Vermont Legislature SmartTranscripts:

[Rep. Alyssa Black (Chair)]: Hi, good afternoon. It is February 17, and this is House Healthcare. We're starting our afternoon off with Commissioner Hawes from DMH and Jeremy. We all just got to meet. Welcome and wanted to provide some follow-up and additional testimony on some things that we've heard. So, go ahead.

[Rep. Lori Houghton (Member/Vice Chair)]: Stay tuned. Good afternoon.

[Emily Hawes (Commissioner, Department of Mental Health)]: For the record, Emily Hawes, Commissioner for the Department of Mental Health. And here with me today is

[Jeremy Terry (Crisis Director, Department of Mental Health)]: Hi, I'm Jeremy Terry, and I'm the Crisis Director with

[Rep. Alyssa Black (Chair)]: the Department of Mental Health.

[Emily Hawes (Commissioner, Department of Mental Health)]: So we're going to be offering some follow-up testimony related to information about how the Department of Mental Health views training for law enforcement and first responders as it relates to our proposed reduction of the Team two. So I'm going to transition it over to Jeremy, and we'll go from there. Thank you.

[Jeremy Terry (Crisis Director, Department of Mental Health)]: So thank you, committee, for letting me come here today. I have a little spiel, if you will, but please, by all means, just interrupt me and ask me any questions that you want. But my team at the department is new. It's just me and two other people, brand new to DMH that oversee all the crisis services, including the 988 global crisis, the urgent cares. And a huge part of what my team does is also training. So Team Two was fantastic, made great relationships with first responders, police officers, and the crisis services. But all of these crisis services were initiatives for the department are new for the state, and so because of that, the training needs also evolved. And that's where my team really came in to help educate the police, EMS, fire, all the first responders that we could get to about nine eighty eight, about the new enhanced mobile crisis, where the mental health urgent cares are located. And so a lot of our trainings, we have one specific training specialist who is contacted the chief of police. We've contacted literally every chief of police who's interested in talking with us and having the training. And they're really scenario based trainings. A lot of it is based on, here's the crisis services. This is what's available to you as a provider in the state. And now, go ahead and ask questions. Let's use the room. We'll bring the designated agency with us. We'll bring a 988 call taker with us to be like, this is what they would do. This is what global crisis would do, depending on any situation. And they're all different depending on which which community you go to. And that's really the crux of what our crisis trainings look like.

[Emily Hawes (Commissioner, Department of Mental Health)]: Jeremy, you mind if I add on a couple of things? We testified a little bit about this during our EAA testimony, but the Department of Mental Health worked very closely with our nine eleven operators to develop a policy that supports individuals who receive calls through 911. Can that someone on the other end might be experiencing a mental health or substance use crisis. And so Jeremy and his team also helped develop the protocol that our nine eleven operators are utilizing to transition appropriate crisis calls over to the 988 line. And so what you're hearing here is that the Department of Mental Health has prioritized supporting our community as best we can, making sure that we have someone to call, someone to respond, and somewhere to go. And being able to manage the training components that go across all of those different entities is one of the reasons why we'd like

[Rep. Daisy Berbeco (Ranking Member)]: to bring that in house.

[Emily Hawes (Commissioner, Department of Mental Health)]: Know that some of the testimony highlighted a concern that it wouldn't that it would be presentation style and that's not our intent. It would be a mixture of very factual information plus, as Jeremy said, scenario based decision making and also de escalation. And like one of the questions I think we've gotten is transitioning the team to program to DMH. And I'd like to shift that a little bit. There are really great components of Team two, but we wouldn't just be taking Team two into DMH and start delivering Team two. There wouldn't be a shift in the information, the scenarios and how that training looks. We wouldn't just be

[Unidentified Committee Member]: redoing the team to training under the guise of the Department of Mental Health.

[Rep. Alyssa Black (Chair)]: Brian?

[Rep. Brian Cina (Member)]: I have three questions. One, does DMH design the current online trainings that all the mobile crisis teams are doing that are through Reliance, I think? We don't design those, no. Are you responsible for them? Reliance

[Jeremy Terry (Crisis Director, Department of Mental Health)]: makes the trainings and then HCRS, we contract with us. We pick which ones we think are most appropriate.

[Rep. Brian Cina (Member)]: Are planning to offer those trainings to the other providers besides crisis workers as part of your shift in training?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, we could consider that. Yeah. Are you saying, I mean, because our goal would be that anyone working within the crisis system, whether they're somebody from say First Call or someone who's mobile or crisis response or something else for some first responder, that folks have a shared language across whatever lens they're approaching a situation.

[Rep. Brian Cina (Member)]: That's what I'm getting at. For example, I'll just randomly pick one, working with military families and military culture is one of the trainings we take. If the police were taking that and the firefighters and EMTs,

[Unidentified Committee Member]: as

[Rep. Brian Cina (Member)]: well as the mental health workers, that would probably improve the functioning of the system. The second question is, is there still going to be in person cross training between provider types? Yes. Okay. I don't think you need to say more about that. The third question is, has department reviewed the recommendations of the Health Equity Advisory Commission regarding training of healthcare workers and more?

[Emily Hawes (Commissioner, Department of Mental Health)]: I'm just sorting through my brain because I have a couple of health equity committees that circulate in my world. We can if we haven't. Most of our trainings are informed directly through the health equity committees.

[Rep. Brian Cina (Member)]: I'll highlight one recommendation, and I'd be happy to just make it easier and send you the link to the report so you're not trying to find what I'm But talking it was a few years ago and it did come to this committee. I know some of us were on it then, not everyone. I think probably one, two, three, four, at least four of us were, if not more, where that report came out. It had an interesting recommendation, which was that in order to promote equity, that trainings, there should be cross training and a unified, broader language of training across all actors of government, even legislators, ironically. So it was saying even legislators should have to take the same employee training as police in terms of health equity, because there's a disconnection from the frontline and the people at the top. So I just share that because there was some important pieces of it that if you are, whether you or team two moves forward with this, I feel like we haven't really followed through on those recommendations and it might be worth looking at.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, that's great. One thing that I mentioned was how valuable language is when working across systems and having a shared language would help with that access to equitable response.

[Rep. Daisy Berbeco (Ranking Member)]: Pivoting to a different topic, I didn't see anything for the PRTF in your budget. Can you speak to where that's being funded?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes, the PRTF comes under the DIVA budget. So they are overseeing the billing components of that, just like they oversee the billing components of the Brattleboro retreat. But I can tell you that we're in contract negotiations right now with the retreat. And that is, glass half full, on track for a 07/01/2006.

[Rep. Brian Cina (Member)]: Okay.

[Rep. Daisy Berbeco (Ranking Member)]: The other issue that I'm grappling with is I looked at the dashboards that are on your website, which are amazing, by the way, and specifically looked at the caseloads that our designated agencies are carrying right now. And for folks who haven't looked at it, there's sort of a minimum threshold for payment. And then once they reach that, the designated agency gets the per member per month, right, for that person. They get a fixed rate for that person. The way that fixed rate's determined, correct me if I'm wrong, is That says it all. So you have in this budget about $5,000,000 for the anticipated additional five CCDFCs. My understanding is that some of the services you're recommending in your budget be rolled into the CCDHCs were not incorporated in those five folks' cost reports.

[Emily Hawes (Commissioner, Department of Mental Health)]: I would need more specifics. But what I have heard is that a question has come to me about elder care, reach up and get services and whether or not those should be rolled into the CCBHC rate. And those specific population based services are not CCBHC eligible. What we did show was, for instance, there's around just shy of 300 folks who receive YIT services. Ninety percent of them have Medicaid or insurance, and they can still get services. It's not under the umbrella of a population specific service. Youth in transition.

[Rep. Alyssa Black (Chair)]: Okay, so everyone understands what that is.

[Rep. Daisy Berbeco (Ranking Member)]: Is there a way for all of the recommendations in the budget that we were suggested will be looked at as part of the CCDHC case rate. Is there a way to transition that so that those services are not going to be unfunded mandates to our designated agencies?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes. So we have a CCBHC manual linked on our website that provides all of the qualifying services that an agency should be billing for a CCBHC service to get the daily rate. We did a TPS one, which is a daily rate for a qualifying fit. And it is our impression that even with those targets in the current case rate, and you look at the amount of people that folks are serving in those three buckets, elder care, reach up or get, there's not such an off balance. There's not so many people being served from elder care, youth in transition, reach up that would help folks meet their targets if they're not meeting them, likely not go over. They are funded for this.

[Rep. Daisy Berbeco (Ranking Member)]: Just to be clear, my concern is that when I looked at those caseloads, a lot of folks are at or going over recently within the last year. So that's my concern. I know 2024 was a little bit different in the trends, but my concern is that if we remove the funds for those, we're going to have huge requests in the DAA to cover the losses. Potentially.

[Emily Hawes (Commissioner, Department of Mental Health)]: From the cost report work and the two agencies that are currently delivering CCVHC care, We base that CCBHC new initiative dollars. So I think there's like 5,400,000.0 in our CCBHC initiative. That number is a number that we got from understanding what their current billing is and being able to anticipate what increasing access to services look like. But or and with elder care it won't be that you're providing elder care service specific for that individual. That individual could receive services under the CCVHC. We also know that most of those services weren't done at home. They were done via telehealth or out in the community somewhere else. Those can also be managed through a traditional CCBHC. Or if somebody's not going to be a CCBHC, they would fall under their face rate. Our goal is for the agency to bill for

[Rep. Daisy Berbeco (Ranking Member)]: those And also to be following best practices. I think that's the best practice to do telehealth for that population.

[Emily Hawes (Commissioner, Department of Mental Health)]: Always. Not always, but some would prefer it.

[Rep. Daisy Berbeco (Ranking Member)]: Lastly, did you factor in that $5,000,000 Does it include the 2% up for Howard, or not Howard, Rutland and Fair Martin?

[Emily Hawes (Commissioner, Department of Mental Health)]: Oh, for the rebates? That the current rate? We'll get a rebate after year one, and so we're not there yet. We'll be there at the June.

[Rep. Alyssa Black (Chair)]: Brian, could you have

[Rep. Brian Cina (Member)]: a question about another DMH topic while we have you here, it sounds like you started, you opened up with Team Two, but we're talking about other appropriations now.

[Rep. Alyssa Black (Chair)]: Actually, I have a question about that too, but go ahead.

[Rep. Brian Cina (Member)]: About Team two or another stuff?

[Rep. Alyssa Black (Chair)]: Well, the other stuff.

[Rep. Brian Cina (Member)]: Well, I'll ask this if it's okay. It's related to mobile crisis. So that's why with Jeremy here, was like, this might be a good question. So it's the BHL, the app that some workers at least are concerned about. I'm curious if you could say more about how much it costs per year, per worker to to pay for that service.

[Jeremy Terry (Crisis Director, Department of Mental Health)]: I would have to get back to you on that. I don't know exactly how much it is.

[Rep. Brian Cina (Member)]: You know how much it is total?

[Jeremy Terry (Crisis Director, Department of Mental Health)]: It's like 350,000 a year for the entire subscription costs, something like that, and it goes up a certain amount each year, but year one it was about that.

[Rep. Brian Cina (Member)]: Yeah, and the reason I asked about per worker is because I thought it was 7 something a year, so this number is going to be wrong, but I was trying to do the math with other crisis workers, and it was paying $1,200 a year per worker. So if the system's spending $100 a month, no, it's going to be less if it's 300 something. It could be like 50 a month per worker that we're spending to have the system, but I'm wondering what are we actually gaining for that expense? That's really the appropriations question here, because it sounds like it's complicating things on the ground. I'm not a witness though, so I can't really go into that. We can always hear from workers or whatever if we want, but I'm curious from DMH's perspective, what do you see as the gain for that cost, that expense? Like how is it going to improve our crisis response system?

[Jeremy Terry (Crisis Director, Department of Mental Health)]: So how is BHL going

[Nolan Langweil (Joint Fiscal Office)]: to improve the

[Rep. Brian Cina (Member)]: crisis? Yeah, yeah, that specific investment.

[Rep. Daisy Berbeco (Ranking Member)]: Yeah, BHL is

[Jeremy Terry (Crisis Director, Department of Mental Health)]: Behavioral Health Link. It's the name of the technology that we work with. So it allows for the crisis continuum to be married, essentially. Without some sort of communication or technology platform, mobile crisis, the other crisis centers, the other DAs, and nine eighty eight would have no way to communicate with one another. And so when we were starting mobile crisis, we had health management associates do a needs assessment for us. We have been trying to follow SAMHSA best practice guidelines. Everywhere says you should really have a GPS enabled dispatch technology. And that was a recommendation for Vermont when we started Mobile Crisis two. And we agree that if someone calls 988, they should have access to Mobile Crisis if they need that. If someone calls NCSS Crisis, but they live in Burlington, they shouldn't have to be transferred. It just gives a better seamless connection statewide for all of the crisis services.

[Emily Hawes (Commissioner, Department of Mental Health)]: One thing to keep in mind with enhanced mobile crisis is that it is not defined by a designated agency or county. So agencies can cross respond to individuals if they're the closest team. So if somebody is in, say, the Virgin's area and there's a Howard Center or NCSS team closer than the CSAC team, you can cross respond to individuals who need the service. From a organization and efficiency lens of delivering care to folks in the quickest way possible, knowing folks are helps to call folks out to the post cis team.

[Rep. Brian Cina (Member)]: One of the challenges of that that I want to express, because maybe then you can weigh in on what the solution is, is that the current workflow for crisis, I don't know, so this speaks to your point, I don't know the workflow in Washington County, even though we call them if we have to coordinate with them. It's not like we don't talk, because we will use the phone the old fashioned way, and you fax them or fax email them things. We do communicate, but it sounds like you're moving towards a more centralized system. One of the challenges of the workflow is that the current crisis teams in Chittenden County have to return to the office or to another location. Like, we can do it at the police station or at the emergency room at our home if authorized. We have to do paperwork before we move on to the next person. We don't just stack up assessments and then stay until all the paperwork's done. So if team had just seen someone in the South Of Charlotte, they would still have to do their paperwork before responding to someone in Ferrisburg. I think that's a really good example, like how close it could be. So I think that I'm wondering how BHL is going to help with that barrier. And then the other thing about

[Rep. Alyssa Black (Chair)]: Can I ask my question? Because I have to go. Okay.

[Jeremy Terry (Crisis Director, Department of Mental Health)]: Would stay off. DHL would stay off, so you would say that you're not available even traveling back to the office. So someone's not gonna dispatch you in the South Of Charlotte if you have to

[Rep. Brian Cina (Member)]: go back and do a note. But then what's the point of having DHL, I guess, because you still have the we can well, I want you to ask your question, then we can come back to this. Just the chair needs to

[Rep. Alyssa Black (Chair)]: Just because it had to do with budget, I'm just thinking about one of the other budget asks that we had was around 02/11. And I know that you're incorporating September and 09/11, you know, so that there's more of a seamless closed loop, I guess you would say, with that along with mobile crisis. I'm just wondering if I'm imagining that there are people calling all sorts of numbers for all sorts of things. And I'm wondering if there's coordination with two eleven with that with 988.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, that's a great question.

[Rep. Alyssa Black (Chair)]: There's not currently is what I'm hearing.

[Emily Hawes (Commissioner, Department of Mental Health)]: I do think 211 has protocols, I don't. Do you want to speak

[Rep. Lori Houghton (Member/Vice Chair)]: to that?

[Jeremy Terry (Crisis Director, Department of Mental Health)]: 988 used to use the 211 system, and then Vibrant Emotional Health, the national vendor, moved us over to the unified platform. And I think just during that transition, 988 had to work with 211. And so there was a really good time for them to communicate. And so there's no seamless transition the way maybe nine eleven has with nine 88 and vice versa. But I think the two eleven folks, I don't want to speak for them, certainly know when to transfer the call. And I know that nine eighty eight understands the 211 services and when to tell people to call 211.

[Rep. Alyssa Black (Chair)]: And the other thing, really quickly, we also have Pathways has their warm line. Yes, they do. Is there still a need for that? I mean, I believe that's been around for it was around before nine eighty eight.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes. So the pathways warm line is a is run by persons with lived experience. And there are individuals who would prefer to utilize that resource versus a September. And so we want to have as many resources available as possible. That line is still up and running. That was it.

[Rep. Alyssa Black (Chair)]: Brian, if you wanted to continue.

[Rep. Brian Cina (Member)]: Thanks. Wanted to make sure.

[Rep. Alyssa Black (Chair)]: Yeah, do need to move on, but

[Rep. Brian Cina (Member)]: We can talk more That's operational stuff that the committee doesn't decide anyway. I'm just trying to understand how it's going to improve the functioning if we approve the expense. That's my intent in this role. I'm trying to delineate from being a crisis worker. My last question related to BHL, as you mentioned, the intent seems to be to unify the system more across agencies. Is there going to be a unified medical record system coming at some point, or is there going be a way to create interoperability around that? Because that's gonna continue to be an issue.

[Jeremy Terry (Crisis Director, Department of Mental Health)]: That's my dream. Right now, I can say we're working with HCRS to, I can only speak for the crisis system, with NetSmart and Credible to allow for Which are electronic health record platforms.

[Nolan Langweil (Joint Fiscal Office)]: Thank you.

[Jeremy Terry (Crisis Director, Department of Mental Health)]: API integration, no idea what API stands for, some IT term to make VHL be able to talk with the EHR and vice versa so the clinician can choose where they want to do the note.

[Emily Hawes (Commissioner, Department of Mental Health)]: It's all care systems in general are trying to solve the access to record challenges. With 42 CFR part two, which is HIPAA protected health information, which just got changed yesterday for an increased access to folks with substance use. But there have been challenges for centralized electronic health record management. That's all of healthcare challenge. I don't think that's just a mobile crisis or mental health system challenge.

[Unidentified Committee Member]: Quick question. Vital, what role are they going to play?

[Emily Hawes (Commissioner, Department of Mental Health)]: I think Vital, if folks don't know, that is the work the state invested in for a centralized electronic health record, essentially for folks to submit the record and be able to get it out. In some ways that's working really well. This is an area I think there's a lot, there's some opportunity for improvement there.

[Rep. Alyssa Black (Chair)]: Thank you. Thank you, Commissioner. Thank you. So I'm going to turn this over to Daisy to chair and Daisy and Lori, both of you, you so much for all the work that you've done on the budget. They're

[Unidentified Committee Member]: going

[Rep. Alyssa Black (Chair)]: to be presenting a spreadsheet that has essentially everything that we've been hearing over the last couple of weeks around budget. It is my hope that we will go through the items, make sure that everybody understands what they are, ask any questions that you have about the individual items if you need clarification. We're on very short time, however, try to get you some answers. I think I'm going to leave with one thing. I'm going to come back here in about half an hour or so. Remember, we are a policy committee, and we are being asked to make recommendations to the Appropriations Committee on where our priorities are and where our priorities within policy are. We're not a money committee. So it's not up to us to figure out how to fund anything. It's up to us to make recommendations, and then we let appropriations either take our recommendations and toss them in the trash or do whatever they want do and find funding. So thank you. Thanks, Daisy. Thank you. Be back soon.

[Rep. Daisy Berbeco (Ranking Member)]: Okay. Does everyone need a minute to orient themselves to the spreadsheet? I know a couple folks haven't done this process before. Karen? Val? Okay. So on the left, the section number refers to the section of the governor's recommended budget that that item was recommended in. So what we've done is we've taken things that need us to make a decision on and pulled those in here so we can weigh in on our position and if it's a priority of ours to support it or not. After the B6 through B315, which cover three departments: DEVA, BDH, and DMH. Then there is a section for the House Health Care Reimbursement Rate Recommendations. So that's where Vermont Care Partners came in and requested a 3.5% increase. So that's where we reflect all of those requests. And after that is a section that includes other non governor recommended requests. So that by the free and referral clinics, Registered Health and Benefit Assisters, Health Association.

[Rep. Alyssa Black (Chair)]: And then on the back side are three more of those.

[Rep. Daisy Berbeco (Ranking Member)]: And finally, winter heated section, which is just really for our tracking purposes. Thank you. For

[Nolan Langweil (Joint Fiscal Office)]: the record, name will join fiscal. Did most of this, not all, but a lot of it shall also be here up and down, so if you need to cross reference it or sectional, it's gonna have it.

[Rep. Daisy Berbeco (Ranking Member)]: Lori, please chime in at any point. Lori is my partner on this project, so please.

[Rep. Lori Houghton (Member/Vice Chair)]: Yeah, and this is new for you too. I just wanna say tomorrow, when we actually go through this again, we will be adding sash as online items. We have not done that yet. So we can talk about it today, but it will be added.

[Rep. Daisy Berbeco (Ranking Member)]: Okay, so we have traditionally done this by each person taking a moment to reflect on what their three priorities are this year. We're going to do five. So you list your top five priorities, and then we're going to go around the table and take turns with everyone letting us know, and we'll report your top five priorities. We want them in ranked order. And then in the end, we'll calculate that out and see which three or five items get the highest rankings. First, Lori, do you want to go through the line items and refresh everyone's memory together? Do you want to do Diva? Sure.

[Rep. Lori Houghton (Member/Vice Chair)]: So is everyone clear kind of where we are? So we're at the very top row. It says, Governors recommend one time funding. B1100(two) DIVA. The description is provider stabilization grants. Gross amount is $2,000,000 and the state general fund amount is $2,000,000 and it's one time money. So this means that it's in the governor's recommends that we take $2,000,000 one time and put it in the provider stabilization pot. This is something that was started a couple during COVID, where we put into the budget money where providers who were having financial difficulties could apply through AHS to get stabilization money. And we have received a report. Through that process, we asked for a report. And so there was a report sent to all of us that showed who has gotten the money and how much. And then they have to go through a process to show that they've stabilized. So that's all in a report. And so there is, I think, 2.7 remaining in the fund. Don't quote me on that. And the governor is asking for 2,000,000 more. Any questions? Who's a provider? I don't think there is specific language, but it is health care. Jen, can you help me?

[Rep. Alyssa Black (Chair)]: Very much, City Council. I do not

[Rep. Lori Houghton (Member/Vice Chair)]: know if QHCs have gotten it. Yeah, I

[Rep. Daisy Berbeco (Ranking Member)]: mean, we've had different definitions based on.

[Rep. Alyssa Black (Chair)]: I'm just wondering if nursing homes are considered providers. Nursing homes and in the emergency stabilization money, I think we gave $14,000,000

[Rep. Lori Houghton (Member/Vice Chair)]: So that's a separate?

[Rep. Alyssa Black (Chair)]: That's separate. That's what

[Rep. Daisy Berbeco (Ranking Member)]: I'm trying

[Rep. Alyssa Black (Chair)]: to understand.

[Rep. Lori Houghton (Member/Vice Chair)]: So then that is the emergency financial relief. That is a totally separate fund specific to nursing homes.

[Rep. Daisy Berbeco (Ranking Member)]: Okay.

[Rep. Alyssa Black (Chair)]: So we can't comment on that? We can,

[Nolan Langweil (Joint Fiscal Office)]: can, but it's jurisdiction.

[Rep. Lori Houghton (Member/Vice Chair)]: Right, I would go comment to human services.

[Rep. Alyssa Black (Chair)]: Could we comment in our budget letter about it?

[Rep. Lori Houghton (Member/Vice Chair)]: I would say that you should go talk to human services.

[Rep. Alyssa Black (Chair)]: So it's $2,000,000 but there's no specific breakdown as to who it's going

[Rep. Brian Cina (Member)]: to

[Rep. Lori Houghton (Member/Vice Chair)]: So we have a report. You should have it. And who the money has gone to previously. And AHS has a process that they set up when someone applies. I think anyone under AHS Dale or DIVA DMH is involved in the decision making process of whether or not they get the money or not. And so I think our question is, do we still believe that is a worthwhile endeavor and that it should be $2,000,000 Good? Okay. So then the next one, B306, Diva Personal Services. This is the Medicare assistance contract that we heard about that Diva is canceling as of 07/01/2026. So it's a gross amount of 547,000 that would go away. State funds is 273,500 space money. And so this is the group within Vermont Legal Aid and the Health Care Advocates that help people with Medicare, I think, trying to recoup money. And I might need some help on that. And that the reason they're canceling it is what they've been able to recoup is less than it's costing for that team to do the work. However, it is a five year contract, I think, that was just restarted, but now they're going to cancel it. But I did not get that right, if anyone's in the room that wants to correct it.

[Rep. Alyssa Black (Chair)]: Any questions? It's only legal.

[Rep. Lori Houghton (Member/Vice Chair)]: Specific for this contract, yes. Yeah. All right, so the next line, B306, still DIVA. This is the I don't know what HAE stands for, but this is Health?

[Rep. Alyssa Black (Chair)]: Health? Excess Yeah.

[Rep. Lori Houghton (Member/Vice Chair)]: Eligibility? So it's the 12 positions that Diva says they need for the redetermination and work requirement work that came through the federal HR1 bill. So this is 12 positions. Gross is $994,000 In the fund, it's almost $500,000 And I think they testified that they feel their productivity will need the workload will be 30% more than what they've been doing and that these 12 positions are what they need to do that work. Then, Ellen, obviously, in at any time,

[Nolan Langweil (Joint Fiscal Office)]: too.

[Rep. Daisy Berbeco (Ranking Member)]: Maybe one thing we should point out, too, is the second column of numbers that's labeled at the top, staff, the stategeneral fund, that's different than the gross on the left. So the difference is federal funds. And we didn't list federal funds out separately, but really, we highlight what's coming from the general fund because that's really how much we're spending. What does the nine months mean on that?

[Rep. Lori Houghton (Member/Vice Chair)]: Meaning that they so the million dollars, they are calculating for nine months versus a full year because they won't hire them at the start of the full year. So they plan for nine months of employment. And then, so if we approve this, then the next budget, we would have to approve the additional to get them to twelve months.

[Nolan Langweil (Joint Fiscal Office)]: That would be considered base, and it wouldn't show up in their budget unless they're changing.

[Rep. Lori Houghton (Member/Vice Chair)]: Unless they were changing, yeah. Going way too easy. Okay, B307, DIVA, this is the Northeastern Family Institute NFIA rate increase. They actually haven't gotten a rate increase in quite some time. But do you remember what they do, Daisy? They're youth, Yeah.

[Rep. Alyssa Black (Chair)]: It's youth. Beva dukes. I

[Rep. Daisy Berbeco (Ranking Member)]: don't remember off the top of my head, but I see someone who does on the sidelines. Hi! Hi! I'm Johnson and her

[Rep. Alyssa Black (Chair)]: foster partner's socials. NFI is one of the specialized service agencies and their supporting mental health for youth families.

[Rep. Daisy Berbeco (Ranking Member)]: Good job, Lori. I thought it was youth.

[Rep. Lori Houghton (Member/Vice Chair)]: Summer in my head, that's what that was.

[Rep. Alyssa Black (Chair)]: So not inpatient, but outpatient. They have residential. That's what I always run out and do home and community based markets.

[Rep. Lori Houghton (Member/Vice Chair)]: And when was the last time they had an increase?

[Rep. Alyssa Black (Chair)]: So they do get increases, but this was a specific part of their programming where they haven't gotten increases. It's been left out of their budget.

[Rep. Lori Houghton (Member/Vice Chair)]: Okay. And it's under DIVA because it's Medicaid, but it's really for mental health? So that's 600,962 gross. I'm going to round up, dollars 252,000 general fund. Are we good with that? The next row, which is the family planning rate change. So this committee put into the budget last year

[Rep. Daisy Berbeco (Ranking Member)]: or the year before.

[Rep. Lori Houghton (Member/Vice Chair)]: I think it was last year. This is something where Melissa is the coder, and the chair black's the coder. But family planning could use certain codes to be able to get an increased rate and an increased match for family planning services. And so we had put this in last year. Now Diva is saying they can't implement it. And there are conversations going back and forth between the parties. Personally, I feel it's like we're leaving money on the table for a very small amount. And other states do it and have been doing it for a very long time. However, Diva is saying they can't do it, and so they took it out of the budget.

[Rep. Daisy Berbeco (Ranking Member)]: What would that do, Lori? I'm so sorry.

[Rep. Alyssa Black (Chair)]: It's a coding issue here?

[Rep. Lori Houghton (Member/Vice Chair)]: Right. So providers who provide family planning could use certain codes for family planning that would give them a higher reimbursement rate and draw down more federal funds. But Diva is saying they cannot implement that.

[Rep. Alyssa Black (Chair)]: So is that forever? Or can

[Rep. Lori Houghton (Member/Vice Chair)]: it be fixed? I mean, it's a So they are saying they cannot implement it. So they are taking it out of the budget. It is our committee's decision whether or not we agree to take it out or we keep it in with language that says come back to us and tell us what you're working on, how you're planning to do this. We've already requested language from them, right?

[Rep. Daisy Berbeco (Ranking Member)]: The BAA. We requested language that would allow them to make it implementable,

[Rep. Alyssa Black (Chair)]: and I don't think we got it. They

[Nolan Langweil (Joint Fiscal Office)]: did send a letter saying, trying to explain why they can't do it, and of course it's always never simple. But essentially they're saying, I'll let them say too, but I do think that they're worried that they can't guarantee that they can get the nine ten on all the codes the way that they're, and so the risk is that if we do this, it could cost us more than $85,000 if we don't get the nine ten. And that's the risk, it could be as much as 300,000 That's what we want. 300,000 If we say go do it, and then they can't get the nine ten, then they need another 200,000 to fully implement that.

[Rep. Lori Houghton (Member/Vice Chair)]: Could we also say go do it, but let us know if you're not going to, like before you get to that last

[Nolan Langweil (Joint Fiscal Office)]: Sometimes we can do it that way. But

[Rep. Alyssa Black (Chair)]: if other states can do it, why can't we?

[Nolan Langweil (Joint Fiscal Office)]: They can do it, they might not be in nine ten, or it might be the way that we are implementing our codes. I mean, it gets into the weeds that I can't even start to explain.

[Rep. Lori Houghton (Member/Vice Chair)]: So there's still a possibility that we'll get more information from this through the budget process, but maybe not before we all decide tomorrow.

[Rep. Daisy Berbeco (Ranking Member)]: So when considering whether we're going to make this a priority, Lori, do you want us to just have it as written here? That would be our vote.

[Rep. Lori Houghton (Member/Vice Chair)]: I would think so, yeah,

[Rep. Alyssa Black (Chair)]: until we know more.

[Rep. Lori Houghton (Member/Vice Chair)]: The next line, I was not here for the testimony. So,

[Rep. Daisy Berbeco (Ranking Member)]: Daisy, I don't know if you want to talk about it. ABA coding, this is the behavioral services that some of us were getting a lot of emails about because there were some coding corrections that Diva made in order to be sure that the Medicaid program is following federal procedures for correct coding, and they are doing something to make sure providers implement practices in the way that they interpret the code to be written by the AMA. That will save us some money. So this represents that down from direct implementation of that code. Okay, we good?

[Rep. Lori Houghton (Member/Vice Chair)]: Yes. The next one, Diva Emergency Department per diem. Diva is suggesting that we discontinue this. This was a per diem rate that we were giving to emergency departments for extended days of people seeking mental health treatment. We started this in July 2022 in response to the fact that we had a lot of people waiting in the emergency departments. We did not get the data for this, but Diva has said that utilization has significantly declined, meaning we don't have as many people waiting in the emergency rooms anymore. Through this committee and with the administration, we've done a lot of work to help with the flow. And so they are suggesting that we discontinue this.

[Rep. Alyssa Black (Chair)]: I think we ask for doctoring

[Rep. Daisy Berbeco (Ranking Member)]: to get some data on that.

[Rep. Alyssa Black (Chair)]: Don't remember Reduced utilization.

[Rep. Daisy Berbeco (Ranking Member)]: Karen, what'd you say? I think

[Rep. Alyssa Black (Chair)]: you remember that we requested data on the reduced utilization, like what is it now?

[Unidentified Committee Member]: How many people are in the car?

[Rep. Daisy Berbeco (Ranking Member)]: Maybe people are waiting. Yeah.

[Rep. Alyssa Black (Chair)]: You

[Rep. Lori Houghton (Member/Vice Chair)]: can try and get that before tomorrow if you'd

[Unidentified Committee Member]: like. I

[Rep. Lori Houghton (Member/Vice Chair)]: do know, just in talking with others, like stakeholders, that it has definitely dropped since the crisis began. Dental incentive payment. So I think that's the first one. Sorry, yes. Dental incentive payment, again, they're asking us to discontinue this. This was something that was also implemented to help entice dentists to dentist practices to see more Medicaid patients. And if you remember, you may not remember those who were here. A couple of years ago, we also increased the rate reimbursement for dentists. It had been at don't quote me on these numbers, but like 50% or something, and we went up to about seventy percent. And that has been an incentive. And we saw some really good data, which I can pull that up if anyone wants it, in a previous year that more dentists were seeing Medicaid, people who hold Medicaid insurance. And I know I've gotten a lot of emails this week,

[Rep. Alyssa Black (Chair)]: I think everyone

[Rep. Lori Houghton (Member/Vice Chair)]: has, from dentists that they feel it is still really important for them. And it's helped them because it's just Medicaid does not pay at the cost of what the care is for dentists. So that's what that is.

[Rep. Alyssa Black (Chair)]: So the incentive was the increase?

[Rep. Daisy Berbeco (Ranking Member)]: Yes. And that's still in place?

[Rep. Lori Houghton (Member/Vice Chair)]: So the base increase that we did a couple of years ago, which I think took us up to like 70%, that's still in the base. This is another additional pot of money, which was an additional incentive. So they would just

[Rep. Alyssa Black (Chair)]: feed dentists with it? How is that money spent if they're already getting the increase?

[Rep. Lori Houghton (Member/Vice Chair)]: So remember, we only went up to 70%. So they're still not covering the cost of care. And so they would, my understanding in talking with someone just before we came in here, they would provide to Diva the data around who they're seeing, and they would get, I don't how much each one is getting. I remember the testimony from Diva was like, it's not a lot. And so they didn't think it was really an incentive. They're saying it's an incentive.

[Rep. Alyssa Black (Chair)]: It's

[Rep. Daisy Berbeco (Ranking Member)]: only $60,000 from the general fund, but 1 and 40,000 And I'm sorry, is that separate? Like, I know FQHC's delivered death bill, is that separate from this?

[Rep. Lori Houghton (Member/Vice Chair)]: Yes. I believe it is. Yeah. I think it's, yeah. All right. And the next one, increasing pharmaceutical drug copays to $4 for preferred and $8 for non preferred for those who have Medicaid as their insurance. This was said during testimony that it was needed to comply with HR1, which is not the case because we already chart, Medicaid holders already have a copay for drugs. I think it's a dollar preferred, two, three? Three. Three for specialty. And I was in a probes when this testimony was given, and the deputy director said, it's really because we haven't increased their co pays in quite a while. And so they would like to so basically, Medicaid holders would be paying more when they go to the drugstore for a drug come July than they do today.

[Rep. Daisy Berbeco (Ranking Member)]: Lori, did you say go ahead.

[Nolan Langweil (Joint Fiscal Office)]: I was gonna also say, and a lot of times what happens is if folks don't have the money for a copay, the pharmacist can do it. Right. The pharmacist can't

[Unidentified Committee Member]: have require a person to

[Rep. Alyssa Black (Chair)]: get a copay without, in order to dispense.

[Rep. Daisy Berbeco (Ranking Member)]: The medication? Sorry. Jennifer, let's see

[Rep. Alyssa Black (Chair)]: if the pharmacist cannot refuse to dispense a medication to a Medicaid beneficiary if the person is

[Rep. Lori Houghton (Member/Vice Chair)]: unable to pay the COVID. So this

[Rep. Alyssa Black (Chair)]: is a hit on pharmacists. Could be a hit on And

[Emily Hawes (Commissioner, Department of Mental Health)]: right now, did you say it's $1 and $3 Yes.

[Rep. Daisy Berbeco (Ranking Member)]: And they want to raise it to 4 and 8? Yes. Pretty big.

[Rep. Alyssa Black (Chair)]: We know what it is in other states.

[Rep. Lori Houghton (Member/Vice Chair)]: No idea.

[Rep. Alyssa Black (Chair)]: It does seem like weird numbers go from one to three or to eight.

[Rep. Lori Houghton (Member/Vice Chair)]: And we could pick another number, or we could say, No, we don't agree with this.

[Nolan Langweil (Joint Fiscal Office)]: But we've had that for the whole time, I've been in this job a long time, and the co pays have been the same the whole time.

[Rep. Alyssa Black (Chair)]: I know. I don't, I can see raising it,

[Jeremy Terry (Crisis Director, Department of Mental Health)]: it just seems like a

[Rep. Alyssa Black (Chair)]: strange number. I just want to understand that total revenue would be a million, 100,000?

[Nolan Langweil (Joint Fiscal Office)]: Not revenue, it's cost reduction.

[Rep. Alyssa Black (Chair)]: Cost reduction.

[Nolan Langweil (Joint Fiscal Office)]: And by the way, you could, in your recommendation, could say, well, we agree they need to go up and down like that, or you can say, so you can play with the numbers a little bit, or you can say a little more, but you're not tied to the four ks threshold.

[Rep. Daisy Berbeco (Ranking Member)]: Does anyone remember if they tied this savings to any need that they have?

[Nolan Langweil (Joint Fiscal Office)]: Need for cuts? Yeah. I think it's all tied to need

[Rep. Daisy Berbeco (Ranking Member)]: for dogs. Do need a specific program? No, don't think so. To fund the 12 positions?

[Nolan Langweil (Joint Fiscal Office)]: I think they had to get, they were trying to find reductions, and this was part of the fire, way they had to hit the numbers that they needed to reduce the budget by.

[Rep. Lori Houghton (Member/Vice Chair)]: And if you remember in some of the testimony, their pharmaceutical costs are actually down already, dollars 3,000,000 to

[Rep. Alyssa Black (Chair)]: $4,000,000

[Nolan Langweil (Joint Fiscal Office)]: It's also hard to know how much of that due to rebates.

[Rep. Daisy Berbeco (Ranking Member)]: Correct.

[Rep. Lori Houghton (Member/Vice Chair)]: Alright, anything else with that?

[Rep. Daisy Berbeco (Ranking Member)]: Do you want to know what

[Rep. Alyssa Black (Chair)]: other states do? Because here's the thing. Sure. Pick a couple. Florida. No copays. Florida. Those are outliers. It's kind of like Connecticut. Connecticut. Connecticut. You think they're about to have

[Rep. Lori Houghton (Member/Vice Chair)]: to do copays? Yeah, they're going to have to do copays. Okay.

[Rep. Alyssa Black (Chair)]: So that may change, obviously. Connecticut, no copays. So

[Rep. Lori Houghton (Member/Vice Chair)]: why don't you just send that to us?

[Rep. Daisy Berbeco (Ranking Member)]: Okay. That'd be great.

[Rep. Alyssa Black (Chair)]: This is from the KFFaun. Who would have

[Unidentified Committee Member]: said, Lori?

[Rep. Daisy Berbeco (Ranking Member)]: She's going to send that to us.

[Rep. Alyssa Black (Chair)]: Kaiser Family Foundation, they do a lot of research on stuff, so I'll send it.

[Rep. Lori Houghton (Member/Vice Chair)]: To Jen's point, with H. R. One, states will have to require co pays. They already have co pays of $1 and $3

[Rep. Alyssa Black (Chair)]: So you were saying it was a testimony that we got, but that what they were saying was not true, that it has to be a certain amount.

[Nolan Langweil (Joint Fiscal Office)]: I think the confusion was not everybody, when I spoke with them, I've got different stories. There were some folks at HS who thought it was just a B farm and so they were like, we have to do it for everybody else. But I was like, I think we do co pays for everybody else. So I think there was a bit

[Unidentified Committee Member]: of confusion in their testimony when they said

[Nolan Langweil (Joint Fiscal Office)]: they had to. I don't think

[Unidentified Committee Member]: they were saying it because they were trying to

[Nolan Langweil (Joint Fiscal Office)]: be nefarious. I think those folks thought it was going to be farm. So I think I'm trying to get clarification, but nonetheless, I'm under the impression right now that everybody is paying and not farm.

[Rep. Daisy Berbeco (Ranking Member)]: We're meeting the requirements of HR1 right now. We just need to decide whether we agree with a $4 and $8 increase?

[Nolan Langweil (Joint Fiscal Office)]: That's my understanding.

[Rep. Daisy Berbeco (Ranking Member)]: Or not, or we want to modify that. Lori, do you to get some?

[Rep. Alyssa Black (Chair)]: It may also be helpful to understand what Diva has in mind, which I don't know the answer to, but for co pays for other services that they may need to implement as a result of HR1. So there may be additional co pays coming from this population that they are not currently experiencing.

[Nolan Langweil (Joint Fiscal Office)]: And Finally, think on this piece, I don't think the copay piece goes into effect another year.

[Rep. Lori Houghton (Member/Vice Chair)]: On HR1.

[Nolan Langweil (Joint Fiscal Office)]: On HR1, so even if we were wrong and we didn't approve it for everybody, I think there's still another year for us to fix or implement or have clarification if we're not doing the full page for everybody, then we should be.

[Rep. Lori Houghton (Member/Vice Chair)]: Okay. The next one is utilization management for DME is durable medical equipment, special rate agreements, code review, other limits. We didn't get much on this. I'll just read what it says in their book. The Diva Clinical Unit has been engaged in several concurrent initiatives related to efficiency and systems alignment consistent with best clinical practice in the areas of DME, special rate agreements, coding reviews, and other limits. This estimate is based on a reduction of 0.25% in the acuity adjustment applied in the consensus process for the intended outcome of these collective efforts.

[Rep. Alyssa Black (Chair)]: Please translate?

[Rep. Lori Houghton (Member/Vice Chair)]: I can't. I will get more information on that before we talk tomorrow. Okay. We're going to BDH. You want me to keep going, Daisy, and then you can do DMH?

[Rep. Alyssa Black (Chair)]: Yeah, we need

[Rep. Daisy Berbeco (Ranking Member)]: to get going.

[Rep. Lori Houghton (Member/Vice Chair)]: Okay, so VDH, Area Health Education Center, which is AHEC program support. This is the scholarships that we took a lot of testimony on in here.

[Unidentified Committee Member]: VSAT.

[Rep. Lori Houghton (Member/Vice Chair)]: VSAT is the next one.

[Unidentified Committee Member]: Okay, yeah, okay, I see.

[Rep. Lori Houghton (Member/Vice Chair)]: Yep, so one is AHAC, and that's the scholarships, and then the education loan repayment. Sorry, I should have And put VSAT

[Rep. Alyssa Black (Chair)]: I got a couple of letters of some students who have $400,000 loans obligation, which they're interested in family medicine. You're not going to go to family medicine with that kind of loan burden. So just to understand what it means philosophically to choose family medicine with what we want for our state. So it's a deal.

[Rep. Lori Houghton (Member/Vice Chair)]: Okay, the next one is the unused drug repository. This was a bill near It's VSAC. I said it's good.

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

[Nolan Langweil (Joint Fiscal Office)]: have a breakdown, by the way. I'm gonna break it down.

[Rep. Alyssa Black (Chair)]: Not right now. Oh, yeah, not right now.

[Rep. Lori Houghton (Member/Vice Chair)]: So unused drug repository, this is a bill that was, I was going say, near to Leslie.

[Rep. Daisy Berbeco (Ranking Member)]: Broken heart, yes.

[Rep. Lori Houghton (Member/Vice Chair)]: We passed it a couple years ago. BBH gave in testimony that they put out a request for proposal to do this work and didn't get any responses.

[Rep. Alyssa Black (Chair)]: My research says that's not true. I'm just putting it out there. Just saying, if you choose not to stand up a program, then just say, be honest.

[Rep. Lori Houghton (Member/Vice Chair)]: So this was a program, correct me if I'm wrong, where it would take, I don't know, when my husband had cancer, we had all these drugs that he didn't use. And instead of trying to figure out how to get rid of them appropriately, there would be a way to do it. And then potentially the drugs, depending, could be reused or they would at least be disposed of properly. It was one of those feel good bills. Everyone loved it. And unfortunately, they're saying that they can't do it. So they're just asking us to take it out of the budget.

[Rep. Alyssa Black (Chair)]: So now we're breathing in the drugs that are being incinerated. That was one of the goals was to improve our environment. I'm sad. Yeah,

[Rep. Daisy Berbeco (Ranking Member)]: I think we all are.

[Rep. Lori Houghton (Member/Vice Chair)]: All right, and that is VDH. So if there's no questions, I'm going to turn it back to Daisy.

[Rep. Daisy Berbeco (Ranking Member)]: B314. Forensic evaluations have increased. This is a general fund reference for $645,000 and that covers evaluations that DMH has seen an increased number of for people who need competency assessments or or insanity assessments. So they're usually done by telehealth, by Inovutel, by a contractor. Amy's shaking her head now. Okay. I think a large portion of them are, but DMH can correct me if I'm wrong. But I just have a note in there. It seems like a pretty large increase. That's over half $1,000,000, and it's going, I think, to contractors.

[Rep. Alyssa Black (Chair)]: We need what we need

[Rep. Daisy Berbeco (Ranking Member)]: with that population. We want to be sure that those folks are taken care of and assessed by professionals. But I'd rather see, personally, money like that go to increased salaries of psychiatrists who live in Vermont. The next line is the Team two, which we just heard from Commissioner Haws about. Does anyone have questions about that or want to talk about it anymore? We go into the- Wendy, do

[Rep. Alyssa Black (Chair)]: you any questions?

[Rep. Daisy Berbeco (Ranking Member)]: No, I just want to I have a question

[Rep. Alyssa Black (Chair)]: about a previous item. Sorry, I'm just not sure I know what it means when it says BAA item.

[Rep. Lori Houghton (Member/Vice Chair)]: It was in the budget adjustment that we passed.

[Rep. Alyssa Black (Chair)]: So now this is on top of what was

[Rep. Lori Houghton (Member/Vice Chair)]: in the BAA. It's to it's go ahead.

[Nolan Langweil (Joint Fiscal Office)]: I don't know, I'm assuming it's the annualizes. So it'll show up in the BAA, and this is the annualized cost.

[Rep. Alyssa Black (Chair)]: So we won't see it again in the BAA next time?

[Unidentified Committee Member]: No.

[Rep. Alyssa Black (Chair)]: Unless they make a change. Unless it's not right,

[Nolan Langweil (Joint Fiscal Office)]: but If you don't include this, then you're undoing something you did at the BAA. Right,

[Rep. Alyssa Black (Chair)]: that's what I'm When it says BA, I just need to Thank you.

[Rep. Daisy Berbeco (Ranking Member)]: Wendy, what were you going to

[Rep. Alyssa Black (Chair)]: say about CBO? Just because I didn't know very much about it until we got the testimony, was it Friday?

[Rep. Daisy Berbeco (Ranking Member)]: I guess I just don't

[Rep. Alyssa Black (Chair)]: understand. There's already this infrastructure in place in this team too, and I guess I understand that they don't like the criteria for it, they want to improve the criteria, but I just don't understand why we're moving this in house. I don't understand why we're moving this in house.

[Rep. Daisy Berbeco (Ranking Member)]: Heard from the commissioner that she wants it to be more aligned, more closely aligned with the things that they're doing in house.

[Rep. Alyssa Black (Chair)]: Did get the part about the different services that could be more confined or more communicative would be together.

[Rep. Daisy Berbeco (Ranking Member)]: What will happen to team two? Does this go away? A good answer, Chris. Okay. You

[Rep. Alyssa Black (Chair)]: asked for my questions. That was my questions.

[Rep. Daisy Berbeco (Ranking Member)]: Touched think one of the

[Rep. Lori Houghton (Member/Vice Chair)]: things to keep in mind too, some of these, and I'm not saying this in favor or against, just in general, over the years, so this is my tenth year in this committee, we have put a lot into place that has brought things into Department of Mental Health. For instance, we put into legislation and they hired a suicide prevention coordinator. And so with those changes and putting things like more money to nine '88 and trying to do more statewide things, I think they're finally looking at all of the programs that they contract out to say, well, we have these people now. We have this new statewideregional process. We can take these things in house. Again, not saying what favor or not favor, but that's what I heard from them.

[Rep. Daisy Berbeco (Ranking Member)]: We're on team two, Alyssa. That's not the only training they're doing that with. They've also stopped doing with CHL. A lot of their suicide prevention stuff is out. Those are downs. And You Matter was one of the trainings that they've had for a long time. And that's why you remember when Kristen was in, I asked if she had ownership and trademark rights for that training. And she said no. So the fact that DMH has paid for the development of that training doesn't stop them from using her curriculum, just like with You Matter and the other things. But that's fair. I mean, she doesn't have trademark on it, and they paid for the development of the content.

[Rep. Alyssa Black (Chair)]: So it's up to them. Okay. So do we know the cost of bringing it in house as opposed to the cost of contracting, benefits, all the personnel costs that go along with that?

[Rep. Daisy Berbeco (Ranking Member)]: They said that it was going to be absorbed by Jeremy and his staff. So he has three people, I believe Kristen said she had three. And the relationships we feel can happen organically, But I it looks like it's a savings, right? Regarding the cost, it would be a savings to our general fund of almost 35,000. So Jeremy's team is existing and they're not asking for any more appropriation to stand this up. That the MDODA?

[Emily Hawes (Commissioner, Department of Mental Health)]: They did ask for an

[Rep. Daisy Berbeco (Ranking Member)]: increase in their salary lines, but we're not looking at salaries and not allowed.

[Rep. Lori Houghton (Member/Vice Chair)]: That's part of the pay act. I mean, we don't have

[Rep. Alyssa Black (Chair)]: a whole lot of say over that.

[Rep. Daisy Berbeco (Ranking Member)]: Just take their word that they can absorb it in house. So it's team two staff now and not be affiliated, they're new, they will? They wouldn't have a relationship going forward.

[Rep. Alyssa Black (Chair)]: That's not

[Rep. Daisy Berbeco (Ranking Member)]: stopping anybody from contracting with anyone. So if Kristen wants to contract with the fire halls, she can do that. DMH doesn't own the trademark. So that's up to them. But this is, I think, a way that the department sees of modernizing the crisis continuum, and that has been their focus for at least the last five years. So with the whole September thing, mobile crisis, mental health urgent cares. And I think this is seen as a way to bring in alignment, another piece of the crisis continuum, so that any developments that are happening in those spaces are part of the messages and trainings going out to these people. Okay. Anything else about Team two? Want me to keep going?

[Rep. Alyssa Black (Chair)]: Yeah, keep going.

[Rep. Daisy Berbeco (Ranking Member)]: Care coordinator for children. This rant is one I would have to refer to my notes, because I didn't type them in here, and I don't remember what it was for. I think it was Lori, do you remember, was this at the one agency? I believe so, yes. Yeah, it's sort of a specialized role at one agency. And

[Rep. Lori Houghton (Member/Vice Chair)]: I think they don't person they were serving, they don't need to serve anymore. Yeah.

[Rep. Daisy Berbeco (Ranking Member)]: They're rolling those services into DCF maybe? Okay, I'm not gonna speculate anymore. Does anyone have questions? Would you like me to follow-up with more information about that grant? Just

[Unidentified Committee Member]: so that I think I know what it is. Okay. This grant was, they were taking care of one person, right? And they don't need to take care of that person anymore. Yeah. That's okay. That's exactly right.

[Rep. Alyssa Black (Chair)]: Let's talk about community outreach. Oh, came back just in time.

[Rep. Daisy Berbeco (Ranking Member)]: Community outreach is a program that we also talked about last year because it was proposed to be cut thin. It's a program where folks are out in the community to help people in crisis. It's a very low barrier end of our crisis response mobilization spectrum. And there's a proposal from the department that says we should cut this and instead direct both to call 988, and someone will come out as part of the mobile crisis team. What I've heard from many designated agencies and clinicians is that the mobile crisis team is a very different part of the response system in that they are required to complete more paperwork. It's a much higher barrier. They can't just go up to someone and start assisting them in crisis. And they don't do the what's it called? They don't do the roaming comb as the community outreach does. And then Lori, you have experience with this system. Yeah.

[Rep. Lori Houghton (Member/Vice Chair)]: So community outreach is something that we started again in this committee a while ago. And it's in Chittenden County. Communities also pay in. So it's a state municipality process. And I'll just give you an example as a business owner. We had someone who was on our property, homeless person sleeping in a tent. And we just wanted to make sure that that person was aware of services that were available. And so we called community outreach, and they were there probably within half an hour. And it was a conversation, right, instead of it being some type of escalated thing. The other way I've heard that they're really used, several of the libraries where people who have needs hang out. Community outreach will come and talk and just check-in on people. And it's a way that they're keeping the situation from getting worse and hopefully being able to provide services. Again, I question whether or not a nine eighty eight mobile response team would be willing and able to do the same thing. And I know we've heard from several of the town's police and managers that this is really important to their communities.

[Rep. Daisy Berbeco (Ranking Member)]: Oh, yeah. It covers nine communities. I don't know if I said that.

[Rep. Alyssa Black (Chair)]: I will say personally, I think I've had emails from other representatives of almost every single community because their communities have reached out to them. A vital service is. I keep going back to sort of what you said is if you respond to everything as an emergency or as a crisis, it will become a crisis. And this is, again, a very low barrier. This is who comes out when it's not a crisis, but there is someone in need that someone in the community has identified as, hey, what's

[Unidentified Committee Member]: Can you talk about? Who oversees this project?

[Rep. Daisy Berbeco (Ranking Member)]: Howard Center. Howard Center.

[Rep. Alyssa Black (Chair)]: Which is a designated agency.

[Unidentified Committee Member]: Right.

[Rep. Alyssa Black (Chair)]: How much is and it's it's $1.01 60, and that's all general funds?

[Rep. Daisy Berbeco (Ranking Member)]: I think the other thing that I would note is that this is the number that my law enforcement calls when they know that they're not the person who needs to help someone, but someone obviously needs a person to talk to. And I know my municipality has written letters in support of this project, and we only use about 14% to 15% of the calls come from Winooski. But that just speaks to how valuable it

[Rep. Alyssa Black (Chair)]: is to us, I think. Can you explain in the notes it says Epic and two-one-one integration? So that's not what I'm hearing you talk about. So I just want to make sure I'm understanding.

[Rep. Lori Houghton (Member/Vice Chair)]: Is that in the wrong

[Rep. Alyssa Black (Chair)]: I think it's in the wrong one. Yeah.

[Rep. Daisy Berbeco (Ranking Member)]: Okay. Would We it

[Rep. Lori Houghton (Member/Vice Chair)]: can just ignore that. Okay.

[Rep. Alyssa Black (Chair)]: I mean, would it go elsewhere? I mean, I could make an arrow, but okay.

[Rep. Lori Houghton (Member/Vice Chair)]: Yes, it goes elsewhere. I also

[Rep. Alyssa Black (Chair)]: I seem sort of concerned that, and this is the second year we've talked about this, there really doesn't seem to have been a lot of thought behind a transition plan. And you know, how to transition, it's just sort of been this, Oh, don't worry about it, mobile crisis can handle it now. And that doesn't seem like a very thoughtful design on how to go from one type of service to another type of service abruptly. VSAC and APIP, same. Yeah. And it's currently in base

[Rep. Daisy Berbeco (Ranking Member)]: It was like a one time last year.

[Rep. Lori Houghton (Member/Vice Chair)]: No, it's base. Right, so could we do it one time

[Rep. Daisy Berbeco (Ranking Member)]: and do a transition? The transition. That could work. I do feel like it can't just stop. Disappear. And here's my thing about this program, which is probably driving the department up the wall right now, because it keeps coming back and we keep pushing back, is I feel like with this focus on the crisis continuum and development, making sure everybody has someone to go to and someone to talk to and whatever, I feel like there's an idea that there's the same approach and offerings and services in every community. And I don't think that is equity. I think that Chittenden County needs community outreach. I don't know that I could say that about every county. If we're making smart investments about fundamental services that people really, really need, I absolutely feel like Chittenden County needs this. Just based on the volume of people we have and the acuity of care they need, I feel like this is a really economical investment and it's a really humane thing to offer people.

[Rep. Alyssa Black (Chair)]: And the proximity of all these towns and cities.

[Rep. Lori Houghton (Member/Vice Chair)]: Cities or villages like we

[Rep. Alyssa Black (Chair)]: still do. The proximity for

[Unidentified Committee Member]: each other. Allen, I respectfully disagree with you. I think there's a need in every town community. We have those same problems at home. But people like us, up home say, well that money went to Chittenden County, that money went to Chittenden County. And we have to depend on pretty much volunteers from our ambulance service and other people that are trained to do these, and our local sheriffs and state police respond to those. I don't want to say it's more so for numbers wise in Chittenden County, but it's just important in the other towns. I agree, those people need false tears.

[Rep. Daisy Berbeco (Ranking Member)]: It's just a matter of degree.

[Rep. Alyssa Black (Chair)]: Yeah, and I also think because Franklin County's designated agency would have mobile crisis, which serves a much smaller population. So do you think that maybe they would be better equipped to absorb this than Chittenden County's mobile crisis?

[Unidentified Committee Member]: I think they're two different things.

[Rep. Alyssa Black (Chair)]: Well, are, but mean, the reason that this has been in Chittenden County is because there are these two really, really distinct needs that are so high at this level that it's almost like you need two different types of responses geared towards that as opposed to some of the other lesser populated counties. Perhaps they can all be I don't know. There are things we need all over the state. I mean, I think Rutland has urgent children, urgent Oh, fuck. Love that. They a specialized program for just children and mental health. And you know what? Chittenden County doesn't have that. Franklin County doesn't have it.

[Rep. Lori Houghton (Member/Vice Chair)]: So I will say we haven't really been advocating for any of the other things on the list. So I would suggest we move on.

[Rep. Daisy Berbeco (Ranking Member)]: CSIP, Collaborative Systems Integration Project. This provides community supports for justice involved non Medicaid, non SMI, old term for serious mental illness, population in Washington County mental health service area only. So I think this is another case potentially of, here's a service that's only benefiting one area. Why did they get it and not others? This program evolved from a single person, 20 fourseven program during Tropical Storm Irene to a program working with individuals involved in the criminal justice system who need support. I think one thing I would point out about this is the department is assuming that individuals served in this program are just going to shift to traditional outpatient services. But if they're non Medicaid, assuming they're all private insurance, they would get tucked into the adult mental health bundle for DAs, which doesn't count toward their targets. So it's basically uncompensated error. So this is the thing I was pointing out to the commissioner. If this is going into their bundle and they're already hitting their targets, this is just an unfunded Why can't I say that? It's our take a little old necklace.

[Nolan Langweil (Joint Fiscal Office)]: That's not a good deity.

[Emily Hawes (Commissioner, Department of Mental Health)]: Neckxus, not a necklace.

[Rep. Brian Cina (Member)]: Know. Not

[Rep. Daisy Berbeco (Ranking Member)]: a necklace. He's

[Jeremy Terry (Crisis Director, Department of Mental Health)]: in white.

[Rep. Daisy Berbeco (Ranking Member)]: So that would be my concern about this, but I do appreciate that they are trying to streamline and be creative where they can redirect people for services.

[Unidentified Committee Member]: I got a rough question. Was all these funded when the pandemic money came? Or these have funded These for have

[Rep. Daisy Berbeco (Ranking Member)]: been funded. It's been funded

[Rep. Lori Houghton (Member/Vice Chair)]: before that, yeah.

[Rep. Daisy Berbeco (Ranking Member)]: Does anyone have questions about that one? Let's go on to Lifeline Suicide Prevention, DHL. DHL ran the suicide prevention portfolio with all of DMH's work, included a lot of trainings and a symposium. DMH is proposing, since CHL has now closed its doors, that they shutter that program and absorb the suicide prevention work within the department under Chris Allen. Remember, Lori mentioned earlier, legislated that position a couple of years ago. So they now have a director of suicide prevention that they didn't have when this grant was initiated. I feel comfortable with this personally, how you've created the suicide prevention portfolio there. And I feel like

[Rep. Alyssa Black (Chair)]: Chris will be able to get it done. Not to mention it's hard to pay someone that doesn't exist anymore. Well, like a contract with somebody. I

[Rep. Daisy Berbeco (Ranking Member)]: feel like the work will still get done.

[Rep. Alyssa Black (Chair)]: Safe Haven at Claire Martin. I'm going to review my notes. I believe that's a residential Can you talk about what the investment project means and the implications of that? Want me to do that. Nolan, why don't you talk

[Nolan Langweil (Joint Fiscal Office)]: about something? It means that it's a global commitment investment. So remember, we talked about investments, that it's things that would not be Medicaid eligible in the absence of the waiver that follow their sort of criteria. They're So just highlighting that this is an investment cost and not a straight Medicaid measure. So for instance, if global commitment goes away, these projects will either be 100% state funded or they won't.

[Rep. Alyssa Black (Chair)]: There's no real implication, it's just a bucket. And how we're it. And how we're paying out of global commitment.

[Rep. Daisy Berbeco (Ranking Member)]: And the investment funds are kind of a special little bit,

[Rep. Alyssa Black (Chair)]: I remember the whole list for a

[Rep. Daisy Berbeco (Ranking Member)]: long time. The DMH has put programs into the investment fund. And they don't have as much oversight, maybe, or monitoring and reporting requirements as the other global commitment things do. Things in there can be a little more loosey goosey, I'm going to say. And now it's a really good idea to clean up stuff that may be a little loosey goosey in our Medicaid waiver.

[Nolan Langweil (Joint Fiscal Office)]: But it's good that it highlights it separately in the budget because then we know, oh, it's coming out of this bucket and not out of the straight bank.

[Rep. Alyssa Black (Chair)]: Yeah. So it's just going to lower our global commitment investment costs. Yeah. Thank

[Unidentified Committee Member]: you.

[Rep. Daisy Berbeco (Ranking Member)]: We were talking about safe haven. Okay, sorry. Did we talk

[Rep. Alyssa Black (Chair)]: about safe haven? No. We got sidelined with GC Investment. We didn't talk about Safe Haven. I might ask Lori to help me with Safe Haven.

[Rep. Lori Houghton (Member/Vice Chair)]: Yep, this funding is for support services for uninsured adults to help with transitional housing and support needs. It includes case management, housing counseling, life skills counseling and peer mentoring, provides emergency shelter bed if one is available. If we allow this to go through DMH, we'll shift to traditional outpatient services for this population, which includes the services that I just listed that are medically necessary as part of a treatment plan. So it's a different way that they are proposing to help this population.

[Rep. Alyssa Black (Chair)]: So that means that they're shifting it in house, just to use their terminology. Is that fair?

[Rep. Lori Houghton (Member/Vice Chair)]: And not in house to them, how Clara Martin

[Rep. Alyssa Black (Chair)]: as a DA would do it. Okay, so it would shift to Clara Martin? It's at Clara Martin. But the cost would shift to Clara Martin. If this went away, the cost would shift to Clara Martin? Yes. Yeah. And Clara Martin in what county are we in?

[Unidentified Committee Member]: Orange.

[Rep. Daisy Berbeco (Ranking Member)]: Orange County?

[Rep. Alyssa Black (Chair)]: Yeah, that's interesting.

[Rep. Daisy Berbeco (Ranking Member)]: Youth in transition services youth ages 16 to 22. And the department is proposing that these individuals can receive the services in a traditional outpatient setting, much the same as they did with the previous two items we looked at. Ninety five percent of them have Medicaid or private insurance coverage. So billing could be done there.

[Rep. Alyssa Black (Chair)]: Can I add that it sounds like we're We're shifting costs from global commitment to DAAs by cutting these? That's right. In this particular case, they

[Rep. Lori Houghton (Member/Vice Chair)]: did say, as she said, that 95% of the people have Medicaid, and we could be doing Medicaid billing for these, which we are not right now.

[Rep. Alyssa Black (Chair)]: Because it's global commitment.

[Rep. Lori Houghton (Member/Vice Chair)]: It's a mid program setup.

[Rep. Daisy Berbeco (Ranking Member)]: But it doesn't change none of this changes the case rate that the DAs get. The DAs still get the same case rate, but yet they have this additional person that's going to be coming to them for these services. They're just loading more people into the DAs without increasing their case rates.

[Rep. Alyssa Black (Chair)]: So could you define case rate for those people who are? Amy Johnson. Amy Johnson, Vermont Care Partners, there's an adult mental health bundle and a children's mental health bundle, and for every agency there's a target. You hit your target, you pull down the funding, and those budgets are capped. So if your target is 100 for the year and you hit 100 and you serve 101 people, you're not gonna get payment for that one hundred and first person.

[Amy Johnson (Vermont Care Partners)]: So for agencies that are already hitting, this would be children's mental health bundle. So for agencies that are hitting their children's mental health bundle, serving these additional clients through that bundle, if you're already hitting that cap, you're not getting paid for those services for those clients. Thank you. Does DMH have a plan for that? Do we hear anywhere along the line?

[Rep. Daisy Berbeco (Ranking Member)]: I asked Emily when she was in. Yeah, so that I'm trying to No, they don't. No plan. So once again, DAs are absorbing. Yes, that's my understanding.

[Rep. Brian Cina (Member)]: I would just say that something I learned when we searched for a new superintendent is that the greatest predictor of future behavior is past behavior.

[Rep. Daisy Berbeco (Ranking Member)]: Okay, we're almost done, and then we're going to take a break. Elder care and reach up.

[Rep. Alyssa Black (Chair)]: That's what I was wondering. So, I'm leaving reach up to the committee down the hall to make a determination on it.

[Rep. Lori Houghton (Member/Vice Chair)]: Yeah, which we should talk about.

[Rep. Brian Cina (Member)]: Oh, okay. I don't

[Rep. Daisy Berbeco (Ranking Member)]: feel like we're And I was out there in the same way.

[Rep. Alyssa Black (Chair)]: The middle of the day, same thing. That's weird. Is really

[Jeremy Terry (Crisis Director, Department of Mental Health)]: the last cup of tea.

[Rep. Daisy Berbeco (Ranking Member)]: Cup of tea? Okay. In that case, I think You want to take a break?

[Rep. Alyssa Black (Chair)]: Yeah, did. This seems like a good time to take a break. It's been an hour and a half with this, so let's take a fifteen minute break. Let's be back here to Here, make me sign up for your mouth. And two then we'll move on to recommendations that we've other non governor recommended that we've received.