Transcript Highlights:

• We narrowly avoided that, but there are other administrative facilities, water facilities, that are also
• We don't have access to that.
• Our report recommended allowing regulators to access confidential facility-level electricity use data
• Our report recommended allowing regulators to access confidential facility-level electricity use data
• , a public safety facility, a publicly funded national facility, a security facility, a publicly owned

Keywords: 987, senate, all

Transcript Highlights:

• HOMES AND BUSINESSES THAT NOW HAVE ACCESS TO BROADBAND RELIABLE SERVICE.
• THIS CAN BE SEEN ON OUR WEBSITE AND LINKED ON THE BOTTOM FOR EASY ACCESS.
• YOU'RE TALKING TO YOUNG KIDS WILL HAVE ACCESS TO TECHNOLOGY, ACCESS TO HIGH-SPEED INTERNET AND HOMEWORK
• I SEE EVERYBODY'S GOT HIGH SPEED ACCESS, THAT'S GREAT. NEXT UP WE HAVE MR.
• GOAL OF EXPANDING ACCESS.

Transcript Highlights:

• News media can have continued access to this information.
• Or how many clients cannot access services.
• eight community facilities, and community transition services.
• the facility?
• We do intend to be looking at individual facilities and characteristics associated with those facilities

Summary: At the May 14, 2025 JLARC meeting, members approved the January 9 minutes and adopted the 2025–27 biennial work plan with a minor typo correction. Staff reviewed the new work plan studies, including a drug take-back program fee/expenditure review due in December 2025 and a state energy performance standard compliance review due in June 2027, and noted JLARC’s recent session activity, including several bills passed related to JLARC work and recommendations. The committee then heard a preliminary cannabis market study showing Washington businesses likely produced two to three times more cannabis than retailers sold in 2023. Staff and RAND said LCB’s data systems are incomplete and unreliable, limiting regulation, tax verification, and diversion tracking; they recommended that LCB submit a plan by year-end for collecting accurate data by the end of 2026. Members and LCB discussed the long timeline for a new traceability system, the causes of missing sales and weight data, overproduction, diversion, and the social equity program’s effect on producer licenses. JLARC also presented a preliminary hospital oversight report concluding that the Department of Health is late on many hospital inspections, does not verify third-party inspection standards, does not review adverse health event correction plans, and could make hospital data more accessible. The committee discussed fee funding, language access, and inspection timing, and DOH said it would work on a strategic plan and continue coordinating with JLARC. Members also heard a preliminary report on the public records survivor exemption, which found agencies are using it but need more guidance; JLARC recommended keeping the exemption and having the Attorney General provide additional training. Finally, the committee approved the DDA processes and staffing final report for distribution, which recommended performance metrics, stronger data quality controls, and workforce planning; DDA concurred. JLARC also introduced proposed study questions for a future DCYF juvenile rehabilitation review focused on safety, security, programs, staffing, education, and contraband, and the meeting adjourned after members asked about scope and facility conditions.

Transcript Highlights:

• There's been some concern facilities.
• to testing facilities when the testing<00:03:22.319> facility<00:03:22.720> makes<00:03
• :23.040> certain<00:03:23.440> certain testing facility makes certain certain testing facility
• readability and accessibility. Um, Mr. readability and accessibility. Um, Mr.
• that teleaalth is actually accessible that teleaalth is actually accessible for<00:07:02.319>

Keywords: 1183, house

Transcript Highlights:

• The Health Care Facilities and System Subcommittee will come to order. Anola, please call the roll.
• I am here presenting HB 229, which is on health facilities.
• homes, assisted living facilities, labs, and health care providers.
• AHCA investigators ensure that health care facilities comply with state regulations.
• Then if they can't access them, then anyway, I'll stop. Thank you, Mr. Chair.

Summary: The Health Care Facilities and System Subcommittee met and heard three bills, all of which passed favorably. HB 229 by Rep. Oliver would update the Health Facilities Authority Act to reflect modern health system structures, allowing not-for-profit LLCs and not-for-profit parent corporations of health systems to use the financing authority, and clarifying that authorities may use loan agreements as well as lease financing. An amendment narrowing and clarifying the not-for-profit definition was adopted without objection. AdventHealth testified in support, and the bill passed 17-0. The committee then heard HB 527 by Rep. Trabulsi, which creates a public records exemption for current and former AHCA personnel who investigate complaints, Medicaid fraud, abuse, waste, or inspect licensed health facilities. The sponsor said the exemption is intended to protect investigators and their families from retaliation. There was no public testimony, and members discussed balancing transparency with safety. The bill passed 17-0. Finally, the committee heard HB 431 by Rep. Trabulsi, which extends by one year the requirement for athletic coaches and similar youth sports volunteers to complete Level 2 background screening through AHCA’s clearinghouse, with the sponsor saying the delay would give the system time to expand and reduce costs over time. Public testimony from youth sports organizations supported the goal of screening but raised concerns about cost, implementation details, and age thresholds for screening. Members generally supported the bill as a child-safety measure, and it also passed 17-0. The meeting then adjourned.

Transcript Highlights:

• Community hospital with critical access Community hospital with critical access Hospital<00:23:36.480
• c> Hospital designation the critical access Hospital designation the critical access designation<00:23
• . support of the critical access um support of the critical access um program<00:24:07.400> has
• Minnesota's future depends on uh access Minnesota's future depends on uh access to<01:19:59.560>
• the aisle with the critical access the aisle with the critical access hospit<01:23:18.880> all

Keywords: 1183, house

Summary: The Health Finance and Policy Committee heard testimony from the Minnesota Hospital Association and several hospital leaders about the financial strain facing hospitals across Minnesota. The association’s CEO said hospitals are essential 24/7 safety-net providers, but rising labor, supply, technology, and drug costs are outpacing reimbursement from Medicaid, Medicare, and commercial payers. He warned that many not-for-profit hospitals are struggling, that workforce shortages remain significant, and that the committee should consider help on Medicaid rates, discharge/boarding problems, mental health services, workforce development, protecting the 340B drug discount program, and avoiding new mandates that add costs. Relle Schultz of Winona Health described a community hospital with a 49-bed facility and long-term care services that has faced years of losses, including a $17 million loss in 2023 and $12 million in losses the following year. She said government payers now make up about 65% of the hospital’s mix, and each 1% increase in that mix costs about $1 million. She highlighted the difficulty of sustaining services such as dialysis, which was nearly closed until a local donor provided $3 million to keep it open for three years, and she emphasized the importance of 340B savings and the need for higher Medicaid payments. Carrie Mulski of Riverview Health in Crookston said critical access hospitals are also under pressure despite their federal designation. She explained that federal support has eroded, that Medicaid and other public programs do not cover full costs, and that her hospital’s 340B savings help keep the doors open. She said Riverview opened a new hospital in 2020 but was hit by the pandemic and inflation, leading to annual losses of $5 million to $6 million and a negative operating margin of 9% to 10%. She also described bond covenant problems, low cash on hand, the prior closure of the nursing home, and the need for rapid state action to stabilize rural hospitals and preserve access to care.

Transcript Highlights:

• Please know this is not about just gaining access to documents.
• That are committed to the facility, including assault on staff.
• Therapists coming in and I had 10 therapists while in that facility.
• Either it's a treatment facility or it's not. You can't have it both ways.
• It requires TDCJ to compile and report annually on a, uh, facility by facility basis, de-identified data

Transcript Highlights:

• be denied access to care at a facility be denied access to care at a facility because<00:25:04.000
• A facility listed in the subsection one may not unreasonably limit access to or medical use of medical
• facility."
• > from facilities or hospice facilities from facilities or hospice facilities from the<00:46:31.359
• hospice facility? hospice facility?

Keywords: Public Health and Welfare - Room 216, 25 February, 2026; 3:00 PM, 925, all

Summary: The committee first handled House Bill 612, which had been laid on the table because of questions about section one. Senator Tate explained that section one would allow the state, counties, and municipalities to enter interlocal agreements to provide installation support services on military installations, mainly road and infrastructure work such as paving and dirt work, and that section two would add Coast Guard medics to an existing provision allowing trained military medics to sit for LPN certification. After questions about the breadth of “installation support services,” the committee adopted the motion for title sufficient, due pass, with opposition noted, and the bill was reported to the Veterans and Military Affairs Committee. House Bill 942 was then passed over at Senator McMahon’s request until Tuesday. The committee then took up House Bill 1034, which would allow terminally ill hospital patients to use medical cannabis gummies. The sponsor said the bill is intended to help terminally ill patients who already qualify for medical cannabis but are denied access in hospitals, and that it prohibits smoking or inhalation. Members raised concerns about whether the bill was too broad, whether it would interfere with hospital and physician judgment, possible drug interactions, federal law issues, liability for hospitals and doctors, storage and disposal requirements, and whether hospitals would incur costs or be forced to handle cannabis on their premises. The sponsor responded that the patient’s use would be logged in the chart, that the caregiver is generally responsible for the lockbox and disposal, and that the bill includes language allowing a facility to opt out if compliance would jeopardize federal funding or licensing. The bill’s author also described the measure as arising from a Coast Guard family’s experience in which a terminally ill patient was denied access to medical cannabis at one hospital but allowed at another, and said the goal is to prevent similar denials for terminally ill patients. He said he was not aware of other drugs treated this way in hospitals, but argued that terminally ill patients should have access to most anything they want. The discussion ended with Senator England asking whether changing the bill’s requirement that a facility “shall” allow medical cannabis to “may” allow it would better protect hospitals and preserve discretion, but no final action on House Bill 1034 was taken in the portion provided.

Transcript Highlights:

• Access to knowledge.
• Access to knowledge. It provides books. Access to knowledge.
• <00:33:27.400> Beardsley facilities. And you know, Mr. Beardsley facilities.
• doubled since 2010 at that facility. doubled since 2010 at that facility.
• since we opened this facility in 2001. since we opened this facility in 2001.

Keywords: 1187, senate, all

Transcript Highlights:

• Tamara Ahmed, Facilities Director for the Judicial Council.
• We provide in-prison programming at nine different facilities.
• , in most cases, are aging facilities.
• You know, I've walked into these facilities.
• I mean, we have state-owned facilities, we have leased-owned facilities.

Keywords: 987, senate, all

Summary: The committee held an informational hearing on the Governor’s May Revision proposals for labor, public safety/judiciary, and transportation, and no votes were taken. In Part A on labor, the Employment Development Department reviewed proposals for EDD Next document management system funding, updated UI loan interest costs, disability insurance and paid family leave benefit and administration adjustments, WIOA funding changes, UI administrative and benefit changes, school employee benefit adjustments, an EMT training reappropriation, and a technical correction tied to EDD Next. PERB discussed funding tied to AB 28 and AB 1, including litigation-related workload and new jurisdiction over legislative employees. DIR presented proposals for legal unit reclassifications, two major IT modernization projects, a new Cal/OSHA emerging technologies unit, a COIA reappropriation, and trailer bill language on electronic assessment payments and the DWC director salary cap. CalHR proposed additional funding for a consolidated employee assistance program contract, and CalPERS and CalSTRS presented budget adjustments tied to investment costs and state contribution changes. Members focused heavily on UI debt and interest payments, asking the administration for a plan to reduce the outstanding loan and relieve employers. Finance said no specific repayment plan was included in the May Revision, while LAO said the state’s UI tax structure is structurally insufficient and that any debt payoff should be paired with tax-system reform. Senators also questioned EDD Next costs and timelines, PERB’s caseload and staffing needs, and DIR’s emerging technologies unit, with LAO noting that the unit would appear focused on physical workplace safety rather than broader AI labor issues. CalHR said the new EAP contract would consolidate services, improve access to clinicians, and lower costs relative to the current model. CalPERS defended higher external management fees as part of a strategy to pursue higher net returns, while some members pressed for more transparency about private investments; CalSTRS said it was not prepared to address investment-strategy questions at this hearing. Public comment in Part A was dominated by advocates urging support for an immigration enforcement emergency relief fund, along with comments supporting the Jails to Jobs proposal, the Apprenticeship Innovation Fund, and additional PERB funding. The chair noted that many of the immigration-related requests might fall under other committees and said staff would follow up. In Part B, Finance and LAO outlined judicial branch and DOJ May Revision items, including funding for court interpreter services, appellate court security, lactation room implementation delays, courthouse construction reappropriations, and DOJ budget increases. LAO recommended approving the language-access proposal with a report on reducing interpreter cost growth and reducing the General Fund backfill for state court facilities by $10 million on an ongoing basis.

Transcript Highlights:

• to the information can access it easily and freely.
• So that would be CSU's, detox facilities, and short-term residential treatment facilities.
• They don't know how to access those services.
• In my district, we have little to no access to beds, and I know... ...little to no access to beds.
• It's hard to access, and the other is the availability of SIP services.

Summary: The Human Services Subcommittee met to review implementation of House Bill 7021, the recent overhaul of Florida’s Baker Act and Marchman Act, and to hear from DCF Assistant Secretary Erica Floyd Thomas about how the department is using the $50 million appropriation tied to the bill. Representative Maney, the bill sponsor, gave a lengthy background on why he pursued the reforms and emphasized that the goal was to improve access, reduce unnecessary crisis interventions, and give agencies the resources needed to carry out their responsibilities. He and the chair both noted that the bill was the product of many years of work and broad bipartisan support. DCF reported several early outcomes and implementation steps, including a statewide reduction in Baker Act initiations over the past five years, strong diversion rates from crisis through 988, mobile response teams, care coordination, and forensic multidisciplinary teams, and the creation of new tools such as a Baker Act dashboard and the first annual Marchman Act report. The department described key statutory changes: law enforcement discretion in initiating Baker Acts, a single-petition process, remote appearances, stronger discharge planning, interim services, updated parent notification and hold-period rules, an ombudsman office for children’s behavioral health, and regional collaboratives to identify local service gaps. DCF said it has updated manuals, FAQs, trainings, and rules, and that the managing entities have begun contracting for services. Members asked about how the $50 million was allocated, why much of it went to crisis capacity rather than outpatient care, how much has been spent so far, whether administrative costs are capped, and how the department will measure success. DCF said most of the money was used to preserve and expand crisis beds, detox beds, CSU beds, short-term residential treatment, discharge planning, and outpatient supports, with $1.3 million for the ombudsman and regional collaboratives and $48.3 million to managing entities. The assistant secretary said the department tracks readmissions, utilization, provider capacity, and monthly and quarterly reports from managing entities, but it is still early to see full effects because contracts were only recently executed. Members also raised concerns about children, families, veterans, workforce shortages, transparency, and gaps for hard-to-place individuals, including those with developmental disabilities or dementia. The meeting ended with no formal action beyond adjournment after questions were completed.

Transcript Highlights:

• Vermont Department of Health Access enrollment tells the story.
• hospital, assuming that, well, if it were not designated a critical access hospital.
• for the fact that they are a critical access hospital.
• In 2029, it is expected that a new forensic facility not operated by DOC will be online.
• This new facility, which may or may not be collocated on a correctional facility, would be operated by

Keywords: 927, senate, all

Transcript Highlights:

• facilities of any kind.
• daycare facilities in industrial areas.
• Where CEQA comes in is before you build a facility or expand an existing facility, you look at the different
• Where sequel comes in is before you build a facility or expand an existing facility, you look at the
• For existing facilities, but any of those existing facilities under CMTA's read of the bill would preclude

Keywords: 988, house, all

Transcript Highlights:

• aging and inadequate facilities. aging and inadequate facilities.
• lab, as well as several other facilities lab, as well as several other facilities updates<00:52:
• access to the playground.
• > playground classroom and accessible playground classroom and accessible playground equipment
• Um, this have access to playground.

Keywords: 1183, house

Transcript Highlights:

• AB 1855 didn't just improve access; it amplified the student voice.
• In my day job, I permit and develop composting facilities.
• the average time is to approve a new facility without this bill?
• Typical facility, small... A new facility without this bill?
• Typical facilities, smaller facilities, typically take two to three years.

Summary: The committee heard a long agenda focused heavily on housing, local government, Brown Act teleconferencing, and public agency administration. Early bills included AB 39, which would require larger cities and counties to adopt electrification planning for EV charging and building decarbonization; AB 76, which clarifies Chula Vista’s university innovation district housing requirements; AB 259, AB 409, and AB 467, which extend or modernize Brown Act teleconferencing provisions for local agencies, community college student bodies, and Los Angeles neighborhood councils; and AB 428, which would let water corporations join joint powers authorities for pooled insurance. Supporters emphasized climate planning, housing access, public participation, safety, and cost savings, while several bills were amended to address stakeholder concerns. Most of these measures advanced on bipartisan votes, generally 6-1 or 7-0, and were left open for additional members to add on later. The committee also heard AB 632, which would strengthen local enforcement tools for serious code violations, fire hazards, illegal cannabis operations, and unsafe housing by allowing unpaid administrative fines to be converted into money judgments and liens. Local government and code enforcement groups supported the bill as a way to improve compliance and reduce costly litigation. AB 670 would let local governments count investments in preserving naturally occurring affordable housing toward housing element reporting and require broader reporting of demolitions and replacement housing compliance; supporters argued preservation is essential because many unsubsidized affordable homes are at risk. AB 761 would allow Monterey-Salinas Transit to place a future sales tax measure on the ballot with approval from two-thirds of its board, rather than separate approval from each member jurisdiction, to preserve transit funding for seniors, veterans, and people with disabilities. These measures also moved forward, with the committee noting amendments and sending them to the next committees of referral. Another major item was AB 810, which would require special districts and joint powers authorities to migrate public-facing websites and email addresses to .gov or CA.gov domains by 2031. The author argued the change would reduce fraud and improve public trust, especially after emergency-related scams, while opponents from special districts and IT organizations said the transition would be costly and difficult for smaller agencies. Several school-related opponents withdrew after amendments, and committee members discussed possible aliases and tribal-government language. The bill passed 7-1 to the Privacy and Consumer Protection Committee. Finally, AB 1206 proposed a pre-approved design catalog for single-family homes and small multifamily developments, modeled on a prior ADU bill, to speed rebuilding and reduce design costs; supporters from Habitat for Humanity and housing advocates said it would help both wildfire recovery and broader housing production, and the bill drew at least one opposed-unless-amended position as the committee moved into further discussion.

Transcript Highlights:

• Yes, but I will be clear that Access is the one who deals with eligibility, I will be clear that Access
• You oversee and license behavioral health facilities, and those facilities have been in the news somewhat
• Yes, most likely after Access.
• All I can tell you is under state statute, we license the facilities, and if that facility has a scope
• and the facility is licensed as a counseling facility, they're not permitted to put anyone in seclusion

Keywords: 1182, all

Transcript Highlights:

• We do make hospital access payments and cost settlements.
• We do make hospital access payments and cost settlements.
• And the hospitals contribute through what we call access payments.
• We're really proud of the 27 critical access hospitals we have in the state.
• We're really proud of the 27 critical access hospitals we have in the state.

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:

• So they can't go to our community facilities, our minimum security facilities, which we'll talk a little
• And then in the community facility, we have eight community facilities across the state of Washington
• of Corrections facility campus.
• It's not facility-based.
• An intensive behavioral health treatment facility really is a mental health treatment facility.

Summary: The committee held a work session focused first on juvenile rehabilitation system capacity. DCYF officials said the juvenile rehabilitation population is older, includes more adult-sentenced youth, and has longer lengths of stay, especially for “post-25” youth who must remain in secure facilities and cannot go to community beds. They described overcrowding at Green Hill School, placement limits at Echo Glen and Harbor Heights, staffing turnover, mental health acuity, and the need for more medium-security and specialized mental health beds. DCYF said it is pursuing a Parkland facility proposal, a staffing model decision package, and a broader feasibility study and master plan update. No votes were taken; members were asked to follow up with questions later. The committee then heard on behavioral health system capacity from the Behavioral Health Administration and the Health Care Authority. DSHS described growth in forensic and civil bed need, expansion at Olympic Heritage, Maple Lane, and Brockman, and construction of a new 350-bed forensic hospital at Western State expected to open in 2028. HCA reported progress on long-term civil commitment beds, intensive behavioral health treatment facilities, PACT teams, and intensive residential treatment teams, saying the community-based system is being expanded to support step-down care and reduce hospital reliance. Members asked about whether capacity is right-sized, the difference between facility types, and federal match eligibility for services. A federal funding update followed, covering the effects of H.R. 1 and H.R. 5371 on SNAP, Medicaid, marketplace coverage, long-term services and supports, K-12, higher education, and hemp regulation. OFM and agency staff said H.R. 1 adds work requirements, changes non-citizen eligibility, increases state administrative and benefit costs, reduces Medicaid and marketplace subsidies for some groups, tightens redeterminations, and may significantly affect provider payments and state-directed payments. H.R. 5371 extended federal funding through January 30, 2026 and included some agency appropriations and other provisions, including changes affecting hemp producers. Members asked about SNAP error rates and special enrollment periods. Finally, budget coordinator Mary Monroe gave a 2026 supplemental budget preview. She reviewed the state’s near general fund outlook, noting revenue declines since the enacted budget, the effect of reversions, and a preliminary maintenance-level outlook showing a projected increase in NGFO spending over the four-year period. She said the supplemental will reflect updated caseload and cost forecasts and mandatory impacts from H.R. 1, but not policy proposals. No actions or votes were taken during the session.

Transcript Highlights:

• The project has an veteran access.
• . facility. facility.
• open the possibility of facility open the possibility of facility facility<00:36:04.160> expansion
• facility expansion. facility expansion.
• We don't have access to other types of nursing type facilities in our region that some of these others

Keywords: Call to Order and Roll Call- 00:00:00 Approve Minutes from November 13, 2025- 00:00:55 RiverLink Tolling Operations for Louisville Bridges-Quarterhill Testimony- 00:01:48 Staff Report on Veterans’ Centers- 00:26:45 Kentucky Department of Veterans Affairs Response to Staff Report- 0:58:53 Adjournment- 1:18:00, 958, all

Summary: The committee first approved the minutes from the November 13, 2025 meeting and then heard testimony from Quarter Hill, the tolling subcontractor for RiverLink on the Indiana-Kentucky bridge system. Quarter Hill described its role in back-office support and call center operations for the Lincoln, Kennedy, and Lewis and Clark bridges, and said the contract began in 2021 with go-live in September 2023. The company reported that revenue has increased since it took over, customer service response times have improved, and it has been operating at a loss because the contract was based on outdated transaction estimates and did not account for higher-than-expected volume and added support costs. Members questioned Quarter Hill about the role of consultants, the low reported collection rate, and why the company was leaving the contract. Quarter Hill said a single large consulting engineering firm had been hired to help shape the RFP and contract, but argued that consultants and overly detailed requirements can create disputes and hinder efficient service. On collection rates, the company said the reported 85% rate reflects the absence of registration holds and other enforcement tools, and that the remaining unpaid tolls are the hardest to collect. The company also said it had lost significant money on the contract and had reached a change order and termination agreement, while emphasizing that the system itself was functioning well. The committee then received a staff report on Kentucky veterans centers. Staff said quality of care is generally high and staffing has improved, but reported occupancy figures are misleading because they are based on certified beds rather than functional capacity after conversions to single-occupancy rooms and capital projects. The report said actual occupancy is closer to 85% than the commonly reported 56%, and that increasing occupancy would not necessarily increase revenue because the state’s cost of care exceeds reimbursement and private-pay revenue. Recommendations included adopting functional occupancy reporting, continuing the move to single-occupancy rooms, reviewing modernization needs at Thompson Hood, including Eastern Kentucky in planning, and referring the Radcliffe HVAC procurement and installation to the Auditor of Public Accounts and Attorney General for review.

Transcript Highlights:

• And this is all in the surveillance system that we would have access to.
• It would be on the data use agreement because that would give us access to surveillance."
• And through the ND TAP program, she has about 20-some hours to be an LAC in our facility.
• The IMD exclusion also does not apply to facilities of 16 beds or less.
• The IMD exclusion also does not apply to facilities of 16 beds or less.

Summary: The meeting focused heavily on behavioral health and substance use treatment, especially the IMD exclusion and whether North Dakota should pursue a Section 1115 waiver to allow Medicaid reimbursement for services in institutions for mental diseases for adults ages 21 to 64. Turtle Mountain representatives described major local needs, including limited access to care, high syphilis rates, and the importance of timely public health data. They also discussed the tribe’s recovery center, which opened the prior year, now operating five levels of care with 16 beds, and the desire to expand capacity, possibly through an IMD waiver or related policy changes. Committee members also raised related issues such as rural health transformation funding, telehealth, workforce retention, and the need for better coordination between tribal and state public health systems. A central issue was Turtle Mountain Public Health’s long-running effort to secure a data use agreement with the state so it can receive surveillance data and respond directly to infectious disease cases among tribal members. Speakers said the tribe had a successful COVID-era agreement that allowed faster contact tracing and case management, but that agreement ended with the pandemic. They argued that current delays in sharing data, especially for sexually transmitted infections, leave the tribe unable to respond quickly, while the state and county epidemiology workload is too distant and stretched to be effective. Committee members expressed support and said they would look into the issue, noting that other tribes have secured similar agreements. The committee also heard a detailed presentation from the National Health Law Program on the IMD exclusion. The presenter explained that federal Medicaid law generally bars payment for care in facilities with more than 16 beds, but that states can use other tools such as state plan amendments, managed care arrangements, telehealth, and community-based services. He said IMD waivers are administratively complex, time-limited, and have shown mixed results in other states, with some gains in residential treatment access but limited evidence of improved overdose outcomes or stronger community-based care. He urged the committee to consider broader continuum-of-care solutions and cautioned that waivers alone are not a cure-all. No final vote was taken on the bill draft during the portion shown, but the committee discussed the proposal to appropriate $49,000 and one FTE to HHS to pursue an IMD waiver and report back in the next interim. Members also debated the policy rationale for the 16-bed limit, the role of the state versus tribal sovereignty, and whether the bill should move through the Health Care or Human Services committee in the future.