Vermont Legislature SmartTranscripts:

[Rep. Robin Scheu (Chair, House Appropriations)]: Good morning, this is House Appropriations, 05/20/2026, 10:50 a. M. And we have gotten back on the roll call on record time and are continuing with S-three 28. And we have Cameron with us, and we're going to

[Rep. Eileen Dickinson (Member)]: go quickly through the rest of Bill very quickly.

[Rep. Robin Scheu (Chair, House Appropriations)]: Hang on to your horses.

[Cameron Wood (Office of Legislative Counsel)]: For the record, Cameron Wood, Office of Legislative Counsel, I'll bring you back to where you were, which is on page 11, section seven. So this section is about the special assessment bonds. This was in H775, as you all passed. Over to the senate. No changes from what you passed. And this would allow the municipality when they they could issue revenue bonds when they create special assessment. And this is not my section. This is technically John Gray's section. But when the municipality creates a special assessment, they can issue these revenue bonds backed by that special assessment, not backed by the faith and credit of the municipality.

[Rep. Robin Scheu (Chair, House Appropriations)]: So this is stuff we already did. Already did, no changes. So we

[Cameron Wood (Office of Legislative Counsel)]: can keep going. The next section is going to be on page 12, section eight. And this version of the language is the Senate version of the language. This is about municipal plans within the housing element of a municipal plan. This would be adding in that the housing element has to include an analysis of regulatory physical constraints preventing the development of housing to meet the municipals' housing targets. This is the Senate version of the same concept that was in H July. The House version was just a lot lengthier in the wording. So I'll keep you moving. Section nine is regarding municipal zoning. And this would add in that a municipality, these land development provisions apply to every municipality, and the real change is on page 14 where the municipality would be required to allow manufactured housing for any district that allows year round residential development. This similar language has been in a few bills, and it was in a bill that you passed earlier this session, seven five seven. I believe this was in seven seven five as well. So it's the version of the language that you all have passed a few times here. Next, in section 10, we get to a few reports that are all new. This this section 10, this was in the Senate version of the bill, wasn't in the House version. It requires the Office of Legislative Counsel to issue to you all a report for common interest communities looking at the legal financing and funding compliance issues with requiring a common interest community to allow leasing, allowing commercial purposes within the units, and allowing the development of ADUs on land that's reserved to exclusive

[Rep. Robin Scheu (Chair, House Appropriations)]: So you guys have to do this. And do you have the capacity to do this in the off session?

[Cameron Wood (Office of Legislative Counsel)]: I will be the one doing it. And I acquiesce to the requests. Yes.

[Rep. Robin Scheu (Chair, House Appropriations)]: Thank you. Summer project.

[Rep. John Kascenska (Member)]: Yes, ma'am. Page

[Cameron Wood (Office of Legislative Counsel)]: 15 is a farm worker housing report. So the Vermont Housing and Conservation Board back in 2021 issued a farm worker housing needs assessment. And what this section will do is it requires VHCb to come back to you all with an update evaluating the program's impact on farm worker housing in Vermont and identifying barriers to improve and expanding farm worker housing. Section 12 is a report required from DHCD November 15 to submit a report to you all about page 16. It's kind of the opposite language here. Bills introduced in other states regarding corporate limiting corporate purchasing of housing, a number of covered entities in Vermont, and how many houses have they been purchasing over the last five years. So it's in our corporate purchase of housing report from GACD. All we need to know about that, Stuart. That gets you all the way to page 19, where there's a section 13 here. It's amending an appropriation from fiscal year twenty twenty four for VHCB to expand the use of those funds to allow them to use the remainder monies here to build housing for individuals with developmental disabilities. Your amendment proposes to strike this section because this has been added in your budget.

[Rep. Robin Scheu (Chair, House Appropriations)]: Oh, I saw that somewhere.

[Cameron Wood (Office of Legislative Counsel)]: Yes. So very quickly, ways and means amendment.

[Rep. Eileen Dickinson (Member)]: Yep.

[Cameron Wood (Office of Legislative Counsel)]: Ways and means amendment makes a few changes. First off, for the off-site construction accelerator pilot program. You remember treasurer's office credit facility adds 1% to purchase off-site construction. There was a pilot program through DHCD. This changes the pilot program, so it's no longer through DHCD. It would instead authorize the state treasurer to do a pilot program, allow the state treasurer to use RFIs or RFPs to try to determine whether or not there are developers and manufacturers who can do this type of off-site construction housing, allows the state treasurer to contract with those entities, exempts the state treasurer from your requirements in statute related to state entities contracting out. So they could do very More flexibility. Simplified bid contracts, etcetera. And then it allows the treasurer to use that 1% credit facility to purchase the off-site construction under the pilots. Pilots are looking at very similar things that you had DHCD looking at, primarily bulk purchasing and pooling of, these bulk orders. And then instead of I think the report was coming to you in 2029. Instead, this would be a report coming to you in 2027. The next change is Vermont Housing Finance Agency. A few years back, you all created a rental housing revolving loan program for the Vermont Housing Finance Agency to have a revolving fund for them to help fund development of multi unit housing for individuals in middle income. That was

[Rep. Robin Scheu (Chair, House Appropriations)]: codifies what

[Rep. Eileen Dickinson (Member)]: Yes, ma'am.

[Cameron Wood (Office of Legislative Counsel)]: It was in session law, and it's been amended once. There was a request to amend it again. So at this point, I felt it needs to be in statute because it is a revolving loan program that has been funded in the past. So it will kind of go into perpetuity. So what section five a is saying is that's the reason we're doing this. Five b is adding all of the language into statute. That's why all of it is underlined.

[Rep. Robin Scheu (Chair, House Appropriations)]: Would exist, so you're just putting it in statute.

[Cameron Wood (Office of Legislative Counsel)]: And there's one amendment to it, and I'll just kind of point to this language here. The program was created to be targeted to individuals. I believe it's between 65% and up to 150% of the area applicable area median income. So it was that middle income individuals. The request from BHFA was to take away that floor to allow them to utilize the money for individuals up to 150%. So allowing them to help use the money to finance low income development for houses of lower income. I'll say it that way. That's the only change. It's made twice throughout this section, but that's the amendment that's in here. Lastly, going all the way down to the bottom of page seven and the top of page eight, there are new sections, 7a and 7b, that are being added into statute. This is John Gray's area, not mine. But essentially, what this is, if you remember in the bill, you're authorizing those revenue bonds that are backed by the special assessments. There was some concern and issue with a municipality who wanted to do those revenue bonds not being able to do them if they had a chip project at the same time, a tip district or a chip district. And so the changes here in Section 7A and the changes here in Section 7B are to the practical consequence of adding this language as you would allow municipalities to be able to move forward with a TIP or a CHIP district and still allow them to be able to use those revenue bonds under the special assessment that you've created.

[Rep. Robin Scheu (Chair, House Appropriations)]: So no money for us in Ways and Means. They just did some other stuff, which is fine. Then let's submit our amendment because I think that will explain

[Rep. Trevor Squirrell (Clerk)]: So we get to

[Cameron Wood (Office of Legislative Counsel)]: your amendment, two instances. First, in section two, which is that advisory council that's being created regarding development of housing for individuals with developmental disabilities. It adds in a subsection G, which would say that members of the advisory council who are not otherwise compensated there's a lot of state employees already on that council, so this would not apply to them. But there are some individuals being appointed by private entities. So if someone is not otherwise compensated for their time, they would be entitled to a per compensation. That per diem compensation would have to come from monies appropriated to Dale in their base budget. Then the next is, as I mentioned, striking out that Section 13, that amendment to the FY24 appropriation, which is in the budget or in your budget negotiations.

[Rep. Robin Scheu (Chair, House Appropriations)]: And that's the So we have that.

[Rep. Melissa Black (Chair, House Health Care)]: Have you seen that in the budget?

[Rep. Robin Scheu (Chair, House Appropriations)]: Have you seen the I

[Ted (Joint Fiscal Office fiscal analyst)]: can see why I said it.

[Unidentified participant (remote/technical)]: It's looking Okay. At That's why I saw it.

[Rep. Robin Scheu (Chair, House Appropriations)]: Okay. So it has been closed out. It's already been approved in the conference committee, removing it from here makes sense. It's not confusing to you. Great, thank you. I think we have Ted here to talk about the fiscal note.

[Rep. Eileen Dickinson (Member)]: It's in a minute, somebody, time you'd like at this time of year.

[Ted (Joint Fiscal Office fiscal analyst)]: Is Trevor Net joined the fiscal office. Is you all saw it in July. The language expanding the treasurer's credit facility for the 10% for Vermont program does have a fiscal impact, and I'll walk through that. But that is really the main piece.

[Rep. Robin Scheu (Chair, House Appropriations)]: It's just a two page fiscal note.

[Unidentified participant (remote/technical)]: I don't want to share. That's strange. Okay. Okay.

[Ted (Joint Fiscal Office fiscal analyst)]: So to walk through the background and details section of the fiscal note, the Service Supported Housing Advisory Council, if the folks who are not state employees and eligible to receive per diems, it's maximum about an $8,000 per year piece of Dale's base budget. The 10% for the So I've talked about this in March. I don't even remember what happened in March, so I'll go through it again. We either. Yes. That was a, yes, a compressed time in all of our lives. So the treasurer invests the state average cash balance, which is the local investment advisory committee projects to be between 1.2 and 1 and a half billion dollars in fiscal year twenty seven. They invest that money. They earn about three and a half percent on those investments, and that generates interest income that goes to the general fund. And so in let's

[Rep. Robin Scheu (Chair, House Appropriations)]: see.

[Ted (Joint Fiscal Office fiscal analyst)]: The January 26 consensus revenue forecast estimates that those investments will generate 27,500,000. By increasing the credit facility in the current 10% per month program to 12.5%, you're taking money that could have been invested through the treasurer's normal management of the state's cash balance and putting it into loans that are at a lower interest rate, decided to support various economic development projects, but they're primarily focused on housing these days. And that average in talking with the treasurer is about one and a half percent. So that difference between the three and a half percent that the treasurer could receive if that money were to stay in the cash balance and the additional amount going through what they they call the LiApp program, that would potentially mean that you would forego about $600,000 in interest income at the current 1.2 to 1,500,000. That's kind of a maximum potential cost. It's not The treasurer has indicated to me that it's not gonna happen in fiscal year twenty seven. They'll get authority to lend out those additional funds. It takes time to solicit bids for those monies, make awards, then the awarded projects, housing projects, take time to get up on the ground. So it will take them time to draw down that money. So you might start seeing it in fiscal year 'twenty eight. And really, 600 It's

[Rep. Robin Scheu (Chair, House Appropriations)]: 7,000 that we're basically investing in housing, right? I mean, that's what we're doing. That's a lot less expensive investment in housing than what we do in other areas. So it seems like a good bang for the buck.

[Ted (Joint Fiscal Office fiscal analyst)]: Certainly. And yes, given I really want to emphasize that that $600,000 is a maximum impact as the state fully expands federal funding. We're expecting the cash balance to go down over time. Will it be go all the way down to what it was pre pandemic? It doesn't seem likely to go all the way down there. But yes, we still wanna flag the maximum potential cost right there. For context, the additional amount of money for the 12 and a half the move to from 10% to 12 and a half percent could make an additional $30,000,000 available to be lent out. Is there anything else to say about that? Oh, so for the right, so the language and ways and means, they house general and housing had the up to 1% of that 12 and a half percent. So 1% of the state's average cash balance, not 1% of the 12 and a half percent could be used for this off-site accelerator pilot. Ways and means just change it to a more general that the charter may use a portion of the 12 and a half percent credit facility on the off-site construction accelerator pilot. There's some information and background on that program The fiscal note, but given time, I'm gonna scoot right on through. And then finally, the fiscal note covers some background on the appropriation to BHCB that your amendment is removing from the bill, so

[Unidentified participant (remote/technical)]: I won't spend a lot of time on it.

[Rep. Robin Scheu (Chair, House Appropriations)]: Okay. Any questions on this bill? Wayne, do think you have a question? Comments. Mean,

[Cameron Wood (Office of Legislative Counsel)]: and councils, we seem to get more and more and more of them. That's usually start making me nervous.

[Rep. Robin Scheu (Chair, House Appropriations)]: I think is this an existing council that we added somebody to?

[Ted (Joint Fiscal Office fiscal analyst)]: I think it was it's creating the service support.

[Rep. Robin Scheu (Chair, House Appropriations)]: It's creating the original the initial council. Yeah.

[Cameron Wood (Office of Legislative Counsel)]: We should probably check up on those someday.

[Rep. Robin Scheu (Chair, House Appropriations)]: Well, actually, I think the Joint Fiscal Committee, they summarized the number of study committees and councils. It's different things. There's legislative study committees, and we've actually cut way back on those. We've got crazy for a few years, but we've cut back there. And I don't know where we stand on advisory councils and how that works, but that would be interesting if Jordan Fiskell does something like that, sort of check up new ones would be helpful to know at some point. We will not create legislation to do that, but just saying it's

[Unidentified committee member]: a point of view. We did include a position for a Disabilities Housing Coordinator at AHS. I think that that council could be very helpful to that person in really pulling all the parties together in one place for at least a period of time to kind of inform the direction of that policy.

[Rep. Robin Scheu (Chair, House Appropriations)]: Dale will be the commissioner and designee, so the coordinator will be able to designee. Right, sure. So we're not going to amend. Yes.

[Rep. Trevor Squirrell (Clerk)]: One of the reasons I think this specific piece is important is I've been hearing from a number of parents of adult disabled, and the concerns they're sharing is they see their time on this earthly plane as diminishing and want to make sure their kids are going to be taken care of. I think this is one way of addressing that and helping make sure that it's going be housing a lot.

[Rep. Eileen Dickinson (Member)]: Lynn, did you add as well that's the thing that I looked on last year a lot, and we put it under the bill last year. There's like 16 places available, that pilot series. More We like 600.

[Rep. Melissa Black (Chair, House Health Care)]: Yes we do, That's

[Rep. Eileen Dickinson (Member)]: right. It's a serious issue.

[Rep. John Kascenska (Member)]: That's right.

[Rep. Eileen Dickinson (Member)]: Yeah, it is. It is. Can't leave these people to just sort

[Rep. Melissa Black (Chair, House Health Care)]: of We move around and move

[Rep. Robin Scheu (Chair, House Appropriations)]: all have constituents, I believe. I mean, I talk to mine regularly too, who are worried. I would be worried too. It's a pretty scary thing when you are aging and your adult child needs help and what's going happen. Any other questions about this bill? So what we'll do is we'll vote on our amendment, and then we vote

[Rep. Melissa Black (Chair, House Health Care)]: on the bill as amended, as amended, as amended, or however amended we keep.

[Rep. Robin Scheu (Chair, House Appropriations)]: And Lynn, this is the treasurer's office. I it might be cheers, but she pointed out to the treasurer's office. She's on two minutes of conference, So is there a motion to support the House Appropriations Amendment to this bill? Dave? Second. Don? Okay,

[Rep. Eileen Dickinson (Member)]: when the clerk is ready.

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

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

[Rep. Trevor Squirrell (Clerk)]: Representative Dickinson? Yes. Representative Feltus? Yes. Representative Kascenska? Yes. Representative Laroche? Yes. Representative Roach? Yes. Representative Nigro? Yes. Representative Squirrell, yes. Representative Stevens? Yes. Representative Yacovone? Yes. Representative Scheu? Yes. Eleven zero zero?

[Rep. Robin Scheu (Chair, House Appropriations)]: And is there a motion to approve S-three 28?

[Rep. Trevor Squirrell (Clerk)]: As passed by Senate and amended by House General Housing and further amended by House Faisal Means and

[Rep. Robin Scheu (Chair, House Appropriations)]: further amended by House Appropriations. As amended as amended. Is there a motion? Lynn and Wayne. I repress, John. Oh, okay. Are you still making the motion?

[Jennifer Carbee (Office of Legislative Counsel)]: I'm still making the motion.

[Rep. Eileen Dickinson (Member)]: Does this mean we concur with the Senate? We have to send it back

[Rep. Robin Scheu (Chair, House Appropriations)]: to the Senate. I think it's going to

[Rep. Melissa Black (Chair, House Health Care)]: have to go

[Rep. Robin Scheu (Chair, House Appropriations)]: back. Reverend Mahal, do you want to introduce yourself and say what you think is going to happen? Rep. Mahali, of general of the house. Well, it's our hope if the bill were to pass out

[Rep. Michael Mrowicki (Member; House General & Housing)]: of this committee by amending,

[Rep. Robin Scheu (Chair, House Appropriations)]: then it's our hope. Mr. Reporter? It'll be rep Dickinson. That it would conceivably, if it's immediately sent, it could conceivably go to the floor. Today. And Means would, but it's amended. The Senate bill was missing things. So they would have to concur with us. So our hope is we can send it to them if they asked enough and suspend rules and eliminate it. Perhaps given the senate, they might have talked and looked at her. That's what happened. Okay. So we'll work on it. So

[Cameron Wood (Office of Legislative Counsel)]: along those along this different avenue, have these changes been discussed with the senate or these just the way that this this is such a normal process for us to, like, amend and amend and amend to go back rather than go automatically to conference. But if they deny the changes, are you ready to go into conference with the changes that are in this bill, or is the House satisfied with that?

[Rep. Robin Scheu (Chair, House Appropriations)]: Everything that's in this bill is The only difference that matters really between the Senate and the House is at the time it was all timing, not substance. At the time the Senate was considering this last, The Department of Housing and Community Development decided they didn't have the people they needed to run the Accelerator of Housing Authority, and

[Rep. Melissa Black (Chair, House Health Care)]: they didn't know what to

[Rep. Robin Scheu (Chair, House Appropriations)]: do about it, so they just took it out. So we went to the treasurer said will you do this? And the treasurer said yes, language was negotiated and etc. So that is the only difference and it's Michael

[Unidentified participant (remote/technical)]: Okay, thank you.

[Rep. Robin Scheu (Chair, House Appropriations)]: Okay, then we should stick with

[Rep. Trevor Squirrell (Clerk)]: them ahead of time.

[Rep. Eileen Dickinson (Member)]: And they were okay with it before, but now just changing the person who I have. Your office is actually gonna You'd let them know?

[Rep. Robin Scheu (Chair, House Appropriations)]: Yeah, I'll give that. Okay, good. All right, we have another bill, so let us, I think we have a first and a second.

[Rep. Trevor Squirrell (Clerk)]: Who's got the?

[Rep. Robin Scheu (Chair, House Appropriations)]: Lynn and Wayne. And not seeing other questions, so let us call the roll when you're ready for this.

[Rep. Trevor Squirrell (Clerk)]: Representative Loomley?

[Rep. Robin Scheu (Chair, House Appropriations)]: Yes. Representative Dickinson? Yes.

[Rep. Trevor Squirrell (Clerk)]: Representative Feltus? Yes. Representative Kascenska? Yes. Representative Rosh? Yes. Representative Rooki? Yes. Representative Nigro? Yes. Swirrell, San Yes. From San Yacovone? Yes. Okay.

[Rep. Robin Scheu (Chair, House Appropriations)]: Thank you all. Thank you, Cameron, for coming in. Thank you, Reverend Mahali.

[Rep. Eileen Dickinson (Member)]: You'll do your thing.

[Rep. Robin Scheu (Chair, House Appropriations)]: Lynn is the reporter of the bill.

[Rep. Eileen Dickinson (Member)]: Do we still vote on the amended bill? We just did it. Everything

[Rep. Robin Scheu (Chair, House Appropriations)]: was eleven-zero-zero. And you may need to do a floor report for this afternoon. It. Pat is okay. We're talking.

[Rep. Eileen Dickinson (Member)]: Alright, I'll talk to Becky. Mark, do

[Rep. Robin Scheu (Chair, House Appropriations)]: you want to let Connor know that we maybe you can grab him upstairs in the speaker's office and tell him

[Rep. Melissa Black (Chair, House Health Care)]: we just passed it out.

[Rep. Robin Scheu (Chair, House Appropriations)]: Mean, I can text him, but I've got to do another bill. Okay. So maybe we can get it on the floor this afternoon. All right, thank you. Next bill, homestretched, S197. Oh, do we want to talk about it from when are we here? When are we here at conference of policy committee? Is that you? Yes. Rep Goldman, do you want to come and chat with us about it?

[Rep. Melissa Black (Chair, House Health Care)]: I'm going to do that next. I start the committee.

[Rep. Robin Scheu (Chair, House Appropriations)]: We can are going to vote on on this. Yes.

[Rep. Trevor Squirrell (Clerk)]: Let's be honest.

[Rep. Robin Scheu (Chair, House Appropriations)]: Oh, per shift. So if you want to briefly scout list the policy, then we'll have Jacob Harvey come in to talk to us

[Rep. Melissa Black (Chair, House Health Care)]: about the bill itself.

[Rep. Leslie Goldman]: So welcome. Thank you. Thank you. I think that we can all agree that our health Leslie Goldman from Rockingham health care has health care. Thank I think we can all agree that our health care system is broken, and this bill is trying to move that conversation. We know that in primary care, every $1 spent in primary care saves the system $13 so there's a financial impact. But we also want to make primary care more available to people in our communities. There's really a tremendous lack of access financially for people in recent days with our QHP plans. That's our qualified health plans. Those costs have gone out of sight.

[Rep. Robin Scheu (Chair, House Appropriations)]: I was where people could be on the exchange, and we had a lot

[Rep. Leslie Goldman]: of Lost subsidies. Credits all went away in January. Lost subsidies. So we've lost many people who were having their health care. So primary care access would get people into the system earlier, save money by working to let's see, how do I phrase this with their primary care teams. It's a bill that supports primary care teams so that if an individual comes in, I can give a personal sort of I worked as primary care for a long time. So someone comes in for a blood pressure check and turns out they're homeless. What do I do with someone sitting in front of me who's homeless that can't do their care? So there'll be a team. This still supports the idea of teams so that people can get what they need when they need it and not take clinician time to do it. So there might be a nutritionist, there might be a case manager. And when it came to us from the Senate, it was focused on the blueprint. We expanded it to say, is the blueprint the right mechanism to do universal primary care? That question needs to be answered. So this bill is asking that question and doing the research to do that.

[Rep. Robin Scheu (Chair, House Appropriations)]: So it's about It's mostly about reports and intent and where you're talking I think the most important, I think what's important is what you

[Rep. Leslie Goldman]: just said, the intent section, which is really getting universal primary care and access.

[Rep. Robin Scheu (Chair, House Appropriations)]: Yes, which we aren't going to have next year. But if we don't get started, we will never get there anytime. But we're not going to

[Rep. Leslie Goldman]: have it next year.

[Rep. Robin Scheu (Chair, House Appropriations)]: But we'll have If we don't And to move ahead,

[Rep. Leslie Goldman]: which is great. This is just an opportunity to have a conversation. Great.

[Rep. Robin Scheu (Chair, House Appropriations)]: Thank you. So we'll have Jen come up and talk to us. And I'm not sure if there's a fiscal note. Nope. Okay. Nolan, you can talk to us anytime as well. Yes. Pardon

[Rep. John Kascenska (Member)]: me?

[Unidentified participant (remote/technical)]: This

[Rep. Robin Scheu (Chair, House Appropriations)]: is a quick bill.

[Unidentified participant (remote/technical)]: Okay, I had phone call up in the queue.

[Rep. Robin Scheu (Chair, House Appropriations)]: Okay, I'm supposed to have a meeting at 11:45, so I'm hoping it'll be

[Rep. Melissa Black (Chair, House Health Care)]: a quick bill. And we're going

[Rep. Robin Scheu (Chair, House Appropriations)]: to vote, but the plan is to vote this out. It's not a complicated bill.

[Unidentified participant (remote/technical)]: Well, could be thirty or it

[Rep. Melissa Black (Chair, House Health Care)]: could be 11:45.

[Rep. Robin Scheu (Chair, House Appropriations)]: Can't promise twelve minutes. That's fine, I'm You're resume, so that's fine. Thank you.

[Jennifer Carbee (Office of Legislative Counsel)]: Good morning. Jen Carvey, Office of Legislative Counsel. We are looking at S197 as recommended by the House Health Care Committee. It's an act as it came over from the Senate, was an act relating to payment reform for primary care. As you'll see at the end, the title of the bill would change to an act relating to reform for primary care. As representative Goldman said, it starts with some legislative intent that kind of directs the bill. It states the legislative intent to invest in primary care and to establish a program of universal primary care that is accessible to and affordable for all the Monters and will promote the public good by improving patient experience of care, improving population health, reducing costs and improving the well-being of clinicians and staff. It states its purposes of the bill to obtain information necessary to develop a framework for implementing universal primary care, optimize the Blueprint for Health, determine whether the Blueprint is an appropriate mechanism for providing universal primary care, and then to explore other approaches to universal primary care and whether they may be more suitable than the Blueprint in meeting Vermont's needs. Section two amends the Blueprint statutes. Some of these are just updates, and conforming with, existing, definitions. And then there is some language requiring health insurers to submit quarterly or more frequently information to the agency of human services, or all information that the director of the blueprint deems necessary to do a comprehensive fiscal analysis of the total cost of care in Vermont and to implement one or more payment models. Also, again, some of this is updating language. It does allow for the use of a different quality standard than the National Committee for Quality Assurance's Patient Centered Medical Home standard as a basis for Blueprint payments, and it specifies that health insurance payments to support the Blueprint from health insurers should be in amounts at least equal to Medicaid payments beginning in 2027. Now Medicaid is making the largest

[Rep. Robin Scheu (Chair, House Appropriations)]: Could you just repeat that last sentence?

[Jennifer Carbee (Office of Legislative Counsel)]: Yes. So I'll back up to where our lead in language is here too. So the Blueprint payment reform methodologies include per person per month payments to medical homes or participating practices by insurers and Medicaid for their attributed patients and for contributions to the shared costs of the Blueprint. And the per person per month payments to practices shall be and then it it adds a new seed from health insurers in amounts at least equal to Medicaid payments beginning in 2027. Currently, as I understand it, Medicaid's payments to support the Blueprint are larger than those from private health insurers. So this would direct the insurers to increase the Medicaid levels. There's some updating again to reflect that Blueprint is currently within the Agency of Human Services, more central office level, as opposed to under the Department of Access where it has been before, and give some guidance to the director of the Blueprint on recommendations for payment amounts to strive to achieve or maintain parity across payers and payment methodologies and adjust methodologies annually as needed to support practices in meeting requirements for participation in the Blueprint programs. Section three is a large report on Blueprint payments to practices, primary care, and some other topics. By 01/15/2027, it directs the director of the Blueprint in consultation with others to report to the House and Senate committees with jurisdiction over health care regarding changes to the payment amounts or payment methodologies or both that would be needed to transition the Blueprints per person per month payments to primary care practices to include payment for the routine primary care needs of attributed patients. So, a broader payment for attributed patients who are covered by participating plans. And the report would first start by establishing definitions of primary care services and primary care provider, which are kind of necessary to guide the rest of the work and define which services should be considered routine primary care. Address differences in methodology for different practice types, make recommendations on risk adjustment and attribution methodologies, describe ways that the methodology will balance capacity, volume, quality, and outcomes, ensure mechanisms for ensuring that health plans make accurate and appropriate payments to practices in a timely manner, make recommendations on participation or quality measurement requirements or both, provide an analysis of including cost sharing amounts for individuals covered by participating plans in the methodology, including the extent to which that would run into problems with federal requirements around high deductible plans. Provide an analysis of ways to incorporate a primary care spending allocation target, which you'll see a little bit more about in a minute, into the methodology, provide an operational plan, any additional legislation needed, and a proposed timeline for implementation, and provide a description of the ways in which the Blueprint can optimize the delivery of services within each of its current initiatives, what it would cost to do so, and what the additional per person per month spending would be needed to support that enhanced delivery. And this concept may be addressed in a slightly different way through a form and recommend a process for moving to the health care claims tax to fund the Blueprint rather than collecting from certain payers the way it's done now, including a potential timeline for implementation. And it requires the director of the Blueprint to or designee to be available upon request to provide an update to the Health Reform Oversight Committee during the summer and fall. Section four requires the agency of human services in consultation with the Green Mountain Care Board to report by 01/15/2027 to the health care committees the baseline per person per month spending on primary care services. So what is paid on a monthly basis now for Vermont residents overall and by each payer using the definitions that the Blueprint establishes in its work in the Section three report. And then Section five directs the agency to establish a target for the amount of per person per month spending on Vermont residents that should be for primary care services. So, Section four is what are we paying? What are people paying now? And Section five is what should be paid? And develop a transitional schedule that increases the target over time and provide by 01/01/2028 the spending targets and transitional schedule, as well as any recommendations for adjustments needed to reflect payer specific differences like age and health status. Section six relates to the distribution of duties for health care regulation and health care reform. This requires the Agency of Human Services, Green Mountain Care Board, and Department of Financial Regulation in collaboration with the Office of the Healthcare Advocate to evaluate the roles that their respective organizations play in health care regulation and health care reform, including with respect to certain efforts around hospital transformation, health insurance rate review, management of the Office of the Healthcare Reform, operation of the Blueprint, etcetera. And then it would have the agency board and department identify where each regulatory and reform function should most appropriately be located in order to optimize collaboration, information sharing, and efficient operations, and furtherance of eighteen eighty act 48 principles, improving access to high quality, affordable health care services, accomplishing health care transformation, and safeguarding hospital sustainability and insurer solvency. By 01/15/2027, the agency board and department will each provide specific recommendations on the distribution of responsibilities resulting from their efforts, including areas where they agree and disagree, any gaps and overlaps identified, and any legislative changes that would be needed to achieve their preferred organizational structures to health care and Senate Health and Welfare and Senate Finance, and also requires them to be available to the Health Reform Oversight Committee during the summer and fall upon request to provide an update. Section seven requires the agency of human services by 01/15/2027 in consultation with others to report to the House and Senate healthcare committees with recommendations on ways to accelerate the appropriate transition of patients from hospital care to care delivered in a community setting, including ways to reduce the extent to which primary care services are delivered to patients in an inpatient hospital setting following surgery or other acute care, when it would be as or more effective and less costly to have care delivered in the community. And it talks about the recommendations, including opportunities to use community health themes through the Blueprint to coordinate care transitions and directing the agency to incorporate the recommendations into the statewide healthcare delivery strategic plan as appropriate. Section eight directs the Office of the State Treasurer in consultation with the Agency of Human Services to collaborate with other Northeastern states to explore the possibility of a regional universal primary care program to be available to all residents of the member states and report by 01/15/2027 on the Treasurer's Office's outreach efforts, interest from other Northeastern states, any legal or regulatory obstacles identified and recommendations for next step. Finally, Section nine amends a health insurance statute to require that not less than sixty days before a health insurer removes prescription drug from its formulary, the insurer notify everyone covered under its plans who filled a prescription for that drug within the last year to let them know that coverage will be discontinued when that will occur. The act would take effect on passage. And as I mentioned in the beginning, the title would change to an act relating to reform for primary.

[Rep. Robin Scheu (Chair, House Appropriations)]: This came out of House Healthcare on a ten zero one vote. House. Yep, I just looked it up. Okay, she'll see that. No, it's all right. This is a great time. Dave has a question, and Wayne.

[Rep. David Yacovone (Member)]: Two questions, if I may. Was there any testimony or does anyone know what, if any, there might be on private insurance premiums when their per member per month blueprint share is increased to whatever Medicaids is.

[Jennifer Carbee (Office of Legislative Counsel)]: Don't believe we have

[Rep. David Yacovone (Member)]: We didn't hear that, they didn't, okay. There's no, it was over asked a question we don't know. And then I think it was section seven. I didn't wanna read minds of this than what you said, but an analysis on the potential impact on hospital acute care. What I'm trying to get at is we know roughly a third of everybody in the emergency room doesn't have emergent care needs. Would section seven get at that or do you have to be admitted as an acute care patient?

[Jennifer Carbee (Office of Legislative Counsel)]: I mean, is specifically looking at accelerating the appropriate transition from hospital care to non hospital care.

[Rep. David Yacovone (Member)]: So that could include outpatient.

[Jennifer Carbee (Office of Legislative Counsel)]: I mean, does say including ways to reduce the extent to which care is being delivered following

[Rep. Robin Scheu (Chair, House Appropriations)]: So inpatient

[Jennifer Carbee (Office of Legislative Counsel)]: I think it could be yes. I mean, think it's broad enough. I think it suggests moving care from the hospital setting to the community setting, but whether that's because a patient doesn't need to be admitted in the first place, I think there's

[Rep. David Yacovone (Member)]: I didn't want the regulators to get caught up on that, be too narrow in their review. Thank you.

[Jennifer Carbee (Office of Legislative Counsel)]: Yes, we'll see what you get, Nick.

[Rep. Robin Scheu (Chair, House Appropriations)]: My next question then, Tiff.

[Cameron Wood (Office of Legislative Counsel)]: My question is similar to Dave's, maybe It was testimony taken, we have a delicate balance in terms of having insurance companies in the state, as well as we have problems in the hospitals, what things are going on there. Does this in any way I don't know if you took any testimony from the, insurance companies. Is this an extra burden on them? Something that they that might head

[Unidentified participant (remote/technical)]: towards the big board or not? No?

[Rep. John Kascenska (Member)]: Are you

[Jennifer Carbee (Office of Legislative Counsel)]: talking about specifically the increase to the Blueprint payment? Is that the I don't recall testimony. I know we have one of our major insurers in the room, so I don't need to put him on the spot, but I don't know if you want Would you

[Rep. Robin Scheu (Chair, House Appropriations)]: like to introduce yourself and make a comment?

[Courtney Lawrence (Blue Cross and Blue Shield of Vermont)]: Sure. Thanks, James. Courtney Lawrence, Blue Cross and Blue Shield of Vermont, to get up to Medicaid per member with a month number would be about an additional $3,400,000 to us. So we would expect a small uptick in premiums. And I should just caveat that in saying we also run adjacent to the blueprint our own internal value based care initiatives that are about equal to that amount. It seemed to be really popular with providers. So we would want to make sure that we're also able to keep those intact with the addition of this extra spending. A good question. Thanks.

[Rep. Robin Scheu (Chair, House Appropriations)]: Okay. Lynn? Oh, I missed TIFF. Okay.

[Rep. Eileen Dickinson (Member)]: TIFF, you go. Lynn will go.

[Unidentified committee member]: Okay. Well, this is actually a question, I think, for the policy committee. And I'm struck by this section about you all need to meet in the same room to figure out who's responsible for what, and which pieces of regulation, etcetera. I am assuming that we are being so directive in different parts of this legislation because we are not making the kind of progress that we need to make in a timely way. And that is the really thrust of this legislation.

[Rep. Melissa Black (Chair, House Health Care)]: For the record, Representative Melissa Black, Chair of House of Health Care. So, you know, it is very often in many of the things that we work in, in all issues that we work in healthcare, that, you know, we have multiple different voices who are tasked with differing things. And oftentimes, you know, sort of don't work together, not that the people don't work together, but that the tasks aren't working in alignment with each other. I'll give you a perfect example of, you know, we're going through this system of hospital transformation and we have, you know, Fremont And Care Board who is responsible for hospital budgets, and yet we have the agency human services responsible for hospital transformation, and that when they're working in those silos, it's

[Rep. Robin Scheu (Chair, House Appropriations)]: difficult for the Green Mountain Care

[Rep. Melissa Black (Chair, House Health Care)]: Board to make determinations on individual hospitals and their budgets when they're not quite part of what is AHS doing to sort of bring down costs or realign services within causal transformation. So this is, you find that in many different areas that there's sort of these, okay, you're tasked with this, they're tasked with that, they kind of work at opposite push pulling of it. And this is really sort of a, if we are going to move forward with universal primary care, then I feel as though the general assembly needs to really have a good read on if services and systems are aligned currently and where things should go if we're moving to universal primary care, where we want to put them. Because I will say for myself personally, I'm lucky enough to be reelected, that I have no interest in saying, you do this, you do that part, you do that part, you do that part, that won't work. And we want to make sure that it's successful. And I will say that all parties need to do this are very agreeable and optimistic.

[Rep. Eileen Dickinson (Member)]: Great. Great. Thank you

[Rep. Melissa Black (Chair, House Health Care)]: for the work, Robin. Thanks. Any

[Rep. Robin Scheu (Chair, House Appropriations)]: other questions? Lynn, go ahead. No.

[Rep. Eileen Dickinson (Member)]: I am really a proponent of quality primary care. I am a proponent of making it accessible and as inexpensive as possible. I see this as just a bunch of language. There was a data council that was started by Richard Snowden that was going to look at the cost of health care. That became the public oversight commission, Dave and I served on. That was the next step. We regulated everything that you could possibly think of along the way, insurance companies, hospitals, COMs, everything. Blueprint came out of that. Now we've got the Green Mountain Care Board. And we just keep adding the same language all the time with every bill. And I'm not sure it really and the ideas are good. We're talking about creating teams. Medicare has that. I get called all the time at home about my Medicare. Do you need to talk to someone? Blah, blah, blah, blah. We have capitation systems. I'm not sure that they work, but they are there. They always go to a capitation system. The question I have, we've had this blueprint probably for about twenty five years, and it was supposed to do this job. Has anybody ever measured the success of blueprint? I mean, we've probably had hundreds of studies over the course

[Rep. Robin Scheu (Chair, House Appropriations)]: of Like they may have talked about that. You have

[Rep. Eileen Dickinson (Member)]: a response there? Did your point?

[Rep. Melissa Black (Chair, House Health Care)]: These are twenty years, blueprint has been in existence for twenty years. I think that the language that we have in the intent section, the bill that came over from us from the Senate was very focused on the blueprint. And I think the intent language that we have added to the Senate's bill pretty clearly states that we're not sure the blueprint is a right mechanism to move forward. The first part

[Rep. Eileen Dickinson (Member)]: of the is really sort

[Rep. Melissa Black (Chair, House Health Care)]: of the blueprint kind of reporting back on itself, and they're actually in the process of doing this all right now. I keep referring to it as sort of modernizing the blueprint, but if we're going to move forward with universal primary care, again, this is to the point of the other section, we need functions that we have currently to be operating at their maximum efficiency so that we can make the determination whether or not that's the right mechanism and that's the right place to go. But yes, our committee has had many, many discussions about the blueprint and whether the blueprint is achieving what the blueprint was set out to do, how they're measuring themselves, how they measure providers. I would say in the last two weeks we've had Doctor. Suvone from the Food for Health and School Director of Luke Mrowicki. He's in our committee on three separate occasions. We are having that conversation. I think that if I could add, there's a no need from a lot from him that he is interested in modernizing the footprint and the word. They're not mentioning right outcomes because they read data and they want a whole ability to revise that, so this gives them the structure to do that. And then answering the question, is this the right mechanism to give

[Rep. Eileen Dickinson (Member)]: yourself access to universal primary care? And for

[Rep. Melissa Black (Chair, House Health Care)]: a question, we don't know that answer yet. We heard all about Turkish, the professors at Harvard, very aggressive, so it's on the table. It is a new one in Massachusetts, it's on the table. So there's a lot of people doing this kind of thinking right now, and we wanna join in that.

[Rep. Eileen Dickinson (Member)]: My memory serves me correctly that their blueprint was a pilot for two or three hospitals, and then

[Rep. Melissa Black (Chair, House Health Care)]: it was made the next year for two more hospitals. It started in one practice, St. John's Fair, and it's now 110,100

[Rep. Eileen Dickinson (Member)]: Yes. And Eventually, they skipped the pilot analysis and they just made it universal for everybody and it went to all sorts places. The point of it is that I have a question. First of all, why is the commercial insurance paying less than Medicaid for your capitation? Number one, usually it's the other way around. Commercial insurance pays a whole lot more. Medicaid and Medicare pay a lot less.

[Rep. Robin Scheu (Chair, House Appropriations)]: Think that we're Getting a bit off the

[Rep. Eileen Dickinson (Member)]: I understand that. But the next question is, why do we have this bill other than the fact that there's like six reports in here? We just talked about studies. Here we go.

[Rep. Robin Scheu (Chair, House Appropriations)]: Well, we don't have six study committees. We have the people who are in here. Mean, if we think that universal primary care and cutting green the cost, we do nothing. Nothing's ever going to happen. So I think this is an attempt to be intentional about moving forward with a process that isn't committing us to doing anything other than at this point gathering information to see if it makes sense. Remember when Sheldon did single payer? And then they found out the cost. Everything sort of collapses that. That was kind of the last time we did anything big around primary care. And yet the need hasn't died. So I think that's really bad.

[Rep. Melissa Black (Chair, House Health Care)]: Go on, Alyssa, last thing I just want to say that I believe the reason, the two reasons that this committee is listening to this now is that in the original version of the bill, it did go to Senate appropriations.

[Rep. Robin Scheu (Chair, House Appropriations)]: We did equal time.

[Rep. Melissa Black (Chair, House Health Care)]: Also there is still looking at the claims tax. That's an alternative. I think that's

[Jennifer Carbee (Office of Legislative Counsel)]: a ways and means. Yeah, went to ways and means.

[Rep. Eileen Dickinson (Member)]: Do you remember what their code was?

[Rep. Robin Scheu (Chair, House Appropriations)]: 911. 911. So there is no money, and we'll get information next year. That's kind of where we are. Okay.

[Rep. Melissa Black (Chair, House Health Care)]: And I'll see you at

[Rep. Robin Scheu (Chair, House Appropriations)]: Black called me sometime this year and said, if I put in HRAS, which I said I know, we'll have more meetings. All right, John, did you have a question also?

[Rep. John Kascenska (Member)]: Another question, just a couple of comments on but we did have the order of the main issue for the food together in terms of the effectiveness of the condition here of food with their health, so that's out there. And we've seen that as well. Yeah, you've got some

[Rep. Melissa Black (Chair, House Health Care)]: piece right there. Right,

[Rep. John Kascenska (Member)]: this is probably this is kind of coming from here and so this is good I think. The other part of this here too, know, should this come to fruition at some point to, you know, start this conversation, see what we ought to do to kind of make this better here for all of our things and stay beyond here. I think one of the things we need to be conscious of here is to make sure nothing about the budget model of kinds of things, which sometimes we make changes here in legislation and there's some unintentional things, but it may not work financially here for all areas for healthcare providers, here for sure. And I think hospitals and other care facilities just need a little more of a need time and heads up on that. So I'm just a word of encouragement take a look at that, we would be.

[Rep. Robin Scheu (Chair, House Appropriations)]: To

[Rep. Melissa Black (Chair, House Health Care)]: working in primary care right now and a lot of the skills is really trying to support primary care as well So we don't have enough providers, we don't have enough access, that's why other parts of the system are being strained like ERs, permanent care. So this part is also addressing the provider experience, is why that's what hit our attention.

[Rep. Eileen Dickinson (Member)]: One last thing. You're depending on human behavior.

[Rep. Robin Scheu (Chair, House Appropriations)]: Sorry. Talking about the providers.

[Rep. Eileen Dickinson (Member)]: Pays. Pays big time, and it's important. And if we could focus our attention on paying that Prevention. Yes, working with prevention. But you're depending on human behavior. People who go to the ER, that's what they do. I mean, it's a very unfortunate situation, but that's what happens.

[Rep. Melissa Black (Chair, House Health Care)]: What we're going to do with while meeting up being over to the office?

[Rep. Eileen Dickinson (Member)]: Yeah, I'm just yeah. And the other thing is, I did ask the president of UDM, the way you get Vermonters to go and live and work in Vermont as a

[Rep. Robin Scheu (Chair, House Appropriations)]: primary care now is to go

[Rep. Eileen Dickinson (Member)]: and invite more Vermonters who live and work in Vermont to the University of Vermont Medical School, like a lot of medical schools in states do, flagships.

[Rep. Robin Scheu (Chair, House Appropriations)]: All right. Thank you all. And Nolan, there's no money. No appropriation. Okay. Great. We just got our moment in the sun. If there are no other questions,

[Rep. Eileen Dickinson (Member)]: I would entertain a motion to support S197. So Dave Tipp.

[Rep. Robin Scheu (Chair, House Appropriations)]: And so this is

[Rep. Melissa Black (Chair, House Health Care)]: And it

[Rep. Trevor Squirrell (Clerk)]: has passed Senate and amended by health.

[Rep. Robin Scheu (Chair, House Appropriations)]: And amended by health care. We don't have one, so we're only having one vote. Okay, any further questions for the committee?

[Rep. Eileen Dickinson (Member)]: Okay, if so, if the clerk is ready, let's call the roll, please. Representative Bluemle?

[Rep. Trevor Squirrell (Clerk)]: Yes. President Dickinson? Yes.

[Rep. Eileen Dickinson (Member)]: Yes.

[Rep. Trevor Squirrell (Clerk)]: Okay. I'm Roseanne Feltus? Yes. Representative Kascenska? Yes. Ben Laroche? Yes. Representative Roveicki? Yes. Representative Nigro? Yes. Squirrell, Representative Stevens? Yes. And Jack Cafony?

[Rep. John Kascenska (Member)]: Yes. And Rose Hood?

[Rep. Melissa Black (Chair, House Health Care)]: Yes.

[Rep. Robin Scheu (Chair, House Appropriations)]: Thank you all. Dave, would

[Rep. Eileen Dickinson (Member)]: this be yours, its blueprint?

[Rep. David Yacovone (Member)]: I don't want to encroach on someone else.

[Rep. Melissa Black (Chair, House Health Care)]: Can you help you do it?

[Rep. David Yacovone (Member)]: I'll be happy to

[Rep. Robin Scheu (Chair, House Appropriations)]: do Okay, and also this the one that also gets reported on the floor this afternoon. You don't have a very complicated thing to say. I'm going to let the speaker know we're trying to move things fast, so we'll see. So that bill and the bill Lynn already has may be on the floor this afternoon. Okay, committee. Thank you. Do we have a bill this afternoon? Not yet. So we have an amendment to the cannabis bill. Once that's done, we'll hear the cannabis bill probably just as well we didn't hear it yesterday because it's all going to change with this amendment. And we have 197, which is the other bill that came over from health care. I think we're going

[Rep. Melissa Black (Chair, House Health Care)]: to hear that one tomorrow. This

[Rep. Robin Scheu (Chair, House Appropriations)]: is 197. Okay. So that I think will be tomorrow, will not be this afternoon. And then we have the miscellaneous ag bill and there may be another amendment to that. So we have maybe three