Good afternoon.

I'd like to call this meeting to order.

Today is Tuesday, April 7th, 2026.

The time is 1213 p.m.

I'm calling this meeting of the Committee on Health to order.

I'm at large Councilmember Christina Henderson, chair of the committee.

Today we have been joined by Councilmember Brienne Nadeau from Ward 1, Councilmember Charles Allen from Ward 6, and Councilmember Zachary Parker from Board 5, and we have a quorum of the committee.

Today we will consider and vote on three bills, one nomination to the Board of Funeral Directors, and six nominations to the Board of Nursing.

I will start with the bills.

This bill amends the Postpartum Coverage Expansion Amendment Act of 2020 to require that the Department of Health Care Finance specifically cover remote patient monitoring, or RPM of blood pressure and blood glucose levels during pregnancy in up to 12 months postpartum.

The original version included a broad and vague requirement that the Department of Healthcare Finance provide coverage for provider delivered digital health interventions that are used to directly manage a patient's pregnancy.

Research shows that RPM improves maternal health by enabling early detection of complications, supports better management of chronic conditions, and reduces preventable morbidity.

RPM is particularly effective in managing hypertension and improving postpartum blood pressure control, with some studies showing improvement in blood pressure control by as much as 43%.

This is especially critical in the district where mothers with gestational hypertension and diabetes experience a significantly higher rate of preterm births compared with those without the conditions, and black mothers facing the highest preterm birth rate compared to white and Hispanic and Latino mothers.

The council had previously funded this postpartum coverage expansion amendment act of 2020 in the FY22 budget at 1.1 million in recurring funds over the four-year financial plan.

However, despite being funded, Department of Healthcare Finance never fully implemented the bill.

During our FY26 budget oversight hearing, um DHCF explained that RPM was in the FY25 budget, but not continued in their FY26 budget.

The agency also noted that MCOs were covering RPM as a value add service through post through as a value add service, though in post-hearing responses, it showed that only two of the district's MCOs uh were actually doing this, which is uh terribly insufficient.

Uh healthcare finance explained that the original FIS was insufficient to cover the cost of RPM for all Medicaid and Alliance patients and did not include equipment cost.

The agency admitted that they, quote, dropped the ball on implementing this law, end quote, and that once they realized that funds were insufficient, they submitted an enhancement to the city administrator and the mayor's budget director.

However, those enhancements were not approved.

Uh DHCF is exploring bundling RPM as a wraparound service under the transforming maternal health model, a federal model that they will implement in 2030.

This bill would enable uh us to do this much earlier.

The committee print did not make any substantive changes to the bill as introduced except for it to update the bill title to reflect the current year.

The updated fiscal impact statement says that the local cost for this will be 1.3 million for the first year of implementation and 4 million over the financial plan, with most of the cost coming from the equipment and monthly monitoring.

Um I want to just add that uh the committee is a little disappointed that the council's uh Office of Racial Equity has said that this bill would likely have a negative impact.

Um the committee believes that there is a flaw in the RIA assumptions, which are based solely on the text of the law and ignores the 2020 law that was never implemented and will not be implemented in the foreseeable future as currently written.

Um as a result, by providing RPM has been left up to the discretion of MCOs.

Only two are providing it voluntarily by improving upon the original bill and clearly defining the scope.

It does significantly uh raise the likelihood that healthcare finance will be able to actually implement the law.

With that, I want to open up the floor to see if there's any discussion.

Okay.

Hearing none, I move the draft report in print for bill 26-356 in block with leave for staff to make any technical or conforming changes.

All in favor, please say aye.

Aye.

Aye.

Any opposed.

Great.

Let the record reflare reflect that the I habit in the measure passes unanimously.

Now, Bill 26-463, the Judith Human Memorial Workers with Disabilities Act was introduced on November 3rd with Council Members Matt Freeman, Brianna Doe, Anita Bonds, Brooke Pento, Robert White, Charles Allen, and Janice Lewis George.

Named after the disabilities rights activist Judith Human, this bill amends the district's Public Assistance Act of 1982 to establish a Medicaid buy-in program, which would be titled the District Workers with Disabilities Program.

This program would enable employed individuals with disabilities who meet specific eligibility criteria to enroll in Medicaid and pay a monthly premium.

Although 48 states have enacted Medicaid buy-in programs, the district lags behind in providing comprehensive coverage options for residents with disabilities.

Currently, aged blind and disabled individuals who earn more than $1,330 per month, or two in person household earning more than $1,800 per month, are ineligible for Medicaid in the district.

This leads to disabled residents experiencing a benefits clift, a phenomenon in which modest increases in their income could result in a loss of critical public benefits, including their health care under, as well as long-term services and supports.

As a result, individuals may decline promotions or higher paying employment opportunities in order to remain eligible for Medicaid services.

And we heard this in our hearing of several witnesses who testified.

This legislation would create a centralized pathway for residents with disabilities to access comprehensive array of services, including prescription drugs, personal care services, non-emergency medical transport, and assistive technology.

The committee print does make several changes to the bill that's introduced.

It removes the introduced virgins age limit of 64 years old.

It allows older adults to participate in the program given that Medicare does not cover long-term support services.

Medicare doesn't even cover dental vision or hearing aids, interestingly enough.

Additionally, the committee removed language restricting home and community-based services waivers, recipients from enrolling in the program, modified the definition of employment to provide greater flexibility for self-employed individuals.

We clarified that temporary behavioral health admissions will not automatically disqualify someone, and clarified that assets and spousal income of enrollees will not be considered in determining eligibility or premium amounts and removed language requiring Department of Healthcare Finance to administer savings accounts for enrollees.

The Office of the Chief Financial Officer estimates that the bill will cost $4.4 million in FY27 and $545.6 million across the financial plan.

That includes both local and federal costs.

The Department of Healthcare Finance requires resources to update the District of Columbia access system, also known as DCAS, build a premium uh plat payment platform.

Uh of course, they need to hire an FTE, and then also pay for services.

The OCFO estimates that the enrollees premiums will generate about $45,000 in fiscal year 27 and $1.4 million over the financial plan.

I do look forward to advancing this legislation and providing comprehensive health care services for those who are employed individuals with disabilities with my colleagues.

And with that, I open up the floor for any discussion.

Great.

Hearing none, I will now move the draft report in print for bill 26-463 with leave for staff to make any technical or conforming changes.

All in favor, please say aye.

Aye.

Aye.

Aye.

Aye.

All opposed?

Let the record reflect that the measure passes unanimously.

Final bill is Bill 26-438, the Medical Debt Mitigation Amendment Act of 2026, which I introduced along with Council Members Charles Allen, Anita Bonds, Janice Lewis George, Brianna Doe, Zachary Parker, Brooke Pinto, and Robert White back in October.

Nearly 90,000 district residents, or 20% of all residents have unpaid medical bills.

Research shows that medical debt can have a significant impact on a household, including bankruptcy, job loss, eviction, food insecurity, and poor physical and mental health outcomes.

Although medical debt is often treated similar to other types of consumer debt like credit card debt, research from the Federal Consumer Financial Protection Bureau has found that medical debt on a credit report is less predictive of future defaults or serious delinquencies than the presence of non-medical debt.

This is because the majority of medical debt comes from an acute illness or medical procedure, so it's not reflective of a person's voluntary spending habits.

This bill takes critical steps to prevent medical debt and place guardrails around medical debt collection to protect patients.

The bill, particularly timely given current and upcoming local and federal changes to public health insurance programs, which will limit the ability of folks to qualify.

It will also limit benefits, leading to more district residents being either underinsured or uninsured or having more out-of-pocket health costs.

I'm going to describe some of the specifics in the committee print that were changed.

So, first, the print requires that certain health care facilities provide free and reduced cost care to low-income patients.

While hospitals, well, some hospitals currently provide financial assistance, their policies vary widely and are not always communicated to patients.

The committee print establishes a uniform requirement that facilities provide free care to patients under 200% of the federal poverty level and reduce care costs on a side and scale with incomes between 200 and 500% of the federal poverty level.

The committee print also requires robust notice requirements for facilities to communicate their financial assistance policies to patients and proactively screen patients who are uninsured, homeless, or receiving public benefits.

The print also requires that facilities provide good faith estimates about the health care cost of services before treatment, except in emergency circumstances.

The committee print requires certain health care facilities to provide payment plans to patients who are eligible for reduced cost care.

The committee print removes two provisions from the bill as introduced regarding the payment plan.

First, the $2300 annual cap on payments and the requirement that facilities forgive any remaining debt once a patient has made those payments on a plan for 36 months.

The DC Hospital Association did push back on both of these provisions as financially challenging and hard to administer.

The committee print retains the cap on monthly installments at 3% of a patient's monthly household income.

Although district hospitals advocate that this percentage increase, sorry.

Our district hospitals are advocating that the percentage increase to 5% to match Maryland's law.

However, the committee did decide that this increase would be too burdensome on patients and instead maintain the 3% cap.

The committee print creates a new definition for the types of health care facilities who must comply in these financial assistance requirements.

A quote health care facility FAP includes all health care facilities that are required to obtain a certificate of need to operate in the district, but exempts certain long-term care facilities, including intermediate intermediate care facilities, skilled nursing facilities, and home health agencies.

Members of the long-term care coalition asked that these facilities be excluded because they are largely serve patients whose costs are paid by public programs and social security income.

The committee worked closely with the hospital association to develop the committee print that holds true to our intent to protect district residents from medical debt while being feasible for hospitals to implement.

It limits the financial assistance requirements to patients' facilities, primary service areas.

So these are generally defined as the zip codes where 75% of the patients reside.

This was in response to the hospital association's concern that offering financial assistance to any patient could lead to the district hospitals becoming a destination for free and reduced cost care.

The committee print also adds a definition of medically necessary health services that are eligible for financial assistance after the hospital association voiced concerns that covering expensive procedures like elective cosmetic surgery would drain the hospital resources.

The committee print defines the term to include any health service provided by health care provider to a patient that is necessary to prevent, diagnose, or treat a condition and meets accepted standards of medicine.

The bill specifies that medically necessary does not include elective cosmetic surgery, except for plastic surgery designed to correct disfigurement.

There will likely colleagues be certain hospitals that will specifically lobby you all to further restrict the definition to only include services that are covered by Medicaid and Medicare.

So I would ask that colleagues stay strong.

Okay, the committee print requires that health care facility uh FAPs must report annually to DC Health on their compliance.

DC Health has the authority to enforce the provisions through corrective action plans on fines aligned with their enforcement for certificate of need requirements, and the Office of the Attorney General has also asked authority to seek injective relief for violations.

The committee print also requires DC Health to create a process for patients to submit a complaint.

In addition, two taking steps to prevent medical debt.

The committee print also includes a new protection for patients who do incur medical debt.

First, the committee print maintains provisions from the bill as introduced to prohibit health care providers from reporting a consumer reporting agency, the amount or existing of any medical debt that a patient owes.

The committee print also prohibits wage garnishments, property liens to collect medical debt.

It limits interest rates on medical debt to no interest for low-income patients and 3% for all other patients.

It also limits liens on financial awards and settlements that a patient receive as compensation for injury and prohibits the revival of judgments for medical debt.

Taken together, these provisions will significantly reduce the negative impact of medical debt on households is affected.

The committee print also restricts certain practices related to medical lending products offered in healthcare settings, prohibits health care providers from assisting patients with completing applications for medical lending products or promoting certain medical lending products when making when patient decision making is compromised, such as when they are under anesthesia or a sedation or administered treatment.

This restriction is narrower in the bill than as introduced as a result of negotiations and conversations with financial institutions and advocates.

And it's tailored to prevent the documented harm that medical lending products have caused patients.

Finally, the committee print adds an applicability date of six months after the costs are included in the financial plan.

This was at the request of the hospital association to give time for facilities to implement the requirements.

Um DC, whose June 2025 report, more than a band-aid systemic changes to protect DC residents from medical debt, deeply informed the drafting of this legislation.

I want to thank them and the many other advocates who testified and collaborate with the committee on this ambitious piece of legislation that will benefit many district residents for years to come.

OCFO says yes, this bill will cost 307,000 in FY27 and 882 over the financial plan because of course DC Health needs two FTEs to review reports covered by the health facilities and produce information to the OAG and receive and manage patient complaints.

All things they currently do for the record.

Please somebody talk so I can get some water.

I open up the floor.

Chairperson Henderson.

Thank you.

Councilmember Parker.

Yes.

One, I would say thank you for all the work that you and your team have put into this bill.

I think the underlying goal is to protect residents from the burden of skyrocketing medical cost.

We all know and have heard of examples of individuals who've lost their life savings and lost much of everything because they've had a one-off emergency or medical debt that they haven't been able to take care of.

And in many ways, I believe this bill will address those things.

I also appreciated you lifting up the work around the term medical necessity.

I have been in touch, as I know you and your team have with the hospital association.

And I don't know if uh they're still in a perfect space, but I think where we land it was right.

Uh I did have a question uh there.

Um part of the definition says that medically necessary health services includes those not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the individual's illness, I believe.

No, that's uh what they wanted to add, but we did not add.

Okay.

Do we reference the cost in our definition?

I don't have the language in front of you.

In our definition of medically necessary, I don't believe we referenced the cost.

Okay.

Um, I think that's a good thing we didn't accept that because, and this was gonna be the concern I raise that that is so subjective.

There's always going to be an alternative lower costing brand service, which I think would create a loophole where this would undermine the intention of the bill.

And so I'm glad we did not uh execute that terminology, although uh again, I appreciate the work that you have put in trying to honor the recommendations of the hospital association.

Zooming back out.

I think what this will mean for residents is that um we will save many residents from the burden of medical debt, but also provide guardrails uh so debt collectors and others cannot harass or garnish wages of individuals who are just trying uh to live and exist.

So thank you again, and I look forward to supporting this bill.

Thank you, Councilmember Parker.

Um, you know, several other states have already done this, and so we based um the definition of medically necessary off of a definition that the state of Illinois currently has in place.

Um honestly, I think that our experience having um done the legislation around prior authorization and the conversations we've had with providers.

Uh also sort of uh guided our thoughts around what happens when you put in certain limits around medically necessary and who gets to determine that.

Any other hearing none, um, I moved the draft report in print for bill 26-438 in block with leave for staff to make any technical or conforming changes.

All in favor, please say aye.

Aye.

Aye.

Great.

Let the record reflect that the ayes have it, and the measure passes unanimously.

I'm gonna now turn to our nominees.

The committee convened a round table on three of the seven nominees because it is our practice to hold round tables on nominees appearing before the committee for the first time.

Um I'm gonna reference some of those discussions with three of the nominees.

I'm gonna start with the one from the board of funeral directors, and then I'm gonna move all of the nominees for the board of nursing in block.

So PR26-548 nominates Casey Martin for a reappointment to the board of funeral directors for a term to end March 1st, 2029.

Ms.

Martin serves as the manager and director of a funeral home that serves a variety of faiths, um, but also requiring expertise in multiple burial traditions.

She has uh provided funeral services for 23 years in the district.

Additionally, Ms.

Martin is the founder of a floral company that provides clients with floral arrangements for burials, memorial ceremonies, and other non-funeral related events.

She's licensed to practice funeral directing in the district, Maryland and Virginia.

And she earned her associates of applied science and mortuary science, excuse me, from Bridgepoint Community College, and she is a ward five resident.

During the round table, Ms.

Martin and I discussed the impact of the funeral director's licensing reform amendment of 2025, which creates a separate license for funeral directors and embalmers.

We also discussed the Green Death Care Option Amendment Act, uh, which authorizes alkaline hydrolysis, which is uh a form of water cremation in the district.

Um we also discussed the retirement trends that are happening currently within the profession with a very large percentage across the country of funeral directors who are planning to retire in the next five years.

Ms.

Martin expressed that although the profession is essential, the salaries of funeral directors may remains unattractive, and that funeral directors should be invited to more career fairs to encourage young people that this is a career option for them.

So, colleagues, as you hear of career fair opportunities coming up, do not forget our funeral homes as an option.

Um with that, I open the floor to any discussion on Ms.

Martin's nomination.

All right.

Hearing none, I move the draft report in print for 26-548 in block with leave for staff to make any technical or conforming changes.

All in favor, please say aye.

Aye.

Aye.

Great.

Let the record reflect that the ayes have it and the measure passes unanimously.

Excuse me.

All right.

I'm now going to turn to the nominees for the board of nursing.

And unless there's an objection, I will move all of them in block, if that's okay.

Great.

All right.

PR26-552 nominates Tiffany Simmons for a reappointment to the Board of Nursing for a term to end July 21st, 2021, 2029.

Ms.

Simmons is a psychiatric registered nurse licensed in the district, um, as well as Maryland and Virginia.

She's on the faculty at Howard University, Chamberlain University and the University of the District of Columbia, teaching undergraduate nursing students.

She has over 19 years of experience as a licensed health care professional, including several clinical roles at the George Washington University Hospital, Children's National, and St.

Elizabeth's.

She cares for persons suffering with serious and acute and chronic and sometimes debilitating psychiatric disorders.

Ms.

Simmons earned her Bachelors of Science in Nursing from the University of the District of Columbia and her master's in nursing education from Chamberlain College of Nursing.

She's a Ward 8 resident.

PR 26-533 nominates Patricia Howard Chittams to the Board of Nursing for a term to end July 21st, 2029.

Ms.

Howard Chittams is a licensed adult geriatric care nurse practitioner in the district.

She currently practices with the Washington Area Nurse Practitioners Group.

She has provided services at Washington Hospital Center, Howard Hospital, Hadley Hospital, and Columbia Hospital for the Women.

She also previously worked as an agency nurse for children's school services with DC Public Schools before being promoted to a nurse manager.

In 2016, she was honored as Nurse Administrator of the Year for the District of Columbia by the National School Nurses Association.

And in 2018, she became a certified in faith community health.

Yeah, faith community health nurse at Children's National Medical Center.

Ms.

Howard Chittham's earned her Bachelors of Science in Nursing from UDC and a Masters of Science in Nursing and Disaster Management from Benedict University or Benedictine, excuse me, University, an adult geriatric nurse practitioner postmaster certificate from Maryville University at St.

Louis.

She is award seven resident.

PR26-554 nominates Dr.

Cami Cooper to the Board of Nursing for a term to end July 21st, 2028.

Dr.

Cooper is a U.S.

Public Health Service Commander with 20 years of federal experience.

She currently serves as a behavioral health and wellness coordinator at NOAA National Weather Service and an emotional wellness lead for at USPHS.

In 2025, she was inducted as a fellow of the American Academy of Nursing, one of the nursing's highest honors.

She also runs a private practice.

Wellness takes fortitude and has taught at Washington Adventist University, an American university.

She holds her doctorate of nursing practice from Duquesne University and is a board certified nurse or board certified psychiatric mental health nurse practitioner.

She's a War 4 resident.

During the confirmation roundtable, we discussed Miss Dr.

Cooper's experience with the U.S.

Public Health Service, and I asked her what she hopes to accomplish in her next term.

She explained that she wanted to formalize common practices and standards to reduce ad hoc ad hoc or emotional decision making when retaining individualized remedies, foster stability on the board process, and push forward to innovation for regulations and oversight.

Dr.

Cooper currently chairs the discipline committee for the Board of Nursing.

Bill 26-555 nominates Judy Brinkerhoff for the board for the remainder of an unexpired term to end on July 1st, 2028.

Miss Brinkenhoff is a registered nurse with over 50 years of clinical and executive health care experience.

She served 22 years as a commissioned officer in the United States Navy Nurse Corps, including as officer in charge of the medical executive treatment unit at the Naval Medical Center.

She was also a staff advisor to the Assistant Secretary of the of Defense for Health Affairs.

Following her military career, she spent 25 years as a school nurse in D.C., primarily at Beauvoir, the National Cathedral Elementary School, and the Lab School of Washington.

She currently serves as a volunteer immunization compliance nurse at St.

Columbia's Nursing School.

Oh, nursery school.

She also serves on the Board of Governors at St.

Columbia's and was recently confirmed to the DC Statewide Health Coordinating Council.

She has her Master's of Science in Nursing from the University of Texas San Antonio and is a Ward 3 resident.

PR 26-555, 556, excuse me, nominates Dr.

Tyrus Ford to the Board of Nursing for a remainder of an unexpired term to end July 21st, 2026, and then also a subsequent term to end July 21st, 2029.

Dr.

Ford is a board certified nurse family practitioner and a doctor of nursing, specializing in primary care, HIV prevention, and LGBTQ health.

He currently serves full-time as a primary care nurse practitioner and HIV specialist at CCI Health Services and as a part-time medical director of Trust in the Journey Wellness, his own practice.

He has over eight years of nursing experience across critical care community and clinical settings.

He's currently pursuing his psychiatric mental health nurse practitioner postgraduate certificate at George Washington University.

She's expected to graduate in December.

He has a Bachelor of Science in Nursing, a doctorate in nursing practice from Marion University and is award seven resident.

During the roundtable, Dr.

Ford stated that he felt motivated by community need to apply to the Board of Nursing.

He emphasized destigmatizing HIV and promoting status neutral approach, integrating behavioral health and mental health into primary care, and aligned board policy and continuum education with national HIV nursing competencies.

He expressed a commitment to the workforce well-being and equitable care for black LGBTQ and other priority populations.

Finally, PR 26-557 nominates Anne Ford to the Board of Nursing for a term to end July 1st, 2029.

Ms.

Ford is a licensed practical nurse with over 40 years of diverse medical experience.

While Ms.

Ford is retired, she currently holds part-time positions at Lab Core and Medstar Health.

Her experience spans pediatric care, home health services, and in-home care for children with special needs, reflecting a strong foundation of compassionate patient centered care.

In addition to her clinical background, Ms.

Ford has demonstrated a deep commitment to public service through her work on black home ownership, strike force, and a quality and compliance advisory council.

Ms.

Ford earned her LPN from Margaret Murray, Washington Career Center.

And she was born and raised in Southeast DC and has lived in Ward 6, 7, and 8 and is currently a Ward 7 resident.

All right.

And I open up the floor if anybody has anything they want to add for any of the six.

Okay, hearing none, I move the draft reports and committee reprints for PR 26-552-553-554-555-556 and dash 557 in block with leave for staff to make any technical conforming and changes.

All in favor, please say aye.

Aye.

Aye.

Wonderful.

Let the record reflect that the eyes have it.

Measures passed unanimously.

This does conclude our meeting.

We expect our hearings to begin on Monday, April 20th.

Can't tell you what they are, but when they are finalized, we'll get to it.

We have no further business before the committee.

The time is now 1245, and this meeting is adjourned.

Thank you.