Transcript Highlights:

• I have been a CNA for 23 years and currently work at the Pines of Plasterville Health Care with PAX.
• I'm a CNA. I've been working at a facility for 15 years.
• I've been working over 30 years as a CNA, and I'm from Sacramento County.
• He said he used that money to pay for many of the CNAs who came up front.
• I used that money to pay for many of the CNAs that you saw come up front.

Summary: The subcommittee heard an overview of the Department of Health Care Services’ proposed budget, including a $229.1 billion total-funds budget and projected Medi-Cal enrollment decline as redeterminations continue. Members focused heavily on the fiscal and programmatic effects of prior budget solutions and federal changes, especially the elimination of General Fund-supported Prop. 56 dental supplemental payments beginning July 1, 2026, the hospice utilization-management change, and the impact of reduced caseloads alongside rising health care costs. DHCS said it is still completing required access and rate-reduction analyses for the dental cuts and has been engaging stakeholders, but could not yet quantify the real-world effect on utilization or provider participation. The committee also reviewed the November 2025 Medi-Cal local assistance estimate, which shows higher General Fund spending despite lower enrollment, driven by managed care rate growth, Medicare cost growth, state-only claiming, and federal policy changes. The hearing then turned to provider taxes and federal H.R. 1 constraints, with extensive discussion of the MCO tax, the hospital quality assurance fee, and other health care-related taxes. DHCS explained that H.R. 1 phases down allowable tax levels and tightens “generally redistributive” rules, making the current MCO tax structure and the proposed higher hospital fee levels difficult or impossible to renew as originally designed. Staff and the LAO described the tradeoff between preserving Medi-Cal funding and avoiding higher costs on private providers and consumers. Members asked about options for preserving revenue, including possible amendments to Prop. 35 or returning to voters, and were told the department is still evaluating approaches while federal guidance remains in flux. The committee also reviewed hospital payment increases already implemented through state-directed payments, with DHCS noting that H.R. 1 will force those payments down to Medicare levels over time. Several budget change proposals were discussed and left open, including requests tied to the managed care final rule, managed care operations, hospital value strategy, long-term care payment transparency, and interoperability requirements. The committee also heard about a one-year trailer bill extension for skilled nursing facility financing, including continuation of the SNF workforce standards program, the SNF quality assurance fee, and annual rate growth, while the department develops a longer-term financing redesign for 2027-28. Members expressed skepticism about repeated rate reform efforts and questioned whether a one-year extension of the eliminated workforce quality incentive program should be restored during the transition. Finally, Covered California presented its budget and enrollment update, reporting that the expiration of the federal enhanced premium tax credit is expected to reduce affordability significantly, with average premiums roughly doubling for many enrollees and as many as 400,000 Californians potentially losing marketplace coverage over time. The exchange said California’s $190 million subsidy program is helping lower-income enrollees, but not enough to offset the federal loss, and it is also implementing a new gender-affirming care benefit and awaiting federal action on benchmark plan changes.

Transcript Highlights:

• Four students earned their CNA certification.
• Four students earned their CNA certification.
• Today, she is working as a CNA and prepared to move directly into a nursing program.

Bills: SB6130, SB6247, SB6260, SB6268, SB6278

Keywords: voter registration, elections, national holiday, civic engagement, government initiative, school funding, financial management, budgeting, transparency, district governance, SB 6260, public education, K-12, Washington State, OSPI, Office of Superintendent of Public Instruction, education finance, school transportation, school buses, zero-emission bus

Transcript Highlights:

• The second program in this funding would support a CNA-to-LPN glide path program.
• In 2024, we were able to support 34 CNAs in this program.
• to LPN Glide path program in 2024 CNA to LPN Glide path program in 2024 we're<00:55:39.240><c> able<
• /c><00:55:39.480><c> to</c><00:55:39.640><c> support</c><00:55:40.200><c> 34</c><00:55:41.200><c> CNAs
• to LPN Glide path so this for the CNA to LPN Glide path so this year<00:58:03.280><c> we're</c><00:58

Keywords: 910, house, all

Summary: The joint hearing covered HB 553 on biomarker testing coverage, HB 556 on colorectal cancer screening access, and later HB 712 on 340B drug pricing. For HB 553, the American Cancer Society Cancer Action Network, patient advocates Natalie Heyman and Susan Hirano, a surgical oncologist, and the American Lung Association strongly supported the bill, arguing that biomarker testing should be covered when ordered by a doctor and guided by current evidence. DHS and several insurers offered comments and requested amendments, with DHS saying it appreciated the intent but wanted changes. The committees then voted to pass HB 553 with amendments, including a House draft and a defective date of July 1, 3000; both the House Health and Human Services and Homelessness committees adopted the recommendation unanimously. For HB 556, testimony focused on closing gaps in colorectal cancer screening, especially for uninsured and underinsured patients who can get stool-based screening but then cannot access follow-up colonoscopies. Community Clinic of Maui, ACS CAN, and the American Cancer Society supported the bill, with ACS CAN urging a program similar to the breast and cervical cancer control program and offering amendments. DHS requested that the program and appropriation not conflict with executive budget priorities, and the committees noted technical amendments, a defective date, a blank appropriation amount, and corrections changing Medicare references to Medicaid. HB 556 was also passed with amendments by both committees. The hearing then moved to HB 712 on 340B drug pricing and contract pharmacies. The Department of Health and the Attorney General’s office expressed concern that the bill would require the state to regulate private commercial activity and said the department lacked the expertise and resources to implement it as written, suggesting it might belong in a different statutory section. In contrast, PhRMA opposed the bill, while Hawaii Pacific Health and Hawaii Island Community Health Center supported it, saying 340B savings are important for hospital services and patient access to low-cost medications, especially where manufacturers have restricted shipments to contract pharmacies. No vote on HB 712 was taken in the portion provided.

Transcript Highlights:

• And those positions, 200 of them are for CNAs, 84 are for nurses, excuse me, not CRNAs, CNAs.

Summary: The Health Care Budget Subcommittee met to review agency budgets, vacant positions, and possible efficiencies across several health and human services agencies. Members were asked to identify savings and potential areas for increased funding, and the discussion repeatedly focused on whether long-vacant FTEs, reversion of funds, and staffing shortages reflect true operational needs or broader budgeting and recruitment problems. The chair and members emphasized that the exercise was intended to help the committee make more informed budget decisions and to identify structural issues that may require legislative action. For the Agency for Persons with Disabilities, members highlighted a large waiting list, including individuals in crisis and children, and discussed whether vacant positions and unspent funds could be redirected to services. Several members raised concerns about delays in crisis applications, the use of paper applications, and whether the issue is staffing, process, or both. For the Department of Children and Families, the presenters discussed vacant positions, the use of staff augmentation in state hospitals, support for expanding behavioral qualified residential treatment program beds, and concerns raised by audits of the managing entities, which showed procurement and financial management problems. They recommended continued oversight, reporting requirements on Medicaid enrollees receiving mental health services through managing entities, and support for the governor’s proposed funding items. Other agencies reviewed included Elder Affairs, where members questioned the need for multiple divisions, CARES assessments, and supervisory overhead; the Department of Health, where vacancies, turnover, pay gaps, and units of rate were discussed as barriers to recruitment and retention; and the Department of Veterans’ Affairs, where the presenters said vacancies were tied to new nursing homes and recommended shifting a major priority into general revenue rather than trust funds. Throughout the meeting, members generally agreed that the vacancy review was eye-opening and suggested deeper, possibly separate, reviews of agency staffing, pay parity, and fund reversion practices. No formal votes were taken during the transcript.

Transcript Highlights:

• CNA we've brought back, which again is adding to the healthcare workforce in our area, CNA and phlebotomy
• We're going to start with our CNA program and then try to build from there.
• We also had some CNA certifications from this year or last year.

Transcript Highlights:

• The second issue was critical access hospitals with the CNAs.
• The CNA thing was like $40,000, but it's meaningful when you actually solve the problem.
• The second issue was critical access hospitals with the CNAs.
• The CNA thing was like $40,000, but it's meaningful when you actually solve the problem.
• </c><00:25:57.120><c> thing</c><00:25:57.279><c> was</c> scale. the this the the CNA thing was scale.

Bills: HF4072, HF3691, HF4613

Keywords: workforce development, journalism, local news, internships, media training, emergency management, essential employees, public safety, law enforcement, workforce, economic development, appropriation, Twin Cities Marathon, Explore Minnesota, grants, 1183, house

Transcript Highlights:

• Number 17 is also with DBA, with Higher Energy, also for RN, LPN, CNA medical staffing services.
• staffing this is for medical staffing services number 17 also with DBA with higher energy also for RN LPN CNA

Keywords: 1204, all

Transcript Highlights:

• Um, there was a program where I got credits for um training to earn my CNA and then working as a CNA
• I got credits for um training to earn my I got credits for um training to earn my CNA<00:41:31.440><c
• then</c><00:41:31.839><c> working</c><00:41:32.000><c> as</c><00:41:32.160><c> a</c><00:41:32.319><c> CNA
• </c><00:41:32.640><c> in</c><00:41:32.720><c> a</c> CNA and then working as a CNA in a CNA and then working
• as a CNA in a long-term<00:41:33.119><c> care</c><00:41:33.359><c> facility.

Keywords: 1187, senate, all

Transcript Highlights:

• Of course, a CNA and LPN district would be more easily able to find that position, and, two, it would
• this school nursing piece, and I'm going to tell you why here in a moment. get by with a an LPN or a CNA
• and for get by with a an LPN or a CNA and for those<00:10:15.880><c> of</c><00:10:16.000><c> you</c>
• </c> kind of certifications of course a CNA kind of certifications of course a CNA and<00:10:21.680><
• cutting mode and cutting a million dollars, whereas we could probably have gotten by with an LPN or a CNA

Bills: HF56, HF780

Keywords: HF56, Minnesota bonding bill, capital investment, state bonds, bond proceeds fund, Hutchinson Area Transportation Services, Hutchinson, McLeod County, transportation facility, vehicle storage, equipment storage, fueling facility, temperate storage, local infrastructure, public works, general obligation bonds, education finance, school funding, state aid, appropriations

Transcript Highlights:

• My CNA and then TMA training were fully funded, and then my fall 2024 tuition also was paid.
• and then TMA training was were fully CNA and then TMA training was were fully founded<00:09:27.519><
• This contribution has made a huge difference in my life and my family's life because moving from CNA
• </c><00:09:52.880><c> to</c><00:09:53.600><c> TMA</c><00:09:54.600><c> I</c> from moving to from CNA
• to TMA I from moving to from CNA to TMA I increase<00:09:55.360><c> my</c><00:09:55.600><c> income</c

Keywords: 1187, senate, all

Transcript Highlights:

• And so if you were somebody who, say, did a semester and got a CNA or a commercial truck driving license
• And so if you were somebody who, say, did a semester and got a CNA or a commercial truck driving license

Summary: The committee first heard House Bill 2510, sponsored by Rep. Steinmeier, which would create a coordinated state framework for critical minerals involving the Departments of Natural Resources, Economic Development, and Higher Education and Workforce Development. The sponsor said Missouri is well positioned because it contains 36 of 60 minerals deemed critical to national security and manufacturing, and argued the bill would help Missouri pursue federal funding, build a workforce pipeline, and support advanced manufacturing with a five-year sunset. Committee members questioned the need for a new state structure and fund, the cost to Missouri, the role of universities, and whether the task force was too narrowly written around the University of Missouri system and mistakenly included DESE instead of higher education. A Missouri Chamber witness supported the bill for its economic and national security benefits, while an environmental witness urged adding an environmental professional to the task force and a mining permitting framework, citing health and water concerns and suggesting a separate mining-regulation bill as an amendment. The committee then took up House Bill 2585, sponsored by Rep. Castile, which updates Missouri workforce development statutes to align with federal law and implement the new Workforce Pell Grant program. The sponsor said the bill would allow short-term, high-value training programs in fields like welding, public safety academies, health technology, and trucking to qualify for Pell support, while preserving oversight and tying eligibility to outcomes such as completion, job placement, and earnings. Members asked about the number and makeup of the workforce board, whether the bill’s staffing references still pointed to the wrong department, how the 150% poverty-level threshold and reporting metrics would work, and whether the board could move quickly enough to meet federal timelines. A Missouri Community College Association witness said all 12 community colleges have programs likely to qualify and explained the federal eligibility standards, including a 70% completion rate, 70% job placement rate, and three-year rolling data review; a FGA Action witness and the Missouri Chamber also supported the bill as a way to expand access to skills training and draw down federal funds. After the bill hearings, the committee received an informational presentation from the Midwestern Higher Education Compact. The presenter described the compact’s regional cost-saving work, including reciprocity for distance education, technology contracts, grants, and efforts on dual credit and FAFSA support. She also shared Missouri-specific data on educational attainment, enrollment trends, student migration, and net price, noting that Missouri lags slightly behind the U.S. in attainment, has projected declines in high school graduates, retains most in-state students, and has higher net prices for low-income students than the Midwest average. The committee then adjourned.

Transcript Highlights:

• At PSP, I regularly checked the job posting board and found a CNA training opportunity.
• They helped me update my resume, research the CNA program, understand the requirements, and even apply
• 53:17.920><c> services,</c><00:53:18.640><c> Henipin</c><00:53:19.119><c> County</c> I completed the CNA
• training and started working at HCMC at Fairview Riverside, where when I first started, I was a CNA
• Because of their support, I was able to complete CNA training, build a career in healthcare, and create

Keywords: 1187, senate, all

Transcript Highlights:

• The other aspect is that this would require adding 937 new CNA and nurses to come into compliance.
• </c><01:17:46.560><c> and</c> require adding 900 937 new CNA and require adding 900 937 new CNA and nurses
• staff by about 0.18 hours per resident day, roughly 5% on average, driven by increases in LPNs and CNAs
• uh driven by increases in LPN's and and uh driven by increases in LPN's and and uh<01:25:19.760><c> CNAs
• facilities annual labor expenses uh CNAs facilities annual labor expenses rose<01:25:23.120><c> by</

Keywords: 1187, senate, all

Transcript Highlights:

• You're talking about the CNA to LPN glide.
• So, for example, at Kaiser, at Hōlly Makua, so we have 200 nurses, CNAs to LPN, in that.
• You're talking about the CNA to LPN glide.
• So, for example, at Kaiser, at Hōlly Makua, so we have 200 nurses, CNAs to LPN, in that.
• So, for example, at Kaiser, at Hōlly Makua, so we have 200 nurses, CNAs to LPN, in that.

Keywords: 910, house, all

Transcript Highlights:

• Here to testify today are Dolores Trujillo, who is a NICU nurse and a CNA board member...
• Dolores Trujillo, who is a NICU nurse and a CNA board member, and former president of the Board of Registered
• And who better than CNA to tell us what they can do and how they would do it.

Summary: The committee heard AB 1979, which would limit the use of AI in health care by requiring licensed professionals to retain final clinical judgment, prohibiting automated systems from directing unlicensed individuals to perform licensed clinical functions, and clarifying medical-record privacy rules for direct-to-consumer health chatbots. Supporters, including nurses and labor groups, said the bill preserves patient safety and keeps care decisions in human hands. Hospital and industry groups opposed unless amended, arguing the bill could create compliance burdens and interfere with training and legitimate AI-assisted care. The bill was approved 6-1 and placed on call. Members then considered AB 2624, which would expand California’s Safe at Home confidentiality program to immigrant service providers, employees, and volunteers facing harassment or doxing. The author and supporters described threats, stalking, and online targeting of immigrant advocates and said the bill would let them use substitute addresses to protect their safety. Opposition focused mainly on concerns about the bill’s legal enforcement language, though the author said it mirrors existing Safe at Home provisions and does not create a new private right of action. The measure passed 4-1 and was placed on call. AB 2103 would make Engaged California a permanent statewide public engagement program. The author and the Office of Data and Innovation said it is meant to broaden civic participation through structured deliberation and transparent publication of results. Some members raised concerns about partisan balance and topic selection, while supporters emphasized the need to reach Californians who do not typically participate in hearings. The bill passed 6-0 and was placed on call. The committee also heard AB 2, a social media accountability bill for harms to children and teens, and AB 883, which would expand privacy protections and shorten data-broker deletion timelines for elected officials and judges; both drew support and opposition, were approved on committee votes, and placed on call. Later, the committee began AB 2023, a chatbot safety bill for children that would require age verification, safety audits, default protections, and limits on ads and data sharing; testimony was strongly supportive from child-safety advocates, while industry groups raised concerns about vague standards, audits, and liability.

Transcript Highlights:

• Here to testify today are Dolores Trujillo, who is a NICU nurse and a CNA board member...
• Dolores Trujillo, who is a NICU nurse and a CNA board member, and former president of the Board of Registered
• And who better than CNA to tell us what they can do and how they would do it.

Keywords: 987, senate, all

Transcript Highlights:

• Also, on that is some more granular data showing you how many people are applying for CNA positions across
• For example, on one CNA position, we had 195 people apply for it.

Summary: The council opened with a prayer, approved the prior meeting minutes, and received the February 2026 Monthly Revenue Report from Carlos Silva of the Bureau of Legislative Research. He reported gross revenues of $5.36 billion and net collections of $4.5 billion, both above the prior year to date, and said the updated forecast now shows a larger expected surplus. Members asked about declines in some tax categories, natural gas severance fee fluctuations, inflation, and economic development incentives; Silva attributed several changes to timing, refunds, tax cuts, weather, and price volatility, and generally described the state’s revenue trend as positive. The Executive Committee, Administrative Rules, Claims Review, Game and Fish, Higher Education, Infrastructure Investment and Jobs Act, Medicaid studies, Occupational Licensing Review, State Insurance Programs Oversight, and other subcommittee reports were adopted. The Medicaid studies report drew extended discussion about DHS staffing and contract nursing costs at state hospitals and human development centers; DHS officials said they were working on a recruitment and retention plan, reported significant vacancies and turnover, and said the state was not at risk of overspending the contracts. Several members urged reducing reliance on contract labor and moving staff onto state payrolls. The Review Subcommittee report prompted questions about a Department of Public Safety aircraft maintenance item and a Department of Shared Administrative Services contract for Deloitte to implement performance and goals management software tied to the state’s new personnel system. After discussion, the aircraft maintenance item was held briefly and then withdrawn from the hold, while the shared services contract was explained as a one-time integration/configuration project for a system that will support employee evaluations and performance-based pay; the report and the separate contract vote were approved. The Personnel Subcommittee also heard testimony from Commerce Secretary Hugh McDonald about reductions in force at the Division of Services for the Blind, which he attributed to funding shortfalls and fiscal mismanagement; members questioned the impact on blind and visually impaired clients, the status of board appointments, and whether federal funds could be at risk. The report was adopted with immediate consideration, and the meeting ended after filing the remaining APER report and adjourning.

Transcript Highlights:

• Also, on that is some more granular data showing you how many people are applying for CNA positions across
• For example, on one CNA position, we had 195 people apply for it.

Summary: The meeting began with a prayer, approval of the prior minutes, and a February 2026 revenue report from Carlos Silva of the Bureau of Legislative Research. He reported gross revenues of $5.36 billion and net collections of $4.5 billion, both above the prior year, and said the updated forecast showed a larger expected surplus than before. Members asked about declines in some tax categories, natural gas severance fees, and possible effects of inflation and international conflict; Silva generally attributed the changes to timing issues, prior tax cuts, refund activity, and price fluctuations, and said he could not speculate on future impacts. The committee then heard and adopted several subcommittee reports, including the Executive Committee, Administrative Rules, Claims Review, Game and Fish State Police, Higher Education, Infrastructure Investment and Jobs Act, Hospital/Medicaid/Developmental Disabilities, Occupational Licensing Review, State Insurance Programs Oversight, and APER filings. Most reports were approved without objection. One budget classification transfer for the Commissioner of State Lands was reviewed and failed. The review report also led to discussion of several contracts, including DHS staffing contracts and a Department of Education security contract, with some items held or separated for individual votes. A major portion of the meeting focused on DHS and state staffing contracts for the Human Development Centers, Arkansas State Hospital, and related facilities. DHS officials said the contracts were on track against seven-year projections, but members expressed concern about heavy reliance on contract labor, vacancy rates, and the need to move workers onto state payrolls. Officials said they were preparing a recruitment and retention plan and described staffing levels, vacancies, and turnover. Members also questioned contract projections and federal-state funding matches, and several urged faster action to reduce contract labor costs. The committee also discussed a Department of Commerce reduction-in-force affecting the Division of Services for the Blind and Employment and Training. Secretary Hugh McDonald said the cuts were driven by funding shortfalls, over-obligation of funds, and federal issues, and that 27 positions would be permanently eliminated while furloughed employees would be recalled. Members raised concerns about service impacts, board appointments, and the division’s fiscal management. The meeting ended after the personnel report was adopted and APER was filed as reviewed, followed by adjournment.

Transcript Highlights:

• You have engineering, you have health care, you have CNAs, and they actually set up career centers in
• You have engineering, you have health care, you have CNAs, and they actually set up career centers in

Summary: The Pre-K through 12 Budget Subcommittee met during Budget Week and first considered three member bills. House Bill 1111, by Rep. Valdes, would eliminate the option for students to leave high school with a certificate of completion instead of a standard diploma. Valdes said the bill was inspired by students who met credit requirements but could not pass a required assessment, and argued the certificate does not provide access to college, trade school, or military service. The bill passed unanimously, 15-0. CS for House Bill 127, by Rep. Kendall, would support students with disabilities by using existing Florida Department of Education curriculum to create micro-credentials and coordinating with the Florida Center for Students with Unique Abilities and OSHA on workplace safety. Goodwill, the Florida Developmental Disabilities Council, Florida PTA, and others supported the bill, which also passed unanimously, 15-0. House Bill 1367, by Rep. Booth, addressed chronic absenteeism by requiring statewide definitions and more uniform attendance reporting, along with rules for excused and unexcused absences and early identification of chronically absent students. Testimony emphasized inconsistent district policies and the need for clearer data and interventions. The bill passed 13-0, with some members noting concerns about implementation details and future rulemaking. The committee then took up PCB-P-PKB-2501, the proposed conforming bill for the fiscal year 2025-2026 Pre-K through 12 budget. The chair said the bill was designed to align statutes with budget and scholarship funding procedures, especially around the Florida Education Finance Program and scholarship payments. The PCB would require Florida student ID numbers for scholarship students, standardize cross-checking against FTE survey data, set quarterly payment dates, and use one data source for both reporting and withholding scholarship-related FFP amounts. It also would reduce certain add-on weights by 50%, remove the budget stabilization program, and repeal the educational enrollment stabilization program. Several members raised concerns that the add-on weight reductions could hurt career and technical education, AICE, IB, and CAPE programs, while the sponsor argued the data showed too much spending in an “other” category and that the reductions were aimed at aligning funding with actual program costs. Public testimony was mixed: some supported tighter accountability and clearer payment rules, while others warned against undermining expensive career-readiness programs. The PCB passed 11-2. After the conforming bill, the chair presented the proposed fiscal year 2025-2026 Pre-K through 12 budget, totaling just under $21 billion, about $400 million below the current year. She said the budget reflects a need to slow spending growth and includes $20 million for New Worlds Scholarship Accounts, $7 million for security grants at Jewish day schools and preschools, $14 million for public school transportation stipends, an overall FEFP increase of about $747.7 million, $100 million for teacher salary increases, and increases in the base student allocation and funds per student. The committee did not vote on the budget recommendation at this meeting; it was distributed for review and will move to the Budget Committee next week.

Transcript Highlights:

• What do we do to incentivize CNAs? We're desperately short of CNAs.
• People, like dentists, we talked $350,000 or, you know, so on, compared to a CNA.
• We don't have to be the knowledge of the CNA. My point is we look at the earnings of a nurse.

Summary: The committee first approved the minutes and then heard a detailed annual presentation from Dr. Thomas Arnold, chair of the Maternal Mortality Review Committee, on maternal mortality trends and review findings. He explained the committee’s structure, the de-identified review process, and the distinction between pregnancy-associated and pregnancy-related deaths. He said national maternal mortality has declined from its 2021 peak, but mental health conditions, substance use, overdose, suicide, cardiovascular disease, hemorrhage, infection, and embolism remain major causes. He emphasized that many deaths are preventable, with especially high rates among non-Hispanic Black women and in the American Indian/Alaska Native population, and noted that a large share of deaths occur after 42 days postpartum. Committee members asked about suicide, domestic abuse, pregnancy testing in unexplained deaths, and the role of home births and midwife training. Dr. Arnold said the committee is adding a caseworker, exploring post-mortem pregnancy testing in suspicious cases, and working with coroners and forensic officials; he also said home births and untrained midwifery pose safety concerns and that better public education and facility-based care are important. The committee then heard from State Fire Marshal Dr. Matt Clark on cigarette ignition propensity standards and fire prevention. He recommended updating North Dakota’s cigarette ignition legislation to the current national standard and also considering legislation requiring fast-breakaway oxygen tubing, citing fatal fires involving smoking around home oxygen. He explained that his office verifies manufacturer testing and maintains certification for cigarettes sold in the state, but does not itself conduct the testing. Members asked about implementation, cost, and whether the standards apply in tribal communities; Clark said he would follow up with cost information and additional details, and that he had not seen evidence of a major issue on tribal lands but would look further. Christine Greff of the Department of Health and Human Services presented the North Dakota Stroke System of Care report. She described the statewide network of two comprehensive stroke centers, four primary stroke centers, and 30 acute stroke-ready hospitals, along with the stroke registry and quality-improvement efforts. She reported that most strokes are ischemic, that the median stroke patient age is 71.5, and that common risk factors include hypertension, dyslipidemia, obesity, and diabetes. She highlighted improvements in door-to-CT, thrombolytic treatment times, dysphagia screening, EMS pre-notification, and interfacility transfer performance, and said new priorities include hemorrhagic stroke quality measures and standardized EMS stroke screening tools. Members asked about the VA hospital’s participation, and Greff said she would pursue outreach. After a break, the committee heard testimony from Taha Khan of Vertex Pharmaceuticals as part of the prior authorization study, focused on non-opioid pain treatment. He argued that prior authorization can delay access to acute pain treatment and may push patients toward opioids, especially in the critical 24- to 72-hour post-discharge window. He cited data showing that even short opioid exposure can increase the risk of long-term use and said prior authorization is often a barrier for physicians and patients. Khan recommended open access with a quantity limit rather than prior authorization, suggesting a 14-day limit supported by the product’s data and an episode-of-care approach. Members asked about dental use, payer discussions, and cost; he said the product’s wholesale acquisition cost is about $16.10 per tablet, with patient assistance available, and that he would follow up on payer and comparison-cost questions.