Vermont Legislature SmartTranscripts:

[Francis McFaun (Vice Chair)]: Hi, welcome back. Sorry for the delay, everybody. Legis Council is going to walk us through some of the changes on 01/1990, and then we will hear from Vaz on that. And it's posted on our website, our webpage. What is that called?

[Jennifer Carvey, Legislative Counsel]: For the record, Jennifer Carvey, legislative counsel. Changes from the draft we looked at this morning are highlighted.

[Francis McFaun (Vice Chair)]: It's 2 0.3. 3.2.

[Brian Cina (Member)]: So this 2.3 one's incorrect in front of

[Jennifer Carvey, Legislative Counsel]: me? Yep. I saw it this morning.

[Francis McFaun (Vice Chair)]: You know it's end of session when you

[Brian Cina (Member)]: I don't need a quick

[Francis McFaun (Vice Chair)]: day redrafts on your schedule. 3.2.

[Brian Cina (Member)]: Little worried about the centers.

[Jennifer Carvey, Legislative Counsel]: Yeah. I'm the 1.1. Get rid of 3.1. Another change since then.

[Brian Cina (Member)]: It's not 3.1 anywhere either?

[Jennifer Carvey, Legislative Counsel]: No, you didn't. I can talk about.

[Francis McFaun (Vice Chair)]: All right, deep breath. Okay.

[Brian Cina (Member)]: I'm gonna do this therapeutic thing and throw out all the old ones.

[Jennifer Carvey, Legislative Counsel]: Okay. So the changes since the last draft, there is a so I've renumbered. I don't know if I can remember that one. I added a new section three. This is brand new, not highlighted in the section number line, and this is amending the cap on outpatient prescription drugs, hospital claims for outpatient prescription drugs last year in Act 55. Legislature enacted this cap on hospitals submitting claims to health insurers for reimbursement of outpatient prescription drugs in an amount that exceeds a 120 percent of the average sales price for any drug for which the hospital charged any insurer more than a 120% of the average sales price in effect as of 04/01/2025, this would increase all of the 1 twenties to one thirties. And similarly for any prescription drug in an outpatient or office setting that the hospital charged 120%, now 130% or less of the Apotel's price in effect as of do you have an estimate? Yeah. As of April '25, the hospital can't go up. Although, in this case, they could go up from $1.20 to $1.30. I don't know if you want to speak

[Jessica Barnard, The University of Vermont Medical Center]: to that part at all.

[Francis McFaun (Vice Chair)]: Okay. So we heard concerns, you know, lots of numbers in here, and a lot of stakeholders running a lot of numbers, trying to get an accurate number. The 3.5% that of

[Devon Green, Vermont Association of Hospitals and Health Systems (VAHHS)]: the

[Francis McFaun (Vice Chair)]: revenue of commercial revenue revenue.

[Jennifer Carvey, Legislative Counsel]: Thank you. Patient revenue for the That

[Francis McFaun (Vice Chair)]: got to an estimate of 56,000,000. And

[Leslie Goldman (Member)]: currently,

[Francis McFaun (Vice Chair)]: you've committed to 50, correct? You've committed to 50. So there was a concern of $6,000,000 So rather than reducing the percentage of net commercial revenue that would then be put into the rates for the QHP market and the VHI, rather than changing that, I suggested that perhaps we can find another way to put that $6,000,000 back in. Thank you so much for all the people who have been working really hard for the last couple hours. It's estimated that if we increase from 120 to 130, it will net back in approximately that amount of money. Actually, I believe it unnumbered a tiny bit and I just said, no, we're not doing percentages, or points of things like that. So 130 would get us to that. So the net effect would be the same, but we have remained untouched with the 3.5%. So that's the reasoning for this.

[Jennifer Carvey, Legislative Counsel]: So that's that change then. Just renumbering sections until we get to what is now section nine on the critical access hospitals. And I modified the intent language, so kept the same introduction part, but modified the intent aspect to say there's the intent of this section to provide information to Vermont seniors and other Medicare beneficiaries about the federal requirement while a working group of interested stakeholders endeavors to develop appropriate and enduring solutions that do not undermine the financial sustainability of our critical access hospitals and that comply with federal law. Just trying to flag that we are aware of the constraints there.

[Francis McFaun (Vice Chair)]: Is this just the radical thing? Would it be stakeholders' endeavors? Maybe it would be, but

[Jennifer Carvey, Legislative Counsel]: Well, it's while a group of interested stakeholders, it's endeavors as a verb. Subsection B, I revised per your discussion this morning on or before 09/01/2026, each critical access hospital shall do all of the following. First is identify all of the outpatient services for which the hospital charges five or more times the Medicare allowed amount for the service. And then we have post prominently on its website and in outpatient departments at the hospital, a disclosure about the federal requirement that Medicare beneficiaries must pay 20% of the charge for outpatient services at critical access hospitals, that Medicare beneficiaries may be able to receive care with reduced out of pocket costs from other providers and how to contact the hospital's Patient Financial Assistance Department for more information. And it says the hospital shall file its proposed disclosure materials with the Green Mountain Care Board for the board's approval prior to this. Then for the effective dates, it would still all take effect on passage, except consulting with the hospitals, put it at least for now that the section three, that changed from 120 to 130% would take effect on July 1. And then I suggested for a title, an act relating to reference based pricing and the Green Mountain Care Board. It sort of generally reflective of what's in the.

[Francis McFaun (Vice Chair)]: Thanks, Jen. Thanks for all your fast and furious work on all of the views. Appreciate it. If you would Devin, do you wanna come on up? Like, generally twice.

[Jennifer Carvey, Legislative Counsel]: I know it's okay. Gotta plug in my computer, so let's put something in. You wanna

[Leslie Goldman (Member)]: put it in here in the meat

[Jennifer Carvey, Legislative Counsel]: cup? Do wanna sign?

[Leslie Goldman (Member)]: Okay. Because you're coming back.

[Francis McFaun (Vice Chair)]: Thanks. Hey, yes, hi. Good afternoon.

[Devon Green, Vermont Association of Hospitals and Health Systems (VAHHS)]: It's Evan Green from Association of Hospitals and Health Systems. I do really, really appreciate the work on this bill. And the chair is correct that the 3.5% as testified to today, I think, was 54,600,000. Either 56.4 or 54.6, I can't remember. And then the hospital budget guidance impacting the critical access hospitals, that net patient service revenue, I believe, is about 3,000,000. So it is above 50,000,000, but we do appreciate the sort of inflation. The acknowledgment of inflation in the Act 55 prescription drug cap, I think that helps. And we are working with our hospitals to just socialize that a little bit. Okay. And as always, I will just say that we still have concerns about the Green Mountain Care Board acting on the critical access hospital piece. But we will continue to work with them within the parameters

[Francis McFaun (Vice Chair)]: of federal law. Do you support the new language?

[Devon Green, Vermont Association of Hospitals and Health Systems (VAHHS)]: Do you support the new language? Okay.

[Francis McFaun (Vice Chair)]: All right. Thank you. Thank you. Really appreciate that. So I, unless anyone has any discussion, but I would Blue Cross Blue Shield like to

[Courtney Harness, Blue Cross Blue Shield of Vermont]: Hi, everyone. Courtney Harness, Blue Cross Blue Shield of Vermont. Fully understanding that we won't make any changes at this point. Would like to make sure that for the record, everyone knows that this change to outpatient drugs on 07/01/2026 will have a material worsening of the financial position of your domestic nonprofit insurer. And I wanted to make sure that everyone was aware of that.

[Francis McFaun (Vice Chair)]: But do you acknowledge that at the same time, the three point five percent will have a much larger effect in the other direction?

[Courtney Harness, Blue Cross Blue Shield of Vermont]: That's the purpose of reference based pricing. Yes.

[Jennifer Carvey, Legislative Counsel]: Go ahead, Brian.

[Francis McFaun (Vice Chair)]: Do you

[Brian Cina (Member)]: have a number? Do have a number of the impact or is it just a general idea?

[Courtney Harness, Blue Cross Blue Shield of Vermont]: I do not have an estimate.

[Francis McFaun (Vice Chair)]: If the hospitals estimate it to be approximately 6,000,000 and you have what share of the market as opposed to of the commercial market?

[Courtney Harness, Blue Cross Blue Shield of Vermont]: 60%.

[Francis McFaun (Vice Chair)]: 60%, so it would be 60% of 6,000,000, which I'm not going to do math.

[Brian Cina (Member)]: 3,600,000.

[Francis McFaun (Vice Chair)]: Good job. And it would be for six months, So that would be probably 1.8. And then beginning immediately in 2027, you would hopefully be able to supplant that one point some loss with a potential $40,000,000 considering these two groups, probably, if we're just guessing, maybe 75% of

[Courtney Harness, Blue Cross Blue Shield of Vermont]: My understanding of the bill is the $1,800,000 will come directly out of the money that would, I would assume, go to our reserves. And as you know, had significant discussion in this committee this session about the solvency of Blue Cross Blue Shield of Vermont. I would reiterate for the record that this is a decision in the exact opposite direction. And I would say it's my understanding the intent of the bill is to reduce premiums with the cost savings at hospitals. I would not anticipate any of those dollars going to Blue Cross and Blue Shield of Vermont. That would be up to the Green Mountain Care Board.

[Francis McFaun (Vice Chair)]: But what the capping at 120 that we did that went into effect in January, what sort of estimation does Blue Cross Blue Shield of how much that has saved Blue Cross Blue Shield just in the first five months?

[Courtney Harness, Blue Cross Blue Shield of Vermont]: Seeing this language for the first time eight minutes ago, I would have to run the numbers for you and get back to you.

[Francis McFaun (Vice Chair)]: What was the actuarial estimation of how much that act would have

[Courtney Harness, Blue Cross Blue Shield of Vermont]: on Yeah, so that's a two pronged question related to my last answer, which was we believe that there was an $87,000,000 reduction in the ASP drugs and Green Mountain Care Board did take that fully out of our premiums. There was no money that went to Blue Cross and Blue Shield from that reduction.

[Francis McFaun (Vice Chair)]: I just will reiterate that the actions of this legislature, state two eighty seven?

[Courtney Harness, Blue Cross Blue Shield of Vermont]: No, state Vermonters.

[Francis McFaun (Vice Chair)]: State Vermonters, 80 some million,

[Jennifer Carvey, Legislative Counsel]: and we're

[Francis McFaun (Vice Chair)]: giving back one point some so that in 2027, you can then have probably another 40.

[Courtney Harness, Blue Cross Blue Shield of Vermont]: For the record, again, sitting here to argue simply to make sure that the committee is aware that this date of passage, not anything to do with the number, the date of passage, will materially weaken the financial position of Blue Cross and Blue Shield of Vermont.

[Francis McFaun (Vice Chair)]: Go ahead, Leslie. I'm not sure it's a question for you.

[Leslie Goldman (Member)]: I mean, it seems like both positions are weak, so it's the question about who's going be weaker. So I think that I understand why we're moving in this direction. I was just wondering on the ASP, moving it from 120 to 130, I can't remember, and if you could remind me, was the 01/2020 in perpetuity or was it a timeframe? And so would it stay at one So the 130 will stay in perpetuity until we Yes. Change Okay.

[Francis McFaun (Vice Chair)]: Would, like, may I ask, may I ask you, Doctor. Houghton? Yes. The date of July 1. So your hospital budget orders are flexible on the date?

[Devon Green, Vermont Association of Hospitals and Health Systems (VAHHS)]: Yes.

[Francis McFaun (Vice Chair)]: When this new price cap would go into effect, would you be willing to make it January 1 Or October 1? Let's do October 1, so we might October 1. Can we do that? Jen, I am so sorry.

[Jennifer Carvey, Legislative Counsel]: Let's see, so the hospital updates, AHP cleared drug annual on January 1 and July 1 based on CMS' AHP calculations for the most recent calendar quarter. I don't know if that

[Francis McFaun (Vice Chair)]: Yeah, that's right, because charts are repriced every three months.

[Jennifer Carvey, Legislative Counsel]: I mean, we could put in, you know, if it seems doable from an implementation standpoint, I think we could just put it in the effective date. Know, we take it back on October 31, you're not standing this provision, we take it back on October 1 and then it would be updated again in January when you're directed that date. I think that was good.

[Devon Green, Vermont Association of Hospitals and Health Systems (VAHHS)]: Then I'm agreeing from medics, to get the numbers right,

[Francis McFaun (Vice Chair)]: we calculate this as having $3,600,000 impact in total.

[Leslie Goldman (Member)]: Which is the PPS hospital.

[Francis McFaun (Vice Chair)]: Which the cap only affects the PPS hospitals anyways, which is Well, two critical active hospitals that are connected to We'll knock out. Okay. Thank you, Barton. So we'll You want to change? So any other thoughts? Okay. So I'm going to hold off on a vote on this for a little bit. We can move on to 197. It's really important to me in this committee that, I mean, in my role, I try to make sure that we all have all the information that we need to make the best decisions on the bills we're voting on, and I value transparency and I value information. And in the effort of ensuring that all the members on this group have feel comfortable with all the information that they need to make an accurate decision that reflects their thoughts. I'm gonna hold off on the vote because I want members to be able to think and consult on this a little bit.

[Brian Cina (Member)]: How long? Till later today or till next week?

[Francis McFaun (Vice Chair)]: Hopefully, within an hour. Okay. But guess what? We have a lot of work to do on s January, so let's get to work on 01/1997.

[Alyssa Black (Chair)]: Can I say something, please? Oh, yes. Of course. I'm sorry. Alyssa Black, thank you. I really appreciate you taking a breath on this. I think that says a lot for everybody, not only the committee, but everyone that has had a voice in this. I am a no still. I need time. I care about every stakeholder. I care about every Vermonter. And I just feel until I see Blue Cross and DFR and Devon sit in that chair across from you and they can pound their fist on the table and say yes and that's what I need. So I appreciate you holding off for a moment until I hear from Rutland Hospital. They're trying to crunch numbers. I just really I really appreciate that. And I do need to excuse myself. I need to go pick Hazel up and I'll join again when I get back.

[Francis McFaun (Vice Chair)]: Great. Thank you, Val. Thank you. Devin, did you want to come up and pound on the table? I was gonna say, I don't want you to be like Director Olson or anything. Okay, let's move on to 197. Jen, if you wanna come on up. Yeah.

[Jennifer Carvey, Legislative Counsel]: I can continue to read. You want me to send it myself on the. Please.

[Francis McFaun (Vice Chair)]: Version of 197 might have probably varied under 10 versions of 190.

[Leslie Goldman (Member)]: We'll look at 3.1, is that where we're standing?

[Francis McFaun (Vice Chair)]: It should be oh,

[Jennifer Carvey, Legislative Counsel]: seven?

[Francis McFaun (Vice Chair)]: 01/1997? Oh, that's the old three

[Jennifer Carvey, Legislative Counsel]: double, got it. That's perfect. That's that's the. That's that's what that is. But that's what they're about. Okay.

[Nolan Langweil, Joint Fiscal Office (likely)]: Oh. Got it.

[Francis McFaun (Vice Chair)]: Right. So we

[Leslie Goldman (Member)]: had pretty

[Francis McFaun (Vice Chair)]: robust, excited discussion in committee, I think that was last Friday. And we, you know, our public hearing, think there was enthusiasm to sort of do some intent some language around where we think we might want to go with this bill. So I think that this bill, as came over from the Senate, it sort of moved us kind of in this direction by strengthening the blueprint and evaluating primary care spending. And I think that these are all really good things. So Jen, I think we should go through what's in the journal. And I also sent around I'm sorry, Jim, can you remind me what the bill number was? Three. S-fifty three from 2018. And the whole committee was sent that bill, and it sort of provided a roadmap, which the bill did not pass at the time.

[Brian Cina (Member)]: I Right on House appropriations, right?

[Francis McFaun (Vice Chair)]: So this is my thoughts around 01/1997. Think we should go through I think we should be thinking about things we might either move or move around or maybe clarify what we're trying to do. Then I think we should put very strong intent language in where we're trying to get to and then create a path so that we can have time to actually think about

[Leslie Goldman (Member)]: the various things that need

[Francis McFaun (Vice Chair)]: to be thought of well and what needs to happen and come forward with recommendations next year with something fully formed and fleshed out. Those are just my thoughts. Other people may have other thoughts. So how does everybody feel about that? Does anyone feel anything? I feel great about that, Alyssa.

[Jennifer Carvey, Legislative Counsel]: Oh, thank you.

[Brian Cina (Member)]: I feel like it's a good process and that maybe we could try to filter questions and comments and really stay focused on the mission of this isn't about getting into philosophical debates about the meaning of a thing. It's about what belongs in here and what doesn't to meet the intent and we'll be as efficient as we can. In fact, we could set timers for ourselves. You have thirty seconds to make your point and the next person goes. Natasha So will ring a

[Francis McFaun (Vice Chair)]: I did work with Jen this morning. Sort of coming. And do you know, it's not a draft, and measure, right? Am But we did have some thoughts and ideas around

[Jennifer Carvey, Legislative Counsel]: was wondering I'd rather not put out my sort of shorthand notes on the document. Alright.

[Leslie Goldman (Member)]: Are we working off 01/1997 or fifteenth grade? Both?

[Nolan Langweil, Joint Fiscal Office (likely)]: 01/1997.

[Francis McFaun (Vice Chair)]: I know that you don't want to post that, but would you mind sharing it with me so that I can have a better reflection of what we might have talked about?

[Brian Cina (Member)]: Process you described was using 197, right?

[Francis McFaun (Vice Chair)]: Yes. That's right.

[Brian Cina (Member)]: Just clarifying your question.

[Francis McFaun (Vice Chair)]: And then we'll go through the language of the bill, then 197 as Thank you. And then at least I'll have my note oh, Jen's notes to refresh me. What's up what some of my thoughts were. So and I'll put them out there.

[Brian Cina (Member)]: I just realized something's auspicious. Okay. Know what? 150 19750. So do wanna

[Francis McFaun (Vice Chair)]: put up 197?

[Jennifer Carvey, Legislative Counsel]: Yes. Sorry. Hung it up, then I took it down too.

[Nolan Langweil, Joint Fiscal Office (likely)]: 250. That's something.

[Brian Cina (Member)]: That's Again, more like, I'm happy. Yeah.

[Francis McFaun (Vice Chair)]: Okay.

[Brian Cina (Member)]: So

[Francis McFaun (Vice Chair)]: it is the intent of the general assembly to invest in primary care. That's right, I forgot. I remember on your notes that that was one of the notes. Primary care, there's streamlined primary care payments that build on the blueprint for health. I as well, I think that if we're going to have intent on moving to a more universal primary care, I don't think we should be in intent language, like tying ourselves the to existing blueprint, because I think we should be thinking about all possible mechanisms for this. Could not agree more.

[Brian Cina (Member)]: Especially because we don't know what's going to happen. I mean, look what happened to the ACO in the head.

[Jennifer Carvey, Legislative Counsel]: So

[Leslie Goldman (Member)]: does the attendant to invest in primary care, streamline primary care payments?

[Brian Cina (Member)]: Is there an intent section in 53 that we

[Francis McFaun (Vice Chair)]: could look at? Well, is. There is.

[Jennifer Carvey, Legislative Counsel]: That looks great.

[Francis McFaun (Vice Chair)]: So we do have, I mean, this is not fully fleshed out, but I will say that, and I know Jen doesn't want to put her notes up and I won't, but do you mind if I read some of the thoughts that we had? Sure. It's the intent

[Brian Cina (Member)]: of the

[Francis McFaun (Vice Chair)]: General Assembly to invest in primary care and to establish a program of universal primary care that is accessible to and affordable for all Vermonters and will promote the public good by increasing access to primary care in order to improve the health of Vermonters.

[Jennifer Carvey, Legislative Counsel]: Is that

[Leslie Goldman (Member)]: age 53? I'm sorry.

[Jennifer Carvey, Legislative Counsel]: No, this is from She had given me her thoughts this morning and I'd taken some notes and she's reading those.

[Leslie Goldman (Member)]: Keep hearing people referring to 53. So I'm just trying to

[Jennifer Carvey, Legislative Counsel]: Oh, it was S53 over twenty eighteen. Oh, that's the old time.

[Leslie Goldman (Member)]: Okay, I needed a little old. Sorry.

[Jennifer Carvey, Legislative Counsel]: When you all started talking about universal primary care last week, Nolan and I vividly remembered working on this in fifteen, sixteen, seventeen.

[Francis McFaun (Vice Chair)]: I'm going to say something really, probably controversial, but I really want people's thoughts on this. Object to putting in intent language, reduce healthcare system costs. I feel like it's just my own thoughts. I feel like when you put your intention that you're going to be reducing costs, that the outcome and what you build and the direction you move in becomes focused on healthcare costs. And if we want to build a vibrant, public, accessible, primary system of universal primary care, shouldn't we be focusing that instead of worrying about what it costs? If you invest, the cost savings will come, but that shouldn't be your intent and your purpose. Leslie. So I agree with that as single. I think

[Leslie Goldman (Member)]: that there's the triple aim or the quadruple aim, depending on how you look at it. The quadruple aim includes costs, but it also includes access, quality and workforce satisfaction, for the want of a better word. I'm not saying that's what we should use, but I think we should look at all four. Okay, let's be my hope.

[Francis McFaun (Vice Chair)]: Okay, so we've got, we want to promote public good by increasing access to prime. Okay, so we've got access, quality,

[Leslie Goldman (Member)]: increase access, increase quality, quality, cost, and improve workforce experience. How about affordability?

[Jennifer Carvey, Legislative Counsel]: I like affordability better than that particular language,

[Devon Green, Vermont Association of Hospitals and Health Systems (VAHHS)]: but I don't care.

[Francis McFaun (Vice Chair)]: Makes sense. Access quality, affordability, and

[Leslie Goldman (Member)]: workforce satisfaction or workforce experience. There's something in actually, AHS has language on the quadruple in

[Francis McFaun (Vice Chair)]: Supporting and valuing.

[Leslie Goldman (Member)]: It's the last one, right? Supporting and valuing health care work force so they provide excellent care and meet the ongoing needs of

[Jennifer Carvey, Legislative Counsel]: the people at the law. Now I'm

[Leslie Goldman (Member)]: not saying we should use that language, but I think including the workforce there

[Jennifer Carvey, Legislative Counsel]: is no provider satisfaction. I think workforce is broader. That's fine. Yeah, because it includes all the staff,

[Leslie Goldman (Member)]: Which we need all staff.

[Francis McFaun (Vice Chair)]: I think. Okay. So let's think about how we can write. What we can write. It's the intent of the general assembly. This is what we is truly marked up. The intent of the General Assembly to invest in primary care and to establish a program of universal primary care that is accessible and affordable for all Vermonters. And will promote public good by increasing access to primary care, supporting primary care workforce. I'm not getting all of those down. What I just read by the way, Jen, is what you have in your notes anyways. Should you say aye? Until I said, increasing access to primary care in order to improve the health of Vermonters and then supporting and health care

[Leslie Goldman (Member)]: increasing quality or Increasing quality, increasing access, increasing workforce satisfaction, and reducing Well, you want to say increasing affordability or I'd say reducing costs because I think people know what that means.

[Jennifer Carvey, Legislative Counsel]: Well, I

[Francis McFaun (Vice Chair)]: think we already have in here that's affordable for all promoters.

[Leslie Goldman (Member)]: I'm not sure what's in there because I'm not looking right I think increasing workforce experience. Yeah, that's fine. Well, I don't know what increasing in experience means. There has to be an adjective. Experience means how they show up at work every It could be shitty experience. That's the language that's increasingly frustrating. What is the language you're Improve

[Francis McFaun (Vice Chair)]: it. That's fine. What's wrong with our guiding principles? Supporting and valuing our healthcare workforce. Yeah, I like it.

[Jennifer Carvey, Legislative Counsel]: I think that's about how you're doing as opposed to what they're experiencing.

[Leslie Goldman (Member)]: Supporting. Improving the patient experience, improving population health, reducing costs, improving clinician staff well-being. That's the quadruple aim.

[Francis McFaun (Vice Chair)]: Okay. Does everybody like that?

[Leslie Goldman (Member)]: And improving the patient experience includes enhancing quality, safety and satisfaction. Improving population health means addressing health disparities, improving outcomes. Reducing costs mean lowering per capita cost of care and improving clinician staff well-being, addressing burnout and providing a positive work environment. So that's sort of the summary of the quadruple aim.

[Jennifer Carvey, Legislative Counsel]: Where do I find the quadruple Yes, exactly. I'll send

[Francis McFaun (Vice Chair)]: it you. You gently, I will send it right here.

[Jennifer Carvey, Legislative Counsel]: Oh.

[Francis McFaun (Vice Chair)]: I just would like to get it into two or three sentences. Yeah. I'm a little worried.

[Brian Cina (Member)]: That one you've put it in AI, tell it to make it three sentences. Yeah.

[Leslie Goldman (Member)]: I'm putting it into Jen's And

[Brian Cina (Member)]: then Jen can look at that picture.

[Jennifer Carvey, Legislative Counsel]: Jennifer,

[Francis McFaun (Vice Chair)]: you I love what generative. They don't.

[Leslie Goldman (Member)]: Can I just say right now, I found that in the past,

[Jennifer Carvey, Legislative Counsel]: group this size is really difficult and

[Francis McFaun (Vice Chair)]: very similar? It is very difficult and time consuming.

[Brian Cina (Member)]: We just spent twenty minutes on three sentences and we're

[Francis McFaun (Vice Chair)]: not sure how else to

[Leslie Goldman (Member)]: But this is the crucial piece, and the rest of

[Francis McFaun (Vice Chair)]: it may flow. Jen, can you actually try while you're on there? Is that a no, no? I'm sorry, I don't actually know.

[Jennifer Carvey, Legislative Counsel]: I mean, I'm happy to work on things while you're talking. I'd rather not pick up the language up and be early. We're all

[Francis McFaun (Vice Chair)]: seeing Google Docs or something like that.

[Brian Cina (Member)]: Would it be possible that Tasha could put the bill up and Jen could type on the computer so Jen's not trying to double fist typing and showing us the

[Jennifer Carvey, Legislative Counsel]: So somebody else, maybe somebody else can still do the right.

[Francis McFaun (Vice Chair)]: So I want to say

[Leslie Goldman (Member)]: this quadruple aim comes out of the Institute of Healthcare Improvement, which is a fundamental organization looking at healthcare improvement. So we might want to include Institute for Healthcare Improvement quadruple aim.

[Francis McFaun (Vice Chair)]: I don't want to name anybody. How about can we land on those are the four things that we want to see?

[Jennifer Carvey, Legislative Counsel]: I'm good with it. Okay.

[Francis McFaun (Vice Chair)]: And then we have a sentence in here at the end of the draft that Jen it's not a draft, the notes that Jen and I were working on. And the last sentence was just the purpose of this bill is to obtain information needed in order to develop a framework for implementation.

[Devon Green, Vermont Association of Hospitals and Health Systems (VAHHS)]: Let me hear it again.

[Jennifer Carvey, Legislative Counsel]: For obtaining information necessary.

[Francis McFaun (Vice Chair)]: Purpose of this bill is to obtain information necessary to develop a framework for implementation of universal primary care. So the legislative intent.

[Jennifer Carvey, Legislative Counsel]: Yeah. Give me a second, and I will tell you what I think I have. It's like I'm just gonna say quadrupling. Okay. Because I haven't gotten put all of that in yet. I I would have it is the intent of the general assembly to invest in primary care and to establish a program of universal primary care that is accessible to and affordable for all Vermonters. I guess I need a beginning of the next sentence, but something you'll promote or I guess we could just keep going and will promote some public good by her name. Then Principles are being triple in. Well, I'm gonna put Yeah. You'll be guilty yet. I just don't, I don't have any here yet. The purpose of this bill is to obtain the necessary, the information necessary to develop a framework for implementation of universal primary care. I mean, it's just as

[Leslie Goldman (Member)]: Okay. As I'm writing here, as I'm speaking.

[Francis McFaun (Vice Chair)]: You're following the first sentence for it. We're spending a fair amount of time.

[Leslie Goldman (Member)]: Only on the intent. But frankly,

[Francis McFaun (Vice Chair)]: that's what's really going matter.

[Brian Cina (Member)]: Because most of it is we're just going to review and decide whether we keep it or not, right?

[Francis McFaun (Vice Chair)]: Yes. So,

[Jennifer Carvey, Legislative Counsel]: know, can I have to charge it back or are you? No.

[Leslie Goldman (Member)]: I have a chart. Okay. So when I went

[Francis McFaun (Vice Chair)]: through the language, let's let Ben get plugged in.

[Nolan Langweil, Joint Fiscal Office (likely)]: I

[Francis McFaun (Vice Chair)]: would never get an appropriation for this, but I think that the general assembly should have chargers every single place, so you don't have to walk around with chargers.

[Nolan Langweil, Joint Fiscal Office (likely)]: This is our perfect fit here.

[Francis McFaun (Vice Chair)]: Have joint fiscal do a summer study of how much it would have cost?

[Jennifer Carvey, Legislative Counsel]: I don't if everybody would walk So

[Francis McFaun (Vice Chair)]: you want to put the language back up? Of 190? No, 197. No, wait, wait with that. Okay. So, let's move on from the intent. As I went through the bill this morning with Jen, we made some notes on things. You want to do just like a standard walkthrough of the bill, and then as we get to parts, I'll sort of say stuff. Sure. I don't know what I'll say, but stuff.

[Jennifer Carvey, Legislative Counsel]: Section two amends the blueprint subchapter, and it makes some modifications to definitions. It's largely just sort of standardizing them with what's in other places in statute and spelling out the definition that is in ATVSA 9402 rather than just cross referencing it, because I think it's helpful to see what is in it, including that it includes to the extent permitted under federal law third party administrators that administer a health plan offering coverage in the state or provide administrative services only. It's important.

[Francis McFaun (Vice Chair)]: We kept all that. Yes, of course.

[Leslie Goldman (Member)]: So Section two, if I'm understanding it right, it kinda, if we adopt this, makes the assumption that the blueprint is the mechanism. Not necessarily. Well, that's what I'm wondering about. That's what I'd like my question.

[Jennifer Carvey, Legislative Counsel]: I think that's what you just took, at least out of the intent.

[Leslie Goldman (Member)]: Okay, but if we go with section two, we're saying the Blueprint will do it. So far, we have

[Jennifer Carvey, Legislative Counsel]: looked at definitions in Blueprint. And I think one of the things we were looking at this morning, bright and early as we were walking through and the or looking at the language of my office is that a lot of this is updating of of this particular section is updating the blueprint. It's not really expanding the blueprint. It's It's not making the assumption that the blueprint will be the No.

[Francis McFaun (Vice Chair)]: It will

[Jennifer Carvey, Legislative Counsel]: make

[Francis McFaun (Vice Chair)]: I

[Jennifer Carvey, Legislative Counsel]: would say some of the future sections do. I think this part that we're in so far does not. Get there, I'll say it again. Yeah.

[Leslie Goldman (Member)]: I don't want that assumption

[Jennifer Carvey, Legislative Counsel]: to tell you when I think we get there, which is the new section being added to the sub chapter. So you're in the right neighborhood. We're just, I don't think, I don't

[Leslie Goldman (Member)]: think it quite does it yet. What if by having this section about the Blueprint do for us?

[Jennifer Carvey, Legislative Counsel]: Well, first of all, implement more and more payment models. Maybe it does.

[Francis McFaun (Vice Chair)]: Yeah. Yeah. We're having this

[Jennifer Carvey, Legislative Counsel]: two. Right. So two says in order to facilitate development of the sustainable payment models necessary for the Blueprint's success, which may not be expanding, but just making sure it's sustainable, health insurers shall submit to the Agency of Human Services at least quarterly or more frequently upon the agency's request all information that the director of the blueprint deems necessary to perform a comprehensive fiscal analysis of the total cost of care within Vermont. And I think this is the piece where I spoke to you soon, and to implement one or more payment models that address health care capacity, volume, quality, and clinical outcomes. So that may be going further than people want. Do you wanna stop there or go further in? And then you can come back to the perks you want to come back to.

[Francis McFaun (Vice Chair)]: No. Because I think that if we're going to do this, first of all, we're going to need information from the actual mechanism that we currently have who is able to make these calculations, payment models, healthcare capacity. We need this information and the blueprint it doesn't necessarily mean that the blueprint will be calmness, but right now they're the ones that hold all this information. So I'm recommending that we keep this in here.

[Leslie Goldman (Member)]: Well then maybe we need a different header because the header says payments to fractions. I mean, just not want to make the assumption that that's a given and that's what I'm stuffing on. Well, that's what's I listen to. I get what you're saying.

[Francis McFaun (Vice Chair)]: I think maybe it will make more sense when we get in a little bit.

[Leslie Goldman (Member)]: Because it's not necessary for the blueprint's success. We're not saying the success of what's in our intent language. We're saying the blue Yes. I don't think it's implying that the blueprint is solely responsible for meeting the intent of the bill. I don't But that sort of But yeah, I mean,

[Francis McFaun (Vice Chair)]: you agree with I'm not sure what you're saying.

[Jennifer Carvey, Legislative Counsel]: Right. I think this is still As I understand it, there may be interest in continuing to update some of the Blueprint statute provisions to make the Blueprint more effective in its work now. In its current state. Yes. Even as you explore using something not the blueprint to move forward toward universal primary care.

[Leslie Goldman (Member)]: And then if it said that, in order to make the blueprint more effective now, which is terrible language, I get it, then we should do whatever. I just feel

[Francis McFaun (Vice Chair)]: Do you want to take out blueprint success?

[Leslie Goldman (Member)]: Yeah, I would be good with that.

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

[Unidentified committee member]: Maybe take out the word success. But I mean, Blueprint is what we have and have had here for a very, very long time. And I would be very concerned about passing the bill. That makes it sound like we're not looking to continue investing in BLUEPRINT and potentially it might be something else.

[Brian Cina (Member)]: Yeah. It might be it's going part of the transition. To be part of the transition.

[Leslie Goldman (Member)]: It's about assumptions that it will be the thing as opposed to allowing us to look at other possibilities.

[Jennifer Carvey, Legislative Counsel]: I don't think this

[Francis McFaun (Vice Chair)]: changes changes it. Don't think this is one more thing. Needs to facilitate development of sustainable payment models because right now it's the payment models are not particularly and in this bill, we're sort of asking them to look at payment models and develop payment models. Say. A blueprint.

[Leslie Goldman (Member)]: And is that in a blueprint charge? They do it later. The reports are later. Those reports.

[Francis McFaun (Vice Chair)]: That's in the reports. And it's my I mean, it's kind of if you read the bill, the whole thing, it's almost like you can see it's trying to get somewhere, and it's doing these things to try to get somewhere. It just didn't feel like it knew where it was trying to get to. So I don't think we should throw out the things that the information that we need necessary to get to where we want to go, because I think it's actually quite valuable in the bill. It doesn't necessarily mean that we're building this and creating. We're not creating anything currently that the blueprint isn't already doing. We're just using their resources and framework to collect the information that we need to make good decisions going forward. And that's what I think this does. Brian? To that point,

[Brian Cina (Member)]: we have reviewed this in her testimony on it already. I hope we could try to maybe focus more on the like, zoom out and look at how all the pieces fit together and decide what's necessary and what's not versus zooming in and hyper focusing on detail that because it takes a lot of time, and then we don't change anything after big discussions. But I don't wanna silence people. It's just a suggestion that we try to step back a little versus zooming in. It's like the Western mindset is to zoom in on a piece and fix a little piece of something and not look at the big picture. And I think right now, this is what you were just talking about is a big picture. It's a vision. It's like zooming out and being like, where do we want to go from here? And what do we have to do to get there? So I think I just wanted to throw that out there.

[Francis McFaun (Vice Chair)]: In order to facilitate development of sustainable payment models, health insurers shall submit to the agency of human services at least quarterly or more frequently when we request all information that the director of Blueprint deems necessary to perform a comprehensive So why don't we just get rid of necessary for the blueprint success? We're still having the blueprint do it. Yeah. It's how's how's everybody feel about that? Okay. Yes. So, okay.

[Jennifer Carvey, Legislative Counsel]: Then I think this may need to move. I mean, right now we're in this subdivision one is health insurance shall participate in the blueprint as a condition of doing business in the state.

[Francis McFaun (Vice Chair)]: Oh, yeah. But we're still having the blueprint do this, so it should stay with the blueprint. We're saying that the director of the blueprint needs to perform a comprehensive fiscal analysis. Right, it

[Jennifer Carvey, Legislative Counsel]: just seems like it's related to participating.

[Unidentified committee member]: That's right. I don't agree with taking it out. I just feel like, Sorry. I just feel like this is about the blueprint. And so why would he be doing an analysis that isn't necessary for the blueprint's success?

[Francis McFaun (Vice Chair)]: Because the analysis comes further down of all the things that he's looking at. I think that's in a different section. It's not.

[Jennifer Carvey, Legislative Counsel]: This is because I mean no. This is this is amending the blueprint statutes. We get to the section on the reporting blueprint fragments to practices primary care report all of those various nine provisions come in an independent section. So this isn't just report one? This isn't report. Is just amending the blueprint statutes.

[Francis McFaun (Vice Chair)]: I know, but I'm trying to figure out what that new language, why it's even in there.

[Leslie Goldman (Member)]: Can I speak to that?

[Francis McFaun (Vice Chair)]: Yes. I think we're trying

[Leslie Goldman (Member)]: to do two things at once. I think that the first thing we're trying to do is support the blueprint in their work. We have this interim time because we're not going to have universal primary care anytime. So we want to support the blueprint in their work and also their contribution to getting to the next level. And then there's the work that goes on with getting to the next level, which is report ABCD. So I'm just wondering if we do both, which I think we should, but maybe move this section later because our intent is about universal primary care eventually, and that's what we want to move towards and also support the blueprint. So that's what I'm seeing if this bill wants to do both. I think we should. I think supporting blueprint's great because they provide clearly important work. But I think that we're conflating the bill.

[Jennifer Carvey, Legislative Counsel]: I think in the bill, as it came over to you, because it was built on the blueprint, it made sense to kind of go right into the blueprint and then how it's going to be used. Think if there's interest in updating the blueprint statutes and also pursuing universal primary care, think you're right that maybe flipping those. So we go from the intent right into whatever some gathering information to move you forward makes sense. Okay. I just want to make sure we're not losing blueprint and

[Leslie Goldman (Member)]: the No, I think that's the we should need to do both, if

[Francis McFaun (Vice Chair)]: that's what I'm thinking. Later in Okay. Move later in the bill. Alright. Next.

[Jennifer Carvey, Legislative Counsel]: Are you wanting to look at top of page three? Is that where we?

[Francis McFaun (Vice Chair)]: Yep. We're at the top of page three. Okay.

[Jennifer Carvey, Legislative Counsel]: And so, again, I don't know with some of these sort of technical ish changes to the blueprint language. I don't know how many remain appropriate if we're not using the blueprint as the base, like changing terminology from medical home to participating practices. I'm looking to AHS and EMS. I think they're I think this may be something that the AHS folks need to maybe make some recommendations based on where you are and are not going.

[Francis McFaun (Vice Chair)]: I am I am going to recommend that we leave this entire section. Not the entire section, but this whole. Two.

[Jennifer Carvey, Legislative Counsel]: C1. C1. B.

[Francis McFaun (Vice Chair)]: C. The next page. All the way to page five. Seven ten. To the seven ten. Yeah. I'm suggesting that we leave all of this because we're still trying to sustain the blueprint. We are not trying to

[Jennifer Carvey, Legislative Counsel]: My only question is really around this particular phrase rather than that. It's something weird. I'm not seeing it. There was there was in because there's the reference to changing medical homes to participating practices because the intention of building these payments I'm trying to hold more, really. Okay. Building these payments on Blueprint was expanding per member per month payments beyond just the current Blueprint medical homes. I just don't know. Is this still updating, you think? I think it should stop taping.

[Leslie Goldman (Member)]: It could take five years to get

[Francis McFaun (Vice Chair)]: this through. I mean, who knows?

[Jessica Barnard, The University of Vermont Medical Center]: Jessica Barnard, the Vermont Medical Center. Yes, I think this is still focused on the current program and things like trying to integrate the women's health initiative and the patient's neuropathic health programs and just calling it one thing rather than asking for everything. So this is

[Francis McFaun (Vice Chair)]: not really anything new. It's more about just cleaning You it know how Doctor. Saroyan comes in and gave that big list and it had all the numbers of the money on it? It's about aligning all those things under one, so it's not broken out by like the CHT and the math and the this and the that. So I told us that we need the bill as is all the way Yeah, to seven ten.

[Brian Cina (Member)]: That's kind of

[Jennifer Carvey, Legislative Counsel]: where it's going. Seven ten, I think you have to stop

[Francis McFaun (Vice Chair)]: and So seven ten.

[Jennifer Carvey, Legislative Counsel]: I don't know if you want hear from AHS. I see Eli has a hand up.

[Francis McFaun (Vice Chair)]: Oh, I'm sorry, Eli. I didn't even I'm sorry. I didn't even know you were here.

[Eli (Agency of Human Services)]: No worries. Eli, I'm happy with Agency of Human Services. I would suggest as well leaving the data section in, and if you'd like to also replicate it later on in the bill, but that data section was written in mind with Blueprint Modernization and wanting to have those data components to inform our current initiatives and our initiatives moving forward in the next few years. And as representative Goldman said, we're right now wanting an information gathering piece that you're speaking about the future of universal primary care. And so we do want to maintain an eye on the current system and the continued ability to validate that.

[Francis McFaun (Vice Chair)]: Yes, I'm suggesting we leave this in. We need to modernize the blueprint. No matter where we go, we still have to modernize the blueprint.

[Leslie Goldman (Member)]: Is that changing the intent section

[Francis McFaun (Vice Chair)]: or just leave that be? No, the intent section is going to change. And then we're going to go into modernizing the blueprint, which is what this part is. No, no, was wondering

[Leslie Goldman (Member)]: to add to modernize the blueprint. Do we need to add?

[Brian Cina (Member)]: No. Modernizing the blueprint is necessary if we're going to move towards a primary care system that's necessary.

[Leslie Goldman (Member)]: I'm willing to keep an open mind.

[Brian Cina (Member)]: Anyway, that being said, what I wanted to say was that I appreciate the suggestion that we not touch as much as possible because I wanna remind everyone, the senate spent months working on this. That's Heard testimony, created this language, and we heard testimony. People waited on this. This is all I think, unless someone was taking notes of any problems, this has all been vetted. So I don't wanna mess it up. And then I'd rather just do what the chair said and focus on how do we end the bill? How do we It's like someone gave us a story and they didn't write the final scene. That's how it feels like. So maybe we can write the final scene, send it to the Senate and hope they like it. If not, maybe we'll go to conference committee at this point because it's not a lot of time. So

[Francis McFaun (Vice Chair)]: Okay. So we get to 07:10.

[Jennifer Carvey, Legislative Counsel]: So for 07:10, I'm not sure it makes sense to keep this in the blueprint statute if you are not or blueprint subchapter, if you're not having the blueprint's duty if you're not having the blueprint direct increased spending to the per person per month payments. And so, you know, I think we can take some some of this aspect of coming out of the agency establishing a target for the amount of per person per month spending on Vermont residents that should be primary care with the transitional schedule and adjusting targets. But maybe you put that as part of their section three report and not as a part of the section.

[Francis McFaun (Vice Chair)]: So take the things out of it that we want them to do, strike this section and keep in the stuff we want them to do, bring it into the blueprint payments practices primary care report. I think the first

[Jennifer Carvey, Legislative Counsel]: two sentences are largely the first two sentences can go into that I think there's so much dunk in there and somewhere else. So I guess there's a separate, currently a separate section on section five is primary care spending targets report. So you could either have a separate report or you could have one report.

[Francis McFaun (Vice Chair)]: I always would choose one. Well, of, the next thing is

[Nolan Langweil, Joint Fiscal Office (likely)]: For the record in all of Anglo Saxon, are you taking Can you go back up, Jen? Are you taking up the language about per month spending?

[Jennifer Carvey, Legislative Counsel]: Yeah, up, well, they're leaving in this concept of establishing a target, but taking out the increased spending shall be directed to.

[Nolan Langweil, Joint Fiscal Office (likely)]: My only suggestion would be just take out the worst per member per month, say, to target the amount of spending because of HR1 concerns.

[Francis McFaun (Vice Chair)]: That we are basically, this last sentence, the increased spending shall be directed at the per member, I do, I think we're striking that whole thing.

[Nolan Langweil, Joint Fiscal Office (likely)]: What kind of time at the first sentence? Shall establish target for the amount per member per month, is that staying in or is that coming out?

[Jennifer Carvey, Legislative Counsel]: I think some version of that was going to stay It's a report on targets.

[Nolan Langweil, Joint Fiscal Office (likely)]: Okay, I still might just take up from my months because conversation I've had with AHS around, they have to start rethinking how they're going to be doing payments in the future because of state directed payment concerns. I think you still can have the concept of Concept of spending. Spending and maybe they just don't call it a PMPM statute. Think Jessa may disagree with me on this, but it's based on a conversation I had today, Jessa.

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

[Nolan Langweil, Joint Fiscal Office (likely)]: So I don't think it changes the intent of it. Just makes it a little more big.

[Jessica Barnard, The University of Vermont Medical Center]: Flexible, yeah. Just to make sure we're not talking about the same thing though, just to be clear, this is about how it's measured, not about how it's spent. The practice is not saying that they have to be spending in a per month way, it's just saying it may equalize how we're measuring between payers how much they're spending on primary care. So when I think about maybe AHS, like a comment in earlier conversations with them, I don't know that this flag, directed payment issue, because it's not about how sustain, it's about how we're measuring how all payers are.

[Nolan Langweil, Joint Fiscal Office (likely)]: Well, I see yourself as target pretty well from spending. So to me, that is potential spending. But I'll leave it to the lawyers, but that's my concern.

[Francis McFaun (Vice Chair)]: What if we just said per person spending

[Nolan Langweil, Joint Fiscal Office (likely)]: on Vermont I believe it's spending, just leave it on the amount of spending on Vermont residents. They can measure it, it's just not putting it in law on this.

[Francis McFaun (Vice Chair)]: We get the Medicaid report every quarter and it has basically how much per member per month the spending Because

[Nolan Langweil, Joint Fiscal Office (likely)]: we're still legal.

[Leslie Goldman (Member)]: Yeah, well no, no, But it's

[Francis McFaun (Vice Chair)]: not actually what, it's not how we're spending the money. It's just-

[Nolan Langweil, Joint Fiscal Office (likely)]: I mean, I'm just gonna caution, I'm not aware, I'm just flagging the concerns that I had about any future potential spending, that's all.

[Francis McFaun (Vice Chair)]: Okay, well, we're establishing targets for the amount of per person spending. I

[Leslie Goldman (Member)]: agree with Noah. Let's just leave it spending and it'll evolve.

[Nolan Langweil, Joint Fiscal Office (likely)]: I'll flag it. I'll let lawyers determine that.

[Jennifer Carvey, Legislative Counsel]: Yeah. Think my concern about just saying spending is that you're going to end up with one large number that doesn't tell you what it actually costs to provide primary care services to an individual. Per person spending. In

[Nolan Langweil, Joint Fiscal Office (likely)]: measurements it's one thing, it's nothing to just, when you're saying targets, then it becomes potential spending. That was

[Jennifer Carvey, Legislative Counsel]: the plan. No, but it doesn't have it coming from Medicaid or private insurers or Medicare or Well, just say this again. Maybe I'm,

[Leslie Goldman (Member)]: right now we know it's 5% of going to primary care, but we want to go up to 35%, whatever we want to go. But see that's what I'm just saying, how much residents should be paying for primary care services so that we do want to increase the amount of spending.

[Francis McFaun (Vice Chair)]: Have to establish a target. The amount of per person spending that shouldn't be for primary care.

[Leslie Goldman (Member)]: Well, 5% versus 35% is the whole system, right? That's what we're

[Francis McFaun (Vice Chair)]: asking them to do is to establish that.

[Leslie Goldman (Member)]: What we use for the numbers, when we say five percent, that's for the system, not for the individual. Where does the 5%, 35% come? When we say the 35% spend the system. That's the system. So I think we should stick with system.

[Francis McFaun (Vice Chair)]: That's not what we're asking in this thing to do. We're not asking for how much we should be spending on primary care. We are asking what is the target amount that you should be spending per member on

[Nolan Langweil, Joint Fiscal Office (likely)]: primary care.

[Leslie Goldman (Member)]: That's That's per member because the next sentence is that they have to be able to be adjusted to reflect their specific differences like age and health status. You can't do that with one left thumb. No, it's very confusing. I'm I going say think we need to move on here. Are

[Francis McFaun (Vice Chair)]: striking this section.

[Nolan Langweil, Joint Fiscal Office (likely)]: I'm sorry that I interrupted. I mean, just It's not Medicaid specific. It's just

[Francis McFaun (Vice Chair)]: how we measure how much we're spending.

[Nolan Langweil, Joint Fiscal Office (likely)]: I was just flagging it, sorry.

[Francis McFaun (Vice Chair)]: I will tell you this week, the last one shall be directed to your health payments. So that's gone. You were going for

[Jennifer Carvey, Legislative Counsel]: a number per month back?

[Francis McFaun (Vice Chair)]: I'm fine with per person spending, but if people want per person, that's where I got stuck. Like per capita. This is a target. They're doing an analysis of what that word-of-mouth should be.

[Nolan Langweil, Joint Fiscal Office (likely)]: Sorry to interrupt you.

[Jennifer Carvey, Legislative Counsel]: No,

[Francis McFaun (Vice Chair)]: everybody, I'm not getting into the weeds with this. We're going to strike this and we're going to take the pieces that need to be measured and we're going to put them into the report of what we need to measure. And then we're cutting everything else out. So on to how many reports this is going to be, we've changed January 1 to January 15 because there's no reporting

[Jennifer Carvey, Legislative Counsel]: the Yes, January 15 throughout. I'm not sure why we ended up with January 1 from just these few. Okay, so the next thing I don't know that this is really blueprint candidates to practices anymore either, but it's some kind of blueprint information report.

[Francis McFaun (Vice Chair)]: All right, so this is the blueprint in consultation with all these things. They by 01/15/2027, they should report on. So number one says define which services should be considered routine primary care.

[Jennifer Carvey, Legislative Counsel]: Right, but I think you have to do the lead in because I don't think you want the lead in anymore. So on or before date, report on changes to payment amounts or payment reform methodologies or both that are necessary to transition the Blueprint per person per month payments to primary care practices to include payment for the routine primary care needs of attributed patients who recover by participating plan. That's using the blueprint as the basis for your

[Leslie Goldman (Member)]: future state. Pretty good. That's why, because it's not a current state question, it's a future state question.

[Francis McFaun (Vice Chair)]: I don't, you want to start with that? I don't understand, because we're not trying to break down the blueprint. Still want to transition

[Jennifer Carvey, Legislative Counsel]: the blueprint's existing payment structure to include payment for routine primary care needs of attributed patients who are covered by participating health plans. That's not universal primary care. It may be a way of getting there, but it's doing it based on the Blueprint, using the Blueprint as the mechanism. If that's what you wanna do, that's fine. That's what it currently says. But if that's not where you're wanting to go, then I think you need to modify Alright.

[Francis McFaun (Vice Chair)]: So what you're asking. Shall we remove the regarding changes to the payment amounts and payment that are necessary to transition the blueprints per member? Should we just get rid of that whole part?

[Jennifer Carvey, Legislative Counsel]: Probably. I think you're looking to have a report from the blueprint more generally on some of the items in this list.

[Leslie Goldman (Member)]: The one through six? I mean, items are great if they can report on the items, but not with the assumption. Right. Yeah.

[Francis McFaun (Vice Chair)]: Okay. So we basically, we stop after Regarding. Regarding. Yep. And then, okay, so we started with number one, it says define which services should be considered routine primary care. I've asked Jen to include in number one only because it comes up almost in every single bill that we do to establish a definition of primary care and primary care provider. Because there is no I can

[Jennifer Carvey, Legislative Counsel]: see Jessa laughing over there. And then, and define which services. And I don't know if you want to continue to say define what services should be considered routine primary care or if that's not relevant. I think that

[Francis McFaun (Vice Chair)]: that's really important. Because those are the services they find, not providers.

[Jennifer Carvey, Legislative Counsel]: Right, but it's which should be considered routine primary care. Is that that's?

[Nolan Langweil, Joint Fiscal Office (likely)]: Is routine

[Brian Cina (Member)]: primary care, is that what you're saying? Is that the phrase you're

[Jennifer Carvey, Legislative Counsel]: Right. Because that was a piece that was being looked what the bill was looking at doing, particularly as originally introduced, was to have a per member per month payment to the practices to cover all of the costs of providing routine primary care services. And so it was important to know which services were

[Leslie Goldman (Member)]: routine. You just pick out routine.

[Francis McFaun (Vice Chair)]: I don't know why we're not leaving this because if we're ever going to develop a methodology, no matter what we go with, we have to figure out what the services are that are going to be considered routine. And then because there's always going to be an aspect of additional services that are not typically routine that will need to be performed. I think

[Jennifer Carvey, Legislative Counsel]: that's what the primary providers care and which services should be considered routine primary care. Okay, let

[Leslie Goldman (Member)]: me ask this question. Like I'm thinking about abdominal pain, right? You want to go see your primary care provider because you have abdominal pain. Is that considered routine primary care? Yes. So, maybe in some worlds it's not. I mean, because then If you end up

[Francis McFaun (Vice Chair)]: you're a care provider and they excise a six centimeter mole off of your eyelid base. That's what it's trying to get at. Is that considered routine primary care?

[Leslie Goldman (Member)]: Yeah, that's we have providers say that. Want to

[Francis McFaun (Vice Chair)]: report that. It's not about fee for service. Stop. Need them to tell us what do we consider routine primary care. Somebody's got to make the call on this. Okay. Address any differences in methodology. Make recommendations.

[Jennifer Carvey, Legislative Counsel]: Does that make Yeah,

[Francis McFaun (Vice Chair)]: it does. Pediatrics, family medicine, GYN, consider primary care. Make recommendations regarding risk adjustment and attribution methodologies. We need that. Remember, this is what we're tasking them to do in this report. Describe the ways in which the methodology will

[Jennifer Carvey, Legislative Counsel]: We have the methodology.

[Francis McFaun (Vice Chair)]: We don't have them with the methodology. I

[Jennifer Carvey, Legislative Counsel]: is when think you get into somebody recommending how to pay for it. It's perhaps when you get into methodology.

[Leslie Goldman (Member)]: Could you say which various methodologies? I mean, because there's maybe there's one methodology here and maybe there there are various ways to skin this cat as it were.

[Jennifer Carvey, Legislative Counsel]: So identify methodologies that will balance capacity.

[Brian Cina (Member)]: That's actually in my head.

[Francis McFaun (Vice Chair)]: Okay. That's great. You need chocolate. Included mechanisms for ensuring healthcare make accurate and appropriate.

[Jennifer Carvey, Legislative Counsel]: I don't Do we need that? Not sure if that's as relevant to your current I don't know where that came from, though. Right. Maybe we get rid of that one. You're doing for others?

[Francis McFaun (Vice Chair)]: Well, keep number six. Daisy, aren't you gonna be, like, so happy with her? Keeping number six? Yes. Sure.

[Jennifer Carvey, Legislative Counsel]: I

[Francis McFaun (Vice Chair)]: don't think we need staff met.

[Jennifer Carvey, Legislative Counsel]: Not sure at this point you do. K.

[Francis McFaun (Vice Chair)]: And this is where you had inserted the language from that strat?

[Jennifer Carvey, Legislative Counsel]: I think so. About yes, I think you could and maybe instead of number eight at this point, you have the primary care spending target piece from took out of the that earlier. We'll keep Primary Yeah. Care spend And

[Francis McFaun (Vice Chair)]: that is ways to incorporate the primary care spending allocation target.

[Jennifer Carvey, Legislative Counsel]: Well, I wasn't gonna keep that. I was gonna replace it with

[Francis McFaun (Vice Chair)]: Replace it.

[Jennifer Carvey, Legislative Counsel]: With the oops. With the primary care spending target. Orange. Alright. And then

[Francis McFaun (Vice Chair)]: Oh. And then we had the last one, provide an operational plan and description of legislation needed and a timeline for implementation.

[Jennifer Carvey, Legislative Counsel]: Right. I think when we were talking about it this morning, were just talking about taking out some of the date language and putting in, yes, an operational plan, timeline, you know, operational or implementation plan, and description of timeline and description of additional legislation. Yeah. But needed to implement what? Because right now, you're just asking them for some information. So maybe you're Uh-huh. Maybe that's I think it might be premature.

[Francis McFaun (Vice Chair)]: It's premature too.

[Jennifer Carvey, Legislative Counsel]: Alright.

[Francis McFaun (Vice Chair)]: They don't want them to come back if they need any further legislation after? Well They're

[Jennifer Carvey, Legislative Counsel]: not they're they're not doing anything yet. They need to get all the information.

[Francis McFaun (Vice Chair)]: Note in here about Blueprint maximizing delivery of existing Blueprint services. Is that we were adding to the report that they needed to I'm look at my notes. How they were maximizing the delivery of their existing services.

[Jennifer Carvey, Legislative Counsel]: Oh, I think you you were interested in some frame down. Let me make some money because

[Leslie Goldman (Member)]: In but, yes, the blueprint or, you

[Jennifer Carvey, Legislative Counsel]: know, in order for the blueprint to maximize the delivery of existing blueprint services, what are the funding needs for each aspect of the blueprint, and include the and how much that would be or that would be in the per member per month Blueprint payments, something like that. And you were wanting them to report separately on the costs. Yeah. Like, if Blueprint were operating, I think the maximized part is that the Blueprint were operating at sort of, you know, it's the peak of its intent of the, you know, the intent behind the program. What would be the additional funding needs for each, you know, hub and spoke and community health teams and health initiatives, whatever it to Right. To enable the blueprint to operate and deliver at its

[Francis McFaun (Vice Chair)]: maximum needs or Yes. Would That's what you have. What we not investing because we don't have the money to invest in it that I would be

[Alyssa Black (Chair)]: know

[Francis McFaun (Vice Chair)]: that we are, I know what time it is, everybody. It's time for universal healthcare. I'm really sorry, but my brain just stopped working a minute ago. I'd like to take I that need a ten minute break.

[Brian Cina (Member)]: That's a

[Francis McFaun (Vice Chair)]: good idea. I