Transcript Highlights:

• That would be dispensing, which would be against the Board of Pharmacy rules.
• All right, we will go to 13, Department of Health, Arkansas State Board of Pharmacy.
• So again, students can participate in some of the local teams.
• So if you want to join your local community team through the Boys and Girls Club. your local community
• local regulatory body, from setting standards of their own.

Committee: All ALC-ADMINISTRATIVE RULES

Summary: The Administrative Rules Subcommittee reviewed a long agenda of agency rules, with most items approved without objection after brief presentations and no public comment. Early items included Department of Energy and Environment rules on landfill post-closure trust fund spending thresholds and liquefied petroleum gas standards, DFA’s electronic odometer disclosure rule, and several Department of Health rules covering ionizing radiation, mobile home and RV parks, lead-based paint, counseling board revisions, hearing instrument dispensers, athletic training, dental examiners, nursing, pharmacy, medical board, speech-language pathology and audiology, radiologic technology, massage therapy, community health workers, doula certification, and cosmetology/body art. Most of these changes were described as updates to match recent acts, federal standards, compact participation, fee adjustments, or cleanup/clarification, and the committee repeatedly approved them without objection. A substantial portion of the meeting focused on the Arkansas State Board of Nursing’s broad set of rule changes implementing multiple 2025 acts. Those changes included creating a dialysis patient care technician registry, updating contact information requirements, expanding APRN authority to delegate certain tasks, clarifying death certificate and pronouncement authority, allowing substitution of therapeutically equivalent medications, permitting purchase of compounded products, and updating certified medication assistant rules and training standards. Members asked detailed questions about the meaning of therapeutically equivalent substitutions, delegation limits, compounded products, and how often medication lists would be updated; the board said it would review rules annually and use future rulemaking as needed. The committee also approved new nursing rules for declaratory orders and the new dialysis registry. The Department of Education’s rules drew the most discussion, especially the Arkansas Children’s Educational Freedom Account Program. The department said the revisions, based on Act 920 of 2025, were intended to add guardrails, clarify eligible expenses, and streamline approvals. Changes included defining core educational expenses, limiting sports-related spending, adding an intentional misuse standard, restricting certain technology purchases and requiring extra justification over $1,000, capping carryover funds at $8,500, and creating a reconsideration process for denied expenses. Members raised concerns about oversight, appeal timelines, sports equipment, provider credentialing, and whether the rules were too restrictive; department officials said the rules were meant to protect taxpayer funds while preserving flexibility, and they noted the program had received extensive public comment. The committee also approved Education rules for scholarships, residency classification, teacher programs, accelerated learning, and graduate medical education, as well as Labor and Licensing rules on wage and hour standards, boiler rules, motor vehicle commission requirements, professional wrestling regulation, appraiser qualifications, and military recruiting incentives.

Transcript Highlights:

• Academic studies say that when communities lose their local journalists, bond prices increase for local
• taxpayers because there are fewer people watching local spending.
• When a town loses a local reporter, it affects all of us.
• We have, in our ecosystem, the majority of local news outlets are very small local news outlets, and
• We have in our ecosystem the majority of local news outlets are very small local news outlets and part

Committee: House Revenue and Taxation

Transcript Highlights:

• but a huge part of my career, in fact most of my career, has been working with elected officials, local
• And then after that, a little bit of time in local government in New York.
• After that, I went into legislative affairs at the White House. local government and the challenges of
• There are the pharmacy benefit managers and all the other entities that manage benefits.
• There are pharmacy benefit management entities. And there are just a whole slew of entities.

Committee: Joint Joint Select Committee on Health Care and Behavioral Health Oversight

Summary: The committee first welcomed new DSHS Secretary Angela Ramirez, who described her background in public service and emphasized collaboration, relationships, and responsiveness to legislators as she begins her tenure. Members thanked her and noted they looked forward to working with her on the governor’s priorities and the state’s budget and service challenges. The committee then heard a presentation on the West Coast Health Alliance from Governor’s Office, Department of Health, and state health leadership. Witnesses said the alliance was formed by Washington, Oregon, California, and Hawaii to provide unified, science-based public health guidance, especially on vaccines, amid federal instability and misinformation. They said the alliance has already issued vaccine recommendations and statements rejecting a vaccine-autism link, and is working on return-to-work guidance and responses to federal ACIP actions. Members asked about workload and coordination with an East Coast public health group; witnesses said the main challenge is communicating unified guidance rather than reviewing studies themselves. Next, the Washington Health Benefit Exchange reported on open enrollment and the effects of federal changes, including the expiration of enhanced premium tax credits and HR1 provisions affecting immigrant eligibility and future auto-renewal rules. Officials said premium increases are driving some customers to drop coverage, while state actions such as silver loading and Cascade Care Savings are helping blunt the impact for many enrollees. They also described outreach through navigators, brokers, tribal organizations, and community groups, and noted rising website traffic and more customer questions during open enrollment. Members asked about enrollment trends, carrier participation, and how to communicate upcoming federal changes. Finally, the Health Care Authority and Office of the Insurance Commissioner reviewed the state’s health reform history and the impact of federal changes on Medicaid and the individual market. They highlighted ongoing state efforts on affordability, prescription drug oversight, primary care and behavioral health access, preventive services, and rural health funding. Witnesses said agencies are coordinating across DSHS, HCA, OIC, the Exchange, Employment Security, and others to prepare for Medicaid work requirements and other HR1 changes, while also trying to reduce administrative burden and preserve access to care. No votes were taken.

Transcript Highlights:

• I'm the director of the Arkansas State Board of Pharmacy. Thank you for being here.
• So again, students can participate in some of the local teams.
• So again, students can participate in some of the local teams.
• Like if I have someone in the local community do something...
• local regulatory body, from setting standards of their own.

Committee: All ALC-ADMINISTRATIVE RULES

Bills: SB255 , SB199 , SB47 , HB605 , HB216 , HB621 , HB148 , HB389 , HB509 , HB248 , SB255 , SB199 , SB47 , HB605 , HB216 , HB621 , HB148 , HB389 , HB509 , HB248 , SB336 , SB293 , SB43 , HB420 , HB60 , HB188 , HB106 , HB105 , HB11 , SB336 , SB293 , SB43 , HB420 , HB60 , HB188 , HB106 , HB105 , HB11

Committee: Senate Judiciary

Keywords: SB255, cannabinoid, hemp, hemp-derived THC, THCa, delta-8 THC, HHC, CBD, THC, novel cannabinoid products, hemp products, intoxicating hemp, delta-8, retail license, Department of Revenue, Department of Agriculture and Industries, testing and labeling, third-party laboratory, product safety, public health

Transcript Highlights:

• The Florida Keys gets $20 million, petroleum tank clean-up $195 million, state and local parks $47 million
• replacing the state's outdated accounting system, $14.4 million for IT updates, $23.4 million for local
• because each locale has its own unique history and issues that are best handled by local authorities
• I don't want anybody out there thinking that local governments are poisoning people.
• And I know this is being discussed at a local level, other communities and in mine as well.

Committee: Senate Appropriations Committee on Agriculture, Environment, and General Government

Summary: The Appropriations Committee on Agriculture, Environment, and General Government heard a presentation on its 2025-2026 budget recommendations and adopted the proposal as a recommendation to the full Senate Appropriations Committee. The chair highlighted major funding items including more than $1.2 billion for water quality and Everglades work, citrus recovery, food bank and pantry grants, wastewater and drinking water loans, beach restoration, flood and sea level rise projects, rural land protection, disaster loans, state facilities repairs, SLERS, accounting system replacement, and continued funding for My Safe Florida Home. Staff were authorized to make technical adjustments, and members were told final proviso project lists would be printed later in the week. The committee then considered several bills and reported them favorably, including SB 796 on DEP general permits for distributed wastewater treatment systems to help local governments address failing septic-related water quality problems; SB 1162 expanding boating improvement and water access facilities programs; SB 466 implementing the Florida Museum of Black History task force’s selection of West Augustine as the museum site; SB 178 creating a FAMU agronomic study on viable crops for land taken out of production; CS/SB 678 allowing pawnbroker transaction forms to be printed or digital; and CS/SB 736 updating the Brownfields program, with a technical amendment adopted. Testimony on these bills was generally supportive, with speakers from affected industries, local governments, and advocacy groups. The committee also took up CS/CS/SB 700, the comprehensive Florida Farm Bill, which included technical agency changes and major policy provisions such as restrictions on additives to public water supplies, labeling requirements for meat, milk, poultry, and eggs, drone-related protections for farmland, disaster recovery loan updates, an honest services registry for charities, FFA scholarship and school infrastructure provisions, and a mechanism for state purchase of former solar-converted agricultural land. The water-additive provisions drew extensive debate and testimony from supporters and opponents, including dental professionals, public health advocates, and groups arguing for medical freedom and local control. Despite the controversy and a no vote from Senator Arrington, the bill was reported favorably. Finally, SB 1226 creating a regulatory framework for pet insurance was also reported favorably, and the committee adjourned after members recorded additional votes on several bills.

Transcript Highlights:

• And just picture your local firefighters delaying their advance because there was some kind of procedural
• And just picture your local firefighters delaying their advance because there was some kind of procedural
• third-party data vendors, uh, is of some interest, especially if it's paralleled with the PBMs in the pharmacy

Committee: House Health, Human Services & Elderly Affairs

Transcript Highlights:

• We the bill for pharmacy um services.
• </c> uh for the benefit of all of our local uh for the benefit of all of our local communities,<03:21
• </c> million towards local wetland million towards local wetland replacement<03:52:54.000><c> which</
• basis to the local bridge replacement program,<03:53:05.040><c> local</c><03:53:05.279><c> road</c><
• </c><04:03:59.920><c> deputy</c> completed, go into their local deputy completed, go into their local

Transcript Highlights:

• Education, they just changed and made it a request for the requirement on medical information to the local
• The other was one from Appropriations. ...information to the local districts.
• It's an act to amend Title 22 relative to pharmacy benefit managers to provide for definitions and provide
• for pharmacy reimbursements.

Bills: SCR12 , HB221 , HB509 , HCR58 , SB78 , SB25 , SB80 , SB132 , SB155 , SB157 , SB202 , SB228 , SB250 , SB414 , SB433 , SB479 , SB513 , SCR9 , SCR58 , SB65 , SB215 , SB249 , SB269 , SB282 , SB296 , SB323 , SB363 , SB369 , SB474 , SB490 , SB492 , SB500 , SB514 , HCR32 , HB17 , HB41 , HB73 , HB223 , HB244 , HB759 , HB906 , HB966 , HB1006 , HB1009 , HB1086 , HB1107 , HB1112 , HB1215 , HB1242 , SB217 , SB283 , SB469 , HB36 , HB42 , HB74 , HB119 , HB159 , HB259 , HB302 , HB414 , HB459 , HB776 , HB848 , HB956 , HB1017 , HB1028 , HB1095 , SB208 , SB312 , SB382 , SB389 , HB210 , HB258 , HB359 , HB368 , HB468 , HB552 , HB732 , HB784 , HB870 , HB953 , HB1117 , HB1236

Keywords: logging, recognition, John Keith, environment, safety, Mississippi River bridge, Trump Expressway, transportation, federal funding, Louisiana highways, injection wells, public hearing, geologic sequestration, environmental impact, public comment, Ascension Parish, state capitol, economic development, community partnership, celebration day

Transcript Highlights:

• I also serve as the executive officer for the Idaho Board of Pharmacy, the Idaho Board of Nursing, and
• The Idaho Board of Pharmacy administers the regulatory provisions of our state's Uniform Controlled Substance
• But also today is Pharmacy Day at the Capitol, so they are up on, I believe, the fourth floor.

Committee: House Health and Welfare

Transcript Highlights:

• Paul Dyson for the committee and local consent calendars.
• For the committee on local consent calendars, HR1469 by Hayes commends...
• For the committee on local consent, HR1470 by Gomez congratulates Dr.
• Paul Dyson for the committee and local consent calendars.
• For the committee on local consent, HR1470 by Gomez congratulates Dr.

Bills: HB149 , HB2017 , HB705 , HB223 , HB 1056 , HB2854 , HB4623 , HB3000 , HB46 , HB 117 , HB3619 , HB4464 , HB5646 , HCR84 , HB500 , HB2963 , HB5509 , HB1973 , HB3909 , HB718 , HB252 , HB5666 , HB 119 , HB346 , HB5624 , HB5658 , HB5677 , HB1545 , HB3073 , HB4081 , HB 121 , HB4236 , HB3848 , HB4144 , HB40 , HB5682 , HB3697 , HB3333 , HB3642 , HB20 , HB549 , HB2731 , HB4233 , HB4690 , HB 127 , HB2525 , SB1637 , SB1 , SB1198 , SB509 , SB13 , SB15 , SB30 , SB268 , SB331 , SB441 , SB447 , SB457 , SB568 , SB650 , SB763 , SB1540 , SB1610 , SB1660 , SB2018 , SB2024 , SB2217 , SB2337 , SB2753 , SB2900 , SB2972 , SB3059 , HB14

Keywords: artificial intelligence, regulation, biometric data, ethical AI, consumer protection, AI governance, intoxication manslaughter, criminal penalties, community supervision, mandatory supervision, parole eligibility, Grayson's Law, cosmetology, licensure, interstate compact, state regulations, public safety, workforce mobility, municipality, procurement

Bills: HB149 , HB2017 , HB705 , HB223 , HB 1056 , HB2854 , HB4623 , HB3000 , HB46 , HB 117 , HB3619 , HB4464 , HB5646 , HCR84 , HB500 , HB2963 , HB5509 , HB1973 , HB3909 , HB718 , HB252 , HB5666 , HB 119 , HB346 , HB5624 , HB5658 , HB5677 , HB1545 , HB3073 , HB4081 , HB 121 , HB4236 , HB3848 , HB4144 , HB40 , HB5682 , HB3697 , HB3333 , HB3642 , HB20 , HB549 , HB2731 , HB4233 , HB4690 , HB 127 , HB2525 , SB1637 , SB1 , SB1198 , SB509 , SB13 , SB15 , SB30 , SB268 , SB331 , SB441 , SB447 , SB457 , SB568 , SB650 , SB763 , SB1540 , SB1610 , SB1660 , SB2018 , SB2024 , SB2217 , SB2337 , SB2753 , SB2900 , SB2972 , SB3059 , HB14

Keywords: artificial intelligence, regulation, biometric data, ethical AI, consumer protection, AI governance, intoxication manslaughter, criminal penalties, community supervision, mandatory supervision, parole eligibility, Grayson's Law, cosmetology, licensure, interstate compact, state regulations, public safety, workforce mobility, municipality, procurement

Transcript Highlights:

• And this bill will help use their insurance for the care that is already available locally.
• And this bill will help use their insurance for the care that is already available locally.
• And so if somewhere is closer to be able to go do it, then they can go to a local person instead of having
• within certain proximities of insured persons to make sure they have access to either physical pharmacies
• or hospitals, you know, there are... ...to make sure they have access to either physical pharmacies

Committee: House Insurance and Banking

Summary: The Committee for Insurance met with a quorum and first took up three bills in executive session. House Bill 2902 was amended with a committee substitute that removed the commission language while keeping provisions on software and key-emulating devices, and members confirmed it still included a Class D felony penalty. The committee adopted the substitute and voted the bill do pass, with one member voting no. House Bill 1789, dealing with delivery network companies and insurance coverage during the delivery availability period, was also amended and adopted; the substitute clarified that the availability period is not commercial activity and that auto insurance applies until a driver is actually engaged in delivery. The committee then voted the bill do pass, with one no vote and one present. House Bill 1647 was amended to remove it from the collateral source rule section and clarify that it applies only to civil actions for damages and property claims; the substitute was adopted and the bill voted do pass, with several no votes recorded. The committee then held a public hearing on House Bill 1894, which would implement federal nondiscrimination requirements for licensed health care providers in Missouri insurance law. The sponsor said the bill is about patient choice, fairness, and access, especially in rural areas, and does not expand scope of practice or require coverage of new services. Supporters from chiropractic, nursing, occupational therapy, podiatry, and nurse anesthetist groups said the bill would ensure equal reimbursement for the same covered services and improve access to local providers. Opponents from the insurance industry argued the bill would interfere with network design, reduce negotiating leverage, and require equal payment regardless of provider type or credentials; they also said current federal law already governs network adequacy and that the bill’s rulemaking language was standard but the reimbursement mandate was the main concern. The committee also heard House Bill 3314, which updates Missouri’s insurance guaranty association laws. The sponsor and supporters explained that the bill would clarify coverage for cyber policies, ensure coverage follows the policyholder in insurance business transfer or corporate division transactions, and allow limited pre-liquidation information sharing from the Department of Commerce and Insurance to guaranty associations so claims can be handled faster after insolvency. Witnesses said the bill is technical and intended to modernize the system without expanding coverage or increasing taxpayer exposure. Members asked about the $300,000 property and casualty claims cap, the definition of high-net-worth individual, oversight of guaranty associations, and confidentiality concerns; supporters said the cap is longstanding, high-net-worth means over $25 million, and the department’s existing oversight and confidentiality protections are sufficient. The hearing closed after a final supportive statement from the Missouri Insurance Coalition, and the committee adjourned.

Transcript Highlights:

• And more importantly, it is just absolutely devastating the local economies of a couple of towns, a couple
• At the same time, there is some evidence of misuse of the 340B program, meaning contracting with pharmacies
• there's not a clear connection between the medical care these hospitals or FQHCs are providing and the pharmacy
• But when I hear that my local hospital is losing millions a year through either charity care or bad debt
• Obviously, we want to defer to local districts' ability to figure out the rules that are best for themselves

Summary: Senate and House Republican leaders held a joint media availability focused on affordability, budget concerns, and opposition to several Democratic tax proposals. John Braun and Drew Stokesbary said Washingtonians are still struggling with the cost of food, gas, housing, child care, and health care, and argued Democrats are not advancing bills that would ease those pressures. They criticized a draft income tax proposal they said would function as a small business tax, especially because it would disallow loss carryforwards and could discourage investment in housing and other capital-intensive sectors. They also objected to a proposed tire fee and a bill they said would prevent tire sellers from telling customers about the tax. The Republicans said they planned to raise budget and tax concerns in an upcoming meeting with Governor Ferguson, and Stokesbary said he had introduced a budget-savings bill to consolidate University of Washington investment management with the State Investment Board. They also discussed a bill to make it harder to qualify citizen initiatives, calling it anti-democratic, and said they want stronger oversight and legal reforms related to DCYF and state liability in child welfare cases. Braun and Stokesbary said they were open to discussing tort reform and a civil claims process, but emphasized the underlying problem is state failure in protecting children. On health care, they said they were still reviewing a bill to eliminate interest on medical debt and a separate 340B drug-pricing proposal, warning both could have unintended effects on hospitals, patients, and drug innovation. They also said they support the idea of protecting children online and in schools, but want any social media, AI chatbot, or cell phone-related bills written carefully to avoid First Amendment problems and unintended consequences. On public safety, they expressed concern about a bill restricting police retention of automatic license plate reader data, arguing law enforcement needs such tools to solve crimes. No votes were taken, and the event ended with the Republicans reiterating their opposition to tax increases and their focus on affordability.

Transcript Highlights:

• And more importantly, it is just absolutely devastating the local economies of a couple of towns, a couple
• At the same time, there is some evidence of misuse of the 340B program, meaning contracting with pharmacies
• there's not a clear connection between the medical care these hospitals or FQHCs are providing and the pharmacy
• But when I hear that my local hospital is losing millions a year through either charity care or bad debt
• Obviously, we want to defer to local districts' ability to figure out the rules that are best for themselves

Summary: Republican legislative leaders used the availability to focus on affordability, budget pressures, and opposition to several Democratic tax proposals. They criticized a circulating draft income tax proposal as a de facto small-business tax, arguing it would hurt LLCs, S corporations, housing investment, and the broader economy. They also attacked a proposed tire fee, a possible cigarette tax increase, and other tax ideas as regressive or hidden from consumers, while saying Republicans would not support any tax increases and urging budget cuts and spending restraint instead. The leaders said they planned to raise these concerns in an upcoming meeting with Governor Ferguson, along with questions about his budget and how he reconciles prior opposition to a wealth tax with support for an income tax. They also discussed a bill to make it harder to qualify initiatives for the legislature, calling it anti-democratic, and said the majority was ignoring or undermining voter-driven policy efforts. On child welfare, they criticized DCYF oversight and supported stronger accountability, including a bill to fix the state’s “imminent harm” standard and another proposal to stop the state from collecting certain federal disability and survivor benefits from foster youth. Other topics included tort liability reform, where Republicans said the state’s repeated failures in child welfare and juvenile rehabilitation are the underlying problem, not just the cost of claims, though they were open to limited reforms such as disclosure of litigation financing. They also discussed the 340B drug pricing program, saying it is complicated and could affect hospitals, FQHCs, patients, and pharmaceutical innovation. On public safety and technology, they expressed cautious support for bills regulating kids’ social media and AI use, but stressed First Amendment concerns and the need to avoid private rights of action; they were more skeptical of a bill limiting police retention of automatic license plate reader data, saying law enforcement needs effective tools to solve crimes. No votes were taken, and the event ended with Republicans reiterating that affordability was their top priority.

Transcript Highlights:

• And this bill will help use their insurance for the care that is already available locally.
• And this bill will help use their insurance for the care that is already available locally.
• And so if somewhere is closer and they're able to go do it, then they can go to a local person instead
• And so if somewhere is closer and they're able to go do it, then they can go to a local person instead
• And so if somewhere is closer and they're able to go do it, then they can go to a local person instead

Committee: House Insurance

Transcript Highlights:

• James did not have a job, transportation, or local family support.
• Because of the Missouri Housing Trust Fund, Love Columbia was able to pay for James to stay at a local
• bill, in your mind, will be able to, if something like COVID happened again, it would clarify for local
• don't think either bill specifically goes to the legal stuff unless it's the state or government or local
• So if we have the pharmacy open or that liquor store, right, whatever, but if the pharmacy is allowed

Committees: House Emerging Issues , House Emerging Issues and Professional Registration

Transcript Highlights:

• disabilities and those who are aging in place: being able to live in their own homes, stay in their local
• Communities, you know, what are we going to do differently locally and at the state level to really be
• As part of local continuums of care, SNFs and ALs play vital roles in hospital relief and bed decompression
• Currently, employers are only allowed to train their own employees and are unable to train other local
• So you'll see things like You'll see things like pharmacy management, advanced care planning, support

Committee: Senate Health & Long-Term Care

Summary: The committee held a work session on the long-term care workforce, hearing first from DSHS Assistant Secretary B. Rector and then from representatives of Washington Health Care Association, SEIU 775, and Behavioral Health Solutions. Presenters described rapid growth in the 85-and-older population, increasing demand for home- and community-based services, and persistent shortages in direct care, nursing, and behavioral health staff. They cited low wages, unstable hours, benefits, certification and testing delays, immigration-related workforce concerns, and burnout as major barriers to recruitment and retention. DSHS highlighted recruitment and retention initiatives funded with federal dollars, including high school training programs, a retention toolkit, transportation support, workforce navigators, tribal partnerships, and remote caregiving pilots. Industry and labor witnesses urged higher reimbursement and compensation, better training pathways, and more worker voice; they also noted that Washington ranks highly nationally on some workforce measures but still faces shortages and turnover. Behavioral Health Solutions added that credentialing delays and mental health staffing gaps are affecting nursing home behavioral care, and that its programs aim to reduce hospital transfers and improve resident outcomes. No votes were taken. The committee then received an overview from the Office of the Insurance Commissioner on the palliative care benefit work group created by 2024 legislation. OIC explained that the work group, with actuarial analysis from Milliman and input from multiple stakeholder organizations, studied a proposed palliative care benefit for commercial plans, Medicaid, PEBB, and SEBB. The report concluded that a new benefit would likely increase costs, estimating about 28 cents per member per month overall and roughly $2.6 million to $4.5 million in annual state Medicaid costs if implemented in 2027. OIC said the evidence was insufficient to conclude that palliative care would produce offsetting savings, though several provider members disagreed and submitted response letters. Members asked about other states, Medicare, health homes, and whether more research could clarify cost savings; OIC said the issue remains unsettled and that additional data may emerge as other states implement similar benefits. Finally, the Health Care Authority provided a broad overview of health care price transparency tools in Washington and federally. Staff described federal hospital and health plan transparency rules, the state all-payer claims database, consumer-facing price and quality tools, prescription drug price transparency reporting, the Health Care Cost Transparency Board, and the Prescription Drug Affordability Board. They emphasized that these tools provide useful but incomplete information because of data lags, proprietary restrictions, limited self-insured employer participation, and the complexity of machine-readable files. The committee also discussed the role of AI in making transparency data more usable and the limits of current tools in helping consumers afford care. No formal action or vote was taken on any item.

Transcript Highlights:

• disabilities and those who are aging in place: to be able to live in their own homes, stay in their local
• What are we going to do differently locally and at the state level to really be prepared for making sure
• Currently, employers are only allowed to train their own employees and are unable to train other local
• So you'll see things like... ...pharmacy management, advanced care planning, support to caregivers, and
• Pricing data comes from PBMs, health carriers, pharmacies, manufacturers, and others in the supply chain

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

Transcript Highlights:

• , but a huge part of my career—in fact, most of my career—has been working with elected officials, local
• And then after that, a little bit of time in local government in New York.
• That's local government and the challenges of integrating that into a city that had a lot of sort of
• There are the pharmacy benefit managers and all the other entities that manage benefits.
• There are pharmacy benefit management entities. And there are just a whole slew of entities.

Committee: Joint Joint Select Committee on Health Care and Behavioral Health Oversight

Summary: The committee first welcomed new DSHS Secretary Angela Ramirez, who introduced herself and described her background in public service, federal and state legislative work, and health and human services leadership. Members emphasized the importance of building strong relationships with her and noted her focus on protecting services, using strategic approaches in a tight budget environment, and improving partnerships with the Legislature. Ramirez said she wanted to keep communication open and that her priorities would be shaped by what she learns from lawmakers and agency partners. The next work session focused on the West Coast Health Alliance and the broader Governor’s Public Health Alliance. Department of Health and governor’s office staff said the West Coast alliance, involving Washington, Oregon, California, and Hawaii, was formed to coordinate science-based public health guidance, especially around vaccines, return-to-work guidance, and responses to federal changes. They said the alliance is intended to reduce confusion, counter misinformation, and preserve access to evidence-based recommendations, with early actions including vaccine guidance for COVID-19, flu, and RSV, a statement rejecting any vaccine-autism link, and preparation for possible ACIP changes. Members asked about workload and coordination with other regional alliances, and staff said there is informal coordination but no formal regular meetings. The committee then heard from the Washington State Health Benefit Exchange about open enrollment and the effects of federal policy changes. Exchange leaders said the expiration of enhanced premium tax credits, HR1 provisions, and immigration-related eligibility changes are affecting affordability and enrollment, with some customers facing large premium increases and some counties becoming harder to serve. They reported early open-enrollment traffic increases, nearly 10,000 new sign-ups, and nearly 12,000 active coverage drops so far, while noting that many more people may disenroll later if subsidies are not extended. They also described mitigation efforts such as silver loading, Cascade Care Savings, outreach through navigators and community partners, and planning for future HR1 requirements like ending auto-renewal and adding verification steps. In the final work session, staff from the Health Care Authority and Insurance Commissioner’s office reviewed Washington’s health reform history and the state’s current affordability and access efforts. They highlighted past ACA-related coverage gains, continued work on prescription drug affordability, PBM oversight, primary care and behavioral health access, and a pending legislative proposal to preserve access to preventive services. They also discussed federal changes affecting Medicaid and the exchange, including work requirements, six-month redeterminations, and the need to coordinate across agencies to implement new rules. Members raised concerns about network adequacy, provider access, and the complexity of the health care system, while staff said they are trying to mitigate harm, simplify administration, and keep coverage and access as stable as possible.