PA House Appropriations — 2026-03-12

We're about to get started. Thank you.

Before we begin, Chairman Struzzi, any introductory comments? Yes, thank you, Chairman Harris. Good afternoon, everyone. Welcome. You'll see happy faces this afternoon, I'm sure. Just for an overview of the current proposal from the governor for your department for the upcoming fiscal year of 2627, he is proposing a $260.3 million budget, an increase of about $740,000 or just 0.3% over the current fiscal year. with about $48 million for the Department of Drug and Alcohol Programs, an increase of 30,000 or 0.1% over the current fiscal year. Obviously, a lot of things to discuss today related to health care, and so we will go ahead and get started.

Our opening? My bad. I'm sorry. Sorry.

Yes.

Thank you so much. Good afternoon, Chairman Harris, Chairman Struzzi, and members of the House Appropriations Committee. Thank you for this opportunity to discuss the proposed fiscal year 2026 budget for the Department of Health I joined here by Executive Deputy Secretary Kristen Rodak This budget supports the health of Pennsylvanians with funding to continue improving outcomes for mothers, children, and families, investing in health research, boosting emergency medical services, and addressing critical health care workforce needs, especially in rural areas. In short, this is a common-sense, balanced budget for Pennsylvanians. It's been a busy year for us at the Department of Health. Last year, with investments made by the General Assembly, we were able to, among many other things outlined in my written testimony, continue support for regional maternal health coalitions to improve care for mothers and babies, provide equipment and training to support EMS professionals as they responded to calls from more than 2.2 million Pennsylvanians, and coordinate with local, county, and state partners to efficiently respond to more than 20 emergency situations, situations, including the recent fire at Lehigh Valley Health Center in Dixon City and the explosion at Bristol Health and Rehab Center in Bucks County. The proposed 26-27 budget will allow the department to continue to focus on improvements in many areas of public health and safety, including improving maternal and child health with a focus on preventing infant deaths, investing in neurodegenerative research to find new treatments and cures for this generation for generations to come, providing period products in schools so students can stay in class and focus on their education, and continuing to support EMS professionals across the state. I look forward to working with all of you to implement this sound budget proposal that enhances the health and well-being of all Pennsylvanians. And I'm happy to answer your questions, but first I'll turn things over to my colleague and friend, Dr. Latika Davis-Jones.

Thank you. Now, Chairman Frankel.

Thank you so much for that question about our program, our medical marijuana program. You know, the Department of Health is tasked with ensuring safety for our program and access to safe medications for patients who need it. Again, this is a medical program, so the people who receive these have underlying health conditions, cancer, seizure disorders, and other things. We're certainly aware of the nationwide concern around lab and lab oversight, the issues of THC inflation, saying the products have higher rates of THC than they do, passing products that don't meet strict regulatory requirements. so it's essential that all of our labs that are certified follow the best policies and practices to ensure patient safety. These labs are really the last stop before the product gets to people, and so we want to make sure that they're doing their job and that they're doing it well. I think we really look forward to talking with you all on what statutory and regulatory options we have out there to ensure that we have the safest products out there. And so I look forward to working with you on potential opportunities. And we have a bill that we sent out of the House. It's sitting in the Senate now, House Bill 33, which will help, I think, give us a more robust testing agenda for the state. Let me turn to something else that was actually brought to my attention. I spoke to Dan Myers about it earlier. it came to my attention that we have a health quality initiative that was federally funded by COVID dollars to the tune of about $25, $30 million that would be available to the Commonwealth. And this was before your tenure, obviously, as Secretary of Health. And that would provide free, high-quality, portable air purifiers to mitigate the spread of COVID, influenza, bacteria, mold, and other airborne pathogens. The program is run through DOH And there money that there that may have to be turned back to the federal government if it not used And it hasn't been publicized for a while. It seemed to me that it's really an opportunity, I think, still before we have to turn back what looks like about somewhere between $12 and $15 million to be able to kind of reinvigorate it. And I think it would be something that members of the General Assembly would be, you know, very interested in being able to take back to their districts as opportunities to get these air purifiers out. And I was hoping you guys might be able to help facilitate that and to maybe reinvigorate the opportunity to publicize this. Sure. Let me tell you a little bit about that program. So as you stated, during the pandemic, it became really discussed widely that HEPA filters are a way to reduce airborne spread of infections, particularly respiratory infections. And so we had COVID funding that we have been using to purchase and distribute HEPA filters to particular types of organizations, to child care programs, to senior centers, to libraries, to schools. and I believe we've distributed about 17,000 of those this year. And that program, the funding is going to be ending soon. And so we're happy to talk with you afterwards, but the program has been out and we did reach out to many, many organizations across the state that met our criteria for eligibility. But happy to discuss with you after. I think our members would be glad to help get that message out and those opportunities out to organizations in our district. So thanks so much. Appreciate it.

Thank you to the testifiers. Appreciate you being here. And I'll keep my questions truncated given the lateness of the appropriations hearings through these last couple weeks. If I were to Google EMS in Pennsylvania, there's another word that pops up, and that would be crisis. Secretary, would you characterize the EMS system in crisis today as well?

Are you optimistic that funding help is on the way, either Medicare reimbursement, insurance reimbursement changes? I know there's some products out there, Hospital 1152. Are you, as an administrator, embracing anything in particular?

I was an EMT for 30 years. I have my own ideas about high turnover. In terms of your perspective, why are we seeing such high turnover?

Yeah, paramedics, EMTs.

You're right. People do move from EMTs to less stressful jobs. I made a mistake of going into the legislature thinking it would be less stressful. They don't call you at 2 in the morning to get out of bed, do they? And just finally, in terms of recruitment, have you found any particular approach to be more efficacious than others drawing people into the field?

Thank you for taking those steps, Secretary. Thank you, Mr. Chairman.

Mr. Chairman, thank you. And Dr. Jones, Dr. Bogan, as well as your staff, thank you for the critical work that you do. Let me begin by asking you these questions. The recent drug surveillance report actually showed an increase in overdose deaths involving stimulants. Can you talk about the factors that you think are contributing to that rise, and then what strategies might be able to address it?

I think you. I think she covered that.

I appreciate that response. Secondarily, we're also seeing an increase in emerging intoxicating substances, including new synthetic opioids, synthetic kratom products, synthetic cannabinoids. Can you talk about the steps the department is taking to monitor and respond to those substances? And then secondarily, what actions do you think this legislature might be able to consider to help ensure they're not reaching consumers, particularly when they're being sold through storefront retailers?

And I'm sure Dr. Davis-Jones would like to add to that. And I'll just pick up from right there. The committee that Dr. Bogan is referencing is our interagency substance use response team. and we are convening agencies again across the Shapiro administration to examine intoxicating hemp derivatives and other products sold at gas stations and throughout Pennsylvania We do recognize that these products are totally unregulated at this point under the current law and we're making some serious you know inquiries about what we might do in the future and so we've been meeting over the past I want to say maybe six to eight weeks taking a deep dive looking at what's out there and what we may be doing in the future. And so we want to make sure that when we move forward that there is public awareness and that there's transparency about these products that are in convenience stores across the Commonwealth. So it's a work in progress.

Listen, I appreciate your responses. My time has expired. Thank you, Mr. Chairman.

Thank you. And I guess the question will, or less, be for Dr. Latika Jones. The D-DAP, D-DAP has oversight over recovery houses and making sure that they're compliant with federal, state, and local laws. What steps does D-DAP take right now to ensure that recovery houses, and we worked on legislation a few years ago regarding recovery houses, what steps do they take right now to ensure that there's compliance with those local ordinances?

I know there's been an issue, but just to move on, because I have one more round, one more thing.

Okay. I know it's an ongoing discussion. I just wanted to shed some light on that, why it's important, because at the end of the day, you guys are that oversight. But one thing I did want to touch on is I'm hearing from some of our providers that payments may be delayed. And we talked a little bit about, I mean, every hearing we have, we talk about worker shortages, provider shortages, and coming from a rural county, that's very real. And one of the reasons is pay and some of the other things that go along with that. But when we look at things being delayed due to issues with D-DAP revising and executing the funding agreements with SCA, single county authorities, what is the department doing to expedite this process to ensure that the money flows to these counties in a timely manner?

Do you recall the number that we had? There are 30 waiting. There's 30 right now at the comptroller ready to be sent to single county authorities.

Yeah, so that's the other question is with the executing this five-year agreement and that interruption, that is resulting in an interruption of cash flow at the end of the calendar year. And some providers are fearful that they may not be reimbursed for services between July and December of 2025. If the invoice wasn't submitted by the end of December, what would you say to providers? How are we going to resolve that? Because we have to have these providers reimbursed for those services they have already provided.

Thank you. And we look forward to working with you on that. any other issues. Thank you for your time here today. Thank you.

Thank you, Chair. Happy Women's History Month. Welcome, Dr. Bogan and Dr. Davis-Jones, for being here. Thank you for being here. And thank you for your continued leadership as we work to end the public health crisis of Black maternal health and maternal health across this Commonwealth. As co-chair of the Pennsylvania Black Maternal Health Caucus, we want to invite you and your team to Black Maternal Health Week at the Capitol and everyone who can hear us, who is watching, we invite you to the Capitol April 13th and 14th as we celebrate, once again, Black Maternal Health Week. I want to talk to you about the Maternal Mortality Review Committee report that is now required to be released to the public every year, which is showing us the trends that are impacting moms across this commonwealth. We know we continue to face racial disparities in maternal mortality and in maternal morbidity, and that across the board, maternal deaths are preventable. So in this most recent report, 98% of maternal deaths were preventable. In the previous year's report, it was 92% were preventable. So Dr. Bogan, I just want to ask you, as much as we are continuing to invest here in our Commonwealth, we have had the greatest investments in maternal health and Black maternal health in our state budget. What's your assessment of what we can continue to do from here as we face a myriad of challenging and complex systemic issues that are contributing to the black maternal mortality rate and maternal mortality rate across the board. We love your insights and we appreciate, again, all the interventions that you've already

I think this is slow and steady work, and we need to continue what we're doing and not let up, right? We need to continue to make sure every person receives early prenatal care, gets the prenatal care they need. And we have challenges in that case. As you know, we have large swaths of the state where that is a real challenge. So we have a lot of work ahead of us, and I think our strategic plan that we're all working on together will help guide our pathway, but we need to keep that gas pedal down and really making sure we're not letting up.

Paranatal Quality Collaborative.

So I want to leave a minute for Dr. Davis-Jones to add if she would like.

Thank you both. Chair, could I have one more minute? Thank you so much. I appreciate that. And I want to turn to the Pennsylvania Momnibus, which is the legislative package that is groundbreaking in our vision of reversing the disturbing trends of maternal mortality and morbidity, that you've addressed some of the ways that we can continue to intervene. I do want to ask a specific question about two medical conditions I don't think are being uplifted enough. And my one bill, House Bill 1234, that addresses the coverage, Medicaid coverage for blood pressure monitors to address preeclampsia or high blood pressure, how important that is to moms and those who are pregnant in our Commonwealth, to make sure we're tracking their blood pressure throughout pregnancy, during labor, and in the postpartum period. I also want to ask you about the impact of cardiovascular or heart health and how is that impacting maternal mortality and morbidity, so preeclampsia and cardiovascular health. What are you seeing in terms of how is that impacting moms across this Commonwealth,

So thank you. The Pennsylvania Black Maternal Health Caucus, we will be unrelenting with you and your leadership roles to address black maternal mortality and morbidity all across this commonwealth. Thank you, Chair.

Chair, thanks. Gentle lady.

Dr. Davis, I would like to talk to you about the opioid settlement funds. And I would like to know if you've entered into any multi-year contracts that go beyond the current fiscal year to provide that funding. Multi-year? Yes. I do. Yes, absolutely we have. Let me just get to my section and my binder. Thank you very much. So to answer your question, yes, we have. And do those contracts contain clauses that voids the contract in the event dollars are not appropriated in 2026-27? or future planning years? That's a good question. We definitely have clauses that talk about being able to separate from whoever the grantee is. But in terms of appropriating, if the funds wouldn't be spent, we would have to reallocate them from that provider to another provider.

We do have commitment for our opioid settlement funds. And just to level set when you think about the opioid settlements we know that 85 percent goes to counties and litigating subdivisions 15 percent comes to the Commonwealth and if appropriated by the General Assembly then DDAT will get those funds And so we have to plan for those funds when we receive them. So therefore, we've had several initiatives earmarked to receive opioid settlement funds. And so at the time that we were looking at the legislation, our thoughts were that that's where those funds are committed, and we were moving forward with those initiatives. And so there's always opportunity. We have said loud and clear that organizations and individuals can meet with all of the counties that do have a process in place to actually talk about the different kinds of initiatives that they want to fund. Some counties do proposals. They put out requests for proposals. Some of them have working committees.

So is this legislation something you would reconsider? We will definitely take it back to our department to have some discussions. I think we're always going to be open to have those discussions, most certainly.

Thank you so much.

Thank the gentlelady, Representative Curry.

I'm here to talk about the devastating impact that maternal care deserts have in the Commonwealth right now. I currently have a bill that we're working on in the Momnibus 2.0, House Bill 432, which addresses maternal health deserts through maternal care access zones. um 23 of pennsylvania's 67 counties do not have a hospital that provides labor and delivery services and all 23 of them are rural counties for families in these areas the average distance to the nearest hospital providing these services is about 27 miles and unfortunately now i can say that in my own county, Delaware County. As maternity units continue to close or consolidate, timely access to care becomes even more critical to healthy pregnancies and births. What is the department's plan to address these maternal care deserts? And how are you working to ensure that expected mothers in these communities can access the care they need close to home? And I have one more questions, so can you answer that one first? Thanks.

The other question that I wanted to say.

Yeah, sure.

Sure, sure. I'll be quick. I promise.

Thank you very much for that. And then hospital closures like Crozier Health have left entire communities with fewer local health care options. When a patient is transported to a hospital by EMS, the patient may have preference of which hospital to go to. Now, in my area, they don't really have that preference, but how does the department monitor these patterns and ensure that hospitals receive adequate support and resources? And I know we've been on calls about this. How's the department monitoring it?

I'm running out of time. Yeah, that's okay. And I know, Chairman.

Thank you, Chairman.

Thank you, Mr. Chairman. I'm going to continue on this line of questioning so we can get more discussion. Before I do, Dr. Bogan, I just wanted to say I love your earrings. I don't know if it's the color or what it is, but I just want to give a compliment first, starting things off.

Yes. Okay. Well, they're very nice, and I might have to get my wife a pair of them here. But I wanted to talk a little bit about rural health care. In my district, AHN is looking to, I'm not sure exactly what the technical term is, affiliate, merge, buy, however that works with Heritage Valley System. And we're very excited about this prospect because there was real concern that that hospital was not going to be able to function long term because of their financial situation. With AHN coming in, we're excited that that staple of the community is going to be there for years to come. But unfortunately, for far too many communities within our Commonwealth, in particular in the northern tier of the Commonwealth, that is not the case. So I wanted to ask a couple of questions with that backdrop in mind. The first is my understanding is that the administration is undertaking an effort to basically change the regulations within the hospital community. Can you give an update on how that process is going and if you are looking and considering during that process the impacts it could have on rural hospitals and keeping them open?

Okay, and a more particular question. Bradford County, the regional medical center there, announced that it was in fact closing, but there was a plan put forward to have a continuity of services going forward. And my understanding is, is they're waiting on an approval from your department. Could you give an update on that situation?

This issue with rural hospitals across the Commonwealth hospitals shutting down, this has been hot for some time. And certainly since this administration has come in, what are some of the steps the administration has taken thus far? And what can we be doing as a legislature to help improve this situation?

Thank you, Doctor. We can get something on the schedule. I appreciate it.

Thank you, Mr. Chairman, and to all of you. I appreciate you being here. It's good to see you. Secretary Gogan, it's great to be with you again. Last time we were together was out at the University of Pittsburgh meeting some of those amazing researchers trying to find cures and therapies and treatments for some of our most devastating diseases. So I really appreciated you making the trip. I was with Chancellor Gable from Pitt yesterday and had a chance to hear the update on their end as far as research dollars go. As you know, we've taken important steps in recent years to address neurodegenerative diseases, including the creation of the first ever Alzheimer's, dementia, and related disorders division over in the Department of Aging, requiring insurance providers to cover biomarker testing for the benefit of earlier diagnoses and precision medicine, and most recently the allocation of $5 million to support neurodegenerative research. Just wondering if you could give an update on the status of that program.

Very good. That's a very positive update, and I appreciate it. And the good news is the governor has yet again proposed it as a now recurring line item. So we'll be fighting for that on our end of the building. Switching gears, a significant portion of your budget is supported by federal funds. But, you know, we've got programs like the Children's Health Insurance Program and Smoking Cestation that rely on tobacco settlement funds. but those dollars are on the decline. So just considering, you know, has the department considered or can you comment on an increase in revenues from tobacco sales and vape products to help stabilize these critical programs? Sure, yes.

Thanks so much. And we definitely have opportunities to collaborate because also within our department, we do have prevention programming. And so we need to think about how we might integrate some of our work to continue not only educating the community around, you know, tobacco. So we recently, as a part of some of our training series, we updated our training management system to include, I think, three or four additional tobacco cessation trainings. And so, again, always opportunities to think about how we will continue to collaborate. That's a great update. Really appreciate it. It always works out with you two testifying together because your missions are very much intertwined. Thanks for your service.

Thanks. Gentleman, Representative Krupa.

If the recreational marijuana is legalized, the Department of Health would likely be responsible for monitoring the range of public health outcomes, including increased emergency room visits related to marijuana intoxication, the accidental ingestion by children from the edible products, potential mental health complications linked to high-potency THC, and all the conversations we had today about maternal health. We know that there will be issues with maternal health and fetal health impacts related to prenatal exposure. And then there's going to be other marijuana-related hospitals. What new systems, staffing, or resources would the department need to properly track and respond to those public health issues? Does your current budget or your requested budget account for those increased in services? Thank you for that question about the adult use. Again, the department currently runs the medical program, and so we have resources from our medical program, And we've learned a lot from our medical program about proper labeling, packaging, trying to really keep things away from children to make them uninterested. So we can learn from all those lessons and we can use the expertise we have. In terms of surveillance, our department does a lot of surveillance around infectious diseases, emergency department visits. So we have the experience and the know-how in the department to continue to expand that surveillance, particularly around emergency department utilization. We work very closely with the poison control centers across the state on surveillance. So, again, we have the expertise on surveillance already in the department.

I think that's a question more for our HR teams than for us. Okay.

with legal, illegal, or illicit substances, the Department of Drug and Alcohol Programs mission remains, and that is to provide treatment, case management, and recovery support services for individuals throughout the Commonwealth should they develop a substance use disorder. And so when you think about this from the perspective of us tracking the prevalence of what may come to be, at this point in time we haven't been tracking where that may go. But what I will say, we're always ensuring that across the Commonwealth with our single county authorities that we are doing needs assessments and we're also developing prevention plans with our single county authorities. And so the great thing about that is that each of those single county authorities, also our local drug and alcohol offices, they have the opportunity to truly understand what's happening in their geographical locations. And so by developing needs assessments, developing those prevention plans, they will be able to earmark funding not only for prevention, treatment, and other recovery support services. In addition to that, we do work hand-in-hand with our drug and alcohol offices. And should there be the need for additional funding, we do have the opportunity currently in place where single county, I keep saying single county authorities or our local drug and alcohol offices, they do have the ability to ask for additional resources. And should we find that our resources aren't able to handle the demand for treatment, of course, we'll be advocating for additional funds.

Thank the gentlelady.

And so, Dr. Davis-Jones, I kind of want to follow up with what you were just talking about.

Part of that is education, and that's what we've been talking about with our interagency substance use response team. You know, there's this piece around public awareness, training. we also do have to ensure that our workforce, our healthcare providers, whether it be in hospital settings and within drug and alcohol treatment facilities, that they are appropriately trained and equipped to address intoxicating hemp products right And so again we are exploring our options but we recognize that this is an important issue and we will be developing a Commonwealth-wide response to addressing this.

issues like kratom, like intoxicating hemp? You know, I hear you. I have similar concerns, right? It's a little bit like playing whack-a-mole. You get one down, you get another one coming up. I think really we need to make sure that everyone understands what they're purchasing, right? And there's a market out there that's extensive. So I think for us, the Department of Health really focuses on education. So how do we make sure that people know what are the potential effects of this? How do we make sure that people are smart about what they're exposing themselves to and making sure that parents understand where and how their children can purchase these products? And we want to keep them out of the hands of children. So again, And I think we have a lot of work ahead of us. I don't have any magic solutions, but I think we need to make sure that it is part of education and widely discussed and that it's not kind of this behind-the-scenes thing that we all need to face.

So share your concerns and love to have some more conversations about how we can work together, because I think there's not one solution to this. It really is going to take all of us kind of working together to figure out how do we reduce this. But again, it's definitely a concern for all of us here.

Thank you.

we continue to hear from nursing facilities across the state about challenges with the department's staffing mandates and the associated impacts amid ongoing workforce shortages. including worsening hospital discharge delays. We hear from hospitals and nursing facilities alike on the strain this puts on the healthcare continuum. While well-intended, do you agree that these regulations are a barrier to accessing post-acute care? I appreciate that question. We've been doing a lot of work on our long-term care facilities and really working on quality of care. So the long-term care regulations passed in 2022. I started in 2023 as they were being implemented. And in the first year, we heard a lot of concerns about staffing and issues with staffing. And I will say that we've been tracking as we go out for our surveys to see how we're doing around staffing. And I'm happy to report, actually, that we have most of the facilities are not having staffing challenges in terms of meeting the regulations. And the facilities that seem to be having staffing challenges are also the ones in general that are not meeting other of our regulations. And so it does mean that some facilities have reduced the number of people in the facilities so that they can meet the staffing. But again, you and I want to make sure that when we drop off our loved ones at a skilled nursing facility, that they get quality of care. And this really is an issue of ensuring quality of care. And these staffing regulations have been demonstrated, or these staffing requirements have been demonstrated to really make sure that people are getting the care they need. We have not heard about delays in the last year around hospital discharges. the ones we have looked into around those delays actually turn out to be more insurance-related than staffing-related. And so if you're hearing specific hospitals having discharges that are related specifically to staffing and long-term care, I'd love to have a conversation about that. But we have been tracking really closely through our survey process what has been the impact. And again, I'm thrilled to say that the facilities are meeting the regulations for the most part. And, again, we are working, my focus and my team's focus is really on ensuring quality of care in our long-term care facilities. And staffing appropriately is part of that quality issue. But, again, if you're hearing specific ones, I'd be happy to discuss that with you because we want to make sure that we are meeting the needs of Pennsylvanians.

So I just wanted to also mention that part because I think it's important. And you did. You know, when these regulations were enacted, you did state that it would increase the quality of care. So do you have any data to support the claim, and can you provide that to the committee? I know, do you have concrete data of that?

Thank you, Madam Secretary.

Thank you, gentlemen. Representative Salisbury. Thank you, Chairman. Today I'd like to talk a little bit about pseudoscience. I have grave concerns about the growing influence of pseudoscientific theories at the federal level of government and as it relates in particular to autism, but in many, many respects, whether it be

in furtherance of those goals. Thank you, Representative, for that question. I'm going to talk about vaccines, if it's okay, because I think that has been a huge focus of the department for the last year in response to some disinformation and misinformation that has been coming out. So the Advisory Committee on Immunization Practices has been a longstanding committee that is actually, through law, required to exist. And the people who are supposed to serve on that committee have to meet very specific training requirements and regulations, and they need to be true scientists with expertise. And as you know, last year the 17-member ACIP committee was disbanded and new committees were appointed. And frankly, many of the people on that committee don't actually meet the criteria that is laid out in legislation around who should be on those committees and what their expertise should be. And as you know, the governor participated with 14 other states on a lawsuit specifically around that committee and the requirements for being on the committee. So we have been working extremely hard to provide education and to put out guidance around vaccines that is evidence That is I want to be clear no science no new science has been introduced to change the recommendations for vaccines right It is, there's no new science. The science is the same, and the recommendations, unfortunately, have changed despite no new science.

So with you, we are working extremely hard. The governor did his executive order in October to safeguard vaccines for Pennsylvanians. We were asked to do a number of things at the department. One was to create a single website where all of our vaccine information lives, pa.gov slash vaccines. That data is available. We've been promoting that. We also have been meeting with a work group of experts from across the state on how do we make sure we get out science. Our communications team has been working on using best practices around disseminating information. Our videos have been very popular. We asked pediatricians across the state to make videos about the truth about vaccines, and those videos have been popular. I'm also just going to say, as a pediatrician, I've had 30 years of pediatric experience, if you count my residency and all of my work, And I've got to personally see the introduction of new vaccines and the impact they've had on the health of children. So I'm just going to give you a couple of quick examples. When I started practice, we used to, every time a child came in with a fever without a source who was less than age three, as pediatricians, we would do a spinal tap, a urine culture, and a blood culture, because strep pneumo and haemophilus influenza type B would be particularly bad actors in that age group. And so we would do this enormous workup to make sure that they didn't have it. Well, after Haemophilus influenzae type B and strep pneumo vaccines were introduced, the entire practice of medicine changed, and we stop having to do that workup if children have those vaccines. So saving dollars and pain to children and families. The rotavirus vaccine in the first year it was introduced, in 2006, cut in half the number of hospitalizations that children had for diarrheal illness at less than age 5, and that has continued to decline. As a matter of fact, we rarely now admit a child for rotavirus. And I could go on and on about all of the vaccines that have been effective. And it's very sad for me because parents are trying to do the right thing for their children. They have what's best interest. They're just being given information that isn't accurate. And so that is very hard. So I think we have a lot of work ahead. I appreciate your support of science and the evidence. And I'm happy to work with all of you on disseminating accurate information and to tell the stories that I think people need to hear and understand so they can make the best informed decisions for their families.

So, as you know, I testified at a hearing back in the fall. So Gaucher's was reapplied for. I'm just going to say that you all passed a great law back in, I think, 2019 or 20, making sure that Pennsylvania aligns with the recommended uniform screening practices, which we do. and we have added a couple of conditions based on our committees as well which is part of the structure you laid out So our committee that reviews applications outside of the RUSP has put together a subcommittee, and that subcommittee will review the application again and see if there's any new information that would change the decision. And then if they recommend that it be added, then it would go to the full committee at the next meeting. So that committee's been formed. They're trying to find a date. I think they may have a date for that, but we don't. I can't tell you exactly, but it's in the works. I'm happy to get back to you as soon as I know.

You can tell this is the end of the hearings. Thank the gentlelady, Representative Nelson.

Sure. I can get back to you with the specifics, but we have just funded a bunch of RFPs that had gone out on those maternal health works, so that data could be updated with that funds. And we have allocated all of the funds that we were issued already. The request for the next $2.5 million is really to focus on a child death review process as well as – let me explain to you what that is.

So the report does explain that there are different, depending on whose criteria you use for maternal mortality, whether you define it as death during pregnancy, delivery, or 42 days postpartum versus the entire year. And there's been a lot of discussions nationally about what should be done. So we have consistently used the up-to-one-year postpartum in our analysis and report because, and again, the CDC also has pregnancy-related versus pregnancy-associated. So it is an important distinction to understand.

So we do use our data to make sure that we are thinking about where the funds need to go. And that's why data is so important in the funding decision. The coalitions work across the regions. And we're also looking at the Rural Health Transformation Plan funds really are focused. One of the main categories of that is certain maternal health focused in rural areas. So, again, I'm happy to meet with you afterwards and review the report in more detail if that would be helpful. I don't have it in front of me to go through. But I think to be understanding that the Maternal Mortality Review Committee makes recommendations on how we can address maternal mortality issues, and the funding we've been used to really try to address those. And we are working across the entire state, including in rural areas, on education, on blood pressure monitoring, on all kinds of services for pregnant people and postpartum.

I think I'm losing some of the detail, but what I can say is a death of a mother leaves a child without a mother, whatever the cause. And we need to make sure we're really trying to... all we can to make sure that mothers have the care they need across the entire spectrum, right? And any maternal death is a loss for that family and for that community. So I'm happy to work with you. This is an area where I spent my career as a pediatrician working at the intersection of maternal and child health, and I did a lot of work in pregnancy. And this is a passion area. So if you would like to meet after this hearing and talk about making sure we're distributing funds appropriately, I would be thrilled to have that conversation. It is important that we address all of the issues and that we do it in a fair and even way.

I'm docking you next year. Just putting it out there. Putting it on the list. Representative Abney.

I so appreciate your asking that question. And I'm going to put my pediatrician hat on for a minute because, like you, really making sure that there's a, you know, families broadly termed that people have support and get support. And we know actually from the medical literature that fathers also suffer from postpartum depression and anxiety, just like new moms do. So it is an important issue. And for a while in our clinic, we did screen fathers for depression as well and offered that. So, again, that's my pediatric hat on. And we did part of a Pittsburgh study that I helped work on. We also screened fathers and found pretty high rates of, again, it's stressful to have a newborn and to go through a pregnancy for all members of the family, right, for the other children, for the support partners. And I think there is a growing understanding that we need to really support not just mothers but the whole family unit, right, because the family unit is what provides. And family can define broadly. It could be grandparents. It could be, you know, neighbors and friends. but communities really support. And so, yes, I appreciate fathers. As a matter of fact, I think when I first started clinical practice, I didn't have a lot of fathers coming to care, and I really appreciated that over the 30 years I was there that fathers often, by the way, came alone to pediatric care with their children. So it's really important that we recognize the role of fathers in this process and provide them the support that they need. Happy to think with you about how to do that I think some opportunities in medical education but again not necessarily in the role of the departments specifically but I think there are real opportunities to make sure people understand what's out there in the literature and the support that people need to be able to be the best parents that they can, right? That's the goal is that parents are supported to be able to nourish themselves and their children so we have optimal growth and development. And we're happy to work with you on ways to make sure that all parts of the family unit get the support they need so that they can raise and support healthy children to become healthy adults.

Yeah, well, thank you for that question. You're absolutely right. Stigma is alive and well. And so one of our major initiatives is our anti-stigma campaign. Our life unites us. campaign. So for all of the legislators that are still here, if you haven't had an opportunity to go visit our Life Unites Us campaign, please do so. It's lifeunitesus.com. But what I can tell you is we recognize that stigma keeps people from getting the help that they need. And we also know that as a part of our work that we're doing to reduce stigma, we recognize that if we don't get people that have lived experience talking about that recovery is possible and that there is hope, the likelihood of others seeking care is significantly reduced. And so as a part of our work with Penn State University, along with a few other collaborators, we're seeing that individuals in recovery are sharing their stories. And we recognize that through the work of this campaign, individuals that have had an opportunity to review the campaign versus those who have not, they're really seeing the opioid epidemic as a serious problem. And so when you compare the two groups, 75% of the respondents who viewed the campaign versus those that did not really are seeing the opioid epidemic as a serious problem. 85% of the respondents who reviewed the campaign agreed that they would be willing to provide naloxone to family members and friends. And we also do know that for those who view the campaign, they are really saying that it's important that employers should not be allowed to deny employment for a person taking medications for opioid use disorder. And so our goal is to continue to spread the message that recovery is possible, that there is hope. We're using social media. We're using people with lived experience. We have over 360 influencers that are spreading the word, and we going to continue to uplift the message that services are available and that there is help Thank you Shout out to the social workers out there Absolutely Thank you Mr Chairman

Thank you, Chairman. We'll try to keep this one short for you. Secretary Davis-Jones, I appreciate everything that D-DAP has been doing to help combat the opioid epidemic. There are a few places in this Commonwealth that aren't hit and touched by this. It's my understanding that D-DAP contracts currently use name brand naloxone. And I know when a lot of folks go to the pharmacy, pharmacists will instead prescribe the generic, lower cost, same effectiveness, efficacy. But Pennsylvania, I believe, is the only major state that hasn't switched to a generic. and we're one of nine, I think, states that haven't switched to a generic for naloxone, which could save millions of dollars or allow our appropriations to go further and potentially even save more lives. Is this something that D-DAP is exploring?

Are we using a generic?

But is the generic still cheaper?

I believe it is, and I would encourage you, and if you could certainly follow up with me about when that contract is available. Again, it's an opportunity for us in the Commonwealth to save money or make our dollar go further. Again, these are lives that we can be saving. And if we have generic opportunities out there that have the same efficacy that can save lives, it meets all the same standards, I would highly encourage us to use it. So with that, Mr. Chairman, that's all I have. I yield back the balance of my time.

Thank you, Chairman Harris. Thank you to both of our secretaries and for your departments for all your hard work. And Dr. Bogan, I just want to thank you for defending the need for safe staffing in nursing homes. I think the question for all of us is do we want a loved one to be in a facility that does not have adequate staffing? And we know, for example, on the hospital route in Pennsylvania, if we had just what California had, Every day we would save three lives from unnecessary, from dying, because we don't have safe staffing standards here in the Commonwealth. I just want to say, do you want to add anything to the importance of safe staffing in our health care facilities?

jobs have support. Yeah. And in fact, the research shows that the facilities actually,

hospital consolidations. So we're seeing a really problematic trend with these private equity and for-profit groups that are buying up hospitals. There was a recent Gallup poll that showed that one in three Americans are actually skipping meals and other necessities to afford health care. One in three Americans. Meanwhile, we have private equity firms and for-profit corporations that are making hundreds of millions of dollars, and the hospitals that they're buying and health facilities that they're buying are struggling because they're extracting those profits. We have legislation here in Pennsylvania. Representative Borowski is leading it. And also, I'm a co-prime on it. And I think all the Democratic members in the Delaware County delegation are co-sponsors as well, are co-prime sponsors on it, that we give the AG powers to really rein in the abuses of these private equity when it comes to hospital mergers and consolidations and acquisitions. Can you talk about the importance of giving the AG that power to rein in this abuse of practices that we're seeing with these for-profit corporations?

Yeah, and I'll just close that out with just saying we've actually seen this is a bipartisan issue we have in the Senate, the U.S. Senate Chuck Grassley and White House working together, calling out some of these really bad actors, a Follow global management.

Yeah.

Thank you. Thank you, Chairman.

Thank you, Chairman Harris, and thank you all for being here today. My question goes out to Secretary Davis-Jones on the opioid settlement. Secretary, Pennsylvania is expected to receive nearly $2 billion from the opioid settlement agreements, with about 70 percent going directly to the counties and local governments. These funds were meant to address the damage caused by the opioid crisis. Secretary, back two years ago, I was at a night out in one of my communities, and my daughter come up to me at the end of the night and there was a bag full of candy and in that bag was an inhaler. And so is that, I guess my question is, what oversight does the Commonwealth have to make sure that, you know, with this Narcan, is that a good use of the Narcan in a bag with a Reese cup going out to the kids? At the end of the night, I gave it to our local police chief and he took it back. And I really didn't dive into this trust fund until shortly after this. So could you just touch on what, I guess, what oversight you have over it?

Yeah. So talk about the structure a little bit. The 70 that goes to the counties The counties have the sole discretion to dispense that 70 or do some of those have to come back to the trust No the counties in litigating subdivisions which is equivalent to 85 of those opioid settlement funds

Okay. I get a lot of questions on this from my police chiefs back in my district. So is there a, I know the last time I went on a website, we could see what grants were awarded, some of the expenditures, but it was, it wasn't year to year. It was like all the way back from 23, 24, I believe. Is there a way that, is there a report out there that we could have access to or some of the expenditures? Is this for the opioid settlement funds?

About how those funds are expended. All right. I have one more question, but I'm going to submit it for the time error

It is late in the afternoon, but I guess we're getting a little carried away. Previously, and I'll point two chairs in front of me here, my female colleague would let you know every time that she's a nurse and she's from Scranton. I'm not a nurse. My mother was a nurse for 38 years in the maternity ward in Roxburgh Memorial Hospital. And so we talk about the other nurse in the room and his area of Philadelphia today. I think that leads, and I'm just sort of endorsing what you know, the support you have for nurses, for the workforce issue and stipends, for maternal issues. Like that maternity ward at Roxborough Hospital doesn't exist any longer. It was bought and sold, the hospital. We know those issues. So I'm refocusing on that private equity issue and want to talk about that a little bit. I was at a conference this summer with the attorney generals from Massachusetts, from New York, and from Rhode Island. And their strongest recommendation was make sure the attorney general in Pennsylvania has the authority to evaluate these acquisitions and mergers. Is that something that you support as a department for Pennsylvania?

My understanding as we sort of peel back the onion, right, that these private equity firms are now moving into specialty practices in oncology and gastrointestinal practices and they're so cash rich that they're buying up these other pieces. And I know in Montgomery County, Pennsylvania, there's really only one gastrointestinal community you can go to. So it becomes a monopoly system rather than a service system. Are you tracking those same kinds of things through the department or seeing trends in those ways?

Sorry, if I could just add to that. There are some instances where there are outpatient facilities associated with a hospital license in addition to what the secretary said. So there could be a case where, you know, there's a closure of a hospital that also had outpatient facilities that also close. And I think to your point about, you know, oversight from the attorney general's office, you know, the Department of Health has oversight of the operators and we regulate the operators. But we can look at kind of the ownership structure within that framework and look at the finances in that sense when there's mergers or change of ownership. but our authority only goes so far, so we can't control really the ownership.

So yes shout to the nurses Thank you gentlemen Representative Rigby Thank you Chairman Harris I sorry I can shout out I don have any family members that are nurses

Yes. The MSOF fund had accumulated more money in its account due to increases in the collection of fees, and we wanted to make sure that money gets back out and is used. So we are using those funds to fund a number of projects that goes through the regional councils to the agencies to do workforce recruitment, education, and equipment. Yes.

Yes, we have it in the proposed budget for this year, and it was originally a three-year spend down to make sure that the money could be used most effectively. And we've been working really closely with the regional councils on what that should look like. and I'm really happy to say I was just out in Allegheny County at an event talking about how, for instance, one of the EMS West was using it to distribute and make sure that all of the ambulances that have ALS can use a video laryngoscope, which is actually a really amazing tool to make sure that people improve first pass intubation techniques and they have an equitable way they're purchasing and distributing those and making sure all of the ambulances that are across the entire EMS West footprint have these tools. So that's an example of how some of the funds have been used by just one regional council. But it is important that this money be distributed over time so that they can get it out and used most effectively.

I really appreciate the opportunity to talk about this important fund. So I just want to be clear. I know there have been some reports out there that money is missing. No money is missing. Every penny went out to the regional councils. and the issue was really around documentation. So I'd like to give you a brief history. So when I arrived as the Secretary of Health in 2023, I received shortly after my arrival the MSOF audit, which is required by law, for the 2018 to 21 year. So it's a two-year delay in the audit. I received that in, I think, March or so, roughly, of 2023, and I met with our team right away. Kristen and I And our deputy went out to all the regional councils to have discussions, figure out what was going on, and really we put in place a response to the audit as well as to really repair the challenges that were between the department and the regional councils. And that's been fixed, which is great. We're working really well with the regional councils. So by the end of 2023, we had in place fiscal management that we had developed new software for tracking. We had worked with the regional councils on implementing it. We implemented all the training, and that happened over the year. And by the end of 2024, everything was in place. The problem is that the next audit that was done covered 2021 to 2024, so two years of which I had no ability to make any change to the prior audit. And so I'm thrilled to tell you that we will not see these challenges again because we've addressed all of the issues in the audit over the last couple of years. and we have in place really careful control measures. Again, no money is missing. It was just really a documentation issue, and we have resolved all of the challenges around documentation. So I am confident that our next MSOF report, which will reflect the time that we have been addressing the issues, will not reflect the same challenges. And it's been really our pleasure to work with the regional councils. I want to give a shout-out to them because they've been great to work with. They all understand the challenges that we are faced, and they appreciate that we are working on this together. So thank you for the opportunity to talk about that.

Thank you, Chairman.

Thank you, gentlemen. Representative Fleming.

to school entities to provide these services? Yes, I appreciate that. And again, another shout out to nurses and the importance of nurses in our health care system, including in our schools. So as you alluded to, we do have a school, many schools have school nurses, but we know that there are not enough. It's been about 35 years since the reimbursement rates have really been updated. And I think the other really important point is that the number of students in our schools that need nursing services, complex nursing services like diabetes management, seizure management, a variety, catheterizations, concussion monitoring, blood pressure monitoring. I know I certainly sent many of my students with prescriptions to the school nurses to monitor things like blood pressure, those have really increased. And when you compare 2015-16 school year to 2023-24, we've seen a 66% increase in students needing complex care for nurses, with a 3.8% decrease in the total number of students. So we're seeing fewer students but more complexity. And really our reimbursement has not kept up with that need. So I think we have seen about a 31% due case in the amount of overall cost coverage in that time period as well. So we'd love to consider and figure out how we make sure that our students that are relying on these services have school nurses available to them. And again, funding is definitely a challenge and reimbursement. So again, important discussion we all need to have.

Thank the gentleman, Representative Madsen.

You know, again, this was a process we went through over a couple of years, creating lists, reaching out to people. We reached out to all the folks on the list multiple times of their interest. the money is I have to get back to you on how much more time we have to get that funding out so if it will be okay we'll work with you after the hearing to make sure we provide information we can about where what we have left to do to get this

Thank you.

Thank the gentleman. Chairman Struzzi.

There's a lot that goes on, not just in these hearings, but behind the scenes, and we appreciate everyone's commitment to this process because it is important and it is for the people of this great, great state. So thank you. Thank you, gentlemen. And I thank Secretaries Bogan and Davis Jones for being here for the work that you do for the 13 million or so people that live in this Commonwealth and to all of your staff and all of the folks at the departments that you lead. I do want to echo the chairman's sentiments. I think, you know, we have different ideologies or policy disagreements, and that's fine. I honestly believe that a healthy government is one with political discourse. You can disagree without being disagreeable. And far too often in our body politic today, I think we don't see enough of that. And so I've tried my best over the last two weeks to give everyone room to share their perspective, ask their questions, but do so in a way that was respectful to the dignity of the chamber and of the work that we do. And I hope that we achieve that goal. And I hope that the people of the Commonwealth, if you don't have anything to do and you can't go to sleep at night, go back and watch the budget here. You'll learn a lot. You actually will learn a lot. No, seriously, though, over the last few days, few weeks, we've had experts in their field come in front of this committee and answer questions on the dollars and cents, the taxpayer dollars and cents that will be expended for the benefit of the people of this Commonwealth. So I am grateful for all of the work of the committee, committee members, the staff, the staff from the agencies, staff from the administration, as we embark upon this next part of the budgetary journey. And with that, budget hearings of 2026 are now closed. Thank you, everybody. Thank you.