Vermont Legislature SmartTranscripts:

[Rep. Francis McFaun (Vice Chair)]: Good morning, this is the healthcare committee. It's Friday, February 27. And for the next hour or so, we'll take up H814 and H816, we hope. So we're gonna start up with H814, rates are no longer to both right, and our first witness is Colin Robinson. Colin, would you join us at the table, please?

[Rep. Alyssa Black (Chair)]: Absolutely, thank

[Colin Robinson (Vermont-NEA)]: you. My pleasure. Good

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

[Colin Robinson (Vermont-NEA)]: For the record, Colin Robinson, Vermont NEA. And we were just asked to speak briefly because Vermont NEA is mentioned in the most recent draft of 08/14 as it relates to Artificial Intelligence Advisory Council. Obviously, artificial intelligence is something that our members are adapting and working with their students in an educational space to address and provide both literacy as well as spaces to identify opportunities and challenges. So the headline is we are happy to appoint a member to the Artificial Intelligence Advisory Council.

[Rep. Brian Cina (Member)]: Okay, thank you.

[Rep. Francis McFaun (Vice Chair)]: Thank you.

[Colin Robinson (Vermont-NEA)]: Representative Cina said that was what you were looking to hear, so if we are okay with that, and we are.

[Rep. Francis McFaun (Vice Chair)]: Good. Thanks a lot.

[Rep. Brian Cina (Member)]: We just didn't want to do, know, the nothing about us without us. We didn't earn

[Rep. Alyssa Black (Chair)]: it. Yeah.

[Rep. Francis McFaun (Vice Chair)]: Thank you very much. You did.

[Colin Robinson (Vermont-NEA)]: I hope my testimony is some of the

[Rep. Leslie Goldman (Member)]: simplest you may receive today. After the four hours. No. I hope it's the most complex we

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

[Rep. Leslie Goldman (Member)]: Any question? Yeah. Look. Can I please cancel? I'm just orienting myself for a minute. That's section four.

[Rep. Brian Cina (Member)]: We're adding a member from the Vermont NEA, appointed by the Vermont NEA

[Mike Fisher (Office of the Health Care Advocate)]: to Got the task it.

[Rep. Brian Cina (Member)]: And the intent is so that we have an educator on when they look at use of AI in education.

[Rep. Leslie Goldman (Member)]: Thank you.

[Mike Fisher (Office of the Health Care Advocate)]: Thank you, Brian.

[Rep. Francis McFaun (Vice Chair)]: No other questions?

[Rep. Daisy Berbeco (Ranking Member)]: Thanks for being here. Yeah, thanks Okay, for being

[Rep. Brian Cina (Member)]: happy town meeting day.

[Rep. Francis McFaun (Vice Chair)]: Okay, the next witness that we have is on Zoom, I believe. Sophia Simkins.

[Sophia Simkins (VFNHP/UVMMC nurse)]: Yes, thank you. So my name is Sophia Simkins, I'm a primary care nurse and I'm the VP of political education for VFNHP. We represent nurses and health professionals at UVMMC. I really appreciate the opportunity to testify today. AI is entering health care rapidly with little input from direct care providers or more importantly from our patients. For example, UVMC is working on implementing a AI remote patient monitoring program that is relatively untested. We looked into it. It only been used by a handful of hospitals for only a few months before they started considering implementing it. So this is relatively untested. It's a third party company that would have a direct live feed of our patients. We don't know what they will do with this data. Will they use it? Will they maintain it and keep it to train future models? And we're talking about people at a very vulnerable point in their life. Like, if they're having remote video monitoring, it's because they're confused. They're delirious. They are not able to maintain their own safety. And so a remote video feed traditionally has been monitored by, a human, from someone, who works directly for the hospital, not a third party company, who then would call the nurse and say, hey. Missus Smith is climbing out of bed. Can you go check on her? So this is very different to have AI in a third party company, to have, video feeds of our patients. And additionally, raises questions, who is held responsible when a patient is harmed? If because this has not been, there's not been adequate safety research to show that this is equivalent to standard practice. Is it the nurse who's at the bedside who's held accountable? Is it the hospital? Is it the third party company? And there's been a lot of questions about that in AI in general, what happens when AI fails. So given that, it's crucial that AI in healthcare is regulated. And additionally, I would urge you to consider having an RN, a registered nurse, as representation on this advisory council. Nurses are in a unique position to advise on the risks and benefits of proposed implementation of AI, as we directly provide the patient care, and are able to evaluate, the risks and benefits. And I would say, like, nursing, we're not health care professionals, we're not necessarily against all AI. There is definitely positives, like the, you know, using AI to help write notes. But we really cannot just let Vermonters be guinea pigs for untested tech technology that shows a strong potential for violating their right to safety and privacy. So these should not be implemented, like, without I agree with having this, like, advisory council to really assess the risks and benefits of the changes, and I don't want them just to be motivated, by the bottom line. And I'm happy to answer any questions if you have any.

[Rep. Francis McFaun (Vice Chair)]: Questions?

[Rep. Leslie Goldman (Member)]: Just a clarification.

[Rep. Allen “Penny” Demar (Member)]: Just wanted to have you say again what VFNHP stands for.

[Sophia Simkins (VFNHP/UVMMC nurse)]: Of course. So the Rock Federation of Nurses and Health Professionals. So this is a health care union, for nurses and other health care professionals that, work for UVMMC. So it's the main camp like, it's the hospital and the surrounding satellite clinics in Burlington.

[Rep. Allen “Penny” Demar (Member)]: Thank you.

[Rep. Leslie Goldman (Member)]: So I see that, we that there is a recommendation to add one member with experience in health care appointed by Vermont Medical Society. So that Vermont Medical Society's docs and PAs, which we know. I'm not seeing anything from nursing. I think your point is well taken. Thank you. That the use of AI in patient care is really a nursing function. So I like to consider adding a nursing network.

[Sophia Simkins (VFNHP/UVMMC nurse)]: I appreciate that.

[Rep. Francis McFaun (Vice Chair)]: Thank you, Alyssa. All right. So

[Rep. Brian Cina (Member)]: you were saying that you have concerns about the impact of the use of artificial intelligence technology on patients' rights. And did you also, or can you say a little bit more about how it might affect the workforce in negative way? Because we've heard how AI can be a tool that can make job work easier, and you even alluded to that when you talked about helping with medical records. But when you were talking about the video monitoring and removing humans from the equation too much, how might that also impact our workforce and our investment in human resources over time if we rely too much on AI?

[Sophia Simkins (VFNHP/UVMMC nurse)]: Of course, yeah, that's actually part of it as well as the hospital is talking about eliminating. That would be more of the support staff union, which is where that role, so not specific part of the union, that I represent. But it definitely would be eliminating labor, with this use of AI and it even goes it does affect nursing and health professionals as well. Part of my role in primary care is answering my TARP messages, and it's a very real possibility in the future that when you message your doctor's office, you won't be reaching a nurse, but you will be reaching like an AI chatbot instead. So that's not something that's being spoken about at my hospital currently, but that's certainly, you know, a possibility for the future as nurses being, replaced with AI. Thank

[Rep. Brian Cina (Member)]: you. So it sounds like the perspective of nursing, either on the council or in the work of that council, would help us maintain the perspective that not only is bringing the experience of patients directly in, but also the experience of a variety of workers on the ground, on the front lines, and how AI could help or not, or actually be a problem in that work.

[Sophia Simkins (VFNHP/UVMMC nurse)]: Agreed and a physician voice though appreciated definitely does not replace the voice of a nurse on this council.

[Rep. Brian Cina (Member)]: Thank you. And I think we're gonna have time for community discussion at some point, but this is really just to validate Leslie's suggestion. We've had a few other providers send in written testimony asking for a voice that there may be a benefit to considering, I because don't think we're going do anything with this bill today. So we have time, so maybe we consider a working group or a subcommittee or giving them the power to form a subcommittee of healthcare providers or some mechanism so that it's not too We can add members to the council, but we could also encourage them to engage others. There's ways we can make sure every voice is included, if not on the council, through the work of the council. So I do hope we have time for that. So just I'm hearing your request, and I think we need to figure out how to make it work.

[Rep. Francis McFaun (Vice Chair)]: And and doing a doing a community discussion. Exactly.

[Rep. Brian Cina (Member)]: We can hatch it out then. Yes. I'm just acknowledging I hear it from from you, and I also hear Leslie saying that you think it would be important, and I agree. I think you just have to figure out the right way. Thank you for being willing to help.

[Sophia Simkins (VFNHP/UVMMC nurse)]: Of course, thank you for hearing my testimony.

[Rep. Francis McFaun (Vice Chair)]: Thank you very much for coming in on the Zoom.

[Sophia Simkins (VFNHP/UVMMC nurse)]: Of course, I appreciate it. I hope you have a good rest of your day.

[Rep. Brian Cina (Member)]: Thank you. You too.

[Rep. Francis McFaun (Vice Chair)]: Next witness, Stephanie Wintense.

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

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: live and in person.

[Rep. Leslie Goldman (Member)]: Zoom from the bench to the chair. Yeah.

[Rep. Alyssa Black (Chair)]: I thank you for sending your stuff in

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: there. Yeah, yeah, absolutely.

[Rep. Francis McFaun (Vice Chair)]: I understand, Stephanie, you want to talk about age 16 too.

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: I was asked to do both, so I can just roll into it if you want me to.

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

[Rep. Leslie Goldman (Member)]: Yeah.

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: Okay, perfect. So good morning for the record, Stephanie Winters representing the Vermont Medical Society and more so on eightsixteen, both the Vermont Medical Society and the Vermont Psychiatric Association. I came prepared on eightfourteen to talk about the original bill. So I don't have as much to say as the new draft with most of it struck out in just the council. So forgive me if I'm on the wrong version, but I thought it important to talk about the original since you hadn't asked the amended version. I just want to begin by acknowledging the importance of what the original bill seeks to address. The rapid development of artificial intelligence and neurotechnology raises legitimate questions about privacy, autonomy, transparency, and protection from misuse. Establishing guardrails around neural data and ensuring Vermonters know what and when AI is being used in health related communication are thoughtful and forward looking goals, although as forward as they used to be, because we are there. Protecting cognitive liberty, preventing exploitation of neural data, and promoting transparency in mental health technologies are important policy objectives. And Vermont has the opportunity to lead thoughtfully in this emerging area. At the same time, it's really important to consider how this bill intersects with Vermont's healthcare workforce reality. There are several practical considerations for clinical medicine that merit attention to ensure that the bill does not unintentionally disrupt routine healthcare delivery. First, clarity of scope is essential. Terms such as neural data should be carefully defined so that the routine diagnostic services such as electroencephalogram EEG, which is a non invasive diagnostic test that reports the electrical activity of the brain, Interoperative neuro monitoring and other neuropsychologic testing are not inadvertently subject to separate consent and record and data destruction frameworks beyond existing medical record laws. Clinical diagnostic data already falls under HIPAA and established professional standards. Second, data destruction provision should be harmonized with medical record retention requirements. Healthcare practitioners are legally obligated to maintain medical records for defined periods. So, any revocation based destruction mandate should clearly exempt data maintained as part of the medical record to avoid creating conflicting legal duties. Thirdly, emergency care should be explicitly protected. In neurologic emergencies, such as seizures, stroke evaluation, or traumatic brain injury, additional procedure steps should not delay care. Fourth, with respect to artificial intelligence, it's important to distinguish between AI used as an internal clinical decision support tool and AI that independently communicates with patients. Clinician supervised AI such as radiology support tools, risk prediction models or documentation assistance should remain clearly permissible without creating ambiguity that might discourage responsible adoption. And finally, Vermont should consider the impact on rural hospitals, small practices and academic research institutions. Layering additional regulatory requirements beyond federal privacy and research standards could unintentionally increase administrative burden and reduce innovation capacity in an already resource constrained healthcare environment. In summary, we feel the goals of eight fourteen are commendable and with targeted clarifications and guardrails, particularly around definitions, record retention alignment, emergency care protections, and clinician supervised AI. This bill could protect Vermonters neurological and digital rights while preserving access to safe, efficient and innovative medical care. I thank you for listening and I've included specific amendments again on the original bill in my written testimony. I can go through them or I'm open to answering any questions.

[Rep. Francis McFaun (Vice Chair)]: Questions first.

[Rep. Alyssa Black (Chair)]: Perfect. Oh, it

[Rep. Brian Cina (Member)]: really swings to the part of having someone appointed to the council.

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: We're happy. I mean, we're happy to be appointed to the council.

[Rep. Brian Cina (Member)]: Absolutely. Hope is that, you know, creating the bill, I was reading through the American Medical Association's policies around AI, they're extensive. Doctors have done a lot of work, just like some of the other professions we've invited in around this issue. I think there's great value in those guidelines being reviewed. I don't know if you're familiar with our amendment that we don't have Legis Council to walk through, but it does basically establish rights, but doesn't go further with regulation, it bumps it all to a study. So with your presence on that council, you would have an opportunity to recommend how to do everything you just said. So I appreciate you pointing out that we may need to vet some of these policies a little bit more before we make a firm decision in terms of specific regulation. Yeah,

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

[Rep. Leslie Goldman (Member)]: I know we don't have much council, and I'm looking at this, I think we're all seeing it for the first time. And it is condensed to what you're saying, it's really supporting the council and a study. Is that making sense? Well, it

[Rep. Brian Cina (Member)]: has an intent section. So it's putting into law our intent, because then the council has that to work with. It establishes basic neurological rights in law. So it's saying, it's making an ethical decision around these six rights, but it's not saying anything about how we enforce them. It's asking the council to come back with recommendations like, Okay, we all agree on this. What does it mean now? And then they will That's tell

[Rep. Leslie Goldman (Member)]: section two. So there are only four or five sections, I guess, including effective date. So that section two is the right so it's the intent, the right section, the advisory council

[Rep. Alyssa Black (Chair)]: And the study.

[Rep. Leslie Goldman (Member)]: And the study. Yeah. Yeah. It distills down to that, which is cool. Yes.

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

[Rep. Leslie Goldman (Member)]: I think that that makes a lot of yeah. It sort of makes it sort of accessible for me anyway to understand what we're talking about. And so you having voice on that council. So a lot of it is just going to come out of that, where you're just going to

[Rep. Alyssa Black (Chair)]: sit back and have the

[Rep. Leslie Goldman (Member)]: council do work. And I didn't see if there's a date for a report. It would be next session.

[Rep. Brian Cina (Member)]: So what we're doing is we're taking a stand, and we're saying we have intent to use this wisely, we're establishing some basic rights, but we are not ready to put up the guardrails. We're going to ask experts to meet come back with recommendations for the guardrails, we don't have the time to really take all the testimony and do that, we'd be rushing. So I think that was apparent, and that's why we constructed this amendment, so that we could take a step forward without jumping off a cliff.

[Rep. Leslie Goldman (Member)]: Well, a notice is that we're asking for a report by January 15. Yeah. And sometimes when we have studies, we say they shall start meeting on a state, you know, like July 3, by July 15, the And level first I'm wondering if that might have value to The council

[Rep. Brian Cina (Member)]: meets regularly anyway, monthly. Yeah, what we might want to do though, to your point, is maybe the effective date is changed to on passage so they can immediately start meeting with the council I think and not that's a good That's a good point. Point. So I should write that down.

[Rep. Francis McFaun (Vice Chair)]: Yeah. Okay. Why don't we have our committee discussions?

[Rep. Brian Cina (Member)]: Yeah. Yeah. Yeah. Yeah. We will.

[Rep. Leslie Goldman (Member)]: No. Just being That's a good point. Any

[Rep. Brian Cina (Member)]: I need to write this.

[Rep. Leslie Goldman (Member)]: Have a question. I'm a

[Rep. Allen “Penny” Demar (Member)]: little confused. I think we're getting awful fast here, but we've got an advisory council.

[Rep. Leslie Goldman (Member)]: Who are they supposed to report to? Agency of Digital Services, I believe.

[Rep. Brian Cina (Member)]: Currently, that council exists. We're just changing the membership a little, we're adding people to it. They currently report to the AI director who reports to ADS, who reports to the governor, and they give a yearly report to the legislature, which I did submit to the record when they came in. I can send it to you if you want to see their recent report. So this is counseled and has existed for many years, and what we are doing is expanding the membership and giving them some focus. So we're just adding two? I think we're yeah. We're adding, like, three people and giving them a mission. Different mission. Yeah. A more focused mission. Yeah.

[Rep. Leslie Goldman (Member)]: I'd like the idea of that report. Maybe if you could send it to us and get

[Rep. Brian Cina (Member)]: it on our our It is on it is. On our page. It's on Wednesday. Right? Okay. Cool. But I can send it out to your email again. I lost track, but I'll do that now anyway.

[Rep. Francis McFaun (Vice Chair)]: We're gonna move on. We thank you very much for 08:14.

[Sophia Simkins (VFNHP/UVMMC nurse)]: 08:16.

[Rep. Allen “Penny” Demar (Member)]: Yeah, go ahead.

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

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: Thank you again for the opportunity to speak on HH-eight 16. Again, for the record, Stephanie Winters from the Vermont Medical Society and the Vermont Psychiatric Association. The intent of this bill is clear and very important, to ensure that artificial intelligence does not substitute for licensed mental health professionals in delivering diagnoses, treatment, or therapeutic judgment. Preserving human clinical accountability in mental health, particularly for vulnerable patients, is a widely shared goal. My comments today focus narrowly on two drafting provisions that may have broader operational impact than intended. First, the consent requirement for processing therapeutic communications. The bill requires patient consent when AI is used to record, transcribe, or process identifiable therapeutic communications. Recording a therapy session clearly warrants consent. However, the terms process is not defined and could be interpreted very broadly. For example, modern mental health practices use AI tools to draft clinical notes, suggest billing codes, format treatment plans, extract quality metrics, and support measurement based care dashboards. Under a literal reading of those functions that could constitute processing identifiable therapeutic communications. And if that interpretation prevails, clinicians may need a separate consent for routine documentation support tools beyond what HIPAA already permits for treatment, payment, and operations. The practical consequence could be increased administrative burden and reduced adoption of tools designed to reduce clinician burnout. Secondly, the prohibition on AI making therapeutic decisions or generating treatment plans. The bill prohibits AI from making therapeutic decisions and generating treatment plans. The concern here is not autonomous AI replacing mental health professionals. That is clearly outside the intent of the bill. The concern is that modern clinical systems generate drafts or provide decision support recommendations that are reviewed and approved by licensed professionals. Examples include suicide risk stratification tools, measurement based care platforms, draft treatment plan templates, auto populated by diagnoses, and medication interaction alerts. In each case, the clinician retains full authority and responsibility. However, H816 as written does not currently include an explicit supervised use exception clarifying that AI assisted outputs are permissible if reviewed and approved by a licensed professional. Without that clarification, providers may interpret, and I'm not supposed to use the word providers, healthcare professionals may interpret the language conservatively and discontinue legitimate decision support tools.

[Rep. Alyssa Black (Chair)]: You have language suggestion?

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: I do. Yeah, I have a page full of language suggested amendments at the end of my testimony. I'll just finish by saying Vermont's healthcare workforce is already constrained, particularly in rural areas. And if documentation tools and decision support systems are curtailed due to ambiguity, it may result in reduced efficiency, increased administrative time, and longer wait times for patients. So thank you for your consideration and specific amendments are in my written testimony at the end.

[Rep. Daisy Berbeco (Ranking Member)]: Thank you for such excellent testimony and such careful read of the bill. And one of your recommendations aligns with feedback that we got from one of our national experts actually. Thank you so much.

[Rep. Alyssa Black (Chair)]: Go ahead, Brian.

[Rep. Brian Cina (Member)]: So we had in 08/14 originally, there was a chatbot provision and 08/16 is chatbots, then in June was a chatbot bill. Did you have a chance to review the other approaches and see how they all intersect or did you just focus on the one in this bill?

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: I just focused on the one in this bill currently.

[Rep. Francis McFaun (Vice Chair)]: Any other questions?

[Rep. Leslie Goldman (Member)]: Alright. Thank you. Thank you so much, Dylan.

[Rep. Brian Cina (Member)]: Mike Fisher showed up. He was supposed to come for 08:14. Oh. I don't know if we have time for him.

[Rep. Alyssa Black (Chair)]: I I don't have mister Fisher on the schedule for 08:14. It was. You wanna testify? You wanna testify at 08:14?

[Rep. Leslie Goldman (Member)]: I think I think I can

[Rep. Brian Cina (Member)]: very brief. He was, and then he I think we took him off when he didn't show up.

[Mike Fisher (Office of the Health Care Advocate)]: Didn't show up. I was, you know, flaking out. No. I didn't do that. Nothing important. Nothing productive.

[Rep. Alyssa Black (Chair)]: As usual.

[Mike Fisher (Office of the Health Care Advocate)]: As usual. I feel confident that you won't that we won't end this testimony with a member of the committee saying thank you for your thoughtful, careful consideration of this bill. I'm happy to sit down very briefly in front of you and say thank you for attending to these issues. This is not something that we've spent a lot of time thinking about and and thinking about ways to address. But I can see that you that members of the committee have and that the committee is looking at it and considering ways to make sure that the public interests continue the public interest continues to have a focus on this and assemble the right people to maintain a focus on it. So I think on a very high level, I just wanted to sit down on the seat committee and say, appreciate your attention to this and consideration of the right people to have on the committee to maintain focus.

[Rep. Brian Cina (Member)]: Thank you.

[Rep. Francis McFaun (Vice Chair)]: Thank you.

[Rep. Alyssa Black (Chair)]: Go ahead. I don't know if you've given a thought

[Rep. Leslie Goldman (Member)]: to it yet, but have you, anyone that's missing on this committee or council that you think about? I did notice that I couldn't, I don't think I can

[Mike Fisher (Office of the Health Care Advocate)]: see the whole list, and I did not go the

[Rep. Leslie Goldman (Member)]: Yeah, you can Google it.

[Mike Fisher (Office of the Health Care Advocate)]: Yeah. I'll I'll Yeah. Take a look at that.

[Rep. Brian Cina (Member)]: I can tell you that the that no other member of the list is a health care provider or is related to health care. It's like public safety, labor, commerce, but you should look. Do you feel comfortable?

[Rep. Alyssa Black (Chair)]: Yes, I was going ask if you wanted to lead discussion on this Are eight

[Rep. Brian Cina (Member)]: you comfortable not being on it as the advocate? Do you trust me if anything comes up, you can go to them with it versus you being on? Cause I figured you guys can go testify to them if you're concerned, you don't have to be on the council, if you felt like we'd add you to our list of people requesting to be on it.

[Mike Fisher (Office of the Health Care Advocate)]: I'm comfortable not being there. Thank you. Nothing good.

[Rep. Brian Cina (Member)]: You're opting out.

[Rep. Alyssa Black (Chair)]: I will just say, as someone who, first of all, I didn't know that we had an AI council, but considering that AI with healthcare seems to be one of the leading industries that AI is going full in on, the fact that we don't have anybody looking at it from a healthcare lens, frankly, is a little alarming to me.

[Rep. Brian Cina (Member)]: I had the Commissioner of Health and that was it. But my concern was that, and you're welcome to weigh in on this, my concern is if you look at the membership of the council when it was created, it's almost all people appointed by the governor, and they're all heads of agencies. I think it's because the angle was how is it internally in government being used, but now we're looking at how the private and public sector intersect and how healthcare being such a hybrid sector, how integrated it is, and that I think it's important that we add a few people, which is why we're adding these different perspectives. Also, you'll see that something we haven't discussed is it delays the repeal of the council. This council was going to cease to exist next, but we're delaying the repeal to 2030 and asking them if that's good enough because there needs to be worked on still, and heard the AI director say that he supported that council.

[Mike Fisher (Office of the Health Care Advocate)]: Usually hear from me, I usually say a line something like, you know, industry run circles around the public interest in things like this. And, you know, like, how you do a multiple of circles, you know, does does it run spheres around us? I I mean, I have a, we are all figuring this thing out, and it's it it is in our lives. And I did have the thought sort of this is not a question for today. It's a question for tomorrow about whether health care is important enough. But so here's it's great that there is a group that's focusing on, you know, on AI generally, but whether it makes sense for that group to have a subgroup that's more focused particularly on its impact in healthcare. I think the previous discussion about

[Rep. Brian Cina (Member)]: really important appropriate uses for AI and how to even support that, at the same time put guardrails around it to prevent more negative things. That being said, if the committee in our discussion decided to create some direction to them to have a working group or subcommittee as part of their work that might achieve that goal, that's something I have been thinking about actually, I don't want to complicate it, but-

[Rep. Alyssa Black (Chair)]: Leslie, go ahead.

[Rep. Leslie Goldman (Member)]: You. I don't know how directed we want to be in that sort of conversation. I mean, they may want to figure out their own process. But I'm looking at section three and four, and you said that the council is going be just dissolved?

[Rep. Brian Cina (Member)]: It was going to be repealed in 2027 if we didn't extend the sunset. Is it in here? Yes. It it there's At the end of section

[Mike Fisher (Office of the Health Care Advocate)]: at the middle of page 25.

[Rep. Brian Cina (Member)]: Before section five begins, you'll see a little thing where the repeal is is is extended.

[Rep. Alyssa Black (Chair)]: May I ask if you have any knowledge of are there any other bills that are moving around the building that have

[Rep. Brian Cina (Member)]: a repeal of the sunset? Not that I'm aware of.

[Rep. Alyssa Black (Chair)]: I didn't know. It should

[Rep. Brian Cina (Member)]: be in the miscellaneous gov ops. They usually do like a miscellaneous boards and commissions bill. So if we missed it, they could always have done that next year in January or February, but it's probably good we do it now if we're adding people and giving them a mission that's going take more than, you know

[Rep. Leslie Goldman (Member)]: They just did reports, but I don't think they did boards.

[Rep. Alyssa Black (Chair)]: Thank you. So, I have this We have this on schedule for the Tuesday when we get back. Tuesday, March 10 in the afternoon. I have it as marked up as possible votes. Is there because I do think we need to walk us through the changes that have been made and we don't have Led Council today. Is there anybody that anyone feels that we have not heard of, that you're still looking for information on, that you still have questions and you're not sure that we can work to try to have that done the Tuesday we get you back. Brian?

[Rep. Brian Cina (Member)]: Well, there is one person. There's one person that I was looking at the list that I needed to look at my cheat sheet. The attorney general's office was willing to, they didn't feel like they had to, but they were invited and they told me today that if they have a chance, they would like to come in, it would be brief. So maybe that day we hear from them. And the only other group that I heard from that I think we haven't heard from is Boss, He sent me an email about, I don't want to speak for them, I think it's safe to say if it's public that they were offering to have a member. A lot of people want to add a member, but I think if Boss is here and we could give them a chance.

[Rep. Alyssa Black (Chair)]: I think Bas is gonna be here in this afternoon and we'll ask if they'd like to either submit written testimony or if they wanna testify on this as well.

[Rep. Brian Cina (Member)]: They're the only ones.

[Rep. Allen “Penny” Demar (Member)]: I just got a question because, you know, we had this bill of 27 pages and now it's down to five. What was the reasoning, or who made the decisions to take out all the 22 pages?

[Rep. Alyssa Black (Chair)]: Can I answer that? Yeah,

[Rep. Leslie Goldman (Member)]: I'm just Do

[Rep. Alyssa Black (Chair)]: you remember the walkthrough of the 27 pages? We were all like our heads were spinning.

[Rep. Allen “Penny” Demar (Member)]: No, know. I know.

[Rep. Alyssa Black (Chair)]: There was an enormous amount of things in the original bill. And we frankly did not have time to do justice to all of those things. So we've

[Rep. Allen “Penny” Demar (Member)]: I just wanted to know.

[Rep. Alyssa Black (Chair)]: We thought, hey, let's get something, acknowledgement and the board or council and yeah.

[Rep. Brian Cina (Member)]: I can't remember exactly how it happened, but I know me and Alyssa talked and Daisy talked and we were like, this is too much to do right now, what's possible? And I think I offered, I said, let me try to create an amendment. And then I wrote something and gave it to gents.

[Rep. Alyssa Black (Chair)]: And if you remember that there was a piece in this bill originally that it didn't mirror, but it sort of dealt with the same issues of 08/16, the other one. And I think that when we originally conceived of this, we thought we would weave them together with these two pieces, but it seemed like we were moving right along with it. And so that's why we're doing the two bills separately now. Okay. Alright. I just wanna I wanna discuss also So, I mean, I'm fine going into lunch if anybody else is fine going into lunch.

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: Just want to catch you up

[Rep. Leslie Goldman (Member)]: on something. We had a conversation in the Lueders Room about maybe changing it to on passage, so rather than July 1, that the council could get started since the council already exists. You can start this work. So you know that.

[Rep. Alyssa Black (Chair)]: We'll have Brian work with council.

[Rep. Brian Cina (Member)]: Yeah, I took a bunch of notes and what I was going do is talk with Alyssa after and just make sure you're okay with my suggestions to Jen. Then Jen would come in with a choose your own adventure where it's like, here's what we have, and we can add these things or leave them. You know how she does that where she has yellow in it? My hope is she'll give the committee choices so it's efficient.

[Rep. Alyssa Black (Chair)]: And we have all Tuesday afternoon. That's the only thing that we have on our schedule.

[Rep. Brian Cina (Member)]: Okay. 08:16?

[Rep. Alyssa Black (Chair)]: So 08:16, sixteen, I'm very sorry everybody. I just haven't been here. I haven't had a I don't know what discussion you had today around 08:16 other than Stephanie.

[Rep. Daisy Berbeco (Ranking Member)]: Well, you were off representing us in Washington, D. C.

[Rep. Alyssa Black (Chair)]: This week.

[Rep. Daisy Berbeco (Ranking Member)]: We heard from Kelsey Stasse from LKHS. We heard from Stephanie Winters. We heard from Jeremy Aderman from the National Council for Mental Well-being who works with providers that use these tools all over The US. And I'm curious if the committee I've been talking individually with committee members about who else they might want to hear from. But like with the other bills that I have in play, we've tried to keep this narrow, not expand it to chatbots intentionally to manage our time well and do diligence for the complexity of all the issues. Brian looks confused.

[Rep. Brian Cina (Member)]: But he said, does he not do chatbots? I'm confused.

[Rep. Daisy Berbeco (Ranking Member)]: Yeah. Chatbots are not in eight sixteen. But this I've been talking with members in the Senate who will make space to do testimony and stuff on chatbots.

[Rep. Brian Cina (Member)]: So

[Rep. Alyssa Black (Chair)]: we're sort of sending them?

[Rep. Daisy Berbeco (Ranking Member)]: Yep. They said if we send them this piece that takes care of the clinical tools and protects patients and providers and the tools, really, that they will take up the chatbot side of it, which is more the public use of chatbots, because we do not have time this week to take, I think, what we need to wrap our brains around that topic as well. Yeah. You're

[Rep. Leslie Goldman (Member)]: welcome.

[Rep. Francis McFaun (Vice Chair)]: I'm sorry.

[Rep. Alyssa Black (Chair)]: No, no, no. I just wanted to say also that I don't know if it's been discussion or not, but maybe if we can work with Vermont Medical Society whose suggested language on the other? Because I do recall that as we were walking through the bill, was thinking, gosh, I mean, I know how medical records are actually generated. So, yeah, actually, their

[Rep. Daisy Berbeco (Ranking Member)]: comments, I have three more changes to the bill. We haven't had ledge counsels, so

[Rep. Leslie Goldman (Member)]: they haven't been made.

[Rep. Daisy Berbeco (Ranking Member)]: We'll need to do, when we come back, another walk through with the changes that we've heard recommended, which are all, I think, very good changes that align with the intent of the bill as we've discussed it.

[Rep. Alyssa Black (Chair)]: Okay. Brian and then Leslie.

[Rep. Brian Cina (Member)]: I know that it doesn't explicitly name chatbots, but it does say that a person, corporation, or other entity shall not offer, provide, or advertise mental health services that represent artificial intelligence as providing therapeutic judgment, diagnosis treatment, or therapeutic communication, and a chatbot falls under that. So even though it doesn't need chatbots, a chatbot is that. So that's why I was like, we're going to address chatbots in this. So we may not solve the problem in this, but I think we at least need to hear from the people who are concerned about chatbots a little bit. And if we don't resolve it here, we don't resolve it here. And I know that the VPA, the Vermont Psych College Association and the National Association of Social Workers have both reached out to me about the chat bot, provision of mental health services using AIPs. And if you look at the letter we got for eightfourteen, it does also say eightsixteen. The Vermont Psychological Association talks about creating a three tiered system. I don't think we're going to work that out today. I feel like the council needs to work that out through the work of 08/14, but in their three tiered system, they talk about administration, human review delivery and automatic delivery. What that would mean is administration would be the notes stuff where it's being used behind the scenes and humans are reviewing it, it's not doing its own thing. But the second part here they're talking about is when you use it as a tool with you, but the third part is the chatbot. It's when it's doing it on its own. And so I guess what I'm saying is hearing from them a little bit about this.

[Rep. Leslie Goldman (Member)]: So Brian,

[Rep. Daisy Berbeco (Ranking Member)]: that keeps it germane so that they can take all that testimony in Senate health and welfare. What did you want, Brian? Additionally, I think this speaks to the tools, and Stephanie gave us a recommendation to put definitions in for things like processing and treatment and further definitions that I think intend to

[Rep. Alyssa Black (Chair)]: speak to that. Can I please? On Tuesday or Wednesday morning, I believe after because I I don't think we have alleged counsel the later half of Wednesday morning, correct? And we have nothing there. Could we schedule, can we work with, Tasha? And can we schedule just one person? About it. And the only reason I'm saying that is because, yes, there is enough language to make it germane and we want the Senate to be able to have that. But let's not forget how quickly things move the last week sometimes of the session where if it comes over to us, we may not have I'd like to introduce the topic.

[Rep. Daisy Berbeco (Ranking Member)]: Kelsey talked a little bit about it. If we remember back to Kelsey's I'd

[Rep. Alyssa Black (Chair)]: like to do it because if it comes back from us, we may be moving really, really quickly and not have time to line that up. So we have some time. So let's just do a

[Rep. Daisy Berbeco (Ranking Member)]: yeah. I also want to note that NASW, who is interested in the chatbot topic, was invited to offer language to this bill weeks ago. So I'm restating that they had the opportunity to advance that topic in here. And I'm not saying we're going to

[Rep. Alyssa Black (Chair)]: change anything in it. I just want to introduce the topics for if it comes back to us with Yeah, amending

[Rep. Brian Cina (Member)]: know if they would agree with that. I think we need to I don't want to speak for them, but they're saying that I've been approached by their lobbyists and by the director, them feeling like they're being left out of the discussion on chatbots. Even when 08/14 came, when the director of the NSW started to talk about chatbots, Topper was ready to redirect her because she was told not to talk about chatbots. So she didn't have her chance. So I feel like they need a chance to at least

[Rep. Alyssa Black (Chair)]: That's what I'm saying.

[Rep. Brian Cina (Member)]: And I

[Rep. Alyssa Black (Chair)]: absolutely do not want to shut anybody out. And I want to hear on this. I'm trying to weave it in with the things that might be moving back and forth.

[Rep. Brian Cina (Member)]: Okay, I feel heard. Thank you.

[Rep. Alyssa Black (Chair)]: So just to let you know that we are planned Wednesday afternoon to come back to

[Mike Fisher (Office of the Health Care Advocate)]: Five eighty five.

[Rep. Alyssa Black (Chair)]: No. Well, no. That's in the morning. Wednesday afternoon, because we have Katie, we're coming back to 08:16 and 08:17. We'll get both of her bills, that's the only time we have her. Yeah.

[Rep. Francis McFaun (Vice Chair)]: The I think I went to 02:30.

[Rep. Alyssa Black (Chair)]: The intent is that we will have these both these bills marked up.

[Rep. Daisy Berbeco (Ranking Member)]: Is this the

[Stephanie Winters (Vermont Medical Society/Vermont Psychiatric Association)]: Oh, thanks.

[Rep. Alyssa Black (Chair)]: So rather than my scrolling, the whole margin, yours is even worse. So, yeah, my intention is that we can do markup impossible votes on both eight sixteen and '17 because we have Katie for a limited amount of time. And we're going to do a little bit because we have Jen in the morning on five eighty five.

[Mike Fisher (Office of the Health Care Advocate)]: And

[Rep. Alyssa Black (Chair)]: I'm going to tell you what my intention is so you can be thinking about it. I know that you're thinking about this all town meeting break. Can we finish on 08/16? I just

[Rep. Leslie Goldman (Member)]: had a question about that. 08/16? You're moving beyond that.

[Rep. Alyssa Black (Chair)]: Oh, I'm sorry. What was the question?

[Rep. Leslie Goldman (Member)]: I appreciated that you brought up Kelsey's name because in my notes there were two questions and I just wanted to get it on the list to make sure I'm misunderstanding. He was talking about a definition of augmented intelligence, and that needed to be included.

[Rep. Alyssa Black (Chair)]: Don't know if

[Rep. Francis McFaun (Vice Chair)]: but

[Rep. Brian Cina (Member)]: I agree

[Rep. Francis McFaun (Vice Chair)]: with that or

[Rep. Leslie Goldman (Member)]: he did bring it up. And the other thing that he brought up, and it left with a confusion for me, is he said there's a conflict within the draft, internal conflict within the draft. I did not understand that. I've got it. Okay, that's all I care about. Thank you. Okay. Thanks so much.

[Rep. Alyssa Black (Chair)]: Thank you, Leslie. So 585, I want you all to be thinking about my intention is there's a lot of sections in this bill, and there's a lot of great stuff in it. He's biased.

[Rep. Leslie Goldman (Member)]: Is it

[Rep. Brian Cina (Member)]: 585?

[Rep. Alyssa Black (Chair)]: Yeah. It is my intention Wednesday morning that I'm actually gonna straw pull each and every section. Oh, that would be That's oftentimes what we will do. I want to get because I want to make sure I want to get the committee

[Rep. Francis McFaun (Vice Chair)]: Understanding each section.

[Rep. Alyssa Black (Chair)]: I want them to understand each section and the various sections are very different. I want to make sure that everybody understands each section. And I really want, I think it's an important bill on many, many levels. And I really want the support of the committee. I'm intending to straw poll each and every section of the bill. When is this going to happen fast? Wednesday morning.

[Rep. Leslie Goldman (Member)]: And you're talking about 1.2, draft 1.2, yeah.

[Rep. Brian Cina (Member)]: Can I just repeat what I heard to make sure I understood? That Tuesday afternoon is going to be AI, Wednesday morning is five eighty five.

[Rep. Alyssa Black (Chair)]: Wednesday morning is five eighty

[Rep. Brian Cina (Member)]: five. Thank you. Okay. Just wanna make sure I'm getting it in my head right.

[Rep. Alyssa Black (Chair)]: But then also Wednesday morning, we're going to do

[Rep. Francis McFaun (Vice Chair)]: a little

[Rep. Alyssa Black (Chair)]: chat bot.

[Rep. Brian Cina (Member)]: The A16 chat bot. Yep.

[Rep. Daisy Berbeco (Ranking Member)]: Why don't you get someone that you wanna hear from?

[Rep. Alyssa Black (Chair)]: You said that you've been approached.

[Rep. Brian Cina (Member)]: I would say Rick Farnett and the NASW, too, I would reply. Let's work with them. Whoever they choose, like, from those groups.

[Rep. Alyssa Black (Chair)]: Okay. That brings us to I think we're think first of all, we can go off of live because I don't That's about as far as we've got.