Vermont Legislature SmartTranscripts:

[Alyssa Black (Chair)]: Hi. Welcome, everybody. It's Friday, February 20. We are gonna do sort of markup and possible vote, and we're also gonna hear from Karen Robinson from the NEA just to make sure that everybody's in alignment on this bill. So, Karen, did she wanna come on up and just speak to this bill and any concerns or Good morning.

[Collin Robinson (Vermont-NEA)]: Good morning, Daisy. Good to see you all. Thanks for being here.

[Collin Robinson (Vermont-NEA)]: For the record, Collin Robinson, Vermont, NEA. Just want to say thank you for quick work on H558. I wanted to let you know that we checked in with folks who are engaged in this type of work to make sure that schools are receiving Medicaid funding in the most effective, efficient ways to meet the needs of students and to provide supports and services to as many students as possible. And we connected, as I mentioned, with some of our national partners, both in the nonprofit as well as policy experts at our national, and thumbs up on the bill. They said it made a lot of sense, that it is best practice, that it's being developed across states in other parts of our country, and that it is a positive step forward to making sure that those resources are maximized for school districts to support students their ability to access their education. Great.

[Alyssa Black (Chair)]: Services are already providing, ensuring that we're maximizing

[Collin Robinson (Vermont-NEA)]: the money. Exactly. My understanding is that this has the potential to bring in some resources that might not already be, school districts might not already be compensated for it, and that is a benefit to taxpayers as well as benefit to the students that need to access those supports. Okay,

[Debra Powers (Member)]: I just would like to go

[Allen “Penny” Demar (Member)]: from square one here. Okay, so what we're talking about is the state Medicaid agency Human Services. They're going to be responsible for determining and maintaining the program. Then they turn the responsibilities over to the Agency of Education?

[Alyssa Black (Chair)]: I believe that they are responsible for the funding of the program, and then they turn over the responsibility for actually Implementing goes to the to the agency of education who is best in a position of implementing policies rather than Diva or AHS, which is best

[Allen “Penny” Demar (Member)]: me at For services. Let me follow the money. What's the steps where the money goes? You're given a service, it's going to cost to implement and to do these things. So who bills Medicaid?

[Jen Carvey (Office of Legislative Counsel)]: Why don't we

[Collin Robinson (Vermont-NEA)]: was going to say it, let's take

[Alyssa Black (Chair)]: you

[Collin Robinson (Vermont-NEA)]: I would defer to somebody else to address

[Debra Powers (Member)]: that question.

[Collin Robinson (Vermont-NEA)]: You know, the specific imagination. Together.

[Allen “Penny” Demar (Member)]: You know? Yep. I'm sure it's fine. Slides. I might have to explain this next week of Yeah.

[Alyssa Black (Chair)]: No. Fair enough.

[Collin Robinson (Vermont-NEA)]: I would say from our perspective, the headline is that right now schools are already receiving Medicaid money, and this creates a more efficient way to ensure that the maximum allowable resources are getting to schools and students that need those resources. And by creating those efficiencies, that means students are able to receive that support they need, and potentially, that means it's gonna have a positive impact for taxpayers as well. But as it relates to specific A to B to Z, I would defer to others. Just seems complicated. A lot of things are

[Brian Cina (Member)]: pretty complicated.

[Collin Robinson (Vermont-NEA)]: But I thoroughly appreciate your desire to understand that complexity because it is important, details do matter.

[Alyssa Black (Chair)]: Thank you. Thank you, Colin. Thank you, Madam Chair. You gave that

[Allen “Penny” Demar (Member)]: short notice. Absolutely. Appreciate it.

[Alyssa Black (Chair)]: Jen, Yeah. Do you want to come on up? Just so we can Is anyone else has questions? We'll flip the language up. We have it on the schedule for markup, but I don't believe we're actually marking anything, just still set.

[Collin Robinson (Vermont-NEA)]: So this is what we will talk through the end of day.

[Jen Carvey (Office of Legislative Counsel)]: Good morning. Jen Carvey from the Office of Legislative Counsel. I will start by putting the the language up, but then I may use some of Ashley's presentation from last week. Yeah. It's last Friday. Great.

[Alyssa Black (Chair)]: So I'm looking at slide six and that Right.

[Jen Carvey (Office of Legislative Counsel)]: Yep. That's what slide five and six kind of explains. Yeah. So I will do that. But first, let's just look sort of generally, I think from the statement of purpose of the bill, this is transferring sole authority over Medicaid school based services over the program to the Agency of Human Services. Right now, it's split between Agency of Human Services and Agency of Education, which may not be the most administratively streamlined way to do that. And I think the agency of education folks don't live in the Medicaid program administration world the way the agency of human services does. And then it also makes some changes to the amounts of the reimbursement that go to the agency and to program administration and are available to go back into the general fund or education fund. Sorry. So now let me see if I can find it. Just pull it up. Let's see. Actually, there we

[Alyssa Black (Chair)]: go. Alright. So now I'm gonna put up

[Jen Carvey (Office of Legislative Counsel)]: this is not my presentation. This is Ashley Berliner's presentation from last week. But I think slide five is helpful in explaining what they were going for. So in this bill, it establishes it sort of closes out an existing special fund and creates a new one that the money would for, from, for AHS would go into to reimburse schools from the federal Medicaid payment. So right now, as I understand it, school pays to provide the services and then the reimbursement comes in from the federal government through, for a portion of that, through the billing federal Medicaid. And this is, and some of that is administered through the agency of education. So all of that part of dealing with the federal government and getting the money would be at the agency of human services with a special fund for that money to go into. It still establishes the Agency of Human Services and through them, the Department of Vermont Health Access as the administrator of the Medicaid school based services. But the services themselves are still being delivered in the schools by school personnel. It gives rule making authority to the agency of human services, and it requires the agency to support students by funding and providing the tools that are needed for program compliance. And the piece that stays with agency of education is authorizing the agency to define how schools can use the federal payments, the the, from the agency of human services, for the Medicaid services that are delivered, and we're calling those reinvestment dollars, and giving the agency of education rulemaking authority to set requirements for how schools are allowed to spend those reinvestment dollars. And there's a bit of funding changes that she had gone over. So in the current allocation, 50% of what comes back from the federal government for these services is available to the schools. Up to 30% goes for state administration, and then 20% and whatever is not spent of that 30% goes into the education fund. And then there's separate piece. I'm not gonna talk about what's not really relevant to this bill. And then what they're proposing is that 55% instead of 50% goes to the schools, and then the administration number changes from up to 30% to up to 25%. And then, still that 20% and unspent administrative dollars go into the education.

[Alyssa Black (Chair)]: And just a reminder, this bill to probably immediately go to ways and means, who I am certain will be asking all the questions around the numbers. When you look at the sponsors, we've got Ways and memes.

[Jen Carvey (Office of Legislative Counsel)]: Right. So I mean, I think as I understand it, sort of the biggest takeaway is that it stops the administration from being split between the agency of human services and the educate agency of education. Agency of human services is the single state agency for Medicaid, federal Medicaid purposes. And so they would be doing all of the administration stuff and also changing a bit, increasing by 5% the amount of the federal reimbursement that is available to the schools.

[Leslie Goldman (Member)]: And then there's a whole EMR part.

[Alyssa Black (Chair)]: Great, any other questions? Do you to put the language back up?

[Jen Carvey (Office of Legislative Counsel)]: I can if it's psyched. I'll do it again.

[Alyssa Black (Chair)]: Go ahead, Brian. So really, the

[Brian Cina (Member)]: question is just the sense I'm getting is that legislative council has worked out the language to make sure that it's achieving the intent. So I don't see any reason that I would need to change what it says. I'm reading it, it's pretty technical or something. It's a very technical bill, but it really sounds like it's just about improving the way that we can fund these services.

[Alyssa Black (Chair)]: Taking advantage of federal dollars.

[Jen Carvey (Office of Legislative Counsel)]: Right. Although it's not changing anything about federal dollars, it's just, I think, ensuring more streamlined compliance with federal requirements. So if we wanna look at language, it specifies legislative intent that the state maximize its receipt of federal reimbursement for medically related services provided to students who are eligible from Medicaid and that our school based medical assistance program comply with all federal Medicaid requirements. And as the state Medicaid agency, the agency of Human Services will have sole responsibility for determining and maintaining program compliance. Then it specifies what the agency of education is responsible for. That's for coordinating the school based medical assistance program with statewide education policy and objectives and for communicating with supervisory unions, and that may specify the use of program funds received by state education agencies in accordance with provision of existing law. And so this is existing law that I think we amend in here, but saying how schools can use the reimbursement dollars that come back in. Val, want to Not to dive into a different rabbit hole. I withdrew the school possible changes going on, Would supervisory union ever be a problem? I think we will if if there are if there are changes, yes, we will need to go through all of the statutes and make sure that they are consistent with whatever the terminology is. So yes, and we'll

[Alyssa Black (Chair)]: be on. Fair question. Leslie,

[Leslie Goldman (Member)]: you actually have the same question, Val. But we currently have more than supervisor unions, even in the current world. There are some supervisory districts.

[Jen Carvey (Office of Legislative Counsel)]: So this is where I'm gonna phone a friend on the side if you wanna talk about the- Or

[Leslie Goldman (Member)]: does this cover everybody no matter what?

[Jen Carvey (Office of Legislative Counsel)]: I think there's different ways that things are laid out in existing statute that this is reflecting as far as communication with supervisory unions and program funds received by state education agencies. But I prefer to call.

[Collin Robinson (Vermont-NEA)]: Yeah, Colin Robinson about any age. So your colleagues down in House Education had this very similar conversation with legislative counsel

[Jen Carvey (Office of Legislative Counsel)]: yesterday. Different legislative counsel. That

[Collin Robinson (Vermont-NEA)]: St. James who does education and they were talking about the BOCES need legislation. And that legislation, it only uses the term SU. And it was confusing the committee and legislative counsel, I don't wanna speak for her, but what I have heard reflect in that conversation is under statute is sort of an all encompassing term for the various types of school government structures that exist in statute right now.

[Alyssa Black (Chair)]: Thank you. Yes. Thank you, I'm sorry, Allen. I'm sorry to have forgotten that. Go ahead Debra, sorry.

[Debra Powers (Member)]: I'm trying to get what you are doing, you get up there. I can't get it.

[Jen Carvey (Office of Legislative Counsel)]: Think it's not I

[Debra Powers (Member)]: can't see that.

[Jen Carvey (Office of Legislative Counsel)]: Not posted under today. I I just Okay. No. That's okay. So if you refresh, you may be able to find it's just H550 eight. Otherwise, you can look up H five fifty eight as introduced, and that's all I'm Great. Want me to keep going through it or just

[Alyssa Black (Chair)]: You know, we went through this bill the other day, hasn't changed. Are there any other questions about this bill? Again, this bill will make several stops along the way.

[Leslie Goldman (Member)]: I just wanted to distinguish between policy and money. So the only

[Alyssa Black (Chair)]: part that's our job is the beginning part. The rest of it's kind of money because it's the reimbursement fund. So it's really just transferring the authority. That's all the authority the government. Absolutely.

[Jen Carvey (Office of Legislative Counsel)]: Emergency freight, AHS. AHS. Yeah, so that's all we're really talking

[Allen “Penny” Demar (Member)]: Could you refresh us on section two?

[Jen Carvey (Office of Legislative Counsel)]: Section two is the special fund.

[Allen “Penny” Demar (Member)]: Yes.

[Jen Carvey (Office of Legislative Counsel)]: Yes. So that there is, I believe there is a special fund in existence. Yes, there is a special fund in existence right now in title 16. That is the education title. And so this is creating kind of the bill is repealing that and creating kind of an analogous letter Right. This is gonna this replaces because if you look at section three, right, yes, it's starting on page five. It strikes the whole Medicaid special reimbursement special funds established in the agency. And it does this. It has this section two special fund instead.

[Alyssa Black (Chair)]: I don't know if you can answer it or not, but

[Jen Carvey (Office of Legislative Counsel)]: how is by combining this, is it increasing the federal reimbursement? I don't think it's increasing the federal reimbursement. It is expressing legislative intent that we maximize our receipt of federal reimbursement. And I think the idea there is that AHS as the single state agency for Medicaid program administration is best positioned to make sure that their administration is in compliance with federal requirements, which is what's necessary for us to ensure federal financial purposes. So just fine by the rule of this. Yeah. Think so. Don't think it's gonna change anything unless they AHS may have a a better sense for how to document services provided that would allow us to more closely track reimbursements with services that are being delivered, but I don't know if that makes sense. That's kind of speculation, I think, yes, I think they're the experts in the Medicaid program administration area, they're best positioned

[Alyssa Black (Chair)]: to administer the drug. Okay. Any other questions? If none, I would entertain A move. Second. Do you move?

[Debra Powers (Member)]: That's five fifty eight, that we pass it back to me,

[Alyssa Black (Chair)]: The way it's written. Can

[Allen “Penny” Demar (Member)]: I just ask the question? So by passing this, we're going to send it on to Ways and Means?

[Alyssa Black (Chair)]: Well, the Clerk of the House will send it. I believe this bill is going to have to go to ways and means, probably education, probably It's got a lot of places to go.

[Brian Cina (Member)]: But we're sending it with our approval. Just saying, we're not just punting it. This is us giving us our blessing and sending it off to the next stop. Bring it favorably. Yes. I bless it.

[Alyssa Black (Chair)]: That's right. The third time comparable. Do we have a reporter? Brian Cina. Yes.

[Jen Carvey (Office of Legislative Counsel)]: Be grateful. Yes. Anita Maher?

[Allen “Penny” Demar (Member)]: Yes.

[Alyssa Black (Chair)]: Leslie Goldman? Yes. Lori Houghton? Karen Lueders? Yes. Debra Powers? Yeah. Yes. I'll reach the other person. Daisy Berbeco. Yes.

[Collin Robinson (Vermont-NEA)]: It's a small area.

[Debra Powers (Member)]: Got your jeans.

[Alyssa Black (Chair)]: Got your jeans. Wow. Where where are we? We're in the middle of a roll call. Alyssa Black. Yes. So it's 1001. Great. Thank you. And Daisy, we'll see the repetitive stuff. Okay. Another question. All have this on our website. Yes. Can we put it on our Somewhere in there. There. A different date from the eighteenth. Okay, thank you. Let's move on. So, we are moving on to Louisville, And this was introduced by representative Michelle Bosland. So we're going to have Michelle come up first and just sort of give us an introduction of why she introduced the bill and then I'll leave it to short form, but we'll have Jen walk us through, I don't know, two sentences. But I thought it would be best if Michelle just introduced it first to us. Oh, there's, like, five sentences. I have a few

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: more than five that I'm gonna share with you. Welcome to representative Thank you. So for the record, I'm representative Michelle Bosalan from the Windham 3 District. I'd like to thank the chair and all of you on the committee for taking time to hear about this issue of medication from specialty pharmacies being allowed in all inpatient settings in Vermont for individuals. To explain how I came to introduce this bill, I'm going to tell you a little bit about my own health situation. I was diagnosed with a rare form of lung cancer last November. Neither surgical treatment nor radiation are possible in my case. The only treatment to reduce the cancer in my body and keep it from metastasizing is a targeted therapy, which comes in the form of a prescription from a specialty pharmacy. I need to take these three pills every day, and I need to reorder these two weeks in advance. There are many medications that come from specialty pharmacies that hospitals and nursing facilities don't stock. There are over 7,000 rare diseases, and not all of them have specialty prescriptions, but many of them do. For those that do, being able to take a prescription can literally determine life or death if someone finds themselves in an inpatient setting. When I asked Ledged Counsel about this issue, I was told something like, There is nothing in statute that requires hospitals to let you take your own medicine. I learned last night, there was a survey, and it turns out all Vermont hospitals actually do already have a means to allow people to take their own drugs in these types of situations. But long term nursing and rehabilitation facilities are also inpatient options where someone like me might have an inpatient stay. The way I learned about this type of situation was from person who shares my diagnosis, who was preparing for a knee replacement. He wasn't in Vermont, but he was planning to go into a nursing facility for a multi week recovery period after his surgery. And he was told he could not take his own medicine. I don't know the policy of long term stay places here in Vermont, but it seems to me it would be wise to ensure that somebody in my situation would be able to take their medication, whatever kind of inpatient setting they're going to land in. There's no such thing as a simple bill, but compared to most, this one is simple. So if you can put into statute people with rare diseases have a right to take their own medicine in inpatient settings, that would ensure that no hospital is going to change their policy to make it complicated, and that in inpatient settings, for short term or long term stays, people would be able to take the medication that they might have to order through different means than whatever would normally stop the pharmacy in the inpatient setting. So H736 would ensure that Vermont hospitals will continue to allow people to take their own drugs, and any future situations where inpatient stays, it would be continued to be allowed as well. So thank you for considering this bill, and I'm happy to answer any questions.

[Allen “Penny” Demar (Member)]: Anyone have any questions? Oh, I might. I agree with it. But when you say to bring your own medicine to a nursing home setting or whatever, there's still gotta be some kind of a responsibility on that agency to make sure you don't overtake or undertake or not take. Right, right. How is that gonna be addressed in this?

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: Well, I mean, currently, as I understand it, all hospitals actually have told someone who's in this room that they do allow people in those settings to take their own medicine. I don't know exactly what that means. I wouldn't be surprised if there is a thorough process where you have to submit your specialty medication, and then the nurses would bring it into you along with the more routine medications that you would be taking. But honestly, I don't know the answer. I think maybe what the policy would be, would be each long term inpatient setting needs to come up with a policy so that when this happens, because I'm not the only person with a rare disease in Vermont, there are thousands of us, They'll be ready and they can have a procedure that they can follow through.

[Allen “Penny” Demar (Member)]: So would there be any liability on the hospitals or doctors or nursing homes?

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: You know what? I don't know the answer to that, but somebody Because with more legal background than me

[Allen “Penny” Demar (Member)]: not every situation is gonna be the same.

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: True. But then the other side would be, if you have an adverse reaction because you're not allowed to take your ongoing medicine, that would be a consequence too.

[Allen “Penny” Demar (Member)]: But they've got to know what medicine you've taken.

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: True. I mean, this isn't about secretly taking

[Alyssa Black (Chair)]: their No, own

[Allen “Penny” Demar (Member)]: but everybody's got to be on the same page.

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: I agree.

[Alyssa Black (Chair)]: Can I comment on that? Yeah, and I think

[Leslie Goldman (Member)]: I just want to say, reassure, there are medication lists that this medicine will be on so that everyone taking care of that person will be aware.

[Alyssa Black (Chair)]: And I think we'll ask Debra when she testifies. I think she's probably best.

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: Yeah, I am not an expert in any way in any of these issues. This is all very new for me. But when I heard somebody in a group of people who have my condition said, This is a big problem. You should all talk to your legislators. And I thought, Okay, all right. I've got something to add of my list of things to do.

[Alyssa Black (Chair)]: Brian and Daisy, but I wanted to ask you really quickly, just from a practical standpoint, you have this draft as short form. Yep. Have you worked with either legislative council or do you have language

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: is already being worked on? There is not further language at this point. I mean, if you needed me to find some from other states, I probably could, but Ledge Council might be able

[Alyssa Black (Chair)]: I just didn't know who worked any

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: work Well, I haven't because I wasn't sure. It's been a little time. Right, I know. I know. I just, I wasn't, yeah.

[Brian Cina (Member)]: One of my questions was going to be if you knew of any other states that had taken action like this. And then the second question, you might not be able to answer, but I'll ask it and then let's counsel if someone could have. I've worked in situations where when we're referring somebody to inpatient, they say, Tell the patient to bring their drugs. So I'm confused, like why we need

[Alyssa Black (Chair)]: to do this. I'm not saying

[Brian Cina (Member)]: we don't, but it's confusing that for your case, these are legitimate pharmaceuticals approved by the FDA that you're being prescribed by a provider. Why would that not be allowed if we're telling a patient to bring their Seroquel to the hospital with them when they go in, that kind of thing? I don't understand why they're not letting all patients do that already, and you may not know the answer to that. Maybe the hospitals do.

[Alyssa Black (Chair)]: Let's ask. Yeah, I

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: don't know answer to But I just know that in some instances, people have had difficulty taking their own medication, And it feels like a good thing to solidify so that this doesn't have to be an issue.

[Brian Cina (Member)]: I agree.

[Alyssa Black (Chair)]: And let's not forget that we always tend to think of inpatient as being inpatient hospital, but there are many, many steps along our continuum of care where people actually are technically inpatient residing long term

[Brian Cina (Member)]: skilled nursing facilities. So partial hospitalization be considered inpatient when you're staying overnight?

[Rep. Michelle Bos-Lun (Windham-3, bill sponsor)]: I'm not sure, but I can say that I was hospitalized last year for a different reason and all the medicine that I got, like doxycycline, all the medicine that I got came from the hospital. They stock that in their hospital pharmacy, but specialty drugs aren't stocked in specialty pharmacy and they don't even have access to order those medications. So you kind of have to bring your own in those cases.

[Alyssa Black (Chair)]: Okay. Thank you. All right. Thanks. I'm so sorry. That's okay.

[Daisy Berbeco (Ranking Member)]: I don't have a question, but I just wanted to say thank you so much for your advocacy in this and humanizing it for us. I think it's really important that we talk to people that understand and help us understand the importance of it.

[Jen Carvey (Office of Legislative Counsel)]: And I'm glad that you're healthy and Well, you. And thanks, everybody. And for the record, Jen Carvey from the Office of Legislative Counsel. I will put up seven h seven thirty six. You can refer this as a short form bill. And for those of who are new to short form bills, a short form bill is the whole beginning of a regular bill with who introduced it. But the subject are a statement of purpose of the bill as introduced, which is really the legislative council plain language summary and the title of the bill. And then that's it. It says text omitted and short form bill. So there isn't the actual legislative language to implement the changes that the bill proposes. So in this case, the statement of purpose of the bill as introduced is kind of what the bill would do if it had been drafted as a standard form bill. And so it says the bill proposes, although it doesn't actually, to make legislative findings regarding the lack of stock of medications for rare diseases in many inpatient healthcare facilities and the difficulties that those facilities may encounter in procuring needed medications in a timely manner when caring for patients who enter the facility while on a treatment regimen for a rare disease. An ability to require facilities to allow patients who are on an inpatient status to continue to take all medically necessary medications prescribed for them by a licensed healthcare provider, even if the facility does not typically dispense or administer one or more of the medications in order to facilitate medication adherence and continuity of patient care across settings. That is the whole language. That's the bill. And then the other piece I just wanted to flag in case it's helpful is, again, oops, about short forms, and that is just the house rule on short forms, which says says so this is for orientation purposes. This is in rule 44, and rule 44 b says short forms shall be drafted in standard form by my office only if requested by a majority vote of the committee to which the bill has been referred. And then it goes on to say that a request by a committee to have a short form bill drafted in standard form may be for any reason that the committee views appropriate and shall not in itself indicate an approval of the bill or an intention to act favorably on it. Then And there is a slightly different process about how it goes unnoticed as well. We would have to vote on whether or not we would like a standard bill drafted. We would do it like a strike all amendment. It's what it looks like.

[Alyssa Black (Chair)]: But that in no bearing is a vote of passing the ballot. Exactly. And then you go, Leslie, and then Looks like you're pondering, Allen.

[Allen “Penny” Demar (Member)]: I just want that explained.

[Alyssa Black (Chair)]: I'm just wondering where

[Leslie Goldman (Member)]: in the process we, one, I could make a motion to change it to

[Alyssa Black (Chair)]: a standard point. You wanna

[Leslie Goldman (Member)]: do it after we hear all the testimony?

[Alyssa Black (Chair)]: Let's hear it after we let's get a little more testimony. Yeah. Go ahead.

[Debra Powers (Member)]: I

[Allen “Penny” Demar (Member)]: forgot my thoughts, so go ahead. Are you testing?

[Alyssa Black (Chair)]: Pondered too long, guess.

[Allen “Penny” Demar (Member)]: I pondered too long,

[Debra Powers (Member)]: yeah. I'm sorry if I was

[Alyssa Black (Chair)]: hoping that might get

[Brian Cina (Member)]: you thinking, It's a question that I could see you asking, which is when we initiate a long form request, do you know what the additional expense is to the state?

[Jen Carvey (Office of Legislative Counsel)]: I don't know that there's a specific expense to the state. Basically, you're asking me to draft a bill.

[Brian Cina (Member)]: Because I was told by another legislator that every time Ledged Council writes a bill, it costs $1,000 which I find hard to believe.

[Jen Carvey (Office of Legislative Counsel)]: Well, I'm not getting a thousand dollars. I'll tell

[Alyssa Black (Chair)]: you that. It's Jen now getting beat. So salary. Was on the plane.

[Brian Cina (Member)]: Their claim was they were using this in the context of, like, me introducing a lot of bills, saying that it costs the taxpayers a thousand dollars every time or something because of all the labor involved. And I'm like, but I write my bills usually and give it to them. So they're not doing all the research. And even if they are, like, how do and so I guess what I'm getting at is I support this regardless, but I am curious when we initiate a bill request like this what it costs and maybe Nolan can tell us.

[Daisy Berbeco (Ranking Member)]: Don't know. I believe there

[Jen Carvey (Office of Legislative Counsel)]: is a specific quantifiable cost associated with requesting or having a bill. Oh, thank you.

[Brian Cina (Member)]: Putting that out there.

[Alyssa Black (Chair)]: I mean, there's a social cost

[Jen Carvey (Office of Legislative Counsel)]: to your family and friends. There's burnout and demands. There's nothing. If we just ask, we ask members to be mindful of how many bills you're requesting generally because all of them do require us to do a lot of work. But that's also the job.

[Allen “Penny” Demar (Member)]: Just a comment. If you took all the salaries of all alleged counsel and their yearly salaries, you you went by 800 bills for 900.

[Jen Carvey (Office of Legislative Counsel)]: We draft more than that. It's over

[Allen “Penny” Demar (Member)]: one Yeah. Thousand But indirectly

[Alyssa Black (Chair)]: But then technically, the more you ask, the better deal you're getting because you're getting around for the same price.

[Jen Carvey (Office of Legislative Counsel)]: Okay, so things look like now until you've gotten new people.

[Alyssa Black (Chair)]: I agree with you. Exactly. Value much more than just drafting bills, as the counsel sitting in front of us having to listen to this. Go ahead,

[Debra Powers (Member)]: Doctor. Is there any other questions on this bill?

[Alyssa Black (Chair)]: Should we move on, do we have any other questions for Jen? Or should we move on to our next witnesses? I'd love to hear from the witnesses. I'd love to hear from Just because. I don't know where I'm on again, but I'm gonna claim it because I'm sure you gotta get somewhere too.

[Daisy Berbeco (Ranking Member)]: Thank you very much. Thank

[Rep. Anne Donahue]: you very much, representative Van Donahue. And just wanted to share why my eyes lit up when I saw this bill had been introduced. And I'll do deference to future testimony. It's not an issue of what are hospitals doing or not doing now or what state or how many years ago? But just a real life, what can happen when this happens? My dad had myasthenia gravis. It qualifies as a rare disease. Requires very specialized medication to keep it. It can still be very unstable, but to try to keep it stable. And it results in usually automatic. It's an autoimmune disorder, results in muscles failing. Eyelids are really typical. The neck is typical, can affect breathing, a number of other things. He was on a trip with my mom, fell and broke his hip, had to go to the hospital. My mom had his critical drugs with him, said he's got to stay on these. And they said, no, we've got to be hospital pharmacy. And of course, the hospital pharmacy didn't have these drugs. And so she was, you know, anxious, had the drugs. I happened to be there at the time when his breathing failed. I watched. They called the code blue. The crash carts, the get out of the room, we need to resuscitate him. And it was a direct effect of not having, the drugs that were keeping him stable. After that happened, they decided to allow him to have the drugs that my mother brought until they could get them. But that's just that's the real life of when that situation exists. It was a really, really scary thing for my mom in there to see. He stopped breathing. He had to be resuscitated for this reason and for

[Alyssa Black (Chair)]: what this bill is trying to address. You. Thanks, Anne, for sharing. All right. A hospital. I was thinking about this in terms of Yeah.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Devin Green, Vermont, Association of Hospitals and Health Systems. I am currently really regretting I had a pharmacy person avail like, trying to set up a pharmacy person available for today, and it didn't work out. But so if you have detailed questions, perhaps we can have a time when that person can come in. But I just wanted to give a high level overview on this bill. Again, it would be great to see drafted language, but based off of the short form, the first piece I would say is I don't think we need to do a study about whether or not hospitals have specialty drugs in them because the majority do not have specialty drugs available. I think if we're looking to establish that, consider it established. But in terms of bringing in specialty drugs from home, bringing in medications from home, I reached out to the hospitals a couple of times, and the majority of them said that they all allow this. There's actually a piece in the pharmacy board's rules that anticipates this and just says that drugs brought into the institution by patients, it must not be administered unless it can be identified and the quality of the drug assured. And our hospitals have systems set up for doing this. I did not hear from all of the hospitals. I may have worded it. It was basically like, do you prohibit people from doing this? I'm guessing there were some hospitals that allow people to do it and felt like they didn't need to respond to me. I can reach out directly just to make sure all of our hospitals do it. But my understanding is that this is not an issue at Vermont's hospitals.

[Alyssa Black (Chair)]: But we're not sure about other yeah.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Yeah. And for that, I would just say, I think I disagree with the definition of inpatient. I would say for skilled nursing facilities and other facilities, I think there is a clear definition of inpatient versus outpatient, and skilled nursing facilities and rehab facilities and other facilities are typically considered residents of those places. You would want to look at how inpatient works there. And then I think also you'd want to talk to those facilities, because I believe they have some pretty complicated federal regulations that they need to follow.

[Alyssa Black (Chair)]: If we decide to turn this into a standard form, then we'll definitely have more people in.

[Allen “Penny” Demar (Member)]: The way that these people bring in their own drug, Do they relinquish ownership

[Alyssa Black (Chair)]: to the hospital? Well, the pharmacy board

[Devin Green (Vermont Association of Hospitals and Health Systems)]: don't rules- believe so. I believe the hospital needs to check the drug and the prescription and assure its quality, and then it's possible that the hospital dispenses the drug. Again, I can go back and

[Debra Powers (Member)]: answer that.

[Allen “Penny” Demar (Member)]: I'm sure we're okay with that.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: They definitely need to keep track of what Yes. Is safe with

[Debra Powers (Member)]: don't

[Alyssa Black (Chair)]: have a question for that. I'm sorry, Brian. It's okay.

[Brian Cina (Member)]: I just want to make sure I heard you correctly. There's two sentences in the statement of purpose. You're saying the first sentence is unnecessary, the second sentence bears further testimony and exploration. Correct. Okay, thanks.

[Alyssa Black (Chair)]: Alright, thank you all. Okay, well, I think we're done for the morning. Go ahead, Leslie. I'd like to

[Leslie Goldman (Member)]: make a motion that we turn 07:36 into a standard form bill,

[Alyssa Black (Chair)]: committee bill. That a question

[Debra Powers (Member)]: I'm or a second waiting to get the second and then I'll make a statement.

[Alyssa Black (Chair)]: Okay. I'll cite the note. Okay.

[Debra Powers (Member)]: Do you want to do it in the form that it's in now with everything that's in there?

[Leslie Goldman (Member)]: No, I want Ledged Counsel to review it and see what is appropriate. Mean, we'll take testimony and it needs to be turned into a standard form bill and then we'll look at it.

[Debra Powers (Member)]: Yeah, I just don't think the first part is So the next

[Leslie Goldman (Member)]: what kind of direction, what would be the language of direction? Yeah,

[Brian Cina (Member)]: Brian? Yeah, I would support this motion if we didn't back on the first sentence and we took second sentence and used that as a starting point. I have more to say about that, but I don't if this is the time to give you more feedback about what might be good or not.

[Alyssa Black (Chair)]: I think the first sentence

[Leslie Goldman (Member)]: should be reiterated. It may be that it looks already standard of practice, so we could say that.

[Brian Cina (Member)]: It asks for an inventory, a study to be made. It says to make findings. Oh, I see. Can just make Okay, all right, all right. So if Legis Council is someone putting the findings in, that's fine. What I wouldn't approve is a study on what the hospitals have. Would

[Alyssa Black (Chair)]: recommend that if we'd like to turn it into a standard form, we would like first of all, either distinguishing or determination around inpatient status versus like a residential status and that we would eliminate the first sentence for legislative findings regarding the lack of stock because they've just said we don't have it.

[Leslie Goldman (Member)]: We know we don't have it.

[Alyssa Black (Chair)]: We know we don't have it. So we don't need that. So would that be Yes, go ahead. Do we really need a whole bill for this? I mean, it seems like a very simple thing. Until it's not.

[Daisy Berbeco (Ranking Member)]: Yeah, my fear is it seems like one simple sentence that should belong somewhere in statute or in a provider manual Penny's laughing at me. But my fear, I'll finish that thought, is that this is going to be something that we need to hear from every facility about, and it's going to take a lot of time in our last three weeks before crossover. And we've got AI coming at us. We've got school mental health coming at us. And we've got, to wrap up the May, May. So I'm concerned about it being a time issue, but that's why I'm questioning, is there a way we can make this a simple tuck in somewhere? Because I absolutely support the need for it, recognize the need for it, and wanna do it, but do

[Alyssa Black (Chair)]: it right. Well, may I? Yes, although I'm not sure I can think of anywhere that this could be tucked in.

[Brian Cina (Member)]: The miscellaneous Diva bill that's floating Leslie?

[Leslie Goldman (Member)]: I just can't imagine that we need to hear from every facility. We just heard someone representing all the hospitals who will then present data to us. We also have advocates that do that for the long term care facilities. I just don't see how establishing access is going to take all that long. Person from

[Alyssa Black (Chair)]: the hospital said we don't need this. Correct.

[Leslie Goldman (Member)]: Right. But we're saying that For the hospitals. For the hospitals. But what about other facilities within our state?

[Daisy Berbeco (Ranking Member)]: That's why we

[Alyssa Black (Chair)]: need to hear from them. That's right. But we

[Leslie Goldman (Member)]: don't need everyone. I'm just saying we have advocates that do that.

[Alyssa Black (Chair)]: I think representative Boslin sort of made the point of, that's current practice now, but just having something in statute means it protects it.

[Brian Cina (Member)]: It's a guardrail. Yes.

[Alyssa Black (Chair)]: So it may be current practice now, but what happens in the instance where all of a sudden it It may be a finding.

[Leslie Goldman (Member)]: I mean, that all hospitals do it and that we want to support that structure. I

[Alyssa Black (Chair)]: can't see anywhere where prescriptions, pharmaceuticals, I can't see a place where this could possibly go. This seems

[Allen “Penny” Demar (Member)]: more of a

[Alyssa Black (Chair)]: clinical thing and I'm thinking we're not doing an awful lot around clinical.

[Jen Carvey (Office of Legislative Counsel)]: I'm wondering if maybe an abuntsman could testify

[Collin Robinson (Vermont-NEA)]: as to what goes on at the nursing homes. I think that it's

[Alyssa Black (Chair)]: We would take more testimony. Okay. Obviously, if we turn it into a bill, we will take testimony. This was just an introduction to the bill. So I'm asking, would the committee I'm asking to get a consensus from the committee what your interest is in turning this into a standard form bill with guidance for legislative counsel on what we'd like to achieve with this and if we would like to take this up. If nobody has interest in that, then we're not going to waste legislative council's time. I'm going to go with Topper and then Brian. Do you want

[Debra Powers (Member)]: to turn the Sentinel Committee bill?

[Alyssa Black (Chair)]: Well, it would be a strike off. Right.

[Brian Cina (Member)]: I'm interested in addressing the issue, but I'm not interested in is taking a massive amount of time on something that's unnecessary. Unnecessary. If we spend the remaining two weeks before crossover taking extensive testimony only to find out that we don't need to do this, it'd be frustrating. When there's things that we need to do where the clock is ticking, and if we don't do it this year, humanity may be in peril. So not to be dramatic, but I think you're going hear about the AI stuff later and then understand I why

[Alyssa Black (Chair)]: that cannot with limited scope that this bill would take very much time. I mean, I'm anticipating, okay, who do we need to hear from? We need to hear from long term care, skilled nursing, anywhere where somebody is residing in a healthcare setting that would not have these specialty drugs on hand. I'm imagining that we would need to speak to, I don't know, the long term care ombudsman. We would need to speak to maybe hear from the hospitals again, possibly board of, I don't know, who does prescriptions? We're a pharmacy, thank you. You know, board of pharmacy. I'm not sure who else we would need to take extensive testimony on. And if we start taking testimony and it's like, wait, we don't need to do this or we don't want to do this, then we just drop it. Allen?

[Allen “Penny” Demar (Member)]: Think we're making this too complicated. If you want to make it a bill, can't you make it a bill as it stands? And then we can work on that, and if you want to take a sentence out, we can. That's what Jen said. So if we're all agreeing that it's an important bill, we should just go along with it and then we'll do the

[Alyssa Black (Chair)]: We will vote on whether or not we want this bill to That's be turned into a standard form the motion, John. That's the motion. Go ahead. Are we gonna take a vote on this? Yes, I'm trying to This is a discussion. Yeah, this is the discussion. I'm ready to vote. I'm

[Brian Cina (Member)]: ready to vote on it too. Okay.

[Debra Powers (Member)]: No,

[Brian Cina (Member)]: I'm ready to vote on it.

[Alyssa Black (Chair)]: And we just need a straw poll on this. All those in favor of turning this into a standard form bill? One, two, three, four, five, six, seven, eight, nine. It's everyone present. Yep, seven zero two.

[Collin Robinson (Vermont-NEA)]: Okay, great.

[Jen Carvey (Office of Legislative Counsel)]: Yes, I think, so Jen Carpin, the legislative council. Yes, right now it's sort of generally described as Thank you. But I think, yes, I'll need to know what healthcare facilities we want to have and think there are liability issues raised earlier that you'll want to address, whose responsibility it is to store, administer,

[Alyssa Black (Chair)]: etcetera. Those are the kinds of things that you will use.

[Debra Powers (Member)]: Yeah, so make sure that they are built.

[Brian Cina (Member)]: Go ahead. So what we approved includes this set finding section. I would

[Jen Carvey (Office of Legislative Counsel)]: What you're doing is strike all anything you want.

[Brian Cina (Member)]: Yeah, so we're proposed as a finding section. So what I'm wondering is how would people feel about a sentence or two stating our intent or purpose and a finding or two based on what we find. Saying according to, I'm just making this up as an example so people know what I'm saying. According to VOS, 100% of hospitals in 2026 have this policy in place. And finding number two, according to this organization, these facilities do this. And then purpose, it is the intent of general assembly to guarantee that patients with rare diseases can have their medications in the facilities and don't go without care, or however we say it.

[Alyssa Black (Chair)]: And then Jen puts in the language in statute that needs to be guaranteed and that's it. How about a legislative purpose intent of providing continuity of care across the healthcare continuum and findings of most inpatient or long term care or residential settings do not have supplies of many specialty drugs. Policy. Policy. But why do we need them to establish a policy? We have gen drafts. Exactly.

[Brian Cina (Member)]: What I was saying is it should have a finding section and a purpose. That's all I was saying. I wasn't saying exactly what it should be.

[Alyssa Black (Chair)]: No, understand, but I'll just take it. We're asking that Okay. Never mind. Sorry. Okay. Anything else? I think they said, so liability. So what facilities do

[Jen Carvey (Office of Legislative Counsel)]: you be going? Is responsible for administering, dispensing and storing the medications? And who bears responsibility if

[Debra Powers (Member)]: they're in In the

[Brian Cina (Member)]: the fridge, you want them to answer

[Debra Powers (Member)]: that right now.

[Alyssa Black (Chair)]: If we want those things to No, I

[Jen Carvey (Office of Legislative Counsel)]: think all of those things need to be

[Brian Cina (Member)]: That's what I'm hearing.

[Leslie Goldman (Member)]: Yes, we need testimony about.

[Brian Cina (Member)]: So do you need us to tell you right now?

[Alyssa Black (Chair)]: No, she needs to know if they need to be in the bill. Then we will take testimony on that.

[Jen Carvey (Office of Legislative Counsel)]: I think I cut well. I'm telling you that those are the elements I would expect to put into the bill, and if there are others I'm happy to do that, but I don't think we're prepared to tell me what you want in those categories. I think those are the issues that you may need to take testimony

[Alyssa Black (Chair)]: on so that you can give

[Jen Carvey (Office of Legislative Counsel)]: me direction to draft a bill, but I don't believe I can draft a bill yet because it's Okay. Still a

[Debra Powers (Member)]: Jim, The phrase that's in here now, that's not good enough

[Jen Carvey (Office of Legislative Counsel)]: to say. Mean the phrase that's in the

[Debra Powers (Member)]: The Act relating to the medication adherence and continuity.

[Alyssa Black (Chair)]: We can call it, I mean, can keep the name if you like the names,

[Allen “Penny” Demar (Member)]: Well, right I'll figure out how

[Jen Carvey (Office of Legislative Counsel)]: we can- What the bill would say if the bill were drafted, but it doesn't mean that I can then just go draft the bill.

[Alyssa Black (Chair)]: Will- Because the bill is very broad strokes. We will schedule testimony for next week on this and then we'll be able to give guidance to legislative counsel on what we debate, Jack. There should be wording that, like going to a hospital, taking your medication to the hospital needs to be in the original container.

[Jen Carvey (Office of Legislative Counsel)]: Would also be part of your conversation. The

[Alyssa Black (Chair)]: other thing is, is my mom lives in assisted living, and she has to order her own medication, but they keep it and administer it to her. Or her doctor has to order it for her.

[Brian Cina (Member)]: So you were saying like some areas that you would need more information on are? Which

[Alyssa Black (Chair)]: facilities?

[Brian Cina (Member)]: Which facilities, liability issues and dispensation practices.

[Alyssa Black (Chair)]: I was trying to think from

[Jen Carvey (Office of Legislative Counsel)]: a practical standpoint, patient is in

[Alyssa Black (Chair)]: their bed

[Jen Carvey (Office of Legislative Counsel)]: in a room, how does the medication get to them, who's responsible for preparing the dosage, administering it if it's a medication that needs to be administered?

[Alyssa Black (Chair)]: If this is something they're gonna

[Jen Carvey (Office of Legislative Counsel)]: be taking at home, I don't know the extent to which facilities allow somebody to administer an injection to themselves in a setting, in a healthcare setting and whose equipment is used. So I just think these are some of the issues that would need to be addressed if you are going to require this or you can require facilities to have

[Alyssa Black (Chair)]: policies, but it doesn't mean policy will do what they want. May I comment? Yes. It seems like this

[Leslie Goldman (Member)]: is during transition period because once someone's established in a place, their medications and their medication lists are ordered and the facility can then order it and have it available. So I'm not particularly worried about the ongoing treatment of someone in a residential setting or in a hospital setting necessarily or the hospital's attempt, you know, transition. It's it's during these moments of transition, like for and that, So that's the sort of moment that I think we're thinking about in trying to protect patients. And that's sort of the idea that patients in transitions from facility into a facility or whatever are protected or have access to their medication if it's not available. Yes.

[Debra Powers (Member)]: I think that's what

[Alyssa Black (Chair)]: I'm trying to get at.

[Leslie Goldman (Member)]: Yeah. But it's a brief moment. It's not over time. Yeah.

[Alyssa Black (Chair)]: Okay. Next week, we will schedule a testimony. We're done for the morning. I was I was sort of hoping we might be able to move our optimism up a little bit, considering the weather, but I don't think that's going to be possible. So I will see everybody back here at 01:00, unless you have to leave, or feel you need to leave, and you can certainly join on Zoom. Or Tasha will send you the link. I will take my link. Okay. If I need a quorum, should

[Leslie Goldman (Member)]: we think about that? Because I'm not

[Alyssa Black (Chair)]: sure what I'm doing, I'm trying to figure it out.

[Leslie Goldman (Member)]: But who's definitely going to be here for this afternoon?

[Brian Cina (Member)]: Can we count people on seeing this quorum?

[Alyssa Black (Chair)]: I don't think we do. I don't think so.

[Brian Cina (Member)]: If you can vote on Zoom, how can you not Yeah. Be counted as a

[Alyssa Black (Chair)]: It's one of your three. I mean, that's a different question. The I mean, we could reschedule. We are we are scheduling testimony next is it Tuesday or Wednesday on this? Is it Wednesday morning we had decided? Tuesday. Could schedule we could reschedule this till that day. I I was hoping that we could the reason we scheduled it this afternoon is because we needed both Katie and Jen, and this was the time that both of them had to be available.

[Jen Carvey (Office of Legislative Counsel)]: So,

[Alyssa Black (Chair)]: I mean, at least today I'd like to get through the walkthroughs.

[Brian Cina (Member)]: Can I check with the clerk and determine what the quorum would be? Because if the clerk says that we can have people remote and have it be quorum, maybe we can at least here do what we can.

[Alyssa Black (Chair)]: I'm looking at the rules, so give me a moment. Oh, who's sleeping early? I might be. That's not bad. And Lori's not here. Still people. That's still a

[Brian Cina (Member)]: We saw the quorum. I'm not leaving. I'll stay as long as I can. May all That means that if it starts snowing at two, we should all leave because we're gonna be screwed. I have to work at the crisis service tonight, so I can't like stay here.

[Alyssa Black (Chair)]: I'm sorry, Katie was unable to get here until 01:30, right? Or was she available? Do we want Jen to do I'm just wondering if we could possibly move our witnesses at 02:15, if they would be amenable to that. They're both on Zoom. As early as they could possibly be here, 12:15.

[Brian Cina (Member)]: We could actually just work another hour and leave, is Yes, that what you're

[Alyssa Black (Chair)]: that's what I'm saying. Yeah. I'd be damned. If possibly we do that. If not, we could reschedule them till they could go before Katie, or we can try to get Katie in here. Jen, I'm sorry, I don't know any sort of protocol around scheduling legislative council between twelve and one.

[Jen Carvey (Office of Legislative Counsel)]: Know, we do whatever the communities need. Have, G and I have a meeting at 12:30, but if you'd be just to

[Alyssa Black (Chair)]: reschedule meetings. I say we

[Debra Powers (Member)]: We're gonna take a break. How does the committee feel about it? Do you wanna do this or not? I that's

[Collin Robinson (Vermont-NEA)]: I don't wanna try to fall in the snow.

[Alyssa Black (Chair)]: I'm fine to stick around and stick with the schedule as planned.

[Debra Powers (Member)]: I can stay around, no sweat. I'm not worried about that. But you've got people that are Yes, yeah.

[Alyssa Black (Chair)]: I've a long way.

[Allen “Penny” Demar (Member)]: To go.

[Debra Powers (Member)]: So let's find out how many people can stay, and

[Alyssa Black (Chair)]: we'll just do it. Okay, one, two, three.

[Debra Powers (Member)]: I got, yeah. Anyone else can stay?

[Alyssa Black (Chair)]: Think I can. Think can. I'm stopping, 03:30. Okay. So you'll be here. Okay, I didn't hear what time you said. 03:30. I'm leave by 03:30. But you guys are going into the slow storm, I'm running away.

[Debra Powers (Member)]: That's true. I've got close

[Allen “Penny” Demar (Member)]: to 100 miles to go, but I'll stay. I'm not gonna leave you short. I got truck.

[Alyssa Black (Chair)]: Got Is it coming up from the South? Yes. It is.

[Brian Cina (Member)]: Is the Northeast King gonna have to leave?

[Alyssa Black (Chair)]: What time can you be here till?

[Brian Cina (Member)]: I can be here in terms of work until three.

[Alyssa Black (Chair)]: Okay. Wendy, you're leaving?

[Jen Carvey (Office of Legislative Counsel)]: No. I can stay here.

[Brian Cina (Member)]: I I The only issue is if it snows heavily, I won't get to work on time if I'm stranded on Interstate 89. It is what it is.

[Debra Powers (Member)]: We've got to accommodate. Okay.

[Alyssa Black (Chair)]: We will keep testimony just out of the bin. One o'clock, I will see everybody back here at 01:00. Please be on a time so we can get going and get moving. And if you have to leave and you feel you need to leave, then leave. As it's going. Or before. It doesn't matter. Here's something I think that in terms of a quorum, I think that the quorum needs to be present when we open a meeting, we have a quorum. And then as whatever happens, happens. Right. So we can start, we have a good point. So I'll be here.

[Brian Cina (Member)]: Yeah, we can