Transcript Highlights:

• the benchmark, according to CHIA's annual report.
• and incentivizing payers and providers to control spending growth at the outset.
• Massachusetts, along with eight other states, uses a health care cost benchmark to keep spending in line
• We want to ensure that we get to our goal, which is to reduce pharmaceutical spending.
• An act strengthening oversight of health care facility spending.

Keywords: 995, all

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

Transcript Highlights:

• risk than the benchmark, or at least equal risk to the benchmark.
• our performance reports, we've reported both the static policy benchmark and the corridor benchmark,
• We've reported both the static policy benchmark and the corridor benchmark, which is the official policy
• benchmark.
• The corridor benchmark has been a higher return, or a more difficult benchmark.

Keywords: 908, all

Transcript Highlights:

• My understanding is that this particular spending document seeks to appropriate somewhere in the order
• This particular spending document would appropriate $189 million.
• We currently stand in FY25 about $1.1 billion above benchmark, with a big caveat.
• This particular spending document would appropriate $189 million.
• We currently stand in FY25 about $1.1 billion above benchmark with a big caveat.

Keywords: 995, all

Summary: The Senate began with the Pledge of Allegiance and then adopted a motion to adjourn in memory of Lenz Arthur Joseph, a five-year-old Hyde Park child whose death was described as a tragic loss to his family, school, and community. Senators offered condolences and a moment of silence was observed. The chamber also recognized several guests, including students and scholarship recipients from the Christian A. Herter Memorial Scholarship Program and visitors from River Valley Charter School and Fall River’s Green School. The main legislative business was Senate 2521, a fiscal year 2025 supplemental appropriations bill providing about $189 million for early education and care providers so they could receive June child care financial assistance payments. The minority leader questioned why the deficiency had arisen so late in the fiscal year and asked about preventing similar shortfalls. The Ways and Means chair responded that the bill was time-sensitive, that such supplemental appropriations are common for caseload-driven accounts, and that the House had already passed the measure. He also reported that FY25 revenues were about $1.1 billion above benchmark, though most of that was restricted Fair Share revenue or excess capital gains. The Senate took a roll-call vote on engrossment, and the bill passed to be engrossed by a vote of 39-0. The Senate then agreed to a conference committee on the FY26 budget bill, House 4001, after insisting on its amendment. It also adopted resolutions recognizing the Massachusetts-Hokkaido sister-state relationship and the Concord-Nani sister-city anniversary. The chamber suspended rules to advance a petition to ban DEHP in IV bags and tubing, and it agreed to a House referral change for Senate 2522, a health care petitions bill, sending it to the Judiciary Committee. Finally, the Senate adopted the emergency preamble and passed Senate 2521 to be enacted before adjourning to meet again the following Monday in memory of Lenz Arthur Joseph.

Transcript Highlights:

• <00:07:17.479> plan know are included in the Benchmark plan know are included in the Benchmark
• not um broadly covered in The Benchmark not um broadly covered in The Benchmark plan<00:07:44.199
• <00:46:08.119> and<00:46:08.319> spending healthcare spending and spending healthcare
• <00:46:47.160> prices report on healthc care spending prices report on healthc care spending
• <00:47:52.760> so out-of-pocket Healthcare spending so out-of-pocket Healthcare spending so

Keywords: 1183, house

Transcript Highlights:

• uh to to compare don't have a benchmark uh to to compare to<00:10:38.560> what<00:10:38.720><
• <00:12:31.120> uh<00:12:31.279> data modeling and Benchmark uh data modeling and Benchmark
• of that Benchmark rate was funded<00:15:17.279> in<00:15:17.480> the<00:15:18.079>
• update and increase Benchmark update and increase Benchmark reimbursement reimbursement reimbursement
• funds to quote increase the Benchmark funds to quote increase the Benchmark rates<00:47:30.920><

Keywords: 958, all

Summary: The Budget Review Subcommittee on Health and Family Services met with a quorum still coming together and first handled roll call and minutes. The main presentation came from the Department for Medicaid Services, with Commissioner Lisa Lee and CFO Steve Beckle giving an overview of Kentucky Medicaid, its federal-state financing structure, and the department’s 1915(c) home- and community-based waiver programs. They explained FMAP funding levels for traditional Medicaid, administration, IT, expansion adults, and CHIP, and noted the size of the program, including more than 600,000 Kentucky children eligible for Medicaid or CHIP, about 485,000 expansion adults, over 69,000 enrolled providers, and $18.5 billion in 2024 expenditures. A major focus was the waiver system, including the acquired brain injury waivers, model waiver, independence waiver, Michelle P. waiver, and Supports for Community Living waiver. The department said these waivers are intended to keep people with physical or developmental disabilities in home and community settings rather than facilities, and that many services are not covered by Medicare or commercial insurance. Officials described participant-directed services, interagency administration, and eligibility rules, including that some waiver programs use the child’s income only rather than family income. They also reported an unduplicated waiver wait list of 13,930 people and said the General Assembly had added waiver slots in the last budget, including 650 ABI slots and 1,275 more to be allocated July 1, 2025. The department also discussed a waiver rate study conducted by Guidehouse, explaining that CMS requires a defensible rate methodology because there is no Medicare or commercial benchmark for many waiver services. They said the study used cost and wage surveys, provider and stakeholder input, and aimed to improve transparency, provider stability, and rate parity. Officials reviewed prior COVID-era Appendix K rate increases and budget-driven increases, and said the budget ultimately funded rates at about 70% of the benchmark study, while preserving higher existing rates where needed so no provider would be cut. They highlighted larger differences in behavioral support and case management rates, and said a public report is available. Members asked several questions about the potential impact of federal FMAP changes, especially possible reductions in the enhanced match for expansion adults and Medicaid IT/admin activities. DMS said any FMAP reduction would require more state general fund dollars, estimating about $75 million for each 1% drop in the expansion match, while impacts on administrative IT funding would depend on the systems being built or implemented in a given year. Members also pressed for clarification on waiver wait-list procedures, funded versus filled slots, and what happens when someone on the wait list is later found ineligible. DMS said people on the wait list may not yet have been assessed, can be reevaluated if conditions change, and are still eligible for regular Medicaid state-plan services if they qualify, even if they are waiting for waiver services.

Transcript Highlights:

• So I really appreciate the benchmark opportunity because...
• But to that point, isn't the benchmark an incomplete picture?
• I'm just worried about the benchmark because the benchmark doesn't represent the entire year.
• That's why they're called benchmarks.
• Madam Chair, Senator Miranda, we could work on a definition of what benchmark means because the benchmark

Bills: HB2093, HB2370, HB2376, HB2380, HB2381, HB2383, HB2423, HB2481, HB2621, HB2895, HB4005, HB4043, HB4109

Keywords: mental health, school curriculum, education policy, instruction requirements, statute repeal, charter schools, education, weapons detection, public safety, school administration, school districts, real estate transactions, school property, bond issuance, land use approval, capital improvements, school governance, board meetings, education funding, parental notification

Summary: The committee first approved the March 18, 2026 minutes and then considered the nomination of John Snyder to the State Board for Charter Schools. Snyder described his background in municipal finance, charter school financings, and prior service with Arizona charter school organizations and the Arizona School for the Arts. Members asked about how his finance experience would help the board’s oversight role, and the committee voted 6-0 with one not voting to recommend his confirmation to the full Senate. The committee then heard HB 2093, which would remove the statutory requirement that health education include mental health instruction tied to multiple dimensions of health and would repeal related consultation requirements in 2037. The sponsor argued the bill would remove social-emotional learning from schools and return mental health matters to parents, while opponents, including students, a suicide-loss parent, and youth mental health advocates, said school-based mental health education saves lives and should remain available with parental opt-out. After debate, the committee voted 4-3 to give the bill a do pass recommendation. Several school safety and education bills followed. HB 4043, requiring at least one campus employee trained in CPR, first aid, and AED use where applicable, passed unanimously after testimony from the sponsor and school administrators. HB 4005, requiring instruction on ethical and educational uses of artificial intelligence in school districts beginning in 2027-28, passed 4-3 despite opposition from the Arizona Education Association over unfunded mandate concerns. HB 2895, allowing Native American language proficiency to satisfy a world language requirement and adding language clarifying districts are not required to offer such courses, passed unanimously as amended. HB 2383, renaming trampoline court safety legislation as Ty’s Law, also passed unanimously as amended. The committee also advanced HB 4109, a school public safety and notification bill requiring district safety policies, parent and law enforcement notification after life-threatening violence or weapon incidents, annual public safety reporting, and misdemeanor penalties for noncompliance. Testimony was sharply divided: supporters cited delayed or inadequate notification in serious incidents, while opponents argued the bill was too broad and criminalized administrators. The bill passed 4-3. The committee then approved HB 2376, appropriating $40 million for the school safety program and prioritizing school resource officers and school safety officers, and HB 2380, requiring greater public access to governing board meetings, materials, video, and out-of-state travel approvals; both passed 4-3. Finally, the committee began considering HB 2381, a major strike-everything amendment on career technical education district governance and funding, along with a follow-up amendment, but the transcript cuts off before final action on that bill.

Transcript Highlights:

• And the dark blue bars are revenue, the white bars are spending.
• So those are some basic benchmarks.
• By far the biggest influence on consumer spending is income.
• This is a broad measure of consumer spending.
• People will continue to spend.

Keywords: 1182, all

Summary: At the April meeting of the Finance Advisory Committee, staff presented an updated state revenue forecast that was more cautious than January’s because of heightened economic uncertainty tied to the Iran conflict and broader national risks. The general fund’s available resources were revised down from $577 million in January to $378 million in the April forecast, with the lower estimate driven by reduced revenue projections while spending assumptions were unchanged. Staff said the outlook depends heavily on how long the Middle East conflict lasts and noted that a prolonged disruption could weaken the forecast further, while a quick resolution could improve conditions. George Hammond of the University of Arizona gave a broad economic overview, highlighting geopolitical risk, elevated oil and gasoline prices, sticky inflation, weak Arizona job growth, and uncertainty around federal policy, tariffs, immigration, and AI-related investment. He said Arizona’s recent job growth has been very weak and concentrated mainly in health services, while most other sectors lost jobs, and he attributed much of the slowdown to low hiring rather than layoffs. He also discussed population growth, noting that Arizona remains above the national average but is increasingly dependent on net migration as natural increase slows, and he warned that housing affordability remains strained even as Phoenix inflation has moderated. Panelists generally echoed the cautious outlook but pointed to some offsets. Liz St. Clair said Arizona’s near-term revenues could benefit from tourism tied to spring training and the Final Four, though higher fuel costs could dampen discretionary spending. Other panelists noted that the federal policy environment, tariffs, and immigration changes are likely to restrain growth, while productivity gains, especially from technology and AI, may help businesses maintain output. Several members also discussed housing, saying single-family permits have fallen while rental supply has improved affordability, and they raised concerns about labor-force growth, wage disparities, and the reliability of recent employment data revisions. No formal votes or actions were taken.

Transcript Highlights:

• But this is spending growth by service category.
• So that would make the total spend a lot bigger per capita.
• So that would make the total spend a lot bigger per capita.
• I've only talked about one leg of the benchmark program.
• I can say I want to measure total spending.

Keywords: 962, all

Summary: The Complex Care Committee meeting focused first on a new Diabetes Caucus launched at the Capitol. Rep. Johnson described the caucus as a forum to educate people about type 1 and type 2 diabetes, genetic risk, early testing, pregnancy-related diabetes, and ways Medicaid policy might improve prevention and lower long-term costs. Members agreed the caucus could intersect with care management, and Carolyn Grandell of CHNCT offered to share information about current diabetes-related care management services at a future meeting. The committee then heard a detailed presentation from Alex Rigger of the Office of Health Strategy, who is moving to the Office of Policy and Management. He reviewed Connecticut health care benchmark data, including total health care expenditures, medical spending, and market-by-market trends. He said 2023 to 2024 per-capita spending grew more than 8.5% statewide and 14% in Medicaid, with long-term care accounting for about 46% of Medicaid spending and retail pharmacy also identified as a major cost driver. Members asked about enrollment changes, dual-eligible populations, Medicare Savings Program members, 340B drug pricing, and value-based payment models. Rigger explained that his office tracks alternate payment models and quality benchmarks, but does not separately capture 340B data. Discussion then shifted to Medicare Advantage, dual eligibles, and hospital discharge planning. Members said they want better data on how many Medicaid members are in Medicare Advantage plans and whether those plans shift costs back to Medicaid or affect access to care, especially for complex-care patients. Staff noted DSS does have some Medicare Advantage indicators and that CMS is developing encounter-data rules for states. Kathy Holt and others raised concerns about denials, nursing home stays, and the need to compare Medicaid spending for dual eligibles in Medicare Advantage versus traditional Medicare. The meeting ended with plans for follow-up data sharing, including Alex Rigger’s slides, the diabetes caucus materials, and a future discussion with DSS and other agencies; no formal votes were taken.

Transcript Highlights:

• As you heard, the work of MMB, they said to offset any new spending needs to be offset with spending
• As you heard, the work of MMB, they said to offset any new spending needs to be offset with spending
• Uh, I think we're all open to take questions. spending in a way that that helps out spending in a way
• with excess taxes, um, excess spending. with excess taxes, um, excess spending.
• upgrades as a possible spend this year. upgrades as a possible spend this year.

Keywords: 1183, house

Transcript Highlights:

• <00:09:55.920> that this because I don't want to spend that this because I don't want to spend
• And, you know, there are international benchmarks.
• um we also modeled as a benchmark um we also modeled spending<00:32:53.200> on<00:32:53.399><
• can help these plans get a better spend can help these plans get a better spend or<00:42:46.559>
• analysis of this is what we're spending analysis of this is what we're spending here<00:46:52.000

Keywords: 928, house, all

Summary: The working session focused on the New Hampshire Prescription Drug Affordability Board’s budget request and its recent work. Early discussion centered on a technical question about a statutory dedicated fund for donations: members asked why the budget did not show a line item for accepting donations, and DHHS CFO Nathan White explained that the statute already authorizes the fund, but because no revenue has been received yet, it does not appear in the budget. He said any future donations would go through the normal process under RSA 14:30-a, with fiscal committee and Governor and Council approval and a memo to the Department of Revenue Administration. The chair clarified that the account was not a prerequisite to soliciting donations, and White said the fund would supplement, not replace, General Fund support. Kirk Williamson, the board’s executive director, then presented the board’s mission and budget. He said the governor’s budget provides about $256,500 in the first year and slightly more in the second, all General Funds, and that the board had distributed a technical amendment to continue the executive director position. He described the board’s role as analyzing prescription drug costs, identifying savings opportunities, monitoring market trends, promoting transparency, and making recommendations to the legislature and public payers. He also emphasized that the board operates publicly, with live-streamed meetings and a stakeholder advisory council that includes unions, state agencies, Medicaid, corrections, higher education, and other stakeholders. A major topic was the board’s estimate of $6 million in potential savings, based on Medicare’s newly negotiated prices for 10 drugs. Williamson explained that the board used those federal negotiated prices as a benchmark to estimate what New Hampshire public payers might be missing by not having similar leverage, and said the board is trying to build evidence for future recommendations rather than directly setting prices. Members asked how those potential savings could become actual savings, and Williamson said the board is sharing findings through its advisory council and feedback loops, though it has not yet sent a formal recommendation letter to specific purchasers. He also discussed the difference between pharmacy-benefit spending, which relies heavily on PBM-negotiated rebates, and medical-benefit spending, which is administered differently and is being added to the board’s next report. Williamson highlighted other work, including a model on Humira and a pending legislative effort to improve biosimilar competition, plus a proposed state-backed pharmacy savings card that would be no cost to the state and could save users about $240 per prescription based on Connecticut’s experience. No votes were taken during the session.

Transcript Highlights:

• And so some of those benchmarks that they mentioned included things like operational benchmarks, the
• I am going to go back to the benchmarks. I'm going to go back to the benchmarks.
• necessarily gone away from benchmarks necessarily gone away from benchmarks entirely.<00:50:37.280
• And so I think some of these benchmarks And so I think some of these benchmarks at<00:51:36.559>
• The next section is the benchmarks.

Keywords: 916, all

Transcript Highlights:

• Uh, it beat its policy benchmark of 9.6%.
• <00:11:32.560> And beat the policy benchmark? And beat the policy benchmark?
• And as you its policy benchmark of 9.6%.
• So relative to the index benchmarks.
• A second question certainly benchmarks.

Keywords: Meeting Start: 00:00 Attendance Roll Call: 01:02 Approval of Minutes: 02:03 Annual Investment Review: 04:10 Adjournment: 37:34, 958, all

Summary: The committee met with a quorum, approved the prior meeting minutes, welcomed new staff member Sean Parks, and announced that it would not meet in November. The next meeting was scheduled for December 8 at 10:00 a.m., with the chair noting that pension bills would be heard then and emphasizing that all pension bills must go through the full process and include actuarial analysis. Brad Gross of the Public Pension Oversight Board presented a detailed review of Kentucky retirement systems’ investments and funding. He said fiscal year 2025 ended with about $50.5 billion in pension assets and $12.52 billion in retiree health assets, both up from the prior year. He reported strong investment performance across the systems, with all Kentucky public pension funds exceeding their policy benchmarks and the median peer return of 10.4%. He also discussed long-term return trends, asset allocation differences among the systems, fee levels, and cash flow, noting that cash flow remains a key monitoring issue and that supplemental appropriations have improved the cash position of some funds, especially the Kentucky State Police and TRS systems. Gross also explained that assumed rates of return have generally fallen over time, which increases unfunded liabilities and required contributions, and said the systems’ current assumptions range from 5.25% to 7.1%. He noted that the committee’s materials included peer comparisons and historical charts, and that all asset classes were within target ranges. In response to a question from Senator Funky From, Gross was asked about pension spiking and whether supplemental general fund contributions could create a false sense of security in cash flow analysis; the question was raised but not resolved in the portion of the transcript provided.

Transcript Highlights:

• If you have benchmarks, who are you benchmarking yourselves against?
• So what are you benchmarking against? California? New York? Who are your benchmarks?
• If you have benchmarks and who are you benchmarking yourselves against?
• So what are you benchmarking against California, New York? Who are your benchmarks?
• Spend more money.

Summary: The Senate Finance Committee heard budget presentations for the Texas Historical Commission, the Pension Review Board, the Employees Retirement System (ERS), Social Security and benefit replacement pay, the Texas Emergency Services Retirement System (TESSRS), and the Cancer Prevention and Research Institute of Texas (CPRIT). The Legislative Budget Board outlined recommendations and major changes for each agency, including reductions tied to one-time projects at the Historical Commission, continued funding for courthouse grants, heritage trails, and Holocaust/genocide education, as well as new or modified riders and capital items. For the pension-related items, LBB described funding changes for PRB, ERS, Social Security, and TESSRS, including ERS health plan cost growth driven largely by pharmacy costs, the status of pension funding reforms, and TESSRS’s request for additional state support to address its unfunded liability and staffing needs. Members asked extensive questions about the Historical Commission’s one-time funding, unexpended balance authority, courthouse preservation, the Presidio La Bahia and National Museum of the Pacific War projects, and coordination of Texas history messaging across sites such as the Alamo, San Jacinto, Washington on the Brazos, and other heritage locations. The Historical Commission chair emphasized heritage tourism, economic development, and the need for continued investment in historic sites, staffing, IT modernization, and vehicles. On the pension items, senators discussed PRB oversight of local systems, including the Dallas police and fire pension situation, and ERS investment returns, benchmark comparisons, and rising health costs. ERS officials said the plan remains well funded overall, noted a 2021 cash balance reform and a planned supplemental legacy payment, and explained that GLP-1 drugs such as Ozempic and Mounjaro are a major driver of pharmacy spending; they also said the agency is working with the Texas Pharmacy Initiative and that rebates are contractually returned to ERS. For TESSRS, LBB and agency staff said the system serves volunteer and part-paid emergency personnel, is facing an infinite amortization period, and is requesting additional appropriations, staffing, and IT funding, along with a statutory change to allow an actuarially determined state contribution. The agency said it may otherwise need to cut benefits for volunteer firefighters. For CPRIT, LBB reported about $600 million in recommended funding for the biennium and a 10-FTE increase, while the agency described its $6 billion voter-approved program, $3.75 billion in grants awarded to date, and $10.4 million in revenue sharing since 2011. CPRIT’s only exceptional item was a request for a 10% salary increase for two exempt positions. No committee votes or formal actions were taken in the transcript.

Transcript Highlights:

• There are no future spending tales.
• benchmark and the upper limit. benchmark and the upper limit.
• a planning benchmark of 5.25%. a planning benchmark of 5.25%.
• benchmark and the upper limit. benchmark and the upper limit.
• for bond spending. for bond spending. >> Chair<01:04:25.440> Hansen.

Keywords: 1183, house

Transcript Highlights:

• We do not yet have our benchmarks.
• But I would say we're pretty much on benchmark.
• We closed FY25 about $2.1 billion above benchmark.
• We repeatedly set benchmarks that are not met.
• We spend an...

Keywords: 995, all

Summary: The Senate took up a series of resolutions and bills, beginning with unanimous adoption of resolutions congratulating two Eagle Scouts. It then advanced several local and special acts, including measures on Machado-Joseph disease awareness day, the Ipswich senior tax referral program, Swampscott conservation commission appointments, protections for individuals with disabilities in MassHealth day habilitation programs, continued employment in Brookfield, Marblehead parking fines, Natick’s home rule charter, and Boston affordable housing/branch library space. The chamber also suspended Joint Rule 12 to refer several House petitions to committees. The Senate enacted House bills authorizing additional wine and malt beverage licenses in Lexington and a means-tested senior property tax exemption in Melrose. It also passed Senate Bill 2603 on affordable car rentals after adopting an amendment; supporters said the bill would reduce rental costs by changing Massachusetts’ rental car insurance rules to align with most other states. Senate Bill 1057 on fentanyl test strips was also passed to be engrossed after Senator Creem argued the bill would expand access to a low-cost overdose prevention tool and save lives. Senator Moore then spoke in support of expanding Nikki’s Law to cover MassHealth day habilitation programs, describing the bill as a needed protection for people with autism and intellectual and developmental disabilities. A major portion of the meeting focused on House 4530, a FY2025 supplemental appropriations bill providing $234 million for hospitals and community health centers. Senators discussed the Health Safety Net shortfall, rising health care costs, underinsurance, and federal reimbursement; Ways and Means explained that about $93 million was expected back in federal financial participation, making the net state cost about $140 million. The Senate also took up House 4531 on the 2026 state primary election date, rejecting an amendment before passing the bill to engrossment. The chamber later adopted emergency preambles for House 4530 and House 4531, and all three final bills—Machado-Joseph Disease Awareness Day, the supplemental budget, and the primary election date bill—were enacted and sent to the Governor. The Senate adjourned in memory of Ricardo Barbosa after a memorial statement by Senator Miranda.

Transcript Highlights:

• I think, you know, you can see sort of in the PSA spend, that there's a significant spend there.
• So now fast forward 13 years into that benchmark plan.
• Our benchmark plan specifically excludes infertility benefits.
• And then we're 15th nationally in spending per capita.
• South Dakota, I think, was number eight in spending per capita.

Keywords: 908, all

Summary: The committee met to review the history and current treatment of North Dakota health insurance mandates, with presentations from Blue Cross Blue Shield of North Dakota, Sanford Health Plan, the Public Employees Retirement System (PERS), and the Insurance Department. The discussion focused on how mandates apply differently to fully insured, self-funded, ACA, Medicaid, and PERS plans; how the state’s benchmark plan and federal essential health benefits affect coverage; and how the existing process requires cost-benefit analysis and, for certain measures, a PERS pilot period before broader application. Presenters also reviewed the long list of existing state mandates, including provider, beneficiary, and coverage requirements, and noted that many were enacted decades ago and have not been revisited despite changes in medical evidence and treatment options. Witnesses from the carriers argued that mandates should be reviewed periodically because some are outdated, can create unintended costs, and may not align with current medical guidance. Examples cited included PSA screening, off-label drug coverage, prior authorization rules, step therapy, and cost-sharing provisions for mental health and substance use treatment. They emphasized that carriers often cover services without a mandate when supported by clinical evidence, and that mandates can shift costs to employers and employees, especially in the fully insured small-group market. They also suggested possible policy improvements such as clearer mandate definitions, better transparency around cost-benefit analyses, a regular 10-year review of mandates, and more timely submission of proposals through the interim process. PERS and the Insurance Department highlighted a recurring tension over what counts as a mandate and when a measure triggers the state’s defrayal obligation under federal law. PERS described its interim committee process, the April 1 deadline for fiscal-impact proposals, and the limited pilot program used for certain measures, noting that only a few bills have gone through the full pilot process. The Insurance Department explained that it views new benefit mandates through the lens of the ACA benchmark plan and essential health benefits, distinguishing true new benefits, such as infertility coverage, from changes to existing benefits, such as telehealth or insulin cost-sharing caps. No votes were taken on policy changes; the meeting was informational, with members asking questions about costs, applicability, transparency, and whether a periodic mandate review should be established.

Transcript Highlights:

• As former county commissioners, we spend a billion dollars a year, counties do, on prisons.
• <00:24:33.919> a former county commissioners, we spend a former county commissioners, we spend
• which by the way are fairly benchmarks which by the way are fairly minimum<00:27:58.399> benchmarks
• <00:29:32.320> are proposal says if those benchmarks are proposal says if those benchmarks
• <00:40:52.320> for have asked for uh money to spend for have asked for uh money to spend for

Bills: SB298, SB91

Keywords: Florence, Lauderdale County, municipal boundaries, corporate limits, land annexation, military installations, tall structures, local government, construction approval, wind energy facilities, aeronautics, Department of Defense, 923, senate, all

Transcript Highlights:

• After spending $500, private testing.
• <01:02:39.680> thousands The families who cannot spend thousands The families who cannot spend
• :03:15.839> energy<01:03:16.319> simply spending all your mental energy simply spending
• <01:32:10.400> on It's the time they are spending on It's the time they are spending on screens
• > more<01:57:10.239> time So immediately I'm spending more time So immediately I'm spending

Keywords: 958, all

Transcript Highlights:

• We're just giving them money as fast as they can spend it. Okay.
• We spend a lot. We gave up camping when we got out of the service.
• If you have benchmarks, who are you benchmarking yourselves against?
• So what are you benchmarking against—California, New York? Who are your benchmarks?
• California, New York—who are your benchmarks?

Bills: SB 1

Keywords: campground safety, youth camp regulations, flood safety, emergency evacuation, health and safety standards

Summary: The committee heard budget presentations from the Legislative Budget Board and agency officials on several agencies, starting with the Texas Historical Commission. LBB described a large biennial reduction driven mainly by the removal of one-time funding and discussed capital projects, rider changes, and exceptional items including Presidio La Bahia and the National Museum of the Pacific War. Senators asked about heritage trails, courthouse grants, unexpended balance authority, and the status of historical-site funding. Historical Commission leadership emphasized preservation, courthouse restoration, heritage tourism, coordination with the Alamo and other Texas Revolution sites, and requested additional IT, staffing, and vehicle funding. No votes were taken. The committee then reviewed the Pension Review Board and the Employees Retirement System. The Pension Review Board’s budget was largely unchanged aside from IT maintenance and salary adjustments, with an exceptional item for additional IT enhancements. Members discussed the Dallas Police and Fire Pension System’s funding dispute and the need for a workable restoration plan. ERS presented a much larger budget, including funding for the retirement system, the group benefits plan, and the legacy payment intended to reduce unfunded liability. Senators focused heavily on pension investment returns, benchmark comparisons, and rising health-care costs, especially pharmacy spending driven by GLP-1 drugs; ERS said the plan covers about 540,000 lives and that premiums would rise 8% while benefits remain unchanged. ERS also said it had no exceptional items, and committee members requested more detailed benchmark information. The committee also heard from the Texas Emergency Services Retirement System and the Cancer Prevention and Research Institute of Texas. TESSORS reported an unfunded liability, an infinite amortization period, and requested additional state support, staffing, and IT funding, including a statutory change to allow a higher contribution level; the agency warned that without more funding it may have to cut benefits. CEPRIT’s presentation covered its bond-funded cancer research and prevention portfolio, revenue-sharing from funded projects, and a request to increase salary limits for its CEO and chief scientific officer. Senators questioned CEPRIT’s accomplishments and return on investment, while CEPRIT cited screening, prevention, and research outcomes, including tens of thousands of detected cancers and precursors and hundreds of thousands of first-time screenings. The meeting ended after these presentations and questions, with no recorded committee action or vote.

Transcript Highlights:

• It's a significant investment for the state. motans spend time with their family and motans spend time
• <00:19:21.120> on note that the majority of spending on note that the majority of spending
• <00:47:40.880> Demolition future spending tales. Demolition future spending tales.
• <01:04:34.000> that introduced some policy benchmarks that introduced some policy benchmarks
• > here<01:08:48.640> sets Again, the planning benchmark here sets Again, the planning benchmark

Keywords: 1187, senate, all