Vermont Legislature SmartTranscripts:

[Alyssa Black (Chair)]: Good morning, everyone. This is the conference committee for H816, an act relating to regulating the use of artificial intelligence in the provision of mental health services. Just want to welcome everyone. And I think we will, because of time, there's so much going on at this late stage. I think we'll just jump right into letting our Legis Council go through the differences between the two versions of the bill. Sure.

[Katie McLennan, Office of Legislative Council]: Good morning, Katie McLennan, Office of Legislative Council. I sent everyone a side by side summary last night.

[Alyssa Black (Chair)]: Let me pull that up. Okay.

[Katie McLennan, Office of Legislative Council]: So, it's not organized by act or bill number or section number because those section numbers don't all match up. Instead, it's organized by topic. Both bills have a purpose section. The house version is a bit longer. It's safeguarding individuals seeking mental health services in Vermont by ensuring therapeutic judgment, clinical decision making, therapeutic communication remain responsibility of a mental health health professional, so delegated to an AI system. Respecting individual choice in selecting mental health services, allowing responsible use of AI for administrative, operational, documentation, quality improvement functions that support access efficiency and innovation in mental health services. Conversely, in the as past Senate version, we're also safeguarding individuals seeking mental health services from psychological harm by ensuring that mental health services are delivered by mental health professionals and not independently by AI systems. So you're picking up the concept in that first bullet in the Senate version. The next section is the unprofessional conduct for certain OPR regulated licensees and applicants. This is very much the same. In concept, you use slightly different words. In the Senate, the phrase engaging in the prohibited use of AI was used to replace misuse because it was tracking the title and the preceding section prohibited uses of artificial intelligence, and it was cross referencing that section, so it was just tracking the language used there. So that's the difference there. The next section is the prohibited uses section. So you have definitions. Some of the definitions are fairly similar. The definitions of AI are similar, with the exception that the House version includes generative AI in the definition of AI, whereas the Senate version doesn't have a definition of generative AI. Both sections have a definition of therapeutic communication, but they are not identical. And we can dive into that in more detail if you wanna look at it, but I know we are short on time. The House version, subsection B prohibits a person, corporation, or other entity from offering, providing, or advertising mental health services in the state that represents AI as providing therapeutic judgment, diagnosis, treatment, or therapeutic communication. In the Senate version, you're prohibiting a corporation or other entity, not an individual, from providing, advertising, or otherwise offering mental health services, including through the use of AI to the public unless a mental health professional, unless mental health services are provided by a mental health professional, approved and reviewed. In the house version, we have language that the section doesn't prohibit the use or disclosure of AI for administrative purposes, documentation, operational purposes, as long as professional clinical responsibility is used. We have similar language with regard to the violations, that this is enforced under the Consumer Protection Act by the AG's office. The Senate version has a civil penalty of $10,000 There's not a penalty in the House version. Both bills have language that this does not preclude or supplant other remedies. And then the senate version has a subsection d that is not in the house version, but I think it captures much of what is trying to be done in the next section for the house. So this section does not preclude mental health professional operating within their scope of practice from utilizing AI tools that are HIPAA compliant, so long as a mental health professional reviews and approves any mental health services. So I think that sort of summarizes a lot of what this next section does. This next section was only in the House version. It has a lot of definitions that didn't make it into the Senate version, including definitions of administrative support, clinical responsibility, consent, peer support, religious counseling, supplementary support, etcetera. In this section, it authorizes a mental health professional to use AI for administrative support, supplementary support, and operational and quality improvement functions, like scheduling, billing, maintenance of clinical records, so long as a mental health professional retains that sole clinical responsibility. In subsection C, use of AI for administrative support and supplementary tasks, including transcription and reporting, subject to privacy protections already in statute. And patient consent is required when AI is used to record identifiable therapeutic communications. In subsection D, it prohibits a mental health professional from using AI innovator that allows AI to independently make therapeutic decisions or generate treatment plans. This section does not prohibit a mental health professional from disclosing or describing a mental health professional's use of AI for administrative support. And then in subdivision three, this section does not apply to religious counseling, non certified peer support providers, generalized education self help resources that do not report to offer mental health services. Okay, now there's language that is only in the Senate version, and that includes having parallel language to the OPR professional responsibility language that was up above, but this pertains to the Board of Medical Practice Regulated Licensee and Applicants, because there are

[Alyssa Black (Chair)]: a

[Katie McLennan, Office of Legislative Council]: few individuals under your definition of mental health professional who are regulated by the Board of Medical Practice, not just OPRs. So now, we have parallel language for all professions, and there is a report in the Senate version, it is not in the House version, that requires OPR and the Board of Medical Practice to submit a report to the General Assembly, obtaining recommendations on the regulation of the use of AI by regulated professions this coming January. And then, an area of concurrence that you both would like the bill to take a Beckham passage.

[Alyssa Black (Chair)]: So

[Katie McLennan, Office of Legislative Council]: that is it, but I can spend a little more time if there's anything you wanna drill down on.

[Alyssa Black (Chair)]: Thank you very much, Chittenden. Thank you, that was great. Any questions on the side by sides as we went through just now? Great. Well, we obviously felt good about the version that we sent back to you, so we're curious about what, you know, what were the issues that brought us here today. We'd love to hear. If could share with that, that would be great. First of all, thank you for your work. I think you tightened up a lot of what we did just notably in section section seventeen, seven fifteen. So, thank you for that. I think you've made things more concise and clear in many places. We heard from providers immediately that they had concerns that this would limit them from using evidence based digital therapeutics. And that is something that we really don't even do. Things like apps to help them with insomnia. There are also emerging tools that are cutting edge and they're definitely the way to the future that clinicians need in order to really step into modern therapy. And these are things that help people with schizophrenia, for example. So we want to support the evolution of this field, and we wanna to support providers who overwhelmingly contacted us. The Psychological Association in Vermont and New Hampshire who had testified in our community. However, they felt the changes that were made really empowered them to do those things with the digital therapeutics. We also heard from researchers who with the language that The Gulf had evolved to would have prohibited them from doing any research to develop those tools. I spoke with a researcher at Dartmouth who works with a lot of Vermont patients to develop tools. Our patients are actively informing these studies, and he would lose his research grades if we went forward with that. We don't want to break that either. I also heard from technology companies who provide you services and tools. They were concerned that the $10,000 private transaction would one, it was debt duplicative to what's already existing in the consumer protection laws that Vermont has. And two, it would allow repeated potentially repeated claims against them for each use. And so I I didn't think that was fair. We thought we'd recommend removing that line of 2,000 and the providers agreed with us on. I think one last thing, just for clarification, I didn't quite understand the need to have HIPAA in there, because HIPAA is more around data privacy and protection on the back end that we've seen these tools. It's not on the front end where we're always looking at it. The interface of where these tools are deployed and how they interact with patients versus the data storage and protection after they're used. So, I would suggest that we focus on making sure that people are using tools that are evidence based. And finally, the Office of Professional Regulation, we recommend that they be added to Brian, what's the name of the council?

[Brian Cina (Member)]: Yeah, the Artificial Intelligence Advisory Council? Yeah.

[Alyssa Black (Chair)]: Which we already have in Vermont. And they agreed they wanted to be added to that. And so we recommend that rather than them working with the board of medical graduates to come up with a support, that they be added to that council where they can really bring a voice for Parkinson's health and other providers that they regularly to that council and then give us a little more comprehensive report on what they make permanent progress it should be. Of the board member. Yes. Okay. So just to recap, make sure I'm understanding. It sounds as though you would like us to remove the $10,000 civil panel being You'd like us to replace the board medical practice with OKR of the AI working group from. And what was the Is there something else? If you look at the document, draft number 1.2 is the reference that Katie dropped it. Katie did a great job of highlighting those things that I noted. It the house or the shelter? I'm gonna go to the next. I have to report from the community conference. Did you share one? Maybe I do.

[Brian Cina (Member)]: Yeah, yeah. Just noticed that on page three, the changes begin and they're highlighted in yellow.

[Alyssa Black (Chair)]: Thank you. They're highlighted in yellow so you can see all of the changes that we are recommending.

[Brian Cina (Member)]: There's a change to definition, right? On page three, it doesn't have the line numbers, but it's highlighted. There's change in the mental health services definition that we're suggesting, right? You explain Well, don't see the I can look for the original. Because I know there was an issue with we had heard something about the definition having

[Alyssa Black (Chair)]: This aligns with the definition of criminal health services, so we want to be consistent regionally with what people are doing, and so it had been requested by providers that we aligned to each other's set of management. Okay. So there are some small word changes throughout the bill. And then the main the three main pieces are being aligning the mental health service definition with name, dollars 10,000 civil penalty, and replacing OCR with board medical practice. Yeah, it's a good thing.

[Katie McLennan, Office of Legislative Council]: Jumping. Also, the in subsection b on page four, there's language that allows the use of tools approved by an institutional review board or privacy board for the purpose of ASSIST. That's great. Yeah. Okay.

[Brian Cina (Member)]: Super. So I think what I would highlight is in the language changes. You'll notice we added clinical in, a bunch, and mental health in a bunch, and then we find the definition of mental health services. That's what I just wanted to say. Like, a lot of the yellow is Yeah. So I think you did boil it down to the I believe it's four key things. Right? There's the definition changes, OPR instead of board of medical practice, the, finding removed, what was the fourth one you just to just thank you. The research exemption or whatever you wanna call it. Yeah.

[Alyssa Black (Chair)]: I do. Any questions from the senate side at this point? Nope. Seem reasonable. Anything else you would like to offer?

[Brian Cina (Member)]: I would just say I appreciate that you worked on this and the other AI bill, and that you brought it forward, and that I think we're only suggesting these changes because we heard this is how it works. We heard feedback afterwards, and we were responding to that, and we run with the conference committee because it was quicker, and I appreciate your understanding.

[Alyssa Black (Chair)]: So we appreciate you also trying to protect Vermonters and protect vulnerable folks who, you know, are in need of mental health counseling. This is just a great It's a great start. It's a good start. I do have lot of work ahead of that question. Yes. A good start. So, yeah. So, I'm looking at the definition that you have on page three and it includes behavioral health.

[Brian Cina (Member)]: Which we defined in log recently, remember that? Yeah, did

[Alyssa Black (Chair)]: find it recently. Yeah, finally. And how many practitioners have we got who would be subject to this? Probably a few.

[Brian Cina (Member)]: Quite a few. Yeah. Okay.

[Alyssa Black (Chair)]: Then my other question is with regard to the Board of Medical Practice and why you would exclude them when they have oversight over specific areas of dental health counseling. Are they on the AI Council?

[Brian Cina (Member)]: No, we are in 08/14, which the governor did sign, it's in effect on passage, soon we will see the Vermont Medical Society appointing someone. So there will be an MD or someone connected to the MDs on there, but there is not Board of Medical Practice representation currently and they won't be added. They could be included through the language, through the language in 08/14 that says, I forgot how

[Alyssa Black (Chair)]: the other Correct. Stakeholder. Exactly. Yeah. Okay. And but OPR is on the advisory board? I'm trying to remember.

[Brian Cina (Member)]: They're not, but we would be this we would be adding them with this.

[Katie McLennan, Office of Legislative Council]: Yeah.

[Brian Cina (Member)]: And it makes sense to me. We added the treasurer because they're looking at public finance, and since we're asking them to look at regulated professions.

[Alyssa Black (Chair)]: Well, okay, that'll be an interesting discussion. Yeah, that will be. Many interesting discussions. So, might I suggest that we only have about seven minutes before the next conference committee. Think we need to stop. Yeah, three of us Katie Would as you all, could you possibly wait outside while we have a quick conversation to see what our next steps? Could faint. Is that alright?

[Brian Cina (Member)]: You asked me to wait. Like If you don't mind,

[Alyssa Black (Chair)]: just wait a few minutes.

[Brian Cina (Member)]: Yeah. I won't go. I won't go anywhere.

[Alyssa Black (Chair)]: I can check. Alright. Thank you.

[Katie McLennan, Office of Legislative Council]: Stand by the portrait.

[Alyssa Black (Chair)]: I appreciate that. We can go up.