the amendments are a step forward in the right direction and we want to continue working with the author and the sponsor on this measure. Conceptually, this is an issue that we want to get right and that we want to put behind us. We know that the directories could be better. It's a two way street.

And I think some of the amendments that are going into the bill today are an acknowledgement of that. And so thank you for listening and we promise to work with the author and sponsor on any modifications to the language moving forward. But you know, with respect to the bill in print, we do have an opposed unless amended position at this time.

Good afternoon Committee Members and Madam Chair. My name is Kevin Guzman with the California Medical Association and we are also opposed unless amended to the bill in print. We just received the committee amendments late last night too and appreciate all the work with the author, the sponsor and the committee staff as well in this bill.

We still have a couple outstanding concerns on the bill, mainly regarding the reimbursement provision for providers and also the central utility provision as well too. So we look forward to continuing those conversations with the author as well and continue to work.

Just wanted to echo the comments as well too and just say that we are also looking forward to finally having accurate providers or accurate directories for our patients and putting this issue behind us. So thank you very much.

Thank you to both of you. Coming up for me toos in opposition to this bill, please.

Steffanie Watkins, on behalf of the Association of California Life and Health Insurance Companies we're also in opposition. Thank you.

Lisa Ann Hurt-Forsyth with the American Association of Payers, Administrators and Networks opposed unless amended.

Eric Dowdy with the California Dental Association were also opposed unless amended and echo CMA's concerns. But we appreciate the work on the bill.

Thank you so much. Bringing it back. I'll kick up the dialogue here. The reason why, you know, we got these amendments so late is because we've been in constant communication long term, you know, back and forth for a while. We're trying to balance this, right? And this isn't the first time this committee has voted on a topic.

You were here for the previous one and we've had similar conversations and my comments are still very the same where there are various peoples at play or various stakeholders here that should be held responsible in the success of the provider directory. But everyone can agree that people that are hurting are the consumers.

And we need to make sure that everybody who's responsible for the success is held responsible and it's not lopsided one way or the other. I do recognize it's a lot like you mentioned, finger pointing. It's their fault. It's their fault.

So we were trying to get to a place where it's not that it's anyone's fault, but it's everyone's responsibility to play a part in being successful. And that's why we wanted to make sure that there wasn't. If there was penalties, it can't just be penalties for one side.

If one entity has to do something, the other entity has to have buy in as well. I've also mentioned in this committee that it's not all of the plan's responsibility to be successful if they have to go to an external party.

But we also recognize that this bill is bringing a third party into play now that is now also going to be held responsible. The central utility is now a third stakeholder in this relationship. That could make it more murky or it could be successful. The evidence or the jury's still out for that.

Even the analysis that noted there isn't enough evidence to show that it would increase its success. But there should be less burden on the providers now because you only have to report to one entity versus having to report constantly to a bunch of costs. So that's where we landed.

I recognize there hasn't been a lot of time for the opposition to read through it. I know the majority leader, as she has shown and proven, will continue to work on further if there is any room to further because she did take a lot of amendments in this committee. Thank you, Vice Chair.

Well, first of all, I want to thank the author for coming in to talk to me about the Bill. Really working your Bill. It's important. And obviously I want to thank the chair too for really trying to come to the middle on this.

It's really, really important that we're working with all stakeholders because at the end of the day, patients do need access to information about where they can seek medical attention, accurate information. I'm going to stay off of the bill today. I don't think you're going to need my vote to get this out, but I'm looking forward to.

I may have spoke too soon, right. Who knows? But I want to get to a support on this, hopefully when it gets to floor. But I want the stakeholders to continue to work with the author on trying to iron out some of your concerns. Thank you.

Senator Weber Pearson.

Thank you, want to also thank the author of this bill. It's a very important yet very complicated issue because there's so many players in this field to get this right. I want to thank the committee for their very thorough and very thoughtful amendments.

As was stated, they just came out, so I haven't had an opportunity to really dig deep and digest them and go one way or the other. So I probably will lay off today. But I do have a question around Medi Cal patients and enforcement.

With Medi Cal, is there any differences in how Medi Cal patients will be managed under this bill versus those with commercial plans?

Would you like to answer?

Yes. Thank you for the question, Senator. In Assembly Appropriations Committee, the committee did remove the enforcement provisions for Medi Cal managed care plans. And so the enforcement of administrative penalties for failures to meet the benchmarks would not apply for Medi Cal managed care. It would only apply for commercial plans.

But the other provisions of the bill, including the requirements for annual reports around how accurate the directories are and requirements for accuracy, would still apply for Medi Cal managed care plans under the amendments that were added in Assembly Appropriations Committee. And we were, of course, disappointed to see those.

Yeah. So what you're saying is that the requirements are still there. However, if those requirements are not met, then those enforcements for our Medi Cal individuals who are oftentimes the ones that are in most need and don't have the ability to just go and pay out of pocket.

You know, I understand, you know, where we are fiscally as a state, I understand why they would have, you know, thought about doing that in appropriations, but I do just have difficulty with leaving behind those that need us the most, implementing something for individuals, some of which can go and pay out of pocket for things, but people who are on Medi Cal, by very definition, cannot.

And I know it's not you, but it's I mean, I think it's, I think it's something that we really need to reconsider because this isn't the only bill today that leaves those individuals behind. But, you know, definitely want to thank the author for working on this and the committee for all the work that you've done.

And Senator, I, too, was disappointed. Right. In these times, we have to make some adjustments and be flexible, and I think that we always can come back and address that.

But I needed to get some foundation in and get the accountability and accessibility back in and people being realized that so many of our clients or colleagues and constituents are really struggling. So I think this is a nice place to land.

Appreciate that. And I know it wasn't you. It's, so this isn't for you

Do we want to name names?

And like I said, you're not the only person with the bill before the committee today that has done that.

But I think this is more a message for the state in terms of the fact that we are leaving behind our most vulnerable in this area. And I've heard before in previous years, people say, well, we can come back. We can come back. And a lot of times we don't end up going back. So.

But I know it's not you. Thank you.

And I. And I will just say, um, I.

Just want to make sure if you directed a question. Sorry.

Oh, and I was just saying that.

Sorry. There's no question directed at you.

Apologies.

Anything else? Okay, Majority Leader, you may close.

Well, thank you. I want to thank the Chair and the Committee Staff for all your work. As you can see, it has been. It's a labor of love. And I think the chair and myself have a lot of commonalities of how these directories have not been sufficient for our friends and families.

This issue negatively impacts access to health care for many Californians, even though current law has required that the plan directories be accurate for the past decade. Hello, a decade. The amendments I've taken reflect the ongoing conversations I've had with the plan, CMA, the Administration, consumer advocates and this committee.

And I again want to thank the committee, their thorough review of this bill as well. We have listened, my staff and I have listened closely to the perspectives of the stakeholders.

We believe these committee amendments create shared accountability between the plans and the providers so we can make the directories more accessible to the consumer, which, at the end of the day, is really our shared goal.

While the amendments do not fully remove opposition, my goal is, in this process, as always, is to strengthen the policy of the bill, regardless of the politics, because Californians come first. Thank you very much. And I respectfully ask for your aye vote when it's appropriate.

Thank you. Don't have a quorum yet, but thank you for your presentation.

Thank you.

We're going on to file item 2, AB 356, Assemblymember Pato. You are ready to go.

Right.

On there.

Assemblymember, whenever you're ready.

Thank you. Good afternoon, Madam Chair and Members. Before starting, I would like to thank Senate Health Committee for their help on this Bill and I will be accepting the amendments to extend the timeline and be more specific on the work groups participants so as not to be duplicative. We will be making the change in the next Committee.

I'm honored to present Assembly Bill 356 today which would establish a working group within the Department of Healthcare Access and Information to evaluate the public health care infrastructure in North San Diego County. This work group will have a specific focus on the long term sustainability of the Palomar Healthcare District.

This is, at its core, a transparency and accountability Bill. The need for this legislation became clear after repeated governance struggles and a troubling lack of public oversight at Palomar Health. Palomar Health is California's largest public health care district serving over 850,000 residents and is home to the region's only public maternity ward.

It received tens of millions of dollars in taxpayer support last year, including more than 70 million in local property taxes and 10 million in zero interest state loans. It serves a patient population with an 80% MediCal mix. This is a crucial public institution. But despite the public funding, Palomar's governance and finances have become dangerously opaque.

The district transferred operational control to a private management company called Mesa Rock, shielding public decision-making from the very constituents of who fund and rely on this system. The maneuver created a board within a board structure that bypassed transparency laws like the Public Records Act and Bagley-Keene and triggered an ongoing FPPC investigation.

Concurrently, the district suffered $165 million operating loss last fiscal year and has over 700 million in debt and received a bond rating downgrade from BBB to B minus in just six months, putting it on the brink of default. Let me be very clear, this Bill is not punitive. It is protective.

It is protective of the public's right to know. It is protective of the essential safety net services this district provides and it is protective of the taxpayers whose dollars are on the line. Since introduction of this Bill, there have been huge challenges or huge changes on the ground.

Palomar has entered into a partnership with UCSD, a neighboring health care district that has partnered with Sharp, a neighboring health care district, sorry, that is partnered with Sharp and I advocated to provide a CHAFA loan extension in the budget Bill so that Palomar wouldn't default on the state loan. That could trigger further defaults and bondholder action.

While this is all encouraging for the health care ecosystem, these changes mean that transparency is more important than ever to verify that public institutions deliver to the public. I greatly admire the work that Palomar does and the point of this Bill is to ensure that this public institution can continue to provide crucial care.

Lastly, I would like to address any concerns that this work group is duplicative or contradictory to the local efforts or the local LAFCO MSR. We see this as complementary. This is a complementary effort and crucial to ensuring consistency between local and state efforts.

This work group allows us to utilize LAFCO's comprehensive reports to understand the entire ecosystem of public health care in North County San Diego, where we have no county hospital. And LAFCO agrees. So with this in mind, I have with me here today Adam Wilson from San Diego LAFCO to testify on behalf of this Bill.

Thank you very much. And at the appropriate time, I respectfully ask for an aye vote.

Thank you, Assemblymember. Sir, you may proceed.

Good afternoon, Madam Chair, honorable Committee Members, my name is Adam Wilson and I'm here today on behalf of the San Diego Local Aid Agency Formation Commission, commonly known as LAFCO, to express our support for Assembly Bill 356 Authored by Assemblywoman Patel.

This Bill is a proactive step toward addressing health care needs for the northern region of San Diego County. It calls for the formation of a working group to assess current healthcare conditions and develop sustainable solutions that will serve our communities well into the future.

We would like to thank Assemblywoman Patel for recently amending the Bill to include San Diego LAFCO as a Member to this important working group. Having a seat at the table is critical because we are currently in the middle of conducting a municipal service review for the four healthcare districts in San Diego.

This comprehensive review aims to independently evaluate the services and functions of each district, identify the strengths and areas of improvement, and offer recommendations for more effective and efficient healthcare delivery. The draft of the MSR is expected to be released for public review in October of this year.

By formally participating in this working group, LAFCO can then serve as a vital link connecting the findings and recommendations of the MSR with policy and planning efforts of a future working group. This integration will ensure the stakeholders and the public are provided with timely, relevant information, fostering greater transparency, accountability and informed decision-making.

Public health care districts are at a crucial crossroads and thoughtful collaborative efforts such as this are essential to ensuring sustainable healthcare for our communities. Once again, we support AB 356 and commend Assemblywoman Patel for her commitment to enhancing healthcare services in San Diego. County. Thank you for your time and consideration.

Do we have anyone that wish to record their Me Too in support of this Bill? Do we have any formal opposition here? Please step forward.

Thank you, Madam Chair and Committee Members. Sarah Bridge, on behalf of the Association of California Healthcare Districts here today in respectful opposition to AB 356. I want to start by recognizing and appreciating the dedication of the Assemblymember and her staff to her public health care delivery system and in particular her healthcare district and those districts surrounding.

We absolutely believe and support in the collaborative approach to addressing healthcare risks in San Diego County and beyond. With that said, our opposition was born around the timeline and the direction of the Bill. While we agree serious conversations need to take place to preserve access to care, we did believe that the Bill may be premature.

Hearing that the Assemblymember does intend to take the amendments outlined by the Committee, we have less concerns around the timeline as well as LAFCO's involvement. However, we do still have concerns about the breadth of the hospitals listed and would be interested in discussing the amendments to narrow that and add some clarity.

Because the Bill now contemplates not just public health care providers as originally drafted, it now includes all hospitals. We do have concerns that there may be undue influence exerted by an in increasingly competitive market without sufficient public participation. With these considerations, we look forward to ongoing conversations with the author and the staff and the Committee.

We do think we can stroke an appropriate balance at this time or in the future. However, currently we remain opposed. Thank you.

Step on up for me too's is in opposition, please.

Good afternoon, Madam Chair, Members of the Committee. Felipe Fuentes here on behalf of Palomar Health, in opposition.

Thank you.

Good afternoon, Madam Chair and Members. Connie Delgado on behalf of the District Hospital Leadership Forum in opposition.

Great, thank you. We actually. The Assemblymember actually took that amendment as well. We did trim that list as well. You can respond if you want.

Thank you. I wasn't sure if that was a question. Yeah, we appreciate that. I think our concern is really more around the status of the entities. So now it says all hospitals. It could include for-profit entities, not-for-profit entities.

The original concept of the Bill was to bring the public health care districts together as well as UCSD to have that public conversation under the Department. We think that would be appropriate, especially given LAFCO's involvement and how the LAFCO process plays out. Locally, however, we do have concerns. For-profit nonprofit entities do affiliate with our districts.

We do, that does go through a public process that includes a public vote should that be undergone. We just have concerns about how those conversations might take place now outside of that.

I think that's something we could discuss in local government committees should it get out, to make sure that that is cohesive with our existing public processes.

Thank you so much. Questions? Comments? Senator Durazo.

I'm sorry, you might have included this in your presentation, but if you could describe to me the difference between what's expected in the LAFCO report. And the working group report.

Sure. I could speak to the working group and then I could have Mr. Wilson speak. Or do you want to go first to the, okay.

So in the working group, the specific tasks are to review and discuss the statutory or other responsibilities of each health care district to provide healthcare services in the communities that they serve and to examine whether current resources, funding and organizational structures in North County, the northern region of San Diego County, can fulfill the goals of providing adequate health care to all the residents, including underserved and vulnerable communities.

Just to paint a little bit of a picture of the history of what's going on, the Fallbrook Healthcare District, which is the neighboring district to the north, they in recent memory closed down their hospital. They don't have a maternity ward.

The Tri City Healthcare District to the east of us, northeast of us and coastal, they no longer have a maternity ward. So the Palomar Healthcare District maternity ward is the only maternity ward maternal healthcare system providing healthcare to over a million residents in the area.

And if we don't carefully look at what our long term plan is for healthcare access in the region, we are going to have increasing issues. Palomar Healthcare District serves 80% of its payers are Medi Cal and we know this is only going to get harder and harder.

So we want to have this working group come together and actually discuss how can we better serve the needs of our public? Really this Bill idea came out of grassroots efforts from people in the district who are genuinely worried about access to healthcare in the community. Mr. Wilson?

Yeah. And just to touch on the municipal service component with San Diego LAFCO. So by state law, LAFCO is required to conduct municipal service reviews on all special districts every five years. The last one that we did in San Diego was 2015, so it's well overdue. And as the Assemblywoman pointed out, the timing is paramount.

Just to gloss over real quick what the MSR covers.

It looks at the core services and functions of a public health care district and in simple terms that would be looking at the operations, the management, the governance and the finances and making sure that that analysis discloses how can we better serve the community and what are Those services and functions being provided in the most effective and efficient way.

And if there isn't any, how can we do better?

So I assume that includes the debt?

Correct. Yeah, that would be included in the finance.

Okay. Thank you, Madam Chair.

Assemblymember Dr. Weber Pierson.

Thank you. Thank you, Chair. Want to really thank the author for bringing this Bill forward. I know this is definitely a passion of hers and an issue that the region has been facing for a very, very, very long time.

And even though it's not my district, I got pulled in in December with the issues that were happening in the Palomar health system and just some of the things that are happening in North County. But, you know, I will definitely be supporting this Bill today.

I do not see this Bill as being duplicative, but actually as complementary to what's going on in the review conducted by LAFCO.

And more importantly, you know, LAFCO being here in support is also an indication that it is not something that is already being done and it is something that the two efforts can actually work hand in hand, helping to realign the regional planning within the broader state level of healthcare goals, specifically in North County, San Diego, which it desperately, desperately needs.

You know, I do want to take a moment to acknowledge and respect Palomar Health's long-standing role in our community in north part of San Diego. You know, it's a critical provider in the care. It's a region where access, as you've mentioned, is already strained and is facing significant pressures and challenges.

And so I do not take their concerns lightly. But what we have been doing is not working for the residents of North County, which then trickle out into the entire region of San Diego County. And North County is one of the most medically underserved parts of San Diego County.

We've seen reductions in labor and delivery closures, strained behavioral health access, and our most vulnerable are being forced to travel very, very, very long distances to get their care. And so I do believe that this Bill is necessary.

It will enhance coordination, improve transparency, and ensure that all key stakeholders are at the table to help shape a more equitable and stable healthcare system for North County and San Diego. And so I will be supporting it at the appropriate time. I'd like to move the Bill. Thank you.

Madam Vice Chair.

Yes, I actually have two questions here. The first is I'm not understanding why this would need legislative action. Has there not been an effort to just bring the group together?

We have had attempts to have conversations and we feel that a more structured format with some kind of legislative backing will help us reach a conclusion much more quickly.

In combination with the MSR that we have coming forward, we will have the data that we need and then bringing a work group to sit together and actually with the intent and focus of doing this important work, it's going to be crucial to actually getting done.

So has there been anything that has prohibited you from doing that to date?

We have attempted many conversations and tried to bring people together and it seems like it's not reaching the level of priority that people on the ground really feel that it needs at this time.

Okay, and then my next question would be for Palomar Health, if their representative is willing to take a question. I would just like to have a better understanding. I know in your letter there is the assertion that this is duplicative. So I would just like to understand that a little bit more.

Thank you, Senator. I think, you know, our letter is pretty clear in that we are concerned about sort of the wasted resources potentially. The analysis does a good job of explaining how it is that the funding for this type of work group won't be ready until next year. We've got processes that are taking place right now.

You've got a two year session that we can avail ourselves of. So our recommendation was to hold the Bill, see how those conversations go.

We'll have some information from the MSR in short order, and then you've got a vehicle in which you can then identify whether it's necessary to make that expenditure in having the state get engaged in a local issue. So that creates opportunities, I think, for efficiencies.

If we took some time and if we don't, then there's an opportunity here for duplication, which I think is not a good use of resources.

Can I follow up on that, please?

Sure.

So in, in reality, this has been in the press for years. It's been several years since it first came out that Palomar Healthcare district was struggling.

Some of it was due to Covid, some of it was due to not being able to accurately anticipate new hospital, a new Kaiser hospital coming in and loss of a patient base. This has been going on and these conversations should have happened a long time ago and they simply have not happened. And I think it's time.

The public is very worried about losing their only maternity ward. The public is very, very worried about losing access to the only public health care district in North County.

And just one last comment here, Chair.

I can completely empathize with you wanting to act as quickly as you can for your community, but I also fear that if there is, even though this may be have been a long-standing conversation and if there is data that is on the way, I think you put yourself in a better position once that information is made public and once the plan is together.

So I think it's reasonable to with the opposition's recommendation to really take a better look at this next year. So I can't support this Bill this year but I completely understand what you're trying to accomplish.

Dr. Weber Pierson.

Thank you. Just want to you know, respect definitely the position of our Vice Chair but I do want to stress what the Assemblymember has been stating.

There have been multiple, multiple conversations and attempted conversations and as I stated in my statement I have even been pulled in to these conversations to meet with the higher ups of these various health entities in North County and. There's a lot going on up there.

This Bill is definitely needed and there have been many attempts to try to fix this non-legislatively. I do not believe that we need a Bill to fix everything.

But once you get to a certain point of having replaced repeated conversations with people in the area and outside of the area and the changes are not happening and we're dealing with the fact that people may actually end up losing coverage, we have to intervene. It is our responsibility as a state to intervene.

And so again I do thank you. I know how hard you've worked and I've seen it. I've been in many of those meetings and so like I said, I'll move the Bill at the appropriate time.

Thank you colleagues for the conversation. No one here is the Senator in your area. The closest one is going to be Senator Dr. Weber Pierson, it's very hard for us to come and tell you, the representative of your area that your issue isn't a real issue in your area.

The job of this Committee was to see how we can tailor it to be more of your intent and be realistic and push out the timeline which you accept it. I also had similar questions of is this the same work that's going to come out of the MSR but the MSR is going to come out in October.

You're going to have recommendations and information that can better position the working group once it starts on what else needs to be done on the follow-up. You have been working on this for a long time. We should not stand in your way to better your community and your respective district.

Which is why I have recommended an aye vote for this Bill. With that please close.

I appreciate the thoughtful input and feedback from Madam Chair as well as this Committee. It's helped us make this Bill a better Bill.

As I stated earlier, this Bill really came out of a need from constituents in our district, grassroots efforts and as a new Assemblymember Representative, I came in with good intentions to try to address the needs in our community, not knowing exactly the pathway of how to get there.

And your guidance and support has helped us put together a better Bill and I appreciate that. At the appropriate time I respectfully ask for an aye vote.

Thank you. This Committee will entertain a motion once we have quorum. Thank you for presentation. Thank you for coming. We're going a little out of order to accommodate a birthday for someone's offspring.

Happy Birthday to my kid who turns 13 today.

Thank you to the fellow Assemblymembers for being so kind to let Assemblymember Schiavo present we're on file item 11, AB 1418. Assemblymember.

Thank you so much Madam Chair and Senators and for the accommodation to make sure I make my kid's birthday celebration. Today I present AB 1418 which is a Bill that enhances the understanding of healthcare workforce trends around across our state when it comes to health insurance, California has long recognized the value of data driven decision-making in healthcare.

Existing law requires the Department of Healthcare Access and Information, or HCAI, to maintain a central research and data center, a vital resource that collects, analyzes and shares data on the healthcare workforce trends educational systems.

HCAI ensures that our healthcare policies are grounded in real world insights with high quality, high value data resulting in informed decisions that support and strengthen our healthcare workforce. AB 1418 builds on this strong foundation by addressing emerging trends in healthcare coverage for healthcare employees who are eligible for benefits in California.

My office and HCAI are actively engaged in developing specific data sets for the healthcare waiting period for workers in the healthcare industry and today I have Beth Malinowski from SEIU State Council and Dr. Sarah Seaman, infectious disease fellow and at UC Davis and a Member of SEIU CIR, the Committee of Interns and Residents to testify as well.

Ladies, you have a combination of five minutes. Okay?

Thank you. Good afternoon Chair and Members Beth Malnowski with SEIU California proud sponsors of AB 1418.

As our author noted in her remarks, this Bill will guarantee we as a state have the information we need to understand trends in health care coverage and health care employees in California and specifically including whether employees otherwise eligible for employer sponsored health care are subject to waiting periods after receiving, or before receiving a coverage. Excuse me.

Research shows that most workers who begin a new job face difficulty in affording health care during an employer's health insurance coverage waiting period. This Bill had bipartisan support in the Assembly and respectfully ask for your aye vote today.

I'm going to hand it over to Dr. Siemens to provide additional perspective and happy and available to answer any questions you may have.

Good afternoon Chair and Members. My name is Dr. Sarah Seaman. I'm here today as a fellow physician and a proud Member of SEIU Committee of Interns and Residents. Today I'll be sharing how current practices regarding healthcare coverage for new hires impacts Californians, including doctors.

I'm right now finishing my clinical fellowship in Infectious Diseases at UC Davis and after this I'll be relocating to Oakland to start working as an attending. I decided to focus on infectious diseases when I was applying to medical school and routine health screening diagnosed me with latent tuberculosis.

Going through treatment was a scary process and it was also the first time that I really interacted with the public health system. I want to help others in that situation. No one should be scared because they don't know how to navigate that system, especially when they're already sick.

Today, too many hard working Californians, even doctors, struggle to make ends meet because of imperial employment practices that force people to cover their own healthcare costs when they first start their job. It just doesn't really make sense to me.

When you get a job, you're working for your paycheck and your medical coverage, but when you start working in the healthcare sector, you only get one of those things at a time when you can least afford the other.

Most residents have to relocate for their new job, take on credit card debt to make the move, and have upwards of $300,000 in student debt so paying for temporary medical coverage can be can totally break us.

Anyone with a health history like mine can't afford the risk of living without health insurance until their employer sponsored coverage kicks in. We have Members who've had to skip prenatal appointments or go without medication because they're stuck in this waiting period. Getting sick while waiting for health insurance can end our careers.

It seems wrong for physicians like me to go further into debt to cover steep COBRA costs or gamble that we won't get sick for a month or more to so that we can provide health care to others. That's why I'm asking for your support of AB 1418.

All health care workers should be able to join the workforce and do their jobs without medical bankruptcy threatening their physical and emotional well-being. At a time when federal healthcare cuts are the new reality, California must make it a priority to understand and track health care coverage on day one for healthcare employees.

AB 1418 reflects who we are as Californians. Thank you in advance for your aye vote today.

Thank you so much. Doctor, Now's the time for me too's in support.

Katie Van Deynes with Health Access California in support. Thank you.

Thank you so much. Do we have any formal opposition? We shouldn't. Great. Any me too's opposed to this Bill? Quickly going through it, colleagues? Senator Dr. Weber Pierson.

Thank you Chair. First of all, please tell your brilliant, beautiful daughter happy birthday. I knew there was a reason why I felt a special bond with her. Fellow Cancer.

Well, in the author statement it talks about the fact that families must wait up to 90 days before accessing employer-sponsored health care coverage due to the allowable waiting period under federal law. So it's federal law that's giving them this three month lag. What. And we know that this is the case.

So what are we looking for in this report?

So the federal law requires providing care by 90 days. So it doesn't require not providing care until 90 days. So this report is really to get a much clearer sense of where California health care providers are falling within those 90 days. Are most of them getting it on day one?

Are most of them getting it on Day 90? We are not, we don't really know and we're not clear on that. And as you know, obviously working in infectious disease and as you know, as a physician seeing sick folks on a regular basis every day having healthcare is really critical.

And so this is kind of a first step for us to get a really clear picture of where the gaps may be in this space.

And it's in this time of initially starting a new employment in health care and making sure that if there is, you know, if there are policy actions that are needed in this space that we have the data to back it up.

Okay. So it's more so to see because I mean we clearly have stories of individuals who are not getting their health care coverage immediately or having to wait a month, 2, 3 months.

So it's more so to see if this is more of the norm or an anomaly and if it's more of the norm than creating policy instead of just going ahead and creating the policy?

Correct. We're being thoughtful.

Okay, thank you.

I think you, what you mentioned is really hit on the nail. It's important data to collect. We want to be data driven here. We should just have information, information at our fingertips. With that, please close.

Very grateful for the opportunity to present and present early special shout out to Assemblymember Harabedian who let me jump the line. And, you know, we really feel like this is a concerning gap, but I think, you know, without the data to really show it, this is an important step for us to really back that up.

And so respectfully request an aye vote when you can do that.

When we get a quorum, yes. Assemblymember, thank you so much. Thank you for coming. Did Assemblymember Harabedian leave? Oh, he was never here. Okay, so we're going to go to Assemblymember Haney. File item 6 AB 669.

Thank you, Chair and members. I want to start by thanking you and your staff for your work on this bill and to accept the committee amendments. We know that the opioid addiction epidemic is still one that we are grappling with as a state.

Far too many of our residents are addicted to opioids, and far too many are still losing their lives. It is a critical goal that I know that we all share to make sure that those who need access to to treatment are able to receive it.

Unfortunately, right now, there are aspects of our laws that relate to people who have private insurance coverage that is preventing them from being able to access that critical care for the amount of time that they need it. Right now, insurance companies can use corporate review panels.

Sometimes these panels have no contact at all with the patient, no contact at all with their doctors, and use that process to deny the coverage that folks in our state critically need and honestly, that they're paying for. They're paying hundreds, sometimes thousands of dollars every month for health insurance, expecting it to be there when they need it.

And in the case of access to opioid addiction treatment, it can be literally life or death. Other states have already taken action to address this challenge and ensure that people have access to care and treatment when they need it. New York, New Jersey, Massachusetts and Delaware all have laws preventing insurers from cutting off addiction treatment too soon.

We know, and you're going to hear from Ms. Christine Matlock, who is here, who is going to speak about the awful, tragic, a loss of her son. Somebody who needed this access to treatment.

But because the insurance company was able to cut off his care despite the fact that he sought it, despite the fact that his Doctor knew he needed it, he was exited from treatment.

This bill would simply ensure that there is 28 days of uninterrupted addiction treatment for patients, it will remove these barriers that lead to people who need treatment being removed from it too soon, even when they are seeking it, even when they are saying that they want to be treated and their own physicians and providers are in agreement.

And this will also align California with these best practices from other states that I mentioned that will strengthen insurance protections for addiction treatment. With me today in support of the bill is Christine Matlock, mother of Ryan Matlock, and Dr. Veronica Lasso

on behalf of the California Society of Addiction Treatment. Louisa Davis, a board Member from the Addiction Treatment Advocacy Coalition, is here to answer technical questions.

Go ahead, dad. Okay. Hi, my name is Christine Matlock. My son, Ryan Matlock was well liked by everyone. He had the most amazing blue eyes, an infectious laugh, and a kind heart that cared about everyone. Yesterday, we should have been celebrating his 28th birthday.

But instead, on March 23, 2021 at the age of 23, he died of a fentanyl overdose after my insurance company let Ryan, me and my family down by not providing adequate care for him during his time of recovery from addiction. I still remember the night Ryan came to me and said, mom, I need help.

I can't do this anymore. I need help from someone who understands what I'm going through. For three and a half weeks, I heard him every day on the phone talking to our insurance company, trying to get them to find a place he could go. Three and a half more weeks, he had to suffer with this disease.

At that point, we stepped in, we did the research. We found the place to treat his addiction. We did the paperwork and sent it to the insurance company. I remember the day I dropped him off at the center. He said, mom, I'm going to make it this time. I'm tired of living like this.

When we arrived, Ryan was approved to stay for seven days to detox, followed by 90 days of inpatient treatment. After three days, my insurance company said his vitals were good and he no longer was having suicidal thoughts. And he could go home. Not to another rehab, not to a sober living house home.

His doctors, psychiatrists and counselors recommended a 90 day stay. It never dawned on me that after three days, Ryan would be sent home to deal with his life threatening, threatening condition. I mistakenly thought he was safe when I dropped him off. The insurance company told us we were wrong.

We were told he knew what to do and did not need the level of care that was recommended by the physician and his care team at the center. I put in an appeal. Ryan put it in appeal. His rehab care team put in appeal.

But without ever speaking to my son, our provider was told to discharge my son. The carrier said he did not need more support. He could do this on his own. Even though this was his third relapse he could do it on his own in an outpatient program. After only three days of treatment.

He hadn't even finished his taper. Due to his recent relapse, his counselor and psychiatrist said he needed a higher level of care. But my insurance company said no. They said they knew better. He could control his addiction if he only wanted to. I remember him calling me and saying, mom, they're going to release me soon.

I'm not strong enough yet to do this on my own. I need help. That was the last time I spoke to my son. He was released the next morning and died 48 hours later from a fentanyl overdose. Even after four years, there's not a day I do not think of him and miss him so very much.

We light a candle every night in his honor. Our lives have never been the same without Ryan. I had a grandchild born a month ago who will never know his uncle. He wanted help. He asked for help. He deserved help, but was denied the level of support he needed.

Based on a generic chart of numbers by my insurance company. There's a hole in our hearts that will never heal. In his memory, I will fight for bills like ABn 69 so not another family has to face the tragedy we live with daily. Thank you. Go ahead.

Honorable chair and members, I'm Dr. Veronica Loso, I'm an MD dual boarded in Psychiatry and addiction Psychiatry. I practice for UCSF at a clinic for the seriously mentally ill on Medi-Cal in San Francisco. I'm here to ask you to support compassionate and medically appropriate treatment for people struggling with addiction.

Residential treatment is a critical level of care for these patients, but it's also a very frightening one for them. For people deep in their addiction who are using to stave off withdrawal, one of the most terrifying prospects for them is to knowingly choose to face this.

This is exactly what we ask of them when they go into residential treatment. And it's not something that they do lightly. These are often patients who don't have trust in the medical system, and with good reason.

I've spent years working with some of my current patients, encouraging them to enter treatment, which is a slow process of rebuilding their damaged trust. And the prospect of this momentous decision being revoked by by the insurance company is an appalling thought to me. Addiction is a disease that we do have good tools to treat.

However, treatment is not a fast process. Our brains have a great capacity for adaptation, which is part of how addiction develops in the first place, but it's also part of the recovery path. This takes a long time.

When I'm counseling my patients about what to expect when they're entering recovery, I counsel them that withdrawal lasts for days to weeks. We have good medications for this. But the actual behavioral and neuroadaptive recovery can take up to a year.

And this definition is baked into the very definitions that we use for the diagnoses in the DSM 5. Early and sustained remission aren't defined until after 90 days or one year.

Can we get your final thoughts, please?

Yeah. The other important piece is that there is a stark increase in mortality after someone loses their tolerance up to 129 times the background read. So I'm asking you for your aye votes on this bill.

Thank you so much. Me toos in support of this bill. Please step forward.

Sherry Daly with the California Consortium of Addiction Programs and Professionals. Proud co-sponsor, in support.

Christine Smith, Health Access California, in support.

Kaylin Dean, on behalf of the California Hospital Association, in strong support.

George Cruz, on behalf of the California Behavioral Health Association, proud co-sponsor and strong support. Thank you.

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

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

Megan Loper on behalf of the United Hospital Association, in support.

Chair Murphy with the California Association of Alcohol and Drug Program Executives, in support.

Louisa Davis, Addiction Treatment Advocacy Coalition, in support. Thank you so much. Formal opposition.

Madam Chairman and members Stephanie Watkins, on behalf of the Association of California Life and Health Insurance Companies. First and foremost, we'd like to thank the author, the sponsors, the committee staff for all their hard work on this ill. We do currently have an oppose unless amended position, and that's really to point to.

I think all of us have a great deal of empathy. Many of us have been touched in our own lives by addiction. And that's something that as we took this back to our members, trying to kind of come to a conclusion about best practices and what those would look like.

We appreciate the amendments that were taken by the author and the committee. We are trying to work through some of the main issues. I know the bill still speaks to 28 days, but there was a request and some clarifying language about the treatment plan that can authorize any number of days and level of care.

So we're trying to reconcile what that would look like and whether or not in many times, you know, 7 days, 21 days, there's initial prior authorization for an initial subset of days, if that would allow us then to do concurrent review and continue to have that dialogue and open conversation with the facilities or the providers.

I think that's a really key component to ensuring that the patient is getting the right care, is to ensure that that communication is consistently happening between the plan and the provider and the facility.

Also, to the degree that we can continue to work together to find maybe a path forward to clarifying whether or not prior authorization is for an initial subset different than the 28 days, or if the 28 days is still the required amount, I think there was some confusion.

Also to the degree it speaks to the 29th day when you would be discharged, we think that there should be quite a bit additional communication prior to that 29th day between the plan and the provider.

And that really is to ensure that there's continuity of care and a relationship they're built so that the patient, as they're transitioned out can ensure that they continue to get the right care. So for those reasons, we continue to remain opposed to the bill.

Look forward to having those conversations and seeing if we can get some additional clarity to that language.

Thank you. Chair Members, my name is Olga Shiloh. I'm here on behalf of the California Association of Health Plans. I'd like to align my remarks with those of my colleague from ACLI and offer additional comments on AB 669. We sincerely appreciate the intent behind the bill and acknowledge the thoughtful work that went into the recent amendments.

These changes represent meaningful progress. That said, we believe some of our core concerns remain unaddressed and we welcome the opportunity to continue working together on further refinements. We share the goal of ensuring timely access to medically necessary care, including for substance use disorder treatment.

At the same time, we do believe utilization management, including both concurrent retrospective review and serve as a critical role in maintaining the integrity and effectiveness of our healthcare system. It ensures medical necessity reinforces provider accountability, protects against fraud, waste and abuse, and safeguards against unnecessary costs. Most importantly, ensures patients receive the right care at the right time.

We would like to continue refining the bill's language to better align with the author's intent, while also providing clarity and consistency for health plans and providers alike. Should the bill continue to move forward, we remain committed to constructive dialogue with the author and stakeholders. However, in its current form and without further amendments, we must respectfully remain opposed.

Thank you for your consideration.

Thank you. You too. MeToo is in opposition. Okay, bringing it back.

Senator, Dr. Ward Pearson, thank you. Chair, thank you to the author for bringing this bill forward. Really want to thank those who came out to speak and give your stories.

It's not easy to open up your life like that to a bunch of strangers, but really appreciate you doing so so that we can see and really feel the impact that it has had on your lives. Because that really translates into many, many, many other lives who cannot come and share their stories like you did.

Assemblymember Haney, would this bill apply to those who are on Medi-Cal?

No, it does not. And as you know, I'm sure quite better than I do, that Medi-Cal has sort of a separate set of processes and intake that's coordinated by the counties. And so in collaboration with past committees that we've been through, this does not extend to medical patients.

Did you. I'm sorry, you were you going to say.

Med has their medical, has their own system, central system, and they are 30 days.

So you're not seeing this issue within Medi-Cal patients. So what you're trying to do is to actually bring the commercial plans up to what we already have in our Medi-Cal system. Yes. Okay. Thank you. Thank you.

Seeing no other questions, I just want to say that I want to thank you for working so hard on this and taking all the amendments to try and get to a place that is balanced.

I'm going to be supporting this today, but I want to continue to hear the conversations are happening with the opposition and I'm going to reserve the right to change my vote on the floor, but you'll be getting my support today. So when you may close.

Thank you. And thank you to the committee and again to the staff. And we've been working very closely with the opposition and taken a lot of amendments along the way and the issues that were raised that are continuing concerns. We're very happy to continue the conversations and potentially some areas of clarification that are needed.

You know, this is really about ensuring that people who want care, who need care, are able to receive it and that the people who know them the best, their families, their Doctor, and they themselves are the ones who are making those decisions. And I really again want to appreciate Christine especially for being here for her courage.

This is very challenging. And we bring this bill forward in Ryan's memory and all of those who have been lost and hope that people who have that courage to come forward and seek treatment in our state are able to receive it and at the appropriate time would respectfully ask for your aye vote.

Thank you. And when we have a quorum, we'll take that motion. Next, we will move to file item number four. Assembly man Harabedian, AB 512 and Assemblyman, you are recognized when you're ready.

Thank you, Madam Vice Chair. I appreciate it. Thank you to all the members who are here. And I'd like to thank committee staff for all their work on this bill. I will be accepting the Committee amendments. I'm here to present AB 512, the Timely Access to Care Act, which brings healthcare services to patients faster without life altering delays.

Prior authorization is something that I don't need to explain to this committee what it is, but it is a process where a healthcare provider needs to obtain approval from a patient's insurance company before proceeding with a specific treatment, procedure or medication.

The step is taken to confirm that the service is covered under the patient's health plan and that it is deemed medically necessary. Prior authorization requests are separated into two categories, urgent and non urgent. And again just for the record, urgent is when there's a serious and imminent threat to health, life and or limb or worse.

And those are really obviously critical. Prior Authorizations to get processed as quickly as possible. Currently, health plans have 72 hours, however, to process urgent prior authorization requests and they have as long as five business days to process non urgent requests.

According to a 2023 study by the American Medical Association, 94% of patients reported experiencing care delays due to prior authorization. Additionally, 78% of patients stated that prior authorization requirements sometimes led to them abandoning treatment altogether, which is unfortunate to say the least. Also, it is burdening our physicians.

Physicians spend an unnecessary amount of their valuable time on prior authorizations. On average, practices complete 39 prior authorizations per physician per week. Physicians and their staff spend 13 hours each week just completing prior authorizations and 40% of physicians have staff who work exclusively on prior authorizations.

89% of physicians report that prior authorization somewhat or significantly increase physician burnout. In a late 2024 survey by AMA of 1,000 physicians, physicians reported that prior authorizations had led to a serious adverse event for a patient in their care. Specifically, 23% reported that it resulted in a patient's hospitalization.

So one in four patients ended up in the hospital because a prior authorization was not, was not administered quickly enough. 18% reported it caused a life threatening event or required intervention to prevent permanent impairment or damage.

One of five patients experienced that and 8% said it led to disability, permanent bodily damage or a congenital anomaly or birth defect or death. Our current system is cruel, and we need to change it. I think the statistics themselves speak to that. This bill, AB 512 proposes the following changes to improve patient care. 1.

It reduces the processing time frame for urgent prior authorization requests from 72 hours to 24 hours for requests submitted electronically and 48 hours for those that are submitted non electronically. It also reduces the time frame for non urgent requests submitted electronically from five business days to three business days.

The bill retains the approval timeline for non urgent cases submitted non electronically at five business days. This bill will improve patient access to timely care and put patient well being at the forefront of our health care system. And when the time comes, I respectfully, respectfully ask for your aye vote. Here is my witnesses.

Thank you for being here. Dr. Raminder Gill, clinical Professor with the Department of Internal Medicine, Division of Hospital Internal Medicine, Division of Hospital Medicine at UC Davis and Sherene Gaducey, Senior Legal Counsel for the California Medical Association.

Thank you. You're both recognized for two minutes.

Go ahead.

Good afternoon, Madam Chair and Committee Members I'm Raminder Gill, MD and I work as a physician at UC Davis Health. Caring for patients admitted to the hospital, I've dedicated my career to meeting the needs of my patients often faced with challenging and life threatening conditions.

I come today to speak as an individual and represent my colleagues at the California Medical Association. As I enter my 26th year of practice in the hospital, including rounding on patients this morning, I feel Californians deserve something different and better than the current prior authorization system.

I can personally attest, having spent many hours over the course of my career submitting the needed information for prior authorization to then receive the reply days or even weeks later. For example, my patient, Mrs. Z was admitted to the hospital with a serious infection to our intensive care unit.

Her condition was stabilized and she was transferred to my General Medicine service outside the ICU. Due to prolonged prior authorization process her discharge was delayed for more than a week while awaiting the insurance company to respond. Even then, it required a telephone conversation with someone at the insurance company to receive approval.

The delay actually increased the health care costs since my patient was in the hospital longer than required. The names, faces and stories can change. Addiction, mental health, infection, heart failure, but the story remains the same. Delays in care, The toll prior authorization has on patients is tremendous.

The prior authorization process is a time consuming barrier to necessary patient care. Hospitals are constantly full. For every patient I discharge, another will soon fill that bed. Delays can cause unnecessary suffering, increased healthcare costs due to complications from postponed treatment, and increased costs of administrative burden on physicians as well as their staff.

AB 512 ensures that health plans respond to prior authorization requests in a consistent, timely manner, avoiding unnecessary delays to medical care that have resulted in unnecessary pain, the worsening of patients, illnesses, and in some cases, even death. With the necessary changes, we can streamline and standardize the process to do more for patients while reducing costs and administrative burden.

Instead of coming to testify about missed opportunities, I'd like to one day return to tell you about how we're doing more for our patients than ever before due to a streamlined and humane prior authorization process. In closing, I thank you for the opportunity to comment on prior authorization.

I urge you to support AB512, which will help patients and doctors to improve the delivery of care in California.

Recognized for two minutes. Good afternoon. Shereen Gaducey, California Medical Association. I'm just here for any technical questions.

Awesome. Wrapped it up. We'll now move to any other individuals in the room in support of the bill. Your name, your position and title only, please.

Thank you. Tim Madden, representing the California Chapter of the American College of Cardiology, the California Rheumatology alliance and the California Society of Plastic Surgeons, all in support.

Good afternoon, Connie Delgado on behalf of the District Hospital Leadership Forum in support.

Andy Mason representing Clean Earth for Kids in support. Also requests from several partners in support, including North County Equity and Justice, Eco Sustainability Peeps, Interfaith Coalition for Earth justice and Activist San Diego.

Nisette Short on behalf of Loma Linda University Health, Adventist Health, the Alliance of Catholic Healthcare and Saint Agnes Medical Center. In support.

Ellie Sutliff at Stone Advocacy on behalf of the California Orthopedic Association, in support.

Good afternoon, Madam Chair, members, Mari Lopez with the California Nurses Association in support.

Christine Smith, Alexis California in support.

Fred Noyer representing Stanford Healthcare in support. Thank you.

Christy Foy with Arnold and Associates representing the California Kidney Care alliance and Frescinius Medical Care in support. Thank you.

Good afternoon, Linda Way with Western center on Law and Poverty in support.

Thank you. Dylan Elliott on behalf of the California State Association of Psychiatrists along with the California Academy of Child and Adolescent Psychiatry, both in support. Thank you.

Megan Loper on behalf of the United Hospital Association, in support.

Jessica Moran on behalf of the Physicians Association of Cal, of California in support. Thank you.

George Cruz on behalf of the California Behavioral Health Association and the California Access coalition. In support.

Dr. John Valli and support from the American the AARP, California.

Kaylyn Dean on behalf of the California Hospital Association, in strong support.

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

Cher Gonzalez on behalf of my clients, the American Diabetes Association, the Association of Northern California Oncologists, otherwise known as ANCO, as well as the Medical Oncology Association of Southern California, California, otherwise known as MOASC, in strong support.

Ryan Spencer, behalf of the California Podiatric Medical Association and the Crohn's and Colitis foundation in support.

We'll now move to any key witnesses in opposition.

Thank you. You are recognized and you each have two minutes. Thank you.

Thank you. Chair and members Nick Louiseos, on behalf of the California Association of Health Plans, we have an opposed unless amended position on the bill. Want to thank the author, his staff and the sponsors for the level of conversation that we've had on this issue.

You know, we certainly understand the motive behind the bill and the intent and we don't necessarily disagree with it. We do believe that authorization for care is an important tool making sure that patients get the right care at the right time, in the right place.

And indeed, you know, this legislature and the governor signed a budget recently that actually places more prior authorization on additional services. In the acknowledgment, we think that we want to prevent low value care from being given to patients. So we do think it's an important tool.

Having said that, though, we understand that the process could be better, it could be more efficient for patients, it could be more efficient for providers, and quite frankly, it could be more efficient for plans as well.

And so in the spirit of embracing solutions, the National Trade Association for the Health Plans, America's Health Insurance Plans, you know, has released a number of principles related to prior authorization. We have, you know, modeled some of our amendments, suggested amendments to this bill based on, you know, what the plans have been able to, to agree to.

And so we forwarded some amendments to the author and we've shared that with others, basically asking that, you know, electronic submissions be required by the providers, of course, giving them enough leeway in delaying the effectiveness of that requirement, the effective date of that requirement, so that they can get the proper infrastructure into place.

We also believe that the requests that come in that would be subject to any new timelines, that the request be clinically complete, that all necessary and information or to approve the request or to at least consider it, you know, include all clinically necessary information.

And then of course we, you know, had some suggestions about the implementation date and other, other issues as well. The amendments that are going into the bill today. From conceptual perspective, we appreciate the fact that electronic submissions are being acknowledged on these amendments. You know, we do prefer that. Wrap up your comments.

Yeah, we prefer that they be required. And so I'll leave my colleague to, you know, continue our line of argumentation. But we do have an opposed unless amended position. The amendments don't quite hit the mark yet. So, thank you.

Madam Chairmember Stephanie Watkins. On behalf of the Association of California Life and Health Insurance Companies, in the interest of time, I will echo many of my colleagues comments. I think the key component

in this is what something we're seeing on the federal level is that move to use technology as an opportunity to fast track and have those requests turn into an answer to patients. I mean, no one appreciates a delay.

So to the degree we can work with our partners and the provider groups and the individual physicians to update their systems as well as collaborate with our systems so that we can move to a more integrated process. I think that's a key component and one for which is a strong provision that we would like to required in the bill.

I think that that will go a long way to really successfully integrating and moving our healthcare system forward and also allowing patients to access care faster. So for those reasons, though, today we remain opposed to the bill, but we look forward to continuing those conversations as the bill moves forward today. Thank you.

Thank you. Is there anyone else in the room here in opposition? State your name, your position on the Bill.

Thank you. Thank you. Madam Chair, members, David Gonzalez today on behalf of America's physician groups with an oppose unless amended position. Thank you.

Chair, members Kathy Mossberg with the Local Health Plans of California oppose unless amended.

We'll now move to the committee. Senator Rubio.

Hello everyone. Well, first of all, I may full disclosure sort of conflate two issues here, so just bear with me. You know, I really appreciate this bill coming forward.

You know, as an educator, I've been trying to get mental health professionals in our schools as we see just a spike and so much trauma in our teens and our youth from, you know, just suicide and other issues, drug use. And, you know, we have this whole generation surviving Covid, surviving Internet bullying, surviving fires.

And now in your community, which I share, I'm your neighbor. So, it trickles down to our communities as well. The trauma on top of trauma of now families that are in your community impacted, hiding from the ICE rates that are happening.

And so, you know, this bill has now become even more important to me in terms of providing services. But I do hear the, you know, the concerns about updating our systems. You know, it's long overdue. Having a more integrated system that can help with faster access and information is critically important.

But I think that this is an important bill that I think it's necessary at this time. We definitely need to make sure that families impacted have access especially I appreciate that it's for those areas designated emergencies as well as just making sure that it's a little narrower. So I hope that that helps a little.

But thank you for bringing it forward. I want to be at it as co-author and I appreciate you working on this, but I can see it firsthand again. I've seen it in our schools and I see it in our communities.

And being your neighbor really has brought me to the forefront of what you're speaking about and what we're seeing. And I really just thank you for the work that you've been doing all around and trying to help our victims and our communities. With that, I'll move the bill when appropriate. Thank you. Senator Durazo.

Thank you. I also want to thank you very much for presenting the bill. The fact that there's recognition from opposition that this needs to be fixed says a lot and so, I hope it goes through in a serious way, not just in a trickling down. And I think you all understand that.

So again, I want to appreciate and I will absolutely be supporting you. Thank you.

Thank you.

Collecting my variants. I apologize. Any other comments on we're on AB 512. I think I'll provide my comments now. We chatted about this, assembly member, a lot on this and this committee has also heard previous commentators I made on this topic before. This isn't the only bill in the prior auth world.

It was very important to one kind of aligned some of the incentives that this committee wanted to put in terms of getting prior auth. This is also a place where there's multiple players that need to be engaged for it to be successful.

And we wanted to make sure that if we're moving towards decreasing the amount of time for prior auth that we should also move towards electronic prior authorization. I think we landed on that place there. And even with urgent care with non electronic that's a big step to go from 72 hours now down to 48 hours.

A huge big step. I know we're not done in this space but let's see how this moves forward. Which is why I'm glad to support this vote the get out of committee. Will she. Are you sure someone senator, we're good. Okay.

Yes. I'm sorry and I was complaining to issues but I just wanted to to be clear, you know I've been running around in two different committees and chairing my own committee which you were there, right? A few seconds ago. So, so I'm sorry if it didn't make sense to a lot of people.

But once again just know that I'm aware that this is a a bill, another bill that you're working on. So, thank you.

Thank you. You may close. Okay. Thank you. Madam Chair. Just wanted to say thank you very much for all of your hard work on this bill and your staff again. And I do think that the chair brought this bill to a better place which incorporated a lot of the points that the opposition has brought up.

And I want to thank them for all the work that they've done on this bill and the testimony. I think we've come a long way with the electronic submissions and the bifurcated system that this bill lays out.

Obviously we want to weigh that and and balance that with the rural and smaller clinics that just can't get to that electronic submission quite yet. But we obviously are getting there slowly but surely.

But I do think that this bill pushes us in the right direction and I would respectfully ask for an aye vote at the appropriate time.

When we have a quorum, assembly member, we're entertaining a motion. Moving on to your next bill.

Thank you, Madam Chair, again and thank you for to the Committee and I think my neighbor Senator Rubio keyed this up and teed this up better than I could.

So I want to thank her for that and for the support we I am going to accept the Committee amendments and I just want to be clear what those amendments are. It would cap the number of visits at 12.

It would clarify that this benefit is intended for those who have experienced displacement, trauma or loss due to the wildfires and outlines the information that may be included in the notice to consumers. This week we actually remembered the six month anniversary of the Eaton and Palisades fire.

And six months ago we experienced the most destructive wildfire in modern memory. And as Senator Rubio pointed out, many of our community Members are still reeling from it and they are suffering from it in many ways. And they're not only suffering from the physical destruction, but they are. Many of them are mourning the loss of lives.

But there is lasting emotional and psychological and mental harm that has been experienced and this has been incurred by thousands of my constituents and constituents throughout Los Angeles County. The California Department of Public Health reports that emotional recovery following a wildfire is especially challenging.

Studies have shown that significant increase in emergency room visits for anxiety, depression, PTSD and substance abuse disorders often occur in the aftermath. And we saw that in these fires. And unfortunately behavioral health services are often severely strained and not available in a timely manner.

Just in the week following the LA wildfires, the California Parent and Youth Helpline saw a dramatic increase in calls and overnight calls surged 366%. Live chats increased 68% and text messages rose by 45%. This Bill, AB 1032 responds directly to this need by ensuring access to behavioral health care for those recovering from wildfire trauma.

AB 1032 requires health plans and insurers to cover eligible enrollees for up to 12 visits with qualified health care plans in counties with wildfire declaration, including those in La County. To be clear, Medi Cal is not included in this Bill.

But I decided to carry the Bill, and I think this Bill is needed because of the enormous gap that exists in our behavioral health system. And we are still fighting for parity between behavioral health and physical health. A survey of over 10,000 CalPERS Members revealed that more than half considered seeking behavioral health care.

Among those who received behavioral health care, 61% were unable to get in plan appointments within two weeks, and 46% identified difficulty finding a provider as the biggest barrier to care. And then more than half actually had to seek that care outside of their health plan.

And this is something that we've seen over and over again, Especially during a traumatic experience like a wildfire. As noted in the cherb analysis, enrollees in commercial and CalPERS policies captured under this Bill have coverage for behavioral health visits Regardless of whether or not there is a wildfire.

However, none of the coverage that allows this coverage does not allow them to see any licensed behavioral health provider. It's only those that are contracted with their plan. And if they want to go outside the plan, they have to jump through a lot of hoops and it's very hard and it causes delays.

This Bill is just trying to remove those barriers and expands access to timely trauma informed care from qualified health providers as my constituents cope with the destruction brought on by the wildfires, including the loss of their homes and the constant battles with their property insurance carriers.

This Bill removes barriers to access immediate mental health services for those suffering from post traumatic stress disorder, Anxiety, depression, and other forms of psychological distress. It provides a vital lifeline and ensures survivors get the help they need to heal, rebuild, and move forward.

I do want to thank the speaker and his staff for their partnership on this Bill. The speaker is a joint author of this Bill and a proud supporter of it, and I just want to thank him again for all his help.

Here to testify in support of the bill is Dr. Martinez Hollingsworth from altamed, which is a federally qualified health center in my district, and her patient, Emmanuel Gomez.

Before you do that, we're going to establish quorum before I lose more Members. Please call the roll.

[Roll Call]

We have quorum. Thank you so much. You may proceed. You have a total of 5 minutes.

Chair and Members, I'd like to thank this body for the opportunity to speak in support of AB 1032, a bill that addresses a critical gap in behavioral health care for California's affected by wildfires Wildfires have become an unfortunate reality for many communities in our state and the trauma and stress that they cause do not end when the flames are expanded extinguished I'm Dr. Adrian Martinez Hollingsworth.

I'm the Director of Research and evaluation at AltaMed, the nation's largest federally qualified health center system. I'm a scientist, a registered nurse and I've spent over two decades serving in the safety net, primarily in psychiatric settings. I also served as the Clinical Incident Commander at the Pasadena Evacuation center during the Eaton wildfires.

Many in our community have lost homes, livelihoods, their sense of safety, and now they face long term mental health challenges. This measure responds to that need by requiring health insurers to cover 12 additional behavioral health visits for wildfire impacted residents, ensuring timely, accessible care beyond what's typically covered. The need is real.

During the Eaton and Palisade wildfires in January, more than 150,000 LA residents were displaced and the psychological toll is profound. In February, a rapid needs assessment led by the LA County Department of Public Health and Ultimate gathered about 2,000 responses and nearly 80% identified mental health as top concern.

Three quarters reported worsening mental health since the fires and over 20% said they needed help finding support or counseling services. Since the fires, ultimate has logged over 18,500 behavioral health appointments, more than doubling our pre wildfire volume in Pasadena alone. Importantly, this measure will help prevent unnecessary ER visits and psychiatric holds, an understated but vital benefit.

Mental health related ER visits take on average seven hours longer to process than medical visits, bumping total wait times from three to 10 hours. In a crisis, those delays matter.

It also allows wildfire affected healthcare workers to seek care outside their insurance networks, which is critical for their confidentiality and comfort, especially for those unable to access behavioral health services at their own workplace. Expanding out of network options increases access for the very people who ran toward danger to help others. This is a compassionate and practical solution.

It expands access, reduces ER burden and supports recovery for wildfire survivors and healthcare providers alike. Thank you again to the author, Speaker Rivas, for their leadership. I respect respectfully urge you to support this as we build a more resilient and mentally Healthy California.

Madam Chair Members Good afternoon and thank you for the opportunity to speak with you all today. My name is Emmanuel Gomez. I'm a transfer student at Long Beach State and a lifelong resident of Pasadena and Altadena.

I am here to express my strong support for AB 1032, which aims to urgently expand access to behavioral health services for survivors of the recent LA wildfires. I come before you not only as a patient of AltaMed, but also as someone who has endured firsthand the devastating impact of the Eaton Wildfire.

Although I am fortunate that the home I rent survived the disaster, the trauma I've grappled with since evacuating my home at approximately approximately 3:30am on January 7th is a shared experience in my community that can be improved with additional support.

After five months of couch surfing, exhausting FEMA allocations, moving from hotels to airbnbs and emergency housing on campus, I returned to Altadena and have relied more heavily on the services provided by my behavioral health therapist to cope with the reality that haunts my beloved community.

I began my behavioral health sessions in 2019 to address the trauma of incarceration. I need consistent support to improve my mental health and unpack the fears that hinder my well being. Unpacking my mental anguish will literally help me unpack my suitcase. That remains bedside. That remains bedside.

Since having returned back home in mid May, I still cover my head sometimes with my bed sheets to block the odor of fire smoke exacerbating my asthma, as I did moments before the mandatory evacuation. But I recognize there are no lingering scents. What I'm dealing with is trauma.

Since beginning my sessions, I have learned coping skills, skills the practice of mindfulness, journaling and advocacy. Having a behavioral health therapist has kept me alive and resilient. AB 1032 is a critical step toward ensuring equitable access to behavioral health care in the LA region.

The proposed legislation directly addresses the surging demand for mental health services since the wildfires. It is my hope that this brief snapshot of my experience illustrates the grave importance for your aye vote today for AB 1032. Thank you.

Thank you so much for sharing your story and being vulnerable with us today. Appreciate it. Me too. Is in support of this Bill.

Katie Van Dynesel, with Health Access California and support. Thank you.

George Cruz, on behalf of the California Behavioral Health Association and California Access Coalition Support. Thank you.

Dylan Elliott, on behalf of the California Academy of Child and Adolescent Psychiatry and support.

Andy Mason, Clean Earth for Kids in support. Also in support North County Equity and Justice, EcoSustainability Peeps, Interfaith Coalition for Earth justice and Activists San Diego.

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

Johan Cardenas, with the California Pan-Ethnic Health Network also in support. Thank you.

Symphony Barbee, on behalf of Planned Parenthood, affiliates of California in support. Formal opposition.

Madam Chair and members, my name is Olga Shilo. I'm here on behalf of the California Association of Health Plans. We recognize the behavioral health impacts that wildfires have on affected communities. However, we must respectful express our opposition to AB 1032 as currently in print and we are reviewing the amendments we received today.

California and federal law already require that mental health and substance use disorder services be covered, parity with physical health care and medically necessary behavioral health services must be provided without arbitrary limits. Furthermore, existing law already provides mechanisms to support displaced enrollees and ensure continuity of care.

Unfortunately, this bill appears to undermine existing protections and introduce unnecessary complexity into well established standards. The bill's selective benefit structure unintentionally creates new inequities and worsens disparities.

AB 1032 limits behavioral health benefits only to individuals in counties affected by wildfires, benefits only those who already have insurance coverage and means to access care, including large group contracts, CalPERS and CalSTRS, while at the same time it exempts Medi Cal and individual enrollees.

Furthermore, the exemption of these benefits from utilization review opens the door to fraud, waste and abuse and takes away important tools for determining medical necessity, ensuring provider accountability, and safeguarding against unnecessary costs. AB 1032 risks layering on complexity, disrupting existing protections, and unintentionally creating new inequities.

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

Madam Chair and members, Steffanie Watkins on behalf of the Association of California Life and Health Insurance Companies, we do appreciate all the hard work that the author and the committee and the sponsors have put towards this.

While we certainly understand, as many of our friends and families have been impacted by the devastating wildfires in California over the last decade, we remain concerned that the bill uniquely ties access to a very specific disaster designation.

As my colleague mentioned, several years ago, AB 2941 created a process for which when there is a declaration of a disaster that all plans are required to file with the Department of Managed Healthcare as well as the California Department of Insurance, a process for which to access and allow access to enrollees and insureds to out of network services, to lift many of the restrictions and oversight and to ensure that people have access to services and when those services are not available in network, there's also a process for them to seek out of network services.

We think that that in itself really does allow the access that this bill is seeking to provide. So we do have concerns about what the overall goal of this is, especially when it really defines and designates one disaster over others. For those reasons, we are opposed.

We remain committed to working on the bill if it moves forward today. But in general, given the fact that this does allow for overall access to out of network services and with when you seek out of network services, these are providers we don't have relationships with, we don't have contracts. There's reimbursement issues.

I know the bill tries to also address those. But we think there's much more work to be done if the bill does move forward. So for those reasons, we remain opposed, but we look forward to continued conversations. Thank you.

Now's the time for me too in opposition of this bill, bring it back to my colleagues.

See, copy and paste from your previous. Yeah, I suppose I wanted to say, you know, but thank you. I just really, you know, thank you to AltaMed. Ultimately, hearing some of the data that you just shared is really eye opening. You said 80% have identified mental health concerns. That's significant.

And that's just I guess an indication to all of us up here what's coming. I don't think we're done seeing the impacts. I was visiting the centers actually during the fires where AltaMed was providing services to those coming in and I just, you know, it brought me back to that moment where you can see the immediate unraveling of families like distress. They didn't know what to do. It was really surreal to, to be part of that moment.

I just want to thank you for the services you provided and after hearing the story, the testimony from the gentleman, it's an indication that, you know, that was a moment in time and how much worse it's going to get when people, you know, not get, they don't get their services or take a long time to get back to your home.

So I just want to acknowledge your story and thank you for sharing it. But it's still the stories keep coming. I'm sure [unintelligible] can attest to the fact that we're constantly hearing these stories and it's hard to help everyone we want to. But I think this is a good step forward in everything I said before. So thank you. Madam Chair.

No, she didn't ask a question. Sorry, Senator Dr. Weber Pearson.

Thank you, Chair. I want to thank the author for bringing this bill forward. Really want to thank those who came out to speak in support and again, sharing your stories and allowing yourself to be vulnerable in front of us. I do have a couple of concerns with this bill.

You, you know, when you talk about behavioral health services, that's very broad. I think there is an assumption that it would be focused on people who have either newly diagnosed or worsened as a result of the wildfire. Anxiety, PTSD, depression, those kind of things.

But when you look at the world of behavioral health and like DSM 5 criteria, there's over 300 diagnoses. And so it's quite broad as it's written, and it doesn't necessarily mean that your diagnosis is tied to something that happened or worsened as a result of. So that's one of the things I was kind of looking for.

And the other thing, and I've spoken. I think this is the third time I've asked this question of an author today. The elimination of Medi Cal patients is very concerning to me because these kind of natural disasters don't target a specific group of people.

And those who are often on Medi Cal, as we've already, as I said many times, those are the patients that need the most. They're the ones that are having an even more difficult time rebuilding their lives because they have less resources.

And yet in this bill, and I think all of us can attest to the fact that there is trauma, you know, that some people have PTSD, anxiety, depression worsen, it oftentimes hits that group of people even worse and they really have no one to turn to.

And so I'm just wondering what is the rationale for us pushing a bill through that really eliminates the most vulnerable in our state? And as you know, your witness stated so eloquently, we want to create a more resilient and healthy California. And in order for us to do that, we can't leave people behind. So why are we leaving our medical population behind?

Thank you, Senator. Thank you, Dr. Senator. And I think that it's a great question and I just want to start by, you know, reframing it. We're not leaving them behind.

I think we all should know that when it comes to behavioral health and mental health, Medi Cal is far and away much more robust and better than our private health plans.

You know, there's an article that one can read, go on Medi Cal to get that why Californians with mental illness are dropping private insurance to get taxpayer funded treatment. So here in California, we treat our Medi Cal patients better when it comes to behavioral health care. They actually get the access to care out of network.

They have robust services that we on private plans don't get. And I think we should be striving to not leave behind the other populations that actually don't have Medi Cal.

And so this bill doesn't actually include Medi Cal because Medi Cal has taken strides because of all of us here and our predecessors to make sure that people actually get parity when it comes to mental health care and behavioral health care.

And I think that's an important point to always remind folks in California that our Medi Cal patients will be treated with the utmost care possible.

And I do think that to your question about kind of the diagnosed, whether the mental health or behavioral health issue was diagnosed or caused by the wildfire, we're not only worried about those patients, we're also worried about the patients who lost their facilities. Many of our facilities within the county affected by the wildfire were burned down.

AltaMed lost a facility. And many, like Mr. Gomez here, had existing mental health and behavioral health issues that he was receiving treatment for. He no longer could go to his provider. The in network services and options were very limited. And folks like Mr. Gomez have had to go outside of network.

And those options, whether or not his issues were caused or diagnosed because of the fire are still persistent. So we are worried about not only those who have started treatment because of the fire, but those who were in treatment for years, like Mr. Gomez, who lost their providers and their clinics.

So I think that we really want to make sure that we're encapsulating all of them, which is why it is broad and again, to the opposition. I want to live in a world where we aren't selective, where this is for everyone, whether you went through a wildfire or not.

And I look forward to next session, all of us partnering up on that bill which says that these services should go for not only wildfire victims, should go for every patient and every constituent and every individual in the State of California. So I look forward to that bill coming.

But until we get that bill, we're going to fight for wildfire victims. And we're going to do it through that.

Thank you for that. So I just want to make sure that I'm clear. In your statement, you're stating that Medi Cal patients who experience this loss do not and have not had any issues finding behavioral health providers, whether it's in network or out of network.

Not saying that at all. I'm not saying that people do not experience issues and we'd have to talk to every Medi Cal patient. I think that we have a long way to go in any health care system for parity when it comes to behavioral health and mental health services.

However, the data shows that Medi Cal patients have much more access, they have less barriers to finding the behavioral health and mental health care that they need. There's still delays, there's still barriers to access, but they are actually way less burdensome than private healthcare plans and the large health care plans that we have here.

So Medi Cal is not perfect, but this bill does not include Medi Cal because we actually think that if the private health plans did just what Medi Cal did, it would be a huge improvement. It would be a huge improvement for anyone who needs this care.

So if you recognize the fact that nothing is perfect and we're moving towards something that is better, why not include them?

Because I think that this bill, in a way, is trying to get parity with Medi Cal when it comes to behavioral health and mental health services. This bill is trying to provide as much access to for a Medi Cal patient as it currently stands for those who are in private health care plans.

And the opposition witness stated it very clearly. There is a process with these large health care plans. You have to go through a process of establishing that there isn't an option in network. And again, that word process was used quite a bit.

She then ended by saying, and we don't have relationships, we don't have a lot of the data we need with these out of network physicians. This process leads to delays.

Those delays do not actually exist in Medi Cal because they have a wider and a broader coalition of healthcare providers that are providing this mental health care on a daily basis for Medi Cal patients.

Yeah, I think that's an interesting standpoint because in every hearing that I've been in, and even in the field, Medi Cal patients are able to find patients or providers for inpatient, but they have very difficult time finding an outpatient.

Oftentimes behavioral healthcare providers do not take Medi Cal and they also, a lot of them don't take commercial insurance as well. And so people end up paying out of pocket.

And so I think the thought process that somebody who's on Medi Cal would have a greater ability to find an outpatient provider is an interesting theory, one of which I have not seen in practice, nor have I heard of any in any of the hearings that we've had, especially for outpatient. Now, inpatient hospitalization, completely different situation.

But what you're referring to here, I think in this bill has to do with outpatient visits, which I have. I just haven't heard that before. But thank you.

Yeah, I appreciate it. And look, for the record I will submit the article which I've referenced with. I mean, the experts actually have written articles on this, and I'll submit it to the committee for the record. But I appreciate the feedback, so thank you.

Senator Grove.

Thank you, Madam Chair. My comments aligned with Dr. Weber Pearson, who is obviously an expert in this field.

And as you were speaking and saying that Medi Cal patients get a better access and you were trying to bring parity with plans, I pulled an article where the State Auditor's Office performed a survey for providers that accept Medi Cal in the state and found that hundreds could not meet the established standard wait times for the appointment.

The audit also found out the Department of Healthcare Services and the Department of Managed Care did not keep, were not keeping comprehensive data on the times. The audit found that 43% of the providers surveyed could not provide an appointment with an individual needing urgent psychiatric care within the state standard of four days.

And some of the providers could only provide this in exceeding three months. It goes on to say that there was an uptick in cases. And it goes on to say that some appointments were scheduled 100 days later on Medi Cal.

When I looked up Altadena's number, it says that 6,800 Medi Cal enrollees are in Altadena, according to the California Department of Public Health. So I am like, why would we leave, along with my colleagues, 6,800 people in Altadena just for a specific city? I referenced it because of the witness that you brought.

If you're going to make them wait 100 days, why would we allow people? I mean, I have Blue Cross Blue Shield. If I wanted to go get in a private, you know, I get the treatment that I needed, but our Medi Cal patients aren't, and they're excluded from this bill. And I appreciate your comments to Dr. Weber, but I don't think you answered her questions with all due respect.

No. And I appreciate whatever data that you are citing. I would love to read. And it's literally the opposite of all the data of the experts that we have worked with on this bill. And so I'm happy to read it.

This is from the State Auditor audited CDPH.

No, I would love to read it. And so we can. And to the extent that there is a movement or an idea that we can expand this bill to, again, capture populations that aren't captured, I am all for that.

And I think that any sponsor of this bill wants to see more people, not less people, getting the treatment they need. We are, this is a bill that is reacting to the statistics and the realities on the ground in the wildfire zones.

And the statistics that we see are that those in big commercial private healthcare plans are experiencing more delays and more barriers to access than those who are on Medi Cal. And that's what the data showed us. I have no idea when that audit was taken.

There's also, I think, some apples and oranges in there, like severe psychotic disorders within. Again, I don't know if we're talking about necessarily the same thing, so I want to be careful here. But I am obviously happy to entertain information about expanding the scope of our mental health care and our behavioral health care. I don't think any of us would not want to do that with the right bill. This bill is obviously very targeted at a certain population of fire victims.

I totally get where you're going with it, and I couldn't even imagine having a fire come over a hill and start burning up your neighborhood and be a part of that and have to function normally and not have any help. I get where you're going with the mental health piece. I really do.

And I understand why you're doing the bill. I am just very deeply concerned that it does not include Medi Cal patients, specifically that there's 6,800 in Altadena. And I have sat on this committee for six years, three chairs, and oftentimes Medi Cal patients are excluded, and they're excluded because the author or the individuals presenting the bill.

And I'm not saying that to, you know, that the Governor will veto it because it is a cost and we are in a budget crisis. I know that even last year, the Chair and I fought for a benefit that was, you know, and she was forced to take an amendment to exclude Medi Cal patients. So I get it,

I get that, you know, this is the State of California. We have a budget crisis, and we have to address those issues, but we also have to. You just talked about equity. I mean, I'd love to see the data that shows that and who produced that data.

I mean, this is from the State Auditor who did an audit of the California Department of Public Health and information on Medi Cal recipients and how they wait a longer period of time outside the normals that are required by us in the legislature to have them providers, you know, treat them. So, anyways, I just. I wanted to follow up on the questions that my colleague offered. Thank you.

Thank you. Before I move on to the next question, I'm going to throw a lifeline here. I'd like to hear from the person that actually works with Medi Cal patients.

Thank you.

Can you hear me? Perfect. Thank you. Really thoughtful, important questions, and I'm wondering if I can address both Senator Dr. Weber Pierson and also Senator Grove. LPS designation for 5150 holds that we get out of the Emergency Department are not always connected to the diagnosis.

So whether or not your diagnosis is a depression or anxiety disorder or a psychotic disorder or something that sort of differs from one of those traditional axis 1, an exacerbation is an exacerbation that requires inpatient hospitalization from an emergency Department. So that connection is sometimes there and sometimes not.

So I think if we were to limit the diagnoses to which this would apply, we might leave out some folks who have things like ADHD that can be compounded. We saw a lot of pediatric emergencies during the wildfire response, so that's just a thought on that.

And then with this generosity of time, you're offering some conceptual framing around the research that I've done for the last six years. I work so specifically to explore the experience of low wage health care workers that represent the communities they serve.

And one of the things that we've seen repeatedly is that there is a thing known as the Medi Cal cliff and what that is, and it's well represented in NIH literature, national institutes on minority health disparities. If you have Medi Cal, you have access to services based on established regulations.

If you qualify for private insurance, maybe less so. Because the challenge is some folks who are in low wage positions, like many of the wildfires that we respond, who responded to this emergency, would have qualified for services.