Transcript Highlights:

• Thank you. clarifying the scope of this autonomy, clarifying the scope of this autonomy, particularly
• Because it sounds like plan review is a section or only a portion of scope of work that an engineer is
• qualified to work on.
• hands-on and design work. hands-on and design work.
• I continue to have concerns regarding the scope of work for engineers and that the qualifications for

Keywords: 910, house, all

Summary: The House Committee on Labor met on February 19, 2026, and heard a series of bills largely focused on public employment, staffing, and professional licensing. Early measures included HB 2276 and HB 2472, both relating to Hawaii Employer-Union Health Benefits Trust Fund staff salaries, which were supported by trust fund representatives and received no opposition or questions. The committee also heard HB 1714 HD1 on housing, where the Hawaii Public Housing Authority testified with comments and the Deputy Attorney General raised concerns about the scope of autonomy, civil service, collective bargaining, and a possible separation-of-powers issue involving legislative approval of long-term contracts. The committee then considered several personnel and civil service bills. HB 2325 HD1, relating to civil service exempt positions at DLNR, drew support from DLNR and the Office of Planning and Sustainable Development, but HGEA opposed it and urged the department to seek other recruitment and retention solutions while keeping employees in civil service. HB 1541, relating to Department of Health positions, was supported by DOH on the grounds that the positions serve vulnerable populations and require specialized expertise, while HGEA opposed. HB 2140 HD1, relating to essential permanent positions, received support from OPSD, HGEA, and the Chamber of Commerce, with written comments from the city Department of Budget and Fiscal Services. HB 2315 HD1, relating to state employment benefits, was strongly supported by DOH, UPW, and HGEA as a recruitment and retention incentive; members questioned the pilot program, and DOH explained it would allow employees to cash out vacation leave earlier than current policy allows. The committee also heard HB 2295 on government contracting, with DOE support not present and IBEW 1186 in opposition. HB 1720, relating to professional engineers, drew strong support from the City and County of Honolulu’s planning department, which argued the bill would help with affordable housing review and only affect eligibility to sit for the licensure exam, but strong opposition from engineering industry and licensing board representatives, who warned it would lower licensing standards and harm reciprocity; members questioned both sides about plan review experience and licensure requirements. HB 2367, relating to employment earnings and pay transparency, received strong support from the Hawaii Civil Rights Commission, AAUW, the Commission on the Status of Women, and others, who said transparency helps small businesses and retention, while written opposition came from the Maui Chamber of Commerce and NFIB. Finally, HB 1935, relating to personal information, drew comments from the Attorney General and the Campaign Spending Commission about implementation burdens and disclosure requirements, with UPW supporting the home-address redaction portion but opposing the broader disclosure process; additional written testimony was noted from OIP, the League of Women Voters, Public Press Law Center, HGEA, and DCCA.

Transcript Highlights:

• What makes competition something that really works?
• Cell phone service doesn't work.
• Yes, so we're working on a proposed decision.
• It always works.
• And so we can't have customers go from something that always works to something that may work.

Summary: The committee held an informational hearing on Carrier of Last Resort (COLR) to examine its history, current operation, and possible future changes in California. Chair Tasha Berner said the hearing was prompted in part by AT&T’s 2023 request for relief from COLR obligations and by broader concerns about public safety, affordability, universal service, and access to modern broadband and telecommunications. The first panel featured a telecommunications expert who traced COLR back to universal service principles and explained how states have handled COLR differently, including full deregulation, limited rural obligations, or transition pathways tied to competition and customer protections. Members asked about affordability, federal and state processes for service withdrawal, and whether COLR remains necessary given modern competition. CPUC staff then described California’s COLR framework, explaining that universal service rests on access, reliability/quality, and affordability, and that COLR requires carriers to provide basic service, including voice-grade calling, 911 access, relay services, and Lifeline. Staff said AT&T’s application sought relief in nearly all of its territory, but no replacement COLR came forward during the proceeding, and public participation hearings drew thousands of comments and strong concern from rural and vulnerable customers. The CPUC outlined its ongoing rulemaking to reconsider whether the 1996 COLR rules and 2012 basic-service definition still fit current conditions, with workshops and public hearings scheduled and a proposed decision expected later in the year or into 2026. Members pressed staff on geographic outreach, wireless coverage, whether broadband can be part of basic service, public safety during wildfires, and what reporting and complaint processes currently exist. In the final panel, industry and public-interest witnesses sharply disagreed. A U.S. Telecom representative argued COLR is outdated, costly, and copper-focused, and said reform should allow technology-neutral alternatives such as wireless, fiber, and satellite while preserving reliable voice and emergency access. The CPUC Public Advocates Office countered that COLR remains a necessary public safeguard, especially for rural and low-income customers, and argued that any transition should maintain or improve service, with public benefits such as broadband investment and continued protections for 911, disability access, and affordability. Committee members focused on the difference between an obligation to serve everyone and a mere option to serve, and on whether the Legislature should provide clearer guidance as the CPUC’s rulemaking moves forward.

Transcript Highlights:

• As I mentioned, it describes what that scope of practice is, which we've clearly defined.
• So I want to thank you for working the bill.
• This bill does not expand scope of practice.
• . meds miss more school, parents, miss work, and continuity in care is disrupted.
• But then after that, if you're not working in that field, you don't see anything else.

Summary: The Health Professions and Program Subcommittee met with a quorum and considered seven bills, all of which were reported favorably. HB 497 would create a neurofibromatosis research grant program within the Department of Health; an amendment removed automatic recurring funding and made the program subject to annual appropriations. Proponents described the disease burden and the need for Florida-based research support. The bill passed 14-0. The committee also approved HB 223, which creates a licensing and regulatory framework for naturopathic medicine, including a Board of Naturopathic Medicine under the Department of Health. Supporters argued licensure would improve patient safety, transparency, and access, while the Florida Osteopathic Medical Association and Florida Medical Association waived in opposition. The bill passed 15-0. HB 683 modernizes physician assistant and APRN prescribing rules by removing certain administrative notice and prescription-labeling requirements and allowing a 30-day course of psychotropic medication; an amendment removed language that would have allowed practice without physician supervision during declared emergencies. It passed 15-0. The committee then approved CS for HB 121, which updates Florida’s seizure action plan law by extending protections to charter school students, requiring schools to accept physician-submitted plans, clarifying training duration, expanding training to regular bus drivers, and requiring seizure-response posters in schools. HB 353 adds sickle cell disease education to existing pain-management continuing education for health professionals, prompted by extensive testimony from patients and advocates about bias, delayed treatment, and lack of provider knowledge; it passed 15-0. HB 1175 directs the Florida Building Commission and State Fire Marshal to develop updated safety design standards for office surgery suites, with an amendment delaying the effective date to January 1, 2027; it passed 14-0. Finally, HB 251 creates a public records exemption for current emergency physicians and their families, narrowed by amendment to current physicians and children up to age 26 and made subject to sunset review; it passed 15-0. The meeting adjourned after all agenda items were completed.

Transcript Highlights:

• Sorry you had to wait so long, but we were working. Thank you very much.
• How does that work, in fact, I'll ask TechSOT.
• How does that work, in fact, I'll as TechSOT?
• We have been working with DPS and looking at the drafting of this bill.
• They are reactive systems limited in scope and... ...they are reactive systems limited in scope and often

Bills: SB2199, SB2200, SB2201, SB2949, SB2332

Keywords: overweight vehicle, vehicle weight limits, hazardous materials, hazmat, cargo tank, fuel transport, trucking, commercial vehicle, Transportation Code, criminal penalty, second-degree felony, loading violation, truck weight, axle weight, gross weight, public safety, commercial carrier, Texas, commercial truck, truck route

Summary: The Senate Committee on Border Security heard several bills related to border security, law enforcement databases, DPS aviation maintenance, and transportation motor fuels. SB 2199, after brief invited testimony from the Texas Trucking Association and DPS, was left pending at first and later reported favorably to the full Senate on a 4-1 vote. SB 2332, relating to aircraft owned and operated by the Department of Public Safety, was laid out by Senator Parker, with DPS and TechSOT witnesses explaining that it would centralize DPS aircraft maintenance under DPS, align state law with FAA responsibility rules, and potentially reduce costs and downtime; it was later reported favorably on a 5-0 vote and placed on the local and uncontested calendar. SB 2949, relating to the regulation of transportation motor fuels, was also adopted as a committee substitute and reported favorably on a 4-1 vote, with a member noting continued interest in refining port-of-entry transloading issues. The committee spent the most time on SB 2201, which would revise Texas intelligence database criteria for criminal street gangs and foreign terrorist organizations. Senator Birdwell described the bill as adding safeguards such as requiring officer identification on submissions, setting retention and validation rules, and updating criteria to reflect technology and social media use. Invited witnesses from the district attorney’s office, DPS, and the Texas Anti-Gang Center generally supported the bill and said it would improve reliability and accountability. Public testimony included support from the Texas Public Policy Foundation and opposition from the Texas Civil Rights Project and the ACLU of Texas, which argued the bill’s language on implied or demonstrated self-admission and other criteria was vague, overly broad, and could lead to erroneous inclusion in the database and downstream consequences. After debate, SB 2201 was reported favorably to the full Senate on a 4-1 vote, with Senator Eckhardt voting no. During questioning on SB 2201, members discussed how gang-database entries are used in investigations and prosecutions, the meaning of “family member,” the scope of self-admission, and how “previously documented areas” would be identified in practice. Opponents raised concerns about due process, First and Fourth Amendment issues, racial profiling, and possible federal consequences if state database information is shared. Supporters emphasized that the database is a law-enforcement tool for identifying organized criminal activity and that the committee substitute adds training, audits, and accountability measures. The committee then completed its business and recessed subject to the call of the chair.

Transcript Highlights:

• Uh, does Templan, we will work on that.
• <00:38:02.800> for support, and love we bring to work for support, and love we bring to work
• understand the scope of this problem. understand the scope of this problem.
• Um, I work as a paraprofessional interim.
• Um I work as a paradur experience.

Bills: HF238, HF3381, HF3754, HF1049

Keywords: microenterprise home kitchen operation, cottage food, home-based food business, home kitchen license, homemade food, prepared food, food entrepreneur, small food business, cottage food law, food safety training, ServSafe, food handler license, agriculture department, Minnesota food law, residential kitchen, local zoning, consumer labeling, allergen labeling, unpasteurized juice, time/temperature control for safety food

Transcript Highlights:

• This is work relating to workforce development, and this requires the Department of Labor and Industrial
• First up on our list is Mike Goluch Jr. for Pride at Work Hawaii in support on Zoom. >> Aloha.
• Work Hawaii in<00:05:31.759> support<00:05:32.080> on<00:05:32.240> Zoom.
• I am president of Pride at Work Hawaii. We stand in strong support of this legislation.
• This would create use outside its scope.

Keywords: 912, senate, all

Summary: The Committee on Labor and Technology heard testimony on several measures. SB 2198 would direct DLIR to study a Hawaii Workforce Excellence Award program and report back to the Legislature; DLIR supported it so long as it did not affect its supplemental budget request. SB 2140 would authorize counties to require contractors to disclose wage, benefit, hour, and employment-status information and to deny or suspend permits for certain labor-law violations; DLIR and labor representatives supported it as an added accountability tool, while the committee discussed whether state law alone was sufficient and whether counties would still need to pass their own ordinances. SB 3055 would prohibit falsely impersonating a union representative; union and labor groups strongly supported it, and UPW said it was open to amendments to address concerns raised by OPA. SB 3090, SB 3091, and SB 3092 were emergency appropriation bills for public employment cost items tied to collective bargaining and temporary hazard pay or salary adjustments for various bargaining units; agencies and unions generally supported moving them forward, and B&F said the amounts were still being finalized because negotiations were ongoing. The committee also heard SB 2761, which would bar social media platforms from allowing users under 16 to create or maintain accounts if the platform knows the user is under 16. DCCA’s Office of Consumer Protection offered comments, while CCIA and Meta opposed the bill, raising constitutional and First Amendment concerns and arguing that blanket bans could push teens to less regulated spaces online. Meta also said the bill’s carveouts were too narrow and would leave major platforms outside the scope of the restriction. In decision-making, the committee recommended passage of SB 2198 with amendments, SB 2140 as is, SB 3055 with amendments adding a specific intent-to-deceive standard, SB 3090 with amendments, SB 3091 with amendments, SB 3092 with amendments, and SB 2761 with amendments adopting DCCA’s changes and noting potential First Amendment issues in the committee report. For the appropriation bills, the committee changed the effective date to January 1, 2077 as a placeholder. All recommendations were adopted, with reservations noted on SB 2761 from Senators Moriwaki, Fevella, and Ihara.

Transcript Highlights:

• working group within DNR. working group within DNR.
• of work, even if the full scope of work hasn't completely been developed.
• of work, even if the full scope of work hasn't completely been developed.
• that has to be done outside of the work that has to be done outside of the scope<00:34:48.800> of
• work on. work on.

Bills: SB2603, SB2083, SB2341, SB2306, SB2782, SB2756, SB2161, SB2477

Keywords: Hawaii Symphony Orchestra, state funding, public performances, educational programs, cultural arts funding, historic properties, preservation, inheritance, working group, public-private partnerships, sustainable funding, historic preservation, Hawaii Revised Statutes, construction, state review, burial sites, cultural artifacts, development review, phased review, administrative fees

Summary: The committee heard testimony on Senate Bill 2603, which would designate the Hawaii Symphony Orchestra as the state orchestra of Hawaii. Testimony was uniformly supportive from the Attorney General’s office, the State Foundation on Culture and the Arts, Retail Merchants of Hawaii, Hawaii Youth Symphony, the Hawaii Symphony Orchestra, the Hawaiian Steel Guitar Association, and others. Supporters emphasized the bill’s value to arts education, cultural vitality, and the visitor economy. The chair noted there were also many written testimonies submitted, and the bill was left without questions or action in the excerpt. The committee then took up Senate Bill 2083, which would create a state-owned historic properties preservation plan working group within DNR. The State Historic Preservation Division supported the bill and said it would help create a statewide database and better planning for state-owned historic properties, while noting its current review work is reactive and project-by-project. The committee asked about duplication and existing consultation processes; SHPD said it already reviews state projects under existing law and has in-house architectural staff. The measure was then set aside after brief discussion, with no vote shown in the excerpt. Next was Senate Bill 2341, which would authorize phased review of certain private-property projects and change SHPD’s review deadlines. SHPD and the Office of Planning and Sustainable Development supported the bill, saying it could encourage more proactive, programmatic review and that the current average review time for simple projects is about 56 days. Several opponents, including Sierra Club of Hawaii, Bianca Isaki, Malama Kane Lua, and Tara Roas, argued phased review would delay projects, create conflict, and weaken historic preservation protections, especially for iwi kūpuna and burial sites. Committee members raised concerns about whether the bill conflicted with prior court decisions and asked SHPD for its view; SHPD said it was not a legal question for them and suggested a programmatic alternative. The bill was not voted on in the excerpt. Finally, the committee began hearing Senate Bill 2306 on administrative fees for the Bureau of Conveyances. HGEA opposed the measure, focusing on a provision allowing the special fund to be used for qualified contractors, while the Bureau of Conveyances supported the bill as a fee correction that would equalize recording fees between systems. The bureau said specialized technical work sometimes requires outside contracting and that it could consider a contract period; the chair and members discussed the HGEA concern and asked whether the issue could be addressed. No final action was shown in the excerpt.

Transcript Highlights:

• Um and the work of the other appointees.
• <00:29:01.760> on practices um to improve our work on practices um to improve our work on
• 02:49.680> evaluation, the scope of the evaluation, the scope of the evaluation, manufacturing
• for his work.
• <01:21:30.880> very<01:21:31.199> very this is work we take very very this is work

Keywords: 1183, house

Transcript Highlights:

• I'm looking forward to doing that work.
• <00:29:18.159> with spring um and continuing to work with spring um and continuing to work
• or retain people who can do that work. or retain people who can do that work.
• to make the whole thing work.
• That is how it works. That is the fact. That is how it works.

Keywords: 1183, house

Transcript Highlights:

• Particularly since staff has already worked hard. All right.
• That is not how the structure works today.
• And it's relatively modest compared probably to the scope of the work that's outstanding.
• And it's relatively modest compared probably to the scope of the work that's outstanding.
• And this is the type of work that has to happen regularly.

Summary: The Budget Subcommittee No. 4 hearing focused on the Greenhouse Gas Reduction Fund (GGRF) and cap-and-trade reauthorization, with members and panelists discussing how to balance climate goals, affordability, and legislative oversight. The chair emphasized the hearing as a broad review of past GGRF spending and future options, while the LAO outlined how GGRF revenues are generated, how variable they have been, and the tradeoffs between continuous appropriations and annual budget control. Two academic panelists, Dr. Kyle Meng and Danny Cullen Ward, argued that cap-and-trade remains an effective climate policy, but stressed that future revenue will depend heavily on market design, allowance allocation, and price levels. They also raised the idea that GGRF could be used more directly for affordability, especially by lowering electricity costs, and for targeted investments in technologies that the market would not otherwise support. Committee members pressed the panelists on where revenues come from, how much has actually been spent, and whether continuous appropriations reduce oversight. CARB staff said more than $33 billion has been generated to date and a little over $11–12 billion has been spent, with the rest committed or in process, and noted that project timelines can be lengthy. Members also asked about ways to lower electricity rates, reduce wildfire-related utility liabilities, and support electrification. The panelists said transportation fuels are the largest source of GGRF revenue, that industrial emitters receive a smaller share of free allowances, and that reducing wildfire liability and investing in grid-scale batteries could help lower costs and speed decarbonization. Public commenters largely urged the Legislature to preserve or expand continuous appropriations for specific climate programs. Speakers supported funding for nature-based solutions, natural and working lands, urban greening, agricultural climate solutions, waste and composting programs, clean transportation, AB 617 community air protection, clean cars, transit, affordable housing near transit, and dairy digesters. Several groups argued these programs are cost-effective, provide public health and affordability benefits, and should receive dedicated shares of GGRF. Others urged reducing free allowances and using more GGRF revenue to directly lower energy costs for households. No votes were taken during the hearing.

Transcript Highlights:

• needs some more work. needs some more work.
• have um an effort to work on it. Okay. have um an effort to work on it. Okay.
• . work. work.
• in their scope of practice this<00:47:59.680> kind<00:48:00.400> of This kind of work,
• everything worked out. everything worked out.

Keywords: 1189, house, all

Transcript Highlights:

• The House committee working group.
• <00:24:50.159> of requirement and increases the scope of requirement and increases the scope
• living and working in Saudi Arabia. living and working in Saudi Arabia.
• goal throughout the system is to work goal throughout the system is to work with<01:23:11.920>
• <01:43:55.040> with to get that and then DEEC worked with to get that and then DEEC worked

Keywords: 927, senate, all

Transcript Highlights:

• I know how this works, maybe. Uh-oh, did I just break it? Okay.
• There's still lots of time to work on things as things go.
• <00:20:24.120> that standards with a geographic scope that standards with a geographic scope
• I think there’s a lot of work we can do to tighten things up, make it happen.
• You want to lay this so anybody else who has questions, please work with the author on that.

Keywords: 1183, house

Transcript Highlights:

• This bill has several important things to improve the lives of Florida's veterans and strengthen the work
• You know, several years ago, I think it was about six years ago, we expanded the scope of practice for
• In conclusion, evidence-based collaborative care models show that pharmacists and physicians working
• Pharmacists play a very important role in our health care continuum, but diagnosing patients work.
• But diagnosing patients, working with patients, and treating patients who have a health condition as

Summary: The Appropriations Committee on Health and Human Services took up two bills. Senator Burgess presented SB 116, the Senate Veterans Package, which would reduce the number of Veterans Hall of Fame nominations, expand FDVA health survey and coordination efforts, add mental health training to the veterans suicide prevention pilot program, fix statutory references, improve coordination between Veterans Florida and FDVA, and require FDVA to develop a plan for adult day health care facilities for veterans and their families. An amendment was adopted to appropriate $300,000 for the suicide prevention training pilot and $50,000 for the health survey. The bill was supported in debate, especially for the adult day care provision, and CS/SB 116 was reported favorably by roll call vote. The committee then heard SB 294 by Senator Harrell, which would exclude specified cardiac conditions—such as heart failure, coronary heart disease, and cardiac arrhythmias—from the list of chronic health conditions that may be managed under collaborative pharmacy practice agreements. Senator Harrell argued that these complex conditions require direct physician involvement and that pharmacists should not be making medication changes for severe cardiac patients based on protocols alone. Senator Rouson asked why heart conditions had been included previously, and Vice Chair Davis asked about fiscal impact; Harrell said there would be no state cost, though patients might face additional out-of-pocket expenses, which she said could be offset by avoiding more serious complications. Public testimony on SB 294 was divided. The Florida Pharmacy Association opposed the bill, arguing that collaborative practice agreements are voluntary, physician-controlled, and already include safeguards, and that pharmacists are highly trained to help manage chronic conditions and improve access and outcomes. A cardiologist with the Florida Chapter of the American College of Cardiology supported the bill, warning that cardiac patients are complex and that pharmacists may make dangerous decisions without the full clinical picture. Senator Burton also supported the bill, saying the original collaborative practice framework was not intended to let pharmacists diagnose or treat serious cardiac disease. SB 294 was then reported favorably by roll call vote. At the end of the meeting, Senators Rodriguez and Garcia asked to be recorded in the affirmative on SB 116, and the committee adjourned without further business.

Transcript Highlights:

• <00:02:28.360> the that um we're clear on the scope the that um we're clear on the scope the
• dollars so there is a a lot of work dollars so there is a a lot of work going<00:06:26.240> on
• people who' be subject to work people who' be subject to work requirements<00:47:17.319> um
• hiring not hiring having attorneys work hiring not hiring having attorneys work in<00:59:33.599>
• <01:27:41.480> in Millions of people who are working in our farm fields or working in our

Keywords: 1187, senate, all

Transcript Highlights:

• employment and become full scope employment and become full scope practitioners<00:02:33.000>
• go out and work on their own.
• Appreciate your work on it. the country. Appreciate your work on it.
• your work on this bill.
• who've worked on the bill. who've worked on the bill.

Keywords: 919, house, all

Summary: The House first took up House File 1794, which would remove the post-graduate collaborative practice requirement for advanced practice registered nurses. The author and several supporters argued the bill would reduce barriers to practice, improve access to primary care and mental health services, especially in rural areas, and align Minnesota with other states. Supporters cited backing from APRN organizations and said the Board of Nursing had no concerns, while opponents, led by Representative Liebling, argued the current one-year collaborative period is a patient-safety safeguard that gives new APRNs needed experience working with physicians before practicing independently. After debate and questions about how the current requirement works in practice, the House passed the bill 119-12. The House then considered House File 4595, which changes licensure reciprocity rules for marriage and family therapists. Representative Schumacher said the bill would expand access to mental health care at no cost by making it easier for qualified out-of-state therapists to obtain Minnesota licenses, eliminating a five-year waiting period and other barriers while maintaining standards through background checks and a jurisprudence exam. Supporters, including Representatives Bierman and Gilman, emphasized workforce shortages and the value of more therapy access for families and relationships. The Board of Marriage and Family Therapy was noted as neutral, and the bill passed unanimously, 133-0. Finally, the House began debate on House File 4493, which would authorize pharmacists to initiate, prescribe, administer, and dispense certain drugs for opioid use disorder, including buprenorphine/Suboxone. Representative Baker said the bill would save lives by allowing people to access treatment immediately through local pharmacies, especially in greater Minnesota, and help them through withdrawal when they are most likely to seek help. The transcript cuts off during the opening of discussion on this bill, before any vote or final action is shown.

Transcript Highlights:

• I RECEIVED MY MASTER OF SOCIAL WORK FROM FSU.
• WE LOOK FORWARD TO WORKING WITH YOU.
• OF WORK BUT WE HAVE SCOPE TO EXPAND FURTHER AND THIS WILL GIVE US THE FOOTPRINT WHERE WE CAN TAKE THE
• SHE HAS WORKED WITH US IT IS ABOVE HER PAYGRADE.
• WORKING WITH THE COURTS SYSTEM THIS SESSION. >> THANK YOU.

Transcript Highlights:

• If we work with an agency and they voiced us that that space does not work with them, we usually have
• Perhaps they are field staff or work out of multiple offices.
• We've worked with agencies multiple times on that.
• with the agency to Locate a space that will work for them.
• The boys are just not working in that Building. Do you have?

Keywords: 914, all

Transcript Highlights:

• Tomassoni working with me in this effort.
• It really is good work that's happening there.
• Walk's work has moved consortium work further down the line to bring synergy into this research.
• So I would just like you to work with OHE and think about who is already doing this work.
• How does this work?

Transcript Highlights:

• working together.
• How does that work?
• We do already do this work. That is a large focus of our work.
• and really working in this area.
• and really working in this area.

Keywords: 908, all

Summary: The Senate Appropriations HR Division met with all members present to review the medical services portion of the HHS budget. Sarah Aker, Executive Director of Medical Services, walked the committee through several budget items, including HCBS cost-to-continue adjustments, the DD bed assessment, expansion of value-based purchasing, targeted rate increases for home health and QSP services, and the cross-disability waiver. Members generally supported the targeted increases for home health and QSP, and Aker explained that the cross-disability waiver funding would support startup work, service design, and infrastructure ahead of a planned July 1, 2028 implementation. The committee spent significant time on rate-setting and provider payment issues. Members discussed ambulance rate rebasing, with several senators expressing concern that the proposed increase was too high relative to peer states; the committee ultimately moved toward reducing that item to $1 million rather than zero so it could be revisited in conference committee. They also discussed a House-added critical access hospital networking grant and similarly leaned toward reducing it to $1 million. Aker explained the department’s value-based purchasing plans, including use of a vendor selected through RFP, and clarified how the department’s existing Medicaid managed care and hospital value-based programs work. A major portion of the meeting focused on long-term care and basic care payments, including a House-added extension of the $5 per day basic care add-on and a proposed shift in nursing facility incentive grants toward a withhold-based model. Senator Mathern indicated he would bring an amendment to delay or modify the withhold change, and Aker said the department would prefer language that directly addresses whether a withhold may be implemented. Members also discussed 1915(i) services, FMAP changes, the Medicaid legacy system modernization carryover, and a House-added legislative intent section on medical assistance. The committee adjourned for the morning with plans to return later to continue Human Services budget work and revisit unresolved items in conference committee.