Transcript Highlights:

• rural Kentuckians most directly.
• of it will be please conduct an impacts of it will be please conduct an economic<00:19:19.120><c> impact
• </c><00:20:51.559><c> rural</c><00:20:52.000><c> Kian</c><00:20:52.880><c> most</c> pollution impacting
• rural Kian most pollution impacting rural Kian most directly<00:20:55.000><c> this</c><00:20:55.200>
• our livestock I don't know how impacts our livestock I don't know how this<00:26:56.520><c> impacts<

Keywords: Meeting Start 00:00 Attendance Roll Call 00:04 SB 89 Discussion 00:59 SB 89 Roll Call Vote 24:49, 958, all

Summary: The committee met in a special called session, confirmed a quorum, and took up Senate Bill 89. The sponsor, Scott Maiden, said the bill was intended to address permitting issues affecting coal and other industries, and he described it as supported by a broad coalition of business, agriculture, and industry groups. He said the bill would align Kentucky’s definition of “waters of the Commonwealth” with federal definitions and would codify the existing definition and calculation method for long-term treatment bond requirements at mine sites. He also emphasized that the bill would not eliminate groundwater protections, drinking water protections, or prohibitions on hazardous substance dumping. A committee amendment was discussed and adopted to add and clarify definitions, including navigable waters, sinkholes with open drains, certain springs, and wellhead protection areas. The sponsor said the amendment was intended to address concerns that the bill was too broad and noted that it was worked on with Louisville Water and other stakeholders. Testimony in opposition came from Rebecca Shelton of Appalachian Citizens Law Center, who argued the bill would leave private wells and groundwater vulnerable and cited groundwater contamination data. Nick Hart of Kentucky Waterways Alliance urged the committee to preserve the current definition and requested a statutory review and economic impact analysis. Audrey Ernsberger of Kentucky Resources Council said the bill would strip protections from most groundwater, ephemeral streams, karst aquifers, and many private wells, and warned of higher water-treatment costs and pollution risks. Members asked questions about the meaning of “carcinogenic” and the difficulty of cleaning up contamination in private wells. During roll call, several members explained their votes, with supporters saying the amendment protected water while preserving needed flexibility for industry, and opponents saying they could not risk weakening water protections or harming private wells and agriculture. The committee voted to pass SB 89 as amended with a favorable recommendation to the Senate, and then moved to roll the committee amendment into a committee substitute.

Transcript Highlights:

• And those adversely impacted pharmacies are now made whole.
• You can see that the impact on the budget is $202,853.
• areas but to stay in these rural areas.
• But it says there rural loan assistance program. So, which counties would not be rural?
• Well, but at the same time, what was that impact? But you go into a rural county, you'd prosecute.

Keywords: 914, all

Transcript Highlights:

• Uh, since the rural health transformation funding rolled out, it appears that we're going to have some
• </c><00:02:39.440><c> health</c> we've since the rural health we've since the rural health transformation
• But in rural Kentucky, it makes such a difference.
• </c><00:08:13.520><c> Kentucky,</c> of Kentucky, especially rural Kentucky, of Kentucky, especially rural
• But in rural Kentucky, it now $60,000.

Keywords: Meeting Start 00:00:00 Kentucky Board of Emergency Medical Services (KBEMS) 00:00:53 Approval of Minutes 00:23:37, 958, all

Summary: The Kentucky Board of EMS presented an additional budget request focused on grant funding for local EMS agencies, not agency operations. Officials said the board has 13 full-time staff after losing employees in the 2022 transition back to state government, and that the request would be a 100% pass-through to providers. They initially described two requests totaling $12.91 million: $10.8 million for the EMS block grant and $2.1 million for workforce education tied to House Bill 484, but later said they would withdraw the $2.1 million request because rural health transformation funding appears likely to cover those education needs. Most of the testimony explained why the EMS block grant should be increased. The board said the grant began in 1980 at about $1.2 million and has remained largely unchanged while EMS costs have risen sharply. They cited higher prices for ambulances, stretchers, and cardiac monitors, along with increased labor and reimbursement pressures. Board members emphasized that modern EMS now provides much more advanced care in the field, especially in rural areas, and argued that equipment such as 12-lead cardiac monitors can significantly improve patient outcomes. They said the current grant provides about $10,000 per county, while the request would raise funding to about $100,000 per county and increase the per-capita amount from roughly 26 cents to $2.60. Members also discussed whether the block grant statute should be reformed to target need more directly. Board officials said they had considered making the grant more competitive, but decided against it for now because many counties rely on the annual funding and shifting money away from some areas would create hardship. In response to questions, they said Kentucky has about 160 class one EMS agencies providing 911 response across 120 counties, and that grant awards in recent years reached 91 counties, then 108, then 110 counties. They also highlighted the cost and safety benefits of power loading systems for stretchers, saying they can reduce back injuries and help retain EMS workers, but are often unaffordable for smaller departments. No votes were taken on the budget request during the hearing. After the testimony and questions, the committee approved the minutes from the prior meeting by motion and second, with no opposition, and then adjourned.

Transcript Highlights:

• communities in the state and rural counties.
• It is having an impact on small businesses in particular.
• rural.
• We have heard directly from rural clinics across Washington State.
• We have heard directly from rural clinics across Washington State.

Bills: SB5877, SB5904, SB5988

Keywords: anesthesiology, medical personnel, surcharges, licensing, healthcare regulations, nursing titles, licensure, healthcare professionals, patient safety, professional standards, opioid treatment, accreditation, health department, fee authority, substance abuse, 904, all

Transcript Highlights:

• The bottom map is our rural water systems in North Dakota.
• The bottom map are our rural water systems in North Dakota.
• So the question is going to be: what's our impact?
• So we have about 4,500 more rural customers to go.
• Rural water is trying to get to those areas.

Summary: The Water Topics Overview Committee met with a quorum and received updates from the Department of Water Resources and the State Water Commission, followed by presentations from Deloitte on two legislative studies required by House Bill 1020. Director Reese Haas reviewed major project and budget updates, including the Northwest Area Water Supply and Southwest Pipeline projects, Resources Trust Fund balances, carryover spending, project prioritization, bid conditions, regional water system coverage, and department process improvements. Members also discussed how the commission prioritizes projects, maintenance expectations, and the impact of limited municipal water supply funding. No formal committee action was taken during the DWR update; the commission’s municipal funding decisions were described as pending its April 8 meeting. Deloitte then presented the cost-share policy study, which found that under current policy and forecasted revenues, North Dakota faces an estimated $1.3 billion shortfall over 14 years, with a near-term gap of about $1.8 billion through 2031. The firm outlined seven recommended options, including tighter definitions and a 25% cost share for eligible replacement projects, caps and financing strategies for the Mouse River and Red River Valley projects, aligning cost share with commission priority guidance, delaying lower-priority projects, using available lines of credit, and adjusting reimbursement timing for revolving loan funds. Committee members questioned inflation assumptions, affordability, user fees, and the use of legacy fund earnings for bonding, but no decisions were made. In the governance and finance study, Deloitte said final recommendations are still being refined, with a final report due May 29. The study examined the Southwest Pipeline, NAWS, and Red River Valley systems using governance and finance criteria such as decision authority, transparency, affordability, risk, and access to funding. For Southwest, Deloitte outlined options ranging from improved state-authority coordination to transferring ownership to the Southwest Water Authority; for NAWS, options focused on strengthening the authority’s role and potentially transitioning operations and maintenance; and for Red River, options ranged from enhanced facilitation to formal state oversight or state ownership. Members asked follow-up questions about ownership transfer, capital repayment streams, and why NAWS was not considered for transfer, and Deloitte said NAWS’s limited organizational maturity made that option less viable in the near term.

Transcript Highlights:

• </c> is um meaningful and has the most impact is um meaningful and has the most impact and<00:53:40.240
• Protecting rural hospitals protects rural communities.
• create impact that and create problem create impact that and create more<02:11:57.599><c> distance</
• rural hospitals protects Protecting rural hospitals protects rural<02:12:47.280><c> communities.
• </c> it's a central point within these rural it's a central point within these rural communities<02:13

Keywords: 1191, senate, all

Transcript Highlights:

• a rural community.
• arena of rural criminal justice, Having heard from my two colleagues about the impactful and incredible
• I am a rural lawyer.
• Going, again, Kansas is a very rural place. Maine is a very rural place.
• and the impact.

Keywords: 1184, house, all

Transcript Highlights:

• Rural and family lands is one of the big ones.
• We've certainly had some impacts on bearing acreage.
• It impacts the whole South Florida region.
• It impacts, you know, the whole South Florida region.
• So yes, it is very, it's been very impactful.

Summary: The Agriculture and Natural Resources Budget Committee met to organize for the session, confirm a quorum, and hear introductory remarks from members about their districts and interests. Chair Esposito outlined the committee’s jurisdiction and budget overview, noting a total budget of about $7.2 billion, with major funding tied to the Department of Environmental Protection, the Department of Agriculture and Consumer Services, Fish and Wildlife, and the Department of Citrus. She also described major cost drivers such as Everglades restoration, water quality, resiliency, land acquisition, and rural family lands, and asked members to review agency requests in small groups later in the process. Agency leaders then presented budget and program updates. Agriculture Commissioner Wilton Simpson emphasized department efficiency efforts, including IT modernization, staff reorganization, rural and family lands conservation, best management practices, Fresh From Florida marketing, hurricane recovery loans for farmers, and completion of the Connor Complex headquarters. DEP Secretary Alexis Lambert highlighted record investments in Everglades restoration, water quality projects, resilience grants, land acquisition, state parks, and enforcement. FWC Executive Director Roger Young discussed conservation research, fisheries and wildlife management, law enforcement, disaster response, and pressures from growth, boating, invasive species, and derelict vessels. Department of Citrus Executive Director Shannon Shep reviewed the industry’s decline due to hurricanes and citrus greening, current research and marketing efforts, and e-commerce campaigns to support Florida citrus sales. Members asked questions about citrus production declines, future replanting and therapies, rural family lands, PFOS cleanup, mangrove restoration, flooding and pump infrastructure, agricultural theft, and derelict vessel removal. Officials generally responded with updates, emphasized science-based management and enforcement, and in several cases said they would follow up with more detailed information later. No formal votes were taken; the meeting ended with the chair directing members to provide feedback on agencies for further budget review and then adjournment.

Transcript Highlights:

• So it has a high impact on our community. Dr. Michael B.
• So it's not just limited to rural areas.
• The way I, it does say rural, but it also is, it also, You know, the way I, it does say rural, but it
• The impact reaches far beyond the individual responders.
• The impacts are an impact on our tax revenue is offset very conservatively at $81 million with revenue

Summary: The committee heard House Bill 66, which would expand and restructure the Health Care Professional Loan Repayment Fund. The sponsor said the substitute narrows the bill to a $25 million fund, with 50% reserved for physicians and the rest for other health professionals, and raises physician awards to at least $75,000 per year for a four-year commitment. Supporters from nursing, physical therapy, health systems, social work, and advocacy groups said the program would help recruit and retain providers in New Mexico. The committee moved the substitute and then passed the bill on a do-pass motion. House Bill 38, dealing with coverage for prosthetics, orthotics, and mobility devices, drew extensive testimony from amputees, Paralympians, clinicians, and disability advocates. The bill would clarify and expand coverage for activity prosthetics, activity wheelchairs, and related complex rehab technology, with limits on the number of devices and replacement tied to physiological changes. Supporters said access to these devices is medically necessary for physical and mental health, independence, and participation in sports and daily life. After questions about provider qualifications, insurance contracting, and replacement for growing children, the committee adopted the substitute and passed the bill. House Bill 257 would appropriate funds to increase Medicaid reimbursement for vagus nerve stimulation implants for drug-resistant epilepsy. The sponsor and manufacturer’s representative argued current reimbursement is too low, leaving only UNM Hospital performing the procedures and limiting access statewide; they said better reimbursement could reduce emergency visits and long-term Medicaid costs. Members raised concerns about the bill’s language, including whether it could allow payment above allowable rates or create uncertainty about the reimbursement standard. A motion to table failed, and the committee then passed the bill 5-4, with several members noting they supported the concept but wanted the language tightened before the next committee. The committee also passed House Bill 178, which appropriates $3 million for shade structures in rural parks and outdoor recreation areas, after testimony that the project would reduce sun exposure, heat illness, and skin cancer risk. House Bill 198, which provides $2 million for peer-to-peer mental health training and treatment for first responders, also advanced on a do-pass without recommendation after members said they supported the goal but wanted clearer language on training standards, liability, and administration. Finally, House Bill 202, which would require data-sharing agreements to help the Office of Child Advocate access records from state agencies, drew support from child advocacy groups but concern from IT and family advocates about timelines, system complexity, privacy, and the need for family collaboration; the discussion continued with suggestions to refine the bill.

Transcript Highlights:

• ways that we can work not just in a bipartisan fashion, but in a nonpartisan fashion, not just in a rural-rural
• In addition to impacting the people, it’s impacting the overall market and the system.
• In addition to impacting the people, it's impacting the overall market and the system.
• There's a federal rural health transformation application.
• We really think that's the best way to get the most impact.

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.

Transcript Highlights:

• and track its impact on existing health disparities.” rural towns, farm workers, and low-income neighborhoods
• and track its impact on existing health disparities.
• Smoke and its impacts into our air quality programming and track its impact on existing health disparities
• And so wildfire impacts are common.
• They can have some impact.

Summary: The committee heard public testimony on House Bill 2619, which would create a joint legislative task force to review and recommend ways to reduce regulatory burdens in agriculture, and on House Joint Memorial 4009, which asks Congress to ensure federal wildfire response agencies remain capable of protecting communities, natural resources, and firefighter safety. On HB 2619, the prime sponsor and supporters from the Washington State Department of Agriculture, cattle, wheat, potato, onion, and dairy interests said the bill responds to farm stress and suicide concerns by examining regulatory overload; WSDA supported the concept but noted a fiscal note, and members discussed whether the task force scope and cost could be reduced before policy cutoff. On HJM 4009, staff and the sponsor described the memorial as a request for stronger federal wildfire capacity and coordination, with testimony from tribes, counties, forest landowners, conservation groups, and public employees emphasizing wildfire risk, smoke impacts, and the importance of federal-state cooperation; the committee also repeatedly tied the memorial to support for state wildfire funding under 1168 and heard broad support for restoring that funding. The committee then took up House Bill 2221, which would require the Department of Fish and Wildlife to designate at-risk ungulate populations and begin predator mitigation when certain population declines occur, while also requiring annual reporting and white-tailed deer surveys. The sponsor argued the bill addresses rapidly declining deer and elk herds, predator pressure, food security, and rural economies in northeast Washington. Supporters included some local residents, ranchers, sheriffs, county officials, and the Colville Tribes, who said predators, livestock conflicts, and reduced hunting opportunity are harming communities and that the state should act more aggressively. Opponents included WDFW staff, Washington Wildlife First, the Sierra Club, the Animal Legal Defense Fund, and other conservation voices, who said the bill is not scientifically supported, would be costly, and wrongly blames predators rather than habitat, forage, weather, disease, and vehicle collisions; several said predator control would have limited value and could undermine wolf recovery. Some agricultural and sportsmen groups supported the bill in principle but asked for amendments, especially to remove or revise the in-state wolf translocation provision. No final votes or executive action were taken in the hearing.

Transcript Highlights:

• like rural communities.
• This shows the impact.
• The impact, this top chart, is the impact of that gas tax increase going all the way back to 1923.
• And then the impact of the legislation in 2020, those two five-cent increases, and then the impact of
• The table below shows the financial impact from those changes.

Summary: The Assembly Transportation Committee first took up three highway naming resolutions on its consent calendar: ACR 109, SCR 78, and SCR 90. The committee approved the consent calendar with 11 aye votes and no no votes, then adjourned the bill-hearing portion. Members also recognized committee science fellow AJ Mendeola for his service, noting his contributions to bill analysis and staff support. The committee then held an informational hearing on alternatives to the gas tax, focused on the projected decline in fuel-tax revenue and the need for a more sustainable transportation funding model. The chair and invited experts described how inflation, improved fuel efficiency, and growth in electric and other alternative-fuel vehicles are eroding gas-tax revenues. Presenters from the National Conference of State Legislatures and the University of California discussed state options such as higher or indexed gas taxes, EV registration fees, road usage charges, delivery fees, public EV charging fees, transportation network company fees, and managed lanes, emphasizing tradeoffs among revenue adequacy, fairness, administrative cost, and public acceptance. Committee members raised concerns that mileage-based fees or EV fees could function as new taxes on commuters and lower-income drivers, especially if the gas tax is not repealed. Presenters responded that road usage charges are generally intended as replacements for the gas tax, not additions, and argued that mileage-based systems better preserve the user-pays principle while being less tied to vehicle fuel efficiency. They also noted that flat EV registration fees are easy to administer but can be less equitable because they are not linked to actual road use. Officials from Hawaii, Utah, and Oregon described their state programs and policy choices. Hawaii said its new road usage charge began July 1, 2025, for EVs, offers a choice between a per-mile charge and a flat annual fee through 2028, and will transition to mandatory EV participation before expanding to all light-duty vehicles by 2033. Utah described its voluntary EV road usage charge program, quarterly reporting, privacy protections, and legislative scenarios for removing the cap or making participation mandatory. Oregon outlined its constitutional cost-responsibility framework and broader transportation funding challenges, including reliance on user fees and limited use of general-fund support.

Transcript Highlights:

• It sounds like you're wanting to do a shortcut for our rural communities.
• It's just that the rural and underserved communities are suffering more.
• These shortages hit rural, tribal, and Hispanic communities.
• When you have a change in your body, that also impacts the baby as well.
• Secondly, there's a second- and third-order impact.

Summary: The committee heard testimony on several health-related bills. HB 2726 would require coverage for diagnosis and treatment of mild obstructive sleep apnea, including a tongue-muscle stimulation device. The sponsor and medical witnesses said the device is a less burdensome alternative to CPAP and could improve adherence and reduce long-term complications, while Access said it already covers medically necessary sleep apnea treatment but was neutral and concerned the bill could narrow review and limit cost-effectiveness analysis. The committee adopted the Bliss amendment and then gave HB 2726 a due-pass recommendation by an 8-4 vote. HB 2435, as amended, would create a provisional licensing pathway for internationally trained physicians who meet specified ECFMG-related criteria, with supervision, fees set by the Medical Board, and automatic conversion to a full license after four years if conditions are met. Supporters argued Arizona faces severe physician shortages, especially in rural and tribal areas, and that the bill would bring in experienced doctors while preserving oversight. Opponents, including the Arizona Medical Board, said current law already allows case-by-case licensure review and warned the bill could weaken safeguards and bypass existing scrutiny. After adopting the amendment, the committee approved HB 2435 on a due-pass recommendation. HB 2958 would require Access coverage for comprehensive dental care for pregnant women age 21 and older, with a $500,000 general fund appropriation for a pilot program. The sponsor and public health witnesses said dental care during pregnancy is linked to better maternal and infant outcomes and could reduce emergency room use and complications. The committee adopted the bill and sent it out with an 11-1 due-pass recommendation. HB 2176, which sets timelines and standards for health care institution complaint investigations and dispute resolution, also received broad support from hospitals and was approved unanimously on a 12-0 due-pass recommendation. The committee then heard HB 2447, which would bar insurers from reimbursing certified registered nurse anesthetists at a lower rate than anesthesiologists for the same service. Opponents argued the bill would interfere with private contracting, ignore differences in training and liability, and likely raise costs for the state and taxpayers; supporters said anesthesia demand has outpaced reimbursement and that parity is needed to protect access, especially in rural areas. The transcript ends during testimony on HB 2447, before any vote is taken.

Transcript Highlights:

• Senate Committee on Water, Agriculture, and Rural Affairs comes to order.
• Katie Fields, who is going to be staffing me for Water, Ag, and Rural.
• For flood, flood has impacted all of the regions in the state.
• But it's now impacting these rural counties as it moves out, and there's great concern.
• It can have a significant impact on this.

Keywords: 1185, senate, all

Transcript Highlights:

• Extending to rural hospitals that may...
• areas. rural.
• In rural and suburban areas, and I'm of course pretty rural being in Roswell, where most of my operations
• in the rural area with assistance.
• In rural areas, it is $41,000.

Transcript Highlights:

• in 130 districts, many of which are in rural areas.
• The Poison Center serves as a vital lifeline for rural clinicians.
• This bill has enormous impact on our little rural school district and creates major cuts just under $1
• Smaller centers in our rural areas may close.
• Working in a rural critical access hospital means I'm fortunate to see firsthand the positive impact

Bills: HB2289

Keywords: appropriations, budget, fiscal matters, state spending, general fund, supplemental budget, biennial budget, substitute bill, public defense, civil legal aid, courts, judicial branch, homelessness, supportive housing, affordable housing, behavioral health, juvenile rehabilitation, youth services, child welfare, foster care

Transcript Highlights:

• in 130 districts, many of which are in rural areas.
• The Poison Center serves as a vital lifeline for rural clinicians.
• This bill has enormous impact on our little rural school district and creates major cuts just under $1
• Smaller centers in our rural areas may close.
• Working in a rural critical access hospital means I'm fortunate to see firsthand the positive impact

Summary: The House Appropriations Committee held a public hearing on proposed substitute House Bill 2289, the House operating budget. Budget staff Mary Monroe gave a detailed overview of the proposal’s near general fund outlook, reserve levels, major revenue assumptions, and major spending and savings items. She highlighted assumed revenue from capital gains and a proposed “millionaires tax,” a transfer from the budget stabilization account, administrative reductions across agencies, and several major policy shifts, including changes affecting Working Connections Child Care, K-12 education, higher education, long-term care, behavioral health, wildfire response, and state employee compensation. Members then asked questions, including about the higher education building account/operating fee swap and its interaction with the capital budget and Climate Commitment Act funds. The committee also announced amendment deadlines for the budget process. The bulk of the meeting was public testimony, with many speakers generally supporting or opposing specific parts of the budget. Supportive testimony praised funding for wildfire prevention, public health, reproductive health, civil legal aid, the Poison Center, some higher education institutions, and certain disability and child welfare services. Many speakers urged restoration or protection of funding for K-12 education, especially transition to kindergarten, local effort assistance, bus depreciation, and Running Start; others opposed cuts to child care, early learning, public defense, long-term care, adult day and home care services, occupational/physical/speech therapy for Medicaid patients, and community and technical colleges. Several local government, health, and nonprofit representatives also asked the committee to preserve public works, homelessness, energy assistance, environmental justice, and recovery/diversion programs, while some business and public safety groups sought continued funding for organized retail crime prevention and related initiatives. No votes were taken during the hearing. The committee recessed briefly and later resumed with virtual testimony, where additional witnesses repeated concerns about education cuts, long-term care, health care access, disability services, dispute resolution, early childhood programs, and the need for ongoing or increased funding in those areas.

Transcript Highlights:

• I think it could have a pretty large impact.
• So, yeah, that would kind of be the impact.”
• These rural counties.
• and these rural counties. ...here and there's perhaps ways to work with these rural communities and these
• It's low impact. But my question for you is: how do you manage CAW?

Summary: The committee met to consider a series of temporary appropriation requests, reserve fund transfers, federal grant appropriations, and review items. Early items included a $32 million appropriation and matching reserve transfer for the Department of Education’s educational freedom account program, a $476,000 request for the State Crime Lab, and a $90,000 assessment coordination request from DFA. Members asked questions about the assessment contract costs, and the item was approved. The committee also approved a $1 ARPA return to the CDC and a Department of Human Services reallocation package that moved general revenue and positions among divisions to meet client needs. The most extensive discussion centered on a $32 million restricted reserve transfer for the educational freedom account program. Members questioned the growing number of participating students, the program’s long-term funding needs, and safeguards against improper purchases. Agency representatives said about 44,000 students were being funded, that reimbursements and marketplace purchases are reviewed, and that reporting and audit controls are in place, though not every instance of fraud can be prevented. The committee approved the transfer after discussion. Members also approved smaller cash and federal grant items, including funding for a teacher shortage data dashboard, All Kids Bike grants, crime lab outsourcing, veterans cemetery operations, and a podiatric medicine licensing investigation fund. The most contentious item was a $7 million federal Forest Legacy grant request for Central Arkansas Water and the Department of Agriculture to acquire land in the Maumelle watershed, including acreage in Perry County and Pulaski County. Members debated water quality, development pressure, property tax impacts, local support, and whether Perry County had been adequately consulted. Agency and company representatives argued the acquisition would protect drinking water, preserve forested watershed land, and support recreation, while some legislators emphasized the county’s tax and development concerns. Senator Davis moved to defer the item to the full Legislative Council and to request removal of the Perry County portion; that motion passed. The committee then reviewed the remaining items, including a Veterans Affairs pay plan request, and adjourned.

Transcript Highlights:

• I'm presenting House Bill 2979, the Rural Missouri Rural Doctors Act.
• I'm presenting House Bill 2979, the Rural Missouri Rural Doctors Act.
• In rural areas, I really feel that non-competes should not, because of the crisis in rural areas, I think
• I would say in rural Missouri, rural hospitals are, I mean, over half of our rural hospitals are operating
• in a rural area?

Summary: The committee first met in executive session and adopted a House committee substitute combining House Bills 1850 and 1975, which was then voted do pass by a 16-0 roll call. The substitute was described as incorporating federal PBM-related transparency and audit provisions, including requirements intended to ensure fair audits, greater transparency for employers and patients, and protections for pharmacies so they are not reimbursed below drug cost and receive a fair fee. Members said the package was a compromise and a needed step because pharmacies are closing. The committee then heard House Bills 2318 and 2368, related to artificial intelligence and mental health. The sponsors said the bills are aimed at truth in advertising, barring AI platforms from marketing themselves as mental health professionals or therapy providers, while not banning AI use in health care generally. Testimony from supporters emphasized concerns about minors and adults relying on chatbots for mental health guidance and the need to protect consumers from misleading claims. The committee adopted an amendment adding social workers to the bill string, rolled it into a substitute, and voted the combined House committee substitute do pass 14-0. Next, House Bill 3313, described as an AOT bill from the prior week, was voted do pass 14-0 without discussion. House Bill 2745 was then amended and passed 14-0; the sponsor explained the changes would require a prompt physical exam for children entering foster care, allow a physician or nurse practitioner to perform it, try to continue existing developmental, behavioral, or emotional care when possible, and require biological parental consent before updating vaccines at the initial visit. House Bill 2463 also received a substitute to close a loophole involving referral payments when a prospective resident or legal representative cancels a contract, and the committee voted the substitute do pass 14-0. The committee also heard House Concurrent Resolution 28, which would designate the last full week of April as Infertility Awareness Week in Missouri. The sponsor linked the resolution to broader efforts to expand fertility access, and supporters, including a patient sharing her infertility experience, spoke about the emotional and physical toll of infertility and the value of awareness. Finally, House Bill 2979, the Rural Missouri Rural Doctors Act, drew extensive testimony. The sponsor and supporters argued it would limit physician non-compete agreements to one year and five miles for nonprofit employers to improve rural access and physician mobility, while opponents from hospitals and health systems said the bill would weaken recruitment, hurt financially stressed rural hospitals, and create uneven treatment between nonprofit and for-profit employers. No vote was taken on HB 2979 in the portion provided.

Transcript Highlights:

• </c> know that this bill, especially in rural know that this bill, especially in rural Kentucky,<00:02
• </c> year and as you suspect in most rural year and as you suspect in most rural communities<00:09:22.000
• rural communities.
• > healthcare</c><00:29:39.520><c> or</c><00:29:39.760><c> rural</c> focused on rural healthcare or rural
• focused on rural healthcare or rural health,<00:29:40.480><c> and</c><00:29:40.720><c> I'm</c><00:29

Keywords: 26RS SB 38 Testimony 00:28 26RS SB 38 Roll Call Vote 06:54 26RS SCR 9 Testimony 11:06 26RS SCR 9 Roll Call Vote 32:00 Adjournment 32:49, 958, all

Summary: The committee first considered Senate Bill 38, sponsored by Sen. Richardson, which would require Medicaid to reimburse pharmacists for services already within their legal scope of practice. Richardson and Taylor Williams of the Kentucky Pharmacists Association argued the bill would improve access to care, especially in rural areas, reduce emergency room use, and lower Medicaid costs by using pharmacists as lower-cost providers. Members asked whether the bill’s language simply aligned Medicaid with an earlier commercial parity law, and Richardson confirmed that it did. He also cited prior study work, research articles, and examples such as strep/flu testing and medication therapy management as covered services. The bill passed unanimously, and several members commented in support, including concerns about pharmacy access and the need for pharmacists to remain available to patients. The committee then took up a concurrent resolution sponsored by Sen. Meredith calling for a feasibility study of a proposed new Medicaid delivery model. Meredith argued that Kentucky’s Medicaid spending is growing unsustainably and that current managed care arrangements are not improving outcomes enough. He proposed an accountable community health care organization, described as a locally owned, not-for-profit public-private partnership combining elements of accountable care models, with the goal of reducing bureaucracy, improving outcomes, and lowering costs. He said the study would examine a five-year program and ultimately test the model in five regions, with initial focus on the Lincoln Trail, Green River, and Barren River area development districts. Members asked about the study timeline, vendor costs, rural versus urban impacts, and provider recruitment; Meredith said the resolution would be studied by November and that no fiscal note had been prepared. The resolution passed unanimously.