Senate Standing Committee on Health

The Civic Committee on Health will come to order. Good afternoon and welcome everyone. We have 11 bills on the agenda with four of them on our proposed consent calendar. File item three, SB 918. Siarco with amends.

File item four, sb 971. Choi with amends. File item five, sb 1047 Nielo and Allen with amends. And file item nine, SB 977 Weber Pearson with amends. Seeing that there is no quorum at this time, we will begin as a subcommittee until a quorum is established.

We will now start with file item number one, SB 895 by Senator Weiner. You may come and approach and begin when you are ready.

Thank you very much, madam chair. I'm here today to present senate bill eight ninety five, which will create the California Foundation for Science and Health Research to funded in part by a proposed bond for the November 2026 ballot to ensure that California remains at the forefront of scientific research and to help establish some of our own independence given the Trump administration's the wrecking ball that this administration is taking to the federal science agencies and to university scientific research. This will be an opportunity for us to double down on California's global leadership on science. I wanna thank the committee for working with us on the bill, and I accept the committee amendments, and I appreciate, that collaboration. Health and science, are a health and scientific research are an integral part of this state.

Makes up a good part of our economy. It helps us find cures for health conditions, improves our environment, and improves the lives of millions of Californians. Research in California has directly saved millions of lives, has made foundational contributions to technological innovation, including the Internet, CRISPR, AI, has helped us discover chemicals, the chemicals that are responsible for holes in the ozone and sequence the human genome. We should all be very proud of the work that's happened here around science in California.

Scientific research constitutes almost 6% of California's GDP, and our state, of course, contributes roughly a third of all US investment in research and development.

The next highest state after our one third contribution is 6.8%. So we are so far out ahead. R and D contributes over $200,000,000,000 annually to California's economy, and the sector directly employs nearly 700,000 people. In 2024, California researchers patented more new technologies than every other state combined. Research supports and bolsters local economies throughout our state.

It creates strong middle class often union jobs that benefit entire regions. For all these reasons, top research talent comes to our state from around the world to work at our leading institutions and to make a home for themselves. From biotechnology to medicine, agriculture, climate, artificial intelligence and beyond, California is the global leader in so many ways. Yet despite the clear benefit and importance of scientific research, the federal government under this administration is attempting to stifle what is in essence the golden goose.

For reasons that I will never actually understand because science has been one of the pillars of American prosperity for the last eighty years. For reasons I don't understand, they are attempting and have slashed billions of dollars in funding, both from specific schools, including schools in California, and from the amazing federal agencies that have been at the heart of scientific research. While the courts have rejected various of these cuts and there has been some bipartisan pushback in Congress, because science helps, both Democrats and Republicans. It doesn't discriminate.

Despite that, we are now in a state of chaos at the federal government, and we are realizing that we should not be as reliant on the federal government as we have been, and we need to engage in self help.

In 2025, the NIH and the National Science Foundation, funded respectively 2225% fewer grants compared to, the the, previous 10. Research requires a stable and predictable funding environment to manage multiyear projects. If researchers are not confident that they can do their work, they will leave. We are already seeing the beginnings of a brain drain of some of our best scientific talent to Canada, to China, and to Europe who are very smartly actively recruiting our most talented scientists. We need to retain them for our future.

SBA ninety five will take the critical step of ensuring our ability to lead by placing this bond on November 2026 ballot. That in combination with other public and private funding will shore up our leadership role. The bill establishes the California Foundation for Science and Health Research within GovOps, that will oversee the monies that are generated that will go into a fund.

The measure also will include provisions to recoup some of the public investment we're making from these discoveries to benefit the people of California, both our budget as well as the cost of drugs that Californians pay. So I respectfully ask for your aye vote.

And with me today to testify is doctor Kim Elaine Barrett, PhD vice president for research and distinguished professor of physiology and membrane biology at UC Davis. And doctor Ben Cox, PhD assistant project scientist in the department of molecular and cell biology, also at u UC Davis and an elected officer of UAW 4811. I wanna thank UAW, the UC, and UAPD for sponsoring this bill. We also have us for any technical questions that come up. Jason Murphy from the University of California.

Thank you, Senator. You will have a total of five minutes for both of your presentations. You may begin.

Good afternoon, Chair Webber Pearson and members of the Senate Health Committee. Thank you for giving me a few moments to share why this proposal is so important to our health, our economy, and the state of California. My name is Kim Barrett.

I'm vice dean for research at the UC Davis School of Medicine. I've been with the University of California for more than forty years. In all my time at UC, I have never seen a more precarious situation for scientific research and greater challenges to our economy, our workforce development, and most importantly, our public health. The California Foundation for Science and Health Research is an opportunity for California to control its own destiny at a moment when UC is facing one of the greatest threats in its history.

The university currently receives $5,700,000,000 in federal support for research each year.

Sustained loss of even a portion of this funding would devastate the university and cause enormous harm to all Californians. Research at UC generates as much as $5,255,200,000,000.0 dollars in economic activity every year. Medical breakthroughs alone generate approximately $13,000,000,000 in economic activity across California and have produced more than 34 three thirty three hundred and forty thousand jobs in biosciences. As federal funding uncertainty continues, we are threatened with a talent exodus and our ability to train the next generation of innovators, researchers, and physician scientists is reduced.

This leads to a weaker talent pipeline to tackle the next pandemic, to create the next cell or gene therapy, or to devise safer and less invasive surgeries.

Loss of funding hurts communities and patients the most. A loss of funding threatens clinical trials that give hope to those suffering from chronic illnesses and slows the development of life altering therapies for depression or interventions that can delay the onset of dementia. We generate cutting edge research and translate it to real world care that can alter the course of someone's life. California has been a leader in scientific inquiry and should invest in its ability to protect jobs, health care, and the economic future of our state.

And for all of the reasons noted above, the University of California is in strong support of SB eight ninety five.

Thank you.

Thanks for the opportunity to speak to this panel today. My name is Doctor Ben Cox. I'm an assistant project scientist in the lab of Doctor Selena Giuliano, Department of Molecular and Cell Biology at the University of California Davis and an elected officer of UAW 4811 the union of academic researchers and and academic workers at the University of California. My lab studies the biological mechanisms behind tissue regeneration. The understanding these pathways can help us lead to new treatment for traumatic brain injuries and neurodegenerative diseases.

Over the last year many of California scientific institutions have seen grants canceled or frozen causing layoffs and research stoppages. Two NIH funded training programs, maximizing access to research careers or MARC and the post baccalaureate research education program or prep were canceled in 2025. These programs aim to increase participation in the sciences especially among historically underrepresented groups.

I and other members of my lab have, mentored many first generation California college students in these programs, all of whom have gone on to prestigious graduate schools or jobs at California biotech firms. While some of the Trump administration's proposed cuts have been rolled back or delayed by courts, many of these injunctions are temporary and the administration is still exerting enormous influence over science.

For example, by mandating that funding calls be approved by Trump appointees, this has caused months long delays for research as crucial and bi partisan as type one diabetes and an overall 90% decrease in funding calls this year, which has disproportionately affected early career researchers like myself. Further, the switch to multi year funding at institutes like the National Cancer Institute has reduced chances of obtaining funding by more than half. The administration has deprioritized scientific peer review and instead now favors proposals that align with the administration's priorities.

Beyond just biomedical research, the Trump administration is also targeting renewable energy as the global economy reckons with another oil crisis. I believe SBA 95 can address the political interference, sabotaging research, and deliver on the promise of California science, which is that we can simultaneously attract the greatest minds from across the world and also uplift our own first generation scientists and not only protect but advance California's status as a world leader in science.

Thank you for your time.

Thank you. That was within five minutes. Very good. Alright. So we will now hear from any other witnesses in support of this bill.

Please come to the mic here. Please state your name, your organization, and your position only.

Good afternoon, madam chair. George Osborne for the Union of American Physicians and Dentists. We're a cosponsor of SB 895 with strong support. Thank you.

Thank you.

Good afternoon. My name is Jack Finn. I'm a UCLA PhD student representing UCLA Graduate Students Association and UCLA Center for LGBTQ plus Advocacy Research and Health were in support of the bill. Thank you.

Good afternoon, Senator. Ami Alden on behalf of UC San Francisco in strong support.

Good afternoon. Renee Bayardo representing Blood Cancer United in strong support.

Good afternoon. Andrew Kehoe from UC Davis Health in strong support.

Good afternoon. Erica Bustamante with Stanford University in support.

Good afternoon. Michael Miller, director of the West Coast region of the UAW. Strong support and a proud cosponsor.

Hi. I am Koen Van Rompe, head of the unit of infectious diseases at California National Primary Research Center at UC Davis. I strongly support this bill.

Dennis Hartigan O'Connor. I'm from UC Davis Health, and I'm very much in support of the bill.

Kathy Yellick from UC Berkeley, vice chancellor for research and a professor of electrical engineering and computer sciences. I strongly support this bill.

Hi. Miguel Martinez on behalf of chancellor UC Berkeley chancellor Rich Lyons. I'm strongly in support of this bill and urge just your support as well. Thank you.

Good afternoon. Alex Graves, the Association of Independent California Colleges and Universities in support. Also just wanted to register the support of California Institute of Technology, one of our members. Thank you.

Doctor Annette Hilton from UC Davis Center for Community and Citizen Science in strong support of this bill.

Good afternoon. Ajay Mendiola on behalf of the, Lieutenant Governor, Eleni Kounalakis, in support.

Good afternoon. Ernest Walker with, UAW 4811 in strong support.

My name is Nika Vincent. I'm a clinical research coordinator and Opti member at UC Davis Health, and I strongly support this bill.

Good afternoon. Jared Gerusso Cloek with the Michael J. Fox Foundation for Parkinson's Research and Strong Support.

Chair members, Nate Solove on behalf of several organizations from the Parkinson's community who couldn't be here today. Appreciate the author and all his hard work. Parkinson's Association of San Diego, Parkinson's Community Los Angeles, Parkinson's Association of Northern California, Greater Fresno Parkinson's Support Group, and the Parkinson's Network of Mount Diablo. Thank you.

Good afternoon, madam chair and members. Gianna Samelli with AFSCME and support.

Good afternoon, chair and members. Kate Ship on behalf of Northeastern University and the California Academy of Nutrition Dietetics in strong support. Thank you.

Good afternoon. My name is Govindra Pandar. I'm a UCSF medical student and I'm in strong support of this bill. Good afternoon. Jia Chen on behalf of the California Consortium of Addiction Programs and Professionals in strong support. Thank you.

Good afternoon. I'm Ivy Foster, junior specialist at UC Davis and in strong support.

Good afternoon, members. Janet Lopez representing UCLA in strong support. Thank you.

Good afternoon. Doctor Catherine Kietzman. I'm the director of the health equity program at the UCLA Center for Health Policy Research and associate researcher at the UCLA Fielding School of Public Health in strong support. Thank you.

Good afternoon. Connor Roderick, PhD candidate at UC Berkeley chemistry and rank and file member of UAW 4811 in strong support.

Good afternoon. Martha Zaragoza Diaz representing the University of California, Chicana x Latinx Alumni Association and we are in strong support.

Hello. I'm Tom Chang. I'm a PhD candidate at UC Berkeley and a UAW member, and I'm in strong support as well.

Good afternoon. Kim L. Spock, professor of management, Graduate School of Management, UC Davis in strong support.

Gabe Klassen. I'm a UC Berkeley graduate student and a member of UAW Local 4811 and I'm in strong support.

Good afternoon. Doctor. Halid Mahmood, UAW 4011 at UC Davis, strong support.

Hello. I'm Richard Skeletar. I'm in the physics department at UC Davis, and I'm in strong support. Donald Palmer, professor in the Graduate School of Management at UC Davis and I support the bill.

Good afternoon committee. Patrick Dexter on behalf of United Auto Workers Region six in strong support.

Good afternoon. John Rundle, professor of physics and astronomy at UC Davis, researching earthquake forecasting and prediction using artificial intelligence. I am in strong support.

I'm Marie Rundle. I'm a retired k twelve science and health teacher from Davis, and I'm in strong support.

Kevin Guzman with the California Medical Association in support.

Missette Short on behalf of Loma Linda University Health in support.

Tom Temprano on behalf of Equality California in strong support.

Good afternoon. Eric Barreves with the California Faculty Association in support.

Good afternoon. Chris Morales with the California State University Office of the Chancellor in support.

Good afternoon. Marsha Nakatani on behalf of UAW local 48 of eleven representing nearly 50,000 members at all 10 campuses in Lawrence Berkeley National Lab. Proud cosponsor on the legislation.

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

I'm Sharon Lawler, professor emeritus, UC Davis entomology and hematology and strong support.

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

Madam chair and senators, Adam Kagan on behalf of Natera in support.

Doctor Robin Adcock. I'm the director of pediatric integrative medicine at the University of California, San Francisco. I'm also a clinical researcher and volunteer faculty in the School of Medicine at UCSF. Strongly support.

Madam chair and members, Jason Murphy on behalf of the UCE office of the president in strong support, also cosponsor. Thank you.

My name is Melanie Lindenal. I'm with the ALS Association in strong support. Thank you, Senator Wiener.

Lawrence Gill representing ALS Association Sacramento in strong support of this bill.

Heather Dawson with ALS ALS Association in strongly support of this bill.

My name is Jack Davis. I have ALS and I support this bill.

My name is Christopher Holes. I'm a representative of the families of I have lost ALS. My father passed away from ALS in twenty in 2011 and I'm in full support of this bill.

Nancy Wakefield with the ALS Association in support of this bill.

Nouriel Richards with the ALS Association and in strong support of this bill.

Mary Hooper, the daughter of one someone who has ALS in support of this bill.

Erin Johnson, former caregiver and spouse of someone who had ALS and representing the ALS Association in strong support of this bill.

My name is Mary Hooper and I have ALS and I support this bill.

I'm Jason Vancourt. I'm a research scientist with CAPS UAW and also a friend of Mary Hooper. I support this bill.

John Campos, brother of Christopher Campos and part of the ALS Foundation and I strongly support this bill.

Hi. Jasmine Diego with UCLA Health in support of the bill.

We will now move and see if we have any lead witnesses in opposition. Seeing none, if anyone would like to register opposition, you may come down to the mic. State your name, your organization, and your position only. Seeing none, I will now move it back to the committee to see if the committee has any questions. Senator Durazo.

Just a comment. I wanna thank the author and I'm proud to be a co author of this bill. We know scientific research has is one of the engines that have really driven California's, success. I especially, appreciate that this bond measure will create high quality union jobs and strengthen our public research, institutes. And a particular provision that I wanna highlight, because I've been working on procurement for for years, is that the bond prioritizes purchasing goods and services from California suppliers and with a good faith effort to have more than 50% of the purchases come from within state businesses. So with that, I'm proud to support the bill.

Thank you, madam chair. I wanna also thank the author and I'm proud to be a co author as well. Thank you to everybody who showed up here today in support of this really important research. We have some of the best educational institutions in the world and the ability to do research, and the potential for life changing, cures or or, you know, assistance is really important. And now, more than ever, we need to make the investments in our our institution. So thank you for taking the lead on it.

Senator Caballero.

Well, since no other comments, I want to echo the comments of the other committee members who have spoken and really thank you for bringing this bill forward again. I am a proud co author on this one as I was the previous version, of the bill.

But I really wanna thank the author and the staff, the health committee staff on working through some of the amendments to really kind of clean up and fine tune some of the things in this bill, especially when you're dealing with the the council that will be created. And so I wanna thank you, the health committee staff and your staff for working so hard on this bill and the amendments. And with that, you are welcome to close.

Alright. Thank you, colleagues. I wanna thank everyone who came out today and particularly the folks with lived experience. You know, I and I've I've actually talked about this in this committee before, so forgive me for repeating myself. But since Iwas 19 years old, I've had Crohn's disease, an autoimmune disease.

And I've always been able to manage it. But it was about a little over ten years ago when biologics came around. And that really was transformational for my life. And so you have people who are living with chronic conditions, some of which have very poor treatment, some of which have good treatment, and all of which we wanna cure.

And the idea that we would just sit by as research funding that can cure diseases, make people's lives better, prevent diseases, help us deal with the impacts of climate change, and which is impact upending so many people's lives and so on and so forth.

The fact that the possibility that we would sit back and just let that fall apart is just not tenable. And so for everyone who whose life can be better for for frankly the entire world, which can which has been improved and will be improved by by scientific research here in California. We do this on behalf of all of them, and this is a, I think, a unique opportunity for us.

When I introduced the first version of the bill last year, it was very bare bones, and I didn't know what would happen. And the coalition just sort of materialized because there's so many people who get it and who care deeply about the future of science.

And so I respectfully ask for your eye vote.

Thank you, Senator. And once we have a quorum, we'll be able to move on that bill. Would like to invite the other members of the health committee who are not here. You can come down so we can establish a quorum. We will now move to file item number two, sb 944.

Senator Wiener, you're ready to go. Great.

Maybe I'll just wait for They're pretty efficient. They're pretty efficient. Oh, I know.

Maybe I'll just wait for They're pretty efficient. They're pretty efficient. Oh, I know.

Thank you very much, madam chair and colleagues. I'm here to present senate bill nine forty four, which will help stabilize and protect access to acupuncture as a medical benefit for all Californians.

Acupuncture is a critical form of health care with proven benefits for pain management, mental health conditions, addiction treatment, nausea, digestive issues, and complications from chemotherapy.

It can be especially helpful for populations where traditional treatments may carry higher risks or side effects, including adolescents and and and pregnant women.

For millions of medical beneficiaries and people living with chronic pain and undergoing chemotherapy and so forth, acupuncture can be a low risk, cost effective option that improves their quality of life and, reduces reliance on more invasive forms of care.

In the midst of our opioid crisis, in particular, acupuncture is exactly the kind of non addictive intervention for chronic pain we should be promoting. And in our affordability crisis, this is a far less expensive kind of treatment.

Acupuncture is prominently used in our Chinese American community. I'm proud that in San Francisco, we have just many amazing providers. But this is really true throughout the state and for many communities.

Ensuring that acupuncture is covered in medical, provides a critical lifeline for people who, rely on it. And so this bill will enshrine in law that acupuncture is a covered benefit and that it is not dependent on whether we have matching funds from the Federal Government.

So I respectfully ask for your Aye vote. I wanna welcome folks who have come here today from San Francisco and elsewhere to express their support for acupuncture as a medical benefit. And with me to testify is Doctor Zhang,

the President of the California Acupuncture Coalition, which is sponsor of SB 944 and Doctor Lily Chao, the Director of Integrative Medicine at Northeast Medical Services, NEMS.

Thank you. Before you begin, we are going to establish a quorum. Assistant, please call the roll.

[Roll Call]

Quorum has been established. You may begin. You both have a combined total of five minutes. Thank you.

Thank you for the opportunity. Can you hear me? Okay. Yeah. Just better now? Okay. Thank you for the opportunity to being a witness today.

Good afternoon, Chair and Members. My name is Doctor Lily Chao. I serve as the Director of Integrate Medicine at Northeast Medical Services, one of the, larger, FQHC in the Bay Areas. And in my clinical experience,

acupuncture play a crucial role in helping patients manage chronic pain, recover from illness, and improve their overall quality of life, particular for those with complex and also long term conditions and also including cancer patients.

And many medical patients, acupuncture, it is not alternative.

It's a essential part of their care. Without it, patients often face unmanaged pain, which can lead to increasing reliance on emergency rooms and more expensive interventions or opioid use.

And for a system perspective, acupuncture, it is a low cost and high value service, and it helps reducing unnecessary health care's utilizations while improving patient outcomes. And this is exactly the type of investment we should be making as we move towards more

integrative and a whole person care in California. So making this benefit permanent, ensures stabilities for both patients and providers and reinforce California's commitment to equitable access to effective and non pharmacological treatments.

The demand is already there, and the infrastructure is already there. What's missing is the policy stabilities. So SB 944 is not about expanding anything new. It is about securing something that is already working and allow it for function as a skill.

At a time when California was looking for a cost effective and non pharmacologic solutions to chronic pain and dispute aligned directly with that goal. So I respectfully asking for your support on SB 944. Thank you. Okay.

Good afternoon, Chairs and the Members. My name is, Danny Zhang. I'm President of, California Acupuncture Coalition, the sponsor of Senate Bill 944. I'd like to thank Senator Wiener for offering this important bill.

Every day in my clinic, I treat medical patients who live with chronic pain, stress, and a serious health condition. In California, licensed acupuncturist are recognized as the primary health care provider with our scope of practice. We know our patients well.

We understand their medical history. Many of our patients rely on us to help manage a serious long term and chronic health conditions. Many of these patients cannot tolerate strong medications or invasive procedures.

Acupuncture gives them another option that is safe, gentle, and effective. Patients report improved sleep, a great mobility, reduced pain, and a higher spirit after acupuncture treatment. For some, acupuncture help provide reliance on opioids and other potent

medication and drugs. Medical patients should have equal access to acupuncture as other Californias. Manage acupuncture differently within medical unnecessary barriers, and the leaves patients and the providers uncertain about their options.

In certain fare and the constant coverage, we improve care, reduce re reliance on more cost or risky treatment, and adventure health equity across the state. SB 944 ensure acupuncture is a established medical benefit, pair with other covered treatment.

This bill will help protect access to care for millions of Californians who's on medical. Thank you for your time and for supporting patient access to the acupuncture.

Thank you. We will now move to public testimony. For those of you who wish to speak in support of this bill, please come to the mic. State your name, your organization, and your position. You may begin.

Thank you. Good afternoon. Dylan Elliot on behalf of the San Francisco Board of Supervisors in support. Thank you.

Ryan McCarthy on behalf of Alhambra Medical University Alumni Association, United Acupuncture Association, in support. Thank you.

Lin Yang. I'm licensed acupuncturist and I'm former president of CAC in strong support of SB 944. Thank you so much.

Sharon Zhang, acupuncturist in strong support.

Hello. My name is Steven Chan, a patient, a retired engineer, and also a acupuncture student. I'm in strong support.

Hello. Hong Li Chen from The Academy of Chinese Culture and Health Sciences in Downtown Oakland. I'm a student, patient, and educator, and strongly support the bill. Thank you.

I'm Krista Chan from the Academy of Chinese Culture and Health Sciences, and I'm a student and a patient in strong support of this bill. Thank you.

Hi. My name is Hong Luo, licensed acupuncturist, in California. And I graduated from, Oakland Chinese Medicine, Chinese acupuncture school for over twenty years. I serve a lot of patients. So I really strong this, bill. Thank you.

Good afternoon. My name is Jinja Vincent. I'm practicing Sacramento Old Town, licensed acupuncturist. I have strong support of you.

Good afternoon. My name is King Hui Zhong. I'm a licensed acupuncturist in California. I am in strong support of 944. Thank you.

Hi. Robert Hoffman, President of Yoastan University of Traditional Chinese Medicine in Los Angeles, California. We're in strong support of this bill. Thank you.

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

Good afternoon. My name is Chulong Shui. I'm a acupuncturist in California, and I serve in thousands Medicare patients per year. I'm very strong support of this bill. Thank you.

Good afternoon. I'm doctor Cho. I'm Korean Association Ecapoture Group president. I'm a strong support sv 944. Thank you.

Good afternoon. I'm Sian Huang, and I licensed acupuncture and practice acupuncture almost forty years. Acupuncture is a safe, effective, side effect free, and also cause effective therapy.

Thank you.

And very strong support of you.

Thank you. Remember your name, your organization, and your position only. Thank you.

Good afternoon. My name is Ying Li, the president of American Association of Chinese Medicine and Acupuncture. And I'm in strong support of SB 944. Thank you.

I'm Jun Hu, local acupuncturist. I'm practice acupuncture almost 39 years from American Association of Chinese Medicine Acupuncture member. So I help a lot. Chronic pain patient has strong support. Thank you.

Hi. Sheng Zhang. I'm a licensed acupuncturist, from University of East West Medicine and support the bill.

Hello. I'm Korean. I'm an acupuncturist in California. I'm a member of its Korean society. I'm strong supporters. Thank you.

Hi. My name is Carissa Chan. I'm a licensed acupuncturist in Roseville, California. I'm support SB4944. Thank you.

Hello. My name's Casey Ching. I'm the licensed acupuncturist in California. I'm Support SB944.

Good afternoon. My name is Kevin Kim. I'm a licensed occupationalist in California. I'm in support of SB499.

Hi. My name is Yan Xin Hong, and I'm a licensed acupuncturist in Sunnyvale. I support, SB 944.

Good afternoon. This is Ivy Chen. I'm president of the company on the overseas Silicon Valley. I'm director of, administration. I'm strong in support SB 944. Thank you.

Good afternoon. My name is Wan Lin Liu. I have I have been a acupuncture patient for five years, and I strong support SB 944. Thank you.

Good afternoon. My name is Tian Yang. I'm an acupuncture patient for ten years with low back pain and neck pain. I strongly support this bill. Thank you.

Hi. My name is Mei Zhang. I'm an acupuncture patient. I strong support this bill.

My name is Zong Wa Fu, acupuncturist for more than thirty years. I strongly support SB944.

My name is Seunghee Lee Sophia, doctor of acupuncture, herbal medicine specialist. Association is Korean Medicine Association. I support SB944.

Hi. Hi. My name is Seok Jang. I'm a licensed acupuncturist in California. I support this in the SB 944.

Good afternoon, Madam Chair and Senators. Sydney Pawn with Northeast Medical Services in strong support.

Good afternoon. Di Wu of Northeast Medical Services in Sean's lead support of this building.

Good afternoon. I'm Robin Adcock. I'm a doctor of acupuncture in Chinese medicine, licensed acupuncturist. For this bill, I'm representing the California State Oriental Medical Association, a thirty year association of students and Clinicians, and we strongly support SB 944. Thank you.

Good afternoon. My name is Joey Quan. I'm an integrative medicine assistant at Northeast Medical Services, and I am in strong support.

Good afternoon. My name is Xiao Xing. I'm working in in greatest medicine assistant in medical Northeast medical service. I strongly support for dispute. Thank you.

Good afternoon, senators. My name is Otto Lee, current board supervisor in Santa Clara County. Speaking on my own personal capacity today, I'm strongly supporting this bill. Thank you.

Good afternoon. My name, Tian Huang. Sorry. I speak Chinese.

I support SB 944. I support SB 944 also. I support SB 944. Thank you. Okay. I support SB 944. I support SB 944.

Okay. Seeing, no others that wish to speak in support, we will now give time for any lead witnesses in opposition. Is there anyone who would like to come forward and speak as a lead witness in opposition?

Seeing none, if there is anyone in the audience that would like to register, their opposition, please come to the mic, state your name, your organization, and your position.

Seeing none, I will now turn it back to the committee to see if anyone on the committee has any questions or comments. Senator Durazo?

Thank you, Madam Chair. I just wanna thank everyone who was here, today. Thank the author for, bringing this up. I represent several API communities, in the Los Angeles area. And I know how important it is not only to the API community, but everyone,

who relies on care acupuncture care for their for their health and well-being. So thank you. I wanna thank also the acupuncture providers for doing what they do. They it's culturally rooted care. That's very important for people to have the trust to go to those providers.

So I'm many of us are strong advocates for Medi Cal to make sure that our immigrant communities are covered by Medi Cal, but they also have to have access and you're part of giving them access to to to true, medical coverage. So thank you very much.

Senator Perez.

Yeah. Thank you. I just wanted to speak to also sub express my support for the bill, SB 944. And appreciate.

I know that, we have some folks here from Alhambra today, who offered their support of this bill. Somebody that grew up in Alhambra and Monterey Park, you know, two communities in the SGV that have some of the largest populations of API communities in the state.

I know how significant this is. It's really important that we honor and respect, Eastern medicine and the role that it plays in the lives of so many. It's certainly something that I have incorporated and my family has incorporated growing up in the SGV.

And it's had such a tremendous benefit for my family. So, making sure that we're continuing to provide medical coverage for acupuncture is really necessary. I know so many of my constituents and their parents who I grew up with really rely on it as a form of care.

So thank you and we'll be excited to vote aye.

Senator Caballero.

I also wanna thank the author. I've I'm a big believer in acupuncture. It's kept me away from any serious health issues. I'm absolutely convinced. My acupuncturist is in Salinas and she was trained in China and she's a doctor.

And one of these days we'll get it right and that you can become a doctorate of acupuncture here as well. And I've I've gone to her for over 25 years. So I appreciate the work you do keeping everyone healthy and thank you to everybody who came to testify as well.

And Senator Durazo has moved the bill. Wanna thank, the Senator and, thank everyone who came out, to speak and support and also our lead witnesses. I think that, you know, we are all aware of the fact that, under Medicaid or Medi Cal, we don't determine what is a

mandatory coverage or an optional coverage. And so this is an optional coverage per federal guidelines. However, I do want to commend you for recognizing that in our code, there was an interesting qualifier that was only placed on acupuncture and not the some of the other

optional benefits. And so that is what we will be correcting with this bill today. And with that, would you like to close?

Alright. Great. Thank you very much. And again, I wanna thank everyone who took the time to come out today. I actually I had not until recently ever had a acupuncture and I had a a strained forearm and it basically fixed it.

And I was so everything that I had been told over time turned out to be true. This really helped a lot of people maintain their health, but also just improve their quality of life and deal with chronic pain in ways that are not that is highly beneficial without the risks of some of the medication.

And so we wanna make sure people can continue to to have access, and it makes no sense to single acupuncture out from other forms of health care and treat it in a more negative way,

which is what the law does now. And so this is equalizing it, protecting access, and I respectfully ask for your Aye vote.

Thank you. The motion has been made by Senator Durazo. The motion is do passed and we refer to the committee on appropriations. Please call roll. Assistant, please call roll.

[Roll Call]

That is Aye 6, Noes 0. We will leave that bill on call. And since we have a quorum, we will move back to file item number one. Do I have a motion on SB 895? Moved by Senator Durazo.

The motion is due passed as amended and re refer to the committee on natural resources and water. Assistant, please call roll.

[Roll Call]

Ayes 6, Noes 0. That bill is on call as well. Thank you.

Thank you all for coming out.

Thank you very much.

Thank you.

Before we move on to our next bill, we will consider the bills on the consent calendar. These are file item three, SB 918 with amends. Item four, SB 971 with amends. Item five, SB 1047 with amends. And item nine, SB 977 with amends. Senator Menjivar has made a motion. Assistant, please call the roll.

[Roll Call]

6- 0 on call. That is 6-0 and we are going to place that as well on call. I would like to strongly recommend that any authors who will be presenting today to come down to health committee in Room 1200?

We will now be moving on to file item 10 SB 987. Madam Chair, whenever you're ready.

Thank you. Thank you. Good afternoon, colleagues. And thank you for the opportunity to present SB 987 the California Health Access Fund. HR 1, the federal reconciliation bill signed last year, makes significant changes to Medicaid eligibility, including new work and

community engagement requirements and more frequent eligibility renewals for certain populations. These changes increase the risk that eligible individuals will lose coverage due to administrative bird barriers rather than changes in income or need.

The Department of Health Care Services estimates up to 2,000,000 Californians could lose their Medi Cal coverage as a result of these federal changes. While coverage loss reduce state Medi Cal expenditures on paper, they do not eliminate health care needs.

Individuals who lose coverage often delay care, rely on emergency services, or receive uncompensated care from safety net providers and safety net hospitals, shifting cost rather than reducing them. Absent state actions, savings generated by reduced enrollment may

not be directed towards maintaining access to care, supporting providers and those safety net hospitals, or addressing gaps created by fund federal disinvestment, but instead, may be just swept back into the general fund.

SB 987 would require the state to establish the California Health Access Fund separate from the Medi Cal program. This fund would capture any savings resulted from the reduced Medi Cal enrollment caused by HR 1.

The Department of Health Care Services would then be tasked with administering the fund to ensure that Californians who lose medical coverage can still receive the health care access and services, and health care providers and their facilities will be reimbursed for providing those services.

This bill is intended to start the conversation as to how we will continue to provide health care and pay providers and safety net hospitals when a large number of Californians can no longer rely on Medi Cal.

At a minimum, we need to repurpose any money that the state saves when people lose Medi Cal and use that money for the healthcare system who will still be serving these individuals. I respectfully ask for your Aye vote.

Thank you, Senator. Do you have any lead witnesses in support? Nope. Okay. Would anyone like to record their #MeToo's in support of SB 987? Please step forward.

Good afternoon, Madam Chair, Members. My name is Conrad Crump with Disability Rights California. On behalf of the many Californians, with disabilities who access life saving care through Medi Cal, all in support of this measure. Thank you very much.

Thank you.

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

Thank you.

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

Thank you.

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

Thank you.

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

Thank you.

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

Thanks.

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

Thank you.

Kevin Guzman with the California Medical Association in support.

Thank you.

Missette Short, on behalf of Adventist Health and Peach representing community safety net hospitals in support.

Thank you.

Thank you. I don't see any registered lead opposition. Anyone anyone like to record their #MeToo's in opposition of this bill? See, no one's been before. Bringing it back to Senator Caballero to start our discussion.

I really appreciate what, you're trying to accomplish with this bill. We always end up in a situation where we expect there's gonna be savings and then they we don't ever see them. They just kinda Disappear. Disappear. Yeah.

So I get it. So I expect we're gonna see some changes over the the the time that the bill is run. But just my 2¢worth is is we've got to figure out what are the biggest holes we have left after HR 1. I think operationally, we're gonna see.

And from my my perspective, I think we need to prioritize indigent care, people that are not covered by insurance, prevention models, maybe people with disabilities and children.

The most vulnerable in our communities are I think gonna be impacted. And so if we had to pick something that in my mind would be a priority over really expensive care that's necessary but, you know, it you can use up an entire fund with very little impact.

So that's thank you for doing this. I really appreciate it. And, I when the appropriate time comes, I'd like to move the bill.

Any other questions? Senator Smallwood-Cuevas.

No. Thank you very much for for bringing this bill forward and it's, our short term general fund savings will rely on the on the the coverage loss which shifts our long term cost to emergency care. And that's one of my questions is as we hopefully will receive these the savings,

will some of those funds be earmarked for indigent care so that we ensure that those folks who may be losing their, their benefits can somehow gain them and have support for health care access Yeah. Within the system?

Yeah. So that's a great question. And that will be a part of the conversation. Really, the the the point of this bill as of right now is to ensure that those funds that are saved don't end up, being taken up by future administrations.

And we aren't able to have that conversation and that, decision as to where it will go. We know that patients are still going to they're not gonna get sick. They're still gonna go to emergency rooms. Our hospitals are gonna have to pay for that uncompensated care.

We already have issues with hospitals closing their doors, which is why we had to do the emergency distress hospital loan a few years ago. We're still gonna have clinics.

We're still gonna have an access issue, and we need to ensure that we have the funds to start having those conversations as to where that could go. I really like Senator Caballero's, suggestion about not just potentially using these funds for when they come

into the emergency room, but trying to figure out a way to use it in a preventative way so that they don't end up getting that more expensive care.

So those are all conversations that will be had, but the import the purpose of this bill is to really take those funds and say, you can't just throw them into the general fund or have them disappear somewhere else, that it needs to be redirected back into the health care system.

No. I appreciate that common sense bill, and we need both. We need that emergency indigenous care reality, but also that preventative care. So thank you for bringing this bill forward.

Yeah. Thank you. Seeing no other questions, we do have a motion from Senator Caballero.

Oh, would you like to close? Wanna thank my colleagues for this robust conversation. I think we have to really start thinking outside of the box and how we're going to help, Californians in this very interesting time from some things that we never thought

we would have to deal with. But with that, I respectfully ask for an Aye vote.

Thank you, secretary. The motion is due pass and re refer to the committee on appropriation. Please call the roll.

[Roll Call] That's not. What was that? 8-0.

8-0. That rule will remain on call.

We will now move to file item seven, SB 964. Senator Smallwood-Cuevas, you may begin.

Thank you so much Madam Chair and thank you for your patience. My missing folder. I wanna thank the committee for their diligent work on this bill and I am accepting the committee's amendments clarifying that the healthcare

professional and the enrollee or insured prescribing provider are treating, are treating providers. I am also accepting the committee's amendment, to remove, subdivision B.

So I'm happy to present SB 694 because it really helps patients with chronic complex conditions that get to get the right dose for medications they are already approved to take without a necessary prior authorization delays,

allowing up to two clinically appropriate adjustments while protecting continuity of care. Under current practice, health plans often require a brand new prior authorization every time a medication dose or frequency needs to be adjusted.

This happens even when the change is medically necessary and the medication itself is already covered.

Think about what that means in real life. A doctor determines that a patient needs a small adjustment to their medication to keep their condition under control.

And instead of being able to make that change right away, the request must go through a prior authorization process with the health insurance. Many of these requests are denied and eventually overturned on appeal.

But by then, valuable time has already been lost. Doctors and care teams spend hours on paperwork. Patients wait in pain and treatment is delayed.

For patients, these delays are not just inconvenient. They can mean interrupted treatment, on preventable disease, having to manage flares, and in some cases, avoidable trips to the emergency room.

I have the opportunity, to get hear a personal story from a patient who is, suffering with with Crohn's disease. And she talked about, how, she has this disease is refractory which means she has persistent inflammation and damage to her gut

despite using advanced therapies. And that she has had to rely heavily on continuous medication adjustments just to keep her, out of the operating room.

And too often, she's forced to have to wait because of these delays to get that necessary relief, from this chronic disease and pain. And we know that women living with chronic disease often face additional burdens, including delayed diagnosis,

higher out of pocket costs, and reduced quality of life. So, for this, we think SB964 allows a licensed health care professional to adjust the dose or frequency of a covered medication up to two times without prior authorization when

clinically appropriate and while maintaining existing clinical standards and excluding controlled substances. We think this is a common sense bill, that helps us provide necessary reforms and to ensure that we don't have unnecessary insurance delays.

Today, testifying, with on this bill to item today is Lisa Lum, a mother of a child with Crohn's disease and Ryan Spencer, Crohn's and Colitis Foundation, who is the sponsor of the bill.

Thank you. You will each have a combined of five minutes for your presentation.

Good afternoon.

Good afternoon, Madam Chair and Members. My name is Lisa Lum. Thank you for letting me speak today on SB964. I'd also like to thank Senator Smallwood-Cuevas for authoring the bill.

At the age of nine, our son Trevor was diagnosed with Crohn's disease after three months of constant blood in his stool. Immediately, all the worries of how we were going to control his this lifelong disease flooded into our minds.

What I remember most was his doctor saying that there are not many approved medications for a patient of his age. Therefore, it's important to make sure each one is given in a timely manner to determine if it's truly ineffective before we

move on to another. Once he stops, his body will create antibodies and he won't be able to use it again. On November 1, 2022, Trevor was placed on Remicade.

The insurance approved the first three infusions, which were only a few weeks apart, followed by a maintenance infusion every eight weeks. Within those first weeks, we were excited. He had minimal bleeding and more energy for the first time in

eight months. Although we saw progress, his doctor said that his blood work is showing that his body is using the Remicade, but he doesn't have enough in his system to last until the maintenance infusion every eight weeks.

So she requested a dosage change from every eight weeks to every four. This was denied by insurance stating that it was not medically necessary. Even after Trevor's doctor submitted clinical trials to support the increase,

the insurance denied the request and appeals for a total of three times. I have records of appeals, denials, expedited review request, letters, and emails of me asking and pleading what else do we need to submit?

What else do we need to get it approved? After over a month and a half of back and forth, I submitted an independent medical review complaint to the Department of Managed Health Care.

Within two days, the increase was approved by the insurance and now considered medically necessary. We did not provide any additional information than the first three times the insurance company had it all and yet it took them 1 1/2 months

versus two days to overturn their denial. Meanwhile, it had been six weeks since Trevor's last infusion and he was now home from school due to cramping, increased bleeding, and he had to begin a round of steroids

which was exactly what his doctor was trying to avoid given the risk of long term steroid therapy. Ultimately, even after the increase, Trevor had to move off of Remicade onto another medication.

But we will never know we would never truly know if he would have received the full benefits of the Remicade had he got it in a timely manner.

There are limited medications out there, and I fear one day he will run out of options. I'm a stay at home mother who had the time and resources to fight for him during this desperate period, and I still could not save him from the pain he experienced.

After this whole ordeal, I remember it so clearly. We are at our children's soccer game and I made a beeline to mister Spencer who I knew worked closely with the Crohn's and Colitis Foundation.

And I said, is there anything we can do to improve this process and what can I do? Because Trevor cannot go through this again, and I know he's not the only one who this is happening to.

Sure enough, they had already started drafting SB 964 to address this very issue. Thank you again, Senator. So I'm here today in front of people who can make change. Please don't let patients like Trevor suffer or slip through the cracks

because of a barrier that insurance creates to get effective health care. We ask the committee to please vote Aye on SB94. Thank you for your time and listening to our story.

Thank you. You have about a minute left.

Thanks. Fine. I'll be really quick and I'll tell a quick personal story. About ten years ago, my mother was diagnosed with triple negative metastatic breast cancer. And she looked for months for treatment that would work.

You know, sadly, she couldn't find one and it went terminal. But I'll tell you, if she found medication that would work, we'd do our damnedest to make sure that she would stay on that medication.

And for some reason, those antibodies started to fight off its effectiveness. And the doctor knows her condition. And it had has the clinical supporting data to support it.

Said, one way to keep the same clinical response is to increase that dose, then we're gonna do it. And if that means that it goes beyond what the FDA approves, but it's something that the doctor knows is worth a shot,

we're not gonna gamble on a new drug. We're gonna find one that works. Now my mom never actually had that chance, but other people do. And so I asked for a Aye vote.

And I represent the Crohn's and Coitus Foundation sponsors of the bill. Thank you.

Thank you. At this time, if anyone else in the audience would like to speak in support of the bill, please come forward. State your name, your organization, and your position. Thank you.

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

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

Good afternoon. Kayln Dean, California Hospital Association in support.

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

Tim Madden representing the California chapter with American College of Cardiology and the California Rheumatology Alliance in support.

Kevin Guzman with the California Medical Association and with the proposed committee amendments, we'll be moving to full support. So thank you.

Seeing no others that wish to speak in support, if there's any one from lead opposition that would like to come and speak in opposition, this is your time.

Seeing no others that wish to speak in support, if there's any one from lead opposition that would like to come and speak in opposition, this is your time.

You will both have a combined five minutes. Thank you.

Thank you, Chair and Members. Cassidy Heckman on behalf of the California Association of Health Plans in respectful opposition today. We appreciate the author's intent to reduce delays in care for patients with complex and chronic conditions.

However, as drafted, SB 964 raises serious concerns related to patient safety, affordability, and oversight. SB 964 would allow dose or frequency increases without confirming they align with FDA guidelines.

Proving that safeguard increases the risk of adverse reactions, misuse, or dosing that has not been proven to be safe or effective. The bill also encourages higher dose use of costly specialty and brand name drugs when clinically appropriate

and lower cost alternatives may be available. The higher cost ultimately impact premiums and affordability for consumers across the state. Health plans use authorization of care to ensure medications and dose increases are safe, evidence

based, and consistent with FDA approved labeling. It is not arbitrary nor used as a means to deny care, but it does ensure the right medication at the right dose is being used at the right time.

We are committed to continuing discussions with the author and sponsors. However, at a time when health care affordability is at the forefront of our minds, we urge careful consideration of health care mandates.

We respectfully ask for a no vote. Thank you.

Madam Chair and Member Stephanie Watkins on behalf of the Association of California Life and Health Insurance Companies. I'd first and foremost like to thank the sponsors we've had, over the last couple years, some very thoughtful conversations

about this bill and about issues related to prior authorization as this committee has as well. And in the interest of time, I'd like to underscore much of my colleague's comments.

The issues raised related to safety and cost along with the bill's impact on proven utilization management safeguards is hard to ignore. With respect to patient safety, plans and insurers often limit a drug or dose for specific reasons related

to preventing abuse or overuse, ensuring that the use aligns with FDA approved labeling, as well as avoiding doses that have not been adequately studied for effectiveness or safety.

Unfortunately, SB 964 removes key guardrails by allowing dose increases without ensuring prescription to remain consistent with FDA labeled dosages or approved uses. That reduces oversight that reduced oversight could increase the risk of adverse

outcomes if dosage change are not clinically appropriate or not carefully monitored. Additionally, as noted in a previous analysis of a similar proposal, SB 964 will result in higher healthcare costs through the increase of premiums.

While we appreciate the sponsor's attempt to narrow the bill, the core concern remains. It can encourage continued use of expensive specialty or brand name drugs even when a generic or lower cost therapeutic alternative is available.

Those added drug costs ultimately affect affordability to patients, employers, and taxpayers. Given the instability in today's market, even minor increases could make the difference between an individual choosing to purchase

coverage or opting to risk going without. Lastly, while we strongly believe SB 964 undermines existing utilization management protocols like prior authorization and step therapy that help ensure patients receive the right medication at the right

time and at the right dose. These tools are especially important in prescription drug coverage given the potential for misuse and high cost of specialty medications. Allowing providers increased dosages up to two times without plan review essentially

weakens critical safety and appropriateness checks. It also ignores the clinical evidence and best practices evolve and plans may appropriately work with patients to transition them to more effective or lower cost formulary options.

For these reasons, we are currently opposed to the bill. That being said, we do look forward to working with the author and sponsor if the bill moves forward today and looking to see if there are potential options going forward. Thank you.

Thank you. If there's anyone else in the audience that would like to register the opposition, please come to the microphone and state your name, your organization, and your position. Seeing none, I am going to turn it over to the committee to see if

anyone has any questions or comments. Seeing none, I have some questions. So when I look at this bill, first of all, thank you for bringing it forward.

Thank you. Thank you so much for your testimony and coming in and sharing your personal story. It talks about the authority for a provider to adjust the dose of frequency of a drug.

But in the opposition statement, they were talking about exceeding FDA approval. Is that what we're referring to here?

No. This the in this bill is focused on making sure that physicians who, already, understand and manage these drugs, who understand how they interact with patient care, to ensure that the evidence based care that they are giving, right.

That they're able their patients are able to access this easier. This is not about, you know, looking at experimental drugs. This bill only applies to drugs that are already covered. Right. So this this question of

Right. So let me make it a a little, clearer. If I have prescribed a medication at a certain dosage and my patient needs a higher dose, that is not necessarily an excess of that dosage.

That is what this bill is trying to prevent me or or that patient from having to wait from the insurance. Or is it when I prescribe a dose that exceeds the recommended dose?

It's the it is the the former. It is Former. And you are prescribed an actual when you prescribed a drug and it is approved by the plan, they approve that drug. Then that drug starts to lose effectiveness on the patient.

And the physician decides based on their research, their clinical data that the best interest of the patient is to keep them on that drug and increase the dose or in the case of a Crohn's patient, the frequency of that dose, then that's the request that they make to the plans.

And it's still within the approved dose regimen that is FDA approved. We're not exceeding a dose. We're not go ahead.

Potentially. But potentially not. In some cases, they will see and you'll see some of these denial letters. That if FDA approves it, say an infusion for eight weeks, But that's the standard infusion. But yet, the body of the patient has developed antibodies for it.

So it's it's not responding. The doctor thinks more frequent infusions would be better for the patient. So they ask for four weeks. FDA did not approve four weeks. They approved eight weeks.

And so, yes. That would be considered off label.

So is there any way to, in the future, as this bill is being moved forward? Because I know as providers, we will oftentimes, go by clinical practice, like but even within that, it has been studied and it is widely used within our own profession.

It may not necessarily be FDA approved for that particular, you know, length of time. Is there any way to clarify that just to ensure that, you know, I don't believe any providers would go rogue, but, you know,

addressing the concerns that the opposition may have that someone may be doing some kind of, hey, let's try this, which is not necessarily standard of care for that particular, condition or, you know, area. Are we able to do that?

May I there's some pressure. Yes. And I say that with absent certainty because in the information that that miss Lum sent to the doctor, they provided that medical information. They provided that data and it was still denied.

Right. I guess what I'm what I'm saying is, they're saying in this bill that it allows for it would allow for that. Is that Yeah.

There's nothing in the bill that prohibits, you know, if the initial diagnosis and prescription is either on label or within FDA approved limits, there's nothing then that says that it has to remain within that.

It just says that it can't be a controlled substance or it can't be I mean, there's a couple different qualifying, but certainly, you would assume and and we have to look at the breadth of this bill.

While most of the testimony has always been around Crohn's and Colitis, the bill really does touch across all segments of health care space and a really large amount of of drugs and treatment plans.

So in those instances, I think, and this is something that we had talked at one point, I think, with the sponsors about limiting it to either FDA approval to ensure that there were protections there about either the frequency, the dose, or that it was on label use.

So I think those would be key components we would be.

I mean, I think that's gonna be a concern for the sponsors to be quite honest with you to specifically limit that.

Well, I'm not I'm not saying limited to FDA because but there are some clinical best clinical guidelines that are that include off label or, you know, a more frequent. And we may and you might wanna consider, including that in the language just to ensure that, you know, no one is harmed.

Well, and that's the intention of this bill is that we want folks to not have to go to the emergency room to need emergency care. We want to create an environment where they are able to, under their doctor's prescription, under their doctor's guidance,

be able to access the medication that is prescribed. And we're happy to continue to work with the opposition on this. I think this is a a nuance that we will dig into as we move the bill forward,

because we don't want anyone harmed. This the goal here is to help Right. Folks reduce some of the suffering.

Right. Senator Valladares.

Yes. So, I think they say you shouldn't marry a comedian because they'll tell your personal stories and you shouldn't marry a legislator either because they'll also talk about their personal stories.

And my husband who takes a thyroid medication has been through this very similar situation. So sorry sorry, Shane. Where he needed an increased dosage and he wasn't approved for it. He ran out of the existing prescription.

And there are side effects when you're not on your thyroid medication. And so I've seen it personally from the patient's perspective, how important having access to, a really quick turnaround on the prescription, dosage is important.

My question though on, I guess, the clinical side or the doctor side is if a doctor prescribes, you know, the wrong dosage or an unsafe medication or messes up, are they not liable for that? And that would still be the case.

So for me, it seems really simple that we trust our doctors and when we're dealing with any type of chronic illness, that we should easily be able to trust the recommendation and prescriptions from our doctors.

Do the other question I have is your doctor prescribes you a medication and then the pharmacist often also looks at that dosage to weigh input as well typically. Is that also correct?

Oh, for us? All of that Sorry. All of that is monitored through the doctor, but also the specialty. Well, it must be because I haven't had any the specialty pharmacy will call me about deliveries, or we go to UC Davis for the infusions.

And no one has ever said anything, but I would assume that if it was dangerous that they would say something, you know. I mean, I work with the doctors.

I speak directly to the specialty pharmacies every month. And I would I would assume that they would say something. Okay.

And so for me, it seems pretty basic. For, the opposition, did you have amendments that could make this better? Clarification language? Was that ever presented?

On earlier iterations of the bill, and this is, you know, much more narrowed bill than we've seen. I think this is the third time, fourth. Sorry. Right? Fourth time we've had this conversation.

It certainly evolved. I think there are amendments we would be happy to sit down and discuss. I think some of where we would wanna go either, like, you know, directing to clinical care guidelines or some sort of, you know, pointing to a

requirement that they meet a certain standard. I understand that many of the usages are often off label. So that's I mean, it's I think what we would want isn't something necessarily that they could agree to given the population that they're looking at.

We can certainly continue to have those conversations and we're happy to do that. But there is that concern partly because the bill is so broad. It isn't just about the Crohn's and Colitis condition but everything.

And so you, as you're trying to address such a wide span of diagnosis treatments, it gets, you know, there's lots of off label. There's lots of things that are really standard of care that are off label.

And then there are ones that are not. And how do you kind of remedy that? And but we're committed to having the conversation if the bill moves forward today and see if there's a pathway. Thank you.

K. Well, want to thank, Senator Smallwood-Cuevas for, introducing this bill and for allowing us to have this robust conversation. Look forward to those continuing conversations.

Yes, you're not gonna get exactly what you want. But I do think that you have, brought up some concerns that we may be able to address with looking at, you know, clinical practice, clinical standards of care.

Which, are less stringent than FDA. But are things that we as providers use and our patients definitely need. You know, there was one part of your bill and that you and I talked about it and I did with the sponsor as well.

That excluded Medi Cal managed patients from this. And I have generally been very clear about the fact that if we're going to do something for one set of patients, we should do them for all.

Especially for those that are on Medi Cal because they often have very chronic significant illnesses. We did reach out to DHCS and it seems like they already have a system in place.

And that they only utilize prior authorizations for like very high dosage that would exceed, the maximum dose restrictions. And so because of that, and I think that this is, very much needed, I will be supporting and you may close.

Well, thank you so much, Madam Chair, and really appreciate your expertise in this subject matter area. This is about helping patients. This is about making sure Californians can get the access to care and pain and suffering relief as quickly

as possible. And also to save money so that folks aren't having to go to the emergency room or needing a more expensive treatment because they weren't able to access, an adjustment in their dose.

So we will continue to work with the opposition. We think this is a good bill even if it is the fourth time around. Fourth time's a charm. And, I respectfully ask for your Aye vote.

Thank you. Would anyone like to move the bill? Move the bill by And the bill has been moved by Senator Padilla. The motion is do pass as amended and re referred to the committee on appropriations. Assistant, please call the roll.

[Roll Call]

11-0 that bill is out. Thank you. Good job.

Alright. We will now move back in file to file item number six, SB 1099 from Senator Reyes. And you may begin whenever you are ready.

Thank you, madam chair and members for this opportunity to present SB 1099. SB 1099 clarifies California local government's authority to provide state or local benefit public benefits to all residents under the statutory exemption provided in the Federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, also known as PRWORA. Historically, California has relied on the statutory exemption under PRWORA that allows local governments, at their discretion, to provide state and local public benefits to all residents.

Thanks to this exemption, our local governments have been able to provide critical services such as health care and safety net programs to all residents without worrying that they are in violation of federal law. Unfortunately, the California statute that provides this PRWORA exemption is too vague and is not directly tied to how local and state public benefits are defined at the federal level.

This creates risk because if the federal definition changes or is reinterpreted, our California exemption may fall out of alignment, potentially exposing a local governments to compliance issues. SB 1099 addresses this by explicitly tying state law to the federal definition, ensuring clarity and consistency with federal requirements. While technical, this is a high impact bill that strengthens and protects local governments ex local governments existing authority to serve all residents.

Here to testify on the bill today are Tony LoPresti, the chair of the civil prosecutors coalition and Santa Clara County Council, and Jordan Flanders, interdepartmental council for homeless services, Oakland City Attorney's Office.

Thank you. You both have a combined five minutes.

Good afternoon, Chair Weber Pierson and members. My name is Tony LoPresti, County Counsel for the County of Santa Clara and Chair of the Civil Prosecutors Coalition. Civil Prosecutors Coalition is proud to support SB 1099. The coalition is composed of seven city attorneys and county councils from the cities of Oakland, San Diego, San Francisco, and San Jose along with counties of Los Angeles, San Diego, and Santa Clara.

We represent some of the largest public law offices in the state and advise our local government clients on all issues including protecting our authority to use public funds to benefit the most vulnerable residents in our communities.

And that is precisely why we are so thrilled to work with Senator Reyes on SB 1099. This bill is a straightforward clarification of long standing California law that allows local agencies to spend state and local funds to offer critical programs and safety net services to all of our residents.

As the federal government continues to layer safety net programs with grant conditions and eligibility criteria, we hope to partner with state, with the state to protect our autonomy and our authority to use state and local dollars to serve our residents as we deem appropriate. As cities and counties, we know our residents and their needs best. And we design programs to respond to those needs.

That's why local control over how we spend state and local funds is so critical. I want to be clear that this bill doesn't require local governments to do anything. It doesn't require that locals spend their money in any specific manner or on any specific constituency. Instead, it clarifies in statute local government's authority to develop and maintain programs that serve our residents based on criteria that we establish, rather than criteria established by the federal government.

As city attorneys and county councils, it's our role to provide as much legal certainty as possible to our local government clients.

This bill will minimize risk and uncertainty, particularly in these very difficult budget times. Civil Prosecutors Coalition requests your support for this bill. Thank you.

Thank you.

Good afternoon. Thank you to the chair, for

the opportunity to speak today. And thank you to Senator Reyes for bringing forward SB 1099. I'm here as the Interdepartmental Homelessness Council for the city, City of Oakland City Attorney's Office in support of this bill, which makes a simple but important change to California law. It reaffirms and clarifies that local governments have the authority to provide essential services to the all residents who live in their community using state and local funding sources, despite any changes to federal law.

Local governments are on the front lines of provide providing services such as health care, emergency shelter, crisis intervention, and food distribution.

These programs must operate quickly, with minimal barriers, and without collecting often without collecting personal information. Many programs serving people in crisis cannot realistically incorporate documentation checks or detailed intake requirements.

For example, homeless outreach teams often engage people in encampments or on the street for only a few minutes at a time. These teams focus on transportation to shelter and crisis de-escalation. Encampment management teams leverage a wide variety of resources to address encampments and must be able to provide those resources to all people living

on the streets if they so choose. These teams generally do not have time or the ability to conduct identification checks during these brief encounters. Similarly, street medicine teams prioritize urgent medical and behavioral health stabilization, which depend on speed and low barrier access. Finally, suicide prevention and crisis hotlines operate anonymously by design. And callers frequently decline to, to provide any identifying information at all.

Gaps or uncertainty about the scope of required screening may cause local governments to hesitate in providing services or to restrict eligibility for locally funded programs unnecessarily. This bill would take advantage of existing provisions of federal law to clarify that local governments in California can continue to use state and local continue to use state and local funding for these services if they choose to do so. It does not require or mandate any local action.

Instead, it provides the legal certainty that cities and counties need to continue providing essential frontline services to the residents using state and local funding to the fullest extent that federal law allows. Thank you.

And at this point, if you are in the audience that would like to register your support, please come to the microphone. State your name, your organization, and your position.

Madam chair and members, I'm Erin Evans. I've been asked to register the support of the San Diego city attorney Heather Ferber. Thank you.

Thank you.

Thank you. Dylan Elliott on behalf of San Francisco city attorney David Chiu as well as the city and county of San Francisco both in support. Thank you.

Thank you.

Good afternoon again senators. My name is Otto Blaisdell serving as the board president of the Santa Clara County Board of Supervisors. And we are strongly supporting and also a cosponsor of this bill representing 2,000,000 people of our county, largest county in Northern California. Thank you.

Thank you.

Kevin Guzman with the California Medical Association in support.

Thank you. At this time, if there's anyone in the audience that would like to speak as lead opposition? Seeing none, if there's anyone in the audience that would like to register your opposition, please come to the mic, state your name, your organization, and your position. Seeing none, I will now turn it over to the committee if anyone has any questions or comments. The bill has been moved by Senator Gonzales.

Senator Reyes, you may close.

Thank you. Respectfully ask for your aye vote.

Thank you. The best close we've had all day. Alright. So the motion by Senator Gonzales is to pass and re refer to the Committee on Human Services. Assistant, please call the roll.

Senators Weber Pierson. Aye. Weber Pearson, aye.

Valadares. Valadares, aye. Caballero? Aye. Caballero, aye.

Durazo, aye. Gonzales? Aye. Gonzales, Aye. Grove?

Aye. Grove, I. Menjivar? Aye. Menjivar, Aye.

Padilla? Aye. Padilla, Aye. Perez? Aye.

Perez, Aye. Rubio? Aye. Rubio, Aye. Smallwood Cuevas?

Smallwood Cuevas, Aye.

Aye.

Eleven zero. It is out.

Eleven zero. That bill is out. Thank you, Senator. Thank you.

We will now move to file item eight. SB 1033 by Senator Padilla. And you may begin when you are ready.

Gotcha.

Afternoon, madam chair, members. My honor to present, SB 1033. I wanna begin by thanking the committee and the chair for working with my staff on this bill. We're happy to accept committee amendments that were worked out to define protein product as either a protein supplement as defined in federal law or a food product that is a protein supplement premixed with water. You can see those highlighted materials in front of you.

This bill requires manufacturers of protein products to test their items for heavy metals and disclose those findings. In recent years, there have been increasing demand for protein fortified items that have led manufacturers releasing an abundance large quantities of these products. This rapid market expansion has occurred without any regulatory oversight.

In October 2025, Consumer Reports conducted an independent investigation of multiple protein powders and protein beverages, and their results were disturbing. They found that several products contain levels of heavy metals including arsenic, cadmium, and lead.

At the federal level, the Food and Drug Administration does not review dietary supplements for safety or for effectiveness, and there are not any federal limits on the amount of heavy metals and products to consumers. Without transparency and standards, consumers are left unaware of the potential toxic exposure from these contaminants in the products they are consuming.

These supplements contaminated with heavy metals can contribute to numerous serious health outcomes including neurological issues, immune suppression and reproductive harm and long term health impacts.

In order to protect consumers, create transparency of these toxic levels that ensure people are purchasing safe products. SB 1033 requires manufacturers to test their products for heavy metals and disclose these findings.

This addresses a growing public health concern, protects California from preventable harm, reinforces our statements, our state's commitments to transparency, safety and responsible product regulation. With me today, I have Ryan Spencer from Environmental Working Group and Caitlin Marv, Research Manager for the Center on Environmental Health.

Thank you. You will both have a combined five minutes.

Thank you, madam chair and members of the committee. Ryan Spencer on behalf of the environmental working group, sponsors of SB 1033. First, I'd like to thank the Senator for introducing this bill as a direct response to the mounting evidence, that some protein products contain levels of heavy metals high enough to raise serious public health concerns, particularly for teens and frequent users. Protein powders, shakes, and bars are not occasional use products.

Many Californians, not just athletes, incorporate them into their daily routines, sometimes multiple times per day.

The pattern of use matters because even low levels of toxic elements can accumulate over time and create real health risks, particularly for pregnant individuals, adolescents, and those with chronic exposure. This is particularly alarming when you consider even a single scoop of protein powder can push someone past the recommended limits for lead, a problem that has grown over the years. A recent consumer report studies the center mentioned showed average lead concentrations higher than those identified in testing conducted fifteen years ago.

And fewer products today are testing below detectable levels. But all, thankfully, is not lost.

Safer outcomes are achievable. That same consumer report study also identified products containing much lower levels of heavy metals than others, which tells us this is not an unavoidable problem. It's a solvable one. Yet consumers have no way to distinguish between those products and what is best for them. SB 1033 corrects this imbalance by introducing a simple but powerful concept.

Transparency back to back accountability. By requiring manufacturers to routinely test their products and make those results publicly available, the bill does two things. First, it gives consumers the ability to make informed decisions based on real data. Second, it creates a strong incentive for companies to improve sourcing and manufacturing practices to remain competitive by lowering their levels of heavy metal. We've already seen this model in California work.

We passed a bill last year, SB 646 by the chair, dealing with prenatal vitamins and heavy metal, so contained in them. So when disclosure requirements are in place, contamination levels drop. Not because of mandates and formulation, because transparency drives better behavior. This bill is not about restricting access, or limiting consumer choice. It's about ensuring the choice is informed, and that products marketed as part of a healthy lifestyle meets a basic standard of accountability.

SB 1033 is a straightforward common sense consumer protection measure. One that aligns with California's long standing leadership in consumer protection and public health, I respectfully ask for your aye vote. Thank you.

Good afternoon. My name is Caitlin Moher, and I'm the research manager at the Center for Environmental Health. We are proud to cosponsor SB1033 and commend Senator Padilla for carrying this bill. When Consumer Reports tested protein powders and shakes, it discovered high levels of lead in more than two thirds of the products, and some products contained cadmium and arsenic. There is no safe level of lead exposure.

Exposure to lead can cause cancer, reproductive and developmental issues, and neurological harm. Low levels of lead can cause cognitive impairment in children. According to the World Health Organization, long term exposure to arsenic in food can cause cancer and skin lesions. Arsenic has also been associated with cardiovascular disease and diabetes. The CDC says that metallic mercury most commonly affects the nervous system.

Exposure can cause tremors and coordination and problems with vision, learning, hearing, memory, and mood. Mercury also hinders fetal and child development. Cadmium can cause developmental and reproductive harm. In addition, consuming just one serving a day of some protein products will cause a person to exceed the FDA's recommended daily limit for from food. Many people consume more than one serving of a protein product daily and could easily exceed this limit.

Remember that heavy metals can accumulate in the body. With more people increasing their consumption of protein, many are consuming protein products daily. SB 1033 will equip consumers with information they need to make informed decisions about their nutrition. I respectfully request your aye vote. Thank you.

If there's anyone else in the audience that would like to register their support, please come to the microphone at this time. State your name, your organization, and your position. Thank you.

Good afternoon. Christopher Sanchez on behalf of the Consumer Federation of California in support.

Hello. Susan Little on behalf of Consumer Reports, Unleaded Kids, and CalPERS.

Good afternoon. Kai Klassen on behalf of Breast Cancer Prevention Partners and strong support. Thank you, author.

Hello. Alana Latticer with the American Nurses Association of California in support.

Ryan Spencer on behalf of the American College OB GYNs in support. Sorry.

We're tweeners.

Of course.

Is that okay? That tweeners. Alright.

Thank you. Dennis Salviani on behalf of the Consumer Brands Association. I wanna compliment the the staff of the the Senator as we met with them and and the consultant to to really try to bring this down and and get some where the testing would be the most effective. We do express some still additional concerns. We think this should be focused on supplements and supplements themselves, and, this one still has beverages and some of the, other products on beyond that.

So we would we would further narrow that, and I think that the folks know know some suggested amendments have been provided and discussed. Second of all, I think we also would consider moving the testing up from the actual end product to the suppliers of of the protein supplement.

That way, it would, you know, it it we were when we discussed it with the with the with the staff, it would focus that and have much less testing requirements and all these products, you'd get it at the source. So we think those are are are constructive options to discuss as this goes forward and we appreciate your time. Thank you.

Thank you. We will now open it up to anyone who is here speaking in lead and opposition.

Well, we're all debating that. My apologies, madam chair, members. Trent Smith on behalf of the Consumer Products Association. We're also, I guess, we are listening concerns. We don't have a problem with testing or reporting over certain levels.

I think our concern right now is, as the analysis points out, heavy metals are naturally occurring and found in soil and leafy greens, spinach, root vegetables. If you're all looking for an excuse not to eat your your spinach perhaps, this is one. But the point being is is that these are naturally occurring in our plant based dietary supplements. And so having reporting everything we think is counterproductive as far as you could actually scare consumers into not having anything.

So again, we're fine with certain elements of it, but concerned about just the overall testing of trace amounts and and so again, we've listed our concerns.

Happy to work with the sponsors and author. Thanks.

Thank you. If there's anyone else that would like to register opposition, please come to the mic. State your name, your organization, and your position.

Madam chair and members, Anthony Molina on behalf of the Natural Products Association in opposition. Thank you.

Thank you.

Madam Chair and members, Mike Lyons on behalf of Dairy Institute. We are still listed in opposition on our letter but all the comments who are made, we share. We appreciate the staff working with the amendments. We've met with you. We appreciate them and we've talked about their your staff.

So we'll continue to work to the process. We're still in this locked position of oppose but I think we can get somewhere. We're optimistic. So thank you.

Thank you. At this point, I will bring it back to committee members if there's any questions or comments. Senator Groves.

Thank you madam chair. I appreciate the bill. I do. And, I'm I am gonna vote yes on it, but I I would like your commitment that you continue working with opposition because sometimes we, you know, we do things like in a different industry and I know this is gonna freak everybody out when I say that. We did fence line monitoring for refineries, but there are certain refineries that don't produce any constituents that would the product they produce, there would be no pollutants at all based because they don't do gasoline.

They do asphalt and ink oils and things like that.

But they still make them test for the stuff that would be in refiners for gasolines. That was a well intended bill to make sure that we didn't have anything passing over the fence line. So this is a well intended bill, but we need to make sure that it doesn't exclude, things that are naturally occurring in spinach or vegetables or anything else. And so, I just like your commitment that you're gonna continue to work with the opposition.

Madam chair and Senator, absolutely.

Thank you. Senator Durazo.

Thank you, madam chair and thank the author. I did a bill last year on menstrual products, right to know. And that was really important to begin the process of people knowing what's in the product that they're using. In that case, of course, using menstrual products for several hours at a time, many consecutive days at a time. Different product, but the same idea is that to watch out for all these things that you need to test.

Otherwise, you wouldn't you wouldn't know. You wouldn't know if there's anything in there hurting you or damaging you. So I I appreciate your your bill.

Thanks.

Seeing no further comments from the committee. Want to thank you so much for bringing this bill forward. Thank your sponsors. And also I really want to, you know, give kudos to the health staff, who really did an amazing job with the amendments. And really dug deep, looked at the different products, looked at the different ingredients to try to really narrow it because it was very, very broad initially.

And so I just want to give kudos to our amazing, consultant for that. Yes. You know, it's interesting when when I was listening, I was hearing some of the same argument that I heard from my prenatal vitamin bill as to why it shouldn't happen.

Oh, it's naturally occurring. We can stop eating spinach and all these leafy greens. Like the same thing. But at the end of the day, we really need to make sure that what we are consuming is safe. And this is not removing products. It is allowing individuals to know what's in their products.

And, I think it was Ryan who who who started off stating that, you know, our our kids are now consuming these protein bars and protein shakes. Then I said, oh my goodness, you're right. Because my 14 year old who's trying to bulk up, eats his protein bars every single day. And, we need to make sure that our kids are healthy. That we're healthy but also our kids especially since it's so so widely available.

And so appreciate you doing this and with that you may close.

Thank you very much, madam chair. I do wanna thank you for your extraordinary leadership in this space. Certainly with respect to the sponsors and our office, we did have some good inspiration from a similar bill to try to build on that and I would echo your compliments of your committee staff. Our committee staff did a amazing job fixing what for a quick second there felt almost like we were gonna go off a cliff and you brought it back. And so very very grateful for your work.

I would just only say that knowledge is power. There are many factors that contribute to what ends up on our plate. And we have the you know, we only have the ability to mitigate that or deal with that or have informed choices as consumers if we have the information. Knowledge is power. That's what this bill is about.

I respectfully ask for an aye vote.

Thank you. Looking for a motion. Moved by Senator Gonzales. The motion is do pass as amended and re refer to the committee on environmental quality. Assistant, please call the roll.

Senators Weber Pierson? Aye. Weber Pierson, aye. Valadares? Aye.

Valadares, aye. Caballero? Aye. Caballero, aye. Durazo?

Durazo. Aye. Gonzales. Gonzales. Aye.

Grove. Menjivar. Aye. Menjivar. Aye.

Padilla. Aye. Perez. Rubio. Smallwood-Cuevas.

Smallwood-Cuevas, Aye.

It's it's 8-0. We will place that bill on call.

Now moving to file item number 11, SB 1049. Senator Weber Pierson, you're recognized when you're ready.

Thank you. Good afternoon, colleagues. Today, I will be presenting SB 1049 which will ensure providers have a fair opportunity to correct minor technical errors on claims. Wanna thank the committee for your thoughtful review, and I accept the amendments. At its core, SB 1049 addresses a gap in current law by ensuring providers have a meaningful opportunity to correct claims after a plan takes action. Today providers are working in an increasingly complex administrative system.

Even when they deliver appropriate care, they face denied payments or retroactive recoupments. Not because care was wrong, but due to minor, correctable errors like coding or documentation. These are not cases of fraud. They are simple mistakes that should be fixable. But under current law, providers often blocked from correcting them because of rigid filing deadlines tied to the original date of service.

From a clinical perspective, that's deeply concerning. When payments are denied or clawed back months or even years later, it creates real instability, especially for small independent practices. That instability affects staffing, limits access to care, and ultimately impacts patients. Let me share a real example. An obstetrics practice in Sacramento was told that 40 claims spanning nearly two years were overpaid, resulting in a $90,000 repayment demand.

The issue wasn't the care. It was a missing diagnostic code, which is a simple fixable error. But when the providers tried to correct and resubmit, they were denied because the filing deadline had passed. Meanwhile, the health plan began recouping payments from ongoing care. So in this case, the care was appropriate.

The error was fixable. But the system did not allow for it to be corrected. That is not a fair nor efficient system. The core issue is simple. Providers don't have a meaningful opportunity to fix errors once they're identified, especially when they're flagged after the deadline.

SB 1049 offers a balanced, straightforward solution. It allows providers to correct claims within ninety days of a health plan's latest action, like a denial or overpayment notice, and prevents plans from rejecting those corrections solely due to the fact that it was past the deadline. It is not open ended. It is reasonable, time limited fix. And importantly, this bill does not excuse improper claims or expand liability for health plans.

It simply gives providers a fair chance to correct honest mistakes. SB 1049 is sponsored by the American College of Obstetrician and Gynecologists and cosponsored by the California Medical Association. And we are actively working with health plans and other stakeholders, and we remain committed to continuing those conversations to address any concerns and find a balanced solution. This is a common sense reform that reduces unnecessary conflict, improves efficiency, and keeps the focus where it belongs, on our patients. I respectfully ask for your aye vote.

And with that, I'd like to introduce our two witnesses, doctor Kathleen Rooney. She's an OB/GYN and ACOG Fellow. And Ryan Spencer, again, who is here this time. I know he's been here all day. This year as a legislative advocate for ACOG District nine.

We're gonna put your name on that seat. Is that what's going on? You're both recognized for five minutes, two and a half minutes each.

Great. Thank you. I would like to thank the committee for this opportunity to speak with you all. And I would especially like to thank doctor Weber Pierson for authoring SB 1049.

My name is Doctor. Kathleen Rooney. I am an OB/GYN and a managing partner of a Sacramento private practice consisting of seven doctors. We care for over 10,000 women in our Sacramento community. I'm here to speak about the importance of SB 1049.

In April 2025, I was notified by my biller that our health plan was withholding payment from current patient care due to a coding error from past claims. These were from sixty one pregnancy claims dating from January 2023 to January 2025. After having to contact the plan to learn why they were withholding our current money, we learned it was simply because the claims did not include a diagnostic code. In this industry industry, this type of behavior is called a clawback.

Upon this discovery, our biller immediately fixed the claims and sent them back.

The resubmitted claims were denied as untimely because it had been more than ninety days from the date of service. As you can see, we were notified two years after a claim was submitted. And so, of course, we were past the timely filing the limit. My biller has then spent over a hundred hours fighting each of these claims. Overall, the plan has withheld a $120,000 from my partnership during the past year.

And to date, 60,000 dollars is still not paid back to us from 31 pending claims. She has to contact the plan multiple times to find a representative that understands the problem. And if she finds a representative that understands the situation, they will process only three claims at a time. Currently, we have 31 outstanding claims that they will not process. I want to be very clear here.