Transcript Highlights:

• >> Chair Harrell: GOOD AFTERNOON AND WELCOME TO THE APPROPRIATIONS COMMITTEE ON HIGHER EDUCATION.
• WITH THAT, WE HAVE WONDERFUL PAGES COMING IN, WELCOME TO THE EDUCATION, HIGHER EDUCATION APPROPRIATIONS
• CAREER TECHNICAL EDUCATION AND INSTITUTIONAL OPERATIONS.
• Calatayud: THANK YOU SENATOR WHEN I VIEW EDUCATION POLICY >> Sen.
• AND HIGHER EDUCATION BILL.

Keywords: 999, senate, all

Transcript Highlights:

• So, we are working with the Kentucky Department of Education very closely.
• If the hospital can't get those doctors, then a nurse practitioner.
• If the hospital can't get those doctors, then a nurse practitioner.
• </c><00:55:58.799><c> practitioner</c> supervision uh of a nurse practitioner supervision uh of a nurse
• ,</c> administrative leadership, education, administrative leadership, education, operational<00:58:37.920

Keywords: 958, all

Summary: The committee first handled several referred administrative regulations, including a package from the Board of Respiratory Care described as a substantive housekeeping update to its regulations and incorporated materials. There were no questions from members, and the committee also heard from the Kentucky Board of Medical Licensure, which was present in case questions arose but did not require action. Members then took up an amendment to the state health plan for facilities and services, specifically 900 KAR 5:02. Wesley Duke explained that a previously proposed criteria related to mega-voltage requirements, originally suggested by the Kentucky Hospital Association, was now being removed because the association no longer considered it necessary. The committee moved to accept the agency amendment, with a motion and second, and approved it without opposition. The committee next considered Senate Joint Resolution 23, a “food is medicine” resolution sponsored by Senator Shelley Funke Frommeyer. Supporters from the Kentucky Department of Agriculture and the Kentucky Hospital Association described the initiative as a voluntary, statewide effort already adopted by 52 hospitals, aimed at improving patient health while supporting Kentucky farmers and local food systems. Members discussed access to healthy food, grocery-store availability, school nutrition, and the need to reduce barriers to local procurement; the resolution was adopted unanimously after a roll call vote, with one senator briefly explaining a late vote due to weather. Finally, the committee began hearing Senate Bill 12, which would allow mid-level practitioners to serve as the leader of a Level IV trauma center under physician direction. The sponsor and witnesses from Appalachian Regional Healthcare argued the change would help address rural trauma-care shortages, align with national standards, and improve access without changing scope of practice or other trauma-center requirements. Several members raised questions and comments about rural access, liability, costs, and the broader health impacts, but no vote on the bill was taken in the portion of the meeting provided.

Transcript Highlights:

• All of this, while nurses, technicians, resident and fellow physicians, and support staff struggle to
• MGB is the largest graduate medical education program in the country.
• The same is true for nurses, the same is true for nursing assistants, and down the line.
• I can't speak first... ...the same is true for nursing assistants and down the line.
• The stress weighs on my family daily, and as a nurse, it also affects how I care for my patients.

Committee: Joint Joint Committee on Health Care Financing

Keywords: 995, all

Summary: The Joint Committee on Health Care Financing held a public hearing on a broad set of health care bills focused on cost, market oversight, pharmaceutical access, transparency, hospital closures, and pharmacy access. Chairs John Lawn and Cindy Friedman opened by emphasizing recent health care reforms and the need for further action on the drug supply chain, PBMs, private equity, and affordability. The committee heard testimony on several measures, including a Betsy Lehman Center bill to make technical changes and create a permanent trust account for federal and private funding, and bills on hospital profits and fairness, hospital closures and health planning, pharmacy deserts, and health care market oversight and pharmaceutical access. No votes were taken during the hearing. On the hospital profits bill, physicians and labor advocates strongly supported capping hospital CEO compensation at 50 times the lowest-paid worker, requiring greater financial transparency, and directing penalties from high-margin public hospitals into a Medicaid reimbursement fund. Testifiers argued that executive pay is excessive while frontline staff and safety-net services are under strain. Committee members raised concerns about unintended consequences, including whether hospitals might shift workers to contract status or lose executive talent, and whether the bill would actually direct money to the safety net. Supporters responded that the measure is one piece of a larger effort and that the bill’s Medicaid reimbursement provisions would help underserved hospitals. Testimony on market oversight and pharmaceutical access centered on rising health care and drug costs, PBM practices, and the proposal to give the Health Policy Commission authority to set upper payment limits for certain drugs. Consumer advocates, disability advocates, an independent pharmacist, the Attorney General’s office, and others supported stronger oversight, citing premium increases, affordability problems, and the impact of high drug prices on patients and community pharmacies. Pharma and some industry witnesses opposed parts of the bill, warning that upper payment limits could disrupt access, create legal issues, and fail to address the broader supply chain. The committee also heard support for stronger hospital closure notice and public hearing requirements, and for a pharmacy deserts bill aimed at identifying and addressing closures like the one in Roxbury that affected thousands of patients.

Transcript Highlights:

• </c> education we're providing for our kids. education we're providing for our kids.
• homes with no nurses because the nurses have been forced out and couldn’t afford homes.
• homes with no nurses because the nurses have been forced out and couldn’t afford homes.
• nurses because the nurses have been no nurses because the nurses have been forced<04:33:37.039><c> out
• </c> driver's education is the most valuable. driver's education is the most valuable.

Keywords: 1189, house, all

Transcript Highlights:

• This is from someone who supports public education.
• And let's be clear, this bill is a direct attack on public education.
• So this just opens that up to allow these nursing homes to have an advanced practice registered nurse
• entering or being readmitted to a nursing home.
• She's not the... ...Commissioner of Education from here until eternity.

Keywords: 959, house, all

Transcript Highlights:

• That person must attend a mandatory educational program. on human trafficking and child exploitation
• Assembly Bill 972 by Assemblymember Wilson, an act relating to post-secondary education.
• The education piece of this, because there was three 20 year olds, two of them passed.
• There were many skilled nursing facilities that were burnt down.
• Skilled nurses and surgical nurses became full-time caregivers.

Keywords: 988, house, all

Transcript Highlights:

• </c> Majority of the committee on education Majority of the committee on education funding<00:39:41.839
• </c> career and technical education courses. career and technical education courses.
• ><c> not</c><00:51:00.319><c> be</c> A child's education should not be A child's education should not
• </c> the term residential care as nursing the term residential care as nursing home<01:03:42.799><c>
• i.e. the nursing home of their parent, i.e. the nursing home or<01:04:58.680><c> hospital,</c><01:04

Keywords: 1189, house, all

Transcript Highlights:

• California has long been a leader in technology and education policy, and the bill ensures that our education
• governor-appointed education commissioner to lead the Department of Education and shifting the elected
• Two, it takes up nurses' time. Three, it's very personal.
• Two, it takes up nurses' times. Three, it's very personal.
• It's Maxine Dugin of the Erotic Service Provider's Legal Education and Research Project.

Summary: The Assembly Appropriations Committee met on May 6, 2026, with a quorum present and began by approving a large consent calendar of bills on two unanimous-support motions. The committee then heard a series of individual bills, with authors and sponsors generally describing low or absorbable state costs and asking for aye votes. Topics included AI/digital safety education for students (AB 1792), hepatitis C treatment access (AB 1843), rent-now-pay-later consumer protections (AB 2350), retirement information for community college faculty (AB 2417), cannabis regulation changes including tribal commerce, drive-through sales, and beverage labeling (AB 2506, AB 2697, AB 2532), emergency equipment training for law enforcement volunteers (AB 1913), cannery law modernization (AB 2706), child care planning in local governments (AB 1914), EV charger permitting fees (AB 1820), election-record notice requirements (AB 1664), nursing home discharge notices (AB 2135), a San Diego energization-delay pilot (AB 2518), mental health training for school coaches (AB 1665), and education governance and oversight changes (AB 2117). Several bills were described as committee or sponsor measures with technical or clarifying changes, including AB 2780, AB 2615, AB 2121, and AB 2771. Testimony was largely supportive, often from sponsor groups, industry representatives, labor, or advocacy organizations. Notable support included TechNet for AB 1792, the California State Sheriffs’ Association for AB 1913, California Dairies and food manufacturers for AB 2706, the Low Income Investment Fund for AB 1914, EV and environmental groups for AB 1820, the Attorney General’s Office for AB 1664, long-term care ombudsman advocates for AB 2135, and the California State Association of Psychiatrists for the cannabis and mental-health-related bills. Some bills drew limited opposition or “opposed unless amended” positions, including AB 2350, AB 1820, and AB 2506, while AB 2697 and AB 2532 were presented as efforts to support the legal cannabis market and consumer safety. The committee also heard a presentation-only item, AB 2541, creating a lowrider specialty license plate, which drew enthusiastic bipartisan comments and co-author requests from members. Most bills were reported out with due pass recommendations, many on roll call and several with specific members not voting or voting no. AB 1664 was reported out as due pass as amended and placed on call before later being moved out on a B roll call. AB 2350 and AB 1914 were also later reported out from call on B roll calls, with AB 1914 noted as passing despite some Republican no votes. The suspense calendar was then deemed approved without individual action, and the meeting concluded after a brief public comment period in which members of the public voiced positions on unrelated bills, including support for AB 2497, AB 1729, AB 2189, AB 1575, AB 2170, and opposition to AB 1603, AB 2447, AB 2411, AB 2492, and AB 1952.

Transcript Highlights:

• So we're looking at HB 2020, educational institutions interference disruption.
• An education bill that was seen in government. Oh, down to you.
• Miranda: Madam Chair, members, House Bill 2409, artificial intelligence statewide education program.
• The bill establishes the Arizona Artificial Intelligence Program within the Department of Education.
• And that's why it should go through the State Board of Education. All right.

Summary: The caucus reviewed a large number of House bills, mostly on third-read consent or for floor strategy, covering education, health, water, land, energy, housing, taxation, and public safety. Topics included ESA administration funding, AI in schools and legal communications, towing and DUI changes, health facility licensing and nursing records, internationally trained physicians, nurse anesthetist reimbursement, childhood cancer research, cybersecurity encryption, school mental health instruction, superintendent pay and benefits, adoption disclosures in college health settings, anti-Semitism provisions, school safety firearms authorization, coerced abortion penalties, domestic violence testimony standards, border health and terrorism-related bills, and multiple water, land, and state trust land measures. Several members flagged concerns about unfunded mandates, local control, constitutional issues, and special legislation, while others supported bills as technical fixes, public safety measures, or ways to expand access and funding. A number of bills were pulled from consent for further discussion, including HB 2020, HB 2093, HB 2386, HB 2481, HB 2575, HB 2906, HB 2040, HB 2136, HB 2665, HB 2904, HB 2957, HB 2044, HB 2352, HB 2667, HB 2830, HB 2307, HB 2425, HB 2426, HB 2427, HB 2497, HB 2751, HB 2780, HB 2804, HB 2926, HB 4030, and HCR 2052, among others. Some bills were noted as unanimous or split votes, and several were described as party-line or having constitutional problems. The caucus also discussed committee amendments on multiple measures, including changes to water, land, health, and AI bills. The meeting ended with a series of remarks on the late Reverend Jesse Jackson and an “affordability award” presentation to Representatives Lorena Austin and Simacek for work on economic justice and working families. The caucus then adjourned.

Transcript Highlights:

• An act to amend the Public Health Law and the Education Law in relation to strengthening protections
• Our nurses play a pivotal role, and this is a great step in that direction.
• Could it be a nurse with any degree, or is there a specific requirement? Yes, Senator May.
• Could it be a nurse with any degree, or is there a specific requirement?
• No, it's specifically RNs and nurse practitioners, as long as there is a registered nurse in New York

Committee: Senate Health

Keywords: 993, senate, all

Summary: The committee considered a series of health-related bills, many of which were described as repeat measures previously passed by the Senate. Topics included expanding telehealth coverage, increasing Department of Health oversight of correctional health services, improving transparency for managed long-term care plans, requiring written consent for psychotropic medications in nursing homes and adult care facilities, extending Medicaid inpatient coverage for childbirth, expanding abortion travel funding eligibility for active-duty military families, simplifying Medicaid enrollment and recertification, adding certified recovery peer advocates to standard coverage, strengthening protections against sexual misconduct by medical providers, covering medically tailored meals and nutrition therapy, regulating retail clinics, requiring nurse representation on hospital governing boards, creating a blood clot and pulmonary embolism work group, testing potable water in parks, setting PFAS drinking water standards, improving lead service line identification, creating a quality incentive program for Medicaid managed care, expanding concussion information requirements to additional youth sports, setting a residency requirement for funeral director licensure, and changing Medicaid Inspector General audit practices. Most bills were briefly explained by sponsors or the chair, with limited debate. Several members asked clarifying questions on specific provisions, including the frequency of park water testing, how concussion information would be distributed, and details of the nurse representation requirement. The chair also noted pulling one correctional health bill from the agenda in favor of a more comprehensive measure, and one bill on correctional health was formally removed from consideration. The committee voted on each remaining bill, generally with unanimous or near-unanimous support. Most measures were reported to either first reading or finance, while the bill on psychotropic medications was sent to aging. The correctional health bill that remained on the agenda was approved despite one opposition, and the bill on funeral director licensure was also advanced with one abstention. The meeting concluded after all listed bills were acted on.

Transcript Highlights:

• Leslie, do the other ones too, like skilled nursing?
• How many people are living in skilled nursing facilities? Do you know offhand?
• How many people are living in skilled nursing facilities? Do you know offhand?
• So moving on. nursing facilities.
• How many people are living in skilled nursing facilities? Do you know offhand?

Keywords: 995, all

Summary: The subcommittee met with MassHealth LTSS Chief Leslie Darcy to review the Personal Care Attendant (PCA) program and the legislative work group focused on its long-term sustainability and cost containment. Darcy and Charlie described the work group’s five meetings and three consensus recommendations: enforce the 66-hour overtime cap, address fraudulent activity in the PCA program, and eliminate MassHealth handling of PCA paperwork/administrative work for members without a live-in exemption because those members are subject to EVV. They explained EVV as an electronic visit verification system replacing paper timesheets, and noted the rollout is expected to be completed this fall. The group estimated about $7 million in savings from the consensus recommendations and agreed to continue meeting through June to consider additional ideas. Darcy presented data showing the PCA program served about 56,000 members in state fiscal year 2024 and has grown from $1.2 billion in FY20 to $1.6 billion in FY24, with projections near $2 billion by 2027. She said much of the growth is driven by wage increases and older adults using more services, and compared PCA costs with other LTSS programs. The discussion also covered overtime spending, the role of federal financial participation, and how Massachusetts’ PCA program differs from other states because it has no hard caps on hours or activities. Several members emphasized the program’s value for independent living and community participation, while also acknowledging the need to control growth without undermining services. Members asked about undocumented immigrants and MassHealth funding, and Darcy explained that some eligibility categories are state-funded only and do not receive federal matching funds. Another member asked about workforce recruitment and wage pressures; Darcy said recent collective bargaining agreements raised PCA wages, with some workers eventually reaching $25 per hour and the entry wage reaching $20. The group also discussed whether IADL hours are disproportionately high compared with ADL needs, and reviewed data suggesting potential savings if IADL hours were limited relative to ADL hours, though no consensus recommendation was made on that point. The meeting ended with approval of the prior minutes by roll call vote, an update that the next health equity informational hearing is scheduled for May 19, and a motion to adjourn carried unanimously.

Transcript Highlights:

• </c><00:30:16.360><c> homes</c> public health clinics nursing homes public health clinics nursing homes
• Supplemental nursing service agency: 2015.
• c> 2015</c><01:02:26.880><c> so</c><01:02:27.720><c> um</c> nurse nursing service agency 2015 so um nurse
• </c><01:04:53.200><c> licensing</c> support of Education licensing support of Education licensing construction
• </c><01:19:54.960><c> homes</c> department is overseeing nursing homes department is overseeing nursing

Committee: Senate Health and Human Services

Keywords: 1187, senate, all

Transcript Highlights:

• I have a master's in education.
• One thing to know about me as well is that I'm also a nurse, and I'm a nurse who worked in pretty much
• One thing to know about me as well is that I'm also a nurse, and I'm a nurse who worked in pretty much
• And as a nurse, I have been doing this work.
• Two things will work: education and enforcement.

Committee: Joint Joint Committee on Public Health

Keywords: 995, all

Summary: The Joint Committee on Public Health heard testimony on a wide range of bills focused on children’s health, tobacco control, newborn screening, pediatric cancer, palliative care, and professional licensure. Early testimony highlighted Senate bills to expand newborn screening for pyruvate dehydrogenase complex deficiency, lysosomal storage disorders, and congenital CMV, with families and clinicians describing severe diagnostic delays, missed treatment windows, and the benefits of early detection. Speakers also supported a bill to improve pediatric cancer research through a dedicated trust fund, and a bill to extend pediatric palliative care services to age 22, with parents and providers emphasizing continuity of care for seriously ill young people. Several witnesses gave personal accounts in support of the newborn screening measures. Families described children who endured years of misdiagnosis before receiving diagnoses such as Gaucher disease, Fabry disease, Pompe disease, Niemann-Pick disease, and CMV, often after irreversible damage had already occurred. Medical and advocacy witnesses said Massachusetts already collects some of the relevant screening data and argued that results should be reported to families, while others urged the committee to add conditions to the state panel because effective treatments already exist. The committee also heard support for a bill to establish a fetal alcohol spectrum disorder program and training for providers. On tobacco and youth health, testimony supported bills to ban internet tobacco sales, strengthen youth protections, and reduce lung cancer deaths through point-of-sale information and quit-line access. A student testified about easily purchasing flavored nicotine products online without meaningful age verification, and public health advocates backed measures to keep tobacco out of children’s environments. The committee also heard testimony on a bill to ensure parents have access to their children’s medical records through age 16, with exceptions for sensitive services already protected by law. The committee additionally took testimony on an optometry licensure bill, where ophthalmologists opposed language they said could broaden scope of practice and allow optometrists to use the title “optometric physician,” while optometry educators and students supported the bill as a modernization measure with no scope expansion. No votes were taken during the hearing; the chair repeatedly reminded speakers of time limits and noted that written testimony could be submitted for additional comments.

Transcript Highlights:

• Tony Hackett, on behalf of Californians Against Waste, Waste Management, American Nurses Association,
• Tony Hackett on behalf of Californians Against Waste, Waste Management, American Nurses Association,
• Tony Hackett, on behalf of Californians Against Waste, Waste Management, American Nurses Association,
• Mandy Estrella, here on behalf of San Diego 350, California Nurses for Environmental Health and Justice
• As a tobacco use prevention education program director, I had a drawer full of vapes that I could not

Committee: Senate Environmental Quality

Keywords: 987, senate, all

Transcript Highlights:

• I'm an emergency nurse representing the Washington State Emergency Nurses Association.
• I am an emergency nurse representing the Washington State Emergency Nurses Association as their government
• Additionally, nursing assistants are made eligible for the Board of Nursing stipend program.
• moved into the Board of Nursing.
• moved into the Board of Nursing.

Summary: The House Health Care & Wellness Committee held public hearings on several bills. House Bill 2232 would create a Department of Health-operated time-sensitive emergency data repository covering trauma, cardiac, and stroke events, with quality improvement reporting and support for rural facilities; it drew strong support from emergency physicians, nurses, and the Department of Health, while the Washington State Hospital Association said hospitals support the goal but lack the resources to absorb the added requirements. House Bill 1812, as a proposed substitute, would bar insurers and public plans from imposing anesthesia time limits or related reimbursement caps; the sponsor and anesthesia providers said it protects patient safety and fair payment, and the Washington State Society of Anesthesiologists asked for a clarifying amendment on physical status modifiers. House Bill 2250 would limit hospital charity care to Washington residents, while preserving emergency care access; supporters from rural hospitals and the Washington State Hospital Association said the change would help border hospitals facing rising nonresident charity care, and opponents from legal aid, patient advocacy, and LGBTQ groups warned it would create barriers, chill access for immigrants and other vulnerable patients, and conflict with Washington’s safety-net values. The committee also heard House Bill 2340, which would extend existing substance-use monitoring program protections and stipend eligibility to nursing assistants under the Board of Nursing’s CARES program. The sponsor described it as a simple equity measure, and the Board of Nursing supported it, saying it would improve access and reduce stigma; members asked where the stipend funding comes from, and staff and the board said it is currently general-fund supported at about $25,000 annually. House Bill 2577 would change hospital inspection law by requiring acute care hospital inspections every 18 months rather than on average, allowing some accredited inspections to satisfy the requirement every 36 months, and clarifying fire-protection reinspection standards; the sponsor and Department of Health said it responds to a JLARC audit and provides needed clarity, while DOH said it is still working to catch up from inspection delays caused by the public health emergency. The meeting ended after public testimony on the bills was closed and the committee adjourned.

Transcript Highlights:

• </c><00:31:04.200><c> through</c> in place, we intend to educate through in place, we intend to educate
• This supports nursing care coverage.
• </c> offer short-term home health and nursing offer short-term home health and nursing care<01:34:34.920
• And home health care and nursing care.
• </c> And making sure that they are educated And making sure that they are educated on<01:35:42.400><c

Committee: Senate Commerce and Consumer Protection

Keywords: 1187, senate, all

Transcript Highlights:

• You are nursing homes, assisted living.
• When my nursing supports are stable.
• For me, it family education services.
• </c><00:45:19.760><c> hours,</c> would mean cuts to nursing hours, would mean cuts to nursing hours,
• This issue has got real-world impact. like this in nursing homes, we have a like this in nursing homes

Bills: HF3174 , HF3800

Committee: House Human Services Finance and Policy

Keywords: background study, disqualification, set-aside, permanent disqualification, Office of Administrative Hearings, chief judge, human services licensing, substance use disorder treatment, SUD treatment, chemical dependency, recovery, rehabilitation, abstinence, foster care, child foster care, vulnerable adults, caregiver background check, license holder, direct contact, risk of harm

Transcript Highlights:

• private post-secondary higher education in California.
• We know that private post-secondary educational institutions play a critical role in training and educating
• trucks, cosmetology, you name it, nurse practitioners.
• We are teaching and educating California's workforce.
• We are teaching and educating California's workforce.

Summary: The joint Sunset Review Oversight Hearing focused on the Bureau for Private Post-Secondary Education (BPPE) and its reauthorization, with committee chairs and members emphasizing the Bureau’s role in protecting students, overseeing private postsecondary schools, and responding to a changing federal higher education landscape. BPPE and the Department of Consumer Affairs reported that the Bureau has modernized data systems, improved enforcement, increased citations and inspections, reduced pending complaints, and is now meeting its statutory inspection mandate. They also said the Bureau faces a structural budget deficit and has reduced costs through staffing cuts, streamlined inspections, and shifting some student-relief functions to the Student Tuition Recovery Fund (STRF).

Transcript Highlights:

• Just educate me on timeline.
• First, I'm 10 years of education in.
• First, I'm 10 years of education in.
• I'm a registered nurse.
• I can be educated. I am educable.

Committee: Senate Rules

Summary: The Committee on Rules met with a quorum and heard extensive debate on SB 734, which would repeal Florida’s wrongful-death medical malpractice exception that bars certain adult children and parents from recovering noneconomic damages. Senator Yarborough presented the bill as a fairness and accountability measure, while many family members testified in support, describing deaths they believed were caused by medical negligence and arguing the current law denies equal justice. Opponents, including physician and insurer representatives, warned the bill could increase malpractice exposure, premiums, defensive medicine, and physician shortages. The committee also considered two late-filed amendments: Senator Burton’s amendment would make Department of Health investigative findings admissible in court, and Senator Martin’s amendment to that amendment would broaden admissibility/discoverability to additional disciplinary and prior-adverse-incident records and insurance coverage facts. After debate, the Martin amendment was adopted, but the Burton amendment as amended failed on a roll call vote. The committee then reported SB 734 favorably without the amendment. The committee next unanimously reported CS for SB 86 favorably. That bill, by Senator Burgess, expands peer support protections for first responders to include support personnel; there was little debate and several law-enforcement-related organizations indicated support. The committee also took up SB 316 on series limited liability companies. Senator Berman explained that the bill creates rules for series LLCs in Florida, and a late-filed amendment, requested by the Secretary of State, delayed implementation by one year. The amendment was adopted and the bill was reported favorably. Finally, the committee considered CS for CS for SB 384, which requires municipalities seeking to annex state-owned land to notify the relevant county legislative delegation when the first public hearing is advertised. Senator Burton presented the bill briefly, there was no opposition or debate, and the committee proceeded to vote on the measure.

Transcript Highlights:

• practitioners and registered nurse practitioners.
• midwives, nurse anesthetists, nurse practitioners, psychiatric nurses, professional counselors, psychologists
• You need people, nurses, people to clean the building.
• , workforce statistics, and dental education data.
• We can probably work on that in terms of education from the association.

Keywords: 908, all

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.