Transcript Highlights:

• approval to list the subject parcel on the open market pursuant to RSA 228:31-b and administrative rule
• This is intended to be the replacement facility for the senior center in Manchester.
• They want to install a new distribution line directly to the new facility.
• <00:23:54.159> currently line easement uh to a facility currently line easement uh to a facility
• electrical services to the new facility electrical services to the new facility uh<00:24:17.440>

Keywords: 928, house, all

Summary: The Long Range Capital Planning and Utilization Committee met and first approved the June 30, 2025 meeting minutes. The committee then took up a series of Department of Transportation property actions, including authorization to grant an access point in Exeter, sell two small tracts in Keene, amend a prior Guilford disposal based on a revised survey and appraisal, sell 0.42 acres in Lincoln, list and sell 9.77 acres in Chesterfield, sell 0.54 acres in Fremont, and approve a permanent access easement in Belmont. The committee also approved a utility easement in Albany and a permanent access easement on Route 153 for the Bickfords. Most of these items involved direct sales or listings, administrative fees of $1,100, and conditions requiring surveys and local/state approvals; several were approved unanimously after brief or no questions. Representative Faulkner declared a conflict of interest on the Chesterfield item, and Representative Newman sat in for that matter; later, Faulkner was recused from the Belmont item as well. The committee also approved a Department of Administrative Services request to grant a perpetual utility line easement to Public Service Company of New Hampshire for a facility under construction at the Hampstead hospital property, with the administrative fee waived because the grant was in exchange for utility service. During discussion of informational item LRCP25-038, staff explained that no committee action was needed because the item was only to notify members that a parcel’s fair market value had been reduced due to a change in access. The committee received additional informational materials from the New Hampshire Council on Resources and Development, including minutes from its May 8 meeting and memorandums on surplus land review for Meredith and Hampstead. The next meeting was set for December 9 at 9:30 a.m. at Granite Place, Room 228, and the chair noted the meeting would be on a Tuesday because of building scheduling. The committee then adjourned.

Transcript Highlights:

• the state health insurance plan, and a total of $200 million in fiscal year 2027 to the School Facilities
• So you guys know, the rule was every year you look at their income limits.
• One question for your chairman, Gress: can you help explain to members the 2% rule on K-12 here?
• And we're also funding School Facilities Board at the $183 million amount, which is what the executive
• And just to that point, the school for the deaf and blind down in Tucson, they've closed that facility

Summary: House Republican caucus met on April 29 to review the FY 2027 budget package and several related “budget implementation” bills, with Chairman Livingston noting that HB 2415 was being held. Staff and members walked through HB 4138, the General Appropriations Act (“feed bill”), which appropriates about $17.96 billion from the general fund and includes one-time fund transfers, 5% lump-sum reductions for most agencies, funding for the state health insurance plan, school facilities, child care, correctional officer stipends, public safety, and other prior-year items. Members emphasized that the budget reflected House and Senate negotiations after the governor left budget talks, and Republican leaders framed it as a package that lowers taxes, shrinks government, and funds priorities such as K-12, child care, foster care, and public safety. The caucus then reviewed a series of mostly standard budget bills: HB 4139 on gaming/racing assessments; HB 4140 on federal monies, the budget stabilization fund, and ACE initiative savings reporting; HB 4141 on capital outlay, highway construction, airport funding, and rural transportation match funds; HB 4142 on commerce and lottery distributions; HB 4143 on corrections reporting; HB 4144 on environmental provisions and water-related fund uses; HB 4145 on state employee health insurance premiums and DES reforms; HB 4146 on higher education funding provisions; HB 4147 on SNAP administration and error-rate reduction; HB 4148 on K-12 inflation adjustments, school facilities, and ASDB property-sale oversight; HB 4150 on county expenditure flexibility and state office rent rates; HB 4151 on the Department of Revenue’s integrated tax system funding and related charges; HB 4152 on tax conformity, deductions, and repeal of several renewable-energy tax preferences and the Rio Nuevo diversion; and HB 4153 on transportation reporting. Discussion repeatedly centered on health plan solvency, SNAP/ACCESS eligibility and fraud controls, school funding, rural transportation, and tax conformity and relief. The caucus also took up several blue-sheet bills: HB 2035 on extended-family placement notifications in child welfare cases; HB 2170 restricting certain PRC-controlled companies from state IT contracts; HB 2249 expanding Parents’ Bill of Rights provisions; HB 2573 on DUI interlock/restricted-license rules and psychotherapy definitions; and HB 2873, which was amended to allow withdrawal of referendum petitions before ballot qualification. HB 2415 was held. The Speaker closed by praising the caucus for its budget work, saying the package delivers tax relief, protects vulnerable populations and public safety, and reflects months of Republican negotiations, and the meeting adjourned to the floor.

Transcript Highlights:

• From an implementation standpoint, the department first met the requirement to adopt rules by December
• So if I'm a dealer, am I going to have to have them stored there at the facility? Yes, sir.
• As part of our rule package that was adopted on December the first of last year, there's a provision
• in our rule that requires the dealers to safely store and, um, and secure those plates.
• By the way, in our facility in Reeves County, we have to draw straws every morning to see who has to

Transcript Highlights:

• You're recognized in a as a rule of thumb in this committee.
• And number 7, maintain rules, specific programs for those seeking or in need of longer trips.
• They do that with dials the centers and senior facilities and senior home.
• What back to you, Stephanie, to to your facility.
• Then this you have a couple of streets E 9 on like a close facility ready to testing.

Keywords: 999, senate, all

Transcript Highlights:

• Miss Hurch can step in, and Miss Stevens can step in and close that facility.
• Miss Upchurch can step in, and Miss Stevens can step in and close that facility.
• Miss Upchurch can step in, and Miss Stevens can step in and close that facility.
• This bill is not aimed at responsible retailers who follow the rules and operate ethically, and that's
• <00:48:55.760> from prevent Healthcare facilities from prevent Healthcare facilities from

Keywords: Call to Order 00:00:00 Roll Call 00:00:35 SB 22 Discussion 00:01:20 SB 22 Vote 00:11:45 SB 100 Discussion 00:15:07 SB 100 Vote 00:38:53 SB 88 Discussion Only 00:42:11 Adjournment 01:03:52, 958, all

Summary: The Senate Standing Committee on Licensing and Occupations met on February 18, 2025, and first took up Senate Bill 22 by Senator Reginald Thomas, which was presented as a cleanup measure following prior cosmetology reforms and a Legislative Oversight and Investigations report. The bill would allow cosmetologists to retake exams multiple times with a one-month wait, authorize the Board of Cosmetology to immediately close facilities that intentionally use unlicensed workers while preserving due process, give the board flexibility to hire an executive director based on qualifications rather than licensure, and recognize certain out-of-state or territorial cosmetology licenses. Board officials said the changes were intended to improve fairness, equality, and administrative due process. Senators asked about retesting fees and whether partial retests could dilute standards; Thomas clarified that the exam is cumulative and must be retaken in full. The committee approved SB 22 with all favorable votes, and Senator Meredith explained his support as a workforce and fairness issue. The committee then heard Senate Bill 100 by Senator Jimmy Higdon, as substituted, concerning tobacco, nicotine, and vapor product retail licensing and enforcement. Youth advocates from the University of Kentucky testified in support, describing youth nicotine use as a public health crisis and urging stronger enforcement, annual compliance checks, retailer licensing, and tougher penalties for illegal sales to minors. Higdon said the bill would create a Division of Tobacco, Nicotine, and Vapor Products Licensing within ABC, require licenses for retailers, authorize inspections and confiscation of contraband, impose escalating criminal and civil penalties for unlicensed sales and sales to minors, publish a list of licensed retailers, and dedicate fine revenue to enforcement and youth education. He said the measure targeted bad actors rather than responsible retailers. A retailer witness also supported licensing but raised concerns about contradictory product definitions that could sweep in hemp and medical marijuana vapor products, and asked that the bill be delayed until after an expected Supreme Court decision affecting federal vapor-product rules. The transcript ends during discussion of SB 100, before any committee vote on that bill.

Transcript Highlights:

• And this is a fairly new practice to adhere to budget rules.
• Um, public facilities authority or PFA.
• um funding for legislative facilities. um funding for legislative facilities.
• for public buildings and facilities for public buildings and facilities mostly?
• that funding and building a facility that funding and building a facility does<01:25:29.520>

Keywords: 1187, senate, all

Transcript Highlights:

• how you reuse uh facilities that are not how you reuse uh facilities that are not being<00:18:33.799>
• modernize existing University facilities modernize existing University facilities those<01:34:22.520
• So there's a research facility, a repurposing of an existing facility for research on the Manoa campus
• The only project... a research facility a repurposing an a research facility a repurposing an existing
• > on<01:39:04.239> the existing facility for research on the existing facility for research

Keywords: 912, senate, all

Summary: The hearing covered Senate Bill 426, which would create an early learning apprenticeship grant program. Testimony was overwhelmingly supportive from the City and County of Honolulu, the Department of Human Services, the Executive Office on Early Learning, the University of Hawaiʻi College of Education, the Attorney General’s office, the Early Childhood Action Strategy, Hawaii Children’s Action Network, the University of Hawaiʻi’s early childhood educator project, and a Zoom testifier who described the importance of investing in high-quality early childhood education. Committee discussion focused on the program’s estimated cost, with figures of about $14.5 million in 2025-26 and $15 million in 2026-27, and on whether the program would require ongoing base-budget funding. The committee recommended technical, non-substantive amendments, including a statewide-concern amendment and a deferred effective date, and both committees adopted the recommendation by vote. The committees then heard Senate Bill 1622, which would appropriate funds to establish the Aloha Intelligence Institute within the University of Hawaiʻi to support statewide artificial intelligence initiatives. University representatives described the proposal as the product of campus-wide input and outlined five pillars: governance and policy, outreach and engagement, research and development, workforce development, and AI tools for key sectors such as health care, creative industries, manufacturing, data science, astronomy, and climate change. Members questioned staffing distribution, tuition, enrollment timing, housing, campus placement, and whether positions would be permanent or temporary; the university said it planned about 10 positions across campuses, would start with internal resources, and would house the effort under the Vice President for Research and Innovation initially. The committees recommended an SD1 with the appropriation amounts blanked out, a July 31, 2050 effective date, and committee-report language on housing and West Oʻahu, and the higher education and labor/technology committees adopted the amended recommendation. Finally, the Higher Education Committee took up Senate Bill 1488, a housekeeping measure to consolidate existing University of Hawaiʻi conference center statutes into a single revolving fund structure, and Senate Bill 636, which would fund retention and internship coordinator positions and broader enrollment management efforts at the University of Hawaiʻi at Hilo. SB 1488 drew university support and no opposition. SB 636 prompted substantial questioning about Hilo’s declining enrollment, current retention rate of 72.8 percent, and the scope of the request, which includes not only two named positions but also about $432,000 for enrollment management initiatives such as data analysis, IT support, and other student services. Hilo said it is targeting 3 to 5 percent annual enrollment growth and that the positions would support recruitment, retention, internships, and data-driven enrollment strategy. The committee pressed for a clearer broader plan, but the discussion in the transcript ended before a final vote on SB 636 was shown.

Transcript Highlights:

• How much staff time is spent administering these rules?
• How much staff time is spent administering these rules?
• Big health care facilities. Let's do more of that.
• Instead of imposing rigid rules, we encourage innovation and flexibility.
• <01:45:31.159> and decide to write their own rules and decide to write their own rules and

Keywords: 1187, senate, all

Transcript Highlights:

• <00:29:42.919> in basically catch up with their rules in basically catch up with their rules
• <01:01:23.559> uh the rules uh the rules uh situation<01:01:25.400> uh<01:01:25.599
• So the idea is that we will ask for rule suspension for late drafting of a resolution.
• any facility proposed to be constructed by a New Hampshire municipal government.”
• He then pointed back to the definition: "Major solid waste disposal facility does not include any facility

Keywords: 928, house, all

Summary: The committee met in a work session on several environmental bills, beginning with HP 152, which would prohibit the sale and use of adhesive-based rodent traps. Members discussed whether the bill should be amended to allow professional pest control use while restricting retail sales to the public. Testimony and member comments focused on animal welfare concerns, the relative humaneness and effectiveness of glue traps versus snap traps, consumer education, enforcement difficulties, and whether the bill should instead be limited to professionals. No vote was taken on HP 152 during the discussion. The committee then turned to HB 171, establishing a moratorium on new landfill permits. Representative Gruber distributed an amendment shortening the proposed moratorium from five years to three years as a compromise. Members supporting the moratorium said it would give the Department of Environmental Services time to update rules and reflect recent landfill-siting reforms, while opponents argued that three years was too long, could tie the hands of a future legislature, and might be difficult to pass in the Senate. Others noted the House, Senate, and governor had each discussed different lengths of moratorium, making the bill a likely bargaining position in later negotiations. Throughout the landfill discussion, members emphasized that the three-year version was intended as a middle ground between a one-year proposal associated with the governor and a six-year Senate bill. Several members said the moratorium reflected years of bipartisan work on solid waste and landfill policy and would help create time for new rules to take effect. The transcript provided does not show a final committee vote or other action on HB 171 during this segment.

Transcript Highlights:

• It's saying three your in your rules.
• <00:30:18.240> in tie it back to some of your rules in tie it back to some of your rules in
• ,<00:30:26.720> but following some of the SPO rules, but following some of the SPO rules,
• facilities when they were in service. facilities when they were in service.
• I'm assuming the facility will be ready by next year. >> So the facility will open in June of 2027, but

Bills: SB2024, SB896, SB2613, SB494, SB2391, SB2125, SB2614, SB2615, SB3262, SB3325, SB3118

Keywords: charter schools, public-private partnership, school facilities, education funding, community need, education, capital improvement, reporting, transparency, technical expertise, public school land transfer, Department of Education, DOE, land conveyance, fee simple title, tax map key, TMK, Act 307, Session Laws of Hawaii 2022, Act 139

Transcript Highlights:

• Sometimes they have different rules in place.
• Sometimes they have different rules in place.
• . rules. rules.
• Um having said different rules in place.
• So, MDH on assisted living facilities.

Keywords: 1183, house

Summary: The committee met on March 2 and approved the February 23 minutes after a quorum was reached. The main presentation was from the Department of Human Services on non-emergency medical transportation (NEMT), a federally required Medicaid benefit that helps Minnesota Health Care Program enrollees get to medically necessary appointments. DHS said the program served more than 250,000 people in 2025 at a cost of $127 million, with participation up about 14% over five years, and described the seven transportation modes, provider enrollment requirements, STS certification, background checks, prior authorization rules, and planned transitions to a single administrator for parts of the program in 2026 and 2027. DHS officials emphasized fraud prevention efforts, saying NEMT is one of the agency’s high-risk Medicaid services. They described enhanced prepayment review, provider revalidation and site visits, removal of inactive providers, and a provider moratorium in metro counties. Inspector General James Clark said the governor’s anti-fraud proposal would add pre-enrollment risk assessments, more staffing and technology, and electronic visit verification. He also noted that about 80% of NEMT spending is in managed care and that managed care organizations have their own compliance and special investigations units. Committee members raised concerns about fraud, oversight, and privatization. Chair Robbins questioned DHS about the absence of the commissioner and the program’s use of brokers, citing past concerns and asking about the vendor MTM’s history; DHS said the RFP for the new broker had closed and the vendor selection was still underway. Representative Pinto questioned why oversight is outsourced to managed care organizations and suggested bringing more oversight back in house. MTM representative Phil Stahlberger defended the company’s record, said the Missouri dispute was about contract terms from about 15 years ago, and said MTM currently works in Minnesota counties and many other states, with on-site reviews, trip verification, and complaint review processes. No further votes or final actions on the NEMT policy were taken in the portion provided.

Transcript Highlights:

• We compare some waivers to ICF IIDs, which is intermediate care facilities.
• We also have some that we compare to nursing facilities.
• You know, it used to be the old 20/80 rule.
• In some respects it's now closer to the 10/90 rule, in which 10% of the population is accounting for
• . rule. rule.

Keywords: 958, all

Summary: The Medicaid Oversight and Advisory Board met on September 24, 2025, approved the minutes from the September 9 meeting, and then continued its discussion of Medicaid waivers with Leslie Hoffman and Carmen Hancock from the Department for Medicaid Services. Members asked for updates on the 2024 waiver waitlist management assessment recommendations, including aligning waiver policies, standardizing applications and waitlist placement, and modernizing data systems. DMS said that work is being done jointly with Aging and Independent Living and Behavioral Health/Developmental and Intellectual Disabilities through task forces, that ARPA spending delayed action, and that implementation timelines extend through March 2027. The board also reviewed per-member waiver cost averages for fiscal years 2023 through 2025 for ABI, ABI long-term care, HCBS, Model II, Michelle P, and SCL. DMS emphasized these figures were benefit-only averages based on paid claims, not full waiver costs, and explained that true budget neutrality is calculated on an aggregate basis against institutional care comparisons approved by CMS. DMS said all six waivers remain in compliance with budget neutrality and that the most recent 18-month lag review for FY 2022 and FY 2023 found costs at or below institutional care. Members also asked about unused waiver slots; DMS said slots generally cannot be reallocated mid-year if they have been used, except in cases such as death or reserved capacity, because CMS treats participants as unduplicated for the waiver year. A major portion of the meeting focused on the new child waiver created under House Bill 6. Legislators questioned whether the waiver’s design, including the exclusion of participant-directed services and the emphasis on high-acuity children with behavioral health, DCBS, or juvenile justice involvement, matched the bill’s intent to keep children at home. DMS said it used the $14.7 million appropriated for FY 2026 to develop the program, that there is no priority list, and that the waiver is intended to serve the highest-acuity children while also addressing residential needs for those sleeping in offices or placed out of state. Members also raised concerns about the rapid growth of the HCBS waiting list and asked for more detail on age and timing patterns, which DMS said it would provide later. Finally, DMS gave average processing times from application to eligibility determination and from approval to service start, and said the overall average from application to services beginning was about 80 days, while members requested follow-up information on the Carewise assessment contract and related costs.

Transcript Highlights:

• Any further discussion on the motion to suspend the rules?
• 3.33 Noor moves that rule 3.33 Noor moves that rule 3.33 relating<00:08:29.000> to<00:08:29.160
• suspend the rules? suspend the rules?
• <00:09:15.080> please motion to suspend the rules please motion to suspend the rules please
• The rules are The motion prevails. The rules are suspended. suspended. suspended.

Keywords: 919, house, all

Summary: The House took up Senate File 476, the human services policy bill on continuity of care, assisted living safety, vulnerable adult protections, and program integrity. Representative Noor, the bill’s author, described it as a broad policy package covering direct care and treatment, Department of Health policy, aging and disability services, behavioral health, maltreatment of vulnerable adults, continuity of care, and miscellaneous changes. Representative Schumacher also supported the bill, saying the final language reflected extensive stakeholder work and compromise, especially in aging and long-term care, while also adding guardrails around fraud-related processes and other DHS policy decisions. Several amendments were considered. A DE3 amendment was offered and adopted, and an A8 amendment to the amendment was initially discussed as a way to create a legislative working group and bring more community input into human services program changes, but Representative Curran withdrew it. Curran then offered A11, which would have changed billing limits for individualized home supports with training, but withdrew that as well after noting DHS concerns about possible costs. The House then suspended the rules to allow Noor’s A13 technical amendment, which was adopted. On third reading, Representative Frederick praised the bipartisan work and highlighted provisions addressing intimidation of staff in the Minnesota Sex Offender Program, extending voluntary return time for certain civilly committed individuals, and allowing some DCT staff to move from unclassified to classified positions. Noor thanked staff and reiterated that the bill protects vulnerable people while preserving program integrity and taxpayer dollars. The bill passed as amended by a vote of 93 ayes to 39 nays, and its title was agreed to.

Transcript Highlights:

• that we are not supposed to read rule that we are not supposed to read bills. bills. bills.
• <00:25:38.240> were<00:25:38.480> in they felt that the the rules were in they felt
• particular facility wasn't necessarily as<00:39:48.079> much<00:39:48.240> based<00:39
• He said there is an ore tenus rule that favors the ruling of the judge and suggested working something
• rule that favors<00:52:25.200> the<00:52:25.440> ruling<00:52:25.760> of<00:52:

Keywords: 1136, house, all

Transcript Highlights:

• Facility. Facility.
• Facility. Facility.
• I from La Vista Correctional Facility.
• anticipated because of a federal rule anticipated because of a federal rule regarding<01:38:19.040
• purchase of academic facilities trueups. purchase of academic facilities trueups.

Keywords: 981, all

Transcript Highlights:

• by employees of residential facilities by employees of residential facilities uh<00:02:33.120>
• I found the rule that Ms. Freeman was referencing for additional proofs of residence allowed.
• listed in um rule in state Rule<00:36:01.280> and<00:36:01.480> so<00:36:02.560> um
• and so um can look up there it in Rule and so um can look up there it in in<00:36:05.240> rule
• ballots following the exact same rules ballots following the exact same rules so<01:34:10.480>

Keywords: 1187, senate, all

Transcript Highlights:

• Brent Decray, our facilities director, has been looking at facility projects and really providing oversight
• on those facility projects.
• And Brent Decray has been out there looking at the facilities.
• rules only allow them to license through the age of 12.
• facility that was built by this.

Summary: The committee met to receive a series of audit presentations, beginning with the statewide Annual Comprehensive Financial Report (ACFR) for fiscal year 2025. The State Auditor’s Office and OMB reported a clean, unmodified opinion for the state, with strong financial results including a $40.6 billion net position, $30.99 billion in assets, $1.81 billion in liabilities, and continued Legacy Fund growth. OMB also explained the new GASB 101 compensated-absences reporting change and discussed pension-liability fluctuations tied to discount-rate assumptions and investment performance. Members asked about how the state compares to others and about the effect of short-term commodity price swings, and OMB said the report reflects actual fiscal-year results rather than forecasts. The committee then heard the University System audit, which also received a clean opinion but included four findings: misreporting of Strategic Investment and Improvements Fund revenue, insufficient monitoring of service organizations at CTS, NDSU, and UND, improper bank reconciliations at Dakota College of Bottineau, Dickinson State, and Williston State, and investment/cash reconciliation problems at Bismarck State College related to bond proceeds. University officials agreed with the findings and said corrective actions were underway, including internal review of bank reconciliations. Members raised questions about NDSU’s use of certificates of deposit, and university staff explained that CDs are used to earn interest on funds being accumulated for future projects. Several other audits were presented, most with clean opinions and no findings, including the State Auditor’s Office, Workforce Safety and Insurance, Housing Finance Agency, Housing Incentive Fund, Job Service North Dakota, the Retirement and Investment Office, PERS, the Center for Distance Education, the Commission on Legal Counsel for Indigents, the Ethics Commission, and the Office of Administrative Hearings. Notable exceptions included a State Fair Association audit with an adverse opinion on the foundation component unit because its financial statements were not available for audit, and a Securities Department performance audit finding that performance-based pay increases and bonuses were issued without required evaluations. The committee also discussed the State Auditor’s future needs, including more staff capacity, data analytics, cybersecurity reviews, possible subpoena authority, independent legal counsel, and whether some audits—such as the Ethics Commission and State Fair—should be handled by independent third parties or under different statutory arrangements.

Transcript Highlights:

• ><00:31:27.919> helped change their rules which helped change their rules which helped precipitate
• <00:36:05.200> and seriously short of facilities and seriously short of facilities and seriously
• <00:51:12.079> we've hospital long-term care facilities we've hospital long-term care facilities
• <00:51:34.880> the sites working with our facil the sites working with our facil the facilities
• was going to cost to build the facility was going to cost to build the facility but<01:06:41.280

Keywords: 924, joint, all

Transcript Highlights:

• Pursuant to the rule, the gentleman from New York, Mr.
• GARBARINO TO SUSPEND THE RULES AND PASS H.R. 1608.
• We do not choose the rules in Illinois' elections.
• WE DO NOT CHOOSE THE RULES IN ILLINOIS' ELECTIONS.
• I FOLLOWED THE RULES OF ILLINOIS.

Keywords: U.S. House of Representatives Floor Proceedings on Monday, November 17, 2025, 1012, house, all

Transcript Highlights:

• that we can put into the rules engine.
• For instance, the rules than providers.
• And shared or not based on those rules.
• that we can put into the nuanced rules that we can put into the rules<00:13:05.040> engine.
• Um, and it's something rules engine.

Keywords: Meeting Start 00:00:00 Attendance Roll Call 00:00:20 CRISP Shared Services 00:01:39 Rural Health Transformation Plan 00:30:55, 958, all

Summary: The Budget Review Subcommittee on Health and Family Services opened its first meeting of the 2026 interim session, took roll, and moved directly into presentations. The main presentation was from Ryan Bramble of Crisp Shared Services, who described the organization’s health information exchange and health data utility model in Kentucky and other states. He emphasized that Crisp is a nonprofit, that data ownership remains with providers, and that governance is local. He also outlined the technical infrastructure, including a master patient index, cloud-based data lake, support for modern standards like FHIR and USCDI as well as older formats, and data quality tools used to normalize and standardize information. Bramble said the model is intended to reduce duplication, lower costs, and support rural providers and future use cases such as reporting, analytics, and AI-enabled decision support. Members asked how the state can ensure the data is actually used and who should drive priorities for health care improvement. Bramble said Crisp can provide tools, expertise, and examples from other states, but local teams such as KHI and state stakeholders must tailor and lead utilization efforts. In response to questions about ownership and coordination, he stressed that successful HIE governance requires a multistakeholder body that includes hospitals, health plans, government, and other interests, with a unified approach rather than multiple competing directives. He also said the Commonwealth has an opportunity to convene those stakeholders and set clear priorities. A senator raised concerns that responsibility for Medicaid and broader health policy has become fragmented and suggested a stronger central role for the state, possibly through the Department of Public Health, to coordinate health priorities. Bramble agreed that a single convening authority and multistakeholder governance are important, and noted that local governance should determine what data is shared and how it is used. No votes or formal actions were taken during this portion of the meeting. After Bramble’s presentation and questions, the committee was told that Secretary Stack from the cabinet would testify next on the rural health transformation plan.