THE SENATE COMMITTEE ON HEALTH
WILL BEGIN IN 10S. YOUR TEN
SECOND WARNING. OVER HERE. NOW
IT REALLY GOES BACK TO REGULAR
SELECTION. SO SENATE COMMITTEE
ON HEALTH WILL COME TO ORDER.
GOOD AFTERNOON, EVERYONE. THANK
YOU FOR JOINING US. MEMBERS OF
THE PUBLIC. AS YOU KNOW, WE
ALLOW SIX MINUTES OF TESTIMONY
PER SIDE, BUT WE HAVE, I DON'T
KNOW, ALMOST 20 ITEMS ON THE
AGENDA TODAY. A COUPLE OF THEM
ARE OFF. SO DON'T FEEL FEEL FREE
NOT TO USE ALL THE TIME IF YOU
DON'T NEED IT. TWO BILLS WILL
WERE PULLED FROM TODAY'S
HEARING. ITEM NUMBER EIGHT,
SENATE BILL 1334. SENATOR
NEWMAN'S SUBSTANCE ABUSE
DISORDER TREATMENT. AND ITEM
NUMBER 20, SENATE BILL 1268.
SENATOR NGUYEN, MEDI-CAL MANAGED
CARE PLANS. WE HAVE 19 BILLS ON
THE AGENDA, WITH THREE OF THEM
BEING ON A PROPOSED CONSENT
CALENDAR ON CONSENT TODAY. ITEM
NUMBER ONE, SENATE BILL 908.
SENATOR CORTEZ, FENTANYL, CHILD
DEATHS. ITEM NUMBER SIX. SENATE
BILL 1464. SENATOR ASHBY, HEALTH
FACILITIES CARDIAC
CATHETERIZATION, ITEM NUMBER 15.
SENATE BILL 1033. SENATOR
MENGIBAR HEALTH FACILITIES.
CONGREGANT LIVING HEALTH
FACILITIES WITH THAT, WE WILL
TAKE OUR FIRST BATTER UP. FIRST
ITEM, ITEM NUMBER TWO. SENATOR
CORTEZ'S SENATE BILL 999. HEALTH
COVERAGE, MENTAL HEALTH AND
SUBSTANCE ABUSE. SUBSTANCE USE
DISORDERS. PLEASE PROCEED WHEN
READY. WELL, THANK YOU, CHAIR
ROTH. I'M VERY PLEASED TO
PRESENT SB 999. THE BILL WILL
ENSURE THAT CALIFORNIANS
SUFFERING FROM MENTAL HEALTH AND
SUBSTANCE USE DISORDERS CAN
RECEIVE THE APPROPRIATE LEVEL OF
TREATMENT AND CARE NECESSARY FOR
A FULL AND LASTING RECOVERY.
EXISTING LAW REQUIRES HEALTH
PLANS AND DISABILITY INSURERS TO
USE GENERALLY ACCEPTED STANDARDS
OF CARE WHEN CONDUCTING
UTILIZATION REVIEWS. UTILIZATION
REVIEW IS WHEN A HEALTH PLAN OR
DISABILITY INSURER APPROVES,
MODIFIES, OR DENIES TREATMENT
BASED ON WHAT THEY CONSIDER
MEDICALLY NECESSARY. HOWEVER,
DESPITE EXISTING LAW, SOME
HEALTH PLANS DISABILITY INSURERS
STILL USE INAPPROPRIATE
UTILIZATION REVIEW PRACTICES TO
AVOID PAYING FOR CARE. AS A
RESULT, MEDICALLY NECESSARY
TREATMENT DAYS ARE OFTEN
ARBITRARILY DENIED. SOME
REVIEWERS HAVE DENIAL RATES
EXCEEDING 95. SB 999 WILL REMEDY
THIS BY REQUIRING THAT
UTILIZATION REVIEW
DETERMINATIONS BE PERFORMED BY A
REVIEWER WITH APPROPRIATE
TRAINING AND RELEVANT EXPERIENCE
IN THE CLINICAL SPECIALTY. THE
BILL REQUIRES REVIEWERS TO
DISCLOSE THEIR BASIS FOR A
TREATMENT DENIAL, INCLUDING A
CITATION OF THE CLINICAL
GUIDELINES THAT WERE FOLLOWED.
SB 999 ALSO CODIFIES THE
STANDARD PRACTICE FOR REVIEWERS
TO LIST THEIR NAMES AND
CREDENTIALS ON A TREATMENT
DENIAL. THIS PRACTICE HAS BEEN
INSTRUMENTAL IN HELPING US TRACK
TRENDS IN UTILIZATION REVIEW
DENIALS. FINALLY THIS BILL
REQUIRES HEALTH PLANS AND
DISABILITY INSURERS TO MAINTAIN
TELEPHONE AND DIRECT
COMMUNICATION ACCESS FOR
UTILIZATION REVIEW DURING
CALIFORNIA BUSINESS HOURS BY
APPLYING THE APPROPRIATE
CLINICAL AND UTILIZATION REVIEW
CRITERIA TO MENTAL HEALTH AND
SUBSTANCE USE DISORDER
TREATMENT. WE CAN SAVE LIVES BY
COMBATING OVERDOSE DEATHS AND
SUICIDES. SB 999 IS CO-SPONSORED
BY THE KENNEDY FORUM. THE
STEINBERG INSTITUTE, SUMMIT
STATE RECOVERY CENTER, THE
CALIFORNIA CONSORTIUM OF
ADDICTION PROGRAMS AND
PROFESSIONALS, AND THE SANTA
CLARA COUNTY OFFICE OF EDUCATION
WITH US TODAY TO TESTIFY IN
SUPPORT IS LAUREN FINK WITH THE
KENNEDY FORUM AND AMANDA
THOMPSON, WHO WILL SHARE HER OWN
LIVED EXPERIENCE. THANK YOU
AGAIN AND I RESPECTFULLY ASK FOR
YOUR I VOTE. THANK YOU, SENATOR.
PLEASE PROCEED WHEN READY. THANK
YOU, CHAIR AND COMMITTEE
MEMBERS. MY NAME IS LAUREN FINK,
SENIOR DIRECTOR OF POLICY AT THE
KENNEDY FORUM. WE'RE PROUD
SPONSORS OF SB 999. WE ARE
DEDICATED TO ENSURING INSURANCE
COVERAGE OF MEDICALLY NECESSARY
MENTAL HEALTH AND SUBSTANCE USE
DISORDER CARE FOR ALL
CALIFORNIANS, AND ARE COMMITTED
TO SEEING THE FULL
IMPLEMENTATION OF SB 855 AMONG
THE COUNTRY'S MOST ROBUST HEALTH
CARE CONSUMER PROTECTION LAWS,
SB 999 ADDRESSES A NUMBER OF
IMPORTANT PLAN AND REGULATORY
CREATIVE BARRIERS, CREATED
BARRIERS TO FULLY IMPLEMENTING
THIS LAW. DESPITE ROBUST LAWS,
HEALTH PLANS ARE CONTINUING THE
PRACTICE OF UTILIZATION REVIEW
BASED ON A LEGAL NON CLINICAL
STANDARDS OF CARE. NOWHERE ARE
THEY DOING THAT MORE BLATANTLY
THAN THROUGH THE USE OF THIRD
PARTY UTILIZATION REVIEWERS.
THESE REVIEWERS DO NOT HAVE
RELEVANT TRAINING OR
CERTIFICATIONS IN THE CLINICAL
SPECIALTY OF THE CASES THEY ARE
REVIEWING. FOR CALIFORNIANS
SEEKING TREATMENT FOR SUBSTANCE
USE DISORDERS, THAT MEANS MANY
REVIEWERS DO NOT HAVE EXPERTISE
OR TRAINING IN ADDICTION
MEDICINE. INDEED, DATA FROM 38
STATE LICENSED ADDICTION
TREATMENT CENTERS SHOWS
REVIEWERS WITH NO TRAINING IN
ADDICTION MEDICINE, DESPITE LAWS
MANDATING THE EXCLUSIVE USE OF
THE AMERICAN SOCIETY OF
ADDICTION MEDICINE, OR ASAM
CRITERIA. THAT DATA SHOWED
REVIEWERS NOT USING OR CITING
ASAM IN THEIR DETERMINATIONS,
WHICH ARE THE VAST MAJORITY OF
THE TIME DENIALS. THIS PRACTICE
IS COMMON ACROSS THE MENTAL
HEALTH AND ADDICTION FIELD,
INCLUDING FOR EATING DISORDERS
AND AUTISM TREATMENT. WHEN
ENROLLEES WHO HAVE BEEN DENIED
CARE APPEAL THESE CLAIMS, THEY
ARE OFTEN CALLED AT ALL HOURS,
EARLY MORNINGS, LATE AT NIGHT
REQUESTING INFORMATION
IMMEDIATELY, AND THREATENED TO
HAVE THEIR CARE DENIED UNLESS
THEY IMMEDIATELY COMPLY. SB 999
ENSURES UTILIZATION REVIEW IS
DONE BY A PROVIDER WITH RELEVANT
CLINICAL TRAINING AND EXPERIENCE
AS THE CLINICIANS WHO ARE
PRESCRIBING THAT CARE, IT
ENSURES CONTACT WITH ENROLLEES
DURING BUSINESS HOURS. IT
REQUIRES THE REVIEWER TO LIST
THEIR NAME AND CREDENTIALS ON A
DENIAL. KNOWING ALL OF ALL THIS
INFORMATION IS WHAT ALLOWED OUR
PROVIDER PARTNERS TO IDENTIFY
THESE ISSUES, AND IS AN
ADDITIONAL TOOL REGULATORS CAN
USE FOR IDENTIFYING BAD ACTORS.
UTILIZATION REVIEWERS. WITH
THESE IMPORTANT PROTECTIONS, WE
CAN ENSURE CALIFORNIANS GET
ACCESS TO THE MEDICALLY
NECESSARY MENTAL HEALTH AND
ADDICTION TREATMENT THEY NEED
WITHOUT RELYING ON AN APPEAL AND
TIME AND MONEY OUT OF POCKET TO
SECURE THAT CARE. THANK YOU.
THANK YOU. NEXT, PLEASE. GOOD
AFTERNOON. MY NAME IS AMANDA AND
I'M HERE TO SHARE MY JOURNEY OF
RECOVERY THAT HAS BEEN
CHALLENGED BY SYSTEMIC BARRIERS
AND WRONGFUL DENIALS, DENIALS OF
CARE. WHEN I ENTERED TREATMENT,
I HAD BEEN DRINKING 1 TO 2
BOTTLES OF WINE DAILY FOR TWO
YEARS, THE RESULT OF A SEVEN
YEAR MARRIAGE TO A VERBALLY
ABUSIVE NARCISSIST, IN WHICH I
ENDURED CONSTANT CRITICISM AND
EXPLOSIVE RAGE. THIS ABUSE
EXTENDED TO OUR TWO DOGS. THIS
MARRIAGE ULTIMATELY STRIPPED ME
OF MY IDENTITY AND SELF-WORTH
SIGNIFICANTLY IMPACTING MY
EMOTIONAL WELL-BEING AND ABILITY
TO GET SOBER. MY PATH TO
RECOVERY, HOWEVER, WAS BLOCKED
NOT JUST BY THESE CHALLENGES,
BUT BY A HEALTH CARE SYSTEM THAT
DID NOT SEEM TO CARE ABOUT MY
NEEDS. DESPITE MY NEED FOR
TREATMENT, MY HEALTH PLAN ANTHEM
DENIED THE ESSENTIAL LAST WEEK
OF MY CARE. THIS DENIAL WAS NOT
BASED ON A LACK OF MEDICAL
NECESSITY, BUT ON A FLAWED
REVIEW PROCESS. FLAWED REVIEW
PROCESS CONDUCTED BY A GERIATRIC
PSYCHIATRY WITH NO EXPERTISE IN
ADDICTION MEDICINE. IN FACT, MY
REVIEWER HAS AN 87 TO 9% DENIAL
RATE FOR ADDICTION SERVICES. THE
CLINICIANS WHO PRESCRIBE THE
CARE THAT MY HEALTH PLAN DENIED
WERE USING A SAM'S NATIONAL
SUBSTANCE USE TREATMENT
CRITERIA. THE FINAL WEEK OF
TREATMENT WAS VITAL TO GIVING ME
THE SUPPORT AND BREAKTHROUGHS
NECESSARY FOR ME TO PROCESS MY
TRAUMA AND FOCUS ON MY RECOVERY.
I STEPPED DOWN TO OUTPATIENT
CARE IN A MUCH HEALTHIER PLACE,
AND LATER RETURNED TO SCHOOL IN
DECEMBER. I WILL COMPLETE MY
MASTER'S DEGREE IN CLINICAL
PSYCHOLOGY. THE COST OF MY
RECOVERY AND CARE THAT SHOULD
HAVE BEEN COVERED UNDER MY
HEALTH PLAN WAS INSTEAD FUNDED
BY MY PARENTS, WHO HAD TO TAKE A
SECOND MORTGAGE OUT ON THEIR
HOUSE AND DIP INTO THEIR
RETIREMENT SAVINGS. A FINANCIAL
STRAIN THEY BEAR. TO THIS DAY.
I'M HERE SPEAKING TO YOU TODAY
NOT JUST AS A SURVIVOR, BUT AS A
TESTAMENT TO WHAT'S AT STAKE
WITHOUT THE LIFE SAVING
POTENTIAL OF THIS BILL. I WAS
FORTUNATE TO HAVE THE SUPPORT OF
MY PARENTS, WHO AT GREAT COST,
WERE ABLE TO PAY FOR THE
MEDICALLY NECESSARY, MEDICALLY
NECESSARY CARE THAT MY HEALTH
PLAN WRONGFULLY DENIED. NOT
EVERYONE STRUGGLING WITH
SUBSTANCE AND MENTAL HEALTH
CHALLENGES IN CALIFORNIA HAS
THAT KIND OF SUPPORT. OUR BATTLE
WITH SUBSTANCE USE IS ALREADY
DAUNTING. LET'S NOT LET HEALTH
PLAN NEGLIGENCE BE ANOTHER
OBSTACLE. I ASK YOU TO PLEASE
JOIN ME IN SUPPORTING THIS BILL,
TO SAFEGUARD THE RIGHT TO
LIFESAVING CARE FOR THOSE
SEEKING TREATMENT FOR MENTAL
HEALTH AND SUBSTANCE USE
DISORDERS. THANK YOU, THANK YOU,
THANK YOU BOTH FOR JOINING US.
ARE THERE ANY OTHER SUPPORTERS
OF THIS MEASURE IN THE HEARING
ROOM? IF SO, PLEASE STEP FORWARD
. YOUR NAME, AFFILIATION AND
POSITION ON THE MEASURE ONLY.
PLEASE GOOD AFTERNOON. SHERRY
DALY WITH THE CALIFORNIA
CONSORTIUM OF ADDICTION PROGRAMS
AND PROFESSIONALS, PROUD
CO-SPONSORS AND SUPPORT. THANK
YOU. THANK YOU. NEXT, PLEASE,
TONY TRUJILLO, ON BEHALF OF THE
CALIFORNIA TEACHERS ASSOCIATION
IN SUPPORT. THANK YOU. SIR JOHN
DREBINGER WITH THE STEINBERG
INSTITUTE, PROUD CO-SPONSOR OF
THE BILL IN SUPPORT. THANK YOU.
THANK YOU. KATIE VAN DINES WITH
HEALTH ACCESS CALIFORNIA AND
STRONG SUPPORT. THANK YOU. THANK
YOU MA'AM. NEXT PLEASE KAT BEST
WITH THE CALIFORNIA ALLIANCE OF
CHILD AND FAMILY SERVICES IN
SUPPORT. THANK YOU. VANESSA
CADENA WITH KP PUBLIC AFFAIRS ON
BEHALF OF THE CALIFORNIA ACADEMY
OF FAMILY PHYSICIANS. HERE IN
SUPPORT. THANK YOU MA'AM. NEXT
PLEASE. TOM RENFREE WITH THE
CALIFORNIA ASSOCIATION OF
ALCOHOL AND DRUG PROGRAM
EXECUTIVES IN SUPPORT. OKAY.
YES, MA'AM. MELISSA CORTEZ, ON
BEHALF OF AUTISM SPEAKS AND THE
COUNCIL OF AUTISM SERVICE
PROVIDERS HERE IN SUPPORT. THANK
YOU FOR JOINING US, SIR. GOOD
AFTERNOON, MR. CHAIR AND
MEMBERS. ANDREW ANTWI WITH CHAU
YODER, ANTWI SCHMELZER AND
LAYING HERE TODAY ON BEHALF OF
THE CALIFORNIA MEDICAL
ASSOCIATION IN SUPPORT. THANK
YOU. GOOD AFTERNOON, CHAIR AND
MEMBERS, TYLER RINDY, ON BEHALF
OF THE CALIFORNIA PSYCHOLOGICAL
ASSOCIATION AND SUPPORT. THANK
YOU SIR. YES, MA'AM. AMANDA
DICKEY, ON BEHALF OF THE SANTA
CLARA COUNTY SUPERINTENDENT OF
SCHOOL, PROUD CO-SPONSOR AND
SUPPORT. THANK YOU, LEAH BARROS,
ON BEHALF OF CALIFORNIA HOSPITAL
ASSOCIATION, IN SUPPORT. THANK
YOU. YES, MA'AM. JESSICA MORAN
WITH THE CALIFORNIA DENTAL
ASSOCIATION IN SUPPORT. THANK
YOU, MA'AM. JENNIFER SNYDER WITH
CAPITAL ADVOCACY ON BEHALF OF
THE CALIFORNIA LIFE SCIENCES IN
SUPPORT. SNYDER. YES, SIR. ON
BEHALF OF THE NATIONAL UNION AND
HEALTH CARE WORKERS AND PINNACLE
EGIS TREATMENT CENTERS IN
SUPPORT. THANK YOU. YES, MA'AM.
JOAN BORSTEN, EXECUTIVE DIRECTOR
OF SUMMIT OF STATE RECOVERY
CENTER. WE'RE PROUD TO SPONSOR
THIS BILL. THANK YOU. ARE THERE
ANY OTHER SUPPORT WITNESSES IN
THE HEARING ROOM? SEEING NONE,
LET'S TURN TO OPPOSITION
WITNESSES FIRST. LEAD OPPOSITION
.
GOOD TO SEE YOU BOTH. PLEASE
IDENTIFY YOURSELVES FOR THE
RECORD AND PROCEED WHEN READY.
YOU JUST TURN IT OFF. GOOD
AFTERNOON. HAPPENS TO ME TOO. I
SHOULD BE USED TO USED TO THIS
BY NOW. SO MY APOLOGIES. IT TOOK
ME 12 YEARS. GOOD AFTERNOON, MR.
CHAIR. MEMBERS OF THE COMMITTEE,
JED HAMPTON WITH CALIFORNIA
ASSOCIATION OF HEALTH PLANS.
REGRETTABLY, HERE, IN OPPOSITION
TO SB 999, WE WOULD LIKE TO
THANK THE AUTHORS OFFICE, THE
SPONSORS AND THE COMMITTEE STAFF
FOR THE PRODUCTIVE CONVERSATIONS
THAT WE'VE HAD ON THE BILL. FROM
OUR PERSPECTIVE, THE MOST RECENT
SET OF AMENDMENTS, ARE REALLY
POSITIVE. WE THINK THEY MOVED
THE BILL IN THE RIGHT DIRECTION.
SO WE'RE VERY PLEASED TO SEE
THOSE RECENT AMENDMENTS.
HOWEVER, WE DO HAVE SOME
REMAINING CONCERNS WITH THE BILL
THAT WE WOULD LIKE TO WORK WITH
THE AUTHOR ON. SPECIFICALLY, WE
ARE CONCERNED THAT THE BILL
WOULD ALLOW INDIVIDUALS TO
ACCESS THE PERSONAL INFORMATION
AND CREDENTIALS OF THE HEALTH
CARE PROVIDER WHO IS MAKING THE
UTILIZATION REVIEW
DETERMINATION. WE ARE CONCERNED
THAT THIS COULD UNNECESSARILY
EXPOSE THE PROVIDER PERFORMING
THAT UTILIZATION REVIEW TO
INAPPROPRIATE AND POTENTIALLY
TROUBLING COMMUNICATION FROM THE
INDIVIDUAL SHOULD THEY DISAGREE
WITH THE DECISION MADE BY THE
PROVIDER. Ã CURRENT LAW
PROVIDES A PATHWAY WHEN AN
ENROLLEE DISAGREES WITH THE
UTILIZATION REVIEW DECISION, AND
ENROLLEE CAN FILE A GRIEVANCE
WITH THE HEALTH PLAN REGARDING
THE DECISION, WHEREBY THE HEALTH
PLAN MUST RECEIVE REVIEW AND
RESOLVE THE GRIEVANCE WITHIN 72
HOURS. WHEN THE ENROLLEE FACES
AN IMMINENT OR SERIOUS THREAT TO
THEIR HEALTH. WE BELIEVE THAT
THE EXISTING GRIEVANCE PROCESS
PROVIDES THE ENROLLEE WITH A
ROBUST AND TIMELY PROCESS FOR
RESOLVING THESE DISPUTED
DECISIONS IN A WAY THAT ALSO
PROTECTS THE PERSONAL
INFORMATION AND THE CLINICAL
DETERMINATION OF THE DETERMINING
PROVIDER. WE ALSO HAVE SOME
REMAINING QUESTIONS AROUND THE
REQUIREMENT FOR DETERMINING
PROVIDERS TO DISCLOSE TO THE
TREATING PROVIDER. THE PLAN'S
BASIS FOR A DENIAL. WE TYPICALLY
DO THIS VIA A DENIAL LETTER,
WHICH IS SENT IN WRITING TO THE
ENROLLEE, AND THAT DENIAL LETTER
TYPICALLY, YOU KNOW, PROVIDES A
BASIS FOR THE DENIAL AND WHY THE
ENROLLEE DID NOT MEET THE
CLINICAL CRITERIA. IN THE DENIAL
LETTER TO THE ENROLLEE. SO WE
ARE A LITTLE UNCLEAR ON ON THIS
BILL RELATIVE TO THE
COMMUNICATION PORTION, WHETHER
THAT DENIAL LETTER ALSO NEEDS TO
BE COMMUNICATED VIA EMAIL OR VIA
TELEPHONE DURING THE TELEPHONE
HOURS OF THE HEALTH PLAN. SO WE
JUST WANT TO SEEK A LITTLE BIT
MORE CLARIFICATION ON THAT
PROVISION MOVING FORWARD. BUT WE
ARE COMMITTED TO WORKING WITH
THE AUTHOR AND THE SPONSORS TO
ENSURE THAT OUR ENROLLEES HAVE
QUALITY MENTAL HEALTH CARE. SO
AGAIN, FOR THE FOR THESE
REASONS, WE ARE CURRENTLY
OPPOSED, BUT LOOK FORWARD TO
WORKING WITH THE AUTHOR AND THE
SPONSORS A LITTLE BIT MORE TO
RESOLVE SOME OF THESE
OUTSTANDING CONCERNS. THANK
THANK YOU, SIR. MA'AM. STEPHANIE
WATKINS, ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA LIFE
AND HEALTH INSURANCE COMPANIES,
IN THE INTEREST OF TIME, I KNOW
WE HAVE A LONG AGENDA TODAY.
I'LL ECHO MANY OF MY COLLEAGUES
COMMENTS AND JUST HIGHLIGHT THE
ISSUES AROUND THE PRIVACY OF THE
INDIVIDUAL REVIEWER. WE'D LIKE
TO HAVE THOSE CONVERSATIONS WITH
THE AUTHOR AND SPONSOR OF THE
BILL MOVES FORWARD TODAY. THANK
YOU. THANK YOU FOR THOSE
COMMENTS. APPRECIATE YOUR
ATTENDANCE. OTHER INDIVIDUALS IN
OPPOSITION NAME, AFFILIATION AND
POSITION ON THE MEASURE, PLEASE.
MR. CHAIR MEMBERS JOHN WINKLER,
ON BEHALF OF AMERICA'S HEALTH
INSURANCE PLANS, JUST ECHO THE
COMMENTS, CAP AND I LOOK FORWARD
TO FUTURE CONVERSATIONS. THANK
YOU SIR. ANY OTHER WITNESSES IN
THE HEARING ROOM IN OPPOSITION
TO THE MEASURE? SEEING NONE,
THERE'S NOBODY TO TURN IT BACK
TO ON THE DAIS YET IN CASE YOU
ALL ARE WONDERING OUT THERE, WE
HAVE MULTIPLE COMMITTEES RUNNING
AT THE SAME TIME TODAY, SO
UNFORTUNATELY YOU'RE STUCK WITH
ME AND IT'S NOT MY DEODORANT.
SENATOR, WOULD YOU LIKE TO
CLOSE? YES. THANK YOU VERY MUCH.
AGAIN, CHAIR, I APPRECIATE VERY
MUCH, THIS COMMITTEE'S ANALYSIS.
CGRTS YOUR YOUR WORK WITH US ON
ON THIS ACTUALLY IN A NUMBER OF
BILLS, THIS SESSION, VERY MUCH
APPRECIATED. I JUST WANT TO
THANK ALL ALL OF THE WITNESSES
TODAY ON ON BOTH SIDES FOR THEIR
TESTIMONY IN THEIR IN THE CASE
OF THE OPPOSITION, THEIR
WILLINGNESS TO CONTINUE TO WORK
WITH US, GIVE US FEEDBACK TO
MAKE IT A BETTER BILL, WE WILL
WORK AND TALK WITH THEM ABOUT
THE PRIVACY CONCERNS, BUT IT IS
OUR UNDERSTANDING AND ACTUALLY
THE WAY WE GET SOME OF THE DATA
ON THIS BILL, IS, IS BECAUSE,
THE INFORMATION NØ CONTACT
INFORMATION I WANT TO EMPHASIZE,
BUT NAME AND CREDENTIALS ARE,
ARE INCLUDED, CURRENTLY, BY BY
SOME OF THE PRACTITIONERS. WE
JUST WANT TO MAKE THAT UNIVERSAL
SO WE CAN BETTER TRACK WHERE ALL
TOO OFTEN RUNNING INTO A
SITUATION WHERE NOT EVERYBODY IS
ABLE TO GIVE US, THE ACTUAL DATA
IN TERMS OF DENIALS. THAT SAID,
MY LAST THANK YOU IS, MORE
SPECIFICALLY TO THE SUPPORT
WITNESSES, ESPECIALLY AMANDA,
WHO CAME FORWARD HERE AND HAS
EVERY RIGHT, YOU KNOW, TO KEEP,
ANONYMOUS AND HER CONCERNS
CONFIDENTIAL. BUT OBVIOUSLY HAD
THE FORTITUDE AND THE COURAGE TO
COME FORWARD TODAY ON BEHALF OF
SO MANY OUT THERE WHO ARE IN
RECOVERY OR NEED TO BE IN
RECOVERY AND WHO NEED THE PROPER
CARE, I RESPECTFULLY ASK FOR
YOUR VOTE. THANK YOU. SENATOR,
AT THE SUCH TIME AS WE GET A
QUORUM, WE'LL TAKE A MOTION AND
WE'LL CONDUCT THE VOTE.
APPRECIATE THAT VERY MUCH. THANK
YOU. THANK YOU. OUR NEXT ITEM IS
ITEM NUMBER THREE. SENATE BILL
TEN ZERO EIGHT, SENATOR
BRADFORD, OBESITY TREATMENT
PARITY ACT. PLEASE PROCEED WHEN
READY. THANK YOU. MISTER CHAIR
AND COMMITTEE MEMBERS, I WANT TO
START BY ACCEPTING THE COMMITTEE
MEMBERS AND I THANK YOU FOR YOUR
WORK WITH THIS ISSUE. 1008,
KNOWN AS THE OBESITY TREATMENT
PARITY ACT, WOULD REQUIRE HEALTH
PLANS AND INSURERS IN CALIFORNIA
TO PROVIDE COVERAGE FOR
TREATMENT OF OBESITY, OBESITY,
INCLUDING INTENSIVE BEHAVIORAL
THERAPY, BARIATRIC SURGERY AND
AT LEAST ONE FDA APPROVED
ANTI-ABUSE MEDICATION.
CURRENTLY, ONE HAS TO BE
MORBIDLY OBESE BEFORE MOST
HEALTH PLANS WILL KICK IN.
TODAY, OVER 42% OF AMERICANS ARE
OBESE. OBESITY IS A SERIOUS
CHRONIC MEDICAL CONDITION WITH
LINKAGES TO MANY OF THE TOP
CAUSES OF DEATH, INCLUDING HEART
DISEASE, STROKE, DIABETES AND
CANCER. NEARLY HALF OF ALL
OVERWEIGHT OR OBESE ADULTS
REPORT HAVING EITHER NO OR
LITTLE AWARENESS OF DRUGS USED
TO MANAGE OBESITY BECAUSE,
AGAIN, MANY OF THESE HEALTH
PLANS DON'T COVER IT, SO THEY
DON'T MAKE IT AVAILABLE AND MAKE
PATIENTS AWARE THE HIGH COST OF
THESE DRUGS $1,000 OR MORE PER
MONTH FOR THE SUPPLY, MAKE THEM
INACCESSIBLE FOR PATIENTS WITH
LOWER INCOMES. AND IT'S BEEN
PROVEN DIET AND EXERCISE ALONE
DOES NOT WORK. WE'VE HAD MANY
CELEBRITIES SUCH AS OPRAH
WINFREY, AMY SCHUMER, ELON MUSK
AND CHARLES BARKLEY CLEARLY
STATE THAT THEY'RE NOW DEPENDENT
ON THESE DRUGS, BUT THEY CAN
EASILY AFFORD THEM WITHOUT A
HEALTH CARE PLAN. BUT OBESITY
DISPROPORTIONATELY AFFECTS LOW
INCOME CALIFORNIANS, WHO CAN'T
AFFORD THE SAME EFFECTIVE
TREATMENT AS THE INDIVIDUALS I
MENTIONED. ADULTS LIVING BELOW
200% OF THE FEDERAL POVERTY
LEVEL HAVE A HIGHER PREVALENCE
OF OBESITY THAN THEIR HIGHER
INCOME COUNTERPARTS. NOT
SURPRISINGLY, WE SEE RACIAL
DISPARITIES IN THE PREVALENCE OF
OBESITY AS WELL. SPECIFICALLY,
IT WAS FOUND THAT BLACK AND
HISPANICS ADULTS WITH OBESITY
WERE MORE LIKELY TO ENCOUNTER
FINANCIAL BARRIERS TO ACCESSING
ANTI-ABUSE CITY MEDICATION
COMPARED TO THEIR CAUCASIAN
COUNTERPARTS. THE DIVIDE AND
ACCESS IS NOT LIMITED TO RACE
AND ETHNICITY ALONE, BUT ALSO
LOCATION AND EXPENSES. RATES OF
OBESITY ARE HIGHER IN RURAL
AREAS, AND IT'S ESTIMATED TRAVEL
TIME TO OBESITY SPECIALISTS IS
ALMOST FIVE TIMES AS LONG
COMPARED TO ADULTS IN URBAN
AREAS. THE COST OF OBESITY IS
HIGH AND IT'S GROWING BY THE
DAY. A RECENT STUDY FOUND THAT
HEALTH CARE COSTS FOR PEOPLE
WITH OBESITY ARE ABOUT $3,500
HIGHER EACH YEAR THAN THOSE WITH
HEALTHY WEIGHT, WHEN THE
INDIRECT COST OF OBESITY ARE
INCLUDED, THE TOTAL ECONOMIC
COSTS OF OBESITY IS A STAGGERING
ESTIMATED AT NEARLY $1.4
TRILLION. LOOKING AT THOSE
FUTURE AVOIDED COSTS, IT MAKES
SENSE THAT MEDI-CAL HAS CHOSEN
TO COVER ANTI-OBESITY MEDICATION
FOR MORE THAN A YEAR NOW, AND
CALPERS HAS ADDED COVERAGE FOR
ANTI-OBESITY MEDICATION AS OF
THIS YEAR. LIKE OTHER CHRONIC
DISEASES, OBESITY TREATMENT
SOMETIMES REQUIRES A CONTINUUM
OF CARE, INCLUDING PRIMARY AND
SPECIALIST CARE, ANTI-OBESITY
MEDICATION, AND POTENTIAL
SURGICAL INTERVENTION. SB 1008
WILL INCREASE ACCESS TO THESE
LIFE CHANGING TREATMENTS.
TESTIFYING IN SUPPORT OF THIS
MEASURE TODAY IS DOCTOR WESLEY
MIZUTANI, RHEUMATOID OTOLOGIST
AND ASSISTANT CLINICAL PROFESSOR
AT OF MEDICINE AT UC SAN DIEGO
AND ESTELLA MATA, CO-FOUNDER AND
PRESIDENT OF LOOMS FOR LUPUS AND
VICE CHAIR OF THE CALIFORNIA
CHRONIC CARE COALITION. I
RESPECTFULLY ASK FOR YOUR VOTE.
I VOTE PLEASE PROCEED WHEN READY
. GOOD AFTERNOON, MR. CHAIR, AND
MEMBERS OF THE COMMITTEE. I AM
ESTELLA MATA CARCAMO, THE
PRESIDENT AND CO-FOUNDER OF
LOOMS FOR LUPUS, A NONPROFIT
ORGANIZATION PROVIDING LUPUS,
FIBROMYALGIA AND MENTAL HEALTH
AWARENESS ADVOCACY AND SUPPORT
TO THOSE LIVING WITH THESE
CONDITIONS. THEIR LOVED ONES AND
CAREGIVERS. LOOMS FOR LUPUS IS A
MEMBER OF CEE-HOPE, THE CHRONIC
OBESITY PREVENTION AND EDUCATION
ALLIANCE, AND IT IS SPONSORING
SB TEN ZERO EIGHT, THE OBESITY
TREATMENT PARITY ACT. OBESITY IS
A CHRONIC DISEASE. IT IS
RECOGNIZED AS SUCH BY COUNTLESS
PROFESSIONALS, PROFESSIONAL
ORGANIZATIONS INCLUDING THE
AMERICAN COLLEGE OF PHYSICIANS,
THE OBESITY MEDICINE
ASSOCIATION, AND THE AMERICAN
MEDICAL ASSOCIATION. ADULTS
IMPACTED BY OBESITY HAVE AN
INCREASED RISK OF HEART DISEASE,
CANCER, DIABETES, COVID 19
COMPLICATIONS AMONG MORE THAN
200 COMORBIDITIES. IT IS
CRITICAL TO ANY DISCUSSION OF
OBESITY TO ACKNOWLEDGE THE
IMPACT OF THE DISEASE IN
UNDERSERVED POPULATIONS. THE
PREVALENCE OF OBESITY IN AFRICAN
AMERICANS IS 35.6. IN THE
HISPANIC POPULATION, PREVALENCE
IS 32.9, COMPARED TO JUST 23.9
CAUCASIAN POPULATION. WE BELIEVE
IT IS PAST TIME THAT SUPPORT IS
PROVIDED FOR THE FOR EVERYONE
COPING WITH OBESITY, ESPECIALLY
THESE AT RISK GROUPS. SB TEN
ZERO EIGHT PROVIDES THAT SUPPORT
. OBESITY IS A COMPLICATED
DISEASE RESULTING FROM MULTIPLE
FACTORS. THOSE FACTORS CAN BE
INHERITED, PHYSIOLOGICAL AND
ENVIRONMENTAL. YES, DIET AND
EXERCISE CAN CONTRIBUTE
POSITIVELY OR NEGATIVELY TO
OBESITY, BUT THESE CONTRIBUTING
FACTORS CHANGE THINGS IN THE
BODY AND MIND, CREATING BRAIN
PATHWAYS THAT ARE DIFFICULT TO
OVERCOME. ASSISTANCE,
PARTICULARLY IN THESE AT RISK
GROUPS WHO MAY MORE THAN ONE
FACTOR, MAY HAVE MORE THAN ONE
FACTOR LEADING TO OBESITY.
PATIENTS WITH OBESITY MAY ALSO
HAVE FACED YEARS OF WEIGHT LOSS
ATTEMPTS AND BEING TOLD THEIR
WEIGHT IS DUE TO FAILURE AND
THEIR CHARACTER. THEY MAY BE
DEPRESSED AND BE SUFFERING FROM
LOSS AND REJECTION VARIOUS WAYS
DUE TO THEIR WEIGHT. THIS LEADS
TO MENTAL HEALTH ISSUES THAT
ALSO LEAVES PEOPLE LESS
INCAPABLE OF CHANGING THEIR
WEIGHT WITHOUT ASSISTANCE. OTHER
DISEASES, HORMONES AND
MEDICATION FOR OTHER CONDITIONS
MAY LEAD TO OBESITY AND
UNSUCCESSFUL WEIGHT LOSS
EFFORTS. THESE PATIENTS NEED
HELP. YET DUE TO SOCIAL STIGMAS
AND THE ASSUMPTION THAT OBESITY
IS A LIFESTYLE CHOICE OR A
CHARACTER DEFICIT, PEOPLE
SUFFERING FROM OBESITY ARE OFTEN
IGNORED AND GIVEN LESS THAN
IDEAL TREATMENT IN LIFE. FOR
THEIR CHRONIC DISEASE. NO ONE
WOULD SEND A PATIENT WITH HEART
DISEASE HOME WITHOUT TEST, A
PLAN, A PRESCRIPTION, AND
PERHAPS SURGERY SCHEDULED. YET
WE DEBATE WHETHER PATIENTS WITH
OBESITY TRULY REQUIRE ACCESS TO
QUALITY TREATMENT. THE LACK OF
TREATMENT FOR OBESITY NEEDS TO
CHANGE. OBESITY MUST BE TREATED
AS A DISEASE AND PATIENTS MUST
RECEIVE ACCESS TO TREATMENT. IT
IS URGENT TO CREATE PARITY IN
THE TREATMENT OF OBESITY AND TO
ADDRESS THE UNEQUAL IMPACT OF
OBESITY ON AT RISK GROUPS. SB
TEN ZERO EIGHT DOES JUST THAT.
PLEASE SUPPORT THE OBESITY
TREATMENT PARITY ACT? THANK YOU
SIR. YOU'RE NEXT MR. CHAIR, AND
MEMBERS OF THE COMMITTEE, THANK
YOU FOR ALLOWING ME THE
OPPORTUNITY TO SPEAK TO YOU
TODAY. I AM DOCTOR WESLEY
MIZUTANI. I'M A PRACTICING
RHEUMATOLOGIST IN HUNTINGTON
BEACH FOR OVER 30 YEARS. I'M
ALSO BOARD MEMBER OF THE
ALLIANCE FOR PATIENT ACCESS, A
PHYSICIAN DRIVEN VOLUNTEER
ORGANIZATION THAT STRIVES TO
IMPROVE THE ACCESS TO HEALTH
CARE FOR ALL PATIENTS. CGRTS I'M
HERE TO ASK YOUR SUPPORT FOR SB
TEN ZERO EIGHT, THE OBESITY
TREATMENT PARITY ACT. OBESITY IS
A DISEASE THAT AFFECTS OVER 40%
OF THE US POPULATION. HOWEVER,
IN MY PRACTICE, IT'S ABOUT 50%
OF MY PATIENTS ARE COPING WITH
THIS DISEASE. AND I WILL DETAIL
WHAT I MEAN BY COPING SHORTLY.
BUT SUFFICE TO SAY, OBESITY IS
CLEARLY BEEN SHOWN TO INCREASE
MORBIDITY AND MORTALITY OF MOST
DISEASES, INCLUDING HEART
DISEASE, DIABETES, AND YES, EVEN
ARTHRITIS. IT IS CRITICAL THAT
PHYSICIANS TREAT OBESITY AS A
DEVASTATING CHRONIC DISEASE AND
THEY HAVE ALL THE TOOLS
NECESSARY. RHEUMATOID ARTHRITIS,
OR RA, IS A CHRONIC SYSTEMIC
INFLAMMATORY ARTHRITIS THAT
LEADS TO JOINT DESTRUCTION AND
IS A LEADING CAUSE OF DISABILITY
IN THE WORKING POPULATION. AND I
THOUGHT IT WOULD BE INSTRUCTIVE
TO PRESENT A CASE FROM MY
PRACTICE THAT ILLUSTRATES HOW
OBESITY CAN COMPLICATE EVERY
ASPECT OF A PATIENT'S LIFE, ROSA
IS A 50 YEAR OLD WORKING MOTHER
OF THREE. SHE'S INSURED BY
MEDI-CAL. SHE HAS HAD SEVERE
RHEUMATOID ARTHRITIS FOR OVER
TEN YEARS. SHE ALSO HAS A
HISTORY OF OBESITY FOR MOST OF
HER LIFE, AND DUE TO THE
SEVERITY OF HER RHEUMATOID
ARTHRITIS, SHE WAS NOT ABLE TO
EXERCISE. AS A RESULT, SHE
GAINED OVER 150 POUNDS IN TEN
YEARS. THIS RESULTED,
UNFORTUNATELY, IN HER DEVELOPING
SEVERE OSTEOARTHRITIS OF BOTH
HIPS AND ULTIMATELY REQUIRED TO
GET A BILATERAL HIP REPLACEMENT
AT AGE 50. HER OBESITY ALSO LED
TO HER DEVELOPING WHAT IS
COMMONLY KNOWN AS FATTY LIVER.
HOWEVER, ROSA WAS ON A
MEDICATION CALLED METHOTREXATE
FOR RHEUMATOID ARTHRITIS AND
RESPONDED QUITE WELL. HOWEVER,
WE HAD TO STOP IT BECAUSE OF HER
FATTY LIVER GETTING OUT, AND HER
RHEUMATOID ARTHRITIS THEREFORE
GOT OUT OF CONTROL AT THE SAME
TIME, HER FATTY LIVER PROGRESSED
TO CIRRHOSIS. THIS MEANT THAT
MANY OF THE BIOLOGIC BIOLOGIC
RHEUMATOLOGIC MEDICATIONS THAT
YOU SEE ON TV, SHE COULD NOT
TAKE MOST OF ROSES TRAGIC
MEDICAL ISSUES COULD HAVE BEEN
PREVENTED IF HER OBESITY HAD
BEEN TREATED AGGRESSIVELY.
OBESITY INCREASES THE
UTILIZATION AND EXPENSE OF THE
HEALTH CARE SYSTEM. IN ROSE'S
CASE, AS IN ROSE'S CASE, OBESITY
IS NOT A DISEASE OF CHOICE OR
LIFESTYLE. WE MUST SUPPORT OUR
PATIENTS WHO STRUGGLE WITH
OBESITY JUST AS WE SUPPORT
PATIENTS WITH CANCER OR HEART
DISEASE. PLEASE HELP ME TO AVOID
MORE CASES LIKE ROSA AND SUPPORT
SB TEN ZERO EIGHT, THE OBESITY
TREATMENT PARITY ACT. THANK YOU.
THANK YOU SIR. ARE THERE ANY
OTHER WITNESSES IN SUPPORT IN
THE HEARING ROOM? PLEASE STEP
FORWARD. YOUR NAME, AFFILIATION
AND POSITION ON THE MEASURE
ONLY. PLEASE MR. CHAIR, TIM
MADDEN, REPRESENTING THE
CALIFORNIA RHEUMATOLOGY ALLIANCE
AND SUPPORT AND ALSO
REPRESENTING THE CALIFORNIA
CHAPTER OF THE AMERICAN COLLEGE
OF CARDIOLOGY. WE HAVE A
SUPPORTIVE, AMENDED POSITION.
THANK YOU. SIR NEXT, PLEASE, MR.
CHAIR. ALEX KAHN, ON BEHALF OF
THE CALIFORNIA CHRONIC CARE
COALITION AND A PROGRAM OF THE
COALITION, THE CHRONIC OBESITY
PREVENTION AND EDUCATION
ALLIANCE, WHICH IS PROUD TO
SPONSOR THE BILL. THANK YOU.
YES, MA'AM. HELLO GOOD
AFTERNOON. WHITNEY FRANCIS WITH
THE WESTERN CENTER ON LAW AND
POVERTY IN SUPPORT. THANK YOU.
JENNIFER SNYDER WITH CAPITAL
ADVOCACY ON BEHALF OF THE
CALIFORNIA LIFE SCIENCES IN
SUPPORT. THANK YOU, MR. SNYDER.
YES, MA'AM. GOOD AFTERNOON,
MISSY JOHNSON WITH NIELSEN
MERKSAMER HERE ON BEHALF OF THE
CALIFORNIA PHARMACISTS
ASSOCIATION IN SUPPORT. THANK
YOU FOR JOINING US. ANY OTHER
WITNESSES IN SUPPORT ABOUT
WITNESSES IN OPPOSITION? FIRST
LEAD OPPOSITION WITNESSES
FOLLOWED BY OTHERS? ANY
OPPOSITION WITNESSES? PLEASE
STEP FORWARD. YOU'RE WELCOME TO
JOIN US AT THE TABLE
.
TAKE YOUR TIME, GENTLEMEN. SORT
OF. PLEASE IDENTIFY YOURSELVES
FOR THE RECORD. THANK YOU, MR.
CHAIR. AND COMMITTEE MEMBERS,
PRESTON YOUNG FROM THE
CALIFORNIA CHAMBER OF COMMERCE
HERE TODAY IN RESPECTFUL
OPPOSITION TO SB TEN ZERO EIGHT,
OBVIOUSLY, I WANT TO JUST MAKE
THIS CLEAR FROM THE BEGINNING.
IT'S A WELL-INTENTIONED BILL. WE
UNDERSTAND THAT, AND IT'S NOT
FROM A POLICY PERSPECTIVE THAT
WE'RE HERE, BUT RATHER IT'S THE
UNINTENDED CONSEQUENCES THAT
HAVE MOTIVATED THE OPPOSITION
TODAY, THE REASON FOR OUR
OPPOSITION IS THE COST IMPACT
THAT SB TEN ZERO EIGHT WILL HAVE
ON CALIFORNIA'S EMPLOYERS. WE
APPRECIATE THE WORK THE AUTHOR
HAS DONE TO REDUCE THE COST
IMPACT FROM PREVIOUS ITERATIONS
OF THIS BILL. HOWEVER, THE
CALIFORNIA HEALTH BENEFITS
REVIEW PROGRAM ANTICIPATES THAT
SB TEN ZERO EIGHT WILL INCREASE
EMPLOYER AND ENROLLEE PREMIUMS
BY APPROXIMATELY $136 MILLION,
THAT'S A SIGNIFICANT AND
PREVENTABLE PREMIUM INCREASE FOR
CALIFORNIA'S EMPLOYERS. SO I
KNOW OFTEN WE'RE IN HERE TALKING
ABOUT MANDATES. AND IF YOU LOOK
AT THEM IN ISOLATION, THE COST
INCREASES TYPICALLY DON'T LOOK
TOO DRAMATIC. BUT WHEN YOU PUT
IT TOGETHER AND HAVE CONTEXT TO
IT, IT OBVIOUSLY TAKES ON A BIT
OF A NEW LIFE ITSELF. SO JUST TO
GIVE A LITTLE CONTEXT TO THAT,
OVER THE LAST FIVE YEARS, THE
AVERAGE PREMIUM FOR FAMILY
COVERAGE IN EMPLOYER SPONSORED
PLANS HAS INCREASED 20% IN 2023,
THE AVERAGE ANNUAL PREMIUMS FOR
CALIFORNIA EMPLOYER SPONSORED
FAMILY HEALTH CARE COVERAGE
REACHED $23,968. WORKERS ON
AVERAGE PAID $6,575 TOWARDS THE
COST OF COVERAGE. SO, CERTAINLY
APPRECIATE THE AUTHOR'S
INTENTIONS, BUT WE DO REMAIN
CONCERNED ABOUT THE UNINTENDED
COST INCREASES. SO THAT'S THE
REASON FOR OUR OPPOSITION HERE
TODAY. THANK YOU SO MUCH. AND
THANK YOU FOR JOINING US, SIR.
GOOD AFTERNOON, MR. CHAIRMAN.
MEMBERS OF THE COMMITTEE, JED
HAMPTON WITH THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS,
ALSO HERE, REGRETTABLY, IN
OPPOSITION TO SB 1008, HEALTH
PLANS CURRENTLY COVER A VARIETY
OF WEIGHT MANAGEMENT TOOLS AND
INTERVENTIONS THAT ARE INTENDED
TO PROMOTE, SUSTAINABLE, HEALTHY
LIFESTYLE CHANGES THAT LOWER THE
RISK FOR LONG TUM HEALTH CARE
COMPLICATIONS. SOME OF THESE
TOOLS AND INTERVENTIONS THAT
HEALTH PLANS USE CAN RANGE FROM
MEAL REPLACEMENT, MEDICAL
MONITORING TO INTENSIVE
BEHAVIORAL BEHAVIORAL THERAPY,
BARIATRIC SURGERY, AND, WHEN
MEDICALLY APPROPRIATE, FDA
APPROVED MEDICATION. HOWEVER, WE
WOULD, ALIGN OUR COMMENTS WITH
WITH MY COLLEAGUE OVER HERE AT
THE CALIFORNIA CHAMBER OF
COMMERCE, WE ARE ALSO CONCERNED
ABOUT THE SUBSTANTIAL PREMIUM
IMPACT THAT THIS BILL WILL
CREATE, WE WOULD ALSO NOTE THAT
WHILE WE APPRECIATE THE
AMENDMENTS, THE MOST RECENT SET
OF AMENDMENTS TO THE BILL, YOU
KNOW, WE ARE STILL, WE ARE STILL
LOOKING AT THE POSSIBILITY OF
POTENTIALLY, HAVING THE
REQUIREMENT FOR HEALTH PLANS TO
COVER NEW CLASS OF DRUGS, THE
GLP ONE DRUGS, IF THAT WERE TO
BE THE CASE OR THE INTENT, WE
WOULD EXPECT THE COST IMPACT OF
THE BILL TO BE ORDERS OF
MAGNITUDE GREATER THAN THE 136
MILLION THAT WAS LISTED IN THE
MOST RECENT SUBGROUP ANALYSIS,
LASTLY, WE WOULD NOTE THAT BOTH
THE SENATE AND THE ASSEMBLY
HEALTH COMMITTEE CHAIRS HAVE
INTRODUCED BILLS THIS YEAR TO
BEGIN A PROCESS OF REVIEWING
CALIFORNIA'S ESSENTIAL HEALTH
BENEFITS, FOR THE BENCHMARK
PLAN, 2027 YEAR A CONCEPTUALLY,
HEALTH PLANS ARE SUPPORTIVE OF
THIS EFFORT AND SEE IT AS MORE
PREFERABLE TO THE APPROACH THAN
CONSIDERING ONE OFF BENEFIT
MANDATES THAT INFLATE HEALTH
CARE PREMIUMS FOR ALL
CALIFORNIANS. SO FOR THESE
REASONS, WE ARE REGRETTABLY
OPPOSED TO SB 1008. AND THANK
YOU. WE APPRECIATE YOUR
COMMENTS. ANY OTHER WITNESSES IN
OPPOSITION IN THE HEARING ROOM?
PLEASE STEP FORWARD. STEPHANIE
WATKINS, ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA LIFE
AND HEALTH INSURANCE COMPANIES,
AS WELL AS AMERICA'S HEALTH
INSURANCE PLANS, IN OPPOSITION.
THANK YOU MA'AM. ANY OTHER
OPPOSITION WITNESSES? SEEING
NONE. AND SINCE I'M THE ONLY ONE
ON THE DAIS, SENATOR, I HAVE NO
QUESTIONS. WOULD YOU LIKE TO
CLOSE? YEAH, I JUST WANT TO
THANK THOSE. WHO CAME AND
TESTIFIED IN SUPPORT AND ALSO
CHALLENGE AND APPRECIATE THE
CHAMBER AND THEIR HEALTH PLAN
MEMBERS. I THINK THEIR
INTENTIONS ARE WELL INTENDED,
BUT THEY'VE TAKEN A VERY
SHORTSIGHTED, VIEW OF THIS BILL.
THERE IS NO DOUBT OF ADDRESSING
CALIFORNIA'S OBESITY EPIDEMIC.
WILL TAKE RESOURCES. IT WILL
COST MONEY. HOWEVER, A REASON
ANALYSIS OF THE FINANCIAL
IMPACTS MUST LOOK AT BOTH THE
FRONT END COST AND THE FAR
GREATER BENEFITS AND COST
SAVINGS THAT WILL BE REALIZED ON
THE BACK END. TO BE CLEAR, WE'RE
NOT TALKING ABOUT REMOTE, VAGUE
OR SPECULATIVE OUTCOMES. WE'RE
TALKING ABOUT ESTABLISHING
CONCRETE COST SAVINGS AND PUBLIC
HEALTH BENEFITS THAT ARE
REASONABLY CERTAIN TO RESULT
FROM THIS BILL. IN 2023, THE
STATE OF NEW YORK FOUND THAT
OBESITY AND OVERWEIGHT COSTS THE
STATE OVER $37 BILLION IN
REDUCED ECONOMIC ACTIVITY, OVER
$5 BILLION IN DIRECT IMPACT TO
THE STATE BUDGET AND LED TO A $3
BILLION LED TO $3 BILLION IN
HIGHER HEALTH CARE COSTS FOR
EMPLOYERS AND ALMOST $2 BILLION
IN HOUSEHOLDS WITH PRIVATE
INSURANCE. MOREOVER, OBESITY AND
OVERWEIGHT LED TO 165,000 FEWER
ADULTS IN THE WORKPLACE. THAT
SAME REPORT RECOMMENDED THE
APPROACH THAT WE'RE TAKING RIGHT
NOW WITH SB 1008 COVERAGE FOR A
COMPREHENSIVE SUITE OF OBESITY
INTERVENTIONS, IT IS MODELED, I
SAID, IN ITS MODELING. THE
REPORT FOUND THAT SUCH COVERAGE
WOULD DRIVE DOWN COSTS OF
OBESITY RATES BY 16% AND THE
LEAST AGGRESSIVE SCENARIO, AND
OVER 70% IN THE MOST AGGRESSIVE
SCENARIO. MEDICAL COSTS AMONG
THE MODELED POPULATION COULD
DECLINE BY THE AVERAGE BY AN
AVERAGE OF OVER $20,000 PER
PERSON AND OVER $70 BILLION OVER
TEN YEARS ON THE STATE LEVEL.
THESE FIGURES DWARF THE INITIAL
INVESTMENT, WHILE PUTTING MONEY
BACK IN THE POCKETS OF FAMILIES
AND EMPLOYERS, FILLING STATE
COFFERS, REJUVENATING OUR
WORKFORCE AND, OF COURSE,
ALLOWING CALIFORNIANS TO LIVE A
HAPPIER, HEALTHIER LIVES, FREE
FROM STIGMA, PAIN AND MENTAL
HEALTH IMPACTS OF OBESITY. FOR
THOSE REASONS, AND MANY THAT ARE
NOT BEING STATED HERE, I
RESPECTFULLY ASK FOR YOUR I
VOTE. THANK YOU SENATOR. WHEN WE
ACHIEVE A QUORUM, WE'LL TAKE A
MOTION TO ENTERTAIN A MOTION AND
TAKE A VOTE. APPRECIATE YOUR
PRESENTATION. THANK YOU.
GENTLEMEN. SENATOR PORTANTINO,
ITEM NUMBER FOUR, SENATE BILL
1147, DRINKING WATER, BOTTLED
WATER, MICROPLASTICS. PROCEED
WHEN READY. THANK YOU. THANK
YOU, MR. CHAIR. I'D SAY
COMMITTEE MEMBERS, BUT THERE ARE
NO COMMITTEE MEMBERS, FOR
LETTING ME PRESENT SB 1147,
WHICH BUILDS UPON WORK FROM 2018
THAT DIRECTED THE STATE WATER
BOARD TO DEFINE MICRO
MICROPLASTICS AND DEVELOP
STANDARDS AND METHODS TO TEST
FOR MICROPLASTICS IN OUR
DRINKING WATER. MICROPLASTICS
HAVE BEEN IDENTIFIED IN RAIN,
DRINKING WATER, SOIL, PRETTY
MUCH JUST ABOUT EVERYWHERE, AND
WE NEED TO MAKE SURE THAT WE
HAVE CLEAR SCIENCE ON WHAT THAT
EXPOSURE MEANS, AND WE NEED TO
HAVE SOME CLEAR METRICS ON THE
PRESENCE OF MICROPLASTICS SO WE
CAN DEAL WITH IT. WE ALSO KNOW
THAT WHEN THEY'RE INGESTED BY
MARINE LIFE, MICROPLASTICS HAVE
BOTH TOXIC AND MECHANICAL
EFFECTS, CAUSING REDUCED
FLOODING, FOOD INTAKE,
SUFFOCATION, BEHAVIORAL CHANGES
AND GENETIC ALTERATIONS. IT'S
IMPERATIVE THAT WE PRIORITIZE
THE RESEARCH AND ANALYSIS.
ANALYSIS OF MICROPLASTICS FOR
THE SAKE OF PUBLIC SAFETY AND
THE PUBLIC HEALTH. SB 1147 WILL
DIRECT THE OFFICE OF
ENVIRONMENTAL HEALTH HAZARDS
ASSESSMENT TO PRIORITIZE THE
STUDY AND STUDY. THE HEALTH
IMPACTS OF MICROPLASTICS IN
DRINKING WATER WILL ALSO WORK
WITH THE STATE WATER BOARD IN
DEVELOPING GOALS TO ADDRESS THE
PROBLEM. AND THAT'S WHAT WE'RE
TRYING TO DO. WE WANT TO ADDRESS
THE PROBLEM, AND WE THINK THIS
IS A GOOD STEP FORWARD. THE
DEPARTMENT OF HEALTH WILL
COLLECT MICROPLASTIC DATA FROM
THE WATER BOTTLING PLANTS.
THAT'S ALSO WHAT'S IMPORTANT IS
WE'RE INCLUDING, DRINKING,
BOTTLES AS WELL, NOT JUST OUR
GENERAL WATER SUPPLY. AND SO,
1147 IS, IS AN EFFORT TO
CONTINUE A COMMITMENT TO
IDENTIFY AND DEAL WITH
MICROPLASTICS IN ALL ASPECTS OF
OUR DRINKING WATER AND, WHEN
APPROPRIATE, WOULD RESPECTFULLY
ASK FOR AN AYE VOTE. WE DON'T
HAVE ANY PRIMARY WITNESSES.
OKAY. THANK YOU. SENATOR, ARE
THERE ANY WITNESSES IN THE
HEARING ROOM IN SUPPORT OF THIS
MEASURE? SENATE BILL 1147,
SEEING NONE, ARE THERE ANY
WITNESSES IN OPPOSITION TO THIS
MATTER? SENATE BILL 1147, PLEASE
STEP FORWARD. YOU'RE WELCOME.
YOU'RE WELCOME TO SPEAK FROM
THERE. YOU I'LL BE BRIEF, MR.
CHAIRMAN. IT'S NOT OPPOSITION,
AS I MENTIONED, TO SENATOR
PORTANTINO ELOY GARCIA FOR THE
INTERNATIONAL BOTTLED WATER
ASSOCIATION. MORE HERE OF
CONCERN. AND WE'VE EXPRESSED, I
THINK INITIALLY OUR CONCERNS
WITH SENATOR PORTENTINO AND HIS
STAFF AND LOOK FORWARD TO
WORKING WITH HIM ONGOING. WE ARE
CONCERNED THAT THIS IS A BIT OF
PUTTING THE CART BEFORE THE
HORSE. A LOT OF WORK THAT STILL
HAS TO BE DONE FROM THE PRIOR
LEGISLATION FROM 2018. WE
HAVEN'T HAD DATA COME IN. DO
APPRECIATE THE STEPS THAT WERE
OUTLINED IN THE COMMITTEE
ANALYSIS THAT CLEARLY INDICATES
THAT THERE IS MULTI YEAR EFFORT
OF INFORMATION, DATA GATHERING
THAT STILL NEEDS TO COME IN. WE
BELIEVE IT MIGHT BE THE TIMING
MAY NOT BE RIGHT OR APPROPRIATE
TO BRING BOTTLED WATER IN WHEN
WE HAVE YET TO DEVELOP PRIMARY
DATA ANALYSIS, DEVELOP A PUBLIC
HEALTH STANDARD, A LOT OF WORK
OVER A MULTI YEAR PERIOD THAT
STILL HAS TO BE DONE BEFORE WE
BELIEVE IT APPROPRIATE TO APPLY
TO PUBLIC TO BOTTLED WATER,
INCLUDING PRIMARY RESEARCH ON
THE ON THE HUMAN HEALTH EFFECTS
OF MICROPLASTICS. WE HOPE THAT
THAT INFORMATION WILL DEVELOP
AND CONTINUE TO RESEARCH, WILL
CONTINUE TO DEVELOP GOING
FORWARD. BUT AGAIN WE WANT TO
WORK WITH THE SENATOR GOING
FORWARD ON THE TIMING, THE
APPLICABILITY AND THE
APPROPRIATENESS OF THE TIMING AS
IT RELATES TO BOTTLED WATER. SO
THANK YOU VERY MUCH. THANK YOU
FOR DOING THAT. ANY OTHER
WITNESSES IN OPPOSITION IN
SUPPORT, PLEASE STEP FORWARD.
WE'LL TAKE YOU. THANK YOU FOR
COMING. I'M JUST ADDING MY ME
TWO'S. IS THAT OKAY NOW? YES
MA'AM. OKAY. MY NAME IS VANESSA
FORSYTHE AND I AM HERE SAYING
SUPPORT OF SENATOR PORTANTINO
BILL FOR THESE ORGANIZATIONS.
CLEAN EARTH FOR KIDS, NORTH
COUNTY EQUITY AND JUSTICE,
INTERFAITH COUNCIL FOR
ENVIRONMENTAL JUSTICE, NCC, CA,
ESP, FACS, AND GRANDPARENTS IN
ACTION. THANK YOU. THANK YOU FOR
JOINING US. SEEING NO OTHER
WITNESSES, AND SINCE I'M THE
ONLY ONE ON THE DAIS AND HAVE NO
QUESTIONS. SENATOR, WOULD YOU
LIKE TO CLOSE? I RESPECTFULLY
ASK FOR AN AYE VOTE WHEN WE
ACHIEVE A QUORUM, WE'LL TAKE A
MOTION AND TAKE A VOTE. THANK
YOU FOR YOUR PRESENTATION,
SENATOR DALI. ITEM NUMBER 11,
SENATE BILL 1423, MEDI-CAL
CRITICAL ACCESS. HOSPITALS,
PLEASE PROCEED WHEN READY. THANK
YOU, MR. CHAIR. I WOULD SAY
MEMBERS, BUT THEY'RE NOT HERE. I
WANT TO THANK YOU. I WANT TO
THANK MY START BY THANKING THE
COMMITTEE FOR WORKING WITH ME ON
THIS BILL. AND I WILL BE
ACCEPTING THE COMMITTEE
AMENDMENTS. THERE ARE 37
CRITICAL ACCESS HOSPITALS IN
CALIFORNIA. THESE HOSPITALS
SERVE RURAL AREAS AND SUPPORT
SUPPORT MOST VULNERABLE
POPULATIONS IN OUR STATE. TO BE
GIVEN A CRITICAL ACCESS
DESIGNATION, HOSPITALS MUST HAVE
25 OR FEWER ACUTE CARE INPATIENT
BEDS BE LOCATED MORE THAN 35
MILES FROM ANOTHER HOSPITAL, OR
MORE THAN 15 MILES FROM ANOTHER
HOSPITAL, IN AN AREA WITH
MOUNTAINOUS TERRAIN AND ONLY
SECONDARY ROADS, MOUNTAIN
MAINTAIN AN AVERAGE LENGTH OF
STAY OF 96 HOURS OR LESS FOR
ACUTE CARE PATIENTS, AND PROVIDE
24 HOUR EMERGENCY CARE SERVICES.
WE WERE WE WERE FIRST CONTACTED
IN OUR OFFICE BY PLUMAS COUNTY
HOSPITAL ABOUT AUTHORING THIS
BILL, BASED ON A NEVADA STATE,
STATE OF NEVADA BILL THAT
REQUIRED CRITICAL ACCESS.
HOSPITALS RECEIVE COST BASED
REIMBURSEMENT FOR SWING BED AND
OUTPATIENT SERVICES RIGHT NOW,
MANY RURAL HOSPITALS ARE LOSING
MONEY, PROVIDING ESSENTIAL CARE
TO PATIENTS, AND ARE ON THE
VERGE OF CLOSING. SINCE 2019,
THE PERCENTAGE OF RURAL
HOSPITALS LOSING MONEY HAS
INCREASED FROM 40 TO 50.
HOSPITALS ARE FACED WITH
INCREASED LABOR EXPENSES, THE
EXPANSION OF MEDI-CAL STAFFING
SHORTAGES AND EXPENSIVE BUILDING
REGULATIONS. WE ARE TRYING TO
CREATE A WINNERS ONLY FINANCIAL
MODEL FOR THESE HOSPITALS. THIS
BILL REQUIRES THAT EACH
PARTICIPATING CRITICAL ACCESS
HOSPITAL RECEIVES 100% OF THE
HOSPITAL'S PROJECTED COST FOR
MEDI-CAL COVERED INPATIENT,
OUTPATIENT, AND SKILLED NURSING
FACILITIES. INPATIENT SERVICE
SERVICES, OR SERVICES FOR THOSE
WHO HAVE BEEN ADMITTED TO
FACILITIES THAT REQUIRE A BED
AND AT LEAST AN OVERNIGHT STAY
AT THAT FACILITY. OUTPATIENT
SERVICES OR NON-EMERGENCY HEALTH
SERVICES FOR PATIENTS WHO WILL
STAY IN THE HOSPITAL LESS THAN
24 HOURS. SKILLED NURSING
FACILITIES PROVIDE CONTINUOUS
SKILLED NURSING CARE TO PATIENTS
WHO REQUIRE THE AVAILABILITY OF
NURSES ON AN ONGOING BASIS. BOTH
FEE FOR SERVICE AND MANAGED CARE
PLANS ARE COVERED BY THIS BILL.
HOSPITALS ARE ABLE TO OPT IN TO
PARTICIPATE IN THE REPAYMENT
METHODOLOGIES. THE OPT IN
REQUIREMENT ALLOWS THE HOSPITALS
TO CHOOSE WHAT REPAYMENT
METHODOLOGY WORKS BEST FOR THEM.
IF CRITICAL ACCESS HOSPITALS ARE
FORCED TO CLOSE, IT SEVERELY
LIMITS THE OPTIONS FOR THOSE
LIVING IN RURAL AREAS. CLOSURES
WILL ALSO INCREASE THE COST OF
PROVIDING HEALTH CARE IN THE
REMAINING HOSPITALS. DUE TO AN
INCREASE IN INCREASE IN PATIENTS
AND LACK OF AVAILABILITY OF
RESOURCES AND OPTIONS. WITH ME
TODAY, I HAVE TO TESTIFY OUR
REPRESENTATIVES FROM THE
HOSPITAL ASSOCIATION, AS WELL AS
SOME REPRESENTATIVES FROM
VARIOUS CRITICAL ACCESS
HOSPITALS, INCLUDING PLUMAS
DISTRICT IN MY DISTRICT. PLEASE
PROCEED WHEN READY. IDENTIFY
YOURSELVES. FOR THE RECORD,
FIRST, THOUGH. GOOD AFTERNOON.
MY NAME IS MARY CASSIUS. I'M A
LIFE LIFETIME RESIDENT OF SAN
BENITO COUNTY. I HAVE BEEN IN
HEALTH CARE FOR NEARLY 30 YEARS,
AND I'M CURRENTLY THE CEO AT
HAZEL HAWKINS MEMORIAL HOSPITAL
IN HOLLISTER. HAZEL HAWKINS, A
PART OF SAN BERNARDINO HEALTH
CARE DISTRICT, IS A 25 BED
CRITICAL ACCESS HOSPITAL. IT IS
THE ONLY HOSPITAL AND EMERGENCY
DEPARTMENT IN SAN BENITO COUNTY.
THE DISTRICT ALSO RUNS SIX RURAL
HEALTH CLINICS AND TWO SKILLED
NURSING FACILITIES. THE
RESIDENTS IN OUR COMMUNITY RELY
ON US TO PROVIDE LIFE SAVING
SERVICES ON A DAILY BASIS. OVER
75% OF OUR PATIENTS ARE EITHER
ON MEDI-CAL OR MEDICARE, AND
MANY ARE UNDERSERVED WORKING IN
AGRICULTURE AND MANUFACTURING
EVERY SINGLE DAY. WE ARE SAVING
LIVES, WHETHER IT'S TREATING
PATIENTS IN OUR HOSPITAL OR
CLINICS OR STABILIZING PATIENTS
AND FLYING THEM OUT TO TERTIARY
CARE CENTERS IN THE BAY AREA, WE
SAVE LIVES. IN NOVEMBER OF 2022,
OUR BOARD OF DIRECTORS DECLARED
A FISCAL EMERGENCY WITH A
PROJECTION TO BE AT 1.5 DAYS
CASH ON HAND. AT THE END OF THE
FOLLOWING MONTH. THIS WAS A
RESULT OF THE EFFECTS OF DEALING
WITH COVID. DIFFICULTIES WITH
FAIR COMMERCIAL CONTRACT
NEGOTIATIONS. ASTRONAUT MEDICAL
INFLATION RATES, AS WELL AS
OTHER FACTORS. OUT OF OUR
CONTROL. WE WERE AT THE POINT OF
PUTTING TOGETHER A CLOSURE PLAN
FOR OUR HOSPITAL AND THE OTHER
SERVICES THE DISTRICT PROVIDES.
KNOWING THAT MY NEIGHBORS,
FRIENDS AND RELATIVES WOULD NOT
HAVE THE LIFE SAVING SERVICES
THAT THEY NEED AND DESERVE WAS
GUT WRENCHING. WE HAVE BEEN ABLE
TO MAKE SOME COST SAVING CHANGES
THROUGH A BANKRUPTCY CASE, BUT
THAT FIGHT IS LONG FROM OVER AND
HAS NOT STABILIZED OUR
ORGANIZATION. FOR THE LONG
TERME. WE ARE GRATEFUL TO HAVE
BEEN APPROVED FOR A LOAN THROUGH
THE DISTRESSED HOSPITAL LOAN
PROGRAM FROM THE STATE LAST YEAR
. THAT ONE TIME SOLUTION IS NOT
SUSTAINABLE IN HEALTH CARE
TERMS. IT'S LIKE PUTTING A
BAND-AID ON A COMPOUND FRACTURE.
WE NEED TO WORK TOGETHER TO MAKE
SYSTEMATIC CHANGES TO COVER THE
COST OF PROVIDING CARE FOR OUR
COMMUNITY. THANK YOU, THANK YOU.
MA'AM. NEXT, SIR. THANK YOU.
CHAIR ROTH, MY NAME IS DARREN
BEATTY. I'M THE CHIEF OPERATING
OFFICER FOR PLYMOUTH DISTRICT
HOSPITAL IN QUINCY. AND WE ARE
IN STRONG SUPPORT OF SB 1423.
MANY RURAL HOSPITALS ARE ON THE
BRINK OF CLOSURE, STRUGGLING TO
SURVIVE FINANCIALLY. THE ROOT
CAUSE REIMBURSEMENT FAILS TO
COVER THE COST OF CARE DELIVERY.
THIS JUST ISN'T A RURAL ISSUE.
IT'S A STATEWIDE CONCERN.
WITHOUT THESE HOSPITALS, WHO
WILL CARE FOR THE BACKBONE OF
OUR STATE'S ECONOMY, OUR
FARMERS, RANCHERS, MINERS,
TIMBER HARVESTERS, ENERGY
WORKERS THEY ALL RELY ON RURAL
HEALTH CARE. AND IT'S NOT JUST
ABOUT WORK, IT'S ABOUT LIFE.
TOURISTS EXPLORING OUR RURAL
TREASURES NEED AND EXPECT ACCESS
TO EMERGENCY SERVICES AT THE
HEIGHT OF THE PANDEMIC, CRITICAL
ACCESS HOSPITALS SKILLFULLY
CARED FOR ICU LEVEL PATIENTS AND
HELPED PREVENT THE COLLAPSE OF
THE HEALTH CARE SYSTEM. THE
SOLUTION IS CLEAR, THOUGH NOT
SIMPLE. WE MUST INCREASE FUNDING
FOR OUR RURAL HOSPITALS,
ENSURING THEY CAN CONTINUE TO
SERVE THEIR COMMUNITIES. THIS
ISN'T CHARITY, IT'S AN
INVESTMENT IN OUR COLLECTIVE
WELL-BEING. IT'S ABOUT
PRESERVING ACCESS TO CARE,
PREVENTING FUTURE HEALTH CARE
CRISES, AND BOLSTERING OUR RURAL
ECONOMIES. TO PERSONALIZE THE
ISSUE, I WAS BORN AT PLYMOUTH
DISTRICT HOSPITAL AND SO WAS MY
DAUGHTER. NEARLY TWO YEARS AGO,
I WAS PART OF THE TEAM THAT HAD
TO MAKE THE HARD CALL TO SUSPEND
LABOR AND DELIVERY SERVICES.
AFTER MORE THAN 60 YEARS OF
OUTSTANDING SERVICE TO OUR
COMMUNITY WITH LOW VOLUME,
INCREASING COSTS AND POOR
REIMBURSEMENT, WE COULD NOT
SUSTAIN THE TRADITIONAL
IN-HOSPITAL LABOR AND DELIVERY
SERVICES, AS OUR LABORING MOMS
NOW MUST DRIVE MORE THAN AN HOUR
AND A HALF OVER SOMETIMES
IMPASSABLE MOUNTAIN ROADS TO
DELIVER THEIR BABIES IN ANOTHER
COUNTY OR EVEN ANOTHER STATE.
THIS BREAKS MY HEART AND WE CAN
DO BETTER. SP 1423 OFFERS A REAL
SOLUTION AND FURTHERS MEANINGFUL
CONVERSATION TO ENSURE ADEQUATE
PAYMENT FOR RURAL CRITICAL
ACCESS HOSPITALS. THE COST OF
INACTION FAR OUTWEIGHS THE PRICE
OF SUPPORT. I WANT TO THANK
SENATOR DALLI AND THE CALIFORNIA
HOSPITAL ASSOCIATION FOR THEIR
COURAGE IN ELEVATING THIS ISSUE,
AND FOR PROVIDING A REASONABLE
SOLUTION TO ENSURE SUSTAINED
ACCESS TO CARE IN RURAL
CALIFORNIA. AND THANK YOU FOR
YOUR EFFORTS AND YOUR SERVICE TO
THIS GREAT STATE. WITH THAT, I
RESPECTFULLY REQUEST YOUR AYE
VOTE. THANK YOU FOR JOINING US
TODAY. ANY OTHER WITNESSES IN
SUPPORT, NAME, AFFILIATION AND
POSITION ON THE MEASURE, PLEASE?
KATHERINE SCOTT, SENIOR VICE
PRESIDENT FOR STATE RELATIONS
AND ADVOCACY AND HERE IN SUPPORT
WITH THE CALIFORNIA HOSPITAL
ASSOCIATION, THANK YOU. THANK
YOU, MA'AM. NEXT, PLEASE.
VANESSA KHN, ON BEHALF OF THE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS HERE IN SUPPORT.
THANK YOU FOR JOINING US NEXT.
MISS SHORT, ON BEHALF OF
ADVENTIST HEALTH. THANK YOU. MÀ
MORTON, ON BEHALF OF THE
CALIFORNIA CHILDREN'S HOSPITAL
ASSOCIATION. THANK YOU. ANY
OTHER WITNESSES IN SUPPORT NOW?
WITNESSES IN OPPOSITION TO THIS
MEASURE. FIRST LEAD WITNESSES,
FOLLOWED BY OTHER OPPOSITION.
ANY OPPOSITION WITNESSES IN THE
HEARING ROOM, PLEASE STEP
FORWARD. SEEING NONE. BRING THE
MATTER BACK TO THE DAIS. SENATOR
MENGIBAR, ANY QUESTIONS? WELL, I
HAVE NO QUESTIONS, SENATOR. AND
WOULD YOU LIKE TO CLOSE? I WOULD
FIRST OF ALL, THANK YOU FOR
WORKING WITH ME ON THIS BILL. I
KNOW THIS IS A NOT EASY, BUT I
JUST WANT TO CLOSE WITH THIS,
TWO WEEKS AGO, MY BEST FRIEND,
AND HIS WIFE, ACTUALLY, WERE ON
THEIR WAY TO THE HOSPITAL WITH A
SIX WEEK, WITH THEIR WITH THEIR,
WITH THEIR, THEIR SON'S WIFE,
THEIR, THEIR WAS PREGNANT. AND
THE BABY CAME SIX WEEKS EARLY
AND THEY WERE TRYING TO GET TO
THE HOSPITAL BECAUSE WHERE WE
LIVE, THERE'S NOT A HOSPITAL
THAT DELIVERS A BABY. IT WAS 75
MILES. THEY DIDN'T MAKE IT. SHE
DELIVERED A SIX WEEK OLD. THE
GRANDMA OF READ DELIVERED THE
SIX WEEK OLD BABY A SIX WEEK
EARLY BABY ON THE SIDE OF THE
ROAD WITH AN AMBULANCE COMING,
DELIVERED IT. THE BABY'S FINE, A
MIRACLE, BUT THAT'S THE KIND OF
SITUATION WE'RE DEALT WITH IN
OUR COMMUNITIES WHERE WE DON'T
HAVE, CAN'T CAN'T DELIVER BABIES
AND WE DON'T HAVE CARE. WE ARE
JUST SIMPLY TRYING TO KEEP THE
REMAINING HOSPITALS THAT ARE
THERE OPEN. SO WE HAVE SOME
SERVICE OF CARE. SO I
RESPECTFULLY ASK FOR AN AYE VOTE
WHEN YOU GET A QUORUM. AND,
HOPEFULLY THIS BILL WILL WILL
GET OUT OF COMMITTEE. SENATOR, I
FORGOT TO ASK. MAYBE I MISSED
IT. DID YOU ACCEPT THE AMENDED?
I DID, THANK YOU VERY MUCH FOR
DOING SO. AND WE GET A QUORUM.
WE'LL TAKE A MOTION AND TAKE THE
VOTE. THANK YOU. THANK YOU FOR
YOUR PRESENTATION, SENATOR
ASHBY. ITEM NUMBER FIVE, SENATE
BILL 1180, HEALTH CARE COVERAGE,
EMERGENCY MEDICAL SERVICES.
PROCEED WHEN READY. THANK YOU,
CHAIRMAN ROTH. HAPPY TO BE HERE
THIS AFTERNOON WITH YOU. I WOULD
LIKE TO START MY PRESENTATION OF
SB 1180 BY ACCEPTING THIS
COMMITTEE'S AMENDMENTS. I'M HERE
TO PRESENT 1180 THE EMERGENCY
MEDICAL SERVICES REIMBURSEMENT
ACT. THIS BILL REQUIRES MEDI-CAL
REIMBURSEMENT AND THAT PRIVATE
HEALTH PLANS ESTABLISH A PROCESS
TO REIMBURSE ESSENTIAL SERVICES
SUCH AS COMMUNITY PARAMEDICINE
TRIAGE TO ALTERNATE DESTINATIONS
AND MOBILE INTEGRATED HEALTH FOR
EMS PROVIDERS. THIS WOULD BE IN
LIEU OF A TRIP TO THE EMERGENCY
DEPARTMENT. SB 1180 ENSURES EMS
REIMBURSEMENT FOR PATIENTS
TRANSPORTED TO AUTHORIZED
SOBERING CENTERS OR MENTAL
HEALTH FACILITIES, PRIORITIZING
HOLISTIC HEALTH CARE DELIVERY
FOR SOME OF OUR MOST VULNERABLE
POPULATIONS. THESE LOCATIONS ARE
EQUIPPED WITH THE RESOURCES
NEEDED TO SUPPORT INDIVIDUALS
FACING SUBSTANCE USE DISORDERS
AND MENTAL HEALTH CRISIS, AND
ARE OFTEN LESS COSTLY THAN A
TRIP TO THE EMERGENCY DEPARTMENT
OF AN ACUTE CARE HOSPITAL. THEY
OFFER SPECIALIZED ALTERNATIVES
TO BUSY EMERGENCY ROOMS. THEY
OFFER TAILORED INTERVENTIONS FOR
INDIVIDUALS GRAPPLING WITH ACUTE
NEEDS, AND ARE A COST EFFECTIVE
ALTERNATIVE WHERE THESE PROGRAMS
EXIST, THEY HAVE ALREADY
RESULTED IN A REDUCTION OF
HOSPITAL READMISSIONS. FOLLOW UP
TRANSPORTS, AND EMERGENCY ROOM
OVERCROWDING, WHICH ALL OF YOU
KNOW IS ONE OF OUR BIG ISSUES.
HOWEVER THE SUSTAINABILITY OF
THESE PROGRAMS IS JEOPARDIZED BY
THE ABSENCE OF A REIMBURSEMENT
PROGRAM, WHICH FURTHER ENHANCES
THE STRAIN ON EMERGENCY ROOMS IN
OUR ACUTE CARE HOSPITALS ACROSS
THE STATE OF CALIFORNIA. SB 1180
WILL ENSURE THAT OUR EMS
PROVIDERS ARE ABLE TO RECOUP
NECESSARY COSTS FOR SERVICES
PROVIDED OUTSIDE OF A
TRADITIONAL EMERGENCY MEDICAL
SERVICES SETTING. TODAY, WITH ME
, I HAVE A SUPPORT WITNESS IN
MEGAN SUBERS, WHO'S A
LEGISLATIVE ADVOCATE FOR THE
CALIFORNIA PROFESSIONAL
FIREFIGHTERS, WHO ARE THE
SPONSOR OF THIS BILL. GOOD
AFTERNOON. PLEASE PROCEED. THANK
YOU. MR. CHAIR AND MEMBERS, I'M
MEGAN STUBER ON BEHALF OF THE
CALIFORNIA PROFESSIONAL
FIREFIGHTERS. I'M PLEASED TO BE
A SPONSOR OF THIS BILL AND
APPRECIATE SENATOR ASHBY FOR
BRINGING IT FORWARD. OUR MEMBERS
HAVE SHARED WITH MANY OF YOU
BEFORE. THE HEALTH CARE NEEDS OF
OUR COMMUNITIES HAVE CHANGED
DRAMATICALLY IN RECENT YEARS,
AND MORE PEOPLE RELY ON
EMERGENCY MEDICAL SERVICES AND
THE EMERGENCY ROOM FOR PRIMARY
CARE, RESULTING IN OVERCROWDING
THAT LEAD TO DELAYS AND LOTS OF
OTHER IMPACTS ACROSS THE
EMERGENCY RESPONSE SYSTEM. IN
RESPONSE, IN RECENT YEARS, NEW
MODELS OF CARE HAVE BEEN HAVE
EMERGED AND BEEN TESTED TO
CONNECT PATIENTS TO NEEDED
SERVICES WITH THE GOAL OF
REDUCING HOSPITAL READMISSIONS
IN FUTURE. 911 CALLS. FIRE
DEPARTMENTS ACROSS THE STATE
HAVE PILOTED AND NOW IMPLEMENTED
THESE COMMUNITY PARAMEDICINE AND
TRIAGE ALTERNATE DESTINATION
PROGRAMS AND DEVELOP MOBILE
INTEGRATED HEALTH UNITS TO MEET
THEIR COMMUNITY MEMBERS WHERE
THEY ARE NEEDED. HOWEVER DESPITE
THE WILLINGNESS OF DEPARTMENTS
TO DEVELOP THESE PROGRAMS, MANY
ARE LIMITED BY THE LACK OF
RESOURCES AVAILABLE TO THEM
UNDER CURRENT LAW, DEPARTMENTS
MAY NOT SEEK REIMBURSEMENT FOR
THE COST OF THESE PROGRAMS AS
THEY ARE NOT CONSIDERED COVERED.
EMERGENCY SERVICES, EVEN IF THEY
ARE GENERATED BY A911 CALL AS
PUBLIC AGENCIES, FIRE
DEPARTMENTS OFTEN WORK WITH
STRICTLY DEFINED BUDGETS,
LEAVING LITTLE ROOM FOR PROGRAMS
THAT ARE NOT SUSTAINABLE. SO
WHAT WE HAVE SEEN IN SOME OF THE
INSTANCES WHERE THESE PROGRAMS
HAVE WORKED ARE BIG COUNTIES
LIKE LA COUNTY OR SACRAMENTO
COUNTY, WHERE THEY MIGHT BE ABLE
TO OPERATE AT A LOSS FOR A
CERTAIN PERIOD OF TIME, BUT ARE
NOT SUSTAINABLE IN THE LONG
TERME. AND MANY WON'T BE AN
OPTION FOR SOME OF THE SMALLER
CITIES AND COUNTIES ACROSS THE
STATE. SO SB 1180 WILL ENSURE
THAT DEPARTMENTS ARE ABLE TO
RECOVER THE NECESSARY COSTS FOR
THE SERVICES THAT THEY PROVIDE
OUTSIDE OF THE TRADITIONAL
EMERGENCY RESPONSE SYSTEM. AND
FOR THOSE REASONS, WE ASK FOR
YOUR SUPPORT TODAY. THANK YOU.
THANK YOU FOR JOINING US. ANY
OTHER WITNESSES IN SUPPORT IN
THE HEARING ROOM? IF SO, PLEASE
STEP FORWARD. YOUR NAME,
AFFILIATION AND POSITION ON THE
MEASURE ONLY. PLEASE. FAITH
BURGESS, ON BEHALF OF CALIFORNIA
AGENTS AND HEALTH INSURANCE
PROFESSIONALS IN SUPPORT. THANK
YOU. NEXT, PLEASE. MR. CHAIR
MEMBERS TIM MADDEN, REPRESENTING
THE CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS IN SUPPORT. THANK YOU
SIR. NEXT THANK YOU. TOM RENFREE
WITH THE CALIFORNIA ASSOCIATION
OF ALCOHOL AND DRUG PROGRAM
EXECUTIVES IN SUPPORT. THANK YOU
FOR JOINING US. ANY OTHER
WITNESSES IN SUPPORT? WELL,
LET'S TURN TO WITNESSES AND
OPPOSITION FIRST LEAD AND THEN
OTHERS. PLEASE STEP FORWARD.
LEAD OPPOSITION. JOIN US AT THE
TABLE IF YOU WISH. GOOD
AFTERNOON AGAIN, MR. CHAIR. AND
MEMBERS OF THE COMMITTEE, JED
HAMPTON WITH THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS, WE
CURRENTLY HAVE AN OPPOSED
POSITION ON SB 1180, BUT WE DO
WANT TO THANK THE AUTHOR. HER
OFFICE, THE SPONSORS. WE'VE HAD
A LOT OF REALLY GOOD
CONVERSATIONS, THOUGHTFUL AND
PRODUCTIVE CONVERSATIONS ON THIS
BILL AND THINK THAT THAT WE HAVE
A PATH FORWARD, JUST
HIGHLIGHTING A COUPLE OF OUR
CONCERNS THAT WE'RE WORKING WITH
THE AUTHOR AND THE SPONSORS
OFFICE AND IS AROUND, JUST SOME
CONCERNS AROUND THE ANALYSIS AND
WHETHER THERE'S ENOUGH
INFORMATION TO KNOW HOW MUCH THE
PROGRAM WOULD COST ON A
STATEWIDE LEVEL, YOU KNOW,
AGAIN, AS THE PAYER IN THE
SYSTEM THAT IS, YOU KNOW,
SOMETHING THAT THAT WE'RE TRYING
TO WORK THROUGH AND UNDERSTAND.
SO WE HAVE SOME LEVEL OF
PREDICTABILITY ABOUT WHAT THOSE
COSTS WILL BE MOVING FORWARD,
AND ADDITIONALLY HAVE A COUPLE
OF CONCERNS AROUND THE APPLYING
AND NETWORK COST SHARING AMOUNTS
TO A NON CONTRACTING PROVIDER.
AGAIN, I KNOW WE'VE HAD SEVERAL
CONVERSATIONS ON THAT PROVISION,
THINGS ARE MOVING IN THE RIGHT
DIRECTION. SO REALLY JUST WANT
TO THANK THE AUTHOR AND THE
SPONSOR FOR WORKING WITH US. AND
WE ARE LOOKING FORWARD TO HAVING
MORE CONVERSATIONS AND RESOLVING
OUR ISSUE. SO THANK YOU. THANK
YOU FOR JOINING US. OTHER
WITNESSES IN OPPOSITION NAME
AFFILIATION, STEPHANIE WATKINS
ON BEHALF OF THE ASSOCIATION OF
CALIFORNIA LIFE AND HEALTH
INSURANCE COMPANIES, ALSO IN
OPPOSITION. THANK YOU MA'AM.
NEXT, PLEASE. MR. CHAIR MEMBERS,
JOHN WENGER, ON BEHALF OF
AMERICA'S HEALTH INSURANCE PLANS
, WOULD ECHO THE COMMENTS OF
CAP. LOOK FORWARD TO THE FUTURE
CONVERSATIONS. THANK YOU. THANK
YOU FOR JOINING US. OKAY, LET'S
BRING THE MATTER BACK TO THE
DAIS, FOR ANY QUESTIONS,
COMMENTS OR CONCERNS. OKAY.
SEEING NONE, SENATOR, I GUESS
YOU MAY CLOSE. I WOULD JUST SAY
THAT WE DID DO THE ANALYSIS AND
THE FINDING WAS THAT THE
ESTIMATE THEY ESTIMATED NO
MEASURE BEALL FISCAL IMPACT OR
SIGNIFICANT UTILIZATION INCREASE
DUE TO THIS BILL, WHICH WE FIND
TO BE COMPELLING ENOUGH TO MOVE
FORWARD. AND I WOULD ALSO ADD
THAT WE'VE ASKED MUCH OF OUR EMS
SYSTEM AND OUR CITIES AND OUR
COUNTIES TO BE CREATIVE AND
INNOVATIVE IN HELPING US ADDRESS
THESE POPULATION THAT ARE
SOMEWHAT UNIQUE, BUT ALSO TEND
TO TAKE OVER OUR EMERGENCY ROOMS
IF WE'RE GOING TO ASK THEM TO DO
THAT, WE NEED TO PROVIDE FOR
THEM THE MECHANISM FOR
REIMBURSEMENT. AND BY ALL
MEASURES, THESE REIMBURSEMENTS,
BOTH FOR PRIVATE INSURANCE AND
FOR MEDI-CAL, SHOULD COME IN
LOWER THAN HAVING TO PAY FOR AN
EMERGENCY ROOM VISIT. SO I, TOO
AM CONFIDENT WE HAVE A PATHWAY
FORWARD AND I AT THE APPROPRIATE
TIME. WHEN YOU HAVE A QUORUM,
I'D ASK FOR AN AYE VOTE. WE WILL
ENTERTAIN A MOTION AS SOON AS WE
GET A QUORUM AND WE WILL TAKE A
VOTE. THANK YOU FOR YOUR
PRESENTATION. THANK YOU VERY
MUCH, SENATOR BREAKSPEARE. ITEM
NUMBER SEVEN, SENATE BILL 1236,
MEDICARE SUPPLEMENT COVERAGE.
OPEN ENROLLMENT PERIODS. THANKS
PROCEED WHEN READY, MA'AM. THANK
YOU, THANK YOU. CHAIR AND
COLLEAGUES. I'M HERE TODAY ON SB
1236, AND I ACCEPT THE
COMMITTEE'S AMENDMENTS. SB 1236
WILL PROVIDE ELIGIBLE MEDICARE
PATIENTS THE RIGHT TO AN ANNUAL
GUARANTEED ISSUE PERIOD FOR
MEDICARE SUPPLEMENTAL INSURANCE,
OTHERWISE KNOWN AS MEDIGAP.
ESSENTIALLY MY BILL WILL IMPROVE
HEALTH CARE ACCESS AND
AFFORDABILITY FOR OUR SENIORS
WHO HAVE SERIOUS HEALTH
CONDITIONS. THIS IS DONE BY
ALLOWING MEDIGAP COVERAGE, OFTEN
USED TO COVER HEALTH CARE
SERVICES THAT ARE NOT COVERED BY
MEDICARE PARTS A AND B TO ALLOW
FOR PREEXISTING CONDITIONS. THE
BILL FOLLOWS WHAT OTHER STATES
LIKE NEW YORK, MASSACHUSETTS,
KENTUCKY, AND CONNECTICUT HAVE
ALREADY DONE. LAST FALL, ONE OF
THREE MAJOR HOSPITAL SYSTEMS IN
MY DISTRICT SCRIPPS HOSPITAL,
DECIDED NOT TO RENEW ITS
CONTRACTS WITH MEDICARE
ADVANTAGE PLANS. THIS CAUSED A
LARGE GROUP OF MY CONSTITUENTS
WHO HAVE MEDICARE ADVANTAGE TO
LOSE ACCESS TO THE HEALTH CARE
PROVIDERS THEY KNOW AND TRUST,
PUTTING THEM IN AN IMPOSSIBLE
SITUATION. THERE ARE OPTIONS
WERE TO EITHER PAY OUT OF POCKET
TO STAY WITH THEIR ESTABLISHED
PROVIDERS, CHANGE THEIR
PROVIDERS, OR CHANGE FROM A
MEDICARE ADVANTAGE PLAN TO A
MEDICARE PLAN OR MEDICARE PLUS
MEDIGAP PLAN. THE OPTION TO PAY
OUT OF POCKET WAS UNREACHABLE
FOR MANY. FOR ANYONE WHO IS ON
MEDICARE OR WHO HAS LOVED ONES
ON MEDICARE, THEY KNOW HOW HARD
CHANGING PROVIDERS CAN BE. IT
INVOLVES DISRUPTING CARE. IT
CONSUMES A LOT OF TIME. WHILE
RELATIONSHIPS WITH NEW PROVIDERS
ARE ESTABLISHED. AND FOR
PATIENTS WITH CONDITIONS
REQUIRING SPECIALIZED CARE,
PROVIDERS AND OTHER HOSPITAL
SYSTEMS MAY NOT HAVE THE
EQUIVALENT EXPERTISE THAT
PATIENTS NEED. CONSTITUENTS WHO
WANTED TO CHANGE THEIR INSURANCE
PLAN WERE FACED WITH THE RISK OF
MEDIGAP PLANS DENYING OR SETTING
HIGH PREMIUM PRICES BASED ON
THEIR PREEXISTING CONDITIONS. NO
SENIORS SHOULD HAVE TO BE IN
THIS SITUATION, AND SENIORS
DEFINITELY SHOULD NOT BE
PENALIZED FOR ISSUES WITH
MEDICARE ADVANTAGE PLANS,
BUSINESS PRACTICES AS MY BILL,
SB 1236, WILL PROVIDE A VIABLE
OPTION FOR SENIORS CAUGHT IN
THIS SITUATION. SPECIFICALLY,
THE BILL WILL ALLOW MEDICARE
PATIENTS TO SWITCH ONTO MEDIGAP
PLANS WITHOUT PENALTY FOR THEIR
PREEXISTING CONDITIONS, THEIR
AGE, OR RELATED ATTRIBUTES
DURING A 90 DAY PERIOD AT THE
BEGINNING OF EACH YEAR. THE FACT
OF THE MATTER IS THAT WHAT
HAPPENED AT SCRIPPS IS NOT AN
ISOLATED INCIDENT THAT'S
SPECIFIC TO MY DISTRICT. ACROSS
THE COUNTRY, THERE IS A GROWING
TREND OF HEALTH CARE PROVIDERS
DROPPING THEIR CONTRACTS WITH MÀ
PLANS OR OTHERWISE CHANGING THE
SERVICES THEY PROVIDE BECAUSE OF
THE MÀ PRACTICES. OUR SENIORS
NEED PROTECTION FROM THIS. SB
1236 WILL GIVE THEM THAT
PROTECTION AND MAKE SURE THEY
HAVE A VIABLE OPTION. MY BILL
WILL ALSO SOLVE THE PROBLEM THAT
RESULTS WHEN SENIORS WHO CHOOSE
A MEDICARE ADVANTAGE PLAN WHEN
THEY WERE 65 THEN DEVELOP A
SERIOUS CONDITION AND ARE UNABLE
TO ACCESS OR AFFORD THE
SPECIALIZED PROVIDERS THAT THEY
NEED TO SEE, THESE SENIORS WOULD
ALSO HAVE THE OPTION TO CHANGE
TO A MEDIGAP PLAN WITHOUT
PENALTY FOR THEIR HEALTH
CONDITION. AT ITS CORE, MY BILL
WILL PROMOTE ACCESS AND
AFFORDABILITY. THE OPPOSITION
HAS RAISED CONCERNS THAT THIS
WILL CREATE ADVERSE SELECTION IN
THE MEDIGAP MARKET AND LEAD TO
UNAFFORDABLE PREMIUM INCREASES.
MY BILL WILL UNDOUBTEDLY RAISE
SOME MEDICARE MEDIGAP PREMIUMS
FOR ALL BENEFICIARIES, BUT THESE
PREMIUM INCREASES WILL BE MODEST
IN COMPARISON TO THE BENEFIT OF
INSURING SENIORS WITH SERIOUS
CONDITIONS HAVE ACCESS TO
QUALITY, AFFORDABLE HEALTH CARE.
THERE ARE NATIONAL AND STATE
ORGANIZATIONS WHO REPRESENT
SENIORS WHO AFFIRM THIS AND ARE
HERE TODAY TO SUPPORT, MANY OF
WHICH HAVE MADE THIS A PRIORITY
BILL THIS YEAR. BEFORE I WRAP
UP, I WANT TO ADDRESS THE
COMMITTEE AMENDMENTS WITH THE
AMENDMENTS, MY BILL WILL EXTEND
THE EXTEND TO PEOPLE WITH END
STAGE RENAL DISEASE OR ESRD. THE
RIGHT TO MEDIGAP COVERAGE. ESRD
IS AN OTHERWISE CHRONIC
CONDITION THAT CAN ONLY BE CURED
THROUGH KIDNEY TRANSPLANTATION.
ESRD PATIENTS ON MEDICARE MUST
ALSO HAVE MEDIGAP IN MOST CASES
TO ACCESS THIS PROCEDURE.
CURRENTLY, THOUGH, STATUTE
PERMITS MEDIGAP PLANS TO REFUSE
COVERAGE TO ESRD PATIENTS WITH
THE COMMITTEE AMENDMENTS. MY
BILL WILL RECTIFY THIS. I THANK
THE ESRD ADVOCATES FOR BRINGING
THIS TO MY ATTENTION AND THE
COMMITTEE FOR THEIR HELP IN
AMENDING THE BILL. NOW, I'D LIKE
TO INVITE MY WITNESSES TO SHARE
THEIR TESTIMONY WITH ME IN
SUPPORT. WE HAVE ADAM ZARIN,
WESTERN STATES REGIONAL DIRECTOR
OF STATE GOVERNMENT AFFAIRS FOR
THE LEUKEMIA AND LYMPHOMA
SOCIETY AND PAT JOHNSTON,
VOLUNTEER FOR THE CALIFORNIA
ASSOCIATION FOR RETIRED
AMERICANS. THANK YOU. YOU MAY
PROCEED THREE MINUTES EACH.
THANK YOU. CHAIR ROTH, MEMBERS
OF THE COMMITTEE. MY NAME IS
ADAM ZARIN. I'M THE DIRECTOR OF
STATE GOVERNMENT AFFAIRS FOR THE
LEUKEMIA AND LYMPHOMA SOCIETY.
WE'RE PROUD TO CO-SPONSOR SENATE
BILL 1236. SB 1236 COMES DOWN TO
ONE CRUCIAL NUMBER, 53,900. THAT
IS, HOW MANY OLDER CALIFORNIANS
WILL NEWLY ENROLL IN MEDICARE
SUPPLEMENT INSURANCE OR MEDIGAP
PLANS. ONE OF THE BEST KEPT
SECRETS IN HEALTH CARE IS THAT
INSURANCE COMPANIES, UNLIKE
EVERY OTHER TYPE OF MAJOR HEALTH
INSURANCE COVERAGE, CAN CHARGE
MORE OR REJECT MEDICARE
BENEFICIARIES WITH PREEXISTING
CONDITIONS. BEFORE AGE 65, MOST
PEOPLE GET TO WEIGH THEIR
OPTIONS AND FUTURE NEEDS TO PICK
A PLAN. BUT WHAT? BUT WHEN THEY
TURN 65, THAT PROCESS CHANGES.
THEY CAN SELECT EITHER
TRADITIONAL MEDICARE AND A
MEDIGAP OR A MEDICARE ADVANTAGE
PLAN, BUT WITH LIMITED
EXCEPTIONS, THEY CAN'T LEAVE AN
MÀ PLAN WITHOUT MEDICAL
UNDERWRITING. MEANWHILE MORE AND
MORE PROVIDERS ARE DECIDING NOT
TO CONTRACT WITH MEDICARE
ADVANTAGE, SOMETHING THAT
SHUPERB ANALYSIS DOES NOT
CONSIDER. IF A DOCTOR IS OUT OF
NETWORK, THE BENEFICIARY PAYS
MORE FOR AN INDIVIDUAL AGED 67
WITH CANCER ESTIMATES, THEY WILL
SEE A REDUCTION IN THEIR TOTAL
ANNUAL SPENDING BY 57. THAT IS,
$5,430 A YEAR. NO MORE CUTTING
THEIR PILLS IN HALF, SKIPPING TO
SEE THE DOCTOR OR TAKING ON
DEBT. 6.6 MILLION CALIFORNIANS
WILL AGAIN HAVE A CHOICE ABOUT
THEIR HEALTH INSURANCE EACH
YEAR. THAT IS FAIR. NOBODY CAN
PERFECTLY PREDICT THEIR HEALTH
NEEDS. A YEARS IN ADVANCE. THE
STATES THAT HAVE ENACTED THIS
POLICY CONTINUE TO HAVE ROBUST
MEDIGAP MARKETS IN CALIFORNIA
WILL REMAIN AN ATTRACTIVE MARKET
BECAUSE OF ITS NATION LEADING
MEDICARE BENEFICIARY POPULATION.
SB 1236 MEANS 53,900 OLDER
CALIFORNIANS CAN HAVE
COMPREHENSIVE HEALTH CARE
COVERAGE, REGARDLESS OF THEIR
HEALTH CONDITIONS. WE URGE YOU
TO SUPPORT THOSE WITH
PREEXISTING CONDITIONS AND VOTE
AYE WHEN APPROPRIATE FOR SB
1236. THANK YOU. RIGHT ON TIME,
MA'AM. YOUR NEXT, MY NAME IS PAT
JOHNSTONE. I LIVE IN SAN ANSELMO
IN MARIN COUNTY. I WAS SOMEWHAT
RELUCTANT TO TESTIFY TODAY AND
DISCUSS MY MEDICAL CONDITIONS
PUBLICLY, BUT SINCE MY HUSBAND
DIED PREMATURELY, BEING DENIED
COSTLY MEDICATION THAT COULD
HAVE PROLONGED HIS LIFE, I HAVE
BEEN WORKING TO REPAIR OUR
BROKEN HEALTH CARE SYSTEM AND
RESTRICTED ACCESS TO MEDIGAP IS
PART OF THAT PROBLEM. I'M ALSO
EMBARRASSED THAT SOMEONE WITH
KNOWLEDGE OF HOW THE SYSTEM
WORKS COULD HERSELF BE PLACED
UNWITTINGLY INTO A MEDICARE
ADVANTAGE PLAN. I NOW FIND
MYSELF HAVING TO CHOOSE BETWEEN
COST AND CARE. I HAVE AN AILMENT
THAT REQUIRES INJECTABLE
MEDICATION 6 TO 7 TIMES A YEAR,
WITH AN OUT-OF-POCKET EXPENSE OF
5 TO $600 PER TREATMENT. WITHOUT
IT, I WILL BE FULLY DISABLED.
MEDIGAP WOULD COVER THAT EXPENSE
DURING OPEN ENROLLMENT. I CALLED
THE NUMBER GIVEN TO ME BY MY
PROVIDER, HELD ON FOR 12 HOURS,
AND EXPLAINED THAT I WAS
EXPLORING MY OPTIONS AND ASKED
WHAT SIMILAR PLANS THEY HAD THAT
MIGHT BE MORE COST EFFECTIVE,
BUT WITH THE SAME COVERAGE, I
WAS ASSURED THIS PLAN WAS BETTER
AND MORE AFFORDABLE. AGAIN, I AM
TOTALLY EMBARRASSED THAT I FELL
FOR THAT SALES PITCH. I DID NOT
REALIZE THAT I WAS IN A
RESTRICTED MEDICARE ADVANTAGE
PLAN UNTIL I TRIED TO MAKE AN
APPOINTMENT WITH THE ORTHOPEDIC
OFFICE I HAD BEEN VISITING FOR
15 YEARS, AND WAS TOLD THAT I
NEEDED A REFERRAL. I HAVE TRIED
TO GET BACK INTO TRADITIONAL
MEDICARE, WHICH I HAD FOR EIGHT
YEARS WITH A MEDIGAP PLAN, BUT
WAS DENIED DUE TO MY PREEXISTING
CONDITION. THE LIST OF
CONDITIONS THAT THEY READ AS
THEY WERE INTERVIEWING ME WAS
LONG, MAKING IT VIRTUALLY
IMPOSSIBLE TO REVERT BACK TO
TRADITIONAL MEDICARE WITH A
MEDIGAP PLAN. MY FRIEND IN MARIN
IS UNDERGOING A SIMILAR
TREATMENT AS MINE, WITH THE SAME
DOCTOR, AND DOES NOT PAY A PENNY
OUT OF POCKET BECAUSE HE HAS
MEDIGAP. YOU NEED TO GIVE
SENIORS OPTIONS OPEN ENROLLMENT
SHOULD BE JUST THAT AS IT IS
NOW. IF YOU GET INTO A MEDICARE
ADVANTAGE PLAN AND HAVE A
CHRONIC CONDITION LIKE MINE, YOU
ARE LOCKED IN. WHETHER YOU LIKE
IT OR NOT. THAT IS NEITHER FAIR
NOR OPEN. I NEVER PAID A PENNY
OUT OF POCKET WHEN I HAD
TRADITIONAL MEDICARE WITH A
MEDIGAP PLAN. THAT WAS PEACE OF
MIND. I URGE YOU TO MOVE SB 1236
FORWARD. THANK YOU. THANK YOU
FOR JOINING US TODAY. ANY OTHER
WITNESSES IN SUPPORT, NAME,
AFFILIATION AND POSITION ON THE
MEASURE, PLEASE? HELLO. MONICA
PADILLA, I'M HERE AS A BLOOD
CANCER ADVOCATE AND I'M IN
SUPPORT OF THIS BECAUSE THE
BLOOD CANCER SURVIVORS IN MY
FAMILY NEED ACCESS TO QUALITY
HEALTH CARE. THANK YOU, THANK
YOU. NEXT, PLEASE. AMY PINE, I'M
WITH THE LEUKEMIA AND LYMPHOMA
SOCIETY IN SUPPORT. THANK YOU.
YES CINDY YOUNG, VICE PRESIDENT,
AMERICANS CO-SPONSOR. THANK YOU,
MA'AM. THANKS FOR JOINING US,
SIR. YES, KEITH YAMAMOTO,
CALIFORNIA ALLIANCE FOR RETIRED
AMERICANS, SACRAMENTO CAT IN
SUPPORT. THANK YOU. YES, MA'AM.
BONNIE BURNS, CALIFORNIA HEALTH
ADVOCATES IN SUPPORT. THANK YOU.
JOE CARSON, CALIFORNIA ALLIANCE
FOR RETIRED AMERICANS AND ALSO
CTA RETIRED IN SUPPORT. THANK
YOU MA'AM. ANN MUNOZ, CALIFORNIA
ALLIANCE FOR RETIRED AMERICANS
IN SUPPORT. THANK YOU MA'AM.
NEXT, PLEASE. SUSAN CHASSIN WITH
CALIFORNIA ALLIANCE FOR RETIRED
AMERICANS AND WITH THE OLD
LESBIANS ORGANIZING FOR CHANGE
IN SUPPORT. THANKS FOR JOINING
US. YES, MA'AM. DAISY OREM,
CALIFORNIA ALLIANCE FOR RETIRED
AMERICANS IN SUPPORT. THANK YOU,
SIR. RJ CERVANTES HERE ON BEHALF
OF THE CALIFORNIA KIDNEY CARE
ALLIANCE IN STRONG SUPPORT.
THANK YOU, PETER KELLISON, ON
BEHALF OF US RENAL CARE AND
SUPPORT. DIANA MENDOCINE,
CALIFORNIA ALLIANCE FOR RETIRED
AMERICANS, RETIRED RN, PLACER
COUNTY SUPPORT. THANK YOU MA'AM.
YES, PLEASE. STAN LONG WITH
CALIFORNIA KNIGHTS FOR RETIRED
AMERICANS AND I'M IN SUPPORT OF
SB 1236. THANK YOU. ARLENE
HARRISON, CALIFORNIA. CARA, IN
SUPPORT. THANK YOU. GOOD
AFTERNOON, LINDA HèA WITH
WESTERN CENTER ON LAW AND
POVERTY AND SUPPORT. THANK YOU,
CHRISTINE SMITH, HEALTH ACCESS
CALIFORNIA IN SUPPORT ALEX KAHN
WITH THE CALIFORNIA CHRONIC CARE
COALITION IN SUPPORT. THANK YOU.
DANIEL SANCHEZ ON BEHALF OF
FARMWORKERS INSTITUTE OF
EDUCATION AND LEADERSHIP
DEVELOPMENT, PROTEUS, INLAND
COALITION FOR IMMIGRANT JUSTICE,
FIRST AID FOUNDATION, INC, AND
CENTRAL VALLEY OPPORTUNITY
CENTER. THANK YOU VERY MUCH.
THANK YOU, SIR. KEVIN INSKO,
FRIENDS COMMITTEE ON LEGISLATION
OF CALIFORNIA AND STRONG
SUPPORT. THANK YOU MA'AM. NEXT,
PLEASE. VANESSA GONZALEZ WITH
THE CALIFORNIA HOSPITAL
ASSOCIATION IN SUPPORT. THANK
YOU. THANK YOU. GOOD AFTERNOON.
BETH MALINOWSKI WITH SEIU
CALIFORNIA IN SUPPORT. YOU,
DYLAN ELLIOTT, ON BEHALF OF THE
CALIFORNIA STATE ASSOCIATION OF
PSYCHIATRISTS, IN SUPPORT.
PAMELA ZALESKI WITH DIALYSIS
PATIENT CITIZENS IN SUPPORT.
JORDAN GERSHMAN ON BEHALF OF
DAVITA IN STRONG SUPPORT. THANK
YOU. MARIA GARCIA WITH FRESENIUS
MEDICAL CARE AND SUPPORT. HI.
KELLY GOSS WITH THE ALS
ASSOCIATION IN STRONG SUPPORT.
THANK YOU SIR PETER SAUL, ON
BEHALF OF AARP CALIFORNIA,
STRONG SUPPORT. THANK YOU SIR.
NEXT PLEASE. GOOD AFTERNOON,
ALEJANDRO SOLIS, ON BEHALF OF
COMITE CIVICO EL VALLE DE LOS
AMIGOS DE LA COMUNIDAD AND LA
COOPERATIVA CAMPESINA DE
CALIFORNIA IN SUPPORT. THANK YOU
. GOOD AFTERNOON, MAURA GIBNEY,
CALIFORNIA ADVOCATES FOR NURSING
HOME REFORM IN SUPPORT. THANK
YOU. ANY OTHER WITNESSES IN
SUPPORT IN THE HEARING ROOM? NOW
LET'S TURN TO WITNESSES IN
OPPOSITION. FIRST LEAD
OPPOSITION WITNESSES, PLEASE
STEP FORWARD.
PROCEED WHEN READY. PLEASE
IDENTIFY YOURSELVES. FOR THE
RECORD, MR. CHAIR. MEMBERS.
STEFANI WATKINS, ON BEHALF OF
THE ASSOCIATION OF CALIFORNIA
LIFE AND HEALTH INSURANCE
COMPANIES. REGRETTABLY, WE ARE
HERE TODAY IN OPPOSITION TO SB
1236, WHICH, IF ENACTED, WOULD
SUBSTANTIALLY EXPAND THE
GUARANTEED ISSUE AND OPEN
ENROLLMENT OPPORTUNITIES IN
MEDICARE SUPPLEMENTAL MARKET.
WHILE WE SINCERELY APPRECIATE
THE OPEN AND THOUGHTFUL
CONVERSATIONS WE'VE HAD WITH THE
AUTHORS, STAFF AND SPONSORS AND
APPRECIATE THEIR INTENTION TO
ADDRESS VERY SPECIFIC CONSUMER
EXPERIENCE WITH RESPECT TO
MEDICARE ADVANTAGE, WE ARE
CONCERNED WITH THE POTENTIAL
DEVASTATING IMPACTS THIS BILL
COULD HAVE ON NOT ONLY THE
VIABILITY OF THE MEDICARE
SUPPLEMENTAL MARKET, BUT MORE
IMPORTANTLY, ON THE 1.1 MILLION
SENIORS WHO, BY NO FAULT OF
THEIR OWN, WOULD EXPERIENCE
SIGNIFICANT RATE INCREASES IF
THIS BILL WERE TO PASS. AS MANY
OF YOU KNOW, MEDIGAP INSURANCE
HELPS PROTECT PEOPLE WHO ARE
ELIGIBLE FOR MEDICARE FROM HIGH
OUT OF POCKET COSTS, NOT COVERED
BY TRADITIONAL MEDICARE. MEDIGAP
COVERAGE ALLOWS SENIORS, MANY OF
WHOM ARE ON FIXED INCOMES, TO
BUDGET FOR MEDICAL COSTS AND
AVOID THE CONFUSION AND
CONVENIENCE OF HANDLING COMPLEX
MEDICAL BILLS. WITH THAT IN
MIND, ALL MEDICARE SUPPLEMENTAL
POLICIES ARE SOLD ON A
GUARANTEED RENEWABLE BASIS. THIS
MEANS THAT THE INSURER CANNOT
CANCEL THE POLICY OR CHANGE THE
BENEFITS. THIS IS KEY ELEMENT TO
UNDERSTANDING, AS IT UNDERSCORES
THE STABILITY AND PREDICTABILITY
OF THE CURRENT MARKET. FOR
EXAMPLE, IN CALIFORNIA'S CURRENT
MARKET, ONE IS GENERALLY
ELIGIBLE TO PURCHASE ANY
MEDICARE SUPPLEMENTAL POLICY
OFFERED IN THE STATE DURING THE
INITIAL SIX MONTH OPEN
ENROLLMENT PERIOD WITH THE WHEN
THEY ARE FIRST ENROLLED IN
MEDICARE PART B DURING THE
MEDICARE OPEN ENROLLMENT PERIOD,
THE ENROLLEE HAS GUARANTEED
ISSUE RIGHTS AND CANNOT BE
CHARGED HIGHER PREMIUMS BASED ON
HEALTH, NOR REQUIRE MEDICAL
UNDERWRITING. THIS LIMITED OPEN
ENROLLMENT PERIOD ENSURES THAT
THE RISK POOL INCLUDES A MIX OF
HEALTHY INDIVIDUALS AND THOSE
WITH HIGHER HEALTH CARE NEEDS.
IF AN ENROLLEE LATER DECIDES TO
CHANGE THE MEDICARE SUPPLEMENTAL
POLICY OUTSIDE OF THE INITIAL
OPEN ENROLLMENT, CALIFORNIA HAS
WHAT WE REFER TO AS THE BIRTHDAY
RULE, WHICH ALLOWS THE CURRENT
POLICY HOLDER TO MOVE INTO A
DIFFERENT POLICY OR SHOP AROUND
FOR EQUAL OR GREATER OR EQUAL
VALUED PRODUCTS. THIS ALLOWS
THEM TO HAVE FLEXIBILITY AND
CHOICE WITHIN THE SYSTEM WITHOUT
UNDERMINING THE CURRENT RISK
POOL. WHY THIS MATTERS IS
BECAUSE THE FUNDAMENTAL
PRINCIPLE OF INSURANCE INVOLVES
THE POOLING OF RISK TO ENSURE
AFFORDABILITY FOR EVERYONE IN
THE RISK POOL, PREMIUMS ARE KEPT
STABLE WHEN THE RISK POOL
INCLUDES BALANCED MIX OF HEALTHY
PEOPLE, AS WELL AS THOSE WHO
NEED MORE HEALTH CARE SERVICES.
ADVERSE SELECTION OCCURS WHEN
THE RISK POOL BECOMES
UNBALANCED, WITH HIGH NUMBERS OF
PEOPLE WHO NEED MORE HEALTH CARE
SERVICES. THIS ADVERSE SELECTION
RESULTS IN AN INCREASE OF THE
RISK POOLS AVERAGE COST, AND
MEANS THAT EVERYONE IN THE
MEDIGAP RISK POOL, MANY OF WHOM
ARE ON FIXED INCOMES, WOULD PAY
HIGHER PREMIUMS TO THIS POINT,
ACCORDING TO THE ANALYSIS, THE
AVERAGE MONTHLY PREMIUMS FOR
MEDICARE SUPPLEMENTAL WOULD
INCREASE FROM $239 TO 319 PER
MEMBER PER MONTH, A 33%
INCREASE. BECAUSE THE AVERAGE
NEW ENROLLEES IN MEDICARE
SUPPLEMENTAL WOULD LIKELY USE
MORE SERVICES THAN THE AVERAGE
ENROLLEE AT BASELINE. FURTHER IS
NOTED IN THE ANALYSIS, THE NEW
ENTRANTS TO THE MEDICARE
SUPPLEMENTAL MARKET WOULD NOT
ONLY BE HIGHER COST ENROLLEES,
BUT THEY WILL LIKELY DISPLACE
LOWER COST ENROLLEES WHO FIND IT
ADVANTAGEOUS TO DISENROLL FROM
THEIR MEDICARE SUPPLEMENTAL,
RATHER THAN HIGHER PREMIUMS TO
CONTINUE THEIR COVERAGE. LASTLY,
AS MENTIONED BY CBRP IN THEIR
LONG TUM IMPACTS, 1236 COULD
RESULT IN FEWER INSURANCE
CARRIERS WILLING TO PARTICIPATE
IN THE MEDICARE SUPPLEMENTAL
MARKET IN CALIFORNIA BASED ON A
SURVEY DONE IN STATES THAT HAVE
SIMILAR POLICIES IN PLACE. WE'VE
SEEN THIS TO BE TRUE, AS THE
NUMBER OF CARRIERS IN THOSE
MARKETS ARE SUBSTANTIALLY
SMALLER. FOR THOSE REASONS, WE
WOULD RESPECTFULLY ASK FOR A NO
VOTE ON THIS MEASURE, BUT DO
LOOK FORWARD TO HAVING CONTINUED
CONVERSATIONS AT THE BILL MOVES
FORWARD. THANK YOU, THANK YOU
MA'AM. NEXT, PLEASE, MR. CHAIR
AND MEMBERS, FAITH BORGESS, ON
BEHALF OF CALIFORNIA AGENTS AND
HEALTH INSURANCE PROFESSIONALS,
CALIF AGENTS HELP MILLIONS OF
SENIORS ENROLL IN AND USE THEIR
HEALTH CARE COVERAGE. AND
THROUGH THIS WORK, THEY ARE
KEENLY AWARE OF THE CHALLENGES
THAT MANY SENIORS FACE IN
UTILIZING AND PAYING FOR THEIR
MEDICARE COVERAGE. THIS BILL IS
DRAFTED WOULD HELP SOME SENIORS,
AND FOR THOSE REASONS, WE WOULD
LIKE TO THANK THE AUTHORS OFFICE
AND THE SPONSORS FOR BEING
GRACIOUS WITH THEIR TIME TO MEET
WITH US, AND WE HOPE TO CONTINUE
THOSE CONSTRUCTIVE CONVERSATIONS
AS WE HAVE A SHARED GOAL OF
HELPING SENIORS ACCESS HIGH
QUALITY COVERAGE. YET AGENTS ARE
STRONGLY OPPOSED TO THE
LEGISLATION AS IT'S BEFORE YOU
TODAY, SINCE IT WOULD HAVE A
DEVASTATING HEALTH AND FINANCIAL
IMPACT FOR MANY SENIORS. AS
NOTED IN THE ANALYSIS CONDUCTED
BY THIS BILL, AS DRAFTED, WOULD
DO THREE THINGS THAT CONCERN
AGENTS ON BEHALF OF THEIR
CLIENTS. THE BILL WOULD DECREASE
THE NUMBER OF ENROLLEES IN HIGH
QUALITY MEDICARE SUPPLEMENT
POLICIES, SINCE UNDER SB 12, 36,
INDIVIDUALS COULD ENROLL IN DIS
ENROLL IN COVERAGE WHEN THEIR
HEALTH OR FINANCIAL NEEDS NEEDED
NEED IT. THIS WOULD LEAD TO
ADVERSE SELECTION, SINCE HEALTHY
INDIVIDUALS WILL LIKELY BE THE
ONES TO EXIT THIS VOLUNTARY
COVERAGE AND SICKER PATIENTS
WOULD REMAIN. WHICH LEADS TO THE
SECOND PROBLEM. GRAVERT
ESTIMATED THAT THE NEW RISK MIX
WOULD INCREASE PREMIUMS FOR
SENIORS ON MEDICARE SUPPLEMENT
COVERAGE BY 33. AND WHILE
STATISTICS CAN LAND AS DISTANT
FIGURES, THESE DOLLARS IN
APPLICATION CAN CAUSE A SENIORS
MONTHLY GROCERY BILL, BUDGET OR
THEIR ABILITY TO PAY AN ELECTRIC
BILL TO VANISH, OR THEY FORGO
THIS VOLUNTARY BUT NEEDED
SUPPLEMENTAL COVERAGE. AND THEY
FACE THE ALARMING REALITY OF THE
OPPOSITE INTENT OF THE BILL THAT
THEY NO LONGER HAVE ACCESS TO
THIS NEEDED COVERAGE DUE TO
FINANCIAL CONSTRAINTS. LASTLY,
AS NOTED IN THE ANALYSIS, THIS
MAY RESULT IN INSURERS LEAVING
THE MEDICARE SUPPLEMENT MARKET,
AND UPON INTRODUCTION OF THIS
BILL, OUR AGENTS RAN ENROLLMENT
QUOTES FOR SENIORS AND OTHER
STATES THAT HAVE ENACTED SIMILAR
REQUIREMENTS. AND THOSE RATES
WERE DOUBLE THE COST OF THOSE
CURRENTLY AVAILABLE IN
CALIFORNIA. WHILE WE APPRECIATE
THE INTENT OF THE LEGISLATION,
THE APPLICATION OF THE BILL AS
IT'S IN FRONT OF YOU NOW WOULD
BE HARMFUL TO SENIORS. AND FOR
THOSE REASONS, WE'RE STRONGLY
OPPOSED. BUT AGAIN, VERY HAPPY
TO CONTINUE THE DIALOG AS WE
LOOK TO PROTECT SENIORS. THANK
YOU FOR JOINING US, AND I
APPRECIATE YOUR COMMENTS. ANY
OTHER WITNESSES IN OPPOSITION
NAME, AFFILIATION, POSITION,
PLEASE. MR. CHAIR MEMBERS, JOHN
WINGER, ON BEHALF OF AMERICA'S
HEALTH INSURANCE PLANS, WOULD
ECHO THE COMMENTS OF ASHLEY. I
APPRECIATE THE CONVERSATIONS
WITH THE AUTHOR AND THE SPONSORS
AND LOOK FORWARD TO CONTINUING
THAT. THANK YOU SIR. NEXT,
PLEASE. GOOD AFTERNOON, MR.
CHAIR. MEMBERS OF THE COMMITTEE,
JED HAMPTON WITH THE CALIFORNIA
ASSOCIATION HEALTH PLANS, AGAIN
WOULD ECHO THE COMMENTS OF ALEC
AND THANK YOU. THANK YOU SIR.
ANY OTHER OPPOSITION WITNESSES
IN THE HEARING ROOM? SEEING
NONE. LET'S BRING THE MATTER
BACK TO THE DAIS. MEMBERS.
COMMENTS, QUESTIONS, CONCERNS.
SENATOR MENGIBAR, YOU'RE UP.
THANK YOU. SENATOR, I KNOW YOU
TOUCHED ON THIS IN YOUR IN YOUR
REMARKS REGARDING THE COST, AND
I THINK YOU MENTIONED SOMETHING
THAT OUTWEIGHS, THE BENEFITS
OUTWEIGH THE COSTS. CAN YOU ALSO
SPEAK ABOUT TRIP ANALYSIS? AND I
KNOW WE TALKED ABOUT THIS
EARLIER. SPEAK TO, HOW WE CAN
PREVENT A LOT OF PEOPLE FALLING
OFF OF THEIR PLANS. YES. I'D
LIKE TO ASK ADAM IF HE MIGHT
ADDRESS THAT QUESTION. THANK YOU
FOR THE QUESTION, CHAIR. THANK
YOU. SENATOR, I THINK THERE ARE
SOME WAYS WE CAN TRY TO ADDRESS
SOME OF PEOPLE FALLING OFF OF
PLANS. YOU CAN CERTAINLY CAP THE
PREMIUM INCREASES IN THE IN THE
BILL. YOU COULD LIMIT THE PLAN
TYPE THAT, ENROLL PEOPLE COULD
ENROLL INTO. SO THERE ARE SOME
OPTIONS IN TRYING TO CONTROL THE
PREMIUM INCREASE. BUT AGAIN, I
THINK FOR US WE THINK THAT
BETTER INSURANCE COSTS MORE
MONEY. WE THINK THAT'S A
WORTHWHILE, SITUATION BECAUSE
WHILE $64 MIGHT HURT YOU AND
PAYING YOUR YOUR GROCERIES, I
THINK THE OUT OF POCKET COSTS OF
THOUSANDS OF DOLLARS WILL PUT
YOU IN POVERTY. SO I THINK
THAT'S AN IMPORTANT THING I
WOULD CONSIDER. I HOPE THAT
ANSWERS YOUR QUESTION, SENATOR.
THANK YOU. SENATOR. ANY OTHER
QUESTIONS, COMMENTS, CONCERNS?
WELL, I HAVE NONE. SEEING NONE,
SENATOR, WOULD YOU LIKE TO
CLOSE. THANK YOU. AND I
RESPECTFULLY ASK FOR YOUR. I
VOTE WHEN WE ARE ABLE TO
ESTABLISH A QUORUM, WE'LL
ENTERTAIN A MOTION AND WE WILL
TAKE A VOTE. APPRECIATE THE
PRESENTATION. THANK YOU, SENATOR
ALLEN. ITEM NUMBER NINE, SENATE
BILL 1339, SUPPORTIVE COMMUNITY
RESIDENCES. PROCEED WHEN READY,
SIR. THANK YOU SO MUCH, MR.
CHAIR. MEMBERS LET ME START BY
THANKING THE COMMITTEE FOR ITS
WORK ON THIS BILL, AND I WILL BE
ACCEPTING THE COMMITTEE
AMENDMENTS TO CLARIFY
DEFINITIONS AND APPRECIATE THE
WORK THAT WAS DONE. LICENSED,
RESIDENTIAL AND INPATIENT CARE
FACILITIES SERVING PEOPLE WITH
MENTAL HEALTH DIAGNOSES AND
SUBSTANCE USE DISORDERS ARE ARE
CLOSING, AND THE NUMBER OF
MENTAL HEALTH PROVIDERS IS
PROJECTED TO DECLINE OVER THE
NEXT DECADE. THIS HAS LED TO
MORE PEOPLE SEEKING SUPPORT FROM
RECOVERY RESIDENCES, SOBER
LIVING HOMES AND OTHER
FACILITIES THAT ARE ALLOWED TO
OPERATE WITHOUT A STATE LICENSE.
NOW, THESE HOMES, OFFER VALUABLE
SERVICE SUCH AS FELLOWSHIP AND
PEER SUPPORT ASSISTANCE FOR
INDIVIDUALS IN RECOVERY. AND YET
WE KNOW THAT THERE ARE SOME,
THAT HAVE, YOU KNOW, SOME
TERRIBLE STORIES THAT HAVE
EMERGED FROM THE UNREGULATED,
SYSTEM THAT A FRAUD, ABUSE AND
NEGLECT. AND THERE'S ONE THAT'S
NEAR AND DEAR TO MY HEART. A
NEIGHBOR OF MINE, THE NELSONS,
MY CONSTITUENT, THEIR SON,
BRANDON NELSON, 26 YEARS OLD,
AEROSPACE ENGINEER. HE ENTERED
THE MENTAL HEALTH CARE SYSTEM
FOLLOWING A PSYCHOTIC BREAK, AND
HE WAS BOUNCED AROUND BETWEEN
VARIOUS FACILITIES AND BRANDON
ENDED UP AT SOVEREIGN HEALTH,
WHICH WAS OPERATING FRAUDULENTLY
AT THE TIME WITHOUT THE
NECESSARY STATE LICENSE. NOW,
SOVEREIGN WAS ULTIMATELY SHUT
DOWN AND THE OWNER WAS CONVICTED
OF RACKETEERING, BUT NOT BEFORE
SOVEREIGN FAILED TO PROVIDE
BRANDON WITH THE CARE THAT HE
WAS PROMISED, WHICH ULTIMATELY
LED TO HIS UNTIMELY AND
PREVENTABLE DEATH. NOW,
BRANDON'S CASE IS NOT THE ONLY
EXAMPLE OF FRAUD IN THIS SECTOR
OR FAILED STATE OVERSIGHT. THERE
WAS AN INVESTIGATION BY THE
SOUTHERN CALIFORNIA NEWS GROUP,
THAT FOUND THAT THE ANNUAL
NUMBER OF COMPLAINTS AGAINST
FACILITIES HAS JUST EXPLODED IN
THE PAST DECADE. THERE ARE
DOZENS OF CASES OF INSURANCE
FRAUD, SEXUAL ABUSE ALLEGATIONS,
MORE NOW THAT HAVE BEEN BROUGHT
TO THE COURTS. THE LA AREA,
CERTAIN PARTS OF LA IN
PARTICULAR, HAVE BEEN DEEMED
REHAB. RIVIERA WE'VE GOT 1000
LICENSED REHAB CENTERS AND
COUNTLESS MORE RECOVERY HOMES
THAT OPERATE WITHOUT A STATE
LICENSE. AND, YOU KNOW, IT'S I
THINK OUR STRONG FEELING THAT
GREATER OVERSIGHT AND
ACCOUNTABILITY ARE REALLY NEEDED
TO SAFEGUARD VULNERABLE
CALIFORNIANS FROM EXPLOITATION
IN WITHIN A SYSTEM THAT WAS THAT
WAS MEANT TO HELP THEM. SO THIS
BILL AIMS TO ENHANCE THE
REGULATORY FRAMEWORK FOR
UNLICENSED MENTAL HEALTH AND
SUBSTANCE USE DISORDER
FACILITIES, ENSURING GREATER
ACCOUNTABILITY AND SAFEGUARDING
THE WELFARE OF VULNERABLE
CALIFORNIANS SEEKING ESSENTIAL
BEHAVIORAL WELLNESS SERVICES.
SINCE SOVEREIGN WAS OPERATING
ILLEGALLY, IT SHOULD NEVER HAVE
BEEN LISTED AS A CARE OPTION FOR
BRANDON NELSON SHOULD NOT HAVE
BEEN ABLE THEY SHOULD NOT HAVE
BEEN ABLE TO BILL INSURANCE FOR
SERVICES THAT THEY WEREN'T
LICENSED TO PROVIDE. SO FIRST,
THE BILL REQUIRES THAT ANY STATE
REGULATED ENTITY THAT PROVIDES
DISCHARGE PLANNING OR REFERRAL
SERVICES OR AUTHORIZES COVERAGE
OF BEHAVIORAL HEALTH SERVICES AT
LEAST OUGHT TO VERIFY THE
LICENSE OR CERTIFICATION OF
RESIDENTIAL OR COMMUNITY CARE
FACILITIES AND INFORM PATIENTS
OR RESIDENTS OF THE LICENSE OR
CERTIFICATION THAT A FACILITY
HOLDS. AND THEN SECONDLY, THE
BILL TASKS THE DEPARTMENT OF
HEALTH CARE SERVICES WITH
CREATING A VOLUNTARY
CERTIFICATION PROGRAM FOR
RESIDENTS, IS OPERATING AT A
LEVEL BELOW THAT WHICH, YOU
KNOW, CURRENTLY REQUIRE LICENSED
STATE LICENSURE, AND THEY HAVE
TO THE DEPARTMENT HAS TO
MAINTAIN A SEARCHABLE DATABASE
OF THESE CERTIFICATIONS. SO IT'S
VOLUNTARY, YOU KNOW, THERE'S NO
CONSEQUENCE FOR THOSE WHO THEN
DON'T AREN'T A PART OF IT. BUT
AT THE VERY LEAST, THAT ASPECT
OF THE BILL WILL SET SOME
MINIMUM STANDARDS THAT PEOPLE
CAN COUNT ON, AND, AND CREATE A
SYSTEM OF OVERSIGHT AND
ENFORCEMENT FOR THESE
INSTITUTIONS, WHICH IS CURRENTLY
LACKING. AND THE HOPE IS THAT IT
WILL BECOME SOMETHING THAT,
THAT, THAT THAT PROPER FOR,
PROPER, YOU KNOW, ORGANIZATIONS
WILL WEAR AS A BADGE OF PRIDE,
AND IT'S A WAY OF SIGNALING TO
CONSUMERS THAT THIS IS A, THIS
IS A FACILITY THAT MEETS, YOU
KNOW, A BASELINE OF STANDARDS
THAT THEY CAN COUNT ON. SO
TESTIFYING IN SUPPORT TODAY, WE
HAVE JASON ROBINSON, WHO'S THE
CHIEF PROGRAM OFFICER OF SHARED
COLLABORATIVE HOUSING, WHICH IS
A VERY, VERY INTERESTING AND
EFFECTIVE HOMELESS HOUSING
MODEL. BUT NOT JUST HOMELESS
HOUSING, BUT BUT BUT IT'S REALLY
DOING SOME REALLY GOOD WORK
ADDRESSING HOMELESS CHALLENGES
IN MY NECK OF THE WOODS AND ALSO
THROUGHOUT LOS ANGELES. AND THEN
MATTHEW MATERNE, WHO'S A
NONPROFIT FOUNDER AND EMPLOYEE
AND CONSUMER RIGHTS ATTORNEY.
GENTLEMEN, PLEASE PROCEED TO
IDENTIFY YOURSELVES FIRST. FOR
THE RECORD, JASON ROBINSON,
CHIEF PROGRAM OFFICER FOR SHARE.
AND THANK YOU, SENATOR ALLEN.
THANK YOU, ESTEEMED COMMITTEE
MEMBERS, FOR CONSIDERING BILL,
SENATE BILL 1339, WHICH WILL
BRING MUCH NEEDED COMMUNITY
SUPPORTS AND HOUSING FOR
CALIFORNIA'S MOST VULNERABLE
CITIZENS, THE NATIONAL HEALTH
INSTITUTE HAS BEEN EMPHASIZING
THE IMPORTANCE OF SOCIAL SUPPORT
AS A LEADING INDICATOR OF
WELLNESS FOR PEOPLE EXPERIENCING
MENTAL HEALTH ISSUES, AND
STUDIES HAVE SHOWN THAT THE
AMOUNT AND QUALITY OF SOCIAL
SUPPORTS ACCOUNT FOR 40% OF
WHETHER OR NOT PEOPLE ARE OKAY.
THESE KIND OF RECOVERY
RESIDENCES ARE ESSENTIAL AS PART
OF OUR SYSTEM AND PEER RUN
RECOVERY RESIDENCES FOR PEOPLE
EXPERIENCING MENTAL HEALTH AND
HOMELESSNESS ARE AN ESSENTIAL
PIECE OF OUR SYSTEM. THEY
ACTIVATE SAMHSA'S FOUR PILLARS
OF RECOVERY HEALTH, HOME,
PURPOSE AND COMMUNITY. USING
PEER SUPPORT TO CONNECT PEOPLE
TO COMMUNITY WHERE THEY DEVELOP
BROAD ORGANIC SOCIAL NETWORKS
THAT STRENGTHEN AS PEOPLE MOVE
FORWARD IN THEIR GOALS. AS
SENATOR ALLEN SAID, SB 1339
SEEKS TO DEFINE RECOVERY
RESIDENCES AND SITUATE THEM IN
THE CONTINUUM OF CARE PROPERLY,
SO THAT NO ONE IS IMPROPERLY
REFERRED TO A RESIDENCY THAT IS
NOT SUITABLE TO THEIR NEEDS.
CREATING DISTINCTIONS FOR
RECOVERY RESIDENCES THAT FOCUS
ON SUBSTANCE USE ISSUES, MENTAL
HEALTH ISSUES, AND DISTINCTIONS
FOR THOSE THAT ARE ABSTINENCE
BASED, NON ABSTINENCE BASED AND
THOSE THAT USE HOUSING FIRST
MODELS SO THAT PEOPLE SO THAT
OPERATORS CAN DISTINGUISH THE
KIND OF SERVICES THEY PROVIDE
AND PEOPLE ARE INFORMED OF WHERE
THEY'RE GOING. AND AS
CALIFORNIA'S PEER WORKFORCE
GROWS AFTER THE PASSAGE OF SB
803, PEER RUN RECOVERY
RESIDENCES OFFER A SCALABLE
SOLUTION EFFECTIVE, EFFICIENT,
AND IMMEDIATE. IN LOS ANGELES
COUNTY, THEY'VE ACCOUNTED FOR
10% OF HOUSING PLACEMENTS FOR
PEOPLE WITH MENTAL HEALTH ISSUES
IN RECENT YEARS, AT A FRACTION
OF THE COST, AS THE TOTAL BUDGET
FOR LA COUNTY PEER RUN RECOVERY
RESIDENCES IS UNDER 2 MILLION.
ADDITIONALLY, THEIR USE OF
EVIDENCE BASED PRACTICES
PRODUCES THE OUTCOMES CALIFORNIA
SEEKS A 96% HOUSING RETENTION
RATE OVER FOUR YEARS, 57%
EMPLOYMENT RATE, AND 62% OF
PEOPLE CONNECTED TO
NON-SUBSIDIZED MARKET RATE
HOUSING, WITH 41% OF PEOPLE
MOVING IN WITHIN 24 HOURS. SB
1339 IS ESSENTIAL TO CREATE A
STANDARD OF CERTIFICATION
PROCESS FOR THESE PEER RUN
RECOVERY RESIDENCES FOR PEOPLE
EXPERIENCING MENTAL HEALTH AND
HOMELESSNESS. THANK YOU. THANK
YOU SIR. NEXT, PLEASE. HI
MATTHEW MATTERN, I'M AN ATTORNEY
AND, I HAVE ALSO VOLUNTEERED AND
DONATED TO SEVEN NONPROFITS
SERVING THE NEEDS OF THE
HOMELESS COMMUNITY IN LOS
ANGELES, THANK YOU, COMMITTEE
MEMBERS FOR YOUR TIME AND
ATTENTION AND SERVICE TO THE
STATE, THE MODEL OF
COLLABORATIVE HOUSING HAS BEEN
IMPLEMENTED BY SHARE IS ONE OF
THE MOST EFFECTIVE. AND I
WHOLEHEARTEDLY ENDORSE THIS,
THIS PROCESS, THE COLLABORATIVE
HOUSING MODEL WITH PEER SUPPORT,
IS EFFECTIVE IN GETTING PEOPLE
OFF THE STREET INTO GOOD HOMES
LIKE THE ONES THAT I'VE TOURED
WITH SENATOR ALLEN THAT WAS
IMMACULATELY CLEAN AND A PLACE
THAT WOULD GIVE DIGNITY AND
RESPECT TO THE PEOPLE IT HOUSES.
THIS COLLABORATIVE HOUSING MODEL
IS ALSO MUCH MORE COST EFFECTIVE
THAN ANY OTHER ALTERNATIVE.
ADDITIONALLY, IT ALLOWS US TO
HOUSE THE UNHOUSED SO MUCH MORE
QUICKLY BECAUSE, WE DON'T HAVE
TO WAIT FOR NEW CONSTRUCTION
THAT TAKES YEARS TO BUILD AND
COSTS OVER $500,000 A UNIT TO
BUILD. IN SHORT, THE
COLLABORATIVE HOUSING MODEL
COMBINES A COMMON SENSE APPROACH
TO HOUSING THE UNHOUSED. IT DOES
SO COST EFFECTIVELY. IT DOES SO
WITH SERVICES OF PEER MENTORING
THAT IS DEMONSTRATED EXCELLENT
RESULTS, AND IT DOES SO WITH
RESPECT AND COMPASSION THAT
HELPS OUR MOST VULNERABLE, GET
BACK ON THEIR FEET. THANK YOU
FOR JOINING US. THANK YOU. ANY
OTHER WITNESSES IN SUPPORT NAME,
AFFILIATION AND POSITION ON THE
MEASURE ONLY PLEASE. THANK YOU.
SHERRY DALY WITH THE CALIFORNIA
CONSORTIUM OF ADDICTION PROGRAMS
AND PROFESSIONALS SUPPORT IN
CONCEPT ONLY RECENTLY MET WITH
THE SPONSOR AND STAFF AND LOOK
FORWARD TO HELPING WITH
TECHNICAL ISSUES AS WE MOVE
FORWARD. THANK YOU. THANK YOU
FOR JOINING US. NEXT. PLEASE
JOHN DREBINGER WITH THE
STEINBERG INSTITUTE IN SUPPORT.
THANK YOU. ANY OTHER WITNESSES
IN SUPPORT? LET'S MOVE TO
WITNESSES AND OPPOSITION, IF
ANY. FIRST LEAD OPPOSITION, THEN
OTHERS SEEING NO OPPOSITION
WITNESSES. LET'S BRING THE
MATTER BACK TO THE DAIS. SENATOR
MENGIBAR, THANK YOU, SENATOR,
WE'VE BEEN GOING BACK AND FORTH.
I GUESS I STILL I STILL HAVE
SOME CONCERNS. SO HELP HELP ME
GET TO THIS FINISH LINE. SURE,
IT IS MY UNDERSTANDING THAT
SOBER LIVING HOMES, RESIDENTIAL
RECOVERY HOMES, ARE IS JUST A
GROUP OF PEOPLE COMING TOGETHER.
THEY DECIDE THEY'RE LIVING IN
THIS HOME. THERE'S NO MEDICAL,
SERVICES PROVIDED, WHICH IS WHY
THEY'RE NOT LICENSED OR NEED A
CERTIFICATION. IT'S JUST PEER
SUPPORT, WHY THEN DO WE NEED TO
CERTIFY? AND WHAT WHAT WHAT ARE
WE CERTIFYING IF THERE'S NO
MEDICAL SERVICES BEING PROVIDED?
I GUESS IT'S MY FIRST QUESTION.
YEAH. WHY BECAUSE THERE'S THERE
HAVE BEEN TERRIBLE INCIDENCES OF
SEXUAL ABUSE, FRAUD OF LOCATIONS
THAT WERE BROADLY COMMITTED,
LIKE THEY WERE PRETENDING THERE
WAS SOMETHING ELSE, NOT JUST A
SOBER LIVING HOMES ACTING AS
SOBER LIVING HOMES. CORRECT.
BECAUSE YOUR EXAMPLE YOU GAVE,
THEY WERE IN BAD FAITH IN
ACTING. IT'S NOT THEY WERE
PRETENDING THERE WAS SOMETHING
ELSE, WELL, IT'S TRUE THAT
SOVEREIGN, YOU KNOW, WAS, WAS
WAS OPERATING ILLEGALLY AND, IT
WAS NOT IT WAS, IT WAS, IT WAS,
IT WAS BILLING INSURANCE FOR
SERVICES THAT THEY WEREN'T
LICENSED TO PROVIDE. THAT BEING
SAID, THEY ALSO WERE, YOU KNOW,
PUT OUT AND LISTED AS A CARE
OPTION FOR SOMEONE LIKE BRANDON.
AND THERE ARE EXAMPLES OF, OF
ORGANIZATIONS, AND I'M SURE
JASON CAN SPEAK MORE TO THIS,
BUT THERE ARE THERE ARE, YOU
KNOW, INSTITUTIONS AROUND THAT
ARE PUTTING THEMSELVES FORWARD
AS GOOD OPTIONS FOR FOLKS THAT
NEED HELP TO GO TO, AND THERE'S
JUST NO STANDARD TO HOLD THEM
ACCOUNTABLE TO ANY LEVEL OF
SERVICE OR SAFETY. SO THAT'S
WHAT ULTIMATELY THIS IS ABOUT.
THERE'S NO CONSEQUENCE
ASSOCIATED WITH NOT, WELL, THE
ONLY CONSEQUENCE ASSOCIATED WITH
NOT BEING PART OF THE
CERTIFICATION PROGRAM IS THAT,
YOU KNOW, THE THAT YOU MAY LOSE
SOME CUSTOM FROM FOLKS THAT WANT
TO BE PART OF THE THAT MIGHT BE
ATTRACTED TO GOING TO A PLACE
WHERE THEY KNOW THAT THERE'S A
BASELINE STANDARD. NOW, WHAT IS
THE BASELINE STANDARD? WE'VE GOT
SAFETY STANDARDS IN THERE, WHAT
DO YOU LIKE? WHAT DO WE MEAN
SAFETY STANDARDS? BECAUSE THIS
IS A PRIVATE HOME. SO THE
SUBSTANCE ABUSE MENTAL HEALTH
SERVICES ADMINISTRATION PUT OUT
A NATIONAL MODEL FOR BEST
PRACTICES IN RECOVERY RESIDENCES
. THAT'S THE STANDARD IN OTHER
STATES. THERE ARE STATE CHAPTERS
FOR THE NATIONAL ASSOCIATION OF
RECOVERY RESIDENCES, WHERE THE
OPERATORS GET A CERTIFICATION,
GO THROUGH A TRAINING PROGRAM,
AND THE CERTIFICATION HAS AN
ANNUAL FOLLOW UP SO THAT THERE'S
A CHECK ON WHETHER OR NOT
THEY'RE INDEED MEETING THOSE
PRACTICES, WHICH IS WHAT WE'RE
LOOKING TO ESTABLISH HERE. DON'T
DO THAT NOW. CORRECT. NOT IN NOT
IN CALIFORNIA. THERE'S NOT A
CHECK. AND WE NEED AN INCENTIVE
FOR OPERATORS TO USE THE BEST
PRACTICES, WHICH IS WHAT THE
INCENTIVE WHICH IS WHAT THE
CERTIFICATION DOES FOR THE
REFERRAL PATHWAY. BUT IT'S A
VOLUNTARY CERTIFICATION.
VOLUNTARY. RIGHT. OKAY AND IT'S
ALL, YOU KNOW, DHS WOULD, WOULD,
WOULD WOULD SET THE MINIMUM
STANDARDS, YOU KNOW, BASED ON
NATIONAL BEST PRACTICES. AND I
THINK YOU'VE RESPONDED TO ME,
BUT I STILL DON'T UNDERSTAND IF
IT'S VOLUNTARY. WHAT IF NO ONE
DOES IT? AND IF ONE DOES IT,
WHAT BENEFITS DO THEY GET? I
THINK I STILL DON'T CLEARLY
UNDERSTAND THAT PART. AND ONE OF
MY OTHER CONCERNS IS, IS
COMMUNITY MEMBERS SAYING, WELL,
THIS ONE ISN'T CERTIFIED. SO
THIS IS THE ONE WE WANT OUT OF
OUR COMMUNITY. THOSE, COMMUNITY
MEMBERS ARE OFTEN BECAUSE
THERE'S NO LICENSING SERVICES
HAPPENING IN THESE. THEY'RE THEY
DON'T GO THROUGH THE CONDITIONAL
USE PERMIT. THEY'RE THEY'RE
OFTEN OPERATING WITHOUT THE
KNOWLEDGE OF THE COMMUNITY
MEMBERS, WHICH IS FINE. THIS
DOES NOT PRECLUDE ANYBODY FROM
MOVING INTO ANYTHING. THE
INCENTIVE AS DEMONSTRATED IN
OVER TWO DOZEN STATES,
APPROXIMATELY, IS THAT THE
CERTIFICATION STANDARD CREATES
THE INCENTIVE FOR PEOPLE TO USE
BEST PRACTICES AND RECEIVE THE
REFERRALS FROM THE STATE SYSTEMS
THAT MAKE SUCCESSFUL OPERATION
POSSIBLE. SENATOR, HAVE WE HAS
THE DEPARTMENT APPROVED THIS,
CERTIFICATION MODEL? HAVE WE
GOTTEN HAVE YOU GOTTEN ANY TO
FROM THEM SAYING THIS IS AN
ACCEPTABLE, WELL, THE DEPARTMENT
THE DEPARTMENT WOULD WOULD. I'M
SORRY. YOU MEAN THE DEPARTMENT
WOULD SET THE BILL, CALLS FOR
THE DEPARTMENT TO LOOK AT
NATIONAL BEST PRACTICES AND
STANDARDS AND SAMHSA OR FOLLOW
THAT ONE? IT WOULD BE TO FOLLOW
THAT ONE, TO USE THAT ONE AS A
BASELINE. OKAY. SO WE'RE
CERTAINLY, YOU KNOW, HAPPY TO
TALK TO YOU ABOUT PUTTING SOME
GUARDRAILS INTO THE BILL TO
ENSURE THAT LOCAL GOVERNMENTS
WOULDN'T, YOU KNOW, WOULD BE
PREVENTED FROM DISCRIMINATING
AGAINST NON-CERTIFIED PROGRAMS
OR THINGS LIKE THAT. SO BECAUSE
I HEAR YOU. RIGHT. I MEAN,
YOU'RE CONCERNED JUST BECAUSE
SOMEONE DOESN'T HAVE THE
WHEREWITHAL OR THE KNOWLEDGE OR
THE DESIRE TO GO GET THE
CERTIFICATION, WE WANT TO MAKE
SURE THEY'RE NOT GOING TO BE
UNFAIRLY. BECAUSE I GET THE
STORY. IT'S A TERRIBLE STORY,
WHAT HAPPENED WITH JASON. BUT I
SEE THAT AS BRANDON, BRANDON,
BRANDON, I'M SO SORRY, I
APOLOGIZE. THIS IS JASON. JASON.
OKAY HE'S LIKE, WHERE DID I GET
JASON FROM? HE'S ALIVE AND WELL,
YEAH. IS A LOT OF PEOPLE NEED A
HIGHER LEVEL OF CARE AND THEY
SHOULD NEVER BE IN SOBER LIVING
FACILITIES OR RECOVERY BECAUSE
THEY NEED A HIGHER LEVEL OF
CARE. RIGHT. AND I GET THE GOAL
WAS, I THINK I GET THE GOAL IS
TO ENSURE THAT IF YOU NEED
HIGHER LEVEL OF CARE, YOU'RE NOT
BEING REFERRED TO THESE PLACES.
YOU SHOULD NEVER BE REFERRED TO
THOSE PLACES. AND IT SOUNDS LIKE
BRANDON WAS REFERRED TO A PLACE.
WELL, THERE'S THAT, BUT BUT
THERE'S ALSO SO THAT'S SO THAT'S
ONE FACTOR. THE OTHER FACTOR IS
IF A THERE THERE ARE SOME THERE
ARE SOME JUST LOW GRADE, YOU
KNOW, FACILITIES OUT THERE THAT
WE SHOULDN'T THAT IN GENERAL WE
PEOPLE SHOULDN'T BE GETTING
REFERRED TO. AND YOU KNOW I SORT
OF SEE THIS AS A, AS A, AS A
KIND OF CONSUMER PROTECTION, YOU
KNOW, ISSUE WHERE WE, WHERE WE
PROVIDE A BASELINE OF
CERTIFICATION, YOU KNOW, YOU CAN
GO OFF AND DO YOUR OWN THING IF
YOU WANT TO. BUT BUT, BUT IF YOU
KNOW THAT IF YOU IF YOU'RE GOING
TO ONE OF THESE FACILITIES THAT
HAS MET THE CERTIFICATION, THAT
WE SET UP UNDER THIS BILL THAT
YOU'RE GOING TO YOU'RE GOING TO
HAVE A BASELINE OF SAFETY AND
PROGRAM STANDARDS. THAT'S REALLY
ALL IT'S ULTIMATELY ABOUT. BUT,
YOU KNOW, AND IF YOU, AS I SAY,
HAPPY TO WORK WITH YOU ON, ON ON
ENSURING THAT THERE'S THAT
NOBODY CAN DISCRIMINATE AGAINST
NON-LICENSED OR NON CERTIFIED
PHªN ABILITIES, BUT BUT THERE
ARE THIS IS A THIS IS A THIS IS
SUCH AN UNREGULATED SPACE AND
IT'S OUR BELIEF THAT THE
CONSUMERS AND FAMILIES,
ESPECIALLY MANY OF WHOM ARE
ENTERING INTO THIS WORLD FOR THE
FIRST TIME, AND IT'S KIND OF
SCARY AND FRIGHTENING. THEY'RE
ALREADY DEALING WITH A
CHALLENGE, YOU KNOW, WITH THEIR
WITH THEIR LOVED ONE. AND, AND
THERE'S JUST THIS FLOOD OF, OF
OPPORTUNITIES THAT ARE OUT THERE
FOR PEOPLE TO UTILIZE. AND YET
WE KNOW THAT, THAT A LOT OF THEM
JUST AREN'T DON'T MAKE THE
GRADE. AND THAT'S ULTIMATELY
WHAT WE'RE TRYING TO ADDRESS
HERE. I DON'T KNOW IF JASON, IF
YOU HAVE ANY ADDITIONAL THOUGHTS
WAITING FOR THE MICROPHONE.
THERE WE GO. YEAH, I THINK THE
IMPORTANT ELEMENT IS BOTH ON ON
ALL SIDES. THERE'S INFORMATION
FOR FAMILIES AND PEOPLE LOOKING
FOR THESE KINDS OF RESIDENCES SO
THEY KNOW WHERE THEY'RE GOING.
AND THERE'S A PATHWAY FOR
PROVIDERS TO BE ABLE TO MEET THE
BASIC STANDARDS AND THE EVIDENCE
BASED PRACTICES IS TO MAKE SURE
THAT THEY HAVE SUCCESSFUL
OUTCOMES, BECAUSE YOU'VE USING
THE EVIDENCE BASED PRACTICES,
ACTUALLY MAKES THESE PLACES MORE
EFFECTIVE FOR PEOPLE RECEIVING
SERVICES, AND IS A BENEFIT FOR
ALL THE OPERATORS. THAT'S THE
THING, RIGHT? I MEAN, IT I MEAN,
IDEALLY WE RAISE STANDARDS
THROUGH THIS AS WELL. AND, YOU
KNOW, THESE FACILITIES WILL BE
PROVIDING WILL BE WILL BE WE'LL
BE PUTTING A MIND TOWARD UPPING
THEIR BEST, THEIR PRACTICES AND
HAVING, YOU KNOW, A GREATER USE
OF BEST PRACTICES ACROSS THE
STATE. ANY OTHER QUESTIONS,
SENATOR? WELL, I. I THOUGHT WE
WERE TALKING ABOUT SOBER LIVING
FACILITIES, BUT MAYBE WE'RE
TALKING ABOUT SOMETHING ELSE.
ANY OTHER QUESTIONS? COLLEAGUES
WELL, WE'D HAVE TO ESTABLISH A
QUORUM FIRST, BUT I THINK I MAY
HAVE MISSED SOMEONE IN THE
AUDIENCE WHO. WHO MAY WANT TO
SPEAK ON EITHER SUPPORT OR
OPPOSITION. AND IF SO, I
APOLOGIZE. I I APPRECIATE THANK
YOU. CHAIR, SO I FAILED TO
MENTION THAT C-CAP IS THE STATE
AFFILIATE FOR THE NATIONAL
ALLIANCE OF RECOVERY RESIDENCES.
SO WE DO CERTIFY, HOMES
THROUGHOUT THE STATE, HUNDREDS
OF THEM, AND WE DO USE A
NATIONAL STANDARD. SO THAT IS
HAPPENING HERE IN CALIFORNIA.
AND THE REASON WHY CERTIFICATION
IS IMPORTANT NOT TO DISCRIMINATE
AGAINST THOSE WHO CHOOSE NOT TO.
IT NEEDS TO BE VOLUNTARY,
BECAUSE PEOPLE LIVING TOGETHER
HAVE A RIGHT TO LIVE TOGETHER.
RIGHT. SO WHAT CERTIFICATION
GIVES IS THE PUBLIC TO SAY I
CHOOSE ONE THAT'S CERTIFIED. BUT
THE OTHER REALLY IMPORTANT THING
IN THIS BILL IS IT'S A TICKET TO
BE INCLUDED IN FUNDING STREAMS
WHERE YOU REALLY DO NEED
LEGITIMATE OPERATORS. SO THIS IS
AN ABILITY LIKE IN HOUSING FIRST
OR OTHER PROGRAMS TO SAY THIS
PROGRAM MEETS A NATIONAL
STANDARD. CAN BE TRUSTED, TREATS
ITS RESIDENTS WELL, RENEWS EVERY
YEAR. SO IT'S REALLY IMPORTANT
TO ESPECIALLY WITH PROP ONE
COMING, THAT WE HAVE HOMES THAT
HAVE BEEN VETTED. SO THAT'S
THAT'S WHY WE'RE SO INTERESTED
IN THIS BILL. THANK YOU FOR YOUR
COURTESY. THANK YOU VERY MUCH,
SENATOR, BEFORE WE CLOSE, I
THINK THAT'S RIGHT, BECAUSE I
REMEMBER WE HAD SENATOR NILO
HERE WITH THE SAME, VERY SIMILAR
BILL ASKING FOR STATE FUNDING,
BUT THEY'RE NOT CERTIFIED. I
MEAN, THEY'RE NOT, LICENSED.
LICENSED. THANK YOU SO MUCH. SO
SO I GET THE INTENT IF WE
LICENSE THEM AND YOU. I THINK
YOU WERE ONE OF THE WITNESSES
THAT SPOKE ABOUT IT, YOU'LL GET
STATE FUNDING, BUT THIS IS A
CERTIFICATION, AND IT'S
VOLUNTARY. I DON'T KNOW, IT'S
ANNUAL CERTIFICATION. OR IS THE
DEPARTMENT ARE YOU ASKING THE
DEPARTMENT TO COME AND CHECK UP
ON THEM? IS THERE GOING TO BE AN
OMBUDS PERSON? IS THERE GOING TO
BE A LINE WHERE PEOPLE CAN CALL
NOW THAT THEY'RE CERTIFIED? I
FEEL LIKE IF WE'RE LOOKING TO
CREATE A LICENSURE FOR THESE
KIND OF ENTITIES, AND THAT'S THE
ROUTE WE SHOULD TAKE VERSUS A
VOLUNTARY CERTIFICATION THAT I
FEEL IS NOT FULLY COOKED.
BECAUSE BECAUSE THIS IS
RESIDENTIAL LIVING AND IT'S NOT
LICENSURE. THE CERTIFICATION IS
THE THING THAT'S BEEN EFFECTIVE
ELSEWHERE. AND THAT'S WHAT WE'RE
LOOKING TO REPLICATE IN
CALIFORNIA. AND WE'RE ALSO
DEALING WITH RESIDENCES. WE NEED
TO DISTINGUISH BECAUSE THERE ARE
RESIDENCES THAT ARE AN
ABSTINENCE BASED MODEL.
RESIDENTS THAT ARE A NON
ABSTINENCE BASED MODEL,
RESIDENTS THAT ARE FOR SUBSTANCE
USE AND RESIDENCES THAT ARE FOR
MENTAL HEALTH ISSUES AND
CREATING THAT DISTINCTION AND
THAT SCOPE OF PRACTICES ENSURES
THAT WE GET THE OUTCOMES THAT WE
WANT. ANY FURTHER QUESTIONS?
OKAY. BEFORE I MOVE ON, SENATOR
ALLEN, DID YOU ACCEPT THE
AMENDMENTS? YES, YES. WE DID.
PERFECT, WE DON'T DO NOT HAVE A
QUORUM YET. WHEN WE DO, WE'LL
ENTERTAIN A MOTION TO TAKE A
VOTE. BUT IN THE MEANTIME, FREE
TO CLOSE. NO, I APPRECIATE THE
DISCUSSION, I, YOU KNOW,
ULTIMATELY, THIS IS ABOUT,
PROVIDING A THERE ARE SOME
REALLY GOOD ACTORS AND THERE'S
SOME GREAT STANDARDS OUT THERE.
WE WANT TO SEE MORE FOLKS ADOPT
THOSE HIGH STANDARDS HERE IN THE
STATE AND PROVIDE BETTER
SERVICES FOR PEOPLE AND PROVIDE
OPPORTUNITY FOR FAMILIES AND
FOLKS LOOKING FOR HELP WITH TO
GET SOME, SOME, SOME, SOME, YOU
KNOW, VERIFICATION,
CERTIFICATION THAT THE FACILITY
THAT THEY'RE GOING THAT THEY'RE
GOING TO MEETS MEETS A, YOU
KNOW, A BASIC STANDARD OF CARE.
AND THAT'S WHAT THIS IS
ULTIMATELY ABOUT. AND SO WITH
THAT, I RESPECTFULLY ASK FOR
YOUR I VOTE WHEN THE TIME. THANK
YOU, SENATOR ALLEN. GREAT
PRESENTATION. THANK YOU. NUMBER
TEN, SENATOR WAHAB. SENATE BILL
1354 LONG TERME HEALTH CARE
FACILITIES PAYMENT SOURCE AND
RESIDENT STATUS PROCEEDING READY
.
HOUSE. SENATOR GROVE LEFT, I
GUESS? OKAY SHE'LL BE BACK. ARE
WE GOOD? PLEASE PROCEED WHEN
READY. THANK YOU. CHAIR.
COLLEAGUES AND MEMBERS OF THE
PUBLIC, FIRST, I JUST WANT TO
SAY I ACCEPT THE COMMITTEE'S
AMENDMENTS AND THANK THE STAFF
FOR THEIR HELP WITH THEM, YOU
KNOW, YOUR STAFF HAS ALSO BEEN
VERY HELPFUL IN A NUMBER OF
OTHER BILLS, SO I REALLY DO
APPRECIATE THEIR WORK. I'M HERE
TO PRESENT SB 1354, WHICH
CODIFIES REGULATIONS REGARDING
SKILLED NURSING FACILITIES AND
PROTECTS THE RIGHTS OF RESIDENTS
REGARDLESS OF THEIR PAYMENT
SOURCE. SB 1354 ALSO REQUIRES
FACILITIES TO INFORM RESIDENTS
BEING TRANSFERRED OR DISCHARGED
THAT THEY MAY BE ELIGIBLE FOR
THE LONG TERME CARE MEDI-CAL
PROGRAM TO HELP PAY FOR THEIR
STAY THERE. FOR DECADES, NURSING
HOMES HAVE FOUND WAYS OF
DISCRIMINATING TO REDUCE THEIR
MEDI-CAL POPULATION AND FREE
BEDS UP TO MAKE SPACE FOR MORE
PRIVATE PAY OR MEDICARE
RESIDENTS. THIS DISCRIMINATION
FORCES LOW INCOME SENIORS TO
MOVE AWAY FROM FAMILY, FRIENDS,
AND THEIR HEALTH CARE PROVIDERS
IN ORDER TO ACCESS A FACILITY
THAT WILL ACCEPT MEDI-CAL, SB
1354 WILL STRENGTHEN AND ENHANCE
THE RIGHTS OF RESIDENTS IN THESE
FACILITIES AND PROTECT AGAINST
THE DISCRIMINATION BASED ON
THEIR PAYMENT SOURCE. I HAVE TWO
WITNESSES THAT I'D LIKE TO
INTRODUCE KRISTA BARNETT NELSON,
EXECUTIVE DIRECTOR AND SENIOR
ADVOCACY OF SENIOR ADVOCACY
SERVICES, AND MARA GIBNEY,
EXECUTIVE DIRECTOR OF CALIFORNIA
ADVOCATES FOR NURSING HOME
REFORM, OTHERWISE KNOWN AS
KANNER. SO WITH YOU, CHAIR,
PLEASE PROCEED. GOOD AFTERNOON,
CHAIRMAN ROTH, AND MEMBERS OF
THE SENATE HEALTH COMMITTEE. I
AM THE KRISTA BARNETT NELSON,
AND I AM THE LONG TUM CARE
OMBUDSMAN FOR SONOMA COUNTY. BUT
TODAY, I'M REPRESENTING THE LONG
TIME CARE OMBUDSMAN, STATE
OMBUDSMAN, BLANCA CASTRO,
BECAUSE SHE'S AT A CONFERENCE IN
TEXAS. AND LET ME JUST SAY, IT'S
NICE TO BE THE BIG CHEESE FOR
EVEN IF IT'S ONLY FOR THREE
MINUTES, ON BEHALF OF THE
300,000 RESIDENTS IN LONG TUM
CARE FACILITIES ACROSS THE STATE
AND THE 35 LOCAL PROGRAMS IN
CALIFORNIA, WE'RE PROUD TO
CO-SPONSOR FOR 1354, THE. WE
APPLAUD SENATOR HUA FOR HER
LEADERSHIP AND CARRYING THIS
CRITICAL BILL. IT IS IMPORTANT
TO NOTE THAT WHILE THE OFFICE OF
THE LONG TUM CARE OMBUDSMAN IS
ADMINISTRATIVELY LOCATED IN THE
CALIFORNIA DEPARTMENT OF AGING,
WE DO NOT REPRESENT THE
DEPARTMENT, AND THIS STATE LONG
TIME CARE OMBUDSMAN IS AN
INDEPENDENT ENTITY UNDER THE OLD
AMERICANS ACT TO TAKE POSITIONS
ON STATE AND FEDERAL
LEGISLATIONS. SO AS A LONG TERME
CARE OMBUDSMAN REPRESENTATIVES
ARE 615 OF US AND WE ENSURE THE
RIGHTS OF RESIDENTS THAT THEY'RE
NOT VIOLATED IN LONG TERME CARE.
IN 2023, WE HANDLED OVER 43,000
COMPLAINTS AND A SIGNIFICANT
PORTION OF THOSE WERE
INVOLUNTARY DISCHARGES DUE TO
MEDI-CAL BENEFICIARIES BEING
DISCRIMINATED AGAINST. PAYMENT
SOURCE DISCRIMINATION IS A
RECOGNIZED PROBLEM. FOR DECADES.
I'VE BEEN DOING THIS FOR 12
YEARS AND I CAN TELL YOU EVERY
SINGLE DAY WE HAVE A CASE OF
MEDI-CAL DISCRIMINATION. I HAVE
PERSONALLY, JUST TO GIVE YOU AN
EXAMPLE, I HAVE PERSONALLY
CALLED EVERY SINGLE FACILITY IN
MY COUNTY PRETENDING THAT MY
MOTHER NEEDED A BED, STATING
THAT SHE WAS ON MEDI-CAL AND
FINDING A BED FOR HER. THEN I
WOULD SWITCH AND SAY, OH NO,
SHE'S NOT ON MEDICARE, SHE'S ON
MEDI-CAL, AND THEY WOULD
IMMEDIATELY TELL ME THAT, OH NO,
I'M SORRY, WE DON'T HAVE ANY
LONG TÂM CARE BEDS. THIS IS
ABSOLUTELY A PERVASIVE PROBLEM.
THE EXISTING STATUTES DO NOT
PROTECT. I HAVE NEVER SEEN
ANYONE EVER HELD ACCOUNTABLE FOR
PAYMENT DISCRIMINATION. EXCUSE
ME? PAYMENT DISCRIMINATION. WE
NEED TO STRENGTHEN THESE LAWS
AROUND THIS. I'D ALSO LIKE TO
HONOR THE FACT THAT THIS BILL IS
ADDRESSING THE ASKING FOR A
CENSUS. ONE OF THE CHALLENGES IS
PEOPLE DON'T EVEN KNOW IF THERE
ARE BEDS AVAILABLE. ANY BED
THAT'S A MEDICARE BED IS ALSO A
MEDI-CAL BED. IF THEY ACCEPT
THAT AS A PAYMENT SOURCE. SO THE
ABILITY FOR A CONSUMER TO ACCESS
THE CENSUS ALLOWS THEM TO KNOW
IF THERE ARE ACTUALLY BEDS
AVAILABLE. THIS IS NOT AN
ADMINISTRATIVE BURDEN IN ANY
WAY. AS AN OMBUDSMAN, WE WALK IN
THE FACILITIES EVERY SINGLE DAY
AND ASK FOR A CENSUS AND THEY
HAND IT TO US, THIS IS EVERYONE
HAS TO OPERATE THAT WAY. ONE
OTHER I'D LIKE TO GIVE YOU JUST
ONE OTHER EXAMPLE OF WHY THIS IS
SO IMPORTANT. I HAVE A RESIDENT
WHO LIVED IN AN ASSISTED LIVING.
SHE EXHAUSTED ALL HER FUNDS AND
WE WERE UNABLE TO FIND HER A
BED. THEY WERE WERE REFUSING
BECAUSE SHE WAS NOW A MEDI-CAL
PERSON, A MEDI-CAL PAYER SOURCE
IN SONOMA COUNTY. THIS IS A
WONDERFUL COUNTY TO LIVE IN, BUT
SHE WAS DISCHARGED LAWFULLY,
DISCHARGED A HOMELESSNESS. SO
SHE HAD EXHAUSTED ALL HER FUNDS.
AND NOW THIS INDIVIDUAL WHO WAS
A TEACHER IN OUR COMMUNITY HAS
NO PLACE TO LIVE. SOME OPPONENTS
CLAIM THAT DISCRIMINATION FOR
PEOPLE ON MEDI-CAL AND
PREVENTING THEM EQUAL ACCESS TO
A SKILLED NURSING FACILITY OF
THEIR CHOICE IN THE COMMUNITY IS
ALREADY IN STATUTE. AND WE SAY
THAT THE LAW IS NOT STRONG OR
ENOUGH. SO PLEASE SUPPORT AND WE
ASK FOR YOUR AYE VOTE ON 1354.
THANK YOU. NEXT, PLEASE, GOOD
AFTERNOON, COMMITTEE MEMBERS. MY
NAME IS MAURY GIBNEY. I'M THE
EXECUTIVE DIRECTOR OF CALIFORNIA
ADVOCATES FOR NURSING HOME
REFORM, OR KANNER. WE'RE A
STATEWIDE NONPROFIT ORGANIZATION
WHICH ADVOCATES TO IMPROVE THE
QUALITY OF CARE IN CALIFORNIA'S
NURSING HOMES. AND WE'RE A PROUD
CO-SPONSOR OF SB 1354. THIS BILL
AIMS TO PUT AN END TO MEDI-CAL
DISCRIMINATION IN NURSING HOMES
THROUGH MINIMAL CHANGES, WHICH
REQUIRE FACILITIES TO MAKE
INFORMATION MORE ACCESSIBLE AND
DISCOURAGE BAD ACTORS FROM
ENGAGING IN ILLEGAL AND
DISCRIMINATORY PRACTICES. IT IS
IMPORTANT TO NOTE THAT
PARTICIPATION IN THE MEDI-CAL
PROGRAM IS COMPLETELY VOLUNTARY.
ABOUT 85% OF CALIFORNIA
FACILITIES CHOOSE TO RECEIVE
THESE PAYMENTS. HOWEVER WHEN
THEY DO SIGN A PROVIDER
AGREEMENT AND COLLECT MEDI-CAL
FUNDS, THEY ALSO AGREE TO COMPLY
WITH FEDERAL AND STATE LAWS THAT
PROHIBIT DISCRIMINATION AGAINST
MEDI-CAL PARTICIPANTS. MY
ORGANIZATION RECEIVES HUNDREDS
OF CALLS ANNUALLY FROM CONSUMERS
ACROSS CALIFORNIA WHO REPORT
MEDI-CAL DISCRIMINATION AT THE
POINT OF PLACEMENT OR WHEN
THEY'RE SHORT. TERME MEDICARE
STAY HAS ENDED AND THEY NEED TO
REMAIN IN A FACILITY.
DISCRIMINATION DURING THE
ADMISSIONS PROCESS IS FUELED BY
A POPULARLY A POPULAR INDUSTRY
MODEL BUILT ON MAXIMIZING MORE
LUCRATIVE SHORT TERME MEDICARE
STAYS AND AVOIDING LONG TERME
MEDI-CAL RESIDENTS FACILITIES
CAN BILL MEDICARE UP TO 1000, OR
SOMETIMES $1,400 A DAY, AS
COMPARED TO MEDI-CAL RATES,
WHICH AVERAGE 250 TO $300 A DAY.
FAMILIES CALL US REPORTING THAT
THEY HAVE TRIED REACHING OUT TO
UP TO 20 NURSING HOMES, TRYING
TO FIND A BED FOR THEIR LOVED
ONE, ALL TO BE TOLD THE SAME
FALSE STORY THAT THERE ARE SHORT
TERME ONLY, OR THAT THERE ARE NO
LONG TERME BEDS AVAILABLE. THIS
MODEL REQUIRES THAT PATIENTS
MUST BE HOSPITALIZED BEFORE THEY
CAN FIND A NURSING HOME BED,
FORCING THEM TO DELAY FINDING
PLACEMENT UNTIL THEY HAVE A
MEDICAL CRISIS AND UNNECESSARILY
CLOGGING UP CALIFORNIA'S
HOSPITAL BEDS. ANOTHER COMMON
SOURCE OF DISCRIMINATION IS AT
THE POINT WHEN MEDICARE COVERAGE
ENDS AND RESIDENTS SWITCH TO
MUCH LOWER MEDI-CAL RATES. MANY
FACILITIES USE THIS SWITCH AS AN
OPPORTUNITY TO MISINFORM
RESIDENTS ABOUT THEIR RIGHTS TO
STAY, RESULTING IN PEOPLE BEING
FORCED INTO UNSAFE DISCHARGE
SITUATIONS SUCH AS A RECENT
CANCER CALLER WHO WAS
NON-AMBULATORY STILL HAD A NEED
FOR SKILLED NURSING, BUT AFTER
HIS MEDICARE DAYS WERE UP, HE
WAS DISCHARGED TO A SECOND STORY
MOTEL ROOM THAT COULD NOT
ACCOMMODATE HIS WHEELCHAIR. HE
WAS DISCHARGED WITHOUT THE
NECESSARY FOLLOW UP CARE, AND HE
LATER DIED. VULNERABLE SENIORS
WITH ONGOING NEEDS FOR SKILLED
NURSING SERVICES ROUTINELY END
UP DUMPED INTO HOMELESS SHELTERS
, MOTELS OR HOMES WITH CLEARLY
INADEQUATE CARE OR SUPERVISION.
THE RECENT DECERTIFICATION OF
LAGUNA HONDA IN SAN FRANCISCO
EXPOSED THE RAMPANT MEDI-CAL
DISCRIMINATION THAT ROUTINELY
OCCURS ACROSS CALIFORNIA AS PART
OF THE CLOSURE PLAN REQUIRED
DURING LAGUNA HONDA'S FEDERAL
DECERTIFICATION PROCESS OVER AN
11 WEEK PERIOD IN THE SUMMER OF
2022, THEIR STAFF REPORTED
MAKING OVER 14,000 PHONE CALLS
TO NURSING HOMES ACROSS
CALIFORNIA TRYING TO FIND
PLACEMENT FOR THEIR 681
RESIDENTS. THOSE 14,000 CALLS
LED TO ONLY 41 SUCCESSFUL
TRANSFERS OF MEDI-CAL RESIDENTS,
35 TO A SINGLE FACILITY DAY
AFTER DAY, THEIR STAFF WERE TOLD
BY HUNDREDS OF NURSING HOMES
ACROSS THE STATE THAT THERE WERE
NO ROOM FOR ANY LAGUNA HONDA
RESIDENTS, EVEN THOUGH NURSING
HOME CENSUS DATA FROM THE TIME
SHOWED THAT HUNDREDS OF
AVAILABLE BEDS, EVEN IN THE CITY
OF SAN FRANCISCO, WERE AVAILABLE
, THOSE FACILITIES WANTED TO
HOLD THOSE BEDS OPEN FOR MORE
LUCRATIVE PATIENTS BEING
DISCHARGED FROM HOSPITALS ON
MEDICARE, SB 1354 CODIFIES STEPS
THAT FACILITIES ARE ALREADY
REQUIRED TO TAKE AND FACILITATES
PUBLIC ACCESS TO ALREADY
AVAILABLE INFORMATION BY
REQUIRING FACILITIES TO MAKE
CENSUS DATA MORE EASILY
AVAILABLE. CLARIFYING
INFORMATION RECEIVED BY
RESIDENTS AT THE POINT OF THEIR
PROPOSED DISCHARGE, AND
CODIFYING THE AGREEMENT
PROVIDERS SIGN WHEN THEY ACCEPT
MEDI-CAL PAYMENTS. IT WILL ALLOW
VICTIMS OF MEDI-CAL
DISCRIMINATION TO HOLD
FACILITIES ACCOUNTABLE TO THE
PROMISES THAT THEY MAKE WHEN
THEY SIGN THOSE AGREEMENTS. FOR
THESE REASONS, ON BEHALF OF
KANNER AND THOUSANDS OF SENIORS
ACROSS CALIFORNIA, I
RESPECTFULLY REQUEST YOUR AYE
VOTE. THANK YOU. PRETTY CLOSE.
OTHER WITNESSES IN SUPPORT.
NAME, AFFILIATION AND POSITION
ON THE MEASURE, PLEASE. SENATOR
YOUNG, CALIFORNIA ALLIANCE FOR
RETIRED AMERICANS IN SUPPORT.
THANK YOU. OTHER WITNESSES IN
SUPPORT OF THE MEASURE. PETER
HANSEL, ADVOCACY VOLUNTEER HERE
ON BEHALF OF AARP CALIFORNIA IN
SUPPORT. THANK YOU. SIR OTHER
WITNESSES IN SUPPORT. LAST CALL
WITNESSES IN OPPOSITION,
STARTING WITH LEAD OPPOSITION.
FIRST LEAD OPPOSITION IS WELCOME
TO JOIN US IN THE WELL. GOOD
AFTERNOON. PLEASE PROCEED WHEN
READY. THANK YOU. JENNIFER
SNYDER WITH CAPITAL ADVOCACY ON
BEHALF OF THE CALIFORNIA
ASSOCIATION OF HEALTH
FACILITIES. JUST WANT TO FIRST
ACKNOWLEDGE AND APPRECIATE THE
COMMITTEE AND THE AUTHOR WORKING
WITH US ON AMENDMENTS, THEY GO A
LONG WAY TO ACTUALLY ADDRESS THE
CONCERNS THAT WE HAVE WITH THE
BILL. AND WE ALSO WANT TO
ACKNOWLEDGE AND, ALSO SUPPORT
THE CONCERN ABOUT AVAILABILITY
OF BEDS IN SKILLED NURSING IN
CALIFORNIA. I THINK, WHILE WE
APPRECIATE AND SUPPORT THAT
PREMISE, I THINK WE, THE
CALIFORNIA ASSOCIATION OF HEALTH
FACILITIES, HAS A JUST A
SLIGHTLY BIT OF A DIFFERENT,
CONCERN AND A SOLUTION TO THAT,
I THINK WE HAVE A SYSTEMATIC
LOOK AND A AND A LARGE STATEWIDE
ISSUE RELATIVE TO AVAILABILITY
OF BEDS. IT'S IMPORTANT TO NOTE
THAT SKILLED NURSING FACILITIES
ACTUALLY ARE, THE ONE OF THE
LARGEST PROVIDERS OF MEDI-CAL
SERVICES TO MEDI-CAL PATIENTS,
GENERALLY SPEAKING, A MEDI-CAL
SKILLED NURSING FACILITY HAS AT
LEAST 70% OF THEIR PATIENTS THAT
ARE MEDI-CAL. IF NOT 80, AND SO
WE ALREADY IN MOST CASES,
SKILLED NURSING FACILITIES HAVE
A HIGH PERCENTAGE OF THEIR
PATIENTS THAT ARE MEDI-CAL. WHAT
WE HAVE IS A LACK OF
AVAILABILITY OF BEDS. AND I KNOW
THAT CAF IS VERY APPRECIATIVE OF
WORKING WITH THE SENATOR ON ON
ANOTHER BILL, WHICH IS ACTUALLY
TRYING TO FIND WAYS THAT WE CAN
STREAMLINE THE PROCESS OF MAKING
SURE THAT WE CAN CREATE MORE
AVAILABILITY OF BEDS, ESPECIALLY
IN THE BEHAVIORAL HEALTH SPACE.
SO WHAT WE HAVE RIGHT NOW IS
WHAT I WOULD SAY IS KIND OF AN
EPIDEMIC OF LACK OF ABILITY,
AVAILABILITY OF BEDS. AND WHY IS
THAT? WELL, WE HAVE LOW
GOVERNMENT REIMBURSEMENT,
NURSING FACILITIES ARE EITHER
MEDI-CAL OR MEDICARE. THEY DO
PROBABLY ONLY ON VERY RARE
OCCASIONS HAVE A PRIVATE PAY
PATIENT, LOW REIMBURSEMENT, LACK
OF REIMBURSEMENT, SLOW
REIMBURSEMENT, LACK OF ABILITY
TO HAVE FLEXIBILITY ON
REIMBURSEMENT. WE HAVE STAFFING
CHALLENGES. WE HAVE PATIENTS
THAT ARE MORE AND MORE
COMPLICATED. AND SO A NURSING
FACILITY REALLY HAS TO TAKE THE
TIME TO TRY TO UNDERSTAND WHAT
WHAT PATIENTS THEY CAN OR CANNOT
SERVE AND BE ABLE TO DO THAT IN
A SAFE MANNER. SO WITH THAT
BEING SAID, AND WE DON'T HAVE
TIME TODAY TO SOLVE THE SKILLED
NURSING FACILITY CRISIS RELATIVE
TO AVAILABILITY OF BEDS. BUT
WITH THAT BEING SAID, WE REALLY
ARE VERY CLOSE TO BEING JUST
FINE WITH THE BILL, AS AMENDED,
WE WOULD LOVE TO WORK WITH THE
AUTHOR ON SOME ADDITIONAL
CONCERNS THAT WE HAVE, MAINLY
AROUND HOW THE COMMUNICATION OF
THE CENSUS WILL OCCUR, AND WE
FEEL LIKE IT NEEDS TO BE VERY
CLEAR ABOUT HOW THAT WILL
HAPPEN, IT SAYS EMAIL AND PHONE
REQUEST AND TO MAKE SURE THAT
THAT COMMUNICATION IS CLEAR AND
THAT FACILITIES CAN BE COMPLIANT
IN THAT COMMUNICATION. AND SO WE
HOPE TO CONTINUE TO WORK WITH
THE AUTHOR AND THE SPONSORS AND
THE COMMITTEE ON THAT. SO I
APPRECIATE YOUR, DILIGENCE AND
LISTENING TO ME, AND I
APPRECIATE YOUR TIME. THANK YOU.
THANK YOU, THANK YOU, MR. CHAIR.
MEMBERS. AMBER KING WITH LEADING
EDGE CALIFORNIA, WANT TO ECHO
THE COMMENTS MADE BY CAF AND
ALSO WANT TO THANK THE COMMITTEE
STAFF AND THE AUTHOR FOR THE
AMENDMENTS THAT WILL BE TAKEN,
WE DO HAVE A FEW REMAINING
CONCERNS, LARGELY WITH THE
PUBLICLY AVAILABLE INFORMATION
THÀNH REQUIREMENT IN THE BILL,
WE ALSO ARE CONCERNED WITH THE
POINT IN TIME DATA REQUIREMENT
AND THAT IT DOESN'T TELL THE
FULL STORY FOR MANY OF OUR
SKILLED NURSING FACILITIES, THAT
ARE THE SMALLER NONPROFIT
FACILITIES IN THE STATE THAT
ARE, HAVING A REALLY HARD TIME
STAFFING THOSE BEDS. AND SO FOR
MANY OF OUR MEMBERS, THEY'RE NOT
ABLE TO FULLY STAFF AT THEIR
LICENSED CAPACITY AND ARE UNABLE
TO ACCEPT ADDITIONAL PATIENTS.
SO THERE'S MANY REASONS WHY OUR
FACILITIES WOULDN'T BE ABLE TO
ACCEPT ALL OF THE PATIENTS, AND
WE HOPE TO CONTINUE WORKING WITH
THE AUTHOR, TO ADDRESS OUR LAST
FEW REMAINING CONCERNS AND
BELIEVE THAT WE CAN GET THERE.
THANK YOU, THANK YOU. ARE THERE
ANY OTHER OPPOSITION WITNESSES
IN THE HEARING ROOM? IF SO,
PLEASE STEP FORWARD AND NAME
AFFILIATION AND POSITION ON THE
MEASURE. OPPOSITION WITNESSES,
IF ANY. SEEING NONE, LET'S BRING
THE MATTER BACK TO THE DAIS,
MEMBERS. QUESTIONS? COMMENTS?
CONCERNS AS SEEING NONE. SENATOR
WAHAB WOULD YOU LIKE TO CLOSE?
SEE, THIS IS A BEAUTIFUL BILL TO
SUPPORT. RIGHT, I DO JUST WANT
TO ADDRESS ONE OF THE THINGS
THAT THE OPPOSITION WITNESS
SAID. PART OF THE AMENDMENTS
THAT WE HAVE COMMITTED TO AND
AGREED UPON IS ONE IS LIMIT THE
PROVISIONS OF A FACILITY'S DAILY
CENSUS TO JUST THE CURRENT DAILY
CENSUS AND TO BE PROVIDED EITHER
ON THEIR WEBSITE OR OVER THE
PHONE OR EMAIL, SO I DO JUST
WANT TO HIGHLIGHT THAT, THAT I
THINK THAT THE COMMITTEE, AND
OUR TEAM KIND OF ADDRESSED THAT.
WE'RE HAPPY TO CONTINUE
CONVERSATIONS. OF COURSE, YOU
KNOW, MY DOOR IS ALWAYS OPEN AND
I REALLY DO AGAIN, APPRECIATE
THE COMMITTEE STAFF FOR HELPING
US WITH THIS BILL. AND I
RESPECTFULLY ASK FOR AN AYE VOTE
AT SUCH TIME AS WE HAVE A QUORUM
, WE'LL ENTERTAIN A MOTION AND
TAKE A VOTE. SENATOR WAHAB,
THANK YOU. NICE PRESENTATION.
THANK YOU. ITEM NUMBER 12,
SENATE BILL 1432. SENATOR
CABALLERO, HEALTH FACILITIES,
SEISMIC STANDARDS PROCEED WHEN
READY. THANK YOU. THANK YOU, MR.
CHAIR. AND MEMBERS. GOOD
AFTERNOON. I'M VERY PLEASED TO
PRESENT SB 1432, WHICH CREATES
TRANSPARENCY, ACCOUNTABILITY AND
A VIABLE PATH FOR HEALTH
FACILITIES TO ACHIEVE SEISMIC
COMPLIANCE. FIRST, LET ME SAY
THAT I REALLY APPRECIATE THE
CHAIR AND COMMITTEE'S
COLLABORATION ON THIS HERCULEAN,
HERCULEAN EFFORT AND WILL GLADLY
ACCEPT THE COMMITTEE'S
AMENDMENTS. AND I WANT TO THANK
ALL OF THE STAKEHOLDERS FOR
MEETING WITH MY OFFICE MULTIPLE
TIMES OVER THE PAST FEW WEEKS. I
REALLY APPRECIATE THE CHAIR
CONVENING THE FIRST MEETING,
ALONG WITH MYSELF AND COAUTHORS,
AS A WAY TO JUMP START THE
PROCESS. AND IT'S BEEN VERY
PRODUCTIVE AS MANY OF YOU ARE
AWARE, GIVEN THE DISTRESSED
FINANCIAL CONDITION OF
CALIFORNIA HOSPITALS, SOME OF
WHICH ARE IN YOUR DISTRICTS,
HEALTH CARE ACCESS FOR ALL IS IN
JEOPARDY. THE ALFRED ALQUIST
HOSPITAL SEISMIC SAFETY ACT
REQUIRES THAT BY JANUARY FIRST,
2030, ALL HOSPITAL BUILDINGS
HAVE THE CAPACITY TO PROVIDE
PATIENT SERVICES FOLLOWING AN
EARTHQUAKE. PURSUANT TO CURRENT
LAW, HOSPITALS THAT DO NOT
COMPLY WITH THIS 2030 SEISMIC
STANDARD WILL BE REQUIRED TO
CLOSE THEIR DOOR TO PATIENT
CARE. I WANT TO REPEAT THAT THE
SOLUTION, IF THEY DON'T MEET THE
STANDARD, IS THAT THEY CLOSE
THEIR DOORS, DOORS TO PATIENT
CARE OR THAT PART OF THE
FACILITY THAT'S NON-COMPLIANT.
ACCORDING TO A 2019 RAND
INSTITUTE STUDY, THE ESTIMATED
COST OF UPGRADES AND
CONSTRUCTION FOR ALL CALIFORNIA
HOSPITALS TO COMPLY WITH THIS
SEISMIC STANDARD RANGE FROM 34
BILLION TO 140 BILLION,
DEPENDING ON COMPLIANCE
APPROACH. AND THAT'S WHETHER YOU
TEAR IT DOWN AND START OVER OR
WHETHER YOU CAN, DO A, A
RETROFIT, AS YOU MAY KNOW,
MADERA COMMUNITY HOSPITAL IN MY
DISTRICT WAS FORCED TO CLOSE ITS
DOORS, DOORS AND FILED FOR
BANKRUPTCY, WHICH LEFT MADERA
COUNTY HOME TO 160,000 PEOPLE,
MOSTLY LATINO, AND NEARLY A
THIRD OF WHOM WORK IN
AGRICULTURE WITHOUT A GENERAL
HOSPITAL OR HEALTH CLINIC TO
OBTAIN MEDICAL CARE. THE CLOSURE
FORCED MADERA RESIDENTS TO SEEK
MEDICAL CARE OUTSIDE THE COUNTY,
NEARLY AN HOUR'S DRIVE AWAY,
COMPELLING MADERA AND FRESNO
COUNTIES TO ISSUE EMERGENCY
HEALTH CARE DECLARATION. IT'S
CLEAR THAT WE DON'T WANT
HOSPITALS TO CLOSE. WE DON'T
WANT TO LOSE THEIR CRITICAL
SERVICES IN THE PROCESS OF WHAT
WILL BE A MIRACULOUS REOPENING
OF MADERA COMMUNITY HOSPITAL, IT
BECAME CLEAR THAT SOME LEVEL OF
RELIEF FOR SEISMIC COMPLIANCE
WOULD BE NECESSARY TO ENSURE
LONG TUM SUSTAINABILITY. SO WHAT
I DID IS THEN BECAUSE WE HAD
BEEN WORKING ON ALL THE
HOSPITALS TOGETHER WITH THE
EMERGENCY DISTRESS LOAN PROGRAM
AND THE MCO TAX, WHICH SHOULD GO
TO INCREASE MEDI-CAL RATES. I
STARTED TALKING TO THE HOSPITAL
ASSOCIATION AND WHAT WE
DISCOVERED, WHAT I DISCOVERED IS
THE TIME FRAME AND COST TO MEET
THE 2030 STANDARDS ARE A MAJOR
CHALLENGE, ESPECIALLY FOR
FINANCIALLY DISTRESSED HOSPITALS
THAT RAN STUDY SUGGESTS THE COST
OF UPGRADES WOULD PUT 40% OF
CALIFORNIA HOSPITALS IN SEVERE
FINANCIAL DISTRESS, IN IMMEDIATE
RISK OF BANKRUPTCY, COMMUNITY
AND PUBLIC HOSPITALS WOULD TAKE
THE MOST SIGNIFICANT HIT FURTHER
HINDERING ACCESS TO CARE TO CARE
FOR THE MANY MEDI-CAL AND
MEDICARE PATIENTS WHO DEPEND ON
THEM. 62% OF HOSPITALS STATEWIDE
HAVE AT LEAST ONE BUILDING THAT
HAS YET TO MEET THE 2030
STRUCTURAL STANDARDS, AND MORE
THAN 50% OF THE CALIFORNIA
HOSPITALS LOSE MONEY EVERY DAY
TO CARE FOR PATIENTS.
FURTHERMORE, HOSPITALS CONTINUE
TO FACE SIGNIFICANT COST
PRESSURES AND ARE FORCED TO
REDUCE SERVICES TO KEEP THEIR
DOORS OPEN. I KNOW THAT YOU'RE
AWARE THAT MANY OF THE HOSPITALS
ARE ARE DISCONTINUING THEIR
MATERNITY AND DELIVERY SERVICES.
HOSPITALS ARE ESSENTIAL TO OUR
COMMUNITY HEALTH AND WELL-BEING,
AND CALIFORNIA MUST ACT QUICKLY
TO PREVENT FURTHER LOSS OF
ACCESS TO CARE. THIS IS THE
REASON THAT SB 1432 IS CRITICAL
TO IMPROVE SEISMIC SAFETY IN OUR
LOCAL HOSPITALS EXPEDITIOUSLY,
TO ENSURE ACCESS TO HEALTH CARE
IN OUR COMMUNITY BY ESTABLISHING
A FRAMEWORK THAT ONE ENHANCES
TRANSPARENCY, TWO DEMANDS
ACCOUNTABILITY, AND THREE
CREATES A VIABLE PATHWAY FOR OUR
HOSPITALS TO MEET SEISMIC
COMPLIANCE STANDARDS. ACCORDING
TO EACH UNIQUE CIRCUMSTANCE,
WHILE CONTINUING TO PROVIDE
CRITICAL HEALTH CARE TO OUR
COMMUNITIES. I APPRECIATE THE
CONCERNS BROUGHT FORTH BY THE
OPPOSITION AND HAVE BEEN WORKING
CLOSELY WITH ALL STAKEHOLDERS TO
ENSURE WE CRAFT A FRAMEWORK THAT
IS NOT A ONE SIZE FITS ALL
APPROACH, BUT RECOGNIZES
REGIONAL HEALTH CARE CHALLENGES.
IN FACT, I SHARE THE CONCERNS
EXPRESSED BY THE OPPOSITION,
ESPECIALLY AS WE LEARN OF
EXCESSIVE EXECUTIVE COMPENSATION
AND BOARD ACTION THAT RESULTS IN
FISCAL AND CONTRACTUAL
LIABILITY. FOR THESE REASONS, I
AM ADVOCATING FOR MORE
TRANSPARENCY AND ACCOUNTABILITY
IN THE PROCESS AND FOR THE
ABILITY OF THE PUBLIC AND
LEGISLATURE TO HAVE IMPORTANT
DATA. EACH HOSPITAL AND
COMMUNITY HAS A UNIQUE PATH TO
BECOME SEISMICALLY COMPLIANT AND
ENSURE HEALTH CARE ACCESS. SB
1432 PROPOSES TO CAPTURE ALL OF
THESE DISTINCT EFFORTS INTO A
PROCESS THAT IS TRANSPARENT,
HOLDS HOSPITAL EXECUTIVES
ACCOUNTABLE, AND ENSURES EVERY
CALIFORNIA COMMUNITY HAS A
SEISMICALLY COMPLIANT HEALTH
CARE FACILITIES TO UPHOLD
CALIFORNIA'S COMMITMENT TO
HEALTH CARE ACCESS. BUT WITH ME
TO TESTIFY IS SHELLEY
SCHILLINGER WITH DIGNITY
HOSPITALS AND CATHERINE SCOTT
WITH THE CALIFORNIA HOSPITAL
ASSOCIATION. PLEASE PROCEED WHEN
READY. GOOD AFTERNOON, CATHERINE
SCOTT WITH THE CALIFORNIA
HOSPITAL ASSOCIATION. AS YOU
HEARD FROM THE AUTHOR, OUR
HOSPITALS HAVE SPENT BILLIONS TO
GET WHERE WE ARE TODAY, WHICH IS
TO ALLOW THOSE HOSPITALS TO
REMAIN STANDING AFTER AN
EARTHQUAKE, PROTECTING PATIENTS
AND WORKERS. THIS BILL WILL
PRESERVE HEALTH CARE ACCESS
WHILE OUR HOSPITALS WORK TO MEET
THE NEXT MANDATE, AND INCLUDES
THOSE TRANSPARENCY MEASURES
THAT, IF NOT MET, THE HOSPITALS
WILL LOSE THEIR LICENSE, I AM
GOING TO DEFER MY TIME TO OUR
WITNESS SO THAT YOU CAN HEAR THE
SEVERAL COMPLEX PROJECTS THAT
THEY HAVE TO FACE AND WHY THIS
TIME IS CRITICAL TO ENSURE THAT
ACCESS, PRESERVATION AND THE
COMMUNITIES SERVED. GOOD
AFTERNOON. I'M SHELLEY SCHLENKER
, EXECUTIVE VICE PRESIDENT AND
CHIEF ADVOCACY OFFICER FOR
DIGNITY HEALTH. I'M PLEASED TO
BE HERE REPRESENTING OUR 31
CALIFORNIA HOSPITALS AS THE
LARGEST PROVIDER OF MEDI-CAL
SERVICES IN THE STATE, DIDN'T
DIGNITY CONSIDERS ITSELF A
PARTNER TO THE STATE IN ASSURING
ACCESS FOR MEDI-CAL
BENEFICIARIES. WE SEE
APPROXIMATELY 10% OF THE ENTIRE
MEDI-CAL PROGRAM. LAST YEAR
ALONE. WE PROVIDED MORE THAN
600,000 INPATIENT DAYS AND 1.2
MILLION OUTPATIENT VISITS
ANNUALLY. AFTER ALL SUPPLEMENTAL
PAYMENTS, INCLUDING THE PROVIDER
FEE, WE LOSE A HALF $1 BILLION
AT COST SERVING MEDI-CAL
PATIENTS. WE DO THIS BECAUSE
IT'S OUR MISSION AND OUR CALLING
. EVEN WITH THE SIGNIFICANT
LOSSES ON MEDI-CAL, WE HAVE ALSO
INVESTED $2 BILLION TOWARDS
SEISMIC COMPLIANCE. OUR
BUILDINGS ARE 2020 COMPLIANT AND
WILL REMAIN STANDING DURING AN
EARTHQUAKE TO PROTECT OUR
PATIENTS, PROVIDERS AND
CAREGIVERS WAS PERHAPS THE BEST
WAY TO UNDERSTAND OUR STATUS IS
TO SHARE THAT DIGNITY HEALTH
STARTED THIS JOURNEY WITH 87
NONCOMPLIANT SPC ONE BUILDINGS.
WE HAVE TAKEN 18 BUILDINGS OUT
OF SERVICE. THE REMAINING ARE
ALL 2020 COMPLIANT, BUT NONE OF
OUR 31 HOSPITALS ARE TOTALLY
2030 COMPLIANT FOR EXAMPLE,
CALIFORNIA HOSPITAL AND MEDICAL
CENTER IN LOS ANGELES IS
COMPLETING A 200 PLUS MILLION
DOLLAR NEW PATIENT TOWER, AND
WHEN COMPLETED THIS YEAR, IT
WILL BE 2030 COMPLIANT. BUT
THERE ARE SIX OTHER BUILDINGS
THAT MAKE UP THE CAMPUS STILL
NEEDING RETROFITTING, COSTING
SEVERAL HUNDRED MILLION MORE.
HOWEVER, IF WE DON'T MEET THE
2030 DEADLINE ON ANY ONE
BUILDING, THE ENTIRE HOSPITAL
WILL CLOSE AS OUTLINED IN THE
STATUTE TO PRESERVE THE
SERVICES. THIS RETROFIT WILL BE
DONE ROOM BY ROOM, AFFECTING
GENERAL MEDICAL SERVICE FLOORS,
ANCILLARY SERVICES AND THE
CENTRAL PLANT. ANOTHER EXAMPLE
IS BAKERSFIELD MEMORIAL
HOSPITAL. OF THE SIX BUILDINGS
ON THE CAMPUS, WE WILL
DECOMMISSION THREE AND RETROFIT
THREE. A TOTAL OF 420 ROOMS ARE
IMPACTED. IN ADDITION TO THE
EMERGENCY DEPARTMENT, THE
CENTRAL PLAN AND ALL ANCILLARY
SERVICES, THE PEDIATRIC BUILDING
AND SERVICES WILL HAVE TO MOVE
OFF SITE OR BE PAUSED DURING THE
DEMOLITION AND REBUILDING
PROCESS OF THAT PARTICULAR
BUILDING. THIS WILL IMPACT THE
ENTIRE COMMUNITY. LASTLY, I
WOULD MENTION NORTHRIDGE
HOSPITAL. WE HAVE SPENT HUNDREDS
OF MILLIONS OF DOLLARS TO DATE
ON PROJECTS. WE HAVE ONE TOWER
THAT CANNOT BE RETROFITTED
BECAUSE OF THE STRUCTURAL
MATERIALS IT CURRENTLY INCLUDES.
THAT TOWER ALONE WILL COST $260
MILLION, AND THE BEDS WILL BE
OFFLINE DURING THE DEMOLITION
AND RECONSTRUCTION BECAUSE THERE
IS NO ADJACENT LAND TO BUILD IT
ON AT EACH HOSPITAL, IT IS A BIT
LIKE TETRIS MOVING AROUND
SERVICES TO MAINTAIN ACCESS
WHILE ADVANCING THE SEISMIC
STANDARDS. MOST PROJECTS WILL
TAKE BEDS OFFLINE TO MANAGE
CONSTRUCTION AND EXTENSION. OAN
WOULD HELP US MINIMIZE
DISRUPTIONS IN CARE FOR THE
COMMUNITY. WE HAVE BILLIONS OF
DOLLARS IN ADDITIONAL
INVESTMENTS THAT WILL BE
REQUIRED TO MEET THE 2030
STANDARD ACROSS OUR SYSTEM, WE
ARE ASSESSING WHAT IS POSSIBLE.
WHAT WE KNOW IS WE CAN'T DO IT
ALL IN THE TIME FRAME AND
FINANCES WE NOW FACE. WE ARE
GOING TO HAVE TO MAKE SOME TOUGH
DECISIONS THAT WILL IMPACT THE
COMMUNITIES WE SERVE. SB 1432
AND THE AMENDMENTS OFFERED TODAY
HELP CREATE A PATHWAY FORWARD
WHERE WE CAN BALANCE THE
BILLIONS OF ADDITIONAL DOLLARS
WE FACE. THE STAGING OF
CONSTRUCTION ACROSS 31 CAMPUSES,
AND THE LIMITED AVAILABILITY OF
CONSTRUCTION COMPANIES AND
RESOURCES. DIGNITY HEALTH
STRONGLY URGES YOUR SUPPORT OF
SB 1432. THANK YOU BOTH VERY
MUCH. ARE THERE ANY OTHER
SUPPORTERS IN THE HEARING ROOM?
PLEASE STEP FORWARD. NAME,
AFFILIATION AND POSITION ON THE
MEASURE. PLEASE GOOD AFTERNOON,
TIMOTHY BURR, ON BEHALF OF
PLUMAS DISTRICT HOSPITAL IN
SUPPORT. THANK YOU. THANK YOU.
GOOD AFTERNOON. CHEN CHASE, ON
BEHALF OF THE UNIVERSITY OF
CALIFORNIA IN SUPPORT. GOOD
AFTERNOON, JOSH GAGER, ON BEHALF
OF THE CALIFORNIA ASSOCIATION OF
PUBLIC HOSPITALS AND HEALTH
SYSTEMS AND SUPPORT. GOOD
AFTERNOON. ALEJANDRO SOLIS, ON
BEHALF OF LOS AMIGOS DE LA
COMUNIDAD AND LA COOPERATIVA
CAMPESINA, CALIFORNIA, IN
SUPPORT. THANK YOU. GOOD
AFTERNOON. DANIEL SANCHEZ, ON
BEHALF OF FARMWORKERS INSTITUTE
OF EDUCATION AND LEADERSHIP
DEVELOPMENT, FIRST Ã
FOUNDATION, INC. AND CENTRAL
VALLEY OPPORTUNITY CENTER IN
SUPPORT. THANK YOU. MEGAN LOPER,
ON BEHALF OF THE UNITED HOSPITAL
ASSOCIATION AND SUPPORT. PRESTON
YOUNG FROM THE CALIFORNIA
CHAMBER OF COMMERCE HERE TODAY
IN SUPPORT. JONATHAN CLARENBACH
FOR SCRIPPS HEALTH IN SAN DIEGO
IN SUPPORT. AARON TAYLOR, ON
BEHALF OF MEMORIAL CARE, IN
SUPPORT. MIA MORTON, ON BEHALF
OF THE CALIFORNIA CHILDREN'S
HOSPITAL ASSOCIATION AND SUPPORT
GRACE COPLIN ON BEHALF OF
PROVIDENCE. AND THERE ARE 17
HOSPITALS IN NORTHERN AND
SOUTHERN CALIFORNIA IN SUPPORT.
THANK YOU. SET SHORT ON BEHALF
OF THE ALLIANCE OF CATHOLIC
HEALTH CARE, PEACH, REPRESENTING
CALIFORNIA'S HOSPITALS, SAFETY
NET, ADVENTIST HEALTH AND LOMA
LINDA UNIVERSITY HEALTH AND
SUPPORT. THANK YOU, MEGAN
ALLRED, ON BEHALF OF LOS ROBLES
MEDICAL CENTER, GOOD SAMARITAN
HOSPITAL AND RIVERSIDE COMMUNITY
HOSPITAL IN SUPPORT. THANK YOU.
GOOD AFTERNOON. RACHEL BLUCHER
WITH NIELSEN MERKSAMER ON BEHALF
OF THE COUNTY OF CONTRA COSTA IN
SUPPORT. THANK YOU. THEO ALEJO'S
IN SUPPORT ON BEHALF OF TENET
AND ITS CENTRAL VALLEY FAMILY OF
HOSPITALS. THANK YOU. THANK YOU
SIR. NEXT, PLEASE. MIKE VILLINES
, ON BEHALF OF COMMUNITY MEDICAL
CENTERS OF FRESNO. THANK YOU.
ANY OTHER WITNESSES IN SUPPORT
OF THIS MEASURE? SEEING NONE.
WITNESSES IN OPPOSITION. FIRST
LEAD WITNESSES. LEAD WITNESSES
IN OPPOSITION MAY JOIN US IN THE
IN THE WELL AT THE TABLE.
DEPENDING ON HOW MANY YOU ARE,
DIVIDE AND CONQUER. MIDDLE. GOOD
AFTERNOON, SENATOR. I PROCEED
WHEN READY. MATTOS. GOOD
AFTERNOON, CHAIR AND MEMBERS MÀ
ON BEHALF OF SEIU CALIFORNIA
HERE. IRONICALLY ON THE LAST
WEEK OF EARTHQUAKE PREPAREDNESS
MONTH TO TALK ABOUT TWO SEISMIC
BILLS. SO, FUN FACT TO START OFF
, WE WOULD LIKE TO THANK THE
AUTHOR, COMMITTEE CHAIR, AND
STAFF FOR THEIR WORK ON THIS
BILL, WE APPRECIATE THE
AMENDMENTS AND ALSO APPRECIATE
THE CONVENING OF STAKEHOLDERS ON
THIS REALLY IMPORTANT ISSUE,
SOMETHING THAT WE'VE TALKED
ABOUT IN THIS LEGISLATURE FOR
MULTIPLE YEARS, HOWEVER, YOU
KNOW, ALTHOUGH WE DO SEE
PROGRESS WITH THE AMENDMENTS, WE
DO STILL HAVE SERIOUS CONCERNS
WITH THE BILL THAT WE APPRECIATE
THE OPPORTUNITY TO SHARE TODAY,
YOU KNOW, IMPORTANTLY, HOSPITAL
SEISMIC SAFETY WAS PUT IN PLACE
AFTER AN EARTHQUAKE THAT KILLED
MANY PEOPLE IN CALIFORNIA, AND
THAT HAPPENED IN 1970. SO THIS
IS A 50 YEAR OLD POLICY THAT
WE'RE ASKING HOSPITALS TO COMPLY
WITH, WORKERS AND PATIENTS IN
THOSE FACILITIES DO EXPECT TO
MAINTAIN OPERATIONS DURING
EARTHQUAKE. I THINK THE GENERAL
PUBLIC EXPECTS THAT AS WELL,
BECAUSE PEOPLE ARE GOING TO GO
TO A HOSPITAL WHEN THEY'RE HURT
OR INJURED AFTER A MAJOR
EARTHQUAKE, AND THEY EXPECT TO
GET CARE THERE, INCLUDING THE
PATIENTS IN THE HOSPITAL, EXPECT
TO CONTINUE TO RECEIVE CARE
THERE. I CAN'T IMAGINE TRYING TO
EVACUATE A PATIENT THAT MAY BE
SENSITIVE, VULNERABLE AND
NEEDING TO MOVE THEM TO ANOTHER
FACILITY BECAUSE THERE'S NOT
POWER, OXYGEN OR SOME OF THE
OTHER LIFE SAVING SERVICES THAT
ARE EXPECTED. AND SEISMIC EVENTS
ARE INHERENTLY UNPREDICTABLE,
UNDERSCORING THE NEED TO
PREPARE. AND THAT'S WHY THIS IS
SO IMPORTANT. AND APPRECIATE THE
CONVERSATION TODAY, REGARDING
THE COST, HOSPITALS, FINANCIAL
HEALTH, THE CALIFORNIA HEALTH
CARE FOUNDATION JUST RELEASED AN
UPDATED FINANCIAL INFORMATION,
FOUND THAT IN 2023, HOSPITALS
MADE A NET PROFIT OF $9 BILLION
AS AN INDUSTRY. AND WHILE WE
RECOGNIZE THAT THERE ARE SOME
HOSPITALS IN FINANCIAL DISTRESS,
THIS BILL DOES NOT ACCOUNT FOR
THAT AND DOES NOT TAILOR THE
EXTENSION BASED ON THE FINANCIAL
NEED OF THE HOSPITAL. AND SO FOR
THAT, WE STILL HAVE CONCERNS,
SEIU HAS ALWAYS UNDERSTOOD THAT
DUE TO THE PANDEMIC,
CONSTRUCTION MAY BE DELAYED OR
PLANS MAY NEED TO CHANGE BECAUSE
, YOU KNOW, WE'VE LEARNED FROM
THE PANDEMIC AND WHERE WE HAVE
CONCERNS IS THAT, THE INDUSTRY
HAS FOR YEARS DRAGGED THEIR FEET
OR NOT COME INTO COMPLIANCE
TRYING TO AMEND THE STANDARD.
AND FROM OUR PERSPECTIVE, WE
DON'T THINK THAT'S A RATIONALE
TO GET A LONGER EXTENSION, WE DO
SEE THESE EFFORTS AS MAKING
CALIFORNIA LESS SAFE FOR THE
NEXT EARTHQUAKE, REALIZING THAT
WITH THESE AMENDMENTS, WE'RE
LOOKING AT ESSENTIALLY FOR THE
NEXT 15 YEARS, NOT HAVING
HOSPITALS COME INTO COMPLIANCE
WITH SEISMIC SAFETY STANDARDS.
SO FOR THAT, WE WANT TO MAKE
SURE THAT PATIENTS ARE SAFE
DURING A MAJOR EARTHQUAKE AND
PARTICULARLY AFTER THE
AFTERMATH, WITHOUT TRUE
ACCOUNTABILITY AND ENFORCEMENT,
FUTURE LEGISLATORS WILL STILL BE
IN THE SAME PLACE THAT WE ARE
TODAY ARGUING ABOUT THESE
STANDARDS, ARGUING ABOUT OUR
HOSPITALS ARE GOING TO COMPLY OR
NOT, WE KNOW THAT THE
LEGISLATURE IS TAKING THESE
ISSUES REALLY SERIOUSLY, AND WE
HOPE THAT THE HOSPITAL
ASSOCIATION CONTINUES TO DO SO.
AND I KNOW THAT THEY ARE MAKING
EFFORTS TO DO SO, BUT DID WANT
TO, YOU KNOW, RAISE CONCERNS OF
THE FACT THAT, YOU KNOW, UNDER
PREVIOUS LEGISLATION, HOSPITAL
BOARDS WERE REQUIRED TO
ACKNOWLEDGE THAT THE STANDARDS
WERE COMING UP AND ABOUT HALF OF
THEM HAVE FAILED TO DO SO. SO
REALLY WANT TO UNDERSCORE THAT
THESE ARE STANDARDS THAT ARE
IMPORTANT. THEY'RE STANDARDS
THAT ARE GOING TO PROTECT
PATIENTS AND WORKERS AND WANT TO
MAKE SURE THAT THEY'RE THERE
WHEN WE NEED THEM, DID ALSO WANT
TO, FLAG THE LANGUAGE IN THE
BILL. AND I APPRECIATE THE
COMMITTEE'S ANALYSIS THAT
POINTED THIS OUT AROUND RURAL
AND CRITICAL ACCESS HOSPITALS.
AND THAT'S A PARTICULAR AREA
THAT NEEDS ADDITIONAL WORK, THAT
WOULD GIVE SOME HOSPITALS THAT
ARE PART OF LARGE SYSTEMS WHO
HAVE THE FINANCIAL RESOURCES TO
DO IT, TIME, ADDITIONAL TIME
UNTIL THE STATE BAILS THEM OUT.
AND SO, YOU KNOW, WE JUST URGE
CONSIDERATION OF REALLY FUTURE
CONSIDERATION OF NEEDING TO
NARROW THAT PIECE OF THE
LANGUAGE TO MAKE SURE THAT WE
ARE, UNDERSCORING AND
APPRECIATING THE ROLE OF SYSTEMS
PLAY IN RURAL AND CRITICAL
ACCESS HOSPITAL. IN CONCLUSION,
WE LOOK FORWARD TO CONTINUED
ONGOING DISCUSSIONS AROUND HOW
TO CREATE REAL ACCOUNTABILITY,
TO THE HOSPITALS SEISMIC
STANDARDS AS PROPOSED IN THIS
BILL THAT WILL MOVE FORWARD TO A
GREATER SAFETY FOR OUR PATIENTS,
HOSPITAL WORKERS IN OUR
COMMUNITY. AND UNFORTUNATELY,
WITH THE BILL AND THE AMENDMENTS
THAT WE HAVE BEFORE US, WE STILL
BELIEVE THAT THIS IS OVERLY
BROAD INSTEAD OF, MEASURED AND
TARGETED RELIEF WORKERS AND
PATIENTS OF CALIFORNIA ARE
RESPECTFULLY OPPOSE THIS BILL.
THANK YOU. MR. CHAIR, MEMBERS
SARAH PHLOX, CALIFORNIA LABOR
FEDERATION, WE REPRESENT BOTH
HEALTH CARE WORKERS IN
HOSPITALS, FIRST RESPONDER WHO
ARE THE ONES WHO ARE FIRST ON
THE SCENE AT NATURAL DISASTERS
LIKE EARTHQUAKES AND THE MANY,
MANY UNION MEMBERS AND THEIR
FAMILIES ACROSS THE STATE THAT
DEPEND ON HOSPITALS FOR EVERYDAY
CARE AND CARE AFTER DISASTERS.
WE'D LIKE TO ECHO MY COLLEAGUE
FROM SEIU, THANK YOU TO THE
CHAIR, AND THANK YOU TO THE
AUTHOR FOR THEIR THE AMENDMENTS
THAT WERE TAKEN AND THE
STAKEHOLDER GROUP, OF COURSE,
THE STAFF AS WELL. WE LOOK
FORWARD TO CONTINUING
CONVERSATIONS AS WE'VE HAD OVER
MANY, MANY YEARS ON THIS TOPIC.
WE'VE SEEN OVER THE YEARS WHAT
HAPPENS AND THE DEVASTATION IN
COMMUNITIES WHEN AN EARTHQUAKE
HITS IN THE BAY AREA, THERE WERE
53 PEOPLE THAT WERE KILLED AND
3753 PEOPLE INJURED IN
NORTHRIDGE. ALMOST 9000 PEOPLE
WERE INJURED IN ADDITION TO ALL
THOSE WHO WERE KILLED, ALL OF
THOSE PEOPLE NEEDED TO GET TO A
HOSPITAL, ALONG WITH MANY OTHERS
WHO WEREN'T EVEN IN THOSE
NUMBERS. AND SO EVACUATING A
HOSPITAL THAT HAS LOST
FUNCTIONALITY NOT ONLY CREATES A
BARRIER TO ALL OF THE PEOPLE WHO
ARE GOING TO THAT HOSPITAL, BUT
IT PUTS A BURDEN ON THE FIRST
RESPONDERS. THEY NEED TO BE
GOING TO THE AREA WHERE THERE'S
FIRES, THERE'S INJURED, THERE'S
PEOPLE TRAPPED IN HOUSES. AT THE
SAME TIME, THEY MAY NEED TO BE
EVACUATED. MONNING,
NONFUNCTIONAL HOSPITALS THAT NOT
ONLY IS AN IMPACT ON THE
PATIENTS WHO ARE IN THOSE
HOSPITALS, BUT ON EVERYBODY WHO
RELIES ON THE SYSTEM OF FIRST
RESPONDERS THAT WE HAVE TO BE ON
THE SCENE. THAT IS WHY 50 YEARS
AGO, MANY DECADES AGO, THESE
GOALS WERE PUT INTO PLACE. BACK
THEN, 2030 SEEMED LIKE IT WAS
LIFETIME IN THE FUTURE AND THAT
THAT WOULD BE ENOUGH TIME FOR
HOSPITALS ACROSS THE STATE TO
FIGURE OUT THEIR FINANCES AND
PREPARE, BECAUSE THESE ARE VERY
SOPHISTICATED ENTITIES, AND WE
HAVE KNOWN FOR DECADES THAT THIS
THIS RULE, THIS LAW THAT A
HOSPITAL NEEDS TO BE FUNCTIONAL,
THAT IT NEEDS TO BE ABLE TO
TREAT THE PEOPLE NOT ONLY COMING
TO THE HOSPITAL, THE 9000 PEOPLE
THAT WERE INJURED OR MORE, BUT
THE PEOPLE THAT ARE STILL GIVING
BIRTH, THAT ARE STILL RECOVERING
FROM SURGERY, FROM ALL THE
PEOPLE WHO ARE IN THAT HOSPITAL.
WE NEED TO MAKE SURE IT IS
FUNCTIONAL. AND SO WE APPRECIATE
THE WORK THAT HAS BEEN DONE. THE
ATTENTION TO TRANSPARENCY. BUT
WE STILL MUST OPPOSE THE BILL IN
PRINT. THANK YOU. ANY OTHER
OPPOSITION WITNESSES IN THE
ROOM? NAME, AFFILIATION AND
POSITION ON THE MEASURE. GOOD
AFTERNOON. SHANE GUZMAN, ON
BEHALF OF THE TEAMSTERS AND
UNITE HERE IN OPPOSITION. THANK
YOU, MR. CHAIR. MEMBERS. MEGAN,
SUPERS, ON BEHALF OF THE
CALIFORNIA PROFESSIONAL
FIREFIGHTERS CURRENTLY OPPOSED
TO THE BILL IN PRINT. LOOK
FORWARD TO CONTINUING
CONVERSATIONS. THANK YOU, STEVE
BAKER, FOR THE PROFESSIONAL
ENGINEERS IN CALIFORNIA
GOVERNMENT AND OPPOSITION. THANK
YOU, DON SHINSKY, ON BEHALF OF
THE STRUCTURAL ENGINEERS
ASSOCIATION OF CALIFORNIA AND
THE EARTHQUAKE ENGINEERING
RESEARCH INSTITUTE, IN
OPPOSITION. GOOD AFTERNOON.
CHAIR MEMBERS MARTY LOPEZ WITH
THE CALIFORNIA NURSES
ASSOCIATION. WE APPRECIATE THE
DISCUSSIONS THAT WE'VE HAD WITH
THE AUTHOR, BUT WE REMAIN
RESPECTFULLY IN OPPOSITION. ERIC
ROBLES, ON BEHALF OF UNGCP,
CURRENTLY OPPOSED. THANK YOU.
GOOD AFTERNOON. JANICE O'MALLEY
WITH AFSCME CALIFORNIA, IN
RESPECT OF OPPOSITION. THANK YOU
. ANY OTHER OPPOSITION WITNESSES
, COLLEAGUES? ANY QUESTIONS,
COMMENTS, CONCERNS? SENATOR
SMALLWOOD CUEVAS THANK YOU, MR.
CHAIR. AND THIS IS A VERY, VERY
DIFFICULT ISSUE, AND AS SOMEONE
THAT'S BEEN IN THE LEGISLATURE
GOING ON 18 MONTHS, THANKS. THIS
IS NOT WHAT I WANTED TO PICK UP,
IS A 50 YEAR OLD ISSUE THAT IS
STILL UNRESOLVED AND THREATENS
THE LIVES OF EVERY HEALTH CARE
WORKER AND PATIENT, IN ALL OF
OUR COMMUNITIES, WE DON'T KNOW
WHEN WE DON'T KNOW WHERE, THAT'S
ONE OF THE CHALLENGES OF LIVING
IN CALIFORNIA. AND SO WHEN I
HEARD ABOUT THIS, THIS ISSUE,
FIRST FROM THE HOSPITALS, AND
MOST RECENTLY FROM, FROM FROM
THE UNIONS, WHO WERE, CHARGED
WITH THE CARE OF THE WORKERS IN
THE BUILDING, REPRESENTING THEM,
IT'S I HAVE SO MANY, CONCERNS,
YOU KNOW. SO I JUST LET ME START
WITH MY QUESTION. SO ONE JUST ON
WHAT WAS PRESENTED, AND THANK
YOU, SENATOR CABALLERO, FOR IN
THE LAST MINUTES TEXTING ON THIS
, AND I WANT TO SAY IT REALLY IS
HELPFUL THAT THERE IS
CONVERSATION HAPPENING BECAUSE,
IT'S, WELL, WE MIGHT AS WELL SAY
IT'S 2025 AND THIS ALL ISN'T
GOING TO BE DONE BY 2030. LIKE,
I DON'T I DON'T I'M NOT SURE HOW
HOW WE GET THERE, EVEN THOUGH
IT'S TAKEN US 50 YEARS TO GET
HERE, BUT I AM. WHY IS IT THAT
HALF OF THE HOSPITALS AS, MATT
JUST SHARED, HALF OF THE
HOSPITALS HAVE NOT SUBMITTED
THEIR PLANS? IS THERE A SENSE OF
WHY THAT IS WHAT IS HAPPENING?
AND I NEED TO THANK YOU. I
ACTUALLY NEED TO CONFER WITH MY
COLLEAGUE TO UNDERSTAND THAT WE,
OUR ATTESTATIONS, HAVE BEEN
REQUIRED FOR A COUPLE OF YEARS
NOW, AND FROM WHAT I UNDERSTAND,
OUR HOSPITALS HAVE MET THAT THAT
MAY BE A FIGURE RELATED TO AN
NPC NUMBER. SO I THINK I NEED TO
UNDERSTAND MORE AND WE'RE THE
MORE WE UNDERSTAND FROM OSHPD. I
THINK THERE'S SOME REPORTING
DISCREPANCIES IN WHAT ASHFORD
HAS PROVIDED, AND FRANKLY, AND
WE'RE DIGGING INTO THAT BECAUSE
THERE ARE MANY INSTANCES WHERE
OUR HOSPITALS WILL HAVE REPORTED
THAT THEY'VE SUBMITTED SOMETHING
TO ASHFORD AND ASHFORD BECAUSE
THEY DIDN'T, SUBMIT THE REPORT
IN THE WAY THEY WANTED IT DONE
OR MAY HAVE LEFT A PIECE OFF
BECAUSE THEY WERE STILL
INVESTIGATING, HAS REPORTED AS
NOT SUBMITTED AT ALL. SO I THINK
I, I THINK I NEED TO UNDERSTAND
BECAUSE FROM WHAT WE KNOW, OUR
HOSPITALS HAVE TO AND SHELLEY
WILL TELL YOU THAT OUR HOSPITALS
HAVE TO PROVIDE THE ATTESTATION
POST THE ATTESTATION, IF THAT'S
THE ONE WE'RE TALKING ABOUT, AND
WE HAVE NOT GOTTEN A LIST FROM
ASHFORD THAT SAYS OUR HOSPITALS
HAVEN'T DONE THAT. SO AND
USUALLY WE KNOW WE WORK WITH
ASHFORD ANNUALLY TO UNDERSTAND
WHO'S NOT DOING WHAT THEY'RE
SUPPOSED TO BE DOING AT THE
ASSOCIATION LEVEL. AND WE PICK
UP THE PHONE AND CALL THOSE CEOS
. SO THE OTHER THE OTHER THING
IS THAT, TO NOT GET IN THE WEEDS
TOO MUCH, BUT THERE ARE NON
STRUCTURAL REQUIREMENTS THAT
HAVE TO DO WITH THINGS THAT ARE
HANGING ON THE WALLS. AND FOR
LACK OF A BETTER WORD, THAT ARE
NOT THE PIPES AND THE CONCRETE
AND THE IT'S THINGS THAT CAN
MOVE AROUND IN AN EARTHQUAKE,
AND THEN THERE ARE THE
STRUCTURAL THINGS THAT NEED TO
BE DONE. AND THERE ARE DIFFERENT
STAGES AT WHICH YOU, DIFFERENT
STAGES TO GET TO. THE FINAL
SOLUTION IS THE BEST WAY TO PUT
IT. SO YOU HAVE TO HAVE
ENGINEERS THAT PREPARE A REPORT,
AND THEN YOU HAVE TO GET CREWS
IN THERE TO, TO ACTUALLY DO THE
WORK. AND SO YOU HAVE DIFFERENT
STAGES. AND SO WE HAVE TO BE
VERY SPECIFIC WHEN WE USE DATA
ABOUT WHY YOU HAVE 50% NOT
COMPLETE, BECAUSE IT'S NOT THAT
THEY HAVEN'T COMPLIED, IT'S THEY
HAVEN'T GOTTEN TO THE POINT.
THEY HAVEN'T GOTTEN TO THE 2030
REQUIREMENT, WHICH IS THE END
PRODUCT, THEY ARE IN ROUTE AND
HAVE DONE SOME OF THE WORK. AND
SO I THINK WE NEED TO GO BACK
AND FIGURE OUT WHAT THAT, IS
REFERRING TO SO THAT WE'RE
SPECIFIC ABOUT WHAT WE'RE WHAT
WE'RE TALKING ABOUT, BECAUSE
IT'S JUST NOT FAIR TO SAY 50%
HAVE DONE NOTHING BECAUSE THAT'S
NOT TRUE. THERE HAVE BEEN
REPORTS AND REQUIREMENTS AND,
AND WHEN I SAY REPORTS, IT'S NOT
JUST, OKAY, WE WROTE UP A
REPORT, IT'S A, IT'S AN ANALYSIS
OF EXACTLY WHAT HAS TO HAPPEN IN
ORDER FOR THERE TO BE, SEISMIC
COMPLIANCE IN THAT PARTICULAR
CATEGORY. SO MAYBE WE CAN, TAKE
A LOOK AT THAT DATA THAT YOU'RE,
THAT YOU'RE REFERRING TO. OR WE
CAN ASK THE, THE SPEAKER OF THE
DATA TO, TO EXPLAIN WHERE THAT
NUMBER COMES FROM AND EXACTLY
WHAT IT WHAT IT MEANS. MATT.
MAYBE CLARIFY. I MEAN, THE IF I
MAY, THE MISTER CHAIR, THE
INFORMATION THAT HCCI PROVIDES
IN ITS SEISMIC BRIEFING
INDICATED INDICATES THAT ABOUT
49% OF HOSPITALS HAD NOT
PROVIDED A NON STRUCTURAL
PERFORMANCE CATEGORY ANALYSIS
AND WORKING PLAN THAT WAS DUE IN
JANUARY OF 2020. FOR MY FURTHER
UNDERSTANDING FROM THE HOSPITAL
ASSOCIATION IS THAT THERE'S SOME
MISCOMMUNICATION AND PERHAPS A
LACK OF UPDATED DATA AS TO
WHETHER THAT NUMBER IS ACTUALLY
ACCURATE, THAT PLANS APPARENTLY
HAVE BEEN, SOME PLANS HAVE BEEN
SUPPORTED, HAVE BEEN SUBMITTED
ON SCHEDULE, TO HCCI, BUT HAVE
NOT MADE IT THROUGH THE ANALYSIS
PHASE. AND SO THE NUMBER 49% IS
LIKELY TO GO DOWN. AND THAT NON
PERFORMANCE CATEGORY WORKING
PLAN HAS TO DO WITH AMONG OTHER
THINGS YOU KNOW THE BONES OF THE
BUILDING ARE GOING TO STAND.
IT'S NOT GOING TO PANCAKE. IT'S
NOT GOING TO BE A NORTHRIDGE.
BUT ARE THE OXYGEN LINES OR THE
GAS LINES OR THE SEWER LINES? IS
THERE BACKUP POWER? POWER
GENERATORS, THE OTHER THINGS
THAT ARE THE NON STRUCTURAL
COMPONENTS OF A HOSPITAL THAT
ENABLE IT TO FUNCTION AND KEEP
PEOPLE ALIVE IN IT. WHEN THE
EARTH MOVEMENT INCIDENT DIDN'T
OTHERWISE TAKE THEM OUT. AND SO
THE WORKING PLAN WAS TO FIGURE
OUT WHAT YOUR SITUATION IS AND
WHAT THE PLAN GOING FORWARD IS
GOING TO BE, AT AN APPROPRIATE
TIME. I'LL REVIEW WITH ALL OF
YOU WHAT THE AMENDMENTS ACTUALLY
DO, BECAUSE THESE AMENDMENTS
CHANGE IN PART REQUIRE AS A
CONDITION OF AN INITIAL
EXTENSION OF THREE YEARS, THAT A
MASTER SEISMIC PLAN BE SUBMITTED
BY THE HEALTH CARE INSTITUTION
WITH GOALS, OBJECTIVES AND
MILESTONES THAT THEN TO GET THE
THREE YEAR INITIAL EXTENSION
MILESTONES THAT CAN THEN BE
EVALUATED BY HCCI FOR
APPROPRIATENESS AND FOR
COMPLETION. AND THEN HCCI CAN
WALK A HEALTH CARE FACILITY
THROUGH THE MILESTONES AS AS
APPROPRIATE, PROVIDE ADDITIONAL
EXTENSIONS UP TO ANOTHER FIVE
YEARS TO ACCOMPLISH THE
MILESTONES. WALKING A HEALTH
CARE FACILITY DOWN THE ROAD,
HOPEFULLY TOWARD ULTIMATE
COMPLIANCE WITH THE SEISMIC
STANDARDS STRUCTURES ALREADY,
COMPLIED WITH. BUT THE
NONSTRUCTURAL SEISMIC STANDARDS
THAT WILL ENABLE THE HOSPITAL
TO, IN ALL LIKELIHOOD, CONTINUE
TO FUNCTION AFTER A MAJOR
EARTHQUAKE. THAT'S WHAT THIS
THAT'S WHAT THE GUTS OF THE
AMENDMENTS TO THIS BILL ACTUALLY
DO. SO I DON'T KNOW IF THAT
HELPS YOU. IT DOES. AND THAT'S
WHY HE IS THE GENERAL AND THE
CHAIR OF THIS COMMITTEE. LET'S
THANK YOU, AMAZING. THANK YOU.
I, I REALIZE THE COMPLEXITY, BUT
I DO, YOU KNOW, HAVE TO ASK AND
PLEASE, SENATOR ROTH, WE, WOULD
LOVE TO HEAR FROM FROM THE
EXPERTS TO. WHY THE QUESTION
ABOUT TAILORING THIS TO RURAL
HOSPITALS OR HOSPITALS THAT ARE
IN ECONOMIC DISTRESS? YES. I
HAVE A CHILDREN'S HOSPITAL THAT
IS ON THE VERGE, AND IS IN NEED
OF A SIMILAR EXTENSION. SO I,
I'M CURIOUS WHY WHY, WHY ISN'T
THERE AS AS STATED BY OUR
WITNESS, WHY ISN'T THERE A
PARTICULAR PLAN THAT'S SPECIFIC?
WHY ISN'T THIS MORE NARROW? AND
NOT ALL HOSPITALS? WELL, THE WAY
IT'S SET UP IS THAT SOME
HOSPITALS WILL ACHIEVE THE 20
2030 REQUIREMENTS ON TIME. AND
SO THOSE HOSPITALS ARE EXPECTED
TO FINISH WHAT THEY'VE ALREADY
STARTED. AND THOSE THAT ARE IN
DISTRESS ARE GOING TO NEED MORE
TIME AND SO INITIALLY IT'S A
THREE YEAR EXTENSION. BUT THEY
HAVE THERE ARE CERTAIN
REQUIREMENTS THAT THEY PLAN. AND
AS THE CHAIR SAID THAT THEY THEY
HAVE GOOD DOCUMENTATION OF WHAT
THE IMPROVEMENTS NEEDED TO MEET
THE REST OF THE SEISMIC
OBLIGATION IS GOING TO BE, AND
IF THEY NEED MORE TIME
FINANCIALLY, THEY GO TO HCCI AND
THEY ASK FOR THAT. BUT IT'S GOT
TO BE THAT THE INFORMATION THEY
GIVE TO HCCI HAS TO JUSTIFY THAT
THEY'RE IN FINANCIAL DISTRESS.
AND THERE'S A PUBLIC HEARING
PROCESS SO THAT THE LOCAL
COMMUNITY CAN PARTICIPATE IN
THAT ANALYSIS OF THE NEED AND,
AND THEY CAN LOOK AT THE, AT THE
DOCUMENTATION THAT'S BEEN
PREPARED AND WEIGH IN WITH HCCI
AS WELL. SO INITIALLY WE STARTED
OFF SAYING TO 2038, BUT YOU ONLY
GET TO 2038 IF YOU CAN SHOW THE
NEED ALONG THE WAY AND YOU MEET
MILESTONES, YOU DON'T GET THERE.
JUST BECAUSE YOU NEED IT. YOU
GET THERE BECAUSE YOU STARTED TO
DO THE ACTUAL WORK THAT NEEDS TO
BE DONE. 20 SO THAT'S 20. THE
2038. AND IT'S, MANY, MANY
MILESTONES. ÓRDENES AND, AND,
AND I APPRECIATE THE AMENDMENTS
THAT THAT, HAVE BEEN TAKEN IN
COMMITTEE AND THE DISCUSSION
WITH ALL OF THE ORGANIZATIONS.
AND I'M GLAD TO HEAR THAT THESE
ARE ONGOING, CONVERSATIONS. I
JUST AND I KNOW SENATOR
CABALLERO, I'M PROBABLY SPEAKING
YOUR LOVE LANGUAGE HERE, BUT
IT'S GRANTING EXTENSIONS ARE NOT
SEEING ANY OUTCOMES. YOU KNOW,
THEY SAY YOU DO THE SAME THING
AND EXPECT A DIFFERENT OUTCOME.
AS WE THINK ABOUT THESE
BENCHMARKS, AND I UNDERSTAND
THAT THERE'S A DEMONSTRATED
PROGRESS, BUT TYPICALLY LIKE,
AND I THINK ABOUT CONSTRUCTION,
IF YOU DON'T MEET A CERTAIN
PHASE, YOUR MONEY GETS WITHHELD
UNTIL THAT WORK GETS DONE, AND
THEN YOU MOVE TO THE NEXT. WHERE
ARE THE ACCOUNTABILITY MEASURES
IN HERE? I KNOW SOME OF THE
CIVIL PENALTIES THAT HAVE BEEN
REMOVED, BUT MY QUESTION IS ARE
ARE THERE FINES? ARE THERE? WHAT
ARE THE WAYS IN WHICH WE AREN'T
BACK HERE IN 2035, YOU KNOW,
FACING A SIMILAR CONVERSATION?
THÀNH. SO YOU ASK A REALLY GOOD
QUESTION. LET ME GIVE YOU THE
FRAME THAT I WAS WORKING ON FOR
THIS. IT'S THAT, AND IT WAS BACK
I WANT TO SAY IT WAS THE LOMA
PRIETA EARTHQUAKE IN, IN THE
LATE 80S, THE, THE DAMAGE THAT
WAS CREATED IN THAT EARTHQUAKE
WAS DAMAGED BECAUSE OF
UNREINFORCED MASONRY. IT WAS
DAMAGED TO DOWNTOWNS THAT WERE
BUILT IN THE 1800S. AND THEY
WERE THEY WERE BRICK BUILDINGS
THAT HAD NO, NO SUPPORT, AND SO
STATE LAW PASSED AND REQUIRED
THAT CITIES GET THEIR, THEIR,
THEIR NON THEIR DOWNTOWNS THAT
HAD UNREINFORCED MASONRY
BUILDINGS RETROFITTED. AND SO WE
DID THAT IN THE CITY OF SALINAS.
AND WE, WE PASSED AN ORDINANCE
THAT SAYS YOU HAVE TO DO THIS.
BUT OUR DOWNTOWN WAS IN TERRIBLE
SHAPE, IT WAS I HATE TO SAY IT,
BUT WHAT K STREET LOOKS LIKE
NOW, IT WAS EMPTY MOSTLY. AND,
AND THERE WERE THERE WERE VERY
FEW BUSINESSES THAT WERE OPEN
AND SO WE TOLD THE BUSINESS
PEOPLE, YOU GOT TO DO THIS. AND
THEY SAID, WE'LL CLOSE IT DOWN
AND WE'RE GOING TO START TEARING
DOWN THE BUILDINGS BECAUSE
THEY'RE NOT WE CAN'T DO IT. WE
CAN'T AFFORD IT. WE GAVE THEM
EXTENSION AFTER EXTENSION AFTER
EXTENSION, AND WE FINALLY SAID,
YOU KNOW WHAT? THEY DON'T HAVE
THE MONEY AND WE DON'T WANT THEM
TO TEAR IT DOWN. WE JUST WANT IT
TO BE SAFE. THAT'S REALLY THE
GOAL. SO THE GOAL HERE IS WE
DON'T WANT THEM TO TEAR DOWN THE
HOSPITALS. WE WANT THEM TO BE
SAFE. SO HOW DO WE GET THEM TO
THERE AND WHAT WE ENDED UP DOING
IS WE TALKED TO OUR LOCAL
COMMUNITY BANK WAY TOO MUCH
INFORMATION AND I APOLOGIZE. BUT
THEY WE HAD ALL THE CITY MONEY
THERE, WHICH ARE MILLIONS OF
DOLLARS IN CHECKS THAT WENT OUT
TO PAY OUR EMPLOYEES AND OUR
DEBTS AND WE SAID, OUR MONEY
SITS IN YOUR BANK AND EARNS 0%
INTEREST. WE WANT YOU TO BE
PARTNER WITH US IN THE DOWNTOWN
BUSINESS OWNERS THAT ARE MAKING
NO MONEY ON THESE, THESE THIS
RENTAL, THE RENTALS THAT THEY
HAVE. AND WE WANT YOU TO DO LOW
INTEREST LOANS AND THE CITY WILL
BACK BACK IT WE WERE THE
BACKSTOP. IN OTHER WORDS, WE
WERE THE GUARANTORS FOR THE
LOANS SO THAT IF ANYBODY
DEFAULTED, THE CITY WOULD STEP
IN AND PAY OFF THAT DEBT, THE
BANK SAID FINE. THE BUSINESSES
ENDED UP GETTING LOANS. THEY ALL
WERE RETROFIT. NONE HAD TO BE
TORN DOWN AND NOT ONE OF THEM
DEFAULTED ON THE LOAN. SO THE
CITY PUT UP NO MONEY. WE MAY
HAVE TO DO SOMETHING IN THE END
TO THOSE HOSPITALS THAT HAVE SO
MANY. FOR LACK OF A BETTER WORD,
MEDICAL AND MEDICARE PATIENTS
THAT THEY THAT THEY ARE THEY
THEY'RE CONSTANTLY STRUGGLING.
AND WE'LL SEE WHAT THE MCO TAX
DOES TO ALLEVIATE THAT AND TO
COME UP BEHIND THEM. AND TO SAY
WE HAVE A LOAN PROGRAM. ONE OF
THE BILLS THAT I DID A COUPLE OF
YEARS AGO WAS AN INCREASE TO THE
VAPE TAX, AND WE ALLOCATED 10%
OF THAT TAX FOR SEISMIC SAFETY
WORK, AND THAT'S GENERATING
ABOUT 2 TO $3 MILLION A YEAR.
AND THAT'S BEING USED BY HCCI TO
HELP SOME OF THE HOSPITALS THAT
NEED, WORK DONE. IT'S THE EARLY
WORK THAT NEEDS TO BE DONE ON
GETTING THE ENGINEERING REPORTS
AND THE STUDIES THAT TELL THEM
WHAT BUILDINGS HAVE TO GO AND
WHAT WHAT BUILDINGS CAN BE
RETROFIT. SO I, I IN ANSWER TO
YOUR QUESTION, THIS BILL DOES
NOT ANTICIPATE BAILING OUT ANY
HOSPITALS. IT DOES NOT
ANTICIPATE PUTTING ANY MONEY IN.
BUT WE MAY HAVE TO GET THERE AT
SOME POINT BECAUSE SOME
HOSPITALS, MADERA HOSPITAL, FOR
EXAMPLE, IT'S GOING TO OPEN UP
AGAIN. BUT THERE'S NO WAY THAT
IN THE NEXT FIVE YEARS THEY'RE
GOING TO BE ABLE TO RETROFIT
THAT HOSPITAL. THEY JUST NEED TO
GET BACK ON THEIR FEET AND THEY
WON'T BE DOING LABOR AND
DELIVERY, WHICH IS TRAGIC IN A
COMMUNITY THAT HAS A HIGH
IMMIGRANT POPULATION. AND SO I
WOULD PREFER THAT THEY FOCUS ON
LABOR AND DELIVERY, BUT THEY'RE
ALSO GOING TO NEED TO FOCUS ON
SEISMIC SAFETY. AND I, I THINK
THAT WE'RE PROBABLY GOING TO
HAVE TO COME UP WITH A PROGRAM
THAT HELPS TO CREATE A FUND FOR
THOSE THAT ARE REALLY
STRUGGLING, BUT WE WANT TO SEE
THE FINANCIALS AND WE WANT
PEOPLE TO WE WANT, TRANSPARENCY
IN THE PROCESS. AND I APPRECIATE
THAT ANALOGY. BUT EVEN IN THE
TIME FRAME, RIGHT, YOU'RE
DOWNTOWN AND THAT SCENARIO HAS
BEEN REBUILT. AND HERE WE ARE 50
AND WE'RE STILL KIND OF JUST AT
THE SECOND, SECOND, SECOND
LEVEL. SO I, I, YOU KNOW, I'M,
MY MAIN CONCERN, OAN, IS
ENSURING THAT THEY ACTUALLY MEET
THE BENCHMARKS. I AGREE. AND
EIGHT YEARS, 3038 IS A SO FAR
AWAY AND THEN WORKING BACK FROM
THAT, THIS BILL IS THREE YEARS,
BUT THREE YEARS. YES. WITH THE
OPPORTUNITY. WITH THE
OPPORTUNITY CORRECT TO GO ALL
THE WAY TO THE DEADLINE IF THE
PROGRESS IS, IS DEMONSTRATED. I
HAVE A LOT OF CONCERNS, ABOUT
THIS. THE ONLY THING THAT IS
PREVENTING, PREVENTING ME FROM
SAYING THAT I WILL NOT SUPPORT
THE BILL IS THAT THERE IS
CONVERSATION HAPPENING ON BOTH
SIDES, I WANT TO SEE THIS BILL
MOVE FORWARD TODAY, BUT I WILL
NOT SUPPORT THIS BILL IF WE
DON'T HAVE A WAY TO HAVE REAL
ACCOUNTING MEASURE
ACCOUNTABILITY MEASURES AND.
BENCHMARK PENALTIES, BECAUSE MY
FEAR IS JUST DEMONSTRATING IS
NOT ENOUGH. AND WE'VE GOT TO
FIGURE OUT A WAY TO HAVE REAL
COMMITMENT MATERIA L COMMITMENT
TO SEEING THIS, MOVE FORWARD, I
AGREE WITH THE OPPOSITION THAT,
WE NEED TO SCALE BACK ON HOW
MUCH TIME WE ARE ALLOTTING FOR
THESE PLANS TO BE REVIEWED AND
APPROVED. I THINK THAT THAT TIME
FRAME IS TOO, TOO WIDE AND TOO
LONG, AND JUST KNOW NOTHING'S
CHEAPER IF YOU WAIT, YOU KNOW,
ANOTHER, 15 YEARS TO, TO GET THE
WORK DONE. IT ONLY GETS MORE AND
MORE EXPENSIVE. AND THEN WE'RE
BACK HERE. SO, YOU KNOW, I
APPRECIATE THE OPPOSITION. I
RESPECT YOUR POSITION, I'M VERY
GLAD TO SEE THIS. THIS
CONVERSATION, BUT I AGREE THAT
THIS IS ABOUT PROTECTING WORKERS
AND CALIFORNIANS, AND MAKING
SURE THAT THE COSTS ARE NOT TOO
GREAT BECAUSE ONCE WE START
LOSING LIVES, IT'S THE COST IS
TOO GREAT. SO THANK YOU. THANK
YOU, THANK YOU, SENATOR. SENATOR
LIMÓN, THANK YOU, YOU KNOW, THIS
IS A COMPLICATED ISSUE, IN
DECEMBER OF 2016, I GOT
APPOINTED TO THE HEALTH
COMMITTEE ON THE ASSEMBLY SIDE,
AND I'VE SERVED ON THE HEALTH
COMMITTEE. AND I THOUGHT AS AN
EXERCISE JUST TO KIND OF GO
BACK, I WOULD LOOK JUST TO SEE
HOW MANY, BILLS PERTAINING NOT
ALL EXTENSIONS TO SEISMIC, WE
WOULD YOU KNOW, I'VE, I'VE SEEN
SINCE I'VE BEEN IN THE
LEGISLATURE AND IT TURNS OUT
I'VE SEEN 14. AND THIS IS THE
15TH BILL. AND THEY'RE ALL
DIFFERENT. THEY'RE ALL ACTUALLY
PUT TOGETHER BY DIFFERENT GROUPS
OR, OR PERSPECTIVES AND, I SHARE
THAT BECAUSE ONE OF THE THINGS
THAT IS DIFFERENT CULT IS,
TRYING TO UNDERSTAND WHAT THE,
WHAT SOLUTION CAN COME FORWARD
THAT WILL ACTUALLY YIELD THE
OUTCOMES WE WANT, WHICH IS FOR
OUR HOSPITALS NOT TO CLOSE THAT
THOSE THAT ARE IN DISTRESS GET
MORE TIME AS THEY MAKE
MILESTONES. I COMPLETELY AGREE
WITH THAT, AND I'M NOT SURE
THROUGH DIFFERENT VARIATIONS.
RIGHT. AGAIN, THEY'VE NOT ALL
BEEN JUST FLAT OUT EXTENSIONS.
THERE'S BEEN DIFFERENT
VARIATIONS OF BILLS, IN THIS
SPACE, WE'VE SEEN, WE'VE NOT
NECESSARILY BEEN ABLE TO
ACCOMPLISH THAT. SO I DON'T
THINK THAT THERE IS A SIDE THAT
IS RIGHT OR WRONG IN THIS
SITUATION. I ACTUALLY THINK
EVERYONE IS RIGHT, AND WE'RE
TRYING TO FIGURE OUT HOW TO MOVE
THIS FORWARD AS THE AUTHOR AND
FROM YOUR PERSPECTIVE, WHAT DO
YOU THINK THIS WILL BE? THE
BILL. YOU KNOW WHAT WHAT
CERTAINTY DO WE HAVE THAT IF
THIS BILL MOVES FORWARD, THIS
BILL WILL BE THE METRICS, THE
STANDARD IN PLACE SO THAT WE SEE
THAT WE'RE MAKING THE PROGRESS
WE WANT AND THAT WE'RE ABLE TO
ACHIEVE, LIKE WHAT IS DIFFERENT
FROM THE PREVIOUS VERSIONS AND
ATTEMPTS TO DO THIS. AND AGAIN,
SOME OF THERE ARE SO MANY
DIFFERENT VARIATIONS. SOME HAVE
BEEN ONE OFF, SOME HAVE BEEN
FLAT OUT EXTENSIONS, NOT ALL
HAVE BEEN BROUGHT TO US BY, YOU
KNOW, THE SAME KIND OF GROUPS,
VERY DIFFERENT. YEAH. I CAN'T
SPEAK TO THE OTHER BILLS BECAUSE
I FRANKLY DON'T WANT TO BE DOING
HEALTH CARE. I WAS PULL KICKING
AND SCREAMING. I'M SORRY. I'M
REALLY SORRY FOR EVERYBODY HERE.
SORRY. THAT'S NOT THE ANSWER I
WAS EXPECTING. OH I REALLY DON'T
WANT TO DO THIS, NO, NO, THIS
THIS IS REALLY COMPLICATED. AND
THE CHALLENGE, I THINK, IS THAT
IS THAT THERE IS AN ASSUMPTION
THAT HOSPITALS JUST DON'T WANT
TO DO THIS, AND IT'S JUST NOT
TRUE, THERE ARE SOME. DO SOME
HOSPITALS HAVE THE ABILITY TO DO
IT, BUT JUST MAYBE DIDN'T DO IT?
MAYBE, I DON'T KNOW, I'M NOT IN
A POSITION TO SAY, BUT I THINK
THERE'S A REALLY, HONEST
INTEREST IN DOING THE RIGHT
THING. IT'S A QUESTION OF
RESOURCES AND IT'S A QUESTION OF
PRIORITIES WITHIN THE HOSPITAL
SETTING, AND, AND PART OF THAT
IS THAT, YOU KNOW, THINGS CHANGE
SO RAPIDLY IN MEDICINE THAT YOU
HAVE TO BE BUYING THE LATEST
EQUIPMENT TO BE ABLE TO DO THE
WORK IN THE HOSPITAL THAT NEEDS
TO GET DONE. AND THOSE ARE
EXPENSIVE, AND SO, SO, PART OF
THE CHALLENGE IS THAT, WE'VE,
WE'VE PUT THIS OBLIGATION ON AND
YES, WE'VE CREATED A LONG
RUNWAY, BUT SOME ARE NOT GOING
TO GET THERE. THEY'RE JUST NOT
GOING TO GET THERE. SO THE
QUESTION BECOMES, RATHER THAN
WHO'S BILL WAS THE BETTER ONE,
WHAT WE TRIED TO DO IS TO SET
UP, MILESTONES THAT SHOW THAT
YOU'RE PROGRESSING AND, AND, AND
A REVIEW BY H. CHI. SO H CHI CAN
, CAN TAKE APART THE NUMBERS
THAT YOU'RE PRESENTING AND THE
WORK THAT YOU'VE DONE SO FAR AND
MAKE SOME DECISIONS ABOUT
WHETHER YOU'RE ON THE RIGHT,
RIGHT TRACK AND AT THE END, TO
GET THE LAST THREE YEARS, YOU
HAVE TO HAVE PLANS. YOU HAVE TO
HAVE, STARTED TO GET PERMITS.
YOU'VE GOT TO HAVE A CONTRACTOR,
YOU'VE GOT TO IDENTIFY A
CONTRACTOR, AND THEN YOU HAVE TO
HAVE A MILESTONES IN TERMS OF
WE'RE GOING TO BREAK GROUND
DOING THIS. WE'RE GOING TO,
DEMOLISH THE BUILDING DUE ON
THIS DATE IN OTHER WORDS, SOME
REAL SPECIFIC THINGS. SO H CHI
CAN WALK THEM THROUGH THAT
PROCESS AND MAKE SURE THAT
THEY'RE DOING IT, BUT THEY'RE
GOING TO NEED THE RESOURCES
THEY'RE GOING TO HAVE TO NEED
THE FINANCES. AND PART OF THAT
WILL BE THE PRESENTATION THAT H.
CHI ABOUT WHERE THEIR RESOURCES
ARE GOING TO COME FROM. AND, AND
WE'RE GOING TO GET A GOOD IDEA
OF WHETHER WE'RE GOING TO HAVE
TO, FOR EXAMPLE, GO OUT AND DO A
BOND THAT HELPS PROVIDE
RESOURCES FOR HOSPITALS TO BE
ABLE TO UPGRADE. YOU KNOW, WE
UPGRADE SCHOOLS, BUT WE HAVEN'T
REALLY DONE A BOND FOR
HOSPITALS. WE'VE DONE A BOND FOR
SOME NEW HOSPITALS, BUT NOT FOR,
SEISMIC, TO MY KNOWLEDGE, SO, SO
I THINK THAT THE WHOLE IDEA IS
RIGHT NOW, AS WE SIT HERE TODAY,
WE HAVE A CHOICE. HOSPITALS. YOU
MEET THE 2030 DEADLINE, OR ELSE
YOU START TEARING OUT YOUR
HOSPITAL, OR YOU START TEARING
OUT THE PIECES THAT ARE NOT
SEISMICALLY, THAT DON'T MEET THE
2030 DEADLINE. AND HAVING SAT IN
THE POSITION OF LOSING A
HOSPITAL AND THEN SPENDING OVER
A YEAR WORKING AT TRYING TO
BRING IT BACK AGAIN AND TO MAKE
SURE THAT THE OTHER HOSPITALS
THAT WERE AT RISK, HAD RESOURCES
AS WELL. THERE'S JUST THERE IS
ABSOLUTELY NO WAY THAT WE CAN
CLOSE HOSPITALS. WE JUST CAN'T.
THE FIRST THING THAT HAPPENS THE
MINUTE YOU GIVE THE WARREN ACT
IS THAT EVERYBODY LEAVES. AND SO
ALL THE NURSES AND THE DOCTORS
IN MADERA COUNTY LEFT. THEY WENT
SOMEWHERE ELSE. AND SO NOW WE'RE
TRYING TO GET THEM BACK TO BE
ABLE TO, TO, TO, TO FILL
POSITIONS THAT THEY LEFT. AND
THEY NEED TO FEEL CONFIDENT THAT
THE HOSPITAL IS TAKING ITS
PLACE, HAS GOT THE WHEREWITHAL
TO, TO SURVIVE. SO IT'S A BRAIN
DRAIN ON THE COMMUNITY. IT'S A
DEVASTATING IMPACT AS PEOPLE TRY
TO FIGURE OUT HOW TO GET
SOMEWHERE, THAT TAKES AN HOUR
LONGER AND THEY'RE HAVING A
HEART ATTACK OR A STROKE AND SO
WE NEED ALL THE HOSPITALS WE CAN
GET. SO SO RATHER THAN SAY,
LET'S WAIT AND SEE WHAT HAPPENS
AT 2030, THE IDEA IS TO SET UP A
FRAMEWORK THAT STARTS TO CREATE
A PUBLIC PROCESS. SO PEOPLE GET
TO SHOW UP AT A PUBLIC HEARING
AND, AND TALK Ã DOCUMENTATION.
THAT'S VERY SPECIFIC. AND IT
GIVES H CHI THE AUTHORITY TO BE
ABLE TO SET UP THIS FRAMEWORK.
WELL, WE SET UP THE FRAMEWORK IN
THE BILL, BUT TO FILL IN THE
FRAMEWORK SO THAT WE CAN SEE
WHO'S ACCOMPLISHING THE TASKS
THAT THEY'VE BEEN GIVEN WITH,
WITH VERY RIGOROUS MILESTONES IN
ALL OF THAT. SO I THAT'S THE,
THE GREAT THING IS THERE'S BEEN
A LOT OF DISCUSSION AND
COLLABORATION, BUT IT BUT
LANGUAGE MAKES THE DIFFERENCE.
AND SO IT'S EASY TO SAY, WELL,
YOU NEED TO DO THIS. BUT
LANGUAGE WOULD BE REALLY HELPFUL
BECAUSE THAT WOULD ALLOW US TO
WRITE THAT INTO THE BILL AS
WELL. BUT WE'VE WE'VE TAKEN INTO
CONSIDERATION EVERYTHING THAT'S
BEEN ARTICULATED. IT'S JUST THAT
THERE'S STILL BAD FEELINGS ABOUT
THIS TAKING SO LONG. AND I'M
SORRY THAT IT'S, YOU KNOW, I
DON'T HAVE AN ANSWER FOR WHY
IT'S TAKEN SO LONG. BUT I CAN
TELL YOU THAT MADERA, WAY BEFORE
IT CLOSED, TOLD ME WE'RE GOING
TO HAVE A REAL HARD TIME MEETING
OUR SEISMIC AND THEY'RE NOT THE
ONLY ONES. SO. SO I THINK WE
NEED A PATHWAY. AND I DO THINK
WE'RE WE'RE PROBABLY AT SOME
POINT GOING TO NEED TO PUT UP
SOME MONEY, BUT THAT'S NOT WHAT
THE BILL DOES RIGHT NOW. I JUST
THINK WE NEED THE DATA AND THE
INFORMATION IN TO BE ABLE TO
MAKE THAT. AND THAT'LL BE THE
LEGISLATURE DOWN THE ROAD. AND I
APPRECIATE THAT. AND I AND I
APPRECIATE YOUR HONESTY AND HOW
DIFFICULT THIS IS. YEAH. BUT YOU
ADDED ME TO THE WHOLE WORLD NOW
THAT THAT WAS NOT THE INTENTION.
BUT, YOU KNOW, I APPRECIATE THE
HONESTY, BUT I THINK THAT YOUR
HONESTY ALSO SHOWS HOW DIFFICULT
THIS IS. AND I SHARE YOUR
CONCERNS AS A MEMBER WHO HAS A
DISTRICT THAT, HAS HAD HAS A
HOSPITAL THAT HAS BEEN ON THE
VERGE OF CLOSING THAT, YOU KNOW,
AS SOME OF US PERCEIVE, YOU
KNOW, ARE LOOKING AT THE
LEGISLATION THAT'S IN FRONT OF
US. WE ALSO KNOW THAT THE
ALTERNATIVE OF NOT HAVING A
HOSPITAL IS VERY SERIOUS. IT'S
VERY REAL AND WOULD BE WORSE.
RIGHT THAN, THAN SAYING, CAN WE
GIVE THEM MORE TIME BECAUSE THE
TRUTH IS, ESPECIALLY IN OUR
RURAL COMMUNITIES, IF THEY
AREN'T GIVEN MORE TIME, THEY GO
AND THEY NEVER COME BACK, JUST
LIKE THE STAFF, RIGHT, THAT YOU
DESCRIBED. SO ONCE THE PHYSICAL
STRUCTURE GOES AWAY, THE STAFF
GOES AWAY. AND IT'S SO HARD TO
BRING BACK, YOU KNOW, HOSPITALS,
MEDICAL CENTERS. I MEAN, WE, YOU
KNOW, WE'VE TRIED IT ALL AND
IT'S VERY DIFFICULT. SO I
ABSOLUTELY RELATE TO THAT. AND I
THINK THAT THAT'S ONE OF, YOU
KNOW, THE PIECES THAT I'M TRYING
TO FIGURE OUT AS A LEGISLATOR,
IT'S VERY HARD TO KEEP SEEING
THE SAME ISSUE COME OVER, COME
UP OVER AND OVER IN DIFFERENT
WAYS, FORMS AND TRIES OR
ATTEMPTS TO KIND OF GET IT OUT
AND KIND OF SAYING, WELL, WHICH
ONE'S THE RIGHT APPROACH? BUT
IT'S ALSO REFLECTIVE OF THE IF
IT'S COMING UP THAT MUCH IS
BECAUSE IT'S THAT MUCH OF A
PROBLEM. RIGHT AND AGAIN, THIS
ISN'T ABOUT ONE SIDE BEING RIGHT
OR WRONG. IT'S JUST A
RECOGNITION THAT THIS IS A VERY
DIFFICULT ISSUE. TO THAT POINT.
THE AMENDMENTS ALSO TALK ABOUT,
YOU KNOW, HCCI NOW HAVING TO
REVIEW THE MILESTONES. WHAT ARE
WHAT IS NOW IN THE BILL, WHAT IS
NEW TO THE BILL THAT ENSURES
THAT THE STATE AGENCY THAT
REVIEWS THESE MILESTONES IS VERY
CLEAR HOW IMPORTANT THESE
MILESTONES ARE. I THINK WE CAN
PROBABLY ALL SIT HERE. AND THINK
OF AN AGENCY. WE'RE LIKE, I
DON'T KNOW THAT THE LEGISLATURE
WOULD HAVE GONE IN THAT
DIRECTION. MAYBE THE LEGISLATURE
WOULD HAVE PUSHED A LITTLE BIT
MORE. WHAT'S IN THE BILL? WHAT
KIND OF METRICS? WHAT KIND OF,
YOU KNOW, THERE'S A PUBLIC
PROCESS. WHAT? HOW DO WE KNOW
THAT H CHI WILL TREAT THIS WITH
THE SAME URGENCY AND CONCERN,
AND FOCUS THAT I THINK THIS
LEGISLATURE HAS IN TERMS OF YOU
CAN'T JUST GET A PASS LIKE JUST
TO GET A PASS, LIKE YOU HAVE TO
FIGURE OUT HOW TO GET THERE. I
DON'T KNOW IF ANYBODY CAN
COMMENT. YEAH WHOEVER
EXPERIENCE. BUT I DEFER TO THE
CHAIR. WELL, LET ME YOU KNOW,
THE AMENDMENTS FOR THOSE THE
AMENDMENTS ARE ON PAGE 12. AND
MAY I JUMP IN, SENATOR? YOU
KNOW, UNFORTUNATELY OR
FORTUNATELY, I WAS NAMED CHAIR
OF THIS COMMITTEE. BUT I'VE BEEN
ON THIS COMMITTEE FOR 12 YEARS,
AND I'VE SEEN THESE SEISMIC
EXTENSIONS COME THROUGH HERE AND
ON ONESIES AND TWOSIES IN TERMS
OF HOSPITALS. AND THIS ONE WANTS
FIVE YEARS AND THIS ONE WANTS
SIX, AND THIS ONE WANTS THREE,
AND THIS ONE WANTS 14. AND YOU
KNOW, I HAVE A BUSINESS
BACKGROUND. AND I SAID THIS IS
NOT A BUSINESS WAY TO RUN THIS
RAILROAD. WE NEED TO ORGANIZE
THIS OPERATION. FIND OUT HOW
MANY OF THESE THINGS THAT ARE
OUT THERE, WHAT THE STATE OF
AFFAIRS IS IN TERMS OF THEIR
SEISMIC COMPLIANCE, HOW MUCH
IT'S GOING TO COST TO FIX THEM,
WHO'S GOING TO PAY FOR IT, AND
HOW LONG IT'S GOING TO TAKE. AND
THAT'S HOW WE'D RUN IT IF WE
WERE RUNNING A BUSINESS NOT
DEALING WITH THESE HIT AND MISS
THINGS WITH A LITTLE BIT OF
INFORMATION, AND THOSE OF US
SITTING UP HERE GET SOME
INFORMATION AND WE JUST VOTE. SO
THE CONCEPT WAS HOW DO WE
ORGANIZE, HOW DO WE BUILD,
DEVELOP SOME ARCHITECTURE FOR
THIS PROCESS. SO WE BRING SOME
ORDER TO THE PROCESS. AND WE HAD
A FEW BILLS COMING TO THE
COMMITTEE THIS YEAR. TWO OF THEM
ARE ON THE AGENDA TODAY. ONE
WE'VE HEARD BEFORE IN A PRIOR
SESSION. AND SO WE CONVENED THIS
WORKING GROUP. YOU LISTEN TO ME
WHINE. I COMMEND ALL OF YOU FOR
STEPPING UP AND PARTICIPATING IN
THE CONVERSATION. TO ANSWER THE
QUESTION, IF WE LOOK AT THE
AMENDMENTS, THE AMENDMENTS
REQUIRE H. KHÎI TO GRANT A THREE
YEAR EXTENSION IF THE HOSPITALS
SUBMIT THESE REPORTS, THESE
SEISMIC REPORTS THAT ARE
REQUIRED, AND THEN AFTER THAT
THEY PERMIT H. Kò TO GRANT AN
ADDITIONAL FIVE YEARS IF THE
HOSPITAL APPLIES AND CAN MAKE
THE CASE BASED ON COMPLEXITY,
FINANCIAL IMPACT, OR POTENTIAL
LOSS OF HEALTH CARE SERVICES. TO
GAIN ADDITIONAL EXTENSIONS AND
IN COMPLIANCE WITH THE
MILESTONES THAT THE HOSPITAL
SETS OUT IN THE MASTER PLAN THAT
IS SUBMITTED. H CHI IS REQUIRED
AND THE HOSPITALS ARE REQUIRED
AS A CONDITION OF GETTING
APPROVAL, THE HOSPITAL IS
REQUIRED TO SUBMIT BUILDING
PLANS AND AN EXTENSION SCHEDULE
TIMELINE, AND TO HAVE TWO MAJOR
MILESTONES RELATING TO SEISMIC
COMPLIANCE THAT WILL BE USED AS
THE BASIS FOR DETERMINING
WHETHER THE HOSPITAL IS MAKING
ADEQUATE PROGRESS. S. AT THE
SUGGESTION, I BELIEVE IT WAS OF
LABOR SOMEWHERE, BUILT INTO THE
AMENDMENTS AS A PUBLIC PROCESS
FOR PUBLIC NOTICE AND AN
OPPORTUNITY FOR PUBLIC COMMENT
PRIOR TO H. CHI GRANTING ANY
APPROVAL BEYOND THE INITIAL
THREE YEAR EXTENSION, THE
HOSPITAL'S EXTENSION REQUEST HAS
TO BE POSTED ALONGSIDE THEIR
SEISMIC COMPLIANCE PLAN, WHICH
WOULD TRIGGER A 45 DAY COMMENT
PERIOD BEFORE HE CAN EVEN TAKE
ANY ACTION BASED ON THE
EXTENSION REQUESTS. AND I'M SURE
THIS IS A WORK IN PROGRESS AND
I'M SURE THIS IS NOT THE END OF
THE STORY WHEN IT COMES TO
TRANSPARENCY AND COMPLIANCE.
WHEN IT COMES TO FINES, WHAT WE
KNOW WITH THESE BIG OPERATORS
AND IT'S NOT ALWAYS THE BIG
OPERATORS. A FINAL PUT US MAY
PUT A SMALL OPERATOR OUT OF
BUSINESS IF THEIR MARGIN IS $1
MILLION, BUT HOW BIG A FINE CAN
YOU CAN YOU LEVY AGAINST A MAJOR
FOR PROFIT HOSPITAL INSTITUTION
THAT HAS FACILITIES ACROSS THE
COUNTRY WHERE IT WOULD REALLY
MAKE A DIFFERENCE AND IS NOT
SIMPLY THE COST OF DOING
BUSINESS. SO THE GOODNESS HERE,
IF THERE IS ANY, IS THAT H CHI
IS CONTROLLING THE SHOTS. IT'S
PART OF THE GOVERNMENT OF THE
STATE OF CALIFORNIA, AND WE'RE
THE LEGISLATURE WITH OVERSIGHT
AUTHORITY OVER H CHI. AND
THERE'S A PUBLIC TRANSPARENCY
PROCESS TO PROVIDE OVERSIGHT
OVER US. AND I DON'T KNOW WHAT
WE DO IF ALL WE DO IS WE GIVE
PEOPLE TWO YEAR EXTENSIONS
WITHOUT ANYTHING ELSE. AND I'M
WAITING FOR SOMEONE TO EXPLAIN
THAT TO ME, HOW THAT WORKS. IF
WE DON'T BUILD A PROCESS TO
DRIVE HEALTH CARE FACILITIES.
THIS ISN'T MY BILL. I'M TAKING
IT OVER. I KNOW, DRIVE HOSPITALS
DOWN TO THE FINISH LINE. WE
WELCOME IT. YEAH, I THINK SO.
BUT BUT OH, PLEASE, I
INTERRUPTED MY COLLEAGUE. NO NO,
THIS IS HELPFUL. PLEASE. I
THINK. WHAT THE. I'VE BEEN THERE
FOR ALL OF THOSE BILLS, I'VE
BEEN DOING THIS WITH SHELLEY, TO
YOUR POINT, BECAUSE THE ULTIMATE
PENALTY IS CLOSURE IS WHY WE'RE
HERE. I MEAN, THERE IS NO
GREATER PENALTY THAN YOUR
LICENSE, AND IT'S NOT YOUR
LICENSE FOR PART OF THE CAMPUS.
IT'S NOT YOUR LICENSE FOR PART
OF THE SERVICES. IT'S YOUR
LICENSE, PERIOD. SO THAT'S WHY
WE KEEP HAVING TO COME BACK TO
THE LEGISLATURE. WE HAVE THIS
HAS BEEN ON THE BOOKS FOR 50
YEARS. BUT FRANKLY, IT BECAME
ENFORCEABLE IN THE EARLY 90S,
WHERE WE PRESENTED WITH OUR
FIRST DATE. WE'VE SPENT TENS OF
BILLIONS OF DOLLARS, NOT NOT
PUBLIC DOLLARS, NOT NOT GENERAL
FUND DOLLARS. HOSPITAL HEALTH
CARE DOLLARS TO MAKE SURE OUR
BUILDINGS DON'T FALL DOWN. I
OFTEN TELL PEOPLE, YOU WANT TO
KNOW WHERE TO GO IN AN
EARTHQUAKE. GO TO A HOSPITAL
BECAUSE IT'S PROBABLY ONE OF THE
SAFEST BUILDINGS IN YOUR
COMMUNITY. WE'RE NOW AT A PLACE
WHERE WE ARE COMMITTED TO AND
HAVE WORKED WITH THE COMMITTEE
TO ENSURE WE GET ON A PATH THAT
THE SERVICES ARE AVAILABLE.
WE'RE NOT IN A PLACE WHERE WE'VE
BEEN BEFORE. WE'RE TRYING TO
NARROW THE REQUIREMENT. WE'RE IN
A PLACE NOW WHERE WE'RE SAYING,
LET'S GET ON A PATH. AND TO
SENATOR ROSS, GOOD WORK AND THE
WORK OF THIS COMMITTEE AND THE
STAKEHOLDERS WHO'VE BROUGHT
GOOD, GOOD COMMENTS TO BEAR. WE
ARE NOW LOOKING AT A STRUCTURAL
FRAMEWORK WE'VE NEVER HAD IN THE
PAST BEFORE, WHERE WE'RE
PROVIDING OUR PLANS, SO THAT
THEN OSHPD CAN TELL US WHAT
SERVICES ARE AT RISK EVERY
BUILDING THAT HAS A RISK, IS AT
RISK. WE'LL HAVE A SERVICE
LABELED FOR THAT BUILDING, AND
OSHPD COULD TELL US. HI. EXCUSE
ME, CAN TELL US. HERE'S ALL THE
SERVICES AT RISK. WE CAN THEN GO
, THEN THAT TO SHELLEY AND
DIGNITY WILL TAKE EVERY PROJECT,
DISSECT EVERY PROJECT, AND WORK
ON A TIMELINE RELATED TO EVERY
PROJECT. THE REALITY IS, IS THEY
CAN'T DO ALL 31 HOSPITALS IN THE
NEXT EIGHT YEARS, AM I WRONG? SO
I THINK IT'S I THINK IT'S ALSO
AN OPPORTUNITY FOR US TO HOLD
THEIR FEET TO THE FIRE, BUT ALSO
PLAN ACCORDINGLY IN WAYS WE
HAVEN'T DONE IN ORDER TO
PRESERVE SERVICES IN THE
COMMUNITY. SO I THINK WE'VE
ACTUALLY THIS BILL ACTUALLY
ACCUMULATES THE EXPERIENCE FROM
20 YEARS, CREATES THE
TRANSPARENCY AND THE DIALOG. AND
I THINK NOW WE JUST HAVE TO
FIGURE OUT HOW TO MAKE SURE THEY
HAVE THE ABILITY TO PUSH THOSE
HOSPITALS THROUGH THE PROCESS.
SO I THINK IT'S ACTUALLY THE
ACCUMULATION OF EXPERIENCE THAT
BRINGS US TO THIS BILL. AND, YOU
KNOW, THAT FRAMEWORK THAT GETS
US ON A PATH, A TRANSPARENT
PATH. AND I GUESS I WOULD JUST
ADD THAT AS I SHARED IN MY
TESTIMONY, WE STARTED OUT WITH
87 SPC ONE COLLAPSIBLE BUILDINGS
. WE NOW HAVE ALL 2020 COMPLIANT
BUILDINGS THAT WILL REMAIN
STANDING AND PROTECT OUR
PATIENTS AND OUR EMPLOYEES. SO
IT'S NOT THAT NOTHING IS
HAPPENED, IT'S THAT THIS NEXT
THRESHOLD IS A SIGNIFICANT
BIGGER LIFT. AND SO I JUST I
KNOW THAT SOUNDS DEFENSIVE, BUT
WE'VE BEEN WORKING OUR TUSHES
OFF TRYING TO GET THIS MOVE
FORWARD. AND IT'S JUST NOT
POSSIBLE IN THE TIME THAT'S LEFT
. THANK YOU. I MEAN, I THINK
THAT THIS IS IT'S AN IMPORTANT
DISCUSSION. AND I DO BELIEVE
THAT EVERYONE'S WORKING TO TRY
TO GET IT DONE. I DO BELIEVE
THAT THIS IS AN IMPORTANT ISSUE,
AND CERTAINLY THAT THE
ALTERNATIVE OF HAVING HOSPITALS
CLOSE PRESENT SIGNIFICANT
CHALLENGES, BUT THERE STILL
CONTINUES TO BE CERTAINLY SOME
SAFETY ISSUES. AND I AM
ENCOURAGED BY THE CONVERSATION
THAT ARE HAPPENING. BUT IT'S
STILL HARD FOR ALL OF US. THANK
YOU. THANK YOU. SENATOR. SENATOR
GROVER, YOU GOT YOUR HAND UP.
THANK YOU. THANK YOU, MR. CHAIR.
YOU KNOW, MY GOOD COLLEAGUE TO
THE NORTH OF ME IN THE CENTRAL
VALLEY. I KNOW YOU DIDN'T WANT
TO DEAL WITH HEALTH CARE. YOU
WANT TO DEAL WITH HEALTH CARE.
WHEN YOUR HOSPITAL CLOSED
ABRUPTLY, YOU DIDN'T WANT TO
DEAL WITH HEALTH CARE WHEN WE
WERE DOING, FINANCIALLY
DISTRESSED HOSPITAL LOAN
PROGRAMS. YOU DIDN'T. YOU KNOW,
I GET IT, BUT I APPLAUD YOU,
ADMIRE YOU, AND I'D AM SO
GRATEFUL TO GOD THAT YOU ARE
DEALING WITH HEALTH CARE BECAUSE
IT'S A VERY TOUGH SUBJECT
MATTER. AND, BEING KIND IN THE
SAME BOAT WITH YOU, WITH
FINANCIALLY DISTRESSED HOSPITAL
PROVIDING THE HIGHEST MEDI-CAL,
HOSPITAL THAT I IN THE ENTIRE
STATE OF CALIFORNIA IS, IS IN MY
DISTRICT, YOU KNOW, OVER 80% IS
MEDI-CAL PAYMENTS, IT'S VERY
DIFFICULT TO STAY ALIVE, AT A,
YOU KNOW, ALIVE, LIKE THE
HOSPITAL TO STAY ALIVE WHEN YOU
HAVE, GET REIMBURSED LOWER
DOLLARS THAN WHAT YOU PUT OUT, I
AM ALSO THE ONLY PERSON THAT HAD
A RECENT EARTHQUAKE IN THE LAST
TEN YEARS AND IN RIDGECREST, AND
I CAN TELL YOU THAT ALL THE
EARTHQUAKE, FACILITIES THAT WERE
CHANGED, INCLUDING, SOME OF THE
REQUIREMENTS THAT WERE THERE
THAT THEY'VE ALREADY ALL
APPROVED AND EVERYTHING JUST THE
OLD BUILDING REMAINED IN
STANDING INTACT, AND THEY HAD TO
MOVE EVERYTHING INTO THE OLD
BUILDING. THAT WAS AN
EARTHQUAKE, APPROVED ACCORDING
TO THE CURRENT STANDARDS, AND
THEY HAVE TO REDO THE NEW
BUILDING, WHICH WAS EARTHQUAKE
STANDARD, APPROVED, I CAN TELL
YOU THAT I KNOW THIS IS A VERY
DIFFICULT, BILL TO GET OUT. I
KNOW THAT OUR HOSPITALS NEED
SOME TYPE OF EXTENSION TO
ADDRESS THE SEISMIC ISSUE. I
AGREE WITH THE HOSPITALS THAT
IT'S NOT THAT NOTHING HASN'T
BEEN DONE. THE 2020, COMPLIANCE
STUFF HAS BEEN MET, BUT I HEAR
FROM MY HOSPITALS ALL THE TIME
THIS MONUMENTAL TASK OF MAKING
SEISMIC HAPPEN AT THIS LEVEL BY
2030, IF THEY'RE TELLING ME IT'S
GOING TO BE IMPOSSIBLE FOR SOME
OF THE STRONGER HOSPITALS THAT I
HAVE IN MY DISTRICT, MUCH LESS
THE ONES THAT ARE COMING, THAT
ARE STILL, YOU KNOW, SEEKING
WAYS TO NOT BE FINANCIALLY
DISTRESSED. SO, I DON'T THINK
THERE'S AND I, I THINK I HAVE
DEEP RESPECT FOR ALL OF MY
COLLEAGUES, BUT I DON'T THINK
THERE'S ANYTHING THIS BUILDING
COULD MAKE THIS HAPPEN AND BRING
TO SEVERAL SIDES TOGETHER AND
ALL THE STAKEHOLDERS TOGETHER TO
MAKE SURE THAT WE LEAVE THIS
YEAR WITH A, A BILL THAT, THAT,
NUMBER ONE, HELPS KEEP OUR
HOSPITALS OPEN BECAUSE THAT'S
HAVING HOSPITALS SHUT DOWN WOULD
BE THE MOST CATASTROPHIC THING
EVER, AND THEN, YOU KNOW,
ADDRESSING THIS ISSUE, I DON'T
THINK ANYBODY ELSE IN THE
BUILDING CAN DO IT. SO THANK
YOU. AND I'D BE GLAD TO MOVE THE
BILL WHEN IT'S APPROPRIATE.
THANK YOU. THANK YOU, SENATOR
GROVE. SENATOR SMALLWOOD, I JUST
HAVE A CLARIFYING QUESTION,
BECAUSE I THINK YOU MENTIONED,
SENATOR CABALLERO, THAT SOME
HOSPITALS DO HAVE THE RESOURCES
TO MOVE FORWARD. SO CAN YOU
EXPLAIN HOW THAT FINANCIAL
METRICS WORKS GIVEN THE
AMENDMENTS IN TERMS OF THOSE WHO
CAN BUILD NOW, ARE THEY ABLE?
THEY CAN DO IT NOW, BUT THEY'RE
GOING TO WAIT TILL NO, THEY THEY
CAN DO IT NOW. HOW DO WHERE DO
THEY FIT. WELL, ARE THEY
REQUIRED TO MOVE FORWARD AND NOT
TAKE ADVANTAGE OF THE EXTENSION
THAT THAT YES. YOU'RE OFFERING.
YES HOW. WELL THEY'RE THEY'RE I
THINK SOMEBODY SAID EARLIER THAT
THE COST IS LESS IF YOU DO IT
NOW. AND THEY'VE BEEN PLANNING
THEIR THEY'VE BEEN PLANNING AND
THEY'VE GOT, THINGS IN MOTION TO
EITHER RETROFIT OR TO TEAR DOWN
AND REDO AS YOU HEARD DIGNITY
EXPLAIN THEIR THEY'RE MOVING ON,
ON, ON THINGS THAT THEY'RE THAT
HAVE BEEN IN THE PLANNING STAGE
FOR A LONG TIME. THEY JUST WON'T
GET EVERYONE EVERYTHING DONE. SO
THE EXPECTATION IS THAT PEOPLE
THAT THAT THESE HOSPITALS ARE
GOING TO MEET THE REQUIREMENTS
OF THE 2030, DEADLINE BY 2030,
IF THEY CAN DO IT. AND AND DO WE
KNOW WHO THOSE HOSPITALS ARE AND
ARE THEY NAMED SO THAT THEY
DON'T SORT OF DECIDE THAT THIS
MIGHT BE A BETTER. YEAH. ALL
THAT INFORMATION IS AT Kò.
THEY'RE THE ONES WHO HAVE BEEN
DOGGING THIS UP TO THIS POINT.
IF YOU'RE IF YOU'RE ASKING FOR A
LIST, WE CAN ASK THEM FOR A
LIST. WELL, REMEMBER, SENATOR,
THIS A PRECONDITION FOR ALL OF
THIS IS THE IS THE PRODUCTION OF
A MASTER SEISMIC COMPLIANCE
PLAN. AND NOBODY GETS ANYTHING
MORE THAN A THREE YEAR EXTENSION
WITHOUT DEMONSTRATING A NEED.
AND WE'RE TALKING ABOUT
CONSTRUCTION PLANS, DRAWINGS,
DESIGNS, IDENTIFICATION OF
CONTRACTORS, FINANCING, PERMITS,
PERMITS, MILESTONES, ALL OF
THAT'S BUILT INTO A CONSTRUCTION
SCHEDULE. AND UNFORTUNATELY,
WHEN YOU'RE DEALING WITH
HOSPITAL FACILITIES THAT CAN
COST 600 TO $800 MILLION. BY THE
WAY, ONE OF MY HOSPITAL, THAT
I'M FAMILIAR WITH TOLD ME TODAY,
ACTUALLY THAT THE COST OF THEIR
CONSTRUCTION WAS $800 MILLION
AND IT WAS 80% OF THE CAPITAL
BUDGET FOR THE ENTIRE
CORPORATION JUST TO COMPLY. SO
THINK ABOUT THAT. SO THE COST IS
ENORMOUS. THE TIMELINE FOR
GETTING CONSTRUCTION DRAWINGS
DONE OR EVEN PLANS APPROVED,
IT'S NOT BUILDING A HOUSE. SO
BUT THAT'S BUILT THAT'S COOKED
INTO THESE AMENDMENTS. AND I'M
SURE BY THE TIME THAT THE
STAKEHOLDERS GET THROUGH WITH
THIS AND THE IF IT GETS OUT OF
THE SENATE AND THE OTHER HOUSE
GETS THROUGH WITH IT, THERE WILL
BE MANY MORE CONDITIONS AND
SAFEGUARDS BUILT INTO THIS
ARCHITECTURE, AS THERE SHOULD
BE. WELL, I JUST WANTED TO MAKE
SURE THAT WE KNOW WHO THOSE
HOSPITALS ARE AND THAT WE
ENCOURAGE THAT RACE TO 2030,
THAT IT HAPPENS. WHAT WHAT I
WOULDN'T WANT THEM TO DO IS TO
STOP BECAUSE THEY MIGHT SAVE OR
CAN USE THAT MONEY TO DO
SOMETHING ELSE, BECAUSE THEN
THEY CAN TAKE ADVANTAGE OF THIS.
I THINK THAT SHOULD BE WE THERE
SHOULD BE A TRACK THAT HAS
IDENTIFIED THOSE HOSPITALS THAT
ARE READY TO ROLL TO 2030, SO
THEY CAN'T BACKSLIDE INTO THIS
PROCESS. SO THAT'S THAT'S ONE
QUESTION I HAD. THE OTHER WAS ON
H. Kò IS THE UNION A PART OF H.
Kò WHO'S WHO IS A PART WHO IS AT
THE H KEY TABLE. ARE YOU THERE
AS A STATE. SO IT'S A STATE
AGENCY THAT OVERSEES, BUILDING
FOR STATE, FOR HOSPITALS. IT'S
BEEN THE STATE HOSPITAL BUILDING
DEPARTMENT FOR YEARS. AND THEY
HAVE EXPERTS, ENGINEERS THAT ARE
INCREDIBLY GOOD AT THIS WORK.
AND WE DO TRUST THEIR EXPERTISE.
I WOULD SAY, ON THE ON THE
PUBLIC PROCESS, THAT'S SOMETHING
THAT WE WOULD LIKE TO CONTINUE
TO WORK WITH THE AUTHOR AND
STAKEHOLDERS ON, TO REALLY BUILD
THAT OUT, TO MAKE SURE REALLY
LOOKING AT SERVICES, MAKE SURE
THOSE ARE PRESERVED. YOU KNOW,
FROM THE UNIONS PERSPECTIVE, WE
COULD SEE, YOU KNOW, A SITUATION
WHERE HOSPITAL WANTS TO COMPLY
AND NOT INCLUDED MATERNITY WARD,
FOR EXAMPLE. AND, YOU KNOW,
THAT'S SOMETHING THAT WE HAVE
WHEN WE'VE DONE ONE OFFS. WE'VE
REALLY HAD THOSE CONVERSATIONS
AT A LOCAL LEVEL TO MAKE SURE
THE PLANS, CAME INTO COMPLIANCE
WITH THE LAW, BUT ALSO PRESERVE
SERVICES FOR THE AREA. NOW, I
DID NOTICE A LOT OF ENGINEERS,
BUT I ALSO SAW THERE SOME
COMMUNITY KIND OF MEMBERS. AND
I'M CURIOUS HOW THIS ONGOING
DISCUSSION KIND OF FORMALLY
CONTINUES. RIGHT. SO IT'S
OBVIOUSLY THERE ARE DISCUSSIONS
AROUND THIS BILL, BUT IS THERE A
TABLE THAT WILL CONTINUE AS WE,
YOU KNOW, MOVE FORWARD IN THIS
CONVERSATION? OAN. YEAH,
THERE'S A STAKEHOLDER PROCESS IN
THE BILL AS WELL AS, THANK YOU.
SORRY, I'VE DONE THIS FOR YEARS
YET I CAN'T PUSH THE BUTTON,
THERE'S A STAKEHOLDER PROCESS
THAT IS INCLUDED IN THE BILL,
ALONG WITH, LIKE MATT SAID. HCCI
PARTICULAR OSHPD HAS A BUILDING
SAFETY BOARD WHERE PUBLIC, THE
PUBLIC AND THE EXPERTS ARE AT
THE TABLE, SO I THINK THERE'S A
COUPLE OF FORMATS AND WE CAN
CONTINUE TO WORK ON THAT PUBLIC
DISCLOSURE PROCESS ALONG WITH,
YOU KNOW, HOW WE MANAGE THE
BENCH BENCHMARK PROCESS THROUGH
THAT AS WELL. SO I THINK I THINK
THERE'S SEVERAL OPPORTUNITIES IN
THE PROCESS. HØI IS ALSO IN
CHARGE OF ACCESS. AND THEY ALSO
HOLD THE OFFICE OF HEALTH CARE
AFFORDABILITY. SO THEY CARE
DEEPLY AS A DEPARTMENT ON IN
RELATIONSHIP TO ACCESS. SO WHEN
WE HAVE THAT CONVERSATION, I
THINK IT'S WELL SITUATED. NO, I
APPRECIATE THAT. I JUST THINK
THIS ONGOING DISCUSSION,
PARTICULARLY WITH WORKERS BEING
CENTERED IN IT, I THINK IS
IMPORTANT. LONG TERME. AND I
JUST WANTED TO MAKE SURE THERE
WAS A SPACE FOR THAT IN THIS,
POLICY. SO THANK YOU. AND
LASTLY, THERE WAS A BILL LAST
YEAR THAT ALSO HAS US 82 YEARS
AGO NOW, 1882, WE, WE ACTUALLY
NOTIFY OUR COUNTY SUPERVISORS,
LOCAL MEDICAL AUTHORITIES, AS
WELL AS OUR LABOR PARTNERS. SO
THERE'S BEEN A LOT OF PIECES AS
WE'VE DONE THIS, THAT REALLY
THIS BILL KIND OF CULMINATES
INTO ALL THAT WORK. THANK YOU
FOR THE CLARIFICATION. WELL,
BEFORE WE DO ANYTHING ELSE,
LET'S ESTABLISH A QUORUM SO WE
CAN ACTUALLY DO SOMETHING THIS
AFTERNOON. PLEASE CALL THE ROLL.
SENATOR ROTH HERE, ROTH HERE.
WHEN? GLASER. GLASER. HERE
GONZALEZ. GONZALEZ. HERE. GROVE
HURTADO. LIMÓN. LIMÓN HERE.
MENGIBAR. MENGIBAR. HERE. RUBIO
SMALLWOOD. CUEVAS. SMALLWOOD.
CUEVAS. HERE. WIENER SIX. WE
HAVE A QUORUM. COLLEAGUES. ANY
OTHER QUESTIONS FOR SENATOR
GONZALEZ? YES. THANK YOU SO
MUCH. AND THANK YOU TO THE
AUTHOR FOR THIS BILL. I KNOW
THIS IS NOT EASY. IT'S I DON'T
WANT TO BELABOR IT. IT'S BEEN
DIFFICULT. AND HERE WE ARE YET
AGAIN, TALKING ABOUT SEISMIC
ISSUES AT OUR HOSPITALS HERE IN
THE STATE, I DO WANT TO THANK
THE AUTHOR. WE SPOKE. I'M SORRY.
THE CHAIR. IT'S BEEN A LONG DAY,
FOR THE AMENDMENTS AND THE
COMMITTEE CONSULTANTS, I KNOW,
IT'S NEVER EASY FINDING THE
RIGHT BALANCE OF WHAT THIS COULD
LOOK LIKE, AND I. AND I
APPRECIATE, THE DIALOG HERE ON
WHAT MORE COULD BE DONE BECAUSE
THERE'S GOING TO BE A LOT MORE
THAT'S GOING TO BE NEEDED TO BE
DONE. IF THIS SHOULD GET OUT OF
COMMITTEE, MY I WILL KIND OF
ALIGN MYSELF WITH SOME COMMENTS
THAT HAVE BEEN MADE BY MY
COLLEAGUES IN TERMS OF LIKE A
MORE NARROWED APPROACH AND WHAT
THAT COULD LOOK LIKE, BECAUSE IT
IS HARD TO VISUALIZE HOW AN
ADDITIONAL THREE YEAR EXTENSION
WOULD HELP THE SITUATION. EVEN
IF, YOU KNOW, WE'RE IN WE'RE IN
A DIRE SITUATION NOW. HOW CAN
THIS THREE YEARS, THREE YEARS
DOES NOT SEEM THAT LONG, RIGHT?
BUT I KNOW THAT THERE COULD BE
AN ADDITIONAL FIVE YEARS AFTER
THAT, BUT IT'S JUST HARD TO
ENVISION THAT NOW WITH SUCH DIRE
SITUATIONS IN SOME OF OUR
HOSPITALS. I AM GOING TO
INHERIT, A HOSPITAL LATER THIS
YEAR THAT IS A RURAL LOS ANGELES
HOSPITAL, 12 BEDS, THAT IS IN A
VERY DIRE SITUATION, BUT WITH
THAT SAID, NOTHING IN HERE ALSO
INCLUDES DISCUSSIONS ABOUT IF
THERE. AND I'M NOT SAYING THAT
I'LL HOSPITALS ARE DOING THIS,
BUT IF THERE IS ANY FINANCIAL
MISMANAGEMENT HAPPENING, I MEAN,
I THINK THAT THAT'S, SOMETHING
THAT I WORRY ABOUT NOW BECAUSE
ON PAGE 12 OF THE, THE BILL,
THIS HOSPITAL, HOSPITAL OWNER
HAS TO DEMONSTRATE LACK OF
FINANCIAL CAPACITY TO
SUBSTANTIALLY COMPLY WITH THE
SEISMIC SAFETY REGULATIONS.
OKAY. BUT IF THERE IS ADDITIONAL
FINANCIAL MISMANAGEMENT
HAPPENING, I JUST I FEEL LIKE
IT'S JUST DIFFICULT TO
UNDERSTAND WHERE THAT MIGHT LAY,
AND THEN SECONDLY, THE PUBLIC
PROCESS WITH HCCI, I'M WONDERING
A QUESTION TO THE AUTHOR IN
TERMS OF, YOU KNOW, WE'VE
DISCUSSED WHAT THAT LOOKS LIKE,
WHO IS ON THE BOARDS, WHO'S
MAKING THESE DECISIONS IN TERMS
OF THE MILESTONES AND NEXT
STEPS. BUT I OFTEN FEEL AND
HEARING BACK FROM THE DISTRICT
THAT THERE ARE SOME LOCAL RULES
AT THE CITY AND COUNTY LEVELS
THAT DON'T THAT DON'T HEAR ABOUT
THIS PUBLIC PROCESS. THEY DON'T
KNOW WHAT THE PUBLIC
NOTIFICATION IS GOING TO LOOK
LIKE. SO IS THERE ANY
STRENGTHENING OF THAT THAT WE
CAN DO? AND I THINK IT'S BEEN
ALLUDED TO THAT WE CAN, BUT I'D
LIKE TO JUST KICK THAT TO YOU AS
TO WHAT THAT COULD LOOK LIKE.
THERE ARE CITY COUNCIL MEMBERS
THAT HAVE THAT SEEM TO THAT
SEEMINGLY TELL ME THAT THERE IS
NO INFORMATION GOING BACK AND
FORTH FROM THE HOSPITAL TO THEM
ABOUT WHAT IS GOING ON AT THESE
HOSPITALS, WHICH IS TERRIFYING.
I THINK THAT'S TRUE. MY
EXPERIENCE, AND THIS IS IN THE
DISTRESSED HOSPITAL, REALM, IS
MOST OF THE HOSPITALS ARE,
PRIVATE NONPROFIT. AND SO THE
REALITY OF THE SITUATION IS THEY
DON'T NEED TO WRITE, OR THEY SAY
THEY DON'T NEED TO SHARE THEIR
FINANCIAL INFORMATION WITH ME
WHEN I ASK ABOUT IT. BUT, BUT
THE I THINK THAT WHAT THE SO IS
THERE AN OPPORTUNITY FOR TO BEEF
UP THE PUBLIC PROCESS. YES. I
MEAN THERE'S NO QUESTION ABOUT
THAT. AND IN TERMS OF THE
FINANCIAL DETAILS THERE ARE IN
THERE, HE ASKS, THEY COLLECT A
WHOLE BUNCH OF INFORMATION AND
SOME OF IT IS PUBLIC, AND THEY
POST IT ON THEIR WEBSITE. AND SO
YOU CAN GLEAN INFORMATION THÀNH
FROM THAT, FROM THAT INFORMATION
THAT THEY RECEIVE, THERE IS THE
OPPORTUNITY TO ASK FOR SPECIFIC
INFORMATION TO GO TO HIÆN
RELATIONSHIP TO FINANCIAL
ABILITY TO MAKE, TO DO THE
SEISMIC WORK, IN PARTICULAR, IS
THERE AND THIS IS MORE PREVALENT
OR MORE POSSIBLE WHEN THERE'S
MULTIPLE HOSPITALS THAT ARE
OWNED BY ONE HEALTH CARE, ENTITY
, IF YOU'RE A SINGLE HOSPITAL,
IT'S DIFFERENT BECAUSE YOU CAN'T
SHIFT MONEY TO ANOTHER HOSPITAL.
FOR EXAMPLE, THAT'S THAT'S NOT
WHAT'S DONE. SO THERE IS MORE
REPORTING THAT MORE ROBUST
REPORTING THAT WE, WE COULD, IN,
IN, IN INSERT AS PART OF THE
THREE YEAR AND THEN THE FIVE
YEAR EXTENSION, BUT, BUT WE NEED
TO FIGURE OUT EXACTLY WHAT KIND
OF INFORMATION HE WOULD BE
INTERESTED IN RECEIVING. AND AND
WE'VE LEFT IT TO THEM TO MAKE
THE DETERMINATION WHETHER THE
CASE HAS BEEN MADE THAT THE
EXTENSION IS, IS NECESSARY AND
THE FISCAL IS CERTAINLY SOME
PART OF THAT ANALYSIS. THANK
YOU. AND I THINK TO THAT, YOU
KNOW, TO ENSURE THAT ALL OF THE
FINANCIAL CONTEXT IS PUT OUT
THERE FOR THE PUBLIC TO CONSUME
AND BE EDUCATED ON BEFORE THAT
45 DAY PUBLIC COMMENT PERIOD IS
FINALIZED, BECAUSE I THINK
THAT'S REALLY IMPORTANT FOR
LOCAL ELECTED OFFICIALS AS WELL,
AND THEN LASTLY, I KNOW THIS
DOESN'T TOUCH ON I GUESS I DON'T
KNOW IF THIS MATTERS OR NOT, BUT
MERGERS AND ACQUISITIONS, AS
SOME, DIRE FINANCIAL, REALLY
DIRE HOSPITALS ARE MOVING
TOWARDS BEING ACQUIRED, WHAT
DOES THAT LOOK LIKE IN THIS
PROCESS? BECAUSE THEY MAY BE IN
THE MIDST OF THAT IN THE NEXT
FEW YEARS. I DON'T KNOW WHAT
HCCI IS CONSIDERING IN THOSE
PROCESSES AND WHAT THAT COULD
ENTAIL. SO WHEN ONE OF THE
THINGS THAT, WE'VE DEALT WITH
THAT, IN DIFFERENT ARENA, THE
CONCERN WAS, HEDGE FUNDS COMING
IN AND PURCHASING HOSPITALS AND
THEN, STRIPPING THEM DOWN AND
TAKING ALL THEIR ASSETS AND
SELLING OFF, THE PROPERTY, THE
REVIEW IS BY THE ATTORNEY
GENERAL. THE ATTORNEY GENERAL
HAS A TEAM THAT COMES IN AND
REVIEWS, ANY ACQUISITION OR SALE
, AND, AND I FOUND THEM TO BE
VERY GOOD. THEY, THEY CAME IN
AND DID AN ANALYSIS OF MADERA
HOSPITAL AND THE INFORMATION I
GOT FROM THEM WAS BETTER THAN
THE INFORMATION THAT I GOT FROM
THE MANAGEMENT AT MADERA, WHICH
HAD ME CONCERNED, BECAUSE IT
WASN'T JUST THE MEDI-CAL
PATIENTS THAT WERE, CAUSING THE
PROBLEM, IT WAS THE PRIVATE PAY
OR THE CONTRACT EMPLOYEES, THEY
WERE THEY WERE TAKING THEIR
INSURANCE POLICIES AND GOING
ELSEWHERE. SO THAT THE
NEGOTIATIONS WITH THE HEALTH
CARE ENTITIES, THAT THAT INSURED
THEM, THEY GOT THE REIMBURSEMENT
WAS WORSE THAN MEDICARE,
MEDI-CAL. AND SO THAT THAT WAS
PART OF THE FISCAL DETERIORATION
OF THE HOSPITAL. THANK YOU. AND
I PERHAPS THAT SHOULD BE
INCLUDED TO SOME AT SOME POINT.
YOU KNOW, THIS ADDITIONAL JUST
DISCLAIMER ON MERGERS AND
ACQUISITIONS AND PROCESSES IS,
RELATED TO THAT, DIFFICULT, OF
COURSE, VERY COMPLEX. I COMMEND
YOU FOR TAKING THIS ON, ALTHOUGH
I'VE ASKED ALL THESE QUESTIONS,
I KNOW THAT THIS IS STILL
ONGOING. I AM INCLINED TO
SUPPORT THIS BILL. I WILL I WILL
HEAR FROM MY COLLEAGUES TODAY ON
THE DÍAS, BUT I KNOW YOU'LL
CONTINUE TO WORK, AND I THINK
EVERYBODY HERE NEEDS TO CONTINUE
TO WORK ON THIS. ABSOLUTELY
THANK YOU, SENATOR MENGIBAR.
THANK YOU, SENATOR GONZALEZ.
THANK YOU SO MUCH. AND I'M SO,
I'M SADDENED THAT I MISSED THE
DISCUSSION. AND I WAS FILLED IN
FOR MY STAFF. SO I WON'T ASK THE
QUESTIONS, BUT THEY'RE VERY
SIMILAR TO THE QUESTIONS THAT
YOU HEARD FROM SENATOR LIMO AND
SENATOR DAVIS AND SENATOR
GONZALEZ. IT'S THE, TRANSPARENCY
PORTION OF IT. IT'S THE
BENCHMARKS. AND THEN FOR ME IS
WHY UP TO FIVE YEARS? I'M NOT
SURE WHERE WE GOT THOSE THOSE
YEARS. AND THEN I KNOW FROM NOW
UNTIL IT'S AN ADDITIONAL SIX
PLUS THREE, NINE, LIKE ALMOST 17
YEARS FROM NOW THAT THEY'LL HAVE
. THAT'S A PRETTY LONG TIME TO
BE ABLE TO MEET THOSE MARKS. AND
THIS COMMITTEE A COUPLE MAYBE
LAST WEEK OR A WEEK AGO, WE
HEARD ONE OF OUR FIRST ONES OF
THIS OF THIS, DID I DO THE MATH?
CORRECT. IT'S 1313. I DID NOT DO
THE MATH. CORRECT. THEY SAID I
WAS GIFTED IN ELEMENTARY SCHOOL
OF MATH, SO I DON'T KNOW. I
MIGHT HAVE LIED, SO WE HEARD ONE
OF THE FIRST SEISMIC BILLS A
COUPLE OF WEEKS AGO, AND, AND IT
WAS PROVIDENCE, AND IT WAS ONE
OF THEM WAS CEDARS OF
PROVIDENCE. AND I'M LIKE CEDARS,
YOU HAVE THE ABILITY TO PAY FOR
THIS SEISMIC, UPDATES. SO I WAS
A LITTLE CRITICAL OF THAT
BECAUSE I DO WANT TO MAKE SURE
WHAT SENATOR SMART WAS MENTIONED
DOESN'T HAPPEN, THAT HOSPITALS
WHO CAN AREN'T THEN LOOKING AT
THIS AS WELL. THIS IS A PASS.
BUT I DO AGREE WITH YOU,
SENATOR, THAT WE NEED TO DO
SOMETHING BECAUSE EVEN AT Kò THE
REPORTS, THEY THEY SHOW THAT
SINCE LIKE AROUND 2022, THEIR,
THEIR, THEIR MARGINS HAVE BEEN
FALLING. AND IN FACT, WHEN WE
PUT TOGETHER THE DISTRESSED
HOSPITAL LOAN PROGRAM, THE
PEOPLE THAT WE THOUGHT THE
HOSPITALS THAT WE THOUGHT WERE
GOING TO APPLY FOR ACTUALLY HAD
TO CLOSE AND WERE NO LONGER
ELIGIBLE TO APPLY BECAUSE THEY
NO LONGER HAD A HOSPITAL TO
APPLY FOR A LOAN. SO WE KNOW
THAT IT'S A PROBLEM, LAST YEAR
WE DID SEE THE MARGINS GROW JUST
A TINY BIT FROM 2% TO 5% IN THE
FIRST THREE QUARTERS. BUT WE
KNOW WE DON'T KNOW IF THAT TREND
IS GOING TO CONTINUE. SO I DO
RECOGNIZE AND IT'S EVEN MORE
PERSONAL FOR PEOPLE WHO
REPRESENT RURAL AREAS THAT ARE
EVEN FURTHER BEING
DISENFRANCHIZED, BECAUSE THEIR
ONE AND ONLY HOSPITALS ARE
CLOSING, AND I HAVE VARIOUS
HOSPITALS WHERE ON THE CUSP OF
CLOSING. AND SO I DO RECOGNIZE
THAT PART. I JUST WANT TO MAKE
SURE THAT WE DON'T CREATE
LOOPHOLES FOR HOSPITALS WHO ARE
ELIGIBLE AND CAN PAY FOR IT TO
MEET THOSE, BECAUSE THIS WAS, AS
A RESULT OF AN EARTHQUAKE IN MY
DISTRICT. AND I SAW AND I SAW
WHAT IT CAUSED IN MY DISTRICT.
AND I WANT TO MAKE SURE WE'RE
WE'RE RESPONDING TO THAT FOR THE
POTENTIAL NEXT ONE SHOULD
WHATEVER THAT HAPPENED. BUT I
WANT TO SUPPORT YOUR BILL
BECAUSE IT'S NEEDED, BUT I WANT
TO MAKE SURE AS IT CONTINUES
THAT THERE ARE GUARDRAILS, THAT
PERHAPS WE CAN LOOK AT THAT
EXTENSION OF FIVE YEARS, I
THINK. I REALLY THINK THAT'S TOO
MUCH. I'M NOT SURE. LIKE SENATOR
GONZALEZ SAID, WHAT MORE CAN BE
DONE FROM THE THREE YEAR
EXTENSION TO THEN ANOTHER
EXTENSION, I DID READ THE
GUARDRAILS IN TERMS OF THE
BENCHMARKS THAT NEED TO BE MADE.
I THINK THERE WERE TWO
MILESTONES THAT NEED TO BE MET
IN ORDER TO GET THE EXTENSION. I
HAVE CONCERNS WITH THE PUBLIC
COMMENT PORTION OF IT. I ALSO
KNOW THAT FROM MY DISTRICT THAT
THERE HAS NEVER, EVER BEEN A
PUBLIC COMMENT FORUM ON ANYTHING
RELATED TO HOSPITALS, IN IN MY,
IN MY AREA. SO I'M NOT SURE HOW
THAT WOULD HAPPEN, A COUPLE OF
WEEKS AGO, WE ALSO HEARD ANOTHER
BILL BY SENATOR CORTEZ, AND THE
HOSPITALS WERE, I THINK, OPPOSED
TO EXTENDED PUBLIC COMMENT
PERIOD OR PROVIDING EXTRA DATA
AS TO THE LOSSES. IF THEY CLOSE
THE PSYCH UNIT OR A MATERNAL
WARD. AND NOW WE'RE ON THE
OPPOSITE SIDE. AND NOW THEY DO
WANT TO PROVIDE ALL THIS EXTRA
DATA AND ALL THIS INFORMATION.
SO I JUST WANT TO MAKE SURE THAT
WE'RE STAY CONSISTENT. WHERE CAN
YOU PROVIDE THIS DATA OR CAN YOU
NOT PROVIDE THIS DATA, SO THAT'S
WHERE I'M AT RIGHT NOW. I WILL
BE SUPPORTING YOUR BILL. OKAY.
AND WITH THE 100 FOOTNOTES
ATTACHED TO IT THAT I JUST THAT
I JUST MENTIONED, I APPRECIATE
THAT. AND I DO HAVE NOTES. THANK
YOU. SENATOR. ANY OTHER
QUESTIONS, COMMENTS OR CONCERNS.
YOU KNOW, LET ME JUST SAY IT
AGAIN. THE PROBLEM IS THAT WE'VE
TAKEN THESE ISSUES ON ONE AT A
TIME AND WE DON'T KNOW WHO'S
DOING WHAT, WHAT THEY'RE DOING,
WHETHER IT'S EFFECTIVE, WHAT THE
TIME IS, HOW MUCH IS IT GOING TO
COST. DO THEY HAVE THE MONEY TO
DO IT? ARE THEY ARE THEY
SPENDING THE MONEY ON OTHER
THINGS. AND I CAN ALMOST TELL
YOU THAT THERE ARE HOSPITALS IN
THIS STATE THAT OVER THE PAST 30
YEARS HAVE SPENT MONEY THAT THEY
HAVE OBTAINED THROUGH BONDS AND
OTHERWISE. AND INSTEAD OF DOING
SEISMIC RETROFIT, THEY'VE DONE,
THEY HAVEN'T SPENT IT ON
NECESSARILY EXECUTIVE
COMPENSATION THEY'VE SPENT
BECAUSE SOME OF THEM ARE
NONPROFIT, THEY'VE SPENT IT ON
UPGRADING SYSTEMS AND EQUIPMENT.
AND THAT'S OKAY. BUT AT SOME
POINT YOU HAVE TO DECIDE THAT
MAYBE WE SHOULDN'T BE SPENDING
ON SYSTEMS AND EQUIPMENT, AND WE
SHOULD BE DOING THE SEISMIC
RETROFIT. SO YOU HAVE SOME PLACE
TO HAVE THE EQUIPMENT OPERATE.
SO IT'S CRITICAL TO ME THAT WE
SET UP SOME SORT OF STRUCTURE SO
THAT WE HAVE AN IDEA OF WHO'S
DOING WHAT, WHAT THEY'RE DOING,
WHEN THEY'RE DOING IT, AND WHEN
WE CAN EXPECT IT TO BE
COMPLETED. IT'S A WORK IN
PROGRESS. IT'S HIGHLY IMPERFECT.
I KNOW I'M CONFIDENT THAT THE
SHAREHOLDERS AT THE TABLE IN
FRONT OF ME, AND THOSE THAT ARE
OUTSIDE THE ROOM, WILL MAKE IT
MORE PERFECT. AND I'M COUNTING
ON THAT. I AM GOING TO ASK THE
COMMITTEE MEMBERS TO IF THEY CAN
POSSIBLY DO SO, TO VOTE FOR THIS
MEASURE, TO MOVE IT ALONG SO WE
CAN CONTINUE TO HAVE, WHICH I
RARELY DO. SO WE CAN CONTINUE TO
HAVE THE CONVERSATION IN THE IN
THE ASSEMBLY AND TRY TO MAKE
THIS A MORE PERFECT, MORE
PERFECT PRODUCT SO WE CAN GET
SEISMIC RETROFIT ON TRACK IN THE
STATE OF CALIFORNIA WITH
HOSPITALS MOVING DOWN TO THE
FINISH LINE ON TIME AND ON
TARGET. AND IF THEY CAN'T GET
THERE, WE KNOW WHO THEY ARE,
WHAT THEY NEED, AND THEN MAKE
DECISIONS AS TO WHAT WE'RE GOING
TO DO ABOUT THAT. SO I DO WANT
TO THANK YOU ALL AGAIN. BOTH THE
REPRESENTATIVES FROM LABOR HERE
AT THE TABLE AND IN THE ROOM FOR
ALL THAT YOU HAVE DONE TO HELP
US TRY TO FLESH OUT WHAT THE
ISSUES ARE AND THE HOSPITAL
ASSOCIATION AND YOUR MEMBERS FOR
COMING TO THE TABLE AND TALKING
TO THE AUTHOR, BECAUSE IT IS HER
BILL, NOT MINE. TO THE AUTHOR
AND HER TEAM ON THIS ISSUE. WITH
THAT. SENATOR CABALLERO, WOULD
YOU LIKE TO CLOSE? SENATOR ROTH,
I'LL ADOPT YOUR, YOUR STATEMENT
AS MY CLOSING. I CAN'T I
COULDN'T SAY IT ANY BETTER. I
REALLY APPRECIATE ALL THE INPUT
THAT, THAT HAS BEEN PROVIDED AND
EVERYBODY HAS MET WITH US
NUMEROUS TIMES AND HAD
CONVERSATIONS THAT HAVE BEEN
REALLY HELPFUL. I TOOK COPIOUS
NOTES, AND I'M HOPING THAT WE
CAN, DO EXACTLY WHAT'S BEEN
SUGGESTED IN TERMS OF TIGHTENING
UP SOME OF THE ACCOUNTABILITY
AND ALSO, TIGHTENING UP THE I Tð
DO NOT WANT, TO FIND A SITUATION
WHERE WORK DOES NOT GET DONE
BECAUSE THERE'S EXTRA TIME, THIS
IS THIS IS REALLY IMPORTANT.
AND, I THINK TO, TO THE ENTIRE
STATE. AND SO WE WANT THAT WE
WANT THOSE RETROFITS DONE,
RETROFITS ARE REBUILDING
WHATEVER NEEDS TO HAPPEN. AND SO
WITH THAT, I WOULD RESPECTFULLY
ASK FOR YOUR I VOTE AND YOU HAVE
MY COMMITMENT. I'M GOING TO
CONTINUE. THIS IS THE FIRST
HEARING. THIS IS THE FIRST TIME
WE'VE HAD AN OPPORTUNITY TO TAKE
A LOOK AT THIS. AND THE REASON
YOU GOT THE SOME OF THE
INFORMATION, AND I HAVE TO THANK
THE CONSULTANT, HE WORKED LONG
AND HARD ON THIS. AND THE REASON
YOU GOT THE REVISED AND ANALYSIS
LATE IS BECAUSE THIS REALLY HAS
BEEN A WORK IN PROGRESS. WE
WANTED TO ADD EVERYTHING IN IT
THAT THAT WE HAD BEEN WORKING
ON. SO RESPECTFULLY ASK FOR YOUR
I VOTE. THANK YOU. SENATOR.
THERE'S A MOTION BY SENATOR
GROVE. THE MOTION IS TO PASS, AS
AMENDED AND REFER THE COMMITTEE
ON APPROPRIATIONS. PLEASE CALL
THE ROLL. SENATOR ROTH, A ROTH
I, WHEN I WHEN I GLASER. GLASER
I GONZALEZ. GONZALEZ I GROVE.
GROVE. I HURTADO. LIMÓN LEMON. I
MENGIBAR. MENGIBAR. I RUBIO.
SMALLWOOD. CUEVAS. SMALLWOOD.
CUEVAS I WIENER. THANK YOU VERY
MUCH. VOTE IS EIGHT ZERO. WE'LL
HOLD THE ROLL OPEN FOR ABSENT
MEMBERS. THANK YOU. COLLEAGUES.
THANK YOU. SENATOR DORADO,
SENATE BILL 1447. HOSPITALS.
SEISMIC COMPLIANCE, CHILDREN'S
HOSPITAL, LOS ANGELES. PLEASE
PROCEED WHEN READY. SENATOR
COULD YOU JUST. WE'LL JUST
COMPLICATE. DITTO. OKAY I. DONE
MOVE THE BILL. WE'RE TALKING TO
YOU ALSO. I KNOW YOU WERE I WAS
I WAS TAKING NOTES. GREAT WELL,
I'M GLAD WE'RE STARTING OUT WITH
THAT ATTITUDE, THANK YOU. AND
THANK YOU, MR. CHAIR. AND
MEMBERS, TODAY I'M PRESENTING,
SB 1447 TO PROVIDE AN EXTENSION
FOR CHILDREN'S HOSPITAL LOS
ANGELES TO COMPLY WITH
ADDITIONAL SEISMIC SAFETY
RETROFIT UPGRADES. THANK YOU,
MR. CHAIR. THANK THE COMMITTEE.
I'M ACCEPTING THE COMMITTEE
AMENDMENTS THAT WERE PROPOSED,
THAT IS, INSTEAD OF A TEN YEAR
EXTENSION FOR CHILDREN'S
HOSPITAL, IT WILL BE THREE YEARS
WITH THE ABILITY TO REQUEST FIVE
ADDITIONAL YEARS, BASED ON
DEMONSTRATING NEED TO H Kò,
CHILDREN'S HOSPITAL LOS ANGELES
IS THE PREMIER ER PEDIATRIC
HOSPITAL PROVIDING CARE FOR THE
MOST CHILDREN WITH THE MOST
DIFFICULT PEDIATRIC CASES IN THE
REGION, AND THE ONLY CHILDREN'S
HOSPITAL IN THE REGION,
CHILDREN'S HOSPITAL AND THE CARE
IT PROVIDES FOR CHILDREN HAS
BECOME MORE IMPORTANT TO THE
REGION AS OTHER HOSPITALS AND
HEALTH CARE FACILITIES HAVE
BEGUN CLOSING OR DOWNSIZING
PEDIATRIC CARE UNITS. THE
HOSPITAL OFTEN RECEIVES
REFERRALS FROM OTHER HOSPITALS
IN THE REGION AND TAKES THOSE
CASES WITHOUT REGARD TO THE
ABILITY OF THE FAMILY TO PAY.
CHILDREN'S HOSPITAL DOES NOT
TURN ANYONE AWAY. 70% OF THE
CHILDREN ARE INSURED BY MEDI-CAL
. THAT MEANS THEY COME FROM VERY
LOW INCOME FAMILIES, YET THEY
GET THE HIGHEST QUALITY MEDICAL
ATTENTION AVAILABLE. CHILDREN'S
HOSPITAL TAKES ITS
RESPONSIBILITY TO HAVE A SAFE
HOSPITAL FOR ITS STAFF, NURSES,
DOCTORS AND PATIENTS VERY
SERIOUSLY. CHILDREN'S HOSPITAL
HAS MET THE PRIMARY EARTHQUAKE
RETROFIT. STRUCTURAL STANDARDS
REQUIRE BY LAW TO ENSURE THAT
ITS STRUCTURES CAN SURVIVE A
MAJOR EARTHQUAKE AND BE
FUNCTIONAL. THE NEXT SET OF
RETROFIT STANDARDS APPLICABLE TO
GENERAL TO CHILDREN'S HOSPITAL
REQUIRE FACILITY IMPROVEMENTS TO
SECURE THE HOSPITAL AND ITS
CAMPUS, HAVE ADEQUATE SEWER,
WATER, POWER GENERATION AND
OTHER INFRASTRUCTURE, TO
INDEPENDENTLY SUPPORT SUPPORT
OPERATION OF THE HOSPITAL AND
ITS CAMPUS FOR A MINIMUM OF 72
HOURS AFTER A MAJOR EARTHQUAKE.
THESE STANDARDS ARE MANDATED BY
2030, AND MEETING THESE
STANDARDS IS ESTIMATED TO COST
APPROXIMATELY OVER $200 MILLION,
WHILE CHILDREN'S HOSPITAL HAS
BEEN WORKING TO BOTH PLAN FOR
AND ACHIEVE COMPLIANCE WITH
THESE UPDATES, IT ALSO HAS HAD
THE PRIMARY ROLE TO PROVIDE
ACUTE HEALTH CARE FOR THE
REGION'S CHILDREN, REGARDLESS OF
THE FAMILY'S ABILITY TO PAY OR
THEIR INSURANCE COVERAGE. AS A
RESULT, COMPLYING WITH THE
INFRASTRUCTURE STANDARDS BY 2030
WOULD PLACE A SEVERE HARDSHIP ON
THE FINANCIAL AND OPERATION OF
THE HOTEL. CHILDREN'S HOSPITAL
HAS A REALISTIC YET AGGRESSIVE
PLAN FOR FEASIBILITY STUDIES
PERMITTING AND CONSTRUCTION TO
ACHIEVE THOSE STANDARDS, AS WELL
AS A PLAN, FINANCIAL PLAN TO
REACH THAT GOAL. PROVIDING THE
EXTENSION AND, THROUGH SB 1447
WILL ALLOW FOR BOTH THE
FINANCING PLAN AND THE
CONSTRUCTION, TO BE IMPLEMENTED,
WHILE AT THE SAME TIME CONTINUE
PROVIDING CARE FOR PEDIATRIC
PATIENTS THROUGHOUT THE REGION.
AND I JUST WANT TO SAY, I HEARD
NOT ONLY IN, THE PREVIOUS,
REMARKS THAT WERE MADE, BUT ALSO
IN MY OWN, MEETINGS WITH
STAKEHOLDERS, I MET WITH THE
NURSES, WITH THE HEALTH CARE
WORKERS, THE HOSPITAL
ASSOCIATION, AND CERTAINLY
EVERYONE HAS THE CONCERN OF
PATIENTS AND STAFF TO, THE
HIGHEST LEVELS OF SAFETY. I WANT
TO HOLD OUR HOSPITAL ACCOUNTABLE
. WHILE THEY ARE RIGHT IN ASKING
THE QUESTION THAT THEY DON'T
WANT A TIME FRAME, WHICH WILL
THEN CHANGE AGAIN, I BELIEVE
CHILDREN'S HOSPITAL WILL COME
THROUGH. OUR KIDS DEPEND UPON
IT. SO, WITH THAT, I WANT TO ASK
OUR, WITNESSES WHO ARE HERE
TODAY, MR. PAUL VIVIANO, CEO OF
CHILDREN'S HOSPITAL, AND JOE
LANG, WHO COULD ANSWER ANY,
TECHNICAL QUESTIONS. THANK YOU.
MEMBERS. THANK YOU. SENATOR.
PLEASE PROCEED. MR. CHAIRMAN.
MEMBERS JOE LANG, REPRESENTING
CHILDREN'S HOSPITAL OF LA, THANK
YOU, MR. CHAIR. AND TO YOUR
STAFF FOR THE REALLY, REALLY
GOOD, COMPREHENSIVE WORK THAT
WAS DONE, TO PUT THIS BILL INTO
VERY GOOD SHAPE. THANK YOU TO
SENATOR DURAZO FOR WILLING BE
WILLING TO CHAMPION THE HEALTH
CARE NEEDS OF THE POOREST OF THE
POOR, THE SICK OF THE SICK
CHILDREN IN THE LOS ANGELES
REGION. IN THE INTEREST OF TIME,
I'M GOING TO JUST TURN IT OVER
TO MR. PAUL VIVIANO, CEO OF
CHLA, WHO WILL GIVE A BRIEF
STATEMENT, AND WE'LL BE READY TO
ANSWER QUESTIONS. THANK YOU.
GOOD AFTERNOON, CHAIRMAN ROTH
AND MEMBERS OF THE COMMITTEE.
CHILDREN'S HOSPITAL LOS ANGELES
IS ESSENTIAL TO PROVIDING CARE
TO THE MILLIONS OF CHILDREN IN
SOUTHERN CALIFORNIA AND IN LOS
ANGELES COUNTY. IN FACT,
CHILDREN'S HOSPITAL LOS ANGELES
IS THE LARGEST PROVIDER OF
PEDIATRIC SERVICES IN THE STATE
OF CALIFORNIA AS IT RELATES TO
COMPLEX CARE, WHICH IS DEFINED
AS THOSE MOST SEVERELY ILL
PATIENTS THAT SUFFER FROM THE
FOLLOWING DIAGNOSIS AS LIVER
TRANSPLANTS, NEONATAL HEART
SURGERY, BONE MARROW
TRANSPLANTS. COMPLEX EPILEPSY.
CRANIOFACIAL DISORDERS, BRAIN
TUMORS. SPINAL BIFIDA, AND
CONGENITAL HEART CONDITIONS
INCLUDING HEART TRANSPLANT AT
CHILDREN'S HOSPITAL LOS ANGELES
PROVIDES MORE THAN 50% OF THE
CARE FOR THOSE CHILDREN. WITH
THOSE VERY SEVERE DIAGNOSES, 50%
IN LA COUNTY, MORE THAN 25% OF
ALL THE CHILDREN IN SOUTHERN
CALIFORNIA, AND MORE THAN 20% OF
ALL THE CHILDREN IN THE STATE OF
CALIFORNIA. WITH THESE COMPLEX
DIAGNOSES COME TO OUR HOSPITAL
AS SENATOR TERRAZZO OUTLINED,
76% OF OUR PATIENTS ARE OUR
BENEFICIARIES IN THE MEDI-CAL
PROGRAM. WE'RE PROUD OF OUR
LEGACY OF PROVIDING CARE TO
EVERY SINGLE FAMILY AND PATIENT,
REGARDLESS OF THEIR FINANCIAL
STATUS. CHILDREN'S HOSPITAL LOS
ANGELES IS ALSO A PRIMARY
TEACHING FACILITY. WE CONDUCT
THE NATION'S THIRD LARGEST
TRAINING PROGRAM FOR
PEDIATRICIANS AND PEDIATRIC
SUBSPECIALISTS. SO TODAY I'M
HERE TO RESPECTFULLY REQUEST AN
EXTENSION TO PROVIDE CHILDREN'S
HOSPITAL LOS ANGELES WITH
SUFFICIENT TIME TO MEET THE 2030
SEISMIC REQUIREMENTS. SO I'LL
PUT THIS IN CONTEXT FOR HOW THIS
PROCESS HAS EVOLVED OVER THE
LAST SEVERAL YEARS. TEN YEARS
AGO, WE INVESTED $1 BILLION INTO
Ã, INTO A NEW TOWER WITH 320
BEDS. WE CLOSED 80 BEDS IN OLDER
TOWERS, THINKING THAT THAT WOULD
MEET THE CAPACITY AND THE DEMAND
IN LOS ANGELES COUNTY. SINCE
THAT TIME, OVER THE LAST TEN
YEARS, 30 HOSPITALS IN LOS
ANGELES COUNTY HAVE CLOSED THEIR
PEDIATRIC SERVICES. WE REOPENED
THOSE 80 BEDS THAT WERE ON OUR
LICENSE. THEY WERE IN SUSPENSE.
WE REOPENED THEM IN OLDER
BUILDINGS THAT AREN'T
SEISMICALLY COMPLIANT. TODAY,
THOSE 80 BEDS ARE FILLED BECAUSE
THOSE 30 HOSPITALS, FOR WHATEVER
REASON, CLOSED THEIR PEDIATRIC
SERVICES. AND HELP PUT THIS IN
CONTEXT EVEN MORE, MORE, MORE,
ESPECIALLY LAST NIGHT AT
CHILDREN'S HOSPITAL LOS ANGELES,
15 OTHER HOSPITALS CALLED US
SEEKING TO TRANSFER PATIENTS
FROM THEIR EMERGENCY DEPARTMENT
FROM THEIR NICU OR SOMEPLACE
ELSE IN THEIR IN THEIR
COMMUNITY, WANTING TO TRANSFER
THOSE PATIENTS TO CHILDREN'S
HOSPITAL LOS ANGELES. WE DIDN'T
HAVE ROOM EVERY BED WAS
LITERALLY FULL. 15 LAST NIGHT.
THAT'S A VERY COMMON STORY. SO
WE CAN'T AFFORD TO CLOSE THESE
BEDS IN THESE OLDER BUILDINGS.
WE NEED TO TAKE THE EXTRA TIME
TO MAKE THEM SEISMICALLY
COMPLIANT. SO THOSE OLD
BUILDINGS, THOSE FOUR BUILDINGS
THAT I REFERENCED ARE, IN FACT
RATED SPC TWO, THEY'RE NOT IN
DANGER OF COLLAPSING, AS HAS
BEEN POINTED OUT BY A VARIETY OF
SOURCES, INCLUDING THE STATE
HCCI. SO THEY ARE NOT A LIFE
SAFETY RISK. THEY ARE NOT GOING
TO COLLAPSE. THE WORK THAT WE
NEED TO DO IS NONSTRUCTURAL IN
NATURE. THERE ARE INFRASTRUCTURE
I WON'T REPEAT, THAT'S BEEN
DESCRIBED HERE SEVERAL TIMES
TODAY THAT INFRASTRUCTURE WORK
WE LITERALLY CAN'T AFFORD TO DO
TODAY FOR TWO REASONS. THE
PANDEMIC HAS IMPACTED OUR
FINANCIAL CIRCUMSTANCES
ADVERSELY. YOU MAY RECALL THE
FIRST PHASE OF THE PANDEMIC
CHILDREN'S HOSPITALS WERE
IMPACTED ADVERSELY. VERY FEW
CHILDREN'S HOSPITALS HAD THE
VOLUME THAT THEY EXPERIENCED.
OUR REVENUE, THE FIRST 12 MONTHS
OF COVID DECLINED $300 MILLION
FROM THE PRIOR YEAR. WE DIDN'T
LAY OFF ONE EMPLOYEE ON TOP OF
THAT OVER THE LAST FIVE YEARS,
OUR MEDI-CAL REIMBURSEMENT FOR
THE CS PROGRAM, ABOUT 60% OF OUR
REVENUE FOR MEDI-CAL CS PATIENTS
HAS DECLINED MORE THAN 25% PER
CASE. OUR REIMBURSEMENT HAS
DECLINED FROM THE STATE FROM
$44,000 PER DISCHARGE TO $31,000
PER DISCHARGE. WHEN YOU MULTIPLY
THAT BY THE 700,000 PATIENTS
THAT WE CARED FOR LAST YEAR,
THAT'S AN $80 MILLION PER YEAR
DECREASE IN REIMBURSED MEANT
THAT CHILDREN'S HOSPITAL LOS
ANGELES HAS BEEN IMPACTED OVER
THE LAST FIVE YEARS. SO AS MUCH
AS WE'D LOVE TO BE IN
COMPLIANCE, WE KNOW THIS IS A
VERY SENSITIVE ISSUES. YOU'VE
HAD GREAT, GREAT TESTIMONY AND
DISCUSSION PREVIOUSLY. TODAY. WE
WANT TO BE IN COMPLIANCE. WE'RE
COMMITTED TO BEING IN
COMPLIANCE. WE KNOW WE NEED TO
HAVE SAFE CONDITIONS FOR OUR
TEAM MEMBERS, FOR FAMILIES, FOR
CAREGIVERS, AND FOR OTHER
PERSONNEL. WE LITERALLY CAN'T
AFFORD IT TODAY. THIS EXTRA TIME
THAT'S BEEN DESCRIBED IN THIS,
IN THIS BILL, ALLOWS US TO TAKE
A PORTION OF OUR ANNUAL CAPITAL
BUDGET. BUT THAT MONEY ASIDE,
MAKE THE PLANS AND MAKE OUR
ORGANIZATION COMPLIANT SO THAT
ALL FOUR OF THOSE OLDER
BUILDINGS WILL MATCH THE SEISMIC
SAFETY OF OUR BRAND NEW TEN YEAR
OLD TOWER. SO WE DON'T TAKE THIS
LIGHTLY, WE RESPECTFULLY REQUEST
THIS EXTENSION. WE'RE GRATEFUL
FOR YOUR CONSIDERATION AND FOR
YOUR SUPPORT. AND WE THANK YOU
FOR THE OPPORTUNITY TO ADDRESS
YOU TODAY. THANK YOU. SIR. ANY
OTHER WITNESSES IN SUPPORT OF
THIS MEASURE? NAME, AFFILIATION
AND POSITION, PLEASE. HI, I'M
ANNE KUNZ, PRESIDENT AND CEO OF
THE CALIFORNIA CHILDREN'S
HOSPITAL ASSOCIATION HERE IN
SUPPORT OF THE BILL. THANK YOU,
MA'AM. YES, SIR. BOB GIROUX ON
BEHALF OF THE INTERNATIONAL
UNION OF PAINTERS AND ALLIED
TRADES DISTRICT COUNCIL, 36, WE
HAVE 12,000 MEMBERS IN THE LOS
ANGELES AREA THAT WILL GET THE
WORK WHEN THE SEISMIC RETROFIT
WORK IS DONE. ALTHOUGH GIVEN THE
FACT THAT PEDIATRIC WARDS ALL
OVER LOS ANGELES ARE
EVAPORATING, WE HAVE MEMBERS NOW
THAT HAVE CHILDREN IN L.A.
CHILDREN'S HOSPITALS. WE HAVE
MEMBERS WHO HAVE BEEN IN L.A.
CHILDREN'S HOSPITAL AS PATIENTS,
AND WE PROBABLY HAVE MEMBERS WHO
WILL HAVE CHILDREN THAT WILL BE
IN CHILDREN'S HOSPITAL OF LA IN
THE FUTURE. SO SO, GIVEN THE
HOBSON'S CHOICE OF AN EXTENSION
OR THE WORK, WE WILL WAIT TO DO
THE WORK IN ORDER TO SERVICE THE
CHILDREN. THANK YOU, THANK YOU
SIR. ANY OTHER WITNESSES IN
SUPPORT? OUR WITNESSES IN
OPPOSITION. FIRST LEAD
WITNESSES, IF ANY. ANY OTHER
OPPOSITION? WITNESSES.
OKAY. YES, MA'AM. OKAY I TURN
THAT. OH, IS IT ON? OH. ALL
RIGHT, THANK YOU FOR THE
OPPORTUNITY. MY NAME IS
CATHERINE KENNEDY. I'M PRESIDENT
OF THE CALIFORNIA NURSES
ASSOCIATION AS CNA IS IN
OPPOSITION TO SB 1437, THE
CALIFORNIA NURSES ASSOCIATION
OAN, REPRESENTING 100,000
REGISTERED NURSES THROUGHOUT
CALIFORNIA, RESPECTFULLY OPPOSES
THIS BILL. THE TRAGEDY OF A
MAJOR EARTHQUAKE NEED NOT
COMPOUND UPON ITSELF BECAUSE OUR
HOSPITAL INFRASTRUCTURE HAS
FAILED US. CHILDREN'S HOSPITAL
LÀ PLAYS A CRITICAL ROLE IN
ENSURING AND PROVIDING PEDIATRIC
CARE, AND THE LOS ANGELES
COMMUNITY SHOULD EXPECT THAT THE
HOSPITAL WILL BE ABLE TO CARE
FOR THEM IN THE EVENT OF A
SEISMIC DISASTER. CALIFORNIA
MUST CONTINUE TO HOLD CHIRLA
ACCOUNTABLE TO OUR STATE'S HIGH
SEISMIC SAFETY STANDARDS, WITH
NO EXTENSION OF THE 2030
COMPLIANCE DEADLINE, CHLA HAS
HAD OVER 30 YEARS TO IMPLEMENT
SEISMIC SAFETY REQUIREMENTS THAT
WOULD ENSURE THE HOSPITAL CAN
STAY OPEN AND FUNCTIONALLY IN
THE EVENT OF A MAJOR EARTHQUAKE.
CIRCUMVENTING THESE SEISMIC
SAFETY REQUIREMENTS. NOW, WITH
YET ANOTHER DELAY IN DEADLINES,
ENDANGERS PATIENTS, NURSES,
REYES AND OTHER HEALTH CARE
WORKERS. NURSES AND OTHER HEALTH
CARE WORKERS WHO CARE FOR
PATIENTS KNOW FIRSTHAND AND THAT
IN THE EVENT OF AN EARTHQUAKE,
HOSPITALS MUST STAND READY TO
NOT ONLY TREAT PATIENTS INJURED
DURING THE COURSE OF THE
EARTHQUAKE, BUT ALSO TO ENSURE
THAT NO SERIOUS INTERRUPTION TO
PATIENT CARE OCCURS IN 1994, THE
NORTHRIDGE EARTHQUAKE NEAR LOS
ANGELES KILLED 57 PEOPLE,
INJURED THOUSANDS, SEVERELY
DAMAGED 11 HOSPITALS, AND FORCED
EIGHT TO EVACUATE. HOSPITAL
WORKERS HAD TO EVACUATE PATIENTS
. NEWBORN BABIES DOWN DARK
STAIRS TO PARKING LOTS. BUT THE
CURRENT 2030 SEISMIC SAFETY
DEADLINE ITSELF WAS A COMPROMISE
FOR THOSE WHO SOUGHT AN
IMMEDIATE RESPONSE. AFTER LIVING
THROUGH THE NORTHRIDGE
EARTHQUAKE, AND I REMEMBER IT
QUITE WELL, DELAYING THE SEISMIC
SAFETY COMPLIANCE DEADLINE FOR
CHILDREN'S HOSPITAL WOULD PLACE
CHILDREN, PARTICULARLY MEDI-CAL
BENEFICIARIES, AT RISK OF LOSING
THEIR HOSPITAL PERMANENTLY IN
THE EVENT OF A MAJOR EARTHQUAKE,
EVEN IF IT DOESN'T COLLAPSE,
THESE COMMUNITIES DESERVE TO
HAVE THE STATE OF CALIFORNIA
ENFORCE BUILDING STANDARDS THAT
WILL ENSURE THEIR HOSPITAL
REMAINS BOTH STANDING AND
OPERATIONAL AFTER AN EARTHQUAKE.
I'VE BEEN A NURSE FOR 44 YEARS.
I WORK IN A NEONATAL INTENSIVE
CARE UNIT AND I LOVE WHAT I DO,
BUT I ALSO WANT TO MAKE SURE
THAT NOT ONLY MYSELF, MY
COLLEAGUES, THE PATIENTS THAT WE
CARE FOR, AND THE COMMUNITY
AROUND IT KNOW THAT WHEN AN
EARTHQUAKE HAPPENS THAT THE
HOSPITAL WILL BE THERE, IT WILL
BE FUNCTIONING SO THAT WE CAN
CARE FOR THOSE PATIENTS COMING
IN. SO CNA CONTINUES AND STILL
OPPOSES SB 1437. THANK YOU.
THANK YOU FOR JOINING US, SIR.
THANK YOU FOR MATT LÀ ON BEHALF
OF SEIU CALIFORNIA. THANK YOU
FOR HAVING ME UP AGAIN, JUST
WANTED TO FIRST APPRECIATE THE
AUTHOR AND SPONSOR FOR THE
IMPORTANT DIALOG ON THIS BILL,
WE ARE RESPECTFULLY OPPOSED,
UNLESS AMENDED, UNLESS THERE IS
AN EXTENSION NO LONGER THAN TWO
YEARS ON THIS BILL, FOR THE
CHILDREN'S HOSPITAL. LÀ, I JUST
WANT TO UNDERSCORE ONE POINT
FROM OUR EARLIER COMMENTS, IT
WAS ONE OF THE COMMENTS THAT THE
SPEAKER WAS MAKING EARLIER
AROUND THE 15, CHILDREN'S
TRANSFERRING IN REALLY
UNDERSCORES THE IMPORTANCE OF
THIS HOSPITAL AND WHY IT REALLY
NEEDS TO COME INTO COMPLIANCE,
BECAUSE UNFORTUNATELY, NOT A LOT
OF HOSPITALS HAVE THE ABILITY TO
CARE FOR CHILDREN DURING AN
EMERGENCY. AND SO THE CAPACITY
TO MOVE PEOPLE FROM ONE HOSPITAL
TO ANOTHER IS VERY LIMITED AND
SO WANT TO MAKE SURE THAT THE
HOSPITAL IS COMING INTO
COMPLIANCE AS QUICKLY AS
POSSIBLE. AND WE THINK A TWO
YEAR EXTENSION IS WARRANTED FOR
THOSE REASONS. THANK YOU VERY
MUCH. APPRECIATE YOUR COMMENTS.
I THINK ONE OF THE THINGS WE MAY
HAVE TO DO IS WE MAY HAVE TO GET
A HANDLE ON EXACTLY HOW LONG IT
TAKES TO DESIGN, DEVELOP, DESIGN
CONSTRUCTION PLANS AND PROCESS
THEM THROUGH THE MAZE. THAT IS
CALIFORNIA'S APPROVAL PROCESS.
AND I THINK WE ALL MIGHT BE
SURPRISED AT THE LENGTH,
UNFORTUNATELY, OF THE LENGTH OF
THAT TIME. AND THAT MIGHT INFORM
THE CONVERSATION AT SOME POINT,
ANY FURTHER OPPOSITION WITNESSES
, NAME, POSITION, AFFILIATION
AND STATEMENT ON THE BILL? MR.
CHAIR MEMBERS. SORRY SARA.
FLOCKS, CALIFORNIA LABOR
FEDERATION, WE ARE IN OPPOSITION
. OAN. THANK YOU, THANK YOU,
THANK YOU, MR. CHAIR AND
MEMBERS. MEGAN SUBERS, ON BEHALF
OF THE CALIFORNIA PROFESSIONAL
FIREFIGHTERS, WE ARE STILL
OPPOSED, UNLESS AMENDED, AND
REQUEST THAT THERE BE NO MORE
THAN TWO YEAR EXTENSION.
APPRECIATE THE CONVERSATION WITH
THE AUTHOR AND THE CO-SPONSORS,
BUT I THINK WE HAVE TO
ACKNOWLEDGE THAT STILL, SEVEN
YEARS FROM NOW. SO, THANK YOU
FOR YOUR TIME. THANK YOU. YES,
SIR. STEVE BAKER, FOR THE
PROFESSIONAL ENGINEERS IN
CALIFORNIA, GOVERNMENT OPPOSED,
UNLESS AMENDED. THANK YOU. ANY
OTHER OPPOSITION WITNESSES?
ANYONE ELSE GOING? GOING, GONE.
OKAY, BACK TO THE DESK.
COMMENTS, QUESTIONS? SENATOR
GLAZER, ANY ANY OTHER COMMENTS?
QUESTIONS? CONCERNS. OKAY BILL
HAS BEEN, MOVED BY SENATOR
GLAZER. PLEASE CALL THE ROLL.
THE MOTION IS TO PASS, AS
AMENDED. REFER TO THE COMMITTEE
ON APPROPRIATIONS. SENATOR ROTH,
A ROTH I WHEN I WHEN I GLAZER I
GLAZER I GONZALEZ I GONZALEZ I
GROVE GROVE I HURTADO LIMON
LIMON I MENGIBAR AND GUEVARA I
RUBIO I RUBIO I SMALLWOOD CUEVAS
I SMALLWOOD. CUEVAS I WIENER.
VOTE IS NINE ZERO WILL HOLD A
ROLL OPEN FOR ABSENT MEMBERS.
THANK YOU ALL. THANK YOU, MR.
CHAIR. THANK YOU. MEMBERS
SENATOR MENGIBAR, YOU ARE UP.
ITEM NUMBER 14, SENATE BILL NINE
FIVE FOR SEXUAL HEALTH
CONTRACEPTIVES. PROCEED WHEN
READY. MR. CHAIR, COULD I DO MY
SECOND ONE FIRST? 1482. YOU
ABSOLUTELY CAN. ITEM NUMBER 16,
SENATE BILL 1492, AS SENATOR
MENGIBAR MEDI-CAL REIMBURSEMENT
RATES. PRIVATE DUTY NURSING.
PERFECT. THE REASON WHY I WANTED
TO SWITCH THEM, BECAUSE IT KIND
OF RESPONDS TO WHAT YOU JUST
HEARD IN THE REMARKS FROM THE
CEO OF CHILDREN'S HEALTH AND
CHILDREN'S HOSPITAL, THE CEO
SPOKE ABOUT, BEDS NOT HAVING
AVAILABLE BEDS. WELL, ONE OF THE
REASONS THEY DON'T HAVE
AVAILABLE BEDS, BECAUSE
CURRENTLY IN THE STATE OF
CALIFORNIA, WE HAVE 1000
CHILDREN WHO QUALIFY FOR PRIVATE
DUTY NURSES ON WAITING LISTS,
EITHER LIVING IN HOSPITALS, LIKE
YOU'VE HEARD, TAKING ON A BED,
AWAITING A PRIVATE DUTY NURSE,
OR AWAITING AT HOME WITHOUT THE
NECESSARY CLINICAL SERVICES THEY
NEED TO THRIVE. AND HOW MUCH
DOES IT COST FOR A CHILD TO BE
LIVING IN A HOSPITAL? BECAUSE
THERE'S NO PRIVATE DUTY NURSE TO
HELP THEM IN A HOME $7,000
UPWARDS OF $7,000 PER DAY? AND
HOW MUCH DOES IT COST FOR A
CHILD TO LIVE AT HOME WITH A
PRIVATE DUTY NURSE? AROUND 666
$662. SO WHAT IS SB 1492 LOOKING
TO DO? THEY'RE LOOKING TO ENSURE
THAT THEY'RE CONSIDERED AS AN
ELIGIBLE CATEGORY FOR THE
MEDI-CAL REIMBURSEMENT RATE
ADJUSTMENT THROUGH THE MCO, ALSO
KNOWN AS THE MANAGED CARE
ORGANIZATION TAX. THE MCO TAX
HERE WAS RECENTLY RENEGOTIATED
TO PROVIDE RATE INCREASES TO A
VARIETY OF PROVIDERS. FURTHER TO
ADD TO THE CASE AS TO WHY SHOULD
BE INCLUDED IN THIS RATE IS THAT
IN 2022, LA TIMES ARTICLE TOOK A
DEEP LOOK AT THIS ISSUE AND
FOUND THAT CALIFORNIA FAMILIES
CONTINUE TO STRUGGLE TO FIND
ADEQUATE NURSING CARE AT HOME
FOR MEDICALLY FRAGILE CHILDREN.
FURTHERMORE FOR A 2023
COMMISSIONED REPORT BY DAVID
DOCTOR DAVID MAX JOLLY FOUND TO
FURTHER CEMENT MY THE NUMBERS I
GAVE YOU ON SAVINGS IS THAT HERE
IN CALIFORNIA, WE COULD SAVE
$175 MILLION A YEAR IF WE ENSURE
THAT THESE KIDS MOVE OUT OF
HOSPITALS INTO HOME. WE'RE
DEALING WITH A BUDGET CRISIS.
WE'RE LOOKING FOR CREATIVE WAYS
TO SAVE MONEY. THIS IS A DIRECT
WAY THAT WE CAN SAVE MONEY
INVESTING FOR THEM TO GO HOME,
GET OUT OF HOSPITALS AND BE IN
THE CARE OF THEIR HOMES. TO
THAT, MR. CHAIR, AND I WOULD
LIKE TO NOW TURN TO WITNESSES I
HAVE HERE TODAY. FIRST IS A
PARENT OF A THREE YEAR OLD MILO,
WHO HAS MILLAA MILLAA MILLAA,
WHO HAS COMPLEX MEDICAL ISSUES,
ANNA LEE AND ALICIA BROADCLOUGH.
I SHOULD NOT INTRODUCE PEOPLE.
I'M JUST GOING TO LET THEM
INTRODUCE THEMSELVES. THANK YOU
FOR THANK YOU FOR JOINING US.
PLEASE PROCEED. PLEASE IDENTIFY
YOURSELVES FOR THE RECORD. FIRST
THOUGH. HI. SO MY NAME IS ANNA
ALICIA BRUSILOFF. I'M HERE TODAY
TALKING ON BEHALF OF MY DAUGHTER
MILA. LOVE OKAY, SO THE DAY
MILA'S DOCTOR TOLD ME HER
PROGNOSIS, I MADE A PROMISE TO
HER. WHATEVER HER LIFE WAS GOING
TO LOOK LIKE, I WOULD BE THERE
FOR IT. I WOULD WORK HARD EVERY
DAY TO MAKE SURE SHE LIVED A
FULL, HAPPY LIFE, REGARDLESS OF
WHAT SHE COULD AND COULDN'T DO.
WHAT I DIDN'T EXPECT WAS JUST
HOW HARD IT WAS GOING TO BE TO
LIVE UP TO MY PROMISE AND GET
HER THE ASSISTANCE SHE NEEDED.
MILA HAS BEEN ON THE WAITLIST
FOR A HOME HEALTH NURSE FOR
ALMOST TWO YEARS NOW, AND WE
HAVE YET TO HAVE A SINGLE NURSE,
LET ALONE A CONSULTATION. MILA
HAS OVER TEN ACTIVE DIAGNOSES,
INCLUDING SPASTIC QUAD CEREBRAL
PALSY AND INTRACTABLE EPILEPSY.
SHE HAS A TRACHEOSTOMY, AS WELL
AS BEING DEPENDENT ON A
VENTILATOR AT NIGHT AND A
FEEDING TUBE FOR ALL OF HER
NUTRITIONAL NEEDS. I REPOSITION
HER EVERY TWO HOURS, SUCTION HER
TRACH, PREPARE AND ADMINISTER
MEDICATIONS, SET UP G-TUBE
FEEDINGS, AND HANDLE SCHEDULING
APPOINTMENTS WITH ALL OF HER
SPECIALISTS. BECAUSE OF THE LACK
OF HOME HEALTH, HOME HEALTH CARE
NURSING. WHEN I HAVE TO WORK,
MILA GOES TO HER GRANDPARENTS
HOUSE WITH PLASTIC BAGGIES FULL
OF PRE-DRAWN SEIZURE
MEDICATIONS. SHE GOES TO THEIR
HOUSE WITH A FEEDING PUMP AND A
BAG OF FORMULA. I LOVE AND TRUST
MY PARENTS, BUT TRUTHFULLY, I
DON'T HAVE AN ALTERNATIVE AND
THEY ARE NOT PROFESSIONALS. I
CANNOT HELP BUT FEEL THAT THE
SYSTEM HAS ABANDONED MY FAMILY
AND ABANDONED MILA. THERE IS
ABSOLUTELY NO DOUBT THAT THE
LACK OF PROFESSIONAL CARE HAS
LED TO THE CONTINUED REGRESSION
OF HER CONDITION. WE DID
EVERYTHING WE WERE SUPPOSED TO
DO AS PARENTS. LACK OF HOME
NURSING MEANT MILA HAD TO
REGULARLY GO INTO THE HOSPITAL
TO GET ASSESSED, AND ENDED UP
ADMITTED EACH TIME. MY
GRIEVANCES WITH THE SYSTEM ARE
NOT ONLY FOR THE SAKE OF MILA,
NOR THE UNNECESSARY SUFFERING IT
CAUSES OUR FAMILY, BUT THAT THE
SYSTEM IS POORLY DESIGNED AND
UNDERFUNDED TO THE EXTENT OF
BEING WASTEFUL. AS HOME NURSING
PROGRAMS ARE CONTINUALLY
UNDERFUNDED AND UNDERSTAFFED,
FAMILIES LIKE OURS ARE FORCED TO
TAKE OUR CHILDREN TO THE
EMERGENCY ROOM TO TAKE TO
RECEIVE BASIC MEDICAL CARE. WHEN
WE COULDN'T HELP MILA, WE HAD NO
CHOICE BUT TO TAKE HER TO
EMERGENCY SERVICES OVER AND OVER
AGAIN. THE HOSPITAL BECAME OUR
SAFE PLACE. I BELIEVE THAT THE
PASSING OF SB 1492 HAS GREAT
POTENTIAL TO HELP HOME BECOME
OUR SAFE PLACE AGAIN. THANK YOU.
THANK YOU FOR JOINING US, SIR.
CHAIRMAN ROTH AND MEMBERS OF THE
COMMITTEE, MY NAME IS MATT
FRIESEN. I AM A HOME HEALTH
NURSE WITH MAXIM HEALTH CARE
SERVICES. I LIVE AND PROVIDE
CARE TO PATIENTS HERE IN
SACRAMENTO. THANK YOU FOR THE
OPPORTUNITY TO TESTIFY IN
SUPPORT OF SENATE BILL 1492 AS A
LICENSED VOCATIONAL NURSE, LVN
FOR SHORT. I PROVIDE PRIVATE
DUTY NURSING CARE FOR PATIENTS
WITHIN THE COMFORT AND SUPPORT
AND SECURITY OF THEIR OWN HOMES.
MY PATIENTS ARE SOME OF THE MOST
MEDICALLY COMPLEX INDIVIDUALS IN
CALIFORNIA THROUGH MEDI-CAL
FUNDED SERVICES. MY PATIENTS ARE
ABLE TO REMAIN IN THEIR HOME AND
RECEIVE THE NECESSARY. SOMETIMES
ICU LEVEL CARE THAT THEY OFTEN
NEED, AND A SINGLE SHIFT. I WILL
PROVIDE LIFE SUSTAINING CARE,
WHICH INCLUDES SIMPLE NURSING
INTERVENTIONS SUCH AS HELPING A
PATIENT EAT OR USE THE RESTROOM,
OR MORE COMPLEX AND SERIOUS
TREATMENTS SUCH AS
GASTROENTEROL, FEEDINGS,
RESPIRATORY THERAPY, USING COUGH
SYNTHESIS AND VENTILATORS, AND
BOWEL AND BLADDER TRAINING OR
THERAPY, AND MANY OTHERS.
RECENTLY, I WAS PROVIDING
OVERNIGHT CARE TO A PATIENT WHO
COULD NOT BREATHE ON THEIR OWN
WORKING WITH A VENTILATOR,
WORKING AS NIGHT SHIFT, I WAS
ENCOURAGED TO MAKE SUGGESTIONS
AND COMMENTS TO THE FAMILY AND
THE PATIENT SITUATION THAT LED
TO A SIGNIFICANT ADJUSTMENT IN
THE CARE BEING PROVIDED FOR THE
PATIENT BY THE FAMILY. THE
PATIENT WAS THEN ABLE TO NOT
ONLY RECEIVE THE BENEFITS OF
EIGHT HOURS OF UNINTERRUPTED
SLEEP DUE TO MEDICAL
INTERVENTION, BUT ALSO HAD FAR
FEWER MEDICAL COMPLICATIONS. THE
PARENTS OF THIS PATIENT WERE
ALSO ABLE TO RECOVER THEIR SLEEP
AND THEIR CARE FOR THEIR PATIENT
INCREASED. SB 1492 IS CRITICAL
BECAUSE THROUGH MEDI-CAL
MEDI-CAL FUNDED SERVICES, MY
PATIENTS ARE ABLE TO GET THE
CARE THEY NEED IN THEIR OWN
HOMES. THE ALTERNATIVE TO TRÊN
IS OFTEN A HOSPITAL ROOM WHERE
NO CHILD OR FAMILY WANTS TO BE
MOVING MEDICALLY FRAGILE KIDS
OUT OF THE HOSPITAL AND INTO
THEIR HOMES WILL ALSO SAVE THE
STATE MONEY. AS THE CARE I
PROVIDE IN THE HOME, WHILE
SPECIALIZED AND OFTEN REQUIRING
THE USE OF ADVANCED TECHNOLOGY
AND DEVICES, IS FAR LESS
EXPENSIVE THAN A HOSPITAL
SETTING. I URGE YOU TO SUPPORT
THIS IMPORTANT LEGISLATION AND
PAVE THE WAY FOR HIGHER MEDI-CAL
REIMBURSEMENT RATES, WHICH WILL
ULTIMATELY SUPPORT NURSES AND
CAREGIVERS AND OUR PATIENTS.
THANK YOU. ON BEHALF OF ALL THE
PD AND CAREGIVERS IN CALIFORNIA,
THANK YOU FOR JOINING US. ARE
THERE ANY OTHER SUPPORTERS IN
THE HEARING ROOM? PLEASE STEP
FORWARD. YOUR NAME, AFFILIATION,
AND POSITION ON THE MEASURE,
PLEASE. THANK YOU. PETER
KELLISON, ON BEHALF OF THE
CALIFORNIA ASSOCIATION FOR
HEALTH SERVICES AT HOME, PLEASED
TO SPONSOR. HAPPY TO SUPPORT.
THANK YOU, SENATOR MENGIBAR.
THANK YOU SIR. NEXT. YES, MA'AM.
GOOD EVENING. THANK YOU VERONICA
CHARLES, DIRECTOR OF GOVERNMENT
AFFAIRS FOR MAXIM HEALTH CARE
SERVICES CO-SPONSOR. THANK YOU
SO MUCH, SENATOR MENGIBAR. WE'RE
HAPPY TO SUPPORT. THANK YOU.
YES, SIR. MR. CHAIRMAN, MEMBERS
AND MARTIN, ON BEHALF OF AVIANA
HEALTH CARE, ONE OF THE LARGEST
PDM PROVIDERS HERE IN THE STATE
OF CALIFORNIA, IN VERY STRONG
SUPPORT. THANK YOU. THANK YOU.
YES, MA'AM. CHAIR AND MEMBERS.
NORLAND REPRESENTING PRIME HOME
HEALTH AND TEAM SELECT IN STRONG
SUPPORT. THANK YOU, THANK YOU.
NEXT ANY OTHER WITNESSES IN
SUPPORT OF THE MEASURE ABOUT
WITNESSES IN OPPOSITION. ANY
OTHER OPPOSITION. ANY OPPOSITION
WITNESSES, LEAD OR OTHERWISE. I
SEE NO ONE COMING FORWARD.
COLLEAGUES, BRING THE MATTER
BACK TO THE DAIS. SENATOR RUBIO.
THANK YOU, MR. CHAIR. WELL,
FIRST, I WANT TO JUST
ACKNOWLEDGE NOT ONLY YOU, BUT
OTHER PARENTS. I MEAN, IT
HAPPENS QUITE OFTEN. AS A FORMER
TEACHER, I JUST REMEMBER EVEN
HAVING PEOPLE COME INTO MY
CLASSROOM TO TAKE CARE OF
MEDICALLY FRAGILE STUDENTS AND
SO I ACKNOWLEDGE JUST, YOU KNOW,
WHAT YOU NEED TO GO THROUGH TO
TAKE CARE OF YOUR CHILD. BUT TO
THE AUTHOR, I THANK YOU FOR
THINKING THIS FAR AHEAD AS WELL,
BECAUSE, YOU KNOW, IT APPEARS TO
ME THAT THIS HAS MULTIPLE
BENEFITS. YOU KNOW, WE JUST
HEARD, THAT THE HOSPITAL
DISCUSSED LACK OF BEDS, WHICH IS
REALLY A BIG ISSUE. AND SO
YOU'RE TRYING TO DO NOT ONLY
MAKE SURE THAT THESE MEDICALLY
FRAGILE PATIENTS HAVE THE CARE
THEY NEED, HELPING NURSES LIKE
YOURSELVES AND PARENTS THAT ARE
STRUGGLING, BUT ALSO ALLEVIATING
THE, YOU KNOW, WHAT'S HAPPENING
IN OUR HOSPITALS, WHICH IS, YOU
KNOW, THE CAPACITY THAT THAT'S
NOT THERE. SO I THINK THIS IS A
GREAT WAY TO DO BOTH ALLEVIATE,
YOU KNOW, JUST THE OVERCROWDING
IN OUR HOSPITALS AND TAKE CARE
OF THE PEOPLE THAT WE NEED TO
TAKE CARE OF. SO I
WHOLEHEARTEDLY SUPPORT IT AND
WANT TO BE ADDED AS A COAUTHOR.
THANK YOU. THANK YOU, SENATOR,
AND I'LL MOVE THE BILL WHEN
APPROPRIATE. THANK YOU, SENATOR.
COLLEAGUES, ANY OTHER QUESTIONS,
COMMENTS, CONCERNS? SEEING NONE.
SENATOR, YOU MAY CLOSE. THANK
YOU SO MUCH COLLEAGUES I
APPRECIATE IT. YES, IT HAS
MULTIPLE BENEFITS. AT THE END OF
THE DAY, I THINK ABOUT IT AS
BEING EQUITABLE. THINK ABOUT A
PARENT WHO DOESN'T HAVE ACCESS
TO TRANSPORTATION AND IN THEIR
CHILD IS IN THE ONE HOSPITAL AND
PERHAPS A RURAL AREA. HOW MANY
BUSSES WOULD THEY HAVE TO TAKE?
WOULD THEY HAVE TO THEN STOP
WORKING BECAUSE THEY WANT TO BE
WITH THEIR CHILD AT THE ONLY
HOSPITAL THAT EXISTS FAR AWAY
FROM THEM? SO IF WE'RE LOOKING
TO ENSURE THAT WE CLOSE THE GAP
FOR ACCESS TO HEALTH CARE, THIS
IS ONE OF THE STEPS WE CAN MAKE
FORWARD WITH THAT. RESPECTFULLY
ASKED FOR AN AYE VOTE. THANK
YOU. IT'S BEEN MOVED BY SENATOR
RUBIO. THE MOTION IS TO PASS AND
REFER TO THE COMMITTEE ON
APPROPRIATIONS. PLEASE CALL THE
ROLL. SENATOR ROTH A ROTH AYE.
WHEN I WHEN I GLASER. GLASER I
GONZALEZ. GONZALEZ I GROVE.
GROVE. I HURTADO. LIMÓN LEMON. I
MENGIBAR. I MENGIBAR. I RUBIO I
RUBIO. I SMALLWOOD. CUEVAS. I
SMALLWOOD. CUEVAS I WIENER VOTE
IS NINE ZERO. WE'LL HOLD THE
ROLL OPEN FOR ABSENT MEMBERS.
SENATOR MENGIBAR, YOUR NEXT ITEM
IS ITEM NUMBER 14. THANK YOU SO
MUCH. APPRECIATE IT. 954. ALL
RIGHT SB 954, HEALTH COMMITTEE,
I AM BACK AGAIN WITH A VERY
SIMILAR BILL I PRESENTED TO YOU
ALL LAST YEAR. THIS TIME I AND
IT MADE IT ALL THE WAY TO THE
GOVERNOR'S DESK AND IT GOT
VETOED DUE TO A BUDGET
CONSTRAINT ISSUE. THIS YEAR,
I'VE ALLOCATED I'VE, INTRODUCED
A WELL, I INTRODUCED I HAVE A
BUDGET REQUEST THAT IS RUNNING
SIMILAR WITH THIS BILL TO ENSURE
WE ADDRESS THE CONCERNS OF THE
GOVERNOR. THIS BILL DOES A LOT
OF THINGS, BUT I'M GOING TO
SPEAK TO ONLY THE PARTS THAT
WILL FALL UNDER THE HEALTH AND
SAFETY CODE UNDER THE PURVIEW OF
THIS COMMITTEE. SO FOR THAT, THE
PROVISION UNDER SB 954 TO THIS
COMMITTEE IS LOOKING TO PROHIBIT
PHARMACIES AND RETAILERS FROM
ASKING FOR PROOF OF AGE
IDENTIFICATION FOR CONDOMS OR
CONTRACEPTIVE PURCHASES,
ACCORDING TO THE DEPARTMENT OF
PUBLIC HEALTH. STATEWIDE DATA
INDICATE OVER HALF OF ALL STIS
IN THE STATE ARE EXPERIENCED
AMONG CALIFORNIA YOUTH AGES 15
TO 24 YEARS OLD, AND YOUTH OF
COLOR ARE DISPROPORTIONATELY
IMPACTED. IN FACT, JUST LAST
YEAR, THE CDC'S REPORT CAME OUT
AND SHOWED THAT, INDIVIDUALS WHO
ARE SEXUALLY ACTIVE, THEIR USAGE
OF CONDOMS HAS DECREASED FOR
MALES. IT WENT FROM 67% TO 58.
AND FOR FEMALES FROM 54% TO 47,
WE'RE HEARING FROM INDIVIDUALS
WHO ARE LOOKING TO GO PURCHASE
THESE ITEMS. SHOULD THEY MAKE
THAT PERSONAL DECISION THAT
THEY'RE BEING TURNED AWAY,
THEY'RE BEING HARASSED AND, AND
EMBARRASSED BECAUSE THEY'RE NOT
18 YEARS OLD IN CALIFORNIA,
THERE IS NO LAW THAT REQUIRES
YOU TO BE 18 TO SHOW
IDENTIFICATION, TO PURCHASE THIS
ITEM. WE WANT TO MAKE SURE WE
JUST CLARIFY THAT. I'D LIKE TO
TURN OVER TO MY TWO WITNESSES TO
TESTIFY IN SUPPORT OF THIS BILL.
PLEASE PROCEED WHEN READY.
GREAT. THANK YOU. SENATOR. GOOD
EVENING, MR. CHAIRMAN, AND
MEMBERS OF THE COMMITTEE. MY
NAME IS AMY MOY. I'M CO CEO AT
ESSENTIAL ACCESS HEALTH AND OUR
ORGANIZATION ADVANCES
REPRODUCTIVE EQUITY AND
CHAMPIONS AND PROMOTES QUALITY
SEXUAL AND REPRODUCTIVE HEALTH
CARE FOR ALL. AND IN THAT
SPIRIT, WE'RE PROUD TO BE
CO-SPONSORS OF THIS BILL. AND
THANK THE SENATOR FOR YOUR
LEADERSHIP ON THIS IMPORTANT
ISSUE. THE SENATOR OUTLINED SOME
OF THE ALARMING STATISTICS ABOUT
THE NEED FOR THIS BILL. SO I
WON'T REPEAT THAT. BUT SINCE,
YOU KNOW, MOST STIS ARE
ASYMPTOMATIC, THEY OFTEN REMAIN
UNDETECTED. AND IF NOT TREATED
AND UNDETECTED, THEY CAN CAUSE
SERIOUS LONG TERME HEALTH RISKS.
BUT THE GOOD NEWS IS THAT THEY
ARE PREVENTABLE. WE HAVE TOOLS
IN OUR TOOLBOX AND THAT CONDOMS
ARE A HIGHLY EFFECTIVE, LOW COST
METHOD OF INTERVENTION THAT
COULD REALLY, HELP INCREASE THE
HEALTH AND SAFETY OF OUR YOUTH.
IF WE CAN REDUCE BARRIERS TO
ACCESS, THAT'S WHY IT'S CRITICAL
THAT WE REMOVE BARRIERS TO
ACCESS TO CONDOMS. AND THIS
CONCEPT FOR THIS BILL ALSO
DERIVED DIRECTLY FROM CALIFORNIA
YOUTH. WE HEARD FROM OUR YOUTH
THAT 68% OF TEENS SAID THAT THEY
DON'T HAVE ACCESS TO CONDOMS IN
SCHOOLS, BUT 92% AGREED THAT
SCHOOLS SHOULD MAKE CONDOMS
AVAILABLE, WHICH IS ONE PIECE OF
THE BILL THAT, THAT WE HAVE
ALREADY DISCUSSED AT THE
EDUCATION COMMITTEE. AND SO I'D
LIKE TO TAKE THE REST OF MY TIME
TO SHARE TESTIMONY FROM TWO
STUDENTS FROM OUR YOUTH HEALTH
EQUITY AND SAFETY FOR CONDOMS
CAMPAIGN, WE HAVE A STUDENT,
MARTIN, FROM THE FROM TROY HIGH
SCHOOL IN FULLERTON THAT SAID,
AS A HIGH SCHOOL SENIOR, I CAN'T
STRESS ENOUGH HOW CRUCIAL ACCESS
TO CONDOMS IS FOR OUR
WELL-BEING. I'VE WITNESSED
FRIENDS FACE UNNECESSARY
HURDLES, LIKE BEING ASKED FOR ID
WHEN PURCHASING CONDOMS BY
ELIMINATING COST BARRIERS AND
TACKLING TACKLING DISCRIMINATORY
PRACTICES. SB 954 EMPOWERS US TO
TAKE CONTROL OF OUR HEALTH AND
MAKE INFORMED CHOICES ABOUT OUR
BODIES WITH CONFIDENCE AND
DIGNITY. AND SO I'LL END THERE
AND LET MARTIN SPEAK ABOUT FOR
THE FOR THE REASON FOR THIS BILL
AS WELL. AND ON BEHALF OF MARTIN
AND OTHER STUDENT LEADERS, WE
ARE PARTNERING WITH AND
CO-SPONSORING WITH, INCLUDING
YOUTH LED ORGANIZATIONS LIKE
GENERATION UP AND VOTERS FOR
TOMORROW, UNITE FOR REPRODUCTIVE
AND GENDER EQUITY, CALIFORNIA
AND THE CALIFORNIA SCHOOL BASED
ALLIANCE. I URGE YOUR AYE VOTE.
THANK YOU. MA'AM, PLEASE PROCEED
SIR. THANK YOU. GOOD EVENING,
ESTEEMED CHAIR AND COMMITTEE
MEMBERS. I'M LIONEL SHULER, THE
DIRECTOR OF YOUTH PROGRAMS AT
BLACK FOR WELLNESS ACTION
PROJECT. OUR TIRELESS COMMITMENT
REVOLVES AROUND ADVANCING
REPRODUCTIVE JUSTICE AND
IMPROVING THE HEALTH AND
WELL-BEING OF BLACK WOMEN AND
GIRLS STATEWIDE. TODAY, I
PROUDLY STAND AS CO-SPONSOR OF
SB 954, THE YOUTH HEALTH EQUITY
AND SAFETY ACT. THIS
TRANSFORMATIVE INITIATIVE HOLDS
THE PROMISE OF ADDRESSING THE
HARROWING SEXUAL HEALTH
DISPARITIES THAT PERSISTS AMONG
YOUTH, ESPECIALLY WITHIN
MARGINALIZED COMMUNITIES. SB 954
IS A BEACON OF HOPE, AIMING TO
DISMANTLE SYSTEMIC BARRIERS
HINDERING YOUNG PEOPLE'S ACCESS
TO ESSENTIAL RESOURCES BY
COMBATING THE DISCRIMINATORY
PRACTICE OF RETAILERS DEMANDING
ID FOR CONDOM PURCHASES. BUT WHY
DOES THIS ISSUE DEMAND OUR
URGENT ATTENTION? AS SENATOR
MENTIONED, THE ANSWER LIES IN
THE STAGGERING STATISTICS. FAR
TOO MANY YOUNG PEOPLE,
PARTICULARLY THOSE IN BLACK,
PARTICULARLY THOSE IN BLACK AND
LGBTQ PLUS COMMUNITIES, BEAR THE
DISPROPORTIONATE BURDEN OF
SEXUALLY TRANSMITTED INFECTIONS.
RECENT FINDINGS FROM LOS ANGELES
COUNTY UNDERSCORE THE GRAVITY OF
THE SITUATION WITH THE SHARP
RISE IN STI RATES OVER THE PAST
DECADE, INCLUDING ALARMING
INCREASES IN CONGENITAL
SYPHILIS, SYPHILIS, GONORRHEA
AND CHLAMYDIA. WITHOUT EQUITABLE
ACCESS TO SEXUAL HEALTH
RESOURCES, THESE YOUNG PEOPLE
ARE LEFT VULNERABLE FOR A MYRIAD
OF RISKS, FROM STIS TO
UNINTENDED PREGNANCIES AND LONG
TERME HEALTH COMPLICATIONS.
DISCRIMINATORY PRACTICES, SUCH
AS HARASSMENT FACED WHEN
ATTEMPTING TO PURCHASE CONDOMS,
OR THE JUDGMENT ENCOUNTERED IN
HEALTH CARE SETTINGS, ONLY
EXACERBATE THESE CHALLENGES. AS
A COMMUNITY BASED HEALTH
EDUCATOR, I UNDERSTAND THE POWER
OF COMPREHENSIVE SEX EDUCATION.
EMPOWERING YOUTH WITH KNOWLEDGE
AND RESOURCES EMPOWERS THEM TO
ADVOCATE FOR THEIR HEALTH AND
WELL-BEING. WHEN WE EQUIP YOUNG
PEOPLE WITH TOOLS TO NAVIGATE
THEIR SEXUAL HEALTH, WE PAVE THE
WAY FOR MEANINGFUL CHANGE. THE
IMPERATIVE TO MOBILIZE RESOURCES
IS CLEAR. SB 954 REPRESENTS A
CRUCIAL STEP IN IN OUR
COLLECTIVE FIGHT AGAINST STI
EPIDEMICS, IN PROMOTING HEALTH
EQUITY BY PROVIDING THE
RESOURCES TO THE MOST
MARGINALIZED POPULATIONS. THIS
BILL ADDRESSES THE
DISPROPORTIONATE IMPACT OF STIS
ON COMMUNITIES OF COLOR. I
IMPLORE EACH OF YOU TO CAST YOUR
VOTE IN FAVOR OF SB 954. BY
DOING SO, YOU TAKE A DECISION A
DECISIVE STAND IN ENSURING THAT
YOUTH HAVE EQUITABLE ACCESS TO
THE RESOURCES THEY NEED TO MAKE
THE MOST INFORMED DECISIONS
ABOUT THEIR SEXUAL HEALTH. THANK
YOU FOR YOUR ATTENTION AND
CONSIDERATION ON THIS PRESSING
ISSUE. THANK YOU FOR JOINING US,
SIR. ANY OTHER SUPPORTERS?
PLEASE STEP FORWARD. NAME,
AFFILIATION, AND POSITION ON THE
MEASURE CHAIR AND MEMBERS KATHY
MOSSBERG WITH THE SAN FRANCISCO
AIDS FOUNDATION, AS WELL AS APLA
HEALTH, BOTH IN STRONG SUPPORT.
THANKS FOR JOINING US. WE'LL FIX
THAT SOMEDAY. YANNI CHOW WITH
THE CALIFORNIA TEACHERS
ASSOCIATION IN SUPPORT. THANK
YOU. KAREN STOUT ON BEHALF OF
REPRODUCTIVE FREEDOM FOR ALL
CALIFORNIA AND STRONG SUPPORT.
THANK YOU, RUTH DAWSON, ACLU,
CALIFORNIA ACTION AND SUPPORT.
THANK YOU. THANK YOU, MR. CHAIR.
AND MEMBERS. AND MARTIN, ON
BEHALF OF THE AIDS HEALTHCARE
FOUNDATION AND ITS PUBLIC HEALTH
DIVISION IN STRONG SUPPORT.
THANK YOU. NEXT. HELLO, MOLLY
ROBSON WITH PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA IN
SUPPORT. GOOD EVENING, KIM LEWIS
REPRESENTING CHILDREN NOW AND
THE CALIFORNIA COALITION FOR
YOUTH IN SUPPORT. HELLO,
STEPHANIE ESTRADA WITH
CALIFORNIA LATINAS AND
REPRODUCTIVE JUSTICE AND
SUPPORT. THANK YOU. THANK YOU.
HI, ISABELLA ERGUETA WITH THE
HEALTH OFFICERS ASSOCIATION OF
CALIFORNIA IN SUPPORT. THANK YOU
, MR. CHAIR. MEMBERS ANDREW
ANTWI ON BEHALF OF THE
CALIFORNIA MEDICAL ASSOCIATION,
IN SUPPORT. THANKS TO THE
AUTHOR. THANK YOU. ANY OTHER
SUPPORTERS? OKAY, LET'S TURN TO
WITNESSES AND OPPOSITION. FIRST,
LEAD OPPOSITION. IF THERE ARE
ANY ANY OTHER OPPOSITION
WITNESSES IN THE HEARING ROOM
SEEING NONE, LET'S BRING THE
MATTER BACK TO THE DAIS.
COLLEAGUES, ANY QUESTIONS,
COMMENTS OR CONCERNS? IT'S BEEN
MOVED BY SENATOR SMALLWOOD.
CUEVAS I SEE NO HANDS UP TO MY
LEFT. THE MOTION IS TO PASS AND
RE REFER TO THE COMMITTEE ON
APPROPRIATIONS. PLEASE CALL THE
ROLL. SENATOR ROTH AYE. ROTH.
AYE. WHEN? WHEN? NO. GLAZER
GLAZER. AYE. GONZALEZ. AYE.
GONZALEZ AYE. GROVE. HURTADO
LIMÓN. LEMON. AYE. MENGIBAR
MENGIBAR. AYE. RUBIO. AYE. RUBIO
AYE. SMALLWOOD. CUEVAS AYE.
SMALLWOOD. CUEVAS. AYE WIENER.
VOTE IS SEVEN ONE. WILL HOLD THE
ROLE. OPEN FOR ABSENT MEMBERS IS
TAKE A PASS AT THE CONSENT
CALENDAR. WE CAN DO THAT. LET'S
LET'S CALL THE CONSENT CALENDAR.
WE HAVE THREE BILLS ON OUR
PROPOSED CONSENT CALENDAR ITEM
NUMBER ONE, SENATE BILL 908 BY
SENATOR CORTEZ. FENTANYL CHILD
DEATHS. ITEM NUMBER SIX. SENATE
BILL 1464 BY SENATOR ASHBY.
HEALTH FACILITIES. CARDIAC
CATHETERIZATION LABORATORY
SERVICES, AND ITEM NUMBER 15.
SENATE BILL 1033 BY SENATOR
MENGIBAR. HEALTH FACILITIES
CONGREGATE LIVING, HEALTH
FACILITIES. IS THERE A MOTION?
OKAY. SENATOR MON MADE THE
MOTION. THE MOTION IS TO PASS,
AS AMENDED, JUST THE CONSENT
CALENDAR. Þ TO THE CONSENT
CALENDAR. OKAY, WE HAVE IT.
PLEASE CALL THE ROLL. SENATOR
ROTH. AYE. ROTH. AYE WHEN I WHEN
I GLASER. GLASER AYE. GONZALEZ.
GONZALEZ. AYE. GROVE GROVE. AYE.
HURTADO. LIMON LIMON. AYE.
MENGIBAR. MENGIBAR. AYE RUBIO.
AYE. RUBIO. AYE. SMALLWOOD
CUEVAS. AYE. SMALLWOOD. CUEVAS.
AYE WIENER NINE. YES. VOTE IS
NINE ZERO. WILL HOLD THE ROW
OPEN FOR ABSENT MEMBERS. SENATOR
LIMON, WOULD YOU LIKE TO PRESENT
ITEM NUMBER 18? SENATE BILL
1061, CONSUMER DEBT. MEDICAL
DEBT. PLEASE PROCEED WHEN READY.
ITEM NUMBER 18. GOOD EVENING,
CHAIR MEMBERS. I'D LIKE TO THANK
THE CHAIR AND THE COMMITTEE
STAFF FOR THEIR WORK AND ADVICE
ON THIS BILL. I PRESENT TO YOU
SB 1061, WHICH WOULD REMOVE
MEDICAL DEBT FROM CONSUMER
CREDIT REPORTS AND IMPROVE OUR
UNDERSTANDING OF THE EFFECTS OF
MEDICAL DEBT COLLECTION,
COLLECTION, LITIGATION. WE ALL
KNOW THAT OUR HEALTH IS NOT
SOMETHING THAT ANY OF US TAKE
FOR GRANTED. OFTENTIMES, OUR
NEED FOR HEALTH CARE SERVICES IS
DRIVEN BY FACTORS COMPLETELY
OUTSIDE OF OUR CONTROL, WHETHER
DUE TO AN ACCIDENT OR GENETICS,
THE SOCIAL DETERMINANTS OF
HEALTH OR JUST PLAIN BAD LUCK.
AND WE LIVE WITH THE HEALTH CARE
SYSTEM IN THIS COUNTRY THAT IS
IMPERFECT, THAT FAILS TO PROVIDE
COMPREHENSIVE AND AFFORDABLE
CARE FOR ALL MEMBERS OF OUR
SOCIETY. WE ALSO KNOW THAT
MEDICAL DEBT DISPROPORTIONATELY
AFFECTS LOW INCOME PEOPLE, BLACK
AND LATINO COMMUNITIES, AND
YOUNG PEOPLE, ALL WHOM ARE LESS
LIKELY TO HAVE SAVINGS OR OTHER
WEALTH TO ABSORB THE FINANCIAL
BURDEN OF DEBT. IN ADDITION TO
BEING NON-DISCRETIONARY AND
OUTSIDE OF THE CONTROL OF THE
PATIENT, MEDICAL DEBT THAT IS
REPORTED TO CREDIT AGENCIES IS
OFTEN INACCURATE, WHETHER DUE TO
BILLING ERRORS, ERRORS, MISTAKES
WITH REIMBURSEMENTS, OR ONGOING
DISPUTES AND CONVERSATIONS WITH
INSURANCE PLANS. WHEN A CONSUMER
DISCOVERS MEDICAL DEBT ON THEIR
CREDIT REPORT, THEY MAY NOT KNOW
WHY IT IS THERE OR WHO TO
CONTACT. THE PROCESS OF
DETERMINING WHETHER AN ALLEGED
MEDICAL DEBT IS ACCURATELY
REPORTED CAN BE TIME CONSUMING
AND FRUSTRATING. ON TOP OF ALL
THESE CHALLENGES, MEDICAL DEBT
IS LESS PREDICTIVE OF A
CONSUMER'S WILLINGNESS TO PAY AN
ABILITY TO PAY FUTURE CREDIT
OBLIGATION THAN OTHER FORMS OF
CONSUMER DEBT. SOME LENDERS AND
CREDIT SCORING MODELS HAVE COME
TO REALIZE THAT FALSE REALIZE
THE FALSE SIGNALS THAT MEDICAL
DEBT CAN SEND, LEADING THEM TO
REMOVE MEDICAL DEBT FROM THEIR
RISK SCORING SYSTEM. THIS BILL
PROHIBITS MEDICAL DEBT FROM
BEING REPORTED TO CREDIT CREDIT
AGENCIES. IT DOES NOT FORGIVE
DEBT. THIS BILL DOES NOT RELIEVE
MANY BURDENS ASSOCIATED WITH
MEDICAL DEBT. THE BILL DOES NOT
FORGIVE DEBT, NOR DOES IT
RESTRICT COLLECTION PRACTICES
RELATED TO MEDICAL DEBT. WHILE
THIS BILL DOES NOT SOLVE ALL OF
THE PROBLEMS WITH MEDICAL DEBT,
IT IS A START. REMOVING MEDICAL
DEBT FROM CREDIT REPORTS WILL
GIVE CONSUMERS A BETTER CHANCE
TO RESTORE THEIR FINANCIAL
HEALTH. I'M FORTUNATE TO WORK
WITH A GREAT GROUP OF
CO-SPONSORS ON THIS BILL, AND
WITH ME TODAY, TESTIFYING IN
SUPPORT IS SONIA HAYDEN, A
CONSUMER WHO WILL SHARE HER
EXPERIENCE WITH MEDICAL DEBT,
SHOWING UP ON HER CREDIT REPORT,
AS WELL AS KATHY KENNEDY, AN RN
AND PRESIDENT OF THE CALIFORNIA
NURSES ASSOCIATION.
WELCOME. PLEASE IDENTIFY
YOURSELVES FOR THE RECORD AND
PROCEED WHEN READY. OKAY HELLO,
CHAIR AND MEMBERS, MY NAME IS
SONIA HAYDEN. THANK YOU FOR
LETTING ME TELL YOU ABOUT MY
EXPERIENCE WITH MEDICAL DEBT. IN
OCTOBER OF 2021, I WAS INVOLVED
IN A MAJOR CAR ACCIDENT WHILE
DRIVING ON I-80 FROM SACRAMENTO
TO OAKLAND. THE ACCIDENT
HAPPENED AROUND 10 P.M. IN THE
EVENING, AND I WAS TAKEN BY
AMBULANCE TO THE E.R. IN
FAIRFIELD. LUCKILY I WAS OKAY,
BUT THEY KEPT ME THERE QUITE A
WHILE TO RUN SOME TESTS AND MAKE
SURE EVERYTHING WAS FINE. AS A
STATE WORKER, I HAVE FULL
INSURANCE COVERAGE THROUGH WORK,
SO THAT WAS AT LEAST ONE LESS
THING I HAD TO WORRY ABOUT. FAST
FORWARD TO A FEW YEARS LATER,
THE SUMMER OF 2023. MY PARTNER
AND I MADE THE DECISION TO TRY
AND BUY OUR FIRST HOME. WHILE
APPLYING FOR A LOAN, I WAS
SURPRISED TO DISCOVER MY CREDIT
SCORE HAD GONE DOWN
SIGNIFICANTLY DUE TO AN UNPAID
MYSTERY BILL. I CALLED THE
CREDIT COMPANY LISTED AND
DISCOVERED THAT THE HOSPITAL I
WAS TAKEN TO AFTER THE ACCIDENT
HAD CORRECTLY BILLED MY
INSURANCE FOR EVERYTHING EXCEPT
FOR EXCEPT FOR ONE VERY
EXPENSIVE TEST THEY HAD DONE. I
THINK IT WAS A SIMPLE MISTAKE.
THEY HAD SIMPLY FORGOTTEN TO ADD
MY INSURANCE INFORMATION TO IT,
AND HAD BILLED ME INSTEAD, BUT I
SOMEHOW NEVER RECEIVED THE BILL.
THIS WAS INCREDIBLY STRESSFUL AT
THE TIME BECAUSE MY CREDIT SCORE
NEGATIVELY AFFECTED OUR MORTGAGE
RATE. AT A TIME WHEN RATES WERE
ALREADY AT AN ALL TIME HIGH. AT
THIS POINT, I'VE SPENT HOURS ON
THE PHONE TRYING TO GET THIS
FIXED, TO NO AVAIL.
REPRESENTATIVES AT THE INSURANCE
COMPANY HAVE TRIED TO HELP ME AS
AND SO HAS THE CREDIT COMPANY.
AS OF NOW, THIS IS STILL SHOWING
ON MY CREDIT SCORE, AND THERE
APPEARS TO BE NOT MUCH THAT I
CAN DO ABOUT IT. AGAIN, THANK
YOU FOR LETTING ME SPEAK IN
FRONT OF YOU TODAY. THANK YOU
FOR JOINING US. THANKS. YES,
MA'AM. GOOD AFTERNOON. AND
AGAIN, THANK YOU, CHAIR ROTH,
FOR THE ONGOING CONVERSATION.
AGAIN, MY NAME IS KATHY KENNEDY,
PRESIDENT OF THE CALIFORNIA
NURSES ASSOCIATION, AND PROUD
SPONSOR OF SB 1061 WITH SENATOR
LEMON. THANK YOU. NURSES
WITNESSED FIRSTHAND THE IMPACTS
TO OUR PATIENTS HEALTH DUE TO
DELAYED MEDICAL CARE. WHEN A
PATIENT WHEN PATIENTS FEAR THAT
MEDICAL DEBT WILL NEGATIVELY
IMPACT THEIR CREDIT, THEY TOO
OFTEN FOREGO IMPORTANT MEDICAL
TREATMENT AND THE OUTCOMES ARE
OFTEN CATASTROPHIC. 78% OF
CALIFORNIANS WITH MEDICAL DEBT
REPORT SKIPPING CARE DUE TO
COST. THAT'S TWICE AS LIKELY AS
PEOPLE WITHOUT ANY MEDICAL DEBT.
IMPORTANTLY, THE PROBLEM OF
DELAYED OR SKIPPED CARE DUE TO
MEDICAL DEBT IS PARTICULARLY
ACUTE FOR PEOPLE OF COLOR AND
WORKING FAMILIES. 1 IN 2 LOW
INCOME CALIFORNIANS HAVE MEDICAL
DEBT. BLACK AND LATINO
CALIFORNIANS ARE MORE LIKELY TO
HAVE MEDICAL DEBT THAN WHITE
CALIFORNIANS, AND PEOPLE LIVING
WITH A DISABILITY ARE TWICE AS
LIKELY TO MEDICAL DEBT.
INFORMATION ON CREDIT REPORTS
CREATES CHAOS FOR WORKING
FAMILIES. ACCESS TO HOUSING,
VEHICLE LOANS AND EVEN
EMPLOYMENT OPPORTUNITIES IS
NEGATIVELY AFFECTING MILLIONS OF
CALIFORNIANS. HOWEVER, A
PATIENT'S ABILITY TO PAY FOR THE
CARE THAT THEY NEED IS NOT AND
SHOULD NOT BE AN INDICATOR OF
THEIR CREDIT WORTHINESS. WHEN
CALIFORNIANS SEEK CARE IN AN
UNEXPECTED EMERGENCY, LIKE A
BROKEN ARM, OR AS OUR YOUNG LADY
THAT JUST TALKED ABOUT IT,
THEY'RE GOING TO VERY LIKELY
INCUR A MEDICAL DEBT. AND THIS
BECOMES WORSE BECAUSE OF HIGH
DEDUCTIBLE PLANS HAVE GROWN
FASTER THAN INFLATION AND IT HAS
JUST SPIRALED. MEDICAL DEBT
SIMPLY DOES NOT BELONG ON CREDIT
REPORTS. EVEN THE CREDIT
REPORTING BUREAUS THEMSELVES
RECOGNIZE THAT MEDICAL DEBT IS
NOT A RELIABLE PREDICTOR OF
CREDIT WORTHINESS. REMOVING
MEDICAL DEBT FROM CREDIT REPORTS
WOULD ADDITIONALLY HELP PREVENT,
DISCRIMINATE, OR BARRIERS TO
HOUSING OR EMPLOYMENT FOR PEOPLE
WITH DISABILITIES, AS WELL AS
PEOPLE OF COLOR. OTHER STATES
ARE ALREADY IMPLEMENTING THIS
TYPE OF BAND IN CALIFORNIA
SHOULD JOIN THE FIGHT TO PROVIDE
BROADER ACCESS TO CREDIT AND
LOWER BARRIERS TO HEALTH CARE
FOR OUR FELLOW RESIDENTS. CNA
URGES THE COMMITTEE TO VOTE YES
ON SB 1061. THANK YOU. THANK YOU
VERY MUCH. OTHER SUPPORTERS OF
THE MEASURE, PLEASE STEP FORWARD
. NAME, AFFILIATION AND POSITION
ON THE MEASURE. PLEASE KATIE VAN
DINES WITH HEALTH ACCESS
CALIFORNIA. WE'RE A PROUD
CO-SPONSOR OF THE MEASURE, AND
I'VE ALSO BEEN ASKED TO REGISTER
THE SUPPORT OF THE LUTHERAN
OFFICE OF PUBLIC POLICY. THANK
YOU, THANK YOU. NEXT, PLEASE.
HI, I'M MARGUERITE CASILLAS. I'M
A VOLUNTEER FOR REPRESENTING THE
NATIONAL MULTIPLE SCLEROSIS
SOCIETY, AND WE ARE IN SUPPORT.
THANK YOU. NEXT, PLEASE. MR.
CHAIR, MEMBERS SARAH PHLOX,
LABOR FEDERATION IN SUPPORT.
THANK YOU, THANK YOU. YES,
MA'AM. GOOD EVENING. CHAIR
MEMBERS JANICE O'MALLEY, AFSCME,
CALIFORNIA IN SUPPORT. THANK
YOU. THANK YOU. YES, SIR. HELLO,
ANTHONY LIU FOR THE OFFICE OF
ATTORNEY GENERAL. ROB BONTA, WE
ARE ONE OF THE CO-SPONSORS OF
THE BILL. AND MY COLLEAGUE
MICHAEL GOLDSMITH AND I ARE HERE
TO ANSWER ANY QUESTIONS.
TECHNICAL QUESTIONS. THE
COMMITTEE MAY HAVE. THANKS.
THANK YOU. CHRISTOPHER SANCHEZ,
REPRESENTING THE CONSUMER
FEDERATION OF CALIFORNIA, WHO IS
A SPONSOR AND STRONG SUPPORT.
THANK YOU. YES, MA'AM. AMY
PINES, SACRAMENTO LOCAL ADVOCATE
IN SUPPORT. THANK YOU. HI,
ANDREA VELASQUEZ, ON BEHALF OF
MYSELF, AS A MOTHER OF A CANCER
PATIENT AND ALSO VICE PRESIDENT
OF MAMA BEARS FIGHTING CHILDHOOD
CANCER IN SUPPORT. THANK YOU.
HELLO. MONICA PADILLA FROM
SACRAMENTO, CALIFORNIA. AND I'M
HERE REPRESENTING MY DAUGHTER,
WHO IS CURRENTLY FIGHTING CANCER
IN SUPPORT. THANK YOU MA'AM,
KEVIN INSKO WITH THE FRIENDS
COMMITTEE ON LEGISLATION OF
CALIFORNIA IN STRONG SUPPORT.
THANK YOU. THANK YOU. GOOD
EVENING. LINDA HèA WITH WESTERN
CENTER ON LAW AND POVERTY IN
SUPPORT. THANKS DALE RICHTER
HERE ON MY OWN BEHALF IN STRONG
SUPPORT OF THE MEASURE. THANK
YOU SIR. MÀ, ON BEHALF OF SEIU
CALIFORNIA IN SUPPORT. THANKS
GOOD EVENING. REBECCA MARCUS, ON
BEHALF OF ONE OF THE
CO-SPONSORS, CALPIRG, AS WELL AS
THE CONSUMER PROTECTION POLICY
CENTER AT THE UNIVERSITY OF SAN
DIEGO SCHOOL OF LAW. THANK YOU.
THANK YOU. GOOD AFTERNOON. DANNY
KENDALL KAISER, ON BEHALF OF TWO
OF THE CO-SPONSORS OF THE BILL,
THE CALIFORNIA LOW INCOME
CONSUMER COALITION AND THE
NATIONAL CONSUMER LAW CENTER.
THANK YOU, MA'AM. SIR ADAMS AND
LEUKEMIA AND LYMPHOMA SOCIETY IN
SUPPORT. THANK YOU. THANK YOU.
TIM MADDEN AND I'M PINCH HITTING
FOR ALS ASSOCIATION IN SUPPORT.
THANK YOU SIR. ANY OTHER
SUPPORTERS IN THE HEARING ROOM?
LET'S TURN TO WITNESSES AND
OPPOSITION. FIRST LEAD
OPPOSITION WITNESSES STEP
FORWARD. AS THEY'RE DOING SO
SENATOR, I MAY HAVE MISSED IT.
DID YOU YOU ACCEPT, PROPOSED AND
ACCEPTED? YES, I ACCEPT THE
PROPOSED AMENDMENTS. THANK YOU.
SORRY, I FORGOT TO SAY THAT.
YES, I DO. GENTLEMEN, PLEASE
IDENTIFY YOURSELVES FOR THE
RECORD AND PROCEED WHEN READY.
THANK YOU, CHAIRMAN ROTH, THE
MEMBERS OF THE HEALTH COMMITTEE.
MY NAME IS DAVID REED, AND I
SERVE AS GENERAL COUNSEL TO THE
RECEIVABLES MANAGEMENT
ASSOCIATION. INTERNATIONAL RMI
IS A NATIONAL NONPROFIT TRADE
ASSOCIATION WHICH REPRESENTS
BANKS, CREDIT UNIONS, COLLECTION
AGENCIES, DEBT BUYING COMPANIES
AND COLLECTION LAW FIRMS. WHILE
RMI APPRECIATES THE AUTHOR'S
INTENT FOR INTRODUCING THE BILL,
RMI IS HERE TODAY IN RESPECTFUL
OPPOSITION TO SENATE BILL 1061.
AS CURRENTLY DRAFTED, RMI IS
PRIMARY CONCERN IS RELATED TO
THE OVERLY BROAD DEFINITION OF
MEDICAL DEBT AND HOW IT
INTERRELATES WITH THE BILL'S
PROHIBITION ON REPORTING MEDICAL
DEBT TO CREDIT BUREAUS AND THE
POTENTIAL EXPUNGEMENT OF THE
DEBT WHILE THE BILL EXEMPTS
GENERAL PURPOSE CREDIT CARDS
FROM THE DEFINITION OF MEDICAL
DEBT DUE TO THE IMPOSSIBILITY OF
KNOWING WHAT GOODS AND SERVICES
BEING PURCHASED ARE MEDICALLY
RELATED, A NUMBER OF OTHER
LENDING PRODUCTS WILL BE
UNINTENTIONALLY PULLED INTO THE
DEFINITION, AS DRAFTED HOME
EQUITY LOANS AND BANKING LINES
OF CREDIT COULD BE DEFINED AS
MEDICAL DEBT BASED ON CONSUMER
ACTION. FOR EXAMPLE, IF A
CONSUMER WERE TO TAKE OUT
$100,000 HOME EQUITY LOAN AND
USE $5,000 FOR BRACES FOR HER
DAUGHTER, THAT HOME EQUITY LOAN
WOULD NOW BE CLASSIFIED AS
MEDICAL DEBT AND SUBJECT TO THE
CREDIT REPORTING BAN.
FURTHERMORE, IT PULLS INTO THE
DEFINITION OF MEDICAL DEBT
SPECIALTY HEALTH BASED CREDIT
CARDS THAT CAN BE USED TO
PURCHASE VARIOUS SERVICES AND
PRODUCTS, INCLUDING HAIR
IMPLANTS, TUMMY TUCKS, FACE
LIFTS, NOT TO MENTION SPA
TREATMENTS, JEWELRY, FLOWERS,
PET INSURANCE, AND BOWFLEX
ATHLETIC EQUIPMENT. ALMAY I
UNDERSTANDS THAT MEDICAL DEBT IS
A UNIQUE TYPE OF DEBT AND SHOULD
BE TREATED AS SUCH BECAUSE
PATIENTS DO NOT CHOOSE TO GET
SICK OR BE IN AN ACCIDENT. BUT
WE NEED TO BE CAREFUL NOT TO
CONFLATE A HAIR IMPLANT. SPA
TREATMENTS, AND ATHLETIC
EQUIPMENT WITH BEING ADMITTED
INTO AN EMERGENCY ROOM OR HAVING
AN APPOINTMENT WITH YOUR PRIMARY
CARE PHYSICIAN. RMI HAS HAD
POSITIVE CONVERSATIONS WITH THE
AUTHOR'S STAFF, AND WE ARE
HOPEFUL AMENDMENTS WILL BE
FORTHCOMING TO ADDRESS OUR
CONCERNS. THANK YOU. THANK YOU,
MR. CHAIRMAN. CLIFF BERG, ON
BEHALF OF THE CALIFORNIA
ASSOCIATION OF COLLECTORS, WE
ARE OPPOSED UNLESS AMENDED. I
WOULD SAY THAT WE HAVE HAD
POSITIVE CONVERSATIONS WITH THE
AUTHOR AND HER STAFF AND WANT TO
THANK HER, BUT THOSE DISCUSSIONS
ARE NOT REACHED THE POINT OF
HAVING ANY LANGUAGE. SO
RESPECTFULLY, I WOULD LIKE TO
DRAW YOUR ATTENTION TO THREE
CONCERNS. ONE IS THE DEFINITION
OF MEDICAL DEBT IN THE BILL. WE
CONCUR WITH DAVID THAT THE
CURRENT DEFINITION OF THE BILL
IS OVERBROAD AND HAS THE
POTENTIAL CONSEQUENCES OF
DRAGGING IN ALL SORTS OF
POTENTIAL PURCHASES AND COVERING
THINGS THAT SHOULD NOT BE WITHIN
THE DEFINITION OF MEDICAL DEBT.
NUMBER TWO, THE SANCTIONS IN THE
BILL ARE AN EXTREME OVERREACH. A
VIOLATION OF THIS BILL WOULD
RESULT IN THE UNDERLYING
UNDISPUTED LEGALLY OWED DEBT
BEING NULLIFIED. FOR VIOLATION
OF A REPORTING PROHIBITION, THAT
WOULD DENY PAYMENT TO THE
PROVIDER AND THE PROVIDER WOULD,
IN ESSENCE, WIND UP UNREIMBURSED
FOR GOOD FOR SERVICES OR GOODS
PROVIDED LEGALLY OR PROVIDED
LEGALLY OWED, WE THINK THAT IS
AN EXTREME OVERREACH FOR A
PENALTY IN THIS KIND OF
LEGISLATION. THÀNH, NUMBER
THREE, THERE ARE SOME SITUATIONS
WHERE, PATIENTS RECEIVE DIRECT
REIMBURSEMENT FROM A PLAN OR OUT
OF NET FOR OUT OF NETWORK
SERVICES AND DO NOT PAY THE
PROVIDER AND WE ARE DISCUSSING
WITH THE AUTHOR'S OFFICE HOW TO
DEAL WITH THOSE SITUATIONS AND
LOOKING FOR A CARVE OUT FROM
THIS BILL OF THOSE SITUATIONS
WHERE THE PAYMENT PATIENT DID
RECEIVE DIRECT REIMBURSEMENT,
THOSE ISSUES ARE OF CONCERN AND
WE THINK WOULD MAKE A
SIGNIFICANT IMPACT. UNINTENDED
CONSEQUENCES IF THIS LEGISLATION
WAS ENACTED IN ITS CURRENT FORM.
WE CONTINUE TO LOOK FORWARD TO
WORKING WITH THE AUTHOR ON THESE
ISSUES. THANK YOU. THANK YOU.
ANY OTHER OPPOSITION WITNESSES
IN THE HEARING ROOM? PLEASE STEP
FORWARD. NAME, AFFILIATION AND
POSITION ON THE MEASURE. PLEASE
GOOD AFTERNOON. STEPHANIE
ESTRADA WITH CRUZ STRATEGIES ON
BEHALF OF ENCORE CAPITAL GROUP.
WE HAVE IN OPPOSE. UNLESS THE
BROAD DEFINITION OF MEDICAL DEBT
IS AMENDED TO BE NARROWED IN
SCOPE. THANK YOU, THANK YOU.
NEXT, PLEASE. HI. MARK FAROOQ,
ON BEHALF OF THE CALIFORNIA
HOSPITAL ASSOCIATION. AND WE'RE
NOT OPPOSED, WE HAVE A LETTER OF
CONCERNS THAT WE'VE SHARED WITH
THE AUTHOR AND WITH THE
COMMITTEE. WE APPRECIATE THE
COMMITTEE'S AMENDMENTS THAT WE
THINK ADDRESS PART OF OUR
CONCERN. WE MAINTAIN THAT WE
STILL HAVE ISSUES RELATED TO THE
LITIGATION DATABASE THAT'S
REQUIRED, THAT WE BELIEVE IS
OUTSIDE OF THE SCOPE AND MISSION
OF HOSPITALS TO MAINTAIN. BUT WE
REALLY APPRECIATE THE GENEROSITY
OF THE AUTHOR AND HER STAFF AND
SPENDING TIME WITH US TO TALK
THROUGH THOSE CONCERNS. LOOK
FORWARD TO CONTINUING THE
CONVERSATION. THANK YOU. ANY
OTHER OPPOSITION WITNESSES?
SEEING NONE. LET'S BRING IT BACK
TO THE DAIS. ANY QUESTIONS,
COMMENTS, CONCERNS I MOVE THE
BILL, SENATOR GLAZER, YOU HAVE A
QUESTION, JUST A COMMENT. I JUST
WANT TO THANK THE, THE AUTHOR
FOR BRINGING THIS BILL FORWARD.
I THINK SHE TOUCHES ON AN ISSUE
THAT COULD HAPPEN TO ANY OF US
AT ANY TIME AND CIRCUMSTANCES,
OUT OF OUR CONTROL AND, I'M
PLEASED TO SUPPORT THE BILL
TODAY. I KNOW THAT, THERE'S SOME
COMPLEXITY INVOLVED IN IT. AND
THERE ARE DETAILS, BUT I'M
CONFIDENT THAT OUR CHAIR OF THE
BANKING COMMITTEE, WHO HAS DEALT
WITH THESE ISSUES, WILL CONTINUE
TO WORK ON IT AND TRY TO RESOLVE
SOME OF THE MAYBE UNINTENDED
CONSEQUENCES AS THE BILL MOVES
FORWARD. IF IT MOVES FORWARD,
AND I'M HAPPY TO MOVE IT AT THE
APPROPRIATE TIME. THANK YOU.
THANK YOU, SENATOR GLAZER.
SENATOR RUBIO, THANK YOU, YOU
KNOW, I APPRECIATE THE PERSONAL
TESTIMONY OF THE YOUNG LADY, YOU
KNOW, THAT THAT ACCIDENT AND, OF
COURSE, ONE LITTLE ITEM COULD
TAKE DOWN YOUR CREDIT. AND SO I
THINK THAT'S IMPORTANT. I THINK
NO ONE SHOULD GET BOGGED DOWN BY
, YOU KNOW, THINGS THAT WERE OUT
OF THEIR CONTROL. I'M JUST
TRYING TO UNDERSTAND A LITTLE
BIT MORE AND TO SEE IF YOU CAN
SPEAK TO SOME OF THE ITEMS THAT
WERE BROUGHT UP, I DO APPRECIATE
THE COSMETIC. I THINK THAT THAT
WAS, REMOVED. RIGHT. EXCLUDE
COSMETIC SURGERIES. BUT, CAN YOU
ADDRESS, LIKE, SOME OF THE
CONCERNS THAT THEY SAID, WHAT IF
SOMEONE GETS DIRECT
REIMBURSEMENT, BUT THEN THEY
FAIL TO PAY? IS THERE A SOLUTION
FOR THAT, YOU KNOW, IS IT
POSSIBLE, JUST LIKE SOMEONE
STATED, RIGHT, THAT YOU TAKE OUT
AN EQUITY LOAN AND CITE MEDICAL,
PAYMENT OR MEDICAL DEBT AND THEN
NOT NECESSARILY USE IT, AND I
KNOW THAT YOU'VE BEEN WORKING ON
A LOT OF THE ISSUES ALREADY, BUT
JUST, YOU KNOW, IF YOU CAN JUST
SHARE A LITTLE BIT MORE ON THAT.
YEAH. SO WE DEFINITELY HAVE
TAKEN THE AMENDMENTS, AMENDMENTS
YOU RECOGNIZED ABOUT, YOU KNOW,
COSMETIC, MEDICAL, ANYTHING IS
TAKEN IN THIS AMENDMENT.
ADDITIONALLY, ONE OF THE
AMENDMENTS WE ALSO TOOK, AND
IT'S STATED IN THE ANALYSIS,
SEEKS TO ADDRESS, WHAT WE'VE
HEARD FROM STAKEHOLDERS RELATED
TO GENERAL PURPOSE SECURED
DEBTS. AND SO THAT'S ALONG THE
EQUITY LINE OF CREDIT THAT
YOU'VE MENTIONED. SO WE FEEL
THAT THAT IS YOU KNOW, A GOOD
STEP AND WE'LL CONTINUE TO WORK
ON IT. IF THERE IF THERE ARE
FOLKS WHO FEEL THAT THE LANGUAGE
DOESN'T SECURE THAT. AND AS FAR
AS THE PIECE OF WHEN THE
REIMBURSEMENT GOES FROM THE
INSURANCE COMPANY TO THE
CONSUMER OR PATIENT DIRECTLY,
WE'RE LOOKING TO SEE HOW WE
ADDRESS THAT. AND SO WE'LL BE
ABLE TO HOPEFULLY ADDRESS THAT
IN THE FUTURE. AND ONE MORE
QUESTION, IF I MAY, ONLY BECAUSE
I WAS HEARING CONFLICTING, YOU
KNOW, I GUESS INFORMATION, JUST
SO I HAD TO DO MY OWN RESEARCH
IN TERMS OF REGULAR CREDIT CARDS
WHEN I UNDERSTAND HERE, A
GENERAL PURPOSE CREDIT CARD OR
EXCLUDED. RIGHT. BUT I LOOKED UP
SOME OF THE, THE ITEMS FOR, WAS
IT CARE CREDIT AND WHAT THEY CAN
BE USED FOR. AND SO I DID GO ON
SOME OF LIKE THE WEBSITES OF
SOME OF THE, THE STORES, FOR
EXAMPLE, WHAT THEY CAN PURCHASE
AT WALMART AND OTHER AREAS AND
IT APPEARS THAT SOME OF THESE
LIKE CARE CREDIT CARDS, CAN BE
USED TO PURCHASE THINGS OUTSIDE
OF MEDICAL, SO, FOR EXAMPLE, I
THINK ONE OF THEM SAID THEY CAN
PURCHASE ANYTHING OTHER THAN
LIKE A LOTTERY TICKET. AND SO,
CAN YOU SHARE? HOW CAN YOU
DIFFERENTIATE? I JUST WANT TO
UNDERSTAND THE PROCESS. YEAH.
AND SO AND THEN THERE'S THAT,
THAT ONE'S PARTICULARLY A
MEDICAL CREDIT CARD. CORRECT.
BUT YET THEY'RE ALLOWED TO BUY
OTHER THINGS. YEAH. SO SINCE YOU
BROUGHT UP CARE CREDIT, I'M
ACTUALLY WONDERING IF WE CAN YOU
ALL HAVE AND I'M WONDERING IF
YOU DON'T HAVE WE PASSED IT OUT.
YES. I JUST SENT IT TO US. SO
YOU SEE THERE, WHAT IS THERE?
AND WHAT YOU WILL SEE IS THAT IN
THE DESCRIPTION ON THE WEBSITE,
ON THE CARE CREDIT, IT ACTUALLY
ADVERTISE, FOR, FOR HEALTH CARE
PURPOSES. SO IF SOMEONE IS USING
A CARD THAT IS BEING MARKETED AT
0% INTEREST RATE AND IS BEING
MARKETED AND DESCRIBED AS A CARD
TO SECURE MEDICAL DEBT AND IS
NOT USING IT FOR THAT, I THINK
THAT THAT IS A DIFFERENT ISSUE,
BUT I ALSO THINK THAT THE OTHER
PIECE IS, IS THAT WE YOU WILL
SEE THAT NOT AND FROM THE LIST
YOU GOT THAT THE PROVIDERS
OUTSIDE IF YOU IF YOU LOOK AT
THE TOP 20 PROVIDERS NEAR THE
CAPITOL OUTSIDE, I DON'T KNOW
WHERE YOU WOULD BE ABLE TO BUY A
LOTTO TICKET BASED ON THOSE
EXCEPT RITE AID. RIGHT SO JUST
TO BE CLEAR, WHAT THE CREDIT
CARD SHOULD DO, THERE IS A CODE
FOR MEDICAL PURCHASES AS WELL AS
SOMETHING LIKE A LOTTO TICKET.
AND THE CREDIT CARD SHOULD SAY
IT SHOULD AUTOMATICALLY DO THIS
BECAUSE BASED ON CODES AND THEY
DO THIS ALL THE TIME, JUST TO BE
CLEAR, SHOULD NOT ACTUALLY ALLOW
A LOTTO TICKET TO BE PURCHASED
ON THAT. CAN I CLARIFY FOR THAT?
NO. IT SAYS YOU CAN PURCHASE
ANYTHING EXCEPT A LOTTO TICKET,
LIKE IF YOU GO TO. SO LET'S JUST
SAY A STEREO. WHAT DO YOU WELL,
IT JUST SAYS, YOU KNOW, A
CHECKOUT, WHEN I WENT TO ONE OF
THE, THE WEBSITES, IT SAYS, YOU
CAN PURCHASE ANYTHING. I THINK
IT WAS LIKE WALMART. YOU CAN
PURCHASE SOME ITEMS THAT ARE NOT
IN. I GUESS I'M NOT TRYING TO BE
JUST, YOU KNOW, JUST
UNDERSTANDING THE DIFFERENCE. IT
SAID EXCEPT A TICKET. BUT IF
THEY GO TO WALMART, THEY COULD
PURCHASE SOME THINGS THAT ARE
NOT NECESSARILY MEDICAL PER SE.
I'M JUST TRYING TO FIGURE OUT
HOW YOU DIFFERENTIATE WHAT'S
REALLY MEDICAL. THE CREDIT CARD
THAT IS ADVERTISED FOR MEDICAL
PURCHASE AND MEDICAL NEEDS HAS
EVERYTHING THAT WE PURCHASE, HAS
CODES TO IT SHOULD BE ABLE TO.
SO THAT IS NOT NECESSARILY THE
BILL IS ABOUT REPORTING MEDICAL
DEBT TO A, YOU KNOW, CREDIT
AGENCY. SO IF SOMEONE DECIDES TO
BUY A STEREO AT WALMART, IN
THEORY, IF A CREDIT CARD IS
WORKING AS IT'S SUPPOSED TO BE A
CARE CARD, RIGHT? SINCE YOU'VE
GIVEN THAT IT SHOULDN'T LET IT
BUY THAT, THAT WOULD HAVE TO BE
PAID ON THEIR OWN DIME. SO IF
THE CARD IS NOT WORKING
CORRECTLY, I HAPPEN TO KNOW THE
CHAIR OF BANKING AND FINANCE,
AND WE CAN HAVE A CONVERSATION
ABOUT THAT. THANK YOU. I JUST
HAD THOSE THOSE QUESTIONS. BUT
CLEARLY, YOU KNOW, I REALLY JUST
MY HEART GOES OUT TO THE YOUNG
LADY THAT THAT ONE LITTLE
INCIDENT JUST AFFECTED HER WHOLE
LIFE. AND SO I THINK IT'S
IMPORTANT BECAUSE WE KNOW SO
MANY OF OUR CONSTITUENTS THAT
TELL THESE HORROR STORIES. AND
IT'S, YOU KNOW, IT'S IMPORTANT.
AGAIN, I WAS JUST TRYING TO
DIFFERENTIATE MEDICAL DEBT,
WHICH IS IMPORTANT. THANK YOU.
VERSUS LET'S SAY, USING A CARD
TO BUY ANYTHING ELSE, WHICH I
THOUGHT MAY GO A LITTLE TOO FAR
AND JUST MAYBE LOOKING INTO IT
TO STRENGTHEN AND TIGHTEN UP
SOME OF THESE ISSUES. BUT THANK
YOU. AND THEY ARE IMPORTANT
QUESTIONS. SO I APPRECIATE IT.
THANK YOU. SENATOR, BEFORE I GO
TO MY COLLEAGUE, SENATOR
SMALLWOOD. CUEVAS NEXT UP TO
BAT, I. MY GUESS IS THAT THE
RETAIL SERVICE AGREEMENT THAT
THE CARD HOLDER ALLOWING THEM OR
THE CARD PROVIDER HAS WITH THE
RETAIL FACILITY, WHETHER IT'S
WALMART RITE AID, WALGREENS,
COSTCO, WHATEVER, YOU CAN
SPECIFY WHAT CAN BE USED, WHAT
CAN BE PURCHASED WITH THE CARD
AND BETWEEN THE CREDIT CARD
COMPANY, THE BANK AND THE RETAIL
LOCATION. THEY CAN RESTRICT THE
USE OF THAT CREDIT CARD. IS THAT
NOT CORRECT? THAT IS CORRECT,
WHICH MAY ADDRESS THE QUESTIONS
OF MY COLLEAGUE TO MY RIGHT,
SENATOR RUBIO. SENATOR SMALLWOOD
RIVAS ANSWERED MY QUESTION TOO.
THANK YOU. SENATOR GONZALEZ. OH,
NO QUESTIONS. ANY OTHER
QUESTIONS TO MY LEFT. I GUESS
YOU'VE EXHAUSTED ALL THE
QUESTIONS, SENATOR, WOULD YOU
LIKE TO CLOSE? WELL, MEMBERS, I
WOULD JUST TELL YOU THAT WE ARE
COMMITTED TO CONTINUE TO WORK ON
THIS. THIS IS A VERY WE THINK
IT'S AN IMPORTANT BILL, BUT ALSO
WE UNDERSTAND THAT THERE'S
COMPLEXITIES AS IT RELATES TO
REPORTING MEDICAL, YOU KNOW,
MEDICAL DEBT. AND WE'RE VERY YOU
KNOW, WE'LL CONTINUE TO WORK
WITH THE OPPOSITION ON ISSUES
RAISED AS APPROPRIATE. WELL, THE
MOTION IS BY SENATOR GLAZER AND
THE MOTION IS TO DO PASS AS
AMENDED AND REFER TO THE
COMMITTEE ON APPROPRIATIONS.
PLEASE CALL THE ROLL. SENATOR
ROTH. AYE. ROTH AYE. WHEN GLAZER
. GONZALEZ. GONZALEZ. AYE GROVE.
HURTADO. HURTADO AYE. LIMÓN.
AYE. LIMÓN. AYE. MENGIBAR
MENGIBAR. AYE. RUBIO. RUBIO. AYE
SMALLWOOD. CUEVAS. SMALLWOOD.
CUEVAS. AYE. WIENER BILL HAS
SEVEN VOTES. VOTES 7 TO 0 WILL
HOLD THE ROLL. OPEN FOR ABSENT
MEMBERS. AND LET'S SEE, SENATOR
LIMON, YOU HAVE ONE MORE ITEM.
NUMBER 19. SENATE BILL 1369.
DENTAL PROVIDERS, FEE BASED
PAYMENTS. THANK YOU. AND I'D
LIKE TO START BY THANKING THE
COMMITTEE STAFF FOR THEIR WORK
ON THIS BILL AND ACCEPTING THE
AMENDMENTS. AMENDMENTS OUTLINED
IN THE ANALYSIS IN AUGUST OF
2023, PROPUBLICA PUBLISHED AN
EXPOSÉ ON INSURANCE ENTITIES
THAT IMPOSE FEES ON DOCTORS WHO
ACCEPT VIRTUAL CREDIT CARD
PAYMENTS, WITH PROCESSING FEES
COSTING PROVIDERS ANYWHERE FROM
3 TO 5. TODAY, WE SEE THIS
PRACTICE IN OUR DENTAL OFFICES.
DENTAL PLANS WILL OFTEN CONTRACT
WITH THIRD PARTY COMPANIES TO
ISSUE PROVIDER PAYMENTS TO
DENTAL PRACTICES WITH VIRTUAL
CREDIT CARDS. HOWEVER, ACCEPTING
THIS FORM OF PAYMENT CHARGES THE
DENTAL OFFICE PROCESSING FEES OF
2 TO 5% OF THE TOTAL PAYMENT
AMOUNT IN ADDITION TO THE
STANDARD MERCHANT TRANSACTION
FEE FOR PROCESSING THE PAYMENT
THROUGH THEIR CREDIT CARD
TERMINAL. THIS LEAVES PROVIDERS
WITH TWO OPTIONS EITHER PROCESS
THE VIRTUAL CREDIT CARD AND
ACCEPT HIGH FEES, OR SPEND
ADMINISTRATIVE TIME CONTINUOUSLY
OPTING OUT OF VIRTUAL CREDIT
CARDS. WHEN ACCEPTING THEIR
PAYMENT. PROVIDERS SHOULD NOT
NEED TO PAY TO GET PAID FOR
THEIR SERVICES. THIS BILL
REQUIRES DENTAL PLANS AND
CONTRACT VIRTUAL CREDIT CARD
COMPANIES TO PROVIDE NOTICE OF
ANY FEES ASSOCIATED WITH
PAYMENT, ALONG WITH DETAILS ON
ALTERNATIVE PAYMENT METHODS. SB
1369 GIVES PROVIDERS THE ABILITY
TO OPT IN WITH AUTHORIZED
CONSENT TO RECEIVE THE VIRTUAL
CREDIT CARDS. WITH ME TODAY, I
HAVE DOCTOR MARCOS, PRESIDENT OF
THE CALIFORNIA DENTAL
ASSOCIATION, AND JESSICA MORAN,
LEGISLATIVE ADVOCATE FOR
CALIFORNIA DENTAL ASSOCIATION.
THANK YOU, SENATOR LEMON. PLEASE
HOLD ON. WOULD YOU BE ACCEPTING
THE AMENDMENTS? YES THANK YOU.
GO AHEAD. PLEASE START. SORRY.
HI. GOOD EVENING, CHAIRMAN ROTH
AND MEMBERS OF THE COMMITTEE. I
CAN LOOK LIKE CHAIRMAN ROTH.
YOUR CHAIR. SORRY CHAIRMAN
NGUYEN, MY NAME IS DOCTOR
CARLISA MARCOS, AND I AM THE. AS
SENATOR LIMÓN SAID, I AM THE
PRESIDENT OF THE CALIFORNIA
DENTAL ASSOCIATION. I HAVE
CO-OWNED A DENTAL PRACTICE WITH
MY BROTHER IN SAN CARLOS SINCE
2005, AND PRIOR TO THAT, WE
WORKED WITH OUR MOTHER, NOW A
RETIRED DENTIST. SO
COLLECTIVELY, MY FAMILY OF
DENTISTS HAS PROVIDED OVER TEN
DECADES DECADES OF DENTAL CARE
TO OUR PATIENTS. I AM HERE TODAY
TO SPEAK ON BEHALF OF OUR 27,000
CDA MEMBERS THROUGHOUT THE STATE
IN SUPPORT OF SB 1369. IN RECENT
YEARS, WE HAVE SEEN AN INCREASE
OF VIRTUAL CREDIT CARDS AS A
PAYMENT METHOD. DENTAL INSURANCE
PLANS CONTRACT WITH THIRD PARTY
COMPANIES, OFTEN MAKING THE
VIRTUAL CREDIT CARDS A DEFAULT
FORM OF PAYMENT. THIS
ESSENTIALLY TRAPS THE DENTIST
INTO EITHER PAYING HIGH
PROCESSING FEES OR SPENDING
HOURS ON THE PHONE TO REQUEST A
DIFFERENT METHOD, AND WAITING
FOR THE DELAYED PAYMENT. EVEN
WHEN WE THINK WE HAVE
SUCCESSFULLY OPTED OUT OF
RECEIVING VCS, THEY ARE OFTEN
REINSTATED WITHOUT OUR CONSENT.
AGAIN THE FEES ASSOCIATED WITH
PROCESSING THESE VIRTUAL CREDIT
CARDS ARE SIGNIFICANT UP TO 10,
WHICH CAN LEAD TO DIFFICULT
BUSINESS DECISIONS. WHEN WE ARE
TRYING TO INVEST IN OUR STAFF,
INCREASE OFFICE EFFICIENCY AND
APPOINTMENT AVAILABILITY, ALL
THINGS THAT IMPROVE THE PATIENT
EXPERIENCE AND ORAL HEALTH. OUR
GOAL AS DENTISTS IS TO PROVIDE
QUALITY CARE TO OUR PATIENTS,
AND THIS BILL WILL ALLOW US TO
PUT MORE TIME AND RESOURCES INTO
TREATING PATIENTS RATHER THAN
DEALING WITH UNNECESSARY
ADMINISTRATIVE BURDENS, WHICH
ADDS TO THE ALREADY HIGH COST OF
RUNNING A BUSINESS IN THE STATE.
SB 1369 WILL CREATE NECESSARY
GUARDRAILS TO ADDRESS PREDATORY
VIRTUAL CREDIT CARD FEES BY
PROVIDING DENTISTS WITH THE
AUTONOMY TO CONSENT TO RECEIVING
THEIR PREFERRED PAYMENT METHOD.
RESPECTFULLY, I ASK YOU FOR AN
AYE VOTE. THANK YOU. THERE YOU
ARE. THANK YOU. GOOD AFTERNOON,
CHAIR AND MEMBERS, JESSICA MORAN
WITH THE CALIFORNIA DENTAL
ASSOCIATION HERE AS A SPONSOR OF
SB 1369. THE INCREASED USE OF
VIRTUAL CREDIT CARDS HAS BEEN A
LONG STANDING CONCERN FOR OUR
MEMBERS. WHEN I STARTED LOOKING
INTO ONE OF THE LARGER VIRTUAL
CREDIT CARD COMPANIES WEBSITES,
I CAME ACROSS A QUOTE THAT THEY
USED TO ADVERTISE THEIR SERVICES
. IT SAID IN LARGE, BOLD FONT,
GETTING PAID SHOULDN'T BE
COMPLICATED. WE AGREE GETTING
PAID SHOULDN'T BE COMPLICATED.
WHEN DENTISTS ENTER INTO
CONTRACTS WITH DENTAL PLANS,
THEY AGREE TO A CERTAIN SET OF
TERMS, INCLUDING REIMBURSEMENT
RATES. THE SHIFT TO ELECTRONIC
PAYMENTS WAS MEANT TO STREAMLINE
AND MODERNIZE THE HEALTH CARE
DELIVERY SYSTEM, BUT INSTEAD HAS
CREATED A SPACE IN THE MARKET
WHERE PROVIDERS ARE PAYING UP TO
10% OF PROCESSING FEES JUST TO
ACCESS THEIR CONTRACTED RATES.
WITH SB 1369, CALIFORNIA COULD
SET THE STRONGEST GUARDRAILS IN
THE COUNTRY FOR USE OF VIRTUAL
CREDIT CARD PAYMENTS, AND FOR
THESE REASONS, I URGE NAI VOTE
TODAY. THANK YOU. THANK YOU.
WITNESSES IN SUPPORT NAME,
AFFILIATION, POSITION ON THE
MEASURE, PLEASE. HI, CHRIS
GROGAN, ON BEHALF OF CHILDREN'S
CHOICE DENTAL CARE AND SUPPORT.
THANK YOU. NEXT HI THERE,
SAMANTHA JOHNSON, ON BEHALF OF
THE CALIFORNIA ASSOCIATION OF
ORTHODONTISTS AND SUPPORT. THANK
YOU MA'AM. OTHER WITNESSES IN
SUPPORT. ARE THERE ANY WITNESSES
IN OPPOSITION IN THE HEARING
ROOM? PLEASE STEP FORWARD.
GOOD EVENING, MR. CHAIR, AND
MEMBERS. I'M CHRISTY WEISS WITH
CAPITAL ADVOCACY ON BEHALF OF
THE CALIFORNIA ASSOCIATION OF
DENTAL PLANS, AND WE ARE HERE IN
AN OPPOSED POSITION, BUT REALLY
WANT TO FIRST START BY
ACKNOWLEDGING THE REALLY SOLID
WORK WE'VE DONE WITH THE
SENATORS STAFF AND WITH THE
SPONSOR, AND APPRECIATE HER
TAKING THE AMENDMENTS THAT SHE'S
ACCEPTING TONIGHT. WE'RE NOT
THERE YET IN A PLACE TO REMOVE
OUR OPPOSITION, FROM THE DENTAL
PLANS PERSPECTIVE, OBVIOUSLY,
THE RELATIONSHIP BETWEEN THE
PLANS AND THE PROVIDERS IS A
VERY IMPORTANT ONE. WE HAVE
HEARD FROM A LOT OF DENTISTS
THAT THEY LIKE THE VIRTUAL
CREDIT CARDS BECAUSE THEY ENABLE
THE DENTIST TO GET THE PAYMENT
IN THE FASTEST WAY POSSIBLE.
WHAT WE'VE LEARNED THROUGH OUR
CONVERSATIONS WITH CDA IS THAT
THAT IS NOT THE CASE FOR MANY OF
THEIR DENTISTS. AS AS THE CDA
PRESIDENT TESTIFIED, THERE ARE
SOME ISSUES. AND SO WE HAVE BEEN
IN A CONVERSATION ABOUT, TRYING
TO FIND A WAY TO THREAD THIS
NEEDLE AND TO RESOLVE THOSE THE
PLANS, HAVE SOME SIGNIFICANT
OPERATIONAL ISSUES THAT THEY
NEED TO NAVIGATE AS WE WORK
THROUGH THE LANGUAGE IN THE BILL
AND ENSURE THAT WE'RE NOT DOING
ANYTHING THAT DELAYS PAYMENTS TO
PROVIDERS. BUT THAT ALSO IS
ALIGNED WITH THE PROMPT PAYMENT
REGULATIONS THAT THE PLANS HAVE
TO COMPLY WITH UNDER DMHC AND
CDI. SO, WE AGAIN, WE'VE HAD
VERY POSITIVE CONVERSATIONS. I
THINK WE ARE IN A PLACE OF
HOPING WE CAN NAIL DOWN TWO
ISSUES. I THINK WE MIGHT
ACTUALLY BE DOWN TO FOUR, FOUR
WORDS IN THE BILL. AND WHILE WE
ARE HERE IN OPPOSITION TODAY,
OUR HOPE IS THAT WE CAN GET TO A
PLACE WHERE WE WILL BE ABLE TO
GO NEUTRAL ON THE BILL, I THINK
IF WE IF WE DO THAT, THIS WILL
BE ONE OF THE FARTHEST REACHING
BILLS IN THE COUNTRY. THAT
REALLY KIND OF FLIPS THE SCRIPT
ON HOW THE DENTISTS ARE ABLE TO,
YOU KNOW, DETERMINE WHICH FORM
OF PAYMENT, THEY RECEIVE. SO
WE'RE WE'RE IN OPPOSITION, BUT
CAUTIOUSLY OPTIMISTIC THAT WE'LL
GET THERE. THANK YOU. THANK YOU
FOR WORKING ON IT. ANY OTHER
OPPOSITION WITNESSES SEEING NONE
. LET'S BRING THE MATTER BACK TO
THE DAIS FOR COMMENTS. QUESTIONS
BY MY COLLEAGUES. I SEE
ABSOLUTELY NONE. IS THERE A
MOTION? EXCUSE ME. SENATOR
GONZALEZ HURTADO, SENATOR
HURTADO, I'M SORRY. WE CAN FLIP
COINS. THE MOTION IS Dð PASS AS
AMENDED. AND RE REFER TO THE
COMMITTEE ON APPROPRIATIONS.
PLEASE CALL THE ROLL. SENATOR
ROTH A ROTH. AYE. WHEN I WHEN I
GLAZER. GONZALEZ I GONZALEZ I
GROVE. HURTADO GROVE I HURTADO I
GROVE I LEMON I LEMON I MENGIBAR
RUBIO I RUBIO I SMALLWOOD CUEVAS
I SMALLWOOD CUEVAS I WIENER I
WIENER I 90590 VOTE IS NINE
ZERO. WE'LL HOLD THE ROLL OPEN
FOR ABSENT MEMBERS. THANK YOU
SENATOR. SENATOR WIENER, ARE YOU
READY WITH ITEM 17, SENATE BILL
966 PHARMACY BENEFITS. PROCEED
WHEN READY. LIKE THAT.
GREAT. THANK YOU. THANK YOU VERY
MUCH, MR. CHAIR. THANK YOU FOR
SETTING THE HEARING. SORRY. NO
COMMOTION THERE ON THE BACK.
OKAY. THANK THANK YOU, MR. CHAIR
. AND I'M HERE TODAY TO PRESENT
SENATE BILL 966, WHICH WILL
REQUIRE PHARMACY BENEFIT
MANAGERS PBM'S TO BE LICENSED.
AND IN THE STATE OF CALIFORNIA
AND WILL PROVIDE BASIC
PROTECTIONS TO MAKE SURE THAT
PBMS ARE NOT ENGAGING IN
BEHAVIORS THAT ARE ANTI-CONSUMER
THAT INCREASE COSTS AND SO
FORTH, THANK YOU FOR WORKING
WITH US ON THIS BILL. AND WE'RE
HAPPY TO ACCEPT THE COMMITTEE
AMENDMENTS AS OUTLINED IN THE
ANALYSIS. AS THE ANALYSIS ALSO
NOTES, WE HAVE AUTHOR AMENDMENTS
THAT I BELIEVE WILL ALL BE
CROSSED TOGETHER, SO COLLEAGUES,
PBMS ARE ESSENTIALLY THE IF I
MAY BE, IF I MAY GENDER IT THE
MIDDLEMEN, I GUESS WE CAN SAY
MIDDLE PEOPLE NOW, OF THE
PHARMACEUTICAL, OF THE HEALTH
CARE INDUSTRY, THEY NEGOTIATE
AND BUY PRESCRIPTION DRUGS IN
BULK FROM MANUFACTURERS ON
BEHALF OF HEALTH PLANS AND
INSURERS. THEY ESTABLISH
FORMULARIES AND CREATE PHARMACY
NETWORKS AND SET REIMBURSEMENT
RATES THAT HEALTH PLANS PAY
THROUGH THE PBMS TO PHARMACIES.
THESE ARE DECISIONS WITH MASSIVE
IMPACT ON HEALTH CARE COSTS AND
PATIENT ACCESS. YET PBMS OPERATE
WITH VERY LITTLE TRANSPARENCY
AND ARE ABLE TO USE BASICALLY
CONFIDENTIAL INFORMATION WITH
LACK OF TRANSPARENCY FREQUENTLY
TO THE HEALTH PLANS, LACK OF
TRANSPARENCY TO THE
PHARMACEUTICAL COMPANIES, LACK
OF TRANSPARENT BèC TO PHARMACIES
WHERE ONLY THE PBMS HAVE THE
FULL PICTURE, AND THAT CAN HAVE
VERY NEGATIVE IMPACTS IN TERMS
OF COSTS, PBMS AT TIMES HAVE
USED THEIR MARKET POWER TO
ENGAGE IN ANTI-CONSUMER AND
ANTI-COMPETITIVE PRACTICES THAT
DRIVE UP, DRUG COSTS FOR PAYERS
AND FOR PATIENTS, FOR EXAMPLE,
THEY, POCKET PHARMACEUTICAL
REBATE DOLLARS THAT WERE
INTENDED TO REDUCE THE COST OF
PRESCRIPTION DRUGS FOR PAYERS
AND PATIENTS, THEY ENGAGE IN
WHAT WE CALL SPREAD PRICING,
WHERE THEY'RE PAID ONE, AMOUNT
BY THE HEALTH PLANS AND THEN PAY
A LOWER AMOUNT TO, TO PHARMACIES
AS, THESE PRACTICES AND OTHERS,
CREATE VERY BAD INCENTIVES AND
EXERT UPWARD PRESSURE ON DRUG
PRICES IN FACT, PBMS, THROUGH
REBATES HAVE AN INCENTIVE TO
GRAVITATE TOWARDS HIGHER PRICED
DRUGS INSTEAD OF GENERICS, THE
BEHAVIOR OF PBMS IS CONCERNING
ENOUGH THAT THE FEDERAL TRADE
COMMISSION AND CONGRESSIONAL
COMMITTEES HAVE LAUNCHED
INVESTIGATIONS INTO SOME OF
THESE BUSINESS PRACTICES IN
CONGRESS, THERE IS BIPARTISAN
SUPPORT ON THIS ISSUE, DESPITE
PLAYING AN INTEGRAL ROLE IN
DETERMINING THE TYPES OF
MEDICATIONS AND SERVICES THAT
PATIENTS RECEIVE AND THE PRICES
THAT ARE PAID, PBMS REMAIN
ALMOST ENTIRELY UNREGULATED HERE
IN CALIFORNIA. WE ARE FAR BEHIND
MOST STATES, AND OUR LACK OF
OVERSIGHT OF THIS INCREDIBLY
SIGNIFICANT POINT, ASPECT OF THE
HEALTH CARE INDUSTRY. VÆ 25
OTHER STATES REQUIRE PBMS TO BE
LICENSED. 17 STATES PROHIBIT,
STEERING PATIENTS TO PREFERRED
PHARMACIES OR PHARMACIES OWNED
BY THE PBMS, AND SEVEN STATES
PROHIBIT SPREAD PRICING. SB 966
IMPLEMENTS VARIOUS PROTECTIONS
AND THESE ARE LONG, LONG OVERDUE
, AND I WANT TO JUST ALSO SAY
THAT WHAT WE'RE SEEING WITH PBMS
IS A REAL CONCENTRATION, WHERE
THREE PBMS CONTROL 90% OF THE
MARKET IN THE US, AND THE PBMS
ARE INCREASINGLY EITHER
ACQUIRING OR CONSOLIDATING WITH
HEALTH PLANS. SO WE HAVE, PBMS
AND HEALTH PLANS COMBINING PBMS,
OWNING THEIR OWN PHARMACIES, AND
THEN STEERING PATIENTS TOWARDS
THOSE PHARMACIES. SO WE'RE
SEEING THIS CONSOLIDATION THAT
IS VERY, VERY BAD FOR HEALTH
CARE COSTS, THESE PROTECTIONS
ARE LONG OVERDUE. Tê. AND I
RESPECTFULLY ASK FOR YOUR AYE,
VOTE WITH ME TODAY TO TESTIFY.
IS DOCTOR MARIA LOPEZ THE OWNER
OF MISSION WELLNESS, A COMMUNITY
PHARMACY IN SAN FRANCISCO'S
MISSION DISTRICT, DOCTOR, JEFF
KOCH, A PATIENT AND THEN WE ARE
ALSO JOINED FOR TECHNICAL
SUPPORT OF QUESTIONS ARISE BY
RACHEL BLÜCHER, THE LEGAL
COUNSEL FOR THE CALIFORNIA
PHARMACISTS ASSOCIATION. PLEASE
PROCEED TO IDENTIFY YOURSELVES
FOR THE RECORD. FIRST, THOUGH.
MARIA LOPEZ, MISSION WELLNESS,
HONORABLE CHAIR AND MEMBERS OF
THE COMMITTEE, PBM STARTED WITH
PHARMACY AND NOW THEY DOMINATE
NOT ONLY PHARMACY MARKET, BUT
ALSO THE HEALTH CARE MARKET AT
LARGE. IN RECENT YEARS, THEY'VE
STARTED TO PURCHASE PHYSICIAN
PRACTICES AND CLINICS. AND AS A
SENATOR TALKED ABOUT, THEY
LITERALLY CONTROL ALL AREAS OF
THE PHARMACY MARKET, SUCH THAT
THEY DICTATE THE CONTRACTS THAT
SIGNIFICANTLY UNDERPAY AND FORCE
PHARMACIES OUT OF BUSINESS. THE
CONTRACTS ARE A TAKE IT OR LEAVE
IT NON NEGOTIABLE AND
UNPRECEDENTED IN ANY OTHER
INDUSTRY. IN FACT, MISSION
WELLNESS WAS FORCED TO DO A
PRIVATE DUE TO A GAG CLAUSES IN
THE CONTRACTS. A YEARS LONG
ARBITRATION. OUR RARE CASE HAS
BEEN UNSEALED AND EXIST IN THE
PUBLIC RECORD. THERE WERE
MILLIONS OF DOLLARS AT STAKE IN
LEGAL FEES AND IN RECRUITMENT,
AND WE WOULD HAVE DEFINITELY
GONE OUT OF BUSINESS HAD WE NOT
WON. IT IS A PAY TO PLAY GAME,
BUT THE FACT IS, MOST PHARMACIES
CANNOT UNDERGO A FIVE YEAR LONG
PLUS ARBITRATION. AND WE'RE
SEEING PHARMACIES ACROSS THE
STATE CLOSE AND WE HEAR MANY ARE
FORCING THE TO TURN AWAY THE
VERY PATIENTS WHO WOULD PREFER
TO GET THEIR MEDICATIONS FROM A
PHARMACIST WHO THEY KNOW AND
TRUST. WE MEANING AMERICANS, PAY
THE HIGHEST PRICES OF MEDICATION
AND HEALTH CARE COSTS OF ANY
NATION IN THE WORLD. SPREAD
PRICING, EFFECTIVE RATES,
REBATES, TO NAME A FEW, PERMIT
THIS INDUSTRY TO HIDE THE TRUE
COST OF A DRUG. THESE MIDDLEMEN
DETERMINE WHICH DRUGS ARE ON
FORMULARIES, OFTEN CHOOSING, AS
A SENATOR NOTED, THE HIGHER COST
DRUG BECAUSE OF THE BETTER
REBATE FOR THEM. THIS RESULTS IN
SKYROCKETING MEDICATION COSTS
AND AN OUT OF CONTROL DRUG
PRICING CYCLE, WHICH RISES YEAR
AFTER YEAR, WHILE PBM PROFITS GO
HIGHER AND HIGHER. THE SCHEMES
UTILIZED DRIVE UP HEALTH CARE
COSTS MOST IMPORTANTLY, OUR
PATIENTS SUFFER. THEY MUST BE
REGULATED AS WE ARE SEEING OTHER
STATES DO. OTHERWISE WE WILL
CONTINUE TO SEE CLOSURE AS JOBS
LOST AND PATIENTS CONTINUE TO
SUFFER. I RESPECTFULLY REQUEST
YOUR AYE VOTE ON SB 966. THANK
YOU, THANK YOU MA'AM. SIR CHAIR
ROTH AND MEMBERS OF THE
COMMITTEE. MY NAME IS JEFFREY
COOK. COACH IS FINE, TOO. IT'S
OKAY, I'M A MEMBER OF THE
INSTRUCTIONAL FACULTY AT BUTTE
COLLEGE AND GRADUATE OF UC
DAVIS, A LONG TIME RESIDENT OF
CALIFORNIA AND A PATIENT AT
PUCCI'S PHARMACY HERE IN
SACRAMENTO SINCE APRIL 2018. I
CURRENTLY RESIDE IN CHICO, BUT
CHOOSE TO DRIVE AN HOUR AND A
HALF TO RECEIVE MY CARE AT
PUCCI'S, EVEN THOUGH THERE ARE
SEVERAL CORPORATE CHAIN
PHARMACIES IN MY COMMUNITY. I DO
THIS BECAUSE I GET TREATED LIKE
A PERSON AND A PATIENT, AND NOT
SIMPLY A PROFIT OR COST CENTER.
THE PBMS I HAVE ENCOUNTERED, AND
I'VE HAD TO DEAL WITH SEVERAL
OVER THE COURSE OF MY ADULT
LIFE, HAVE MADE IT INCREDIBLY
DIFFICULT TO RECEIVE MY
MEDICATION. IN FACT, I RECENTLY
LEARNED FROM MY PHARMACIST,
CLINT HOPKINS, THAT THEY WERE
ACTUALLY LOSING MONEY ON MY
PRESCRIPTION EVERY MONTH FOR
YEARS. THIS IS SIMPLY
UNACCEPTABLE. AND AS THE RESULT
OF UNFAIR AND ANTI-COMPETITIVE
PRACTICES THAT HAVE BECOME
NORMALIZED UNDER PBMS REGIME OF
MARKET MANIPULATION, UNFAIR
PRACTICES THAT HAVE SO FAR GONE
UNREGULATED HERE IN CALIFORNIA,
FROM INCREASES TO MY OUT OF
POCKET COSTS WITHOUT
NOTIFICATION OR EXPLANATION TO
DISCONTINUING COVERAGE FOR MY
MEDICATION WITHOUT NOTIFICATION
OR EXPLANATION. THESE PBMS HAVE
CAUSED ME SIGNIFICANT EMOTIONAL,
PHYSICAL, AND FINANCIAL STRESS
WITH MY ILLNESS, MISSING DOSES
OF MY MEDICATION REDUCES ITS
USEFULNESS AND RESULTS IN HIGH
LIKELIHOOD OF DEVELOPING DRUG
RESISTANCE, WHICH CAN ACTUALLY,
I'M SORRY, WHICH CAN MAKE THAT
LINE OF TREATMENT INEFFECTIVE
PERMANENTLY. I HAVE MANAGED TO
NAVIGATE THIS SYSTEM BECAUSE I
HAVE PEOPLE LIKE CLINT AND HIS
COMMUNITY PHARMACY MAKING SURE I
HAVE WHAT I NEED, BUT I REALLY
CAN'T IMAGINE WHERE I WOULD BE
IF I DIDN'T HAVE THEM OR IF I
WAS NOT WILLING AND ABLE TO
ADVOCATE AND FIGHT FOR MY OWN
MEDICAL NEEDS. BUT I KNOW THAT
THERE MUST BE MANY PEOPLE WHO
JUST DON'T KNOW, WHO JUST GO
WITHOUT BECAUSE THEY DON'T KNOW
WHAT TO DO WHEN THEIR
MEDICATIONS GET DENIED BY A PBM
OR THEY'RE COVERED, BUT THE
PHARMACY CAN'T FILL THE
MEDICATION BECAUSE THEY WOULD BE
LOSING MONEY. IT'S INCREDIBLY
FRUSTRATING, CONFUSING, AND
UNNECESSARILY COMPLICATED. THIS
COMPLICATION SEEMS ENTIRELY
INTENTIONAL. IF AN INSURER PBM
OR INSURER PBM MAKES IT
COMPLICATED, CUMBERSOME, AND
EXPENSIVE TO GET A TO GET AN
EXPENSIVE MEDICATION FILLED,
FEWER PATIENTS WILL ACCESS
CERTAIN MEDICATIONS THAT ARE NOT
AS PROFITABLE FOR THE PBMS, AND
THEY CAN NEGOTIATE HIGHER
MARGINS ON THE ON THE
MEDICATIONS THAT ARE CHEAP AND
PLENTIFUL AND CLAIM THAT THEY
ARE INCREASING ACCESS AT A LOWER
COST. AND OUR CURRENT SYSTEM,
PATIENTS, COMMUNITY PHARMACIES
AND DOCTORS ARE THE LOSERS IN
PBMS AND INSURANCE COMPANIES ARE
THE WINNERS. THE PBM LOBBY
CLAIMS THAT THEY ARE LOWERING
PRESCRIPTION DRUG DRUG COSTS AND
INCREASING ACCESS. WELL, THAT
HAS NOT BEEN MY EXPERIENCE. AS
TO THE PBMS, I'M A NUMBER ON A
SPREADSHEET, AN INSURANCE ID
NUMBER THAT EITHER DRIVES PROFIT
OR IS A COST CENTER TO MY
PHARMACIST. I'M A FRIEND AND A
PATIENT WHO THEY HAVE COMMITTED
TO PROVIDING THE BEST POSSIBLE
CARE TO. THIS BILL WOULD DO WHAT
MANY OTHER STATES HAVE ALREADY
DONE LEVEL THE PLAYING FIELD
BETWEEN CORPORATE PHARMACIES AND
COMMUNITY PHARMACIES. CREATE
TRANSPARENCY AND FAIRNESS THAT
WILL PROTECT SMALL BUSINESSES
AND PATIENTS FROM HIDDEN FEES,
AND MAKE IT ILLEGAL FOR PBMS AND
INSURERS TO CLAIM A PRESCRIPTION
IS COVERED, THEN CLAW BACK MONEY
LATER. IT WOULD ALSO PROHIBIT
PBMS AND INSURERS FROM
NEGOTIATING BACKROOM DEALS THAT
LINE THEIR POCKETS, WHILE
PATIENTS AND COMMUNITY
PHARMACIES, COMMUNITY PHARMACIES
SUFFER, GO OUT OF BUSINESS OR
ARE FORCED INTO BEING ACQUIRED
BY INSURERS AND THEIR PBMS. THAT
CAUSE THEM TO FAIL IN THE FIRST
PLACE. THERE ARE MANY ISSUES
WITH OUR CURRENT HEALTH CARE
MODEL, IN MY HUMBLE OPINION, BUT
THIS IS AN ISSUE WITH A
SOLUTION. YOU CAN BE PART OF
THAT SOLUTION. SENATORS, AND I
ASK YOU FROM THE BOTTOM OF MY
HEART TO CHOOSE TO BE AN
ADVOCATE FOR PATIENTS AND SMALL
BUSINESSES, TO NOT PASS THIS
LEGISLATION WOULD GIVE A FREE
PASS TO PBMS AND INSURERS TO
CONTINUE TO EXTRACT PROFIT FROM
OUR MOST VULNERABLE AND THAT
SIMPLY IS NOT RIGHT. I
RESPECTFULLY ASK FOR YOUR FOR A
YES VOTE ON SB 966. THANK YOU
SIR. ARE THERE OTHER WITNESSES
IN SUPPORT IN THE HEARING ROOM?
IF SO, PLEASE STEP FORWARD.
NAME, AFFILIATION AND POSITION
ON THE BILL, PLEASE. MR. CHAIR
AND MEMBERS, RAND MARTIN, ON
BEHALF OF THE AIDS HEALTHCARE
FOUNDATION, WHICH OWNS AND
OPERATES PHARMACIES ACROSS THE
STATE AND STRONG SUPPORT OF THIS
BILL. THANK YOU. THANK YOU.
CHAIR MEMBERS KATHY MOSSBERG
WITH THE SAN FRANCISCO AIDS
FOUNDATION AND APLA HEALTH, BOTH
IN SUPPORT. THANK YOU. MY NAME
IS FRED NOWHERE, REPRESENTING
PHARMA IN SUPPORT. THANK YOU.
THANK YOU SIR. THANK YOU, MR.
CHAIR. MEGAN SUBERS, ON BEHALF
OF THE LOS ANGELES LGBT CENTER
AND SUPPORT. THANK YOU, TIM
MADDEN, REPRESENTING THE
CALIFORNIA RHEUMATOLOGY
ALLIANCE. WE HAVE A SUPPORTIVE,
AMENDED POSITION, AND I'M ALSO
STEPPING IN FOR THE ALS
ASSOCIATION WHO IS IN STRAIGHT
SUPPORT. THANK YOU. THANK YOU.
GOOD EVENING, MR. CHAIR. AND
MEMBERS, MOIRA TOPP, ON BEHALF
OF BIOCOM CALIFORNIA, IN SUPPORT
. JENNIFER SNIDER, WITH CAPITAL
ADVOCACY ON BEHALF OF THE
CALIFORNIA LIFE SCIENCES AND
SUPPORT. SANDRA GUCKIAN WITH THE
NATIONAL ASSOCIATION OF CHAIN
DRUG STORES IN SUPPORT. MR.
CHAIR MEMBERS ANDREW ANTWI, ON
BEHALF OF THE CALIFORNIA MEDICAL
ASSOCIATION, IN SUPPORT THANKS
TO THE AUTHOR. CHER GONZALEZ ON
BEHALF OF MY CLIENTS, THE
AMERICAN DIABETES ASSOCIATION IN
SUPPORT AS WELL AS THE
HEMOPHILIA COUNCIL OF CALIFORNIA
IN SUPPORT. THANK YOU, MICHELLE
RIVAS WITH THE CALIFORNIA
PHARMACISTS ASSOCIATION IN
SUPPORT, AND ALSO ON BEHALF OF
THE CHRONIC CARE COALITION AND
SUPPORT CO-SPONSORS. THANK YOU.
THANK YOU MA'AM. ANY OTHER
WITNESSES IN SUPPORT? NOW LET'S
TURN TO WITNESSES AND OPPOSITION
. FIRST, LEAD WITNESSES IN
OPPOSITION. COME ON DOWN. YOU
CAN JUST SLIDE OVER.
OKAY ARE YOU GOOD? YEAH, I THINK
WE'RE GOOD. OKAY. 12345.
EVERYBODY HAS A MIC. WE DO
IDENTIFY YOURSELVES FOR THE
RECORD, PLEASE, AND PROCEED WHEN
READY. CHAIR ROTH AND MEMBERS OF
THE COMMITTEE. MY NAME IS BILL
HEAD WITH PCMA. WE'RE THE
NATIONAL PBM TRADE ASSOCIATION,
RESPECTFULLY, IN OPPOSITION TO
SB 966. I DO WANT TO THANK THE
CHAIR IN PARTICULAR AND THE
COMMITTEE STAFF FOR ALL THE HARD
WORK THAT'S BEEN DONE ON THE
BILL. WE APPRECIATE THAT. ALSO,
VERY MUCH APPRECIATE THE AUTHOR
ACCEPTING THE AMENDMENTS,
UNFORTUNATELY, WE REMAIN
OPPOSED. WE'RE STILL OUR MEMBERS
ARE STILL EVALUATING THE BILL,
BUT THE INITIAL FEEDBACK IS WE
WOULD LOVE TO MEET WITH THE
AUTHOR AND THE SPONSORS. WE DO
THINK WE HAVE SOME TECHNICAL
CHANGES THAT WE DON'T THINK
UNDERMINES THE INTENT OF THE
BILL, THAT AS WE AS THIS
PROGRESSES, WE'D LIKE TO SHARE
AND GO OVER. BUT THERE ARE SOME
SUBSTANTIVE ISSUES AS WELL THAT
REMAIN CONCERNS FOR US. AMONG
THAT IS, IS SOME OF THE
REPORTING CRITERIA, AND SOME OF
IT IS JUST SORT OF NON-SEQUITUR,
I GUESS, IF YOU WILL. SOME OF
THE REPORTING IS ON THE, THE
PROFIT OF, OF OR THE REVENUE
GENERATED FROM THE SALE OF
DRUGS. PBMS DON'T BUY OR SELL
DRUGS, AS YOU DESCRIBED WITH THE
MIDDLE PERSON ADMINISTRATING THE
DRUG. AND BY THE WAY, WE
ADMINISTER THE DRUG BENEFIT FOR
30 MILLION CALIFORNIANS, SO BUT
THAT DOES SPEAK TO ANOTHER
ISSUE, WHICH I THINK THE AUTHOR
HAS BEEN GOOD ABOUT IDENTIFYING.
WE'RE NOT THE ONLY ENTITY IN THE
SUPPLY CHAIN. AND, WHILE WE ARE,
WE DO AGREE THAT LICENSING MAKES
SENSE. WE'RE OPERATING IN A
STATE, THAT ARE REPORTING, IN
SOME IF IT'S DONE RIGHT. MAKES
SENSE. WE'RE ALREADY DOING THAT
WITH THE CLIENT. SO THEY ARE
GETTING ALL THE REBATE
INFORMATION, ALL THE ALL THE
PAYMENT INFORMATION UNDER AB
315. BUT WHEN IT COMES LIKE TO
REVENUE AND OTHER DATA, I THINK
OF AN IMPORTANT PIECE THAT'S
MISSING IS THE PHARMACEUTICAL
MANUFACTURER DATA, THE FACT THAT
WE ASSERT AND WE THINK THE DATA
SUPPORTS OUR CLAIM THAT WE DO
DRIVE DOWN THE COST FOR THE
PAYER AND THE PATIENT. AND I
THINK THE STATE HAVING ACCESS TO
MORE THAN JUST THE PBM DATA,
WOULD HELP, I THINK, MAKE THAT
POINT OR NOT MAKE THAT POINT.
BUT I THINK JUST GETTING PBM
DATA IS, IS NOT GOING TO GIVE
THE STATE A COMPLETE PICTURE OF
THE DRUG SUPPLY CHAIN, SO WE'RE
WILLING TO DO OUR PART, BUT WE
THINK THAT IT'S IMPORTANT TO
LOOK AT THE ENTIRE, THE ENTIRETY
OF THE, OF THE DRUG SUPPLY
CHAIN. I THINK SUBSTANTIVELY,
THE OTHER ISSUE THAT REMAINS IS
SPREAD THE BAN ON SPREAD
PRICING. AND I THINK IT WOULD BE
HELPFUL JUST TO UNDERSTAND
PAYERS HAVE TWO OPTIONS FOR HOW
THEY PAY FOR THE DRUG. THE DRUGS
OF THEIR BENEFICIARIES. THEY CAN
EITHER DO A PASS THROUGH IN
WHICH THEY SIMPLY GET THE
INVOICE FOR WHATEVER THE
NEGOTIATED PRICE WAS FOR THAT
DRUG FROM THAT PHARMACY, AND
THEY PAY THAT. OR THE SECOND
OPTION IS TO DO SPREAD PRICING
IN WHICH WE CALL RISK
MITIGATION, WHERE THE PBM
ASSUMES THE RISK OF PRICE
FLUCTUATIONS FOR THAT DRUG. IF
THE PRICE GOES UP, THE PBM IS
GOING TO BEAR THE RISK OF THAT
INCREASE. SO GIVEN THAT PAYERS
JUST HAVE TWO OPTIONS, AS YOU'RE
ELIMINATING ONE OF THE OPTIONS
FOR THEM AND SAYING YOU CAN'T
YOU CAN'T ASK FOR THIS IN YOUR
RFP, YOU HAVE TO DO A PASS
THROUGH. AND PBMS COMPETE WITH
EACH OTHER BY ASSUMING MORE OF
THAT RISK, BEING WILLING TO
ASSUME MORE OF THAT RISK FOR ON
BEHALF OF THE PATIENT, THE PAYER
AND ONE THIRD OF HEALTH PLANS,
ONE THIRD OF EMPLOYERS, ONE
THIRD OF UNIONS CHOOSE THAT
OPTION AS A MEANS OF HAVING MORE
DEFINITIVE OF OR CLARITY AROUND
WHAT THEIR DRUG SPEND IS AND
BECAUSE OF ALL THE REPORTING
UNDER AB 315 THAT THAT CLIENT IS
GETTING, THEY KNOW WHETHER OR
NOT IT'S A BARGAIN OR NOT OR
WHETHER OR NOT IT SUITS THEM.
AND THEY COMMONLY WILL ASK FOR
BOTH MODELS AND SAY, WHAT WILL
IT LOOK LIKE FOR A PASS THROUGH?
WHAT WILL IT LOOK LIKE ON A
SPREAD MODEL? AND THEN WE'RE
B2B. SO AT THE END OF THE DAY,
IT'S THEIR DECISION. I DO WANT
TO SAY THIS IN CLOSING ON
REBATES, MORE THAN 95% OF THE
REBATE DOLLAR GOES BACK TO THE
PAYER OR TO THE PLAN SPONSOR.
IT'S THEIR REBATE. THEY DECIDE
WHAT THEY WANT TO DO WITH IT. IF
THERE'S ANY AMOUNT KEPT BY THE
PBM, IT'S IN PAYMENT FOR
SERVICES THAT THE PBM IS
PROVIDING. IT'S NOT POCKETING
MAKING A PROFIT. AND THE
FORMULARY BELONGS TO THE HEALTH
PLAN SPONSOR. WE MANAGE IT, BUT
THE DECISIONS ARE MADE BY THE
HEALTH PLAN SPONSOR. FOR THESE
REASONS, WE HOPE WE CAN WORK
WITH THE SPONSORS AND THE
AUTHOR. BUT AT THIS POINT DO
OPPOSE THE BILL. THANK YOU SIR.
NEXT. THANK YOU, MR. CHAIR.
MEMBERS JOHN WENGER ON BEHALF OF
AMERICA'S HEALTH INSURANCE PLANS
OR THE NATIONAL TRADE
ASSOCIATION FOR THE HEALTH
PLANS, I THINK JUST OVERALL,
SOPHISTICATED PURCHASERS LIKE
HEALTH PLANS, SELF-INSURED LARGE
BUSINESSES, UNION TRUSTS, PUBLIC
EMPLOYERS, THEY ALL VOLUNTARILY
ENTER INTO CONTRACT AGREEMENTS
WITH PBMS FOR THE SOLE PURPOSE
OF LOWERING DRUG COSTS. SO
THAT'S WHERE WE'RE COMING FROM
ON THIS. I THINK WE DO CAN
CONTINUE TO HAVE A OPPOSED
POSITION ON THE BILL. DO WANT TO
APPRECIATE THE COMMITTEE'S WORK
ON ON THE BILL AND THE
AMENDMENTS. WE'RE CONTINUING TO
REVIEW THEM. I THINK THE
AMENDMENTS ARE STARTING TO GO IN
THE RIGHT, RIGHT DIRECTION, AND
WE CERTAINLY APPRECIATE THAT.
WOULD ALSO LIKE TO HAVE A
CONVERSATION WITH THE AUTHOR AND
THE SPONSORS ON, VARIOUS
PROVISIONS OF THE BILL THAT WE
STILL HAVE SOME, SOME ISSUES
WITH. I THINK, ONE ISSUE THAT'S
COME UP WITH THE AMENDMENTS IS
THE DEFINITION OF THE, OF PBMS,
IT LOOKS FROM OUR FIRST REVIEW,
PRETTY BROAD AND COULD CAPTURE
HEALTH PLANS IN THAT DEFINITION,
WHICH WOULD MEAN THE HEALTH PLAN
WOULD THEN BE REGISTERED WITH
CDI OR LICENSED WITH CDI AS A
PBM, AND THEN ALSO LICENSED WITH
DMC. I DON'T THINK THAT'S THE
INTENT. AND SO WE WOULD
APPRECIATE A CONVERSATION AROUND
THAT AS WE CONTINUE TO HAVE
CONCERNS AROUND THE BANNING OF
SPREAD PRICING. AS MR. HEAD
SAID, THAT IS A FORM OF PAYMENT.
IT IS AN OPTION FOR THE PLAN TO
CHOOSE, MOST OF THOSE PLANS THAT
DO CHOOSE THAT ARE USUALLY THE
SMALLER, SMALLER PURCHASERS THAT
WANT SOME STABILITY AND SOME
PREDICTABILITY IN THEIR DRUG
SPEND, WHICH STABILIZES THEIR
PREMIUM AS WELL, AND SO WE THINK
THAT OPTION IS CONTINUES, NEEDS
TO CONTINUE TO BE ALLOWED, WE'RE
STILL LOOKING AT THE, THE
PAYMENT STRUCTURE AND THE
NETWORK'S, CHANGES IN THE
AMENDMENTS. I THINK WE'RE STILL
TRYING TO REVIEW TO SEE IF THAT
INTERFERES WITH ANY SORT OF
PERFORMANCE BASED CONTRACTING
THAT ALLOWS US TO HELP TO DRIVE
DOWN THE DRUG SPEND, OBVIOUSLY,
PRESCRIPTION DRUGS CONTINUE TO
BE A SIGNIFICANT, COST DRIVER
FOR US. IT'S GONE FROM, YOU
KNOW, 10% OF THE PREMIUM DOLLAR
TO NOW 14.7. AND SO, TRYING TO
CONTINUE TO LOOK FOR TOOLS IN
THE TOOLBOX TO DRIVE DOWN THAT
COST IS OBVIOUSLY A SENSITIVE
ISSUE FOR US, WE DO HAVE SOME
TECHNICAL ISSUES AROUND THE
REPORTING THAT WE WANT TO TALK
THROUGH AND LOOK AT, I THINK
OVERALL, IN THE AGGREGATE, WE'RE
DEFINITELY OPEN TO TRANSPARENT
AND REPORTING, WE JUST WANT TO
MAKE SURE THAT IT'S NOT TO A
GRANULAR LEVEL THAT WOULD ALLOW
FOR SOME ANTI-COMPETITIVE
PRACTICES WITHIN THE ON THE
MANUFACTURER SIDE WITH
NEGOTIATING REBATES, WHICH
COULD, YOU KNOW, POTENTIALLY
CREATE KIND OF A CEILING ON
DRIVING DOWN REBATES RATHER THAN
A FLOOR. OR I MIGHT HAVE THAT
BACKWARDS. I DON'T KNOW, IT'S
PRETTY LATE, BUT FOR THOSE
REASONS, WE, WE ARE OPPOSED TO
THE BILL TODAY, BUT LOOK FORWARD
TO CONTINUING CONVERSATIONS.
THANK YOU. ANY OTHER WITNESSES
IN OPPOSITION IN THE ROOM? STEP
FORWARD PLEASE. NAME,
AFFILIATION AND POSITION ON THE
MEASURE. STEPHANIE WATKINS, ON
BEHALF OF THE ASSOCIATION OF
CALIFORNIA LIFE AND HEALTH
INSURANCE COMPANIES IN
OPPOSITION. THANKS FOR STAYING
WITH US. GOOD EVENING. KATIE VAN
ÓRDENES WITH HEALTH ACCESS
CALIFORNIA. AND WE WANTED TO SAY
WE VERY MUCH APPRECIATE THE
AMENDMENTS TAKING IN BUSINESS
AND PROFESSIONS AND IN HEALTH
TODAY, TAKEN TOGETHER, THESE
AMENDMENTS MAKE SIGNIFICANT
PROGRESS TO ADDRESS OUR
CONCERNS, AND WE'RE NOT YET
READY TO REMOVE OUR OPPOSITION
BECAUSE WE REMAIN CONCERNED
ABOUT COST AND WE'RE REVIEWING
THE AMENDMENTS ON COMPENSATION
TO UNDERSTAND THE IMPLICATIONS,
FOR THAT, THANK YOU. AND WE LOOK
FORWARD TO WORKING WITH THE
AUTHOR, COMMITTEE AND SPONSORS
MOVING FORWARD AS THE MEASURE
PROGRESSES. THANKS. THANK YOU.
MANDY ISAACS LEE, I WAS ASKED TO
REGISTER THE OPPOSITION FOR THE
CALIFORNIA TEAMSTERS PUBLIC
AFFAIRS COUNCIL WHO COULDN'T BE
HERE. THANK YOU, JULIAN KENNEDY.
ON BEHALF OF THE CALIFORNIA
HISPANIC CHAMBERS AND AS WELL AS
OUR 20 COALITION MEMBERS WHO ARE
LISTED IN OUR COALITION THAT WE
SUBMITTED AND OPPOSED OPPOSING.
THANK YOU. GOOD EVENING, MR.
CHAIR. MEMBERS OF THE COMMITTEE,
JED HAMPTON WITH THE CALIFORNIA
ASSOCIATION OF HEALTH PLANS IN
OPPOSITION. THANK YOU. THANK YOU
SIR. ANY OTHER WITNESSES IN
OPPOSITION? SEEING NONE, I
SHOULD BRING THE MATTER BACK TO
THE DAIS AND MY COLLEAGUES
BEFORE I CHECK TO SEE IF THERE
ARE ANY HANDS UP. I WAS GOING TO
ASK YOU TO, SORT OF GIVE ME A
COUPLE EXAMPLES OF SPREAD
PRICING THE WAY YOU ALL THINK IT
WORKS AND WHO IT IMPACTS, AND
WHO IT DOESN'T. BUT SINCE IT'S,
6:35 P.M, I THINK I'LL WAIT TO
SEE IF ANY OF MY COLLEAGUES ARE
INTERESTED IN HEARING THAT. I'M
ACTUALLY INTERESTED IN THAT,
TOO, MR. CHAIR, BECAUSE I WAS
GOING TO BE MY QUESTION. WELL,
THEN THERE'S ONLY TWO OPTIONS
RIGHT FOR THEM. RIGHT. AND WHY
WOULD WE REMOVE ONE OF THE
OPTIONS. SO MAYBE YOU COULD SORT
OF TELL US HOW THE SPREAD
PRICING WORKS WITH, WITH
SPECIFICS AS TO A PARTICULAR
DRUG. PICK ONE AND A PRICE AND
SURE, HOW THAT SORT OF WORKS
DOWN THE CHAIN, BECAUSE WE'RE
DEALING WITH PHARMACIES AND
WE'RE DEALING WITH YOU AND WE'RE
DEALING WITH PLANS. AND THEN WE
GOT A MANUFACTURE SITTING UP
TOP. SURE. AND I'VE ALREADY
MISSED MY FLIGHT BACK HOME TO
LA. SO I'M HERE FOR THE
DURATION. SO YOU'RE IN TROUBLE,
SO SPREAD PRICING IS A CONTRACT
SOLELY BETWEEN THE PURCHASER AND
THE PBM. IT DOESN'T INVOLVE THE
PHARMACY. AND TYPICALLY WHAT IT
WILL DO IS. AND NOT TO GET TOO
TECHNICAL, BUT IT'LL IT'LL SAY
AVERAGE WHOLESALE PRICE AWP
MINUS TEN. AND SO THAT IS WHAT
THE PLAN WILL BE LOCKED IN FOR,
FOR THE FOR THE CONTRACT
DETERMINED. THE CONTRACT $90 SAY
$9,090. SO THERE ARE GOING TO BE
INSTANCES WHERE FOR SOME
PHARMACIES THEY CHARGE $90. AND
IT'S A IT'S A WASH. SOME FARMERS
SEE THE REIMBURSEMENT MAY BE
$91, IN WHICH CASE THE PBM IS ON
THE HOOK FOR THE DOLLAR. IN
OTHER CASES, IT MAY BE $89, IN
WHICH THE PBM COLLECTS AN EXTRA
DOLLAR FROM THE PLAN. BUT THE
PBM IS BECAUSE THEY'RE COMPETING
WITH EACH OTHER, IS ALWAYS GOING
TO TRY TO GET AS CLOSE TO ZERO
AS POSSIBLE IN OFFERING THAT TO
THE PLAN, BECAUSE THEY KNOW
OTHER PBMS ARE DOING THE SAME
BECAUSE AND BECAUSE OF ALL THE
REPORTING THAT GOES BACK TO THE
PLAN. THE PLAN WILL KNOW IF
THEY'RE WELL, GEE, YOU GAVE ME
THE SPREAD PRICING, BUT YOU MADE
$100,000 OFF THIS. WELL, THAT
WAS THAT WASN'T YOU KNOW, WHO'S
GOING TO HIRE THAT PBM. RIGHT.
SO THE THEY ARE ASSUMING THE
RISK, BUT THEY'RE MORE LIKELY TO
ERROR ON THE SIDE OF TO GET THE
BUSINESS TO GET THE BOOK OF
BUSINESS, THEY'RE GOING TO WANT
TO SAY, I'M WILLING TO ASSUME
MORE OF THE RISK I'LL GIVE
INSTEAD OF AWP MINUS TEN, I'M
GOING TO OFFER YOU AWP -15 AS
YOUR BENCHMARK. RIGHT. BUT IT'S
GOING TO IT'S GOING TO FLUCTUATE
BACK AND FORTH. SO YES, THERE
WILL BE TIMES WHEN THE PLAN PAYS
MORE THAN WHAT THE PBM
REIMBURSES THE PHARMACY. BUT
THERE'S GOING TO BE TIMES THAT
THE PLAN PAYS A PBM LESS THAN
WHAT THE PBM REIMBURSES. THE
PHARMACY. BUT IT'S TYPICALLY THE
IT'S THE IT'S ALWAYS IN THE RFP.
IT'S WHAT THE PLAN IS ASKING TO
LOOK AT AND EVALUATE. COMPARED
TO JUST A STRAIGHT PASS THROUGH
WHERE THERE'S SIMPLY PAYING THE
AMOUNT THAT THE PBM IS PAYING
THE PHARMACY. AND DO YOU THINK
PART OF THE PROBLEM HERE IS THE
LACK OF TRANSPARENCY AND PEOPLE
DON'T KNOW? WELL I WE WOULD
ARGUE THAT THE PEOPLE WHO NEED
TO KNOW DO KNOW THE PLAN IS THE
PLAN IS GETTING IS GETTING THE
TRANSPARENCY THROUGH. AND
TYPICALLY PLANS WILL AUDIT THE
PBM IN ADDITION TO GETTING ALL
THE REPORTING UNDER 315. I
UNDERSTAND. BUT YOU KNOW, THE
PROBLEM IS THERE ARE THE PEOPLE
THAT THAT WANT TO UNDERSTAND
THAT ONE SURE THAT WANT TO
UNDERSTAND IT NEED TO KNOW THAT
ARE IN THE BUSINESS DEAL. AND
THEN THERE'S EVERYBODY ELSE ON
THE OUTSIDE WHICH ARE THE
CONSUMER AND THE PROVIDERS AND,
AND THAT AND THAT GETS INTO MY
EARLIER COMMENT, MR. CHAIR, IS,
IS THAT, WE'RE NOT OPPOSED TO
GIVING THE GIVING DATA TO THE
STATE TO EVALUATE, BUT WE THINK
THE STATE NEEDS TO HAVE ALL THE
DATA. LET'S ALL LET'S EVERYBODY
PUT THE CARDS ON THE TABLE,
RIGHT? LET'S HAVE THE
MANUFACTURERS, THE CEOS, THE
PHARMACIES, THE HOSPITALS.
YOU'VE GOT TO LOOK AT THE
COMPLETE SET OF DATA, NOT JUST
ONE INDUSTRY. RIGHT. BECAUSE AT
THE END OF THE DAY, THIS ALL
STARTS WITH THE PRICE SET BY THE
MANUFACTURER. AND THEN THERE WAS
THERE WAS SOME LANGUAGE OR
COMMENT IN THE ANALYSIS ABOUT,
YOU KNOW, NOT LIMITING IT
NECESSARILY TO AN ADMINISTRATIVE
FEE AS COMPENSATION TO THE PBM,
BUT INSTEAD SOME CONSIDERATION
THÀNH GIVEN TO PERFORMANCE BASED
ACTIVITY. YOUR THOUGHTS ON THAT?
RIGHT. AND WE AND WE APPRECIATE
THE CHANGE MADE BY THE, BY THE
BY THE COMMITTEE BECAUSE WE'RE
STILL CONCERNED ABOUT THE
POTENTIAL IMPACT ON VALUE BASED
CONTRACTING, BECAUSE IN ADDITION
TO THE REBATES, IT PBMS OFTEN
WILL HAVE OTHER AGREEMENTS WITH
THE PURCHASER, LIKE IF WE FIND
OTHER WAYS TO SAVE YOU AND YOUR
BENEFICIARIES, MONEY CAN CAN WE
SHARE IN THOSE SAVINGS? RIGHT.
AND SO THERE'S AN INCENTIVE FOR
THE PBM TO INVEST TIME AND
RESOURCES AND PERSONNEL INTO
FINDING OTHER WAYS TO MANAGE
THAT SPEND WHILE STILL PROVIDING
QUALITY CARE. I MEAN, AND MR.
CHAIR, I DON'T KNOW IF PERHAPS
IF MY WITNESSES COULD ALSO
RESPOND TO THAT, BUT THAT'S
FINE. I DON'T WANT TO TAKE AWAY
FROM MY COLLEAGUES EITHER. BUT
PLEASE. SO, MR. LOPEZ, DOCTOR
LOPEZ, C¢M. THANK YOU. SENATOR
ROTH, I JUST WANT TO CLARIFY ON
THE PERFORMANCE BASED REBATE
THAT YOU'RE ASKING ABOUT. MIKE A
REBATE OR THE PERFORMANCE BASED
INCENTIVE. YES. MY CASE WAS
SPECIFICALLY AROUND THAT. AND
BECAUSE OF THE LACK OF THE
TRANSPARENCIES, LACK OF
TRANSPARENCY WITH THE PBMS, THEY
ARE THE MIDDLEMEN. THEY ARE NOT
THE CLINICIAN. THEY'RE NOT
SEEING THE PATIENT. THEY'RE NOT
THE PRESCRIBER THERE. SO THEY
HAVE NONE OF THE CLINICAL DATA
ON THE PATIENT. THEY ARE JUST
LOOKING AT, BASED ON THEIR,
THEIR FORMULARIES, AND SO WE,
YOU KNOW, MY LEGAL TEAM SHOWED
BASICALLY THAT THERE WAS NO
PERFORMANCE BASED PAYMENT
BECAUSE THEY DON'T HAVE THAT
INFORMATION AND THAT THAT WAS A
MAJOR PART OF OUR CASE. SO I DO
I DO WANT TO BRING UP THAT THAT
IS ONE CONCERN WHEN THEY SAY
THAT THEY THEY WENT TO CMS AND
THEY SAID, WE'RE GOING TO DO
PERFORMANCE BASED PAYMENTS, BUT
THEY DON'T ACTUALLY HAVE THAT
INFORMATION BECAUSE THEY'RE JUST
THE MIDDLEMEN. THE DATA
AGGREGATOR. BUT IN TERMS OF THE
CHAIR HAD ASKED THE PBMS ABOUT
SPREAD PRICING. AND SO I DON'T
KNOW IF MISS BLUCHER, I WOULD
LIKE TO PROVIDE OUR PERSPECTIVE
ON THAT TOO. AND I WILL NOTE
THAT SEVEN STATES HAVE BANNED
SPREAD PRICING. SO SEVEN STATES
HAVE BANNED IT. IT'S NOT THIS IS
NOT LIKE A NEW THING THAT WE'RE
CONSIDERING. THIS IS SOMETHING
THAT OTHER STATES HAVE DONE
BECAUSE IT IS A PROBLEM. BUT
MISS BLUCHER, YES, IF I MAY, I
JUST WILL QUICKLY REMIND
EVERYONE THAT PBMS ARE PAID IN A
VARIETY OF DIFFERENT WAYS.
THEY'RE PAID VIA THE SPREAD
PRICING. THEY'RE PAID VIA FEES.
THEY'RE ALSO PAID THROUGH
RETENTION OF REBATES. AND THERE
ARE LOTS OF DIFFERENT CONTRACTS.
I THINK THE OPPOSITION
RECOGNIZES AND HAS STATED. AND
ONE OF OUR CONCERNS, I THINK
EXACTLY AS YOU STATED, SENATOR
ROTH, IS THE LACK OF
TRANSPARENCY AROUND THAT
PRACTICE. AND IF YOU LOOK AT
WHO'S RETAINING THE PROFIT OF OR
THE, THE SPREAD PRICE, THE
SPREAD ON THE SPREAD PRICING, IT
DOES APPEAR THAT PBMS ARE
RETAINING THAT, THAT A LARGE
PERCENTAGE OF THAT BY SOME
ACCOUNTS, 40% OF THAT SPREAD.
AND IN OTHER INSTANCES, WE'VE
SEEN THAT SPREAD PRICING
INCREASES HAVE GONE UP OVER THE
YEARS. SO WE'RE NOT STAYING AT
THE SAME AMOUNT. BUT THERE'S
BEEN AN INCREASE TO THE SPREAD.
AND SO THOSE ARE THE PROBLEMATIC
PRACTICES THAT WE'RE TRYING TO
ADDRESS AND GET SOME
TRANSPARENCY AROUND, SENATOR
MENGIBAR. DID YOU HAVE FURTHER
QUESTIONS TO BE HONEST, SIR, I
THINK, I GOT FURTHER CONFUSED ON
THE MATTER, IT'S A VERY
COMPLICATED AND I THINK I
STARTED TRYING TO UNDERSTAND
THIS LAST YEAR. I'M STILL
UNDERSTANDING IT, AND I THINK
I'M AT THE PLACE WHERE HEALTH
ACCESS IS AT, I, WHERE I KNOW
YOU'VE MADE A LOT OF PROGRESS
SINCE BMP. YOU KNOW, I HEARD IT
IN THERE AND THERE'S A LOT OF
AMENDMENTS TAKEN. I'M SUPPORTING
THE BILL BECAUSE THERE HAS BEEN
MOVEMENT, AND I KNOW HE WILL
CONTINUE. YOU KNOW, I SORRY, I
WON'T INTERRUPT, YOU KNOW, AND
WE DID ACTUALLY, I CONVENED A
MEETING WITH HEALTH ACCESS AND,
CHRONIC CARE COALITION AND THE
PHARMACISTS AND MY OFFICE JUST
TO WE WANTED TO MAKE SURE
EVERYONE UNDERSTOOD WHERE WE
WERE COMING FROM. AND I THINK
I'M. I NEVER WILL PREDICT THE
FUTURE, BUT I FELT GOOD COMING
OUT OF THAT MEETING THAT WE ARE
I THINK WE'RE GOING TO HAVE
PRODUCTIVE CONVERSATIONS WITH
WITH HEALTH ACCESS. AND, YOU
KNOW, I JUST ONE THING I WHEN WE
TALK ABOUT SPREAD PRICING AND
REBATES. ET CETERA. ET CETERA.
IT'S THERE'S A LOT OF COMPLEXITY
HERE AND COMPLEXITY IN THE
HEALTH CARE SYSTEM WHEN THERE
DOESN'T NEED TO BE. COMPLEXITY
CAN OFTEN LEAD TO INCREASED
COSTS. WHEN PBMS WERE CREATED,
THEY WERE IT WAS LIKE A MUCH
SMALLER ENTITIES CREATED TO
ASSIST HEALTH PLANS AND CREATING
THE FORMULARY AND ENGAGING IN
THESE ACTIVITIES. THEY WERE NOT
MORE MEGA MASSIVE CORPORATIONS
THAT OWN THEIR OWN PHARMACIES
AND WERE, YOU KNOW, SORT OF
MASSIVE ACTORS IN THE HEALTH
CARE INDUSTRY. THEY HAVE BECOME
THAT. AND THEY NOW PLAY THIS
MIDDLE PERSON ROLE WHERE YOU
HAVE SPREAD PRICING, WHICH I'M
NOT SAYING IT'S TERRIBLE IN
EVERY SINGLE SITUATION, BUT YOU
HAVE SITUATIONS ÓRDENES WHERE
THEY ARE PAYING THE PHARMACIES
SIGNIFICANTLY LESS THAN WHAT
THEY'RE BEING PAID, TO THE POINT
WHERE THE PHARMACIES AREN'T EVEN
ABLE TO MAKE MONEY, OR THE
REBATES WHERE THEY ARE, WHERE
IT'S VERY NONTRANSPARENT AND
THEY ARE THEY HAVE AN INCENTIVE
BECAUSE THE REBATES ARE A
PERCENTAGE TO FAVOR HIGHER
COSTS, BECAUSE THAT MEANS A
HIGHER REBATE. IT'S A PERCENTAGE
OF THE TOTAL COST. AND WE KNOW
THAT THERE ARE SITUATIONS WHERE
THEY'RE SUPPOSED TO PASS THROUGH
95% OF THE REBATE TO THE TO THE
PAYER, BUT IT'S UNCLEAR WHAT
THEY'RE EVEN DEFINING AS THAT
REBATE OR NOT AS THAT REBATE.
AND SO IT'S UNCLEAR IF THEY'RE
PASSING THAT 95% THROUGH. AND I
WILL JUST NOTE THAT JUST LAST
MONTH, THE INSPECTOR GENERAL OF
THE US POSTAL SERVICE OR OF THE
I'M SORRY, THE INSPECTOR GENERAL
OF THE US OFFICE OF PERSONNEL
MANAGEMENT AUDITED A PBM WITH
RESPECT TO THE POSTAL WORKER
UNION HEALTH PLAN AND FOUND THAT
THE PBM HAD OVERCHARGED, THE
CARRIER, 44, ALMOST $45 MILLION
BY NOT PASSING THROUGH ALL THE
DISCOUNTS AND CREDITS THAT THEY
WERE SUPPOSED TO. SO THIS IS AN
ISSUE, AND THERE IS A WAY OF
COMPENSATING THROUGH SIMPLY A
FEE FOR SERVICE, BUT, YOU KNOW,
THE PBMS HAVE A LOT OF LEVERAGE
AS WELL. AND SO IT RESULTS IN
ALL OF THESE DIFFERENT
STRUCTURED FORMS OF COMPENSATION
THAT DO NOT ALWAYS BENEFIT THE
HEALTH CARE SYSTEM. THANK YOU.
SENATOR. SENATOR SMALLWOOD
CUEVAS, THANK YOU. AND I
REMEMBER HEARING THIS IN BNP. SO
BUT BUT ONE OF THE DATA POINTS
THAT CAME OUT IN ITS EMERGING
AND EARLY IS THE REASON WHY
WE'RE EVEN IN THIS CONVERSATION
IS THE SAVINGS AND WHAT THE
CONSUMER IS SAVING. AND I DON'T
KNOW IF YOU COULD SHARE JUST
WHAT SOME OF THE VERY EARLIEST
BECAUSE THIS SORT OF LOOK AT
PBMS IS RELATIVELY NEW, BUT
THEY'RE IN SOME STATES, WE'RE
SEEING SOME SOME RESULTS. YEAH,
DEFINITELY. WE'VE SEEN, AS I
THINK I MENTIONED IN BNP, BUT I,
I WILL SAY AGAIN, IT IS
DIFFICULT TO KIND OF QUANTIFY
THE EXACT SAVINGS AS THESE
REGULATIONS HAVE BEEN RELATIVELY
NEW IN MANY STATES. BUT THERE
HAVE BEEN SOME QUALIFICATIONS
THAT WEST VIRGINIA ISSUED A
REPORT WHERE THEY, SAVED $54
MILLION. WE'VE ALSO ANECDOTALLY,
AFTER BNP TALKED TO ARKANSAS,
WHICH WAS ONE OF THE FIRST
STATES TO ENACT PBM REGULATION,
THEY'RE THE STATE THAT WENT UP
TO THE SUPREME COURT ON THE
PREEMPTION CASE. AND THEY HAVE
SEEN THAT THEIR PREMIUMS HAVE
NOT INCREASED AS MUCH AS
COMPARED. THIS IS ANECDOTAL,
FRANKLY, AS COMPARED TO OTHER
STATES THAT DO NOT HAVE THE
REFORM AND ALSO THEY ARE LOOKING
AT, NOT AS MANY PHARMACY
CLOSURES. AND THAT'S FROM PEOPLE
ON THE GROUND IN ARKANSAS. SO I,
I ALSO, AS I MENTIONED, THERE
ARE SEVERAL INSTANCES OF
MEDICAID PROGRAMS SAVING DOLLARS
. SOME OF THAT HAS TO DO WITH
SPREAD. SOME OF IT HAS TO DO
WITH THE SENATOR WIENER
MENTIONED KIND OF CORRECTING
MAYBE DOLLARS THAT WEREN'T
PASSED THROUGH BECAUSE ONE OF
THE CHALLENGES WITH PLANS AND
ENGAGEMENT WITH PLANS AND PBMS
IS YOU MAY HAVE AN EMPLOYER'S
YOU MAY HAVE VERY FAVORABLE
CONTRACT PROVISIONS FOR EXAMPLE,
CALPERS, WE HAVE TALKED TO, IN
IN WORKING ON THIS LEGISLATION.
THEY HAVE HAD PASSED THROUGH
SINCE 2006. BUT WHAT THEY SHARED
IS THAT IT'S VERY DIFFICULT TO
CONFIRM THAT THE PBM IS MEETING
THE METRICS OF THE CONTRACT
WITHOUT INVESTING QUITE A LOT IN
AUDITORS DOLLARS TO MAKE SURE
THAT, YOU KNOW, LOOKING AT
EXACTLY WHAT THE BOTTOM LINE IS.
AND SO I THINK WHAT WE'RE HOPING
IS THAT SOME OF THE STATE
REGULATION WILL HELP LEVEL THE
PLAYING FIELD A LITTLE BIT FOR
ALL ENTITIES THAT NEED TO
CONTRACT WITH PBMS, AND WILL
ALSO ALLOW FOR US TO SEE SOME OF
THE IMPACT OF THOSE SAVINGS. SO
WE WORKED WITH THE COMMITTEE
STAFF, AND THANK YOU VERY MUCH
FOR YOUR WORK ON MAKING SURE
THAT THERE WERE MORE,
TRANSPARENCY METRICS. I THINK
WE'RE ABSOLUTELY OPEN TO MORE.
IF THERE ARE MORE PIECES OF
INFORMATION THAT SHOULD BE
INCLUDED IN THOSE REPORTS, AND
WE'LL CONTINUE TO SHARE, I THINK
WE DO HAVE SOME HELPFUL GRAPHICS
FROM THE, NATIONAL ORGANIZATIONS
THAT WE CAN SHARE WITH THE
COMMITTEE. AFTER THE HEARING.
THANK YOU. SENATOR RUBIO. THANK
YOU, MR. CHAIR. AND I WILL
CONCUR WITH MY COLLEAGUE,
MENGIBAR THAT SOMETIMES THE MORE
YOU HEAR ABOUT, THE MORE
CONFUSING IT GETS, RIGHT? AND,
BUT AT THE END OF THE DAY, I
MEAN, I THINK I HEAR BOTH SIDES
STATING IN A ROUNDABOUT WAY THAT
IT BENEFITS, YOU KNOW, THE
PATIENTS AND FOCUSES ON REDUCING
HEALTH CARE COSTS. SO A SHORT
VERSION, I'D LIKE TO GIVE BOTH
SIDES THE OPPORTUNITY TO GIVE ME
YOUR SHORT VERSION. AND HOW DOES
IT REDUCE COST FOR PATIENTS. SO
I'M GOING TO START WITH THE, THE
SUPPORTERS. YES. WELL, THANK YOU
VERY MUCH. I THINK ULTIMATELY
WHAT WE WANT TO SEE HERE IS
DIRECT REGULATION OF ONE ENTITY
WITHIN THE WHOLE CHAIN THAT IS
NOT REGULATED. SO WE HAVE A VERY
COMPLEX AND, A CHAIN AND
PHARMACEUTICAL SUPPLY CHAIN. AND
ALL OF THOSE ENTITIES ARE
REGULATED EXCEPT AT THIS TIME
FOR, THESE MIDDLEMEN. AS SENATOR
WIENER SAID, THE IMPORTANCE OF,
THE IMPACT TO CONSUMERS AND TO
THEIR PHARMACY PARTNERS IS THAT
THEY ARE ABLE TO HAVE MORE
DIRECT DOLLARS COMING TO THEM
INSTEAD OF GETTING LOCKED UP IN
THIS MIDDLE SPOT. SO THERE'S A
VALUE THAT PBMS PROVIDE. BUT
WHAT WE THINK, BECAUSE OF LACK
OF TRANSPARENCY, BECAUSE OF
PERVERSE INCENTIVES DUE TO
VERTICAL INTEGRATION AND SOME OF
THE RELATIONSHIPS BETWEEN PBMS
PLANS AND PHARMACIES THAT ARE
OWNED BY THOSE THERE HAS BEEN AN
OPPORTUNITY FOR THOSE ENTITIES
TO TAKE ADVANTAGE OF THOSE
RELATIONSHIPS AND CHANGE THE
INCENTIVES WITHIN THE SYSTEM AND
RETAIN MORE PROFIT THAN WE THINK
IS APPROPRIATE GIVEN THE MARKET.
AND SO I DO THINK THAT ONE OF
THE VALUES IS TO DIRECT
REGULATION. THÀNH IS ENSURING
THAT WE CAN HAVE TRANSPARENCY
AROUND THE PRACTICES AND ALLOW
THE PARTICIPANTS WITHIN THE
MARKET REALLY HAVE FULL AND
COMPLETE INFORMATION. THÀNH AS
TO WHAT IS THE BEST DEAL FOR
THEIR CONSUMERS, BECAUSE
ULTIMATELY THE PLANS ARE SERVING
ENROLLEES AND BENEFICIARIES, AND
ULTIMATELY THEY WANT TO MAKE
SURE THAT THEY HAVE THE BEST
SERVICES AT THE LOWEST COST FOR
THOSE ENROLLEES. NOW IF I CAN
HAVE THE OPPOSITION, GIVE US
YOUR VERSION JUST SO WE CAN BE
CLEAR, HOW DOES IT REDUCE COSTS?
YEAH, THANK YOU FOR THE
QUESTION, SENATOR. AND LET ME
BEGIN BY SAYING, DRUG
MANUFACTURERS ARE NOT REGULATED
BY THE STATE OF CALIFORNIA. SO
TO SAY THAT WE'RE THE ONLY
ENTITY NOT REGULATED, I THINK IS
A VERY MISLEADING STATE. I DON'T
THINK THAT WAS INTENDED. BUT
DRUG MANUFACTURERS WHO SET THE
PRICES AND MANUFACTURE THE DRUGS
AND THEY'RE IMPORTANT ENTITIES,
BUT YOU HAVE LITTLE TO NO
ABILITY TO DO ANYTHING WITH THEM
OTHER THAN THE REPORTING UNDER
SB 17. I WOULD CONTEND THIS BILL
DOES NOTHING TO EXPAND ACCESS OR
LOWER COST FOR PATIENTS. AT THE
END OF THE DAY, THAT'S REALLY
WHAT THE FOCUS SHOULD BE. IS
THIS LEGISLATION, THIS POLICY
RESULT IN A LOWER PRICE FOR THE
CONSUMER. SO A LOT OF THE THINGS
THAT ARE BEING SORT OF
QUESTIONED OR, YOU KNOW, CALLED
INTO QUESTION OR BEING
CRITICIZED ARE TOOLS USED BY
PBMS AND BY PLANS TO LOWER THE
PREMIUMS, TO LOWER CO-PAYS, TO
LOWER DEDUCTIBLES FOR THE FOR
THE CONSUMER, FOR THE PATIENT AT
THE END OF THE DAY AND WHILE
LEGISLATION IS AND I THINK IT
WAS, INSTEAD, IT'S REALLY HARD
TO TEASE OUT WHAT BILLS IMPACT
PREMIUMS AND WHAT HAVE YOU. BUT
NONE OF THE NONE OF THE STATES
THAT HAVE PASSED PBM REFORM OR
WHAT HAVE YOU HAS THERE BEEN
INDICATIONS THAT PATIENTS HAVE
GOTTEN LOWER COST DRUGS OR THAT
IT'S EXPANDED ACCESS? SO I THINK
WE SOMETIMES LOSE SIGHT OF THAT.
AND I KNOW WE CAN BE GUILTY AS
AN INDUSTRY AND AS PEOPLE IN THE
SUPPLY CHAIN, WE END UP POINTING
FINGERS AT EACH OTHER. AND
THAT'S WHY WE ARE OPEN TO
GETTING DATA TO THE STATE, BUT
EVERYBODY'S DATA TO THE STATE.
SO YOU CAN REALLY WRAP YOUR ARMS
AROUND WHERE WHERE ARE THE
PRESSURE POINTS, WHERE ARE THE
OPPORTUNITIES FOR SAVINGS FOR
PATIENTS? BECAUSE AT THE END OF
THE DAY, THAT SHOULD BE ALL OF
OUR FOCUS. WELL, THANK YOU FOR
THAT. BUT, YOU KNOW, IT STILL
FEELS LIKE I'M STILL STRUGGLING
TO SEE THE DIRECT BENEFIT FOR
PATIENTS. I'M ON BOTH ENDS, BUT,
I WOULD WANT TO ADD TO THAT. OH,
I WOULD JUST SAY FROM THE FROM
THE PLAN PERSPECTIVE, THEY ENTER
THESE CONTRACTS WITH PBMS TO
LEVERAGE LIVES TO DRIVE THE COST
DOWN OF PRESCRIPTION DRUGS,
RIGHT? I MEAN, THE
PHARMACEUTICAL MANUFACTURER
COVERS OR SETS THE PRICE. WE ARE
OBLIGATED TO COVER ANY MEDICALLY
AVAILABLE DRUGS. SO IT'S NOT A
FREE MARKET, RIGHT? WE HAVE TO
COVER IT. SO YOU HAVE TO USE
TOOLS IN THE TOOLBOX TO TRY TO
DRIVE DOWN THAT COST. AND THAT'S
WHAT THE PBM IS USED FOR. SO
THAT'S ULTIMATELY A BENEFIT TO
THE CONSUMER. BY KEEPING THAT
PREMIUM DOLLAR DOWN, I
UNDERSTAND THAT, YOU KNOW, SOME
OF THESE CONTRACT PROVISIONS
COULD CREATE, YOU KNOW, SOME
SORT OF INCONVENIENCES OF NOT
BEING ABLE TO GO TO EVERY
PHARMACY. BUT THERE HAS TO BE A
BALANCE BETWEEN THE ACCESS AND
THE OVERALL COST. AND, YOU KNOW,
WE ARE REGULATED BY DMHC. WE'RE
REQUIRED TO HAVE NETWORK
ADEQUACY. SO WE HAVE TO HAVE
PHARMACIES, IF TOO MANY IF
PHARMACIES START GOING OUT OF
BUSINESS, THEN WE'RE NO LONGER
ABLE TO MATCH OUR OUR NETWORK
ADEQUACY STANDARDS, AND THEN
WE'RE OUT OF COMPLIANCE. AND SO,
THE PBM IS ESSENTIALLY REGULATED
THROUGH THE PLAN. AB 315 MADE
THAT VERY, VERY CLEAR, THERE'S A
LOT OF TRANSPARENCY PROVISIONS
IN AB 315 TO WHERE THE PBM HAS
TO REPORT TO THE CLIENT WHAT
WHAT ALL IS BEING DONE, AND SO
I, YOU KNOW, WE APPRECIATE THE
SENTIMENT THAT, SOME OF THE
STUFF WE SHOULD BE PROTECTED
AGAINST OURSELVES, BUT I THINK
WE'RE SOPHISTICATED ENOUGH
PURCHASERS TO KNOW WHAT WE'RE
GETTING INTO. AND I DON'T THINK
THAT WE ARE, YOU KNOW, BEING
FOOLED BY THE PBMS AND SOMEHOW
THEY'RE TAKING MASSIVE AMOUNTS
OF REBATES FROM US, WITHOUT US
NOTICING IT. SO WE WOULD
DISAGREE WITH THAT. THANK YOU.
WELL, AND TO THE AUTHOR, I MEAN,
CLEARLY THERE'S SO MUCH HERE
THAT'S HAPPENING IN SUCH A YOU
SAID IT FIRST WITH YOUR OPENING
STATEMENT, SUCH A COMPLEX TOPIC
TO DEAL WITH. AND A LOT OF, YOU
KNOW, DATA THAT CANNOT
NECESSARILY BE QUANTIFIED. AND
SO FOR MY ONLY ASK IS THAT THESE
CONVERSATIONS CONTINUE AND
FIGURE OUT HOW WE STRENGTHEN
THIS PROCESS. SO IT'S CLEAR. BUT
THANK YOU. ABSOLUTELY. AND WE'LL
CONTINUE TO DO THAT. I DO JUST
WANT TO SAY THOUGH, IN TERMS OF
PATIENTS, TWO THINGS. FIRST OF
ALL, ONE PIECE THAT WE HAVEN'T
TALKED ABOUT, WE MENTIONED THAT
BUT NOT REALLY TALKED ABOUT IS
PATIENT STEERING, SO ONE OF THE
THINGS WE'RE SEEING IS THAT PBM
CMS WILL OWN THEIR OWN PHARMACY,
AND THEY WILL, ESSENTIALLY ONLY
SOMETIMES IT'S SORT OF FORCING
YOU OR SORT OF, REPRESENTING TO
YOU THAT YOUR ONLY OPTION IS TO
USE THEIR PHARMACY AND SO YOU
CAN'T GO TO YOUR NEIGHBORHOOD
PHARMACY, THAT THEY WILL REQUIRE
YOU OR SOMEHOW GET YOU TO USE
THEIR PHARMACY THAT DIRECTLY
HARMS CONSUMERS. I WILL ALSO
NOTE THAT THERE ARE TIMES WHEN
ON, THE FORMULARIES, THE FOR
EXAMPLE, WITH INSULIN, GENERIC
VERSUS NAME BRAND AND THEIR
FORMULARIES THAT ONLY HAVE THE
NAME BRAND AND DON'T HAVE THE
GENERIC RIGHT, RIGHT, AND THOSE
FORMULAS ARE CREATED BY THE
PBMS. WHY IS THAT? THAT
INCREASES COST FOR THE HEALTH
CARE SYSTEM, WHICH HARMS
CONSUMERS, SO THERE ARE YOU
KNOW, THIS IS HARMFUL TO, TO
PATIENTS. OKAY. ANY OTHER
QUESTIONS? WE'RE STILL ALIVE
SEEING NO QUESTIONS, SENATOR,
YOU MAY CLOSE, THANK YOU AGAIN.
THANK YOU. THE COMMITTEE FOR
WORKING WITH US. WE WILL, OF
COURSE, CONTINUE TO WORK WITH
WITH ALL STAKEHOLDERS. THIS IS,
WE ARE NOT THE FIRST STATE, BUT
WE SHOULD BE THE NEXT STATE. AND
I RESPECTFULLY ASK FOR YOUR. I
VOTE, IS THERE A MOTION? SENATOR
GONZALEZ MAKES THE MOTION. OKAY
LET'S CALL THE ROLL. THE MOTION
IS TO PASS, AS AMENDED. AND RE
REFER TO THE COMMITTEE ON
APPROPRIATIONS. SENATOR ROTH, A
ROTH I, WHEN I WHEN I GLASER.
GLASER I GONZALEZ. GONZALEZ I
GROVE. GROVE. I HURTADO. LIMÓN
LIMÓN. I MENGIBAR. MENGIBAR I.
RUBIO. I RUBIO. I SMALLWOOD.
CUEVAS. SMALLWOOD. CUEVAS. I
WIENER. I WIENER. I VOTE IS 10
TO 0. HOLDER OPEN FOR ABSENT
MEMBERS. LADIES AND GENTLEMEN,
WE HAVE ONE MORE ITEM. IT
HAPPENS TO BE MY ITEM. ITEM
NUMBER 21, SB 1289. IN SUPPORT.
DO YOU WANT TO SCRIPT IT ALL?
YEAH, YEAH, I FIGURE IT CAN'T
HURT RIGHT. OKAY, SO THIS BILL
HAS SUPPORT. SUPPORT. HINT HINT.
RENEW THE BILL. THE BILL
REQUIRES DHS TO COLLECT DATA AND
DEVELOP STANDARDS FOR CALL
CENTERS OPERATED BY THE COUNTIES
TO ASSIST PEOPLE WITH THEIR
MEDI-CAL. FEDERAL AND STATE LAW
REQUIRE THAT PEOPLE BE ABLE TO
APPLY FOR MEDI-CAL AND TURN IN
INFORMATION OVER THE PHONE. THIS
BILL WILL REQUIRE COUNTIES TO
SUBMIT DATA REGARDING CALL
CENTER WAIT TIMES, BECAUSE THE
WAIT TIMES FACED BY MANY
MEDI-CAL RECIPIENTS TO REACH
THEIR COUNTY WORKERS BY PHONE
ARE FAR TOO LONG, SO THE BILL
WILL REQUIRE COUNTIES TO SUBMIT
DATA REGARDING CALL CENTER WAIT
TIMES AND WILL REQUIRE DHS TO
ESTABLISH STANDARDS SO THAT
PEOPLE ON MEDI-CAL CAN GET THE
ASSISTANCE THEY NEED. THERE HAVE
BEEN SOME AMENDMENTS TO NARROW
THE BILL, SO IT ONLY INVOLVES
THOSE COUNTIES OPERATING CALL
CENTERS FOR MEDI-CAL RECIPIENTS
AND GIVES STAKEHOLDERS INPUT
INTO THE DEVELOPMENT OF THE
STANDARDS. WITH ME TODAY, WE
HAVE LINDA HèA OF WESTERN CENTER
ON LAW AND POVERTY, POVERTY, AND
KEVIN, KEVIN ASLANIAN OF
CALIFORNIA COALITION OF WELFARE
RIGHTS ADVOCATES. BY BUTCHER
YOUR NAMES, PLEASE. GOOD
EVENING. LINDA HèA WITH WESTERN
CENTER ON LAW AND POVERTY, PROUD
CO-SPONSORS OF THIS IMPORTANT
MEASURE. CONSIDERING THE SUPPORT
ON BOTH SIDES. HAPPY TO ANSWER
ANY QUESTIONS. THANK YOU. THANK
YOU. KEVIN ESTÁN COALITION,
CALIFORNIA WELFARE RIGHTS
ORGANIZATION. WE SUPPORT THIS
BILL IN PART BECAUSE WE HAVE
CLIENTS WHO HAVE A LOT OF
PROBLEMS. ONE OF ONE CLIENT THAT
COMES TO MY MIND FROM LÀ 83, A
WOMAN WHO CALLED ME UP AND HER
HHS WAS TERMINATED BECAUSE HER
MEDI-CAL WAS STOPPED AND I HAD
TO CALL UP THE WELFARE OFFICE,
AND I GOT HER BENEFITS BACK. BUT
NOT EVERYBODY COULD CALL ME UP.
AND I WISH I COULD CLONE MYSELF,
BUT THAT'S NOT GOING TO HAPPEN.
SHE CALLED THE RENEWAL LINE
SEVERAL TIMES. ONE TIME SHE WAS
ON ON HOLD FOR ONE HOUR AND 20
MINUTES, AND THEN THEY JUST
DROPPED THE CALL. AND, THIS
LEADS TO A LOT OF PEOPLE LOSING
THEIR MEDI-CAL. AND WE HAVE
HEARD SIMILAR PROBLEMS FROM
LEGAL, LEGAL SERVICES PROGRAMS.
AND WHEN I CALLED UP THE DELTA
AIRLINE TO GET A RESERVATION,
THEY JUST DO THE CALL BACK
WITHIN 15 MINUTES. IN CALIFORNIA
, THEY HAVE 31 CALL CENTERS.
ONLY 13 OF THEM HAVE CALL BACK
FEATURES. SO THERE'S A BIG
PROBLEM. AND THERE WAS A SURVEY
DONE BY THE DEPARTMENT OF HEALTH
CARE SERVICES THAT SHOWED IN
NOVEMBER, 31% OF THE CASES HAD
DROPPED. CALLS IN DECEMBER FOR
CHRISTMAS WAS 32% IN JANUARY OF
THIS YEAR WAS 35% OF THE CASES
WERE DROPPED OR DISCONNECTED OR
NO ANSWER. SO WE SUPPORT THIS
BILL URGE AND I VOTE. THANK YOU.
THANK YOU. ANY ME TWOS IN
SUPPORT? PLEASE COME FORWARD.
KAREN MEMBERS KATHY MOSSBERG
WITH THE CALIFORNIA ASSOCIATION
OF FOOD BANKS IN SUPPORT MARY
CREASY ON BEHALF OF THE
CHILDREN'S PARTNERSHIP AND
SUPPORT. THANK YOU. ANY LEAD
WITNESSES IN OPPOSITION, PLEASE
COME FORWARD.
GOOD EVENING. I'M EILEEN
KUBINSKI WITH THE COUNTY WELFARE
DIRECTORS ASSOCIATION. WE REALLY
APPRECIATE THE AMENDMENTS THAT
HAVE RECENTLY BEEN PROPOSED AND
TAKEN. THOSE SHOULD ADDRESS A
COUPLE OF OUR CONCERNS. BUT WE
DO STILL HAVE AN OPPOSE UNLESS
AMENDED POSITION ON THIS BILL. I
DO WANT TO ACKNOWLEDGE, FIRST
OFF, THE FRUSTRATION AND THE
DIFFICULTIES WITH CALL CENTER
WAIT TIMES AND OTHER TECHNICAL
PROBLEMS WITH THE CALLS. WE'RE
CERTAINLY IN UNPRECEDENTED TIMES
WITH RESPECT TO THE VOLUME OF
REDETERMINATIONS THAT WE HAVE
POST PANDEMIC AND THE WORKFORCE
CRISIS THAT COUNTIES ARE
EXPERIENCING. I DON'T OFFER THAT
AS AN EXCUSE. I DO WANT TO
ASSURE YOU, THOUGH, THAT COUNTY
HUMAN SERVICES AGENCIES ARE
DEVOTING ALL THE MANPOWER AND
RESOURCES THAT THEY CAN TO
ENSURE THAT CLIENTS CAN BE
HELPED AS QUICKLY AS POSSIBLE TO
PREVENT ELIGIBLE RECIPIENTS FROM
LOSING THEIR MEDI-CAL COVERAGE,
CALL CENTERS EMERGED DECADES
AGO, ESTABLISHED BY COUNTIES
VOLUNTARILY TO PROVIDE ANOTHER
SERVICE OPTION FOR THEIR
CLIENTS, AND AS SUCH, THEY'VE
EVOLVED DIFFERENTLY IN DIFFERENT
PLACES TO MEET DIFFERENT LOCAL
NEEDS AT DIFFERENT AT THE TIME,
NOT ALL COUNTIES HAVE CALL
CENTERS AS HAS BEEN ESTABLISHED,
WHILE OTHERS HANDLE ONLY
MEDI-CAL AND CALFRESH CALLS.
OTHERS DO HANDLE MULTIPLE
BENEFIT PROGRAMS AS A ONE STOP
SHOP FOR CLIENTS, AND THEY ALSO
HAVE DIFFERENT APPROACHES TO
CUSTOMER SERVICES, WITH SOME
DESIGNED TO HANDLE THE
CUSTOMER'S PROBLEMS RIGHT THERE
ON THE PHONE AT THE MOMENT,
WHILE OTHERS ROUTE CALLS TO
ELIGIBILITY WORKERS. AND ALL OF
THIS LEADS TO VARYING WAIT TIMES
FROM COUNTY TO COUNTY AND
BETWEEN PROGRAMS. AGAIN, I
UNDERSTAND IT'S VERY
FRUSTRATING. WE DON'T OPPOSE AT
ALL CREATING STANDARDS FOR CALL
CENTERS, BUT WE DO WANT TO
PARTICIPATE IN THE ESTABLISHMENT
OF THOSE STANDARDS, AND THAT'S
WHY WE REALLY APPRECIATE THE
AMENDMENTS, TO INCLUDE US AND
OTHER STAKEHOLDERS IN THE
DEVELOPMENT PROCESS. I THINK
THAT'S REALLY IMPORTANT TO GET
ALL OF THE DIFFERENT
PERSPECTIVES ON IT, BUT WE DO
NEED TO ENSURE THAT WHATEVER
STANDARDS ARE IMPOSED AND ARE
PUT PLACE ARE ADEQUATELY
RESOURCED SO THAT THEY CAN
ACTUALLY BE ACHIEVED, OTHERWISE
WILL NOT BE ABLE TO MEET THOSE
STANDARDS, OR WILL HAVE TO DO SO
AT THE EXPENSE OF OTHER CUSTOMER
SERVICE AND WORKLOAD, INCLUDING
IN-PERSON ASSISTANCE AND THE
PROCESSING OF APPLICATIONS AND
REDETERMINATIONS. WE ALSO DON'T
OBJECT AT ALL TO REPORTING. WE
JUST WANT TO ENSURE THAT THE
METRICS AND DATA ELEMENTS EXIST
AND CAN BE PROVIDED. SO WE
CONTINUE TO LOOK FORWARD TO
WORKING ON THIS BILL. WE'RE
GRATEFUL TO THE AUTHOR AND THE
SPONSORS COMMITMENT TO WORKING
ON THE ISSUES. WE LOOK FORWARD
TO CONTINUING TO SERVE OUR
CUSTOMERS AND WORKING TOWARDS
OUR COMMON GOAL OF IMPROVING
PROGRAM ACCESS OVERALL. THANK
YOU. THANK YOU. ANY OTHER, ANY
INDIVIDUALS WHO WOULD LIKE TO
COME FORWARD TO OPPOSE SEEING
NONE. COLLEAGUES. QUESTIONS
COMMENTS? THERE'S A MOTION BY
SENATOR MENGIBAR, MR. CHAIRMAN,
WOULD YOU LIKE TO CLOSE? MADAM
CHAIR, I JUST WANT TO THANK THE
WITNESSES ON BOTH SIDES WHO CAME
AND STAYED WITH US TO SPEAK ON
THE BILL, ASK FOR AN AYE VOTE.
THANK YOU. AND THIS THIS IS DO
PASS AS AMENDED. AND WE REFER TO
THE COMMITTEE ON APPROPRIATIONS.
MADAM CLERK, PLEASE CALL THE
ROLL. SENATOR ROTH. AYE ROTH.
AYE. WHEN I WHEN I GLASER.
GLASER. I GONZALEZ. GONZALEZ I
GROVE. GROVE. I HURTADO. HURTADO
I LIMÓN LIMÓN I MENGIBAR
MENGIBAR I RUBIO. RUBIO. I
SMALLWOOD. CUEVAS. SMALLWOOD.
CUEVAS I WIENER I WIENER I.
THAT'S 11 ZERO. THAT FILLS OUT.
IT'S OUT. THAT'S 11 ZERO AND THE
BILLS OUT OKAY I'M GOING TO
WRITE IT DOWN HERE. OKAY. WE
HAVE EVERYBODY BACK I GUESS
RIGHT. YEAH. NOBODY'S HERE,
WE'RE GOING TO OPEN THE ROLL ON
OPEN ITEMS. WE'RE GOING TO START
WITH THE CONSENT CALENDAR. AND
ON THE CONSENT CALENDAR WE HAVE
ITEM NUMBER ONE, SENATE BILL
908. SENATOR CORTEZ, ITEM NUMBER
SIX, SENATE BILL 1464, SENATOR
ASHBY. AND ITEM NUMBER 15,
SENATE BILL 1033. SENATOR
MENGIBAR CURRENT VOTE IS NINE
ZERO. CHAIR VOTING I. PLEASE
OPEN THE ROLL. SENATOR HURTADO I
HURTADO I WIENER. WIENER I 11
ZERO VOTE IS 11 ZERO. CONSENT
CALENDAR IS OUT. SO I THINK. LET
ME TALK AND THEN WORK YOUR WAY
THROUGH. AND THE FIRST SIX OR
SOMETHING. WE DON'T HAVE MOTIONS
ON OR ANYTHING. WELL THAT'S
RIGHT WE DON'T. YEAH. LET'S JUST
START. WELL WAIT WE DID I DID
START WITH ONE OF THE ONES.
CONSENT. RIGHT. NUMBER TWO.
SORRY THE SECOND ITEM IS, NUMBER
TWO, SENATE BILL 999 BY SENATOR
CORTEZ. HEALTH COVERAGE, MENTAL
HEALTH AND SUBSTANCE ABUSE
DISORDERS, WE'LL NEED A MOTION
TO MOVE THE BILL, SENATOR
GONZALEZ MOVES THE BILL. A
MOTION IS TO PASS. WE REFER TO
THE COMMITTEE ON APPROPRIATIONS.
PLEASE CALL THE ROLL. SENATOR
ROTH A ROTH. AYE. WHEN GLAZER
BLAZER I GONZALEZ, I GONZALEZ I
GROVE. GROVE. NO. HURTADO I
HURTADO I LIMÓN LIMON I MENGIBAR
I MENGIBAR I RUBIO I RUBIO I
SMALLWOOD. CUEVAS I SMALLWOOD.
CUEVAS I WIENER WIENER I. 9591
VOTE IS NINE. ONE VOTE IS NINE
ONE THAT MATTER IS OUT. ITEM
NUMBER THREE SENATE BILL TEN
ZERO EIGHT. SENATOR BRADFORD
OBESITY TREATMENT. DO I HAVE A
MOTION? SENATOR MENGIBAR, PLEASE
CALL THE ROLL. THE MOTION IS TO
PASS AS AMENDED. REFER TO THE
COMMITTEE ON APPROPRIATIONS.
SENATOR ROTH, A ROTH I WHEN? NO.
WHEN. NO. GLAZER GLAZER. AYE.
GONZALEZ. GONZALEZ I GROVE.
GROVE. NO. HURTADO. HURTADO I
LIMÓN. LIMON I MENGIBAR.
MENGIBAR I. RUBIO I. RUBIO I.
SMALLWOOD CUEVAS. SMALLWOOD.
CUEVAS I WIENER I WIENER I VOTE
IS 9 TO 2 IN THAT MATTER IS OUT.
ITEM NUMBER FOUR SENATE BILL
1147. SENATOR PORTANTINO
DRINKING WATER. IS THERE A
MOTION? THE BILL, SENATOR
GONZALEZ, THANK YOU. MOTION IS
TO PASS AND REFER TO THE
COMMITTEE ON APPROPRIATIONS.
PLEASE CALL THE ROLL. SENATOR
ROTH A ROTH. AYE. WHEN GLASER.
GLASER. AYE. GONZALEZ AYE.
GONZALEZ. AYE. GROVE HURTADO.
HURTADO. AYE. LIMÓN LEMON. AYE.
MENGIBAR. MENGIBAR AYE. RUBIO.
AYE. RUBIO. AYE. SMALLWOOD.
CUEVAS SMALLWOOD. CUEVAS. AYE.
WIENER. WIENER AYE 090. VOTE IS
NINE ZERO. THAT MATTER IS OUT.
ITEM NUMBER FIVE. SENATE BILL
1180. SENATOR ASHBY, HEALTH CARE
COVERAGE, EMERGENCY MEDICAL
SERVICES. DO I HAVE A MOTION?
SENATOR GONZALEZ, MOVE THE BILL.
THANK YOU. MA'AM. MOTION IS TO
PASS, AS AMENDED. REFER TO THE
COMMITTEE ON APPROPRIATIONS.
PLEASE CALL THE ROLL. SENATOR
ROTH. AYE. ROTH. AYE. WHEN
GLASER. GLASER. AYE. GONZALEZ
GONZALEZ. AYE. GROVE. GROVE AYE.
HURTADO. HURTADO. AYE. LEMON
LEMON. AYE. MENGIBAR. MENGIBAR.
AYE RUBIO. AYE. RUBIO. AYE.
SMALLWOOD. CUEVAS SMALLWOOD.
CUEVAS. AYE. WIENER. Ã. WIENER
AYE. VOTE IS TEN ZERO. THAT
MATTER IS OUT. ITEM NUMBER
SEVEN. SENATE BILL 1236. SENATOR
BREAKSPEAR MEDICAL CARE
SUPPLEMENT COVERAGE. OPEN
ENROLLMENT PERIODS. DO I HAVE A
MOTION? SENATOR GONZALEZ, THANK
YOU VERY MUCH. MOTION IS TO
PASS, AS AMENDED. WE REFER TO
THE COMMITTEE ON APPROPRIATIONS.
PLEASE CALL THE ROLL. SENATOR
ROTH. AYE. ROTH I WHEN I, WHEN I
GLASER. GLASER I GONZALEZ.
GONZALEZ I GROVE. GROVE I
HURTADO I HURTADO I LIMÓN. LIMÓN
I MENGIBAR. MENGIBAR. I RUBIO I
RUBIO. I SMALLWOOD. CUEVAS.
SMALLWOOD CUEVAS I WIENER I
WIENER I VOTE IS 11 ZERO. THAT
MATTERS OUT. ITEM NUMBER NINE.
SENATE BILL 1339 BY SENATOR
ALLEN. SUPPORTIVE COMMUNITY
RESIDENCES. DO I HAVE A MOTION
BY SENATOR GLAZER? MOTION IS TO
PASS, AS AMENDED. REFERRED TO
THE COMMITTEE ON APPROPRIATIONS.
PLEASE CALL THE ROLL. SENATOR
ROTH A ROTH I WHEN I WHEN I
GLASER. GLASER. I GONZALEZ.
GONZALEZ I GROVE. GROVE. I
HURTADO. HURTADO I LIMÓN. LIMON.
I MENGIBAR. MENGIBAR. I RUBIO. I
RUBIO. I. SMALLWOOD. CUEVAS.
SMALLWOOD. CUEVAS I WIENER I
WIENER. I VOTE IS 11 ZERO. THAT
MATTER IS OUT. NUMBER TEN SENATE
BILL 1354 BY SENATOR WAHAB LONG
TERME HEALTH CARE FACILITIES TO
HAVE A MOTION. RUBIO SENATOR
RUBIO CHANGING IT UP. THE MOTION
IS TO PASS, AS AMENDED, REFERRED
TO THE COMMITTEE ON
APPROPRIATIONS. PLEASE CALL THE
ROLL. SENATOR ROTH, A ROTH I
WHEN? NO. WHEN. NO. GLASER
GLASER. AYE. GONZALEZ. GONZALEZ
AYE. GROVE. GROVE. NO. HURTADO
HURTADO. AYE. LIMÓN. LIMÓN. AYE
MENGIBAR. MENGIBAR. AYE. RUBIO
RUBIO. AYE. SMALLWOOD. CUEVAS
SMALLWOOD. CUEVAS. AYE. WIENER.
WIENER. AYE VOTE IS 9 TO 2. THAT
MATTER IS OUT. ITEM NUMBER 11.
SENATE BILL 1423 BY SENATOR
DALLI. MEDI-CAL CRITICAL ACCESS
HOSPITALS. IS THERE A MOTION?
MOVE IT. WHEN SENATOR NGUYEN
MOVES THE BILL, THE MOTION IS TO
PASS AS AMENDED AND REFERRED TO
THE COMMITTEE ON APPROPRIATIONS.
PLEASE CALL THE ROLL. SENATOR
ROTH I ROTH I WHEN I WHEN I
GLASER. GLASER I GONZALEZ.
GONZALEZ I. GROVE. GROVE. I
HURTADO. HURTADO I LIMÓN. LIMÓN
I MENGIBAR. MENGIBAR. I RUBIO.
RUBIO. I. SMALLWOOD. CUEVAS. NOT
VOTING. WAIT. DID SHE? SHE
HASN'T VOTED ON THIS WEEK. SO
THIS IS THE DOLLAR 11. YEAH. ONE
SECOND. I SMALL DOLLAR AND 11.
YES, YES. SMALLWOOD. CUEVAS I
WIENER WIENER I VOTE IS 11 ZERO.
THAT MATTER IS OUT. LET'S SEE.
ITEM NUMBER. SEE IF WE PICK UP
ANYBODY. ITEM NUMBER 12. SENATE
BILL 1432. SENATOR CABALLERO.
HEALTH FACILITIES, SEISMIC
STANDARDS. CURRENT VOTE IS 8 TO
0. CHAIR VOTING AYE. MOTION IS
TO PASS, AS AMENDED. REFER TO
THE COMMITTEE ON APPROPRIATIONS.
PLEASE OPEN THE ROLL. SENATOR
HURTADO. HURTADO. AYE. RUBIO.
RUBIO VÚI. WIENER. Ã. WIENER I
VOTE IS 11 ZERO. THAT MATTER IS
OUT. ITEM NUMBER 13. SENATE BILL
1447 BY SENATOR DURAZZO HOSPITAL
SEISMIC COMPLIANCE. CURRENT VOTE
NINE ZERO. CHAIR VOTING AYE.
MOTION DO PASS AS AMENDED. WE
REFER TO THE COMMITTEE ON
APPROPRIATIONS. PLEASE OPEN THE
ROLL. HURTADO. HURTADO AYE.
WIENER. AYE. WIENER. AYE VOTE IS
11 ZERO. THAT MATTER IS OUT.
ITEM NUMBER 14. SENATE BILL 954
BY SENATOR MENGIBAR. SEXUAL
HEALTH CONTRACEPTIVES, CURRENT
VOTE IS 7 TO 1. CHAIR VOTING
AYE. MOTION TO PASS AND REFER TO
THE COMMITTEE ON APPROPRIATIONS.
PLEASE OPEN THE ROLL. GROVE
HURTADO. HURTADO I WIENER WIENER
I VOTE IS 9 TO 1. THAT MATTER IS
OUT. ITEM NUMBER 16. SENATE BILL
1492 BY SENATOR MENGIBAR
MEDI-CAL REIMBURSEMENT RATES.
PRIVATE DUTY NURSING. CURRENT
VOTE 920. CHAIR VOTING I. MOTION
TO PASS. WE REFER TO THE
COMMITTEE ON APPROPRIATIONS.
PLEASE OPEN THE ROLL. SENATOR
HURTADO HURTADO Ã WIENER WIENER
I VOTE IS 11 ZERO. THAT MATTER
IS OUT. ITEM NUMBER 17. SENATE
BILL 966 BY SENATOR WIENER.
PHARMACY BENEFITS. CURRENT VOTE
TEN ZERO CHAIR. VOTING AYE.
MOTION DO. PASSES AMENDED. WE
REFER TO THE COMMITTEE ON
APPROPRIATIONS. PLEASE OPEN THE
ROLL. SENATOR HURTADO HURTADO A
VOTE IS 11 ZERO. THAT MATTER IS
OUT. ITEM NUMBER 18. SENATE BILL
1061 BY SENATOR LIMÓN, CONSUMER
DEBT. MEDICAL DEBT. CURRENT VOTE
SEVEN ZERO. CHAIR. VOTING AYE.
MOTION DO PASS AS AMENDED. WE
REFER TO COMMITTEE ON
APPROPRIATIONS. PLEASE OPEN THE
ROLL. SENATOR, WHEN GLAZER.
GLAZER I GROVE WIENER I WIENER I
VOTE IS NINE ZERO. THAT MATTER
IS OUT. ITEM NUMBER 19. SENATE
BILL 1369 BY SENATOR LIMÓN
DENTAL PROVIDERS CURRENT VOTE
NINE ZERO. CHAIR VOTING I.
MOTION TO PASS, AS AMENDED,
REFER TO THE COMMITTEE ON
APPROPRIATIONS. PLEASE OPEN THE
ROLL. SENATOR GLASER. GLASER I
MENGIBAR. IS SHE COMING BACK? I
THOUGHT SHE VOTED FOR IT. VOTE
IS TEN ZERO. THAT MATTER IS OUT.
THAT CONCLUDES THE HEARING.
SENATE HEALTH COMMITTEE HEARING
FOR TODAY, 7:15 P.M. WE ARE
ADJOURNED