Vermont Legislature SmartTranscripts:

[Rep. Robin Scheu (Chair)]: Good morning. This is the House Appropriations Committee. It is Thursday, 01/08/2026, and we are continuing to talk about lots of different things. This morning, we're going to talk about the Rural Health Transformation Grant. The state was awarded $195,000,000 here for five years, and it's kind of a big deal, as Woody would say. So we're looking forward to hearing about that. So we have Jill from the Agency of Human Services and Tracy O'Connell. Okay.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: So if you both

[Rep. Robin Scheu (Chair)]: want to introduce yourselves and take it away, that would

[Rep. David Yacovone (Member)]: be great.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Sure. I'm Jill Mazel Olson. I am the new Medicaid and Health Systems Director with the Agency of Human Services. I So have responsibilities for the Medicaid program and also for health care reform.

[Rep. David Yacovone (Member)]: And for the record,

[Tracy O'Connell (Chief Financial Officer, Agency of Human Services)]: I am Tracy O'Connell, and I am the chief financial officer with the Agency of Human Services. Is this the first time that you took a few years?

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: This is the first time I've ever testified other than advocacy of speed dating. Yes. Today, we're

[Rep. Robin Scheu (Chair)]: going to practice introducing ourselves. Haven't had to do that for a while. Dave.

[Rep. John Kascenska (Member)]: Good to see you, Jeff. Tracy, good to see you again, too. Good morning. Good morning. I'm John Kascir from the town of Berkeley, the the of district.

[Rep. Michael Nigro (Member)]: I'm Nick Nigro, represent Bennington Pell.

[Rep. Thomas Stevens (Member)]: Thomas Stevens from Waterbury representing Washington Chittenden,

[Rep. John Kascenska (Member)]: which includes Bolton, Huntington and Bureauscore. Marty

[Rep. Tiffany Bluemle (Ranking Member)]: Feltus from London, Robin Scheu from Biddlebury. Tiffany Bluemle from the South End Of Burlington.

[Rep. Trevor Squirrell (Clerk)]: Trevor Squirrell, Underhill and Jericho. Wayne Laroche, Highgate, Franklin, Berkshire and Richford.

[Rep. John Kascenska (Member)]: Hi, I'm Michael Murphy, Sattler. I represent the Windham Ford District of Phi A. Douglas. Lynn Dickinson, I represent St. Albans Town.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Good. Thank you so much.

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

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: so I think we're going to tag team a little bit is our plan. I think I will probably lead us through, but I really wanted to make sure Tracy was here, especially because a lot of the mechanics of things are new to me. So I wanted to make sure we could get to your questions. I've testified on this a few times, and I can tell you it's very hard to get through all 40 projects.

[Rep. Robin Scheu (Chair)]: I also thought there were 30.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: It's kind of 40 when you add a few things in. And I don't have full subject matter expertise, as you can imagine, on every single project. So I'm not going to attempt that. But I will try to give you an overview so you have a feel for sort of the direction that we're heading in and want to share, this is in my slides, that we do have a dedicated website for the Rural Health Transformation Fund. And it does include both, it includes our application, an overall summary. But honestly, I made a list for the list of people. And so it's a spreadsheet of every single project with a short description. So I actually think if you're trying to understand what's in here, this is the most helpful document if you're interested in detail, but not 65 pages of application. Great.

[Rep. Robin Scheu (Chair)]: And so that's on your website? On our website.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes. And there's a link in our slides.

[Rep. Robin Scheu (Chair)]: Okay. Oh, there is. Yes.

[Rep. David Yacovone (Member)]: I just wanted to share that with you. Okay.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Great. I also should just say, I did share this with the committee. I have a hard stop at ten because I'm supposed to be presenting to others at 10:15, and I have to make a transition to another building. So hopefully, we can get through it all. So let me start with the first slide. So I think, as you know, this is an opportunity from CMS, Centers for Medicare and Medicaid Services, to help states modernize systems, their rural health care systems. So it's really meant to be aimed at rural areas of states. And the Notice of Funding Opportunity came out on September 15, and it included a series of directions that CMS wanted to take us, along with some scoring criteria for essentially things that already exist, rural metrics, numbers of providers in Vermont, the size of our state, policies that we might or might not have in place, and then scoring that was impacted by our application. So the first $100,000,000 as we understood it, going to go to every state, was going to get $100,000,000 per year. The question was what would happen to an opportunity for the second $100,000,000 And so the rural metrics, the policies in place, things we could not change, were part of the scoring. And we knew we weren't going to score highly on those. We could score ourselves. And so to me, the size of the award reflects the strength of the application. We did well. And the only metric we had to do well on was the application itself. So to me, it says that we had a credible application. There is a lot of work left to do on implementation. So we're getting lots of questions about exactly how are we going to do this, how will everything look. We are working on building all of that out. This was a really fast moving process. Yes.

[Rep. Robin Scheu (Chair)]: And so who did you collaborate with and bring in and talk to when you were putting this together?

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: I'm going to get there. Okay. That's okay. It's a great question. I anticipated it. So let me keep going. Just in terms of where we are in the timeline. So we submitted our application. We had a little back and forth with CMS right around the holidays around some questions that they had. And in that back and forth, it became clear that one of our proposals was not going to be allowable, which was a proposal to build workforce housing. They really just don't want us to do a lot of capital investment. Renovations. So it just is a limit. It's really too bad. It was a really cool idea. And then we got our notice of award on the December 29. So this

[Rep. Robin Scheu (Chair)]: was really, la la la la

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: holiday season for us. And then we have a budget due back to them on January 30.

[Rep. Robin Scheu (Chair)]: Did you do a budget in the original application?

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes, new budget, because new number. Dollars 200,000,000, now we have to have a 195. Not too It shouldn't be too

[Rep. Robin Scheu (Chair)]: hard to revise it.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: No, it's not Some states have a much bigger adjustment to make than we did. And then we will hear Then they have thirty days to let us know if they have further questions or concerns. So I think it's going to be a while before we have everything fully finalized.

[Rep. Robin Scheu (Chair)]: Let's go to the next question.

[Rep. David Yacovone (Member)]: Just a quick

[Rep. Eileen “Lynn” Dickinson (Member)]: question in the Can you go back one slide, please? And so just in improving access quality and sustainability through infrastructure workforce and care where does affordability play? Was that ever part of the application or the process? Yes, it seemed a very important word considering, especially considering that the federal government has stopped subsidizing people's affordable care. And so I'm very focused on how we use that word, and I don't even see it here.

[Rep. David Yacovone (Member)]: Yeah,

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: so it's an important word, and I totally agree with you. I think what's important to understand is we can't use these dollars for the purpose of the premiums, for the purpose of state match. We can't use it for those things. It is not allowable for those purposes. So this is really about system redesign and where affordability comes in is not direct to individuals, but more about right care, right place, right setting and investments to make that happen.

[Rep. Eileen “Lynn” Dickinson (Member)]: I appreciate that. I just want to make clear accessibility doesn't matter if you can't get in the building.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes, absolutely. Okay. Let me see, we talked about the award, the amount, and I think, oh, and I didn't say this, but we are probably one of the third highest per capita, we think, behind Wyoming and Alaska. And we are the second highest in New England. So again, I think CMS viewed it as a strong application that met their requirements, and we were really trying to meet our own goals. I may skip our I may have to do a different order a little bit. No, I'll keep going this way. So some of the things to know I think I've said some of these, but I wanted to make sure some of these things were clear. So we had areas of focus. So this is not our entire health care plan. This is a tool we're using to support our plan. So there's lots of questions about what isn't in this. And what we're trying to do is match our goals and projects that we want to expand using this opportunity for what we're allowed to use it for. So trying to match our goals with what this does. We can't make it something it isn't. It is essentially one time funding. It lasts for five years, but what we're really trying to focus on launching initiatives, scaling things up, transitioning to new models, purchasing technology and equipment, promoting collaboration, those kinds of things so that we're not left with a lot of programs at the end that we can't keep supporting and that become part of the base. So that is sort of part of our thinking behind this. And then there are some funding limitations. So we cannot supplant the state budget. So if it's something we typically fund with our state budget, we can't use this for it. Oh, I apologize.

[Rep. Trevor Squirrell (Clerk)]: Go ahead.

[Rep. John Kascenska (Member)]: You're sort of heading back here. Don't want stop you

[Rep. Trevor Squirrell (Clerk)]: in a mid sentence. That's Okay. So since it's five years, you're going to prioritize things that would build infrastructure or whatever that would

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Or transition to some new model, change things.

[Rep. Trevor Squirrell (Clerk)]: And just advanced technology and interoperability, some computer work and that kind of stuff to get everything up to

[Rep. John Kascenska (Member)]: snug. Exactly.

[Rep. Trevor Squirrell (Clerk)]: Another question was rural. What do you define rural as?

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yeah. So we have a little bit of work to do there. There are lots of different ways to define rural. We are clearly a rural state, although under this application, we actually were a little less rural than we might all think we are, just in terms of that definition. But there are some specific questions we're getting about providers in Chittenden County and how they fit into this. So we are working on answering those questions internally. And so I just want to acknowledge we're getting those. And I view that as on the list of things we got to sort out. That's one of them we got to sort out. So

[Rep. Robin Scheu (Chair)]: you have to spend $195,000,000 by 09/30/2027. Yeah, so this feels like Yes. We have to spend all the money. We had a longer time frame. Well, the first batch, the CRF stuff, had nine months, which is insane. But, so as you're rolling out a five year timeline, you have to figure out what you can actually accomplish,

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: can spend. What

[Rep. Robin Scheu (Chair)]: I guess you don't

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: have to finish a project. You just have to spend all

[Rep. Robin Scheu (Chair)]: the money by that time.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes, we do also have metrics that we have to meet and we have, so there are various obligations I expect, but yeah,

[Rep. David Yacovone (Member)]: do you want to? That's correct. Okay. And

[Rep. Eileen “Lynn” Dickinson (Member)]: so if the focus is to try to do stuff that we can do

[Rep. John Kascenska (Member)]: after the money runs out, and

[Rep. Eileen “Lynn” Dickinson (Member)]: yet we can't supplant the state budget, I'm finding it hard to connect or to cross that bridge that says, wow if we develop all these new things, I can see technology and you know I mean we just heard from ADS this week and we know that it's kind of an open pit money to try to

[Rep. John Kascenska (Member)]: get it

[Rep. Eileen “Lynn” Dickinson (Member)]: right. So I'm having trouble connecting, not supplanting the state budget and creating new programs that are not things that we already paid for.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes, so I'm not sleeping much. There's a lot to figure out. There's no question about it. So I don't want to represent today that we have this all mapped out. We do have a plan. We do have a budget. We weren't sure how much money we were going to get. So there were sort of a lot of timelines to think through. And we are now working through the process of really understanding at deep level what we can do with these dollars and how we're going to use it. Let me get to the projects, because I do have projects to talk about. So can we hold your

[Rep. David Yacovone (Member)]: question, Lynn, to talk to you about progress? Yeah, I just want to say, you're talking about transformation. Transformation is not a case of creating a new program. You're talking about changing the culture and the structure

[Rep. John Kascenska (Member)]: of the system. That's how we work.

[Rep. David Yacovone (Member)]: Similar to what I think we were trying to do last year on F126. Yes, Yes. So that's different than saying we're going to go and plug in the things that we already do or create new things.

[Rep. Robin Scheu (Chair)]: Right, exactly. This is not backfilling old stuff. Yeah.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: That's

[Rep. Robin Scheu (Chair)]: right. It's shifting. It's a complete shift in how we operate.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Me say a couple more things on the slide. I'm going to get to projects, and I think that will help. I may not satisfy you fully, but I think it will help. So we can't supplant the state budget. We generally can't, fund things that are otherwise billable, although we can do it looks like there's some nuance there where we can do some starting up of things, and we can't generally fund clinician salaries. So there's a lot we can't spend it on. I hear your concern. But there are a lot of things we can spend it on. And, let me start to get to that. Let's see. There we go. Okay. So again, this is many, many projects on one slide. So there's a

[Rep. Trevor Squirrell (Clerk)]: lot

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: here. Like to start with workforce, even though it's not the first one on my list. I like to start with workforce because that is the one that is probably the most straightforward. And one of the things I like about spending dollars on workforce is that it actually is, if you spend money on things like tuition assistance, it is something we can turn on and off. When we take care of tuition assistance and provide people with dollars for a while. We might not be able to support a new class of students, but we can support a current class of students for several years. So it is something where and we have, in fact, in Vermont, put different amounts of dollars toward VSAC and toward funding for workforce. So we do have one of our projects is tuition assistance with a five year service in Vermont that's required by the grant if we give those dollars out. And so that's a program that essentially creates it's essentially forgivable loan in that tuition assistance becomes debt if you don't fulfill your obligation. So it's not debt. It's not debt that you're bringing and we're paying it back. That's the sort of the hook to meet the service requirement. So that's one that's more straightforward. We have also we're talking about restarting the critical occupations program that was at the old Vermont Tech, now Vermont State. And that was a program that allowed for free tuition for critical occupations. So funding for nursing, nurses at all levels. We tried to keep the application as open as we could so that we could consider med techs, pharmacy, all kinds of things that we need across our system. So that one, I think, is going to be the least complicated to achieve and probably where we can move money the most quickly. Could you just help us with the acronyms because I'm

[Rep. Robin Scheu (Chair)]: trying say electronic health records, but then I see electronic medical records and now you have EMS and I don't know, it's just alphabet soup. Thank you. You.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Thank you. Sorry, sorry, sorry. I do speak really fluent healthcare and it is problem for sure. I'm just doing a little too long. So EHR, electronic health record. Yes. EMS, emergency medical services. So EMS is ambulance service. Okay. So it really is the

[Rep. Robin Scheu (Chair)]: EMS that we think of.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: As commonly understood, yes, it's not effective. Yep, thank you.

[Rep. Eileen “Lynn” Dickinson (Member)]: And so the tuition assistance program, would that be based or it sounds a lot like what we've tried to do with the National Guard by recruiting people and paying for their tuition if they promise to serve in the Guard for these part time. Is that

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: I'm not familiar with that, but we have had a nurse a BSAC has had a program for nurses for a while. So that. It's built

[Rep. David Yacovone (Member)]: I can clarify We have that with the pandemic, with ARPA money, and we have critical occupations, it was all the health occupations, it was mental health counselors, it was a couple others, But that was all done by the VSAC because you had free tuition. It was a free virtual loan if you did not skim Vermont. So VSAC knows how to do that.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: And so VSAT is

[Rep. David Yacovone (Member)]: the one that was, we did this winter in commerce as part of the ARPA money. And it has expired from what I understand now. But it was a very valuable thing to get a lot of people in who need to get to school and want to do these professions and want to go and contribute because we need those professions. Exactly. Real shortages. And then at that point, and continuing it this way, it's really going to be basically the same thing as we had before. So we're putting it up to a different pot of money.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: It's a different pot of money and it's more money and also trying to expand it beyond nurses. So the VSAC program that we had was critical occupations was more expensive. The VSAC was just nursing. So we tried to leave room application. Oh,

[Rep. David Yacovone (Member)]: hygiene. Think.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Oh, maybe was dental. Anyway.

[Rep. Robin Scheu (Chair)]: We're gonna move on because we don't have to.

[Rep. Trevor Squirrell (Clerk)]: Just quickly improve transfers transfers.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes. Okay. Again, this is healthcare speak. So, let me go to stronger rural health networks. So we have the blueprint for health. There's a lot to say about the blueprint for health. It is a program by which we support primary care. It's been around in Vermont a long time. It's kind of ready for some modernizing, both in terms of the payment model and in terms of just sort of how we implement it consistently. So there's quite a bit there that will allow us to build on something that we already know how to do. But I think there's room to do it in some new ways and to scale it up further. Transfer is what we mean as transfers between hospitals and other providers or hospitals and hospitals. It's really hard to have good information about where services are available, where beds are available. Now, will say a bed is not a bed. I always say it's not the pillows and blankets that make a bed in a healthcare. It is the people that make the beds. The staff is what makes a bed. But it's really hard to know sometimes where there's availability. We have people being stuck in acute settings that really don't belong there, don't need care. They're taking up space in a bed that it's not good for them. It's not better to stay in the hospital too long, but it can be hard to figure out where to transfer. So other states have come up with some models that seem to be helping to facilitate those transfers. So we want to use these dollars to help with that. So that's the kind of thing where if we improve the process for transfers, it would have a long term impact.

[Rep. Trevor Squirrell (Clerk)]: It's software and training.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: It's software, it's data. Yes, exactly. EMS, we want to enlist that workforce in a new way. So EMS is actually a healthcare workforce that isn't always working. So they might actually be able to go to a home and draw a lab in advance of a procedure, rather than going to the doctor's office. That's good for the doctor's office, a little less work for them. It's good for the patient, because I think we all know taking your mom to the doctor is a family project. It's a family project. So when my mom is not able to drive, which has happened to her a few times and she needs to go to the doctor. It's like a whole thing. She doesn't live here. She lives somewhere else. That's true for families all over the country are experiencing that. And so the more we can bring care into people's homes, better for them, better for families, less pressure on the rest of the system. Filling out mental health urgent care, expanding complex care in nursing homes. So dialysis vent units in nursing homes, will definitely help with our capacity in the acute care setting where people are not able to get transferred out because there's nowhere for them to go. New mobile units for mobile health and dental. And then I do want to pause here. There is funding here for regional transformation. So this is where we're really trying to think about how to this is the most innovative and complicated. We're doing some of this as part of ACT 167 and ACT 68 of last year, working with hospitals to think about what kind of care should they really be providing in their regions? Are there ways to collaborate? Do it differently? We haven't really built it out to non hospital providers. And so this would help us do more of that work to try to get more care we can get out of hospitals. If people don't need to be in the hospital, we want them to be in the lower cost setting. Again, better for them and better for the system. So really trying to work on that. We have more work to do, I think, before we have the dollars will be released for that. We've got to do some more planning work around that. Yes, technology shared electronic health records. We have some hospitals that are interested in sharing an electronic health record that will make data sharing easier for them. There are other ways to achieve that. AI transcription for small providers. And then there's also dollars here for planning and for some other work. I'm going to stop there, because it's just, like I said, it's hard to do 40 projects in short periods of time.

[Rep. Robin Scheu (Chair)]: Do you have a sense of what projects you're going

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: to start on first? We're building out sort of a thirty, sixty, ninety day project plan right now. Definitely, I'm prioritizing workforce because I think it's going to be the easiest to get out the door. So I want to get that sorted. And then there's also projects that I think may have a, I'm sort of trying to think about what can we do quickly but well. And then also, what is going to be complicated that we need to start right now to make sure we're doing the So thinking I'm sort of thinking about it in different ways. That's short term and long term. Short term, long term. Yeah. And so we're working on that project plan and starting to look at the list of projects we've made in sort of

[Rep. Robin Scheu (Chair)]: a new way. And I'm not sure I got my question answered yet. I'm about to collaborate with and all of

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: that. Okay.

[Rep. Trevor Squirrell (Clerk)]: Short term, long term, and also the one that would give those that give you the biggest buck. Yes. After it's all done.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes, all of those things. This is a lot. It's really a lot to think about. And so that's where we get to the public engagement piece. So we did do engagement in advance. So let me say a few things about that. When I got to the agency, I started at the agency part time in September. In order to be engaged on this. I sort of overlapped with my previous closing out my previous job and listening in on this so that I was ready to go roll on October, whatever it was, the October when I started full time. The secretary had already set a vision that I think made a lot of sense, which was, what do we already do that we already know about that we want to scale up? And where do we already have good input? Because we've done so much health care reform work already. And so there's a lot of that. We have a primary care steering committee that's meeting on a regular basis. We had multiple meetings with the provider health care coalition network. We have a page where people could just submit their ideas to us. So we were able to view their ideas. But we also had pretty much our workforce plan was taken from the strategic workforce plan built over the last two years by a workforce strategic planning committee created by this body. I don't remember when, but several years ago. So we really were trying to build on existing work in order to do this. We are now working on our next step of engagement in this time. And so I think we're going to need to do I'm really hearing a lot of anxiety from the provider community that we're going to get out in front of them or move too fast or they won't be able to provide input. So I'm really sensitive to that. As many of you know, I've spent the last twenty five years representing providers. So I definitely hear that anxiety. So we want to give them an opportunity to hear about the projects. And more importantly, we need their ideas, especially on the things that are a little more open ended. We need other thought partners in terms of how to actually roll this out. And we can't know for them what's going to be the most useful. So there's some real work to do there. So that's part of our communication strategy for the next steps as part of our planning.

[Rep. Trevor Squirrell (Clerk)]: Okay,

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Lynn? Yeah, this sounds a

[Rep. David Yacovone (Member)]: lot like what we do with the spectologists. Transformation From of

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yeah, yeah, yeah, yeah. Fair enough. Yeah.

[Rep. David Yacovone (Member)]: Are you planning on hiring a project manager? Oh, yes. We hired a project manager for all of these disparate groups and gave them a chance to help formulate what we needed to do and give their ideas as to how we could do it and actually built a way to dissipate the resistance. Yes.

[Rep. Robin Scheu (Chair)]: So absolutely. Would you like to hire that person?

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes, so the grant does allow us to hire some positions, and we are working on it for us to get a position for a project matter in particular.

[Rep. Robin Scheu (Chair)]: Speed of government has to speed up in order to make this happen. You can't have one coming on in six months.

[Tracy O'Connell (Chief Financial Officer, Agency of Human Services)]: That would be helpful.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: That would be really helpful.

[Tracy O'Connell (Chief Financial Officer, Agency of Human Services)]: So we have been consulting with the joint fiscal team on how to speed up that process because what we might do is do it in tranches because we are in this period where we're still in negotiation, but we have an award. We know we're getting $195,000,000 So we're trying to identify those critical needs right off the bat, which is certainly a project manager and at least a financial manager also.

[Rep. Robin Scheu (Chair)]: Probably HR will be supportive of moving the stacks.

[Rep. John Kascenska (Member)]: Good morning. So I spent a lot of time serving as a trustee for one of our local hospitals. I'm in tune for what we've had to do, the transformation and anticipating this. But also includes our EMS folks in our region because we have two rather large ish services there. They have many towns. Have kind of one of the most rural parts of the state of The United you know, I worked Kingdom. As an EMT here for a chunk of time as well for one of our local services. So kind of understand how long it takes to get to certain places. But where I'm kind of going here is that I understand. So one of the pieces on this, there's some limitations, including which involves billable services. So our EMS professionals there, they're at various levels of paramedics or a little bit lower here perhaps. So I assume there might be potential tuition to kind of bring them up speed so they can do some of those things you noted here in terms of lab kinds of things, which we'd have to just don't get too far into the weeds here, but think about how to get to those places without taking like an ambulance out of service.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes, exactly.

[Rep. John Kascenska (Member)]: Because we struggle

[Rep. David Yacovone (Member)]: with that.

[Rep. John Kascenska (Member)]: We have a bunch of ambulances. We've probably collected, we've got six or seven of the mobile units there. You have to kind of just think about how to balance that all out here, I know. And I'm also aware here too that EMS is in the current position here of looking at regionalization, how can they better leverage what they have to support each other? We do that pretty well, Yes, but it's not

[Rep. David Yacovone (Member)]: but is there ways Yes.

[Rep. John Kascenska (Member)]: I just think you need a project manager for that.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yes. So EMS, of course, the health department has an EMS office, they are going to need some help in order to really move this forward. We do have some models, a model in Brattleboro. So there are some things to look at in the state in terms of other things that we're working on. What I've learned about testifying about rural health transformation is there's always someone who knows way more about EMS than I do on the committee. So I'm not going to pretend that I know more.

[Rep. David Yacovone (Member)]: I don't. You know more.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: And there's a lot of details that we're going to need to sort out. But this is really people are really especially excited about this Yeah.

[Rep. John Kascenska (Member)]: You, David. I just wanted to make those two.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yeah, no, great points.

[Rep. Tiffany Bluemle (Ranking Member)]: Well, I'm excited that this is available to us and may help us move faster towards events that we've been talking about. I'm wondering, system wide, our participants in the whole system, you know, DAs, FQHCs, all of those are going to benefit from this and be participants in it.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: That is our intention. Absolutely. So we really tried to, I actually was a little sensitive when I started in the role because we had certain providers listed and I was like, how are we listing them? Or is there any way we worked on to either try to list them all, which is actually hard. It's easier if you can't believe how often you can just forget somebody. But to make sure that it was always like, and others, so that there's nothing we wrote should restrict us. And our intention is to engage with all of the providers. I am coming from the community provider world. I've worked I've for been around a while. I've worked for hospitals and I've worked for home health. And so I am deep in which is also long term care. So I'm deep in both hospital I work for insurance too. I have a lot of in my mind about community providers, hospitals, everybody's role in the system. What I always say is we really need those community providers to help us prevent hospitalizations. They're the experts. That do we need to ask? How do we prevent hospitalizations? The people who prevent them all the time.

[Rep. Tiffany Bluemle (Ranking Member)]: Well, I guess I was under the impression that there was some question about whether they would be eligible for

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: The only question is about whether or not providers in Chittenden County in particular, That's where the question is lying. What happens to an or I know or so we just have to sort it out because people are concerned about this. We're watching what other states are doing what New Hampshire is doing. We have a little coalition of New England states, and so we're checking with them. So that's the question and we will answer it.

[Rep. Robin Scheu (Chair)]: Okay. Yes. So I'm just briefly skimming your project list, and I see that Maple Mountain residency program, which we tried to get last year, you remember we put money in the budget, and it was sort of contingent on getting global commitment. And then there was it was kind of said, no, I can. So I'm glad to see it here. But it looks like there's also going to be general fund money that's going to be needed for that. It says the state will be contributing from its own funds to support start up.

[Tracy O'Connell (Chief Financial Officer, Agency of Human Services)]: So because of the non supplantation condition, we actually have to use that general fund first to do the startup, but then we would tap the RHT money to fully build out the program.

[Rep. Robin Scheu (Chair)]: Okay, and that's not considered supplanting? No, because we only had,

[Tracy O'Connell (Chief Financial Officer, Agency of Human Services)]: it was one time in nature.

[Rep. Robin Scheu (Chair)]: Okay. So we'll see something in the budget is my guess about that. Anyway, I'm glad to see it in here.

[Rep. David Yacovone (Member)]: Primary care. Yes. One of

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: the few partners actually named this particular Yes. It was there was such strong support. And so Great. Yeah. Dave?

[Rep. Trevor Squirrell (Clerk)]: Jill has to leave,

[Rep. John Kascenska (Member)]: but before she does, it's perhaps obvious to the committee. Vermont is really fortunate to have one of the most capable, qualified people in our little state sitting in that chair, helping to run this at this time. We're lucky.

[Rep. Robin Scheu (Chair)]: All right.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: This is a hard job you guys.

[Rep. Robin Scheu (Chair)]: Is a hard job. It's not getting as much as you thought you were going to get. I mean, think everybody was kind of blown away by that. So in a world where good news is hard to find, it's great to

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

[Rep. Tiffany Bluemle (Ranking Member)]: Thanks. Just to follow-up on Chittenden County.

[Rep. David Yacovone (Member)]: You may follow-up. Okay, thank you.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: I just want to

[Rep. David Yacovone (Member)]: I'm a

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: bit serious here.

[Rep. Tiffany Bluemle (Ranking Member)]: Okay. So Chittenden County service providers, serve folks from all over, right? Yes. So, is it a priority of the administration to find ways to What do you do? What's that?

[Rep. David Yacovone (Member)]: Are you Dave?

[Rep. Tiffany Bluemle (Ranking Member)]: Representative Yacovone? No, she'll answer it, not me.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Okay. Is it a priority of the administration

[Rep. David Yacovone (Member)]: to find

[Rep. Tiffany Bluemle (Ranking Member)]: a way to support Chittenden County providers through this? Do you know?

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: It is a priority of the administration to have a strong healthcare system across our state, absolutely. Exactly whether this is our mechanism, what our mechanisms are, that I can't answer sitting here today. But absolutely, there is no part of our system that we can let go without planning. There may be things we don't need anymore. There may be ways we can do things differently. But we need an entire continuum of care everywhere.

[Rep. Tiffany Bluemle (Ranking Member)]: Agreed. Yes.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Great.

[Rep. Robin Scheu (Chair)]: I'm sure we could spend a lot. Maybe we'll have you back in later when you have budget We'll and all get sort of progress reports would be great because this is a really big deal. Yeah. So thank you very much. Thank you so much for all the work you have to do and good luck getting to January 30.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: That's so hard. Thirty five minutes and not two.

[Rep. Eileen “Lynn” Dickinson (Member)]: Congratulations.

[Rep. Robin Scheu (Chair)]: Found the link to the list right from the thing. So we can post that

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: on our website so people can take a look at it if they want to.

[Rep. Robin Scheu (Chair)]: So, committee, we're going to take a break a few minutes early, but we have transportation, AOT, coming in. They're going to talk about, you may recall over the summer, the Washington administration canceled our EV charger thing, and then I think we've got it back. So an update on that. They want to talk about the T fund. You may recall that with the downgraded revenue for the T Fund, they had to do a rescission. So the joint fiscal committee had to hear about that. So we want to get an update on what happened. And did the people that had to be let go or they

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: landed somewhere? What did they know? And they have some other things they may want to talk about as well.

[Rep. Robin Scheu (Chair)]: And finally, since we have extra time, if you want to read, I forwarded you the December revenue results.

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: Yeah, okay, so take a look. Take

[Rep. John Kascenska (Member)]: a look. And

[Rep. Robin Scheu (Chair)]: so we will

[Rep. David Yacovone (Member)]: go

[Jill Mazel Olson (Medicaid & Health Systems Director, Agency of Human Services)]: offline