Vermont Legislature SmartTranscripts:

[Rep. Robin Scheu (Chair)]: Good morning. This is the House Appropriations Committee. It's Tuesday, 03/17/2026. It's 09:45AM, and we are going to hear Bill H410, which relates to recidivism and other related criminology measures. So we have Michelle Childs from Legislative Counsel. We have Chris Root from Joint Fiscal. And we have the reporter of the bill, Rev Dolan, from House Judiciary. So we'll go in that order and then take a lead, Michelle.

[Michelle Childs (Office of Legislative Counsel)]: Good morning. So for the record, Michelle Childs, Office of Legislative Counsel. And you should have a copy of what was voted out of House Judiciary if you're I don't know what your draft but it's draft 4.2, which is up at the top. And so the judiciary committees, like all throughout the legislature, folks are looking at data driving the policies, and this is one step in that direction. So there's a lot of various places and statutes for certain types of data gathering and reports. And the chair of house judiciary thought it would probably make some sense to start aggregating these things in one location in Title 13, which is your crimes and criminal procedure title. And so what the proposal does is it creates a new chapter in Title XIII for criminology measures. And the idea being that as the legislature is doing its work when it's looking at what kind of data do we want to be making these policy decisions around bail, around sentencing, around conditions of release, things like that, is to try to aggregate all of this in one particular place and make sure there's no overlap and we don't have different things in different parts of titles that might be replicating things or maybe aren't of value any longer. And so you'll see there in section one, it creates the new chapter and creates a definition section. And the only definition we have in there now is a new definition of recidivism. And I'll show you in a section after this is where we are repealing something in Title 28 in your corrections title that has, there's currently a calculation for recidivism, but the testimony has been that that's not really particularly used by DOC. And so you'll see the definition there is more of a plain language understanding of what recidivism is. It's a relapse into criminal activity as evidenced by an individual who's convicted of a criminal offense after receiving a criminal conviction for a previous crime. So basically, you've been convicted once, and you are later convicted of a separate crime. And then there's different ways to measure that. I don't know how detailed you want me to explain this definition.

[Rep. Robin Scheu (Chair)]: I think high level is.

[Michelle Childs (Office of Legislative Counsel)]: Okay. All right. And then the rest of the definition just talks about how you calculate it, the point of which you're going to run the clock. Because if you're doing a three year look back or a five year look back, and so it identifies those certain points in time for the folks who are doing the statistical analysis. Then in Section 8,122, which is on line 18, it's directing the Vermont Statistical Analysis Center, which is a crime research group, which I think most folks have heard of. They're kind of the designated state body that pulls together all the data and is kind of a link between law enforcement and the data and policymakers. So you'll see in subsection A, there's a requirement for certain annual reports. So it's on or before April 1. SAC shall submit the following reports to the Senate and House Committees on Judiciary, the House Committee on Corrections and Institutions, and the Senate Committee on Institutions. And then you'll see on page two the list of the types of reports. So again, these would be annual reports. So, there's an appropriation here at the end, and that is just for FY 'twenty seven, but it would be something that would be reoccurring because we're putting this in statute. The first one is on bail rates. So it's an annualized report on bail rates, including hold without bail, monetary amounts, and bail posting information aggregated by county. The second one is an annual report on recidivism. So it's just using that definition that we just spoke about. And it specifies there for purposes of recidivism that they're using a three and a five year period of look back. The next one, subdivision three, unlike 12, is arrests and clearance rates. And that is to be organized by crime, according to data from NIBRS. The next one is subdivision four, and this is the most convicted crimes. We struggled a little bit with how to talk about that. But colloquially people kind of say it's the top 20 crimes that are charged that we see in Vermont. So you'll see in subdivision A, it's a report detailing aggregated information on the number, type and length of sentences, including the fines for the 20 crimes with the highest number of convictions in the state. And then the second one is a report detailing the total combined years of probation and incarceration sentenced by the court in the prior year. Page three, subsection B is just on demographics, is that when they're collecting this data, if the data is available, then they're supposed to be reporting on race, gender, age, and other demographic available information whenever it's possible. Subsection C is just saying that anybody that has this data is to be cooperating with the SAC to make sure that they can collect this data and provide it in their reports. Section two, this is what I mentioned a little bit earlier, which is there's a current definition of how to measure recidivism in Title 28, and this proposal repeals that. I don't recall the year that that was adopted, but it was prior to Justice Reinvestment I. Fifteen or twenty years. It's been there for a while. Recollection was it was at the time, Senator Sears was working with CRG a lot and looking at moving forward with justice reinvestment. This was a measure that some other states were using at the time. And so Vermont adopted it. But again, the testimony in the House, I think, both your corrections committee and judiciary was that this isn't currently a particularly helpful definition and using a more plain language definition, as you see now in title 13 is more appropriate. So on page four, section three, this is just repealing a cross reference for that definition of recidivism. And now we get to the good stuff in section four at the bottom of page four. And so in FY '27, the following monies are appropriated from the general fund to the SAC. House judiciary just kind of put this as a placeholder, knowing that you're the experts about where it comes from.

[Rep. Robin Scheu (Chair)]: We were concerned about I don't know about the amounts. Do they have any do have a reason for the amounts or

[Michelle Childs (Office of Legislative Counsel)]: The amounts came from SAC about what it would cost them to do the reports from the Vermont Statistical Analysis Center. So SAC,

[Rep. Robin Scheu (Chair)]: we think of as Senate Appropriations Committee. So that's why it's Crazy lady, every time you say that, you're thinking, no, not them. It's something Let me say

[Michelle Childs (Office of Legislative Counsel)]: CRG because CRG basically is the SEC. My understanding is that each state has a designated state entity that is the one that does these types of compilations of crime data. Yes, I see. Okay. Yes. And then you'll just see the amounts that are there. My understanding is that the and I think Chris will probably address it, which is that the money goes to DPS and then goes to CRG through a rant. But they can probably folks can talk to you a little bit more about that. But the numbers did come from Yeah. Okay. Great. Thanks. Tiffany?

[Rep. Tiffany Bluemle (Ranking Member)]: I love data. Making sure it's complete and in correct order. My concern is not that you're doing this because I approve wholeheartedly, but the fact that we may not require certain data or we aren't making a thorough assessment of what data we need in order to make decisions down the road. And it doesn't seem like the data center will be doing that. Is there anybody? Do we have any authority or is there anybody that's actually looking at the data types that we're collecting and making sure that we have what they are. And then whoever is collecting the data, whether it's from the police or from the judiciary or corrections, that they are all on the same page and knowing what data they need to collect in order to make the system work and be accurate.

[Michelle Childs (Office of Legislative Counsel)]: Well, sounds like you want more data. And I can say is that there are various places in statute, not all right here. And I think what the House District is looking at is to try to start to use this as an opportunity to really drill down into the policies that y'all are considering now and figure out what data do we need that we aren't getting in some respect. Because DOC does all kinds of data reports right now, right? And so there's that. Then there's some other provisions. There was an act passed, I think, in 2024, and it's entitled '28 that requires every three years certain data be compiled and stuff. And I think the longer term plan is to be looking at all of it to consolidate it if you're in one place, to make it a little easier to understand what you're asking of people, make sure you're not duplicating anything and to see where the gaps might be. Well, the statistical folks get into the process of doing it, they're going to

[Rep. Tiffany Bluemle (Ranking Member)]: find out what things don't fit, what square pegs don't fit in round

[Rep. Alyssa Black (Chair, House Health Care)]: holes.

[Rep. Robin Scheu (Chair)]: So I think this is a question for the committee member, not for Michelle, who's here to talk about the draft bill. So I want to have Chris come up. Also. You don't have to lead.

[Rep. Eileen "Lynn" Dickinson (Member)]: Chris can sit next to me.

[Rep. Robin Scheu (Chair)]: Did you have a question about clarification on the bill at all, Lynn, or is this something Well, I no, I was trying to think.

[Rep. Eileen "Lynn" Dickinson (Member)]: I remember CRG being a very important part of both institutions and judiciary with incredible data and really good stuff. I'm just curious as to why we're now creating an SAC that would be We're not. We're not.

[Rep. Robin Scheu (Chair)]: So we'll have Rick

[Rep. Alyssa Black (Chair, House Health Care)]: Dillon talk about that.

[Rep. Robin Scheu (Chair)]: These are just the facts people. We'll get all the

[Rep. Alyssa Black (Chair, House Health Care)]: rest of it. Okay. Chris. Hey, everyone. Chris from

[Chris Rupe (Joint Fiscal Office)]: the joint fiscal office. Might be arguably the shortest fiscal note I've written in all session so far. The you know, the there's only three things I wanted to talk to you about with the bill from a fiscal nature. Otherwise, I probably wouldn't have even spent the time to write this fiscal note. But the three things are this appropriates $25,000 for the full report from the general fund in f five twenty seven. The second thing I wanted to mention is that should you agree to fund this, you will probably want to reword the language around the appropriation to appropriate the monies to the Department of Public Safety to then grant to the statistical analysis center. So that's just a technicality of how the money flows. The third thing I wanted to point out is that this is an annual reporting requirement. So this $25,000 appropriation pays for the reports in FY '27. But this would be an ongoing obligation and years beyond that that would need to be factored into budget. So

[Rep. Robin Scheu (Chair)]: It would be base. Okay. And so I do have a question about that, which I'll ask rep about. Okay. Everybody clear on what the appropriation is? And we'll get if we decide we do it, we'll get the Okay. Thank you, Chris. I'm going to ask Rev Dolan to come to the table too. You can either all bring another chair or leave her to be there by herself or

[Michelle Childs (Office of Legislative Counsel)]: Hi, everybody.

[Rep. Dolan (Reporter, House Judiciary)]: I'm President of County Dolan, Senate House Futuciary, and happy to speak to H-four ten. So I will share that I was here in 2023 when the act was passed that Ledge Counsel was referencing. It is Act 40 of twenty And twenty that was a step that we were taking to really be data driven in our decisions. It was building off the justice reinvestment. And so we do have this data report that is created for every three years, and it has lots of data. In some ways, it could be too much data. I think there's different perspectives on it. And the piece that we don't have is that we didn't necessarily codify how that was going to be sustainable. So CRG is an entity that is our statistical analysis center. They get a lot of funding from the federal government through, I'm not going to remember the exact name of it, justice something. As you are well aware that our federal funding landscape is ever shifting right now, and so they can't rely on that money. So they are like, we might not be able to get this report to you, but they were thinking of. And so this for us, creates a sustainable system in statute for us to get the basics of the data. And we're starting with this because we really wanted to find that balance of what is the key data that we need, but we don't want to collect all of it because we know each report comes with a price tag. And so that's the balance that we were trying to create is we agree there's a lot more data that we could be looking at. Let's start with this, create something that is sustainable and that'll be there that we can look to each year. Because as we're also seeing, our criminal justice landscape is also shifting. We're starting to see numbers go up again, and that's a cost for our state. And so we can be looking at those numbers to find what can we do to adjust that for not only costs, but also for public safety and for impacts of the criminal justice system. That's the goal with this. I do have one question myself.

[Rep. Eileen "Lynn" Dickinson (Member)]: Taurus.

[Rep. Robin Scheu (Chair)]: Does it have to be every year? It will

[Rep. Dolan (Reporter, House Judiciary)]: be every other year. What's the worry if it's not every single year? Yeah, I don't know if we talked about that specifically. I think it's hard. Right now, the criminal justice landscape is shifting very quickly. So I would say every year is important. I don't know if it is putting in a piece like So I'd want to in the near future for every year, but maybe there is a point that we could look at it going to every year. We didn't have that exact conversation. So it's something we could explore. Okay.

[Rep. Robin Scheu (Chair)]: I was waiting in a minute.

[Rep. Tiffany Bluemle (Ranking Member)]: That's just a Well, once the databases were built properly, you ought to be able to have an automated generated report every year, but you wouldn't have to have

[Rep. Dolan (Reporter, House Judiciary)]: Yes. So the thing

[Michelle Childs (Office of Legislative Counsel)]: that is tricky with this, and

[Rep. Dolan (Reporter, House Judiciary)]: this is why we really appreciate CRG and their work, is that they have built, and if they're listening, they're probably like, She is not explaining, right? But they have contracts or MOUs with all the different entities. So with the court system, with the Department of Public Safety, all the different ones, to be able to get their data. And then they take it, and I think they have to clean it, scrub it, and put it all in together. So I think even if the database exists, they still have to work with all the different entities to collect their data and put it in so that it all cut, like you're getting apples here, oranges here, watermelons, how do you put it all together to analyze? So I agree, there's some that will be easy, but I think there's some that they have to do the work every year.

[Rep. Tiffany Bluemle (Ranking Member)]: At least maintain it, because we could have the systems linked in ways still things brave, someone that would have to be able to

[Rep. Robin Scheu (Chair)]: Marty and then John. This

[Rep. Dolan (Reporter, House Judiciary)]: is just information for the committee. The Department of Public Safety already has a contract with CRG through the official States Declithical Analysis Group or whatever that is and it's $147,000 a year. It used to be 134 since 2014, this year it's gone up $10,000 This '25 will be in addition. According to the commissioner of the Department of Public Safety, this would be very helpful that this particular group has been very helpful to them in the past, looking at the efficiencies of doing various things, the accountability for it, a variety of other things, and they do rely upon this information. They think it's a small amount to pay for the information they get, and they believe that this extra $20,000 would certainly be well, it's not in their budget but they would have been based. Okay, because it has to go through them. Right, the grant has to. Right, the grant is, they've just, among the agencies they decided to channel them through the Department of Public Safety.

[Rep. Trevor Squirrell (Clerk)]: John, did you have pictures real quick? Have nothing to do

[Chris Rupe (Joint Fiscal Office)]: with the money here, but

[Rep. Trevor Squirrell (Clerk)]: the data that is collected, there a steady flow of that that gets sent to the data center? Is it like thirty six months or experience about that?

[Rep. Dolan (Reporter, House Judiciary)]: That I don't know the specific details of it, but again, they develop contracts with each one of them. And the other thing that we put in the bill specifically is that because that's kind of a different thing, right? You put your data out, put everything out there to the center that's going to create this report that we had that they will have a chance to review, preview the report before it goes live. So they can be like, oh, what? Can we add a little aspect here explaining why this is that? So it really is trying to be a partnership, not just taking your data and posting it. Let's really tell the whole story. When you're talking

[Rep. Trevor Squirrell (Clerk)]: about reporting rates of things here, so time at which everyone should receive the data.

[Rep. Dolan (Reporter, House Judiciary)]: Yes. Yes. Go ahead. Yes. Yep. Thanks.

[Rep. Robin Scheu (Chair)]: Yes,

[Rep. Trevor Squirrell (Clerk)]: I wanna speak to the funding. I knew that this bill was coming here. I knew the appropriation was there. If you remember the conversation we had a week ago about the Gold Board and how we found money in the pre trial supervision program that we're suspending currently, which frees up about 650,000 one time money, dollars 850,000 of base money. And we used 75,000 across those two categories for the parole board bill, my recommendation would be to take an additional 25 out of that $8.50, which is at least one day, to support this program, so we're not adding to our ask in the budget. Right. Okay, we would give them a $25,000 appropriation, but account for it by reducing the appropriation for the pretrial.

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

[Rep. Alyssa Black (Chair, House Health Care)]: But was it still not through the DPS budget?

[Rep. Trevor Squirrell (Clerk)]: Oh, yes. If you're still making an appropriation. We're just counting the

[Rep. Robin Scheu (Chair)]: money, we have the money elsewhere, yeah, so

[Rep. Alyssa Black (Chair, House Health Care)]: we can go to this. It doesn't change that. Love this teamwork, right?

[Rep. Robin Scheu (Chair)]: As my five year old grandson says, we're doing teamwork! It's very cute. Does that make sense to people to do that? Are people, Chris?

[Chris Rupe (Joint Fiscal Office)]: Madam Chair, I'm actually going suggest that if that's the direction the committee wants to go down and this is going to do similar to H1P economic world war, I would suggest that the committee might want legislative council to draft a simple amendment that discuss that money through PSS and I believe that by a good job. So

[Rep. Robin Scheu (Chair)]: if we can get that back then we could vote on this today, maybe this morning. We have another bill that is about to be in our position, and we're going to vote on it this morning as well, the one we already heard, nine forty, which has no money. So we could get that. I'm looking around and seeing heads nod that we want to do this. So if you could just send that back to us and then we'll maybe

[Rep. Alyssa Black (Chair, House Health Care)]: sent something wrong this morning. You already sent something?

[Michelle Childs (Office of Legislative Counsel)]: No, I will.

[Rep. Robin Scheu (Chair)]: Oh, okay. You'll send it. And then I don't know that we actually need to have Michelle come back to tell us that we're giving it to. I don't think so don't worry about that because we can manage it. Chris can also tell us if we need more help understanding the sentence change.

[Michelle Childs (Office of Legislative Counsel)]: And I won't need to be

[Rep. Alyssa Black (Chair, House Health Care)]: here as well. You don't

[Rep. Robin Scheu (Chair)]: need to be here either, but you can sense where we're going even if you haven't voted. So thank you very much.

[Rep. Alyssa Black (Chair, House Health Care)]: Nice, thank you. Thanks for all. Appreciate it.

[Rep. Robin Scheu (Chair)]: Thanks everybody. Hey, we have Thank you. This is perfect timing. We are on a roll here. Let's check our and so I'm wondering, is this going to be, it's going to DPS, but is it Trevor's term or is it, why don't you and Trevor decide? There's a lot of you and Trevor having decided to do that. Fantastic. Doesn't matter to me.

[Rep. Alyssa Black (Chair, House Health Care)]: The actual bill will simply say that we Internally we know where the money's coming from, we are still appropriating money to do

[Rep. Robin Scheu (Chair)]: that for them to. Yes, yes. But it certainly is related to judiciary. It's just who it goes through. So it may be more Trevor type than you probably. We'll tell Trevor if that's the case. Okay, so what ten fifteen. We have Nolan. Does Rev Black know she's talking to Okay.

[Rep. Alyssa Black (Chair, House Health Care)]: Are we

[Rep. Eileen "Lynn" Dickinson (Member)]: allowed to start early? I think

[Rep. Alyssa Black (Chair, House Health Care)]: we're allowed to start early.

[Rep. Eileen "Lynn" Dickinson (Member)]: Are you guys ready to start?

[Rep. Robin Scheu (Chair)]: Okay. So this is age five eighty three. You have that?

[Michelle Childs (Office of Legislative Counsel)]: Yeah.

[Rep. Alyssa Black (Chair, House Health Care)]: So,

[Rep. Robin Scheu (Chair)]: it will be on our website. Then Jen do you want to share the screen?

[Jen Carvey (Office of Legislative Counsel)]: Yes, that would be great. Maybe just do a zoom here.

[Rep. Robin Scheu (Chair)]: I think this is another one that actually doesn't have any money.

[Rep. Alyssa Black (Chair, House Health Care)]: That is correct. Yes. It does have money.

[Rep. Robin Scheu (Chair)]: It does have yes, it has no money. Alright. Thank you very much. That was. So whenever you're ready, Jen, go ahead.

[Jen Carvey (Office of Legislative Counsel)]: Great. Good morning, Jen Carvey from the Office of Legislative Counsel. I will put the phone number on the screen. And we'll give you a high level or as low or high as you wish. But there, as noted at the outset, there is no money in this bill.

[Rep. Robin Scheu (Chair)]: So let's just keep it high level.

[Jen Carvey (Office of Legislative Counsel)]: We are looking at H583, an accolating to health care financial transactions and clinical decision making, although you'll see for the end that the name would change to just an accolating to clinical decision making. This bill adds a new chapter in Title 18 on clinical decision making. It starts out with several pages of definitions, including definitions of hedge fund to be private equity group, which is really what we're currently talking about in this bill with respect to health care facilities. So section what would be AT and ASA 9,772 is limitations on control over clinical decision making by private equity group or hedge fund. And this is the concept of a prohibition on the corporate practice of medicine, if you've heard of the Corporal Practice of Medicine doctrine. And it says the purpose of the section is to ensure that clinical decision making and treatment decisions are exclusively in the hands of healthcare providers and to safeguard against non licensed individuals or entities, such as private equity groups and hedge funds, exerting influence or control over healthcare delivery. And then it prohibits private equity groups in health and hedge funds involved in any manner with health care facilities doing business in the state from doing certain things with respect to the health care facility, like interfering with the judgment of the providers and making health care decisions or exercising control or being delegated the power to set certain standards around delivery of services, hiring or firing of providers based on clinical competency or proficiency, basically doing things that require clinical decision making or clinical judgment if they are not licensed health care professionals. And then some additional provisions around that. And then it allows a health care provider who is aggrieved by the actions of a private equity group or hedge fund or someone controlled directly in whole or in part by a private equity group or hedge fund in violation of this section to bring an action in superior court for equitable relief, actual damages, reasonable costs, and attorney's fees. Section ninety seven seventy three requires health care facilities and management service organ services organizations to provide information to the Green Mountain Care Board by July 1, either saying they do have a private equity group or hedge fund ownership or investment interest, or they do not. If they do have involvement from a private equity group or hedge fund, then they would have to provide certain information to the board a form and manner required by the board, and it spells out what that information is. And then after 07/01/2026, they would also have to report any time they get new private equity or hedge fund ownership or investment interest or there's a modification to that an existing interest. It exempts certain entities from reporting and requires provides that information is public and non confidential, proprietary, or trade secret, except an individual provider's tax ID or personal contact information and the profit and loss statements and balance sheets, although that would be provided to the Office of the Healthcare Advocate. There are penalties for knowingly failing to report the required information and also for a health care facility or management services organization that makes the material misrepresentation in a report required under this section, and it allows the Attorney General to maintain an actions per court to collect those penalties and seek appropriate injunctive relief. Section ninety seven seventy four requires the Green Mountain Care Board by 02/01/2027 and every few years after that. The post on its website a report about the information that was provided to it under the previous section to allow people to have a sense for ownership of health care facilities and management services organizations in the state. Again, that information is largely public except for an individual provider's social security number and allowing the Green Mountain Care Board to share that information with other state agencies as appropriate. The Act would take effect on July 1. You can see, after passage, the title of the bill would be an Act relating to clinical decision making.

[Rep. Alyssa Black (Chair, House Health Care)]: We put up a really

[Rep. Robin Scheu (Chair)]: high level quick run through. I'm not seeing a lot of questions. Nolan, did you have anything you wanted to add?

[Rep. Alyssa Black (Chair, House Health Care)]: We don't

[Rep. Robin Scheu (Chair)]: have a fiscal note because was there money at some point?

[Jen Carvey (Office of Legislative Counsel)]: There was As we understand it, there was a special fund in the bill. There was a special fund in That's the right. It was created to receive penalties. So it didn't have affirmative money coming out of the treasury going into it, but it would have been created to receive penalties for various violations of penalties.

[Rep. Trevor Squirrell (Clerk)]: So the reason we

[Rep. Robin Scheu (Chair)]: all had the special fund, and that's why it's not just our Do you have anything to add to this?

[Chris Rupe (Joint Fiscal Office)]: No, other than, like Jess said, there's no cost.

[Rep. Trevor Squirrell (Clerk)]: There's no physical back state. Great.

[Rep. Robin Scheu (Chair)]: Okay, Rep Black is here, Chair Black from House Healthcare. Do you have anything you want to add to this conversation? I really didn't unless you wanted to read

[Rep. Alyssa Black (Chair, House Health Care)]: the first aid in my bill report.

[Rep. Tiffany Bluemle (Ranking Member)]: So my questions are, did you get any testimony from the industry to let you know what kind of impacts it would have? Is this going to attract medical professionals to the state of Vermont or is it going to drive them away?

[Rep. Robin Scheu (Chair)]: So let's have Chair Black come to the table and sit next to Jen. You can introduce yourself and we'll have the conversation.

[Rep. Alyssa Black (Chair, House Health Care)]: I would say that we had

[Rep. Robin Scheu (Chair)]: Introduce yourself. Oh, I'm sorry. Yes.

[Rep. Alyssa Black (Chair, House Health Care)]: Representative Alyssa Black, Chair of House Health Care, and co lead sponsor on this bill with Representative Bluemle. I would say we had lots of testimony on concerns about the impact of investment in health care facilities, practices, organizations, and whether or not this would improve access or hinder access to those investments. And we took, as evidenced by the fact that this bill is not what it was at introduction, which is probably why it got sent here. We worked really extensively with all the various healthcare organizations that represent providers, represent hospitals, represent facilities, And that's how we landed on the language because we do not want to hinder investment in our healthcare. This also has a

[Rep. Tiffany Bluemle (Ranking Member)]: lot of supporting. Does the Green Mountain Care Board have the capacity to deal with the amount of reporting that would come out of this?

[Rep. Alyssa Black (Chair, House Health Care)]: It is just submitted to the Green Mountain Care Board. And actually, most of the reporting, health care providers have to essentially attest if they do not have ownership or agreements with private equity or hedge funds. So there's probably not nearly as much reporting as it may look like on the surface because the only reporting really has to be done by private equity and hedge funds management service organizations that have a financial relationship with those. And of course, we have no idea how many there are because there is no reporting of that currently.

[Rep. Tiffany Bluemle (Ranking Member)]: So Green Mountain Care Board didn't say anything about the potential to drive people to the of Young Center or anything like that while they're doing this?

[Rep. Alyssa Black (Chair, House Health Care)]: No. And this bill was written in deep, deep consultation with Green Mountain Care Board from the very beginning, as well as the Office of the Attorney General.

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

[Rep. Eileen "Lynn" Dickinson (Member)]: Was there any testimony or anything about the difference between a private equity coming in and a group like the Hospital Corporation of America, which created partnerships with hospitals often in rural areas, or MedStar, or any of those? I mean, those are not private equity, or what's the difference there? I don't think they are private equity, but I'm not sure what distinguishes those two groups. Well,

[Rep. Alyssa Black (Chair, House Health Care)]: we're not sure either, which is the need for this bill. And we heard lots of testimony on the effects within a healthcare system when private equity comes in to a facility on quality, increased costs, closures. I never thought I would have to learn more about leveraged buyouts and leasebacks and just the effects on the healthcare system when private equity comes in.

[Rep. Robin Scheu (Chair)]: So

[Unidentified Committee Member]: the way I'm hearing this just in this short amount of time is that we want this data just to first to simply know where private equity firms, which we're separating out from other kinds of investors, is it because that there's a fear that let me rephrase it. So those are private equity firms investing in things that affect potentially affect our public health system. And what I'm seeing here is that we want this proposal is to get data so we know what who's owning what processes and then we're restricting them from making medical decisions.

[Rep. Alyssa Black (Chair, House Health Care)]: I would look at it in the reverse, which is the majority of this bill has to do with the corporate practice of medicine in that only licensed health care professionals should be making the decisions around health care and medical decision making. So the entire beginning of the bill is around essentially the corporate practice of medicine and banning the corporate practice of medicine. The reporting piece is in place to be able to identify if that is happening because we would not know what's happening without the reporting of how facilities, practices, providers are owned so that we could see violations to the corporate practice of medicine. Did I make that even more confusing?

[Rep. Tiffany Bluemle (Ranking Member)]: Yeah, I

[Unidentified Committee Member]: need another cup of coffee to get there. So I guess I'm just trying to reduce this so we're not as a committee or at least as a committee for jumping too deep into your weeds, but the idea here that I'm trying to figure out if a private equity, if an owner of a facility says well I need to know what those decisions are and shape them in order to make things work or to be successful facility? Did you get pushback from people saying that this might be considered intrusive in the way that they're doing business with a private company?

[Rep. Alyssa Black (Chair, House Health Care)]: We heard a lot of pushback on that they would be doing this and that this is how they operate. And the pushback was essentially, please protect providers and patients. I don't believe we heard anybody, anybody who thought that investors and shareholders should be making decisions about what tests providers order or the length of time that a provider can see a patient or what their coding or diagnostic or billing coding should be. So, there was universal consensus that that is something that we don't want to have happen. And that is why the beginning of the bill is essentially, you cannot do this if you just by virtue of ownership or management service agreements from the clinical practice of medicine. It doesn't mean that you can't make improve efficiencies with technology or that you can't give tools for better administrative. It doesn't mean you can't help out with billing functions and make those more efficient or revenue cycle management. It just simply says you cannot make clinical decisions. And by virtue of banning those practices, we then have the reporting piece so that we know who's owned by who in case those things happen, and also so that providers can have recourse.

[Rep. Trevor Squirrell (Clerk)]: You.

[Rep. Robin Scheu (Chair)]: Arne and then Wayne

[Rep. Alyssa Black (Chair, House Health Care)]: and then Lynn. My only question is on page 11, where you discuss the entities that are exempt from this reporting requirement. And the first one in particular, nursing homes. I wonder why that's there because certainly we have to be terms about ownership. Do. And the reason they're exempted is that there's already a process in place through Dale where ownership structures are reported to Dale and they go through a regulation process that way. Which provides essentially the same information that you're already asking for for these other entities.

[Rep. Tiffany Bluemle (Ranking Member)]: I'm looking at page eight D1, the organizational form of a healthcare facility as a sole proprietorship, partnership, foundation, or corporate entity of any kind shall not affect the applicability of this section. That suggests to me that if you get two doctors that have a partnership that this would apply to them. How would that hinder harm or somehow impact their business?

[Jen Carvey (Office of Legislative Counsel)]: I'm gonna take that Yes, please. So this is in the section on clinical decision making and making sure that clinical decision making is exclusively in the hands of health care providers. So if there is a private equity group or hedge fund involved with that two person practice and some investment or ownership capacity, the private equity group or hedge fund would still be prohibited from directing the actions of the health care providers. So what that provision is saying is it doesn't matter what type of corporate or organizational form the facility, health care facility takes, there's still the ban on the corporate practice amendments.

[Rep. Eileen "Lynn" Dickinson (Member)]: Yeah. Did you hear any testimony with the insurance companies? We did. What did they say?

[Rep. Alyssa Black (Chair, House Health Care)]: Our one domiciled insurance company, Blue Cross Blue Shield of Vermont, is very much in favor of this bill. I believe we also heard from MVP, who is our other insurer in qualified health market, and they also were in favor. We did hear some concerns from Cigna, which is the only other insurer that we have in the state. And they had concerns around some telehealth things that they have, and that's another reason why there is a carve out on the reporting piece for entities whose healthcare services are delivered in Vermont and provided exclusively through telehealth. Other than that, they did not voice any concerns.

[Rep. Robin Scheu (Chair)]: Any other questions for folks? There is no money. We've heard the bill. I would love to have us voted out if people feel like they're ready to take a vote so we

[Rep. Alyssa Black (Chair, House Health Care)]: don't have to come back to it later. I ask a procedural question? Sure. Is it even in your committee yet, technically? Let me

[Rep. Robin Scheu (Chair)]: find out. We are delaying a vote on something that's coming to us this morning.

[Rep. Alyssa Black (Chair, House Health Care)]: This is a very selfish question because I'm wondering when this is going to be on the floor.

[Rep. Robin Scheu (Chair)]: We're holding on yet. There's another one we heard at 08:30 and we hadn't gone on the floor. So now we have to go back around and vote after. But this one we have. And that

[Rep. Alyssa Black (Chair, House Health Care)]: means it goes back unnoticed for the second reading on Thursday. Thank you. That was really, it was very selfish of me to add.

[Rep. Robin Scheu (Chair)]: I'm getting a lot of text from committee chairs saying, when are you doing my bill? You do it later so it can happen next week? The next two weeks or, you know, anyway. I'm just asking for Wednesday to be able to write this thing. Yeah, then it's Thursday, Friday. So if there's no further discussion, I'd entertain a motion to approve H583 So moved. As amended. Thank you, Dave. Second, John. Okay. Any further discussion? Seeing none, when the clerk is ready, you may call the vote.

[Rep. Trevor Squirrell (Clerk)]: Representative Bluemle? Yes. Representative Dickinson? Yes. Representative Feltus?

[Rep. Martha Feltus (Vice Chair) — roll call response]: Yes. Representative Kascenska? Yes. Representative Laroche? No.

[Rep. Trevor Squirrell (Clerk)]: Representative Mrowicki? Yes. Representative Nigro? Yes. Representative Squirrell?

[Rep. Trevor Squirrell (Clerk) — roll call response]: Yes. Representative Stevens? Yes. Senator Yacovone? Yes.

[Rep. David Yacovone (Member) — roll call response]: And represents Shaw? Yes. 1010.

[Rep. Robin Scheu (Chair)]: Okay. And the reporter, I believe, is Dave.

[Rep. Trevor Squirrell (Clerk)]: Oh, do you think so?

[Rep. Alyssa Black (Chair, House Health Care)]: Well, do

[Rep. Robin Scheu (Chair)]: you think there's somebody else?

[Rep. Alyssa Black (Chair, House Health Care)]: I

[Rep. Robin Scheu (Chair)]: think it's you. So thank you all very much. If you just pass it out, it will be on notice today and on the floor Thursday and Friday. You a day and a half to wait until notice tomorrow. Notice tomorrow, two days, I don't know, plenty of time.

[Rep. Alyssa Black (Chair, House Health Care)]: Thank you all. I have another one that's up tomorrow that I have to write tonight. Okay,

[Rep. Robin Scheu (Chair)]: another one we can move from in to out.

[Rep. Trevor Squirrell (Clerk)]: Yeah, well you could put

[Rep. Robin Scheu (Chair)]: that hand to five minutes, one of it to out so we can have that satisfaction.

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

[Rep. Robin Scheu (Chair)]: have emergency management do we actually have everybody here yet? I don't think so. Let's go offline and we'll come back in ten minutes. This is break time.