Ohio Senate Medicaid Committee - 5-19-2026

Thank you, Mr. Chairman. Good morning, Chairman Roman Chuck, Vice Chair Huffman, Ranking Member Liston, and members of the Senate Medicaid Committee. My name is Brittany Colvin. If you know me or have seen me around the Statehouse, it's usually in my current role as a lobbyist and advocate on behalf of numerous clients. And while I'm usually in the background preparing those clients for testimony before committees, today is a very unusual and special moment for me because I'm here to testify on behalf of myself. I'm not here on behalf of my firm, nor any of my firm's clients, but to share my own personal lived experience battling breast cancer and doing so with the help of a cold cap. In January 2024, I was diagnosed with stage one breast cancer. I had just turned 40 two weeks prior and 1.7 centimeter cancerous tumor was found while getting my first ever mammogram. I never once felt the tumor, not even after diagnosis. That is how small and early my cancer was detected. In March of 2024, the tumor was removed, and in that two-month span, it had grown from 1.7 centimeters to 2.1 centimeters, meaning it moved from stage one to stage two. Because of how fast-growing my cancer cells were, my oncology team recommended that I receive four rounds of chemotherapy as adjuvant treatment to kill any lingering cells that may have broken away from the tumor and could still be in my body. Upon hearing this news, I was devastated. I spent weeks agonizing over whether or not I wanted to go through with the preventative chemo. At one point, I said I would rather, quote, roll the dice and pray that all 2 billion, yes, billion with a B, that all 2 billion cancer cells that were once in my body had all been removed rather than lose my hair. This was, in complete and total honesty, the most psychologically painful decision I have ever had to make. Do I put my body through hell and lose all of my hair just so I can eradicate any cancer cells that may or may not be still in my body in the hopes of prolonging my life? To many, that question may seem ridiculous. A lot of people are quick to say, it's just hair, it'll grow back. And said it to me directly many, many times. But what those people don't realize is that losing your hair to chemo is not about vanity. It is about holding on to your dignity. When a person loses their hair to chemo, the very first reaction everyone has when they see that person is to give him or her a look of pity and think, oh, they must be sick, or, oh, they're dying. Then the secondary reaction is to handle that person with kid gloves. They all mean well. And believe me, before my own experience, I, too, was one of those people. But you need to understand, I was working at that time in a very important role, and the last thing I wanted was to be thought of as less than. I didn want anyone making a knee assumption because of the way I looked that I was weak incapable or unfit to do the work I had always prided myself on and defined myself by Ultimately I changed my mind and decided to proceed with the chemotherapy treatments, and the only reason why was thanks to the invention of scalp cooling, or as it is more colloquially known, cold capping. I brought my cold cap with me today so that everybody on the dais, as well as those both in the audience behind me, as well as virtually, can get a more in-depth understanding. So what is cold capping? Cold cap systems are used to reduce chemotherapy-induced hair loss by lowering scalp temperature to freezing point to constrict blood vessels, thus preventing the chemo from penetrating the hair follicles. There are two primary types of cold caps available, automated or machine-driven, which is what I ended up using, which is this, and manual or frozen gel cap systems, which is this. I used an automated device that connects to a machine that continuously circulates a liquid that is cooled to a specific temperature to freeze the scalp and maintain that frozen temperature throughout the entire chemo session. Other significantly cheaper, more manual systems exist that are basically silicone caps that look similar to a swearer's cap that patients freeze themselves beforehand. So how does it work? For automated, patients wet their hair and then put on the cap, and then the insulated cap over top before each chemo treatment begins. That cap connects to a machine via a tube. Patients then wait for their scalp to freeze before starting the chemotherapy. The cap remains on during the entirety of the chemo treatment and for a period of time after the treatment. I wore my cap at the James Hospital for one and a half hours before my treatment started to ensure full freeze, then 45 minutes while receiving chemo, and then for an additional hour and a half after the chemo is finished. For manual caps, patients freeze the caps themselves by putting multiple caps in their home freezer, then transport them to the hospital in their own cooler, and switch them out frequently during treatment as each cap begins to thaw. Think of it as more of the DIY method. And based on reviews and medical studies, manual caps are significantly less effective, if at all effective, but typically the only option that many can afford. So then how much is machine-driven scalp cooling? At the time, I was working for the state, and so I had what many call the Cadillac of health insurance coverage. I was blessed, but I was surprised to learn that cold capping is not covered by health insurance. So my cold cap cost me, out of pocket, almost $3,000 to use four times. Now, I'm fortunate enough that I was able to pay that cost, but I know my situation is rare. I thought often of the women at the James getting chemo alongside me who couldn't afford a cap and had to simply accept that they would lose all of their hair within 14 days of beginning chemo. What a gut-wrenching feeling to know a solution exists, but it is out of reach for so many. I even inquired about donating my cap once I completed chemo. Unfortunately, I wasn't allowed. Because it is an FDA-regulated medical device, it must be prescribed to an individual. So here I am, with the most expensive sock hat ever, just sitting in my garage. Finally, let me just say that, yes, wigs do exist, and they've certainly come a long way in looking and feeling realistic. But when cancer has taken so much from a woman, being forced to wait two more years after fighting cancer for her hair to grow back so that she can finally return to feeling normal takes such a mental, emotional, and psychological toll. Members of the committee, I recognize that your job is not easy And dozens of insurance mandates Bills are proposed every year My testimony is not meant to suggest That providing health insurance coverage for scalp cooling Is more important than any other ideas you may be considering My hope today is that I have helped you understand that cold capping is not about vanity Cold capping is about preserving dignity, identity, and a sense of normalcy during one of the hardest experiences a person can face. Cold capping is about helping a person maintain control over a part of themselves at a time when so much feels out of their control. And the preservation of a person's hair, thanks to cold capping, lets others know that anyone undergoing treatment is more than their diagnosis and deserves the ability to move through life without immediately being defined by cancer. Thank you so much for your time, and thanks to Senator Chavez for bringing much-needed attention to this important issue. I would be more than happy to answer any questions.

Thank you, Mr. Chair. Thank you for your testimony, and your hair is beautiful.

I do have a question, though, regarding the two different types, or different types, or maybe who knows what's coming.

Will the insurance company be required to, I mean, will Medicaid be required or insurance be required to cover whichever you choose, or will they be able to do, like, say, the dentist, that they'd say, we don't cover, or we cover a certain amount, and then you have to be responsible for the rest of it?

Okay, thank you.

Thank you, Chairman, and thank you for sharing your story. I appreciate it. having a $3,000 sock sock hat seems maybe not good for anybody right? So I guess my question is about the experience that you might have had with during your infusions were there people that were able to tell you about this? Were there any resources that women are provided with or any even I guess support groups that have, could be instrumental in facilitating access in other ways?

Oh. I mean, just. No. No? Okay. And to your knowledge, it's because it's the FDA-approved medical device requiring an individual prescription, which may prohibit. And I see some nods in that. So I will say I'm asking the question, and anyone who wants to answer as they come up, feel free. Just thinking about how I'm sure you would love to make use of what you have already and if there are options for that in the future. So I will withdraw the question and kind of put that concept out there for anyone that might respond in the future. So thank you.

So is the $3,000 for the physical machine and the cap, or is it just the cap with your hose that you have in your hand? Is it $3,000 just for that piece?

Okay, good.

Thank you.

All right, thank you. Chair Romanchuk, Vice Chair Huffman, Ranking Member Liston, and members of the Ohio Medicaid Committee, good morning. My name is Jessica Huffman. I'm pleased to provide testimony today in support of Senate Bill 313. I'm incredibly grateful to Senator Brian Chavez for meeting with me several months ago back home at a local coffee shop in Marietta, Ohio to talk about cancer care from my personal experience. He left that conversation and moved quickly into action by introducing this very important piece of legislation to support cancer patients across Ohio. I live in Belprie, Ohio with my husband of nearly 17 years and our six children. I am licensed in the state of Ohio as a registered nurse, and I have the privilege of serving as the vice president of system nursing strategies at West Virginia University Medicine. I hold a bachelor's degree in nursing from Ohio University, a master's degree in nursing from Xavier University in Cincinnati, and a doctoral degree in nursing practice also and also from Xavier, focused in population health leadership. A lot of people have questions about what does that mean. To give some context, a doctoral degree in population health leadership represents the highest level of academic and professional expertise, specifically focused on improving health outcomes for the entire community rather than individual patients. It combines advanced health science with organizational management, data analytics, and policy design. And I'm here today because I firmly believe that this legislation can help us translate proven clinical research and health data into actionable state policy if we were able to pass it. So I'd like to go through, I will try not to repeat what the previous speaker explained about the service because I think she did a really nice job. But I'll sort of breeze through the health science, the organizational considerations, data, and policy implications. First, one out of every eight women in our country will be diagnosed with breast cancer at some point in their lifetime. That was something that I had studied, and two years ago I went from studying that statistic to becoming that statistic. When I was unexpectedly diagnosed with invasive breast cancer at the age of 36, four years before I would have even had a mammogram because I felt a lump. I also sought care at the Ohio State University James Cancer Center. I had a double mastectomy and lost both of my breasts. I then went through a full course of chemotherapy closer to home in Belprie, Ohio. It's about a two-hour drive for me to get here. And I also had a year of immune-targeted therapy so that I could help prevent future recurrence because my cancer was an aggressive type. When I was diagnosed with cancer, my world flipped upside down. I really wanted to keep a little bit of normalcy. I have a lot of responsibilities in my day-to-day life. And for my children, I really didn't want them to see me looking sick or frail or weak, and I didn't want cancer to dominate every room that we walked into or every conversation that they heard at school. I, again, am very research-focused. I looked up lots of studies on this and saw that hair loss is one of the most frequently reported and psychologically distressing effects of chemotherapeutic agents. I found this to be true in my lived experience. Losing my breasts really didn't bother me too much, but losing my hair was really, really difficult. When I was diagnosed, I had hair extending down my back. It was very long, and I lost all of it within the first few weeks of my chemotherapy treatment. It was bothersome to me, but I was most worried about how it was impacting my children. And so two of my daughters are here with me today, and I appreciate their support. What I found in the research, it also showed that children are negatively impacted by visible changes when their parent looks ill, not only just the fact that they have a diagnosis, but that they look visibly ill to the outside world. My children ranged from 3 to 13 at the time of my diagnosis, and so awareness of what was actually happening with me was limited in some of my children. and I had to use very age-appropriate explanations on what was happening to me at that time. But what I learned is that children can feel disconnected during this process. They may not be able to really express how they're feeling or what they're going through, and they can be burdened by worries about their parent dying, which is something that no child should have to worry about. By ensuring all Ohioans get access to some sort of affordable option for scalp pulling treatment I think that we can really lessen the emotional injury for children that are impacted by a parent in circumstances like mine I not going to go through a lot of detail about how the scalp cooling systems work, because I think that that was already really well explained. But I didn't personally have the option to use scalp cooling in my community. My local cancer Center did not have the service at the time. And to expand on the previous speaker, the hospital typically purchases or leases permanent equipment, and then each patient uses a personalized cap that plugs into that equipment. And my hospital did not have any of the devices in the clinic that would have been necessary for me to use the treatment. Again, living two hours away, it was not going to be feasible for me at that time to travel more than weekly sometimes to get treatment and still balance my family and my career responsibilities. However, I became really interested in this. I think it's really, really amazing technology, and I started going into the data and saw there was extensive data published by the American Cancer Society that shows it does not increase your risk of cancer spreading somewhere else? That was a question that came up for me. If you use it, does that lower your risk of metastases? And it did not. The side effects were reported to be minor and temporary, though I did not personally go through that, of course. It's not a universal solution. It's not available for children, unfortunately, for children that have cancer. It's not for people that have maybe a brain cancer or a skin or a blood type cancer where you need the chemotherapy to cycle through that area. Those with cold hypersensitivity probably don't want to use this treatment as well, but it does have really good results with taxane-based chemotherapies, which was the type of chemotherapy I was on. So if it had been in my area, I probably would have used it personally. As a registered nurse working in a large health system in a system-level role, I'm often thinking about operational and resource considerations as we evaluate new services or treatments for patients. And something I know is that access to care is really important in rural areas. And so one consideration that I know from a health care executive would be having is, was that going to lower our chair time? Can we keep getting enough patients through the door for their treatments? And I talked to many different colleagues from hospitals in Ohio and West Virginia that offer the service, and I did not hear from any that they had a lower access to their infusion center because of offering this service. So I think that's important. There are some centers that are also using equipment. I think there's three FDA vendors that have scalp cooling systems that are mechanical, and I know one of them now has a movable device that looks more like a rolling luggage, so they can do their treatment in the infusion chair and then maybe wait in the lobby while they need to finish with the cooling. So it is really important, I think, with increased cancer incidence that we are keeping sure access is going in the clinic. And then something that was really, really important to all of us this year is that as of January 1st, 2026, the American Medical Association officially replaced temporary Category 3 codes with three new permanent Category 1 CPT codes for mechanical scalp cooling The Centers for Medicare and Medicaid Services also added mechanical scalp cooling to the Medicare physician fee schedule and the hospital outpatient payment system. So there are billing mechanisms for reimbursement, which makes it a lot easier for the insurance companies as well. But I think this transition is especially important. and it helps establish a stable, predictable insurance reimbursement pathway for the health care providers that does cover everything from the initial cap fitting through the patient education, pre- and post-cooling increments in time. I think assessing health care mandates, we want to be really careful about what we're mandating, and I think one of the policy concerns with this legislation is the financial burden that it could place on a health care system or insurance premium pools. So that's something I've looked at quite a bit. There's several different states, as I'll mention here in a minute, that are looking at similar legislation, and there's been some really great studies that have come out about this that weren't around a couple of years ago about the financial implications. What I've seen by reading lots of different articles and testimony is that it really represents a microscopic drop in the bucket compared to the total cost of comprehensive cancer care. Right now, many insurance companies pay for a wig. The wig that I personally bought for myself was over $1,000. I've established a fund at a local community foundation where I'm also buying wigs for women that don't have coverage, and most of the human hair wigs that we're buying for them, to get them hair that look maybe like their natural hair, they've ranged between $1,000 to $2,000. So we're seeing a reactive approach being funded by insurance companies, and so I think that this would give us maybe save the cost on paying for a wig and be proactive in paying for them to keep their hair. I think for the average Ohioan, we're also feeling the crunch of daily expenses going up. It's an expensive time to live, and so it's important that we're looking at what the costs would be for people if we don't pass something like this. The expenses vary by vendor and by insurance company and hospital, Of course, those are all negotiated prices, but I'm using the figure 2,500 in my expense calculations. And I pulled all of my own cancer claims since January of 2024 when I was first diagnosed. And if I would have used this, it would have represented less than half a percent of my overall medical claims for cancer care. So just to show you how small this would be in comparison to everything else that we are currently covering. Right now, Medicare, Medicaid, some private insurance plans, they may be covering some scalp cooling treatment, but it's widely varying. So what we're asking for with this is that across the board we have consistency, so that all patients are having that access that have insurance. Right now, the access seems to be more on those that can afford it or maybe those who live in more urban areas and leaves those that are living in more rural areas or are in a lower socioeconomic bracket without the ability to access this treatment So it creates a two system If we look at our own state health data I reviewed the Ohio Annual Cancer Report for 2026, and breast cancer remains the highest volume of new invasive cancer cases in Ohio. We have about almost 11,000 cases per year, and female breast cancer mortality rates in Ohio have declined, which is great. We're seeing more people diagnosed with cancer, and earlier on, that's been increasing by 0.8% annually during the same period. So more people are being diagnosed, but more people are also living a longer time, which is very great. However, there is a lot of research out there that talks about a strong correlation between the health insurance status and breast cancer outcomes. Uninsured patients and those on Medicaid consistently experience higher rates of late-stage diagnosis. They're not getting diagnosed earlier on when their prognosis is going to be worse. They are often experiencing treatment delays, and this is in comparison to privately insured patients. In Ohio's rural areas, like where I live, a disproportionate number of residents do receive later stage diagnoses due to what they're calling oncology deserts, so having to travel long distances to seek care from specialized facilities. Rural patients are already burdened by immense travel costs. A lack of coverage for this kind of treatment will make, I think, access to this really impossible for some of these communities. I don't think, again, we're not asking Ohio to be the first in the country to try this out to see if it's something we want to do. It's been FDA cleared for almost 10 years now, and we have seen a law passed in New York as the first state in the country. Louisiana passed after that. I work in West Virginia, and we passed a law this year that they actually named the Jessica Huffman Law after me for scalp cooling legislation, and Maryland just recently passed a as well. There are 10 other states with active legislation at this time, so it's something that is gaining momentum in the country, and I think it's wonderful to see that as someone that's gone through this. For me, I love my job. I'm so proud to be a registered nurse. I love doing what I do, and so I really wanted to keep working and supporting my family. I'm also very active in my community. I wanted to be able to keep going out, supporting local businesses, eating at restaurants that I love, going to my kids' schools, but I wanted to walk into meetings at work and be seen for my contributions and for my value, not for my diagnosis. And because I was completely bald, which was very different than my normal appearance, everybody saw me as somebody that looked sick. I could have taken a leave of absence or gone on disability during that time, but I didn't want to. It was brought up to me more than once, and I wanted to keep working. I actually I attended my daughter's high school orientation the same day that I had surgery in Columbus one morning. So I wanted to be there. I did not want to miss out on my kid's childhood. But I didn't want my kids to have a stigma because their very sick-looking mother walked through the door. When I found out that I had cancer, I prayed so hard to God that I wanted to live. I had so much living I wanted to do. And I didn't want to wait until I was done with my treatments to live. I didn't want to spend my time just in the cancer centers getting treatment I wanted to take trips with my family and be there for my kids childhood go to church go to sporting events, and I looked visibly ill, and I felt really good inside, and it stunk because there was times where I kind of forgot I had cancer, which was sort of a blessing because it was on my mind all the time, and we'd be out, and then I would catch a glance from somebody, and I would see how they were looking at me, and it would kind of bring me back down to earth, and I would remember what I was going through at that time, but I wasn't the only one that noticed that. Kids are so intuitive. My kids would see that. And I didn't want that to make them feel afraid about, I'm telling them I'm okay, I'm going to be all right, these treatments are working. But I didn't want them to think that there was something more wrong with me because the looks I got from people were looks of pity, and it was not that great. So that was hard. It's just something that kids should not have to bear. And unfortunately for me, my six kids did have to. So I tell you all this because, honestly, before I would have gone through this, I may have thought something like this was something about a little more related to vanity. Like, it's hair. It grows back. I have a whole new appreciation after I've gone through this. I think I'm a pretty good nurse. I've taken care of cancer patients before. I think I'm compassionate. I thought I knew what people were going through, but until I actually was in those shoes, I have a whole new perspective on this. I was so lucky to have a good care team. I had wonderful resources to eradicate my cancer. I am a cancer survivor. I continue to follow up. I have no evidence of disease, and I'm so happy about that. When I read about New York passing this law, it was something that was on my mind. I didn't even use this system, but I felt this is something that could really help a lot of patients in the future. So I have nothing personally to gain. I've already lost my hair. It's coming back nicely, but I want to help this so that other people do not have to go through this in the future. We have the advanced health sciences to prove that it works. We have the organizational data to know how it can be implemented, how we can balance the financial aspects of this. And we know that it's really a microscopic fraction of the overall cancer expenditures. So the final piece here is the policy design. It's important that we have a good bill. So on behalf of thousands of Ohioans living with cancer and those that will unfortunately receive a diagnosis in the future, on behalf of the children who have to go through the terrible experience of hearing their mother say, I have cancer, I urge this committee to vote in favor of Senate Bill 313 and to help us ensure compassionate and comprehensive care is available for all Ohioans. As a breast cancer survivor and nurse leader, My two worlds, I feel like, have collided. What I've been in life is coming together. What I found is that, like the previous testimony, for me, I didn't really think much about it. I was going to do whatever I had to do to be able to live. So losing my hair, I chose to lose my hair. But what I found is that up to 8% of women that are given a diagnosis and the doctor tells them that they need to have chemotherapy be do not seek treatment because of losing their hair. And that's shocking to me. If you think about the 10,000 people a year, if you look at 8% of them that are not getting treatment, I think the legislation could save lives of Ohio women. So thank you very much for the opportunity to speak today. I'm happy to answer any questions the committee may have.

Thank you for giving me the chance to speak today. My name is Julianna Huffman. I'm the daughter of Jessica Huffman. I'm a sophomore at Warren High School in Vincent, Ohio. I'm here today in support of Senate Bill 313. When my mom went through cancer treatment and lost her hair, it affected our whole family. My little sister Eloise was only four years old at the time, but she still noticed how hard it was on our mom. At Christmas, Eloise got to shop with her preschool class at the Santa shop to pick out presents for our family. She bought my mom lotion and called it hair growing cream because she wanted so badly to help her hair come back. She was so excited to give it to my mom on Christmas morning. I also remember Eloise drawing pictures of my mom often. She would draw hair on my mom's head and point out that my mom looked happy with her hair, even though my mom was bald at the time and still going through treatments. Personally, I will never forget helping my mom shave her head on Mother's Day morning after her hair started falling out from chemotherapy. These memories show me that hair loss during cancer treatment impacts not just the patient but the entire family. Senate Bill 313 is about scalp cooling. The scalp cooling is about so much more than appearance. It helps patients keep their confidence, their dignity, and a sense of feeling normal during one of the hardest times of their life. Our family didn't get to experience this, but knowing that it is available and up for consideration and knowing it could help so many patients in Ohio and their families makes me really hopeful for the future. Thank you for your consideration and your time. Thank you. Thank you.

we sincerely ask that you support Senate Bill 313. Thank you. Thank you very much.

Thank you, Mr. Chair. And thank you, all three of you, for your testimony. And your hair is gorgeous. I do have a question, since you didn't use a system. Is your thinking that Medicaid and the insurance companies would be required to cover which system? Because though it's a cooling system, there are several different means of doing that. And so are we saying that the $3,000, which unfortunately with health care costs may rise to something well beyond that, or should the insurance company be choosing? This is kind of the same question I just asked. Will it be up to the plan? Say your work decides what plan you have. You have a big plan that covers everything. You have another plan to cover some things. And then so what is the requirement going to do? And I will say this. You mentioned something that's really very, very important besides all of this, and that's late stage diagnosis, which unfortunately comes for some people, poor people, minority, whether they're urban or rural, all too late sometimes. So that's another issue that needs to be addressed and who covers that earlier on. But for this one, the question is about what system do you pay for or what do you expect us to pay for?

Senator Ingram. Thank you, Mr. Chair. So I think we have to be really clear about what that expectation is and what the amount would be. And so maybe if we took a look at the language that's in West Virginia or what was the other state, Maryland? New York, Louisiana, and Maryland. And what they're actually covering and who's paying for that. So that makes a difference as to how we proceed because there would be different providers. I know the first speaker mentioned a provider that particularly carries a certain product, and so that would make a difference, I think, because I think it's important for us to do the cooling cap. It's not vanity. It's about how you feel about yourself, and I get that part of it. But many people would look at it, and when they start to add the cost, and we do this on a lot of things, unfortunately, which is why people get diagnosed late. So, I think that what I'm hearing is that this amount that we're looking at that we're requiring would be for the mechanical piece. Okay. Thank you.

Are there any other questions? Senator Huffman.

Through the chair to Senator Huffman, that's not what my understanding is of this discussion. Right now, the cost share when we did fiscal notes with the other state was to provide a lot bigger coverage, but to also include coinsurance and co-pays, but then to provide that coverage after the patient portion was met. Okay. Thank you.

Okay, thank you.

Thank you. Good morning, Chair Romanczyk and members of the committee. My name is Melissa Borstam. I represent Paxman, manufacturer of FDA cleared scalp cooling systems, and I think we'll be able to give you a little clarity on some of your questions. My role with Paxman is one of advocacy and access. You will also be hearing from my colleague, Sissy, who is a cancer survivor in addition to working directly with providers. So I'm here today in support of SB 313. And scalp cooling, as you've heard, helps reduce chemotherapy-induced alopecia. and for many patients, including many of the survivors that are here, this is significant to their emotional well-being, privacy, social functioning, and normalcy during treatment. So I'm going to leave that part of it to our advocates that are here to talk with you about. I am happy to address some of the questions that have already come up related to coverage and also the different systems. And first, a little clarification. So there are three systems that currently have FDA clearance. As a result of a merger last year, two of those systems are now manufactured by Paxman. So there's the Paxman scalp cooling system, which is what you saw the cap of earlier, and then there's also the Dignacap scalp cooling system, which is very, very similar to that. Both of them have a machine, and then the patient typically gets this kit that has their own cap. and those are both FDA cleared. Then there's a third system also on the market as Jessica referred to. So the main thing with the FDA clearance is that all of these devices have had to go through the rigorous FDA clearance process to demonstrate efficacy and most importantly, safety. The manual caps, as you talked about, that are available for patients to order online have not had to demonstrate that safety. Although they are, in cases of many regimens, effective for some patients on some regimens, there certainly is some concern with safety. But as it relates to a mandate like this, more importantly, there is not an established regulatory pathway or an established reimbursement pathway, rather, for those. So the CPT codes that the AMA issued, about four years ago we had Category 3 CPT codes issued, and then this year in January they were upgraded to the Category 1 codes. Those are specifically for the mechanized scalp cooling systems. It might help a little to know that many people in the industry refer to those three devices that are FDA-cleared as scalp cooling systems, and all the others are cold caps. So that kind of you are putting those either in a medical freezer or in dry ice and you have to change them every 20 minutes It a very excruciating process and very labor for the patient So for the FDA scalp cooling devices I can speak to the CPT codes which there were fee schedules that were issued from both the outpatient and physician fee schedules. So there are corresponding payments from CMS for those. And additionally, we are concurrently with all of this legislative activity in discussions with all of the MACs across the country, including CGS, to work toward having a coverage decision for the MAC. So that kind of will address a bit of the potential discrepancy on the Medicare side. Let's see. we've already talked about the machines there at the center. I'm kind of skipping through some of my notes because you've already heard some really good information. So clinically scalp cooling is very well established. The NCCN clinical practice guidelines do include scalp cooling with a Category 2A treatment recommendation. And as these new codes became effective in January of this year, we're really working toward establishing scalp cooling as standard of care. So these broader reimbursement pathways will now help support that for provider-delivered scalp cooling. One of the differences, and where we are right now, there are currently about 50 providers in the state of Ohio that have either the DigniCap or the Paxman system. What we are doing right now is we're in the process of switching those providers over from the direct pay model where the patients get the prescription but go online and order the kit, to what we call our insurance-based billing model. So I know many of you have a health care background. You can appreciate that that's an administrative change for the practice. So instead of the patient putting this on their credit card or whatever, the practice is going to purchase the supply, and then it's entirely administered by trained people in the provider's office, usually the nurses in the oncology-appriced suite. So then they're the ones that are going and filing for this reimbursement. That's the established pathway that works with the CPT codes. The manual caps, the nurses are not ever going to be able to administer those. There's just not a pathway for that. So what I can share with you, you might want to take note of, in California, Bill AB 1682 is currently pending and has had several hearings already. That is right now a bill that also includes Medicaid, similar to Ohio. But one thing you might want to look at in the language of that is that the oncologist who brought that to the attention of the Assembly very wisely suggested that there's a requirement that the coverage for scalp cooling is commensurate with the coverage for chemotherapy. So if you're covering chemotherapy at 80% or 100%, someone's not just getting $100 for this other scalp cooling treatment and being left to cover that cost. So that has been a nice concept there. I would say the California bill is the most specific of the 15 that have been introduced in this cycle. And they also the California Health Benefits Review Program issued two separate very detailed analysis one that includes a lot of fiscal analysis and the other one a technical analysis done by an independent third organization Those are both available online. I'm happy to email it to all of you. But the upshot of the whole thing is that the cost of this, based on the numbers, the projections they used in California to the state, it's approximately one penny per month per insured, so about $0.12 per year per insured. And that is very comparable to the fiscal study that was done this past year in Maryland. Also found it was a little less in Maryland than one penny per month per insured. So for $0.12 to $0.14 a year, that's the kind of cost that we're looking at. I think the interesting thing with scalp cooling is this seems like it's a really huge impact on the patient. The actual cost of this, you know, we're talking about $2,500. In the scheme of Jessica previously shared with me, her overall treatment cost was $650,000. So, you know, it's really a very, very small cost for a significant improvement in overall wellness and quality of life for the patient. Let's see. The other items that I was going to talk with you about, you had asked about support, other groups that might offer patient support. In addition to training the providers, usually this comes up at a chemo teaching appointment. So you've got cancer, you're going to start chemo, and they'll have them come and sit down with the nurse to find out about all of the different side effects that they will likely encounter during chemo and prepare them for that. that's typically when they introduce them to scalp cooling and let them make the decision about whether this is the right treatment. There are several organizations across the country that are foundations that do provide a little bit of financial support. Many of them, though, are limited by what the income level is. So it might be four times the federal poverty level. Depending on where you live, that could be a large number of people or a small number of people. So some of those foundations are also quite supportive of this because they feel the need is there and they just don't have the funds that they need to support everybody. As we talked about, scalp cooling is not new or experimental. This really, the goal of all of this legislation is to align insurance coverage with the technology and services that are already in place. So the momentum really is building nationally. We've talked about New York and Louisiana. Maryland and West Virginia have enacted legislation. West Virginia was the first to include Medicaid and state employees. But importantly, Connecticut also has just had both chambers pass this legislation. The governor himself had issued testimony related to the bill, so we have no doubt the governor will be signing this in Connecticut and hope to see that in the next couple weeks. I talked about California that are with Medi-Cal coverage. that that's advancing, and then there are nine additional states that still have, including Pennsylvania, New Jersey, Vermont, Rhode Island, that still have legislation that's viable in this session. So the question before you really is not whether scalp cooling is clinically accepted or available. It just whether access should continue to depend on a patient ability to pay during their treatment The bill represents an important opportunity for you to join this growing national movement and I really thank you for your consideration Thank you.

Yes. Good morning, Chair and members of the committee. My name is Sissy Carrigan, and I am here representing Paxman Scalp Cooling. Thank you so much for the opportunity. I'm really honored to be here to speak today in strong support of House Bill 313 to require insurance coverage for scalp cooling. I'm here as a two-time survivor of breast cancer and also a scalp cooling advocate. I was diagnosed with stage 3 HER2 positive cancer in 2004, and then again I had a recurrence in 2012. During both rounds of treatment, I did lose my hair to chemotherapy, and my first concern, like many patients facing that diagnosis, was survival, but also how it would affect my children first, and also my privacy, my ability to maintain some sense of normalcy during treatment, and that's very difficult to do when you lose your hair. Hair loss for patients is deeply personal and affects you in so many ways and has nothing to do with vanity, as some of our other speakers have shared. It is the most feared side effect in more than 75% of patients, and it changes how people see you and how you see yourself. It is the most visible indicator that you are receiving chemotherapy treatment. At my second diagnosis, I needed to seek employment before treatment ended. I was trying to move on with my life, But employers ruled me out because of my appearance, and I was forced to accept a position that I was overqualified for and was not adequate in terms of salary. And that was quite shocking to experience. And I can remember being in an interview with a few people and just the looks on their faces, and I knew they were wondering, questioning what was happening with me. So it was obvious that I was facing some or receiving some type of treatment. More than 70,000 Ohioans were diagnosed with cancer in 2025, and many of them will face the same challenges that I did if this bill is not passed. That is why scalp cooling matters. scalp cooling allows patients to live normally through treatment and preserving their hair can help them preserve their dignity, their privacy, and their self-esteem. And if in the case, in my situation, having children was particularly challenging, they were four years old, and I did not want them to have a memory of me with no hair. That is too startling and frightening for four-year-olds or for any children. And so I wore a wig all the time so that they did not have that experience. I've been with Paxman since 2017, and I wanted to be a part of bringing this, what I think is miraculous. Sorry. Life-changing treatment to patients in the U.S. As an educator, I'm fortunate to work with patients, doctors, and nurses every day, and I see the positive impact that scalp cooling has on patients who are so grateful to feel and look like themselves and be able to live normally. It is an enormous benefit. Thank you. But unfortunately, many patients cannot access scalp cooling because insurance coverage is unavailable. And then the decision to scalp cool is often based on financial ability. For families already facing treatment costs, that is an unfair barrier. And this bill would help correct that imbalance. By requiring insurance coverage for scalp cooling, you would make it possible for patients, more patients to benefit from this option without being forced to pay out of pocket. And no patient should have to choose between their dignity and financial hardship to preserve their hair during cancer. I urge you to support this bill and make insurance coverage for scalp cooling a reality for chemotherapy patients. Thank you for your time, your consideration, and your commitment to patients and families across the state.

No. No. Okay. No, so success really is dependent on multiple factors, but which regimen you're on, the quality of your hair, how you take care of your hair is critically important, all of those things. And we do give people very detailed instructions in terms of what they want to do to ensure success. No, thank you.

So I think the easiest way to think about this is that because of the reimbursement situation when we first brought this to the United States 10 years ago and there was no reimbursement, the fastest and easiest way to make this available to patients was just to order it online, right? That was the way you got it out there. But now we're in a situation where getting people switched over to this insurance model means that we will be like everything else in an infusion center. There's nothing else in the infusion center that they say, oh, go order this port and bring it in and we'll put it in for you. Bring your blood pressure cuff with you. Bring your, you know, IV pole. There's nothing else in a hospital like that. This really was an anomaly in that sense. And so part of this also for us as manufacturers is standardizing this into the regular workflow for the clinic. So for Paxman and DigniCap, you know, we do have the device, which, by the way, is part of our insurance model. They pay nothing for it. There's no lease fee. We just give them the device. And then they are billed on a per-patient basis for purchasing the kit, which contains the cap that you saw. So there's a very fixed cost whether that patient has to have four treatments or 16 treatments. They're just paying one time to give them that kit. And then there actually are three CPT codes. The first one includes the supply and the training for the patient. And then there's a code for, with each infusion, there's a code, there's some work that's done by the nurse before treatment where they're putting the cap on, They getting their hair wet they putting the cap on all that kind of stuff And then the whole time that they sitting there getting their infusion due to the conversations we had with CMS about the structure of these codes that's actually cut out because they're already being reimbursed for getting chemo, right? So that's not billable. But then there is additional chair time that they need to be wearing the cap. They may be doing that in the infusion center. All of these devices are portable. They can move them someplace else to a lounge or something if they want them out of the infusion center. So then that chair time is billed in 30-minute increments. So with certain regimens, you may be wearing the cap for two hours after. With adriamycin, you might be wearing it for three hours afterwards. And so they're able to bill that time. And that's a big value point for providers. You know, as Jessica mentioned earlier, like chair time is the premium in a cancer center. And so they wanted, in order to be able to afford to offer this, they have to be able to get reimbursed for the fact that that patient's sitting in the chair. So overhead, so by putting all of this into the provider for ordering everything, it also just really simplifies the delivery of the care and the supplies. That answer your question?

Okay. I mean, it's the supply and the service, and of course they have to be trained to administer the service. You know, the cap, like even though we have the cap and you look at it, that means nothing without the machine to stick it into. So the cap is really only part of it. That is the part that was easiest to, that's the single patient, like these are all cleared as single patient use devices. Because you're wearing it during chemo, also you may have toxic, the chemotherapy may be excreted through your system. Multiple reasons, it's single patient use. And so that's kind of part of it. but then the machine that's there is very much staying in the center, maintained by our companies, going in for preventative maintenance, that kind of thing.

Right. So when they're paying out of pocket, typically some facilities are paying a small lease fee. We're talking about maybe a couple hundred dollars a month. Some of them are paying a small lease fee to have the device. Some of them right now are not. I mean, we're really all over the map right now in terms of models because this has been such a transition over the last couple years. And so then the patients are only paying, right now they pay, what, $1,800 to get their kit. They pay $1,800 to get the kit, and then they use that as many times as they need to for their treatment.

in terms of like the overall plan for treatment. So for instance, it's already loaded in their Epic system and it's, you know, they ask the patient, right? And that's, that's the other part of this. We're not saying this is right for every patient. It's definitely a choice. Do you want to be cold, you know, while you're sitting there during chemo? Do you want this to take an additional two hours, if you've got a long drive to get to your treatment anyway, that might not be something you want to do. But on the other hand, maybe it is. So, you know, it's an option that in those cases, it would come up as part of their whole capsule in Epic, and you check off, you know, the things that they want to do. I think it's certainly like, as we look at value-based care and minimizing additional complications down the road, patients are more and more seeing the value of, especially just addressing, you know, the overall wellness, right, of even when you have something like the flu, you know, you wake up in the morning and you look at yourself and you go, oh, I look horrible today. I'm just getting back in bed, right? And when that happens for a cancer patient and they look at themselves and they don't even see themselves in the mirror because now you have no hair, you just look sick, right? So you maybe you're not as inclined to get up and go for a walk out in the sunshine or go to work or take care of your kids, like all of those things are harder when you don't feel like you look your best. So many physicians have shared with us that they do feel that this is really important just for overall wellness. And then further down the road, you know, patients just feel like they've also

Senator Huffman.

Okay, are there any further questions? Seeing none, thank you so much for your testimony.

So we have three more witnesses. Are you together the next three, or are you separate?

Okay. Okay. Stephanie Van Fleet, if you're ready, please proceed.

He's the chair. He's the boss.

Okay. Yeah, we got a pretty good look at it. We can, if you want. Yeah. Okay.

Are there questions? Just one from me. In your testimony, you said your out-of-pocket was a total of $2,000. and you go on to say that you had an amazing support system that helped make that possible. How did, was it your insurance? Were you private pay? Private pay.

Seeing no other questions, thank you for your testimony. Can I address one thing? Sure.

of when you were going through treatment and being introduced to all of the chemotherapies and such, and what that looks like for particular patients.

Thank you. Thank you. The committee would now like to call Philip Smith.

Please.

Learning about cold capping gave me a bit of hope and control over my situation. Beyond survival, my biggest concern is how having cancer will impact my child. I appreciate so much that his mom can still look like the mom he's used to. despite many other things happening. I still have to battle many side effects during chemotherapy, such as strong nausea, joint pain fatigue shortness of breath but so far I holding onto my hair which allows me to still feel a little like me I miss feeling normal But for now, I am grateful that I still look normal. Like the mom and woman I am inside. Thanks in part to scalp cooling. While I'm acutely aware, having cancer at all times, I'm so thankful when I look in the mirror, see a photo of myself, I don't see someone with cancer. This has helped my mental health, my quality of life, and my outlook to be a bit brighter. Jenny Shaw-Smith. We're fortunate that we're able to access this treatment. Many families facing cancer are already struggling with financial burden of treatment itself, and scalp cooling remains financially out of reach for so many patients who benefit from it and want the option. But I do think it's important to recognize, and I think this addresses something, Senator Huffman, that you've raised, and I think validly. This is not an easy or a comfortable process. Not every patient will choose it, even if it's provided to them. Not every patient will, number one, feel it might be worthwhile for them personally, or it might be too painful. It might add the extra three hours like it does for us. The majority of people who would choose this option tend to be younger women, and it tends to be those who are struggling to juggle careers, juggling family, juggling those that matter so much to them. I think that there's a self-limiting factor to those that would choose this option. I don't think that it's something that would be accepted by 100% of those who are given the option. But those who do value this option, it's really important. and I don't want them to lose access because of cost. Because breast cancer is increasingly affecting younger women during prime working and family-raising years. We were just talking about this with our nurses, many of whom continue working and caring for their families throughout treatment whenever possible. I think if you just look around this room, you'll see that to be true. Supportive care that helps preserve dignity and emotional well-being during treatment should not be available only to those patients who can afford the significant out-of-pocket costs. I do believe that Senate Bill 313 recognizes that quality of life during cancer treatments matter. And I respectfully ask the committee to support it. I want to thank Senator Chavez for introducing this legislation and for recognizing the importance of supportive care for patients and families navigating cancer treatment I thank you and I be happy to answer any questions you might have Thank you for your testimony Are there any questions

Yes.

Actually, our insurance is actually out of the state of New York, which just recently passed requiring the coverage of it. And as you know, insurance works, or doesn't work sometimes, In a delayed fashion. And so I actually don't know how much of it is covered so far or if we're going to bear the out-of-pocket costs. But like I said, we're in a financial position where we could, and so many aren't.

Thank you.

Good morning. My name is Erin Green, and I'm currently undergoing chemotherapy for breast cancer at the Stephanie Stoops-Spielman Center. I have my last and final chemo next Tuesday, and I can't wait to be done. Sorry. Because of the Paxman cooling system, you would not know I have cancer just by looking at me. It has helped me keep a sense of normal life. I can go to my kids' soccer games, go to school. But this option is not covered by insurance, and many patients are forced to pay out of pocket. or they go without it. I ask you to support Senate Bill 313 so patients can have access to CoolScalping during chemotherapy. Thank you for your time.

Thanks.