Vermont Legislature SmartTranscripts:

[Rep. Alyssa Black (Chair)]: System, we're live. Okay. Okay. Hi, everybody. Welcome back. Sorry. We had a had to wait for our legislative council working on one of our bills and wait meetings. Glad to hear it. So we are I have I have to correct the record. Oh, yes. Yes. We we talked about thank you. Apparently, I misspoke yesterday. I was told that when we were talking about on the team two testimony that a social worker left the Westminster Barracks because of the tragedy there, and that in fact was not true, that she had already had that transfer in motion. So I just want to be sure that that record is clear. Thank you. Thanks, Leslie. Appreciate it. Alright, so we're moving on to H. I. 58, and we're going to do a walkthrough with Jen on it.

[Jen Carby, Office of Legislative Counsel]: Good afternoon, Jen Carby from the Office of Legislative Counsel. I will put this language up on the screen. So we are looking at H558. And this is an act relating to the Medicaid School Based Services Program. And so at a high level, this is really transferring sole authority over school based Medicaid services from being split between the Agency of Human Services and Agency of Education to being just in the Agency of Human Services. And there's some additional provisions as well. So inoculating to Medicaid School the Medicaid School Based Services Program starts out by adding a new section in title 33 in the chapter on Medicaid that it would be entitled the Medicaid School Based Services Program. And it starts there with expressing legislative intent that the state maximize its receipt of federal reimbursement for medically related services provided to students who are eligible under Title 19 Medicaid of the Social Security Act. And it is also legislative intent that Vermont's school based medical assistance programs shall comply with all federal Medicaid requirements. And as the state Medicaid agency, the agency of human services shall have sole responsibility for determining and maintaining program compliance. The Medicaid is the role of the agency of education, which will be responsible for coordination of the school based medical assistance program with statewide education policy and objectives and for communicating with supervisory unions and may specify the use of program funds received by state education agencies in accordance with 16 ESA 2959A, which I believe you'll see coming up in the bill. Connects the agency of human services to adopt rules to identify the services that are available through the school based Medicaid medical assistance program and set forth the requirements for supervisory union participation. And the rules would include state and federal requirements for Medicaid reimbursements, Medicaid cost reports, provider enrollment and trainings, service documentation, Medicaid eligibility, and any other provisions needed for compliance with the Medicaid program. And it directs the Agency of Human Services to support supervisory unions by funding and providing the technical elements of the program necessary for federal compliance. Section two adds a new section creating the School Based Medicaid Reimbursement Fund. This would be in the statutes right after the section we just looked at. And this would establish a special fund to receive federal reimbursements for medically related services delivered pursuant to the Medicaid School Based Services Program described in the previous section. The money received by the state under this section would go into the Fund, which would be administered by the Agency of Human Services and Fund receipts shall be allocated in accordance with this section. Directs the Department of Vermont Health Access to pay 55 percent of the federal reimbursement monies generated by the medically related services delivered in each supervisory union under the Medicaid School Based Services Program to the Supervisory Union. So 55% of the federal reimbursement from those medical services or medically related services would go to the Supervisory Union based on the Medicaid cost reports, service claims, and Medicaid administrative costs submitted by the Supervisory Union. Up to 25% of the federal reimbursement monies generated by those services will be available for the administrative costs of the Agency of Education and the Agency of Human Services related to collecting, operating, and reporting school based medical assistance programs and statewide programs. Requires the agencies to enter into a Memorandum of Understanding, an MOU, that sets forth the processes by which Medicaid reimbursement monies available for administrative costs and statewide programs are allocated to each of the agencies, and requires the Secretaries of Education and of Human Services to expend monies from the Fund only as appropriated by the General Assembly. At the close of each fiscal year, the Commissioner of Finance and Management is directed to transfer and deposit any balance remaining in the School Based Medicaid Universal Fund into the Education Fund. Section three amends 16 BSA 29.59A. That was the section referred to in Section one. It's a provision in Title 16, the Education Title, currently entitled Education Medicaid Receipts. We changed that to Medicaid School Based Services Program, Supervisory Unions, and Supervisory Districts. It starts out with some similar language to what we saw at the beginning of section one, expressing legislative intent that the state maximize its receipt of federal reimbursement for medically related services provided to students who are eligible under title 19 of the Social Security Act. That's really modifying to parallel those sections And expressing further intent that each supervisory union, as you can see, some of this is current law, whatever is not underlined, each supervisory union identifies special education and other students who are eligible for Medicaid reimbursement and to the extent possible, submit and changes the language from Medicaid bills for services reimbursement to Medicaid compliant cost reports and service claims. I'm sure you'll hear more from IHS about why these language changes are necessary. And then keeps language directing the agencies to work with local school districts to maximize reimbursements, including services to non IEP students. Most of the language on the special fund was moved and modified in section two, so all of that language and some of the specifics under it, which you can see, I think it was 55% in the new language, 50% here goes to the supervisory union. So some modifications and some changes from specific dollar amounts and amounts in excess of minimum thresholds. So the special fund in Cambridge has changed fairly significantly. And then this directs the supervisory unions to use the funds that they receive from the special fund to pay for the reasonable costs of administering and delivering medically related services pursuant to the Medicaid Spent Related Services Program, and then keeps language allowing school districts and supervisory unions to use the funds received under the section for prevention and intervention programs in pre K through grade 12, And then delete some additional language about the programs. And then this has the Agency of Education adopting rules, setting forth the requirements that supervisory unions and school districts must meet regarding the use of Medicaid reimbursements from the special fund coordinating reimbursement related to state place students under Section 2,950 of this chapter in the education statutes with the Medicaid School Based Services Program as set forth in what is now sections one and two of the bill. And these rules must address the manner in which supervisory unions receive and reconcile funds in alignment with education cost reimbursements under Act 60 BSA 2,950. And the act would take effect on July 1. So again, big picture is moving really all for Medicaid purposes, all of the Medicaid administration to the Agency of Human Services, but keeping some responsibilities for both AHS and AOP.

[Rep. Alyssa Black (Chair)]: Any questions on the language for Jen? Go ahead, Leslie. I just want make sure I'm understanding this. So in section B or section two, subsection B, it's 55% to the SU.

[Jen Carby, Office of Legislative Counsel]: Yes.

[Rep. Alyssa Black (Chair)]: And then in C, up to 25%. Yes. What about the rest? You'll have

[Jen Carby, Office of Legislative Counsel]: to ask the agencies what the plan is for the rest.

[Rep. Alyssa Black (Chair)]: Anything that will be included in the bill?

[Unidentified Committee Member]: That is

[Jen Carby, Office of Legislative Counsel]: unspent would go into the education fund at the end of the year. But this language was provided to me, so I will encourage you to ask. Go ahead.

[Rep. Alyssa Black (Chair)]: I would defer that to when Ashley speaks, she's gonna talk how it's currently done and why it's changed. And so she will answer that.

[Jen Carby, Office of Legislative Counsel]: Okay, great. I

[Rep. Alyssa Black (Chair)]: have one more question, if I may. In C3, it says they shall expend monies for the fund only as appropriated by the general assembly through the budget process. Is that what that means?

[Jen Carby, Office of Legislative Counsel]: Yes. Or through any like, I mean, through any legislation.

[Rep. Alyssa Black (Chair)]: It could be the year round kind of thing also if we're not in session. How does that I don't

[Jen Carby, Office of Legislative Counsel]: know what that what the year round thing is. Let's ask questions. Okay. Yes. But in

[Rep. Alyssa Black (Chair)]: general Thinking about JFa the emergency or whatever committees do that, but we're not here.

[Jen Carby, Office of Legislative Counsel]: Yeah, they should not be appropriating funds with the exception of some certain allocations authorized by the emergency board. But appropriation is a legislative function. And whether it happens in the budget bill, which is the standard these days, but has not always been, or in some other legislation.

[Rep. Alyssa Black (Chair)]: Thank you. Thanks. Thank you, Chair.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: For the record, Ashley Berliner. I'm the director of Medicaid policy for the Agency of Human Services. It's good to be here in three d today.

[Rep. Alyssa Black (Chair)]: I am

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: going to share my slides. How do I do that? Oh my gosh, I'm so sorry.

[Rep. Alyssa Black (Chair)]: It's not like I've

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: been sitting here for forty five minutes, or I could have prepared.

[Rep. Alyssa Black (Chair)]: Or we usually have Alex in and she runs the slides. I

[Jen Carby, Office of Legislative Counsel]: just need the legs, and that comes so we can just join it and then share your screen. Thanks, Tasha.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: I would talk while I'm doing this, but I've learned that I can't. Incapable of doing anything else when I'm joining Zoom.

[Rep. Alyssa Black (Chair)]: Just to reallocate This is it might make sense of this. I think Ashley should make sense of that. I think that you give us applications.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: It's getting it's getting closer.

[Rep. Alyssa Black (Chair)]: I don't know why that slide's blank, though.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: Animation I didn't know about. Okay. Can you see that?

[Rep. Alyssa Black (Chair)]: You can. All right. Is that the title you want? What? Are we talking about electronic health records?

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: Nope, that's not the right title. Okay, thank you. Was like, sorry.

[Jen Carby, Office of Legislative Counsel]: The rest of this is very custom, though. Okay.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: So for the agenda today, I definitely want to put in plain language what Ledg Council just walked through. So we'll go through that in detail. Before I do that, I really want to talk about why we're putting that in statute, why we're looking for this change. And I'm going start with just what are Medicaid school based services. Medicaid school based services are services provided to Medicaid kids in the school setting. So they're Medicaid services that you can get anywhere else, but they're unique because they're provided in schools. And the federal government has made exceptions to how those services can be delivered, paid for, and generally provided when they're in the school setting. So qualifications for providers can be different. Documentation needs are different. What the services actually are from a medical necessity process can be different. So they're a unique category of Medicaid services. So for about the last year and a half, the Agency of Human Services and the Agency of Education have been working really closely together to reform Medicaid school based services, how we're doing it today, and migrating it into a new system of care. We have a goal of migrating this program by 10/01/2026, so coming up really soon here. And that reform effort that we want to hit tenonetwenty six aims to solve numerous existing programmatic issues in the current state and also encourage school participation through administrative efficiencies. We really have four pillars for what's guiding this reform effort, and that is ensuring federal compliance, expanding access to Medicaid covered school based services, reducing the administrative burden on schools and the state, and maximizing the federal reimbursement. It references here a CMS grant, and that is because we have a federal grant to help us do this, to actually modernize the program. CMS issued new guidance for school based services in 2023 that allows states to bill and think about school based services in a more flexible way. And so this effort really allows us to take advantage of that new guidance and modernize our system. The current system is broken. It is not something that we feel like we want to get in and tweak around the edges. We are really looking to overhaul the system in its entirety. And that includes these three legs of the stool, these three buckets here. The first is changing the program administration, moving program from AOE to AHS, establishing a new payment methodology, moving to a random moment time study, and having clear clinical level data. And we're doing that through an electronic health record. So what is in that statute that Jen so eloquently read to us? To put it in plain language, it does a few things. For the Agency of Human Services, it establishes a special fund so that AHS can receive and reimburse the federal dollars that schools are delivering for the Medicaid services that schools are delivering. It establishes AHSDIVA as the administrator of school based services. And AHSDiva here is an important thing to point out. Diva is the payer. They are going to be the ones who are functionally administering this program from a business office perspective. But policy sits at AHS, and so it will be a joint endeavor between AHS and DIVA. The proposed statute provides rulemaking authority for AHS to establish requirements for school based services. And in that, we specifically want to require schools to use the random moment time study for billing of school based services and to use the electronic health record to ensure that we have compliant clinical level data for Medicaid services. And then on the IHS side, it requires IHS to support schools by funding those things. So we're gonna be funding the RMTS. We're not asking schools to pay for that. And we're gonna be funding and standing up and providing technical assistance for the electronic health record. We are not asking schools to pay for that.

[Unidentified Committee Member]: Can you talk a little bit about RMTS? I

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: can talk a little

[Jen Carby, Office of Legislative Counsel]: bit about it.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: That's all I need. RMTS is a random moment in time study, and it is something it is a payment methodology. It allows us to create a statistically significant percentage allocation of the amount of time that certain eligible school based providers are spending providing Medicaid eligible services to Medicaid eligible kids. So it actually generates a number that allows us to say 25% of these people's time can be billed to the Medicaid program. From a school perspective, it's a really light touch. We do this now. DCF has it for their Family Services Division caseworkers. We do it in corrections for probation and parole. Random moment time studies are a really ubiquitous way to get that allocation across funding streams. For schools, what will be required of them is once a quarter, a small sample of providers will get basically a prompt to say, go into the system and tell us exactly what you did during this moment on this day. And there's a pretty short time frame to go in and enter that data, because we don't want people to have to remember back weeks ago. And they say, I was providing physical therapy to a Medicaid eligible kid. I don't even think they have to say Medicaid eligible. I just think they say providing physical therapy. And then we collect those moments in time. We match that up with the cost allocation plan that schools submit and the Medicaid eligibility that schools have, school district supervisory unions. And that generates a percentage where we get to bill Medicaid for x percentage of their time, their costs. I'm sure that that isn't a perfect explanation of it, but you can definitely have someone come in who is a real expert on that if you need more information. That's the gist. So that's the AHS side of the house in terms of that statutory proposal. For AOE, it authorizes the Agency of Education to define how schools may use the federal payments from AHS for Medicaid services delivered. AOE is going to come talk about that and use the term reinvestment dollars. So I just want to clarify here that that's what this is. And it also grants AOE rulemaking authority to set requirements for how schools are allowed to spend reinvestment dollars paid by AHS. So I'm going to get to the slide here and have a little bit of a better idea of how those percentages play in. So the proposal really aims to simplify how this is broken down in statute. The current state says that 50% of federal revenue can be paid back to the school in the form of reinvestment dollars. Up to 30% is used for state administration. Anything that's not used up to that 30% gets put to the ed fund in addition to another 20% to the ed fund. And then there's this very convoluted language around an incentive fund that we are asking to be stricken. It is not used today. It's a mechanism for providing additional payments for schools if certain threshold amounts are exceeded. It is not in use and just overly complicates the funding picture. The top half of that current state is for direct services. And that's what you think of when you think about kids getting services at schools. That is a part of the school based services that's currently administered by AOE. Below that, Health Access and Outreach, that is our Medicaid administrative claiming program. And that a different subset of school based services. It's administered by the Department of Health. And it is what we think of as health outreach and access. Appointments. It is helping get medical appointments, making sure that the kid has access to vaccinations and has a PCP. It's really those administrative functions. And that is happening through the health department right now. That breakdown in how federal funding participation is 85% to the schools and 15% to state admin. In the future state, we are combining direct services and health access and outreach. They will no longer be two programs administered by two separate entities. Everything will be combined. Everything will be using that random moment time study. And it'll all be administered at AHSdata. So the changes to the numbers and statute that you see. You see that schools are the reinvestment dollars are increasing from 50% to 55%. The state administration max is decreasing from 30% to 25%. And the ed fund is remaining the same, 20% plus unspent admin funds. The investment fund is going away because, again, it's not used, it's just really overly complicated. So those are the changes and percentage that you're seeing and that Jen walked through in that statute. This include SB6 services? It does not. Great question. So a SuccessBand six services are excluded from this. This is limited today to the services that schools are delivering in house and their school nurses doing access and outreach. Can

[Rep. Alyssa Black (Chair)]: you speak to how Success Beyond six gets billed then? How's it? Well, maybe not. Sorry. I asked.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: No, Success Beyond six is administered through the Department of Mental Health. And it is services that the school contracts with the designated agencies to provide. And it really is a separate mental health component. We're thinking about how that will fit in so that we can leverage some of the flexibilities that we're going to take advantage of here, how we'll be able to leverage that for Success Beyond Sex in the future. But that's phase two. As you can imagine, this is a huge lift. And so we're really just trying to keep it narrow, not include Success Beyond Sex. And then hopefully, we can take advantage of some lessons learned and bring them to Success Beyond Sex in the future. Thank you.

[Rep. Alyssa Black (Chair)]: Essentially, the bill is just making things uncomplicated, or it's a step in the process that we're going through right now to redo this. Yeah, so it's a necessary step to give us spending authority to make sure that we can administer it at AHS. And it also streamlines

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: payback of the federal funds a little bit.

[Rep. Alyssa Black (Chair)]: Do you remember me sending you that email from CMS in 2023 about this?

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: I do. Maybe. About the new guidance.

[Rep. Alyssa Black (Chair)]: The grant that they were offering. And I was like, are we really maximizing the way that we do this? And you did it. Here I am. Here you are on the way. But just thank you for everything that you do with Medicaid for us. You're just

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: It's been such a massive effort and so thankful to the Agency of Education for the really, really close collaboration. We've been working on this for almost two years now. So it's a really massive team effort, for sure. Great.

[Rep. Alyssa Black (Chair)]: Thank you, Ashley. Just trying to add up the numbers on the right. I'm sorry. I had to get out my calculator because it's alphabetic. It's 55 plus 25 and that equals 80. And then you add the 20 and then you're 100. So what about the unspent admin? So I'm just trying to understand how that fits together.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: Yeah. So today, if you look at current state on the Ed Fund, the statute says you can spend up to 30% on admin. That's not happening. AOE is not spending 30% of this. So anything that they're not spending is going to the ed fund. That's that unspent percentage. And that's the same on the future state, too. The statute has really placeholder language of up to 25%. We don't anticipate it costing up to 25%. So it just defaults to anything.

[Rep. Alyssa Black (Chair)]: For each of those levels, there's going to be perhaps unspent, and that'll go to the ed fund.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: Not for schools. Schools locked in at 55%. That's not going be

[Rep. Alyssa Black (Chair)]: on That's not going to change, but the state of admin and the ed fund might vary. Yes. Got it. Thank you.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: And sorry. No, I was going

[Rep. Alyssa Black (Chair)]: say good time to mention that reminder that we're doing the policy and I am making a 100% guaranteed guess that our clerk of the house will send this to Ways and Means who probably will spend a great deal of time looking at that piece of it. I just want to understand it. I'm sorry.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: It actually prompted me to say something that I should have said at the beginning, which as we played with these numbers a little bit, we were really intent on holding everything harmless. So making sure that we didn't take any more money out of a Ed fund, making sure that the admin pieces continued to be covered. So that was all thought through when we changed those percentages. And when we were looking at it, we were like, we can give the schools an extra 5%. We have that. So that's how that shook out.

[Rep. Alyssa Black (Chair)]: Thank you. You also mentioned that you're suggesting language. Did you say that you're suggesting language? I sent

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: you language a while ago, but now it's going to the bill, so I'm not exactly sure. Did you not know that? Okay. I've been working with Rakuten on that piece, And I think I even saw it in the big Belgian.

[Rep. Alyssa Black (Chair)]: So yeah, let's coordinate and make sure that's in there. Yeah. Rephoton had given me a heads up that there was maybe a small change that you wanted to make. I assume that So we'll figure that out. Can I ask another question? In three, I was just curious to understand. It just says, shall expend the money only appropriated by the General Assembly in the big bill?

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: Or is Yeah, I think that's That's not that's that language. When AOE and AHS come with their budgets, the legislature will appropriate money.

[Jen Carby, Office of Legislative Counsel]: Okay.

[Rep. Alyssa Black (Chair)]: Yeah. So that does not need to be stated. Thank you. Thanks, Ashley. Thank you. Thank you much. And we have Jill. Do you want to come on up? We have the whole team. We have the whole team.

[Jill Briggs Gamble, Deputy Secretary of Education & Chief of Operations]: Yeah, we'll take a minute to get some chairs.

[Rep. Alyssa Black (Chair)]: I think we went over to the agency of a gentleman. I mean,

[Katie Smith, Education Medicaid Director, Agency of Education]: I knew this building a lot,

[Unidentified Committee Member]: and I was like, where is this house?

[Katie Smith, Education Medicaid Director, Agency of Education]: Found y'all. We got there. I'm going to

[Unidentified Committee Member]: sit to the side because you're mainly going to be going from Kate. Sorry, Kate.

[Jill Briggs Gamble, Deputy Secretary of Education & Chief of Operations]: So for the record, I'm Jill Briggs Gamble. I'm the Deputy Secretary of Education and Chief of Operations. And I'm joined today by Katie from our team finance. I will let them introduce themselves. I'll do just very brief opening remarks, but you're mainly going to

[Jill Briggs Gamble, Deputy Secretary of Education & Chief of Operations]: hear them from Katie. But we're all available to answer some questions should you have them. So Katie, if want

[Katie Smith, Education Medicaid Director, Agency of Education]: to introduce yourselves. Yeah. For the record, I'm Katie Smith.

[Katie Smith, Education Medicaid Director, Agency of Education]: I'm the Education Medicaid Director for the Agency of Education. Great. For the record, I'm Cassandra Ryan, the Chief Financial Officer at the Agency of Education.

[Jill Briggs Gamble, Deputy Secretary of Education & Chief of Operations]: So my very brief opening remarks, you've already heard

[Katie Smith, Education Medicaid Director, Agency of Education]: from Ashley. So what you have in front of you in terms

[Jill Briggs Gamble, Deputy Secretary of Education & Chief of Operations]: of this language is the result of a really collaborative process that's been going on for almost two years, recognition of a realignment of roles and responsibilities in ways that will best serve our schools and also streamline administration, and really, as I like to think about, having the right expertise in the right locations. So the role of the agency of education in this space is three things. One is ensuring that oh, wow. Ensuring that the agency of education has very tight partnerships, as you might imagine, with our school districts. So helping to build those kind of collaborative relationships with our partners at HHS, our communication lines, identifying key stakeholders and implementation partners. So really leveraging those relationships and helping to elevate any potential barriers or obstacles or you might want to be thinking about this. So just being kind of thought partners in that way. The second is we're really laser focused on, you know, our education system, just like our health care system, is under a lot of pressure and change right now. So really ensuring that this piece of work in this transformation, we're just bearing in mind the bigger picture and ensuring that we're trying to line up timelines as best we can. They're not matching as much as we would like, but that's okay. That almost never works out perfectly. But just really keeping that bigger picture in mind. And then during the transition, focused on maintaining operational continuity and minimizing disruption in the field. So that's sort of our main areas of focus and how we are supporting this work. And so I think our presentation is brief because you've gotten really the big overview from Ashley, but you may have some specific questions for us. And I'll kick it over to Katie. All right. Thank you.

[Rep. Alyssa Black (Chair)]: All right, so this is

[Katie Smith, Education Medicaid Director, Agency of Education]: an overview just of what you've already seen. This is after the claims have been processed and paid, there's the fifty-thirty-twenty split of the federal dollars. So what are the functional updates that are needed to Title 16 to elevate the program? Our goal overall is to design a responsive system that increases direct support to schools, provides insight to the health outcomes that impact academic success. That 55 reimbursement, that is what is reinvested back into the schools in prevention and intervention programs, and those are to serve all students. I guess I should also add, too, the removal of the obsolete requirements here, those were mechanisms designed to encourage participation. But future moving away from the claims based model, they're no longer needed.

[Unidentified Committee Member]: Great. So I'll talk a little bit about the agency's priorities right now through this implementation phase. So of course, as Jill mentioned, our top priority is to coordinate between agencies to make sure that our districts continue to receive consistent and clear communications, leveraging those relationships that we have and those communication methods. We've got some established lists that we use and making sure to always connect it back to that education policy. We are gonna support the transition worried about continuity of operations. When I say worried, I just mean we're gonna watch it. We're gonna be very watchful to make sure that during the transition, that the school districts remain unharmed through that, making sure that everything continues. There will be a period of time where two systems are operating at the same time, not at the same time, but two systems operating in one fiscal year. So there's that period between July 1 and, as Ashley mentioned, that tenone implementation date of the new system, we will have to maintain status quo. That will be on us. We will be supporting AHS's communication plans, and then really focusing on strengthening that reinvestment process. That's where we get to that 55% that is going to be going to the school districts. But we're following up the reinvestment process. That will require us to make rules, and we're very aware that timing rulemaking will be something we'll really need to keep our eye on. A pretty quick timeline, so we'll be focusing on that and really making sure that we're prioritizing the use of data as we inform those rules. That will make you a process. So

[Katie Smith, Education Medicaid Director, Agency of Education]: the main takeaway here is that we really want to be intentional with planning and the best use of the funds. With the state level funding, we want to be the example. We want to review how we're spending our 25% share. We're going to prioritize statewide interventions and establish that memorandum of understanding. And then on the other side, our goal is to guide the LEAs, which are the school districts, to be intentional as well. We want to give them parameters for fund use and reporting through rulemaking, establishing planning processes, and aligning the spending with the goals that they already have,

[Unidentified Committee Member]: which are in their continuous improvement plans.

[Jen Carby, Office of Legislative Counsel]: Barbara,

[Unidentified Committee Member]: everything. Yep. Yeah, so we're just trying to

[Katie Smith, Education Medicaid Director, Agency of Education]: get to the heart about CLEMs reporting. The rulemaking is really going to help the LEAs navigate a clear process, clear expectations, building on the success of what's working well already. We want to design a reinvestment process on the strengths of both the MAC, which is the Health Access and Outreach process, as well as our current school based health services processes. We also want to create a unified data set for Vermont Department of Health and us, AOA, to use. And just to close, we want to make these funds and processes to make sure the program supports students in a meaningful way.

[Jill Briggs Gamble, Deputy Secretary of Education & Chief of Operations]: And I would say our current state, in some ways, is Katie and Katie's team is focusing on the administration of the program. And so we've identified, just as we are across the agency of education and kind of all things right now, where we can make some improvements. And so what you heard from Katie is really the focus on how that 55% is being used effectively in our schools. And as we diagnose with most things in the education system, there is wide variety and variability in the quality of those reinvestment plans. Right now, we really have sort of a back end reporting function, trying to, did you do it? And we're really looking to shift our focus and support to how are you doing it? How does it actually align with your larger continuous improvement plan? What are you identifying as student needs? And how are you leveraging these funds? So we're really trying to shift districts to thinking about, here's our needs, here's our plan, what funds are available to fund that plan, rather than letting the fund drive the work. So I think that we actually we're pretty excited about this. We think that we can really do a lot of good work in this space, and we're all about elevating the quality of what's happening in our system. So as I said, this is really aligning our expertise to the right place and then aligning the expertise of Diva and AHS to the right place in ways that I think will actually benefit the whole system.

[Rep. Alyssa Black (Chair)]: Any questions for anyone? Yeah, go ahead. Sorry. On your slide, I see that you're close to your computer, but on slide four. So the overlap of the two systems is really going to be two months. Is it just from July to October? Yes. Okay, so July, August, September, four months.

[Jill Briggs Gamble, Deputy Secretary of Education & Chief of Operations]: And then is that including close-up? That will happen after the final There's a claims run out period.

[Katie Smith, Education Medicaid Director, Agency of Education]: The services will be provided up that will be paid for under our model, the current model, up until the September. And then from that last day of service, they have six months to get the claims in. And so we'll be providing support through that time.

[Rep. Alyssa Black (Chair)]: As someone who's been intimate with electronic health record conversion, that's torture. So thinking about the random time study, how do you integrate using that data collection through the random time study while you're making this conversion? So, we're being really thoughtful with AHS, and I think

[Katie Smith, Education Medicaid Director, Agency of Education]: that they are leading that plan. Okay.

[Rep. Alyssa Black (Chair)]: I'm I can't believe I'm in this position, but I'm wondering, is there anybody else we need to hear from? Do we need to hear anything else on this? I mean, this seems like you have been working for a couple of years on developing a better process. That process has been developed and you need language from us to implement appropriately. Do I need to hear from anybody else? Do you have suggestions on if we need to hear from anybody else? I wouldn't mind an answer from AHS on my question if that's a future question or not. Just the thought about it. Can you remind me of the EHS converters? They have four months of overlap. How that is going to impact providers at the school level.

[Unidentified Committee Member]: It sounds like the implementation plan for the EHR. Yeah. And how that's going to affect.

[Rep. Alyssa Black (Chair)]: That's hard. I just don't want people to get When are you doing your time study, random RMTS, new to me. So how does that all fit in?

[Jill Briggs Gamble, Deputy Secretary of Education & Chief of Operations]: It's important to us that they don't have to it at as well.

[Katie Smith, Education Medicaid Director, Agency of Education]: I'm sorry? It's important to us that they don't

[Rep. Alyssa Black (Chair)]: have to flick it at work. Yeah, I'm sure. Yeah, you all seem to agree.

[Jill Briggs Gamble, Deputy Secretary of Education & Chief of Operations]: I'm not trying to point, I'm actually trying to point it to the

[Katie Smith, Education Medicaid Director, Agency of Education]: team that's leading it. Yeah. Don't you Here, why don't we swatch?

[Rep. Alyssa Black (Chair)]: Sorry.

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: So the RMTS and the electronic health record are not integrated. So those are not connected situations. One is a statistical measure, and one is an electronic health record. Today, what's happening is schools are documenting all of their clinical data on paper. So we are aware that this is a significant change for the schools in Vermont. We have staffed this unlike anything I've ever seen. I've been in Vermont Medicaid for a long time, and the amount of resources we have to make sure that this is successful are really impressive, I think. We have a vendor working on change management and doing all these communications with us and focus groups and really working closely to make sure that we know what schools need. We have a technical assistance vendor that's working really closely to understand the business needs of schools. We're going to also have a business assistance vendor that is working hand in hand with schools to make sure that they are registering users correctly, that they're getting their data in correctly, that all of those annoying hanks of getting into an EHR for the first time are being carefully held by a professional. So we really are thinking about this in the most thoughtful way. The last thing we want to do is make it harder for school providers. That is really the antithesis of this entire work. And we know that it's going to be a lift and a sprint getting to October. But we think it is worth the effort, and it's going to just really improve things once we get that behind us. Can I ask another question? When do you think your first study, time study, might be? We're implementing the time oh, and let me also say thank you. These are really helpful to prompt new information to share with you. So the RMTS, the Random Moment Time Study, is being implemented statewide on tenone. That is a change in payment methodology, and that change in payment methodology is happening across the state all at once. The electronic health record is going to be implemented over a phased period of time. So we're really looking at school calendar year 'twenty six, 'twenty seven to get that rolled out to all the districts. We're going to start with a small group of high achiever volunteer districts, is our plan right now to really not pilot, but start out the EHR, make sure that we're hitting our marks, and then we're going to roll it out to different supervisory unions from there. So we are not standing up the electronic health record statewide all at once. I think that would be too big of an ask and wouldn't allow us to iterate in the way that we think we need to and are really going to phase it in.

[Rep. Alyssa Black (Chair)]: That's great. One more, just curiosity. When you do your first studies over that first year, will working in the electronic record be one of the choices of where you are in your time, or is that not? Oh, that's

[Ashley Berliner, Director of Medicaid Policy, Agency of Human Services]: a great I don't know. That's a great question. I can look into that. I don't know. Yeah. Presume it's anything related to delivering the service, but we can find out.

[Rep. Alyssa Black (Chair)]: Okay. Well, thank you. Thanks for coming in.

[Jen Carby, Office of Legislative Counsel]: I'd like to give you a squeeze once.

[Rep. Alyssa Black (Chair)]: Okay, thank you. I think that I, unless anyone has anything further, I think I'll work with Tasha and possibly put this on our schedule for next week for Martha and Pete's new vote. You asked if there was anyone else that we should speak to, this is going to be an uninterrupted changeover to the providers themselves. Do we need to hear from the providers? Their souls? Let's ask Ashley that. And I think it sort of plays into the question that Leslie had asked. So if we need further clarification, we'll get that. Then we'll decide. So next week, sometime. All right? We can go