Transcript Highlights:

• Scope of practice issues come up.
• They want us to practice issues come up.
• We will partner with collaborative.
• That's how continue to be collaborative.
• . collaborate. collaborate.

Keywords: 958, all

Summary: The committee met and approved the minutes from its August 27 meeting. It then received a presentation from Katherine Castanza of the National Conference of State Legislators on the Medicaid provisions in the 2025 budget reconciliation bill, referred to as HR1. She explained that the bill is estimated by CBO to save the federal government $911 billion over 10 years, with more than 20 Medicaid-specific provisions, most of the savings concentrated in five policies and largely backloaded into 2030-2034. She emphasized that the bill’s effects will vary by state, but that expansion states and hospitals are expected to be most affected, in part because of changes to eligibility, provider taxes, and state-directed payments. Castanza highlighted several new funding and flexibility provisions, including a $50 billion Rural Health Transformation Fund for 2026-2030 and a new home- and community-based services waiver option effective July 1, 2028, with $100 million in grants in fiscal year 2027. She also outlined major eligibility changes for Medicaid expansion adults: work or community engagement requirements effective January 1, 2027; twice-yearly redeterminations for the expansion population effective the same date; and new cost sharing for certain expansion adults effective October 1, 2028. She noted that Kentucky, as an expansion state, would be subject to these changes and that state agencies would face significant implementation demands, especially because federal guidance and timelines are tight. A substantial portion of the presentation focused on financing changes. Castanza described new limits on provider taxes, including a 0% safe harbor for new taxes and a phased reduction for existing taxes in expansion states beginning in 2028, while nursing facilities and intermediate care facilities are exempt from the reduction if already taxed. She also explained that state-directed payments will be capped and phased down over time, with existing arrangements grandfathered only briefly; she said Kentucky has 11 approved state-directed payments and could see significant fiscal effects. She added that the bill also bars Medicaid payments to Planned Parenthood or similarly situated providers for one year, changes immigrant eligibility rules effective October 1, 2026, lowers the federal match for certain emergency services, and expands the scope of the federal erroneous payment recoupment provision effective October 1, 2029. Throughout, she stressed that federal savings may translate into state cost shifts and that implementation timing will be critical.

Transcript Highlights:

• > Your leadership, collaboration inspired Your leadership, collaboration inspired make<00:26:09.440><
• Practice what you preach. faith? Practice what you preach.
• </c> as we want, but SOP practice and etc. as we want, but SOP practice and etc. has<01:28:09.520><c>
• It's practical for the county recorders and stuff.
• It's practical for the county recorders and stuff.

Keywords: 1183, house

Transcript Highlights:

• way I think this is the collaborative way I think this is the the<00:16:04.160><c> easiest</c><00:16
• </c><00:22:57.640><c> work</c> can't continue their collaborative work can't continue their collaborative
• on setting the agenda and collaboration on setting the agenda and figuring<00:31:31.639><c> out</c><
• </c><00:43:31.920><c> manner</c> working in a a very collaborative manner working in a a very collaborative
• </c><01:25:41.600><c> fashion</c> in a bipartisan collaborative fashion in a bipartisan collaborative

Keywords: 1187, senate, all

Transcript Highlights:

• I think what we're what the goal is is to look at this as a collaboration.
• So again, it is it is a collaborative effort and I think we all are on the same page.
• </c><00:33:35.679><c> Um</c><00:33:36.000><c> because</c> as as a collaboration.
• Um because as as a collaboration.
• , evidence-based and doing best practice, evidence-based and doing no<00:35:52.079><c> harm.

Keywords: 958, all

Summary: The committee met with a quorum, approved the prior meeting minutes, and then heard testimony on the use of artificial intelligence in therapy and mental health settings. Representative Lisa Willner and Brenda Rosen of NASW Kentucky argued for “guard rails” on AI chatbots so they cannot present themselves as licensed therapists or replace school counselors, psychologists, or social workers. They said AI can support licensed professionals, but warned that chatbots cannot reliably recognize nonverbal cues, escalate crises, or provide accountable care, and they cited examples of harmful chatbot interactions, including a suicide case and a chatbot telling a user to “Please die.” The witnesses also raised concerns about data privacy, commercialization of sensitive mental health conversations, and the use of personal clinical content to train AI models. They said minors should require parental consent and suggested transparency about how a chatbot is trained and who created it. They distinguished between unvetted consumer chatbots and AI tools that have been scientifically validated or approved as digital therapeutics, noting that some evidence-based tools may be useful for specific conditions such as depression, anxiety, or eating disorders. Committee members asked whether regulation should be handled by the legislature or by professional boards, and whether a multi-state model would be preferable to 50 different state approaches. The witnesses generally favored expert-led standards and said a board or panel of experts could review and approve mental health chatbots, but members cautioned that boards can become too restrictive and that legislation should preserve flexibility and avoid discouraging children from seeking help. The discussion ended with a request for the witnesses to restate their proposed policy ideas, including privacy protections, bans on commercialization, limits on training AI with clinical content, transparency requirements, and informed consent.

Transcript Highlights:

• Our focus is on working proactively with developers to navigate these challenges together, finding practical
• And the ability to do this is constrained by a combination of legacy policy, preference, and just practice
• So I very much support what Addison mentioned with regard to collaboration.
• each other about the internal process improvements that they're making so that they can learn best practices
• We appreciate the committee's focus on implementation and look forward to working on practical solutions

Keywords: 988, house, all

Transcript Highlights:

• While collaboration with the federal government may simplify processes and improve services, it is critical
• </c><00:13:45.279><c> with</c> about my rights while collaboration with about my rights while collaboration
• One other thing to note: I'm not sure if anywhere in the state has a sort of best practices for state
• One other thing to note: I'm not sure if anywhere in the state has a sort of best practices for state
• </c><00:23:11.840><c> program</c> have sort of a best practices program have sort of a best practices

Keywords: 910, house, all

Summary: The committee on Economic Development and Technology heard testimony on several bills, beginning with HB 22, which would limit state and local cooperation with federal immigration detainers. Supporters, including the Legal Clinic, the Office of the Public Defender, and the ACLU of Hawaiʻi, argued the bill would protect due process and constitutional rights regardless of immigration status. Some supporters requested amendments, including removing a probable-cause terrorism provision, adding enforcement language, and preserving warrant requirements. Public testimony was heavily in favor, with the chair announcing 91 testimonies in support and 52 in opposition. The committee then heard HB 73, which would prohibit setting aside public lands for immigration detention facilities. Testifiers in support said public land should serve local needs, not detention centers, and cited housing, food security, and community trust concerns. The Office of the Public Defender and others also supported the measure, and the chair reported 85 testimonies in support and 40 in opposition. The committee next took up HB 438, which would fund legal representation for people in immigration proceedings. Supporters, including the Public Defender, the University of Hawaiʻi Law School Refugee and Immigration Clinic, the Hawaiʻi Coalition for Immigrant Rights, the Legal Clinic, and the ACLU, emphasized the civil nature of immigration court, the severe consequences of removal, and the need for more pro bono and trained attorneys. Several suggested amendments focused on training and building a legal-services pipeline; the chair reported 83 testimonies in support and 51 in opposition. The committee also heard HB 457, aimed at requiring notice to detained individuals about their rights when ICE seeks to interview them or has a detainer request. Supporters said the bill would ensure people understand their right to remain silent and to refuse interviews, and the Legal Clinic suggested the warning be given orally, potentially via recorded messages, rather than only in writing. The Office of the Public Defender noted the bill aligns with existing due-process warnings in criminal court and suggested referencing current law. Finally, HB 476, which would raise the capital gains tax rate, drew support from Hawaiʻi Appleseed on fairness grounds; the Department of Taxation said it would review revenue questions but had no estimate available. After recess, the committee returned to decision-making and moved HB 22 forward on the chair’s recommendation of HD1, with the chair noting that the bill already contained language allowing counties to adopt stronger standards and protections.

Transcript Highlights:

• And practical tests from the Commission on Fire Protection.
• But that's a very practical application that has... ...a very real impact.
• I mean, is that a practice or policy? I just haven't known of that.
• on the research project that we collaborated with.
• Typically, they are collaborative efforts with respect to FIF funding.

Keywords: 997, house, all

Transcript Highlights:

• </c><00:48:20.079><c> with</c> well as continue to collaborate with well as continue to collaborate with
• I think we should have a bold and practical plan.
• </c> add impact is in my collaboration add impact is in my collaboration building<01:12:48.159><c> and
• </c><01:13:00.880><c> relationships</c> building collaborative relationships building collaborative relationships
• </c><01:13:13.040><c> and</c> opportunity for collaboration and opportunity for collaboration and Partnerships

Keywords: 1187, senate, all

Transcript Highlights:

• So we'll see how this plays out in practice.
• three groups of concerns from the Office of the Attorney General with due process and kind of some practical
• And then the third are kind of some practical considerations.
• It makes collaboration with requesters near impossible at times due to the level of trust that is put
• I don’t know what the solutions are other than, I mean, do we, and we just did the best practices for

Keywords: Freedom of Information Advisory Council, 976, house, all

Transcript Highlights:

• But that has been an established practice. To help cover some of their costs.
• But that has been an established practice, and actually for some of that more detailed history, I'm going
• We do not try to have that practice with all of our assessment fees and provider payments.
• To have that practice with all of our assessment fees and provider payments, to, as we collect it, then
• Because not just hospitals, but our other collaborative providers can't survive on paltry rates anymore

Summary: The subcommittee met to review Department of Human Services hospital payments in Arkansas Medicaid, with DHS Secretary Janet Mann and Deputy Secretary Misty Eubanks presenting first, followed by Arkansas Hospital Association Executive Vice President Jody Ann Tritt and a brief comment from Arkansas Children’s. DHS outlined the main hospital payment streams: fee-for-service per diem payments, upper payment limit (UPL) supplemental payments, cost settlements, and smaller payments such as graduate medical education and disproportionate share hospital funds. Members asked for plain-language explanations of cost settlements, why per diem rates vary by hospital type, and why UPL applies to private hospitals. DHS said cost settlements and UPL are mechanisms to help offset Medicaid underpayment, with SFY 2025 hospital payments totaling hundreds of millions of dollars and no general revenue used for supplemental payments beyond the state share funded through hospital assessments and related financing structures. Committee members focused heavily on whether Arkansas hospitals are adequately reimbursed and why rural hospitals struggle. Tritt explained that critical access hospitals, rural emergency hospitals, PPS hospitals, and specialty hospitals operate under different federal and state rules, and said lower per diem rates for some facilities help with cash flow and later cost settlement adjustments. She said Arkansas hospitals are under financial strain, citing a negative patient services margin statewide and noting that Medicaid, Medicare, and commercial payers all contribute to the problem. She also said the association had just authorized a statewide survey of hospital finances and costs, which she expected would take about a year to complete. A major theme was commercial insurance reimbursement. Tritt argued Arkansas hospitals are paid far less than hospitals in neighboring states even though premiums are similar, and said administrative burdens, prior authorizations, and denials add to the problem. She said hospitals receive about 52 to 53 cents on the dollar for Medicaid costs without UPL and about 78 cents with UPL, still below cost. Members also discussed Medicare wage index issues, Medicare Advantage, and whether hospitals could use technology or alternative arrangements to improve finances. No votes were taken on the hospital presentation. At the end of the meeting, DHS provided a brief update on Living Choices and assisted living reimbursement. Officials said one assisted living facility, Pillars of the Community in Crossett, had announced closure, with nine waiver clients being transitioned to other settings. DHS said the current cost reporting period was underway and that a new rate study could be ready for review before the end of the fiscal year if reports were submitted on time. Members also asked about the broader waiver plan, and DHS said the next waiver iteration would likely be brought back to the committee in the summer.

Transcript Highlights:

• But that has been an established practice. To help cover some of their costs.
• But that has been an established practice, and actually for some of that more detailed history, I'm going
• We do not try to have that practice with all of our assessment fees and provider payments.
• To have that practice with all of our assessment fees and provider payments, to, as we collect it, then
• Because not just hospitals, but our other collaborative providers can't survive on paltry rates anymore

Summary: The subcommittee met to review Arkansas DHS hospital spending and reimbursement methods, with Secretary Janet Mann and Deputy Secretary Misty Eubanks explaining Medicaid hospital payments. They described fee-for-service per diem payments, cost settlements, and the upper payment limit (UPL) program, noting that SFY 2025 hospital payments included $688 million in inpatient/outpatient claims, $473 million in UPL payments, $248 million in cost settlements, and about $47 million in other payments such as graduate medical education and disproportionate share hospital funds. Members asked about why per diem rates vary, how cost settlements work, why UPL applies mainly to private hospitals, and how assessment fees are structured and funded. DHS said the hospital assessment fee is broad-based and uniform, used as the state share to draw federal funds, and that supplemental hospital payments after federal match totaled $548 million with no general revenue used. The Arkansas Hospital Association’s Jody Ann Tritt then gave a broader overview of the hospital landscape, explaining the different hospital types in the state, including critical access hospitals, rural emergency hospitals, PPS hospitals, and specialty hospitals. She said Arkansas hospitals face financial strain, citing a negative 5.18% patient service margin statewide and lower reimbursement than surrounding states. She argued that Arkansas hospitals are paid less than hospitals in neighboring states for similar services, that commercial payer rates and administrative burdens are a major problem, and that Medicaid and Medicare rates remain below cost even with UPL support. She also said hospitals are the backbone of community care, provide emergency and public health functions, and are looking for ways to invest in technology and telehealth but often lack the revenue to do so. Members pressed for clearer data on hospital finances, reimbursement adequacy, and the impact of commercial insurers. Tritt said the association had just authorized a statewide survey to gather updated financial information from hospitals, which she said would take about a year to complete. She also explained that Medicaid pays weekly, Medicare and commercial plans can involve delays and denials, and that hospitals often spend significant resources on revenue cycle work. The discussion ended with a brief update on assisted living reimbursement: DHS said one facility, The Pillars of the Community in Crossett, had announced closure, nine Living Choices waiver clients were being transitioned, and the updated rate study would be available after cost reports are collected, likely before the end of the fiscal year. The meeting then adjourned.

Transcript Highlights:

• such as a synthetic frog model or frogopedia, an application for mobile phones or tablets, offer a practical
• They also have the right to their own self-determination, especially as it applies to this kind of practice
• And we're in support of this bill because we see it as a good collaboration between parents and their
• AB 86 is an affordable, efficient solution developed through extensive collaboration with policymakers
• Well, I am going to introduce this because it's good practice for me.

Keywords: 988, house, all

Transcript Highlights:

• It would make federal agencies collaborate on this problem.
• Act with Senator Welsh of Vermont, this bipartisan bill is one step we can take to stop the bad practice
• It would make federal agencies collaborate on this problem again.
• You talked about collaboration and, of course, common data.
• and the work that you're doing on the ground every day to save lives, and what's happened to your practice

Keywords: opioid crisis, overdose, naloxone, drug trafficking, law enforcement, treatment, prevention, older adults, Medicaid expansion

Summary: The meeting convened to address the dire opioid crisis affecting communities nationwide, with a particular focus on the alarming rise of opioid use disorder among older adults. Key testimonies highlighted the critical need for a comprehensive approach that encompasses prevention, treatment, and strict law enforcement actions against drug traffickers. Sheriff Dennis Lima from Seminole County outlined successful strategies implemented in Florida, including increased access to naloxone and legislative changes to hold drug dealers accountable for overdoses. Various members expressed a united front on tackling this multifaceted issue, advocating for the expansion of Medicaid and better access to treatment as essential steps to curbing the epidemic.

Transcript Highlights:

• Though in practice, I managing care.
• </c> they're practically unattainable. they're practically unattainable.
• </c> practice A with two physicians, practice practice A with two physicians, practice B<01:17:36.880
• in the market, or simply flipping the practice to another PE firm. practice.
• I was never in private practice.

Keywords: 1187, senate, all

Transcript Highlights:

• , and communities that have practices, and communities that have sustained<01:02:24.120><c> Hawaii's<
• can collaborate with our communities<01:07:41.960><c> on</c><01:07:42.240><c> co-management.
• So it is, again, a very good co-management collaborative process.
• So we wouldn't collaborative process.
• Again, right, um, that's the collaborative approach depending on what the need of that public land is

Keywords: 912, senate, all

Summary: The committee first heard HB 649, which would create a small boat harbor commercial vessel special fund and raise mortgage fees on commercial vessels to fund harbor improvements. DLNR stood on written testimony in support, while the Ocean Tourism Coalition, Activity and Attractions Association of Hawaii, Calypso Charters, and a local commercial operator all opposed the bill, arguing that the fee increase would burden thin-margin businesses without fixing procurement and staffing problems and that the bill’s fee language and fund allocations were too vague. A DLNR witness also noted a prior bill, HB 2477, had sought to broaden the fee base to more ocean operators statewide rather than increase the percentage. No vote was taken on HB 649 during the portion shown. The committee then heard HB 2599 on aquatic protection, which would prioritize ecosystem integrity and use of best available science in managing aquatic resources and set coral reef resilience goals. DLNR supported the measure, and a testifier from the public urged stronger coral goals for Oahu and a broader framework including water quality, herbivore management, fishery management, enforcement, and coral restoration. There was no opposition or vote shown on HB 2599 before the committee recessed to a joint hearing. In the joint Economic Development and Tourism / Water, Land, Culture, and the Arts hearing, members heard HB 2118 on transferring the State Foundation on Culture and the Arts and the King Kamehameha Celebration Commission from DAGS to DBED, HB 2474 on authorizing non-binding international cooperative agreements, HB 1863 on creating an honorary ambassador to Canada, HB 1943 on out-of-state DBED offices and export promotion, and HB 2604 on a performing arts ticket surcharge. Testimony was generally supportive for HB 2118, HB 2474, HB 1863, and HB 1943, with questions focused on agency placement, sister-state relationships, and the rationale for overseas offices. HB 2604 drew opposition from the Tax Foundation and others, who argued the surcharge functioned as a tax and would make arts participation more expensive; the chair recommended deferring it. During decision-making, both committees passed HB 2118, HB 2474, HB 1863, and HB 1943 with amendments, including technical changes and revised effective dates. For HB 2474, the amendments were described as clarifying definitions for sister-state and international cooperative agreements, allowing relationships with national governments, and preserving legislative approval and transparency. HB 1943 was amended to require an office in Laoag City, Philippines, rather than a non-existent DBED Philippines office. HB 2604 was deferred. After the joint session, the Water, Land, Culture, and the Arts committee resumed and heard HB 2395 on permits for taking marine deposits and HB 2361 on administrative support for the Kahului Bay Regional Council, both of which drew only DLNR written testimony and no further action in the excerpt. The committee then began HB 1823 on Coastal Zone Management Act exemptions, with the Office of Hawaiian Affairs testifying first, but the transcript cuts off before further testimony or action.

Transcript Highlights:

• Um, we do work in collaboration and conjunction with our federal partners.
• ><c> with</c><00:05:00.000><c> our</c> collaboration and conjunction with our collaboration and conjunction
• So there'll be collaboration and cooperation with those entities to help with that process.
• So there'll be collaboration and cooperation with those entities to help with that process.
• </c> working on the psychiatric collaborative working on the psychiatric collaborative care<01:52:15.360

Keywords: 958, all

Summary: The Medicaid Oversight and Advisory Board reconvened and heard a presentation from the Attorney General’s Office Medicaid Fraud and Abuse Control unit. AG staff described the unit’s structure and work: it investigates and prosecutes Medicaid provider fraud, and also handles abuse, neglect, and exploitation cases involving vulnerable adults in facility settings when asked to assist. They said the office has prosecutors, detectives, auditors, and support staff, works with federal partners, Commonwealth’s attorneys, CHFS, DMS, OIG, and MCOs, and uses a hotline and referral line for complaints. They also explained the MCO referral process, including monthly meetings, stand-down lists, and review of referrals for a “credible allegation of fraud” before the AG office decides whether to open a criminal or civil investigation. The presentation focused heavily on current fraud trends. Staff said behavioral health is a major concern, along with participant-directed waiver services, medically assisted treatment, cash billing for services, controlled-substance billing, and vision and dental fraud. They gave examples such as duplicate time sheets for family caregivers, questionable Suboxone counseling and urine drug screening practices, and a prior optometry case involving false claims for children’s glasses. They also discussed CMS’s estimate that about 5% of Medicaid payments are improper, noted that most improper payments are at the fee-for-service level, and said there is no reliable overall fraud-rate estimate. They highlighted a sharp shift in behavioral health billing after the cabinet’s November 1, 2024 policy changes, saying individual psychotherapy spending dropped while group billing increased, suggesting providers may have moved billing to different codes. Members asked about the scale and timing of cases, how MCO referrals are screened, and whether the data reflected more people being served or just higher spending. The AG office said investigations can take years, with some federal cases still awaiting sentencing from 2018 and 2019 matters, and that they currently had nine individuals awaiting sentencing in federal court. They also reported 58 hotline reports during the referenced period, six cases opened from MCO referrals, and four additional MCO referrals not accepted for active cases. Several members raised concerns about home-based services and the risk of abuse or fraud when family members are reimbursed, and asked whether the process could be streamlined; the AG office said it had no immediate recommendations but would be willing to return with suggestions after further review.

Transcript Highlights:

• </c><00:20:53.840><c> with</c> initiatives in collaboration with initiatives in collaboration with various
• </c><00:43:32.400><c> that</c> traditional and cultural practices that traditional and cultural practices
• This is a best practice. Please pass this measure. Thank you.
• There are some scattered practice.
• 01:15:32.239><c> that</c><01:15:32.400><c> the</c> practice around the country that the practice around

Keywords: 912, senate, all

Summary: The joint committees heard testimony on several measures. SB 2723, which would designate April 27 as State Sheriff’s Day, was supported by the Department of Law Enforcement and a long-serving sheriff, who described the historical roots of Hawaii’s sheriffs in the Kingdom of Hawaii and said the bill would recognize that legacy. HGA submitted written comments, and there was no opposition or vote taken on the measure during the excerpt. The committees then heard SB 17 on wildfire mitigation. The Public Utilities Commission, DLNR, the State Fire Council, OPSD, the Attorney General’s office, and Kamehameha Schools all testified, mostly in support of the bill’s intent but with suggested amendments. Several witnesses said the bill should better define the working group’s structure, staffing, and funding, and the Attorney General noted constitutional concerns about placing the group outside a principal department and pointed out possible overlap with Acts 302 and 303 from the prior year. Committee members questioned whether SB 17 duplicated earlier wildfire legislation, and witnesses generally said it did not directly conflict but overlapped with existing efforts. On SB 2358, which would require reimbursement for search-and-rescue costs when people leave trails and enter closed areas, the State Fire Council and the Hawaii SAR Alliance testified in opposition or caution, arguing that reimbursement could deter people from calling for help and that Hawaii’s SAR system still has structural and administrative gaps. A committee member asked whether other jurisdictions had used similar measures without discouraging rescues; the Fire Council said Kauai has a similar law but it has not resulted in invoices being sent. No action was taken in the excerpt. The final measure discussed was SB 2475 on Red Hill remediation funding and reimbursement from the Department of Defense. The Board of Water Supply, DLNR, and other testifiers supported the bill, emphasizing the need for long-term research, monitoring, and cleanup, while also noting the unique groundwater conditions and the importance of keeping the funds focused on Red Hill contamination response. Committee members asked about existing federal and state funding, whether the state had received any direct federal money, and what would happen if reimbursement is not obtained. DLNR said it was still working through the reimbursement mechanism and that some federal funding had gone to the Red Hill registry, but not directly to the state for this purpose.

Transcript Highlights:

• environment to keep our communities safe and our youth protected. juvenile collaborative environment
• The prosecutor involvement is collaboration. There's no mandate of certification of adult in this.
• And so, again, this is collaboration. There's no mandate of certification of adult.
• It just brings the prosecutor into a collaborative environment.
• This is standard practice of delaying care.

Keywords: 959, house, all

Transcript Highlights:

• My laboratory does cattle fever tick research in collaboration with the scientists at Kerrville, as do
• When we collaborate with them, it's to improve their ability to respond to their mission.
• Because a lot of their people, when they rotate down to Panama, they get that practical experience of
• The most practical frontline tool is feed-through ivermectin.
• What we need is to align this new federal Authority with practical readiness in Texas.

Keywords: 997, house, all

Transcript Highlights:

• </c> to do is just give some practical to do is just give some practical experience<00:25:55.840><c>
• I started a support group and standardized screening practices 18 years ago.
• </c> proposal it works it works practically proposal it works it works practically and<00:44:37.119><
• However, November 1st is a much more practical date. Yes, and one more dumb question.
• </c><02:59:34.640><c> cost</c> estimates that these practices cost estimates that these practices cost

Keywords: 1191, senate, all