Transcript Highlights:

• </c> 80% of NEMT spending is in managed care. 80% of NEMT spending is in managed care.
• Claims Act.
• </c> under the False Claims Act. under the False Claims Act.
• and uh, and claim scrutiny.
• </c> claims in on a quarterly basis? claims in on a quarterly basis?

Committee: House Fraud Prevention and State Agency Oversight Policy

Keywords: 1183, house

Transcript Highlights:

• And those are estimated claims.
• I mean, the same claims exist, but the value of those claims has gone up exponentially.
• Right now, we assign claims and assign values to each of our claims.
• for each claim, both what has actually gone out the door and what we value the claim to be.
• In CYFD, any claim, we have 2,600 claims, totally an estimated claim right now of $400 million.

Summary: The committee first heard Senate Bill 246, which would require licensure and inspections for massage therapy establishments. The sponsor and Regulation and Licensing Department said the bill is intended to close a gap in oversight, improve sanitation and public safety, and help address human trafficking and prostitution concerns. Supporters from the massage therapy profession and industry groups said establishment licensing would create accountability and protect legitimate practitioners, while AMTA took a neutral position but supported the rulemaking process. Several senators raised concerns about privacy, home-based businesses, and whether mobile or traveling therapists would be affected; the department said the bill would apply to establishments, not individual therapists, and that home inspections would be governed by rules. The committee voted 8-0 to give SB 246 a do pass recommendation. The committee then took up Senate Bill 300, an appropriation for CYFD computer hardware and software to improve compatibility with the national child welfare management system. The sponsor said the goal was to reduce delays and improve data sharing, especially in child welfare and ICWA-related cases. Members asked about the current system and how the funding would help, and the sponsor said the bill was aimed at better interoperability. The committee voted 8-0 to send SB 300 forward with a do pass recommendation. Finally, the committee considered Senate Bill 146, which would amend the New Mexico Civil Rights Act. The bill and committee substitute would align the legal standard more closely with federal deliberate indifference language, reduce damages caps, shorten the statute of limitations, require 90 days’ notice, and bar double recovery under both the Civil Rights Act and Tort Claims Act. Supporters, including county and city representatives, law enforcement, AFSCME, and risk management officials, argued the changes were needed to control rapidly rising claims costs and protect public budgets. Opponents from the ACLU, civil rights, poverty, immigrant, and LGBTQ advocacy groups said the bill would weaken accountability, reintroduce qualified immunity-like protections, and make it harder for people harmed by government actors to seek justice. After a failed motion to table and a 5-5 vote on the committee substitute, the bill remained in committee and did not advance.

Transcript Highlights:

• Okay, this is the Sedgwick claims management service.
• This is our claims manager, kind of the third-party administrator on the property insurance side.
• consistency in who's starting the claim, managing the... ...the important part of having the consistency
• in who's starting the claim, managing the claim, and ending the claim is important for the integrity
• the claims.

Committee: All ALC-STATE INSURANCE PROGRAMS OVERSIGHT SUBCOMMITTEE

Keywords: 1204, all

Transcript Highlights:

• Now claims, we last year received 16,384 claims in total.
• Not all those claims have cost associated with them. Some of them are report-only claims.
• To close out Hurricane Ian claims and Hurricane Adalia claims, which are all now closed.
• Hurricane E.N. claims and Hurricane Adalia claims, which are all now closed.
• We're going to send claims, claim forms. We're going to send claims forms to the claimants.

Summary: The subcommittee heard presentations from the Department of Financial Services and the Department of Business and Professional Regulation, then returned to its ongoing budget workshop with the Department of Management Services. DFS’s Division of Risk Management described its role as the state self-insurance fund, covering about 200,000 employees and 27,000 vehicles, paying roughly $150 million in claims last year, and managing a pilot ETS treatment program for veterans and first responders that had 49 patients and 804 treatments as of the latest report. The Division of State Fire Marshal outlined its fire prevention, training, emergency response, and grant programs, including hurricane deployments, the Florida State Fire College, and several capital and grant requests for roof, courtyard, memorial, and equipment needs. The Division of Rehabilitation and Liquidation explained how it handles insolvent insurers under Chapter 631, currently administering 14 estates with $1.2 billion in assets and $3.7 billion in liabilities, and said no new receiverships had been opened since February 2023. Members asked about grant backlogs, fire truck procurement delays, memorial repairs, and whether affiliate transfers were occurring in insurer liquidations. Secretary Griffin then updated the committee on DBPR’s implementation of House Bill 1021 on community associations. He said the department had used the new authority to expand education, complaint handling, and ombudsman services, including 10 free standardized courses, a new condo website, and a four-hour board certification course that had already drawn more than 12,000 attendees. He reported that outreach to condominium communities had increased by more than 60%, that complaint filings were up 39% while jurisdictional dismissals dropped to 11%, and that about 81% to 82% of the 65 new positions had been filled. Members pressed him on whether the department had enough authority and funding, how condominium counts are determined, how self-reported structural integrity reserve study data is verified, and whether more public-facing complaint tracking and better reporting from local governments or developers would improve the system. The committee then resumed questioning Secretary Allende of DMS about outstanding budget and operations issues. Members focused on the delayed People First contract extension required by statute, with the secretary saying the delay involved technical and contractual complexity in moving a legacy hard-coded system to the cloud. They also revisited the state data team and data catalog project, asking why a statutory 2022 deadline had not been met, how the four-person team and broader data staff were organized, how many applicants were considered for key positions, and what each role was doing. The secretary said the catalog work was being simplified into six metadata fields and supported by a broader community of practice, but no firm completion date was given during the exchange.

Transcript Highlights:

• And that's the reason I was asking a question because I did spend a lot of my corporate career managing
• disturbed by the actions that have been done in The last several weeks by this body, a body that claims
• It's claimed all the time that you want healthy women. You want them to have access to health care.
• Representative Stark now moves House Bill 3931 be managed ordered without objection.

Bills: HR1036 , HB2975 , HB3026 , HB3297 , HB2981 , HB2978 , HB4144 , HB1322 , HB1818 , HB3194 , HB3767 , HB3342 , HB3344 , HB4170 , HB3287 , HB3288 , HB4454 , HB3264 , HB3266 , HB3268 , HB4095 , HB4115 , HB4316 , HB3530 , HB3428 , HB4272 , HB4273 , HB4274 , HB3405 , HB3406 , HB3467 , HB3469 , HB3931

Keywords: Bob Wills, Western Swing, Cain's Ballroom, Oklahoma music history, country music, rock and roll, folk jazz blues, Oklahoma Arts Council, Oklahoma Film and Music Office, Oklahoma Historical Society, OKPOP Museum, commemorative resolution, day at the Capitol, musician recognition, heritage celebration, Tulsa, poultry waste, nutrient management, environmental regulations, agriculture

Transcript Highlights:

• and that's the reason I was asking a question, because I did spend a lot of my corporate career managing
• disturbed by the actions that have been done in the last several weeks by this body, a body that claims
• disturbed by the actions that have been done in the last several weeks by this body, a body that claims
• It's claimed all the time that you want healthy women.

Bills: HR1036 , HB2975 , HB3026 , HB3297 , HB2981 , HB2978 , HB4144 , HB1322 , HB1818 , HB3194 , HB3767 , HB3342 , HB3344 , HB4170 , HB3287 , HB3288 , HB4454 , HB3264 , HB3266 , HB3268 , HB4095 , HB4115 , HB4316 , HB3530 , HB3428 , HB4272 , HB4273 , HB4274 , HB3405 , HB3406 , HB3467 , HB3469 , HB3931

Keywords: Bob Wills, Western Swing, Cain's Ballroom, Oklahoma music history, country music, rock and roll, folk jazz blues, Oklahoma Arts Council, Oklahoma Film and Music Office, Oklahoma Historical Society, OKPOP Museum, commemorative resolution, day at the Capitol, musician recognition, heritage celebration, Tulsa, poultry waste, nutrient management, environmental regulations, agriculture

Summary: The House opened with roll call, prayer, the Pledge of Allegiance, and several recognitions, including Veteran of the Week Donald W. DeLap, 2025 Oklahoma Teacher of the Year Melissa Yvonne, Doctor of the Day Dr. Corey Shawnaway, Nurse of the Day Rusty Rutherford, and Psychologist of the Day Dr. Glenna Stumbling Bear Riddle. Members also recognized Bob Wills Day at the Capitol with a resolution and musical presentation, and introduced visiting student groups and pages. The chamber then moved into second- and third-reading business on a series of bills. Several measures passed with little or no opposition. House Bill 2975, a Department of Agriculture cleanup bill on poultry litter spreading/exporting, passed 89-8 after questions about removed misdemeanor language and hauler information. House Bill 3026, allowing children of U.S. military allies to start kindergarten according to their home-country timelines, passed 97-0 and its emergency clause also passed 97-0. House Bill 3297, creating a regulatory framework for highway remediation services, passed 87-0. House Bill 2981, requiring school boards to post approved meeting minutes within two weeks and within two clicks, passed 93-0. House Bill 4144, clarifying that arrest and incident reports are open records, passed 97-0. House Bill 1818, updating social work licensing terminology, also passed 97-0. House Bill 3767, updating controlled dangerous substance scheduling to match federal law and DEA watch lists, passed later in the day. The most extended debate centered on House Bill 3194, which would protect pregnancy resource centers from being singled out for regulation or lawsuits. Supporters argued the bill would shield private nonprofit centers from post-Dobbs legal attacks and let them focus on helping pregnant women and families. Opponents raised concerns about transparency, oversight of private nonprofits receiving state funds, the bill’s abortion definition, and whether it could create liability or reduce accountability. After lengthy debate, the House passed the bill 79-18. House Bill 3342, relating to Medicaid audits, passed 67-25 after discussion about making audits corrective rather than punitive. House Bill 3344, a foster care bill based on an interim study, was extensively debated over kinship placement standards, income thresholds, sleeping arrangements, transportation, tribal placement issues, and whether codifying DHS rules would improve accountability; the transcript cuts off before a final vote is shown.

Bills: HB2936 , HB2937 , HB2951 , HB2960 , HB2979 , HB2980 , HB3062 , HB3082 , HB3087 , HB3148 , HB3152 , HB3262 , HB3264 , HB3266 , HB3268 , HB3269 , HB3278 , HB3299 , HB3544 , HB3606 , HB3678 , HB3790 , HB3903 , HB3996 , HB4139 , HB4140 , HB4142 , HB4143 , HB4144 , HB4260 , HB4272 , HB4296 , HB4324 , HB4339 , HB4341 , HB4342

Committee: House Judiciary and Public Safety Oversight

Keywords: HB2936, children, child protection, adoption, Oklahoma Adoption Code, gestational carrier, gestational agreement, surrogacy, intended parent, preplacement home study, home study, prospective adoptive parent, foster placement, child abuse, child neglect, child sexual abuse, child sexual exploitation, lewd molestation, sex offender registry, Oklahoma Sex Offenders Registration Act

Bills: HB2936 , HB2937 , HB2951 , HB2960 , HB2979 , HB2980 , HB3062 , HB3082 , HB3087 , HB3148 , HB3152 , HB3262 , HB3264 , HB3266 , HB3268 , HB3269 , HB3278 , HB3299 , HB3544 , HB3606 , HB3678 , HB3790 , HB3903 , HB3996 , HB4139 , HB4140 , HB4142 , HB4143 , HB4144 , HB4260 , HB4272 , HB4296 , HB4324 , HB4339 , HB4341 , HB4342

Committee: House Judiciary and Public Safety Oversight

Keywords: HB2936, children, child protection, adoption, Oklahoma Adoption Code, gestational carrier, gestational agreement, surrogacy, intended parent, preplacement home study, home study, prospective adoptive parent, foster placement, child abuse, child neglect, child sexual abuse, child sexual exploitation, lewd molestation, sex offender registry, Oklahoma Sex Offenders Registration Act

Summary: The committee heard a long series of House bills, mostly on criminal justice, public safety, transportation, and administrative procedures. Measures included lowering school-zone speed issues on certain highways (HB 2979), allowing DMV staff to accept physical proof of insurance (HB 2980), barring people convicted of pedophilia from adopting children (HB 2936), allowing lawful weapon carry on boats (HB 2937), and restricting fire departments from hiring people required to register as sex offenders (HB 382). Other bills addressed warrant fee increases for counties (HB 3262), making strangulation in domestic violence cases an 85% crime (HB 3264), creating offenses for reckless driving tied to racing and collisions (HB 3266), criminalizing knowingly making or displaying fictitious license plates (HB 3268), and allowing electronic arrest warrants (HB 3269). The committee also advanced bills on Open Meetings Act enforcement, OCC port-of-entry arrest authority, expanding protections for municipal officials and notaries, creating vessel titling, and modernizing vehicle inspection/title procedures. Several members raised questions about costs, enforcement authority, and whether new penalties would shift burdens to consumers or local governments. For example, HB 3262 drew concern about passing warrant-fee costs to the public, and HB 3268 prompted questions about existing law and the need for a new felony for fake tags. The OCC port-of-entry bill generated extended discussion about whether a regulatory agency should have arrest authority, with supporters arguing it would free up Highway Patrol and sheriff resources and opponents questioning the expansion of quasi-law-enforcement powers. Other bills were presented as request bills from agencies or constituents, including the Attorney General, Oklahoma City police, the Bomb Squad, the Corporation Commission, and local residents. The committee also approved a number of bills with little or no opposition, including a domestic violence strangulation measure, a bill on Open Meetings Act remedies, a bill allowing sentence modification requests by district attorneys, and a bill requiring domestic violence incident reports and judicial training. Later, the committee considered additional public safety and criminal procedure bills such as making firearm theft a felony, increasing the damage threshold for police response in property-damage crashes, and requiring the state to pay expert witness costs in capital appeals. Most measures were reported out do pass, with several unanimous votes and a few split votes, including HB 3262 and the OCC port-of-entry bill. The meeting ended after laying over a few bills and adjourning.

Transcript Highlights:

• Um, and still we're managing to perform. Um, that's in light of all of this national press.
• Um, and still we're we're managing<00:35:55.760><c> to</c><00:35:55.920><c> perform.
• Um, that's in light managing to perform.
• We actually put some language, and I can't remember it when we were doing our county manager.
• I actually put the amendment on county manager.

Bills: SB115 , SB131 , SB93 , HB319 , HB163 , HB268 , SB115 , SB131 , SB93 , HB319 , HB163 , HB268 , HB181 , HB153 , SB132 , SB26 , SB189 , SB196 , HB140 , SB197 , HB117 , HB181 , HB153 , SB132 , SB26 , SB189 , SB196 , HB140 , SB197 , HB117

Committee: Senate County and Municipal Government

Keywords: SB115, Alabama, impersonating a peace officer, peace officer, law enforcement impersonation, police impersonation, unauthorized police officer, fake cop, certification revoked, certification suspended, Alabama Peace Officers' Standards and Training Commission, APOSTC, Class C felony, law enforcement hiring, appointment of officers, federal law enforcement, arrest authority, public order, criminal offenses, Judiciary Committee

Transcript Highlights:

• Okay, this is the Sedgwick Claims Management Service.
• This is our claims manager, kind of the third-party administrator on the property insurance side.
• Okay, this is the Seduit Claims Management Service.
• This is our claims manager, kind of the third party administrator on the property insurance side.
• He added that consistency in who starts, manages, and ends a claim is important for the integrity of

Committee: All ALC-STATE INSURANCE PROGRAMS OVERSIGHT SUBCOMMITTEE

Summary: The State Insurance Programs Oversight Subcommittee met on June 17 and reviewed a series of Employee Benefits Division and Office of Property Risk items. Grant Wallace presented March and April formulary changes, explaining that the updates favored lower-cost generics, re-tiered some drugs, left several new-to-market drugs uncovered pending more evidence, and added quantity limits in some cases. The committee approved those formulary recommendations. The subcommittee also approved a cell and gene therapy policy that would exclude automatic coverage of those therapies and route them through prior authorization and review, with members noting the process should not delay urgent cases and that appeals remain available. Members then discussed a UAMS professional consultant services contract amendment for pharmacy benefit consulting. The discussion focused on confusion over the dollar amount and scope, with Wallace clarifying that the committee was being asked to approve up to $2.596 million, including optional services related to coupon and rebate management that could be used later without returning for another approval. Several members raised concerns about matching the written contract to the approval amount and about the relationship to the current pharmacy benefit manager, but the committee ultimately approved the item with the understanding that any use of the optional services would return to the committee. The committee also reviewed, without objection, a Blue Cross/Blue Advantage third-party administrator contract, a CompSack employee assistance program contract, and approved proposed 2027 employee and public school health plan rates of 9.8% and 4.9% increases, respectively. Wallace also said the UnitedHealthcare rebid was in final negotiation and would return in August. On the property risk side, the committee reviewed permanent rules for the property insurance program, a contingency-fee subrogation contract with Denenberg-Tuffly, and extensions for Sedgwick Claims Management, Actuarial Advantage, and Stevens Capital Management. Members asked about claim-adjustment delays after a major winter storm, and Wallace said performance guarantees and communication requirements had been added, with claims still expected to vary by case. The committee also approved 2026-27 captive insurance program rates, which included no change to minimum deductibles, lower rates for K-12 and higher education, a higher rate for state agencies, and an overall 10% reduction. Wallace said the reductions reflected improved actuarial foundations, better claims management, and the program’s first-year performance. The meeting adjourned after approving the rate item.

Transcript Highlights:

• A clean claim is defined as a claim that has no defect or impropriety, including any lack of required
• payment of all or part of the claim and the reason for the denial.
• And we're identifying what a clean claim is.
• million claims in 2025, and this bill covers the claims for our 120,000 providers and 104 hospital system
• That represents approximately 320,000 claims across the state.

Bills: SB5915 , SB5988 , SB6025 , SJM8002

Committee: House Health Care & Wellness

Keywords: SB 5915, health technology assessment, HTA, clinical committee, medical technology review, coverage determination, state-purchased health care, Washington health care, RCW, evidence-based medicine, cost-effectiveness, safety and efficacy, Medicare coverage, national coverage determination, clinical guidelines, patient advocacy, public comment, medical necessity, rare disease, life-threatening disease

Transcript Highlights:

• And those are estimated claims.
• I mean, the same claims exist, but the value of those claims has gone up exponentially.
• Right now, we assign claims and assign values to each of our claims.
• In CYFD, any claim, we have 2,600 claims, totally an estimated claim right now of $400 million.
• bring a claim.

Bills: SB246 , SB146 , SB300 , SB301 , SB309 , SM17

Committee: Senate Senate Health & Public Affairs

Keywords: massage therapy, licensure, health and safety standards, continuing education, establishment licensing, civil rights, sovereign immunity, damages, public body, lawsuit limitations, legal notice, child welfare, computing infrastructure, data management, Department of Health, appropriation, foster care, Indian children, cultural competency, training services

Transcript Highlights:

• Everyone I know thinks that a malpractice claim, a paid claim, is like a lightning strike.
• mean payout per claim.
• So, one paid claim in the last five years— we have data only on paid claims.
• On average, the claims are sending a signal. On average, these are not bad claims.
• filed claim.

Committee: House Legislative Health & Human Services Committee

Transcript Highlights:

• A clean claim is defined as a claim that has no defect or impropriety, including any lack of required
• And we're identifying what a clean claim is.
• claims in 2025, and this bill covers the claims for our 120,000 providers and 104 hospital system, so
• Senate Bill 5845 establishes clear timelines for payment claim claims. 5845 establishes clear timelines
• for payment claim claims, and it sets expectations for both when additional information must be requested

Summary: The Health Care and Wellness Committee held a public hearing on several bills and a joint memorial. SB 5915 would update the health technology assessment program by adding technologies recommended for Medicare populations or in national guidelines to the review priority list, requiring broader evidence review for life-threatening or rare diseases, and setting timelines for posting and deciding review requests. Supporters, including rare disease advocates and providers, said the current process is outdated and too rigid; the bill was then held for later action. SJM 8002 urged Congress to strengthen original Medicare, oppose privatization, add benefits like dental, vision, and hearing, and reduce Medicare Advantage overpayments and fraud. Supporters from labor and senior groups argued it would protect beneficiaries and send a message to federal officials; the memorial was also held after testimony. The committee also heard SB 5395 on prior authorization. Staff explained it would tighten notice requirements, require a licensed clinician—not AI alone—to deny requests based on medical necessity, add transparency around policy changes, and change how retrospective denials are treated. The prime sponsor and provider groups said the bill was a negotiated compromise meant to reduce delays and inappropriate denials, while insurers were generally neutral but sought a narrow amendment. Testifiers described prior authorization as a major source of delay and administrative burden, and the bill was held after public testimony. SB 5845 would require carriers to pay or deny clean claims within 30 days, set timelines for non-clean claims and information requests, and allow penalties for repeated noncompliance. Hospitals, physicians, and health systems supported it as a way to improve predictable payment, while insurers were neutral and asked for a narrow amendment; the bill was also held. The committee heard SB 6025, which would change the definition of fetal death so gestational age is calculated using the best clinically accurate age rather than the last menstrual period. Obstetric and nursing witnesses said the current law can force inaccurate records and unnecessary burdens on grieving families, while opponents objected to the bill’s abortion-related definitions. The bill was held after testimony. Finally, SB 5988 would authorize the Department of Health to continue accrediting opioid treatment programs and charge fees to support that work. The department and the sponsor said the measure would preserve a patient-centered accreditation option amid budget pressure, and the committee closed testimony and held the bill.

Transcript Highlights:

• their claims well.
• For instance, a claim may have been withdrawn. It may have been a duplicate claim.
• claims filed.
• managed-repair program.
• and pay claims promptly.

Summary: The Insurance and Banking Subcommittee received a lengthy presentation from Citizens Property Insurance Corporation CEO Tim Serio, with Insurance Commissioner Michael Yaworski also answering questions. Serio reviewed Citizens’ role as Florida’s insurer of last resort, its statutory funding structure, eligibility rules, depopulation program, reinsurance obligations, and the surcharge/emergency assessment mechanisms that can be used if Citizens runs a deficit. He emphasized that recent legislative reforms, combined with lower litigation and improved market conditions, have helped the private market recover and reduced Citizens’ policy count from a peak of about 1.41 million in 2023 to 936,182 at the end of 2024, with a projected drop to about 771,000 by the end of 2025. He also said the reforms reduced Citizens’ rate need and helped avoid an emergency assessment after the 2024 storms. Members asked about Citizens’ rate increases, why Citizens still seeks higher rates despite lower litigation, how the 20% eligibility threshold works, whether Citizens should be wind-only, and whether the state or federal government could help with deficits. Serio explained that Citizens is still charging below actuarially sound rates in most areas, that rate filings reflect reduced litigation and lower reinsurance exposure, and that assessments on all Florida property policyholders are the reason Citizens tries to build surplus and depopulate. He said the depopulation program is working better than in the past, with less than 2% of takeout policies returning to Citizens, and that the Office of Insurance Regulation has been vetting takeout companies more carefully. A substantial portion of the discussion focused on claims handling after Debby, Helene, and Milton, including flood-versus-wind disputes and Citizens’ use of the Division of Administrative Hearings for some claim disputes. Serio said Citizens had received 76,625 claims from the three storms and had paid nearly $823 million in indemnity and expenses as of January 7, 2025. He said many closed-without-payment claims were either below deductible, withdrawn, duplicate, or flood-only, and that Citizens had asked its internal audit function to independently review the claims data and denials. He also described Citizens’ storm outreach, catastrophe response centers, managed-repair program, and claim review process, and said the corporation remains focused on paying valid claims while minimizing the risk of assessments on the broader Florida market.

Transcript Highlights:

• claims.
• And when DHS reviews those flagged claims, how does DHS define a potentially fraudulent claim?
• </c> claims that need further investigation. claims that need further investigation.
• We pause payments for 13 claims.
• </c> more than 70 claims out of the hundred. more than 70 claims out of the hundred.

Committee: Senate Human Services

Keywords: 1187, senate, all

Transcript Highlights:

• The claims were just—one claim was submitted at the end of February, and it's been paid.
• Most of the claims, like 70% of claims that are denied, are for a correctable reason.
• But across all claims, only 14% of unique claims have been denied.
• Most of the claims, like 70% of claims that are denied are for a correctable reason.
• But across all claims, only 14% of unique claims have been denied.

Summary: The hearing focused first on behavioral health, especially serious mental illness and anosognosia, a condition described by witnesses as a neurological symptom that prevents people from recognizing they are ill. The chair framed the issue around families cycling through emergency rooms, jails, conservatorships, and short-term stabilization without lasting treatment, and warned that federal changes under H.R. 1 could reduce Medi-Cal funding and worsen access. Dawn Marie Anderson gave a personal account of her son’s long history of psychosis, homelessness, arrests, repeated jail and state hospital stays, and eventual stability when he received sustained medication and coordinated support. She argued that the system often treats the problem as criminal rather than medical and that voluntary programs and short-term services are not enough for people who lack insight into their illness. Other panelists, including representatives from the California Behavioral Health Association, Santa Barbara County Behavioral Health, and the County Behavioral Health Directors Association, agreed that anosognosia is not denial or noncompliance and said the system needs long-term, coordinated care, including assertive community treatment, mobile crisis, supportive housing, medication support, and stronger handoffs between county and managed care systems. They said CalAIM and other reforms have improved some coordination, but significant gaps remain, especially for people with serious mental illness, for those in jail or locked settings, and for people with private insurance, which witnesses said often offers little meaningful coverage for early psychosis or intensive behavioral health services. Several witnesses urged the Legislature to protect Medi-Cal, shore up county safety-net services, and invest in training and family engagement. The committee then turned to the Children and Youth Behavioral Health Initiative, with a focus on the virtual services platforms BrightLife Kids and Soluna and the CYBHI fee schedule. DHCS reported strong growth in app registrations, coaching sessions, referrals, and positive user outcomes, saying the platforms provide free, culturally responsive, early-intervention support statewide and help connect users to higher levels of care when needed. On the fee schedule, DHCS said more than 500 LEAs, colleges, universities, and school-linked providers are participating, 181 LEAs have submitted claims, and $9.6 million has been reimbursed to date, with 41,556 students represented in claims. The chair and several members criticized the pace of implementation and the amount of money spent relative to reimbursement levels, saying the Legislature had requested data earlier and that the return on investment still appeared low. DHCS responded that many claims are still being submitted, that 70% of denials are correctable, that $400 million in capacity grants has been distributed locally, and that reimbursement is increasing rapidly as more districts come online. Public comment included a rural county behavioral health director who said private insurance denials leave counties with significant uncompensated work, especially for unlicensed staff providing case management and mobile crisis services.

Transcript Highlights:

• There's case managers at the department.
• It contains health care claims data.
• care claims for dental services.
• It contains health care claims data.
• care claims for dental services, how it's made available.

Summary: The committee began with an extended work session on the long-term care workforce. DSHS Assistant Secretary B. Rector described the new Home and Community Living Administration and outlined major workforce pressures: Washington had about 126,000 long-term care workers in 2022, with demand expected to outpace supply as the 85-plus population and dementia prevalence rise sharply. She emphasized that direct care workers are largely women, people of color, and immigrants, and that family caregivers are also a major part of the system. She highlighted recruitment and retention efforts funded through federal Money Follows the Person dollars, including high school training partnerships, a retention toolkit, transportation support, caregiver newsletters, tribal workforce navigators, and a remote caregiving pilot. Committee members asked about career pathways, technology use, and turnover drivers; Rector said wages, benefits, unstable hours, and workplace support are key issues and promised follow-up data. Aidan Swain of the Washington Health Care Association said skilled nursing and assisted living facilities face acute RN vacancies, wage pressures, and Medicaid reimbursement that does not cover costs, and urged modernization of training, better reimbursement, and continued support for facility-based care. Maddie Fouch of SEIU 775, representing about 55,000 caregivers, said low wages, weak benefits, lack of voice, and certification delays are driving turnover and shortages, and argued for higher compensation, better worker protections, and more transparent reimbursement. Catherine Smith of Behavioral Health Solutions described growing behavioral health needs in nursing homes, the role of expanded behavioral supports programs, and credentialing delays that slow hiring. No votes were taken; the panel was informational only. The second agenda item was an overview of the palliative care benefit work group report required by 2024 legislation. Nico Jansen of the Office of the Insurance Commissioner explained that the work group, convened with the Health Care Authority, studied a potential palliative care benefit for fully insured commercial plans and also Medicaid, PEBB, and SEBB. He said palliative care is a philosophy of care focused on symptom management, coordination, and support for serious illness, and is distinct from hospice because it can be provided alongside curative treatment. The actuarial analysis concluded that creating a new benefit would likely increase costs, estimating about a 28-cent per member per month increase overall and roughly $2.6 million to $4.5 million in annual state Medicaid costs if implemented in 2027. Jansen said the consultants did not find sufficient evidence to assume savings from avoided hospitalizations or long-term care, though several work group members disagreed and submitted response letters. Senators asked about other states, Medicare, health homes, and whether more research could clarify cost savings; OIC said some states, including Hawaii, are moving ahead with Medicaid palliative care benefits, Medicare covers some related services but not in the same way, and further evidence may emerge over time. OIC did not take a position on whether the Legislature should create the benefit. The final presentation covered health care price transparency tools in Washington and federally. Evan Klein and HCA Chief Data Officer Vishal Chaudry reviewed federal hospital and health plan transparency rules, the state all-payer claims database, prescription drug price transparency, the Health Care Cost Transparency Board, the Prescription Drug Affordability Board, and other reporting systems. They explained that the APCD contains claims from fully insured commercial plans, Medicaid, and public employee programs, but not self-insured employer data except for limited voluntary submissions. They also described how machine-readable files, consumer price tools, and aggregated dashboards are used, and noted that data limitations, delays, and complexity remain significant. Senators asked about voluntary self-insured participation, the role of AI in making data more usable, and whether transparency can really help consumers given access barriers and medical debt. HCA said AI is increasingly used by private entities to mine large transparency datasets, but state agencies still face limits in data access and analytic capacity. The committee did not take action; the session was informational and ended with a discussion of how transparency data might better inform policy and purchasing decisions in the future.

Transcript Highlights:

• Claims volume is expected to grow quickly. Currently, 10 LEAs are able to submit claims.
• They shared at that webinar that seven LEAs have filed claims, 18 claims.
• , EDI claims forms to the third party administrator. claims EDI claims forms to the third party administrator
• It requires health care service plans, including Medi-Cal managed care and dental managed care plans
• It requires health plans to reimburse claims no later than 30 calendar days after receipt of a claim,

Summary: The committee heard a budget oversight hearing on the Department of Health Care Services, focusing first on the overall Medi-Cal budget and a March General Fund loan to cover a current-year shortfall. DHCS said the 2025-26 budget proposal totals $193.4 billion, with Medi-Cal projected at $188.1 billion total funds and $42.1 billion General Fund, driven by higher enrollment, pharmacy costs, managed care growth, and costs tied to eligibility expansions and the COVID-era redetermination unwinding. The department said the $3.44 billion loan was needed to manage cash flow and ensure timely payments to providers and plans, while the LAO noted Medi-Cal’s cash-basis budgeting creates volatility and that more detailed estimates would come with the May Revision. Members discussed federal Medicaid threats, the need for transparency on cost drivers, and the impact of pharmacy spending, long-term care, and immigration-related coverage expansions. The second major topic was family health programs, including California Children’s Services, the continuous coverage unwinding, and opioid settlement fund spending. DHCS described CCS funding methodology changes, ongoing county stakeholder work, and a delayed rollout of CCS monitoring and oversight until July 1, 2025, while county representatives and advocates argued the program is underfunded and asked for more technical assistance and a delay in implementation. On the unwinding, the department explained that federal redetermination flexibilities helped maintain coverage after the pandemic, but the Governor’s budget proposes ending them at the end of June 2025; advocates urged making the flexibilities permanent to avoid coverage losses. For opioid settlement funds, DHCS and Finance said the budget increases funding for naloxone distribution while reducing other harm-reduction spending based on updated settlement revenues, prompting criticism from members and public commenters who argued the change would weaken effective harm-reduction programs. The hearing also included an update on Proposition 35 implementation. DHCS said the voter-approved measure continuously appropriates MCO tax revenues beginning in 2025, with up to $4.6 billion annually available for specified Medi-Cal and provider investments in 2025 and 2026, but implementation depends on consultation with the required stakeholder advisory committee. The department and LAO noted uncertainty about future federal rules affecting the MCO tax after 2026. Public testimony largely supported maintaining Medi-Cal expansions, protecting immigrant coverage, preserving harm-reduction funding, and increasing support for community health workers, pediatric dental care, and CCS county administration. No votes were taken during the portion of the hearing provided.

Transcript Highlights:

• On the managed care side, this cares reported to us that they they paid for 959,000 biomarker claims,
• They're managed care. Also a limited number of paid claims there.
• to get that get that paid on the managed care side.
• We've also asked any prior claims that have been denied for prior authorization by managed care plan
• And the all these examples to manage the managed Care channel that managed care provider doesn't actually