Vermont Legislature SmartTranscripts:

[Rep. Brian Cina (Member)]: AI in a No. We're all done with AI. No. It's AI in elections. Hi.

[Rep. Alyssa Black (Chair)]: Welcome back. We are gonna have legislative council walk us through amendment that we are proposing to H5 is the

[Rep. Brian Cina (Member)]: Eight eight. Five eight eight.

[Rep. Alyssa Black (Chair)]: Five eight eight. Is a bill that was voted out of government operations, I think last, whenever last. And just FYI, the legislative council who drafted this was unable to be with us. So Jen's gonna Yeah, Jen's pitching in for it.

[Jennifer Carbee, Office of Legislative Counsel]: All right. With Lo again, Jen Carvey from the Office of Legislative Counsel. Here is the language. As the chair said, this is an amendment to H588, which is the OPR, miscellaneous OPR bill. And this would add a new section around pharmacists to specifically address in the scope of clinical pharmacy, pharmacists, just prescribing, but also doing some testing. So under existing law, a pharmacist can engage in the practice of clinical pharmacy, including certain prescribing, but there are certain things they cannot do. And one of those under existing law is they cannot initiate antibiotic therapy, except pursuant to a collaborative practice agreement, which is an agreement with a particular prescriber or a state protocol if the Commissioner of Health adopts a protocol saying that there are certain things a pharmacist can do, and in this case can initiate antibiotic therapy. So again, under existing law, the only exception around initiating antibiotic therapy is percentage of collaborative practice agreement. And then this would add or state protocol. Also under existing law, it specifies the context in which pharmacists can prescribe. And under that, we have the state protocol. Because I don't think we've looked at this language together. Under existing law, a pharmacist can prescribe, order or administer in a manner consistent with valid state protocols approved by the Commissioner of Health after consultation with the Director of OTR and the Board of Pharmacy and the ability for public comment. The pharmacist may prescribe, order or administer. Under the list, under existing law, this isn't changing that when prescribing of albuterol or glucagon while contemporaneously contacting emergency services. So some life saving stuff. This would strike out language authorizing the keep forgetting to lead in prescribe, order, or administer tests for COVID nineteen for individuals by entities holding a particular certificate of waiver. This is some of the COVID era specific language, and you've got a broader version that's coming up as the new law. And also striking out the specific language around tests for SARS CoV. Anyone remembers that was what we were calling it at one point? Again, tied to this certificate of waiver under federal law. And instead, this would add after the existing provision for emergency contraception, this would add tests waived under particular provision of federal law for COVID-nineteen, influenza, and streptococcal pharyngitis and subsequent drug treatment. I think we'll hear from OPR why they are asking for that one.

[Rep. Alyssa Black (Chair)]: Any questions? Great. Oh, wait. So close. I

[Rep. Leslie Goldman (Member)]: just didn't know what 42 UFC is that relevant?

[Jennifer Carbee, Office of Legislative Counsel]: I believe it is. I think there are certain tests that are waived under federal law that OPR is about to tell you about. I'm looking at Jen and Karen. If they are not, then I will look into it and tell you more. Thank you.

[Rep. Alyssa Black (Chair)]: Thank you. So there's a change to it?

[Jennifer Carbee, Office of Legislative Counsel]: Yes, there is a minor change to reference. Should be to the Code of Federal of Federal Regulations, not the United States Code. Okay.

[Rep. Alyssa Black (Chair)]: Do you want to come out? Different chat. Jen, I shouldn't

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: Jenny. Hi. Jen, Jenny, Jennifer, director of the Office of Professional Regulation. Thank you for having us today. OKYAR does support this amendment to H5-eighty eight. It allows tests to treat for very limited conditions. And the way this amendment came about, our understanding is that as part of the Rural Health Transformation Program, there have been funds approved for the fiscal year. And Test to Treat was one of the initiatives that was intended to be covered by that World Health Transformation Program. So these statutory revisions include that pursuant to state protocols, which the Vermont Department of Health, the Commissioner of Health would approve and work with OPR and the Board of Pharmacy and stakeholders to come up with those protocols, but that those protocols could be used for point of care testing and treating of COVID-nineteen, influenza, and strep. And again, those are obviously very limited conditions where the testing and treatment is fairly straightforward. There are a lot of other states that actually do this test to treat or that allow this test to treat at point of care in pharmacies. And I think part of the reason is because it's an access issue. It's easy for folks to walk into their local pharmacy and receive these kind of services and get tested and treated for very quickly rather than having to make appointments with their primary care providers. So it's a way to increase access and, again, done in a number of states. And from OPR's lens, our lens is always what is safe for the public. Public protection is our mandate. And this is well within the pharmacy scope of practice. And we support the language.

[Rep. Alyssa Black (Chair)]: So currently, pharmacies test for COVID, but they can't actually do anything if somebody was to test positive, they would have to then send that person to a prescribing physician to prescribe the treatment or the medication that

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: Or if they have a collaborative practice agreement with a provider, I think they would be able to prescribe treatment, but unless there's a state protocol or an order from a provider or a collaborative practice agreement, then the pharmacists aren't able to prescribe.

[Rep. Alyssa Black (Chair)]: This would allow that within their scope of practice. Correct. Right.

[Jennifer Carbee, Office of Legislative Counsel]: Is that mean that each pharmacist then has to

[Rep. Alyssa Black (Chair)]: update their scope of practice or is it a blanket? How does that work?

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: No, a scope of practice is essentially dictated by, first of all, pharmacy education, which is extensive in this area. So I think it's well within and I'm looking at our EO for the Board of Pharmacy, but it's well within the training and education for pharmacists in general. And then additional training and experience that any individual pharmacist might have can also dictate a scope of practice. So it just depends on the individual's training, experience and education.

[Rep. Alyssa Black (Chair)]: Any other questions for Jen? Alright, well thank you. Okay, great. Lauren is not coming.

[Dr. [Name unknown], Vermont Health Commissioner]: Correct.

[Rep. Leslie Goldman (Member)]: She's in another

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: committee, that's her apology.

[Rep. Alyssa Black (Chair)]: Sorry. Probably down in gov ops. We miss her. Gum ops, it's all alone from Lauren, it seems like. Doctor. Hill? Good afternoon. Thanks for coming in on short notice.

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: Happy to be here.

[Rep. Alyssa Black (Chair)]: You had a chance to look at the language of this? I have, I have. Did you want to address it?

[Dr. [Name unknown], Vermont Health Commissioner]: Yeah. So for the record, Hill, the brand commissioner Oh. This concept of test to treat, I think, is one we've thought about a lot, and frankly, one that I had to do a bit of investigation on because I'm new to this. And I can say clinically, I oftentimes will see people who get delayed treatment. Timely treatment for these conditions is super important with flu, as an example. If you don't get started on Tamiflu in the first seventy two hours, you can't get Tamiflu. It's then no longer indicated. And anyone who's taking Tamiflu knows it works really well and you get back to work faster. And a lot of times, unfortunately, what happens is people may get a test, they may do a home test, which we have available now, but they can't get in to get prescription for treatment. Frankly, access to medications can sometimes be a challenge, but getting an access to a primary care appointment is a real barrier. Same thing's true for COVID, as we know. We want to get people treated as rapidly as we can. We do have oral treatments available that can be very effective in reducing the disease burden and the infectivity of people and strep throat, another common infectious disease, it really can be very dangerous if you delay treatment with strep throat, valve problems. So this is intended to improve access in the way that we looked at improving access to testing in the past with COVID era changes and does empower the pharmacist to prescribe. The other thing to say is, as our colleagues at OPR said, we're going to be working together on having a very tight protocol here so that it's very clearly defined whether the inclusion and the exclusion criteria. Other states have done it very successfully. Usually includes provisions like if you do test positive and get a treatment, you have have a follow-up appointment with your primary care physician, which I think is prudent in many of these cases, ensure that you don't have any ill effects of the treatment. So there's a lot of protections that we'll put in place with this. But I think this is an opportunity to improve access to Vermonters for common conditions that can at times bog down urgent cares in other places and opens up another venue for care.

[Rep. Alyssa Black (Chair)]: I'm sitting here flipping through the RHT grant, and I don't know if you have this or maybe

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: Jill Olson.

[Rep. Alyssa Black (Chair)]: So this was part of the Rural Health Transformation Grant. How and we were awarded this and it was approved.

[Dr. [Name unknown], Vermont Health Commissioner]: Yeah, this is one of the approved things in our budget.

[Rep. Alyssa Black (Chair)]: How much are we is being allocated to that? Does anyone know?

[Dr. [Name unknown], Vermont Health Commissioner]: I don't. It's primarily going to be led by Diva. And when we discussed this, it was clear that I was going to work with Diva to operationalize this to make sure it went well. But Diva is the main agency working on it. But Jill is 25. You got it. Okay.

[Rep. Alyssa Black (Chair)]: $1,070,000.

[Dr. [Name unknown], Vermont Health Commissioner]: That sounds great.

[Rep. Alyssa Black (Chair)]: Okay. So if we do not do this, we actually wouldn't even be able to spend that money? Yeah, if

[Dr. [Name unknown], Vermont Health Commissioner]: we never did this, that's true. If we said we don't feel the timing and we want to wait a year, we would struggle to spend $1,000,000 this year on that program, which has implications in the RHDP program. But it would be a challenge. So that is a consideration. It's not the only consideration here. I think we should take this in the context of, hey, this is a thing that many other states have done. They've done it effectively. It's been successful in improving access for these conditions. And we're going to have important progress. Thank

[Rep. Alyssa Black (Chair)]: you. Oh, go ahead, Leslie. I'm sorry.

[Rep. Leslie Goldman (Member)]: Thank you. This will take effect on passage. So what do you imagine the turnaround time might be on getting your protocols ready to

[Dr. [Name unknown], Vermont Health Commissioner]: do that? Well, and part of that, I believe the reason we're pushing for on passage has to do with the timing of this RH2P. So we want to get up and running rapidly. We still need to get RFPs out the door. We've got things that we have in front of us to do this. I don't want to get ahead of our OPR physician colleagues on this. The good news is there are protocols that do exist in other states that we can shamelessly copy from in many ways. But you're right, there's a tight timeframe on that. We're well aware of that.

[Rep. Leslie Goldman (Member)]: I think some of us who've had the opportunity to listen to the primary care, and you're talking about getting follow-up in your primary care within a week, forget it. So I'm glad to be able to know that we can offer other venues for people to get care. But what if we can't get care? I mean, if you write into new protocols that they're going to get follow-up in a week and that's not doable, then what?

[Dr. [Name unknown], Vermont Health Commissioner]: Yeah, again, there's a lot of other pieces we're going to have to figure out with I don't have the answer to those, but I work with BMS and our providers to make sure we do. Speaking as a provider, I can tell you, yes, you're right. When you have an appointment, they may get. But when you have an urgent medical need, there's ways that that can get addressed as well. And every clinic has a different way of doing that. But it oftentimes goes to asking the doctor, saying, Hey, yeah, I have this need. Can it be done on a sooner basis? And they stay late, which is really unfortunate. And I know we all hate to have our Then you permanent

[Rep. Alyssa Black (Chair)]: come out, and that's

[Dr. [Name unknown], Vermont Health Commissioner]: that. You're right. But that is what happens in many, many, many clinics where, when there's an urgent medical need, that people, they work through their lunch hour. Some people, thankfully, do have open slots that they keep Build in. Specifically for this, and that's a prudent practice.

[Rep. Leslie Goldman (Member)]: Do you think there are other people that could be the follow-up process rather than I'm wondering.

[Dr. [Name unknown], Vermont Health Commissioner]: Yeah, urgent care would be the other place to look, which again, the point is not to burden our urgent care. I don't know the answer to that, but I think it's certainly worth looking at. What's the right way to follow-up after having I

[Rep. Alyssa Black (Chair)]: would say a lot of people don't have access to urgent care.

[Dr. [Name unknown], Vermont Health Commissioner]: Yeah, that's actually true. And my concern is people

[Rep. Alyssa Black (Chair)]: will go to the emergency department for

[Dr. [Name unknown], Vermont Health Commissioner]: That is what we want to avoid, right? And that's part of

[Rep. Alyssa Black (Chair)]: what we're trying to prevent

[Rep. Leslie Goldman (Member)]: here. Or some of those stuff, that's the thing. It's horrible. It could be horrible stuff for some people.

[Rep. Alyssa Black (Chair)]: Meeting follow-up and having that access.

[Dr. [Name unknown], Vermont Health Commissioner]: And again, access to this doesn't solve our access to primary care. You guys know that. Mean, we're just adding Well, more the demand is there. This is trying to at least have a venue for early treatment. You can get timely treatment. It doesn't obviate the need for primary care follow-up in many cases. But a number of people are going to be negative that would be using up primary care visits. So that could be a

[Rep. Leslie Goldman (Member)]: So do you think that everyone that takes the drug needs follow-up? Or maybe could that be perhaps rather than absolute?

[Rep. Brian Cina (Member)]: Again, I

[Rep. Alyssa Black (Chair)]: know you're going to walk through your thing, but I'm thinking of wondering about that.

[Dr. [Name unknown], Vermont Health Commissioner]: Yeah, that's a fair question.

[Rep. Alyssa Black (Chair)]: Oh. This is not really in the scope of the I do realize what we're doing here, but And maybe Jill would be better to answer just from the diva side rather than the health department. Are these reimbursable services? If you're

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: I believe No, it's not reimbursed.

[Rep. Alyssa Black (Chair)]: So I actually would want to go back

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: to Dana to talk to him

[Rep. Alyssa Black (Chair)]: about that, but that would be the only way to

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: make this sustainable, right? Would be

[Dr. [Name unknown], Vermont Health Commissioner]: to be a reversible service.

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: I think this is why we've got interest in private pharmacies and doing this I

[Rep. Alyssa Black (Chair)]: can get you to those details.

[Dr. [Name unknown], Vermont Health Commissioner]: My understanding is that the intent here is not to be using these funds, though, for the service itself, but rather to set up the pharmacy so that they can do it, which could be equipment and training and all those things, because we specifically can't use RHDP for Right, personal

[Rep. Alyssa Black (Chair)]: it could be for

[Rep. Leslie Goldman (Member)]: us to be sitting in the halls.

[Rep. Alyssa Black (Chair)]: We can bring that up to anyone. But it would be safe to say that this helps support our pharmacies. And patients. Patients.

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: If it doesn't support

[Dr. [Name unknown], Vermont Health Commissioner]: our pharmacies, they're not going to take us up on the offer.

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: So it is in

[Dr. [Name unknown], Vermont Health Commissioner]: our best interest to structure this so that

[Rep. Alyssa Black (Chair)]: it supports our pharmacies. Right. Okay, well great. Any other questions for Doctor. Elba? Thank you.

[Dr. [Name unknown], Vermont Health Commissioner]: Thank

[Rep. Brian Cina (Member)]: you, S. G. Japanese,

[Rep. Alyssa Black (Chair)]: you want to come on up?

[Stephanie Winters, Deputy Director, Vermont Medical Society]: Hi, Stephanie Winters. I am the deputy director of the Vermont Medical Society. Thank you for inviting me. I threw together some testimony, so hopefully it makes sense. I wanna begin by saying explicitly that pharmacists are essential members of the healthcare team And that broad unrestricted test to treat authority moves beyond, I think what we would want to see in our state, it fragments patient care and introduces new safety risks. But I will say Vermont's state protocol based model works, and it's the model that Vermont should continue to follow. And BMS supports that the amendment language regarding COVID flu and strep testing, test to treat is condition or medication specific and protocol driven and not open ended. And as you all were talking, I just would be remiss in saying that if we had a really well supported and strong functioning primary care system, we wouldn't have to create all these alternative systems like urgent care or like moving care into pharmacies, are already so busy on their own, period. I just say, let's remember, and I know this committee knows that and wants to support primary care, but just a stop point. And more on the protocol based approach. Some of you weren't here when we passed that in 2020, but we have a strong history of working together to create this protocol, a landmark example where that expanded pharmacists prescribing authority safely and deliberately, so through jointly approved protocols by OPR and by the Commissioner of Health, this has been a really transparent process. We've been part of the board of pharmacy meetings, had input and really created some really strong protocol that I think creates that patient safety and is the most effective framework for expanding pharmacy practice. So we have appreciated that protocol process.

[Rep. Alyssa Black (Chair)]: Can I interrupt you? As part of that protocol, the existing protocol, is there mechanisms around continuity of care to ensure that?

[Stephanie Winters, Deputy Director, Vermont Medical Society]: Yeah, so all of the protocols require asking about a primary care practitioner, making sure people have them, if they don't, trying to do the connection. And then they all are different, depending on the medication. So oral contraceptives are different than NRT, are different than immunizations. And so What's NRT? Nicotine replacement therapy. So they will all be different. And as you were talking to the commissioner about what will this protocol look like, I think that remains to be seen. We've talked with some of our pediatric colleagues about strep and when a patient should be referred. And obviously there are concerns about finding primary care. My hope would be if there is a good communication and collaboration between that pharmacy and primary care in that area, that they have a sort of peer to peer contact and get the patient in. I would assume that the protocol might say referral to primary care within a certain amount of time, not necessarily that you get in, but we don't know what that protocol will look like.

[Rep. Alyssa Black (Chair)]: Just a little side note. I just wanted to ensure that pharmacies would be sending documentation to a primary care that, hey, your patient was seen, they were prescribed that. Mean, that would be And in existing protocols?

[Stephanie Winters, Deputy Director, Vermont Medical Society]: Yes, and I think it's using the, some of it's the VPMS, some of it's the immunization registry, then yes, there is seven days or five days, I'm looking at Carrie with OPR. All of the protocols have the same format and they do involve informants with carrier's provider of what they have is through a variety of different ways. Sorry, keep going. No. Just a couple of implementation considerations that we just want to point out that there is some worry about allowing pharmacists employed for a for profit entity to both diagnose and prescribe. It could introduce a potential conflict of interest. And also just worrying about our pharmacy colleagues. And if you've been in a pharmacy lately, you know how busy they are. So just their workload is busy too. And as we talk about, they may not wanna take it on and they don't have to take it on, but some of these are employed and they may kind of have to take it on. So just considerations there. In conclusion, we support safe collaborative models of pharmacist engagement, those that complement and not replace patient centered medical homes. We support that this language is condition or medication specific and protocol driven, not open ended. And we very much look forward to taking part in the protocol process, which we hope will address information sharing, coordination with practitioners and other primary care practitioners, notification after prescribing, patient screening and referrals, and then training oversight, and obviously protections for both patients and pharmacists from being placed in unsafe clinical situations and decision making.

[Rep. Alyssa Black (Chair)]: Any questions for Stephanie? Go ahead, Leslie.

[Rep. Leslie Goldman (Member)]: Can you talk about what you mean by oversight? It's in your next to last bullet, including training oversight and data report. How does oversight mean?

[Stephanie Winters, Deputy Director, Vermont Medical Society]: I mean, I think oversight by OPR, their licensing facility, making sure that the protocol is being followed and how that all works with the collaboration and coordination.

[Rep. Leslie Goldman (Member)]: Is that already in play in that OPR? Is this Well, yes.

[Stephanie Winters, Deputy Director, Vermont Medical Society]: Yeah, the licensing body already looks over them. We're implementing a new process. They don't currently do testing and treating. So there needs to be processes for

[Rep. Alyssa Black (Chair)]: how to monitor that. Yeah,

[Rep. Leslie Goldman (Member)]: That's what I'm worried about.

[Rep. Alyssa Black (Chair)]: Thank you. Any other questions? Alright. So, two things. So, I have sponsored this amendment, and then there's a couple other people on it. If anyone else would like to put their name on this amendment, it'll be a floor amendment. Are you inviting us to? I'm inviting anyone who would like to sign on, we can still do that. Yeah, we do. Yeah, let's counsel. So we have Wendy Critchlow.

[Rep. Brian Cina (Member)]: I'll add my name, can also put in a clause about universal healthcare.

[Rep. Leslie Goldman (Member)]: Gordon Lee, Brian off.

[Rep. Alyssa Black (Chair)]: Brian and Wendy. This one's Karen. Oh, Karen, the other Wendy. The other thing is I have spoken with the chair of GovOps, and I'm actually going in there tomorrow afternoon to present this. And the the chair of gov ops knows all about it as well. So this is not a big shocker on the floor or anything like that. I saw you're on their schedule too to present it. And I believe that the same witnesses that we've just heard from will also be there. So they'll be in that committee tomorrow.

[Rep. Leslie Goldman (Member)]: So this came from OPR to here? I think it's a

[Rep. Alyssa Black (Chair)]: little OPR miscellaneous, the housekeeping bill or something?

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: The OPR, the annual OPR. So you

[Rep. Leslie Goldman (Member)]: just noticed that this wasn't here and you were hoping to edit?

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: No, that's not how it came about. You're curious about how

[Rep. Leslie Goldman (Member)]: it relates to origin. Origin stories, I love them.

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: Yeah, we've been coordinating with BDH and the Rural Health Transformation Program, and that conversation kind of culminated in that last week. And so those grant funds, I believe, were recently awarded, but I can't really speak to those. It's okay, Matt, you.

[Dr. [Name unknown], Vermont Health Commissioner]: I can chime in. It was pretty clear, we don't do this, we're going to struggle with kids program.

[Rep. Leslie Goldman (Member)]: So someone recognizes gap and Yes.

[Rep. Alyssa Black (Chair)]: Call at the Frida Kahna Blue House last week. Okay, so I should take a straw poll on what the committee supports the amendments. I think I just need to do a straw poll. So all in favor of the healthcare oversight on this amendment? Would raise a hand if you support the amendment. Okay.

[Dr. [Name unknown], Vermont Health Commissioner]: The amendment of H5A8. Yes. Okay. Ten zero one.

[Rep. Alyssa Black (Chair)]: Thank you, that'll be my lead in. We want to pivot back to Thank you everybody for coming in. We want to pivot back to H814 and see the changes that Jen has made in the record tests. It's yours now, so we're still online. Just okay. Sorry. Actually, again, that face. I don't have to put it in today, do I? It must refer to appropriations. Okay. That's what I was thinking, is maybe I'll wait to submit it until it's gone through its other places in case anything changes. And if so, then I will advise everybody on any changes that are made to Alright. Thanks, Jen.

[Jennifer Carbee, Office of Legislative Counsel]: Yeah. Thanks. Again, Jen Carvey, office of legislative council. We're going back to page eight fourteen. So I cleaned it up, and it's actually a clean version because the changes were pretty minimal. I will walk you through what they are. Oh, and I have not sent it to Send it to Tasha. Have not sent it to Tasha, so she has not

[Stephanie Winters, Deputy Director, Vermont Medical Society]: posted it.

[Jennifer Carbee, Office of Legislative Counsel]: No. I'm maybe don't have

[Rep. Alyssa Black (Chair)]: it yet. You don't have it. It's gonna be 2.1, but

[Jennifer Carbee, Office of Legislative Counsel]: Yes. It'll be 2.1, and it's winging its way over to Tasha.

[Rep. Alyssa Black (Chair)]: And I only said that because I saw it really quickly when you put it up on the screen.

[Stephanie Winters, Deputy Director, Vermont Medical Society]: Breath. So it will not be just stuck.

[Rep. Alyssa Black (Chair)]: I still don't know. Is it one point Yeah. It depends. I

[Jennifer Carbee, Office of Legislative Counsel]: just made your amendment 1.3.

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

[Dr. [Name unknown], Vermont Health Commissioner]: Excuse me.

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: Is the window open?

[Jennifer Carbee, Office of Legislative Counsel]: Alright. Do you want me to wait

[Rep. Leslie Goldman (Member)]: until it's posted or do

[Jennifer Carbee, Office of Legislative Counsel]: you wanna okay. Alright. His fault that he walked out. So this is draft 2.1 of h eight fourteen, an act relating to neurological rights and use of artificial intelligence technology in health and human services. So no changes to the intent section in

[Rep. Alyssa Black (Chair)]: the

[Jennifer Carbee, Office of Legislative Counsel]: neurological rights. Just I incorporated the change from the last draft, and and it's clean now. So that was number three changed in the previous draft, and now it's incorporated. So now we jump all the way to section three.

[Rep. Leslie Goldman (Member)]: We don't have to go through the 23

[Jennifer Carbee, Office of Legislative Counsel]: pages of Strykers. And we get to the the artificial intelligence advisory council. So we did a couple of things here, and I just wanna make sure I'm highlighting them all for you. So the first thing I did was simply to swap out, instead of having secretary of human services or designee being a looking like a totally new ad, it's now just striking the commissioner of health and inserting instead the secretary of human services and keeping the board designee. And then separately, adding as a new j, the member with experience being public education. I think that was the the one that was that had looked like it was replacing the commissioner of health. So that's a stand alone j. And then down here, we have L. M got an and. An N is one member with relevant knowledge and expertise appointed by the governor. And then in the oops. And

[Stephanie Winters, Deputy Director, Vermont Medical Society]: section four,

[Jennifer Carbee, Office of Legislative Counsel]: we have the the council in coordination with the director of the division of artificial intelligence and in consultation with interested stakeholders, Shell, and then we didn't make any change to what they are actually doing and just incorporated the prior changes, get rid of the highlighting, and then finally, the effective date may act to take effect on decisions.

[Rep. Alyssa Black (Chair)]: Brian, did you see the one member with relevant knowledge and expertise appointed by the governor is now in? No. And she cleaned

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: up so that it was

[Rep. Brian Cina (Member)]: You scroll up slightly. Sorry, had to run out for a second. It looks slightly more.

[Rep. Alyssa Black (Chair)]: So it's a little bit stronger I've made it, Mr.

[Jennifer Carbee, Office of Legislative Counsel]: Health becomes Secretary of Human Services here, and then was public education one stands by itself as Jay, and then the new governor is then.

[Rep. Alyssa Black (Chair)]: I see what you did. You.

[Jennifer Carbee, Office of Legislative Counsel]: He's here to explain. Yes. Should have done that Using people. Mhmm. And then we got the the consultation with the stakeholders and effective on this.

[Rep. Alyssa Black (Chair)]: Great. Any questions? 20 pages of the annotation. Since '27 to

[Dr. [Name unknown], Vermont Health Commissioner]: six. Go

[Rep. Alyssa Black (Chair)]: ahead, Cathaline. So we

[Jennifer Carbee, Office of Legislative Counsel]: and I'm sorry if I missed it. So we're we will not be looking at like, for example, the Montmedic Society has given us five recommendations of clarity. We won't be looking at any of the emails, which is

[Rep. Alyssa Black (Chair)]: I think that they submitted a lot of things, clarity, which have now completely been struck as it went from 27 pages to

[Rep. Leslie Goldman (Member)]: Would the

[Rep. Alyssa Black (Chair)]: Vermont Medical Society like to comment?

[Stephanie Winters, Deputy Director, Vermont Medical Society]: Sure, Stephanie Windham, Deputy Director of Vermont Medical Society. Yes, when I testified, this language was not official language and had just come out that day and I prepared for language on the original, the OG bill. So this is completely different, so those comments.

[Jennifer Carbee, Office of Legislative Counsel]: That means you're 100% comfortable with the new

[Stephanie Winters, Deputy Director, Vermont Medical Society]: With the commission, yeah.

[Rep. Leslie Goldman (Member)]: Go ahead,

[Rep. Brian Cina (Member)]: You're gonna be giving a seat on it Do you feel like that having a seat on the council will give you the opportunity to address these things as those policies are considered? As you look at how any regulation- hope that would be

[Rep. Alyssa Black (Chair)]: the case,

[Stephanie Winters, Deputy Director, Vermont Medical Society]: depends on which council is run, but I hope that that would be the case and then we can build what you're looking for and address those. Okay.

[Rep. Brian Cina (Member)]: Can I ask one more question? In preparing the original bill, I did review the American Medical Association has extensive guidelines on artificial intelligence and that's why I mentioned that. And so I just wanted to ask if there's anything more you would say about what you have to offer based on those guidelines. Do you feel like?

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: Yeah, I can't speak to that right now.

[Stephanie Winters, Deputy Director, Vermont Medical Society]: I do know that they're calling it,

[Rep. Alyssa Black (Chair)]: I think, augmented intelligence. Don't know

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

[Jennifer Carbee, Office of Legislative Counsel]: We have some of that language.

[Rep. Brian Cina (Member)]: If you're comfortable with where we've landed.

[Stephanie Winters, Deputy Director, Vermont Medical Society]: Yeah, mean, it's very simple. It depends on your policy decisions. I sound like Jenna. It's up to you on policy decisions. There's nothing harmful in creating a commission to really discuss augmented or artificial intelligence and its effect on healthcare.

[Rep. Alyssa Black (Chair)]: Leslie, just curious if I may, what's the process for the government also trying to kill for each other? How do we think of that? Is it a board decision?

[Rep. Leslie Goldman (Member)]: Is it a DB decision?

[Stephanie Winters, Deputy Director, Vermont Medical Society]: We probably would bring it to our board. What we would probably do is send it out in our weekly newsletter and see if there's anyone that's interested. Also would reach out to people we know have expertise in AI or technology in healthcare, which there are a number of them. And so we would work both ways to identify an appointee. Thanks.

[Rep. Alyssa Black (Chair)]: Great, any other questions? Go ahead.

[Rep. Leslie Goldman (Member)]: Did the Office of the Healthcare Advocate express any interest at all? They supported it,

[Rep. Brian Cina (Member)]: but said they don't feel like they need a seat on it, that they will weigh in if needed. But they came in and they supported it, it was quick.

[Rep. Alyssa Black (Chair)]: Yeah, the office of the healthcare advocate just had to walk out.

[Rep. Brian Cina (Member)]: He's standing right there before.

[Rep. Alyssa Black (Chair)]: Yeah, if he had something.

[Rep. Leslie Goldman (Member)]: Yeah, because I was like, they would be in, I'm not recommending this. I'm just thinking it would have made a lot of sense to have them be the one to recommend someone with ethics and human rights.

[Rep. Alyssa Black (Chair)]: Well, if everyone has had their questions answered and feels prepared, I would entertain motion be approved, and this will need to go to appropriations, and I'll consult with the chair of GovOps, maybe when I'm in there tomorrow on the other day, about maybe just doing a drive by at this. Or I'll speak with him and find out what she'd like to do.

[Rep. Francis McFaun (Vice Chair)]: I from this, I

[Dr. [Name unknown], Vermont Health Commissioner]: have a question. Yeah, of course.

[Rep. Francis McFaun (Vice Chair)]: I know we've been told we do policy, we don't do appropriations, but do you have any idea what this will cost?

[Rep. Brian Cina (Member)]: I did hear that.

[Rep. Alyssa Black (Chair)]: I think they did. Don't they get like a a daily

[Rep. Brian Cina (Member)]: It's $50 a

[Rep. Francis McFaun (Vice Chair)]: Doesn't matter.

[Rep. Brian Cina (Member)]: It's $50 a meeting per

[Jennifer Carbee, Office of Legislative Counsel]: person for those It depends how many

[Dr. [Name unknown], Vermont Health Commissioner]: Yes.

[Rep. Brian Cina (Member)]: We didn't get an estimate of when they were here, we asked this, and they said the additional expense would be like several $100.

[Rep. Francis McFaun (Vice Chair)]: Hey, send in something over there when they say, oh, old guy, don't even know what this is gonna cost. Yeah,

[Rep. Alyssa Black (Chair)]: we did make that money on that.

[Rep. Brian Cina (Member)]: It was like an add several $100 to the budget, something like that. Don't have a fiscal note, but I remember when we looked at it with them.

[Rep. Alyssa Black (Chair)]: De minimis. What does

[Dr. [Name unknown], Vermont Health Commissioner]: that mean?

[Rep. Alyssa Black (Chair)]: Pretty unmeasurable.

[Rep. Brian Cina (Member)]: And you know what, they can choose to strip the stipends out of it completely if they want, they've done that in the past if they need So they have the power to do that, and

[Dr. [Name unknown], Vermont Health Commissioner]: that's their decision. Okay,

[Rep. Alyssa Black (Chair)]: so I would entertain a motion that we pass version 2.1 of H814. Anybody willing to make a motion? I make a motion that we vote on. Vote on? H1 four. Clerk, ready? Right.

[Rep. Leslie Goldman (Member)]: And the clerk can follow the rules.

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

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

[Rep. Alyssa Black (Chair)]: Wendy Critchlow. Yes. Allen Demar. Yes. Leslie Goldman.

[Rep. Leslie Goldman (Member)]: Yes. Lori Houghton. Karen Lueders. Yes. Francis McFaun.

[Rep. Alyssa Black (Chair)]: Debra Powers. Yes. Valerie Taylor. And just, Addison, Braveco? Yes. Like this one?

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

[Rep. Alyssa Black (Chair)]: Chair Black. Yes. And once again, I've forgotten to find a reporter of the bill, but I'm gonna go with representative Cina. You will be. You will

[Rep. Leslie Goldman (Member)]: be reporting this. I owe me for it.

[Rep. Alyssa Black (Chair)]: The most you're going get, Brian. Yeah. Alright, so Representative Cina will be reporting.

[Rep. Leslie Goldman (Member)]: This is

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

[Jennifer (last name unknown), Director, Vermont Office of Professional Regulation]: Thank you everybody.

[Rep. Alyssa Black (Chair)]: This is with the goal.

[Jennifer Carbee, Office of Legislative Counsel]: Favorable with the amendment and drafted

[Rep. Alyssa Black (Chair)]: one way. All right, well, you. We can go off above.