Transcript Highlights:

• Dedicated Revenue Legislative Council staff estimates $343 million in fiscal year 2026-27, a half-year
• to increase our general is estimated to increase our general fund<07:48:16.878><c> revenue</c><07:48
• So we are contracting with the distributor to do work for the government, and we pay a price for that
• There is a price for that. The distributor is not going to do this for...
• cars, higher-priced electric vehicles, and increasing them for lower price vehicles.

Transcript Highlights:

• We're estimating that cost just for that bridge to be around 3 million.
• Phase two is estimated to be just over 29 million and we'll fund the construction equipment and supplies
• Phase 4 is estimated to be just over 33 million for the construction of equipment and supplies for a
• I just looked up the statewide price agreement this morning as I was building this presentation.
• And so that is kind of already baked into most of the pricing of homes.

Committee: House Water & Natural Resources Committee

Transcript Highlights:

• If they don't come home, the price they pay, the change in their life, the difference in what their future
• They do and pay a price very similar to the veteran. They earn this consideration.
• sure that when we think of veterans, we think of that whole body being families and spouses and the price
• Most of the responses are they do not even know how to estimate the cost, because everything will have
• They couldn't even estimate how many millions this is going to cost, but it's going to be a lot of money

Transcript Highlights:

• If they don't come home, the price they pay, the change in their life, the difference in what their future
• They do and pay a price very similar to the veteran. They earn this consideration.
• sure that when we think of veterans, we think of that whole body being families and spouses, and the price
• Most of the responses are they do not even know how to estimate the cost, because everything will have
• They couldn't even estimate how many millions this is going to cost, but it's going to be a lot of money

Summary: The House approved the journal from the prior day and received Senate messages on House Joint Resolutions 173 and 174, along with committee reports recommending passage of several measures, including House Bill 2180, House Bill 1870, House Bill 2596, House Bill 1866, House Bill 2536, House Bill 2855, and House Joint Resolution 115. The chamber then took up a series of Senate amendments and third-reading bills, with members frequently debating fiscal impacts, constitutional issues, and policy details. House Bill 2180, dealing with notice procedures for blind pension recipients and allowing electronic opt-in, was adopted and finally passed by overwhelming votes after supporters said it would save the state money and better accommodate blind and rural Missourians. House Bill 1870, updating bankruptcy exemptions and garnishment procedures, also cleared the House despite some opposition over a minor Senate wording change. The House refused to adopt Senate changes to House Bill 2596 and requested a conference committee, while House Bill 1866, concerning peace officer licensing and school protection officers, had Senate amendments concurred in and was finally passed. The chamber then passed House Joint Resolution 115, which would place before voters a property tax exemption for 100% service-connected disabled veterans and their spouses; debate centered on whether the measure would shift tax burdens to others, but supporters emphasized veterans’ sacrifice and the small number affected. Other bills passed included House Bill 1736 on park sales tax funds for stormwater and flood mitigation, House Bill 1887 and related bills on AI/truth-in-advertising issues, House Bill 2855 lowering workers’ compensation assessment rates, House Bill 1906 allowing more flexible tax payment schedules, House Bill 2297 on fence responsibilities for livestock, House Bill 2142/2058 revising the Missouri Film Program, House Bill 3004 on hardwood industry labeling, House Bill 2536 defining male and female by biological sex for certain government facilities, and House Bill 2151 raising income thresholds for a workforce-related program. Several of these passed on divided votes, with House Bill 2536 and House Joint Resolution 115 drawing especially sharp partisan and policy debate.

Transcript Highlights:

• It is estimated that 75 million cats and dogs will go without care by 2030 just because there are not
• Price.
• find them confused about what coverage is actually being offered by the carrier at that point, the pricing
• And another concern about this bill when you look at it is The pricing needs of the carrier at that point
• At an estimated $70 million for restoration and $25 million for local public outdoor recreation projects

Bills: S0302 , S0394 , S0480 , S0546 , S0636 , S0774 , S0796 , S1028 , S1050 , S1066 , S1120 , S1230 , S1288 , S1682

Committee: Senate Appropriations Committee on Agriculture, Environment, and General Government

Summary: The committee heard and advanced several bills, beginning with CS/SB 796, which would create Veterinary Professional Associates as a new supervised veterinary role, expand telehealth prescription timeframes, and set training and scope limits. Supporters said it would improve access to care, lower costs, and create a career path, while opponents argued the proposal lacked a clear regulatory framework, could create liability and federal-law conflicts, and would not address the real shortage in rural large-animal practice. After debate, the committee reported the bill favorably. Members also heard and favorably reported SB 1682 on local authority over derelict and abandoned vessels, CS/SB 1028 on a commercial Citizens clearinghouse for property insurance, SB 394 on exempting certain reinsurance underwriting managers from licensing, SB 636 on beach management and erosion designations, CS/SB 546 on public notice for conservation land sales or exchanges, CS/SB 302 on Biscayne Bay nature-based solutions and related coastal resiliency provisions, SB 1050 on pharmacy choice for pet medications, and SB 774 extending workers’ compensation benefits to 911 public safety telecommunicators for mental and nervous injuries. Testimony on these bills generally focused on access, regulatory clarity, environmental protection, or workforce support, with some concerns raised on insurance consumer protections and beach-management language. Senator Harrell’s bills were also taken up and reported favorably: CS/SB 480, a major overhaul of state IT governance creating DIGIT and new procurement, reporting, and workforce structures; CS/SB 1230, restricting PFAS-containing firefighting foam and adding testing, inventory, and disposal requirements; and CS/SB 1288, a naming bill designating the Andrew Red Harris Shoal and requiring markers. Finally, the committee heard extensive testimony on SB 1066 regarding restoration of the Oklawaha/Rodman system, with supporters emphasizing ecological restoration, flood-risk reduction, and economic benefits, and opponents warning about local impacts, water quality, and the loss of a world-class fishery. The transcript ends during testimony on that bill, before final action is shown.

Transcript Highlights:

• We estimate the impacts of HR1 to reduce funding for our hospitals and clinics in Washington State by
• We estimate the impacts of HR1 to reduce funding for our hospitals and clinic in Washington State by
• protecting important programs such as the 340B program that allows us to acquire drugs at a discounted price
• And just know for those folks I just described, the price increases will be so severe we expect many,
• have strong mitigation measures in place that will protect many Washingtonians from these kinds of price

Committee: House Health Care & Wellness

Summary: The committee heard a JLARC audit presentation on the Department of Health’s oversight of hospital inspections, complaints, and hospital data reporting. JLARC said DOH was late on 72% of acute care hospital inspections as of December 2024, had not verified that third-party accrediting standards were substantially equivalent to state requirements, did not consistently collect proof of those inspections, and was not reviewing adverse health event corrective action plans as required. JLARC also said DOH’s complaint system may have language-access barriers and that hospital data posted online is difficult for the public to use. JLARC made five recommendations to DOH and one to the Legislature; DOH concurred with the recommendations. DOH then outlined a response plan and said it had already begun work on several items. Officials said they would develop staffing and performance plans for inspections, verify accrediting body standards and require proof of third-party inspections, expand complaint forms into additional languages, seek funding and legal updates for adverse event review, and improve public access to hospital data, including a possible dashboard. They said annual progress updates would be provided to the Legislature and noted some improvement in inspection timeliness, while also emphasizing staffing, funding, and pandemic-related backlogs as constraints. The committee also received a DOH presentation on certificate of need modernization. DOH described the current program as a tool to assess community need, financial feasibility, quality, and cost containment for certain facility expansions and new services, and recommended a phased modernization focused on clarifying statutory purpose, creating a planning entity, adding flexibility, reducing legal costs, modernizing access standards, expanding oversight to freestanding emergency departments and urgent care, addressing equity, improving cost control coordination, securing ongoing funding, and using new state data systems. Members asked about streamlining overlapping inspections and whether triggers could be used to target inspections more efficiently. A final panel discussed artificial intelligence in health care, with a Coalition for Health AI representative describing industry efforts to create standards for responsible AI, including principles of usefulness, fairness, safety, transparency, security, and privacy, plus tools such as model cards and quality-assurance frameworks. The committee then heard testimony on federal and state health care funding changes from the Washington State Hospital Association and Providence Swedish, which warned that state cuts, taxes, and federal HR1 changes would worsen already thin margins, lead to service reductions, layoffs, and delayed capital investments, and increase charity care and uncompensated care. The Washington Health Benefit Exchange also began a presentation on expiring federal ACA premium tax credits and the state’s Cascade Care Savings program, warning that coverage affordability for exchange customers could be affected if federal enhancements are not extended.

Transcript Highlights:

• We estimate the impacts of HR1 to reduce funding for our hospitals and clinics in Washington State by
• We estimate the impacts of HR1 to reduce funding for our hospitals and clinics in Washington State by
• protecting important programs such as the 340B program that allows us to acquire drugs at a discounted price
• “And just know, for those folks I just described, the price increases will be so severe we expect many
• have strong mitigation measures in place that will protect many Washingtonians from these kinds of price

Summary: The committee heard a JLARC presentation on the Department of Health’s oversight of hospital inspections, complaints, and reporting. JLARC said DOH was late on 72% of acute care hospital inspections as of December 2024, had not verified that third-party accrediting standards were substantially equivalent to state standards, did not consistently require proof of those inspections, did not review adverse health event corrective plans, and could make hospital data more accessible. JLARC also raised a possible language-access barrier in the complaint system. Members asked about complaint filing by staff, the meaning of adverse health events, inspection outcomes, and whether the audit compared DOH to other agencies. JLARC said it had not reviewed inspection results or cross-agency comparisons, but noted inspectors were dedicated and working long hours. DOH later said it concurred with the recommendations and outlined a strategic plan with target dates for improving timeliness, verifying accreditation standards, expanding language access, reviewing adverse event laws, and improving public data access, with annual reporting to the Legislature expected. The committee then heard a Department of Health presentation on certificate of need modernization. DOH described the current certificate of need process, which reviews need, financial feasibility, quality, and cost containment for certain facility changes and new services, and said the program has not been modernized since the 1980s. DOH proposed 10 statutory modernization recommendations, including clarifying the program’s purpose, creating a planning entity, adding flexibility, reducing legal costs, updating access-to-care standards, expanding oversight to freestanding emergency departments and urgent care, addressing equity, improving cost control coordination, strengthening long-term funding, and using better data systems. Members asked about oversight of freestanding urgent care and EDs, funding sources, and whether the process could be streamlined or made more responsive to complaints or other triggers. A third panel discussed artificial intelligence in health care. Lucy O’Rourke of the Coalition for Health AI described CHAI’s work on responsible AI principles, technical standards, model cards or “nutrition labels,” testing and governance tools, and educational resources for providers. She said the group is focused on trust, transparency, fairness, safety, security, and privacy, and noted Washington’s AI-related policy work as among the more progressive in the country. No questions were asked. The final portion focused on the financial impact of federal and state health care policy changes. The Washington State Hospital Association said hospitals are facing low or negative operating margins, service reductions, layoffs, and closures, and that state cuts and taxes enacted in 2025, combined with federal HR1 changes, will significantly worsen finances. Providence Swedish leaders described staffing reductions, service cuts, delayed capital investments, and pressure from denials, tariffs, and reimbursement changes, while emphasizing that frontline staffing cuts are tied to service reductions rather than nurse-to-patient ratio changes. The Washington Health Benefit Exchange then began a presentation on expiring federal ACA premium tax credits, state Cascade Care Savings assistance, and eligibility changes affecting lawfully present non-citizens, with examples showing large premium increases for customers if federal subsidies expire.

Transcript Highlights:

• We had them estimate those.
• And then what we saw was a pressure on pricing.
• So the prices of the cannabis they were expecting at the time decreased by 20%.
• However, the revenues have dropped and the pricing for her product has dropped.
• In a local New Mexico business, there are roughly $60.5 million, and NMFA has estimated roughly $5 million

Committee: House New Mexico Finance Authority Oversight Committee

Transcript Highlights:

• The estimate is that it will lead to at least 500 additional wrongful death lawsuits per year, Shelly
• Nikic: which is considered a conservative estimate.
• Usually if your deductible increases, the price you pay for the insurance should stay the same or sometimes
• These increases in price and the insurer exits from the marketplace are due to nuclear verdicts which
• You cannot compare a small stack of medical malpractice premium rates to the price that my father paid

Transcript Highlights:

• But this progress comes at a price, and the state's budget is stressed.
• But this progress comes at a price, and the state's budget is stressed.
• But this progress comes at a price, and the state's budget is stressed.
• I can't even estimate it in amount of hours.
• I can't even estimate it in amount of hours.

Transcript Highlights:

• The FIR estimates that a family could receive over or at about $1,900 or more annually under House Bill
• The FIR estimates that a family could receive over or at about $1,900 or more annually under House Bill
• However, these mandates often come with a hidden price tag.
• I think the purpose for this, and my objective, is estimates. So can we show costs?
• I think the purpose for this, and my objective is estimates. So can we show costs?

Summary: The committee first took up HB 195, as amended by committee substitute, which would protect the personal assets of individual medical providers from medical malpractice judgments when they carry appropriate insurance or participate in the Patient Compensation Fund. The sponsor said the bill was intended to address providers’ fear of losing homes and other personal property, while opponents argued it could exempt a class of people from civil justice. Supporters said it was a reasonable compromise that preserved patient access to justice while helping recruit and retain providers. The committee adopted the substitute and advanced it on a do pass vote. The committee then heard HB 295, a revised version of the Accessibility Act, which would create a centralized office for accessibility reporting, technical assistance, and annual reporting on barriers in state buildings and websites. Supporters said the bill would improve coordination, data collection, and compliance with existing ADA requirements; opponents argued it duplicated existing law and would create another government office without enforcement power. Members debated whether the Governor’s Commission on Disability should handle the work instead, but the sponsors said the commission lacked capacity and the Department of Health was a better fit. The committee adopted the substitute and advanced it 8-1. Next, HB 296 proposed doubling the working families tax credit. The sponsor and supporters described it as an anti-poverty measure that would benefit more than 200,000 families and strengthen work incentives, while committee members asked about the fiscal impact, administration, and interaction with other tax credits. The bill was quickly advanced on a do pass vote. The committee then heard HB 338, which would extend the gross receipts tax deduction for health care providers through 2031 and add co-insurance payments. Health care advocates supported it, but city and municipal representatives warned it would reduce local revenue unless a full hold harmless was added. After extended discussion, the committee rejected a motion to table and instead advanced the bill 9-0 with no recommendation, with several members saying they would not support it on the floor unless local governments were made whole. Finally, the committee heard HB 259, which would create an optional actuarial review process for proposed health insurance legislation through the Legislative Finance Committee. Supporters said it would give lawmakers better data on premium, utilization, and spending impacts before voting on coverage mandates; opponents and some members raised concerns about cost, staffing, data access, and whether the process would be too limited to be useful. After discussion, the committee advanced the bill on a do pass vote. HB 279 was rolled at the sponsor’s request, and the committee adjourned after reminding members about the evening dinner.

Transcript Highlights:

• Our estimate was in total, employers paid approximately $770 million in calendar year 2024.
• Our estimate was in total employers paid an additional $770 million in calendar year 2024. $770 million
• So out of the $1.24 billion that we have estimated, EDD has been given $660. $161 million in the last
• Our estimates show us that the integrated clean management system, which is a combination of UI, DI,
• And so the RAND study estimated that for current claims and those claims that are pending at the fund

Transcript Highlights:

• Grant's question, do you have an estimate of sort of a typical cost for going through that proceeding
• Grant's question, do you have an estimate of sort of a typical cost for going through that proceeding
• Grant's question, do you have an estimate of sort of a typical cost for going through that proceeding
• Grant's question, do you have an estimate of sort of a typical cost for going through that proceeding
• </c><02:17:13.200><c> that</c> evictions and they can also price that evictions and they can also price

Committee: House Housing

Transcript Highlights:

• Surveillance pricing undermines the concept of a uniform price.
• With surveillance pricing, the price that you see may not be the price that someone else sees, and you
• moving the baseline price.
• all-in pricing laws were in effect at the time, the price demonstrated... ...actually.
• The price is the price of an...

Summary: The committee heard several bills, with the main discussion focused on AB 1705, AB 1898, AB 2076, and AB 2564. AB 1705 would require pornographic websites and uploaders to certify consent and age before sexually explicit content is posted, including AI-generated nude images, and would allow civil actions by nonconsenting individuals or minors depicted in the material. Supporters, including child advocacy, women’s groups, district attorneys, and university women’s organizations, said it would help combat nonconsensual sexual imagery and revenge pornography; there was no opposition testimony, and the bill drew favorable comments from members. AB 1898 would require employers to give workers advance notice before using AI-powered tools to surveil or manage employees, including disclosure of the purpose, data collected, decisions affected, and general locations of use. Labor groups and privacy advocates supported the measure as a transparency and worker-protection bill, while business and industry groups opposed it, arguing the definitions were too broad, the notice requirements could expose proprietary or security-sensitive information, and the private right of action could lead to litigation and overbroad compliance burdens. Members raised cybersecurity and scope concerns, and the author said the bill had already been narrowed and would continue to be refined, but the committee ultimately took a roll call and advanced the bill on a vote, leaving it on call for absent members. AB 2076 would add nitrous oxide to the list of products subject to online age verification under the Parents’ Accountability and Child Protection Act and increase penalties for large sellers that fail to comply. The author and supporters, including a parent, a deputy district attorney, narcotics officers, Children Now, labor, and the Children’s Advocacy Institute, described rising youth access, health harms, and online sales loopholes. Some opposition groups said they appreciated the amendments but remained concerned about other provisions. Members questioned the bill’s gift-card restrictions and whether they would unnecessarily limit adult purchasing choices; the author and committee staff explained the restriction was aimed at anonymous purchases of the most dangerous items. The bill passed on a 7-0 vote and was left on call for absent members. AB 2564 would prohibit “surveillance pricing,” or using personal data to set individualized prices, while preserving certain transparent discounts and loyalty programs. The author and supporters from Consumer Reports, TechEquity, labor, and privacy groups argued the bill would prevent discriminatory pricing and protect consumers from opaque data-driven price manipulation. Retail, chamber, and industry opponents said the bill was too broad, could chill legitimate discounts and promotions, created compliance and litigation risks, and contained vague definitions. Members discussed the balance between consumer protection and business concerns, but the transcript cuts off before a final vote on AB 2564.

Transcript Highlights:

• The opposition has said that AB 1798 will cause increased prices, market disruption, and information
• Family history is sufficient for insurers to price risk.
• process by which an insurer looks at reviewing medical records to determine risk and appropriate pricing
• The other argument in opposition to your bill is that by allowing compounding, it will drive the price
• It is also a very low price for Medicaid—$245 a month. And a third of Californians are on Medicaid.

Summary: The committee heard several bills focused on privacy, accessibility, labor, and public safety. AB 1798 by Assemblymember Wilson would bar life and disability insurers from using non-diagnostic genetic information, including direct-to-consumer test results, in underwriting. Supporters argued the bill would protect privacy and encourage genetic testing, while insurers opposed it as unnecessary and said genetic data should be treated like other predictive health information. The bill passed the committee on a 7-0 vote and was held open for absent members. AB 2190 by Assemblymember Wallace would create website accessibility standards based on WCAG guidelines and add affirmative defenses intended to reduce serial litigation while improving access for people with disabilities. Disability advocates supported the measure as a needed civil-rights update, while business groups warned it could increase liability and create unclear compliance obligations. The bill passed 9-0 and was sent to Appropriations. AB 2721 by Assemblymember Carrillo would require hotels to post notice when they know or should know that U.S. Customs and Border Protection or ICE are using the premises, with supporters saying workers and guests deserve transparency and safety. Hotel and business groups opposed it, citing privacy, liability, and concerns about interfering with federal operations. The committee voted 6-2 to pass the bill to Appropriations, with the roll left open. AB 2027 by Assemblymember Ward would restrict employers from using worker data to train AI systems that replace workers and limit sharing of worker data for automation; labor groups supported it and business and public-sector groups opposed it as too broad. The bill passed 7-2 to Appropriations, with the roll left open. The committee also heard AB 1837 by Assemblymember Mark Gonzalez, which would extend and tighten privacy rules for transit agencies’ use of forward-facing cameras to enforce bus-lane violations; supporters said the cameras improve transit flow and safety, and the bill was presented with amendments, though no final vote is reflected in the transcript excerpt.

Transcript Highlights:

• a</c><00:26:16.679><c> the</c><00:26:17.080><c> the</c><00:26:17.360><c> high</c><00:26:17.840><c> price
• </c> recognized a the the high price recognized a the the high price increases<00:26:19.559><c> that<
• So the 120 would be, in our estimation, because you have a fund that's involved when a fund is involved
• and because you have a fund estimation and because you have a fund that's<01:02:47.480><c> involved<
• </c> concerns about increasing uh the prices concerns about increasing uh the prices for<01:33:48.520

Committee: House Labor

Transcript Highlights:

• the Merrimack River from one of the most urbanized neighborhoods in the City of Lowell, with an estimated
• That is a price tag that is effectively rendering those records, even though they are technically public
• We also see needless delays and, as you just heard, a pretty hefty price tag.
• Senator, I just have to ask: was the $245,000 price tag a function of time, like the amount of time it
• Yet there's still an estimated backlog of 1,700 to 1,800 unsolved cases.

Committee: Joint Joint Committee on State Administration and Regulatory Oversight

Summary: The committee heard testimony on several bills. Representative David Linsky supported HB 3383, which would designate the song “Roadrunner” as the official rock song of Massachusetts, describing its Boston roots and cultural significance. Representative Sean Garberle supported HB 3335 on public access to historical records, arguing that records from state institutions should be released after 75 years and that families and researchers should be able to identify people buried in unmarked graves at former state institutions. Representative Rodney Elliott and Lowell officials supported HB 4138, authorizing easements for a Lowell sewer separation project; they said the project is needed for Clean Water Act compliance, will reduce combined sewer overflows into the Merrimack River, and must proceed quickly to meet SRF and consent-decree timelines. Committee members asked about Article 97, the location and scope of the easement, environmental justice impacts, and minority/small business participation in construction. The committee also heard extensive testimony on Senate 2183 and its House companion, which would elevate the Massachusetts National Guard to a cabinet-level position reporting directly to the Governor. Senators Mike Moore and John Velis, along with the National Guard Association’s Matthew McKenna, argued the change would reduce bureaucracy, improve communication and readiness, and reflect the Guard’s broad domestic and military missions. Velis cited the Holyoke Soldiers’ Home tragedy as an example of a breakdown in communication, while committee members said they wanted more information, including input from the Governor’s office and Guard leadership, before acting. The committee noted the distinction between state-controlled and federalized Guard missions and said it would continue reviewing the issue. Senator Liz Miranda and a large panel of survivors, advocates, and Northeastern law students testified in support of S. 2174 and S. 2177, which would create an office and task force on unsolved homicides, allow families to petition for case review after three years, require written responses, and establish a tip line, database, and dedicated funding. Witnesses described long-standing lack of communication, low clearance rates, and the disproportionate impact on Black and Brown communities. Senator Becca Rausch also testified on S. 2210, extending public records law to the governor and Legislature, and S. 2207, creating stronger information-governance and records-retention standards; she said both would improve transparency and reduce waste. The transcript does not reflect any votes taken during the hearing, though chairs repeatedly indicated support for moving some bills favorably and said the committee would continue reviewing the National Guard proposal.

Transcript Highlights:

• And we estimated at that time that, at the rate things were happening, we would have 49 deaths on our
• section of my presentation, where I want to just highlight some policies and reforms that, in my estimation
• Unfortunately, though, in my estimation, the waiver in some states has been the beginning of an erosion
• The sale price of that... Is that, is that okay, Chairman Hawley? Absolutely. Good afternoon again.
• The sale price of those eight sales was $4,608,943, and there are four of those with no sales data.

Committee: Joint Tribal and State Relations Committee

Summary: The meeting focused on Turtle Mountain’s public health and behavioral health priorities, especially access to rural health transformation funding and a long-running data use agreement with the state. Tribal public health leaders described how, during COVID, a temporary data-sharing arrangement allowed them to do their own contact tracing and case management, and they argued that a similar agreement is now needed to respond more quickly to very high syphilis rates and other infectious disease concerns. Committee members generally expressed support and said they would follow up with state officials, while tribal representatives emphasized that they already have the staff and infrastructure to use timely data effectively. A major portion of the meeting was devoted to the Turtle Mountain Recovery Center and the broader issue of the IMD exclusion and residential treatment capacity. Tribal leaders described the center’s opening, its five levels of care, its 16-bed limit, and its efforts to become financially sustainable through billing, grants, and partnerships. They shared success stories and argued for an IMD waiver or similar flexibility so the center could expand to 32 beds and better meet local need. Committee members discussed the policy barriers to expanding residential treatment, including federal approval timelines, state funding choices, and the need to preserve a continuum of care that includes outpatient and community-based services. The committee then heard a detailed presentation from Hector Hernandez-Dogato of the National Health Law Program on the history and mechanics of the IMD exclusion and Section 1115 waivers. He explained that the exclusion limits Medicaid payment for services in facilities with more than 16 beds, but noted existing exceptions and alternatives such as state plan options, managed care arrangements, telehealth, and community-based services. He also reviewed mixed results from states that have used IMD waivers, warning that they do not automatically improve overdose deaths, emergency room use, or access to community care, and may risk reinforcing institutionalization if not paired with strong upstream services. The committee discussed a draft bill to appropriate $49,000 and one FTE for HHS to pursue an IMD waiver, with members suggesting the bill may need to explicitly include serious mental illness as well as substance use disorder and asking for department input at a future meeting.

Transcript Highlights:

• And we estimated at that time that, at the rate things were happening, we would have 49 deaths on our
• section of my presentation, where I want to just highlight some policies and reforms that, in my estimation
• Unfortunately, though, in my estimation, the waiver in some states has been the beginning of an erosion
• The sale price of that... ...of those eight sales was $4,608,943, and there are four of those with no
• The sale price of that, of those eight sales was $4,608,943, and there are four of those with no sales

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.

Transcript Highlights:

• It's estimated there's another, at least maybe double that, with other informal acequias, but in terms
• this is done, it's going to be silly for departments to do that because there's going to be bulk pricing

Bills: SB193 , SB132 , SB35 , SB145

Committee: Senate Senate Finance

Keywords: SB193, acequia, community ditch, irrigation works construction fund, water infrastructure, ditch infrastructure, irrigation, New Mexico water law, agricultural water, farmers, Rio Grande, acequia association, forest land protection revolving fund, state fund transfer, irrigation projects, SB132, DOIT, Department of Information Technology, software replacement, equipment replacement