Transcript Highlights:

• The substitute includes downcoding in the definition of adverse determination.
• This means downcoding would be eligible for...
• I do think downcoding should be utilized and changed as it is.
• That's downcoding, and the downcoding is based on medical decision making.
• This is a lot, and I don't know that a lot of patients go, darn, I got downcoded.

Bills: SB 6, SB6, SB504, SB765, SB815, SB929

Keywords: hemp, consumable hemp, hemp-derived cannabinoids, CBD, cannabidiol, CBG, cannabigerol, delta-8, delta-9, intoxicating hemp, hemp gummies, hemp vape, edibles, cannabinoid regulation, hemp licensing, retailer registration, product registration, QR code labeling, child-resistant packaging, minor access

Transcript Highlights:

• Um, next, regarding the external review process for downcoding claims, uh, we note that we don't have
• Uh, we note that for downcoding claims.
• So, this is regarding down coding, and it says that each subsection D on page 8, each downcoded claim
• So, this is regarding down coding, and it says that each subsection D on page 8, each downcoded claim
• > inappropriate of downcoding and inappropriate of downcoding and inappropriate modifications<

Keywords: 910, house, all

Summary: The joint hearing opened with House Bill 1969, which would provide state funding for colorectal cancer screenings for uninsured and underinsured residents. The Department of Human Services said it supports the goal of early screening but would need new administrative capacity, including a program manager and claim pre-screening, to run the program. The Department of Health supported the measure and cited low screening rates in Hawaii, noting an educational campaign to encourage screening. The Insurance Division raised concerns about reliance on federal FAQs, warning that guidance can change and may create state cost exposure. Supporters including the American Cancer Society Cancer Action Network and the Hawaii Medical Association argued the bill would close a preventive-care gap, reduce late-stage diagnoses, and save long-term costs; the committee also discussed implementation costs, estimated by DHS at roughly $1.4 million to $2 million annually plus administrative expenses, and a 6-month to 1-year timeline to establish the program. The committee then took up House Bill 1965, which would require health carriers to spend at least 6% of total medical expenditures on primary care providers. The Insurance Division said several provisions raise technical and legal concerns, including the premium freeze, the medical loss ratio language, the lack of an existing external review process for downcoding claims, and a new mandate for medically necessary inter-island transportation that could trigger an ACA defrayal. The Department of Human Services supported the intent but suggested broader language to include primary care supports and services, and noted that QUEST integration plans already invested at least 9% of total medical expenditures in primary care in 2024, with additional spending on supports and low-value care reductions. State health planning officials strongly supported the bill as an investment in primary care, saying it could improve outcomes and lower long-term costs, though they acknowledged a possible temporary premium increase during the transition. Testimony in support emphasized Hawaii’s physician shortage, especially on Maui, the Big Island, and other neighbor islands, and warned that clinics are under financial strain and may close without higher primary care reimbursement. The Hawaii Healthcare Task Force, AARP Hawaii, and other supporters said the bill would help retain providers, improve access for Medicare and Medicaid patients, and prevent downstream costs from emergency room use and avoidable hospitalizations. No votes or final committee action were taken in the portion of the hearing provided.

Transcript Highlights:

• House Bill 484, which relates to health insurance, ethics and fairness, carrier business practices, downcoded
• House Bill 484 was the bill about insurance carrier downcoding practices.
• House Bill 484 was the bill about insurance carrier downcoding practices.

Keywords: April 22, 2026 - Reconvened Session, 976, house, all

Transcript Highlights:

• said because they are not kept abreast of current billing laws, medical billing is consistently downcoded
• said because they are not kept abreast of current billing laws, medical billing is consistently downcoded
• said because they are not kept abreast of current billing laws, medical billing is consistently downcoded

Bills: HCR92, HCR46, HCR172, HCR147, HCR112, HCR100, HR84, HR42, HR139, HR104, HR92

Keywords: automated external defibrillator, AED, cardiac arrest, state buildings, health education, public health, lifeguards, first responders, public safety, ocean safety, emergency response, Hawaii, workers' compensation, auditor, procurement audit, compliance, Department of Human Resources Development, transparency, accountability, medical care

Bills: SB2421, SB2690, SB3103, SB3137, SB3164, SB3206, SB2933, SB3133, SB3315

Keywords: cannabis, marijuana, Hawaii Cannabis Law, legalization, decriminalization, adult use, hemp, taxation, social equity, public health, primary care, health insurance, health carrier, insurance commissioner, Med-QUEST, Medicaid managed care, provider reimbursement, downcoding, prior authorization, utilization review

Summary: The committee heard testimony on several health-related bills. HB 1864, which would require health insurance coverage for standard fertility preservation services for people undergoing medically necessary treatment, drew broad support from SHIPA, the Department of Health, HMSA, the Hawaii Association of Health Plans, and others. Testifiers emphasized that fertility preservation is routine coverage on the mainland and important for patients facing infertility from cancer or other treatment; one patient described incurring more than $20,000 in costs. The Insurance Division flagged possible Affordable Care Act issues, a potential conflict in the bill’s language about using patient history to determine limits, and a mismatch with state medical-necessity standards. Committee discussion also focused on whether the bill should apply to all women of childbearing age rather than a narrower age-based category. HB 2305 would require nutrition and metabolic education as part of physicians’ continuing medical education. The Hawaii Medical Board opposed the measure, arguing that CME should remain flexible and tailored to each physician’s specialty and warning that topic-specific mandates can expand over time. The Office of the Governor supported the bill, saying it would help the state’s rural health transformation application and could improve federal funding prospects, though the exact impact was unclear. Members questioned whether nutrition is already covered in medical training and whether the requirement should be limited to primary care physicians; the board said Hawaii currently has no topic-specific CME mandates and that physicians can already choose relevant courses. The committee also heard strong support for HB 1597, which would establish an Alzheimer’s disease research center at the University of Hawaii. Supporters from the university, the Alzheimer’s Association, AARP, and others said the center could attract federal research dollars, expand clinical trials, and help address the state’s high Alzheimer’s-related health costs. HB 2159, which appropriates funds for health care workforce development, also received broad support from the University of Hawaii, health systems, and advocacy groups, with no opposition noted. Finally, HB 2121, which would prohibit the sale and distribution of disposable electronic smoking devices, drew support from the Department of Health, youth advocates, and public health groups citing youth addiction, environmental waste, and fire hazards; the department said a separate bill, HB 1573, would be more comprehensive and better defined for enforcement and penalties. The committee ended with HB 1913, creating a veteran services mental health coordinator position at Tripler Army Medical Center, which was supported by veteran services officials and others who said veterans need better navigation and coordination for behavioral health care.

Transcript Highlights:

• Senate Bill 1090 by Hughes relates to bundling and downcoding practices conducted by certain providers

Bills: SJR36, SB26, SJR3, SJR48, SJR50, SJR51, SCR15, SCR17, SB3, SB5, SB12, SB18, SB1001, SB1002, SB1003, SB1004, SB1005, SB1006, SB1007, SB1008, SB1009, SB1010, SB1011, SB1012, SB1013, SB1014, SB1015, SB1016, SB1017, SB1018, SB1019, SB1020, SB1021, SB1022, SB1023, SB1024, SB1025, SB1026, SB1027, SB1028, SB1029, SB1030, SB1031, SB1032, SB1033, SB1034, SB1035, SB1036, SB1037, SB1038, SB1039, SB1040, SB1041, SB1042, SB1043, SB1044, SB1045, SB1046, SB1049, SB1050, SB1051, SB1052, SB1053, SB1054, SB1055, SB1056, SB1057, SB1058, SB1059, SB1060, SB1061, SB1062, SB1063, SB1064, SB1065, SB1066, SB1067, SB1068, SB1069, SB1070, SB1071, SB1072, SB1073, SB1074, SB1075, SB1076, SB1077, SB1078, SB1079, SB1080, SB1081, SB1082, SB1083, SB1084, SB1085, SB1086, SB1087, SB1088, SB1089, SB1090, SB1091, SB1092, SB1093, SB1094, SB1095, SB1096, SB1097, SB1098, SB1099, SB1100, SB1101, SB1102, SB1103, SB1104, SB1105, SB1106, SB1107, SB1108, SB1109, SB1110, SB1111, SB1112, SB1113, SB1114, SB1115, SB1116, SB1117, SB1118, SB1119, SB1120, SB1121, SB1122, SB1123, SB1124, SB1125, SB1126, SB1127, SB1128, SB1129, SB1130, SB1131, SB1132, SB1133, SB1134, SB1135, SB1136, SB1137, SB1138, SB1139, SB1140, SB1141, SB1142, SB1143, SB1144, SB1145, SB1146, SB1147, SB1148, SB1149, SB1150, SB1565

Keywords: teacher compensation, education funding, public school educators, teacher retention, teacher designation, dementia, Alzheimer's disease, Parkinson's disease, research funding, state budget, prevention, healthcare, medical research, Dementia Prevention and Research Institute, severance tax, oil and gas, Texas STRONG fund, economic stabilization, public health, property tax relief

Transcript Highlights:

• Senate Bill 1090 by Hughes, relating to bundling and downcoding practices conducted by certain providers

Summary: The Senate met briefly and referred a large number of first-reading bills and resolutions to standing committees. The measures covered a wide range of topics, including hemp regulation, dementia research funding, parental rights and public education, municipal library funding, tax and local government issues, criminal justice, health care, education, transportation, natural resources, and election law. Several constitutional resolutions were also referred, including proposals related to the Dementia Prevention and Research Institute of Texas and a severance tax revenue fund. Most of the transcript consists of the reading of bill captions and committee referrals, with no substantive debate or testimony recorded. The listed measures included proposals on school uniforms, charter schools, Medicaid fraud remedies, insurance practices, occupational licensing for people with criminal convictions, water and sewer utility cybersecurity, agricultural protections, public meeting broadcasting, and various local and state governance matters. No votes were taken on the bills in this segment. The only formal action reflected was referral of the bills and resolutions to the appropriate committees, followed by adjournment of the Senate until the next scheduled meeting.

Transcript Highlights:

• I have on this committee substitute, second committee substitute, removed all reference to downcoding

Bills: SB213, SB378, SB610, SB681, SB918, SB1172, SB1252, SB1343, SCR8

Keywords: SB 213, Texas insurance, Insurance Code, Chapter 551, Chapter 541, bundling, tying arrangement, cross-selling, homeowners insurance, residential property insurance, auto insurance, personal automobile insurance, consumer protection, unfair trade practice, deceptive insurance practice, property and casualty insurer, Lloyd's plan, county mutual, reciprocal exchange, farm mutual

Transcript Highlights:

• Amendment dated March 22, 2026, at 12:59 p.m. removes the total number of claims that were completely downcoded
• that a health care insurer must include in its annual claim denial report to DIFI and removes the downcode
• The claims denial report to DIFI and removes the downcode definition.
• If there's a removal of the downcoding language, it improves the bill, but it does not resolve our core

Bills: SB1052, SB1115, SB1118, SB1120, SB1121, SB1124, SB1171, SB1172, SB1174, SB1175, SB1214, SB1233, SB1235, SB1316, SB1345, SB1372, SB1399, SB1458, SB1494, SB1496, SB1564, SB1602, SB1621, SB1628, SB1630, SB1631, SB1668, SB1672, SB1814, SB1821

Keywords: assisted living, health care, hyperbaric oxygen therapy, physician orders, informed consent, AHCCCS, remote work, state agency, employment, public health, housing, zoning, middle housing, urban development, duplexes, triplexes, fourplexes, townhomes, historic preservation, radiation protection

Summary: The committee first heard Senate Bill 1121, which would prohibit hospitals from requiring lead aprons for cardiac catheterization staff when a radiation protection system is in place, while still allowing hospitals to require aprons outside the designated safety zone or when exposure levels warrant additional protection. An amendment added flexibility for radiation safety officers to require lead or other PPE if exposures approach occupational limits and removed expedited rulemaking language. Supporters, including the sponsor and interventional cardiologists, argued the devices reduce radiation and orthopedic injuries and improve recruitment and retention; hospital groups shifted to neutral after the amendment. The committee adopted the amendment and passed SB 1121 on a 9-2 vote. The committee then considered Senate Bill 1120, which would require hospitals performing cardiac catheterization procedures to equip at least 50% of those rooms with radiation protection systems by 2027. Supporters said the systems protect clinicians from radiation and long-term injury, while opponents, including hospital and radiology groups, argued the bill was overly prescriptive, could create a captive market, and might not fit all rooms or procedures. After adopting a children’s hospital exemption amendment, the committee passed SB 1120 on a 6-6 vote, with the chair breaking the tie in favor of the bill. Senate Bill 1118, an appropriation measure tied to the radiation protection system proposal, was also advanced after brief discussion, passing 6-5. The committee then took up Senate Bill 1214, which would create guardrails for non-FDA-approved stem cell and regenerative therapies, including provider standards, informed consent, advertising limits, reporting requirements, and a private right of action for violations. Supporters described it as a patient-protection and access bill, while testimony emphasized concerns about unregulated “bad actors” and patients traveling out of state for treatment. The committee adopted an amendment removing a reference to the National Law and passed SB 1214 on a 9-3 vote. The transcript then began discussion of SB 1630, which would create a Medicaid-funded home and community-based service benefit for adults with serious mental illness, with AHCCCS taking a neutral position and estimating a significant fiscal impact.

Transcript Highlights:

• stakeholders, on this committee substitute, second committee substitute, I removed all reference to downcoding

Bills: SB213, SB378, SB610, SB681, SB918, SB1172, SB1252, SB1343, SCR8

Keywords: SB 213, Texas insurance, Insurance Code, Chapter 551, Chapter 541, bundling, tying arrangement, cross-selling, homeowners insurance, residential property insurance, auto insurance, personal automobile insurance, consumer protection, unfair trade practice, deceptive insurance practice, property and casualty insurer, Lloyd's plan, county mutual, reciprocal exchange, farm mutual

Summary: The Senate Committee on Business and Commerce met with a quorum and took up several pending bills, first reporting SB 1006 favorably after adopting a committee substitute that adds quarterly ZIP-code-level reporting to TDI on insurer declinations, cancellations, and nonrenewals. The committee also adopted substitutes and favorably reported SB 388, which adds nuclear to a credit program and excludes batteries from the dispatchable definition; SB 917; SB 504, which narrows reporting requirements for certain local entities, raises a salary threshold, and authorizes AG injunctive relief; SB 925, which clarifies that federal match dollars are included in a PLA-related prohibition; and SB 815, which removes downcoding references and focuses on AI use in prior authorization. SB 815 advanced on an 8-2 vote, while SB 388 advanced 6-3 and the others were reported 9-0 or 6-0 as noted. The committee then heard testimony on SB 378, which would prohibit aestheticians and cosmetologists from administering injections or using prescriptive medical devices unless legally authorized and would clarify TDLR disciplinary authority. The author and a retired neurosurgeon testified that unsafe, unauthorized injections pose real patient risks, and a TDLR witness said the bill addresses a long-standing regulatory gap. SB 378 was left pending after testimony. The committee also heard SB 1252, aimed at reducing municipal permitting barriers for residential backup power systems; the author and industry witnesses said city permitting is costly and inconsistent, while municipal utility representatives and advocates said the substitute preserved safety and utility oversight. That bill was also left pending. Additional bills heard but left pending included SB 1172, which would let LPs and LLCs sell their own property without a real estate license; SB 681, which would extend engineer license renewal periods and apply similar flexibility to engineering firms; SB 918, a TDLR cleanup bill for orthotics and prosthetics exemptions; SB 1343, which would require data brokers to post a clear link explaining Texans’ privacy rights and how to exercise them; SB 213, which would prohibit forced bundling of residential property and auto insurance while preserving voluntary discounts; SB 610, which would codify TDLR’s anti-trafficking unit; and SCR 8, expressing opposition to a central bank digital currency over privacy, security, and financial-stability concerns. Public testimony on SB 1343 and SB 213 was generally supportive, with consumer and advocacy groups emphasizing privacy, competition, and survivor safety, and the committee closed the day with those measures and others left pending.

Transcript Highlights:

• And they started telling me what the AI engine was that they were using to downcode.
• Downcoding. >> Ah. Do you know anything about what those are?
• >> So this specific downcoding technology, I haven't personally looked into.

Keywords: 1189, house, all

Transcript Highlights:

• The payer looks at that and says, maybe I'll pay that, or maybe I'll bundle it, or downcode it, or not

Keywords: 1185, senate, all