Transcript Highlights:

• <00:46:22.720> The<00:46:22.880> acuity<00:46:23.440> issues<00:46:24.000>
• The acuity issues are residential care. The acuity issues are more<00:46:24.640> intense.

Keywords: 958, all

Summary: The meeting opened with roll call, approval of the September 17 minutes, and an introduction of Sarah Rome to the committee. The chair also noted that the committee would stay on schedule and then moved to presentations. Representative Amy Neighbors and Taylor Williams of the Kentucky Pharmacists Association presented a refiled “pharmacy parity” proposal, formerly House Bill 3, to require Medicaid reimbursement for pharmacist clinical services already authorized under current scope of practice. They said the bill would not expand Medicaid or pharmacist scope, but would align Medicaid with commercial insurance, improve access and outcomes, and likely save money; they cited a Cabinet report under Senate Joint Resolution 26, which found similar laws in other states were producing savings or trending toward savings and would require only modest administrative updates. No member questions were raised after that presentation. The committee then heard an update on the Kentucky Colon Cancer Screening Program from Senator Stephen Meredith, Dr. Whitney Jones, Melissa Carrier, and Representative Neighbors. They described the program’s goals of increasing screening, reducing deaths through earlier detection, and preventing cancers by finding polyps, saying it has produced substantial savings and improved outcomes. Speakers emphasized Kentucky’s high colorectal cancer burden, especially in younger adults, and said the program helps uninsured and underinsured Kentuckians access stool-based screening and follow-up colonoscopies through a network of partners including the Department for Public Health, Kentucky Cancer Link, and university cancer programs. They requested an increase in funding from $500,000 to $1.25 million annually, or $2.5 million over the biennium, to expand services, fill geographic gaps, and support education and navigation. Members asked whether the colon cancer screening was already covered by Medicaid, and the presenters replied that Medicaid does cover it, but the program serves people who are not on Medicaid or who fall into a separate eligibility category based on income and insurance status. A member also clarified the requested funding increase. The committee then moved on to the next agenda item, an update from the Children’s Home of Northern Kentucky, where board member Sal Santoro and CHNK Behavioral Health leaders began a presentation describing the organization’s broader behavioral health work and its request, but the transcript cuts off before that presentation concludes or any action is taken.

Transcript Highlights:

• However, under that system, children with the highest acuity of needs have to move into a specific type
• Children with the highest acuity of needs have to move into a specific type of placement setting in order
• needs, not the placement type, ensuring that all children can have their needs met at any level of acuity

Summary: The Assembly Budget Subcommittee on Human Services held an informational hearing on child welfare, foster care, child support, and related prevention efforts. The chair opened by emphasizing mandated reporting reform, foster care system improvements, and community-based prevention, and noted that no votes would be taken. Public testimony focused first on mandated reporting, where a lived-experience advocate and several organizations argued that the current system overreports families, especially Black, Native, and Latino families, causes trauma, and should be reformed through standardized training, clearer thresholds, and stronger community supports rather than more hotline referrals. Casey Family Programs cited data showing nearly 90% of reports are unsubstantiated, while CDSS said it is already forming a Mandated Reporting Advisory Committee, updating training, and exploring community pathways and possible changes to the list of mandated reporters. CWDA and SEIU supported training and alternative response concepts but stressed child safety, county capacity, funding, and the need for careful implementation and accountability. The committee then discussed a proposal to create a foster care multi-agency office within the California Health and Human Services Agency, led by a chief foster youth advocate with authority to coordinate across departments. Advocates said foster youth often need services from education, health, housing, and behavioral health systems that do not coordinate well, and argued that a central office with real authority could improve placement stability and access to services. CDSS responded that existing structures already provide coordination, including AB 2083 interagency teams, the Child Welfare Council, complex care steering committees, and the foster care ombudsperson, but said it was open to technical assistance. Members raised concerns about whether the new office would have enough authority and funding to avoid becoming another layer of bureaucracy, and the chair emphasized the need for real “teeth” and better interagency action. The final major topic was the continuation and expansion of Promise Neighborhoods. A community leader described strong early results from the state-funded neighborhoods, including improved kindergarten readiness, reduced chronic absenteeism, higher graduation rates, food access, housing supports, and mental health services, but warned that current funding sunsets in June 2025 and that a fiscal cliff could jeopardize staff and services. CDSS said the four funded neighborhoods have reported positive outcomes and valuable flexibility, but also noted challenges with one-time funding, student mental health, and long-term planning. Assemblymember Mia Bonta urged continued investment, saying the place-based model is difficult to rebuild once lost, and the chair asked LAO to help identify the minimum funding needed to preserve the existing infrastructure while evaluation results are still pending.

Transcript Highlights:

• higher-level skilled nursing facility slash nursing home, where you need round-the-clock care there for your acuity

Keywords: 994, senate, all

Summary: The committee met with a quorum present and heard a presentation from Marty Wright, CEO of the West Virginia Healthcare Association, on the state’s long-term care system. He described the continuum from home care to assisted living to skilled nursing facilities, emphasizing that these settings increasingly serve short-term rehab-to-home patients as well as older adults needing round-the-clock care. He also outlined the number of facilities in West Virginia, the predominance of Medicaid as the payer for long-term nursing home care, the private-pay nature of assisted living, and the role of OFAC/CMS in regulation. A major focus of the presentation was workforce shortages and turnover, especially for CNAs, LPNs, and RNs, along with declining interest in nursing careers and the impact of regulatory burden and burnout. Wright said the system is also struggling to serve younger patients with substance use disorder, mental illness, or other behavioral needs, who are often not well suited for traditional nursing home placement but have limited alternatives. Senators raised concerns about where such patients are being housed, the long-term effects of opioid and behavioral health issues, and the gap between school-age special needs populations and adult care needs. Wright said Medicaid can cover long-term nursing home care for those who meet financial and medical eligibility requirements, but affordability and spend-down requirements remain major barriers. He also warned that Medicare Advantage can create confusion and shorter covered stays for rehab patients, and he urged early planning around long-term care insurance and estate planning. No votes were taken on the presentation, and the committee adjourned after questions and discussion.

Transcript Highlights:

• Again, there is reduced access to hospital beds for high-acuity patients. There is staff burnout.

Summary: The meeting focused on hospital “avoidable days” and the difficulty of discharging medically stable patients who still need post-acute placement or social services. Presenters from Saint Anthony Hospital Midtown, the Oklahoma Hospital Association, City Care, and OU Health described common barriers including lack of skilled nursing, rehab, long-term care, behavioral health, and hospice placements; insurance prior authorization delays; Medicaid and Social Security eligibility delays; guardianship and Adult Protective Services bottlenecks; limited home health and private duty nursing; and the challenge of placing unhoused, uninsured, or medically complex patients. Several speakers emphasized that these delays reduce bed availability, increase emergency department boarding, contribute to staff burnout, and expose patients to hospital-acquired conditions and other harms. The testimony included multiple examples of patients remaining in acute care for days, weeks, or even months after being medically ready for discharge, including patients awaiting guardianship, disability determinations, or placement in facilities willing to accept them. Speakers also highlighted special populations such as patients with behavioral health or substance use disorders, medically fragile children, patients with criminal histories, and unhoused individuals who need respite or hospice care. City Care described its planned 40-bed medical respite facility, set to open in 2027, as a way to provide clinical support and housing navigation for patients too sick to recover on the street or in shelters. Witnesses recommended policy and system changes such as standardizing preauthorization protocols, expanding rural swing-bed and home-based services, increasing public guardianship resources, improving data collection on homelessness, expanding private duty nursing hours, and creating more placement options for complex patients. They also suggested better coordination between hospitals, DHS, APS, the Health Department, and post-acute facilities, including a database of facility services to improve discharge planning and keep patients closer to home. No votes or formal committee actions were taken in the transcript, but the chair indicated the issue would require collaboration across multiple agencies and partners.

Transcript Highlights:

• accessibility and provide the space for Minnesota's most vulnerable children to have access to the high-acuity
• have access to vulnerable children to have access to the<00:51:09.040> high<00:51:09.280> acuity
• c> that<00:51:10.480> they<00:51:10.720> need<00:51:11.200> and the high acuity
• care that they need and the high acuity care that they need and give<00:51:11.839> children,<
• over 400 men and women on any given day living with chronic substance use disorder and very high acuity

Bills: HF2434

Keywords: healthcare, personal care assistance, worker retention, disability services, state funding, 1183, house

Transcript Highlights:

• people are in danger of losing residential services and then anything else we can use to find high-acuity
• people are in danger of losing residential services and then anything else we can use to find high-acuity
• people are in danger of losing residential services and then anything else we can use to find high-acuity
• we can use to and then anything else we can use to find<02:19:39.359> high<02:19:39.760> acuity
• find high acuity people that we serve. find high acuity people that we serve.

Keywords: 1187, senate, all

Transcript Highlights:

• There are a number of studies about the relationship between hearing loss and cognitive acuity, hearing
• There are a number of studies about the relationship between hearing loss and cognitive acuity, hearing

Keywords: 995, all

Summary: The Joint Committee on Financial Services held a public hearing on a wide range of bills, with testimony first focused on H. 1315/S. 824, which would require insurance coverage for pain management options during IUD insertion. Representative Sabadosa, Planned Parenthood clinicians, and policy advocates said sedation can reduce fear and trauma, improve access to effective contraception, and should be reimbursed so providers can continue offering it. A Tufts OB-GYN resident also testified that pain control should be standard care for intrauterine procedures. No votes were taken during the hearing. The committee then heard extensive testimony on firefighter health bills, especially H. 1230/S. 690 requiring insurance coverage for cancer screenings for firefighters. Professional Fire Fighters of Massachusetts leaders, a Dana-Farber oncologist, and firefighters themselves described occupational exposure to carcinogens and personal stories of late-stage cancer detection, arguing that early screening can save lives and reduce long-term costs. Representative Crichton and Representative Howitt also spoke in support, and Representative Ayers testified for H. 4012, which would require neurological disorder screenings for firefighters. Committee members expressed support and sympathy, but no action was taken. The hearing also covered H. 3946/S. 756 on hearing aid coverage, with testimony from students, adults with hearing loss, disability advocates, and HLAA representatives describing the educational, social, and financial barriers caused by lack of coverage and urging broader insurance mandates. Later, Representative Donahue and Representative Vargas testified for H. 1337 to expand insurance coverage for opioid antagonists and related medications, including naloxone dispensed at discharge. The committee additionally heard testimony on H. 1134 to improve chronic pain care coordination and non-opioid access, and H. 4162 to improve ostomy supply coverage and access to certified ostomy care, with patients and clinicians describing denials, quantity limits, and non-medical switching. The transcript ends while testimony on H. 1315/S. 824 is still ongoing; no votes or formal committee actions are recorded in the excerpt.

Transcript Highlights:

• long-term care facilities, in particular our Vietnam-era veterans, we do see them presenting with higher acuity
• long-term care facilities, in particular our Vietnam-era veterans, we do see them presenting with higher acuity

Keywords: 987, senate, all

Summary: The subcommittee heard a budget item on vehicle license fee backfill funding, where the Department of Finance said the administration was not proposing the requested $119 million for San Mateo County, Alpine, and Mono, arguing the payment is discretionary and that existing excess ERAF formulas should remain unchanged. Senator Becker and former Senator Jackie Speier testified that the money is owed under the VLF swap arrangement and that San Mateo County faces major service cuts without the backfill; Senator Cabaldon raised broader policy questions about county boundaries and the structure of the formula. The chair held the item open after public comment. The committee then reviewed Secretary of State budget proposals. The department requested funding for SB 851 implementation, including additional duties related to election litigation notice, voting system standards, and vendor reporting, with $1.1 million General Fund in 2026-27 and $807,000 ongoing for four positions and software. Members asked about election security, federal HAVA funding, staffing, and implementation timing; the department said current federal funds are expected to run out in 2027-28 and that it hopes to hire quickly once funded. The item was held open. The Secretary of State also presented the Cal Access Replacement System (CARS), seeking $11.8 million General Fund to finish the project and begin operations, and the notary automation replacement project, seeking $9.795 million in Business Fees Fund for continued development of the outdated notary system. Members focused on project delays, stakeholder input, and whether the funding requests matched prior plans; the department said both projects were still on their original funding tracks but had shifted timelines due to planning needs and election-related workload. Both items were held open. CalVet presented its department overview and then discussed the new 240-bed skilled nursing facility at Yountville, which is nearing completion and will replace the aging Holderman Hospital building. Members asked about the future of Holderman, other campus capital projects, and a payroll/fringe-benefit issue affecting some employees; CalVet said Holderman will continue to house some functions, the roofing and steam projects remain in progress, and the tax issue has been addressed with new procedures and repayment arrangements. The committee also discussed eliminating vacant positions under Control Section 4.12, with CalVet saying the positions were long-vacant CNA and related jobs and the LAO noting the Legislature had not concurred; Senator Cabaldon said he had no objection, and the item was held open. Finally, the California Arts Council gave an overview of its work and its cultural districts program, describing grants and technical assistance in all 58 counties and citing examples of local impact. Senator Smallwood-Cuevas strongly supported additional funding, including a proposed $50 million General Fund investment and a $10 million carve-out for cultural districts, arguing the program supports economic development, preservation, and community identity; council staff said the program is currently unfunded and has only been able to designate a fraction of applicants. Senator Cabaldon noted that many parts of the state still lack cultural districts and urged broader geographic representation. The item was informational and no vote was taken.

Transcript Highlights:

• And the most high acuity examples of that for us are the out-of-state instances that we know about.
• And the most high acuity examples of that for us are the out-of-state instances that we know about.

Bills: SB97, SB55, SB40, SB38, SB120, SB113, SB116, SB117, SB118

Keywords: tax credits, municipality, county property, industrial revenue bonds, economic development, qualified expenditures, solar energy, tax credit, renewable energy, photovoltaic, solar thermal, New Mexico, economic incentive, energy independence, SB40, Driver Privacy and Safety Act, automated license plate reader, ALPR, license plate reader, vehicle surveillance

Transcript Highlights:

• Think of it like acuity. So they may require up to an additional 90 days to succeed.
• Think of it like acuity. So they may require up to an additional 90 days to succeed.

Bills: HB2076, HB2135, HB2175, HB2186, HB2223, HB2345, HB2364, HB2417, HB2440, HB2666, HB2763, HCR2043

Keywords: school safety, employee training, firearm certification, crisis response, school policies, reimbursement fund, local law enforcement, HB2135, Arizona, civil liability, private right of action, DEI, diversity equity and inclusion, critical race theory, anti-racism, race stereotyping, sex stereotyping, race scapegoating, sex scapegoating, gender identity

Summary: The Judiciary Committee heard and advanced several bills. HB 2763 would require legislative approval before the Arizona Game and Fish Commission could close a state-run shooting range. Supporters, including the sponsor, a Prescott doctor, gun-rights advocates, and Game and Fish, argued that range closures can push shooting into unsafe desert areas and that the legislature should have a voice; the bill passed 8-1. HB 2417 would let courts, at a defendant’s request, use speed-inhibiting devices instead of license suspension for certain speeding and racing offenses. The sponsor and supporters said it would help people keep working and reduce recidivism, while an Arizona Trucking Association representative warned the bill was overbroad and conflicted with federal law; the committee adopted an amendment and passed the bill 7-2. HB 2345 created a felony for unlawfully present persons possessing falsified CDLs and imposed vehicle forfeiture and employer penalties; trucking industry testimony said it was preempted by federal law and unenforceable, but the sponsor said he would keep working on it, and the bill passed 5-3 with one present after amendment. The committee also considered HB 2666, which increases penalties for sexual extortion involving victims ages 15-17. The sponsor and supporters from the anti-trafficking community and county attorney’s office said the bill responds to a serious and growing online exploitation problem affecting teens. Defense and juvenile-justice concerns focused on whether the bill could sweep in minors, create mandatory consecutive sentences, and fail to account for age-related defenses; the sponsor and supporters said they were open to discussing amendments, but the bill passed 8-0 with one present. HB 2175 would add political expression and political affiliation to Arizona’s bias-crime sentencing enhancements and create new misdemeanor-level enhancements for certain bias-motivated offenses. The sponsor, ADL, and county attorney’s office said it fills gaps and targets conduct, not speech; the ACLU and defense testimony warned it could chill speech and give prosecutors too much discretion. The bill passed 6-2 after amendment. HB 2186 would allow a passenger in a traffic stop to satisfy identity requirements by verbally providing name and date of birth rather than producing physical ID. The sponsor said it was meant to fix an unconstitutional-vagueness problem and clarify the law after a prior court issue; there was little opposition, and it passed 7-0 with one present. The committee also began hearing HB 2364, which would add penalties for distributing or receiving abortion-inducing drugs by courier, delivery, or rail service; the sponsor said it would strengthen enforcement of existing Arizona restrictions, but the transcript cuts off before testimony, debate, or any vote on that bill.

Transcript Highlights:

• It's based on the acuity of the resident mix.
• It's based on the acuity of the resident mix.

Keywords: 1191, senate, all

Transcript Highlights:

• I happen to be a home base for a lot of high-acuity patients in the Medicare managed care program.

Keywords: 999, senate, all

Transcript Highlights:

• I happen to be a home base for a lot of high-acuity patients in the Medicare managed care program.

Summary: The Legislative Budget Commission considered 21 budget amendments, most of them routine authority adjustments tied to federal grants, Medicaid payment programs, and trust fund realignments. The Department of Education received $14.751 million for a Preschool Development Grant to support early learning system improvements, workforce credentialing and training, IT modernization, and related early childhood certification work. The Department of Veterans Affairs shifted $2.2 million within its trust fund to cover higher nursing home occupancy, replace contract nursing with OPS staff, and meet rising operating costs. The Department of Health moved about $9.1 million to support Disability Determinations, where roughly 140,000 cases were pending or in process, and said the change would help reduce backlog and avoid a deficit. The Agency for Health Care Administration presented multiple amendments for Medicaid-related programs, including $766 million for indirect medical education, $1.9 million for managed care network adequacy audits, $209 million for the Rural Health Transformation Program, and several large supplemental payment programs for hospitals and physicians; members asked about CMS approval delays, provider access, and how rural funds would be distributed. The commission also adopted an amendment realigning KidCare funds, placing a $32.1 million surplus into reserve, though several members objected that the state had not yet implemented the 2023 KidCare expansion and that children remained on a wait list. Another Medicaid amendment placed a $376 million surplus into reserve after updated estimating conference projections. Other agencies also received approvals. FDLE received $16.26 million to buy counter-unmanned aircraft systems equipment such as radar and RF sensors to detect and mitigate drone threats. The Department of Juvenile Justice received $1.6 million for the Florida Scholars Academy and a Social Services Block Grant realignment, with staff confirming corrective action had been taken after prior audit findings about allowable SSBG spending. The Division of Emergency Management received federal pass-through authority for FIFA World Cup security and counter-UAS funds, both controlled by the Miami host committee, and members noted the state had little direct oversight over how those local grants would be used. The Department of Commerce received $148.4 million for Community Development Block Grant Disaster Recovery work, with questions focused on the split between housing, infrastructure, and administrative costs. The Department of State received $408,377 for arts and culture federal grant obligations. All amendments were adopted, generally without objection, after brief questioning and no public testimony.

Transcript Highlights:

• home rates are adjusted twice a year, and they're based on what's called case mix, so the medical acuity
• home rates are adjusted twice a year, and they're based on what's called case mix, so the medical acuity
• home rates are adjusted twice a year, and they're based on what's called case mix, so the medical acuity
• home rates are adjusted twice a year, and they're based on what's called case mix, so the medical acuity
• patients is the professional high Acuity patients is the professional fees<03:13:28.239> and<

Keywords: 1191, senate, all

Transcript Highlights:

• And we do stratify our medical patients into an acuity risk.
• So typically with panels, you try and balance them, you know, with so much acuity, so you’re not concentrating
• So typically with panels, you try and balance them, you know, with so much acuity, so you're not concentrating

Keywords: 987, senate, all

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

Transcript Highlights:

• Despite the trials, high acuity, and constant demands of emergency and burn care, they consistently provided
• <01:14:03.280> the<01:14:03.400> trials,<01:14:03.960> high<01:14:04.120> acuity
• ,<01:14:04.640> and Despite the trials, high acuity, and Despite the trials, high acuity,

Bills: HF4343

Keywords: sales tax, use tax, advertising tax, taxable services, digital advertising, online marketing, marketing services, search engine marketing, lead generation, internet advertising, ad agency, media buying, campaign planning, Minnesota tax law, service tax, broadening tax base, web advertising, promotional services, 1183, house

Transcript Highlights:

• This changed how rates were determined based on the person's level of acuity or level of need.
• determined based on the person's level determined based on the person's level of<00:42:17.200> acuity
• <00:42:19.200> This<00:42:19.440> was<00:42:19.520> a of acuity or level of
• This was a of acuity or level of need.

Bills: HF3379

Keywords: housing stabilization, disability services, predatory funding, provider requirements, housing accessibility, 1183, house

Transcript Highlights:

• Medicaid managed care rates in 2025, largely increases to their capitation rates to respond to rising acuity
• > rising capitation rates um to respond to rising capitation rates um to respond to rising acuity
• <00:28:18.000> So,<00:28:18.159> these acuity among their population.
• So, these acuity among their population.

Keywords: 1187, senate, all

Transcript Highlights:

• Right now, we have to really think out of the box for folks in the acuity, severity, and chronicity of
• <01:04:54.400> folks<01:04:54.720> in<01:04:54.960> the<01:04:55.119> acuity
• ,<01:04:55.680> severity, box for folks in the acuity, severity, box for folks in the acuity

Bills: HF2435

Keywords: healthcare, dementia services, public health funding, opioid prevention, women's health, community health boards, mental health, 1183, house

Transcript Highlights:

• Our previous speaker talked about the acuity levels of our residents matching the needs for supportive
• increase<00:24:49.080> in<00:24:49.240> the<00:24:49.480> acity<00:24:50.279> Acuity
• <00:24:50.760> of<00:24:50.919> service increase in the acity Acuity of service increase
• in the acity Acuity of service needs<00:24:51.679> that<00:24:51.799> were<00:24:52.159

Keywords: 1187, senate, all