Transcript Highlights:

• And these are, there are some exclusions: primary care is excluded.
• And these are, there are some exclusions: primary care is excluded.
• Primary care services, behavioral health services are excluded.
• And these are, there are some exclusions, primary care is excluded.
• Primary care services and behavioral health services are excluded.

Summary: The committee first received an update on the effects of HR1 and related federal Medicaid and marketplace changes from Governor’s Office and Health Care Authority staff. Presenters said the most immediate coverage losses are expected in the individual market beginning in January, with premium increases and an estimated 80,000 people potentially unable to afford coverage. They warned that larger Medicaid impacts will follow over the next year and beyond, including tighter eligibility checks, work requirements, reduced retroactive coverage, limits on state-directed payments and provider taxes, new cost-sharing, and changes affecting certain non-citizen adults. They also said the state plans to seek a waiver or extension for work requirements and will continue to analyze impacts, including on rural providers and Planned Parenthood-related services. Members asked about the effect on nursing homes, rural hospitals, and how the state can help providers and enrollees navigate the new requirements; staff said timelines and a state-specific implementation chart are being developed. The committee then heard a report on the International Medical Graduate Work Group and Washington’s efforts to create pathways for internationally trained physicians. Testimony described the clinical experience license, the clinical evaluation assessment tool, grant funding for IMG support organizations, and a new hardship waiver process enacted this year. National presenters said many states have adopted similar pathways because of physician shortages, but Washington and Tennessee are among the few states that have actually issued licenses so far. They recommended clear guardrails, an employment offer before application, ECFMG certification, supervised practice, and data collection to avoid exploitation and protect patients. Members asked about state-to-state variation, retention of IMGs, and whether Washington should pursue dedicated residency or preceptorship options; presenters said the key next step is moving successful participants from supervised experience to a durable long-term license. The final topic was implementation of Washington’s Apple Health doula benefit and the statewide doula hub and referral system. Senator T’wina Nobles highlighted the state’s $3,500 per-birth Medicaid reimbursement rate for doulas and the importance of the hub for referrals, training, and billing. Health Care Authority staff said the benefit launched January 1, 2025, and covers prenatal intake, labor and delivery, postpartum visits, and telehealth-supported services. They reported 336 state-certified doulas, 134 enrolled in Apple Health, 287 unique clients served, and 641 claims paid so far. Testimony emphasized doulas’ role in improving birth outcomes, reducing unnecessary interventions, and addressing racial disparities in maternal health, while noting that implementation is still early and ongoing.

Transcript Highlights:

• , We are the first in the nation primary, We are the first in the nation primary, the<02:47:38.640
• primary care? primary care? >> Anyone<02:47:46.399> else?
• interdisiplinary primary care workforce. interdisiplinary primary care workforce.
• providers. their payer mix may look very different their payer mix may look very different than<02:51
• <02:57:17.760> It for primary care reimbursement. It for primary care reimbursement.

Keywords: 1189, house, all

Transcript Highlights:

• <01:37:55.199> With primary care measures, right? With primary care measures, right?
• health and primary care access burden. health and primary care access burden.
• Hampshire Cancer Registry, all payer Hampshire Cancer Registry, all payer claims<01:41:31.040>
• access to primary care. The drive times access to primary care.
• report we do an analysis of the primary report we do an analysis of the primary care<02:05:55.119

Keywords: 928, house, all

Summary: The committee first approved the draft minutes from its May 29 meeting and then received an informational update from the Commission for the Deaf and Hard of Hearing about the state’s ASL interpreter pipeline. Representative Woods and Associate Commissioner Ann Landry explained that the American Sign Language program at UNH Manchester, the nation’s first fully accredited program, is facing viability concerns because high tuition has left only two of a potential 20 students committed so far. They warned that if enrollment does not recover, the program could face a teachout and eventually be lost, which they said would be detrimental because many state services and legal proceedings require qualified interpreters. Members discussed possible alternatives, including whether community colleges could help, and asked for follow-up research and contact information for UNH officials. The committee also heard that interpreter demand across DHHS continues to rise and that the department must ensure compliance with civil rights and service-access requirements. The committee then turned to Medicaid policy changes tied to Senate Bill 134 and a new federal interim final rule on Medicaid community engagement, or work, requirements. DHHS officials Olivia May and Ann Landry explained that the state law and federal rule align in many areas, but the committee still needed to decide how to implement several remaining policy choices. The department recommended adopting all four short-term hardship exceptions because the federal rule requires states to take them all or none: inpatient or institutional care, federally declared emergencies, high-unemployment areas, and extensive out-of-state travel for serious medical care. Members generally supported the exceptions but raised concerns about how they would be defined and applied, especially the emergency and medical-travel categories. Several legislators asked for more clarity on terms like “extensively” and “serious or complex medical care,” and DHHS said the federal rule does not rigidly define them, though the state could refine implementation through rulemaking if authorized. The department also said the emergency exception would apply only to federally declared emergencies, not state declarations, and would be tied to the emergency event itself. No final vote on the Medicaid policy was recorded in the portion provided, but the discussion indicated the committee was reviewing the remaining decisions needed to implement Senate Bill 134 under the new federal framework.

Transcript Highlights:

• This is a standard billing practice in Medicare that can be incorporated for commercial payers in a less
• This is a standard billing practice in Medicare that can be incorporated for commercial payers in a less
• She was a military spouse and was charged a $300 facility fee because this was considered primary care
• You're going to be like, so 40 to 80 to 40 to 70% outpatient for outpatient payer makes square members
• For outpatient payer makes for our members, larger urban members, uninsured or Medicaid, no facility,

Bills: SB500, SB719, SB912, SB1232, SB1467, SB1777, SB1864, SB2023, SB2119, SB2458

Keywords: SB 500, Texas adoption law, Family Code, DFPS, Department of Family and Protective Services, child-placing agency, prospective adoptive parents, adoption records, confidential information, nondisclosure agreement, child history report, health history, social history, educational history, genetic history, termination of parental rights, permanency plan, single source continuum contractor, privacy, redaction

Summary: The committee first took up several pending bills and reported them favorably: SB 968, SB 636 as substituted, SB 1137, and SB 1138 as substituted. Each was advanced by roll call vote, and the committee also recommended the approved bills for the local and uncontested calendar. The chair then moved to the posted agenda and heard SB 719, a mental health bed-capacity study bill by Senator Eckhart, with a committee substitute that refined the data collection to distinguish state and non-state beds, child and adult beds, include two point-in-time counts, and capture jail diversion data. Testimony on SB 719 was largely supportive from Integral Care, NAMI Texas, and the Children’s Hospital Association of Texas, all of whom said Texas needs better data on inpatient psychiatric capacity, workforce needs, and future demand. Several witnesses described long waits for beds, especially for forensic restoration, and argued the study would help target future investments. Senator Perry and others noted the state has already made major investments in new beds and urged the bill to account for beds already coming online; the committee ultimately withdrew the substitute and left SB 719 pending after public testimony closed. The committee then heard SB 1864, which would allow small egg producers to sell ungraded eggs more broadly, including to restaurants and retailers, with the substitute increasing the weekly sales threshold and addressing sanitation and labeling. Supporters said grading is about size, not safety, and that the bill would help small farms reach new markets; opponents from the Texas Poultry Federation argued grading and candling help identify cracks and defects that can affect safety and quality. The committee adopted the substitute and left the bill pending. It also heard SB 1467, requiring DSHS to share death record information with hospitals for record accuracy and quality review, and SB 912, which would modernize continuing education tracking for health licensing agencies; both bills drew supportive testimony and were left pending. Finally, the committee heard SB 2023, which would create an HHSC grant program to help counties pay for indigent burial costs, with county representatives testifying in support.

Transcript Highlights:

• Healthcare, if over the next decade interest in healthcare are the primary drivers of U.S. sovereign
• To do that, I would say that CMS, which functions as the payer and the regulator of the private payers
• I don't think that is AHRQ's primary function historically. Okay, well great.

Keywords: artificial intelligence, waste reduction, fraud prevention, government efficiency, improper payments, data reliability, oversight

Summary: The meeting was chaired by Chairman Schweikert and involved a comprehensive discussion on how to utilize artificial intelligence (AI) for reducing waste, fraud, and improper payments within federal programs. Key witnesses, including Mr. Andrew Canarsa from the Council of the Inspectors General, provided insights on the potential of AI in enhancing government efficiency. The committee emphasized the importance of reliable data and thorough examination of AI application to avoid unintended consequences while addressing the estimated $162 billion in improper payments reported by the federal government. Concerns were raised regarding the recent firing of inspectors general and the impacts that could have on oversight and accountability processes.

Transcript Highlights:

• Our payer mix is see if they're going to get the vaccine.
• And your payer mix was interesting to me.
• Is your payer mix pretty typical?
• Our payer mix has been changing. But it has not changed dramatically.
• If I could ask, Madam Chair, could you just— I was not fast enough to write down the mix of your payers

Transcript Highlights:

• The system is the primary driver of losses in our community across rural Minnesota and the urban core
• The bill before you helps address what is widely regarded as the primary driver of pharmacy closures:
• <00:48:31.440> driver is widely regarded as the primary driver is widely regarded as the primary
• on 4.31: the commissioner must determine the quarterly payment amount using the average commercial payer
• rate or using average commercial payer rate or using another<01:37:14.360> method<01:37:15.440

Keywords: 1183, house

Transcript Highlights:

• And this bill infringes on the local and effective control already enjoyed. with by our rate payers.
• The primary concern is that...
• And the financing and the cost to the rate payer is a constant discussion on our city council.
• And this is so that current rate payers don't have to shoulder all the costs. and we can push it out
• Payers in the district, right? Or the taxpayers. Or the taxpayers. So, if...

Bills: HB1520, HB1525, HB1530, HB1535, HB2068, HB2091, HB2347, HB2372, HB2805, HB2815, HB2867, HB3154, HB3482, HB3483, HB3663, HB3781, HB3901, HB3915, HB4135, HB4153, HB4158, HB4329, HB4331

Keywords: Angelina and Neches River Authority, river authority, Sunset Advisory Commission, Texas Sunset Act, Special District Local Laws Code, local government, natural resources, board of directors, director training, board governance, public testimony, open meetings, public information, conflict of interest, ethics, complaint system, general manager, board president, staggered terms, removal of director

Transcript Highlights:

• fault of the payer. fault of the payer.
• But there's also a primary undeniable.
• <00:56:09.440> does that uh the practices of payers does that uh the practices of payers does
• It's very hard to address those things. there are too few um primary care there are too few um primary
• We're the sole provider of primary care in the Berlin-Gorham region, and recently established a primary

Keywords: 1191, senate, all

Transcript Highlights:

• current law as adopted in the 2017 federal Tax Cuts and Jobs Act, California personal income tax payers
• The primary reason for our recommendation is that we just do not view there as being a clear justification
• So the chief program was authorized by budget authorities in 2014, and so these were rate payer funds
• Right now, everything is done through rate payer funds with the IOUs.

Keywords: 988, house, all

Transcript Highlights:

• North Dakota currently has two comprehensive stroke centers, four primary stroke centers, and 30 acute
• It displays our 30 acute stroke-ready hospital centers in green, four primary stroke centers in yellow
• Have you worked with our major payers at all on this?"
• I can certainly go back and see what kind of activity we've had with some of the other payers in the
• So on the slide, I have three primary loan repayment programs for dental providers.

Summary: The committee first approved the previous meeting minutes and then heard a detailed annual report from Dr. Thomas Arnold, chair of the Maternal Mortality Review Committee, on maternal mortality trends and policy issues. He explained the committee’s review process, confidentiality protections, and national and North Dakota data showing that most maternal deaths are preventable and that mental health conditions, substance use, cardiovascular issues, infection, hemorrhage, and embolism are the leading causes. Members asked about suicide, domestic violence, midwife training, home births, and whether pregnancy testing at death scenes should be expanded; Dr. Arnold said better coroner education, more investigation of unexplained deaths, and possible post-mortem pregnancy testing could improve case identification, especially in rural areas. He also noted that deaths often occur well after 42 days postpartum and that mental health-related deaths remain a major concern. The committee then heard from State Fire Marshal Dr. Matthew Clark on cigarette reduced-ignition-propensity standards and related fire prevention issues. He recommended updating the state’s cigarette propensity law to current national standards and also raised a separate recommendation to require fast-breakaway oxygen tubing for home oxygen users, citing fatal fires linked to smoking around oxygen. Members asked about implementation, cost, insurance coverage, and whether the standards apply in tribal communities; Dr. Clark said he would provide follow-up information and was willing to help with any legislation, but no agency bill had yet been planned. Next, Christine Greff of the Department of Health and Human Services reported on the North Dakota Stroke System of Care. She described the statewide network of stroke-ready hospitals, registry-based quality improvement, and performance data showing continued improvement in stroke recognition, imaging, thrombolytic treatment, transfers, and EMS pre-notification. She highlighted new quality measures for inter-facility transfers and intracerebral hemorrhage care, and said the system remains strong but depends on continued legislative and hospital support. Committee members asked about participation by the VA hospital and were encouraged to consider outreach to include it more fully in the stroke system. Finally, the committee began a presentation on prior authorization and non-opioid pain treatment from Taha Khan of Vertex Pharmaceuticals. He argued that prior authorization can delay access to non-opioid acute pain medications, especially in the 24- to 72-hour post-discharge window when pain is most severe, and said delays can push patients toward opioids. He emphasized that prior authorization has a role in utilization management but should not create barriers in acute pain care, and he noted that current use of the company’s non-opioid product remains very low. The discussion was still underway when the transcript ended.

Transcript Highlights:

• Last year, the Secretary of State spent more money than was allocated for the 2024 primary election and
• used FY 25 funding to cover primary costs which occurred in FY 24.
• These are primary elections, general elections, and regular local elections.
• Primary and general elections occur in even-numbered years, while regular local elections occur in odd
• So that's kind of the rationale for having Medicaid be a better payer.

Bills: HB37, HB51, HB173, HB180, HB192, HB306, HB366, HB393, HB485, HB516, HB521, HB526, HB638, HB752, HB817, HB976, HB1006, HB1044

Keywords: HB37, expropriation, eminent domain, property rights, foreign entity, foreign corporation, limited liability company, LLC, reciprocal expropriation agreement, Louisiana property law, land acquisition, utility infrastructure, public utilities, railroad, waterworks, sewerage, natural gas pipeline, electric utility, telecommunications, carbon dioxide pipeline

Transcript Highlights:

• An approved mental health screener used in routine primary care visits, a maximum of one per year.

Bills: SB1290, SB1332, SB1369, SB1379, SB1381, SB1386, SB1390, SB1428, SB1584, SB1696, SB175, SB1778, SB1794, SB1806, SB1836, SB201

Keywords: 2-1-1 services, revolving fund, Department of Human Services, crisis pregnancy, abortion, legal funding, housing, infrastructure, water projects, Oklahoma Water Resources Board, economic development, zero-interest loans, clawback provision, local contractors, mental health, crisis services, 988 Lifeline, suicide prevention, behavioral health, human trafficking

Transcript Highlights:

• As noted in my testimony, how a primary care physician would view nutrition and metabolic health-based
• As noted in my testimony, how a primary care physician would view nutrition and metabolic health-based
• As noted in my testimony, how a primary care physician would view nutrition and metabolic health-based
• A physician has different areas of practice, such as, as I mentioned before, surgical, primary care,
• And, um, for example, nutrition is not a primary health care practice in Western medicine, and so, um

Bills: SB2421, SB2690, SB3103, SB3137, SB3164, SB3206, SB2933, SB3133, SB3315

Keywords: cannabis, marijuana, Hawaii Cannabis Law, legalization, decriminalization, adult use, hemp, taxation, social equity, public health, primary care, health insurance, health carrier, insurance commissioner, Med-QUEST, Medicaid managed care, provider reimbursement, downcoding, prior authorization, utilization review

Summary: The committee heard testimony on several health-related bills. HB 1864, which would require health insurance coverage for standard fertility preservation services for people undergoing medically necessary treatment, drew broad support from SHIPA, the Department of Health, HMSA, the Hawaii Association of Health Plans, and others. Testifiers emphasized that fertility preservation is routine coverage on the mainland and important for patients facing infertility from cancer or other treatment; one patient described incurring more than $20,000 in costs. The Insurance Division flagged possible Affordable Care Act issues, a potential conflict in the bill’s language about using patient history to determine limits, and a mismatch with state medical-necessity standards. Committee discussion also focused on whether the bill should apply to all women of childbearing age rather than a narrower age-based category. HB 2305 would require nutrition and metabolic education as part of physicians’ continuing medical education. The Hawaii Medical Board opposed the measure, arguing that CME should remain flexible and tailored to each physician’s specialty and warning that topic-specific mandates can expand over time. The Office of the Governor supported the bill, saying it would help the state’s rural health transformation application and could improve federal funding prospects, though the exact impact was unclear. Members questioned whether nutrition is already covered in medical training and whether the requirement should be limited to primary care physicians; the board said Hawaii currently has no topic-specific CME mandates and that physicians can already choose relevant courses. The committee also heard strong support for HB 1597, which would establish an Alzheimer’s disease research center at the University of Hawaii. Supporters from the university, the Alzheimer’s Association, AARP, and others said the center could attract federal research dollars, expand clinical trials, and help address the state’s high Alzheimer’s-related health costs. HB 2159, which appropriates funds for health care workforce development, also received broad support from the University of Hawaii, health systems, and advocacy groups, with no opposition noted. Finally, HB 2121, which would prohibit the sale and distribution of disposable electronic smoking devices, drew support from the Department of Health, youth advocates, and public health groups citing youth addiction, environmental waste, and fire hazards; the department said a separate bill, HB 1573, would be more comprehensive and better defined for enforcement and penalties. The committee ended with HB 1913, creating a veteran services mental health coordinator position at Tripler Army Medical Center, which was supported by veteran services officials and others who said veterans need better navigation and coordination for behavioral health care.

Transcript Highlights:

• But now referral agencies are the primary way we get our our customers.

Bills: HB 1531, HB 2667, HB 2809, HB 2865, HB 3589, HB 3151, HB 3748, HB 3750, HB 4419, HB 4643, HB 3597, HB 4129, HB 4130, HB 4131

Keywords: workplace violence prevention, health and safety code, Chapter 331, facility definition, home and community support services agency, home health agency, home health care, nursing staff, registered nurses, health care workplace safety, hospital, nursing facility, ambulatory surgical center, freestanding emergency medical care facility, mental hospital, Texas health care regulation, provider compliance, occupational safety, senior living, referral agencies

Transcript Highlights:

• These are the primary way we get our customers.

Bills: HB1531, HB2667, HB2809, HB2865, HB3589, HB3151, HB3748, HB3750, HB4419, HB4643, HB3597, HB4129, HB4130, HB4131

Keywords: workplace violence prevention, health and safety code, Chapter 331, facility definition, home and community support services agency, home health agency, home health care, nursing staff, registered nurses, health care workplace safety, hospital, nursing facility, ambulatory surgical center, freestanding emergency medical care facility, mental hospital, Texas health care regulation, provider compliance, occupational safety, senior living, referral agencies

Transcript Highlights:

• Chair Rhoads, Federally Qualified Health Centers (FQHCs) are non-profit primary care providers that serve
• They bring the primary care there that we need.

Bills: HB1531, HB2667, HB2809, HB2865, HB3589, HB3151, HB3748, HB3750, HB4419, HB4643, HB3597, HB4129, HB4130, HB4131

Keywords: workplace violence prevention, health and safety code, Chapter 331, facility definition, home and community support services agency, home health agency, home health care, nursing staff, registered nurses, health care workplace safety, hospital, nursing facility, ambulatory surgical center, freestanding emergency medical care facility, mental hospital, Texas health care regulation, provider compliance, occupational safety, senior living, referral agencies

Transcript Highlights:

• community supervision including deferred adjudication community supervision of a defendant who is a primary

Bills: SJR34, SB10, SB18, SB19, SB21, SB72, SB140, SB262, SB370, SB480, SB495, SB627, SB703, SB767, SB790

Keywords: parental rights, parents, children, custody, care and control, upbringing, family law, constitutional amendment, Texas Constitution, child welfare, education policy, medical decisions, parental authority, primary decision makers, family autonomy, education, Ten Commandments, public schools, religious display, First Amendment

Transcript Highlights:

• I am the owner and president of Integrative Medical Center of New Mexico, where I provide primary care
• There are some estimates that by 2030, we'll be short 2,000 primary care doctors in our state.
• But they're not primary care physicians, and they're not thinking about your health care maintenance.
• So that does, with Medicaid, as you all know, being our primary payer, to me color differently what it
• So we have more Nurse practitioners and physician assistants are providing primary care.

Keywords: 996, all