Senate Health Committee

Good afternoon, Chair Weber Pearson and members of the Senate Health Committee. Thank you for giving me a few moments to share why this proposal is so important to our health, our economy, and the state of California. My name is Kim Barrett. I'm Vice Dean for Research at the UC Davis School of Medicine. I've been with the University of California for more than 40 years. In all my time at UC, I have never seen a more precarious situation for scientific research and greater challenges to our economy, our workforce development, and most importantly, our public health. The California Foundation for Science and Health Research is an opportunity for California to control its own destiny at a moment when UC is facing one of the greatest threats in its history. The university currently receives $5.7 billion in federal support for research each year. Sustained loss of even a portion of this funding would devastate the university and cause enormous harm to all Californians. Research at UC generates as much as $55.2 billion in economic activity every year. Medical breakthroughs alone generate approximately $13 billion in economic activity across California and have produced more than 340,000 jobs in biosciences. As federal funding uncertainty continues, we are threatened with a talent exodus and our ability to train the next generation of innovators, researchers, and physician scientists is reduced. This leads to a weaker talent pipeline to tackle the next pandemic, to create the next cell or gene therapy, or to devise safer and less invasive surgeries. Loss of funding hurts communities and patients the most. A loss of funding threatens clinical trials that give hope to those suffering from chronic illnesses and slows the development of life-altering therapies for depression or interventions that can delay the onset of dementia. We generate cutting-edge research and translate it to real-world care that can alter the course of someone's life. California has been a leader in scientific inquiry and should invest in its ability to protect jobs, health care, and the economic future of our state. And for all of the reasons noted above, the University of California is in strong support of SB 895. Thank you.

Thank you. That was within five minutes. Very good. All right. So we will now hear from any other witnesses in support of this bill. Please come to the mic here. Please state your name, your organization, and your position only. Good afternoon, Madam Chair. George Osborne for the Union of American Physicians and Dentists. We're a co-sponsor of SB 895 with strong support. Thank you. Thank you. Good afternoon. My name is Jack Finn. I'm a UCLA PhD student representing UCLA Graduate Students Association, UCLA Center for LGBTQ plus advocacy, research and health. We're in support of the bill. Thank you. Good afternoon, Senator Ami Alden on behalf of UC San Francisco in strong support. Good afternoon, Rene Bayardo representing Blood Cancer United in strong support. Good afternoon, Andrew Kehoe from UC Davis Health in strong support. Good afternoon, Erica Bustamante with Stanford University in support. Good afternoon, Michael Miller, director of the West Coast region of the UAW, strong support and a proud co-sponsor. I am Kuhn Van Rompe, head of the unit of infectious diseases at the California National Primary Research Center at UC Davis. I strongly support this bill. Dennis Hardigan-O'Connor, I'm from UC Davis Health, and I'm very much in support of the bill. Kathy Jellick from UC Berkeley, Vice Chancellor for Research, and a professor of Electrical Engineering and Computer Sciences. I strongly support this bill. Hi, Miguel Martinez on behalf of UC Berkeley Chancellor Rich Lyons. I'm strongly in support of this bill and urges your support as well. Thank you. Good afternoon Alex Graves the Association of Independent California Colleges and Universities in support. Also just wanted to register the support of California Institute of Technology, one of our members. Thank you. Dr. Annette Hilton from UC Davis Center for Community and Citizen Science in strong support of this bill. Good afternoon, AJ Mendiola on behalf of the Lieutenant Governor, Eleni Kunalakis, in support. Good afternoon, Ernest Walker with UAW 4811 in strong support. My name is Nico Vincent. I'm a clinical research coordinator and up team member at UC Davis Health, and I strongly support this bill. Good afternoon. Jared Russo-Cloak with the Michael J. Fox Foundation for Parkinson's Research and Strong Support. Chair and members, Nate Solove on behalf of several organizations from the Parkinson's community who couldn't be here today. Appreciate the author and all his hard work. Parkinson's Association of San Diego. Parkinson's Community Los Angeles. Parkinson's Association of Northern California. Greater Fresno Parkinson's Support Group. And the Parkinson's Network of Mount Diablo. Thank you. Good afternoon, Madam Chair and members. Giannis O'Malley with AFSCME in support. Good afternoon, Chair and members. Keshav on behalf of Northeastern University and the California Academy of Nutrition and Dietetics in strong support. Thank you. Good afternoon. My name is Gobinder Pander. I'm a UCSF medical student, and I'm in strong support of this bill. Good afternoon. Gia Chen on behalf of the California Consortium of Addiction Programs and Professionals in strong support. Thank you. Good afternoon. I'm Ivy Foster, junior specialist at UC Davis and in strong support. Good afternoon, members. Janet Lopez representing UCLA in strong support. Thank you. Good afternoon, Dr. Katherine Keatsman. I'm the director of the Health Equity Program at the UCLA Center for Health Policy Research, an associate researcher at the UCLA Fielding School of Public Health, in strong support. Thank you. Good afternoon, Connor Roderick, PhD candidate at UC Berkeley Chemistry and rank and file member of UAW 4811, in strong support. Good afternoon, Martha Zaragoza-Diaz, representing the University of California Chicana Ex-Latinx Alumni Association, and we are in strong support. Hello, I'm Tom Shang. I'm a PhD candidate at UC Berkeley and a UAW member, and I'm in strong support as well. Good afternoon, Kim Elsbach, Professor of Management, Graduate School of Management, UC Davis, in strong support. I'm Gabe Klaassen, I'm a UC Berkeley graduate student and a member of UAW local 4811 and I'm in strong support. Good afternoon. Dr. Khaled Mahmood, UAW 4811 at UC Davis, strong support. Hello, I'm Richard Scalator, I'm in the physics department at UC Davis and I'm in strong support. Donald Palmer professor in the Graduate School of Management at UC Davis and I support the bill Good afternoon committee Patrick Dexter on behalf of United Auto Workers Region 6 in strong support Good afternoon. John Rundle, professor of physics and astronomy at UC Davis, researching earthquake forecasting and prediction using artificial intelligence. I am in strong support. I'm Marie Rundle. I'm a retired K-12 science and health teacher from Davis, and I'm in strong support. Kevin Guzman with the California Medical Association, in support. Missette Short on behalf of Loma Linda University Health, in support. Tom Temprano on behalf of Equality California, in strong support. Good afternoon, Eric Paredes with the California Faculty Association in support. Good afternoon, Chris Morales with the California State University Office of the Chancellor in support. Good afternoon, Marshall Nakatani on behalf of UAW Local 4811 representing nearly 50,000 members at all 10 campuses in Lawrence Berkeley National Lab, a proud co-sponsor on the legislation. Good afternoon, Chair and members. Marty Lopez with the California Nurses Association in support. I'm Sharon Lawler, Professor Emeritus, UC Davis, Entomology and Nematology in strong support. Good afternoon. Linda Way with Western Center on Law and Poverty in support. Madam Chair and Senators, Adam Caglin on behalf of Natara in support. Dr. Robin Adcock, I'm the director of pediatric integrative medicine at the University of California, San Francisco. I'm also a clinical researcher and volunteer faculty in the School of Medicine at UCSF. Strongly support. Madam Chair and members, Jason Murphy on behalf of the UC Office of the President, in strong support, also co-sponsor. Thank you. My name is Melanie Lendonel. I'm with the ALS Association in strong support. Thank you, Senator Weiner. Good afternoon. My name is Dr. Christopher Shepard. I'm an assistant professor of neurology at UC Davis. I am a person with ALS on behalf of the ALS Association. I am strongly in support of this bill. Lawrence Gill, representing ALS Association Sacramento, in strong support of this bill. Heather Dawson with ALS Association, in strong support of this bill. My name is Jack Davis. I have ALS, and I support this bill. My name is Christopher Holtz I a representative of the families of people that have lost ALS I finally passed away from ALS in 2011 and I in full support of this bill Nancy Wakefield with the ALS Association in support of this bill. Norielle Richards with the ALS Association in strong support of this bill. Mary Hooper, the daughter of someone who has ALS, in support of this bill. Erin Johnson, former caregiver and spouse of someone who had ALS, and representing the ALS Association, in strong support of this bill. My name is Mary Hooper, and I have ALS, and I support this bill. I'm Jason VanCourt. I'm a research scientist with CAPS UAW and also a friend of Mary Hooper. I support this bill. John Campos, brother of Christopher Campos, and part of the ALS Foundation, and I strongly support this bill. Hi, Jasmine Diego, UCLA Health, in support of the bill. We will now move and see if we have any lead witnesses in opposition. Seeing none, if anyone would like to register opposition, you may come down to the mic, state your name, your organization, and your position only. Seeing none, I will now move back to the committee to see if the committee has any questions. Senator Durazo. Just a comment. I want to thank the author and proud to be a co-author of this bill. We know scientific research is one of the engines that have really driven California's success. I especially appreciate that this bond measure will create high-quality union jobs and strengthen our public research institutes. And a particular provision that I want to highlight, because I've been working on procurement for years, is that the bond prioritizes purchasing goods and services from California suppliers and with a good faith effort to have more than 50% of the purchases come from within state businesses. So with that, I'm proud to support the bill. Senator Caballero. Thank you, Madam Chair. I want to also thank the author, and I'm proud to be a co-author as well. Thank you to everybody who showed up here today in support of this really important research. We have some of the best educational institutions in the world, and the ability to do research and the potential for life-changing cures or assistance is really important. And now more than ever, we need to make the investments in our institution. So thank you for taking the lead on it. We'll say no other comments. I want to echo the comments of the other committee members who have spoken and really thank you for bringing this bill forward again. I am a proud co-author on this one as I was the previous version of the bill, but I really want to thank the author and the staff the health committee staff on working through some of the amendments to really kind of clean up and fine some of the things in this bill especially when you dealing with the council that will be created And so I want to thank you the health committee staff and your staff for working so hard on this bill and the amendments And with that, you are welcome to close. Thank you, colleagues. I want to thank everyone who came out today and particularly the folks with lived experience. You know I and I've actually talked about this in this committee before so forgive me for repeating myself But since I was 19 years old I've had Crohn's disease an autoimmune disease and I've always been able to manage it But it was about a little over 10 years ago when biologics came around And that really was transformational for my life And so you have people who are living with chronic conditions conditions, some of which have very poor treatment, some of which have good treatment, and all of which we want to cure. And the idea that we would just sit by as research funding that can cure diseases, make people's lives better, prevent diseases, help us deal with the impacts of climate change, which is upending so many people's lives, and so on and so forth. the possibility that we would sit back and just let that fall apart is just not tenable. And so for everyone whose life can be better, for, frankly, the entire world, which has been improved and will be improved by scientific research here in California, we do this on behalf of all of them. And this is, I think, a unique opportunity for us. when I introduced the first version of the bill last year, it was very bare bones, and I didn't know what would happen. And the coalition just sort of materialized because there are so many people who get it and who care deeply about the future of science. And so I respectfully ask for your aye vote. Thank you, Senator. And once we have a quorum, we'll be able to move on that bill. I would like to invite the other members of the health committee who are not here. You can come down so we can establish a quorum. We will now move to file item number 2, SB 944. Senator Wiener, you're ready to go. Great. Maybe I'll just wait for... They were pretty efficient. They were pretty efficient. Oh, I know. Thank you. as a Medi-Cal benefit for all Californians. Acupuncture is a critical form of health care with proven benefits for pain management, mental health conditions, addiction treatment, nausea, digestive issues, and complications from chemotherapy. It can be especially helpful for populations where traditional treatments may carry higher risks or side effects, including adolescents and pregnant women. For millions of Medi-Cal beneficiaries and people living with chronic pain and undergoing chemotherapy and so forth, acupuncture can be a low-risk, cost-effective option that improves their quality of life and reduces reliance on more invasive forms of care. In the midst of our opioid crisis, a particular acupuncture is exactly the kind of non-addictive intervention for chronic pain we should be promoting. And in our affordability crisis, this is a far less expensive kind of treatment. Acupuncture is prominently used in our Chinese-American community. I'm proud that in San Francisco we have just many amazing providers. But this is really true throughout the state and for many communities. ensuring that acupuncture is covered in Medi-Cal provides a critical lifeline for people who rely on it. And so this bill will enshrine in law that acupuncture is a covered benefit and that it is not dependent on whether we have matching funds from the federal government. So I respectfully ask for your aye vote. I want to welcome folks who have come here today from San Francisco and elsewhere to express their support for acupuncture as a Medi-Cal benefit. And with me today to testify is Dr. Zhang, the president of the California Acupuncture Coalition, which is a sponsor of SB 944, and Dr. Lily Chow, the director of integrative medicine at Northeast Medical Services, NEMS. Thank you. Before you begin, we are going to establish a quorum. Assistant, please call the roll. Senators Weber Pearson. Here. Weber Pearson here. Valladares. Here. Valladares here. Caballero. Here. Caballero here. Durazo. Here. Durazo here. Gonzalez. Grove. Mangivar. Here. Mangivar here. Padilla. Perez. Here. Perez here. Rubio. Smallwood Cuevas. Quorum has been established. You may begin. You both have a combined total of five minutes. Thank you. Thank you. Thank you for the opportunity. Can you hear me? Okay. Is this better now? Okay. Thank you for the opportunity to be a witness today. Good afternoon, Chair and members. My name is Dr. Lily Chow. I serve as the director of Integrate Medicine and Northeast Medical Services, one of the larger FQHC in the Bay Area. And in my clinical experience, acupuncture plays a crucial role in helping patients manage chronic pain, recover from illness, and improve their overall quality of life, particularly for those with complex and also long-term conditions. and also including cancer patients And many medical patients acupuncture it is not alternative It an essential part of their care Without it, patients often face unmanaged pain, which can lead to increasing reliance on emergency rooms and more expensive interventions or opioid use. And for a system perspective, acupuncture, it is a low-cost and high-value service and it helps reducing unnecessary health care utilization while improving patient outcomes. And this is exactly the type of investment we should be making as we move towards more integrative and whole person care in California. So making this benefit permanent ensures stabilities for both patients and providers and reinforce California's commitment to equitable access to effective and non-pharmacological treatments. The demand is already there, and the infrastructure is already there. What's missing is the policy stabilities. So SB 944 is not about expanding anything new. It is about securing something that is already working and allow it for function as a skill. At a time when California was looking for a cost effective, and non-pharmacology solutions to chronic pain, and this bill align directly with that goal. So I respectfully asking for your support on SB 944. Thank you. Good afternoon, chairs and members. My name is Danny Zhang. I'm president of California Acupuncture Collation, the sponsor of Senate Bill 944. I'd like to thank Senator Wiener for offering this important bill. Every day in my clinic, I treat medical patients who live with chronic pain, stress, and serious health condition. In California, licensed acupuncturists are recognized as the primary health care provider with our scope of practice. We know our patients well. We understand their medical history. Many of our patients rely on us to help manage a serious long-term and chronic health conditions. Many of these patients cannot tolerate strong medications or invasive procedures. Acupuncture gives them another option that is safe, gentle, and effective. Patients report improved sleep, a great mobility, reduced pain, and a higher spirit after acupuncture treatment. For some, acupuncture helps provide reliance on opioids and other potent medication and drugs. Medical patients should have equal access to acupuncture as other Californians. manage acupuncture differently within medical recruiters, unnecessary barriers, and leaves patients and providers uncertain about their options. Inserting fear and constant coverage will improve care, reduce reliance on more costly or risky treatment, and adventure health equity across the state. SB 944 ensures acupuncture is an established medical benefit on pair with other covered treatments This bill will help protect access to care for millions of the Californians who rely on medical Thank you for your time and for supporting patient access to the acupuncture. Thank you. We will now move to public testimony. For those of you who wish to speak in support of this bill, please come to the mic. state your name, your organization, and your position, you may begin. Thank you. Good afternoon. Dylan Elliott on behalf of the San Francisco Board of Supervisors in support. Thank you. Ryan McCarthy on behalf of Alhambra Medical University Alumni Association, United Acupuncture Association in support. Thank you. I'm a licensed acupuncturist and a former president of CAC in strong support of SB 944. Thank you so much. Sharon Zhang, acupuncturist in strong support. Hello, my name is Steven Chan, a patient, a retired engineer and also an acupuncture student. I'm in strong support. Hello, Hong Li Chen from the Academy of Chinese Culture and Health Sciences in downtown Oakland. I'm a student, patient, and educator, and strongly support the bill. Thank you. I'm Krista Chan from the Academy of Chinese Culture and Health Sciences, and I'm a student and a patient in strong support of this bill. Thank you. Hi, my name's Hongluo, licensed acupuncturist in California, and I graduated from Oakland Chinese acupuncture school for over 20 years. I served a lot of patients, so I really strong this bill. Thank you. Good afternoon. My name is Ginger Vincent. I'm practicing Sacramento, Old Town. Licensed acupuncturist. I have strong support. Good afternoon. My name is King Hui Zong. I'm a licensed acupuncturist in California. I am in strong support of 944. Thank you. Robert Hoffman, president of Yosan University of Traditional Chinese Medicine in Los Angeles, California. We're in strong support of this bill. Thank you. Katie Van Dyne with Health Access California in support. Thank you. Good afternoon. My name is Chulong Shui. I'm an acupuncturist in California, and I serve thousands of medical patients per year. I'm very strong in support of this bill. Thank you. Good afternoon. I'm Dr. Cho. I'm Korean Association Acupuncture Group, the president. I'm strong in support SB 944. Thank you. Good afternoon. I'm Xiang Huang, and I'm licensed in acupuncture and practice acupuncture almost 40 years. Acupuncture is safe, effective, side-effect-free, and also cause effective therapy Thank you I very strong support of you Thank you Remember your name your organization and your position only Thank you Good afternoon My name is Ying Li the president of American Association of Chinese Medicine and Acupuncture I'm in strong support of SB 944. Thank you. I'm Jing Hu, local acupuncturist. I've practiced acupuncture almost 39 years. from America Association of Chinese Medicine Acupuncture member. So I hope a lot chronic pain patients. I strong support the bill. Thank you. Hi, Sheng Zhang. I'm a licensed acupuncturist from University of East to West Medicine and support the bill. Thank you. Hello, I'm Korean. I'm an acupuncturist in California. I'm a member of the Korean society. I'm a strong supporter. Thank you. Hi, my name is Carissa Chan. I'm a licensed acupuncturist in Roseville, California. I support SB 944. Thank you. Hello. My name is Casey Ching. I'm a licensed acupuncturist in California. I support SB 944. Good afternoon. My name is Kevin Kim. I'm a licensed acupuncturist in California. I'm in support of SB499. Hi, my name is Ian Chin-Hung and I'm a licensed acupuncturist in Sunnyvale. I support SB944. Good afternoon. This is Ivy Chen. I'm president of California University, Silicon Valley. I'm Director of Administration. I'm strong in support SB 944. Thank you. Good afternoon. My name is Wanling Liu. I have been an acupuncture patient for five years, and I strong support SB 944. Thank you. Good afternoon. My name is Tianyang. I'm an acupuncture patient for 10 years with low back pain and neck pain. I strongly support this bill. Thank you. Hi, my name is Meya Zhang. I'm an acupuncture patient. I strongly support this bill. My name is Zhonghua Fu, an acupuncturist for more than 30 years. I strongly support SB 944. My name is Seunghee Lee Sophia, Doctor of Acupuncture, Urban Medicine Specialist. Association is Korean Medicine Association. I support SB 944. Hi. My name is Sogu Jang. I'm a licensed acupuncturist in California. I support SB 944. Good afternoon, Madam Chair and Senators. Sydney Pond with Northeast Medical Services in strong support. Good afternoon, D. Wu with Northeast Medical Services in strong support of this building. Good afternoon. I'm Robin Adcock. I'm a doctor of acupuncture and Chinese medicine, licensed acupuncturist. For this bill, I'm representing the California State Oriental Medical Association, a 30-year association of students and clinicians, and we strongly support SB 944. Thank you. Thank you. Good afternoon. My name is Joey Kwan. I'm an integrative medicine assistant at Northeast Medical Services and I am in strong support. Good afternoon. My name is Xiaoxing. I'm working in the integrative medicine assistant in Northeast Medical Services. I strongly support this bill. Thank you. Good afternoon, Senators. My name is Otto Lee, current board supervisor in Santa Clara County. Speaking on my own personal capacity today, I'm strongly supporting this bill. Thank you. Good afternoon. My name is Chen Kuan. Sorry, I speak Chinese. I support SB944. I support SB944. Okay, seeing no others that wish to speak in support, we will now give time for any lead witnesses in opposition. Is there anyone who would like to come forward and speak as a lead witness in opposition? Seeing none, if there is anyone in the audience that would like to register their opposition, please come to the mic. State your name, your organization, and your position. Seeing none, I will now turn it back to the committee to see if anyone on the committee has any questions or comments. Senator Durazo? Thank you, Madam Chair. I just want to thank everyone who was here today. Thank the author for bringing this up. I represent several AAPI communities in the Los Angeles area, and I know how important it is not only to the AAPI community but everyone who relies on care, acupuncture care, for their health and well-being. So thank you. I want to thank also the acupuncture providers for doing what they do. It's culturally rooted care. That's very important for people to have the trust to go to those providers. So many of us are strong advocates for Medi-Cal to make sure that our immigrant communities are covered by Medi-Cal, but they also have to have access, and you're part of giving them access to true medical coverage. So thank you very much. Senator Perez? Yeah, thank you. I just wanted to speak to also express my support for the bill SB 944 and appreciate. I know that we have some folks here from Alhambra today who offered their support of this bill. Somebody that grew up in Alhambra and Monterey Park, you know, two communities in the SGV that have some of the largest populations of API communities in the state. I know how significant this is. it's really important that we honor and respect Eastern medicine and the role that it plays in the lives of so many. It's certainly something that I have incorporated and my family has incorporated growing up in the SGV and it had such a tremendous benefit for my family So making sure that we continuing to provide Medi coverage for acupuncture is really necessary I know so many of my constituents and their parents who I grew up with really rely on it as a form of care. So thank you, and we'll be excited to vote aye. Senator Caballero. I also want to thank the author. I'm a big believer in acupuncture. It's kept me away from any serious health issues. I'm absolutely convinced. My acupuncturist is in Salinas, and she was trained in China, and she's a doctor. And one of these days we'll get it right, and you can become a doctorate of acupuncture here as well. and I've gone to her for over 25 years, so I appreciate the work you do, keeping everyone healthy, and thank you to everybody who came to testify as well. And Senator DeRazzo has moved the bill. I want to thank the senator and thank everyone who came out to speak in support and also our lead witnesses. I think that we are all aware of the fact that under Medicaid or Medi-Cal, we don't determine what is a mandatory coverage or an optional coverage. And so this is an optional coverage per federal guidelines. However, I do want to commend you for recognizing that in our code, there was an interesting qualifier that was only placed on acupuncture and not some of the other optional benefits. And so that is what we will be correcting with this bill today. And with that, would you like to close? Great. Thank you very much. And again, I want to thank everyone who took the time to come out today. Actually, I had not until recently ever had acupuncture, and I had a strained forearm, and it basically fixed it. And so everything that I had been told over time turned out to be true. This really helps a lot of people maintain their health but also just improve their quality of life and deal with chronic pain in ways that are not, that is highly beneficial without the risks of some of the medication. And so we want to make sure people can continue to have access. And it makes no sense to single acupuncture out from other forms of health care and treat it in a more negative way, which is what the law does now. And so this is equalizing it, protecting access, and I respectfully ask for your aye vote. Thank you. The motion has been made by Senator Durazo. The motion is due pass and re-refer to the Committee on Appropriations. Please call roll. Assistant, please call roll. Senators Weber-Pearson? Aye. Weber-Pearson, aye. Valle-Adares? Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzalez, Grove, Menjivar? Aye. Menjivar, aye. Padilla, Perez? Aye. Perez, aye. Rubio, Smallwood-Cuevas? Aye. Smallwood-Cuevas, aye. That is ayes six, noes zero. We will leave that bill on call. And since we have a quorum, we will move back to file item number one. Do I have a motion on SB 895? So moved. Moved by Senator Durazo The motion is do pass as amended and re to the Committee on Natural Resources and Water Assistant please call roll Senators Weber Pearson? Aye. Weber Pearson, aye. Valladares? Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzalez? Grove? Menjivar? Aye. Menjivar, aye. Padilla? Perez? Aye. Perez, aye. Rubio? Smallwood-Quevas? Aye. Smallwood-Quevas, aye. I-6, no, zero. That bill is on call as well. Thank you, Senator. Thank you all for coming out. Before we move on to our next bill, we will consider the bills on the consent calendar. These are file item 3, SB 918 with amends, item 4, SB 971 with amends, item 5, SB 1047 with amends, and Item 9, SB 977, with amend. Senator Menjivar has made a motion. Assistant, please call the roll. Senators Weber-Pearson? Aye. Weber-Pearson, aye. Valladares? Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzalez? Grove? Menjivar? Aye. Menjivar, aye. Padilla? Perez? Aye. Perez, aye. Rubio? is Paul Wood Cuevas. Aye. Smallwood Cuevas, aye. That is 6-0 and we are going to place that as well on call. I would like to strongly recommend that any authors who will be presenting today to come down to Health Committee in room 1200. I'm ready. Are you ready or not? All right, then I'll go. You want to pass that to me? Yes. We will now be moving on to file item 10, SB987, Madam Chair. I was... Whenever you're ready. Thank you. Thank you. Good afternoon, colleagues, and thank you for the opportunity to present SB 987, the California Health Access Fund. H.R. 1, the federal reconciliation bill signed last year, makes significant changes to Medicaid eligibility, including new work and community engagement requirements. and more frequent eligibility renewals for certain populations. These changes increase the risk that eligible individuals will lose coverage due to administrative barriers rather than changes in income or need. The Department of Health Care Services estimates up to 2 million Californians could lose their Medi coverage as a result of these federal changes While coverage loss reduced state Medi expenditures on paper they do not eliminate health care needs Individuals who lose coverage often delay care rely on emergency services, or receive uncompensated care from safety net providers and safety net hospitals, shifting costs rather than reducing them. Absent state actions savings generated by reduced enrollment may not be directed towards maintaining access to care, supporting providers and those safety net hospitals, or addressing gaps created by federal disinvestment, but instead may be just swept back into the general fund. SB 987 would require the state to establish the California Health Access Fund separate from the Medi-Cal program. This fund would capture any savings resulted from the reduced Medi-Cal enrollment caused by H.R.1. The Department of Health Care Services would then be tasked with administering the fund to ensure that Californians who lose Medi-Cal coverage can still receive the health care access and services, and health care providers and their facilities will be reimbursed for providing those services. This bill is intended to start the conversation as to how we will continue to provide health care and pay providers and safety net hospitals when a large number of Californians can no longer rely on Medi-Cal. At a minimum, we need to repurpose any money that the state saves when people lose Medi-Cal and use that money for the health care system who will still be serving these individuals. I respectfully ask for your aye vote. Thank you, Senator. Do you have any lead witnesses in support? Nope. Okay. Would anyone like to record their Me Too's in support of SB987? Please step forward.

Thank you.

Thank you. I don't see any registered lead opposition. Anyone like to record their me too's in opposition of this bill? I see no one stepping forward. Bringing it back to Senator Caballero to start our discussion. I really appreciate what you're trying to accomplish with this bill. We always end up in a situation where we expect there's going to be savings, and then we don't ever see them. They just kind of disappear. Yeah, so I get it. So I expect we're going to see some changes over the time that the bill is run. but just my two cents worth is we've got to figure out what are the biggest tolls we have left after H.R. 1. I think operationally we're going see. And from my perspective, I think we need to prioritize indigent care, people that are not covered by insurance, prevention models, maybe people with disabilities and children. The most vulnerable in our communities are, I think, going to be impacted. And so if we had to pick something that, in my mind, would be a priority over really expensive care that's necessary, but, you know, you can use up an entire fund with very little impact. So thank you for doing this. I really appreciate it. And when the appropriate time comes, I'd like to move the bill. Any other questions? Thank you.

Really, the point of this bill as of right now is to ensure that those funds that are saved don't end up being taken up by future administrations, and we aren't able to have that conversation and that decision as to where it will go. We know that patients are still going to, they're not going to get sick. They're still going to go to emergency rooms. Our hospitals are going to have to pay for that uncompensated care. We already have issues with hospitals closing their doors, which is why we had to do the emergency distress hospital loan a few years ago. We're still going to have clinics. We're still going to have an access issue, and we need to ensure that we have the funds to start having those conversations as to where that could go. I really like Senator Caballero's suggestion about not just potentially using these funds for when they come into the emergency room,

Thank you. Seeing no other questions, we do have a motion from Senator Caballero. Oh, would you like to close? I want to thank my colleagues for this robust conversation. I think we have to really start thinking outside the box and how we're going to help Californians in this very interesting time from some things that we never thought we would have to deal with. But with that, I respectfully ask for an aye vote. Thank you. Secretary, the motion is due pass and re-refer to the Committee on Appropriations. Please call the roll. Weber Pearson, aye. Valladares, aye. Valladares, aye. Caballero, aye. Caballero, aye. Durazo, aye. Gonzales, Grove. Menjivar, aye. Menjivar, aye. Padilla, aye. Padilla, aye. Perez, aye. Perez, aye. Rubio, Smallwood-Cuevas, aye. Smallwood-Cuevas, aye. What was that? 8-0. That will remain on call. We will now move to file item 7, SB 964. Senator Smallwood Cuevas, you may begin.

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

Thank you. You have about a minute left.

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

Katie Van Dines with Health Access California in support.

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

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

So thank you. Seeing no others that wish to speak in support, If there's anyone from LEAD Opposition that would like to come and speak in opposition, this is your time. You will both have a combined five minutes. Thank you.

Thank you.

Allowing providers to increase dosages up to two times without plan review essentially weakens critical safety and appropriateness checks. It also ignores the clinical evidence and best practices evolve, and plans may appropriately work with patients to transition them to more effective or lower cost formulary options. For these reasons, we are currently opposed to the bill. That being said, we do look forward to working with the author and sponsor if the bill moves forward today and looking to see if there are potential options going forward. Thank you. Thank you. If there's anyone else in the audience that would like to register the opposition, please come to the microphone and state your name, your organization, and your position. Seeing none I am going to turn it over to the committee to see if anyone has any questions or comments Seeing none I have some questions So when I look at this bill first of all thank you for bringing it forward Thank you. Thank you so much for your testimony and coming in and sharing your personal story. It talks about the authority for a provider to adjust the dose of frequency of a drug. But in the opposition statement, they were talking about exceeding FDA approvals. Is that what we're referring to here? No. This bill is focused on making sure that physicians who already understand and manage these drugs, who understand how they interact with patient care, to ensure that the evidence-based care that they are giving, that their patients are able to access this easier. This is not about looking at experimental drugs. this bill only applies to drugs that are already covered. Right. So this question of... Right. So let me make it a little clearer. If I have prescribed a medication at a certain dosage and my patient needs a higher dose, that is not necessarily an excess of that dosage. that is what this bill is trying to prevent me or that patient from having to wait from the insurance? Or is it when I prescribe a dose that exceeds the recommended dose? It is the former. The former. When you are prescribed a drug and it is approved by the plan, they approve that drug, then that drug starts to lose effectiveness on the patient, and the physician decides based on their research, their clinical data, that the best interest of the patient is to keep them on that drug and increase the dose or, in the case of a Crohn's patient, the frequency of that dose, then that's the request that they make to the plans. And it's still within the approved dose regimen that is FDA approved. We're not exceeding a dose. We're not. Go ahead. Potentially, but potentially not. In some cases they will see, and you'll see some of these denial letters, that if FDA approves it, say, an infusion for eight weeks, but that's the standard infusion, but yet the body of the patient has developed antibodies for it, so it's not responding. The doctor thinks more frequent infusions would be better for the patient, so they ask for four weeks. FDA did not approve four weeks. They approved eight weeks, and so, yes, that would be considered off-label. So is there any way to, in the future, as this bill is being moved forward, because I know as providers we will oftentimes go by clinical practice, but even within that it has been studied and it is widely used within our own profession. It may not necessarily be FDA approved for that particular, you know, length of time. Is there any way to clarify that just to ensure that, you know, I don't believe any providers would go rogue, but, you know, addressing the concerns that the opposition may have, that someone may be doing some kind of, hey let try this which is not necessarily standard of care for that particular condition or you know area Are we able to do that May I Yes And I say that with absolute certainty because in the information that Ms Lump sent to the doctor, they provided that medical information, they provided that data, and it was still denied. Right, I guess what I'm saying is they're saying in this bill that it would allow for that. There's nothing in the bill that prohibits, you know, if the initial diagnosis and prescription is either on label or within FDA approved limits, there's nothing then that says that it has to remain within that. It just says that it can't be a controlled substance or it can't be, I mean, there's a couple of different qualifying, but certainly you would assume, and we have to look at the breadth of this bill. While most of the testimony has always been around Crohn's and colitis, the bill really does touch across all segments of healthcare space and a really large amount of drugs and treatment plans. So in those instances, I think, and this is something that we had talked at one point, I think, with the sponsors about limiting it to either FDA approval to ensure that there were protections there about either the frequency, the dose, or that it was on-label use. So I think those would be key components we would be, I mean, I think that's going to be a concern for the sponsors, to be quite honest with you, to specifically limit that. Well, I'm not saying limit it to FDA, but there are some best clinical guidelines that include off-label or more frequent. And you might want to consider including that in the language just to ensure that no one is harmed. And that's the intention of this bill, is that we want folks to not have to go to the emergency room to need emergency care. We want to create an environment where they are able to, under their doctor's prescription, under their doctor's guidance, be able to access the medication that is prescribed. And we're happy to continue to work with the opposition on this. I think this is a nuance that we will dig into as we move the bill forward because we don't want anyone harmed. The goal here is to help folks reduce some of the suffering. All right, Senator Valladares. Yeah, so I think they say you shouldn't marry a comedian because it will tell your personal stories, and you shouldn't marry a legislator either because they'll also talk about their personal stories. And my husband, who takes thyroid medication, has been through this very similar situation. So sorry, Shane, where he needed an increased dosage, and he wasn't approved for it. He ran out of the existing prescription. And there are side effects when you're not on your thyroid medication. And so I've seen it personally from the patient's perspective, how important having access to a really quick turnaround in the prescription dosage is important. My question, though, on, I guess, the clinical side or the doctor's side is, if a doctor prescribes, you know, the wrong dosage or an unsafe medication or messes up, are they not liable for that? And that would still be the case. Sure. So for me, it seems really simple that we trust our doctors, and when we're dealing with any type of chronic illness, that we should easily be able to trust the recommendation and prescriptions from our doctors. The other question I have is your doctor prescribes you a medication, and then the pharmacist often also looks at that dosage to weigh input as well, typically. Is that also correct Oh for us All of that is monitored through the doctor but also the specialty Well, it must be because I haven't had any. The specialty pharmacy will call me about deliveries or we go to UC Davis for the infusions, and no one has ever said anything. but I would assume that if it was dangerous that they would say something. You know, I mean, I work with the doctors. I speak directly to the specialty pharmacies every month, and I would assume that they would say something. Okay. And so for me it seems pretty basic. For the opposition, do you have amendments that could make this better, clarification language? Was that ever presented? On earlier iterations of the bill, and this is, you know, a much more narrowed bill than we've seen. I think this is the third time, fourth, sorry, right? Fourth time we've had this conversation. It's certainly evolved. I think there are amendments we would be happy to sit down and discuss. I think some of where we would want to go, either, like, you know, directing to clinical care guidelines or some sort of, you know, pointing to a requirement that they meet a certain standard. I understand that many of the usages are often off-label. So that's, I mean, it's, I think what we would want isn't something necessarily that they could agree to, given the population that they're looking at. We can certainly continue to have those conversations, and we're happy to do that. But there is that concern, partly because the bill is so broad. It isn't just about the Crohn's and colitis condition, but everything. And so as you're trying to address such a wide span of diagnosis treatments, there's lots of off-label. There's lots of things that are really standard of care that are off-label. And then there are ones that are not. And how do you kind of remedy that? But we're committed to having the conversation if the bill moves forward today and see if there's a pathway. Thank you. Okay. Well, I want to thank Senator Smallwood Cuevas for introducing this bill and for allowing us to have this robust conversation. Look forward to those continuing conversations. Yes, you're not going to get exactly what you want, but I do think that you have brought up some concerns that we may be able to address with looking at clinical practice, clinical standards of care, which are less stringent than FDA, but are things that we as providers use and our patients definitely need. Like, you know, there was one part of your bill, and you and I talked about it, and I did with the sponsor as well, that excluded Medi-Cal managed patients from this. And I have generally been very clear about the fact that if we're going to do something for one set of patients, we should do them for all, especially for those that are on Medi-Cal because they often have very chronic significant illnesses. We did reach out to DHCS, and it seems like they already have a system in place and that they only utilize prior authorizations for very high dosage that would exceed the maximum dose restrictions. And so because of that, and I think that this is very much needed, I will be supporting, and you may close. Well, thank you so much, Madam Chair. Thank you. Really appreciate your expertise in this subject matter area. This is about helping patients. This is about making sure Californians can get the access to care and pain and suffering relief as quickly as possible. And also to save money so that folks aren't having to go to the emergency room or needing a more expensive treatment because they weren't able to access an adjustment in their dose. So we will continue to work with the opposition. We think this is a good bill, even if it is the fourth time around, fourth time's a charm. And I respectfully ask for your aye vote. Thank you. Would anyone like to move the bill? Move the bill. The bill has been moved by Senator Padilla. The motion is do pass as amended and re-referred to the Committee on Appropriations. Assistant, please call the roll. Senators Weber-Pearson? Aye. Weber-Pearson, aye. Valladares? Aye. Valladares, aye. Caballero? Aye. Caballero, aye. Durazo, aye. Durazo, aye. Gonzales, aye. Gonzales, aye. Grove, aye. Grove, aye. Menjivar, aye. Menjivar, aye. Padilla, aye. Padilla, aye. Perez, aye. Perez, aye. Rubio, aye. Rubio, aye. Smallwood Cuevas, aye. Smallwood Cuevas, aye. 11-0, it's out. Wow. 11-0, that bill is out. Thank you. Good job. Alright, we will now move back in file to file item number 6, SB 1099 from Senator Reyes. And you may begin whenever you are ready. Thank you, Madam Chair and members, for this opportunity to present SB 1099. SB 1099 clarifies California local government's authority to provide state or local public benefits to all residents under the statutory exemption provided in the Federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996, also known as PRO-ORA. Historically, California has relied on a statutory exemption under PROWRA that allows local governments, at their discretion, to provide state and local public benefits to all residents. Thanks to this exemption, our local governments have been able to provide critical services such as health care and safety net programs to all residents without worrying that they are in violation of federal law. Unfortunately, the California statute that provides this pro-ORA exemption is too vague and is not directly tied to how local and state public benefits are defined at the federal level. This creates risk because if the federal definition changes or is reinterpreted, our California exemption may fall out of alignment, potentially exposing a local government to compliance issues. SB 1099 addresses this by explicitly tying state law to the federal definition, ensuring clarity and consistency with federal requirements. While technical, this is a high-impact bill that strengthens and protects local government's existing authority to serve all residents. Here to testify on the bill today are Tony Lopresti the chair of the Civil Prosecutors Coalition and Santa Clara County Council and Jordan Flanders Interdepartmental Counsel for Homeless Services Oakland City Attorney Office Thank you. You will both have a combined five minutes. Good afternoon, Chair Weber Pearson and members. My name is Tony Lopresti, County Council for the County of Santa Clara and chair of the Civil Prosecutors Coalition. Civil Prosecutors Coalition is proud to support SB 1099. The coalition is composed of seven city attorneys and county councils from the cities of Oakland, San Diego, San Francisco, and San Jose, along with the counties of Los Angeles, San Diego, and Santa Clara. We represent some of the largest public law offices in the state and advise our local government clients on all issues, including protecting our authority to use public funds to benefit the most vulnerable residents in our communities. And that is precisely why we are so thrilled to work with Senator Reyes on SB 1099. This bill is a straightforward clarification of longstanding California law that allows local agencies to spend state and local funds to offer critical programs and safety net services to all of our residents. As the federal government continues to layer safety net programs with grant conditions and eligibility criteria, we hope to partner with the state to protect our autonomy and our authority to use state and local dollars to serve our residents as we deem appropriate. As cities and counties, we know our residents and their needs best, and we design programs to respond to those needs. That's why local control over how we spend state and local funds is so critical. I want to be clear that this bill doesn't require local governments to do anything. It doesn't require that locals spend their money in any specific manner or on any specific constituency. Instead, it clarifies in statute local governments' authority to develop and maintain programs that serve our residents based on criteria that we establish rather than criteria established by the federal government. As city attorneys and county councils, it's our role to provide as much legal certainty as possible to our local government clients. This bill will minimize risk and uncertainty, particularly in these very difficult budget times. Civil Prosecutors Coalition requests your support for this bill. Thank you. Thank you. Good afternoon. Thank you to the chair for the opportunity to speak today and thank you to Senator Reyes for bringing forward SB 1099. I'm here as the interdepartmental homelessness council for the city of Oakland city attorney's office in support of this bill which makes a simple but important change to California law. It reaffirms and clarifies that local governments have the authority to provide essential services to all residents who live in their community using state and local funding sources, despite any changes to federal law. Local governments are on the front lines of providing services such as health care, emergency shelter, crisis intervention, and food distribution. These programs must operate quickly, with minimal barriers, and often without collecting personal information. Many programs serving people in crisis cannot realistically incorporate documentation checks or detailed intake requirements. For example, homeless outreach teams often engage people in encampments or on the street for only a few minutes at a time. These teams focus on transportation to shelter and crisis de Encampment management teams leverage a wide variety of resources to address encampments and must be able to provide those resources to all people living on the streets if they so choose These teams generally do not have time or the ability to conduct identification checks during these brief encounters. Similarly, street medicine teams prioritize urgent medical and behavioral health stabilization, which depend on speed and low barrier access. Finally, suicide prevention and crisis hotlines operate anonymously by design, and callers frequently decline to provide any identifying information at all. Gaps or uncertainty about the scope of required screening may cause local governments to hesitate in providing services or to restrict eligibility for locally funded programs unnecessarily. This bill would take advantage of existing provisions of federal law to clarify that local governments in California can continue to use state and local funding for these services if they choose to do so. It does not require or mandate any local action. Instead, it provides the legal certainty that cities and counties need to continue providing essential frontline services to their residents using state and local funding to the fullest extent that federal law allows. Thank you. And at this point, if you are in the audience and would like to register your support, please come to the microphone, state your name, your organization, and your position. Madam Chair and members, I'm Erin Evans. I've been asked to register the support of the San Diego City Attorney Heather Ferbert. Thank you. Thank you. Dylan Elliott on behalf of San Francisco City Attorney David Chu as well as the city and county of San Francisco, both in support. Thank you. Thank you. Good afternoon again, Senators. My name is Otto Blaisdill, serving as the board president of the Santa Clara County Board of Supervisors, and we are strongly supporting and also a co-sponsor of this bill, representing 2 million people of our county. Longest county in Northern California. Thank you. Thank you. Kevin Guzman of the California Medical Association in support. Thank you. At this time, if there's anyone in the audience that would like to speak as lead opposition, Seeing none, if there's anyone in the audience that would like to register your opposition, please come to the mic, state your name, your organization, and your position. Seeing none, I will now turn it over to the committee if anyone has any questions or comments. The bill has been moved by Senator Gonzalez. Senator Reyes, you may close. Thank you. I respectfully ask for your aye vote. Thank you. The best clothes we've had all day. All right, so the motion by Senator Gonzalez is to pass and re-refer to the Committee on Human Services. Assistant, please call the roll. Senators Weber-Pearson? Aye. Weber-Pearson, aye. Valladares? Aye. Valladares, aye. Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzalez? Aye. Gonzalez, aye. Grove? Aye. Grove, aye. Menjavar? Aye. Menjivar, aye. Padilla, aye. Padilla, aye. Perez, aye. Perez, aye. Rubio, aye. Rubio, aye. Smallwood, Cuevas, aye. Smallwood, Cuevas, aye. 11-0, that bill is out. Thank you, Senator. Thank you. We will now move to file item 8, SB 1033, by Senator Padilla. and you may begin when you are ready Thank you Ready Afternoon, Madam Chair and members. It's my honor to present SB 1033. I want to begin by thanking the committee and the chair for working with my staff on this bill. We're happy to accept committee amendments that were worked out to define protein product as either a protein supplement, as defined in federal law, or a food product that is a protein supplement premixed with water. You can see those highlighted materials in front of you. This bill requires manufacturers of protein products to test their items for heavy metals and disclose those findings. In recent years, there have been increasing demand for protein-fortified items that have led manufacturers releasing an abundance, large quantities of these products. This rapid market expansion has occurred without any regulatory oversight. In October of 2025, Consumer Reports conducted an independent investigation of multiple protein powders and protein beverages, and their results were disturbing. They found that several products contain levels of heavy metals, including arsenic, cadmium, and lead. At the federal level, the Food and Drug Administration does not review dietary supplements for safety or for effectiveness, and there are not any federal limits on the amount of heavy metals and products to consumers. Without transparency and standards, consumers are left unaware of the potential toxic exposure from these contaminants and the products they are consuming. These supplements contaminated with heavy metals can contribute to numerous serious health outcomes, including neurological issues, immune suppression and reproductive harm, and long-term health impacts. In order to protect consumers, create transparency at these toxic levels and ensure people are purchasing safe products, SB 1033 requires manufacturers to test their products for heavy metals and disclose these findings. This addresses a growing public health concern, protects Californians from preventable harm, reinforces our state's commitments to transparency, safety, and responsible product regulation. With me today, I have Ryan Spencer from Environmental Working Group and Caitlin Marr, Research Manager for the Center on Environmental Health. Thank you. You will both have a combined five minutes. Thank you, Madam Chair and members of the committee. Ryan Spencer on behalf of the Environmental Working Group, sponsors of SB 1033. First, I'd like to thank the senator for introducing this bill as a direct response to the mounting evidence that some protein products contain levels of heavy metals high enough to raise serious public health concerns, particularly for teens and frequent users. Protein powders, shakes, and bars are not occasional use products. Many Californians, not just athletes, incorporate them into their daily routines, sometimes multiple times per day. The pattern of use matters because even low levels of toxic ailments can accumulate over time and create real health risks, particularly for pregnant individuals, adolescents, and those with chronic exposure. This is particularly alarming when you consider even a single scoop of protein powder can push someone past the recommended limits for lead, a problem that has grown over the years. A recent Consumer Reports study the center mentioned showed average lead concentrations higher than those identified in testing conducted 15 years ago, and fewer products today are testing below detectable levels. But all, thankfully, is not lost. Safer outcomes are achievable. That same Consumer Reports study also identified products containing much lower levels of heavy metals than others, which tells us this is not an unavoidable problem. It's a solvable one. Yet consumers have no way to distinguish between those products and what is best for them. SB 1033 corrects this imbalance by introducing a simple but powerful concept, transparency backed by accountability. By requiring... Iron manufacturers routinely test their products and make those results publicly available, the bill does two things. First, it gives consumers the ability to make informed decisions based on real data. Second, it creates a strong incentive for companies to improve sourcing and manufacturing practices to remain competitive by lowering their levels of heavy metal. We've already seen this model in California work. We passed a bill last year, SB 646, by the chair dealing with prenatal vitamins and heavy metal contained in them. So when disclosure requirements are in place, contamination levels drop, not because of mandates and formulation, because transparency drives better behavior. This bill is not about restricting access or limiting consumer choice. It's about ensuring the choice is informed and that products marketed as part of a healthy lifestyle meets a basic standard of accountability. SB 1033 is a straightforward, common-sense consumer protection measure, one that aligns with California's longstanding leadership in consumer protection and public health. I respectfully ask for your aye vote. Thank you. Good afternoon. My name is Caitlin Moore and I'm the research manager at the Center for Environmental Health. We are proud to co-sponsor SB 1033 and commend Senator Padilla for carrying this bill. When Consumer Reports tested protein powders and shakes, it discovered high levels of lead in more than two-thirds of the products. And some products contained cadmium and arsenic. There is no safe level of lead exposure. Exposure to lead can cause cancer, reproductive and developmental issues, and neurological harm. Low levels of lead can cause cognitive impairment in children. According to the World Health Organization, long-term exposure to arsenic in food can cause cancer and skin lesions. Arsenic has also been associated with cardiovascular disease and diabetes. The CDC says that metallic mercury most commonly affects the nervous system. Exposure can cause tremors and coordination and problems with vision, learning, hearing, memory, and mood. Mercury also hinders fetal and child development. Cadmium can cause developmental and reproductive harm. In addition, consuming just one serving a day of some protein products will cause a person to exceed the FDA's recommended daily limit from food. Many people consume more than one serving of a protein product daily and could easily exceed this limit. Remember that heavy metals can accumulate in the body. With more people increasing their consumption of protein, many are consuming protein products daily. SB 1033 will equip consumers with information they need to make informed decisions about their nutrition. I respectfully request your aye vote. Thank you. If there's anyone else in the audience that would like to register their support, please come to the microphone at this time. State your name, your organization, and your position. Thank you. Good afternoon. Christopher Sanchez on behalf of the Consumer Federation of California in support. Hello. Susan Little on behalf of Consumer Reports, Unleaded Kids, and CalPERS. Good afternoon. Kai Clausen on behalf of Breast Cancer Prevention Partners in strong support. Thank you, author. Hello. Alana Latticer with the American Nurses Association of California in support. Ryan Spencer on behalf of the American College of OBGYNs in support. Sorry. We're tweeners. Is that okay? Tweeners, all right. Thank you. Dennis Albiani on behalf of the Consumer Brands Association. I want to compliment the staff of the senator as we met with him and the consultant to really try to bring this down and get some where the testing would be the most effective We do express some still additional concerns We think this should be focused on supplements and supplements themselves, and this one still has beverages and some of the other products beyond that, so we would further narrow that. And I think the folks know some suggested amendments that have been provided and discussed. Second of all, I think we also would consider moving the testing up from the actual end product to the suppliers of the protein supplements. That way it would, you know, when we discussed it with the staff, it would focus that and have much less testing requirements in all these products. You'd get it at the source. So we think those are constructive options to discuss as this goes forward, and we appreciate your time. Thank you. Thank you. We will now open it up to anyone who is here speaking in lead in opposition. Well, we're all debating that. My apologies, Madam Chair, members, Trent Smith on behalf of the Consumer Products Association. We're also, I guess, we are listed in concerns. We don't have a problem with testing or reporting over certain levels. I think our concern right now is, as the analysis points out, heavy metals are naturally occurring and found in soil and leafy greens, spinach, root vegetables. If you're all looking for an excuse not to eat your spinach, perhaps, this is one. But the point being is that these are naturally occurring in our plant-based dietary supplements. And so reporting everything we think is counterproductive as far as you could actually scare consumers into not having anything. So, again, we're fine with certain elements of it but concerned about just the overall testing of trace amounts. And so, again, we've listed our concerns. Happy to work with the sponsors and author. Thanks. Thank you. If there's anyone else that would like to register opposition, please come to the mic. State your name, your organization, and your position. Madam Chair and members, Anthony Molina on behalf of the Natural Products Association in opposition. Thank you. Thank you. Madam Chair and members, Mike Fiennes on behalf of Dairy Institute. We are still listed in opposition on our letter, but all the comments that were made we share. We appreciate the staff working with the amendments. We've met with you. We appreciate it, and we've talked about their, your staff. So we'll continue to work through the process. We're still in this locked position of opposed, but I think we can get somewhere. We're optimistic, so thank you. Thank you. At this point, I will bring it back to committee members if there's any questions or comments. Senator Grove. Thank you, Madam Chair. I appreciate the bill. I do. And I am going to vote yes on it, but I would like your commitment that you continue working with opposition because sometimes we do things like in a different industry, and I know this is going to freak everybody out when I say that. We did fence line monitoring for refineries, but there are certain refineries that don't produce any constituents. The product they produce, there would be no pollutants at all because they don't do gasoline. They do asphalt and ink oils and things like that. But they still make them tests for the stuff that would be in refiners for gasolines. That was a well-intended bill to make sure that we didn't have anything passing over the fence line. So this is a well-intended bill, But we need to make sure that it doesn't exclude things that are naturally occurring in spinach or vegetables or anything else. And so I just like your commitment that you going to continue to work with the opposition Madam Chair and Senator absolutely Thank you Senator Garraza Thank you Madam Chair and thank the author I did a bill last year on menstrual products, right to know, and it was really important to begin the process of people knowing what's in the product that they're using. In that case, of course, using menstrual products for several hours at a time, many consecutive days at a time. Different product, but the same idea is that to watch out for all these things that you need to test. Otherwise, you wouldn't know. You wouldn't know if there's anything in there hurting you or damaging you. So I appreciate your bill. Thank you, Senator. Seeing no further comments from the committee. I want to thank you so much for bringing this bill forward. Thank your sponsors. And also, I really want to give kudos to the health staff who really did an amazing job with the amendments and really dug deep, looked at the different products, looked at the different ingredients to try to really narrow it because it was very, very broad initially. And so I just want to give kudos to our amazing consultant for that. Yes. A little bit of a moment. Yes. You know, it's interesting. When I was listening, I was hearing some of the same arguments that I heard from my prenatal vitamin bill as to why it shouldn't happen. Oh, it's naturally occurring. We can stop eating spinach and all these leafy greens. Like the same thing. But at the end of the day, we really need to make sure that what we are consuming is safe. And this is not removing products. It is allowing individuals to know what's in their products. And I think it was Ryan who started off stating that, you know, our kids are now consuming these protein bars and protein shakes. And I said, oh, my goodness, you're right, because my 14-year-old who's trying to bulk up eats his protein bars every single day. And we need to make sure that our kids are healthy, that we're healthy, but also our kids, especially since it's so widely available. And so I appreciate you doing this, and with that, you may close. Thank you very much, Madam Chair. I do want to thank you for your extraordinary leadership in this space. Certainly with respect to the sponsors and our office, we did have some good inspiration. from a similar bill to try to build on that. And I would echo your compliments of your committee staff. Our committee staff did an amazing job fixing what, for a quick second there, felt almost like we were going to go off a cliff, and you brought it back. And so I'm very, very grateful for your work. I would just only say that knowledge is power. There are many factors that contribute to what ends up on our plate, and we only have the ability to mitigate that or deal with that or have informed choices as consumers if we have the information. Knowledge is power. That's what this bill is about. I would respectfully ask for an aye vote. Thank you. Looking for a motion? Move the down. Moved by Senator Gonzalez. The motion is due pass as amended and re-refer to the Committee on Environmental Quality. Assistant, please call the roll. Senators Weber-Pearson? Aye. Weber-Pearson, aye. Valadares? Aye. Valadares, aye. Caballero Aye Caballero aye DeRazzo Aye DeRazzo aye Gonzales Aye Gonzales aye Grove Menjivar Aye Menjivar aye Padilla Aye Padilla aye Perez Rubio Smallwood Cuevas Aye Smallwood Cuevas aye It's 8-0. We will place that bill on call. Thank you. I will be presenting SB 1049, which will ensure providers have a fair opportunity to correct minor technical errors on claims. I want to thank the committee for your thoughtful review, and I accept the amendments. At its core, SB 1049 addresses a gap in current law by ensuring providers have a meaningful opportunity to correct claims after a plan takes action. Today, providers are working in an increasingly complex administrative system. Even when they deliver appropriate care, they face denied payments or retroactive recoupments. Not because care was wrong, but due to minor correctable errors like coding or documentation. These are not cases of fraud. They are simple mistakes that should be fixable. But under current law, providers often blocked from correcting them because of rigid filing deadlines tied to the original date of service. From a clinical perspective, that's deeply concerning. When payments are denied or clawed back months or even years later, it creates real instability, especially for small, independent practices. That instability affects staffing, limits access to care, and ultimately impacts patients. Let me share a real example. An obstetrics practice in Sacramento was told that 40 claims spanning nearly two years were overpaid, resulting in a $90,000 repayment demand. The issue wasn't the care. It was a missing diagnostic code, which is a simple fixable error. But when the providers tried to correct and resubmit, they were denied because the filing deadline had passed. Meanwhile, the health plan began recouping payments from ongoing care. So in this case, the care was appropriate, the error was fixable, but the system did not allow for it to be corrected. That is not a fair nor efficient system. The core issue is simple. Providers don't have a meaningful opportunity to fix errors once they're identified, especially when they're flagged after the deadline. SB 1049 offers a balanced, straightforward solution. It allows providers to correct claims within 90 days of a health plan's latest action, like a denial or overpayment notice, and prevents plans from rejecting those corrections solely due to the fact that it was past the deadline. It is not open-ended. It is reasonable, time-limited fixed. And importantly, this bill does not excuse improper claims or expand liability for health care It simply gives providers a fair chance to correct honest mistakes. SB 1049 is sponsored by the American College of Obstetricians and Gynecologists and co-sponsored by the California Medical Association. And we are actively working with health plans and other stakeholders, and we remain committed to continuing those conversations to address any concerns and find a balanced solution. This is a common sense reform that reduces unnecessary conflict, improves efficiency, and keeps the focus where it belongs, on our patients. I respectfully ask for your aye vote, and with that, I'd like to introduce our two witnesses, Dr. Kathleen Rooney. She's an OBGYN and ACOG fellow. and Ryan Spencer again, who is here this time, I know he's been here all day, this year as a legislative advocate for ACOG District 9. We're going to put your name on that seat? Is that what's going on? You're both recognized for five minutes, two and a half minutes each. Great, thank you. I would like to thank the committee for this opportunity to speak with you all, and I would especially like to thank Dr. Weber Pearson for authoring SB 1049. My name is Dr. Kathleen Rooney. I am an OBGYN and a managing partner of a Sacramento private practice consistent of seven doctors. We care for over 10,000 women in our Sacramento community. I'm here to speak about the importance of SB 1049. In April 2025, I was notified by my biller that our health plan was withholding payment from current patient care due to a coding error from past claims. These were from 61 pregnancy claims dating from January 2023 to January 2025. After having to contact the plan to learn why they were withholding our current money, we learned it was simply because the claims did not include a diagnostic code. In this industry, this type of behavior is called a clawback. Upon this discovery, our biller immediately fixed the claims and sent them back. The resubmitted claims were denied as untimely because it had been more than 90 days from the date of service. As you can see, we were notified two years after a claim was submitted. And so, of course, we were past the timely filing limit. My biller has then spent over 100 hours fighting each of these claims. Overall, the plan has withheld $120,000 from my partnership during the past year, and to date, $60,000 is still not paid back to us from 31 pending claims. She has to contact the plan multiple times to find a representative that understands the problem, and if she finds a representative that understands the situation, they will process only three claims at a time. Currently, we have 31 outstanding claims that they will not process. I want to be very clear here. The work that we did was competent, gold standard care that was approved by the plan. The only thing missing was the gestational age code. My business filed a financial loss this year specifically due to this clawback. My first thought when I determined what happened was this should be illegal. Why should an insurance company be afforded so much time to recoup a payment yet we are restricted to 90 days from date of service to correct it? It does not make sense The insurance company may say they have a process for denied claims but I hope my words resonate today that their process is horribly broken and unfair It only benefits the insurance company financially while harming physicians like me and most importantly, the patients that we serve. Without financial stability and necessary resources, our ability to provide appropriate care to our patients is severely limited. SB 1049 presents a reasonable solution that could have prevented all of this. By allowing providers extra time to cure a defect in the claim form itself, it ensures that minor correctable errors, like a missing gestational age code, do not result in permanent nonpayment for medically necessary approved care. Being a small business, fighting insurance companies over a coding error is exhausting, time-consuming, and financially draining, and has affected other private practices like my own throughout California. Please help restore a fair and balanced process between plans and providers that prevent an easy-to-fix solution from becoming a multi-year nightmare. I respectfully ask for your aye vote on SB 1049. Thank you for your time. You have one minute. Sure. I'll be quicker. Ryan Spencer on behalf of the American College of OBGYNs, District 9, sponsors of the measure. I'd just like to thank the senator for authoring this bill and the witness for bringing this to our attention. Thank you very much. Ask for your aye vote. We will now open this up to any Me Too's here that would like to state your name, your organization, and your position. Kevin Guzman with the California Medical Association, proud co-sponsor to the bill. Angela Pontus on behalf of Planned Parenthood Affiliates of California in support. Kaitlyn Dean on behalf of the California Hospital Association in proud support. Lawrence Gayden on behalf of the California Dental Association in support. Angelica Fascio, office manager at a private practice in support. Dr. Haley McNair, private practice OBGYN in support. I'm Joe Monroe, licensed marriage and family therapist in private practice. My full support. Tim Madden, representing the California Chapter of the American College of Emergency Physicians, the California Chapter of the American College of Cardiology, the California Rheumatology Alliance, and the California Society of Plastic Surgeons, all in support. Thank you. We'll now open it up to two lead witnesses in opposition. Please come forward. One thing, a new bill just took effect. Thank you, Chair and members. Cassidy Heckman on behalf of the California Association of Health Plans. We are in an opposed and less amended position today, but we've had productive conversations with both the author and the sponsor of the bill. We're still concerned about the inclusion of denials and the 90-day timeline, but we're looking forward to continuing those conversations. Stephanie Watkins on behalf of the Association of California Life and Health Insurance Company. similar position to pose unless amended. Look forward to working with the author and sponsor the bill most for today. Thank you. Thank you. Is there anyone else here in opposition or tweeners? Seeing none, let's bring it back to the committee. Any questions? Seeing none, would you like to close? Yes Well first off I want to thank you all Thank the committee staff again for the amendments thank the sponsors And I really want to thank um my witness Dr Kathleen Rooney As I was listening to your story one of the things that I kept thinking about is the fact that we are dealing with an issue of access We are losing providers left and right here in California and having a really hard time recruiting them. And we're also having an issue with large corporations coming in and gobbling up smaller private practices. And this is a huge obstacle for those, especially in smaller private practices. And we should not be allowing something as small as an error for a billing code. And I've been in those same positions. I mean, I keep changing, so it's like how do we know what to check at which time? to really be the reason why someone has to close their doors, why that access for our patients will continue to be limited. And so with that, I commit to continuing to work with those who are opposed unless amended, but this really is a very serious issue for our providers, for our patients, for our community. And with that, I respectfully ask for an aye vote on SB 1049. Thank you. Thank you. Do I have a motion? Senator Caballero, who is a bill? Secretary, the motion is due passed to the Committee on Appropriations. Please call the roll. Do pass as amended to the Committee on Appropriations. Please call the roll. Senators Weber-Pearson. Aye. Weber-Pearson, aye. Valladares. Aye. Caballero. Aye. Caballero, aye. Durazo. Aye. Durazo, aye. Gonzalez. Aye. Gonzalez, aye. Grove. Menjivar. Aye. Menjivar, aye. Padilla. Aye. Padilla, aye. Perez, Rubio, Smallwood-Cuevas, aye. That bill is 7-0 and is on call. Thank you. We are going to go through all of the bills. I would strongly recommend that anyone who is on the committee and wishes to register their vote, please come down. We're going to start with the consent calendar. Assistant, please call the absent members. Senators Valladares? Aye. Valladares, aye. Gonzalez? Aye. Gonzalez, aye. Grove? Padilla? Aye. Padilla, aye. Rubio? Aye. 9-0, we'll place that back on call. We'll go to file item number 1, SB 895. Assistant, please call the absent members. The motion is due pass as amended and re-referred to the Committee on Natural Resources and Water. Senators Valladares? No. Valladares, no. Gonzalez? Aye. Gonzalez, aye. Grove? Padilla? Aye. Padilla, aye. Rubio? Eight to one. Eight to one. We will put that on call. We will now move to file item two, SB 944. Motion is due pass and re to the Committee on Appropriations Senators Valadares Gonzalez Gonzalez I Grove Padilla Padilla I Rubio Ayes 8, Noes 1. That's on call. We will move to file item number 6, SB 1099. Motion do pass and re-refer to the Committee on Human Services. That one is already out. That one is out. 7 is out. We will move to file item 8, SB 1033. Motion is due pass as amended and re-refer to the Committee on Environmental Quality. Senators Grove? Aye. Deasville, right? Yes. Grove, aye. Perez? Rubio? Ayes, 9. No, 0. That bill is on call. We will move to file item 10, SB 987. Motion is due pass and we refer to the committee on appropriations. Assistant, please call the absent members. Senators Gonzales? Aye. Gonzales, aye. Grove? Rubio? Thank you. So it's 9-0 call. Thank you. Thank you. So we are now on file item 11, SB 1049. Motion is due pass as amended and re-refer to the committee on appropriations. Assistant, please call the absent members. Senators Grove? Grove, no. Perez? Rubio? That's 7-1. That will be on call. We will open the roll again for the consent calendar. Assistant, please call the absent members. Senators Grove. Grove, aye. Rubio. That's 10-0. That's 10-0. We will place that back on call. We will open up file item number 1, SB 895. Motion do pass as amended and re-refer to the committee on natural resources and water. Assistant, please call the absent members. Senators Grove? No. Grove, no. Rubio? 8-2. We will leave that on call. So Perez is not voting on the rest of these. Okay. So which one? Thank you All right we will open the roll If there are any other members who wish to add on to the roll, please come down now. This is the last time we will be going through the roll. We are starting with the consent calendar. Assistant, please call the absent members. Senator Rubio. Aye. Rubio, aye. 11-0, out. That vote is 11-0. That is out. We will move back to file item number one, SB 895. Motion is do pass as amended and re-referred to the Committee on Natural Resources and Water. Assistant, please call the absent members. Senators Rubio. Aye. Rubio, aye. One, two, three, four, five, six, seven, nine to two. That vote is nine to two. That bill is out. We will move to file item number two, SB 944, recommendation. The motion is do pass and re to the committee on appropriations Assistant please call the absent members Senators Valladares Grove Rubio Aye Rubio aye 9-0. That vote is 9-0. That bill is out. We are now at file item 8, SB 1033. Motion is due pass as amended and re-refer to the Committee on Environmental Quality. Senators Rubio? Aye. Rubio, aye. 10-0. 10-0, that bill is out. We are now at file item number 10, SB987. File item 10, SB987. Motion is due pass and re-refer to the committee on appropriations. Assistant, please call the absent members. This is 1033 Senators Grove Rubio Aye. Rubio, aye. Okay, so that's 10-0. 10-0, that bill is out. We are now at file item 11, SB 1049. Motion is due pass as amended and re-refer to the committee on appropriations. Assistant, please call the absent members. Senators Valladares, Grove, Rubio. Aye. Rubio, aye. Oh, sorry. Perez. Just Perez. Oh, Senator Perez. Eight to one. 8 to 1, that bill is out. I want to thank everyone who presented today. Thank all of the members for the committee. This committee is adjourned.