Transcript Highlights:

• Because I thought critical access was limited to 25 patient beds.
• about 20 long-term care patients.
• It won't necessarily be a physician working with a patient.
• I do not want to be part of destroying the money coming in for our patients.
• I do not want to be part of destroying the money coming in for our patients.

Bills: HB1623

Committee: Joint Appropriations

Summary: The committee first heard House Bill 1624, the “Universal Lunch Bill,” from Rep. Mike Nathie. He argued the proposal should be placed in Century Code rather than the Constitution so future legislatures can adjust it if state finances tighten, and said the bill would start the program a year earlier with a $65 million appropriation for one school year. DPI testified that the estimate did not include nonpublic schools that do not participate, and members questioned the impact on Title I, free-and-reduced applications, private-school accountability, breakfast mandates for schools that do not currently serve breakfast, and whether the funding could come from the DPI budget or other sources. Supporters, including North Dakota United, the North Dakota Catholic Conference, a pediatrician, and the American Heart Association, said universal meals improve student health and learning, reduce family costs, and are better handled in statute than by constitutional amendment. No opposition testimony was offered, and the chair closed the hearing for later work-session action. The committee then took up House Bill 1627, introduced by Rep. Tye Dressler, which would raise the income threshold for the state-funded school lunch program from 225% to 300% of poverty, with an estimated cost of about $7 million for 2026-27. Dressler said the bill is intended as a targeted, budget-friendly alternative to the ballot measure and emphasized that the state should maximize federal meal dollars while improving participation in the current program. Members questioned whether raising the threshold would actually increase utilization, whether a dollar amount would be clearer than a percentage, and how the change would affect federal reimbursements and application rates. DPI said it could quickly calculate additional percentage levels, and the chair closed the hearing, directing DPI to prepare more numbers for the work session. Finally, the committee opened Senate Bill 2403, presented by Sen. Schiable, to create a short-term bridge-loan program for financially distressed hospitals, centered on Jacobson Memorial Hospital in Elgin. The bill would authorize up to $5 million per loan, with a $10 million appropriation available on a first-come, first-served basis, and would run only through June 30, 2027. Schiable said the hospital’s debt and operating problems threaten local health care, ambulance service, and the community’s economy, and that the proposal was designed narrowly with Bank of North Dakota review to avoid creating a broad precedent. Committee members asked whether the appropriation could be reduced and whether the bank would still apply commercial feasibility and repayment standards; Schiable said yes, the bank would still evaluate the loan and could reject it if it was not sound.

Transcript Highlights:

• Gladly, the Health Benefit Coverage of Hair Processes for Cancer Patients referred to the Committee on
• preferential voting of certain elections, HB 541 by Shaheen, relating to the provision of direct patient
• amendment requiring the state to expand eligibility for Medicaid. to certain individuals under the Patient
• and appealing the requirement that an officer against the Articles of Impeachment who have been preferred
• proposing a constitutional amendment authorizing a statewide referendum allowing voters to indicate a preference

Transcript Highlights:

• underinsured patients under federal law<00:37:40.800><c> patients</c><00:37:41.520><c> receiving</c>
• <00:37:41.880><c> these</c> law patients receiving these law patients receiving these 1781<00:37:43.880
• </c> savings received by these patients savings received by these patients assuming<00:38:19.280><c>
• </c> project so do you know if any patients project so do you know if any patients were<00:51:55.280>
• our patients.

Committee: House Consumer Protection & Commerce

Summary: The committee heard several measures, beginning with SB 1046 SD1 on condominiums. Testimony on that bill focused on reserve funding and enforcement of reserve study requirements. The Community Associations Institute opposed the bill, saying it would create hardship, confusion, and be difficult to administer, while also urging stronger penalties for boards that fail to comply with reserve study rules. The Real Estate Commission offered comments, and one testifier spoke in support. No vote was taken during the portion provided. The committee then heard SB 532 SD2 HD1 relating to the Department of Education, which would improve access to pre-approved medications for students with health conditions at school and during off-campus activities. The Department of Health, University of Hawaiʻi nursing and medical programs, and the Department of Education all supported the measure, with DOH suggesting amendments to better identify the correct student and improve medication safety. Members had no questions, and the bill moved on. Next was SB 1245 SD2 HD1 relating to pharmacists, a bill to allow reimbursement for clinical services pharmacists are already trained and licensed to provide. The University of Hawaiʻi, Board of Pharmacy, Walgreens, Mikai Drugs, and the Hawaiʻi Pharmacists Association supported the bill, emphasizing improved access to care, recruitment and retention of pharmacists, and better chronic disease management. The Hawaiʻi Pharmacists Association also discussed proposed amendments to prevent plans from denying coverage or network participation when pharmacists meet credentialing requirements. Members questioned whether insurers would actually use pharmacists and how the bill would affect pay and contracting; no vote was taken in the excerpt. The committee also heard SB 1279 SD2 HD1, another pharmacists bill focused on telepharmacy and 340B-related issues. The Department of Corrections and Rehabilitation supported it, saying telehealth could reduce costs and avoid travel for audits, while the Board of Pharmacy opposed it. Lānaʻi representatives opposed the bill and asked for an exemption, arguing the island already has close in-person access to a resident pharmacist and clinics. The Hawaiʻi Primary Care Association supported the measure, citing large patient savings from 340B pricing, while Mikai Drugs opposed it, arguing that mail-order and telepharmacy are not necessary on some islands and can create delivery and medication-safety problems. Members asked questions about insurer participation, scope of practice, and whether the bill would meaningfully change reimbursement; the transcript ends before any final action or vote.

Transcript Highlights:

• . ...seriously injured patients, so to reduce their injuries and care for them in a timely manner.
• </c><01:13:35.480><c> drug</c> what drugs are on our preferred drug what drugs are on our preferred drug
• </c> professional input about the preferred professional input about the preferred drug<01:13:44.520>
• If they can't move that patient off the floor, then they're backed up; the ER's backed up.
• </c> liabilities to make sure the patient liabilities to make sure the patient actually<01:25:52.600>

Committee: House Health Finance and Policy

Transcript Highlights:

• First, would you prefer the sections or the titles?
• Patients don't suffer.
• I think we can all agree on patient privacy, patient safety.
• We started by focusing on the patient protection piece, knowing that under law, Patients are protected
• fee if the patient canceled for the person.

Committee: House House Health & Human Services

Transcript Highlights:

• I think that there will always be categories. categories of patients, subcategories of patients in every
• patient visits are outpatient.
• Patients don't even know what a facility fee is.
• patients. like those battling cancer.
• Okay, and so these patients would...

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

Committee: Senate Health & Human Services

Transcript Highlights:

• Many carless people would prefer lower rent over a parking spot.
• I mean, but I would prefer, we're asking for a city, not town. I come from a town, Alda, Gregory.
• So Madam Chair, Senator, you would prefer a table? Opposed to pulling it back, yes.
• It's a crazy process coming from a metro area and how long we've got to take these patients.
• It's a crazy process coming from a metro area and how long we've got to take these patients.

Bills: SB211 , SB131 , SB183 , SB222 , SB246 , SB254

Committee: Senate Senate Health & Public Affairs

Transcript Highlights:

• areas needing investigation include long COVID treatment, the implementation of the New Hampshire Patient
• Some doctor office who decided to use this document to inform their patients—what's the nature of this
• for me, it looks like it's a good example of what one chain medical provider communicates to the patients
• >> I would prefer to do it now, uh, basic discussions. All right.
• But I would prefer that at least be safe because it's an important part and it was...

Summary: The Special Committee on COVID Response Efficacy met to review its mission, approve prior minutes at a future meeting, and discuss materials related to COVID-19 vaccination guidance. Members examined a pediatric vaccination handout from a private pediatric practice and compared it with New Hampshire DHHS and AAP/AAFP immunization guidance, focusing on how COVID-19 vaccine recommendations are presented for children and adults. Committee members also discussed the scope and accuracy of the committee’s endnotes and supporting documents. The main business was a draft letter urging the governor to direct state agencies to stop recommending COVID-19 mRNA vaccines. Members revised the letter paragraph by paragraph, including changing wording about age ranges for children, clarifying references to the American Academy of Pediatrics, and adding discussion of vaccine safety concerns, alleged suppression of safety data, and federal investigations. They also debated whether to reference specific reporting systems such as VAERS and V-safe, and whether to include examples from other states, including Tennessee, Arizona, Minnesota, and Florida, as evidence of broader concern about mRNA vaccines. After the edits were completed, Representative Villio moved to accept the letter as amended, Representative Leroy seconded, and the committee approved it by voice vote 4-0. The chair said the revised letter would be finalized and distributed later in the week. The meeting then adjourned at approximately 11:57 a.m.

Transcript Highlights:

• gap between the hospitals are paid by Medicaid and the actual cost of delivering care to Medicaid patients
• I prefer end the set for 3.6 prevent document pending approval with CMS to increase that to 7.8 billion
• Also to address the wait time for patients seeking care?
• Wait times as somebody receiving Medicaid, new patients. Can somebody get employment within ever?
• That limits for the non Medicaid. >> Patients. My other question, sir, is on Page 6 of your slides.

Transcript Highlights:

• This is a... ...pharmaceutical therapy for patients.
• It's essential to my ability to continue to provide care to my patients.
• Protecting provider safety protects patients' access to care.
• It's essential to my ability to continue to provide care to my patients.
• Protecting provider safety protects patients' access to care.

Summary: The committee heard testimony on several bills, beginning with House Bill 2333, which would expand protections for elected officials, candidates, executive state officers, election officials, and criminal justice participants by allowing address confidentiality, redacting campaign and property records, increasing some penalties for threats, and authorizing security assessments and reimbursement for personal security measures. The prime sponsor and supporters described rising political violence and personal threats, while opponents and agency staff raised concerns about implementation, constitutional issues, public-records transparency, costs, and whether the bill would actually prevent determined actors from finding addresses through other sources. The Secretary of State’s office, county officials, and the Public Disclosure Commission said the bill would create major logistical and fiscal challenges, while prosecutors, judges, and advocacy groups testified that the protections were needed for safety and retention in public service. House Bill 2176 would make collaborative drug therapy agreements confidential under the Public Records Act except when the agreement is the basis for a disciplinary action, in which case only relevant information would be disclosed with personal information redacted. The sponsor and supporters, including pharmacists, physicians, and reproductive-health advocates, said the bill would protect clinicians from harassment and out-of-state targeting while preserving accountability for misconduct. News media representatives and open-government advocates said the underlying agreements should remain accessible only in limited circumstances and emphasized the balance between privacy and transparency. Committee members also discussed how the bill would affect access to the agreements and the scope of disclosure. House Bill 2120 would eliminate two JLARC reporting requirements: the biennial report on municipal lodging-tax revenues and the periodic evaluation of the training benefits program. The bill’s sponsor and JLARC leadership described it as a cost-saving measure that would free staff for other audits, while the hospitality industry supported tourism funding but warned that the lodging-tax report provides useful oversight and accountability. The committee also received staff briefings on House Bill 2244, which would implement multiple Public Records Exemptions Accountability Committee recommendations by changing confidentiality rules in 13 areas, including grand jury reports, accident reports, driver case records, certain health and social-service records, corporate interrogatories, family court files, and other records.

Transcript Highlights:

• Our agency strongly prefers the Senate budget and really appreciate the good work that you did.
• In this time of escalating federal attacks and increased demand from out-of-state patients, it's more
• And PPAA, thank you very much for investing in sexual and reproductive health so all patients who need
• My patients and your constituents deserve to have ready access to pharmacy services.
• Losing coverage could mean detrimental disruptions in care for patients currently in treatment or in

Summary: The committee held a public hearing on the Senate operating budget proposal, beginning with a staff briefing from James Kettle. He described the budget as built on relatively flat revenue after multiple forecast updates, with substantial mandatory cost growth, especially in Health Care Authority, DSHS, and DCYF. He highlighted major policy-level additions and savings, including large tort liability costs, continued support for long-term services, reductions tied to child care and K-12 items, several assumed revenue bills, and major transfers from reserves and other accounts. Kettle also noted the four-year outlook remained positive overall, with about $1 billion ending fund balance in the final year and roughly $3 billion in total reserves. A committee member asked about a diagram showing the loss of federal funds, and staff said they would follow up. Public testimony then focused first on K-12 education, where school leaders, teachers, OSPI, PTA, and rural district representatives largely opposed the proposed cuts to local effort assistance, transition to kindergarten, bus depreciation, and related school funding items. Many argued the reductions would disproportionately harm rural and property-poor districts and weaken early learning access, while several students and educators spoke in favor of career and technical education and IT Academy funding. The committee also heard support for wildfire prevention funding from the Commissioner of Public Lands, who thanked the Senate for restoring those dollars but raised concerns about recreation program reductions. Higher education testimony was mixed but generally supportive of the Senate proposal compared with the governor’s budget. Community and technical college leaders warned that the budget still shifts compensation costs to tuition and reduces Running Start funding, while university representatives from Western, Eastern, Central, WSU, and UW thanked the committee for avoiding deeper cuts. Private vocational college students and administrators urged extension of Washington College Grant eligibility for students already enrolled, and others asked to preserve IT Academy and related certification funding. In early learning, child care and advocacy groups praised the decision not to cap Working Connections Child Care but warned that child care and transition to kindergarten still bear a disproportionate share of cuts; they also requested continued support for Dolly Parton Imagination Library and Pierce County early childhood programs, including Family Connects. The hearing continued with testimony on employee compensation, mental health, and human services. State employee and retiree groups supported the budget’s COLA and wildfire funding but objected to cuts in retiree health benefits. Behavioral health and public safety advocates supported mentoring, Trueblood-related funding, crisis stabilization, and the Recovery Navigator Program, while others opposed reductions to those programs and to community-based recovery services. In human services, witnesses thanked the committee for funding victim services, child welfare supports, health homes, adult day care, community health centers, energy assistance, and disability services, while urging the committee to avoid further reductions to skilled nursing, case management, and recovery navigation. No votes were taken during the hearing.

Transcript Highlights:

• They do have significant value for patients with sickle cell... Medicaid.
• They do have significant value for patients with sickle cell.
• We already cover medication-assisted treatment, or MAT therapy, for Medicaid patients, which is a treatment
• We already cover medication-assisted treatment, or MAT therapy, for Medicaid patients, which is a treatment
• . ...by grammar, punctuation, and style to conform our rules with existing BLR preferences.

Committee: All ALC-ADMINISTRATIVE RULES

Transcript Highlights:

• Loser is the patient.
• A patient actually has higher out-of-pocket costs. Downcoding never hurts a patient.
• That's how complex this patient is, that's a high level.
• It's wrong for our patients.
• It's wrong for the patients of the state, and it's wrong for the patients of the employers of the state

Bills: SB 6 , SB6 , SB504 , SB765 , SB815 , SB929

Committee: Senate Business & Commerce

Transcript Highlights:

• Chair, Chair, Ms. and members of the committee, my name is Jim Freeberg, here on behalf of the Patient
• The Patient Coalition of Washington represents 18 of the state's leading patient groups to have one voice
• Chair, Chair, Ms. and members of the committee, my name is Jim Freeberg, here on behalf of the Patient
• The Patient Coalition of Washington represents 18 of the state's leading patient groups to have one.
• The patient coalition of Washington represents 18 of the state's leading patient groups to have one voice

Summary: The committee heard public testimony on House Bill 2073, which would require nonprofit health carriers with surplus above 600% of risk-based capital to pay 3% of the excess to support the Cascade Care Savings premium assistance program. Committee staff said the bill could generate about $80 million in FY 2027 based on 2024 surplus data, while carriers and business groups argued their reserves are needed to pay claims, manage risk, and avoid premium increases. Supporters said the bill would redirect consumer-funded surplus to help Washingtonians afford coverage, especially as federal subsidies expire. No action was taken on the bill during the hearing. The committee then heard House Bill 2132, which limits disclosure and retention of personally identifying and financial information in WASFA applications. Staff explained the bill would exempt WASFA records from public disclosure, restrict sharing to narrow purposes, and shorten retention periods, with significant fiscal impacts tied to purging records and updating data-sharing practices. Student and advocacy testimony strongly supported the bill as a privacy and safety measure for immigrant and mixed-status students. The committee also heard House Bill 2403, which lowers the penalty for failure to register as a sex offender and adds community custody and DOC supervision; public defense supported it as a cost-saving, consensus reform, and staff projected DOC savings. House Bill 2587 was also heard, creating a Commerce pilot to provide limited advance grant funding to eligible nonprofits; supporters said it would help smaller nonprofits manage reimbursement-based contracts, while staff estimated indeterminate but potentially significant administrative costs. The committee heard House Bill 2607, which would require DCYF to periodically rebase child care subsidy rate regions to better reflect local cost differences. Supporters from Benton and Franklin counties said current regional rates are outdated and unfairly low in fast-growing areas; staff said the fiscal impact was indeterminate. The committee then moved into possible executive session on several bills. Second Substitute House Bill 1170, dealing with generative AI disclosures and provenance tools, was amended and ultimately passed out of committee on an 18-9 vote after all proposed amendments were rejected. Substitute House Bill 1570 was amended to narrow its scope to Western Washington University and then passed out of committee on a 17-9 vote. The committee also began action on proposed Third Substitute House Bill 1710, which would create a state pre-clearance requirement under the Washington Voting Rights Act, but the transcript cuts off during consideration of amendments to that bill.

Transcript Highlights:

• </c> consent is good, critical patient care. consent is good, critical patient care.
• in fully inform the patient regarding to in fully inform the patient regarding risks<02:25:24.160><c
• When you are treating a patient in the ER and that patient is unresponsive or not alert and oriented
• patient is uh unresponsive or not alert patient is uh unresponsive or not alert and<02:36:55.120><c>
• </c> additional protections to the patient additional protections to the patient despite<02:44:48.640

Committee: House Judiciary

Summary: The Judiciary Committee opened a hearing on House Bill 1067-FN, which would formalize and expand mental health courts in New Hampshire and create a grant-based funding structure for them. Representative Mark Pearson, the prime sponsor, described the bill as a bipartisan, compassionate, and cost-effective approach that would connect people with mental illness to treatment and supervision instead of incarceration, while still holding them accountable. He said the proposal was developed with input from the judicial branch, law enforcement, corrections, mental health organizations, and others, and emphasized that local courts could tailor programs to their needs. Committee members questioned the bill’s fiscal note, whether the legislature had previously studied the issue, how the program would be funded, and whether the bill should more explicitly address treatment, prevention, and data collection. Representative Buzz Sher, who helped develop the bill, explained how mental health courts work, including referral, clinical and public-safety assessments, case management, goal-setting, and graduation from the program. He said existing New Hampshire mental health courts are mostly partial and county-funded, and that the bill would formalize them, set standards, and allow grant funding. He also cited data from Georgia and New Hampshire suggesting significant savings from reduced incarceration and related costs. Members also raised concerns about due process, whether people not formally charged could be swept into the system, and whether individuals with violent offenses or domestic violence histories could be diverted inappropriately. Sher responded that only people already in the criminal justice process are eligible and that courts use safety assessments to screen out most violent cases. The committee requested that Sher file supporting financial data from other jurisdictions, and he agreed to do so. No vote or final action was taken during the hearing.

Transcript Highlights:

• psychotherapy records must comply with existing confidentiality laws and protect the data privacy of patients
• This line, that line, really matters for patient safety.
• a licensed professional remains fully responsible, the bill would limit widely used tools such as patient
• a licensed professional remains fully responsible, the bill would limit widely used tools such as patient
• check-ins, journaling, and workflow support that improve continuity. widely used tools such as patient

Committee: Senate Privacy, Digital Technologies, and Consumer Protection

Transcript Highlights:

• It is about protecting patients.
• I think we all have our preferences, and I'm for everybody having their preferences.
• So when I see patients' rights, if I'm a patient, I and my other job work with people that have a lifelong
• I asked the question whether or not if a patient came in, if you refused to treat a patient because they
• I asked the question whether or not if a patient came in, if you refused to treat a patient because they

Committee: Senate Health Policy

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

Transcript Highlights:

• DEI is preferable. Please vote no. Thank you for your testimony.
• Nothing in this bill changes patient practices.
• Nothing in this bill changes patient practices.
• Laura Munoz wanted to speak and waive, which would you prefer?
• Laura Munoz wanted to speak and wave, which would you prefer? She was.

Bills: S0092 , S0110 , S0192 , S0212 , S0260 , S0350 , S0394 , S0422 , S0434 , S0442 , S0484 , S0546 , S0556 , S0684 , S0696 , S0706 , S0748 , S0786 , S0820 , S0824 , S0838 , S0840 , S0848 , S0856 , S0962 , S1000 , S1014 , S1036 , S1050 , S1054 , S1080 , S1118 , S1134 , S1338 , S1480 , S1500 , S1506 , S1622 , S1724

Committee: Senate Rules

Summary: The Committee on Rules met with a quorum and considered a long agenda of bills, many of them retained from the prior week. The most debated measure was CS for SB 706, which would preempt naming of major commercial service airports to the state and designate Palm Beach International Airport as the Donald J. Trump International Airport, subject to FAA approval and a trademark agreement. Amendments were offered and rejected, including proposals to prevent private financial benefit from the naming. Several senators spoke in opposition, citing concerns about naming an airport after a sitting president, lack of local input, and the trademark/licensing arrangement; supporters argued there was no cost to the airport and that the bill simply set a state naming policy. The committee reported the bill favorably after a roll call vote. The committee also reported favorably CS for SB 546 on conservation land notice requirements, CS for CS for SB 1014 on municipal utility service to properties outside city limits, CS for SB 1500 on uncontested probate proceedings, SB 962 on excluding farms from certain zoning definitions, and CS for SB 820 on problem-solving court reporting requirements. The committee then approved several bills from Senator DiCeglie and Senator Arrington. SB 840, addressing land-use regulations for local governments affected by natural disasters, was supported by local-government and environmental advocates who said it would restore local control after SB 180’s hurricane-related restrictions; the sponsor said it was intended to correct unintended consequences of last year’s law. CS for SB 856, requiring online listing platforms to show estimated ad valorem taxes on residential listings, was amended to exclude social media platforms and broaden liability protections; the sponsor and a county property appraiser described it as a consumer-transparency measure. CS for SB 110, clarifying homestead exemption treatment for long-term leases that end at death, was also reported favorably. The committee took up a controversial strike-all amendment to SB 212, which focused on public swimming pools and added residency and related restrictions for certain sex offenders and offenders on community control or probation. The amendment drew strong opposition from advocates and affected families, who argued it would worsen homelessness, impose broad geographic restrictions, and lack evidence of improving child safety; supporters said it was a targeted public-safety measure. Despite the objections, the committee reported the bill favorably. The committee also approved SB 684 on electronic signatures for total-loss vehicle and vessel titles, SB 394 on reinsurance intermediary managers, SB 434 on property tax assessment treatment for wind-hardening improvements, CS for CS for SBs 658 and 608 on water-safety requirements for rental properties with pools or nearby water, SB 748 on adding voting-rights restoration information to sentencing score sheets, and CS for SB 824 requiring school districts to inventory unimproved real property. The meeting ended while the committee was beginning SB 848 on stormwater treatment, with an amendment being introduced as the transcript cut off.

Transcript Highlights:

• <00:36:47.079><c> care</c> patient care patient care plan<00:36:50.240><c> um</c><00:36:50.400><c> at
• </c><00:44:36.599><c> unpaid</c> as care for uninsured patients unpaid as care for uninsured patients
• 36% % of their of commercial patients 36% % of their patient<01:19:25.760><c> payer</c><01:19:26.159
• </c> com uncompensated care is from patients com uncompensated care is from patients who<01:47:27.880
• </c><02:05:59.199><c> to</c> of commercially insured patients to of commercially insured patients to

Committee: Senate Health and Human Services

Transcript Highlights:

• Step therapy is a practice that requires a patient to try a preferred medication or therapy and find
• And why is that preferable over the coverage?
• Across all providers, 33,979 unique patients were seen, which is an average of 105.3 patients per enrolled
• new patients, while the other half reported that they are not currently taking new patients.
• are rural, and what percentage of Medicaid patients are you taking.

Summary: The committee met to review the history and current treatment of North Dakota health insurance mandates, with presentations from Blue Cross Blue Shield of North Dakota, Sanford Health Plan, the Public Employees Retirement System (PERS), and the Insurance Department. The discussion focused on how mandates apply differently to fully insured, self-funded, ACA, Medicaid, and PERS plans; how the state’s benchmark plan and federal essential health benefits affect coverage; and how the existing process requires cost-benefit analysis and, for certain measures, a PERS pilot period before broader application. Presenters also reviewed the long list of existing state mandates, including provider, beneficiary, and coverage requirements, and noted that many were enacted decades ago and have not been revisited despite changes in medical evidence and treatment options. Witnesses from the carriers argued that mandates should be reviewed periodically because some are outdated, can create unintended costs, and may not align with current medical guidance. Examples cited included PSA screening, off-label drug coverage, prior authorization rules, step therapy, and cost-sharing provisions for mental health and substance use treatment. They emphasized that carriers often cover services without a mandate when supported by clinical evidence, and that mandates can shift costs to employers and employees, especially in the fully insured small-group market. They also suggested possible policy improvements such as clearer mandate definitions, better transparency around cost-benefit analyses, a regular 10-year review of mandates, and more timely submission of proposals through the interim process. PERS and the Insurance Department highlighted a recurring tension over what counts as a mandate and when a measure triggers the state’s defrayal obligation under federal law. PERS described its interim committee process, the April 1 deadline for fiscal-impact proposals, and the limited pilot program used for certain measures, noting that only a few bills have gone through the full pilot process. The Insurance Department explained that it views new benefit mandates through the lens of the ACA benchmark plan and essential health benefits, distinguishing true new benefits, such as infertility coverage, from changes to existing benefits, such as telehealth or insulin cost-sharing caps. No votes were taken on policy changes; the meeting was informational, with members asking questions about costs, applicability, transparency, and whether a periodic mandate review should be established.