SmartTranscript of House Healthcare - 2025-05-08 - 3:45 PM

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[Chair Alyssa Black]: Afternoon of May eighth, and we are coming back to s fifty three. So some concerns this morning were raised, and I'll be honest with you, concerns I had not heard of before. I think we were all a little surprised. This bill went through the Senate, multiple committees, and concerns weren't raised. And I've been thinking about, I've been thinking about the fact that I keep having to remind myself that we are a policy committee, and it's our job to put good policy out. This bill will end up going to both ways and means and appropriations, our money committees. And I've been thinking about the policy that's in this bill and what I believe is good policy and policy that we have been working on for years in this bill. And there is one item that I really do believe is policy related. And I completely and totally understand the, difficult position that our Agency of Human Services and our Department of Vermont Health Access is in right now regarding amending our state agreement in a, choppy federal water where, you know, we're not quite sure what's happening. So I've asked Jen to, prepare an amendment, and she'll walk us through that amendment that I am hoping will alleviate concerns from our agency of human services, legitimate concerns around the timing of seeking our state plan amendment. Thank you. SPA. That's right. [Jen Carby]: It's a SPAHA. Great. Nobody put language up? Great. Jen Carby from the office of legislative counsel. Here is language. It's posted on the House Health Care Committee page. It's not a strike all. It's just a couple of instances. So this is s fifty three. This is the doula bill. The first instance of amendment would strike out section seven on the state plan amendment and put in a new section seven that would give a, not later than. So there was no date in the bill as it came over from the senate. This would say not later than July first of twenty twenty six. The Department of Vermont Health Access shall seek a state plan amendment. I took out the language saying if needed because we understand it is. So shall seek a state plan amendment from CMS to allow a Medicaid program to provide coverage for doula services in accordance with, that new statutory section. And then in the effective dates for the effective date for the Medicaid coverage, it would now say it will take effect on the later of July first twenty twenty six or approval of the state plan amendment requested pursuant to section seven. So that second piece isn't appreciably different, but it's getting rid of the ambiguity about if a state plan amendment is needed. [Chair Alyssa Black]: And my hope is that not later than by telling them that they have a year to seek a state plan amendment, that it will allow them to maybe [Brian Cina]: get through the [Chair Alyssa Black]: fall and the winter with federal, budget time where they will know a little bit more about where they stand and whether or not this is a good idea. Also, if they need more time, we will be back in January. And, they can come to us and and ask for additional time if they need if they feel they need it. So any thoughts on this? [Vice Chair Francis McFaun]: Do, does anybody who doesn't approve of this amendment? Is anybody not approved for that? In here. Yeah. In here. Just give us some time to look at, compare, and contrast what we had earlier and Well, the time you want. [Jen Carby]: I can cut them up side by side if that would be helpful. Yeah. With the same consumer. But And Just a sec. [Vice Chair Francis McFaun]: Are we going to hear from Diva eventually? [Chair Alyssa Black]: Diva's certainly welcome to comment. [Vice Chair Francis McFaun]: I'm happy to provide a comment to the [Alex McCracken]: committee manager. For the record, Alex McCracken, Department of Health Access. We view this as a big seller in the right direction, and we really appreciate the work that we're doing to give us this flexibility in a little bit more runway to see the state of unamended. As the chair noted, this is a tumultuous federal environment. We wanna exercise every caution available to us, and we appreciate a change in the amendment. [Vice Chair Francis McFaun]: So you support it? The amendment is a step [Alex McCracken]: in the right direction. I'm not able to comment on the the change in position to the bill itself. There were other outstanding issues that this amendment does not address, but this amendment is greatly appreciated and very much helpful. [Brian Cina]: Yeah. Okay. Have been missed. [Jen Carby]: Okay. I will attempt to put up my we have to do my actual [Chair Alyssa Black]: You're fainting? [Mari Cordes]: I'm so tired. [Jen Carby]: Alright. So I put these up side by side, and then you can see so on the left is the the new version with the date. So it's adding in not later than July first twenty twenty six, which is not in the bill as it came to you. And then it still both has the Department of Vermont Health Access shall seek a state plan amendment from the Centers for Medicare and Medicaid Services. And then in this original version, if needed, and here it just says to allow. So if needed to allow, just to allow Vermont's Medicaid program to provide coverage for doula services in accordance with that statutory provision as added by this. So it's really just the addition on the amendment oops, the addition of this not later than July first twenty twenty six and dropping me if needed by over here. Those are the changes in this section, and then I can scroll down to the effective dates if not. But [Mari Cordes]: And so this is because we know it's needed. And, also, it gives us some wiggle room so that if next January, Diva is concerned about this, they can come to us and say, look. This is not a good idea, and we could change the law. Will we change [Jen Carby]: the law? It gives them some flexibility on the timing. There was no date specified, so arguably it could have said that not later than or any time before or after July first twenty twenty six. But this puts gives them, you know, a a year plus to choose their opportunities or to come back to you during the next legislative session and say, we need more time or this is not workable. [Chair Alyssa Black]: And and we would is this session law? This particular piece is. [Mari Cordes]: Yeah. So then we would just change our session law next year. Like, we we would we we passed it. It wouldn't, like, be changing statutes. It'd be changing session laws. [Jen Carby]: It depends what you chose to do. [Mari Cordes]: Oh, okay. [Jen Carby]: I mean, yes. If it were just a matter of changing the date, yes, if you were changing some of the Medicaid coverage requirements. [Vice Chair Francis McFaun]: Or the [Mari Cordes]: professional regulation stuff. It would the [Jen Carby]: correct regulation stuff. Right. [Mari Cordes]: Alright. Thank you. I just wanna I I think my point is just that this it gives them some time, but it also gives them time to come back and say stop. Don't do this if it's really gonna be dangerous. [Jen Carby]: And then for the effective date, struck out, b, you put in a new b. So, again, section five, that same reference, same description shall take effect, and then the bill, as it came to you, it was on July first or if a state plan amendment is necessary upon approval of the state plan amendment, whichever is later. Here, I've moved the later, but it still shall take effect on the later of that same date, July first twenty twenty six, or approval of the state plan amendment. And I took out this if a state plan amendment is necessary because we know it is, and then just clarify that requested pursuant to section seven since that one is specifically directing them to do it. [Vice Chair Francis McFaun]: So Jim. Oh, wait. [Brian Cina]: Go on. Go on. [Vice Chair Francis McFaun]: Go on. Go on. Go on. Go on. Go on. Go on. Go on. Go on. Go on. Go on. Go on. Go on. [Chair Alyssa Black]: Go on. Go on. Go on. Go on. Go on. Go on. Go on. [Vice Chair Francis McFaun]: Go related to Deepak. Has is that still a concern, or or is this this amendment help in any way in that regard, probably. [Alex McCracken]: This amendment doesn't address that portion of my earlier testimony, but it does allow us to come back as representative Gina said next session with a clearer view of the federal landscape as well as the governor's recommended budget for twenty seven. [Vice Chair Francis McFaun]: And and we we can come back to [Chair Alyssa Black]: Absolutely. Absolutely. If fever comes back, that's it. Yeah. [Mari Cordes]: Brian? But it is allowing us to move forward with the certification of doulas and the and validating their work and acknowledging their work and allowing their profession to move forward in our state with greater recognition. [Jen Carby]: Yes. The certification is for a subset of doulas. But, yes, it allows the rulemaking process to move forward [Vice Chair Francis McFaun]: Yeah. [Jen Carby]: So that the certification process will be available in Yeah. [Mari Cordes]: So we're not holding everything up. Just hold on a second. We're just we're we're delaying the financial piece, but we're allowing everything else that I don't know. Not that this not that it was needs state legitimacy, but that's what this is giving. You know? [Chair Alyssa Black]: And I would point out, we may not even be delaying it. I mean Right. Jiva may say, oh, we think we're we're safe to go forward with this, and they can start that at any time. But if they need more time, then they can come and ask for more time. Or this gives them time to gauge the federal landscape a little bit better. [Alex McCracken]: As well as work with OPR, I certainly Yeah. [Vice Chair Francis McFaun]: Yep. Absolutely. [Jen Carby]: Have a question? No. No. [Vice Chair Francis McFaun]: No. No. Almost said is what I was gonna say. [Mari Cordes]: Say it again even longer. Yeah. So I I guess [Vice Chair Francis McFaun]: get ready for tonight. [Chair Alyssa Black]: So I'll take a straw poll on whether or not we need amend S fifty three with draft number one point one. And all those in favor? Okay. Eleven-zero-zero. And if somebody would entertain a motion. I know [Brian Cina]: that House Health Care vote favorably on s fifty three and act relating to [Speaker 6 ]: the certification of community based parent [Brian Cina]: aid of the children who are contributing to those services as amended. Second. [Chair Alyssa Black]: Alright. Clerk. Call them all. [Brian Cina]: Representative Tina. [Vice Chair Francis McFaun]: Yes. [Brian Cina]: Representative Chris Button. Yes. Representative Demara. Yes. I didn't even know what that means. [Mari Cordes]: You. Yeah. But, like, yeah. So that would happen. [Brian Cina]: Oh, yes. That's Representative Hope Poe. Yes. Representative Paige. [Vice Chair Francis McFaun]: Yes. [Brian Cina]: Representative Powers? Yes. Representative Rebecca? Yes. Representative Hickon? [Vice Chair Francis McFaun]: Yes. [Brian Cina]: Representative Black? Yes. [Chair Alyssa Black]: Well, passes on a vote for eleven zero zero. Can I explain my vote? Yes. I'm voting yes in honor of representative Cordes. Oh, thank you. Years of work you have done. Thank you. And because of that, I would like you to please be the reporter of this bill. [Brian Cina]: I would love to, especially since I've already started working with my Yeah. Yeah. [Chair Alyssa Black]: You need instructions, I'm gonna have to send that to the clerk. Alright. Thank you, everybody. Thank you. Okay. Really, we're done with committee for today. [Alex McCracken]: If you notice, we didn't [Chair Alyssa Black]: have I know. I'm sorry. I'm sorry. [Mari Cordes]: Before we go offline, can I just ask a question about the committee committee business, which is, is [Chair Alyssa Black]: this the last bill in committee? This is the last bill that except for the senate house bill spread. [Mari Cordes]: The ones in motion. Yeah. But this is the last one currently in our committee. [Brian Cina]: No. Except for all the other No. [Mari Cordes]: Currently in play in our committee. So that means Yeah. From this point till the end, whenever that may be, of the session, I'd say Yeah. That it's gonna be the bills that haven't been signed yet bouncing back and forth, but we have at least moved every bill out that we could. [Chair Alyssa Black]: Yeah. And I don't know if you've heard, but it's possible that we may have a lot of spare time for committee work. And tomorrow during committee, we're going to be talking. We're gonna have committee discussion, conversation amongst ourselves around some maybe some testimony that means we might wanna kind of start listening to. We could line up for things that people are interested in working on maybe next year. [Mari Cordes]: We're, like, a public hearing. [Chair Alyssa Black]: Okay. We're doing a public hearing this year. [Jen Carby]: Go ahead, [Chair Alyssa Black]: Saye. Okay. Thank you. We can go
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