Meetings
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[Unknown Committee Member]: Can
[Alyssa Black (Chair)]: you tell me when we're actually live?
[Daisy Berbeco (Ranking Member)]: We're live, everybody.
[Alyssa Black (Chair)]: Sorry, I just snapped at everyone. Welcome back. We're back after a short wait and we've got about twenty minutes and I asked representative Berbeco, Daisy, to, as I was sitting on the floor listening to all the doors coming to healthcare, I'm like, Rebecca, Rebecca, Rebecca.
[Daisy Berbeco (Ranking Member)]: Hey Daisy, why don't you tell us about
[Alyssa Black (Chair)]: some of the bills that you've introduced?
[Daisy Berbeco (Ranking Member)]: Thank you for giving the time. I do have several bills.
[Alyssa Black (Chair)]: Shout out if you
[Daisy Berbeco (Ranking Member)]: want me to I wasn't going to talk about the one that we're talking about, which Mike, the prescription drug one. Yeah, we don't need to do that one.
[Alyssa Black (Chair)]: All right, let's start with They're short form, so tell us about what problem we're trying
[Daisy Berbeco (Ranking Member)]: to solve for. Five twenty two, age five twenty two. And have you all figured out how to find the bills on the legislative website? You can sort of
[Alyssa Black (Chair)]: bills and
[Daisy Berbeco (Ranking Member)]: then just use the search bar. That's the best way that I do it. If you
[Alyssa Black (Chair)]: have the number. I go to our healthcare page and it's bills in and out of committees, and it'll tell you all the bills that are in our committee. And H522 should be
[Daisy Berbeco (Ranking Member)]: in there. It's a short form bill. This is one that was up last biennium as well. It's intended to increase the oversight of the use of psychotropic medications for youth that are on Medicaid. So any psychotropic med that's used, like SSRIs, the things that treat depression and anxiety are an example. Those are used off label if they're used in children and youth. And they're used very heavily for kids with behavioral And disorders or mental health there is not a lot of reporting. In fact, think it was the Human, yeah, the International Human Rights Commission actually did a report and found that Vermont is severely lacking in oversight and accountability on monitoring the use of these drugs. So they approached and asked if we would consider increasing our monitoring reporting. The Human Rights Commission. Vermont. National. National. Yeah. And we're not
[Alyssa Black (Chair)]: There's nothing in this bill that is banning the youth. There's nothing that It's really more of an oversight. Well, it's
[Daisy Berbeco (Ranking Member)]: a short form. So short form bills are I do have legislative language now, but it's putting the conversation up there. And I don't have a stance on this. I don't have any specific things that I think we need to start monitoring. But as a committee, I'm saying, let's please bring up this topic and talk about what the problem is and what we think we might do to improve it or solve it. H, I'm going to go to 573. Okay, we're going to get a little more technical. Involuntary commitment is when someone is brought into mental health care, hospital level of care, a physician, being certified, that they are a threat to themselves or others, and they're in need of treatment. So they're not voluntarily coming into hospital level of mental health care. There's a process. It's a very if you look at the statute for how involuntary commitment is done, it's very lengthy, detailed, I think, confusing still. One thing that happens is at the start of it, there has to be a person who, say, witnesses an event if someone's in the community and having a mental health crisis. A law enforcement officer might file a paper that says, I think this person is in need of mental health care. And then they have to be certified by a physician after that. Right now, there's not enough approval. And BOSS, the Hospital Association, noticed this. There are not enough people that can do that first step that has to be done by a certain license of person. And there are not enough people that are licensed to do that. So there's this bottleneck. And these folks who are in mental health crisis are ending up in our emergency rooms, where they are not getting care. Those people in emergency rooms are not at all trained to support folks in a crisis. So what this bill would do is it would increase the type of folks to include physician assistants. So they could also help open up the start of this when people need to get into a higher level of care or get into hospitalized care. But it doesn't mean that it changes the bar at all for the requirements that someone needs to go through in order to certify that someone needs that level of care. It just simply opens up a bottleneck so that folks aren't languishing in the emergency room. Do have a question?
[Unknown Committee Member]: Yes. So would they have to see a physician themselves? Okay,
[Daisy Berbeco (Ranking Member)]: so they Yeah, there's a better choice to go see
[Unknown Committee Member]: a physician and then seek additional help after that?
[Daisy Berbeco (Ranking Member)]: No. So the first thing is someone has to fill out a request for a physician to come and certify that they need it. So you have to have a physician. Right now, it's a qualified mental health professional. And the hospitals are saying, can we please add physician assistants? Because that's who's most often available, especially in rural hospitals in Vermont. So we want to make sure that folks who are really actually the ones that are most often seeing these folks are able to do what they can to get these folks closer to care.
[Alyssa Black (Chair)]: Correct me if I'm wrong, are we referring to involuntary or voluntary or both? This is involuntary. So if somebody's seeing their own and decides to then seek additional, would be voluntary. It wouldn't apply to this.
[Daisy Berbeco (Ranking Member)]: Is your question valid? Do a How quick
[Unknown Committee Member]: does, because it is involuntary, how does that nexus or that shift? Like you've had the person report and then you're supposed to see the medical, whatever category of medical professionals that would be able to certify, how does that happen if it's involuntary? Like, don't go knock on the doctor's door and
[Daisy Berbeco (Ranking Member)]: say, Here I am, check me out. No, they don't. There's a form that has to be filled out by someone who witnesses an event and sees that the person is potentially in need of mental health care or getting care potentially to themselves or others. And then they have to get a warrant for a physician to come out and certify that, yes, this person is indeed in need of mental health care. And then they get in the custody of the commissioner. It's, like I said, a very lengthy process that is in statute and frankly very confusing. I think we'll see other bills about this process possibly. I don't want
[Alyssa Black (Chair)]: to get into it. I think there, if I'm not mistaken, I think judiciary. This is one area where our committee processes the judiciary. And I think that they might have a bill. So we will probably do maybe a sort of a flyover drive through. We try not to
[Daisy Berbeco (Ranking Member)]: use drive by in the community. And
[Alyssa Black (Chair)]: we'll get into the whole process of how things, how it's set up currently for voluntary, involuntary. Katie, that brings Katie to the the person that's right now just the physician that can do that, correct? And you're asking for the scope to be broader?
[Daisy Berbeco (Ranking Member)]: Yeah, yeah, well, for the first step it has to be, I think, a qualified mental health professional. Okay. And so I'm saying physician assistants Yeah. Should be able to do
[Alyssa Black (Chair)]: Are they actually a certification for those that can do that, or is it?
[Daisy Berbeco (Ranking Member)]: Yeah, there it is. PAs. For the mental health folks. Yes. Okay. Yes. And this is just the first step. They don't assess a mental health or anything. This is just the first step of saying, yes, this person is in crisis and gets help.
[Alyssa Black (Chair)]: And you expanded it to include nurse practitioners, nurses, social workers, and just looking at the language. So it's beyond PAs, just really expanding. Thank That's the proposed point.
[Daisy Berbeco (Ranking Member)]: That's good. Okay, great. And then there is
[Alyssa Black (Chair)]: Start with an H.
[Daisy Berbeco (Ranking Member)]: I'm probably a five. I need reading glasses.
[Leslie Goldman (Member)]: You got 576, 586.
[Daisy Berbeco (Ranking Member)]: 586 is reintroducing something actually Leslie and I introduced together last Friday.
[Leslie Goldman (Member)]: I was
[Daisy Berbeco (Ranking Member)]: happy to see that, thank you. Yes, which proposes to limit the use of facility fees for certain hospital outpatient department services.
[Leslie Goldman (Member)]: You can explain that.
[Daisy Berbeco (Ranking Member)]: Well, is a short form. So again, I just want to point out it's not as detailed in its scope as the previous one. So it allows us to debate this because I think it's a very We would have to do a lot of work having the hospitals come in and explain to us the variety of things that go into a facility fee. But this would say, if I go to the hospital and I am getting a procedure that is a minor procedure, I want us to have a conversation. Should we be paying a facility fee for that? When is it appropriate? Should we standardize when it's appropriate and when it's not to pay a facility fee, which can be $3,000 I think it's one way to look at addressing our premiums and penny affordability.
[Alyssa Black (Chair)]: And I will just say that since I've been in the legislature, a bill like this has been in some form on every single wall. And I noticed that five eighty five representative McFaun's bill had a piece in it. And I thought, where's our facility fee filled this year? And there wasn't one, so I asked if they need to do some work on that. Because there is a piece.
[Leslie Goldman (Member)]: So authority we're to have over there? We can facility fee. What are we trying to legislate?
[Daisy Berbeco (Ranking Member)]: Well, it's a short form to open the conversation. I have no idea, to be honest, what's our authority. But there is a lot we can do in terms of the budget process with the Green Mountain Care Board. We did some stuff with that. There's another bill. I don't know the number, which is related to this. It would make hospital board meetings have to follow public open meeting laws. Yeah, because right now they don't. So nurses can't sit in on their hospital conversations that their leadership is having about their workplace. And I think that that's really unfair. So the bill would pull language from what we had for the ACO modeling after that as a starting point. But I was really shocked when I heard that hospital meetings are not open and following public meeting law, given the amount of federal and state funds that they receive.
[Alyssa Black (Chair)]: And full disclosure, I intend, and I'm not quite sure when I'm going to do this because I'm still sort of waiting for a couple other things, but I really feel like we're going to do a deep dive on hospitals, hospital billings, different categories of hospitals and how they bill and what fees they receive and how they get paid. And so I feel like this facility fee, there's also a piece around some pay parity in one of these other things. I'm hoping that we as a committee can really start looking into this and be thinking about ways that we can address some affordability issues within our healthcare system. Leslie? So just to give a little context about facility fees in EC 167, it was recommended that we move out of hospitals but into ambulatory care centers. Ambulatory care centers don't charge facilities fees, part of why they're much less expensive, whereas hospitals do. So it's looking at where those fees exist and how we can
[Leslie Goldman (Member)]: I was just wondering how we would be negotiating?
[Alyssa Black (Chair)]: I think we're the negotiator, but we create statute and we stay to the Green Mountain Care Board to think about that. So that's just an example of why facility fees can have impacts.
[Leslie Goldman (Member)]: Oh no, I know that.
[Alyssa Black (Chair)]: I wasn't sure.
[Leslie Goldman (Member)]: I do understand that. Do we legislate it? Do we go through the Green Mouth Care Board?
[Alyssa Black (Chair)]: Yeah, I mean, policy, they execute.
[Daisy Berbeco (Ranking Member)]: Yeah, okay. Okay, I have three more really quick details. Think we have sent some votes on it. There is another bill, I'm sorry I don't have the number at this second, but that would move the Department of Substance Use into the Department of Mental Health. And on our list of reports that Jim and Katie were walking through, one of them was recommendations on improving the AHS. And that is one of the recommendations that they came up with as well.
[Unknown Committee Member]: I'm sorry, can you repeat that? What was the recommendation?
[Daisy Berbeco (Ranking Member)]: That DSU be merged with DMH for efficiencies, and because we know that substance use issues and mental health issues are often co occurring?
[Alyssa Black (Chair)]: Currently, use is in the Department of Health, BDH. Mental health is within DMH, and because they are so often co occurring, we have two different agencies that are departments. Brian?
[Brian Cina (Member)]: I will say that we didn't go through what people's jobs are in the community yet, but I'm a clinical social worker and that we just did training at the designated agency on What is the new acronym? The BB
[Alyssa Black (Chair)]: something? CCBHC?
[Brian Cina (Member)]: Yes, the CCBHC, to be a CCBHC. And we had to do all this training in recovery, approaches to recovery. And it's pretty What SAMHSA is rolling out, you do not separate substance use and mental illness anymore at all. I mean, in practice we don't, but literally the language is it is not recovery focused if you're not treating it co occurring. So this is long overdue. It's way overdue.
[Alyssa Black (Chair)]: I believe in order for our designated agencies to receive the CCBHC designation, which allows them to receive higher reimbursements or additional funding, they have to integrate the
[Leslie Goldman (Member)]: Yes, we do. And do we have to legislate that?
[Daisy Berbeco (Ranking Member)]: Not the CCBHC, the state's already going forward with that without us. And they set their own requirements for us.
[Brian Cina (Member)]: But it's, in my opinion, inefficient when the government hasn't divided when the practice No, I agree.
[Daisy Berbeco (Ranking Member)]: We divide it in a light slate or two, so we need to ask that we get the Addictions portfolio here.
[Brian Cina (Member)]: So that's where we have to do the work, is that high level policy statewide, to align with practice on the ground and the vets.
[Daisy Berbeco (Ranking Member)]: And not just practice, but
[Alyssa Black (Chair)]: the body and how it shows up.
[Brian Cina (Member)]: You mean science? The body Yes. That Yeah, yeah, yeah. It doesn't have to like the legislative body. Next
[Daisy Berbeco (Ranking Member)]: one is mental health and AI. Some people may have and read the seen these really horrific cases of people who have completed suicide after chatting with a bot. And that has been researched. And one recommendation is that people take a look at limiting both the marketing of chatbots as mental health counselors or mental health therapy. It's just not. And so this bill really helps to put guardrails on that in Vermont. And so those practices cannot happen here and masquerade as health care. It's not. And the attorney general's office would actually have what's it called? There if would be a people marketed those services if they are not delivered by a certified licensed mental health therapist. So consumer protection. Consumer protection, thank you very much. And I know this is complementary to a bill that Brian has, which is much more comprehensive that deals with health care and AI. And I feel very strongly about this AI and counseling bill. I think it's probably the most important one we have here. And it's co sponsored by Angela Arsenault and Monique Priestley, who have led a lot of the AI work in the legislature here. So I really, really hope we can protect kids and adults with this wellness session. Lastly, kids and mental health. I have a bill that I am talking with the administration about, which would bring a pilot for peer to peer youth counseling to schools. This has been done in other states. Great success. Kids should be talking to each other. We all know that not every school has the behavioral interventionists that they should right now. And we also know that kids and the peer approach is incredibly effective. So it does that. It also increases the mental and multiliteracy for training for staff and teachers in schools around the state. And it would let the local school districts choose what materials they wanted to use. But there are some existing, like with NAMI Vermont and other places like that. We just want to formalize that we expect mental health awareness to be part of every teacher and anyone who works in the school setting. Is it an age for the peer? Nope, that would be part what That would be part of what we talked talked about. Okay.
[Unknown Committee Member]: Could you give me a little example of the peer to peer, it's new to me, what would that look like? You would have a licensed professional teacher that was trained in the room and then commute?
[Daisy Berbeco (Ranking Member)]: Yeah, so there's different models of how to do it. But basically, it would be like a group setting of kids that if they're all struggling with depression or anxiety or stressed about tests or overworking or whatever issues can have, body image issues, food disorders or eating disorders, they can come together in a group setting and find some peer support with each other and let each other know they're not alone.
[Leslie Goldman (Member)]: The person, would there be a person in the group that experienced that particular thing has overcome it?
[Daisy Berbeco (Ranking Member)]: Yes. I mean, everyone would be going through recovery together. And for a lot of these issues that they would be talking about, it's a process. It's not like they had it and then it's done. Often these things are a lifelong challenge for folks, and that's why we need to keep talking about it with each other. But yes, there would be a supervising adult in the room with them all the time.
[Leslie Goldman (Member)]: When you say any supervising adult, or is this somebody trained in mental illness or counseling of some sort, or just any
[Daisy Berbeco (Ranking Member)]: Well, you know what, I want the experts to have the opportunity to come in and tell us what they think it should look like.
[Leslie Goldman (Member)]: Yeah, you're talking about mental illness in schools, I think it'd be important to have something like that.
[Daisy Berbeco (Ranking Member)]: Yeah, I think so too.
[Alyssa Black (Chair)]: Really quickly, because we do have to end.
[Brian Cina (Member)]: Okay. My first job in Vermont was a peer outreach program. It was 'ninety eight to 2003, and I'm not saying this is what they're gonna recommend now, but the way it did work is it was 15 to 21 year olds as the counselors, but we were all supervised by a licensed social worker, and we got the same training and supervision as Yeah, but we went out, it was different though, because we would go out on the streets and stuff, it wasn't a group. I do think there'd be a value to hearing about the current models. But just to give you an example of how the there's oversight.
[Alyssa Black (Chair)]: Thank you, Baez. And then you have a technical bill.
[Daisy Berbeco (Ranking Member)]: I have a DEVA technical bill,
[Alyssa Black (Chair)]: which thank you so much for putting in because I failed on it.
[Brian Cina (Member)]: That's what Debra's
[Daisy Berbeco (Ranking Member)]: one of the cumbersomebody.
[Alyssa Black (Chair)]: Oh, I I don't
[Daisy Berbeco (Ranking Member)]: That's a VFR.
[Alyssa Black (Chair)]: Yeah. That's a VFR technical.