Vermont Legislature SmartTranscripts:

[Speaker 0]: And we're back from our break. We have Ledged Council in here and before we went to break we had a couple questions and I thought that it would be helpful if maybe Ledged Council could walk us through pertinent things related to telehealth consent. Take

[Jen Harvey (Office of Legislative Counsel)]: it away. Good morning, Jen Harvey from the Office of Legislative Council. I'm going to put some statutory language up on the screen here. So the first one that I thought would be helpful to look at is, in title eight in the health insurance chapter, because it's where we define, we have the definition of telemedicine, also STORE and FORWARD if you want to look at that. So telemedicine, and this definition gets cross referenced in the statutes around the delivery of services through telehealth. Telemedicine means the delivery of healthcare services, including dental services, such as diagnosis, consultation or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of HIPAA, that's what the Health Insurance Portability and Accountability Act of 1996 says. And we, often interchangeably use the terms telehealth and telemedicine. As I understand the telehealth is a broader umbrella that covers telemedicine, store forward, audio only telephone services, sometimes other services like remote telemonitoring, where somebody might be having their vitals measured over a distance. So we talk about telehealth. I would say the bill is about telehealth, but within that, we are talking specifically about telemedicine and audio only for purposes of what is being authorized in the bill. Store and forward, because we talked about it a little bit yesterday, is the asynchronous, so not at the same time, transmission of medical information, which could be video clips, audio clips, still images, x rays, MRI scans, electrocardiograms, electroencephalograms, or lab results sent over again a secure connection that complies with HIPAA to be reviewed at a later date by a healthcare provider at a distant site who is trained in the relevant specialty. And in store and forward, the healthcare provider at the distant site reviews the medical information without the patient present in real time and communicates a care plan or treatment recommendation back to the patient or referring provider or both. So our statutes often address telemedicine and store and forward together for purposes of H84 and recording, we're really talking about this telemedicine one, the interactive audio and video, and also the audio only telephone. So I'll take that down for a sec and then we'll hop over to Title 18, which is where we have two similar statutes to each other on delivering through telemedicine at Storm Forward and delivering through audio only to help. So now we are in Title 18 or in 18 BSA nine thousand three and sixty one. And this is talking is really directed mainly in health care providers delivering health care services through telemedicine or by store and forward means. And so I wanted to look at that definition from Title eight first, because the definition used here says telemedicine has the same meaning as in eight VSA 498A, which is that section. So this first authorizes. Subject to the limitations of their license, a healthcare provider who's licensed in this state may prescribe, dispense, or administer drugs or medical supplies or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient in person through telemedicine or by the use of instrumentation and diagnostic equipment through which images and medical records can be transmitted electronically and treatment recommendations made electronically are held to the same standards of appropriate patient care as in in person settings. Subsection C says that a healthcare provider delivering services through telemedicine must obtain and document the patient's oral or written informed consent for the use of telemedicine technology prior to delivering services to the patient. And the informed consent must be provided in accordance with Vermont and national policies and guidelines on the appropriate use of telemedicine within the provider's profession and include an easily understandable language, an explanation of the opportunities and limitations and sort of pros and cons of using telemedicine, informing the patient of the presence of any other individual who will be participating in or observing the patient's consultation with the provider at the distant site where the provider is and getting the patient's permission. So somebody might be off screen but in the same room and listening. So that information, and that permission would have to be obtained. Assurance that all services the provider delivers through telemedicine will be delivered over a secure HIPAA compliant connection. And then for services delivered through telemedicine on an ongoing basis, they don't have to go through the informed consent every time. They just have to get it at the first episode of care. So if it's

[Speaker 0]: going to be particularly

[Francis "Topper" McFaun (Vice Chair)]: we've

[Jen Harvey (Office of Legislative Counsel)]: talked about this in the mental health context, of an ongoing therapy relationship, the provider doesn't have to go through this every time if it's going to be weekly or biweekly meetings, for example. The provider must include the patient's written consent in the patient's medical record or document their oral consent in the patient's medical record. And then some insurers in particular have providers use a third party vendor. So a healthcare provider delivering telemedicine through a contract with a third party vendor has to comply with the provisions of the informed consent requirements to the extent permissible under the terms of the contract, which may be a little bit different. If the contract requires the provider to use the vendor's own informed consent provisions, then the provider is deemed to be in compliance with the informed consent provisions here if they adhere to the terms of the vendor's policies. And then there are certain times that a provider does not have to get a patient's informed consent to use telemedicine. So if there's a medical emergency, if they're doing the second certification of an emergency examination determining whether an individual is a person in need of treatment. So, this is a very specific mental health context or involuntary commitment or for psychiatrist examination to determine whether an individual is in need of inpatient hospitalization. Again, this is in a sort of fairly specific, and otherwise dictated mental health context. And then here's the one that we have been looking at neither a healthcare provider nor a patient shall create or cause to be created a recording of a provider's telemedicine consultation with a patient. This is the part you'd be amending, if you move forward with H84. Then it also gives some rights to the patient. So a patient who is receiving services by, this one is store and forward. By store and forward means is informed of their right to refuse to receive services that way and to request services in an alternative format, which might be in person or telemedicine. And getting services by store and forward means does not preclude a patient from having a real time telemedicine or in person visit with the distant site provider at a future date. And originating site healthcare providers involved in STORE and Forward must obtain informed consent as described in subsection C. So if a provider who is doing telemedicine with a patient is going to be sending clips to a distance specialist, then they have to the patient, the provider who is working directly with the patient has to get the patient's informed consent. There are similar but different provisions for audio only telephone. I don't know if

[Allen "Penny" Demar (Member)]: you want

[Jen Harvey (Office of Legislative Counsel)]: to look at those as well. They're just different considerations when doing audio only telephone services.

[Speaker 0]: Is the provision in audio only that the patient has the right to refuse services by audio only if they wish another. Yes, I believe that is the patient's choice

[Jen Harvey (Office of Legislative Counsel)]: to decide whether or not they'll receive these services. So again, have the same definitions, again, subject to the limitations of their license, the provider may, and this is for Medicaid patients to the extent permitted by the Centers for Medicare and Medicaid Services because CMS will not pay for audio only telephone in all circumstances. A healthcare provider may deliver healthcare services to a patient using audio only telephone if the patient elects to receive the services in this manner and it is clinically appropriate to do so. So there are stricter guardrails around the use of audio only. Provider must comply with any training requirement imposed by their licensing board on appropriate use of audio only in healthcare delivery. There are the same or similar documentation requirements for informed consent. Also, provider has to document in the patient's medical record the reasons the provider determined it was clinically appropriate to deliver healthcare services to the patient by audio only telephone. So there may just be different considerations. For example, it may be more difficult to do a dermatology consult by audio only if there is a visual component that's necessary. The provider shall not require a patient to receive healthcare services by audio only telephone if the patient does not wish to, and that's what the chair was mentioning. And then put some restrictions on a provider. Sort of can't be punitive if the patient doesn't want to do audio only. The provider must deliver care that is timely, complies with contractual requirements and not delay care unnecessarily if the patient wants to have an in person or telemedicine visit instead. There's documenting the oral or written informed consent similar to with the telemedicine. And then we've got the same language about, you know, they can have services by audio only telephone in person or through telemedicine to the extent clinically appropriate that receiving audio only services doesn't prevent them from getting services in person or by telemedicine at a later date. Pros and cons of using audio only telephone, informing the patient of anyone else who is participating or listening and getting permission for that. And then there is a little additional information about whether the services will be billed to the patient's health insurance plan. There's been a lot of conversation about what's the difference between a provider answering your question over the phone or giving lab results over the phone that might not be billed to insurance and incur a copay, versus having an actual visit that is by audio only telephone and how could the patient know the difference. So whether the services will be billed to the patient's plan and what it may mean for the patient's financial responsibility for out of pocket costs and informing the patient that not all audio only healthcare services are covered by all plans. Again, if it's ongoing, they only have to get for audio only telephone. Consent is only required at the first episode of care. If the patient provides oral informed consent, the provider has to offer a written copy. And then it's not required, informed consent is not required in a medical emergency. Those other two exceptions that were in the telemedicine statute don't apply in this context. They're not allowed to be audio only. Telephone is not allowed to be used in those circumstances. It allows a provider to use a single informed consent form for all telehealth modalities, including telemedicine, store and forward, and audio only, as long as it complies with requirements in the previous section and this section. And then here's that prohibition on creating a recording that is the H84 language we've been looking at. And then this is specifically saying no audio, only telephone for those two circumstances where it is permissible without informed consent and telemedicine, which is the second certification and the psychiatrist examination for inpatient hospitalization, involuntary inpatient.

[Speaker 0]: Is that helpful, hopefully? Very helpful to me. Is that helpful to everybody else in the committee? Yeah, Bell.

[Wendy Critchlow (Member)]: Several times I sought oral or written consent. That wouldn't be a liability, especially with AI. Can't AI recreate conversations with someone's voice that has been prerecorded? So to a large extent, this

[Jen Harvey (Office of Legislative Counsel)]: is all predating any kind of AI. It does not contemplate AI. I think one of your members has been thinking about those issues for longer than others.

[Brian Cina (Member)]: I have an answer for that too. When we do oral consent, usually you say, do you consent? And when they say yes, you write in the note, patient orally consented, but AI isn't involved.

[Jen Harvey (Office of Legislative Counsel)]: No, but I think the concern being raised is could somebody other than or not the patient personally be the one

[Brian Cina (Member)]: But then you would be talking to an AI pretending to be a patient, which would be a thing we haven't seen yet. Can you imagine?

[Speaker 0]: Oh, let's not see it.

[Brian Cina (Member)]: It's possible. There are some bills to mail that would prevent this, by the way. Will be sending it the I'll be sending it to the public.

[Speaker 0]: I'll talk to I can't remember

[Leslie Goldman (Member)]: what you've been reaching. Is your

[Brian Cina (Member)]: concern, just not to invalidate it, is your concern that someone might use an AI to trick a provider into thinking they're the patient?

[Jen Harvey (Office of Legislative Counsel)]: Then informed consent's probably the least of the concern. Mean, there's some bigger concerns there. But yes, there may be a need for the provider to take reasonable steps to ensure that they are talking to the person that they believe they are talking to. Commitment is

[Wendy Critchlow (Member)]: something you know. I mean, if you have someone on the phone, I didn't even know that that was something that

[Speaker 0]: They do ask was a a lot of first, not

[Brian Cina (Member)]: that it could build out.

[Leslie Goldman (Member)]: That's easy, that's But out

[Speaker 0]: you have to ask yourself, how does a provider even know if you're presenting from somebody who worked in a facility for There were many people who presented themselves as someone completely who they were not.

[Daisy Berbeco (Ranking Member)]: They all had

[Speaker 0]: various other names that they would use. Used to have a

[Wendy Critchlow (Member)]: whole list of them. When I call my daughter's doctor's office, they really won't do anything over the phone.

[Speaker 0]: Really?

[Brian Cina (Member)]: You mean sharing your info with you? I

[Speaker 0]: mean, if I speak

[Wendy Critchlow (Member)]: to a nurse, she could say yes, you should come in because your daughter has whatever symptoms.

[Speaker 0]: Yeah.

[Wendy Critchlow (Member)]: But I don't, this is just something very new to me.

[Brian Cina (Member)]: You done telehealth

[Speaker 0]: at I had, can I give an anecdote? I had the greatest telehealth experience in December, thanks to our Leslie. I called my primary care on Sunday because Leslie lifted my finger on Saturday and said, Oh, you need to call your doctor. I got the on call doctor to call me back. She went through a whole, this is all on the phone, went through the whole history, HPI history and present illness, did an assessment of what I had, cellulitis in my finger. Oh, sorry, sounds painful. And she e prescribed an antibiotic over the phone. I went to the pharmacy fifteen minutes later, it was 60¢. She charged me for the visit, which she absolutely should have. She did a full evaluation and management Then I took pictures of my finger and I uploaded them into my portal so that they had them. My doctor ended up calling me back, my real doctor. Well, not that the other one wasn't a real doctor, but my personal doctor, she was the on call, checked out to make sure that the antibiotic was resolving my finger, and I still have a finger today. It always didn't require surgery. It didn't require surgery. Or the ER. Or the ER, or even an urgent care. And I thought to myself, this is exactly the way quality, accessible, affordable healthcare is supposed to be. But they follow-up? They followed up. Oh, no. Followed up five days later to make sure that my finger was resolving because they had the pictures.

[Brian Cina (Member)]: And it was a human. It a human. It was not a robot. Not

[Speaker 0]: once did they see me other than a generic finger with a cellulitis on it, and I call, I give my name, I give my date of birth. Did you get a patient satisfaction survey? I think I did, but I realize it. Anyways, telehealth is dependent upon why you're calling or when you're calling and whether or not they're going to do that, which is sort of the point of that they make an assessment over the phone whether or not you need to be seen in person.

[Wendy Critchlow (Member)]: And does it start with an initial visit in person? No, not have to.

[Jen Harvey (Office of Legislative Counsel)]: It was part of the language as well. There does not have to be an existing relationship between the patient and provider.

[Speaker 0]: And I know this really all took off during COVID. Right? That's when

[Katie McLennan (Office of Legislative Counsel)]: we changed a lot of our laws to allow us

[Speaker 0]: to ensure people could still have access.

[Allen "Penny" Demar (Member)]: Last year, when you first called, you didn't talk to your regular doctor.

[Speaker 0]: I talked to the on call doctor who works in the same practice.

[Francis "Topper" McFaun (Vice Chair)]: Okay.

[Speaker 0]: They share calls. Actually, first I talked to the answering service who then phages. Suspect they don't have pagers anymore. They have cell phones. How much information did you

[Francis "Topper" McFaun (Vice Chair)]: have to give them?

[Speaker 0]: I told them what was going on. She asked how it started. It was because I had gone to get my Christmas tree and I got a whole bunch of little cuts on my finger from the Christmas tree. And I only knew that because I had been squeezing lemons the day after I got my Christmas tree and it hurt. And it turned into cellulitis.

[Allen "Penny" Demar (Member)]: And they gave that information to You your all guessed my question to me, how many other people or who else could have access to that information?

[Speaker 0]: Same people as if you were doing it in person.

[Allen "Penny" Demar (Member)]: So nobody else would pretty secure there.

[Speaker 0]: Do portals you have like a MyChart with Do you have a portal? A patient portal?

[Allen "Penny" Demar (Member)]: I don't think so.

[Leslie Goldman (Member)]: I'm sure you do. I

[Allen "Penny" Demar (Member)]: do, but I don't have access to it.

[Speaker 0]: They are HIPAA compliant and HIPAA secure, which is why I was asking today about Teams. I didn't realize Teams had been designated now. Oh, is it? Oh, yeah. And Zoom.

[Jen Harvey (Office of Legislative Counsel)]: I knew there was a burden of Zoom that was HIPAA compliant. Yeah. Don't know if all Zoom is You

[Brian Cina (Member)]: have to purchase the I've

[Speaker 0]: been out of this since I am.

[Jen Harvey (Office of Legislative Counsel)]: Chopper. $200

[Brian Cina (Member)]: minimum a month. That's a lot. I just canceled a month, Teams. Goodbye. It's like 60 a month, sorry. No, I do this all the time.

[Francis "Topper" McFaun (Vice Chair)]: I'm the one that initiates the call. I call my doctor. If my doctor doesn't happen, if he's not on at that time, there's another doctor in the practice that takes the call, takes care of me. Then I'm supposed to follow-up with my regular doctor. And sometimes he calls me just to make sure everything's all right. It's pretty I mean, I've never had a problem. I'm 80, almost 87 years old, and no one's ever done anything wrong to me.

[Katie McLennan (Office of Legislative Counsel)]: Lord, yeah. And I think the key is that it depends on who you

[Speaker 0]: are and what you want, and your life circumstances. You don't have to do things by telehealth, but for some, it works.

[Allen "Penny" Demar (Member)]: Well, like I said, it's coming whether we want it or not. What's coming?

[Speaker 0]: I know a lot of people.

[Brian Cina (Member)]: It's here. It's two and three minutes in this room right now. So listening to everything you said.

[Speaker 0]: So I'll have Jen bring up the bill as currently configured, we can decide whether or not, I mean this is technically markup, I'm not sure if anyone has suggestions of how we can mark it differently. Yes. I want to make sure everybody understands what we're doing. We have a binding Any committee discussion, and then I'm going to call for a vote.

[Jen Harvey (Office of Legislative Counsel)]: So this is H84 is the bill as introduced. As we yesterday, and now you have some more context for it, this amends those two statutes we looked at that talk about providers delivering care through telemedicine and by audio only telephone to add language to the prohibition about creating a recording of the consultation, the telemedicine, the telephone consultation to allow recording if the patient and provider both consent.

[Speaker 0]: That's it,

[Jen Harvey (Office of Legislative Counsel)]: it's back to bone end.

[Speaker 0]: That's it. Any discussion? Anyone have any questions at all about what we're doing? Make sure everybody's comfortable. Yes? I just want to say,

[Katie McLennan (Office of Legislative Counsel)]: I think this is really

[Speaker 0]: important for our providers. I mean, this committee has done a lot of work over the years helping with provider burnout. I think this is another good step. I share many of the committee's concerns, other members around AI, but as the healthcare advocate said, the train has left the station or the horses left the farm and we're not going to stop that. When we did these five years ago, this wasn't a thing. And I think this is important to our provider community, particularly our mental health provider community. And I think it's also really important in context of the Rural Health Transformation grant that the state received to be able to implement some of their ideas in using AI scribe and helping community providers do that. They're at a disadvantage of costs with that.

[Francis "Topper" McFaun (Vice Chair)]: We love things, because it helps the patient get services. Yeah,

[Brian Cina (Member)]: I mean, as nervous as I am about all the applications of the policy change of this bill beyond the bill, we can come to that, we will, but we shall perhaps may Some come to those of us say if we don't do it now, we're going to have to eventually, but hopefully not in five years like this. But when we first passed the telehealth laws, we hadn't hit the pandemic yet. And we literally had just done it. And then the pandemic hit, and if we hadn't, we'd get rid of emergency provisions, but we were luckily prepared. And within one week, got sick with what we now believe had been COVID, but for the first time, I was doing telehealth from home three weeks into the shutdown. It was so quick and it revolutionized healthcare delivery. And so I think this, not doing this is delaying access to care to people at this point. So we need to remove this barrier to access. And furthermore, this is also impacting workforce development. So I think for those two main reasons, I'm willing to work these changes despite my concerns about the bigger picture, but I really hope we make time this year to start addressing the bigger picture, because if we don't, we're going to be back here five years since being like, oh

[Speaker 0]: no, now we have to

[Brian Cina (Member)]: do all these things and they're recording children's brains. Do we have to talk about bot patients? Nope. It's not related to this bill, but there is generative AI right now. Impersonating people is a thing and it's getting incredibly sophisticated. And if you look, I don't know if it's in the AI healthcare bill, but there's other AI bills I'm sending out. One of them does say that if someone is using a robot to call, it has to say I'm a robot upfront. So it would have to be like, I am Lori Houghton's digital receptionist calling you to remind you of a meeting.

[Katie McLennan (Office of Legislative Counsel)]: Wow, I wish I had one

[Brian Cina (Member)]: of those. It exists now. I'm getting ads for it. I'm getting ads now for digital receptionists for my practice. When you call someone, it answers for you instead of a voicemail and it says, Hello. And it doesn't say who it is at first because it doesn't have to. So it's your voice talking. And then if you push it, it says, I'm actually not Brian, I'm the receptionist. But it doesn't say that at first, because it doesn't have to. So I think that's not in this bill. We're going have to come to that separately. I support this. Long story short.

[Speaker 0]: Just feel

[Wendy Critchlow (Member)]: if there are any issues that would surface down the road, that's life in many different areas, maybe every area of our life. And you deal with it as it comes, and you amend or change as you go. You have every person's patient's consent. I wish it was written. I'm not 100%

[Jen Harvey (Office of Legislative Counsel)]: comfortable with the oral consent. Would feel that That's would existing law, to, well, maybe not a misreading piece, but this is just about her reporting.

[Brian Cina (Member)]: Oh, I see your point. We could say unless they provide written consent, I mean,

[Speaker 0]: That's it's my point

[Wendy Critchlow (Member)]: of saying, otherwise I'm not even a computer person. I think it sounds

[Jen Harvey (Office of Legislative Counsel)]: advantageous.

[Brian Cina (Member)]: Does that

[Wendy Critchlow (Member)]: mean to

[Brian Cina (Member)]: support it? I do. Okay. I see your point though, because this could say unless the patient and provider consent to Unless the patient and the provider consent in writing to the recording.

[Jen Harvey (Office of Legislative Counsel)]: Would be difficult to operationalize, think, because inherently they're not in the same as one patient.

[Leslie Goldman (Member)]: They may not.

[Brian Cina (Member)]: So we could do it, but it would be, you're saying you're recommending against it because it

[Jen Harvey (Office of Legislative Counsel)]: would create complications that I'm unforeseen just noting for you that that would require some sort of, it would not allow the visit to continue until there had been some sort of provision of a written material from the patient the bladder.

[Wendy Critchlow (Member)]: Right, that's why I asked about an initial visit. And I know that's not, especially in emergencies, whatever, just like an initial consultation with your doctor who has a written would make me feel better, just because I think AI can do so

[Speaker 0]: much. I work for Debra and right now it's going through legal what's considered a wet signature? Yeah,

[Wendy Critchlow (Member)]: so when you do these,

[Speaker 0]: like if you are online and you're filling something out and you electronically, it's not considered a wet signature. If you're going to get into signing stuff, then you have to be really specific about what you're You know what I mean?

[Brian Cina (Member)]: We could use biometric data, like you scan your eye to sign.

[Speaker 0]: You know, I mean it's probably more accurate.

[Brian Cina (Member)]: Well, it's not this bill though, so we could come to it later.

[Speaker 0]: Any other questions? Concerns, thoughts? Alright, I would entertain a motion that we move to pass H84 as introduced.

[Francis "Topper" McFaun (Vice Chair)]: A move that we've gone on, 84 as introduced.

[Leslie Goldman (Member)]: Is that the title, an act relating to allowing telehealth appointments to be recorded with patient and provider consent? Well, that we pass our committee.

[Francis "Topper" McFaun (Vice Chair)]: So

[Speaker 0]: our clerk is online, so for the sake of expediency, and unfortunately not able to vote on this as well, because I learned from the clerk that we haven't extended the remote voting to past calendar year 'twenty five, so it's not in effect for 2026. I thought we had three vote. It was only for '25. So it's going back to rules? Yeah. So I've asked Leslie if she would act as our

[Leslie Goldman (Member)]: interim. Happy to hear.

[Speaker 0]: Would the clerk please commence to call the role? Brian Cina.

[Francis "Topper" McFaun (Vice Chair)]: Yes.

[Speaker 0]: Wendy Critchlow. Yes. Penny Demar?

[Leslie Goldman (Member)]: Yes. Leslie Goldman? Yes.

[Speaker 0]: Aaron Lueders? Yes.

[Leslie Goldman (Member)]: And Deb's not voting. Did you skip me? No, because you wanted to go, you said last. Oh, I'm sorry, I might have skipped you. You wanted the top of the table last. Lori

[Daisy Berbeco (Ranking Member)]: Houghton. Yes. I can't think of you as the top

[Speaker 0]: of the table. I'm not. Only, only. No, not even here.

[Leslie Goldman (Member)]: Valerie Taylor. Daisy Berbeco. Yes. Papa McFaun. Yes. Alyssa Black.

[Speaker 0]: Yes. You still need to

[Leslie Goldman (Member)]: call her and then say she's absent. Or she'll call it. Okay. So Debra Powers, absence.

[Brian Cina (Member)]: Lori used to be clerk.

[Speaker 0]: Long time ago.

[Brian Cina (Member)]: Yeah. Minutes ago.

[Speaker 0]: Many minutes ago.

[Leslie Goldman (Member)]: All right. So the vote is ten, zero, one. And Daisy is reporter. Daisy will be reporting. And I need to know what to do with this, so you'll help it.

[Speaker 0]: We need to report to the clerk's office and Daisy needs to report. Thank you, Jen. Super. And I anticipate this will be on the floor up for action, second reading on Thursday. Because today's Tuesday. I thought today was Tuesday, honestly. Okay. Great, let's move on. Thank you. I just have this image of the former representative from Bristol watching us on YouTube as we were doing, yes, our former longtime clerk. Alright, so we are moving on to I need to find clearly what day it is and what time it is. The priority.

[Brian Cina (Member)]: The priority. Discussion of eleven. Perfect timing.

[Speaker 0]: I know. Okay, so had Topper pass out list of bills that are on our wall. Another one, I'm sorry, I left them elsewhere. Thank Sorry

[Brian Cina (Member)]: Debra, you're using your paper. Government efficiency.

[Speaker 0]: So I just want to say before we start this, because I wasn't here yesterday when this was passed out, Topper, Daisy, and I went through all the bills that are currently on our wall in committee. And I just want to say that there are some really fantastic, wonderful, important bills that are not on this list. And that doesn't mean we won't hear about them. It doesn't mean that we won't take testimony on them. But one thing that we talked about the first day of the session about what our priorities were for this session, I believe almost everyone mentioned something around affordability and knowing what we are facing around federal cuts to our Medicaid program in the coming years. I just could not see expanding services when we in few years may be faced with making some really, really difficult decisions around cutting services. So if you didn't make this list, it doesn't mean you're not important. But affordability is the word of the session, I think. So, does anyone want to and I understand that this is just a list and it's the bill names and you may not know exactly what the bill is, if you have any questions about not that we have led to counsel here and not doing a walkthrough of any of this. If we wanted to talk about things that might be priorities for us. Daisy, do you want to do, you're so good at the spreadsheets, do you want to do sort of a ranking of who gets votes and where priority

[Leslie Goldman (Member)]: is Like track it?

[Speaker 0]: Yeah, kind of track what people do you want to start first?

[Daisy Berbeco (Ranking Member)]: We also considered when we were reviewing these bills, bills that had already basically been You want

[Speaker 0]: to explain it? Oh yeah, there are lots of because we have a ton of things up here. A lot of these bills actually we've already done. Several of them were companion bills in the Senate from last year. And so they're already, they may not have passed in the House bill, but they passed in the Senate bill. There's also a lot of bills where we took the bill and we incorporated that bill into another bill that we've already worked on. And I will say that there are several I don't think we eliminated anything, but there are some things that the Senate is actually working on right now that I anticipate that we will be getting the companion bill from the Senate. So, our session is kind of in two parts. House bills, and then we start working on the Senate bills that come over to us. Although I think we left those on here. Thank you for reminding me of that.

[Katie McLennan (Office of Legislative Counsel)]: I don't want to

[Speaker 0]: go first because I want to sign up instead. Okay, anybody want to Brian?

[Katie McLennan (Office of Legislative Counsel)]: That's it, I can ask a question.

[Speaker 0]: Course. What's the C mean? Oh, the Caheen is a compact. Just Oh, okay. There are so many compacts that I just thought Let's see in terms of the compact so we can easily identify them. Thank you.

[Leslie Goldman (Member)]: I thought it meant Cardi.

[Brian Cina (Member)]: Anybody want to I will go first if you want. My working memory isn't great. What did you say the process

[Francis "Topper" McFaun (Vice Chair)]: is you want us to do?

[Speaker 0]: Rank two or three on here that you

[Brian Cina (Member)]: are really interested. Two or three priorities? Yes. So I would classify the priorities and cluster them.

[Speaker 0]: Is this your way of trying to get more than two or three?

[Brian Cina (Member)]: Think that when you hear me, you'll see it's not some kind of effort to circumvent the process, but rather be more efficient. There's an AI bill, but there's going to be more AI bills. So what I would ask is that we take testimony on the AI bills as one unit, and then see how we could piece the different policies together into some action on AI. I don't think that's a way to Because I think it'd be a waste to be like, my priorities are this AI bill, this AI bill, and this AI bill.

[Speaker 0]: What do we have for AI? We've got six forty four.

[Brian Cina (Member)]: And there's the one I circulated to you all that will be

[Speaker 0]: public soon. Okay, so we don't have a number on that.

[Brian Cina (Member)]: No, and I believe there's another one out there someone is doing, because I remember hearing about this. So there's at least three. So just to be fair, I think we look at the three and we see what's the overlap, and then we combine them into one, whether it's a committee bill or one of them makes sense to fit the pieces into. So that would be my number one priority, because I think we're already too far behind on AI. Number two to me would be the incremental implementation of Green Mountain Care, even if it's unrealistic in its current form, that we need a backup plan, maybe it's not even a backup plan anymore in face of the federal changes and perhaps some kind of universal access, some kind of step forward with Act 48 makes sense right now. And there may be other bills like there is the universal primary care program bill, H-one 185. Think there was a new one that is coming in or

[Speaker 0]: H-six 80 is released today. I'm looking at the Is that another primary care access bill? An act relating to primary care access reform problem.

[Brian Cina (Member)]: So I think these bills, once again, it's not about wanting to pass multiple bills, it's like, let's look at the issue and see if there's some action we can take that addresses pieces of those bills. I know that even though I'm a big proponent of H-four 33, I understand that it's unrealistic in its current form, but if we could at least take testimony on it and move over with some action towards the expansion of this concept of a universal system or at least universal primary care. Then last but not least, I would lump together the compacts because it's been a policy of this committee to pass compacts as they come out, and I know that each one needs to be handled separately, but I don't want to have to say, I think that respiratory care is more important than dental. I think they're all important, so if there was a way we could do a few compacts this year, it would be in line with our pattern over the last few years of joining compacts. Thank you, next. Thank you. Oh, and just for the record, anyone out here listening, it doesn't mean I don't care about the other bills. I do. That

[Speaker 0]: goes without saying anything for everything. And I didn't mean to be flippant about, is this your way of getting

[Brian Cina (Member)]: Yeah, don't think you were Yeah, I just want people to know

[Speaker 0]: that like I completely understand. It's hard prioritize. Okay, anybody want to go next? Happy to. Yeah, go ahead, Leslie.

[Leslie Goldman (Member)]: So looking at three, and I'm not going to count one of my three, I circled the four compacts. Is that important enough to take up? We've done many of them. It should be pretty straightforward and easy, and it does expand access to care. So it seems worth doing that. Was there one compact in particular you were or? No, the impact of these different compacts. So therefore there's the school psychologist, the respiratory care, dietitian and dentist and dental hygienist. I don't know. That would require testimony to know which would have the most impact on the population. So I'd want to know that first somehow figure that out. Have no idea how.

[Speaker 0]: For our two main members, compacts are licensure compacts multi state. So if you're licensed in one state, which is a compact state, you can practice in the state of Vermont without having to go and get a brand new Vermont license because you have a compact license. Just to let you know, that's what a compact is.

[Wendy Critchlow (Member)]: So

[Leslie Goldman (Member)]: putting my compact hat aside for a second, am interested in age five sixty nine, which is an APRN bill. Obviously I care about this, that it would actually, it seems to me sort of put into statute what's already going on, but allowing APRNs to be recognized as primary care providers and put into the hospital not primary care, I suppose, but hospitalists and put that into statute.

[Speaker 0]: Leslie, is that your bill? There is a bill in the Senate, S163, which is in hospitals. Is that the same bill? I wasn't aware.

[Leslie Goldman (Member)]: Okay. That's what was it? Did you say the Senate is?

[Speaker 0]: Think it's

[Leslie Goldman (Member)]: S63. I'll take a look. Leslie, I didn't get the number. Five sixty nine. So I am interested in supporting and expanding nurse practitioner doing what they're already doing,

[Speaker 0]: but making it an inspection.

[Leslie Goldman (Member)]: I am also interested in $5.86, which is the facility fee bill that Daisy proposed. I went to the same conference she did, as she had mentioned. And I think that there's a lot of extra costs going into facilities that maybe don't need to. So I think an exploration of that would also reduce costs in the system. So that's one thing I'm thinking about. And I'm also interested in five eighty three, which is the private equity bill. And I'm particularly interested because in my I think private equity space is a lot in long term care facilities. In Springfield, Vermont, there is a nursing home that is a disaster. And people have been there and have had to be moved away from there because of the kind of care, and they're owned by private equity. And I think private equity is exploiting our nursing homes, or could be, and I think we need to know about it. So, are my three. What was that last one? I'm 83. I'll

[Speaker 0]: go. Yeah. I want

[Katie McLennan (Office of Legislative Counsel)]: to take up H558, the Medicaid School Based Services Program. And I'm just going to do a lump recommendation that we hear anything that could potentially lower costs

[Speaker 0]: to remembers because there's a lot of this. I'm glad you're not advocating to add back in ones that would increase costs for patients.

[Leslie Goldman (Member)]: No, no, no, no.

[Katie McLennan (Office of Legislative Counsel)]: We've never done that. I could take them all in. Yes.

[Leslie Goldman (Member)]: I did not choose the Rebond prescription discount card program, even though I think it's great and we should do it because I think we're already doing it, but maybe I miss. Is it tomorrow? Yeah. Saw that we were getting

[Speaker 0]: this on

[Leslie Goldman (Member)]: the back. Was enough. I didn't choose it because I knew we

[Katie McLennan (Office of Legislative Counsel)]: were already Sorry, and I will just add one thing. I'm curious about H585, which is toppers.

[Francis "Topper" McFaun (Vice Chair)]: My number one choice.

[Katie McLennan (Office of Legislative Counsel)]: I'm curious about it. I wasn't saying it was 49

[Speaker 0]: or 36. There's some good stuff in that belt.

[Brian Cina (Member)]: There is

[Speaker 0]: some great stuff. Did.

[Allen "Penny" Demar (Member)]: Allen? I've been scratching so many years. I'm going to back up copper there on that number one, health insurance reforms. Number two, because I'm up in the area of Aunt 800270, confidentiality for peer support counseling among emergency providers.

[Speaker 0]: We're cheering on that this afternoon. I

[Allen "Penny" Demar (Member)]: think three, limiting facility fees for certain hospital outpatient department services, which I think is important. And my fourth one was the Vermont's adoption of respiratory care and interstate comp. And again

[Brian Cina (Member)]: Which one was the last one, I'm sorry? Respiratory pain? Anything else that don't cost us money. I'm with you. You knew that,

[Speaker 0]: Oh, Karen, do want to go? Sure. I'm interested in those bills that are saving money. So things like the hospital fees, prescription, which I guess we're doing already. I'm really interested in expanding primary care and making that a whole subject matter that we really look into. And it's one other Well, don't know what it's about because I haven't looked at it,

[Katie McLennan (Office of Legislative Counsel)]: and I apologize, I should

[Speaker 0]: have looked at this since last night, but it has to do with transparency and No, mental health.

[Wendy Critchlow (Member)]: Let me just see.

[Speaker 0]: I think it might be 58, yeah, 58. I don't know what that's about, but it's subject matter, I'm just going to be knowing more about. So I'm just looking at the title. Black Hole. I didn't say that outside. That's on the record. I'm sorry. Wendy. I have to say I did read and I realized, like, useful, it's H185. Then, what? 01/1985? Yes.

[Francis "Topper" McFaun (Vice Chair)]: Primary check. And

[Speaker 0]: I do like the May. And I don't know enough about five seventy three set years. Yes. That's a little elevator, thankfully.

[Daisy Berbeco (Ranking Member)]: It opens up a pathway for folks who are in a mental health crisis to get to the highest level of care. So it would expand the people who would be able to do that certification that they're in a crisis. Right now, physician assistants can't do it, but they're the ones

[Katie McLennan (Office of Legislative Counsel)]: that most often are available to do it.

[Speaker 0]: Okay, I like that one too then. Daisy, do you want to go next? Think, oh, Val, did you? I don't, I feel I have a lot of learning to do. Thanks, Pun. Script.

[Daisy Berbeco (Ranking Member)]: Okay, I'm going to ignore the fact that the ones that we have on our agenda, because I think that we've already started off the session with really strong approach to what we're taking up, including the prescription drug card and the EMT or the emergency service responder privacy. And I I don't know. I'm thinking bigger this session. I'd like to see us take up toppers, though, in terms of health care reform, because I think there are a lot of cost saving measures in there that are really sensible and could have a major impact on the way that we pay for health care. But at the same time, I'm thinking bigger in terms of how we deliver health care. So I'd like to see us take out the issue of let's see which bill. The universal primary care or universal care. I think Brian suggested just having a general bill, a committee bill or something where we look at that. But I think there's never been a better time to really think outside the box with all the reforms that we're doing in payment reform as well. So that, and then AI. And I agree with Brian again that we have several bills that are all really urgent around AI coming at us. I have one around mental health counseling to protect folks from chatbots. And that's probably my top priority in AI, but I do agree that there are other equally urgent topics in AI. So universal care, AI, and Toppers, though.

[Brian Cina (Member)]: Which one's Toppers again? Otherwise, I'm sorry.

[Francis "Topper" McFaun (Vice Chair)]: $5.85.

[Leslie Goldman (Member)]: Steady. It's

[Allen "Penny" Demar (Member)]: a lot of pages.

[Katie McLennan (Office of Legislative Counsel)]: Stab that, right on the tip.

[Allen "Penny" Demar (Member)]: Flip pages.

[Speaker 0]: Okay, think that leaves me. Was going to make a joke that if it was your priority, you just volunteered to report it. Val is the smartest one. So in full transparency, you have a lot of people identified a lot of the bills around primary care and sort of coalescing them all and thinking of them as one topic. I will say that the chair of the Senate Health and Welfare Committee has introduced a bill around primary care. And I suspect that we will be talking a great deal about primary care. And much like what we did last year with S126, it is my hope that in the first half of the session before crossover, as we have time, I will be scheduling like just sort of subject, testimony on the subject that I think that probably the latter half of the year we'll really be diving in. So, I'm going to pepper in testimony throughout the year, so it's things that we can be thinking about. So let everybody know that. What are my priorities? I forgot to think about this. Because I didn't have Topper reminding me yesterday that I left. So, would say my biggest priority is H583, which is healthcare financial transactions. That's essentially corporate practice of medicine. I'm not going to list any of the things that we're kind of dealing with right now. So, obviously, age 84, we already did that. We're getting here on H 270 and H 577. This stuff is already scheduled. I am H585, topper fill is probably my number two. No, my bill is number one. I'd say mine and yours, but they're not. They're all of our bills, so it doesn't matter whose name is on them. And I really hope that we can do some We have H-five 58, which is the school based services, and Daisy has some things around sort of We talk in this committee about practicing to the top of your license a lot, and that goes to the APRN bill that Leslie you were talking about. So I'm hoping we can sort of deal with all of that. So I'm lumping them all together. And yeah, so those are my priorities. So Daisy will sort of culminate this and we'll get We have four compacts. I will say it has traditionally been the practice of this committee that we love to expand coverage. However, I know that the Office of Professional Regulation, while they always support these, we do have an ongoing concern around the fees that they're collecting, is not keeping up with the demands and that compacts lower their fees that they receive. That's always kind of the one overarching concern with pumpbacks. Is that a vote for a pumpbacks or no? I'm not going to put that on there, but maybe. I'm not sure how much we would have to I don't know how much time we have, because while the compacts typically I don't want to say they're easy or that they're no brainers because they're not We do end up taking a lot of testimony on each individual profession. And while it seems like a lot, I mean, it seems to make sense to combine them all, to be thinking about all four of them at the same time. It means we're delving deep into four different professions. And the ensuing testimony that all of that takes and the time that will take. And since I had a panic attack the other day of, Oh my gosh, we're running out of time.

[Brian Cina (Member)]: Brian, and then Leslie. Yeah, hear that because it was one of my priorities. What I would suggest is if we were to consider pursuing any of them, that perhaps we find out the status of the compact before we dedicate too much time to it, or we do like an hour where each profession has fifteen minutes to say, here's where our compact is at, and then we decide if we're going to move forward or not. Because I know with the social work compact, it was a short form, then it came out, then we found out it was forming and we got in. And it was useful to do so, but there might be some that there's no rush to join it or there might be ones that are well functioning and we're the last state. And it might be like, why, let's do it, let's just get

[Speaker 0]: it done.

[Brian Cina (Member)]: Let there be dietitians in every state or whatever that can practice in every other state or whatever. So my suggestion would be if we are going to do it, we do some kind of update on where the compacts are at and then decide so that we don't go down a rabbit hole and spend hours and hours and hours and hours to just do nothing.

[Speaker 0]: Good idea, because you're right. I forget that all of the compacts are at different levels.

[Brian Cina (Member)]: And we could be the tipping point for one of them. And if that was the case, then I'd like, let's do an interesting compact on a carrot salesman or whatever. Are we making something up so it doesn't indicate support for anybody?

[Speaker 0]: I don't know. It's all carrots.

[Brian Cina (Member)]: It's not in this committee.

[Daisy Berbeco (Ranking Member)]: The sponsors with the bills should be able to tell us what is the work workforce demand or potential impact of passing that. That would be a factor in my decision, personally.

[Brian Cina (Member)]: Or if someone from their professional organization reached out to the committee, hint hint, and said, here's where we're at, that might be proactive work that would then help us decide.

[Speaker 0]: Leslie, I think you had

[Leslie Goldman (Member)]: Yeah, just a couple of things. Yes, there is a companion bill in the Senate, it's S163, the APRN bill. S163? Yeah, S163. So it's the identical language. So I don't know if or where it might start. So just, you asked, so I found out.

[Francis "Topper" McFaun (Vice Chair)]: Everybody contributed?

[Speaker 0]: I think so. Wait,

[Daisy Berbeco (Ranking Member)]: took toppers. Topper did not go.

[Speaker 0]: No, you said yours was

[Daisy Berbeco (Ranking Member)]: your number one. I do not have toppers.

[Francis "Topper" McFaun (Vice Chair)]: We I didn't do it yet. She wrote the tax law. So I'm

[Speaker 0]: gonna do it right now. Right.

[Jen Harvey (Office of Legislative Counsel)]: And then I go I

[Francis "Topper" McFaun (Vice Chair)]: was wondering why she said that now she's gonna calculate all

[Speaker 0]: of So can I go ahead and come

[Leslie Goldman (Member)]: back after him? Yeah. Thank you. Okay.

[Francis "Topper" McFaun (Vice Chair)]: Do have someone here? Yes. That is what my bill is on. And with complete transparency. This is the Governor's bill. Probably all missed it. Oh, never mind. No, don't get into politics. Is good stuff for me. That's number one. Number two is developing and implementing the universal public care.

[Speaker 0]: Is that the governor's bill as well? No.

[Brian Cina (Member)]: The next governor maybe.

[Francis "Topper" McFaun (Vice Chair)]: That

[Brian Cina (Member)]: would be me.

[Francis "Topper" McFaun (Vice Chair)]: And my third priority is five eighty three, which is healthcare finance transactions and stuff.

[Speaker 0]: I'm making number two and you're making me number three?

[Francis "Topper" McFaun (Vice Chair)]: Well, number two is the universal healthcare, which I've been pushing for years,

[Brian Cina (Member)]: since the invention Oh, of health anyway,

[Francis "Topper" McFaun (Vice Chair)]: I can't abandon those things.

[Daisy Berbeco (Ranking Member)]: What's the number of the second one, Copper?

[Francis "Topper" McFaun (Vice Chair)]: 185. Got it.

[Brian Cina (Member)]: So the governor's bill is which one? Because I'm gonna read it in detail now.

[Leslie Goldman (Member)]: 585.

[Francis "Topper" McFaun (Vice Chair)]: Alright. 85. I'm going to

[Brian Cina (Member)]: read it in great detail and take it seriously without judgment based on

[Francis "Topper" McFaun (Vice Chair)]: think I think we should calculate all this. Once they come out on top, really look at them.

[Brian Cina (Member)]: I'm still gonna be

[Speaker 0]: And I will say that the Department of Financial Regulation put a lot of work into that.

[Francis "Topper" McFaun (Vice Chair)]: Yes, they did. To which one? To 580 Okay, 585. They put a tremendous amount of work in them.

[Leslie Goldman (Member)]: Leslie? So, I've been saying that I didn't pick five eighty five because I figured everyone else would, but I think looking at it and reviewing it is excellent. So thank you, Tanper. Also just want to, this is a fourth for me, so I'm not sure I'm allowed, but I think the Medicaid school based payment system is crucial and sort of wanna What's my four? I have four on my list. Don't count five eighty five.

[Speaker 0]: Because I know it's going to happen anyway.

[Leslie Goldman (Member)]: But I think the Medicaid school based stuff is important. That should be my fourth.

[Francis "Topper" McFaun (Vice Chair)]: What is that crystal ball? I'd like to have that. Leslie, who is your crystal ball?

[Leslie Goldman (Member)]: What am I looking at? My crystal ball?

[Francis "Topper" McFaun (Vice Chair)]: Where your crystal ball there? But you said 585 is gonna happen.

[Leslie Goldman (Member)]: No. It's gonna be taken up. Oh. It's gonna be discussed. That that I felt pretty confident about.

[Speaker 0]: So 558. There's this sort of that.

[Leslie Goldman (Member)]: Yeah. 558. I'd like to Some

[Brian Cina (Member)]: pieces I like. Some I like near.

[Leslie Goldman (Member)]: So mine was 569, 586, 583, and 558, and I'm not including the comments.

[Speaker 0]: Okay. All right. Any other questions? Daisy will kind get all of this together.

[Brian Cina (Member)]: Can plug it into chat GPT and see what it tells us.

[Speaker 0]: How do we know though if it's our real priorities or if they're just top priorities?

[Brian Cina (Member)]: You have to review the decision. It's a human reviewed decision. Yeah. That's that's

[Francis "Topper" McFaun (Vice Chair)]: I like to do it this way.

[Speaker 0]: We're moving on, hon. We're gonna take some testimony this afternoon on h 270. So we were able to get Katie in to do a book through We're on time. H two seventy. Perfect.

[Francis "Topper" McFaun (Vice Chair)]: Time for once.

[Brian Cina (Member)]: We're not like, oh, can we bump you fifteen minutes?

[Speaker 0]: And thank you, committee, for your input on all this. Thank you for this process.

[Brian Cina (Member)]: You should have seen some of the past processes. There's one year you had to put stickers and there were people in the room following us, nagging us about where we put our sticker. Do you remember that? Yeah, it was like, this is better.

[Speaker 0]: So everything that bugs away. Yeah, tape will take away. So much better. I've been walking through the State House and I'm marking up pieces of art that I would poach that I like knitting. I do like that one. Oh, was going to change that out. It's better than the old burning building. The burning building is not going be. We got some robot ones, but it's good. Don't think it's a can be, so kind of a brainy with wire coming out. I don't know.

[Brian Cina (Member)]: Well speaking of Feng Shui there's cake taking up the middle of the table if anyone wants it. There

[Speaker 0]: is one.

[Brian Cina (Member)]: Katie,

[Speaker 0]: do you mind if I do a procedural? Tasha, we had discussion on BAA today. Where did that move? Okay, well we're going to be needing to move that again. Okay?

[Francis "Topper" McFaun (Vice Chair)]: We

[Wendy Critchlow (Member)]: shortened it tonight so that

[Speaker 0]: we could hear Katie's well before the testing needs happen. Yeah. We're going to need to schedule that this afternoon because we need to get our recommendations to Appropriations. Okay. Thank you, Katie. Good

[Katie McLennan (Office of Legislative Counsel)]: morning. For a little bit longer.

[Speaker 0]: Are you ready for me?

[Katie McLennan (Office of Legislative Counsel)]: Yeah. We're ready. Okay. Great. Katie McLennan, Office of Legislative Counsel. Let me share my screen. So this morning, we're doing a walk through in advance of testimony that you're receiving this afternoon on H two seventy. Here we are. H two seventy, which is an actuating confidentiality for peer support counseling aligned with emergency service providers. This is a bill that has been on the wall in various iterations over maybe the past four or five years. But the concept is that emergency service providers in their line of work may be exposed to maybe traumatic or difficult issues. Often there is counseling that is provided through their employer. And this bill looks at the counseling services and looks to provide confidentiality protections to what is said in those counseling activities. So that is sort of the overview. We start off with a list of definitions. I normally don't like to spend a lot of time on definitions, but I think they're important and relevant here. There's a critical incident stress management program that's mentioned. And then there's also a definition for a peer support counseling session. I just wanted to talk a little bit about how those pieces fit together. The program itself administers peer support counseling sessions. The sessions are offered as part of the umbrella program, if that makes sense. So that is sort of how to distinguish in your mind between the two terms, but we can look at the language. The program, Critical Incident Stress Management Program, means a program established by the employer of the emergency service providers to provide counseling or support services to emergency service providers working in paid or voluntary capacity. And then who do we mean when we say an emergency service provider? An individual currently recognized by Vermont Fire Department as a firefighter, currently licensed by VDH as an emergency medical technician, an emergency medical responder, an advanced emergency medical technician or paramedic. Currently certified as a law enforcement officer by the Vermont Criminal Justice Council, including constables and sheriffs. Currently employed by DOC as a probation, parole or correctional officer. Top of page three, somebody who's currently certified by the Enhanced nine eleven Board as a 911 call taker or employed as an emergency communications dispatcher providing service for emergency service provider organizations. And lastly, somebody who's currently registered as a ski patroller at a Vermont ski resort with the National Ski Patroller Professional Ski Patrol Association. So that is who we're talking about when we say somebody who is an emergency service provider. We have a definition of employer. It means an entity that employs or oversees this provider working in a paid or volunteer capacity. So that's important because a lot of emergency service providers in the state are working in a volunteer capacity, including a state or local agency such as a county sheriff, municipal police department, Vermont state police, or any state or local public body that employs or oversees volunteer emergency service providers. And lastly, we have our definition of the session. So again, the session is under the larger umbrella of the program that administers the session. That means a critical incident stress management program session for emergency service providers who have been involved in a traumatic incident by reason of their employment or volunteer service. Subsection B starts accept as provided in subsection D. So we will look at subsection D. Both subsections B and C start this way. So they're laying out a rule, then we're going to look at what the exceptions to the rule are. Any communication that's made by a participant or a counselor of a peer support counseling session of a critical incident stress management program established by an employer of emergency service providers, including any oral or written information conveyed during that session, shall not be disclosed by any individual participating in the peer counseling session. Somebody who is participating in the session can't communicate outside of that session, something that was conveyed. The top of page four, similar language except as provided in D. Any communication relating to a peer support counseling session between counselors, between counselors and staff members of the program, or between two staff members or more staff members of the program, including oral or written information, shall not be disclosed by any individual participating in the communication. And then we have language about the PRA, the Public Records Act. So written communications that are described in this section, like notes or records or reports related to the session, the counseling session, are exempt from public inspection under the Public Records Act and are kept confidential. The Public Records Act exemption created in this section is not subject to one BSA 70 one-seven. That is language about reviewing the PRA exemption every five years. So section C, you'll see we start in the same way. Except as provided in D. So laying out the rule and then we'll look at the exceptions. A counseling session communicate I should look at this. Any communication made by a participant or a counselor and a peer support counseling session, including any oral or written communication, such as notes, records and reports related to the session, are not admissible in a judicial administrative or arbitration proceeding. Limitations on disclosure imposed by the subsection include disclosure during any discovery conducted as part of an adjudicatory process. But limitations on disclosure imposed by the section exclude knowledge acquired by the emergency service provider from an observation made during the course of employment or volunteer service or information acquired by the emergency service provider during the course of employment or volunteer service that is otherwise subject to discovery. So an observation about the person's workplace, for example, wouldn't be excluded. But it's those conversations or notes that are happening as part of the counseling session that are protected. And then we get to the which is our list of exceptions. So the confidentiality protections that were described in B and C that we just looked at shall only apply to peer support counseling sessions conducted by an individual who has been designated by an employer or a critical incident stress management program to act as a counselor, and the person has received training and counseling and providing emotional and moral support to emergency service providers who have been involved in emotionally traumatic incidents by reason of their employment. So if it's not a counselor that meets those two standards, then the protections don't attach. In subdivision D2, confidentiality protections described in B and C don't apply to the following information as it pertains to an individual designated to receive such information in the normal course of the individual's professional responsibilities. So protections on confidentiality wouldn't attach if there's any threat of suicide or homicide made by a participant of a peer support counseling session or any information conveyed in a peer support counseling session relating to a threat of suicide or homicide. Confidentiality protections wouldn't attach for any information relating to the abuse of a child or a vulnerable adult or other information that is required to be reported by law. At top of page six, any admission of criminal conduct wouldn't be protected, and any admission of a plan to commit a crime wouldn't be protected. And then we have language that nothing in this section is to prohibit any communications between counselors regarding peer support counseling sessions or between counselors and other staff members of a critical incident stress management program. So they're allowed to communicate with each other within the program to counselors. But it's when the communication goes beyond that. When I was looking at this again last night, I wanted to flag that this subsection and, let's say, B2, which also talks about the communication between counselors. I'm not sure if they're redundant or if they're trying to do something a little bit different, but we should

[Speaker 0]: look at those a little

[Katie McLennan (Office of Legislative Counsel)]: bit more closely to see where the distinctions are and if we need both. Subsection F, an employer shall not be liable for any disclosure made in violation of this section by an emergency service provider who participates in a peer support counseling session. So if somebody who's part of the counseling session violates this law and shares something from the session outside of the session, it's not the the employer is not liable for that. That's it. Takes effect on 07/01/2025.

[Leslie Goldman (Member)]: Oh. Or not. Right.

[Speaker 0]: Yeah. It

[Katie McLennan (Office of Legislative Counsel)]: was introduced last year. First edit. Know. First part, yeah.

[Speaker 0]: You say, well, you definitely need an amendment. I

[Allen "Penny" Demar (Member)]: don't think I missed it, but is there anything in there about the peer support being voluntary or mandatory?

[Katie McLennan (Office of Legislative Counsel)]: Doesn't say anything about that. It's just if it's offered, these are the protections, the confidentiality protections that are attached to it.

[Speaker 0]: Al, do you have a question? Oh, so Well, my question is, doesn't HIPAA already cover this

[Katie McLennan (Office of Legislative Counsel)]: to the extent that they're a HIPAA entity? So who is providing the care? Is it a health care provider? How are we defining counselor? A on, let me stop sharing and go through this. So right now it's looking at somebody who's been designated by an employer or critical incident stress management program to ask as a counselor, and then receive training on counseling and providing emotional moral support. So to what extent is that person a licensed health care provider that's falling under HIPAA protections? I'm not sure.

[Speaker 0]: I'm just thinking that you don't have to be a licensed anything to still fall under HIPAA because if you're employed as a receptionist, you're still bound by HIPAA, but you're not licensed. So, if you're designated as a peer support counselor, I guess wouldn't that fall under Or is it because the particular agency that would be contracting with you to provide peer support grants? Like, they're not actually HIPAA entities.

[Daisy Berbeco (Ranking Member)]: Yes. This is different than our peer certified.

[Speaker 0]: For everybody for That would work. Help bring talk through everything. That's why we have the folks come in to tell us about the services. Great. But it's different. Leslie, did you have?

[Leslie Goldman (Member)]: No. That was my question. How is this different than other peer supports? And that's the

[Speaker 0]: Yep, and Brian?

[Brian Cina (Member)]: No, I'm just trying to understand. This is saying that if there's a peer support group in an emergency responder setting and that the information shared amongst participants will be made confidential by this law?

[Speaker 0]: How

[Brian Cina (Member)]: is it not already confidential and how come only them and not other settings? How could, right now when group therapy occurs, the participants make an agreement to keep it confidential. Why do they need this in the law? Why can't they just all sign an agreement that would This feels like it's creating something extra for one population that I thought all populations already did because it's part of the consent process of being part of the treatment or group therapy or whatever, that you're agreeing to confidentiality. I'm just going say about aside, you're

[Speaker 0]: agreeing to it. Exactly. But HIPAA aside, you're agreeing to it.

[Brian Cina (Member)]: You agree to do a group, usually you sign a consent form or you sign something like an agreement or a contract, whatever you want to call it. And usually at the very least, there's other board group agreements and it's like, does everyone consent to these agreements? What is said here stays here. You say, yes, it's like a verbal contract. Why do we need it in law? And if we do, why are we only doing it for this population? Why wouldn't it be like an act relating to confidentiality for peer support counseling, period?

[Katie McLennan (Office of Legislative Counsel)]: I think those are all good questions. Think one thing, you you haven't somebody testified this afternoon. I think one of the questions you might want to dig into is like, what is the nature of the program that's being offered and who specifically is hosting these sessions and what are their credentials, I think that will get you a little bit closer. I can ask them

[Brian Cina (Member)]: what I just asked you. I shall. I shall not be.

[Allen "Penny" Demar (Member)]: I just want to say a little bit, at home, rural area, the biggest thing is fire department, they see some horrendous things. So when they go back to fire station or whatever, they say, Okay, we're going to have a counselor come in. But then all of a sudden, you've got other people there that are your bosses that are hanging around listening to all this. So the confidentiality means some of those people shouldn't even be in that room.

[Brian Cina (Member)]: So in a small town everybody knows everybody. Yeah. Shouldn't that also aren't there like federal and state workplace regulations around that?

[Allen "Penny" Demar (Member)]: I think there is in sheriff's departments and bigger the small There's also

[Daisy Berbeco (Ranking Member)]: groups therapy, though. This also potentially could be one on one. Think we have to hear from the providers. Right.

[Speaker 0]: I think we have a ton of questions, but it all seems to be around how does this work? And I think that our witnesses coming in are really going to What problems are

[Brian Cina (Member)]: solving for who and why only this group? It could be, we did, if I may say this, we did a bill one early on in my time here, probably before Alyssa, Topper was in human services because this, with the one I'm thinking of, it was about mental health counseling for LGBTQ youth. We were like, why are we only doing this for them? And we did it for all youth. So in the test we realized, why are we only making a carve out for one population? So it could be that what comes out of this is we just do something for all peer support counseling, I don't know.

[Daisy Berbeco (Ranking Member)]: I would just note the nature of the entities that these folks are working for. It's different, right? It's not a personal identification that we're addressing, but it's people who work for fire departments and pseudo government entities. Well, I want

[Brian Cina (Member)]: to know why they need special protection that other people wouldn't get in their workplaces, though. Think everybody else just

[Speaker 0]: Would had you happen to, off the top of your, oh wait, I think I, oh, I figured it out. Act 37 of 2021. I was trying to remember when we created the Emergency Service Provider Wellness Commission. Yeah.

[Katie McLennan (Office of Legislative Counsel)]: What year was it? '21, you said? '21. Oh, okay. I remember

[Speaker 0]: that because I was sitting at my dining room table.

[Katie McLennan (Office of Legislative Counsel)]: So I'm sitting here looking at the HIPAA definition of healthcare provider because I think a lot of the questions are do they fall in or out of the definition. I think we would need to learn a little bit more about the organization to get a sense for that. It does say a provider of medical or health services, but there are a lot of caveats. Even though that language is broad, I don't have a great assessment right off the

[Daisy Berbeco (Ranking Member)]: top of my head. It's so tricky. This was written before we certified peer workers for recovery and mental health in Vermont. I think the definitions are now, I assume we're talking about recovery coaches or certified peer specialists. But this is a totally different kind.

[Katie McLennan (Office of Legislative Counsel)]: Depending on what you learn, or if it is somebody who's certified through OPR, you'd probably want to take another look

[Speaker 0]: at the language and integrate. I think we're going to hear all about secure. I'm sorry, I'm just reading a report that they issued. Go ahead, Brian.

[Brian Cina (Member)]: No, I'm just wondering, and you may not know the answer to this either, because you just drafted it, you might have just been following orders, so to speak.

[Speaker 0]: Well, you know, because that's how

[Brian Cina (Member)]: it is. We tell alleged counsel what we want and sometimes they just do it if it's legal and they don't say, Why are you doing it that way? So you may not know why. But I'm wondering why in the definition of emergency service provider, they have firefighter, EMTs essentially, there's a few variations of that concept, because DMT, EMS, EMR, whatever. Then we have law enforcement, but then we have correctional officers as an emergency provider, but they are not just showing up in emergencies. They are watching over people day and night. So that's weird to me that they would be put in as an emergency provider, but I don't see crisis workers in here and we show up at hotel rooms where people are overdue. We show up a place where people are on the verge of death, and we are an emergency service 20 fourseven, and we only go when there's an emergency. So why is corrections in here, but not crisis responders? I get why nine eleven call takers are in here, I get why ski patrols are in here, though. So I'm wondering, who decided what an emergency provider was in this bill? Because that seems strange to me.

[Speaker 0]: I remember vividly going over the list of every single thing and who decided. Know you.

[Brian Cina (Member)]: This bill has its own definition though.

[Speaker 0]: I think those people are

[Katie McLennan (Office of Legislative Counsel)]: I am curious whether it mirrors the commission. I would have to double check. And if not, it was written over a year ago, so I don't know. I no longer recall how the list came to be if it's not mirrored on the commission. So the commission was Act 37 of 2021. Let me take a look.

[Speaker 0]: I do think it mirrors exactly the people that we consider to be emergency service providers.

[Katie McLennan (Office of Legislative Counsel)]: Okay. We have the list up from Act 37. We have So do you want to cross check it as I go through it?

[Brian Cina (Member)]: I'm trying to find it. I did just find it.

[Katie McLennan (Office of Legislative Counsel)]: If you look at Act 30 I'll read Act 37. Says, Currently and formally recognized by a fire department as a firefighter, currently or formally licensed by a health department as emergency medical technician, emergency medical responder advanced. Yeah, this is the same paramedic. Currently or former certified as law enforcement officer by Vermont Criminal Justice Council, Constable of Sheriffs. Currently or formally employed by DOC for probation parole correctional officer. He currently or formally certified by Enhance nine eleven. And that's it, no ski patrol.

[Brian Cina (Member)]: Right, so they're adding ski patrol or so maybe we need to add in some other things too, to make it more accurate, because it feels like it's not accurate to me. It's just weird to me that someone who's there 20 fourseven watching over people is considered an emergency provider, but someone who actually goes to another category of someone who only goes to emergencies isn't. It just feels like a weird categorization.

[Speaker 0]: I feel like somewhere along, because I'm looking at the current wellness commission members and one of the members, the last one, is a member of the National Ski Patrol appointed by Consensus of N and S Vermont Regional Directors.

[Brian Cina (Member)]: Could we do a bill since then that amended? Because there was another emergency service bill somewhere between 2021 and now.

[Speaker 0]: Maybe we can ask our witnesses today. Any other questions for Katie? Alright, so I think we're done for the morning. I'll see you all back here at one Let's try to be back here right at 01:00 for our witnesses because we are trying to squeeze something additional into our agenda. Like to get through that before