Vermont Legislature SmartTranscripts:

[Rep. Theresa Wood (Chair)]: Wherever if you're set up there, that's fine. We can talk like that. Whatever. Okay. Welcome back, folks. We are going to hopefully complete our first markup, our initial markup of h 05:45 this afternoon. So we left off on line nine, section two, which is on page five of version 1.1. For anybody online or in the audience here who's following along, can find that on Tuesday's version of our webpage.

[Rep. Doug Bishop (Member)]: I apologize. Could you repeat which page and last one?

[Rep. Theresa Wood (Chair)]: That's okay. It's page five, and it's section two, line 10. So, this is a completely new section, because this is talking about what the Commission is going to do based on the advice, remember, from the advisory panel. So I think that that's probably something to be clear about. Commissioner is not just acting unilaterally, which some of the feedback that we have received sort of infers the commissioners is not infers, kind of comes right out and says commissioners got total unilateral. I I know.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: He gets It's an advisory.

[Rep. Theresa Wood (Chair)]: It's an advisory recommendation. Yeah. The authority. Right. And before I move to that, I just wanna make sure did that last one get posted on today's, Laurie? The the feedback you told me it was posted, and I didn't look at it. Was another there was another email that was received. We're having some issues in posting. We were

[Rep. Golrang "Rey" Garofano (Vice Chair)]: told we didn't we could post more documents,

[Lori (Committee Assistant)]: and now I'm seeing they're not showing up.

[Rep. Theresa Wood (Chair)]: Gotcha. So I'm gonna save them as PDFs and repost. Okay. We received another piece of feedback today that will be posted on today's version of our website. So to summarize the pieces of feedback around folks who haven't been 100 supportive of the bill, it really kind of stems around the commissioner having that sort of authority to do that, quote unquote, on his own. And so we'll get to that. So that's kind of the first line, line 11. But let's look before we do that and talk about that issue. Let's look at the things that we should consider.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Alright, I was just gonna say, because line 11 itself, what he's issuing is recommendations. Exactly. And I think that's The whole thing is recommendations. Right, and what's the effect of the recommendations? The effect is that he can order the drugs, get cheaper prices, that insurers have to pay for it if a parent or if an adult wants them. Correct. I think those are the two impacts of the recommendations. Yeah. Yes. And

[Rep. Theresa Wood (Chair)]: just again, to be clear, these are only recommendations. It's not changing anything in any current statute that says any particular vaccine has to be provided prior to anything or as a result of anything. These are recommendations. And you just eloquently summarized it. It's so that insurance companies will pay for it, so that pharmacists can administer it. And so I think that there's three. Oh, right. Who can administer Pharmacists can administer it. And I just lost the second one. And accessing the lower prices. The lower prices, right. So let's look at the five things that the commissioner will be making recommendations regarding. So it's the immunizations that children and adults should. It doesn't say shall, but I have a question about that because legislature doesn't normally like to use the word should.

[Katie (Legislative Counsel)]: Mhmm. Shall and may are both funny fits here. Obviously, we don't want a shall, but they I guess we could say may receive, but that almost indicates

[Rep. Theresa Wood (Chair)]: That they might be getting something.

[Katie (Legislative Counsel)]: Then they might not get it. Yeah.

[Rep. Brenda Steady (Member)]: Depends. Right?

[Rep. Golrang "Rey" Garofano (Vice Chair)]: What was that? You're repeating recommendation which

[Rep. Theresa Wood (Chair)]: you asked for.

[Katie (Legislative Counsel)]: Like, show periodically.

[Rep. Theresa Wood (Chair)]: I actually like which immunizations children and adults are recommended

[Rep. Golrang "Rey" Garofano (Vice Chair)]: to receive. To receive? Yeah. Even though it's using the word twice. Yeah.

[Rep. Theresa Wood (Chair)]: I know, it's not fixed. I think it's better than should, I think. Yeah, think so too. We do recommend it together again.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: So that's fine. Yeah.

[Rep. Anne B. Donahue (Ranking Member)]: The age at which

[Rep. Brenda Steady (Member)]: each immunization is recommended to be given.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Was that? Oh, were on number one. On number two, I would

[Rep. Brenda Steady (Member)]: The age at which each immunization is recommended to be given.

[Rep. Theresa Wood (Chair)]: Yeah, I realize that we're using recommended a lot, but

[Rep. Brenda Steady (Member)]: But the whole list sort of gets Well, it looks like every one of them almost has been switched around, yeah.

[Rep. Theresa Wood (Chair)]: And would say on number four, to insert the recommended amount of time between doses of an immunization. Doesn't have any recommendation in that one. Any other recommendations? And I would say, instead of insure, I think think promote would be a better word because we can't ensure those things. Do you see where I'm saying, Katie? I'm 17. Got it.

[Rep. Brenda Steady (Member)]: I had wondered about just taking out two insurers just to say necessary to maintain public health.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: But then it's still necessary to maintain it.

[Rep. Theresa Wood (Chair)]: I'm sorry, I didn't the go other one.

[Rep. Brenda Steady (Member)]: Promote is better. So

[Rep. Theresa Wood (Chair)]: that's A. Are there any other comments about A? Okay. Prior to issuing recommendations, the commissioner so this again, it means the commissioner can't do it on his or her or their own. Consult with the advisory council. Also to consider recommendations by the CDC, as well as the professional organizations reliance in on science of doing this? Anybody have any suggestions or edits to that? Okay. Moving on to c.

[Rep. Anne B. Donahue (Ranking Member)]: Just I'm sorry. Just back on the line six. I guess it covers it under any other organization, but if a name was to change of one of these, they could because then it would capture it under any other organization.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: You just say, well, we're gonna have this one.

[Rep. Anne B. Donahue (Ranking Member)]: Yeah, yeah. Or if one ceased to exhibit another one could

[Rep. Brenda Steady (Member)]: be in place or whatever.

[Rep. Anne B. Donahue (Ranking Member)]: So, okay, never mind. We received,

[Rep. Theresa Wood (Chair)]: I think the The nurses. That was

[Rep. Golrang "Rey" Garofano (Vice Chair)]: about being on the advisory council, which we have got. Okay.

[Rep. Theresa Wood (Chair)]: Yeah. Yeah. Okay. Alright. So we're on we're on c now. I have to go back and look up that. Okay. Let's see. This is the immunity from civil and administrative liability.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Go ahead. So yeah, vague recollection and maybe it's a question for Katie or if you know it. This seems to mirror what exists currently in federal law for those who follow the CDC recommendations that we're just saying, and now that we're issuing the recommendations, you have that same immunity. Would have to confirm that.

[Katie (Legislative Counsel)]: Don't know off the top of my head. I pulled the language from the opioid antagonist statute.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: I'm not expecting it would be word for word, but yeah, it would be worth checking because I think that is current law in terms

[Lauren Lehman (General Counsel, Vermont Department of Health)]: of I

[Katie (Legislative Counsel)]: will take a look.

[Rep. Theresa Wood (Chair)]: Okay. And just so you know, the judiciary committee is going to do a drive by and they're going to look at this that one section on Wednesday morning, think, sometime, I don't know, Wednesday. They're they're gonna be in contact. Okay. He said they just need Katie. I said, yeah. If you need to bump us to go there, that's fine. Okay, and then D is something that was a total new concept to me that came up during the COVID immunizations this fall. The commissioner can initiate a standing order, that means that anybody can go in. The order is applying to the populace.

[Rep. Brenda Steady (Member)]: Like a prescription for everybody?

[Rep. Theresa Wood (Chair)]: For everybody, right. Was like

[Rep. Golrang "Rey" Garofano (Vice Chair)]: I haven't prescribed to you

[Rep. Brenda Steady (Member)]: by the chief prevention officer. Yeah. I

[Rep. Theresa Wood (Chair)]: was like, really?

[Katie (Legislative Counsel)]: Madam Chair, you had a comment about subsection C from the health department. I didn't know if you were making comments. Yes.

[Rep. Theresa Wood (Chair)]: What is that? Go ahead, Jessica.

[Jessica (Vermont Department of Health staff)]: Oh, I wanted to just weigh in

[Katie (Legislative Counsel)]: on the

[Jessica (Vermont Department of Health staff)]: provision you were discussing with regards to immunity and the current federal system for the vaccine injury compensation program. And so I'll let my colleague Lauren Lehman jump in on that explanation. Lauren Lehman, general counsel for the Department of Health. There is federal protections. There's not a pass through the immunity fee right now.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: There's an entire court system at the federal level where injuries can be reported and compensation provided to families, but the provider then is insulated from direct tort liability. This would provide comparable protections as long as they were acting in accordance with state law and with the recommendations and were negligent, etcetera. So it still provides that protection where they have to act in the form of the and all the expertise and the standard of care. And if the federal kind of insulation tort system isn't available over that vaccine injury compensation program, this would have that protection here. And we think it improves access because doctors, providers, be

[Rep. Golrang "Rey" Garofano (Vice Chair)]: more willing to act in accordance with Vermont's recommendations in those situations. So that, yeah, that sounds like what I was thinking of, that it is analogous, but that raises another question that you're reminding me that several process incorporated into it is an avenue by which someone injured can get reimbursed because they can't sue the provider or whatever. And we wouldn't have something like that available. But would they still have access to the federal court process?

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Yes, it's very complicated. The vaccine protections at that federal level are often limited to the vaccines recommended at the federal level. So to the extent the state recommendations were different from the federal, there would still be, somebody can all get to a report in the state. Might be the provider maybe of June, but there might be other avenues to manufacture and other options. So there's always still options for compensation that will allow this level. This provision specifically insulates the healthcare provider as long as they're not being negligent as long as they're working in accordance with the state recommendations. And I'm

[Rep. Golrang "Rey" Garofano (Vice Chair)]: not suggesting we wouldn't want that, but I'm just wanting to understand and have us be clear on how that does or doesn't change existing. So there's sort of a quid pro quo, if you will, in the federal law. You can't sue, but you have an avenue of getting compensation. And this change would still allow that existing process for things that Vermont has that are the same, but when we have ones that are different, that would not be available to them. But this group of people would be immune from a tort claim unless they were grossly negligent or reckless. Okay.

[Rep. Theresa Wood (Chair)]: Thank you. Thank you for that clarification.

[Katie (Legislative Counsel)]: I'm sorry, I didn't see

[Rep. Theresa Wood (Chair)]: a hand or a nod or whatever.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: No worries. I'll try to be in barn.

[Rep. Theresa Wood (Chair)]: I see you switched sides.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Was trying to see if that helped.

[Rep. Theresa Wood (Chair)]: Representative McGill is not here today. So I see I have a direct line here. I mean, McGill is here. Okay. It's all good. Okay. And the standing order and how it relates to pharmacists, we're going to hear from the Office of Professional Regulation on Tuesday afternoon. Then we're pulling in the piece from the OPR bill. I don't know where

[Katie (Legislative Counsel)]: This will be a standalone section.

[Rep. Theresa Wood (Chair)]: It'll be a standalone section. Do do standalone sections? Esme.

[Rep. Esme Cole (Member)]: One piece here with the Section B is wondering how we are we need or want to be about incorporating the advisory council here, or if prior language above helps to sort of just have that assumption that they're going to be involved in that conversation.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: About who should be under the standing order if

[Rep. Esme Cole (Member)]: it changes. Yeah, or about making that call, that final call. Because seems alone looking at this paragraph, the commissioner has a lot of power, which is good. But also I think that incorporating and making sure that the advisory council is really woven in there.

[Rep. Theresa Wood (Chair)]: What I'm wondering about is, because it is an advisory council, but what I'm wondering about is if there I'm not anticipating it, but sometimes you have to anticipate the unanticipated. If there is some sort of thing that we should insert that if the commissioner commissioner issues issues a recommendation that is different than the advisory panel's recommendation, that there's I don't know who would be notified. But it feels like there should be a, I guess, just a little bit of Yeah. Director. Yep.

[Rep. Doug Bishop (Member)]: To their boss, the governor?

[Rep. Theresa Wood (Chair)]: No. No. I'm I'm wondering about maybe the the medical practice board or something. I don't know. Okay.

[Katie (Legislative Counsel)]: I was also, as you're saying that, thinking of, like, some kind of note on public education documentation about the schedule, so it's noted for the public somewhere.

[Rep. Theresa Wood (Chair)]: If there's a disclosure to the public.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: I

[Rep. Theresa Wood (Chair)]: like that idea. That there's a provision for public disclosure if the commissioner's public recommendations differ from the advisory panels.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Okay. Yeah, go ahead, Anne. So back to the original question about the commissioner having to consult, but current language does the only part where the commissioner shall consult is only to coming up with the recommended So I mean, I like the idea of saying, again, to really make it clear that this is not commissioner just unilaterally, that in issuing a standing order that change which professionals can do that, that there be advice from the advisory panel. Maybe it doesn't need to be a whole section, but maybe incorporated into the duties of the advisory panel. But I like the thought you're raising that The spirit of it. Yeah, the spirit of it, right. That if the commissioner can issue the standing order, that there be input from the advisory council.

[Katie (Legislative Counsel)]: The term recommended immunizations, if we go back to the definition, it does refer back to the process that's set forth in this section. So it says, these are recommended immunizations, recommended by the practice guidelines for children and adults established by the commissioner pursuant to section eleven thirty a, which is what we're looking at. So the definition of recommended immunization itself does refer back to the process and not just one person's recommendations. The process requires Process, the

[Rep. Golrang "Rey" Garofano (Vice Chair)]: consultation. Okay, then that's

[Rep. Esme Cole (Member)]: Brenda?

[Rep. Brenda Steady (Member)]: Instead of the Vermont advisory panel, how about federal recommendations?

[Rep. Theresa Wood (Chair)]: Well, we say line one, Line one

[Rep. Golrang "Rey" Garofano (Vice Chair)]: on this page.

[Katie (Legislative Counsel)]: On this page.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: And zero recommendations

[Rep. Theresa Wood (Chair)]: from the Centers for Disease Control. That's the federal.

[Rep. Brenda Steady (Member)]: And that would be federal? Yes. Now I might be in la la land, but so parents are notified before a vaccination is given.

[Rep. Theresa Wood (Chair)]: This is all new to me. Vaccinations are voluntary. Okay, so parents are notified. Parents actually have to seek them out.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: I know I told you I might be

[Rep. Golrang "Rey" Garofano (Vice Chair)]: way off. They have to give informed consent.

[Rep. Brenda Steady (Member)]: They do have to give informed consent and it is in here that federal recommendations. It's right there. Thank you. Line one. The panel, so I didn't know. Yeah, it's page six. Recommendations. Okay, thank you. Okay. Sorry, I just, this is new to me.

[Rep. Theresa Wood (Chair)]: Go ahead. We're in discussion, you don't have to raise your hand.

[Rep. Brenda Steady (Member)]: It is. I'm wondering what other members think about, like something in the policy that talks about educating the providers and the public about the discrepancy that there might be between the federal recommendations and the Vermont recommendations, because we went through that with COVID, with the COVID vaccines just in the fall, where there was a standing order in Vermont, but many providers were not following that standing order because they were worried about federal guidelines, federal funding, federal whatever it was. There was a lot of miscommunication, and the Vermont Medical Society brought that up in their testimony that there is a lot. And they're thinking about how to do that. But I wonder if we've had to say it's also the responsibility of the department and all the stakeholders, advisory. I don't know how we would want to frame it, but just to make it explicit that there needs to be because there will be discrepancies in what these providers are hearing from the feds and us and the state. So, do you have

[Lauren Lehman (General Counsel, Vermont Department of Health)]: a suggestion? I don't, but

[Rep. Brenda Steady (Member)]: I can think about it. So along those lines, I'm thinking of now partly why this is being done. So Vermont has the right, know,

[Katie (Legislative Counsel)]: takes But in

[Rep. Brenda Steady (Member)]: three years, the commission might recommend the CDC's.

[Rep. Theresa Wood (Chair)]: We're gonna have, at the end, we're gonna have a sunset of this. So that it will need to be reconsidered at we'll decide on what period.

[Rep. Brenda Steady (Member)]: Could we stay something at that moment? A sunset moment or something like that? Well, I mean, I think

[Rep. Theresa Wood (Chair)]: what what Ray is getting at is each time the commissioner makes a recommendation, if there is a difference between that and what is recommended by the CDC, that providers need to be informed about that.

[Rep. Brenda Steady (Member)]: I see.

[Rep. Theresa Wood (Chair)]: Yes. And that's the the medical society said, you know, was it was we were in new territory. In new We're in new territory. We had a dry run-in the fall with the COVID vaccine. And we heard from the commissioner that we did what we felt was the right thing to do. And this change in statute back set up. So I guess I'm trying to figure out whose responsibility is it. Is it the medical society's responsibility? Is it the department's responsibility? Is it the physician's responsibility themselves to be seeking out whatever the recommendation is? I'm trying not to overburden the department on something that people have professional responsibility if you're I

[Rep. Doug Bishop (Member)]: would argue it's professional organizations and the professionals themselves and would not look to your point.

[Rep. Brenda Steady (Member)]: From a consumer perspective, I guess I would ask the committee or the department, where would a consumer go if they know what the state law is? Like, with the COVID vaccine that was authorized in Vermont, I knew I should be able to get it. I should be able to access it, right? I knew that. I'm a legislator. I knew what the law was. I knew what the rule was. But I had to go to so many different layers of providers to get that vaccine. And finally, when I did get it, I was it wasn't under the Vermont standing order. It was under their interpretation of what the federal government said. So where would me as a consumer go if I'm denied access to the immunization that I should have access to under the scanning order? I guess that's

[Rep. Golrang "Rey" Garofano (Vice Chair)]: So the it should and it could be something that was in the statute or maybe just clarified with the commissioner. The Department of Health website. It should have posted. Should have a promise.

[Rep. Theresa Wood (Chair)]: Was posted during the COVID

[Rep. Golrang "Rey" Garofano (Vice Chair)]: It was hosted. Yeah. Public outreach that that's where you look to find access and to understand. This is the website.

[Rep. Theresa Wood (Chair)]: So I think probably at a minimum, we should say in here to be explicit that the commissioner's recommendation should be posted. There's probably other things about the commissioner's recommendation, like if there are any And

[Rep. Golrang "Rey" Garofano (Vice Chair)]: any changes. Should be prompted.

[Rep. Doug Bishop (Member)]: You post the immunization schedule. It's available on their website.

[Katie (Legislative Counsel)]: Yeah, okay.

[Rep. Theresa Wood (Chair)]: Yeah, I'm just trying to,

[Katie (Legislative Counsel)]: I don't want to be

[Rep. Brenda Steady (Member)]: too prescriptive. I know, I know.

[Rep. Theresa Wood (Chair)]: Maybe we just say relevant information regarding the commissioner's immunization recommendations we posted on the department's website.

[Rep. Brenda Steady (Member)]: Let me add something more. Efforts to, I see things like ads on social media, get your access. How to access.

[Rep. Esme Cole (Member)]: Help Beach is adding that.

[Rep. Brenda Steady (Member)]: Or point of service, where the service is given.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Can you, where you which

[Rep. Brenda Steady (Member)]: What's easiest I like what Ray's touching upon. Yeah. So yeah. The website

[Rep. Golrang "Rey" Garofano (Vice Chair)]: should should list it and should also

[Rep. Brenda Steady (Member)]: It should also be a

[Rep. Theresa Wood (Chair)]: point of service. Right. Identify. Oh, well, pull it down now. It's probably not on there now, right?

[Rep. Brenda Steady (Member)]: Well, no, by any vaccine. No, no,

[Rep. Theresa Wood (Chair)]: I'm just thinking about if we could look at the website, health department's website right now and see what they posted for COVID, but that's probably that's not. It's not on there.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Looking right

[Rep. Doug Bishop (Member)]: now. All

[Rep. Theresa Wood (Chair)]: and RSV. Right. I'm

[Rep. Doug Bishop (Member)]: Vaccine access is listed on the flu, COVID and RSV vaccine section of the homepage.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Does it say where you get it and on the homepage of vaccine?

[Rep. Doug Bishop (Member)]: See, if you don't have a well, contact your health care provider. If you

[Rep. Brenda Steady (Member)]: don't have one, call 211. Where where where is it? That's not the cover date. Fine then.

[Rep. Doug Bishop (Member)]: Or contact the nearest federally qualified health center or one of Vermont's free and referral clinics. And there's links for some of those links.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: I think where are you seeing that Ben? I'm not seeing that.

[Katie (Legislative Counsel)]: Oh, Ray, I'm confused.

[Rep. Theresa Wood (Chair)]: So, okay. Just a second. I'm sorry. That's right. I'm seeking Doug to respond to it because I don't, I'm not.

[Rep. Doug Bishop (Member)]: It's Department of Health slash Disease hyphen Control slash this one

[Rep. Anne B. Donahue (Ranking Member)]: is respiratory illness because it's food. It's not

[Rep. Doug Bishop (Member)]: on the

[Rep. Golrang "Rey" Garofano (Vice Chair)]: cover page of the Department of Health.

[Rep. Doug Bishop (Member)]: Right, it's the right Google Assistant.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: No, no, I just went to what do people get if they open the Department of Health website and they don't get anything highlighting. And in fact we'll note to the commissioner right now, the statement about the CDC change in recommendations, what it says on there is something right, there's a thing statement from Vermont Health Commissioner Rick Hilbrand. And it doesn't say about the CDC changes. So you wouldn't have a clue about that. But it seems to me that that's where you would want something to a direct link like the other direct links they have to

[Rep. Theresa Wood (Chair)]: So the I think that we should just indicate to be prominently displayed on the department's website. Yeah.

[Rep. Brenda Steady (Member)]: That's perfect. How about also at the point, some people don't have a computer or don't even know how to use one. So wouldn't it be at the point, like where they go? At their doctor's offices Right, or not just the point of service.

[Rep. Doug Bishop (Member)]: I worry about us creating a whole new public media campaign that would have to go on forever. I mean, this has a sunset, but That was

[Rep. Theresa Wood (Chair)]: a money.

[Rep. Doug Bishop (Member)]: Yeah. It's a lot of state money. It's I worry about its ultimate success. I think this is conversations

[Rep. Theresa Wood (Chair)]: that health care

[Rep. Doug Bishop (Member)]: providers have with the families that they serve.

[Rep. Brenda Steady (Member)]: How about we insert a QR code into the bill?

[Rep. Anne B. Donahue (Ranking Member)]: Because I didn't mean

[Rep. Brenda Steady (Member)]: the statute.

[Rep. Theresa Wood (Chair)]: Alright. So I think alright. To summarize we're going to leave it at prominently displayed on the department's website. Okay, now we're on, we're still on page six on line four. We did that section. We're 19. That's nothing new for us. That's it. Okay. We're on page seven. Alright. So this is the advisory council and membership. And this is where we heard from the advanced practice nursing people that they would like a seat.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Two seats. Advanced practice nursing and I forget you.

[Rep. Theresa Wood (Chair)]: Two types of. So that I forwarded that information to everybody. What are your thoughts about that? And I want to

[Rep. Brenda Steady (Member)]: know what the department's thoughts are about that.

[Rep. Theresa Wood (Chair)]: Maybe I'll ask the department, you want ask the department first?

[Lauren Lehman (General Counsel, Vermont Department of Health)]: There's a definition in the statute already that was referred to at the bottom of the last page of healthcare professionals. Suggestion would be to add a seat for healthcare professional and that could encapsulate APRNs and other healthcare providers. We recommend they be licensed in the state of Vermont because in this situation, because there's different scopes of practice for a lot of advanced providers to finish that.

[Katie (Legislative Counsel)]: I'm not

[Rep. Theresa Wood (Chair)]: sure that totally gets at what they're looking for. I understand that the definition of healthcare professional includes those people, but it also includes physicians and other people. And so it wouldn't guarantee that they would have a seat at the table.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: We were trying to avoid having a seat for every professional, but I was about

[Rep. Golrang "Rey" Garofano (Vice Chair)]: to say there could well be others who would be of value, you end up with a group that's too large to be effective and

[Lauren Lehman (General Counsel, Vermont Department of Health)]: I have support of definitions at the Board of Nursing, a seat for the executive office of the Board of Nursing, and would suggest that it also be a seat for the Board of Pharmacy well.

[Rep. Theresa Wood (Chair)]: One, two, three, four, five, six, seven, eight, nine, ten, eleven. We're never going to go with an even number, we're either going be 9 or 11. They just recommended two. Right. So, I think we could say something about the definition of the healthcare professional that doesn't duplicate one of the previous so we already have a pediatrician. I know I've seen that worded somehow. You

[Katie (Legislative Counsel)]: did, yeah.

[Rep. Theresa Wood (Chair)]: In different Do you know what I'm getting at, Katie? So I think we'll go with the healthcare professional because that includes the advanced practice nursing. But just to indicate that we won't duplicate somebody who already has a standing on the board. Because we

[Katie (Legislative Counsel)]: have appointments for the Board of Nursing, Board of Pharmacy, for the Board of Medical Practice, we have the governor.

[Rep. Theresa Wood (Chair)]: At the Board of Nursing, aren't we saying a physician? Don't you say ACRN appointed I

[Lauren Lehman (General Counsel, Vermont Department of Health)]: think it's the executive officer of the Board of Nursing and the executive officer of the Board of Pharmacy and that one could depend on what you're dealing with, designee elsewhere. It could be the executive officer or designee.

[Rep. Theresa Wood (Chair)]: Appointed by Okay, got it. Appointed themselves, right?

[Rep. Brenda Steady (Member)]: Yeah, you

[Katie (Legislative Counsel)]: do want designee, executive officer designee in both places?

[Rep. Theresa Wood (Chair)]: Yeah, because I mean, they could recommend somebody

[Katie (Legislative Counsel)]: else. And then the appointment for the healthcare professional.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: That somebody has to appoint, that because they don't have an organization. What did we do for the other ones where?

[Rep. Brenda Steady (Member)]: Governor.

[Rep. Theresa Wood (Chair)]: They're all governor. I've got

[Katie (Legislative Counsel)]: a governor.

[Rep. Brenda Steady (Member)]: Unless it's a specific office.

[Rep. Theresa Wood (Chair)]: Alright. Governor. Yeah. Okay. Just make sure that we don't end up with an even number because I just realized it continues on page eight. Alright. Ultimately,

[Rep. Doug Bishop (Member)]: it's a citizen of info or a representative citizen's any other person deemed necessary by the commissioner.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: We actually would We really need that.

[Rep. Theresa Wood (Chair)]: I don't really need that.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: No, because now it's more open with other health care professionals, because otherwise that does put us even. We just added three and nine plus three isn't even.

[Rep. Theresa Wood (Chair)]: I'm just looking to the department.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: I think we need to get back to them, would be to consult with the folks that work with the committee, if that's all right. Okay.

[Katie (Legislative Counsel)]: I found it. Because six is two individuals, did you catch that?

[Rep. Theresa Wood (Chair)]: Yeah, I did. Oh, I did. Oh, That's right. Oh,

[Rep. Brenda Steady (Member)]: yep. Yeah. Right? It's a

[Katie (Legislative Counsel)]: two. Two two people. Okay. I missed eight. And number two is yep. So that would be yep. I think that would be okay.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: But, oh, does that even mean it's from each? It's a percentage of both.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Okay, has to mean one of each.

[Rep. Theresa Wood (Chair)]: I think we're going with a representative of public schools.

[Katie (Legislative Counsel)]: One. That brings us back down to 12. Is that okay?

[Rep. Brenda Steady (Member)]: No, I think she needs to scrap independent schools. Is that what she needs?

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Oh, Number six, which meant there were two people. So now we lost first although maybe you didn't count those two people. No, we got 13 when we counted that as two. So now

[Katie (Legislative Counsel)]: that brings you back down to 12.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Well, I'm not sure. Oh, did I do my math?

[Rep. Golrang "Rey" Garofano (Vice Chair)]: You counted eight as two because I don't think it's Okay.

[Katie (Legislative Counsel)]: Let me try again. Actually,

[Rep. Brenda Steady (Member)]: number eight Alright, could be

[Rep. Theresa Wood (Chair)]: for a moment while we my Katie counts so we

[Lauren Lehman (General Counsel, Vermont Department of Health)]: can Okay.

[Rep. Esme Cole (Member)]: 12. Know, I would

[Katie (Legislative Counsel)]: I would invite other folks to come.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: So we all count again.

[Rep. Theresa Wood (Chair)]: In your drafting, can you separate out human services and education on number two, just so we don't do exactly what we just did and count them as one.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: I have 13 up to and not including eight, however that's interpreted.

[Katie (Legislative Counsel)]: Yeah, it's two. 5789101112.

[Rep. Theresa Wood (Chair)]: It is 13. 13.

[Katie (Legislative Counsel)]: 13. Perfect. Are you striking the new 9? The new nine, the olds? Yeah. I don't know

[Rep. Theresa Wood (Chair)]: if that's the word taking that under they're gonna get back to

[Rep. Golrang "Rey" Garofano (Vice Chair)]: I'm sorry. Is eliminating eight, and I don't know if you wanna totally eliminate it or change it. Am I counting up and

[Rep. Theresa Wood (Chair)]: getting I'm eliminating, I'm just changing it to public.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Right, okay, so then there's 14. Got 13 not When even

[Rep. Theresa Wood (Chair)]: it's redrafted, Yeah, we count okay. Then the next version will count them. All right. The council. Three hours. Know. Interest. Yeah,

[Rep. Golrang "Rey" Garofano (Vice Chair)]: don't continue this on live.

[Rep. Theresa Wood (Chair)]: We don't need to consider that. Okay, so then we're moving down to the duties of the council. So this just this just adds including any advice regarding the recommendations. To be issued by the commissioner. This is why you wanted this to

[Rep. Brenda Steady (Member)]: be rewritten to clarify it because you were very confused.

[Rep. Theresa Wood (Chair)]: No. That was that was back before she took out a couple of things, including advice. Oh, yes. You're right. This was I had two places. This was the second place. Yeah. Oh, it's circular. It's circular, and it makes it sound like the advice comes after the commissioner makes the recommendation.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Oh, right. Advice regarding those issued by. Because

[Katie (Legislative Counsel)]: it's past tense. Yeah. You could just say including advice regarding recommended immunizations as defined in Yes.

[Rep. Esme Cole (Member)]: That's better. Are we being clear enough about how advice is being delivered into humans very specifically? I know it's in schools, but like

[Rep. Theresa Wood (Chair)]: The advice of this group is only to the commissioner.

[Katie (Legislative Counsel)]: Oh, I see. Separate from everyone, obviously. Yep.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: And is all existing other than clarifying that it includes the immunization recommendations?

[Rep. Theresa Wood (Chair)]: So can you Okay. So just to sum it up, pardon?

[Rep. Doug Bishop (Member)]: I was just hoping we could get right back

[Rep. Brenda Steady (Member)]: what we've

[Rep. Doug Bishop (Member)]: changed.

[Rep. Theresa Wood (Chair)]: I was just gonna say, I was just Okay. Gonna Go ahead, Kate.

[Katie (Legislative Counsel)]: So the council shall, jumping down to two, provide any other advice and expertise requested by the commissioner, including advice regarding recommended immunizations as defined in section eleven thirty. Period. That

[Rep. Golrang "Rey" Garofano (Vice Chair)]: sounds good.

[Rep. Theresa Wood (Chair)]: Okay, now we're onto this question about administrative, technical and legal. Now we have an attorney here.

[Rep. Anne B. Donahue (Ranking Member)]: So

[Rep. Theresa Wood (Chair)]: this looks like it was making it consistent with the previous panel. And we had questions about whether or not that was going to be sufficient assistance, and whether or not we should be making the previous panel be consistent with this one.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Lauren Lehman, General Counsel, Department of Health. Have concerns with the legal advice in particular to committees that are not under the authority of the department, because when our client as the lawyer there, and there are ethical obligations to clients the department. And so if the committee's interests are different than the department's interests, it's difficult to know, I don't want to provide them with bias advice for my client with bias advice. So it's, it worked to represent two sides of the coin. So providing legal assistance to these committees both generally is a challenge that we've had to navigate. So I'm hesitant to, so given the opportunity to remove one of those concerns, that's what we were getting there.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Seems to me that because you're an advisory committee, I'm not clear why legal assistance is really needed. I mean, they make a recommendation of some that's not legal or not within their authority, then the department's attorney is going to say well this one is not

[Rep. Theresa Wood (Chair)]: with the We'll advise the commissioner.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Right, we'll advise the commissioner.

[Rep. Theresa Wood (Chair)]: So I don't, it doesn't seem to me, I think they probably do need technical assistance but So I understand the argument. Let me pose a question, sort of a hypothetical. So if the group asked for an interpretation of something that's written on the federal level, is that something that would be provided? Would that be considered technical? If they're just looking for, the words up on the page and they want to know exactly what those mean from a legal perspective.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: In that situation, I would likely speak with my client who's a member of the board or a member of the committee, and then they could share their understanding of it and walk through, so it's not constituting legal advice.

[Rep. Theresa Wood (Chair)]: So not you delivering it.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: The internet is not doing legal advice. And and they know the committee then knows it's not coming from a lawyer. They're not interpreting it as legal advice. I think the situations where legal advice is needed often is in open meeting laws and public records forms. And in those situations, what we've done so far is to provide overall guidance. And then of course, we handle the administrative functions. So we make sure that the notice is provided, that there's open meeting access, recordings are provided. So that's how we've handled that in the past.

[Rep. Theresa Wood (Chair)]: Okay, so what about if we compromise and put in both places administrative and technical?

[Lauren Lehman (General Counsel, Vermont Department of Health)]: I would be fine with that.

[Rep. Theresa Wood (Chair)]: Okay, let's do that, Katie. And I think we're going be putting back in, but no less than once per year. Yeah. Why have it if you're not going to meet?

[Rep. Doug Bishop (Member)]: Yeah. I I wonder if it speaks to that. I don't know anything about the council, but looking at the website, there's currently only four members, which didn't seem to be a full complement of what the statute is. So I guess it's it's has not been particularly active, but we are asking something very different now. Exactly. Want it to be active.

[Rep. Theresa Wood (Chair)]: It hasn't had to be active in the more recent past or distant past. So elected chair from his membership, constitutes quorum. I don't know if somebody's gonna raise the issue of payment. I mean, all of these people are in professional positions.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: A lot of times it's specifically when it says payment, it says payment to any member who is not in the capacity of their

[Rep. Anne B. Donahue (Ranking Member)]: That's usually people lived experience.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Yeah, I think there's anyone there that's been unpaid in their job in terms of participating.

[Rep. Theresa Wood (Chair)]: Katie, do you think we need to

[Katie (Legislative Counsel)]: add anything? Given this list and the fact that it's all professional people, I don't feel strongly about adding it and it's operated without it for a long time. But it's a policy decision or we might get over to DevOps and they might

[Rep. Theresa Wood (Chair)]: Well, that's kind of what I was thinking, although John Ganon is not there anymore. He

[Rep. Brenda Steady (Member)]: was always a nitpicker. My first year If I'm all pure.

[Rep. Theresa Wood (Chair)]: Yeah. I know. So

[Rep. Brenda Steady (Member)]: yeah. From past boards I've been on when there's a lot of membership where it says the council shall select a chair from among its members, do you think with such a large amount, it'd be better if the commissioner pick the chair? Because it's going to be harder. And they all don't know each other, but the commissioner would know more what each brings to the table. Just thought it.

[Rep. Theresa Wood (Chair)]: Yeah, I mean, it's an interesting thought. But generally in these kinds of councils, there will be somebody who kind of comes forth as a leader of the group. And I think that that's you know, sometimes we say the commissioner shall call the first meeting or something like that. Yep. But this is a this is an existing. It's not a new one. So I I think it's better to leave it.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: And then well, in this case, because its function is to advise the commissioner, many advisory councils

[Rep. Brenda Steady (Member)]: Oh, correct.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Doing something different. Yeah.

[Rep. Theresa Wood (Chair)]: Now they have that

[Rep. Golrang "Rey" Garofano (Vice Chair)]: commissioner then. So but then

[Rep. Brenda Steady (Member)]: that brings me to this. The council shall convene at the call of the commissioner, and you took out the time.

[Rep. Anne B. Donahue (Ranking Member)]: We were just having Oh,

[Rep. Brenda Steady (Member)]: you did. That's what I missed. And I'm thinking, how are they gonna pick a chair when he might not call a meeting?

[Rep. Theresa Wood (Chair)]: Well, no. We said

[Rep. Brenda Steady (Member)]: Oh, you did want it back in. I was hoping for that.

[Rep. Theresa Wood (Chair)]: Yeah. We just did just a second ago.

[Katie (Legislative Counsel)]: I missed it. Thank you. There be any point in excluding the commissioner from being the chair since the purpose of the commission is his Yeah.

[Rep. Theresa Wood (Chair)]: Would that would make sense. Right.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: But

[Rep. Theresa Wood (Chair)]: but we're not done.

[Katie (Legislative Counsel)]: Yeah.

[Rep. Theresa Wood (Chair)]: Okay. And now we're moving into other policy in the financial regulation area, and we will be having somebody from DFR. Yes. Okay, good. Yes. They've been actually following along. They on our feed on Tuesday when we took testimony. So the change here is that we're referencing it back to the statute that we were just amending instead of listing. As defined. As defined. So it's not only the CDC, it's the CDC or the commissioner. Okay. Okay?

[Rep. Doug Bishop (Member)]: Does it say the CDC or the commissioner, or is it just the

[Rep. Theresa Wood (Chair)]: As defined in eleven thirty, which is Which is CDC and commit the commissioner is considering that. Yes. And then this is under the next thing is under insurance health benefit plans. Again, saying that these are covered services. Shall not impose any co payment, coinsurance or deductible. And that's what is current law. So again, we're just changing the language, say, as defined in eleventhirty. And we do want to change the effective date to effective upon passage.

[Katie (Legislative Counsel)]: If you'd like to look at that OPR language, I can pull up my

[Rep. Theresa Wood (Chair)]: draft. That would be great. So there's a current bill, the Miscellaneous Office of Professional Regulation bill that is in government ops that they took the pieces that are relevant to this bill and is moving them into this bill.

[Katie (Legislative Counsel)]: Okay. So this is an unedited draft. We have highlighting because I highlight all the changes between the drafts. So these are two sections that I dropped in from the OPR bill and renumbered. First, clinical pharmacy and prescribing. Can get rid the Yeah. I was thinking, can I get rid of this thing? And then you can also get out there. Is that helpful? Okay. Pharmacists may prescribe in the following context. And we have the state protocol. A pharmacist may prescribe, order, or administer in a manner consistent with valid state protocols that are approved by the Commissioner of Health after consultation with the Director of Professional Regulation and the Board and the ability for public comment. We have a whole list. Opioid antagonists, epinephrine.

[Rep. Theresa Wood (Chair)]: Those are all current statute.

[Katie (Legislative Counsel)]: Yes. Thank you. Dietary fluoride supplements, that's current statute. And then in Roman numeral seven, immunizations for patients 18 years of age or older. I should say that this had said vaccines in the OPR version and to be consistent with the language change that the health department brought, I changed it to immunizations. And same thing in Roman numeral VIII. For patients five years of age or older, influenza, immunization, COVID-nineteen immunization and subsequent formulations or combination products thereof.

[Rep. Theresa Wood (Chair)]: And we have similar language in seven. Oops. Can I ask a question? Why are we being specific about the vaccine fair, not saying as recommended? That's

[Katie (Legislative Counsel)]: probably an OPR question. Okay. Well, one, weren't working with the definition of recommended immunizations in their bill. Immunizations. Guess you could just say recommended immunizations as defined in.

[Rep. Theresa Wood (Chair)]: Right, and you wouldn't need seven and eight. Yep.

[Katie (Legislative Counsel)]: Well, for patients five and older. So an 80, it's limited to the number of immunizations. So I'm not sure why they're specifically calling those out.

[Rep. Theresa Wood (Chair)]: Okay, all right, we'll ask them. For

[Katie (Legislative Counsel)]: seven, though, couldn't it say as recommended? You could say recommended immunizations as defined in '18 BSA eleven thirty for patients 18 years of age or older. Or if there is no need to call out specific immunizations for patients five years of age or older, then you could just have seven and get rid of the age reference and 18 and just say recommended immunizations. And that brings in the whole schedule.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Yeah, because the recommendations are gonna divvy up among agents.

[Rep. Theresa Wood (Chair)]: Right. And there may be reasons that have been agreed to previously about what pharmacists are willing to do. And it might be limited to those. I don't know. There might be

[Katie (Legislative Counsel)]: a reason. I haven't had any conversations with OPR about this language. We're going hear from

[Rep. Theresa Wood (Chair)]: the head of the pharmacy board or whatever they're called as well. Something like that. Are they coming that person coming with OPR? I think she told me that. Okay.

[Katie (Legislative Counsel)]: The next section is fairly similar. It says pharmacy technicians qualifications for registration. Pharmacy technician shall only administer immunizations to patients 18 years of age or older.

[Rep. Theresa Wood (Chair)]: What is that division reference to? What we just

[Katie (Legislative Counsel)]: were I'll talking just take a look. As established in '18. I'll take a look. And the resulting state protocol subdivision two to patients five years of age or older. And then it's the same three listed out. And there's language pursuant to the schedules recommended by the CDC. So that is the proposal is to remove that because recommended immunizations, if you choose to use that word, pulls in the whole consultation process. And then when a licensed pharmacist who is trained to immunize is present and able to assist. And then Subdivision D is proposed to be removed. Pharmacy technician shall administer only those immunizations that are recommended by the CDC's Advisory Committee on Immunization Practices, and licensed pharmacists are permitted to administer under the state clinical pharmacy protocol as established in Subdivision 20 twenty three(two). So I'll have to look at what 20 twenty three(two). Okay.

[Rep. Theresa Wood (Chair)]: So we'll save our questions on why they made the choices that they made until they come in. Okay. And then so I think that on Thursday morning Yes. Oh, it's the Blue Cross Blue Shield pharmacy director. Lori, would Okay. The you the lady from OPR if she wants to bring the board of person? It's just crunching my head. Oh, so on Thursday morning now, Katie, it's gonna be on your schedule for judiciary. Oh, okay. And I believe it's gonna be Wednesday morning or Wednesday sometime in health care.

[Katie (Legislative Counsel)]: Okay. That has popped up on my calendar earlier. And

[Rep. Theresa Wood (Chair)]: so we're still going to look to vote this out next week, probably towards the end of the week, after we get any feedback from those folks. I I heard from the chair, although he might after looking at it, he might want to take a look at it, I don't, of GovOps. He he might do a quick run through of that section that we were just looking at.

[Katie (Legislative Counsel)]: So

[Rep. Theresa Wood (Chair)]: this is what happens when you have bill that touches Different. Yes. Other committees in different parts of the statute. So Anybody else have any questions about what we just did? Okay, guess we're good Katie, I think That's great. Thank you. It. So are we like Tuesday morning, maybe? Or Tuesday afternoon?

[Lauren Lehman (General Counsel, Vermont Department of Health)]: I think we'll have a draft by Tuesday morning.

[Rep. Theresa Wood (Chair)]: Okay. Great. And we have you scheduled at some point. Perfect. Won't remember exactly what day it is. Okay. Okay. So let me find the draft agenda. There.

[Rep. Anne B. Donahue (Ranking Member)]: Oh, oh, while we're still on this subject, I just wanted I had brought up around trying to come up with a way to make sure that people have access to vaccines as part of why we're talking about them. And I actually wanted to know I've met with the health department, and we're gonna have some discussions with Dale around how there may be greater access or we come up with ways to access at senior centers and meal sites and just people that maybe want a vaccine, but really hard for them around transportation So or we're gonna talk. And I'll report back, and it'll be at some point.

[Rep. Brenda Steady (Member)]: For COVID, mean, right at our shelter, and it was often for some folks their first time, just being able to access and having that kind of coming to people.

[Rep. Theresa Wood (Chair)]: We had a lot more resources during

[Rep. Brenda Steady (Member)]: Oh, the no, I understand. But those kind of points where you've got lots, you can reach a high volume of people.

[Rep. Theresa Wood (Chair)]: It could the local pharmacist that might come do

[Rep. Brenda Steady (Member)]: it. That's right.

[Rep. Anne B. Donahue (Ranking Member)]: And so we're gonna we'll talk. Great.

[Rep. Theresa Wood (Chair)]: Thanks for following up on that, Anne. Okay. Just to review what's up on schedule for next week. So we'll be taking this up again after caucuses and lunch on Tuesday. That's when we're going to be hearing from the Office of Professional Regulation. We're going to be hearing from the Department of Financial Regulation. We'll be hearing from the health insurer folks, MVP, Blue Cross Blue Shield. And then we are going to be doing H534, a walkthrough. This is a pretty simple bill. When you see the language, if you want to take a look at it over the weekend, you'll recognize it from H91. It is the very last section of H91. Well, next to the last section, I guess, after effective dates. It has to do with just the makeup of the boards and what community action agencies are called in statute. A housekeeping thing. There's no money. There's no anything like that.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: We discovered the housekeeping was needed last year. We discovered it in

[Rep. Theresa Wood (Chair)]: the office. We were like, why are they called this in statute when that's not what we call them? So that is going to be a really simple one. And we're only going to take testimony from the community action agencies and from the state, the department, because they're really the only two people or entities involved in that. And and we'll be voting that one out next week as well.

[Rep. Brenda Steady (Member)]: Is it?

[Rep. Theresa Wood (Chair)]: I don't know yet. And then we're gonna be doing a walk through and start to be taking testimony on h five ninety four. That's Eric's bill on our homelessness issues. So stay tuned. We don't have a witness list for that yet, but we will before we get to Thursday. And then we're having a joint hearing with the health care committee on Act 119 of 2024. There is a report in our report section that you should read before we get to that hearing. This is on the reimagining of the agency of human services, something they have been working on in terms of a process. This was something senator Kitchell had put in place before she retired. And so we will be doing that on Thursday. And then Friday, we'll hearing from additional witnesses, but we don't have them yet.

[Rep. Golrang "Rey" Garofano (Vice Chair)]: Plus some bill books in there, of course, of the schedule.

[Rep. Theresa Wood (Chair)]: Yes. Yes. And Our budget BAA. Our BA right. We'll be reviewing the BAA memo on Tuesday, and I'm gonna be testifying in house appropriations on Thursday afternoon around our recommendations. So that's what next week looks like. And as you can see, we kind of got sections up there and the ones all the way to the right are bills that we passed out last year. The ones just to the left of that, H five thirty four, five forty five, five ninety four, and 91, those are all bills that we're working on in process or will be over the next couple of weeks. And then, we will take a look at, hopefully by the end of next week, we've received the biggest chunk of what we're going to be getting. We'll see if we have any more room left on the board. And we'll be looking also at some of the reports that we have coming in. And then, of course, by the week after, the governor's budget will have been released, and we will be starting budget work and testimony on budget work and the teamwork that people are going to do. So we got childcare coming up and we got recovery housing coming up from the Senate. And we have some DCF child welfare stuff coming up. So we're going to have, as I said earlier this week, a busy session. So hopefully the first week wasn't too stressful for folks and we'll be back at it again on Tuesday. But for now, you get to do constituent work.