Vermont Legislature SmartTranscripts:

[Rep. Robin Scheu (Chair)]: Good afternoon. This is the House Appropriations Committee. It is Tuesday, 12/16/2025. We have had morning sessions and lunch, and now we are back to talk about the Budget Adjustment Act. And we are going to this afternoon is Agency of Human Services Day. Afternoon, so We have the secretary, I believe, is on Zoom, or will be, yes. Hello, Secretary Samuelson. Sorry you're not feeling well. Glad you could join us. And Tracy, remind me your last name. O'Connell. O'Connell. Who's the new CFO at AHS? That's correct. Letters. So welcome to both of you. Have have any Can I get some documents? Oh, okay. Okay, I was looking for mine. And

[Emily Hawes (Commissioner, Department of Mental Health)]: why don't you two introduce

[Rep. Robin Scheu (Chair)]: yourself for the record while I'm finding my answer. Good

[Jenny Samuelson (Secretary, Agency of Human Services)]: afternoon. I'm Jenny Samuelson. The secretary for the agency of human services. I apologize for not being able to be in person today, but I am following the guidance of our commissioner of health who says when you stay home.

[Rep. Robin Scheu (Chair)]: Thank you for role modeling good behavior.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: And for the record, I am Tracy O'Connell and I am the Chief Financial Officer for the Agency of Human Services. And so we have a PowerPoint overview of what our budget adjustment request looks like. And I believe Autumn is my colleague, Sean on? Okay. So Sean Bennington, my colleague at AHS is going to share on the screen, but I think you also have it electronically and then handouts.

[Jenny Samuelson (Secretary, Agency of Human Services)]: So again, good afternoon. We're going to start with a basic overview of the agency, and then we'll roll through with a little bit more detail what you can expect over the next couple of hours with the departments within the Agency of Human Services. So just as a reminder, the Agency of Human Services includes six departments, including Department for Aging and Independent Living, Department for Children and Families, Department for Corrections, Health, Health Access, and the Department of Mental Health. As we go through the budget today, we're going to give you a broad breadth overview of what you're going to see in BAA, for each of the six departments and the central office, and the central office includes health care reform, along with some of the detailed categories where we are seeing some major changes. As a reminder, the, Agency of Human Services, budget for fiscal year twenty six, was $5,800,000,000, across all fund sources, with about 1,400,000,000.0 of that in general fund. The budget adjustment that we're going to present today includes a total of 32 33,200,000 of general fund plus some additional one time funds.

[Rep. Robin Scheu (Chair)]: So

[Jenny Samuelson (Secretary, Agency of Human Services)]: what we've seen in major changes since the last time we were here in presenting our budget are significant pressures in a few main categories. So you'll see budget pressures or budget ups to the tune of $49,500,000 These primarily fall in the area of caseload, where we're seeing an increase in the number of individuals who are coming onto our programs, required rate adjustments, and those include both state and federal required rate adjustments for providers, contractual agreements that we've had to renegotiate over the period since the budget was passed, and a smaller category of other general operating expenses. You'll also see that there are a couple of areas where we see savings and offsets. That includes $16,300,000 and that includes increased revenue and a decrease in caseload in some of our smaller programs. We'll present this across the entirety of the agency. The executive leadership team of the agency, which includes the commissioners of each of the six departments plus the Medicaid director, the deputy director, the deputy secretary, and the secretary are presenting this budget on behalf of the agency. For that, I'm going to turn it over to Tracy for some of the more detailed specifics in each one of these categories where we see our pressures.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: Great. Thank you, secretary. So the first category where we're seeing pressures is in the caseload and utilization space. We are requesting $23,200,000 of general fund to address this pressure. The main drivers of that are DIVA Medicaid consensus,

[Emily Hawes (Commissioner, Department of Mental Health)]: as well

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: as DIVA clawback. At DMH, we're seeing increased caseload and utilization at the private non medical institution providers. DCF has a also increasing an increase in the sub adoption space, as well as the general assistance support services, which includes burials, dentals, and abortions. In the Dale Choices for Care, we're seeing nursing home bed days as well as home and community based pressures. And then for the DOC out of state, there was an out of state trip on November 1 that sent 30 individuals to the out of state provider.

[Rep. Robin Scheu (Chair)]: Well, I just have a sort of a broad question. We spent a lot of money on increased caseload utilization last year. We had to do that budget adjustment. And so we're doing it again this year. So what's I I can see it one time, but we have this continuing upward trend

[Emily Hawes (Commissioner, Department of Mental Health)]: of this. Do you have any thoughts about what's going on here? I think Oh, go ahead, Jenny. Go ahead, Jenny. No,

[Jenny Samuelson (Secretary, Agency of Human Services)]: that's okay. Again, please, Tracy, jump in here. What we've seen with the Medicaid program and the consensus forecast, that's been much more stable in terms of the overall caseload. But in this case, what we're seeing in the Medicaid program at least, is that is a increase in overall utilization so that the cost per actual individual who is enrolled has increased significantly. Because we also, have health care reform, we can see that that's consistent not just within Medicaid, but across multiple insurers. So I can't speak to exactly what's driving that, but we are seeing significant increase in utilization. Tracy, if you want, I think you probably have something to add there.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: I was also going to hit upon in the choices for care space. For the nursing home bed days, there were three providers that were experiencing a backlog in claims due to some transition of ownership. And so I believe that's $9,000,000 gross or about $4,500,000 general fund that was an expense for last year that carried forward into this year by the time claims were paid out. But I'm interested in why we

[Rep. Robin Scheu (Chair)]: are having this increase in utilization. So is the agency looking into trying to understand that better?

[Jenny Samuelson (Secretary, Agency of Human Services)]: Yeah. When it comes to Medicaid, Diva, we can give them a heads up. If not today, your time, they can provide a little more of an overview and where they're seeing an increase in utilization. We are monitoring and tracking that closely. And Diva, particularly for the Medicaid program, can provide more of an answer there.

[Emily Hawes (Commissioner, Department of Mental Health)]: Okay. Thank you.

[Unknown Committee Member (called “Chip” by Chair)]: Can I just ask

[Emily Hawes (Commissioner, Department of Mental Health)]: one follow-up question?

[Unknown Committee Member (called “Chip” by Chair)]: I'm sorry. When we say utilization, are we talking about the number of visits? Or I mean it's so the use of Medicaid of a medical plan has increased it's not the cost that has increased is correct. Okay. That is correct.

[Rep. Robin Scheu (Chair)]: Okay. Wayne Linn Dave.

[Rep. Wayne Laroche (Member)]: So the question then becomes is it following the demographics of the aging of the population is that because what we're getting to, we're here for BAA again. These are one time unanticipated things that you just can't predict. That's one thing. The other thing is if you have demographics that are shifting in a predictable way, then you could write it into your budget without having to go to the eighth.

[Rep. Robin Scheu (Chair)]: What do I want to know about it? Yeah,

[Unknown Committee Member (House Appropriations)]: what I hear you saying is the number of people on Medicaid is not increasing. That's a stable number, but the intensity of their care, they're sicker than they require more care, the ones that are there. And maybe that hooks into the demographics. And that might also hook into your nursing home choices for care as well. They're just older, sicker, more utilization for the same number of people. Is that correct?

[Rep. Robin Scheu (Chair)]: I think that's what we're

[Emily Hawes (Commissioner, Department of Mental Health)]: going to

[Rep. Robin Scheu (Chair)]: ask Diva.

[Jenny Samuelson (Secretary, Agency of Human Services)]: Any assumptions about demographic issue here in terms of the older and sicker? Well, Diva can definitely come in and provide more information on where we're seeing utilization. That said, I do think that we are seeing more use in our nursing home and that probably is more directly related to the demographic issue. But the broader Medicaid utilization, I would wanna I would want Diva to come in with their with their numbers.

[Rep. Robin Scheu (Chair)]: Thank you. Kate?

[Rep. David Yacovone (Member)]: It may show up elsewhere in the presentation, but imagine if you had to explain these bullets to 150 people at varying degrees of understanding. If you could give us a couple of sentences, written at the sixth grade level, what is fallback? That would be helpful, somebody's And I hate to make more work for people, but it would be helpful. Yes.

[Rep. Robin Scheu (Chair)]: Nolan.

[Nolan Langweil (Joint Fiscal Office – Medicaid Consensus Group)]: Nolan, I'm from the director's office. I'm a part of the Medicaid Consent Group. I also want to flag that it's not necessarily that utilization is up, it's that utilization came in higher than we projected. So just as much a measure of what we thought would happen versus what did happen. So it's not necessarily utilization reduction, and it is, but it's just just varying from what we thought it was going to.

[Rep. Robin Scheu (Chair)]: It really projects an

[Nolan Langweil (Joint Fiscal Office – Medicaid Consensus Group)]: adjustment because we're trying to use a magic ball or snow globe to predict the future and this just tells us how much we're right or wrong.

[Rep. Robin Scheu (Chair)]: Right, and we've been kind of off the last two years on utilization.

[Nolan Langweil (Joint Fiscal Office – Medicaid Consensus Group)]: Because the trend is, excuse me, the post COVID trend was still having to figure it out. It used to be we can look at it, it's when we were trying to figure it out. Now it's like the world is all looking like. So I just want to point out it's not just utilization up per se, it's just up compared to what we thought.

[Rep. Robin Scheu (Chair)]: Our ability to predict has not There's been so

[Nolan Langweil (Joint Fiscal Office – Medicaid Consensus Group)]: a bit of that, I just wanted to sort of reframe it little bit. Thank you. And it is consensus, so it's us and HS.

[Rep. Robin Scheu (Chair)]: Yeah. This will be interesting to know, understand what it is about utilization, which would maybe help the predictions better.

[Nolan Langweil (Joint Fiscal Office – Medicaid Consensus Group)]: Instead of, can talk, she can say, okay, within this particular Medicaid eligibility group or in this, she can dig deeper than that.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, that would be helpful.

[Rep. Robin Scheu (Chair)]: Okay, thank you.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: The next area where we're having pressures is in the space of required rate adjustments. There are certain instances where we are either required by law or rule to pay higher rates that were not anticipated in the state fiscal '26 budget. The first example is the DIVA Medicare Economic Index adjustment for FQHCs and RHCs. That's approximately a 2.7% increase. And also at Dale, they're seeing additional requests for extraordinary financial relief. And also the Vermont Veterans Home Cost settlement is coming in higher than what was anticipated in state fiscal year '26.

[Rep. Wayne Laroche (Member)]: So what was that again on the veterans' homes?

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: The gross amount is just shy of a million dollars and the general fund portion is about 370,000 Next area is contractual agreements. And as secretary said, this is where we had to negotiate contracts over the course of the year that resulted in higher costs. A lot of the first couple are in the IT space for Gainwell, the MMIS vendor at Diva, as well as with Deloitte, who is the vendor responsible for our Medicaid data warehouse and analytics solution. There's also pressures in the transportation area for both DCF and DMH, seeing a small tick for increased costs or the rate, but more it's based on utilization. DMH travel nurses that is also a pressure that Commissioner Haas will speak about as well as the uptick in forensic evaluations. There's a $1,900,000 request for the Crisis Stabilization Program at a Windham facility. And then there's an increase for the WellPath Health Care contract. There's two components to that. One is to cover the average daily population increase. And then the second part is for some costs that were incurred in state fiscal year '25 that we had to pay in state fiscal year '26.

[Rep. Robin Scheu (Chair)]: I just asked while we're on here the DCF and DMH transportation. Is that the non emergency medical transportation? That's correct. And so a contract has yet

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: to be awarded on that. Is that correct? We have two vendors that supply transportation services. One is Youth Transit Authority. We've had a contract with them for a number of years, as well as the sheriffs. They also provide transportation.

[Rep. Robin Scheu (Chair)]: Okay. So our public buses systems don't, aren't part of that? That's not part of this. John.

[Rep. John Kascenska (Member)]: Real quick, if you get

[Rep. Michael Nigro (Member)]: the way till later, that's fine here, but on the travel nurse part of things, is that like a greater number of them or a greater cost that they identified for us to pay? Do you have a person? Some of the hospitals have like had a pushback on them and say we're not gonna pay that rate any longer.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: I always look at her to Commissioner Hawkes when she comes in. She's up next.

[Rep. John Kascenska (Member)]: You know I'm saying?

[Rep. Wayne Laroche (Member)]: The transportation non emergency, is that to transport prisoners to the hospitals? Mentioned the sheriffs, so is that part of that or is this some

[Rep. David Yacovone (Member)]: other?

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: I don't believe not. No, because that would be

[Rep. Robin Scheu (Chair)]: a DOC funded activity. So but sheriffs would be involved in transport from this?

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: I I believe like for crisis stabilization, you know, when perhaps individuals experiencing a crisis, could be utilized.

[Rep. Robin Scheu (Chair)]: Thank you. Great. Okay.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: All right. Moving on to other operating pressures. The first item is the Pilgrim Park lease, as I'm sure most are aware of the return to office and AHS needs to secure additional lease space to accommodate additional seats. So that is that's going to be an annual cost of $433,000 gross. So Diva is just asking for a portion of the general fund share and budget adjustment. We have the Planned Parenthood Medicaid backfill. So one of the conditions of HR1 was a one year moratorium for Planned Parenthood to receive Medicaid reimbursement for claims. And so we are seeking approximately $1,100,000 backfill. So we can because they are critical providers that serves approximately about 16,000 patients, we felt it was necessary to backfill this with general funds for this for one year period. The DCF Income Verification System, there's a federal portal that we can no longer utilize to verify income. So DCF is procuring a new system to verify that. And then we have hot shelter expansion investments. There are a few shelters that we've been funding with one time dollars that we need to also ask for additional funding to cover those ongoing operating expenses.

[Rep. Robin Scheu (Chair)]: How much is in that line?

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: $2,000,000 And then DOC has a couple of utilities for water and sewer that they're requesting adjustment for as well as staffing supports such as short turnaround stays at hotels and water and uniforms for those that are in the facility. We did have a few as the secretary indicated, we had some savings and offsets. So for one, the utilization that we're seeing for the child, this new adult group That's funded at 90% federal reimbursement. So, we are seeing an increased utilization for that Medicaid eligibility group. So, that's approximately $4,800,000 in general fund savings. We also had $4,600,000 in general fund that was carry forward from state fiscal year '25. And then also in DOC, there is a global commitment investment for community rehabilitative care where we draw down Medicaid investments for probation and parole officers. And we just recently implemented a new random moment time study. And the results are showing that we can claim more for global commitment investment. So that is savings for us.

[Unknown Committee Member (called “Chip” by Chair)]: Great, so less general fund more. Correct, yes.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: It actually saves us $1,400,000 And then in the caseload space, the buy in for Diva is coming in less than was originally budgeted. And then DCF has other caseloads where they're seeing a decrease, particularly in the FSD and the ESD space.

[Rep. Robin Scheu (Chair)]: What is a FI in? I've never heard of that one.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: FI in is where we pay a fee of Medicare Part B, is that right? B or D?

[Rep. Robin Scheu (Chair)]: To Do you want to phone a friend or do you

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: have to go into my consensus partner here? Believe it's Diva will be able to speak more to it. But we have to pay invoices to the federal government for cost sharing on the start sheets.

[Nolan Langweil (Joint Fiscal Office – Medicaid Consensus Group)]: Okay,

[Rep. Robin Scheu (Chair)]: you're keeping a list right? Yeah. You.

[Unknown Committee Member (House Appropriations)]: You used an acronym for the DCF other case loads.

[Rep. Robin Scheu (Chair)]: What are those acronyms? Oh, I'm sorry.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: In the Family Support Division, Family Services Division and the Economic Services Division. Okay. Moving on to the onetime request. We are requesting $385,000 in general fund for the fit up of Pilgrim Park. This is to purchase desks, chairs, conference room, technology and furniture, partitions, and doors. We hope to also get federal funding so the total estimated cost for the fit up is $765,000 gross but the general fund portion is 385,000 The next one time is in Diva. It's for Vermont Health Connect, dollars 2,700,000.0 general fund matched with $5,000,000 federal fund. This is So the vendor right now, they're transitioning, and so there needs to be upgrade for security and compliance in order to maintain connection to the federal data services hub. The Brattleboro retreat bed day utilization. This was a budget adjustment one time item last year as well. We have about 20,000 bed days budgeted in the contract for the Brattleboro retreat, but we're seeing approximately 3,000 additional beds higher than what we had budgeted. So it's a utilization adjustment.

[Rep. Wayne Laroche (Member)]: Any explanation of what's the increase what's driving the increase?

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: I think Diva and DMH would be able to answer that. And lastly, the DCF Child Abuse Hotline. In order to maintain this hotline, there needs to be an upgrade to server requirements.

[Nolan Langweil (Joint Fiscal Office – Medicaid Consensus Group)]: So, is

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: a one time request for that.

[Rep. Robin Scheu (Chair)]: Could we go back to the office setup? You said that you're expecting to get some federal funds? Yeah. How likely is that? And then what happens if you don't?

[Rep. David Yacovone (Member)]: You're just going have to pay it out of your own budget?

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: It's pretty likely it's an administrative cost that we would be able to run through our cost allocation plan.

[Rep. Robin Scheu (Chair)]: You're feeling pretty comfortable about that? Yes. Okay. That

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: concludes running through the slides. If we'd like to turn to the AHS ups and downs packet. Yeah, so you can refer to this throughout the AHS testimonies. It gives the line item descriptions and the various fund adjustments throughout budget adjustment. Beginning on page three, that's where there's some minor adjustments for the secretary's office. Let's highlight. The first one is a net neutral adjustment where the secretary's office is going to earn more dollars in the SSBG which is a social services block grant. And then we're giving the general fund to MH and Dale instead. Those are just some natural adjustments. And then on the operating expense, you'll see this recurring adjustment. This is to transfer money for the ADS service level agreement. In '26, we budgeted an increase in the secretary's office not knowing how it would be parsed out and so these are just net neutral adjustments that you'll see within the agency. So we'll see numbers going up in the other departments.

[Emily Hawes (Commissioner, Department of Mental Health)]: Is

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: correct. And then the last item there is a $1,100,000 request for ADS invoices that we were not able to pay out last year and so we did carry forward money but it was reverted and then requested this way. And that is to address the modernization upgrade of the automated call distribution center. That was about $1,000,000 and then some other timesheet billings that we were not able to pay before the end of the fiscal year.

[Rep. Robin Scheu (Chair)]: So when you say you couldn't pay

[Emily Hawes (Commissioner, Department of Mental Health)]: it before the end of the

[Rep. Robin Scheu (Chair)]: fiscal year, why was that?

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: We come in to close out, we manage across the agency where things will land and we were seeing pressures in divas, pressures in some other places. And so we just held off paying this one to see where we would finally land at close out. And so by the time that happened, we hadn't paid these bills, but we did have identified carryforward to the fact. Okay, and then on to page four. This is B301. So this is the big global commitment appropriation. Overall, it's 2,200,000,000 all funds. So this is the mixing bowl to fund Medicaid. So where departments have increases in global commitment, you'll see offsetting increases or decreases in this appropriation to account for both the general fund match component and the federal fund match component. So in the first line item, this is the new adult change that I referenced earlier, where we're, there's a savings of $4,800,000 general fund, and we'll get $4,800,000 federal fund in replacement. And then the other line items, again, these reflect all the increases and decreases of the global commitment changes throughout the department's ups and downs. There are a few offsets to note. So, we had a little bit of carry forward for Medicaid consensus, that it was about $209,000 And then one other thing to highlight and Diva can speak more to it is the family planning rate increase that was appropriated in state fiscal year '26. Diva was not able to implement that as it was intended to draw down ninetyten. And so we are making that adjustment here and Diva can speak more to that. They can speak more. Yes. We don't want Diva to. And then a couple other down below Dale, there's a couple other carry forward amounts that are statutorily required. Well, the first one is statutorily required for choices for care where we must require we're required to carry forward that for the program. And then we also the AFSME. This is the collective bargaining unit that covers independent care workers. Their bonus payment was paid out, believe in like the first or second week in July, so we had to carry forward funding for that. So overall in Global Commitment, it's a $17,000,000 general fund increase just about 2.4%.

[Rep. Robin Scheu (Chair)]: Page are you on now?

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: I'm sorry, what

[Rep. Robin Scheu (Chair)]: page are you on? Oh, that was on page four. Yes. Thank you. The rest we're going to hear from the

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: specific areas. Yes, they'll get into the details.

[Rep. Robin Scheu (Chair)]: Questions? Well, I'll ask a question. This is great to hear and thank you for presenting this. This is the ups and downs. When we get to the budget, we're going be looking for different things. And you have that information.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: Yes. We're testing out some different scenarios that we're going to run by the joint fiscal team to see if it meets the request. Yes.

[Rep. Robin Scheu (Chair)]: Yeah, that's great. That's great. We're trying to move to something that's more meaningful for all of us, I think. And so when I see this, it makes me think about how little information we get this way. But I can understand it with a budget adjustment, we're changing something that we've already approved. But a new budget is very different.

[Emily Hawes (Commissioner, Department of Mental Health)]: So good. I'm glad you're aware of it.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: You're working We on are working on it. We're excited with the new upgrade to Adaptive that we can track different reports to help aid in telling that story.

[Rep. Robin Scheu (Chair)]: Great. Well, we can look forward to that. So anything else from the clinic? Thank you so much. Thank you very much. She's coming in and welcome to HHC. Is this

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: super fun being here? It's rolling. Yes.

[Rep. Robin Scheu (Chair)]: Have you met

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: everybody before? I think so. Yeah, I served as the deputy previously. So I've always been in the audience. Yeah.

[Emily Hawes (Commissioner, Department of Mental Health)]: Alright. Available for questions. We're getting

[Rep. Robin Scheu (Chair)]: back in shape, I'm getting back in shape. We have to introduce ourselves. Thank you so much.

[Rep. David Yacovone (Member)]: Question, I One hope you're not on the phone. Sorry, I didn't want to, I'm being asked by constituents, so if you could pull it together for me, what is the total cost of any leases related to the return to office? I understand the fit ups, and I understand that some movement with people moving out of the complex, out building of into Pilgrim, but if somebody could just give me one little spot and say, here's what the cost is.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: Yeah. The net new cost annually will be 433 gross.

[Rep. David Yacovone (Member)]: Okay.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: Yes. For the new space.

[Jenny Samuelson (Secretary, Agency of Human Services)]: And and the one the one thing to contemplate there is is that well, we've talked about as a net new cost. This is this is a direct result of the sale of 108 Cherry Street. And so as we come in and we talk about the nuance of that, I think it's important for us to understand that the reason that we're needing to add additional space in Waterbury is because the building that the Department of Health was at in Burlington is a building that the state has put up for sale. And so that is a little bit different than needing new space for new space sake. It's replacing a space that that we no longer have.

[Rep. Wayne Laroche (Member)]: Thank you. Same kind of question. Course, we poured Waterbury in a lot of empty space So here at the you're telling us that with the people coming back to work as well as the people from Cherry Street that you should have enough space at Waterbury.

[Rep. Robin Scheu (Chair)]: Only with the addition of this other place Waterbury, whose name I've been over. I was going say pigeon.

[Rep. Wayne Laroche (Member)]: Without anticipating any big spacing.

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: Any additional spacing beyond Pilgrim Park? I

[Jenny Samuelson (Secretary, Agency of Human Services)]: can't I don't we need to wait and see what happens with the return to office. The 108 Cherry Street had 508 seats. The Pilgrim The Pilgrim Park lease that we are engaging and entering in has a 172. So we need to deter we need to wait and determine what's gonna happen in terms of exemptions, days of the week that people are in the office. Once we've established and settled that down, then we'll be able to answer that question with more specificity.

[Rep. Robin Scheu (Chair)]: Thanks. Thank you. Thank you both very much. Appreciate it. Feel better, Jenny. Okay, gonna move right along. Commissioner Hawes, did you bring friends? I did. I always bring friends. Do you have enough chairs for all your friends?

[Emily Hawes (Commissioner, Department of Mental Health)]: Well, just have one friend today. Who's retiring at the end of next week, so this will be a special trip for her today to give her the big hurrah and knock.

[Rep. Robin Scheu (Chair)]: Good, have a cookie. Those are retirement cookies. They don't count.

[Emily Hawes (Commissioner, Department of Mental Health)]: No calories.

[Rep. Robin Scheu (Chair)]: So welcome, and when you're ready, introduce yourselves and have some things here. Here we go.

[Emily Hawes (Commissioner, Department of Mental Health)]: All right. Good afternoon. My name is Emily Hawes, Commissioner for the Department of Mental Health. Thanks for having us today. Shannon? Hello, I'm Shannon Thompson, the Financial Director for the Department of Mental Health. Nice to see you. So we'll be continuing the discussion around the BAA. So first, I'd just like to reactivate folks to the mental health system. And this is a grid of the different levels of care the Department of Mental Health oversees from the lowest sort of outpatient approach community mental health programs. That is our foundation blocks to the overall system. And then up at the top is our highest level for care, inpatient hospitalization for youth and adults. So currently at the inpatient level, DMH has a 25 bed facility for adults here in Berlin, the Vermont Psychiatric Care Hospital. We also contract with the Brattleboro Retreat for both youth and adults. And then we also have beds located within the Rutland Regional Medical Center that serve what's historically been referred to as level one. But those individuals who require additional resources in order to meet their hospitalization stay. Then you'll see a step down is our secure residential, the River Valley, a therapeutic residence that is located in Essex. And then the next level down is our intensive residential and treatment programs for youth and adults, as well as a peer run residential. There is a new resource coming online in the next few months, the Youth Psychiatric Residential Treatment Facility, otherwise known as a PRTF. That will be coming online at the Brattleboro Retreat here in the coming months. And then further down is our crisis support and response. So things like our mental health urgent cares, 988, our mobile crisis response, crisis assessment, supports and referrals to different levels of care that is across the age span, as well as our community mental health services, such as your traditional case management therapy. There are group homes in that system as well. And that's how we identify our base supports for the entire system.

[Rep. Wayne Laroche (Member)]: So your new facility coming on board, how many beds or what's the capacity of that?

[Emily Hawes (Commissioner, Department of Mental Health)]: I believe that it is 12, but I can confirm with So

[Rep. Robin Scheu (Chair)]: how does that one that's the one at the Brattleboro retreats, There have been a number of failed attempts to have a replacement for Woodside. And there's something in Newbury, there's something in Regents. Is this Brattleboro one is that the So what level would that one be at on this chart? Is that secure residential or

[Emily Hawes (Commissioner, Department of Mental Health)]: What level is the Woodside replacement? Yes. I'll let DCF speak to the Woodside replacement plans and progress. But when you think about an intensive residential program like the PRTF or the intensive residential programming for adults, those are individuals who need 20 fourseven care. Not as high as your nursing ratios for a hospital stay, but still need 20 fourseven care with medical and nursing oversight. The one thing that's not on here yet, but should be coming on line is the adolescent inpatient unit outside Southwest Vermont Medical Center. Construction has not started on that, but we're in the final stages of starting construction for that. And that was a historical legislative act from last year.

[Rep. Wayne Laroche (Member)]: I'm just trying to get a handle on with the new things that you have coming online. How does that address the real capacity issue? It false? Is it 50%? It

[Emily Hawes (Commissioner, Department of Mental Health)]: love that question. It's a good one. So two things. The PRTF, currently the state of Vermont does not offer that level of care. And so youth are sent out of state to access that. So the PRTF will be our opportunity to bring you back for that level of care. With the inpatient hospitalization, the only place to receive inpatient care for our youth in Vermont is at the Brattleboro Retreat. And so the SVMC project does a couple of things. It increases access so there will be more available beds for youth. It also follows our goals of integrated care. So it is attached to a medical facility. And so some youth who have really complex medical and mental health needs on the Rattleboro Retreat is not an adequate facility to serve them. So, this would allow an opportunity to have in state access to that level of care. So with that, we can go into our ups and downs. I'm going to turn it over to Shannon.

[Rep. Robin Scheu (Chair)]: All right. She's got a retirement. One more time. Okay.

[Shannon Thompson (Financial Director, Department of Mental Health)]: Does everybody have the ups and downs in front of you? Perfect.

[Rep. Robin Scheu (Chair)]: It's in the what section number you're talking?

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: 314. 314.

[Rep. Robin Scheu (Chair)]: 22 if people are using. I just want to orient people. Okay.

[Emily Hawes (Commissioner, Department of Mental Health)]: So

[Shannon Thompson (Financial Director, Department of Mental Health)]: last year, DMH split our budget into two separate appropriations. We have one appropriation for central office, and that encompasses the children, adults, and central office with all the crisis services. And then we have the facilities appropriation, which is Vermont Psychiatric Care Hospital and the Therapeutic Community Residence. So we have two separate appropriations to talk about today. The first item is for transportation. There's been some increased cost for both youth and adults. So this is just representing the increased cost and a shift from Medicaid funds to general fund.

[Emily Hawes (Commissioner, Department of Mental Health)]: So I know there were some questions in the previous testimony, but I can give a little more information around transportation. Tracy answered that correctly. We have two contracts, the YTA, youth transit, and then sheriffs. And so we've seen a shift in historically families, caregivers were able to provide transportation. We have seen the ability and availability of family to support transport to inpatient or discharge decrease. And so we have had to utilize our transportation contracts more often than we have historically. Additionally, individuals who say who are perhaps court ordered or are under the care and custody of the commissioner aren't always someone considered as having a severe mental illness. And so we need to be we've had more of those requests for transports, and those need to come under our DRIP. The transportation is to a facility? Could be to a facility. From a facility. We try not to do that as often as possible.

[Rep. Robin Scheu (Chair)]: The discharge? Yes.

[Emily Hawes (Commissioner, Department of Mental Health)]: It could also be, say, somebody requires a trip to the dentist and is in involuntary care, we would use sometimes a sheriff to do that. Court transports if somebody's at a hospital, they've been ordered or in an emergency room, they've been ordered there by the court, we'll provide the transportation to the next level of care that's appropriate. So how many rides are we talking about? Oh, we can get that for you. I don't know off the top of my head about both of those folks. It's a narrow thing

[Rep. Robin Scheu (Chair)]: that you're doing. And so I'm just wondering, how does the cost compare with those audits?

[Rep. Wayne Laroche (Member)]: Yeah. The sheriffs are being used for transport of

[Rep. Robin Scheu (Chair)]: a troubled child that was taken into custody,

[Rep. Wayne Laroche (Member)]: that sort of thing. They're not being just used for, it's a general contract to transport people, but specific kind of people that need Yes, to be

[Emily Hawes (Commissioner, Department of Mental Health)]: if there's an elevated need for safety, Also, if there's not transport available from, say, YTA, we also don't want somebody waiting in an emergency room unnecessarily. So we'll try. We're required to transport folks in the least restrictive manner. But we also want to get folks to their next level of care as soon as possible. And so there is a balance there. Those requests do come through the department for transport and we arrange for those.

[Rep. Robin Scheu (Chair)]: David, did you have a question?

[Rep. David Yacovone (Member)]: Yes, thank you. I just wondered if somebody could help us, not necessarily now, but just what is the order of magnitude of the increase? Is it 2% increase or 15%? Could you provide

[Emily Hawes (Commissioner, Department of Mental Health)]: some From a dollar amount That or a,

[Shannon Thompson (Financial Director, Department of Mental Health)]: is a really great question, and

[Emily Hawes (Commissioner, Department of Mental Health)]: we'd like to get back to you on that.

[Rep. David Yacovone (Member)]: Oh, sure, thank you.

[Rep. Robin Scheu (Chair)]: Continue, please. Thank you.

[Shannon Thompson (Financial Director, Department of Mental Health)]: The next item, forensic evaluations. So this is, again, cost increase for forensic evaluations. And it's also putting it all into general fund because a lot of the folks do not have serious mental illness.

[Emily Hawes (Commissioner, Department of Mental Health)]: So for some context, the Department of Mental Health operates as sort of a scheduler of these evaluations that are ordered by the court. So a court will decide whether or not a forensic evaluation should be ordered. And that is because the court is considering whether or not somebody is confident to stand trial. And so the number of competency evaluations have increased in Vermont as well as the types of individuals that are being ordered for competency. And so we have seen an increase in individuals presenting with a traumatic brain injury, with substance use, with other illnesses that are outside of a mental health condition.

[Shannon Thompson (Financial Director, Department of Mental Health)]: The next item you've probably seen in everybody's budgets, it is an increase. It's a net neutral increase per DMH for ADS service level agreements. Federal revenue reconciliation, this is funding that was social service block grant funding to support residentials. And DMH is doing a lot of work with and crisis beds. And we have shifted that funding to general fund to help support those facilities covering costs that might not be Medicaid eligible. Such as room and board. Okay.

[Rep. Robin Scheu (Chair)]: So it's not like you could get it federal funds. It's that what you're doing is not federal funds eligible.

[Emily Hawes (Commissioner, Department of Mental Health)]: We're working not to pass that cost on to the individual in the residential as well.

[Shannon Thompson (Financial Director, Department of Mental Health)]: Yeah. And mostly, it's with the residentials and crisis beds. So this is mostly to help cover those room and board costs in the crisis beds because it just doesn't feel right to charge moving forward for somebody who's in that crisis. The next item is private nonmedical institutions, PNMI. It is a caseload and utilization increase. It's $3,200,000

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes, so this is an increase as well in which utilization as well as a small rate. Those PNMIs have a small rate increase. And these facilities, private non medical, so that speaks to the amount of medical and nursing oversight. It's a lower level of care than, say, a hospital or an intensive residential facility. And they treat children and adolescents with emotional and other challenges.

[Rep. Robin Scheu (Chair)]: So you're finding more people. That's the increased caseload and more utilization, so more need to same person, multiple trips, or multiple issues, or Potentially.

[Emily Hawes (Commissioner, Department of Mental Health)]: Or increasing number of youth who need that level and require that level of care. Correct me if I'm wrong. These are also in state and out of state institutions. And so your out of state PNMI costs, we don't have as much control over those as we do our in state. So it's a mixture of those varying elements that we don't have control over all of it, at least some of it.

[Rep. Robin Scheu (Chair)]: So I asked before and they said I have to ask Diva, but this sounds like this part is yours, about the utilization piece that's related to your work. What are you seeing are the drivers of that, or what do you sense is causing this?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, that's a great question, and I wish there was one single thing that we could point to. But actually, there's quite a few things that are impacting our youth today. And so you'll see that we've targeted a lot of services towards youth across the system. But namely that youth are presenting with significant mental health challenges and needing additional supports that are more than that can be provided in your typical outpatient setting. So they need more than one session a week or one session a month. They need a more intensive service delivery in order to recover, step down, and be productive back in their communities.

[Rep. Robin Scheu (Chair)]: I think some of this is post pandemic fallout. I mean, I guess you can't it's anecdotal, but

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, it's hard to say. I mean, I think we've all been impacted by the pandemic in one way or another. We know that youth missed quite a bit of social interaction through school. We also know that I have a four year old and an eight year old and they spent years in masks. And so they interact with people a little bit differently at times. So we know that youth specifically are impacted by any major disruption and COVID was certainly a major disruption for all of us.

[Rep. Robin Scheu (Chair)]: Mike and then Dave and then Marty.

[Rep. Michael Mrowicki (Member)]: Thanks for coming in. I don't need an answer now to give you back. Budget. I'm curious, after meeting with the Brattleboro retreat folks, they said they had cut their use of travelers by over half, which is significant savings. I'm just wondering, is the use of travelers in your facilities been high and have you seen a decrease in that or?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes. So the Vermont Psychiatric Care Hospital and River Valley Therapeutic Community residents both experience a high level of fractures. We are from a hospital perspective, we have three less than we did last year. But that is still hovering around 47 travelers to fill vacant positions. And there are complexities to hiring hospital level of staff, specifically psychiatric hospital staff, and that it's a narrowing workforce. And we are a part of the broader state of Vermont collective bargaining agreement. And so we do work closely with our HR partners hiring into range. There are some limits for internal candidates moving up through different positions. We're able to hire folks in and retention is also just as big a big challenge as getting folks in. We have seen an increase in applicants that's not going to impact this testimony, but I certainly hope that we're here next year with a very different story of travel partners. We're also working to decrease those contracts and continue to bring those contracts down. Thanks.

[Unknown Committee Member (House Appropriations)]: Yep, you're welcome.

[Rep. Robin Scheu (Chair)]: Thank you. Dave and then Marty.

[Rep. David Yacovone (Member)]: Often when I'm out and about in my community, I hear from people who say, Dave, if we just had more community based services, sensitive family based services, It's a lot better for these kids to serve them attached to their family with wraparound supports. I said, okay, that makes sense. But if that were done at an earlier stage, could these be prevented Or are these as the PNMI, it's nothing you can do, they just got to go into a residential

[Emily Hawes (Commissioner, Department of Mental Health)]: Well, hesitate to say there's nothing we can do. There are always points along somebody's interaction with the system where perhaps we could have done better or something else could have maybe interrupted that trajectory towards the highest levels of care. And so you'll see that some of the work that we've put into this system with our mental health urgent cares across the age span nine eighty eight. But the folks who are accessing those higher levels of care need that level of care. And so we want to make sure we have tools in the toolbox for everyone. Our goal, though, is that we're able to interact with folks as early as possible because we know the long term effects of being in an institutional setting, whether that's a hospital or an intensive residential program. We don't want adults or youth to be accessing that level of care unless they

[Rep. David Yacovone (Member)]: need Let me just follow-up. Would a more robust success beyond six program change what we're seeing? Is that pretty as good as we can get it?

[Emily Hawes (Commissioner, Department of Mental Health)]: This is going to sound very political, but nothing is as good as we can get it, right? And so each part of the state is very different. Some Success Beyond six programs are working really well because they have been able to hire and they're providing the services that the youth need in those schools. Others have vacancies and that's a little bit more of a challenge. And then we're also seeing folks with private insurance needing access to care that is folks are just as acute, have just as high of needs with their private insurance. So we are seeing some shifts in that population as well.

[Rep. David Yacovone (Member)]: Complicated. Thank you.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes, I wish it were not as complicated.

[Shannon Thompson (Financial Director, Department of Mental Health)]: Humans are complicated. Yeah, I'm going back

[Rep. Robin Scheu (Chair)]: to this line where there's a three point two million increase in private non medical PNMI. Yes. Is that both adults and youth or is that both or is that

[Emily Hawes (Commissioner, Department of Mental Health)]: only youth? It is youth and adolescents.

[Rep. Robin Scheu (Chair)]: Adolescents, okay. And so then does that fit into the third level of your graph here where you have youth residential PNMI that's

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes, on this row intensive residential and treatment programs. The green signifies youth specific programs. And is that the one that you said is not yet open? No, those are open and operating. If you look to the far right where it says youth psychiatric Oh, thank you. Is that a youth player? Thank you. Who did the arrow? Oh, it's helpful. Anyway, the PRTF is not on board yet.

[Rep. Robin Scheu (Chair)]: That is wonderful.

[Emily Hawes (Commissioner, Department of Mental Health)]: That's Rattleboro Retreat. And then the unit at SVMC is a hospital level. And so that's going to be up at the top level. And that's not online yet.

[Rep. Robin Scheu (Chair)]: Okay, gotcha. All right. Thank you. Wayne? And then four years ago, I

[Rep. Wayne Laroche (Member)]: was on the economic development commerce committee. We were trying to provide grants and whatever to get more nurses. Are you seeing that being productive?

[Emily Hawes (Commissioner, Department of Mental Health)]: I think it did provide some initial supports for folks coming in. We partner very closely with all of the schools that offer nursing programs to give them an opportunity to come in to a facility like BPCH. Folks oftentimes picture it as something very different. And so we really try to get folks in there. But yes, those programs did have an initial impact. And we'll see over the long term how that really shifts. But we are seeing an increase in applicants.

[Unknown Committee Member (House Appropriations)]: Yeah, thank you. I'm just curious as to how the drug situation, the opioid crisis, all of the other drug related issues working with these, both adults and with young people, Is this part of your population that you're seeing here?

[Emily Hawes (Commissioner, Department of Mental Health)]: Folks with substance use disorder are the system is managed by the Vermont Department of Health. And so it is very likely that folks who are interacting with this system also have a co occurring disorder such as using opioids or alcohol. We, for say, hospital level of care, you're looking at that hospital level of care for someone's symptoms of mental illness, not necessarily that they need detox or something like that related to opioid use. But we do offer evidence based substance use services across this continuum in a variety of different ways because we know that folks who are interacting with our system are also likely using substances. And we'll talk a little bit about, once the session gets going, about our efforts with certified community integrated health centers, which provides an opportunity for community members to access co occurring care, substitutes and mental health treatment without them having to decide which door they're going. And our goal is that a community member can arrive and we have a system that can serve them whatever their needs are. Substance use or mental health. Thank you.

[Rep. Robin Scheu (Chair)]: Do you have more for us? Yeah. Okay. Next one. All

[Shannon Thompson (Financial Director, Department of Mental Health)]: right. So now we're on to our health facilities appropriation. And this first line item is shifting funding from general fund to Medicaid. We're actually able to bill down Medicaid for certain stays. And we just, prior to this, didn't have a good handle on we didn't have good data on how much Medicaid we'd be able to pull in. So we're just moving this from general fund to Medicaid. Now we've got our What billing section or page are you on now?

[Emily Hawes (Commissioner, Department of Mental Health)]: Oh, I'm sorry.

[Rep. Robin Scheu (Chair)]: 315. 315.

[Rep. David Yacovone (Member)]: Thank you.

[Shannon Thompson (Financial Director, Department of Mental Health)]: Any questions? Moving on down. The next two items here work together. It's really to right size our budget, put money in the right places. So we have the vacancy turnover savings. We've increased that. So it's a higher vacancy savings amount. And we have increased costs for travel nurses. And as Commissioner has spoke earlier, it's not necessarily that we have more travel nurses, we just didn't have enough money in that budget line item.

[Rep. Robin Scheu (Chair)]: Sorry, Chip and then John.

[Unknown Committee Member (called “Chip” by Chair)]: Thanks a lot. So first, if I'm remembering correctly, a couple of years ago, maybe even three years ago, you came in here with a visiting nurse price tag at budget adjustment of like almost $20,000,000. Yeah. So this seems to

[Tracy O’Connell (Chief Financial Officer, Agency of Human Services)]: me like we're going in

[Unknown Committee Member (called “Chip” by Chair)]: the right direction. I'm wondering though, what is the cost of the vacancy rate to

[Rep. David Yacovone (Member)]: the

[Unknown Committee Member (called “Chip” by Chair)]: institution? Because it's not just visiting nurses, right? Yes,

[Emily Hawes (Commissioner, Department of Mental Health)]: so as a whole, let's use VPCH as an example, about this time a year ago, they were at 43% vacancy. And so that's primarily your 20 fourseven positions. Those are your positions that are on the floor. Your nurses and your mental health specialists. Now, VPCH is at 39% vacancy. So we are in a year we have seen that shift. When you are running a facility that has a high number of travelers and permanent staff, but it's off balance, you do run the risk of some impacts with morale. It is not lost on permanent staff that a travel contract is getting more money and more flexibility at But it also has the potential to impact the safety of the facility. And we are always striking that balance of too many travelers and not enough permanent staff where we have the ongoing institutional knowledge and training. We train everybody. Everybody is well trained, but there's a risk when your battle is out of whack with your travel contracts and permanent staff. And so that's one of the real impacts, is the care that folks are potentially receiving. People get good care there, but the laws in Vermont are very different than other states' statutes. And so it takes a period of an adjustment time for folks to kind of come in.

[Unknown Committee Member (called “Chip” by Chair)]: Are there other areas where you are not hiring or not able to hire?

[Emily Hawes (Commissioner, Department of Mental Health)]: There are no areas outside of nursing and our mental health specialists that we are not able to hire. We have a full psychology team. We have a full social work team. We have a full recovery services team, full kitchen, full admissions staff, full staffing office. All of predominantly all of the other ancillary departments are full.

[Rep. Wayne Laroche (Member)]: Same question, just a little

[Rep. David Yacovone (Member)]: bit different. How many people are you deficit? We can get that for you.

[Emily Hawes (Commissioner, Department of Mental Health)]: And that would be a point in time that people are coming and going all the time, but we're happy to provide

[Rep. David Yacovone (Member)]: that. Hi. Good to see you again. Good to see you.

[Rep. Michael Nigro (Member)]: Thanks for coming in. So I kind of have a question about traveling nursing, possibly that, because I just finished serving a six year term as a trustee on our board of directors for our local hospital chair for a couple of years. So it was just a time period, we needed to hire a lot more traveling nurses to fill the void and paying what they were charging here us. We've dropped ours just through more permanent fulfillment of open nursing positions, that's been great here for us. So just to get myself up to speed on kind of where you've been here with us with the cost of that, do they define the cost to you or do you define what we need? It's an interesting question here.

[Emily Hawes (Commissioner, Department of Mental Health)]: It is, Yes.

[Rep. Michael Nigro (Member)]: We've had such big reliance on it, and we still do. So criticism against hiring and traveling nurses, we have to.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes, I love a day when we don't have friends. We would all want that. So we do negotiate those contracts. And we are seeing that negotiation power shift. So during COVID, right after COVID, that negotiation strength really sat with the travel companies. And so as healthcare starts to rebound a little bit, that's shifting and we have a yeah, and we're renegotiating those contracts now. That's been a successful process. It has been so far. It'll be, I think, our third attempt at our third sort of shift down. Thank you. You're welcome.

[Rep. Robin Scheu (Chair)]: Okay. Next slide, I think.

[Emily Hawes (Commissioner, Department of Mental Health)]: We have one other line item,

[Shannon Thompson (Financial Director, Department of Mental Health)]: and that is funds to cover the cost of room and board. Again, it's not necessarily an increase. It's just shifting from Medicaid to general fund to cover those costs.

[Rep. Robin Scheu (Chair)]: So it's just not authorized. It's not what they authorized.

[Shannon Thompson (Financial Director, Department of Mental Health)]: Medicaid will not cover women's ward costs.

[Rep. Robin Scheu (Chair)]: Great. Any questions for

[Rep. Wayne Laroche (Member)]: in case Go ahead, Michael. Back on that same question, how many people are deficit, give you an idea of what the average cost is. Know with overhead and everything else that goes into it, say a $75,000 employee that's making that is probably 150,000 or close to $150,000 Do you have any idea of what it might have?

[Emily Hawes (Commissioner, Department of Mental Health)]: I don't but I would imagine our HR partners have a lot of that information.

[Rep. Robin Scheu (Chair)]: Okay, I'm not seeing any more questions. Okay,

[Emily Hawes (Commissioner, Department of Mental Health)]: well, you.

[Rep. Robin Scheu (Chair)]: Thank you so much, Shakin. I guess I have one more question for you, and that's what I've asked before. You guys are getting set for your budget presentation and you have our agency letter and you kind of know what's going on and you know you can fill with friends over here if you need them. I'll set on that.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes, you. Perfect. We look forward to hearing you. Yeah, thank you. You.

[Rep. Michael Mrowicki (Member)]: You for your service.

[Emily Hawes (Commissioner, Department of Mental Health)]: In my graduation. Power I'll blasts. Great. Enjoy. Well deserved.

[Rep. Robin Scheu (Chair)]: So committee, we are going

[Shannon Thompson (Financial Director, Department of Mental Health)]: to take a seven minute break.