GOOD AFTERNOON, WE'LL GO AHEAD
AND CALL TO ORDER THE ASSEMBLY
HEALTH COMMITTEE MEETING AND
ENCOURAGE MEMBERS OF THE
COMMITTEE TO MAKE THEIR WAY DOWN
HERE. BUT SINCE WE DO HAVE
REPRESENTATION ON THE COMMITTEE.
WE HAVE ENOUGH TO GO AHEAD AND
GET STARTED TODAY. SO THANK YOU
VERY MUCH FOR BEING HERE BEFORE
WE BEGIN. I'D LIKE TO MAKE A
STATEMENT PROVIDING TESTS ABOUT
PROVIDING TESTIMONY AT THIS
HEARING. WE SEEK TO PROTECT THE
RIGHTS OF ALL WHO PARTICIPATE IN
THE LEGISLATIVE PROCESS THAT WE
CAN HAVE EFFECTIVE DELIBERATION
ON CRITICAL ISSUES FACING
CALIFORNIA. OUR WITNESSES WILL
BE TESTIFYING IN PERSON WILL
ALLOW TO MAKE WITNESSES OR A
MAXIMUM OF THREE MINUTES EACH.
ADDITIONAL TESTIMONY WILL ALSO
BE IN PERSON AND LIMITED TO NAME
POSITION AND ORGANIZATION. IF
YOU REPRESENT ONE ALL TESTIMONY
, COMMENTS ARE LIMITED TO THE
BILL AT HAND. UM WE DO HAVE
BILLS PROPOSED FOR CONSENT TODAY
. UM ANY MEMBER OF THE COMMITTEE
MAY REMOVE A BILL FROM CONSENT.
THE PROPOSED CONSENT CALENDAR IS
ITEM NUMBER TWO A B 2 89 BY SOME
REMEMBER HOLDEN. ITEM NUMBER
THREE, MAYBE 3 85 BY SIMILAR
MEMBER TÂM. ITEM NUMBER FIVE.
MAYBE 3 87 BY ASSEMBLYMEMBER'S
AGUILAR CURRY. ITEM NUMBER EIGHT
A B 22 83 EXCUSE ME BY
ASSEMBLYMEMBER'S JIM PATTERSON.
ITEM NUMBER NINE A. B 5 12 BY
VICE CHAIR MS WALDRON WITH
AMENDMENTS. WE HAVE A SUBSTITUTE
TODAY. SO MANY MEMBER TOM LACKEY
WILL REPLACE ASSEMBLYMEMBER'S
VINCE FONG FOR TODAY'S HEARING.
WE WILL BE VOTING TO ADOPT. UM
23 22,023 24 SESSION RULES
COMMITTEE COMMITTEE RULES TODAY
. THE COPY OF THE RULES HAS BEEN
PROVIDED TO ALL MEMBERS OF THE
COMMITTEE. A NEW STAFF. WE HAVE
A NEW STAFF MEMBER WITH THE
ASSEMBLY HEALTH COMMITTEE. I'M
PLEASED TO ANNOUNCE THAT THE
ASSEMBLY HEALTH COMMITTEE HAS A
NEW CONSULTANT HANDLING MEDIC,
THE MEDICAL PORTFOLIO. PLEASE
HELP ME. WELCOME LISA MOREAU SKI
WHO HAS COME BACK TO THE
ASSEMBLY. WE'RE HAPPY TO HAVE
HER WELCOME, LISA. AND WILL BE
BE SEEING A LOT MORE OF HER IN
THE FUTURE. SO UM, AS WE NOW
HAVE WE DO NOT HAVE A QUORUM, SO
WE WON'T BE ABLE TO VOTE ON
ANYTHING BUT WE CAN ENTERTAIN A
BILL IF WE HAD AN AUTHOR WHICH
WE DON'T ACCEPT, UM. EXCEPT FOR
ME, AND I THINK WE'LL WAIT ON MY
BILL. SO, UM SO I'D SAY HAVE A
CUP OF COFFEE, BUT WE CAN'T
OFFER THAT. SOON AS WE HAVE AN
AUTHOR WILL, UH WE'LL GET GOING.
THANK YOU.
MR HOLDEN WHENEVER YOU'RE READY,
SIR. WE'RE ALL IN OUR PLACES
HERE, RIGHT? SHINY FACES.
I'M SORRY WHENEVER YOU'RE READY.
THANKS THANK YOU, MR CHAIR.
MEMBERS OF THE COMMITTEE. I
APPRECIATE THE OPPORTUNITY TO
PRESENT ASSEMBLY BILL 2 36.
ACHIEVING HEALTH CARE FOR ALL
HAS BEEN A LONG TIME GOAL OF
BOTH CALIFORNIA AND THE NATION
AS A WHOLE. IN 2010. WE TOOK AN
IMPORTANT STEP TOWARDS THAT GOAL
WITH THE ENACTMENT OF THE
AFFORDABLE HEALTHCARE ACT IN
2015, CALIFORNIA 11 STEP FURTHER
WITH SB 1 37. WHICH CREATED SOME
OF THE STRONGEST STANDARDS FOR
HEALTH PLANS IN THE NATION.
DESPITE THIS, WE'RE STILL SEEING
HEALTH PLANS MAINTAIN INACCURATE
PROVIDER REFERRAL DIRECTORIES
PRACTICE THAT RESTRICTS CONSUMER
ACCESS TO PROMISE HEALTHCARE
SERVICES. THESE INACCURACIES
LIST ARE OFTEN REFERRED TO AS
GHOST NETWORKS. BECAUSE THEY DO
NOT ACTUALLY EXIST. FOR
CONSUMERS. GHOST NETWORKS MEANS
SPENDING HOURS. CAT CONTACTING
DOESN'T HAVE HEALTH CARE
PROVIDERS REFERRED TO THEM BY
THEIR INSURANCE. ONLY TO ME MET
WITH PROVIDERS THAT ARE NO
LONGER ACCEPTING NEW PATIENTS NO
LONGER ACCEPTING THE PATIENT'S
INSURANCE OR SOMETIMES EVEN NO
LONGER IN PRACTICE. THE STRUGGLE
OF NAVIGATING THESE COMPLICATED
NETWORKS PREDOMINANTLY AFFECTS
COMMUNITIES OF COLOR THOSE WITH
DISABILITIES AND THOSE WHO MAY
NOT HAVE ENGLISH AS THEIR FIRST
LANGUAGE. THE ISSUE HERE IS NOT
THE QUALITY OR THE COST OF CARE,
BUT THE ACTUAL ACCESS IN AN
EFFORT TO ELIMINATE THESE GHOST
NETWORKS AND ADDRESS RAMPANT
DIRECTORY INACCURACIES. A B 2 36
DEFINES CLEAR BENCHMARKS AND
ACCURACY GUIDELINES. THIS BILL
ALSO ESTABLISHES ENFORCEMENT
GUIDELINES AND ADMINISTRATIVE
PENALTIES, WHICH ARE GIVEN IN
THE EVENT OF BENCHMARK HAS NOT
MET OR AN INACCURATE PROVIDER
LISTING IS FOUND. THESE
STANDARDS WILL HELP ENSURE
COMPLIANCE WITH EXISTING
REGULATIONS. AND, MORE
IMPORTANTLY, HELP CALIFORNIANS
GET THE CARE THAT HAS BEEN
PROMISED TO THEM. HERE WITH ME
TO TESTIFY IN SUPPORT OF A B 2
36 IS JOSE TORRES CASILLAS TNCS.
FROM HEALTH ACCESS CALIFORNIA
AND SARAH SORKIN, A LICENSED
MARRIAGE AND FAMILY THERAPIST
WITH SOLANO COUNTY BEHAVIORAL
HEALTH. AS A MENTAL HEALTH
CLINICIAN. I HAVE SEEN FIRSTHAND
HOW INACCURATE PROVIDER
DIRECTORIES HARM PATIENTS. IN MY
SIX YEARS AS A TRIAGE AND CRISIS
THERAPIST AT KAISER. IT WAS A
RARE DAY THAT I DID NOT SPEAK TO
AT LEAST ONE PATIENT REPORTING
THEY CALLED THROUGH LISTS OF
PROVIDERS TO INITIATE INDIVIDUAL
PSYCHOTHERAPY. THE PROVIDERS
EITHER DID NOT CALL THEM BACK OR
WEREN'T AVAILABLE. ALL THE WHILE
THEIR MENTAL HEALTH CONDITION
HAD WORSENED. KAISER THE MAIN
OPTION FOR WEEKLY INDIVIDUAL
PSYCHOTHERAPY, EASE FOR
CONDITIONS NEEDING MORE THAN A
BRIEF DURATION OF TREATMENT. IS
THROUGH OVER REFERRAL TO THE
BEACON PROVIDER NETWORK RECENTLY
RENAMED CAROLAN. THE TRIAGE IN
CRISIS TEAM. I BELONG TO IT.
KAISER CAME TO EXPECT DAILY
CALLS FROM PATIENTS UNABLE TO
FIND AN AVAILABLE THERAPIST IN
THE CAROLAN NETWORK. THESE WERE
PATIENTS EXPERIENCING CONDITIONS
SUCH AS DEPRESSION, ANXIETY AND
BEREAVEMENT. THEY WERE EXPECTED
TO CALL THROUGH THE PROVIDER
LIST OF 25 50 OR MORE IN AN
ATTEMPT TO GET CONNECTED TO
TREATMENT. EVEN THOUGH THEIR
SYMPTOMS MADE DOING SO EXTREMELY
CHALLENGING. AS AN EXAMPLE OF A
TRAGIC OUTCOME PATIENTS CAN FACE
FROM THESE GHOSTS NETWORKS. I
EVALUATED A PATIENT IN THE
EMERGENCY DEPARTMENT WHO HAD
ATTEMPTED SUICIDE AFTER CALLING
THROUGH A LIST OF 50 PROVIDERS.
MOST OF THE PROVIDERS DID NOT
CALL THE PATIENT BACK AND THE
ONES WHO DID WERE UNAVAILABLE.
THE PATIENT LOST HOPE. GAVE UP
AND SPIRAL DEEPER INTO
DEPRESSION. THIS PATIENT NOW HAS
THE TRAUMA OF A SUICIDE ATTEMPT
TO ADD TO THEIR TREATMENT NEEDS.
WHEN I WORKED AT U. C L, A
STUDENT COUNSELING CENTER. WE
SPENT VALUABLE TIME THAT COULD
HAVE BEEN USED TO PROVIDE
ASSESSMENT OR TREATMENT TO
STUDENTS. CALLING THROUGH LISTS
OF THERAPISTS ON THE ANTHEM
PROVIDER DIRECTORY. IN ORDER TO
CREATE A MORE ACCURATE LIST. WE
COULD GIVE STUDENTS TO INCREASE
THE LIKELIHOOD OF THEM GETTING
CONNECTED TO THE PSYCHOTHERAPY
TREATMENT THEY NEEDED. PATIENTS
WHO NEED SERVICES AND LANGUAGES
OTHER THAN ENGLISH OR CULTURALLY
COMPETENT CARE AND CHILDREN HAVE
FACED PARTICULAR DIFFICULTIES
FINDING A THERAPIST AVAILABLE TO
MEET THEIR NEEDS ON THESE
PROVIDER NETWORKS. PATIENTS WHO
HAVE MEANS END UP PAYING OUT OF
POCKET FOR PSYCHOTHERAPY WHEN
THEY CANNOT FIND AN AVAILABLE
PROVIDER COVERED BY THEIR
INSURANCE. LEAVING THOSE UNABLE
TO AFFORD PRIVATE PAY LEFT
WITHOUT TREATMENT. THIS IS IN
EFFECT, A TWO TIER SYSTEM OF
HEALTHCARE. WE WOULD BE
NEGLIGENT IF WE DIDN'T DO
EVERYTHING IN OUR POWER TO
ENSURE PATIENTS GET THE HEALTH
CARE THEY NEED AND PAY FOR. A B
2 36 WILL HOLD HEALTH INSURANCE
COMPANIES ACCOUNTABLE FOR THE
ACCURACY OF THEIR PROVIDER
NETWORK LISTS. AND THIS WILL
IMPROVE ACCESS TO CARE. THANK
YOU VERY MUCH NEXT WITNESS. ALL
RIGHT. GOOD AFTERNOON CHAIR AND
MEMBERS JOSE TORRES WITH HEALTH
ACCESS CALIFORNIA, THE STATEWIDE
HEALTHCARE CONSUMER ADVOCACY
COALITION. I'M HERE TODAY AS A
SPONSOR AND SUPPORTER OF MAYBE 2
36, WHICH WOULD ADDRESS IT
INACCURACIES WITHIN PROVIDER
DIRECTORIES. CURRENT LAW
REQUIRES THAT HEALTH PLANS
MAINTAINED AND UPDATED LIST OF
IN NETWORK PROVIDERS FOR THEIR
ENROLLEES. THESE DIRECTORIES
INCLUDE DOCTORS, MENTAL HEALTH
PROFESSIONALS. HOSPITALS LABS
AND IMAGING CENTERS. JUST NAME A
FEW EXAMPLES. THE INFORMATION
REQUIRED UNDER CURRENT LAW IS
PRETTY BASIC NAME, PHONE NUMBER,
ADDRESS LANGUAGES SPOKEN. AND
CONSUMERS RELY ON THESE
DIRECTORIES TO FIND AN IN
NETWORK PROVIDER IN ORDER TO
RECEIVE NECESSARY CARE. HOWEVER
CURRENT LAW DOES NOT REQUIRE
THAT THE DIRECTORS BE ACCURATE
AND DUE TO SUCH INACCURACIES IN
THESE DIRECTORIES, CONSUMERS
WILL CALL DOZENS OF PROVIDERS
SEEKING CARE. THE STORY THAT
SARAH JUST MENTIONED OR THAT
SHARED WITH US ABOUT A PATIENT
CALLING 50 PROVIDERS AND LOSING
HOPE AND GIVING UP THAT IS,
UNFORTUNATELY WAY TOO COMMON FOR
CONSUMERS. AS SUCH, CONSUMERS
MAY DELAY SEEKING NECESSARY CARE
OR MAY DECIDE TO SEEK CARE OUT
OF NETWORK AND PAY HIGH PRICES
OR OUT OF NETWORK CARE, EVEN
THOUGH THEY HAVE INSURANCE.
THESE INACCURACIES HAVE THE
GREATEST IMPACT ON CONSUMERS WHO
FACED THE WORST ACCESS. PEOPLE
WITH LIMITED ENGLISH PROFICIENCY
PEOPLE WITH DISABILITIES AND
OTHERS IN MARGINALIZED
COMMUNITIES. HEALTH PLANS MAY
SAY THAT THEY HAVE BEEN
INVESTING INTO THEIR DIRECTORIES
. BUT YET PROVIDER DIRECTORIES
CONTINUE TO HAVE SIGNIFICANT
NUMBER OF INACCURACIES AND
STUDIES HAVE SHOWN THAT MAJOR
HEALTH LANDS WILL HAVE A RANGE
OF INACCURACIES BETWEEN 20 TO
30% OR PRIMARY CARE AND
SPECIALTY CARE PROVIDERS. BUT
THEN WHEN YOU LOOK AT MENTAL
HEALTH PROVIDERS, THE INACCURACY
PERCENTAGES SKYROCKET AND ARE
EVEN HIGHER. AND THAT IS HOW YOU
GET CONSUMERS LIKE THE PATIENT.
SARAH MENTIONED HAVING TO CALL
50 PROVIDERS JUSTICE HE CARE. A
B 2 36 WILL HELP ADDRESS THE
ISSUE OF INACCURACIES BY
CREATING SPECIFIC BENCHMARKS
THAT PLANS HAVE TO REACH IN
TERMS OF ACCURACY. IT WILL
REQUIRE THAT PLANS AUDIT THEIR
DIRECTORIES USING THE STANDARDS
SET BY D. M. H C AND THE ONLY
THE PROPER IN NETWORK PROVIDERS
WITH THEIR ACCURATE INFORMATION
BE LISTED. OTHERWISE THE PLAN
WOULD FACE A FINANCIAL PENALTY.
IT IS TIME THAT HEALTH INSURERS
ARE HELD ACCOUNTABLE FOR
PROVIDER DIRECTORY. I THANK YOU
FOR YOUR TIME, AND THAT'S THAT
YOU SUPPORT A B 2 36 HERE TODAY.
THANK YOU VERY MUCH OTHERS IN
SUPPORT. MHM HE'S COME FORWARD.
JUST YOUR NAME. OBVIOUSLY YOU
HAVE A SUPPORT POSITION IN ANY
ORGANIZATION. IF YOU REPRESENT
ONE. GOOD AFTERNOON, ANDREA
RIVERA ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK AND SUPPORT THANK YOU.
CHAIR AND MEMBERS AUTUMN OGDEN
SMITH WITH THE AMERICAN CANCER
SOCIETY CANCER ACTION NETWORK,
ALSO IN SUPPORT. AFTERNOON
YASMIN PILL IT ON BEHALF OF
JUSTICE AND AGING AND SUPPORT.
VACCINE MANTLE ON BEHALF OF THE
NATIONAL MULTIPLE SCLEROSIS
SOCIETY AND SUPPORT. NOW WE WILL
ASK FOR WITNESSES AND
OPPOSITION. PLEASE COME FORWARD.
YOU CAN COME UP AND SIT DOWN IF
YOU WANT. HAVE A SEAT ANYWAY.
THANK YOU, MR CHAIR AND MEMBERS
NICK LOUISA'S ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF HEALTH
PLANS. REGRETTABLY WE ARE HERE
IN OPPOSITION TO ASSEMBLY BILL 2
36, WHICH WOULD ESTABLISH NEW
AND ONEROUS ACCURACY, DEADLINES
, PENALTIES AND OTHER
REQUIREMENTS FOR HEALTH PLAN
PROVIDER DIRECTORIES. WHILE OUR
MEMBERS DO APPRECIATE THE INTENT
OF THIS BILL, AND WE DO SHARE
THE AUTHORS CONCERNED ABOUT THE
ACCURACY OF PROVIDER DIRECTORIES
, THIS BILL IS UNFORTUNATELY
UNWARRANTED, OVERLY PUNITIVE AND
IGNORES THE SHARED
RESPONSIBILITY COMPONENT BETWEEN
PROVIDERS AND PLANS AND
DEVELOPING THESE DIRECTORIES. ON
THIS LAST POINT MEMBERS. HEALTH
PLANS MUST LIST AT LEAST 13
PIECES OF INFORMATION ON THE
PROVIDER DIRECTORY, ALMOST ALL
OF WHICH MUST BE DERIVED
DIRECTLY FROM THE PROVIDERS.
HEALTH PLANS ARE ALSO REQUIRED
TO CHECK THE ACT DIRECTORIES FOR
ACCURACY. UM UM EVERY 90 DAYS AT
A MINIMUM, SOMETIMES MORE
FREQUENTLY. AND IN DEVELOPING
AND MAINTAINING THESE
DIRECTORIES ARE PLANS REACH OUT
TO OUR CONTRACT PROVIDERS VIA
EMAIL, TELEPHONE AND FACTS IF
THEY STILL USE THE FACTS TO
SURVEY THE ACCURACY OF THE
INFORMATION WE HAVE LISTED IF
HE'S OUTREACH ATTEMPTS ARE NOT
RESPONDED TO. WE HAVE NO WAY OF
KNOWING IF THE PROVIDERS
INFORMATION IS UP TO DATE. UM SO
JUST TO RESTATE IF THE HEALTH
PLANS DO NOT RECEIVE THE
INFORMATION THAT'S NECESSARY TO
BUILD THE PROVIDER DIRECTORY, UM
IN AN ACCURATE OR TIMELY MANNER,
THEN WE CANNOT UPDATE THEM
ACCORDINGLY. UNFORTUNATELY WE
DON'T BELIEVE THIS BILL
CONSIDERS THE SHARED
RESPONSIBILITY COMPONENT THAT'S
NECESSARY HERE. INSTEAD, IT'S
SOLELY PUNISHES THE HEALTH PLAN
FOR, UM WITH ENORMOUS FINANCIAL
PENALTIES WHEN PROVIDER
DIRECTORIES FAILED TO MEET
ACCURACY THRESHOLDS. EVEN WHEN A
PROVIDER FAILS TO DISCLOSE THE
NECESSARY INFORMATION, AND WE
BELIEVE THAT THIS ENFORCEMENT
MECHANISM IS UNNECESSARILY
PUNITIVE, UM AND FUNDAMENTALLY
UNFAIR TO OUR MEMBERS, AND IT
WILL NOT LEAD TO MORE ACCURATE
PROVIDER DIRECTORIES. UM IT IS
ALSO IMPORTANT TO NOTE THAT MUCH
WORK IS CURRENTLY BEING DONE TO
IMPROVE THE ACCURACY OF THE
DIRECTORIES. UM INCLUDING THE
HEALTH PLANS CONTINUE WORK WITH
REGULATORS AND OTHERS. UM IN A
STAKEHOLDER PROCESS AROUND SP 1
37, THE ORIGINAL PROVIDER
DIRECTORY BILL, AND THE
REGULATIONS ARE ACTUALLY STILL
IN DEVELOPMENT. ON THAT THE
FINAL REGULATIONS, HEALTH PLANS
ARE ALSO INTRICATELY INVOLVED
WITH I H A, UM AND SYMPHONY,
WHICH MEANS, WHICH MAINTAINS A
PLANNED FUNDED SINGLE SOURCE
DATABASE TO BETTER RECEIVED
PROVIDER DATA AND THE QUALIFIED
HEALTH PLANS THAT PARTICIPATE AT
COVERED CALIFORNIA ARE REQUIRED
VIA CONTRACT TO PARTICIPATE IN
THIS, UH, DATABASE. HEALTH PLANS
ARE ALSO DEEPLY INVOLVED IN
IMPLEMENTING NEW FEDERAL LAWS
AROUND THIS AREA. THE NO
SURPRISE ACT AT THE FEDERAL
LEVEL HAS NEW PROVIDER DIRECTORY
REQUIREMENTS. UM AND, UM YOU
KNOW, OTHER RECENT FEDERAL
ACTION AS WELL, UM, SO REMEMBER
, PLANS ARE DEDICATED TO HAVE A
CONVERSATION AND THEY'VE ALREADY
DEDICATED SUBSTANTIAL TIME AND
RESOURCES TOWARDS THIS EFFORT.
UM TO TRY TO ADDRESS THE ISSUES
THAT ARE THAT ARE YOU KNOW,
OUTLINED IN THIS BILL, AND YOU
KNOW, WE REMAIN COMMITTED TO
FINDING WAYS WE JUST DON'T
BELIEVE THAT THIS PARTICULAR
BILL IS A SOLUTION, AND WE CAN'T
DO THIS ALONE. UM YOU KNOW, WE
NEED OTHERS TO BE AT THE TABLE,
UM, TO RESOLVE THIS ISSUE, AND
FOR THESE REASONS WERE OPPOSED
TO MAYBE 2 36. THANK YOU. THANK
YOU VERY MUCH, AND BEFORE YOU
GO, WE HAVE A QUORUM AND IT'S
ALWAYS TENUOUS. SO WE'D LIKE TO
TAKE ROLL SO WE CAN CONDUCT OUR
BUSINESS. SO SECRETARY. PLEASE
CALL THE ROLL. WOULD WALDRON
AGUIAR-CURRY. ARAMBULA.
BOERNER HORVATH CARILLO. FLORA.
LARKY. MAIENSCHEIN MCCARTHY. JOE
PATTERSON. RODRIGUEZ. SANTIAGO.
VÆ VALLAPUDUA. WEBER. WE DO
INDEED HAVE A QUORUM. THAT'S A
GOOD THING. SO PLEASE THE NEXT
WITNESS. GOOD AFTERNOON CHRISTIE
WEEKS ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF DENTAL
PLANS, ALSO HERE IN OPPOSITION.
WE SHARE A LOT OF THE CONCERNS
EXPRESSED BY BY CAP, I THINK IN
THE DENTAL SPACE, YOU KNOW,
OBVIOUSLY, THE PLANS WANT TO
OFFER COMPLETE NETWORKS. THEY
WANT THEIR MEMBERS TO BE ABLE TO
GET ACCURATE INFORMATION AND THE
PLANS WORKED VERY HARD, VERY
DILIGENTLY WITH THE PROVIDERS TO
MAKE SURE THAT ACCURATE
INFORMATION IS AVAILABLE. YOU
KNOW, OBVIOUSLY, WE NEED TO HAVE
A LARGER CONVERSATION HERE ABOUT
THE PROVIDERS ROLE IN SUBMITTING
THAT INFORMATION BACK TO THE
PLANS AND WE LOOK FORWARD TO
HAVING THAT CONVERSATION ON THE
DENTAL SIDE. I THINK THAT ONE OF
THE BIGGEST CONCERNS FOR OUR
PLANS IS THE DENTAL IS DIFFERENT
. WE TALKED ABOUT THAT A LOT IN
THIS COMMITTEE AND YOU KNOW FOR
DENTAL NETWORKS. OFTENTIMES THEY
WILL HAVE A SPECIALTY DENTAL
PROVIDER. WHO MAY NOT SEE VERY
MANY PATIENTS A YEAR. UM, THE
LANGUAGE IN THE BILL WOULD HAVE
THE EFFECT OF IN MANY CASES, THE
PLANS WOULD HAVE TO REMOVE THOSE
PROVIDERS FROM THE NETWORK WHEN
THEY DON'T SEE, I THINK THE
THRESHOLD IS FIVE CASES A YEAR,
AND THAT'S PERFECTLY APPROPRIATE
IN SOME CASES, DEPENDING ON WHAT
THEIR SPECIALTY SO OUR CLIENT
HAS SUBMITTED A NUMBER OF RAISED
A NUMBER OF TECHNICAL ISSUES
WHICH ARE OUTLINED IN OUR
LETTER, AND WE APPRECIATE THE
COMMITTEE, INCLUDING THOSE IN
THE ANALYSIS. WE THINK YOU KNOW,
KIND OF WRIT LARGE IT IS IT IS.
WE ALL SHARE THE SAME GOAL, BUT
THE LANGUAGE IN THE BILL IS TOO
FAR. IT IS TO OVERREACHING AND
FOR THOSE REASONS WE ARE
OPPOSED. THANK YOU. THANK YOU
VERY MUCH OTHERS IN OPPOSITION.
JUST YOUR NAME AND ORGANIZATION
IF YOU REPRESENT ONE. MR CHAIR
MEMBER, STEPHANIE WATKINS ON
BEHALF OF THE ASSOCIATION OF
CALIFORNIA LIFE AND HEALTH
INSURANCE COMPANIES, ALSO
REGRETTABLY OPPOSED. GOOD
AFTERNOON CHAIR. REMEMBER
STEPHANIE MORE ON BEHALF OF
AMERICA'S HEALTH INSURANCE PLANS
IN OPPOSITION. SEE NO ONE ELSE
WILL BRING IT BACK TO THE
COMMITTEE QUESTIONS OR COMMENTS.
DR WEBBER. THANK YOU, MR CHAIR.
THANK YOU FOR THE MEMBER HOLDEN
AND THOSE OF YOU, WHO TESTIFIED
TODAY. UM I HAVE A LOT OF
QUESTIONS AND A LOT OF CONCERNS
ABOUT THIS PARTICULAR BILL. UM
BUT MY FIRST QUESTION WILL BE TO
ASSEMBLYMEMBER'S HOLDEN. WE JUST
HEARD THAT THERE ARE, UM
DIFFERENT PROCESSES IN PLACE.
THEY ARE ALREADY CHECKING THE
DIRECTORY. I THINK YOU SAID
EVERY 90 DAYS, UM AND
CONSIDERING THE FACT THAT THIS
IS A SHARED PARTNERSHIP BETWEEN
THE INSURANCE COMPANIES AND THE
PROVIDERS. HOW EXACTLY IS THIS
GOING TO CHANGE SINCE THEY
ALREADY HAVE A PROCESS IN PLACE?
TO EVALUATE THEIR DIRECTORY. I
APPRECIATE THE. REPRESENTATION
OF WHAT EFFORTS ARE UNDERWAY TO
MONITOR AND TO CHANGE AND TO
KEEP THE DIRECTORY UP TO SPEED.
I THINK WHAT WE'VE NOTICED AND
WHAT WE'VE GATHERED IS THAT IT'S
THE CONSUMER WHO IS GOING
THROUGH THIS PROCESS OF TRYING
TO FIND A PROVIDER WHO WILL BE
ABLE TO MEET THEIR NEEDS AND ARE
HAVING A HARD TIME FINDING
ACCURACY IN THIS DIRECTORY. SO.
YOU KNOW, I'M KIND OF LOOKING AT
IT FROM A CONSUMER LENS. IF YOU
WILL. I'M LOOKING AT IT FROM THE
STANDPOINT THAT AND I'M NOT
GOING TO SAY THAT ALL OF THE
WORK THAT'S BEING DONE IS AND IN
SOME FORM OF GOOD FAITH AND
TRYING TO FIGURE OUT HOW TO KEEP
THE DIRECTORY ACCURATE,
ACCURATE, BUT IF YOU HAVE
CONSUMERS WHO ARE THE ONES WHO
ARE FALLING THROUGH THE CRACKS
ON THIS PROCESSED AND
SOMETHING'S NOT HAPPENING. IN
THE WAY THAT IT SHOULD. UM THE
RELATIONSHIP BETWEEN THE PLANS
AND THE PROVIDERS? YEAH IT
SHOULD WORK, BUT IT OBVIOUSLY
ISN'T THERE WOULD NOT BE A NEED
FOR THIS BILL, OR CERTAINLY THIS
CONVERSATION IF THERE IF IT WERE
THE INACCURACIES OR OF NOT JUST
SMALL. PORTION IT'S RATHER LARGE
AND DISCREPANCY IN TERMS OF HOW
MANY. UH HUH. HOW INACCURATE THE
LISTS ARE AND SO IT'S RISES TO A
LEVEL OF KIND OF NOT JUST A
YELLOW LIGHT BUT A RED LIGHT AS
IT RELATES TO CONSUMERS AND
THEIR CONCERN, AND HOW DO WE FIX
IT FROM THEIR VANTAGE POINT? AND
AGAIN? I IF THIS IS A PROCESS
THAT THEY NORMALLY GO THROUGH UH
UM, I'M NOT GOING TO DEBATE THE
PROCESS ITSELF. BUT IT JUST
ISN'T WORKING. I GUESS MY
QUESTION IS, UM IT'S A IT'S A
PARTNERSHIP, RIGHT? SO IF THEY
ARE. UM, ASKING FOR THIS. BUT
THEY'RE NOT GETTING IT BACK
THEN. BUT THEN THEY'RE GOING TO
BE HELD FINANCIALLY LIABLE. HOW
HOW DOES IT IMPROVE THE DIRECT
LIKE HOW DOES THIS BILL IMPROVE
IT? SINCE IT'S A PARTNERSHIP,
LET'S TAKE IT FROM THE
STANDPOINT THAT THE SPILL
DOESN'T EXIST. AND IF YOU'RE A
PROVIDER, AND YOU'RE REACHING
OUT TO YOUR PARTNER AND YOUR
PARTNER'S NOT GETTING BACK TO
YOU, OR YOU'RE FINDING THAT
THERE'S SOME THING HAPPENING
HERE THAT WOULD SUGGEST THAT IF
YOU'RE HAVING A HARD TIME
CONNECTING WITH THEM, WHAT DO
YOU THINK THE CONSUMER IS HAVING
ON THE OTHER END? SO THEN WHAT
DO YOU DO TO REMEDY THAT WOULD
BECOME THE COMMON SENSE NEXT
STEP IF YOU FIND YOURSELF
WORKING WITH WITH A PARTNER.
THAT ISN'T EITHER PROVIDING
ACCURATE INFORMATION BECAUSE YOU
CAN'T GET A HOLD OF THEM OR
THEIR THEIR SOME OTHER ISSUE
THAT OBVIOUSLY THE CONSUMERS ARE
, THEY WOULD BE GETTING THE SAME
REACTION IF YOU WILL. AND THEN I
WOULD LOOK TO THE PROVIDERS AND
THE PLANS TO THEN. TAKING
AFFIRMATIVE ACTION TO THEN SAY
WE'VE TRIED. WE NEED TO TAKE
THEM OFF BECAUSE OBVIOUSLY THIS
IS SOMEONE WHO, IF A IF A
CONSUMER IS LOOKING TO CONNECT
WITH A, UH WITH A PHYSICIAN, AND
THEY ARE HAVING A HARD TIME
MAKING THAT WORK, THEN THEN,
WHETHER INTENDED OR NOT, THE
BURDEN SHIFTS BACK TO THEM. SO I
WOULD JUST SAY THAT UH, THAT THE
PARTNERSHIP EITHER WILL WORK
BECAUSE THERE'S CONTACT AND
MUTUAL COMMUNICATION OR IF IT
DOESN'T, THEN THEY HAVE TO TAKE
THE AFFIRMATIVE ACTION, SAYING
WE JUST NEED TO TAKE THEM OFF
THE LIST AND JUST OUT OF
CURIOSITY, HAVE YOU BROUGHT THE
OTHER? PIECE OF THIS PARTNERSHIP
TO THE TABLE TO HAVE A
DISCUSSION WITH ALL PARTIES
INVOLVED TO SEE HOW A SYSTEM
COULD BE CREATED THAT DOES
ACTUALLY PRODUCED AN ACCURATE
DIRECTORY. WE HAVE JUST DEALT
WITH THE FACT THAT THERE IS A
THERE IS A NEED. WE HAVE NOT.
I'M SURE THERE'S BEEN SOME REACH
OUT AND TO SOME DEGREE, BUT THE
FOCUS THAT WE SEE AND HAVE SEEN
KIND OF HISTORICALLY AND THESE
TYPE OF SITUATIONS AND CERTAINLY
WE CAN TALK ABOUT WHAT IS THE
APPROPRIATE LEVEL OF A FINE BUT
THERE. THERE NEEDS TO BE. A
RECOGNITION THAT YOU KNOW WE CAN
GO. WE WOULD HAVE TO THEN GO
THROUGH THE SAME LIST AND START
IDENTIFYING WHO CAN COME IN AND
WHO CAN BE A PART OF THAT
CONVERSATION OF THE PARTNERSHIP
EXIST WITH THE PLANS AND I WOULD
ALSO LOOK TO THEM TO MAYBE SAY,
HEY, LET'S BRING IN SOME OF OUR
PARTNERS TO BE A PART OF THAT
CONVERSATION. AND MAYBE THAT IS
SOMETHING THAT CAN CAN HAPPEN,
BUT I WOULD ALSO LOOK TO THE
PLANS TO BE THE ONES TO SORT OF
IDENTIFY WHO THEY ARE. AND THEN
HELP US ANSWER THE QUESTION BY
THOSE PARTNERS COMING TO THE
TABLE TOGETHER. WE SHOULDN'T
NECESSARILY HAVE TO GO OUT AND
IDENTIFY EACH PERSON WHEN WE
ALREADY KNOW IT'S A CHALLENGE TO
IDENTIFY THEM. BASED ON WHAT
WE'RE HEARING FROM FROM THOSE
WHO ARE WELL WHEN I SAY THE
PARTNERS THE PARTNERS ARE THE
PROVIDERS. CORRECT. WE KNOW HOW
TO REACH OUT TO DIFFERENT THOSE
DIFFERENT GROUPS TO SAY HEY, YOU
KNOW PEOPLE WHO YOU REPRESENT
ARE NOT RESPONDING TO THE
SURVEYS. I'M NOT EVEN SURE WHO
EXACTLY GETS THE SURVEYS. IF
IT'S A LARGE INSTITUTION, DOES
IT GO TO THAT INSTITUTION? IF
IT'S A SMALLER PRACTITIONER,
DOES IT GO TO THAT SMALLER
PRACTITIONERS? SO UM, BUT I
THINK WE KNOW HOW TO REACH OUT
TO THE PEOPLE THAT REPRESENT THE
MEDICAL PROVIDERS TO SAY, HEY,
THIS IS AN ISSUE. HOW CAN WE
WORK TOGETHER TO FIX IT? UM MY
OTHER QUESTION. UM IS ABOUT THE
DELETION OF PROVIDERS IF THEY
HAVE NOT PAID CLAIMS. UM. WHEN
YOU WERE SPEAKING ABOUT SOME
SPECIALIZED DENTIST, IT REALLY
HIT WITH ME AS A SPECIALIST,
RIGHT? UM, ESPECIALLY BEING HERE
IN SACRAMENTO. UM I MAY NOT
NECESSARILY WHAT I'M NOT SEEING
AS MANY PATIENTS AS I SAW BEFORE
I CAME HERE. UM BUT THAT DOESN'T
MEAN THAT I'M NOT STILL SEEING
PATIENTS AND THAT I'M NOT STILL
PROVIDING THAT CARE TO THE
PEOPLE IN MY AREA. AND SO IF I
HAVE SEEN FOUR PATIENTS WITHIN A
YEAR SUBMITTED FOR CLAIMS
BECAUSE I'M NOT SEEING AS MANY
PATIENTS BECAUSE I'M HERE. THEN
I'M ESSENTIALLY REMOVED FROM
THAT PROVIDER DIRECTORY. SO WHEN
SOMEONE IS LOOKING FOR A PD GEIN
I'M REMOVED BECAUSE I ONLY SAW
FOUR LAST YEAR OR PROVIDED FOR
CLAIMS. UM I DO FIND THAT
PROBLEMATIC. ADDITIONALLY, I
THINK WE ALL KNOW AND THAT YOU
KNOW, OFTENTIMES PROVIDERS WILL
STILL HAVE RELATIONSHIPS AND
CONTEXT WITH PATIENTS. EVEN IF
THEY'RE NOT SUBMITTING A BILL.
YOU SEND MESSAGES ALL THE TIME,
UH, VIA ELECTRONIC MEDICAL
RECORDS, OR IF YOU HAVE OTHER
RELATIONSHIPS YOU MAY TEXT AND
SAY, HEY, I NEED A REFILL ON
THIS OR THIS OR THAT SO I DO
FIND THAT ALSO, UM, VERY
PROBLEMATIC. SO I HAVE A
QUESTION FOR THE INSURANCE. TEAM
MEDICAL INSURANCE TEAM, SO IF IT
PAID IF A PROVIDER IS REMOVED
FROM YOUR LIST HOW DO THEY GET
BACK ON? UH THANK YOU. SOMEBODY
REMEMBER WHATEVER. UM SO IF I'M
INTERPRETING, SO THERE'S BOTH
STATE AND FEDERAL LAW ON THIS
ISSUE. UM AND SO, UM, UNDER THE
CURRENT FEDERAL LAW IF I'M NOT
MISTAKEN, UM A PLAN WILL MAY
SUPPRESS PROVIDER FROM THE
DIRECTORY. UM YOU KNOW, UNDER
CERTAIN CERTAIN CIRCUMSTANCES,
AND I BELIEVE THE ONE THAT
YOU'RE RAISING IS ONE OF THOSE
CIRCUMSTANCES. UM AND THEN
THERE'S A PERIOD OF TIME WHERE
THE PROVIDER UM CAN FURNISH THE
APPROPRIATE INFORMATION. AND
ONCE THAT IS ESTABLISHED, UM
THEY CAN BE LET BACK ONTO THE
PROVIDER PROVIDER DIRECTORY. DO
YOU KNOW WHAT THAT TIMEFRAME IS?
IS IT LIKE, AH, YEAR HAVE TO
LOOK THAT UP. I YOU KNOW, I
DON'T KNOW IF THE TOP OF MY HEAD
PROVIDER IS REMOVED FROM THE
DIRECTORY, ARE THEY INFORMED? UM
I BELIEVE SO. YEAH I WAS. I WAS
ACTUALLY LOOKING AT SOME HEALTH
PLAN, YOU KNOW, POLICY PAMPHLETS
ON THE NO SURPRISE ACT AND OTHER
RECENT FEDERAL ACTIONS AND THERE
IS A PROCESS IN PLACE. YOU KNOW,
THEY'LL HAVE, UM UM, THEY'LL
HAVE PRACTICE PROFILE KIND OF
DATA REQUESTS TO PROVIDERS THAT
THE PROVIDERS CAN RESPOND TO. SO
UM YES. YEAH IF I MAY JUST ONE,
UH COMMENT TO ADD. NICK IS
REFERRING TO THE FEDERAL NO
SURPRISES ACT, WHICH APPARENTLY
DOES NOT INCLUDE DENTAL, SO
THERE'S ACTUALLY NOT THAT SAME
PARADIGM AT THE FEDERAL LEVEL,
WHICH IS ONE OF OUR CONCERNS.
WITH THIS BILL. THIS BILL WOULD
WOULD CREATE A PROCESS TO
SUPPRESS PROVIDERS. UM BUT I
DON'T KNOW THAT THAT I DON'T
BELIEVE THAT THE DOWN PLANS HAVE
THAT SAME PROCESS. OUTLINED AT
THE FEDERAL LEVEL TO REINSTATE
PROVIDERS. REALLY? SO. WAIT SO
THERE'S NO PROCESS TO REINSTATE
THEM. THERE IS A PROCESS.
HOWEVER THE FEDERAL NO SURPRISES
ACT, WHICH IS WHAT NICK WAS
REFERRING TO AT THE FEDERAL
LEVEL, NOT INCLUDE DENTAL PLANS.
IT ONLY INCLUDES MEDICAL PLANS.
SO THAT'S ANOTHER PLACE WHERE
THE LANGUAGE IN THIS BILL IS, UM
, MISALIGNED WITH THE FEDERAL.
SO YOU'RE SAYING THAT A DENTAL
PROVIDER CAN BE REMOVED FROM THE
PLAN UNDER THIS UNDER THIS BILL,
IF YOU DON'T DO YOUR FIVE
CLAIMS, RIGHT, AND HE OR SHE MAY
OR MAY NOT BE INFORMED. I WOULD
NEED TO CHECK WITH THE DENTAL
PLANS AND FIND OUT KIND OF WHAT
THEIR PROCESS WOULD BE. BUT AS
THE PLANS WERE REVIEWING THE
BILL, ONE THING THAT DID COME UP
IS THAT BECAUSE DENTAL IS
TREATED A LITTLE BIT
DIFFERENTLY, THE FEDERAL LAW
APPLIES TO MEDICAL PLANS, BUT
NOT MEDICAL AND DENTAL. THIS
BILL WOULD APPLY TO MEDICAL
INDEX. OKAY ALL RIGHT, AND SO
THERE MAY NOT BE A WAITING
PERIOD OR WHATEVER FOR THEM TO
RESPOND. THAT'S WHAT YOU'RE
SAYING IS PROBABLY A PLAN BY
PLAN PRICE. OKAY ALRIGHT.
REMEMBER WHEREVER IF I MAY ADD
ALSO ON THIS SO ON THE REMOVAL
OF PROVIDERS, SO THERE IS
SPECIFIC SPECIFIC PROVISIONS
WITHIN THE BILL TO ADDRESS WE
DID TO TAKE INTO CONSIDERATION
RURAL PROVIDERS WHO MAY NOT SEE
PATIENTS AS FREQUENTLY AS WELL
AS SPECIALIST WHO MAY NOT SEE A
PROVIDER HUMAN PATIENTS AS
FREQUENTLY SO THERE IS A
SPECIFIC UH, PROVISIONS TO ALLOW
THOSE TO SAY ON HIS AND ALSO
WITH GUIDANCE BEING CREATED FROM
WITH GMHC THAT WOULD CREATE THAT
SPECIFIC GUIDANCE FOR THESE
INDIVIDUALS FOR THESE PROVIDERS
TO BE ABLE TO STAY ON THE
PROVIDE ON THE DIRECTORY WITHOUT
BEING REMOVED. SO WITH A
PROVIDER HAVE TO TAKE ON THAT
RESPONSIBILITY OF ACTUALLY
BUILDING SOMETHING OUT AND
SAYING, THAT'S WHAT I THAT'S
WHAT I WOULD WANT OR LIKE, HOW
WOULD THAT WORK? SO THIS IS THE
THIS WOULD BE UP TO THE
REGULATIONS THAT WE CREATED
UNDER CMHC, BUT SPECIFICALLY FOR
WITHIN CURRENT LAW THERE IS HAS
BEEN HAS HAS BEEN MENTIONED THAT
PROVIDERS CAN BE REMOVED ALREADY
. UM THE THERE'S JUST GOES TO
SHOW THAT THERE IS A SPECIAL
RELATIONSHIP BETWEEN PROVIDERS
AND HEALTH PLANS AND ONE OF THE
BIGGEST ISSUE IS THAT THERE HAS
NOT BEEN ENFORCEMENT ON PROVIDER
DIRECTORIES AS MUCH AS I SHOULD
HAVE BEEN SINCE THE PASSENGER OF
THE ORIGINAL BILL, UM GOES TO
SHOW THAT THE ENFORCEMENT
STANDARDS HAVE JUST BEEN
INADEQUATE AND BECAUSE THEY HAVE
BEEN IN FREQUENT THIS IS WHY
THIS BILL IS UP TODAY. UM THIS
IS WHY THIS BILL IS UP TODAY SO
THAT WE CAN ADDRESS THAT
CONSUMERS DO NOT HAVE TO KEEP
CALLING. 50 DIFFERENT PROVIDERS.
JUSTICE SEEK CARE RIGHT AND WE
UNDERSTAND THAT THERE IS A
RELATIONSHIP BETWEEN THE
PROVIDERS AND THE HEALTH PLANS
AND AS SUCH HAVE TAKEN INTO
CONSIDERATION THE SPECIAL
CIRCUMSTANCES THAT MAY ARISE
WITHIN SPECIALTY CARE AS WELL AS
, UM, PROVIDERS THAT LIVE IN A
ROW ARE IN A RURAL AREA THAT MAY
NOT SEE PATIENTS AS FREQUENTLY.
UM, THANK YOU FOR THAT. AND YOU
KNOW, LIKE I SAID, I AM. I'M
VERY CONCERNED ABOUT THIS BILL.
IT'S EARLY, SO YOU HAVE TIME TO
CONTINUE THE DISCUSSIONS AND UM
AND HOPEFULLY IMPROVE IT BEFORE
IT HITS THE IF IT HITS THE FLOOR
, AND YOU KNOW WHEN IT HITS THE
FLOOR. UM AND FOR THAT REASON
ONLY I WILL BE SUPPORTING IT
TODAY. UM BUT I DO THINK THAT AS
WRITTEN, I DON'T SEE HOW IT'S
ACTUALLY GOING TO HELP THE
PROBLEM. IT IS AN ISSUE,
ESPECIALLY IN THE AREA OF MENTAL
HEALTH. AND UM, YOU KNOW, WE
DISCUSSED THIS IN THE BEHAVIORAL
HEALTH UM. HEARING THAT WE HAD
THERE IS JUST AN ISSUE WITH
MENTAL HEALTH PROVIDERS OR
BEHAVIORAL PROVIDERS TAKING ANY
INSURANCE AND MOST OF THEM DON'T
UM AND EVEN IF THEY'RE LISTED,
AND EVEN IF THE PERSON CAN GET
REIMBURSED BECAUSE IT'S JUST SO
MUCH OF A HASSLE, THEY PUT IT ON
THE PATIENT THEMSELVES. THE
PATIENT STILL HAS TO COME OUT OF
POCKET. GET THAT RECEIPT AND
PROVIDED TO THE INSURANCE
COMPANY AND SO THERE'S A LOT
THAT WE NEED TO DO IN THE AREAS
OF MENTAL HEALTH. I DID NOTE
THAT BOTH OF WHAT YOU ALL WERE
REFERRING TO. REALLY
SPECIFICALLY ADDRESSED THAT AND
WE DO NEED TO FIX THAT, UM, FOR
EVERYONE, UM AND WE NEED TO FIX
OUR PROVIDER DIRECTORY. I'M NOT
SURE IF THIS IS THE WAY BUT I
THINK IT'S A GOOD CONVERSATION
TO START HAVING THANK YOU.
ASSEMBLYMEMBER'S THANK YOU.
THANK YOU, DR WEBBER. MR
SANTIAGO. SURE NOT MAKING MY
COMMENTS BRIEF AND I THINK. I
SUPPORT THE BILL, AND I THINK
THAT WHAT YOU'RE TRYING TO DO IS
THE RIGHT THING TO DO. MAKE SURE
THAT ALL THE DIRECTORIES UP TO
DATE, UM, BECAUSE THAT'S
IMPORTANT. I DON'T NEED AN
ANSWER RIGHT NOW. BUT JUST JUST
AS YOU'RE MOVING FORWARD, JUST
IF YOU COULD CONTEMPLATE MAYBE A
SUMMER'S HATE TO USE THE WORD
BUT PROVIDE A RESPONSIBILITY TO
MAKE SURE THAT THE DIRECTORY IS
UP TO DATE AS MUCH AS POSSIBLE.
IF YOU I WORKED WITH YOU ON
LEGISLATION BEFORE, SO I HAVE
EVERY CONFIDENCE THAT YOU'LL GET
THERE. AND IF SOME THOUGHT PUT
TO THAT, AS YOU MOVE DOWN THE
LINE, I THINK IT WOULD BE
GREATLY APPRECIATED. DO PLAN TO
SUPPORT TODAY. THANK YOU. SORRY,
MISS AGUIAR-CURRY. THANK YOU.
ASSEMBLYMEMBER'S BRINGING
FORWARD. THE PLANS HAVE SAID
THAT THEIR INACCURACIES ARE NOT
FULLY IN THEIR CONTROL AND THAT
THE BILL'S REQUIREMENTS WILL
RESULT IN RURAL COMMUNITIES
BEING LEFT BEHIND. WHAT DO YOU
THINK OF THAT COMPLAINT? HAVE
YOU HEARD THAT COMPLAINT? YOU
KNOW ME. I'M GOING TO GUARD MY
RURAL COMMUNITIES. AS WELL. YOU
SHOULD. OKAY? NO, I THINK IT'S I
THINK WE'VE RECOGNIZED THAT
THERE ARE THAT THEY'RE IN TERMS
OF THE RURAL COMMUNITIES THAT
THERE HAS TO BE SOME RECOGNITION
OF HOW WE CAN MAKE SURE THAT
THIS IS PROVIDING THE RIGHT KIND
OF CONSUMER BENEFITS, BUT AT THE
SAME TIME NOT DOING ANYTHING
THAT'S GOING TO UNDERMINE THE
SERVICES. I'M GOING TO LET MY
SPONSOR HAVE A LITTLE BIT OF A
COMMENT ON THIS, BUT I DO. HEAR
WHAT YOU'RE SAYING. AND WE'RE
MAKING SURE THAT THAT AREA IS
DISCOVERED AS WELL. OF COURSE,
AND THEN AS AS MENTIONED WITH
THIS WAS TAKING CONSIDERATION,
ESPECIALLY WITHIN, UH, AREAS
THAT ARE MORE ROLE THAT DOES
PROVIDE WHERE PROVIDERS DO NOT
SEE AS FREQUENT PATIENTS. IT WAS
THAT CONSIDERATION. WE WANT TO
MAKE SURE THAT, UM THERE IS
SPECIFIC GUIDANCE CREATE FROM
GMHC AND WANT TO WANT TO MAKE
SURE THAT RURAL PROVIDERS ARE
STILL PROTECTED AND KEPT ON THE
DIRECTORIES. UM THROUGH THE
THROUGH THE GUIDANCE GRADED BY
THE MHC, BUT AGAIN AT THE END OF
THE DAY, WE'LL ADD ON AND SAY
THAT LIKE WE'VE BEEN KICKING THE
CAN THE CAN DOWN THE ROAD, SO
WHO IS ULTIMATELY RESPONSIBLE?
UH, YOU KNOW, WE KEEP THROWING
BLAME AROUND ONE OTHER, BUT
CONSUMERS ARE BEING THE MOST
AFFECTED BOTH RURAL URBAN AND
THROUGHOUT CALIFORNIA, WHERE WE
ARE BASING IN HAVING INDIVIDUALS
CALL SO MANY PROVIDERS
JUSTIFYING SOMEONE TO TAKE CARE
OF THEM, RIGHT. UM AS AS MY
COLLEAGUE HERE MENTIONED, UM,
HAS SHE HAD THE PATIENT CALLED
50 PROVIDES 50 FIGHTERS IN SAN
DIEGO LAST YEAR, THERE WAS A
STORY IN THE WASHINGTON POST
ABOUT AN INDIVIDUAL WHO WAS
SEEKING CARE AND HOW TO COST 75
PROVIDERS. RIGHT AND ULTIMATELY,
AT THE END OF DAY LIKE IF WE'RE
GOING TO DO SOMETHING ON
PROVIDER INACCURACIES, WE HAVE
TO START SOMEWHERE AND THIS IS A
START TO CREATE A BETTER
INCENTIVE THAN WHAT IS CURRENTLY
BEING DONE BECAUSE WHAT'S
CURRENTLY BEING DONE ON THE
INCENTIVES CURRENTLY IS NOT
WORKING. REALLY QUESTION. I JUST
WANT TO MAKE IT ONE MORE COMMENT
. SURE, THANK YOU. I MEAN,
THERE'S DEFINITELY A PROBLEM.
HOW YOU GET THERE? I DON'T KNOW.
BUT AS YOU CONTINUE WITH THIS
BILL, AND I'LL SUPPORT YOUR BILL
TODAY, IF YOU CONTINUE TO WORK
ON MY RURAL COMMUNITIES AND LEFT
THEM THEY CONTINUE TO GET ME
LEFT BEHIND. I DON'T NEED AN
ADDITIONAL COSTS TO THEM. I JUST
WANT TO MAKE SURE THAT WE WERE
NOT FORGOTTEN. SO THANK YOU VERY
MUCH FOR BRINGING IT FORWARD. MR
LOCKIE. THANK YOU, MR CHAIR. I
DO APPRECIATE REALLY, GENUINELY
WHAT YOU'RE TRYING TO DO HERE,
AND I BELIEVE IT'S A IT'S AN
ISSUE THAT, UH NEEDS TO BE
ADDRESSED IN A VERY SERIOUS WAY
AND INCLUDING IMPROVING ACCESS
TO CARE. UM AND MY DISTRICT, AS
HAS BEEN INDICATED. IT'S ALSO
VERY, VERY RURAL, SO PEOPLE HAVE
TO DRIVE A LONG WAY. TO GET TO
THE DOCTOR'S OFFICE AND WHEN THE
INFORMATION IS INACCURATE, AH,
IT IT CREATES QUITE A DIFFICULT
CIRCUMSTANCE FOR THOSE PEOPLE.
AND SO, UM, I THINK THAT THEY DO
DESERVE ACCURATE INFORMATION.
BUT HERE HERE'S MY FRUSTRATIONS
. I DON'T BELIEVE THAT
PENALTIES. SEEMED TO BE THE
RIGHT ANSWER. UH THERE ARE MANY
MOVING PARTS WITH THIS
COMPLICATED ISSUE, BUT IT SEEMS
LIKE FINE FINES COULD ACTUALLY
MAKE IT MORE DIFFICULT AND
ACTUALLY ADD GASOLINE TO THE
FIRE. AND I DON'T SEE HOW THEY
ENSURE ACUMEN. ACCURACY OF
INFORMATION, AND I'M HOPING
THAT, UH YOU'LL BE ABLE TO WORK
WITH THESE PLANS HERE TO BUILD
SOME CONSENSUS BECAUSE I DON'T
BELIEVE ANYBODY'S HAPPY WITH THE
CURRENT STATUS OF THE WAY THINGS
ACTUALLY ARE. UM IF I COULD JUST
ASK THE QUESTION TO SOMEBODY ON
THAT PANEL HELP ME UNDERSTAND
HOW FINDING THESE HEALTH PLANS
LARGE AMOUNTS OF MONEY ACTUALLY
LEADS TO MORE ACCURATE. UH,
PROVIDER DIRECTORY INFORMATION.
I'M TRYING TO UNDERSTAND IT. I
DON'T UNDERSTAND IT COURSE.
THANK YOU. SOME MEMBER FOR THE
QUESTION. SO HAS BEEN MENTIONED
CALIFORNIA THAT DOES HAVE, UH,
SOME OF THE STRONGEST LAWS BUT
WHEN IT COMES TO PROVIDER
DIRECTORIES, HOWEVER, THE
COMPLIANCE IS THAT ARE VERY LOW
LEVEL PARTIALLY DUE TO THE LOW,
UM, THE INEFFECTIVE ENFORCEMENT
STANDARDS THAT ARE CURRENTLY IN
PLACE. SO WITH THESE PENALTIES
THAT WOULD WORK AS A BETTER
INCENTIVE THAT THEN WHAT'S IN
PLACE? UM AND UNDERSTANDING THAT
THERE IS A SPECIAL SPECIAL
SPECIAL RELATIONSHIP BETWEEN
HEALTH PLANS AND PROVIDERS, SO
WITH THE PENALTIES AFFECTING THE
HEALTH PLANS, THERE'S ALSO THE
CONNECTION TO THE PROVIDER WHERE
THE CURRENT UNDER CURRENT
STATUTE. PROVIDERS CAN BE
REMOVED. BUT WITH THIS BILL AS
WELL, IF THE PROVIDER DOES NOT
PROVIDE ACCURATE INFORMATION,
THEY CAN ALSO BE REMOVED. SO
UNDERSTANDING THAT THERE IS A
SPECIAL RELATIONSHIP BETWEEN
PROVIDER AND HEALTH PLAN, BUT
ULTIMATELY, THE BUCK STOPS WITH
HEALTH PLANS AS THEY ARE THE
ONES THAT ARE MAINTAINING THE
PROVIDER. THE PROVIDER
DIRECTORIES. OKAY I'D LIKE TO
LET THE PLANS RESPOND TO THAT.
YEAH THANK YOU. SOMEBODY
REMEMBER LACKEY FOR THAT
QUESTION. I MEAN, IF THE
CHALLENGE IS GETTING MORE
ACCURATE AND TIMELY INFORMATION
FROM THE PROVIDERS, I MEAN, WE
AGREE WITH YOU. I MEAN, WE FAIL
TO SEE HOW FINDS UM, WILL
MAGICALLY LEAD TO THE RECEIPT OF
THIS INFORMATION FROM THE
PROVIDERS, UM YOU KNOW, I HAVE
TO SAY THAT. YOU KNOW, WE'RE
STILL WORKING WITH THE
DEPARTMENT. UM UH, THE
DEPARTMENT'S, UH, YOU KNOW,
CURRENTLY WORKING ON DEPARTMENT
MANAGED HEALTH CARE IS CURRENTLY
WORKING ON INFORMAL RULEMAKING,
UM AND IS IN THE FINAL STAGES OF
DEVELOPMENT. UM, YOU KNOW, ONCE
AT A CERTAIN POINT, THE PROCESS
THEY'RE GOING TO BEGIN A PRE
NOTICED STAKEHOLDER PROCESS. YOU
KNOW, WITH VARIOUS FOLKS AND
DRAFT REGULATIONS WILL BE
RELEASED. WE BELIEVE IN MAY. UM
YOU KNOW, IN FOLLOWING THE
REVIEW OF STAKEHOLDER COMMENTS,
THE DEPARTMENTS WILL COULD
POTENTIALLY REVISED REGULATIONS
AND THEN MOVE TO FORMAL
RULEMAKING. YOU KNOW, ALL OF
WHICH IS TO SAY A LOT OF THIS IS
VERY PREMATURE. I MEAN, THERE'S
STILL A LOT OF WORK BEING DONE,
YOU KNOW, TO MAKE SURE THIS
PROCESS WORKS. UM UH, YOU KNOW,
AT AT ITS AT ITS HIGHEST LEVEL,
YOU KNOW AT THE HIGHEST POSSIBLE
LEVEL. AND YOU KNOW IF YOU KNOW,
WITH YOUR INDULGENCE, I MEAN,
YOU KNOW, YOU KNOW, I JUST
WANTED TO SAY BACK TO
ASSEMBLYMEMBER'S WEBBER'S
COMMENTS ABOUT THIS SUPPRESSION
OF PROVIDERS ON THE DIRECTORY. I
MEAN, WE DON'T WE DON'T THINK
THAT'S A GOOD CONSUMER OR A PRO
CONSUMER SOLUTION TO THIS
INFORMATION OR TO OR TO
SITUATION. UM EVEN THOUGH THE
PLANS ARE ALLOWED TO DO THAT,
YOU KNOW, IT'S NOT A GREAT
OPTION BECAUSE IT LEADS TO A
PROVIDER DIRECTORY THAT'S LESS
REFLECTIVE. OF YOU KNOW THE
PLAN'S PROVIDER NETWORK. AND SO
I THINK THERE'S AN INTERNAL
LOGIC PROBLEM WITH THIS BILL,
AND WITH THE FINES ISSUE THAT
YOU'RE RAISED OKAY. WELL THANK
YOU SUDDENLY MEMBER. I KNOW THAT
YOU'RE A VERY SKILLED LEGISLATOR
VERY EXPERIENCED ONE. AND SO I
HAVE CONFIDENCE THAT YOU'RE
GOING TO BE ABLE TO WORK. I WENT
THESE OTHER INDIVIDUALS, BUT IN
ITS CURRENT FORM, I'M GOING TO
BE ABSTAINING TODAY AND I HOPE
TO BE ABLE TO SUPPORT THIS ON
THE FLOOR WHEN IT GETS THERE AND
ITS NEW REFORM. THANK YOU. THANK
MR PATTERSON. THANK YOU. UM JUST
A QUESTION FOR THE PROPONENT
WITNESSES. UH IF YOU DON'T MIND
SOMEONE MEMBER UM I DON'T THINK
YOU'RE SUGGESTING THAT THE
HEALTH PLANS DON'T WANT TO HAVE
UPDATED INFORMATION, ARE YOU. NO
THEY ABSOLUTELY DO. IT IS WHAT
THIS BILL WOULD DO IS JUST
CREATE A STRONGER INCENTIVE TO
ACTUALLY CREATE. UH IT WOULD BE
A PROVIDER BETTER INCENTIVE THAN
WAS CURRENTLY BEING DONE. AND IN
THE CURRENT PROCESS, THAT'S ALL.
UM ALL RIGHT. SO JUST TO, UH YOU
KNOW, DURING THE. YOU KNOW,
EVERYTHING WAS SHUT DOWN FOR A
WHILE. WE WERE LOOKING FOR A
MENTAL HEALTH PROVIDER FOR A
WHILE AND, UM, YOU KNOW, WE DID
USE DIRECTORIES AND WE'RE
LOOKING FOR AND, UH YOU KNOW, WE
DID. WE WOULD CALL THE
PROVIDER'S ON THERE. AND I THINK
THERE WERE SOME CIRCUMSTANCES
WHERE, YOU KNOW FOR WHATEVER
REASON, YOU KNOW HOURS WERE
CHANGED AND THINGS LIKE THAT.
BUT WHAT I ACTUALLY FOUND, YOU
KNOW, CALLING THROUGH IS THAT,
UM, SOME OF THE PROVIDERS AND
MAYBE IT'S IN THIS PARTICULAR
CASE. THEY DIDN'T SEEM TO, UM
BAD. THE ONE WE ENDED UP
CHOOSING ACTUALLY DIDN'T SEEM TO
HAVE A PARTICULAR INTEREST IN
HAVING, UH, YOU KNOW UP TO DATE
INFORMATION WASN'T REALLY A
PRIORITY OF HERS. YOU KNOW, SHE
WAS PRETTY BUSY ALREADY. AND UM
, YOU KNOW, SO I SO SHE'S NOT
MAKING THE EFFORT. I JUST WONDER
, UM, WHY PENALIZE THE PLANS?
YOU KNOW, SHE SHE REALLY DIDN'T
HAVE AN INTEREST IN UPDATING AND
SO I'M CURIOUS WHAT THE PLANS I
MEAN, WE TALKED ABOUT THIS A
LITTLE BIT, BUT WHAT DO YOU DO
RIGHT NOW TO JUST HIGH LEVEL TO
VERIFY THIS INFORMATION? RIGHT
SO THANK YOU. UM, YOU KNOW,
OBVIOUSLY WE'RE COMPLYING WITH
SB 1 37, WHICH IS THE UM, YOU
KNOW, THE BASELINE LAW THAT WAS
ESTABLISHED IN THE STATE OF
CALIFORNIA AND PROVIDER
DIRECTORIES. UM YOU KNOW, AS AS
PART OF THAT PROCESS, UM, UM, AT
LEAST EVERY DAY. ANY DAYS, THERE
ARE SOME INSTANCES WHERE THE
PLAN HAS TO DO WEEKLY REVIEWS OF
THE DIRECTORY, BUT AT LEAST
EVERY 90 DAYS, YOU KNOW, WE'RE
REACHING BACK OUT TO PROVIDERS
TO VERIFY INFORMATION. UM YOU
KNOW, WE DO THE INITIAL SWEEP TO
GET THE INFORMATION FROM THE
PROVIDERS. UM AND YOU KNOW WE'RE
YOU KNOW, WE'RE COUNTING ON THAT
INFORMATION TO BE ACCURATE. UM
YOU KNOW, UH, FOR THE DIRECTORY
. THE PLANS CURRENTLY ARE ALSO
WORKING AT THE COVERED
CALIFORNIA LEVEL. UM WITH AN
ENTITY CALLED SYMPHONY, WHICH IS
INTENDED TO BE AT A SINGLE
SOURCE PROVIDER DIRECTORY
DATABASE. THAT UM YOU KNOW IS
CURRENTLY RECEIVING
PARTICIPATION NOT ONLY FROM THE
PLANS, BUT PROVIDER GROUPS AS
WELL. SO THEY'RE HOPING THAT,
UM, YOU KNOW, UH, SINGLE SOURCE
DATABASE WILL BE SOMETHING THAT
FOLKS CAN RETRIEVE DATA FROM UM
, UH AND TRY TO REDUCE THE
ADMINISTRATIVE BARRIER. UM YOU
KNOW ON BOTH PLANS AND PROVIDERS
, SO THAT IS SOMETHING THAT IS
LAUNCHING THIS YEAR. SO UM, YOU
KNOW, ANOTHER REASON WHY, YOU
KNOW THIS BILL IS PREMATURE. SO,
YEAH, SO REACHING OUT TO
PROVIDERS ON THE 13 AT LEAST 13
PIECES OF INFORMATION WE NEED
FROM THE PROVIDERS. THE 90 DAY
FOLLOW UP REQUESTS, UM, AND WE
ASKED PROVIDERS TO VERIFY THEIR
DATA. THROUGH YOU KNOW, AS I
STATED BEFORE PRACTICE, PROFILE
, OUT OF STATIONS, ROSTER
SUBMISSIONS AND OTHER SOURCES OF
DATA AGAIN AT LEAST EVERY 90
DAYS. SO WORK BEING DONE. WELL,
THANKS. AND I DON'T KNOW IF, UM
YOU KNOW THIS INFORMATION IS
REALLY ATTAINABLE. BUT IT WOULD
BE INTERESTING TO KNOW WHAT
RESPONSE LEVELS ARE ON THAT IF
YOU HAVE IT, I WOULD LOVE. YEAH
NO, AND I APPRECIATE IT. IF I IF
I MAY ASSEMBLYMEMBER'S I
APPRECIATE IT. I THINK THAT YOU
KNOW, THERE'S NOT ONLY A
CHALLENGE OF CONSTRUCTING THE
DIRECTORIES, UM I THINK
MEASURING THE ACCURACY OF THE
DIRECTORIES IS ALSO A CHALLENGE
. AND YOU KNOW, I WANT I WANT TO
TAKE THIS OPPORTUNITY HERE. I
MEAN, YOU KNOW, SOME OF THE DATA
THAT'S BEEN SUBMITTED BY THE
SPONSORS IS A BIT DATED, UM, YOU
KNOW, CERTAINLY, YOU KNOW, PRIOR
TO THE EVENTUAL IMPLEMENTATION
OF THE YOU KNOW, SINGLE SOURCE
DATABASE THAT COVERED
CALIFORNIA. AND OTHER
STANDARDIZED PIECES OF
INFORMATION THAT HAVE COME ALONG
THE WAY THROUGHOUT THE YEARS. SO
WE HAVE TO SAY THAT ALSO LIKE
TELEPHONE SURVEYS AND COLD
CALLING DOCTORS OFFICE ISN'T
ALWAYS THE GREATEST AND MOST
SCIENTIFIC WAY OF, YOU KNOW,
ESTABLISHING, UM YOU KNOW THE
ACCURACY OF THE DIRECTORY
BECAUSE YOU DON'T KNOW WHO'S
ANSWERING THE PHONE AND WHAT
THEY KNOW, ETCETERA. YOU KNOW,
MAYBE YOU KNOW, COMPARING
COMPOSITE DATA FROM VARIOUS
SOURCES TO MAKE SURE
EVERYTHING'S ACCURATE, YOU KNOW,
COULD BE PART OF THE EQUATION AS
WELL. SO UM, SO YEAH, I THINK
YOU KNOW THERE'S MORE WORK THAT
COULD BE DONE NOT ONLY IN
CONSTRUCTING THE DATABASE
INACCURATE MATTER, BUT BUT EVEN
MEASURING IT. AND I KNOW WE HAVE
, YOU KNOW, ADMINISTRATIVE
WORKLOAD THAT HAS BEEN PUT ONTO
THE PROVIDERS. JUST GENERALLY
SPEAKING, YOU KNOW, OVER TIME,
AND I THINK YOU KNOW PERSONALLY
, I LIKE, YOU KNOW. HEY I WANT
TO SEE A MORE ACCURATE. AH UM,
YOU KNOW, PROVIDER DATABASE LIKE
A MENTION. WE WERE SORT OF GOING
THROUGH THIS PROCESS AND AH, UM
YOU KNOW, I AM SINCERE IN SAYING
THAT I SHARE THAT GOAL AND DOING
IT. UM AND I AM JUST I DO THINK
THE PENALTY SIDE OF IT. UH UM
WHEN IT'S IT SEEMS LIKE THERE'S
AN EXISTING PROCESS OUT THERE TO
GET THIS INFORMATION AND I'M NOT
SURE THE HEALTH PLANS HAVE THE
ENTIRE UM YOU KNOW, BLAME HERE
AND, UM YOU KNOW, THERE'S
MULTIPLE PARTIES. SO UM, YOU
KNOW IF THERE'S SOME WAY I CAN
WORK ON THIS IN THE FUTURE SEEMS
LIKE WE HAVE MUCH BETTER EXPERTS
IN THIS SPACE THEN THAN ME. UM
YOU KNOW SOMETHING I'M REALLY
INTERESTED IN WORKING ON
SINCERELY, BUT I THINK RIGHT NOW
IT IS A TOUGH, TOUGH ONE FOR ME
TO SUPPORT SO, BUT I REALLY
APPRECIATE YOU BRINGING IT AND
YOU KNOW, HOPEFULLY CONSIDER.
WELL, I KNOW. HOPEFULLY THE
PLANS WILL WORK AS WELL. I'M
SURE THEY WILL AND I WOULD COME
UP TO A SOLUTION. ANY ANY OTHER
MEMBERS. NO ONE ELSE BRING IT TO
MYSELF. AND I HAVE SOME
QUESTIONS. COMMENTS ACTUALLY
MORE THAN ANYTHING, UM, UH, I
WILL SAY THAT YOU KNOW, WHEN I
WAS PRACTICING DENTISTRY, THERE
WERE SOME SPECIALTY PLANS THAT I
MAY ONLY HAVE SEEN ONE OR TWO
PATIENTS A YEAR. UM I DID SOME
WORKERS COMP CASES, AND THAT WAS
MAYBE ONE OR TWO CASES EVERY
COUPLE OF YEARS FOR DIFFERENT
CARRIERS AND A VARIETY OF OTHER
KINDS OF PLANS. UM MAYBE THAT'S
NOT JUST A RURAL ISSUE. MAYBE
IT'S AN URBAN ISSUE AS WELL. I
SUSPECT IT IS. UM AND SO, UM,
YOU KNOW, I WOULD HOPE THAT YOU
CONTINUE WORKING. OBVIOUSLY THE
DENTAL PLANS. I KNOW THIS IS A
CONCERN FOR THEM IS PROBABLY
CONCERNED FOR OTHERS AS WELL, UM
, JUST IN GENERAL TO AS A JUST
BECAUSE YOU TAKE AN INSURANCE
COME IN PLAN DOESN'T MEAN YOU'RE
A CONTRACT ID PROVIDER. UM I
WOULD HOPE THAT PROVIDERS THAT
ARE ACTUALLY SIGNING CONTRACTS
KNOW WHAT PLANS THEY HAVE SIGNED
FOR? UM BUT WE ALSO HAVE FOUND
ALSO FOUND OVER THE YEARS THAT I
WAS A CONTRACTOR PROVIDER FOR
ONE COMPANY, ONLY TO FIND OUT
THAT SOMEHOW THAT MEANT I WAS A
CONTRACTOR PROVIDER FOR OTHER
COMPANIES, WHICH I THINK IS
PROBLEMATIC. MAYBE THAT'S
SOMETHING MORE IN DENTISTRY. AND
NOT IN MEDICINE. BUT I'M NOT SO
SURE ABOUT ABOUT THAT. UM I
GUESS I GO BACK TO YES THERE IS
ADMINISTRATIVE BURDENS WITH
EVERYBODY AND EVERY BUSINESS,
BUT I DO BELIEVE THAT THE
PROVIDERS SHOULD HAVE SOME SKIN
IN THE GAME ON THIS. THEY SHOULD
HAVE SOME SOME RESPONSIBILITY
FOR THIS AS WELL. AFTER ALL.
THEY DO HOPEFULLY WANT PATIENTS
FROM THE PLANS THAT THEY ARE
PROVIDERS FOR SO WHY THEY'RE NOT
SUBMITTING INFORMATION IS
FRUSTRATING AT BEST, UM AND YOU
KNOW, CHALLENGING. I WILL GO
BACK TO AND I'M GOING TO ASK,
UM, MR LOUISA, SOME A MOMENT IN
A MOMENT ABOUT SOMETHING, BUT,
UM AND I CAN'T EVEN READ MY
WRITING HERE ON THIS. THIS IS
SCARY, BUT ONE OF THE CHANCE ONE
OF THE THINGS THAT I SEE AND
WE'VE TALKED ABOUT THIS AND
INTERNALLY IN OUR OFFICES THAT
GOSH, IF WE HAD A UNIFIED SINGLE
DATABASE, A HEALTH INFORMATION
EXCHANGE. WOULDN'T THAT BE
WONDERFUL THING? BECAUSE THEN WE
COULD ACTUALLY GET ACCESS TO
THIS INFORMATION PROVIDERS COULD
ACTUALLY GO TO A SINGLE SOURCE
AND ACTUALLY FIND OUT WHAT PLANS
THEY ARE COVERED BY. MAYBE THERE
COULD EVEN BE A SINGLE KIND OF
APPLICATION FORM THAT PEOPLE
COULD SUBMIT AND ALL BE, YOU
KNOW, AND ALL THE UNIFORM
BECAUSE I'M GOING TO GUESS AND I
DON'T EVEN NEED TO GUESS I KNOW
THAT EVERY INSURANCE PLAN IS
GOING TO HAVE THEIR OWN FORMAT
FOR HOW THEY ASKED FOR THE
INFORMATION. AND WE GET
COUNTLESS PIECES OF MAIL AND THE
PRACTICE IN THE DAY, AND
SOMETIMES IT LOOKS PRETTY
INNOCUOUS. AND THOSE INNOCUOUS
THINGS GO TO THE BOTTOM OF THE
PILE. QUITE QUITE FRANKLY. SO,
UM, I DO THINK IT'S WARRANTED. I
THINK I'M GONNA OBVIOUSLY I'M
GONNA SUPPORT YOUR BILL TODAY,
BUT I WOULD HOPE THAT AS YOU GO
FORWARD, THERE CAN BE ADDITIONAL
CONVERSATIONS GOING FORWARD
THERE. I WANT TO GO BACK AND
HISTORY LESSON BECAUSE I DIDN'T
KNOW THIS MYSELF. THE GENESIS
FOR SB 1 37, WHICH WE'RE TALKING
ABOUT CAME FROM COVER
CALIFORNIA. THEY WENT TO DOCTOR
, THEN ED HERNANDEZ IN THE
SENATE SAID, HEY, WE'RE HAVING A
HARD TIME FIGURING OUT WHO
CONTRACTED PROVIDERS ARE AND
THAT'S WHERE THIS STARTED. SO
IT'S DISTURBING TO ME TO HEAR
THAT. WE'RE STILL IN A
RULEMAKING PROCESS WITH THE
DEPARTMENT OF MANAGED HEALTH
CARE THAT WAS 2015. UM WE ATE
ALMOST EIGHT YEARS AGO. AND
WE'RE STILL IN THE RULEMAKING
PROCESS, SO IT'S HARD FOR THE
PLANS TO KNOW EXACTLY WHAT THE
RULES ARE, BECAUSE THERE'S AS AM
I AM I CORRECT MR LOUISE OWES
YEAH. YOU KNOW, I TALKED TO MY
LEGAL AND REGULATORY AFFAIRS
PEOPLE TODAY ABOUT THAT, AND IT
I BELIEVE SO NOW THAT DOESN'T
MEAN THERE HASN'T BEEN WORKED ON
AT THE REGULATORY LEVEL. BUT
THERE'S STILL IT'S NOT. IT'S NOT
FINAL. YEAH YEAH, IT'S NOT
COMPLETE. YEAH YEAH, RIGHT.
RIGHT SO WE'RE HERE. WE'RE GONNA
MAKE SURE I GET THAT OUT, AND I
APPRECIATE THAT, BUT WE'RE SEVEN
PLUS YEARS INTO THE PROCESS.
WITH STATE GOVERNMENT IN THE
RULEMAKING PROCESS. THAT'S NOT
COMPLETE. SO THERE ARE THERE ARE
OBVIOUSLY CHALLENGES THERE.
THAT'S THAT'S A FAIR WRECK. YEAH
I KNOW. I BELIEVE SO AND YOU
KNOW, I YOU KNOW THAT I WASN'T
MEANT TO, YOU KNOW, BE OVERLY
CRITICAL OF THE DEPARTMENT. BUT
UM, YOU KNOW, ONE OF THE GOOD IF
HE QUOTE UNQUOTE GOOD THINGS
ABOUT YOU KNOW WHERE WE'RE AT IS
THAT THERE WILL BE THERE WILL BE
STAKEHOLDER, YOU KNOW, COMMENTS
AND IN THE PROCESS IS AS A PART
OF THEM WINDING, WINDING DOWN ON
THE REGULATORY SIDE SO AND I'LL
TAKE THAT AS AN OPPORTUNITY TO
SAY THAT MAYBE THIS IS AN ISSUE
THAT REQUIRES A META LEGISLATIVE
SOLUTION, AS OPPOSED TO, YOU
KNOW, SOMETHING THAT WE BELIEVE
IS KIND OF A HAMMER. UM AND A
PRETTY BIG ONE AND UNNECESSARY
ONE. SO THANK YOU APPRECIATE IT.
APPRECIATE THAT PERSPECTIVE. UM
ANY OTHER QUESTIONS OR COMMENTS
? UM WE'LL GO AHEAD AND BRING IT
BACK, UM, LOOKING ACTUALLY,
FIRST VOTE BEFORE WE ASK FOR
EMOTION AND GIVE YOU AN
OPPORTUNITY TO CLOSE MR HOLDEN.
YOU HAVE AMENDMENTS. UM BEFORE
US AND YOU'RE ACCEPTING ACCEPTED
. OKAY SO WHEN THERE IS A
MOTION, IT WILL BE DUE PASSES AS
AMENDED, BUT I'M GOING TO ASK,
UH, MR HOLDEN. TOO CLOSE IF YOU
LIKE. THANK YOU, MR CHAIR. YOU
KNOW, LET ME JUST SAY THAT. IF
YOU'RE SOMEONE AT HOME WATCHING
THIS PROCEEDING TODAY, AND YOU
HAVE BEEN TRYING TO WORK THROUGH
A DIRECTORY. YOU'RE GOING TO END
UP AT THE END OF THIS DAY MORE
CONFUSED THAN YOU WERE WHEN YOU
STARTED. AND WHEN YOU HAVE A
PLAN AND PROVIDERS AND SAY THEY
WORK IN PARTNERSHIP, BUT THEN
THEY DON'T REALLY KNOW WHO'S ON
FIRST AND WHO'S ON SECOND.
THERE'S KIND OF AN UNDERSTANDING
THEY'RE STILL TRYING TO FIGURE
IT OUT. THE RULES ARE STILL
TRYING TO BE CLEARLY ARTICULATED
. IN THE MEANTIME, THE CONSUMERS
ARE THE ONES WHO ARE FALLING
BETWEEN THE CRACKS. THAT'S WHY
THIS BILL IS BEFORE US. BECAUSE
EVERY DAY PEOPLE ARE GOING TO
THOSE DIRECTORIES WITH THE
EXPECTATION THAT THERE IS GOING
TO WORK. THEY'RE NOT INTIMATE IN
TERMS OF STUDIES THAT ARE STILL
GOING ON 10 YEARS LATER, THEY'RE
NOT AWARE OF HOW THE INTRICACIES
OF THESE PLANS AND PROVIDERS
WORK. THEY JUST KNOW THAT
THEY'VE BEEN TOLD TO GO TO A
LIST AND THAT LIST SHOULD
PROVIDE YOU WITH SOMEONE WHO CAN
MEET YOUR NEEDS. AND IF IT'S NOT
WORKING AND THEY'RE SAYING,
WELL, HOW DO YOU ENFORCE IT,
THEN? WE DON'T HAVE A LOT OF
TOOLS TO WORK WITH TO TRY TO GET
ENFORCEMENT. SO YES, WE WILL
CONTINUE TO HAVE CONVERSATIONS.
YES, WELL UNDERSTAND THAT THIS
IS STILL ELEMENTS OF EVAN FLOW,
BUT THE BOTTOM LINE HERE IS THIS
BILL IS TRYING TO DO SOMETHING
TO PROTECT PEOPLE WHO RIGHT NOW
AREN'T BEING VERY WELL
PROTECTED. AND WHO ARE IN NEED.
AND WHO ARE LOOKING FOR IT TO
WORK, AND IT'S NOT WORKING. AND
SO WHAT DID THEY DO? OKAY SO ALL
I'M SAYING IS THAT WE'LL DO OUR
PART. WE'VE HEARD THE CONCERNS.
WE UNDERSTAND THE DENTAL
COMMUNITIES ISSUES AND WE WILL
HAVE UNDERSTOOD THEM FOR THE
BEGINNING. BUT WE WILL CONTINUE
TO HAVE CONVERSATIONS WILL
CONTINUE TO TRY TO FIND WAYS OF
UNDERSTANDING. WE LOOK FROM SOME
FEEDBACK, TOO. HERE'S WHAT
ENFORCEMENT COULD WORK FOR US,
NOT I. WE'VE GOT PROCESSES GOING
ON OUT THERE AND WE'RE GONNA
WAIT AND SEE WHAT HAPPENS AT
THAT LEVEL THAT AIN'T WORKING.
BUT IF IT COMES BACK TO WITHIN
THE CONTEXT OF THIS BILL WITHIN
THE CONTEXT OF THIS PROCESS HERE
IS WHAT WE WOULD SUGGEST. THEN
WE'LL CERTAINLY LOOK AT THAT AND
BE WILLING TO TAKE THOSE
AMENDMENTS SHOULD THEY MAKE
SENSE TO THE CONSUMER ON THE
OTHER END AND CREATE SOME
FACILITATION AND EXPEDITION,
EXPEDITING THE PROCESS AND
CLEANING UP A PROCESS THAT RIGHT
NOW HAS THEM TWISTED IN KNOTS.
WITHOUT I RESPECTFULLY ASK FOR
YOUR VOTE. THANK YOU VERY MUCH,
MR HOLDEN, HAPPY TO ENTERTAIN A
MOTION. MOTION BY, UH MISS
AGUILAR. CURIOUS SECOND BY MR
SANTIAGO. THE MOTION IS DUE PASS
AS AMENDED TO APPROPRIATIONS.
MADAM SECRETARY. PLEASE CALL THE
ROLL. WOULD WOULD I? WALDRON
WALDRON, NO AGUIAR-CURRY. EDGAR
CURRY. I ARAMBULA
BOERNER HORVATH CARILLO. FLORA.
BLACKIE. NOT VOTING. MAIENSCHEIN
. MCCARTY MCCARTHY, I. PATERSON
. PATERSON, NOT VOTING
RODRIGUEZ. SANTIAGO. SANTIAGO. I
VE VALLAPUDUA VALLAPUDUA. AYE,
WEBER. HOWEVER, I. YOU HAVE SIX
VOTES. WE HAVE SEVERAL COMMITTEE
MEMBERS MISSING, SO WE'LL LEAVE
THAT BILL ON CALL. THANK YOU
VERY MUCH BEFORE WE GO TO OUR
NEXT WITNESS, WHICH WE WILL,
WHICH WILL BE MISS BARRICADE.
KHN WILL BE QUICK HERE. I SEE
YOU THERE. UM WE'D LIKE TO MAKE
HAVE A MOTION TO ADOPT THE
COMMITTEE RULES. WE HAVE A
SECOND MOTION BY MR SANTIAGO AND
A SECOND BY MS WALDRON AND
SECRETARY PLEASE CALL THE ROLL.
WOULD WOULD I, WALDRON WALDRON.
NIAGARA CURRY CURRY. I ARAMBULA
BOERNER HORVATH. CARILLO FLORA.
BLACKIE. COMMITTEE RULES. OKAY,
I MAIENSCHEIN MCCARTHY. MCCARTHY
I, JOE PATTERSON. SO PATERSON I
RODRIGUEZ. SANTIAGO SANTIAGO,
I'LL BE VALLAPUDUA PUT WHY
WEBBER WEBBER? AYE. SO THAT'S
THE RULES. COMMITTEE RULES ARE
ADOPTED. AND THEN FINALLY BEFORE
JUST IT'S YOU KNOW, IF I LET
THEM ALL OUT, YOU KNOW AT THIS
POINT YEAH. WE WOULD LIKE TO.
I'D LIKE TO PRESENT THE CONSENT
CALENDAR, WHICH INCLUDES ITEM
NUMBER TWO A B 2 89. MR HOLDEN.
ITEM NUMBER THREE A B 3 85 MR
TAHA. ITEM NUMBER 5 83 87 MISS
AGUIAR-CURRY ITEM NUMBER EIGHT A
B 2 83 MR JIM PATTERSON. ITEM
NUMBER NINE A. B 512 OUR VICE
CHAIRMAN WALDRON, UM, WITH
AMENDMENTS, UM HAPPY TO ACCEPT
THE MOTION ON THE CONSENT
CALENDAR MOTION BY MR SANTIAGO A
SECOND BY MR MCCARTHY. MADAM
SECRETARY, PLEASE CALL THE ROLL
ON THE CONSENT CALENDAR. I WOULD
I, WALDRON WALDRON CURRY CURRY.
I ARAMBULA OR NO CORVETTE.
CARILLO. FLORA BLACKIE. LUCKY I
MAIENSCHEIN MCCARTHY. MCCARTHY I
, JOE PATERSON, PATERSON, I
RODRIGUEZ SANTIAGO. SANTIAGO IVY
VALLAPUDUA. BE VALLAPUDUA. AYE,
WEBER. HOWEVER, I. 90 THAT'S
PASSED WILL GO ON AND LET'S
BARRICADE HAND WOULD YOU LIKE TO
PRESENT UM A B 2 54. UP PUSHED
DURING THE MICHAEL, PLEASE.
THANK YOU. THANK YOU, DR WEBBER.
UM I AM PRESENTING 82 54. AS YOU
HEARD. THIS IS A COMMON SENSE
MEASURES TO PROTECT REPRODUCTIVE
HEALTH INFORMATION. NEARLY ONE
THIRD OF US WOMEN USE
REPRODUCTIVE AND FERTILITY
TRACKING APPS TO GUIDE THEM
THROUGH THEIR LIVES AND THEIR
PREGNANCIES AND THE END OF THEIR
CYCLES. FOR MENSTRUAL CYCLE.
TRACKING THE FIRST QUESTION
USERS MUST ANSWER BEFORE EVEN
ENTERING THE APP IS OFTEN ARE
YOU PREGNANT? THESE APPS RECORD
WHEN PREGNANCIES BEGIN, AND WHEN
THEY END THESE APPS OFFER LITTLE
IN THE WAY OF PROTECTION FOR
THAT DATA WITH OBSCURE PRIVACY
POLICIES AND LITTLE MEANINGFUL
REGULATION. CONSUMER REPORTS
STUDY FOUND THAT NONE OF THE
LEADING MENSTRUAL TRACKING APPS
OFFER TRANSPARENCY ABOUT WHO
THEY SHARE THE DATA WITH THE
STUDY ALSO FOUND A MAJORITY OF
THOSE APPS USE THIRD PARTY
TRACKERS. THIS IS UNACCEPTABLE,
ESPECIALLY IN A POST FOR A WORLD
SELLING THIS HEALTH DATA COULD
RESULT IN ARREST. 82 54 PROTECTS
THIS DATA BY ADDING C M I, A THE
CALIFORNIA MEDICAL INFORMATION
ACT PROTECTIONS TO REPRODUCTIVE
AND SEXUAL HEALTH INFORMATION
COLLECTED BY DIGITAL SERVICES.
REPRODUCTIVE HEALTH INFORMATION
IS HEALTH INFORMATION AND SHOULD
NOT BE SOLD WITH ME TODAY AND
SUPPORT OUR JUSTIN BROOKMAN WITH
CONSUMER REPORTS AND BECCA
CRAMER MATTER WITH BLU
CALIFORNIA THANK YOU. PLEASE GO
AHEAD. HELLO GOOD AFTERNOON.
CHAIR MEMBERS. MY NAME IS JUSTIN
BROOKMAN, DIRECTOR OF TECHNOLOGY
POLICY THAT CONSUMER REPORTS
URGING SUPPORT FOR 80 TO 54 TO
EXTEND CMI A PROTECTION TO
FERTILITY AND SEXUALITY AT DATA.
CONSUMER REPORTS HAS BEEN AROUND
FOR 85 YEARS FIGHTING FOR
CONSUMERS AND THE LAST SEVERAL
YEARS THAT INCLUDES FIGHTING TO
PROTECT PERSONAL, UH, PARIS
PRIVACY AND SECURITY, AND A LOT
OF OUR WORK HAS ACTUALLY BEEN
AROUND PERIOD. TRACKING APPS ARE
FIRST PRIVACY SECURITY
INVESTIGATION BACK IN 2015 WAS
INTO THE GLOW APP. WE UNCOVERED
A NUMBER OF PRIVACY AND SECURITY
VULNERABILITIES EXPOSED PERSONAL
INFORMATION. THAT EVENTUALLY LED
TO FIND AN ENFORCEMENT ACTION
FROM THE CALIFORNIA ATTORNEY
GENERAL'S OFFICE IN 2020. WE
EVALUATED THE FIVE MOST MOST
POWERFUL FIVE OF THE MOST
POPULAR PERIOD, TRACKING APPS
FOR PRIVACY AND SECURITY
ATTRIBUTES. UM NONE OF THEM
ACTUALLY DID A VERY GOOD JOB.
ALL OF THEM BY THE FAULT DID
SHARE DATA WITH COMPANIES LIKE
GOOGLE AND FACEBOOK AND DATA
BROKERS. IN 2022 IN THE WAKE OF
DOBBS. WE ACTUALLY TRIED TO SEEK
OUT SOME OF THE BEST PRIVACY
PRESERVING, UH, PERIOD TRACKER
APPS. AND THERE ARE ACTUALLY
SOME APPS LIKE DRIP AND YUKI AND
PERIODICAL DID A PRETTY GOOD JOB
THAT KEPT THE DATA LOCAL ON THE
DEVICE THEY DIDN'T SHARE. THEY
ALLOWED PSEUDONYMOUS ACCOUNTS.
THERE WAS NO LOCATION TRACKING,
BUT THEY WERE THE EXCEPTION AND
NOT THE RULE AND KIND OF PUT
FOLLOW OWNERS ON CONSUMERS TO
TRY TO FIGURE OUT WHICH OF THESE
DOZENS OF THAT'S DOES A GOOD JOB
THEY EXPECTED TO READ THROUGH
PRIVACY POLICIES TRY TO MEASURE
INFORMATION COMING OFF THE
DEVICE. I WOULD ARGUE THAT FOR
DATA SUCH AS THIS, YOU SHOULD
JUST EXPECT IT TO BE PROTECTED
BY DEFAULT. WHEN YOU GO TO THE
DOCTOR'S OFFICE. YOU'RE NOT
WORRIED ABOUT YOUR DOCTORS
SELLING YOUR DATA TO FACEBOOK.
THAT SHOULD BE THE SAME CASE FOR
APPLICATIONS THAT HAVE ACCESS TO
THE SAME LEVEL OF SENSITIVE DATA
. THE CCP A PROVIDES SOME
PROTECTIONS, BUT IT'S STILL PUT
THE ONUS ON CONSUMERS TO GO TRY
TO EXERCISE OPT OUT RIGHT TRY TO
FIGURE OUT WHAT'S GOING ON, TRY
TO NAVIGATE DIFFERENT
INTERFACES. THE FEDERAL TRADE
COMMISSION'S DONE A BETTER JOB.
IN RECENT YEARS. THEY HAVE
BROUGHT SOME IMPORTANT
ENFORCEMENT ACTIONS, INCLUDING
AGAINST FLOW, FERTILITY APP, UM
, BUT YOU KNOW, THEY'RE STILL
THEY'RE UNDERFUNDED. THE LAW'S
VAGUE IT HASN'T BEEN TESTED IN
COURT. UM AND SO I THINK MAYBE 2
54 IS A REAL OPPORTUNITY TO
PROVIDE CLEAR LINES AND CLEARER
COMMON SENSE PROTECTIONS FOR
DATA THAT I THINK WE SHOULD ALL
SHOULD AGREE. SHOULD BE
PROTECTED BY DEFAULT. THANK YOU
VERY MUCH AND HAPPY TO ANSWER
ANY QUESTIONS YOU MIGHT HAVE.
THANK YOU. CHAIR AND MEMBERS.
BECCA CRAMER MATTER ON BEHALF OF
A C L U CALIFORNIA ACTION AND
SUPPORT GIVEN THE NATIONAL
CLIMATE, REPRODUCTIVE AND SEXUAL
HEALTH INFORMATION IS BECOMING
MORE VALUABLE AND POSES EVEN
GREATER RISK TO USERS WHEN
SHARED WITHOUT THEIR CONSENT. AS
STATES ACROSS THE COUNTRY
CRIMINALIZE PEOPLE FOR RECEIVING
REPRODUCTIVE HEALTHCARE BECOMES
EVEN MORE IMPORTANT THAT
CALIFORNIA DOES MORE TO PROTECT
AGAINST DIGITAL TRACKING. THE
LACK SECURITY OF APPS THAT TRACK
MENSTRUAL CYCLES ARE PREGNANCY
MEANS THIS DATA COULD EASILY BE
ACQUIRED AND USED AS EVIDENCE TO
CRIMINALIZE PREGNANCY LOSS,
ABORTION OR GENDER AFFIRMING
CARE. THE DATA COLLECTED BY
THESE APPS AS EXTENSIVE ADS FOR
REPRODUCTIVE HEALTH SERVICES MAY
TAKE A USER DIRECTLY TO A SURVEY
THAT TRACKS FAMILY MEDICAL
HISTORY, MOOD MEDICATIONS,
PREGNANCY STATUS AND OTHER
INFORMATION. UNLIKE INFORMATION
PROVIDED IN A DOCTOR'S OFFICE.
THE INFORMATION IN THESE APPS IS
NOT COVERED BY HIPAA OR C M I A
BECAUSE IT IS CONSIDERED HEALTH
INFORMATION RATHER THAN MEDICAL
INFORMATION, A DISTINCTION THAT
CARRIES A BIG DIFFERENCE IN
TERMS OF THE PROTECTIONS AND
SAFEGUARDS AND LEGAL OBLIGATIONS
. BUT THAT IS MEANINGLESS AND
NONSENSICAL TO THE AVERAGE USER.
THE DATA SHARING PROVISIONS AND
ENFORCEMENT MECHANISMS GOVERNING
HEALTH INFORMATION CURRENTLY DO
NOT PROVIDE ADEQUATE PROTECTION
. THIS BILL MAKES THOSE CLAIMS
OF PRIVACY REAL BY ADDING THIS
INFORMATION TO THE CMA PRIVACY
PROTECTION. AND GIVING USERS
WITH MEDICAL PRIVACY PROTECTIONS
THAT THEY OFTENTIMES WRONGLY
ASSUMED. THIS INFORMATION
ALREADY HAS BECAUSE OF THIS, WE
ARE STRONGLY IN SUPPORT OF A B
254. THANK YOU. THANK YOU VERY
MUCH OTHERS IN SUPPORT COME
FORWARD AND JUST YOUR NAME AND
ORGANIZATION IF YOU REPRESENT
ONE. GOOD AFTERNOON, ANDREA
RIVERA ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK AND SUPPORT THANK YOU.
MR CHAIRMAN MEMBERS. I'M AARON
EVANS ON BEHALF OF NARAL PRO
CHOICE CALIFORNIA AND THE
CALIFORNIA NURSE MIDWIVES
ASSOCIATION BOTH IN SUPPORT.
THANK YOU. BRIAN SPENCER BEHALF
OF THE AMERICAN COLLEGE OF O B.
G. Y N S DISTRICT NINE AND
SUPPORT THANK YOU. THERE ARE
THERE WITNESSES AND OPPOSITION.
TESTIMONY AND OPPOSITION. SEEN
NONE. ANYBODY THERE'S NO ONE IN
OPPOSITION WILL BRING IT BACK TO
THE COMMITTEE FOR QUESTIONS OR
COMMENTS ANY QUESTIONS OR
COMMENTS FROM THE COMMITTEE.
YES, MISS DR WEBBER. EXCUSE ME.
THANK YOU, MR CHAIR. UM THANK
YOU SO MUCH FOR THIS BILL. YOU
KNOW, IT'S INTERESTING. I OFTEN
RECOMMEND ONE OF THE PERIOD APPS
FOR MY PATIENTS TO KEEP TRACK OF
THEIR CYCLES WHEN THEY COME IN
COMPLAINING OF IRREGULAR PERIODS
OR SOMETHING, AND IT WASN'T
UNTIL AFTER THE DOBBS CASE AND A
LOT OF DISCUSSIONS AMONGST G Y N
S IN THE COUNTRY AS TO WHAT THAT
MEANS THAT WE STARTED TALKING
ABOUT WHETHER OR NOT WE SHOULD
CONTINUE TO RECOMMEND THESE APPS
FOR OUR PATIENTS BECAUSE OF
PRIVACY CONCERNS, SO THANK YOU
SO MUCH. I DO HAVE, UM, READING
THROUGH THE ANALYSIS ONE OF THE
CONCERNS AND WAS THE BROAD
DEFINITION OF REPRODUCTIVE OR
SEXUAL HEALTH APPLICATION
INFORMATION, PRODUCTIVE OR
SEXUAL HEALTH DIGITAL SERVICE. I
WOULD, UM, RECOMMEND THAT AS YOU
ARE CONTINUING TO MOVE THIS BILL
FORWARD AND CONTINUING
CONVERSATIONS YOU KIND OF
TIGHTEN UP THAT DEFINITION, FOR
EXAMPLE, LIKE I HAVE UM, THE
AURA RING, WHICH IS NOT A PERIOD
APP OR ANYONE WOULD NECESSARILY
THINK WOULD BE, UM UH, SOMETHING
DEALING WITH A WOMAN'S
REPRODUCTIVE CYCLE. HOWEVER, IT
DOES. KEEP TRACK OF MY
TEMPERATURE. AND IT LETS ME KNOW
WHAT MY TEMPERATURE IS, AND IF
IT'S UP OR NORMAL OR BELOW AND
SO, YOU KNOW, THEY CAN CORRELATE
THAT TO YOUR BASAL BODY
TEMPERATURE, WHICH IS WHAT WE
USE ALL THE TIME IN TERMS OF
WHAT ARE YOU OVULATING,
ESPECIALLY FOR INFERTILITY
PATIENTS. AND SO ARE YOU NOW
GOING TO PULL THEM INTO THIS AS
WELL. SO I DO THINK THAT, UM
IT'S THE DEFINITION NEEDS TO BE
TIGHTER, SO THAT OTHER THINGS
THAT WE USE THAT YOU MAY NOT BE
THINKING ABOUT AREN'T
ARBITRARILY PULLED INTO THIS
BILL. BUT THANK YOU SO MUCH.
THANK YOU, DR ROBERT. ANY ANY
OTHER QUESTIONS OR COMMENTS?
YES, MISS BOERNER HORVATH. THANK
YOU. I REALLY APPRECIATE YOU
BRINGING FORWARD THE SPELL AND I
WOULD LOVE TO BE ADDED AS A CO
AUTHOR WHEN THE TIME COMES THANK
YOU ANYONE ELSE? NO. ONE WOULD
YOU LIKE TO CLOSE? YES. THANK
YOU, MR CHAIR, AND I JUST WANT
TO ADDRESS UM WHAT DR WEBBER
SAID ABOUT THE DEFINITIONS AND I
WILL POINT OUT THAT THE
ORGANIZATION IS ACTUALLY THE
SAME ORGANIZATION THAT OPPOSED
MY MENTAL HEALTH BILL THAT WAS
ALMOST IDENTICAL LAST YEAR. UM,
AND THROUGH THAT PROCESS, IT
BECAME CLEAR THAT THERE ARE JUST
ORGANIZATIONS THAT WANT TO MAKE
MONEY OFF OF THIS DATA. AND SO I
IMAGINE WE WILL NOT BE WITHOUT
OPPOSITION THROUGHOUT THIS
PROCESS BECAUSE THERE ARE
ORGANIZATIONS THAT MAKE A LOT OF
MONEY SELLING OUR PRIVATE HEALTH
INFORMATION. SO UM, AND THE
DEFINITION HERE IT REQUIRES
SEVERAL THINGS, SO THEY'RE
COMPLAINING ABOUT THE
REPRODUCTIVE OR SEXUAL HEALTH
APPLICATION INFORMATION
DEFINITION. BUT IF YOU LOOK AT
HOW THE BILL IS WRITTEN. IT
REQUIRES FOR THEM TO BE A
REPRODUCTIVE OR SEXUAL HEALTH,
DIGITAL SERVICE AND IN ORDER FOR
THAT, TO BE THE CASE, THEY HAVE
TO SATISFY THREE SEPARATE
THINGS, AND ALL OF THOSE THINGS
HAVE TO BE PRESENT, INCLUDING,
FOR EXAMPLE, THAT THEY MARKET
THEMSELVES AS A REPRODUCTIVE OR
SEXUAL HEALTH APPLICATION, RIGHT
, SO THEY HAVE TO PUT THEMSELVES
OUT INTO THE WORLD AS SOMEONE
WHO IS SERVING YOU IN THE
REPRODUCTIVE AND SEXUAL HEALTH
SPACE, WHICH I DON'T THINK THE
AURA RING DOES. UM, AND SO THEY
WOULDN'T QUALIFY UNDER THIS. UM
AND THAT THEY USE THE
INFORMATION TO FACILITATE
REPRODUCTIVE OR SEXUAL HEALTH
SERVICES TO A CONSUMER SO WE CAN
CONTINUE TO WORK ON IT. BUT I
THINK IT IS MORE NARROW THAN THE
OPPOSITION HAS LET ON. I WILL
SAY, UM SO AND WITH THAT, I
RESPECTFULLY ASK FOR NEITHER.
THANK YOU VERY MUCH. DO WE HAVE
EMOTION? MOTION BY MS
BOERNER HORVATH SECOND BY MR
RODRIGUEZ. IT DOES ENJOY A Dð
PAST RECOMMENDATION BY THE CHAIR
OF THE MOTION IS DUE PAST YOUR
PRIVACY AND CONSUMER PROTECTION
. MADAM SECRETARY, PLEASE CALL
THE ROLL, WALDRON WALDRON, IAGAR
CURRY CURRY. I ARAMBULA.
BOERNER HORVATH BOERNER HORVATH.
AYE, CARILLO. FLORA. LUCKY LUCKY
I MAIENSCHEIN MAIENSCHEIN I'M
MCCARTY. MCCARTHY I, JOE
PATTERSON. RODRIGUEZ RODRIGUEZ,
I SANTIAGO. SANTIAGO I VE
VALLAPUDUA BE VALLAPUDUA. AYE,
WEBER. HOWEVER, I. YOUR YOUR
BILL HAS 11 VOTES KNOWN OPPOSING
WILL LEAVE THE ROLE OPEN FOR
OTHERS TO ADD ON. THANK YOU VERY
MUCH, MR BAUER-KAHAN. MS
AGUIAR-CURRY. AGUIAR-CURRY HAS A
B 48.
THANK YOU. CHAIR WOOD AND
MEMBERS. FIRST I'D LIKE TO
ACCEPT THE TECHNICAL COMMITTEE
AMENDMENT SUGGESTED BY YOUR
STAFF AND AS ALWAYS THANK THEM
FOR THEIR THOROUGH REVIEW AND
THOUGHTFUL INPUT. MEMBERS I WANT
TO PREFACE THAT THIS BILL IS
ABOUT TAKING CARE OF OUR MOST
VULNERABLE SENIORS AND GIVING
THEM THE DIGNITY, THE FAIRNESS,
TRANSPARENCY AND THE RESPECT
THEY DESERVE. IT IS A SAD
REALITY THAT SOME NURSING HOMES
ACROSS THE UNITED STATES,
INCLUDING CALIFORNIA. ROUTINELY
GIVE ANTI PSYCHOTIC DRUGS TO
RESIDENTS WITH DEMENTIA TO
CONTROL THEIR BEHAVIOR, DESPITE
RULES AGAINST THE MISUSE OF SUCH
DRUGS AS CHEMICAL RESTRAINTS.
THESE CHEMICAL RESTRAINTS ARE
BEING PRESCRIBED TO SEDATE AND
SUBDUE RESIDENTS WHO OFTEN USE
BEHAVIOR TO COMMUNICATE THEIR
PAIN, JUST COMFORT OR DISTRESS.
A B 48 WILL HELP STEM THIS
PRACTICE IN CALIFORNIA. IN 2018
. A REPORT BY THE HUMAN RIGHTS
WATCH FOUND THAT THIS ABUSIVE
PRACTICE HAS BECOME MORE
WIDESPREAD. THE REPORT ESTIMATES
THAT EVERY WEEK IN THE UNITED
STATES NURSING FACILITIES MORE
THAN 100 AND 79,000 PEOPLE,
MOSTLY OLDER ADULTS, AND THOSE
LIVING WITH DEMENTIA ARE GIVEN
ANTIPSYCHOTIC DRUGS WITHOUT AN
APPROPRIATE DIAGNOSIS. AND I
PSYCHOTIC DRUGS ARE MEANT TO
TREAT PSYCHIATRIC CONDITIONS
LIKE SCHIZOPHRENIA. THE FDA HAS
NEVER APPROVED ANTI PSYCHOTIC
DRUGS IS SAFE AND EFFECTIVE FOR
THE TREATMENT OF DEMENTIA
SYMPTOMS. STUDY SOME SHOWN THAT
ANTI PSYCHOTIC DRUGS NEARLY
DOUBLE THE RISK DEATH IN OLDER
PEOPLE WITH DEMENTIA. THE FOOD
AND DRUG ADMINISTRATION REQUIRES
MANUFACTURERS TO LABEL THESE
DRUGS BUT THE STRONGEST BLACK
BOX WARNING ABOUT THE RISK THEY
POSE TO PEOPLE WITH DEMENTIA.
HOWEVER WHEN THESE DRUGS ARE
ADMINISTERED WITHOUT INFORMED
CONSENT PATIENTS AND THEIR
FAMILIES ARE NOT MAKING THE
CHOICE TO TAKE SUCH A RISK.
EVERY 48 BUILDS ON EXISTING
PROTECTIONS FOR NURSING HOME
RESIDENTS AND STATE LAW AND
REGULATIONS. FIRST THIS BILL
CODIFIES AND EXPANDS RULES TO
ESTABLISH A NURSING HOME
RESIDENTS RIGHT TO PROVIDE OR
WITHHOLD WRITTEN, INFORMED
CONSENT PERTAINING TO THE USE OF
AS PSYCHOTHERAPEUTIC DRUGS. THE
BILL ALSO SPECIFIES THAT
RESIDENTS AND THEIR
REPRESENTATIVES MUST BE INFORMED
IN WRITING ABOUT THE CONTENT OF
THE BLACK BOX WARNINGS FOR
PROPOSED DRUGS AND WHETHER THE
DRUGS PROPOSED USE USED HAS BEEN
APPROVED BY THE FDA. FINALLY THE
BILL PROVIDES NEEDED ENFORCEMENT
BY REQUIRING THE STATE
DEPARTMENT OF PUBLIC HEALTH TO
EVALUATE NURSING FACILITY
COMPLIANCE WITH THESE PROVISIONS
DURING STATE LICENSING
INSPECTIONS. THANK YOU, MR CHAIR
. AND I'D LIKE TO, UM,
INTRODUCED WITH ME TODAY IN
SUPPORT. TONY CHICK, IT'LL STAFF
ATTORNEY WITH THE CALIFORNIANS
FOR NURSING HOME REFORM. AND,
YES, MEAN BELLIED, SENIOR POLICY
ADVOCATE WITH JUSTICE AND AGING.
GOOD AFTERNOON. I'M TONY CHICK,
IT'LL SENIOR STAFF ATTORNEY FOR
CALIFORNIA ADVOCATES FOR NURSING
HOME REFORM. UH, THANK YOU FOR
THIS OPPORTUNITY TO TESTIFY AND
THANK YOU TO THE COMMITTEE STAFF
FOR THEIR VERY THOROUGH ANALYSIS
OF THE BILL. UH I WAS HERE IN
2000. I WAS AT THE LEGISLATURE
IN 2009. ON BEHALF OF SP 303 AT
THE TIME IT WAS BUILT TO CODIFY
WRITTEN INFORMED CONSENT
REQUIREMENTS VERY SIMILAR TO
THIS BILL. AND THAT BILL GOT
THROUGH THE LEGISLATURE AND IT
WAS VETOED BY GOVERNOR
SCHWARZENEGGER, WHO IN HIS VETO
MESSAGE WROTE. ESSENTIALLY I'M
NOT TOTALLY CONVINCED. THERE'S A
PROBLEM HERE. I'M GONNA HAVE MY
DEPARTMENT OF PUBLIC HEALTH.
CHECK IT OUT. AND TO ITS CREDIT
, THE DEPARTMENT DID IT DID A
WHAT THEY CALL IT ANTI PSYCHOTIC
DRUG COLLABORATIVE, WHERE THEY
LOOKED AT THE ADMINISTRATION OF
ANTIPSYCHOTIC DRUGS IN NURSING
HOMES AND CAME AWAY WITH A
REPORT THAT SAID THAT THERE WAS
ALL SORTS OF VIOLATIONS RELATED
TO INFORMED CONSENT AND THE
RULES THAT WE HAD AT THE TIME.
WE SHOULD HAVE PROBABLY COME
BACK AT THAT POINT AND ASKED FOR
WRITTEN INFORMED CONSENT
REQUIREMENT, BUT OUR ENERGY AT
THAT TIME WAS ABSORBED AT THE
FEDERAL LEVEL. THERE WAS A LOT
OF FEDERAL ATTENTION TO THIS
ISSUE. 12 4013. WE SPENT A LOT
OF TIME ON IT. WE MADE A FAIR
AMOUNT OF PROGRESS. OVER THE
LAST FOUR OR FIVE YEARS, THOUGH
THAT'S WE'VE HAD A LOT OF
REGRESSION AND AT THE POINT NOW,
WHERE ABOUT 80% OF ALL NURSING
MEMBERS? THIS IS ALL TIME HIGH
ABOUT 80% ARE RECEIVING A
PSYCHOTROPIC DRUG. UM SO WE CAME
BACK LAST YEAR WE HAD ASSEMBLY
BUILT 18. OH, NINE. FROM
ASSEMBLYMEMBER'S AGUIAR-CURRY.
THAT BILL WAS ALSO VETO, BUT IT
WAS IT WAS SOLELY BECAUSE THERE
WAS SOME MISTAKES MADE AT THE
VERY END WITH WHAT AMENDMENTS
WERE SUBMITTED. THE LEGISLATIVE
COUNCIL AT THE LAST SECOND AND
WE DIDN'T GET THEM ALL IN UM, SO
WE'VE GOT THEM IN NOW, AND WE'RE
COMFORTABLE THAT THE DEPARTMENT
OF PUBLIC HEALTH WILL SUPPORT
THIS. THE GOVERNOR WILL SUPPORT
THIS. WE'VE NEVER WE'VE NEVER
NEEDED IT MORE THAN WE NEED IT
NOW. THESE WE'VE WE'VE TRIED
LOTS OF OTHER APPROACHES TO GET
AT THIS PROBLEM, AND I THINK BY
FAR THE STRONGEST APPROACHES TO
EDUCATE OUR CONSUMERS, THE
RESIDENTS THEMSELVES AND THEIR
REPRESENTATIVES AND GET
ULTIMATELY GIVE THEM THE
DECISION ON WHETHER THEY'RE
GOING TO APPROVE. THESE DRUGS
ARE NOT. THANK YOU. THANK YOU
VERY MUCH. THANK YOU. GOOD
AFTERNOON, MR CHAIR AND MEMBERS
. MY NAME IS YASMINE PILLET. I'M
A SENIOR POLICY ADVOCATE WITH
JUSTICE AND AGING WERE A
NATIONAL LEGAL ADVOCACY
ORGANIZATION FOCUSED ON
SUPPORTING THE RIGHTS OF LOW
INCOME OLDER ADULTS. WE HEARD
TODAY IN STRONG SUPPORT OF MAYBE
48. THIS IMPORTANT BILL TO
ENSURE THAT NURSING FACILITY
RESIDENTS ARE NOT MEDICATED
AGAINST THEIR WILL. WITH
PSYCHOTHERAPEUTIC DRUGS. THESE
MEDICATIONS INCLUDE
ANTIPSYCHOTICS, ANTICONVULSANTS
HYPNOTICS, AMONG OTHERS, LIKE
ANY OTHER CALIFORNIAN, A NURSING
FACILITY, RESIDENTS SHOULD BE
ENTITLED TO BASIC INFORMED
CONSENT PROTECTIONS. A
MEDICATION SHOULD ONLY BE
ADMINISTERED AFTER THE PERSON
HAS BEEN GIVEN CLEAR INFORMATION
ABOUT THE MEDICATIONS, BENEFITS
AND RISKS AND AFTER RECEIVING
THAT INFORMATION HAS CLEARLY
ASSENTED. AS THE ASSEMBLY WOMAN
MENTIONED NURSING FACILITY,
RESIDENTS FOR DECADES HAVE BEEN
MEDICATED WITH ANTI PSYCHOTICS
AND OTHER PSYCHOTHERAPEUTIC SO
IN ORDER TO SEDATE THEM AND TO
MAKE THEM MORE EASILY MANAGED.
PSYCHOTHERAPEUTIC SLOWED DOWN
THE BRAIN'S ABILITY TO FUNCTION
. AS A RESULT, THEY CAN DECREASE
PEOPLE'S ABILITY TO UNDERSTAND
THEIR SURROUNDINGS NEGATIVELY
AFFECT THEIR QUALITY OF LIFE,
AND ESPECIALLY FOR THE CASE OF
ANTI PSYCHOTIC MEDICATIONS
INCREASED THE RISK OF DEATH.
THESE ANTI PSYCHOTIC MEDICATIONS
, LIKE THE ASSEMBLY WOMAN SAID.
CARRY THESE BLACK BOX WARNINGS,
BUT THEY'RE DANGEROUS TO OLDER
PATIENTS AND THE RISKS ARE
CURRENTLY NOT BEING
COMMUNICATED. OVERUSE OF
PSYCHOTHERAPEUTIC HAS PLAGUED
NURSING FACILITIES FOR DECADES.
BACK IN 1987, A CONGRESSIONAL
COMMITTEE REPORTED ON THE
OVERUSE OF THESE DRUGS AND NOW,
35 YEARS LATER, AS THE ASSEMBLY
WOMAN SAID, THERE WAS JUST A
RECENT REPORT FROM THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES, FINDING THAT 80% OF
NURSING FACILITY RESIDENTS ARE
STILL ROUTINELY RECEIVING THESE
MEDICATIONS AND THAT MANY
RESIDENTS ARE BEING
INAPPROPRIATELY DRUGGED.
INFORMATION AND CHOICE ARE A
NURSING FACILITY RESIDENTS BEST
PROTECTION AGAINST INAPPROPRIATE
MEDICATION AND A B 48 INSURERS
NURSING FACILITY. RESIDENTS ARE
GIVEN IMPORTANT INFORMATION
UPFRONT ABOUT MEDICATIONS THAT
ARE PRESCRIBED FOR THEM AND A
FAIR OPPORTUNITY TO CONSENT OR
WITHHOLD THEIR CONSENT. FOR
THESE REASONS, WE'RE IN STRONG
SUPPORT AND REQUESTER. I VOTE
TODAY. THANK YOU. THANK YOU
OTHERS IN SUPPORT. NO ONE IS OUR
OTHER WITNESSES AND OPPOSITION
TO THE BILL. PLEASE COME
FORWARD.
FOR YOUR HEALTH COALITION
ADVOCACY IN SUPPORT OF A B 48.
I'M SORRY, I THOUGHT WAS I
THOUGHT I DIDN'T REALIZE YOU
WERE IN SUPPORT. OKAY. THANK
YOU. I WAS A LITTLE TOO QUICK, I
GUESS SO. ANYONE IN OPPOSITION.
YOU KNOW WHEN WE'RE BRINGING
BACK TO THE COMMITTEE FOR
QUESTIONS OR COMMENTS DR WEBBER.
GOOD AFTERNOON. THANK YOU SO
MUCH FOR THIS BILL. UM I GUESS
MY QUESTION IS THERE IS ALREADY
A CONSENT PROCESS IN PLACE FOR
THESE MEDICATIONS. UM REQUIRING
THE HEALTHCARE PROVIDER THE
ATTENDING PHYSICIAN TO DO THIS.
SO HOW EXACTLY IS THIS
DIFFERENT? YEAH THANKS FOR THAT
QUESTION, SO THERE ARE
REGULATIONS, STATE REGULATIONS
IN THE BOOKS RIGHT NOW, UM, THEY
WERE ADOPTED IN THE 19 EIGHTIES
AS A RESULT OF LITIGATION THAT
MY ORGANIZATION HAD FILED
AGAINST THE STATE A LONG TIME
AGO. WE BELIEVE THAT THOSE
REGULATIONS ARE IMPORTANT AND
IT'S A GOOD STARTING POINT. THE
PRIMARY DIFFERENCE BETWEEN WHAT
IS THERE NOW AND WHAT WOULD BE
IN THIS BILL IS THAT THE CURRENT
REGULATIONS REQUIRE A
CONVERSATION AND THE ONLY
DOCUMENTATION THAT CONVERSATION
IS UP TO THE FACILITY. AND IF
YOU GO THROUGH NURSING AND
MEDICAL RECORDS, WHAT YOU SEE
ARE THE THREE LETTERS I C O,
WHICH MEANS INFORMED CONSENT
OBTAINED SO YOU'LL SEE A
PRESCRIPTION AND THEN WE'VE
HEARD AND FROM LAWSUITS AND FROM
STAFF WORKERS AT AT THESE
FACILITIES, THEY'RE TRAINED TO
JUST REFLEXIVELY RIGHT. I CEO
INFORMED CONSENT OBTAINED.
THERE'S NO REQUIREMENT THAT
THERE BE AN ACTUAL RECORD FROM
THE RESIDENT OF THE RESIDENT
REPRESENTATIVE THAT THEY
PARTICIPATED IN THIS
CONVERSATION. SO MAYBE 48 THE
BIG PIECES THAT THERE'S GOING TO
BE NOW A WRITTEN FORM. THAT WILL
HAVE TO BE SIGNED BY THE
PRESIDENT OR THEIR
REPRESENTATIVES TO VERIFY THAT
THAT CONVERSATION TOOK PLACE. OK
SO ESSENTIALLY, WHAT YOU'RE
CREATING IS LIKE A FORM THAT
PATIENTS USE BEFORE THEY HAVE A
SURGICAL PROCEDURE. THAT'S THE
DIFFERENCE, RIGHT? YEAH. THANK
YOU. THANK YOU. ANYONE ELSE? MR
RODRIGUEZ? YES I WANT TO THANK
THE MEMBER FOR BRINGING THIS
BILL FORWARD. YOU KNOW, IT COMES
TO MIND. AND ON MY YEARS WORKING
IN THE AMBULANCE INDUSTRY, YOU
KNOW, A LOT OF THOSE FACILITIES
ARE CALLING 911 AND WE'RE
SHOWING UP AND NOT TO HAMPER.
THE GOOD FACILITIES ARE WORKING.
THERE'S A LOT OF BAD ACTORS OUT
THERE. THAT'S ONLY OBVIOUS WHAT
THEY'RE DOING SOME OF THESE
PATIENTS BY GIVING THEM THESE
TYPES OF MEDICATION JUST TO KIND
OF PUT THEM ASIDE AND DON'T HAVE
TO WORRY ABOUT IT. SO I REALLY
THANK YOU FOR BRINGING THIS BILL
FORWARD. IT REALLY MAKES A LOT
OF SENSE. IT'S WAY OVERDUE AND
HOPEFULLY, BILL GETS OUT AND ON
AND GET SIGNED AND BECOME LAW.
THANK YOU. THANK YOU ANYONE
ELSE? SEE NO ONE. WOULD YOU LIKE
TO CLOSE MR AGUIAR-CURRY? ISN'T
IT A SHAME? AND WE'RE SITTING
HERE 14 YEARS AGO WE TRIED TO
BRING THIS ACROSS THE LINE.
ISN'T ASHAMED OF FAMILIES THAT
HAVE SUFFERED AND THE PATIENTS
THAT HAVE SUFFERED I ASKED FOR
YOUR I VOTE FOR TODAY. MAKE SURE
THAT THIS DOESN'T HAPPEN ANY
LONGER. AND I HOPE WE GET THIS
SIGNED AND ACROSS THE FINAL
FINISH LINE. THANK YOU. THANK
YOU VERY MUCH. MISS AGUILAR
CURRY. WE HAVE A MOTION. OKAY
WHAT? WHAT? OKAY WELL, WE'LL
MAKE. WE'LL MAKE YOU THE SECOND,
MR RODRIGUEZ, BUT WE'LL MAKE THE
MOTION TO DR WEBBER SO THE
MOTION IS DUE PASS AS AMENDED TO
JUDICIARY AND BEFORE HE CALLED,
I JUST WANT TO SAY THANK YOU,
MISS AGUIAR-CURRY AND YOUR
ADVOCATES FOR BRINGING THIS
FORWARD. IT'S A SHAME THAT IT
KIND OF GOT THINGS GET WRAPPED
UP IN TECHNICALITIES, BUT I'M
GLAD TO SEE YOU'RE BACK AND THAT
THIS IS WELL ON ITS WAY TO
PASSAGE AND SIGNATURE. HOPEFULLY
SO THANK YOU VERY MUCH. SO MADAM
SECRETARY. PLEASE CALL THE ROLL.
THE MOTION IS DUE PASS AS
AMENDED TO JUDICIARY, WOULD
WOULD I, WALDRON WALDRON, I
AGUIAR-CURRY CURRY. I ARAMBULA.
BOERNER HORVATH OR NO HARVEST. I
CARILLO FLORA BLACKIE, BLACKIE.
I MAIENSCHEIN MAIENSCHEIN. AYE
MCCARTY. MCCARTHY I, JOE
PATTERSON. RODRIGUEZ RODRIGUEZ,
I SANTIAGO. VALLAPUDUA
VALLAPUDUA WEBER. WHOEVER I.
THAT'S 10 0 WILL LEAVE THE ROLE
OPEN FOR OTHERS TO ADD ON. THANK
YOU VERY MUCH. MR GARRETT CURRY.
MR RODRIGUEZ. YOU HAVE A B 70?
THANK YOU, MR CHAIRMAN MEMBERS.
THANK YOU FOR ALLOWING ME TO
PRESENT A B 70, WHICH REQUIRES
CERTAIN PUBLIC AND PRIVATE
BUILDINGS THAT UNDERGO
RENOVATIONS OR MODIFICATIONS
WITH COSTS THAT EXCEED 100,000
TO INSTALL AND MAINTAIN SIX
TRAUMA KITS ON THE PREMISES IN
ORDER TO TREAT PEOPLE IN NEED OF
EMERGENCY MEDICAL CARE DURING A
TRAUMATIC EMERGENCY EVENT. THIS
BILL IS AN EXPANSION OF A B 20
TO 60 FROM LAST YEAR, WHICH
REQUIRED THE PLACEMENT OF SIX
TRAUMA KITS AND SIMILAR NEW
CONSTRUCTION BUILDINGS. IN
RESPONSE TO THE TRAGIC MASS
SHOOTING AT SANDY HOOK
ELEMENTARY SCHOOL, A GROUP OF
DOCTORS CONVENE A PANEL OF
NATIONAL EXPERTS FROM LAW
ENFORCEMENT AND EMERGENCY
MEDICAL SERVICES TO CREATE AN
IMPROVED RESPONSE SYSTEM
DIRECTED PRIMARILY AT THE
CONTROL OF LIFE'S THREATENING
BLOOD LOSS. IN THE
RECOMMENDATIONS, THE GROUP OF
EXPERTS CONCLUDED THAT
BYSTANDERS IMMEDIATE RESPONDERS
SHOULD BE TRAINED AND EMPOWERED
TO STOP HEMORRHAGING IN ORDER TO
SAVE LIVES. THESE EXPERTS ALSO
RECOMMENDED TRAUMA KIDS TO BE
PLACED IN PUBLIC PLACES SUCH AS
SHOPPING MALLS, SCHOOLS, SPORT
VENUES, TRANSPORTATION CENTERS,
ETCETERA NEXT TO A E. D S.
RECOGNIZING THE DIFFICULTY TO
MAINTAIN DIRECT PRESSURE. THEY
ALSO RECOMMENDED THE USE OF
TOURNIQUETS TO CONTROL SEVERE
BLEEDING. WITH MASS CASUALTY
CASUALTY EVENTS BECOMING MORE
COMMON IN 2015 PRESIDENT OBAMA
LAUNCHED STOP THE BLEED CAMPAIGN
TO ENCOURAGE BYSTANDERS TO
BECOME TRAINED AND EMPOWERED TO
TAKE LIFE SAVING ACTION WHILE
EMS PERSONNEL ARE EN ROUTE.
DURING THESE TRAGIC EVENTS, A
PERSON SUFFERING FROM SEVERE
BLOOD LOSS CAN DIE WITHIN FIVE
MINUTES, SO EVERY SECOND COUNTS.
THAT IS WHY IT'S IMPORTANT TO
ENSURE OUR IMMEDIATE RESPONDERS
HAVE THE INSTRUCTIONS AND
EQUIPMENT NEEDED TO SAVE AND
RENDER MERCY CARE AT THE SCENE
OF EMERGENCY. FOR ME TO PROVIDE
TESTIMONY ARE DR CRAIG GOOLSBEE
, CHAIR OF THE DEPARTMENT OF
EMERGENCY MEDICINE AT HARBOR
UCLA MEDICAL CENTER AND
PROFESSOR OF CLINICAL EMERGENCY
MEDICINE AT THE SCHOOL OF
MEDICINE AT U. C. L. A. AND
DOCTORS, CIGARETTE BURSTS WHO IS
THE TRAUMA SURGEON AND ASSOCIATE
PROFESSOR OF SURGERY AND TRAUMA
DIVISION AT LOMA LINDA
UNIVERSITY ON BEHALF OF THE
AMERICAN COLLEGE OF SURGEONS AND
THE CALIFORNIA CHAPTERS OF
AMERICAN COLLEGE OF SURGEONS.
THANK YOU VERY MUCH. PLEASE GO
AHEAD. AND THE COMMITTEE FOR THE
PRIVILEGE OF ADDRESSING YOU. I
AM DR SIGURD BORIS, A DOUBLE
BOARD CERTIFIED TRAUMA SURGEON
AND SURGICAL INTENSIVE IST AT
LOMA LINDA UNIVERSITY MEDICAL
CENTER. LOMA LINDA IS AN
AMERICAN COLLEGE OF SURGEONS
VERIFIED LEVEL ONE TRAUMA CENTER
AND WE SEE BLEEDING ON A DAILY
BASIS. I REPRESENT THE AMERICAN
COLLEGE OF SURGEONS AND THE
THREE CALIFORNIA CHAPTERS OF
THEM A CS AND MYSELF. BLEEDING
IS THE LEADING CAUSE OF DEATH
AFTER INJURY AND EARLY USE OF
BLEEDING CONTROL TECHNIQUES IS
ESSENTIAL FOR IMPROVING SURVIVAL
. PROMISED SURGEONS HAVE
RECOGNIZED THE NEED FOR
COMMUNITY MEMBERS TO LEARN
BLEEDING CONTROL TECHNIQUES AND
HAVE ACCESS TO BLEEDING
CONTROLLED KITS AFTER THE SANDY
HOOK ELEMENTARY SCHOOL SHOOTING
AS WAS MENTIONED. THIS RESULTED
IN COLLABORATION BETWEEN
SURGEONS, FIRST RESPONDERS AND
THE MILITARY WITH THE SUBSEQUENT
DEVELOPMENT OF THE STOPS, OF
COURSE BY THE AMERICAN COLLEGE
OF SURGEONS, WHICH IS NOW HOUSED
UNDER THE DEPARTMENT OF DEFENSE.
THE EDUCATION PROVIDED BY THE
STOP THE BLEED CLASSES WITH
ACCESS TO EQUIPMENT, SAYS JUST
TOURNIQUETS AND PACKING HAVE
SAVED COUNTLESS LIVES. IT GIVES
PATIENTS THE MEANS TO STOP LIFE
THREATENING BLEEDING AND THE
MUCH NEEDED TIME TO GET TO A
HOSPITAL. FOR EXAMPLE, DATA FROM
L. A COUNTY SHOWS THAT
UTILIZATION OF TOURNIQUETS HAS
DECREASED THE IN HOSPITAL DEATHS
FROM 9% TO 1% WHEN TOURNIQUETS
ARE IMPLEMENTED IN THE FIELD. IN
ADDITION, A RECENT PEER REVIEWED
ARTICLE SHOWED THAT 95% OF
FAMILIES WANTED THEIR JUNIOR IN
HIGH SCHOOL STUDENTS TO LEARN.
STOP THE BLEED, INCLUDING
TOURNIQUET PLACEMENT. THIS THEN
REQUIRES ACCESS TO BLEEDING
CONTROL KITS TO HELP SAVE A
LIFE. THE STOPS WILL BE COURSE
CAME OUT OF ALL THESE MASS
CASUALTY EVENTS, BUT THE
LIFESAVING TECHNIQUES CAN APPLY
TO MANY OTHER CIRCUMSTANCES SUCH
AS MOTOR VEHICLE CRASHES,
WORKPLACE INJURIES AND NATURAL
DISASTERS SUCH AS EARTHQUAKES
WHEN THERE'S INJURY TO MAJOR
VESSELS. ONE EXAMPLE IS A RECENT
WORKER. WHO SUSTAINED A PARTIAL
AMPUTATION OF HIS UPPER
EXTREMITY WITH HIS CHAINSAW, A
BYSTANDER WAS ABLE TO APPLY A
COMMERCIAL CAT TOURNIQUET,
STOPPING THE BLEEDING AND SAVING
HIS LIFE. IT TAKES ONLY A FEW
MINUTES TO BLEED OUT FROM SUCH
AN INJURY. BUT THAT WAS IS WHAT
IS NEEDED BEFORE PARAMEDICS OR
OTHER PRE HOSPITAL CAN ARRIVE.
EVERYONE DESERVES ACCESS TO
BLEEDING CONTROL KIT. WE DON'T
KNOW WHEN WE WILL NEED THEM THAT
THEY NEED TO BE PRESENT.
CALIFORNIA LED THE WAY WITH
MAYBE 20 TO 60 TO PLAY SPEED AND
CONTROL KITS AND NEWLY
CONSTRUCTED BUILDINGS. AND WE
THANK YOU FOR YOUR SUPPORT. LET
US LEAD THE WAY TO CONTINUE TO
IMPROVE ACCESS TO BLEEDING
CONTROL KITS FOR YOUR COMMUNITY
MEMBERS. I URGE YOU TO VOTE YES,
ON A B 70 OUR PATIENTS AND OUR
COMMUNITY DESERVE AND NEED THIS
TO SAVE LIVES AND TO STOP THE
BLEED. THANK YOU. THANK YOU.
THANK YOU, MR CHAIR. MY NAME IS
CRAIG GOOLSBEE. I'M AN EMERGENCY
MEDICINE PHYSICIAN AND CHAIR OF
THE DEPARTMENT OF EMERGENCY
MEDICINE AT HARBOR UCLA MEDICAL
CENTER IN LOS ANGELES COUNTY.
PREVIOUSLY SERVED IN THE UNITED
STATES AIR FORCE SUPPLYING TWICE
TO A MILITARY HOSPITAL IN IRAQ
AND LATER SERVED FOR A DECADE AT
THE UNIFORMED SERVICES
UNIVERSITY IN BETHESDA. I
CREATED AND SHARE THAT STOPPED
THE BLEED EDUCATION CONSORTIUM
AND I'M, A MEMBER OF THE
AMERICAN RED CROSS IS SCIENTIFIC
ADVISORY COUNCIL AND I'M HERE
TODAY ON BEHALF OF THE RED CROSS
TO OFFER MY SUPPORT FOR A B 70.
I BECAME INTERESTED IN PUBLIC
BLEEDING CONTROL AFTER SEEING
SOLDIERS SURVIVED TERRIBLE
WOUNDS IN IRAQ AND KNOWING THAT
THEY WOULD HAVE DIED FROM THOSE
SAME INJURIES AND OTHER PLACES I
HAD WORKED IN THE UNITED STATES.
QUICK ACTIONS BY THEIR FELLOW
SOLDIERS, WHO OFTEN HAD LITTLE
TO NO MEDICAL TRAINING AND THE
USE OF VERY SIMPLE DEVICES SUCH
AS TOURNIQUETS AND GAUZE PROVED
TO BE LIFESAVING FOR THOSE
SOLDIERS. MILITARY STUDIES ABOUT
THE EFFECTIVENESS OF TOURNIQUETS
ARE SO COMPELLING THAT THE
DEFENSE DEPARTMENT NOW TRAINS
ALL SERVICE MEMBERS TO USE THEM
AND EQUIPS THEM WHEN THEY
DEPLOYED WITH THIS BASIC TYPES
OF EQUIPMENT. WHILE THE
BATTLEFIELD DATA IS CLEAR THE
USE CASE FOR THE AMERICAN PUBLIC
IS ALSO PERSUASIVE. TRAUMA IS
THE LEADING CAUSE OF DEATH FOR
YOUNG PEOPLE IN THE UNITED
STATES AND THE TOP KILLER FOR
ALL AGES. TRAUMA IS NOT JUST
VIOLENCE. IT'S IN EVERYONE.
EVERYDAY PROBLEM. WORKPLACE
ACCIDENTS, TRAFFIC COLLISIONS,
BICYCLE FALLS, BROKEN GLASS AND
EVEN INJURIES AT SCHOOL. FOR
SEVERE INJURIES, MINUTES MATTER
. AN AMBULANCE MAY TAKE EIGHT
MINUTES OR LONGER TO REACH
SOMEONE WHO'S INJURED. AND SOME
PEOPLE WITH TREATABLE INJURIES
WILL BLEED TO DEATH BEFORE A
PARAMEDIC CAN SAVE THEIR LIFE.
PUBLIC DEFIBRILLATORS SAVE THE
LIVES OF THOSE IN CARDIAC ARREST
AND PUBLIC TRAUMA KITS WILL DO
THE SAME FOR THE INJURED. MY
RESEARCH TEAM HAS ENROLLED MORE
THAN 1000 MEMBERS OF THE PUBLIC.
INCLUDING CHILDREN AND STUDIES
ALL OVER THE COUNTRY. WE FOUND
REPEATEDLY THAT THE PUBLIC CAN
AND WILL APPLY TOURNIQUETS. I
WANTED TO SHARE A QUICK STORY OF
A NINE YEAR OLD FROM GEORGIA.
HER, UM, STORY WAS PUBLISHED
WIDELY IN THE NEWS AT THE TIME.
SHE FELL FROM A PIECE OF
PLAYGROUND EQUIPMENT AT SCHOOL
AND ANOTHER CHILD FELL ON TOP OF
HER. DURING THE FALL, SHE BROKE
HER ARM AND SHE SUFFERED HER
BREAK Y'ALL ARTERY AND WAS
RAPIDLY BLEEDING TO DEATH.
FORTUNATELY HER SCHOOL NURSE HAD
A PUBLICLY AVAILABLE STOP THE
BLEED CODE AND RECENT TRAINING
AND QUICKLY APPLIED A TOURNIQUET
TO SAVE HER LIFE. WELL THIS MAY
BE A SOMEWHAT UNUSUAL STORY.
AMONG CALIFORNIA'S 39 MILLION
PEOPLE. THERE ARE UNUSUAL
INJURIES LIKE THIS EVERY DAY.
PUBLICLY ACCESS TO BLEEDING
CONTROL SUPPLY OF WILL SAVE
LIVES. AND I THANK YOU VERY MUCH
FOR YOUR TIME AND CONSIDERATION.
THANK YOU VERY MUCH OTHERS IN
SUPPORT. DON'T SEEM THAT THERE
ARE THERE. IS THERE ANY
OPPOSITION TO THE BILL? SEEING
NONE WILL BRING IT BACK TO THE
COMMITTEE FOR COMMENTS OR
QUESTIONS FROM THE COMMITTEE.
AGUIAR-CURRY FIRST OF ALL, THANK
YOU FOR YOUR SERVICE. BOTH OF
YOU REALLY DO APPRECIATE IT. THE
THING THAT CAUGHT MY EAR WAS
EIGHT MINUTES OR LONGER FOR ANY
AMBULANCE TO GET SOMEWHERE IN
THE RURAL COMMUNITIES. THAT
COULD BE A HALF HOUR 45 MINUTES.
SO I WILL BE SUPPORTING YOUR
BILL TODAY. THANK YOU ANY ANYONE
ELSE? MR MCCARTY. I SUPPORT
THIS, MAYBE JUST GIVE US AN
EXAMPLE. LIKE IN THIS BUILDING.
WE HAVE ONE OF THESE HERE AND
WHERE WOULD IT BE? WELL.
PROBABLY NEXT TO THE E D.
WHEREVER THE A D IS GONNA BE
RIGHT NEXT TO THE E D. THAT'S
WE'RE LOOKING AT PLACE NOW. SO
THE 80 MAYBE OUT IN THE HALLWAY
SOMEWHERE SOMEWHERE, IT'S
VISIBLE WHERE THERE'S A LOT OF
TRAFFIC. JUST BE A BOX BELOW AND
JUST RIGHT NEXT TO IT, SO YOU
FIND PLACES WHERE THERE'S AN
EXISTING? YES CORRECT. OKAY.
PERFECT. THANK YOU. GREAT. THANK
YOU ANYONE ELSE? AND THE MOTION
BY MR LACKEY A SECOND BY DR
WEBBER. I THINK NO, I'M SORRY. I
MISSED AGUIAR-CURRY SORRY.
HEARING VOICES. MR. RODRIGUEZ.
WOULD YOU LIKE TO CLOSE? RESPECT
WE ASKED FOR I WILL HELP SAVE
LIVES. THANK YOU. THANK YOU VERY
MUCH. MADAM SECRETARY. THE
MOTION ACTUALLY IS DUE PAST YOU
. DO YOU, UH TO JUDICIARY?
JUDICIAL REVIEW DISH. VERY UM,
MADAM SECRETARY. PLEASE CALL THE
ROLL. WOULD WOULD I, WALDRON
WALDRON, I GOTTA CREE. I GOT
KOREA ARAMBULA. BOERNER HORVATH
BOERNER HORVATH. AYE, CARILLO.
FLORA. BLACKIE BLACKIE. I
MAIENSCHEIN MCCARTHY. MCCARTHY
I, JOE PATTERSON. RODRIGUEZ
RODRIGUEZ. AYE. SANTIAGO.
VALLAPUDUA VÆ VALLAPUDUA. AYE,
WEBER. HOWEVER, I. 90 YOUR BILLS
OUT WILL LEAVE THE ROLE OPEN FOR
OTHERS TO ADD ON. THANK YOU. WE
HAVE ONE MORE BILL. WHICH IS ME,
SO I'M GONNA TURN THIS OVER TO
OUR VICE CHAIR. IT'S WALTER.
OKAY CHAIRMAN A B 242. THANK YOU
VERY MUCH, MADAM. MADAM CHAIR.
UM AND VICE CHAIR AND MEMBERS. A
B 2 42 ELIMINATES THE FIVE YEARS
SUNSET ON A PRIOR BILL OF MINE A
B 2024. AND ANOTHER SIMILAR
PILOT BY ASSEMBLYMEMBER'S WEST
CHESEBRO FROM 2004 TO 2011. THIS
BILL PERMITS FEDERALLY CERTIFIED
CRITICAL ACCESS HOSPITALS TO
EMPLOY PHYSICIANS AND BE ABLE TO
BUILD FOR THEIR PROFESSIONAL
SERVICES. CRITICAL ACCESS
HOSPITALS ARE OFTEN REFERRED TO
AS FRONTIER HOSPITALS BECAUSE
MOST OF THEM ARE LOCATED IN
REMOTE RURAL AREAS. THERE ARE 34
SUCH HOSPITALS IN THE STATE.
THEY ALL HAVE 25 OR FEWER BEDS.
WHILE THESE HOSPITALS ARE SMALL
, THEY PROVIDE CRITICAL SERVICES
AND VALUE TO THEIR COMMUNITIES.
WITHOUT THESE HOSPITALS, PEOPLE
WOULD NEED TO DRIVE MANY MILES
BEFORE REACHING ANOTHER
HOSPITAL. ONE OF THE ISSUES I
CONTINUE TO HEAR THROUGHOUT MY
DISTRICT IS HOW DIFFICULT IT IS
TO REACH TO RECRUIT PHYSICIANS.
SIX OF THE 34 CRITICAL ACCESS
HOSPITALS ARE IN MY DISTRICT.
OTHER HOSPITALS THROUGHOUT THE
STATE OR HOSPITALS LIKE BEAR
VALLEY HEALTH CARE. CATALINA
ISLAND. EASTERN PLUMAS DISTRICT
HOSPITAL. SANTA YNEZ VALLEY
COTTAGE HOSPITAL HAVE A HARD
TIME IMAGINING THAT'S A BIG
HOSPITAL. UM AND THEY ALL HAVE
SIMILAR SIMILAR CHARACTERISTICS.
HAVING BEEN A HEALTHCARE
PROVIDER MYSELF. I UNDERSTAND
THE CONCERNS OF THE MEDICAL
COMMUNITY ABOUT WHETHER ALLOWING
HOSPITALS TO EMPLOY PHYSICIANS
WILL CHANGE THE NATURE OF THE
PHYSICIAN'S CLINICAL DECISION,
BUT THE OPPORTUNITY FOR THESE
HOSPITALS TO HIGHER POSITIONS
HAS BEEN PILOTED TWO TIMES WITH
NO NEGATIVE FEEDBACK. THE
OPPOSITION HAS REQUESTED A
SUNSET REMAIN IN PLACE. WHILE I
REMAIN OPEN TO THEIR CONCERNS
PENDING THE RESULTS OF THE
REPORT CALLED FOR IN MY EARLIER
REGISTERED LEGISLATION. TODAY I
BELIEVE THAT TWO PILOTS IS
ADEQUATE TO DETERMINE IF THERE
ARE ANY CONCERNS ALLOWING THE
HOSPITALS TO HIRE PHYSICIANS.
IT'S IMPORTANT TO POINT OUT THAT
IT CONTINUED. SUNSET CREATES
UNCERTAINTY TO PHYSICIANS WHO
MAY BE SEEKING EMPLOYMENT AND
WHETHER THE LENGTH OF
APPOINTMENT COULD END ABRUPTLY
BY THE SUNSET. THIS IS WHAT
HAPPENED WITH THE END OF THE
ORIGINAL PILOT BY MR CHESS, BRO.
82 42 IS A MODEST BILL AND
PROVIDES A LIMITED EXEMPTION FOR
THOSE HOSPITALS MOST AT RISK OF
CLOSING THEIR DOORS. THEY CANNOT
ADDRESS THEIR PHYSICIAN STAFFING
NEEDS. AND SUPPORTED THE
MEASURE. TODAY. I HAVE TED OWEN
, EXECUTIVE DIRECTOR OF
GOVERNANCE AND BUSINESS
DEVELOPED WITH THE TOP TAHOE
FOREST HEALTHCARE DISTRICT, AND
IT MUST HAVE BEEN FUN GETTING
HERE. I CAN ASSURE YOU THAT'S
TRUE. UM I'M SURPRISED I'M HERE
. MR CHAIRMAN, MEMBERS OF THE
COMMITTEE. I'M TED OWENS,
EXECUTIVE DIRECTOR OF GOVERNANCE
AND BUSINESS DEVELOPMENT FOR THE
TOP OF FOREST HEALTH SYSTEM. THE
TITLE FOREST HEALTH SYSTEM IS A
CRITICAL ACCESS HOSPITAL BASED
IN TRUCKEE, CALIFORNIA, SERVING
THE WEST AND NORTH SHORE
COMMUNITIES OF TRUCKEE DONNER
SUMMIT AND LAKE TAHOE. UNDER THE
PROVISIONS OF A B 2024 TAHOE
FOREST ENGAGED IN PHYSICIAN
DIRECT EMPLOYMENT. AND TODAY,
WITH FEW EXCEPTIONS, TAHOE
FOREST EMPLOYS THE MAJORITY OF
ALL POSITIONS IN OUR REGION. IT
HAS PROVEN TO BE A GREAT
BENEFIT. FOR THE ORGANIZATION
FOR PROVIDERS, AND FOR OUR
PATIENTS, PARTICULARLY TRUE IN A
RURAL SETTING, AND FOR THE
FOLLOWING REASONS. IN OUR AREA.
IT HAS STOPPED PHYSICIAN
TURNOVER OR PHYSICIANS WHO HAVE
ESTABLISHED A CLINICAL BUSINESS
AND THEN CLOSED AND MOVED TO
OTHER LOCATIONS. DIRECT
EMPLOYMENT HAS PRODUCED
EXCEPTIONALLY STRONG RETENTION.
WE HAVE LOST ONLY ONE PROVIDER
IN THE TIME THAT WE ENGAGED IN
THIS PROCESS. BUT HE WAS MOVING
TO COLORADO AND FOR FAMILY
REASONS. IT IS FAR EASIER TO
RECRUIT ESTABLISHED PHYSICIANS
BY ELIMINATING THE CHALLENGES OF
EXPENSIVE CLINIC SPACE BUSINESS
OFFICE STAFF. INSURANCE
PROVISIONS AND REGULATORY
COMPLIANCE. IT HAS ENABLED TAHOE
FOREST HOSPITAL TO RECRUIT YOUNG
PHYSICIANS COMING OUT OF
RESIDENCY AND OR FELLOWSHIP BY
PROVISION OF STRONG EMPLOYMENT
PACKAGE SO THEY MAY PAY DOWN
THEIR EDUCATIONAL DEBT AND
ESTABLISH A CAREER. OUR
RECRUITMENT EFFORTS HAVE TAUGHT
US THAT YOUNG PHYSICIANS WANT
EMPLOYMENT, NOT ESTABLISHMENT OF
STANDALONE CRITICAL CLINICAL
BUSINESS. BECAUSE IT DOES NOT
MAKE FINANCIAL SENSE FOR THEM.
AND IT IS A VALUABLE TOOL FOR
VERY RURAL HOSPITALS TO RETAIN
AND RECRUIT IN REGIONS WHERE
LOSS OF A SINGLE PROVIDER CAN BE
THE DIFFERENCE OF SURVIVAL FOR
THE HOSPITAL, NOT TO MENTION THE
IMPACT OF THE COMMUNITY THAT IT
SERVES. SHOULD THEY BE 20 TO 40
TO FAIL, AND THIS FOR NOW IS
UNIQUE TO THE TAHOE FOREST
HEALTH SYSTEM. IT WILL PLACE US
AT A FORK IN THE ROAD TO MAKE A
DECISION WHETHER TO COMPLY WITH
THE STATE OF CALIFORNIA OR THE
FEDERAL GOVERNMENT. WE RECENTLY
CONCLUDED A DISPUTE WITH THE IRS
AND THE SOCIAL SECURITY
ADMINISTRATION. OVER TAHOE FORCE
CONTRACTED SERVICES FOR THE 2020
2014 YEAR, UTILIZING HIS COMMON
A PROFESSIONAL SERVICE AGREEMENT
WITH PROVIDERS. BOTH AGENCIES
CLAIMED PHYSICIANS UNDER
PROFESSIONAL SERVICE AGREEMENTS
TO BE EMPLOYEES. THESE FEDERAL
AGENCIES ULTIMATELY DETERMINED
THAT PHYSICIANS MUST BE
EMPLOYEES, REGARDLESS OF
CALIFORNIA'S CORPORATE PRACTICE
MEDICINE LAWS. DIRECT EMPLOYMENT
HAS PUT US IN COMPLIANCE WITH
THOSE FEDERAL AGENCIES. I AM
HAPPY TO PROVIDE THROUGH THE
CHAIRMAN'S OFFICE. DOCUMENTATION
OF THIS NOW CONCLUDED DISPUTE.
IF THIS IS OF INTEREST TO THE
COMMITTEE, WE STRONGLY SUPPORT A
B 242 AND THANK YOU FOR YOUR
TIME. THANK YOU, UM ARE THERE
OTHER WITNESSES AND SUPPORT.
MADAM CHAIR. REMEMBER SARAH
BRIDGE ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA
HEALTHCARE DISTRICTS HERE IN
STRONG SUPPORT, MAYBE 242. THANK
YOU. GOOD AFTERNOON MEMBERS.
CONNIE DELGADO ON BEHALF OF THE
DISTRICT HOSPITAL LEADERSHIP
FORUM IN SUPPORT. THE SET SHORT
ON BEHALF OF ADVENTIST HEALTH
AND SUPPORT. GOOD AFTERNOON RANA
VERTIGO ON BEHALF OF THE
CALIFORNIA HOSPITAL ASSOCIATION
AND SUPPORT THANK YOU. JEANETTE
CARPENTER ON BEHALF OF
PROVIDENCE. HEALTH AND STRONG
SUPPORT. THANK YOU. THANK YOU
AND, UH WITNESSES AND OPPOSITION
PLEASE COME FORWARD.
THANK YOU, MR CHAIR. UH MADAM,
VICE CHAIR MEMBERS OF THE
COMMITTEE BRANDON MARCHI WITH
THE CALIFORNIA MEDICAL
ASSOCIATION, UH, HERE IN AN
OPPOSING LESS AMENDED POSITION.
WE THANK THE CHAIRMAN FOR HIS
WORK ON THIS ISSUE AND ON HIS
PREVIOUS LEGISLATION THAT WE
ULTIMATELY DID END ON A NEUTRAL
POSITION FOR, UM THE CHAIRMAN
SUMMED UP OUR ARGUMENTS QUITE
WELL. AND OUR AMENDMENTS IF WE?
WE WOULD LIKE TO SEE THE RESULTS
OF THAT REPORT IN JANUARY, 1ST
BEFORE WE CAN AGREE TO A
PERMANENT EXTENSION OF THE BAN
ON THE CORPORATE OF PRACTICE OF
MEDICINE. SO UM, UNTIL THAT
REPORT IS DONE, AND THOSE
RESULTS AND ANY TYPE OF IMPACT
TO PATIENT CARE OR PRACTICE
AVAILABILITY IN THE REGION IS
CONDUCTED. WE RESPECTFULLY ASK
THAT THE SUNSET BE EXTENDED FOR
FIVE YEARS. THANK YOU. THANK YOU
. ARE THERE ANY OTHER WITNESSES
AND OPPOSITION? THING NONE BRING
IT BACK TO THE COMMITTEE FOR
QUESTIONS OF THE AUTHOR. DR
WEBBER. THANK YOU SO MUCH FOR
THIS BILL. UM I WILL START WITH
A QUESTION. WHAT HOW EXACTLY DO
YOU BECOME A FEDERALLY CERTIFIED
CRITICAL ACCESS HOSPITAL. IT IS
A FEDERAL DEFINITION. I BELIEVE
THAT IT IS BASICALLY, IT'S 25
BEDS ARE LESS. UM AND TYPICALLY,
THESE ARE HOSPITALS THAT ARE OUR
REMOTE. THEY'RE NOT ALL
NECESSARILY REMOTE, BUT IT THE
KEY PIECE OF THAT AT THEIR 25
BEDS OR LESS. THANK YOU, UM YOU
KNOW, IT WAS INTERESTING WHEN I
WAS LOOKING AT, UH THE OUTCOME
OF YOUR YOUR BILL FOR THE
EXPANSION. UM OR THE PREVIOUS
BILL FOR THE EXPANSION OF THE,
UM PROHIBITION OR WHATEVER THE
CORPORATE PRACTICE OF MEDICINE
THAT THERE WEREN'T VERY MANY
HOSPITALS THAT ACTUALLY HIRED
PHYSICIANS. UM I WANT TO COME
IN. TAHOE FORCE HOSPITAL
DISTRICT. BECAUSE YOU GUYS DID
WHAT YOU'RE SUPPOSED TO DO THE
PURPOSE OF A PILOT OR AN
EXTENSION IS TO IS TO SEE IF
THERE IS A NEED, UM AND WHETHER
OR NOT THIS WILL FULFILL THEIR
NEED. I WAS VERY DISAPPOINTED TO
SEE THAT, UM OF THE 36 HOSPITALS
THAT COULD LESS THAN TWO
ACTUALLY HIRED 10 OR MORE
PHYSICIANS AND YOU ALL BEING ONE
OF THEM. I MEAN, YOU ALL DID AN
OUTSTANDING JOB. SO THANK YOU SO
MUCH FOR RECOGNIZING THE NEED OF
YOUR COMMUNITY AND GOING OUT AND
GETTING PHYSICIANS TO ACTUALLY
SERVE YOUR YOUR RESIDENTS. THANK
YOU FOR THAT. UM. I THINK ONE OF
MY CONCERNS, UM IS THAT WITH THE
CORPORATE PRACTICE OF MEDICINE
IT PREVENTS UM EMPLOYERS ARE
PHYSICIANS BY A CORPORATION TO
INTERFERE WITH THEIR INDEPENDENT
ABILITY TO, UM MAKE MEDICAL
JUDGMENTS AND WE HAVE SEEN THAT
UM, WITH SOME OF THE HOSPITAL
SYSTEMS THAT ARE USING, YOU KNOW
THEIR RELIGIOUS EXEMPTION. UM
AND SO ONE OF MY CONCERNS IS
THAT IF WE JUST YOU KNOW
COMPLETELY REMOVE THIS, UM,
CORPORATE PRACTICE OF MEDICINE
HERE IN CALIFORNIA. THAT WE
WOULDN'T. PEOPLE WOULDN'T
NECESSARILY NEED TO USE THAT
THEIR RELIGIOUS EXEMPTION AT
TIMES AND SO WE ARE A STATE THAT
HAS STATED THAT WE, UM, VALUE
EVERYONE, REGARDLESS OF THEIR
GENDER, REGARDLESS OF THEIR
SEXUAL ORIENTATION, UM, THAT WE
VALUE A WOMAN'S RIGHT TO CHOOSE.
AND UM. I JUST WANT PEOPLE TO
REMEMBER THAT AS WE ARE CREATING
THIS BILL, UM TO MAKE SURE THAT
WE DON'T PUT OURSELVES IN A
SITUATION WHERE IN THESE AREAS,
ESPECIALLY THESE RURAL AREAS
THAT HAVE LIMITED ACCESS TO
PROVIDERS THAT WE'RE NOT
LIMITING IT EVEN FURTHER BY
ALLOWING THESE, UM, HOSPITALS OR
THESE CLINICS TO COME THAT DO
NOT PROVIDE UH, A FULL ACCESS OF
CARE TO EVERYONE. SO, UM I JUST
WANT TO MAKE SURE THAT WE ARE
KEEPING THAT IN MIND AS THIS
BILL CONTINUES TO MOVE FORWARD,
RECOGNIZING THAT WE HAVE AN
ISSUE A PHYSICIAN SHORTAGES, WE
HAVE AN ISSUE WITH HOSPITALS
CLOSING, UM AND WE HAVE TO FIX
THAT. I JUST DON'T WANT US TO
MAKE THOSE WHO ARE ALREADY, UM,
LACKING ACCESS HAVE EVEN FURTHER
LACK OF ACCESS UNDER THE SHIELD
THAT WE HAVE PROVIDED. UM
HOSPITAL OR CLINIC SERVICE IN
THAT AREA, SO THANK YOU VERY
MUCH. ANY OTHER COMMENTS OR
QUESTIONS FROM COMMITTEE. THING
NONE IF YOU WOULD LIKE TO CLOSE
, MR. CHAIRMAN THANK YOU. THANK
YOU, MADAM VICE CHAIR. YES I
WOULD. AND FIRST OF ALL, ADDRESS
THE CONCERNS OF THE OPPOSITION.
I WOULD HAVE THOUGHT BY NOW THAT
IF THERE WERE ADVERSE OUTCOMES
THAT WE WOULD HAVE HEARD ABOUT
IT, UM FROM HOSPITALS, HOSPITALS
, I HAVE NOT. WE HAVE NOT HEARD
OF ANY UM I WOULD VENTURE TO
GUESS AND I'M NOT. I'M GOING TO
GUESS AT THIS POINT, BUT THE
UNCERTAINTY OF A FIVE YEAR
SUNSET MAKES IT DIFFICULT TO
ATTRACT SOMEBODY LONG TERM. AND
UM AND SOME OF THESE ARE VERY,
VERY REMOTE AREAS, SO THE
CERTAINTY OF THE ABILITY TO BE
HIRED AND STAY THERE LONG TERM,
I THINK WILL WILL SHOW AND I
HOPE WILL SHOW AN INCREASE IN
THE NUMBERS. REGARDLESS THOSE
HOSPITALS THAT HAVE HIRED
PHYSICIANS HAVE SEEN A POSITIVE
BENEFIT FROM THAT. I WILL NOTE
THAT, UM, THESE, UH WHAT I WOULD
SAY THIS HOSPITAL TAHOE TAHOE
HOSPITAL IS DIFFERENT THAN THAN
THAN MANY OF THE OTHERS. UM MOST
OF THESE HOSPITALS HAVE HIRED A
PHYSICIAN OR TWO PHYSICIANS.
THEY ARE NOT GOING TO BE
PROVIDING ALL SERVICES THAT A
THAT A LARGER, MORE URBAN
HOSPITAL WOULD PROVIDE, SO THEY
MIGHT NOT BE PROVIDING GENDER
FROM THEIR LIKELY NOT PROVIDING
GENDER AFFIRMING CARE. THEY'RE
NOT LIKELY NOT PROVIDING UM,
ABORTION SERVICES. IT DOESN'T
MEAN THAT THERE'S A PROBE THEY
PROBE THERE'S A PROHIBITION THAT
ARE NECESSARILY BUT THEY MAY NOT
HAVE THE CAPACITY THE EXPERIENCE
TO DO THAT. UM HOWEVER, THE
VALUE OF HAVING A DOCTOR AT THE
HOSPITAL IS SIGNIFICANT IN SOME
OF THESE SMALL COMMUNITIES, THE
POPULATION DOESN'T MAKE IT EASY
FOR SOMEONE TO ESTABLISH A
PRACTICE. AND THEN GET HOSPITAL
PRIVILEGES TO BELONG TO THE
HOSPITAL. THAT'S THE PROBLEM
WE'RE TRYING TO SOLVE HERE, AND
THERE ARE A NUMBER OF
COMMUNITIES THAT ARE JUST LIKE
THAT. UM AND SO I BELIEVE THAT
THERE, I BELIEVE I BELIEVE THERE
IS NO HARM DONE HERE. I BELIEVE
THAT THIS IS, UM THIS IS
IMPORTANT FOR RURAL COMMUNITIES
. AND AS SUCH, I ASKED THAT WE
REMOVED THE SUNSET. ALLOW THIS
TO CONTINUE, AND I RESPECTFULLY
ASK FOR YOUR VOTE. THANK YOU, MR
CHAIR. THE RECOMMENDATION IS DO
PASS TO APPROPRIATIONS. DO WE
HAVE A MOTION? YEAH, I DID IT.
YEAH I GUESS SO. MR LACKEY. SO
THE MOTION MR PATTERSON FOR THE
SECOND. MADAM SECRETARY. PLEASE
CALL THE ROLL WOULD I WOULD I,
ALDRIN WALDRON. I AGUIAR-CURRY
HAGAR CURRIE. I ARAMBULA
ARAMBULA. I BOERNER HORVATH
BOERNER HORVATH. AYE, CARILLO.
FLORA. BLACKIE. BLACKIE. I
MAIENSCHEIN. MCCARTHY MCCARTHY
I, JOE PATTERSON. JOE PATTERSON.
I RODRIGUEZ RODRIGUEZ I SANTIAGO
SANTIAGO IVY VALLAPUDUA
VALLAPUDUA, AYE, WEBER. HOWEVER,
I. THAT BILL IS 12 0.
THANK YOU, MADAM VICE CHAIR AND
MEMBERS WHO ARE NOT PRESIDENT.
ASSET MEMBERS ARE NOT PRESENT.
PLEASE COME DOWN SO WE CAN
CONCLUDE OUR BUSINESS HERE. THE
MEANTIME, I'D LIKE TO GO THROUGH
THE AGENDA FROM THE TOP. UM ALL
OF THE BILLS HAVE, UM, HALF
PAST. SO WHAT WE'LL BE DOING
ITEM ONE HAS NOT. OH, SORRY,
WITH THE EXCEPTION OF ITEM ONE.
EXCUSE ME. SO MY BAD SO AT THIS
POINT, WE ASK MADAM SECRETARY,
PLEASE OPEN THE ROLL. CALL THE
ABSENT MEMBERS FOR ITEM NUMBER
ONE A. B 2 36 BY MR HOLDEN. AND
LIFT THE CALL. ARAMBULA.
ARAMBULA AYE, BOERNER. HORVATH
HORVATH. I CARILLO. LARA
MAIENSCHEIN. RODRIGUEZ
RODRIGUEZ. AYE. 9 TO 1 THAT HAS
NINE VOTES. AND THE VOTE IS 9 TO
1. I DIDN'T NUMBER 2358 AND NINE
ARE THE CONSENT CALENDAR. UM
MADAM SECRETARY, PLEASE OPEN THE
ROLL. CALL THE ABSENT MEMBERS ON
THE CONSENT COUNTER ARAMBULA.
ARAMBULA AYE, BOERNER HORVATH.
BOERNER HORVATH. AYE, CARILLO.
LARA MAIENSCHEIN. RODRIGUEZ.
RODRIGUEZ? AYE. COME THROUGH 12
0. PLEASE OPEN THE ROLL. CALL
THE ABSENT MEMBERS. ITEM NUMBER
FOUR A B 48 BY MISS AGUILAR
CURRY. ARAMBULA ARAMBULA AYE
CARILLO LARA. JOE PATTERSON. JOE
PATTERSON. AYE. SANTIAGO. UNTIL
I GO. I 13 0 13 0, PLEASE OPEN
THE ROLL. CALL THE ABSENT
MEMBERS. ITEM NUMBER SIX A B 70
BY MR RODRIGUEZ ARAMBULA
ARAMBULA. AYE, CARILLO LARA.
MAIENSCHEIN PATERSON. JOE
PATTERSON. I SANTIAGO SANTIAGO.
AYE. 0 12 0, PLEASE OPEN THE
ROLL. CALL THE ABSENT MEMBERS.
ADAM NUMBER 7 82 54 BY MISBAH
BAUER-KAHAN ARAMBULA ARAMBULA.
AYE CARILLO FLORA. PATERSON.
PATERSON. AYE. THAT'S 13 0. WE
DID. AH JUST DO NOT ITEM NUMBER
10. I DON'T THERE'S NO NEW
MEMBERS WHO CAME IN SO MR
MAIENSCHEIN JUST ENTERED ITEM
NUMBER 10 82 42 BY
ASSEMBLYMEMBER'S WOULD UM,
PLEASE OPEN THE ROYAL CALLED THE
ABSENT MEMBERS CARILLO FLORA
MAIENSCHEIN. YES. MAIENSCHEIN.
AYE. 13 0 13 0. MAYBE 70. CHECK
WE'LL CHECK THAT OUT RIGHT RIGHT
NOW. YEAH WE HAVE AN I VOTE, MR
SANTIAGO. OKAY? SO, UM. SO WE'LL
GO BACK. WE NEED TO OPEN THE
ROLL ON SOME ITEMS FOR MR
MAIENSCHEIN. SO ASK ITEM NUMBER
ONE. A B 2 36 BY MR HOLDEN.
PLEASE OPEN THE ROLE CALLED THE
ABSOLUTE MEMBERS. REAL. FLORA.
MAIENSCHEIN MAIENSCHEIN, AYE. 10
AND 10 TO 1 10 TO 1. CONSENT
CALENDAR. UM THE CONSENT
CALENDAR. I WAS 2358 AND NINE,
PLEASE OPEN THE ROLL. CALL THE
ABSENT MEMBERS CARILLO LARA
MAIENSCHEIN. MAIENSCHEIN I 13 0.
I'M SICK. ADAM 6 80 70 BY MR
RODRIGUEZ, PLEASE OPEN THE ROLL
. CALL THE ABSENT MEMBERS.
CARILLO FLORA MAIENSCHEIN
MAIENSCHEIN I 13 0. I THINK,
MOTHER, I THINK WE GOT IT
COVERED. THANKS VERY MUCH. LET'S
HAVE ONE MEMBER MISSING. OKAY?
NEVER.
OKAY, UM. WE THE OTHER THE OTHER
MEMBERS ARE NOT GOING TO BE ABLE
TO MAKE IT TODAY. SO WE, THE
BUSINESS OF THE HEALTH COMMITTEE
IS NOW IS NOW CONCLUDED. WE WILL
GO AHEAD AND ADJOURN. THANK YOU
VERY MUCH.