Transcript Highlights:

• and health care providers.
• House Bill 1612 by Frank relating to direct payments for certain health care provided by a hospital.
• issuers and health care providers.
• issuers and health care providers.
• Texas Health Care Workforce Education Fund to help fix the health care workforce shortages in our great

Summary: The House convened with a quorum, heard the invocation and pledges, and then took up a series of memorial resolutions and recognitions. Members adopted memorial resolutions honoring former President Jimmy Carter and Dr. Alice Gail Hudgens, with remarks highlighting their public service and community impact, and adopted resolutions recognizing Victoria College’s 100th anniversary and May 2025 as Mental Health Awareness Month. The chamber also recognized Texas A&M system interns and later granted permission for several committees to meet while the House was in session. The House then moved through a long third-reading calendar, passing a number of bills on wide margins. Measures approved included SB 304 on municipal court jurisdiction over nuisance abatement ordinances, SB 608 on reporting evidence collection kits, SB 2312 creating a Texas Advisory Committee on Geopolitical Conflict, SB 494 creating a petroleum theft task force, SB 530 on postsecondary accreditation, HB 45 giving the Attorney General a role in prosecuting human trafficking cases, HB 35 on peer support for first responders, HB 47 and HB 3073 on sexual assault policy and prosecution, HB 318 and HB 3000 creating rural sheriff and ambulance grant programs, HB 554 on Juneteenth fireworks sales with county opt-in authority restored, HB 705 and HB 932 joining licensure compacts for cosmetology and occupational therapy, HB 849 allowing county park boards to meet by video conference, HB 1119 on mental health bed reporting, HB 3041 on students with nontraditional secondary education, HB 713 on maternal mortality review reporting, HB 3104 on Webb County bailiff appointments, HB 3970 on electricity planning for large loads, HB 4042 on Railroad Commission safety provisions for gas distribution pipelines, HB 4490 protecting next-of-kin information, HB 1731 on the physician assistant compact, HB 2607 on Walker County Hospital District governance, HB 3689 on Texas Windstorm Insurance Association funding, HB 1788 on continuing education for barbers and cosmetologists about abuse and trafficking, HB 1612 on hospital direct payments for uninsured patients, and HB 138 on health impact cost and coverage analysis. Several bills drew extended debate or amendments. HB 353, creating a trespass offense near schools and daycares, prompted questions about constitutional concerns and property rights before passing. HB 3211 on optometrists in managed care plans received a perfecting amendment and a Medicaid-related amendment setting a minimum payment level. HB 1056 on gold and silver specie and a state-based currency prompted detailed questioning about its mechanics and fees, followed by a point of order challenging the caption. The House also adopted or postponed a number of items, including postponing HB 2520 and HB 1359 until later in the calendar before later passing both, and laying several bills on the table subject to call. Many measures passed overwhelmingly, while a few, including HB 3326 on loan forgiveness for adjunct professors and HB 3237 on energy consumption goals, passed with narrower margins.

Transcript Highlights:

• Health care is number one. Leader Hogue has a question. Mr.
• Of course, what's driving some of that is our health care positions.
• Health care, health care support is, again, short term and long term, Health care, health care support
• And the second question would be, so we've invested in child care.
• in a bill, for evaluation of child care programs.

Summary: The committee met with a quorum, approved the previous minutes, and then received an update from Senator Jonathan Sickler on the Cash Management Board’s work under House Bill 1278. He said the board has been reviewing statewide cash, liquidity, and investment practices, finding that the state generally manages money well but could improve forecasting, automation, and coordination across agencies. He highlighted that the state has about $35 billion in liquid assets and investments, with most in longer-term investments, and described a change already underway replacing more than 500 six-month CDs with a special-rate savings account to reduce administrative work. Members also discussed the impact of House Bill 1176 on Legacy Fund earnings and the possibility of future legislation to avoid losing investment returns when large transfers are made all at once. The board also noted that some agencies still hold funds outside the Bank of North Dakota system, and that this is being reviewed. Representative Nathan Toman then updated the Task Force on Government Efficiency, saying the group has focused on how to measure whether programs are actually working. He said the task force has not yet proposed legislation, but the administration has agreed that new and expanding programs should answer five questions, including who is affected, what outcome is expected, whether there is another way to do it, and how success will be measured. Members discussed the need for dashboards, program evaluators, better data collection, and possible use of artificial intelligence to identify duplicate or outdated programs. Toman said the task force will continue reviewing agency workflows, with upcoming presentations from courts, the university system, the auditor, and other agencies, and that future legislation or rule changes may be needed to require performance metrics. Phil Davis of Job Service North Dakota presented labor market and program updates. He reported that North Dakota’s unemployment rate is 2.5%, labor force participation is about 68.7%, and the state continues to rank near the top nationally. He reviewed job openings, in-demand occupations, and several workforce programs, including H-2A agricultural worker inspections, the Job Placement Partnership Program with DOCR, and virtual and in-person job fairs. Davis said the DOCR partnership has shown strong results, with lower recidivism and higher earnings for participants, and he emphasized that Job Service tracks outcomes and reports them to federal and state partners. Members asked about child care subsidies, workforce participation, agency coordination, and whether more staff are needed for H-2A inspections. Finally, Allen Knutson presented the updated S&P Global revenue forecast. He said oil prices have risen sharply since the last update, making the revenue outlook more favorable but still volatile. S&P’s baseline forecast showed the current biennium’s four major tax collections about $89 million above the legislative forecast, and a much larger increase for the next biennium, though he cautioned that federal tax changes and oil market uncertainty could alter the numbers. In an alternate scenario using higher near-term oil prices, he estimated about $242 million more in oil and gas tax collections and roughly $120 million more for the Strategic Investment Fund. Members asked whether another forecast should be requested once oil markets stabilize and about changes in tribal oil production assumptions.

Transcript Highlights:

• So I think sometimes we direct our information or direct some of our money in an inappropriate way because
• </c><00:25:31.279><c> some</c> we direct our information or direct some we direct our information or
• Yet we direct a lot of our lack of food.
• So that is working with our private child care providers in residential care, providing both training
• It's a nationally recognized program for our residentials that care for our out-of-home care population

Keywords: 958, all

Summary: The committee first approved contracts 98, 99, and 100 on a roll call vote, with Chairman Douglas voting no but the items still passing. It then took up a Kentucky Department of Tourism contract involving the United Kingdom, France, and Germany/Austria/Switzerland markets. Tourism officials said the state has had similar contracts since 2013, that international visitors spend about six times more per day than domestic travelers, and that the effort supports marketing, public relations, and familiarization trips. The committee approved that contract as well, with Chairman Douglas voting yes after expressing support for tourism promotion. Next, the committee reviewed two Finance Cabinet facilities and support services items involving engineering and architectural services for a specialized lab expansion project. Members discussed why the design work was expensive, and the cabinet explained that the project’s pathogen-related complexity required specialized firms. Chairman Douglas said he believed some architectural and engineering reimbursement rates were too high and should be reexamined, but the committee still approved the items by roll call. The committee then heard from the Attorney General’s office and the Kentucky Opioid Abatement Advisory Commission on an MOA related to substance use disorder funding. Senator Meredith asked how the commission’s work coordinated with behavioral health programs, and staff explained that the commission allocates funds based on applications and includes relevant state officials. The contract was approved. After that, the committee considered behavioral health items: one new 988 chat-and-text contract to expand Kentucky-based crisis response coverage, and a Voices of Hope amendment that doubled funding to continue services into the next fiscal year. Officials said the 988 contract would move more chats and texts in-state, and that the Voices of Hope increase reflected continuation of SAMHSA-funded services; both were approved. Finally, the committee reviewed DCBS contracts, including a food insecurity survey contract with a Kentucky nonprofit and a Building Bridges Initiative training contract. Members questioned whether the food survey group’s advocacy role created a conflict, but DCBS said the organization was chosen for its statewide network and that the cabinet would receive the raw data. For Building Bridges, DCBS said the program began in the fall and provides training and peer mentorship for residential child care providers, with results still too early to assess. Both items were approved. The last set of contracts, under the State Treasurer for the Kentucky Council on Developmental Disabilities, prompted questions about why the funding flowed through the treasurer’s office and about a sexuality-related capacity-building initiative. Staff explained the treasurer serves as the designated state agency for federal DD Act funds, and that the sexuality initiative is part of a broader five-year plan focused on self-advocacy, system change, and capacity building; the committee then moved to approve those contracts as well.

Transcript Highlights:

• House Bill 5301E, a bill to be entitled an act relating to health care.
• House Bill 5301E, a bill to be entitled an act relating to health care. Was that second reading?
• House Bill 5301E, a bill to be entitled an act relating to health care.
• House Bill 5301E, a bill to be entitled an act relating to health care. Are there amendments?
• House Bill 5301E, a bill to be entitled an act relating to health care. Is there a debate?

Keywords: 998, house, all

Transcript Highlights:

• For over 10 years, coercive federal policy has directed spending in the continuum of care in Texas, of
• of Care, The Continuum of Care acts as its own little fiefdom.
• Right Care is the original Texas MDRT model. Care in Dallas.
• really need that care.
• care, outpatient care, and even supportive housing.

Keywords: 1184, house, all

Transcript Highlights:

• So on AB 728, dealing with skin care products and age verification. All right.
• So when will the kids ever be directed to use?
• So when will the kids ever be directed to use?
• We care deeply about food safety and quality.
• Let's, yeah, direct comments to the committee. 7-OH tablet.

Summary: The committee heard a series of environmental safety and toxic materials measures, with several bills moving forward on unanimous or near-unanimous votes to Appropriations. Early in the meeting, the consent calendar was approved, including AB 372, AB 455, AB 1096, AB 1102, and AB 754. AB 362 by Assembly Member Ramos, which would recognize tribal beneficial uses of water and strengthen consultation and protection for tribal water uses, drew strong support from tribes and environmental groups. Water agencies and local government representatives opposed unless amended, raising concerns about CEQA requirements, co-management language, and conflicts with existing water law. The bill advanced to Appropriations, with some members voting aye and others not voting or absent. AB 728 by Assembly Member Lee would require age verification for the sale of certain anti-aging skin care products to minors. The author and a youth witness described social media-driven use of adult skin products by children and alleged skin damage, while supporters argued age checks are a reasonable consumer protection. Dermatologists and retailers opposed the bill, saying it could restrict legitimate acne and other medical uses of over-the-counter products, create compliance problems, and lacked a clear scientific basis. The committee discussed possible ambiguity in the bill’s definition of anti-aging products, but the measure still passed to Appropriations. AB 532 on low-income water rate assistance, AB 773 on copper-based anti-fouling paint, AB 998 on household hazardous waste disposal of vape pens, AB 1031 on geothermal hazardous waste fees, and AB 864 on solar panel hazardous waste and recycling all received strong support and advanced to Appropriations. Supporters for AB 532 emphasized water affordability and local program authority; AB 773 supporters said conflicting state water and pesticide rules are creating confusion for harbors and cities; AB 998 was presented as a practical way to let schools and local facilities dispose of confiscated vape devices safely; AB 1031 was framed as reducing DTSC fee burdens on geothermal development in Imperial County; and AB 864 would ease recycling and reuse of end-of-life solar panels. The committee also began hearing AB 1264 on ultra-processed foods in school meals, with the author and supporters arguing it would phase out the most harmful ultra-processed foods from school meals by 2032, but the transcript cuts off before the full discussion and any action on that bill.

Transcript Highlights:

• care... ...quality child care system, support the building of child care, support the building of the
• The demand for child care has increased due to the universal child care program.
• The demand for child care has increased due to the universal child care program.
• the home for care.
• , evidence-based health care.

Summary: The committee first took up Senate Bill 20, a prior-authorization measure aimed at exempting certain medications and treatments for seriously mentally ill adults from repeat insurance prior authorization, while also extending prior authorization approvals to three years for chronic maintenance drugs. The sponsor described the bill as the latest in a series of bipartisan prior-authorization reforms and accepted an amendment from the Health Care Authority and the Office of the Superintendent of Insurance to apply the bill to adults only and to cover PBMs in the interagency purchasing collaborative. Supporters, including NAMI New Mexico and state health officials, argued the bill would reduce barriers to needed care, especially for mental health treatment. Opponents from health plans, PBMs, and insurers warned the bill was too broad, lacked clear definitions for serious mental illness and chronic conditions, created patient-safety concerns, and should have a shorter reauthorization period and later implementation date. After committee discussion, the sponsor agreed to work on a committee substitute, and the bill was rolled over for a later meeting. The committee then heard Senate Bill 53, the Chispa data privacy bill, which would impose broad limits on the collection, sale, and use of personal data, require opt-in consent for many uses, strengthen rights to access, correct, and delete data, and create enforcement mechanisms including a private right of action. Supporters from advocacy, women’s, behavioral health, reproductive health, and civil rights groups said the bill was needed to protect sensitive health and location data, prevent surveillance and criminalization, and give New Mexicans real control over their information. Business, technology, insurance, and hospital representatives opposed the bill, arguing it was more restrictive than other states’ privacy laws, would burden small businesses and health-related services, create compliance uncertainty, and risk limiting digital services and innovation. After extensive questioning about data breaches, opt-in consent, nonprofit exemptions, and the bill’s impact on businesses and health care access, a motion to table failed 5-4, and the committee then passed SB 53 on a 5-4 vote. The committee next heard Senate Bill 86, which updates the state’s harassment-by-telephone law to cover electronic communications such as social media, messaging apps, and email. The sponsor and a Las Cruces police chief said the change would modernize an outdated 1967 statute and help law enforcement address harassment and domestic violence through current technology. The bill drew support from the governor’s public safety advisor and the Greater Albuquerque Chamber of Commerce, and members asked a few clarifying questions about the wording. The committee approved SB 86 unanimously, 9-0. Finally, the committee began hearing Senate Bill 96, on regulated childcare zoning requirements, using a committee substitute. The sponsor and the Early Childhood Education and Care Department said the bill would reduce confusing zoning and fire-code barriers to opening or expanding child care homes and centers, helping address a statewide shortage of child care slots and supporting working families. The discussion began with the committee substitute and an explanation that the measure is intended to streamline local requirements and expand child care supply.

Transcript Highlights:

• There are also sometimes federal direct payments that go directly to local government.
• No supplemental payment system that's eliminating uncompensated care for the large part.
• directive, "We're going to take those back down."
• Well, there's been a change in administration and a change in policy directive now.
• Loss if you don't easily move to another health care coverage.

Transcript Highlights:

• </c><04:11:40.960><c> This</c> step in the right direction. This step in the right direction.
• Directed by Congress.
• . care. care.
• <07:48:51.680><c> and</c> care and care and lifesaving<07:48:54.958><c> medications.
• </c> system like the Affordable Care Act. system like the Affordable Care Act.

Keywords: U.S. House of Representatives Floor Proceedings on Monday, April 28, 2025, 1012, house, all

Transcript Highlights:

• SB 1323 SD2/HD2 relating to healthcare, uniform health care decisions act, advanced health care directives
• , advanced mental health care directives.
• ><c> directives</c> advanced healthc care directives advanced healthc care directives advanced<02:22:
• </c> advanced mental health care directives. advanced mental health care directives.
• It basically modernizes our advanced health care directives and mental health care directives that we

Keywords: 910, house, all

Transcript Highlights:

• As people lose their health care coverage, we anticipate that UC Health’s uncompensated care costs will
• , specialty care, and inpatient care.
• In addition to our extensive health care services, UC operates one of the largest health care professional
• provided UC compensated care costs will increase.
• , specialty care, and inpatient care.

Keywords: 988, house, all

Transcript Highlights:

• The administration usually cared that much about intent language in the world.
• That is an immediate direct impact that we are trying to manage.
• That is an immediate direct impact that we are trying to manage.
• Where are Californians being directed? This is a really good question.
• The first time I was six years old, which led to my placement in foster care.

Keywords: 987, senate, all

Transcript Highlights:

• It continues to direct dispense, it continues the direct dispense program, and it requires DOH work with
• the health care budget.
• other than their HIV care.
• But y'all don't care about that. We know.
• , and child care.

Summary: The House convened with prayer, a moment of silence for former Senator Donnell C. Childers, the Pledge of Allegiance, and recognition of Officer Antonio Richardson as law enforcement officer of the day. A quorum was announced, the journal was approved, and the Speaker said the chamber would take up 11 budget conference reports, with debate and final votes on each report. The first report considered was HB 7031E, the tax package, followed by HB 501E, the state budget appropriations bill. On HB 7031E, Chair Duggan explained that the conference report included a range of tax reductions and tax-related changes, including sales tax holidays, property tax and homestead-related provisions, reductions in certain taxes and fees, and new exemptions or administrative clarifications. He said the package also added items such as sales tax relief for certain university construction projects, a tennis admissions exemption, and changes to agricultural property tax treatment, and that the amendment reduced state and local tax revenues by $272.2 million. Members questioned the bill about the child care tax credit reduction from three years to one, the homestead exemption provision for certain diplomats and foreign service personnel, the absence of gas tax relief and combined reporting, and the inclusion of firearm accessories and tennis tickets in sales tax holidays. After structured debate, the House adopted the conference report and passed HB 7031E by a vote of 88-11. The House then began the conference report on HB 501E, the $114.5 billion budget for fiscal year 2026-2027, which was described as below the prior year’s spending level and leaving more than $14 billion in reserves. Subcommittee chairs outlined major allocations across education, higher education, IT, health care, transportation and economic development, justice, state administration, and agriculture/natural resources. Highlights included increased FEFP funding and veteran teacher raises, full funding for Bright Futures, major IT modernization projects, Medicaid and behavioral health funding, transportation and local infrastructure spending, correctional and law enforcement investments, fire station and emergency response funding, and large environmental and water-quality appropriations. Members asked detailed questions about school voucher fraud oversight, scholarship funding, teacher raises, preeminence funding, ADAP changes, SNAP data tools and error rates, Medicaid rate changes, prison wastewater monitoring, and other budget items, but the transcript ends during the budget questions before final action on HB 501E is shown.

Transcript Highlights:

• of care plus increases.
• in a setting that best fits their needs, and state-contracted direct service programs for child care
• I feel very encouraged that we're heading in the right direction with looking at cost of care, because
• Child care helps families in getting support in early child care education.
• their child care costs.

Keywords: 988, house, all

Transcript Highlights:

• I've spent most of my career in health care. My passion for health care is personal.
• of Medicaid managed care?
• We're very careful.
• I'm in that mode today, taking care of these children that really need care.
• Children that really need care.

Summary: The Health Policy Committee met with a quorum and took up a long agenda of health care, Medicaid, and patient-access measures, along with confirmation votes. The committee first reconsidered and amended SB 1606 on patient access to records, clarifying portal obligations, deleting a section affecting nursing home facility records, and setting a January 1, 2026 effective date; the bill then passed favorably as a committee substitute. The committee also recommended confirmation of a block of appointees and separately confirmed Chavon Harris as Secretary of the Agency for Health Care Administration after Harris testified about priorities including financial accountability, managed care oversight, transparency, and quality improvement. Senators asked about audit findings and Medicaid managed care performance, and several witnesses and committee members voiced support for her appointment. The committee then advanced a series of bills, most of them with amendments, including claims bills SB 28 and SB 22 for South Broward Hospital District settlements, SB 772 on undesignated glucagon in schools, SB 998 on death certification by physician assistants and APRNs, SB 1412 on home health administration flexibility, SB 1800 creating a Parkinson’s disease research consortium at USF, SB 306 on managed care network access during holidays and after hours, SB 1768 on stem cell therapies by physicians, SB 1602 on pediatric readiness in emergency departments, SB 1156 on the home health aide program for medically fragile children, SB 1490 on Children’s Medical Services and managed care administration, and SB 1182 on Medicaid coverage of continuous glucose monitors. Most of these bills received support from industry, advocacy, or provider groups and were reported favorably as committee substitutes. The most debated measure was SB 1270, a broad strike-all amendment combining provisions on mRNA vaccine documentation, vaccination-status protections in the Patient Bill of Rights, medical marijuana reporting and background-screening definitions, compact language, and volunteer immunity. The committee heard extensive testimony both for and against the vaccine-related provisions, including concerns about discrimination, patient safety, provider discretion, and medical liability. After additional technical amendments and a time-certain motion, the bill passed favorably as a committee substitute, with Senators Davis and Osgood voting no and Senator Harrell expressing a weak yes. At the end of the meeting, senators recorded their votes on selected tabs, and the committee adjourned.

Transcript Highlights:

• No violence directed against officials, no violence directed against unelected employees of the government
• NO VIOLENCE DIRECTED AGAINST OFFICIALS, NO VIOLENCE DIRECTED AGAINST UNELECTED EMPLOYEES OF THE GOVERNMENT
• We have to be really careful what we say.
• REALLY CAREFUL WHAT WE SAY.
• WE HAVE SEEN HATE DIRECTED IN MULTIPLE DIRECTIONS OFTEN NOT WITH ANY IDEOLOGICAL OR PHYLLIS PHILOSOPHICAL

Keywords: 1187, senate, all

Transcript Highlights:

• </c> exposure forc assimilation and direct exposure forc assimilation and direct Violence<00:00:59.079
• that they provide and the care that they feel.
• </c><00:14:31.360><c> that</c> understanding and inadequate care that understanding and inadequate care
• ><c> I've</c> provide and the care that they feel I've provide and the care that they feel I've also<
• </c><00:15:48.199><c> system</c> actively shaping a Health Care system actively shaping a Health Care

Keywords: 1187, senate, all

Transcript Highlights:

• life-saving care.
• wrong direction.
• Every additional Administrative burden is a minute taken away from direct patient care.
• Reproductive health care is essential health care, and access to this care should never be dependent
• and abortion care is absolutely essential. ...how critical safe access to health care and abortion care

Summary: The Assembly Health Committee heard a long agenda of health-related bills, beginning with AB 2651 by Bonta, which would require schools to notify parents when school vaccination rates fall below herd immunity thresholds. Supporters, including family physicians, PTA representatives, and medical groups, said the bill would improve transparency and help parents protect children and vulnerable family members. Opponents argued the data could be misleading, could identify medically exempt or conditional students, and might lead to stigma or discrimination. The bill was later moved out of committee on a due-pass-as-amended motion, with one no vote recorded on the roll call. The committee also heard AB 2123 by Aguirre-Curry on medical debt relief, AB 1570 by Wilson to eliminate out-of-pocket costs for medically necessary breast diagnostic and supplemental imaging, AB 2201 by Berner to restore Medi-Cal eligibility and renewal flexibilities, AB 2448 by Berman to strengthen privacy protections for reproductive and gender-affirming care records, AB 2034 by Addis on food additive safety and transparency, and AB 2598 by Krell to require better notification of next of kin when a patient dies in a hospital. Each bill drew strong support from authors, advocates, and affected individuals, while some drew opposition from insurers, industry groups, or transparency critics who raised concerns about cost, duplication, implementation, or unintended harm. Several bills were moved forward on due-pass-as-amended motions, including AB 2123, AB 2201, AB 2448, AB 2034, and AB 2598. The committee also heard AB 2551 by Elhawary, which would require health plans to collect and publish data on how often enrollees must go out of network for behavioral health care and why. Supporters said the measure would expose access barriers and high out-of-pocket costs, especially for communities of color and people with language access needs; opponents said it would add another reporting mandate and might not solve provider shortage problems. Members generally expressed support for the bill’s goals and several described personal or district-level experiences with behavioral health access problems. The bill was then moved out of committee on a due-pass motion. The committee also took up consent items and other procedural motions, with multiple bills reported out and some placed on call.

Transcript Highlights:

• If you’re strict fee-for-service, direct care, whatever term you want to use to call it, you don’t have
• If you’re strict fee-for-service, direct care, whatever term you want to use to call it, you don’t have
• If you’re strict fee-for-service, direct care, whatever term you want to use to call it, you don’t have
• If you’re strict fee-for-service, direct care, whatever term you want to use to call it, you don’t have
• If you’re strict fee-for-service, direct care, whatever term you want to use to call it, you don’t have

Keywords: 1189, house, all

Transcript Highlights:

• and the kind of care and the various interagency collaboration the level of care and the kind of care
• In almost 20 years providing direct care in the private sector, it was really the first time I'd ever
• In almost 20 years providing direct care in the private sector, it was really the first time I'd ever
• for hospital care.
• Do they need a lower level of care or a higher level of care?

Keywords: 995, all

Summary: The special legislative commission on the future of Pappas Rehabilitation Hospital for Children held a hybrid public hearing focused on the hospital’s future, admissions, staffing, infrastructure, and whether the facility should be preserved, expanded, or reimagined. Opening remarks from legislators, commissioners, parents, and union representatives emphasized that Pappas provides a unique combination of medical, rehabilitative, educational, and residential services for children with complex needs, and several speakers argued that the hospital is effectively being depopulated through reduced admissions and ongoing discharges despite public assurances that it remains open. Multiple speakers urged the commission to extend its authorization and continue its work before any closure or major change can occur. Testimony from labor leaders, including AFSCME, SEIU Local 509, and the Massachusetts Nurses Association, described a “silent closure” in practice, with staff reporting confusion about the hospital’s status, declining census numbers, blocked admissions, and uncertainty about the workforce’s future. They called for immediate action to stop admission denials and unnecessary discharges, and some proposed short-term solutions such as temporary modular structures to address infrastructure barriers and allow admissions to resume. Parents and former patients testified that Pappas provided life-changing independence, specialized therapy, and campus-based supports that they said could not be replicated elsewhere, and they criticized alternative placements as inadequate. Commissioner Robert Goldstein of the Department of Public Health said the administration supports keeping Pappas open and funded while the commission works, but he argued that admissions must comply with hospital-level-of-care rules and that the campus’s deteriorating infrastructure limits the kinds of children who can safely be served there. He said the department is continuing admissions for appropriate patients, working to expand outreach and services, and exploring long-term options, including broader statewide models of care. Commissioners pressed him on whether discharge status or lack of a clear discharge plan had been used as a barrier to admission, and requested de-identified data on patients recommended for admission but denied. No formal votes were taken during the hearing.