Vermont Legislature SmartTranscripts:

[Theresa Wood, Chair]: Okay. Welcome back, folks. We are shifting gears here now in to h five 34, which is an act relating to community action agencies. Katie's gonna walk us through the bill, but I just wanna refresh everyone's memories. In H91, there was a section about some updates to statute with regard to community action agencies, one being what they're called and updating that and some other things. And so the Community Action Agency Network asked if we could proceed with some of those changes, even though H91 did not pass. Well, passed, but then it was vetoed. And so this is a separate standalone bill. It should be I hesitate to say it out loud because it always jinxes it, but it should be relatively noncontroversial. So I'm going to put out there to anybody who has not done a bill report yet, if you are interested in doing a bill report on the floor, to come see me. This might be your bill. Katie. Thank you. Good afternoon. Katie McLean, Office of Legislative Counsel.

[Katie McLean, Office of Legislative Counsel]: Let me pull up the draft. Okay, here it is. Excuse me. H534. This language was plotted directly from h 90 1. Trying to refresh your memory a little bit about what's in this. So the big thing is that the term community service agencies is used throughout the chapter, and this changes it to community action agencies. There's some antiquated language that has been cleaned up, and there's a little bit of language at the end about the terms for people serving on the boards for the community action agencies. So we'll go through all of that. So this is three BSA chapter 59. The first section is thirty nine zero one, and the name of the chapter itself is changing from community service agencies to community action agencies as proposed here. First, finding some purpose, recognizing that the economic and well-being of social and social equity of every Vermonter has long been fundamental concern of the state. It remains evident that a substantial number of Vermont's population continues to experience poverty, replacing, It remains evident that poverty continues to be the lot of a substantial number of Vermont's population.

[Theresa Wood, Chair]: I still have a hard time believing that a lawyer would have put that statue, but must have been a long time ago. I don't know.

[Katie McLean, Office of Legislative Counsel]: Yeah. Subsection B, it's the purpose of this chapter to strengthen, supplement and coordinate efforts that further this policy through, skipping ahead subdivision two, the better organization and utilization of a range of services related to the needs of individuals with low income instead of the poor. Similarly, in three, the broadening of the resource base of programs to secure a more active role in assisting individuals with low income from business, labor and other groups from the private sector. That brings us to Section 3,902, Office of Economic Opportunity. In subsection A, we're changing community service agencies to community action agencies. Same change in subsection b. Have it twice there. And then at the bottom of that subdivision, we have language components of those services and activities may involve without limitation of other activities and supporting facilities designed to assist participants with low income instead of low income participants so that it's person first. And then we have a list. Skipping down to Subdivision 4, have access to safe, secure and permanent housing instead of to provide and maintain adequate housing in a suitable living environment. And in Subdivision 5, to obtain prevention, intervention, treatment and recovery services for individuals with substance use disorder instead of to obtain services for the prevention of narcotics addiction, alcoholism, and for the rehabilitation of narcotic addicts and alcoholics. And Subdivision 0, we've added an and. So in conjunction to this list between nine and ten. And then at the top of page four, to coordinate and establish linkages between governmental and other social service programs to ensure the effective delivery of such services to persons with low income against again, person first. And then that brings us to section thirty nine zero three. We're crossing out on that line ten and eleven, the version of community based that isn't hyphenated and replacing it with a hyphenated version. So the director shall designate a private non part nonprofit community based organization organizations that have demonstrated or that can demonstrate the ability to provide services and activities as defined in 3902 as community action instead of community service agencies. And section 3,904, striking services for action again, community action agency plan. Each designated community action instead of service agency shall determine the need for activities and services. Gonna skip ahead. Here is a substantive change. Top of page five, community services plan shall be completed every three years and updated annually. And I believe the testimony that you heard last year was that was consistent with what was already required that it was completed every three years. But you might wanna confirm that I'm remembering that correctly. 3905, again, a change to the title, Community Action Agencies instead of Services.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Subsection a, again, updating community action agency instead of community service agency. Subsection b, line a, the same change to the hyphenated version of community based. And on line nine, changing from community service to community action agency.

[Katie McLean, Office of Legislative Counsel]: This language is governing the board of each community action agency. So in subdivision two, you

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: have

[Katie McLean, Office of Legislative Counsel]: language that one third of the members of the board or persons chosen in accordance with the election procedures adequate to ensure that they are representative of individuals with low income in the area served instead of the poor. I'll skip over three. In subdivision subsection c, each member of a board selected to represent a specific geographic area within a community shall reside in the area that the member represents. Striking language that no person selected shall serve on the board for more than five consecutive years or more than a total of ten years. And instead replacing that with each board shall adopt term limits to govern its members. So less prescriptive, and then you have an effective date of 07/01/1926.

[Theresa Wood, Chair]: Great. Are there any questions about what Katie is just it's just keeps going down to Zon. It's just Zon. Any questions about that? That essentially is, as Katie said, what we had taken testimony on last year. We're gonna hear some testimony today. But to be clear, we're not gonna take a, a gazillion The two entities involved are the community action agencies themselves and the Office of Economic Opportunity. So that's who we're going to hear from. Any questions for Katie?

[Unidentified Committee Member]: Great. So, go ahead, represent Steady. So, understand. So, we're just basically changing community services to community action.

[Katie McLean, Office of Legislative Counsel]: Basic action agency, that's the big change. There are some phrases that are being updated and then allowing the boards to set their own terms instead of

[Unidentified Committee Member]: being prescriptive. So otherwise, really no big changes.

[Theresa Wood, Chair]: I know. Depends how you can set up picture of what you're That is difficult for-

[Katie McLean, Office of Legislative Counsel]: Yes, I just- Yeah, no, I'm

[Theresa Wood, Chair]: just saying it's a question that requires a judgment.

[Katie McLean, Office of Legislative Counsel]: Oh, so care what? So there's really no big changes.

[Unidentified Committee Member]: What would I need to know as a new person doing this?

[Theresa Wood, Chair]: One, we've taken a lot of testimony about this community action agencies last year. And I understand that. Two, that it's basically changing the name in statute to be consistent with what we've said. It's changing outdated language like the poor to individuals with low income, things like that. And it's enabling the board to adopt term limits to govern its members. Sounds simple to me. And I think that the annual plan we'll hear from Lily in a minute, but I think that is already, I think that's already I think I've recalled the same thing that you did, Katie, that they were doing every three years and updated annually already. So that's just putting that in here. So thanks. You're welcome. Any other questions? Dan? Nope. Okay, great.

[Unidentified Committee Member]: Oh, I had one just.

[Theresa Wood, Chair]: Oh, I'm sorry. Didn't see that.

[Unidentified Committee Member]: Yeah, no problem. This language over or how this is developed? Will this end up to an extent, serpent seeding the authority of the already established designated agencies within substance abuse, mental health or no? Okay. Not at all. You understand where I'm going with that?

[Theresa Wood, Chair]: Yes. Yeah. No.

[Unidentified Committee Member]: So it doesn't change the designation. It's just changing the name, but it doesn't have any authority or changing any type of the designation of

[Theresa Wood, Chair]: No, you're talking about the preferred providers from If

[Unidentified Committee Member]: we county has a designated house Like, how many provider or designated

[Theresa Wood, Chair]: It doesn't change any of that. No change to any of that. No. It just says that community action agencies will continue to do what they've been doing, which is providing supports and services to people of low income, trying to help them with any variety of issues that they have. And that also means working with. That's why it says working with other community based organizations. Yeah.

[Unidentified Committee Member]: I just didn't wanna see there might be some confusion that gets on out there where one circumcised the other.

[Theresa Wood, Chair]: Yeah. It does not. But we can we can we can verify that with our witnesses. Thank you, Katie. And Josh is online. Hi, Josh. Thank you for being here this afternoon. Appreciate your willingness to talk to this from the perspective of the Community Action Agency.

[Joshua Davis, Executive Director, SEVCA (representing Vermont Community Action Partnership)]: Thank you so much for having me.

[Theresa Wood, Chair]: The floor is yours.

[Joshua Davis, Executive Director, SEVCA (representing Vermont Community Action Partnership)]: Thank you very much. And so as you're discussing, we feel that this is, well, first of all, I'll say my name is Joshua Davis. I am the executive director of SEVCA, Southeastern Vermont Community Action. And I'm here also representing Vermont Community Action Partnership, VCAP. I'm pleased to share that VCAP is unanimously in favor of the changes that are proposed here. We've vetted this a number of different times last year as we were going through the process for H91. Nothing has really changed since then. As you were discussing, I was listening in, key updates are around terminology, community service agencies to community action agencies, people first language. There's just an outdated language that we've updated to reflect people first framing, clarifying planning expectations. That's the piece on page five. I can say from my perspective that this is consistent with what is required from OEO, but you're also going to hear from OEO to confirm that. And the biggest thing on here is around the board term limit provisions, where we're just seeking to have that be set by the community action agencies themselves, as opposed to being in statute in terms of a maximum of ten years. Also, way that the language previously read around board terms was that it's capped at ten years, but you can only serve consecutively five. And so there is an odd thing that has happened in the past where a board member will serve five, have to go off the board for a period of time, come back onto the board to reach that collective ten year term limit. So we feel that's awkward and really should set board term limits through our bylaws, flippantly. And that's it. So I really appreciate your consideration and happy to answer any questions you may have.

[Theresa Wood, Chair]: Thank you. I appreciate that. And my experience with bylaws of nonprofit organizations is that term limits are and method for electing boards of director and things like that are contained in the bylaws. So that seems totally appropriate. Yeah.

[Joshua Davis, Executive Director, SEVCA (representing Vermont Community Action Partnership)]: I wanna underscore that we are absolutely in favor of term limits. So this is not saying that we are asking for members for life, but that they just be set at a local level.

[Theresa Wood, Chair]: Thank you. Questions for Josh? We appreciate hearing from the Southeastern part of the state and are glad to have you here this afternoon, Josh. Thank you very much.

[Joshua Davis, Executive Director, SEVCA (representing Vermont Community Action Partnership)]: Thank you very much.

[Theresa Wood, Chair]: And will you stay online just in case there happens to be a question pop up?

[Joshua Davis, Executive Director, SEVCA (representing Vermont Community Action Partnership)]: I'm happy to stay online. Yeah, can. Thank you.

[Theresa Wood, Chair]: Thank you. Okay, next we're going to hear from Lily Sojourner, who is the director of the Office of Economic Opportunity. First time back, won't be the only time, but we're just So gonna back this welcome back, Lily.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Thank you so much. It's nice to see everyone and happy to be here to talk about this. I also hope that this will be pretty straightforward. And I've been knocking on wood every time I've said that. I'm Lily Sojourner, the director of the Office of Economic Opportunity within the Department for Children and Families. I echo Katie and Josh. I think the majority of this is really technical, small language fixes. I do think there are two sections that I want to raise that are not necessarily requiring changes, but I just want to fully talk about a nuance. I think that they are not exclusionary of other practices, but I just wanted to make sure folks had a shared understanding. So the top of I think it's maybe the bottom of page four and the top of page five when we're talking about the community action plan. The three year requirement has to do with a community needs assessment. And last year, we were talking about linking that to a larger regional plan every three years. The community action agencies do have to submit an annual work plan. So again, I think that this language is fine. I think the fact that it references that the plan is updated annually works. I just wanted to clarify that, again, specifically the community needs assessment is happening every three years. If the community action agencies, per this, want to do a larger plan every three years and then update it every year when we do our work plan request, I think that functionally can work. I just wanted to share that. And we are also required to do an annual update to DOCSIS Community Services federally on our plan and priorities for the state. So that was an area where, again, I don't think it's exclusionary. I think there's a little nuance there and just wanted to make sure folks had a shared understanding. And then also on that page, when talking about the board and the composition of the board, again, I don't think this they exclude each other, but it is a little bit more nuanced, where it is a minimum of onethree of the membership must be representative of individuals with low incomes. Onethree is elected officials, and then the remainder is the larger group. Again, I

[Theresa Wood, Chair]: think the way this is worded I wouldn't mind inserting a minimum of onethree.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Okay. And then again, I don't know if we want to, again, call out specifically onethree of elected officials or just acknowledge because, again, the way it's written for number three, it says major groups are interested in the community. So again, depending on how specific folks would like to be, those are just some of the areas that, again, I don't think anything is in conflict, but just the potential for clarity if the committee and the community action agencies are interested. I also do plan to be here tomorrow morning. I believe this is on your schedule tomorrow morning so that if there are questions tomorrow as well

[Theresa Wood, Chair]: So can I ask a question on number three? So that's current law. Nobody's suggesting any change to that. Are you saying that there would be a better way to say that? Are you suggesting a better way to say that?

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: If folks were interested in mirroring the federal language, it would be a minimum of onethree represent those who are low income. Got that part. Onethree are elected officials or their representatives. And then the remaining board are those from those other business industry and so on? When you say

[Theresa Wood, Chair]: elected officials, I'm not clear what that means.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: That could be select board members, state representatives, folks from the community who, again, are filling some type of public service role and either are on the board or have a designee on the board.

[Theresa Wood, Chair]: So that's current federal rule or regulation?

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Yeah. And I don't know if when this was written, it was just felt that that would fall under what is remained remaining old enough that

[Theresa Wood, Chair]: this could have been what was current at the time. Right. And so I'm fine with making it current. Okay. Is current? Yeah. Okay. Great. But we need suggested language if

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: you could Yeah. Can

[Theresa Wood, Chair]: about that.

[Katie McLean, Office of Legislative Counsel]: So just wanna make, sorry,

[Theresa Wood, Chair]: didn't draw it.

[Katie McLean, Office of Legislative Counsel]: The ellipses on line 13, everybody is recognizing that there's language that is currently in statute that's not there, and that language is one third of the members of the

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: board are elected public officials. Okay, already there. Okay. If you wanna see it, I can pull

[Unidentified Committee Member]: it up.

[Theresa Wood, Chair]: I believe you. Okay.

[Sandy Reider, MD]: Okay,

[Theresa Wood, Chair]: so it already has one third are elected officials. Thank you for highlighting that. So Katie, I do wish to make a change then. I wish to make what is listed as number two, number one. And then number two, just flip those two. Because these agencies exist for the benefit of the people, and so they should be the first ones listed. And again, if

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: and I could send the language, but have it as a minimum of one third as opposed

[Theresa Wood, Chair]: to Yeah, minimum is fine. And is that for both?

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: No, it's just Just members of Okay. Low

[Unidentified Committee Member]: Yes,

[Katie McLean, Office of Legislative Counsel]: go ahead, Rex.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Thanks really. Can we go back to the plan?

[Theresa Wood, Chair]: I just Before want to we do that, just want make sure. Are there any other comments, Lily, that you have about the membership? No, thank you. And thank you. Okay. Are there any other questions? And Josh, I'm just checking in with you. You okay with those changes that we're proposing?

[Joshua Davis, Executive Director, SEVCA (representing Vermont Community Action Partnership)]: Absolutely. These are all consistent with how we operate. So, yeah.

[Theresa Wood, Chair]: Okay. Thank you. Yeah, that's okay. I just wanted to summarize.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: So I just want to make sure I'm understanding. So currently, the CAHPS are preparing or developing, completing a needs assessment every three years. So the language here would then be a change, because we're asking them I do think it's a slight change, because right now they do a needs assessment at least every three years. And then every year, as part of our annual plan process, we ask for a work plan. They do have to reference that needs assessment in their work plan. So in some ways, this layers on potentially another requirement to have maybe a larger requirement, this larger plan every I two think depending on how an agency operationalizes it, it may not be significant more work. I'm not sure that it's necessary. I think that's up to the group. And I don't know if Josh has thoughts. Again, I think the thought last year was that because they were doing the larger needs assessment every three years, there would be a new larger plan every three years. And then because at the time, we had talked about also writing certain housing data that they would look at. Started to fill another function. But then either way, we need an annual work plan from the agencies.

[Theresa Wood, Chair]: Maybe should we just address the annual work plan here?

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: That's what I'm wondering. I think that can simplify things. And I I mean, I would defer to to the caps depending if if for some reason they are interested in doing this every three years. I guess

[Theresa Wood, Chair]: and we don't know how any of our housing slash homelessness bill is gonna end up. We don't know who who will have that responsibility for overall somebody's gonna have the responsibility. I can guarantee that. But we don't know who is gonna have that responsibility. So, Joshua, would you be okay if we just change that to the work plan or whatever it's called? I I wanna make sure you all are using the same terminology or the terminology that is required.

[Joshua Davis, Executive Director, SEVCA (representing Vermont Community Action Partnership)]: Yes, I would be definitely okay with that if we just say that it's the annual work plan. That's consistent with the work that we're doing and what our requirements are. And I appreciate that, Lily, as my ensuring that we stay up to date on everything has given me the choice of what we are able to complete in that. But yeah, that would be consistent language.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: So we're going to remove the three years and just reference the annual work Katie,

[Theresa Wood, Chair]: do you have that? Or language that Lily will help you with?

[Katie McLean, Office of Legislative Counsel]: I think what we're doing on line 17 of page four and line one of page five community services and replacing it at work or camp. I

[Theresa Wood, Chair]: just want make sure that we use the right terminology. Could I

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: take a look after and follow-up with Josh and others? I think it has a couple similar to community action agency or community action program, there's a few different options, and so I'll just circulate some choices. Okay. And if work you with

[Theresa Wood, Chair]: Katie on draft language that can be reviewed tomorrow morning, that would be great. We have Representative Eastes and then Representative Bishop.

[Unidentified Committee Member]: So my question would be, do we need this section at all? Mean, it's already required by you, does it need to be in statute? It sounds like a federal requirement, the annual requirement for this work. I miss it? Did I

[Theresa Wood, Chair]: If somehow it became not to be an annual requirement, then we would want it still.

[Unidentified Committee Member]: I see.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: And I think there is also the expectation that the work of the community action agencies is in statute.

[Unidentified Committee Member]: Okay. I don't want to undo that part. If she's saying it's already sent somewhere else, then yeah. Okay. Representative Bishop. My question relates to the community needs assessment. We've been talking about that, but that's not referenced here. Is that part of federal requirements or where does that live, if you will?

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: That is part of federal requirements along with a number of other things that are administered by the Office of Community Services and then the state. So I think it's striking the right balance of what needs to be in. I think primarily looking at this as an update seems to be appropriate as opposed to adding in too many of the other pieces. I think it's a relevant question, though. And

[Theresa Wood, Chair]: it might be question number two for Representative Bishop. If you're doing an annual work plan, what's that work plan based on? You know, based on a needs assessment. Yeah. And and so I I guess what I would love to have you do, Lily, if you could work with Katie and Josh, you too, to come up with language that doesn't expand what it is that community action agencies are doing, but accurately reflects it in as concise a way as possible.

[Unidentified Committee Member]: And maybe reflects the pieces that we wanted to share exist if there were changes at the federal level. It could be a through z at the federal level, but if we're interested in community assessments in an annual work plan, it may be worth We want the

[Theresa Wood, Chair]: work plan to be based upon the needs of the community. So I think it is relevant to reference the needs assessment, even though it's not referenced here now. Mhmm. We can take the opportunity to not only update it, but make it better. Existing language. Other thoughts, Lily? No, thank you. Okay. Just to summarize this last piece of conversation that we just had. So the community services, it might say, needs assessment and action plan. I don't know. The title will have to change, Katie. So Lily and Josh and Katie will work on updated language that reflects the current federal requirements in as concise a way as possible that connects the needs assessment with the annual work plan. Is that what everybody thinks they're doing? Okay. And then we will update the next draft to have a minimum of one third. So we're adding minimum of one third members of the board, A person's chosen with low income, that will be number one. Number two will be the elected officials. And then number three will be the remainder of the board. Those are the changes that we've just talked about. Okay. Any other questions for Lily? Okay, that's great. Thank you, Lily. Thank you, Josh. And thank you, Katie.

[Sandy Reider, MD]: Thank you. Okay,

[Theresa Wood, Chair]: Shell has been patiently waiting here all afternoon. And your bonus for waiting all afternoon is you get to come on seven minutes early.

[Unidentified Committee Member]: I'm going to message my cohort who is coming out

[Theresa Wood, Chair]: remotely real quick. Oh, okay, great. Is that Betsy? Yes. Yes, okay. While that's happening, members, we are going to look at tomorrow to see the next draft of this and then potentially vote on this tomorrow. So as I said earlier, anybody who has not presented a bill who might want to present one, that's fairly straightforward. I'm happy to talk to you. You can see me at the end of the day. Or if there's anybody who is, like, hot to trot, really want to talk about this bill on the floor, you can also chat with me. There's no preassigned individual. I introduced the bill, but it was just at the request of the community action agency. So just let me know, okay? And if nobody volunteers, then I'll volunteer somebody. Nobody volunteers.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Happy to

[Theresa Wood, Chair]: be here.

[Unidentified Committee Member]: Me as well.

[Theresa Wood, Chair]: Okay, thank you. I just wanted to make sure that people Yeah,

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: I wanna give other folks

[Theresa Wood, Chair]: People who haven't done a bill before can be a little This nerve is a good one to kind of wet your feet. Something. I think that's the right analogy, but whatever it is. Don't think wet your feet is. Put your toes in the water. Thank you. Can we wait for your counterpart? This is our annual reports prepared for the House Human Services evening. Hi, luck. It's Betsy. Okay, great. Welcome. Thank you. Michelle, you were here for the introductions. Welcome, Betsy. It's a pleasure to have you here this afternoon. And thank you for signing on a few minutes early. First, we were behind, then we were ahead, and now we're a little bit ahead again. So welcome. So committee, we are flipping back to H545, And we are going to hear from the nurses and the folks who have submitted recommendations around language change, around nursing profession being represented, as well as whatever else they want to testify about H545. So the floor is yours. Thank you. For the record, Michelle Wade, I'm

[Michelle Wade, President, Vermont Nurse Practitioners Association]: the president of the Vermont Nurse Practitioners Association. And thank you, Chair Wood and committee, for all of the work that you guys are doing on five forty five and the work that you're allowing, the amendments that are incoming. On behalf of the Vermont Nurse Practitioners Association, we do support the intent of this legislation, as did OPR today, as well as we are here to request the amendment of Section three on H545 to ensure representation from advanced practice registered nurses and nurses. It's really important and it's integral to Vermonters that nurses are at the table and advanced practice registered nurses are as well. We are the front line in many of the rural and underserved parts of the state. Often, APRNs are the primary and only health care provider delivering immunizations. Nursing is the front line delivering immunizations in the pediatricians' offices, and often asked frequently by parents when they're encountered in the schools where APNs work and nurses work about immunizations. So it's important that we are a part of this process across primary care practices, hospitals, schools, long term care facilities, public health clinics, and community settings. We are the clinicians who most often counsel these patients. We also administer the vaccines. We manage the safety and storage of the vaccines. We often order them, and we respond to patient concerns and complaints about them. We do do education around them. You heard about BIS earlier today. We do provide BIS paperwork. We also do provide informed consent. Despite this central role, nurses and nurse practitioners are not currently represented on the Immunization Advisory Council as it's presented currently, and we would like to ask for your blessing in the amendment to add nurses and nurse practitioners to that advisory committee. I did submit a longer version of the testimony, but this is the core of it. And I know you all have had a long day, so I don't want to reiterate what you can also read.

[Theresa Wood, Chair]: That's okay. We appreciate that. Well, I guess before I ask any questions, I'm just going to turn to Betsy and ask you to make your comments too. So then we can ask any questions of both of you.

[Betsy Hassan, American Nurses Association Vermont (Immediate Past President)]: Sure, thank you. So, hi, my name is Betsy Hassan. I am here representing the American Nurses Association Vermont Chapter. I'm the immediate past president, and I'm also a fellow in the American Academy of Nursing. So Chair Wood and members of the committee, thank you for having me here today and for your work on H545. This work really demonstrates your commitment to ensuring Vermonters have evidence based recommendations and plans for immunization. On behalf of the American Nurses Association Vermont, we support the intention of this legislation just as VNPA does, and we know that it will support healthcare providers, patients, and our communities. Respectfully, though, the American Nurses Association seeks for amendment to the composition of the Immunization Advisory Council stated in Section three membership. For healthcare providers, only physicians and specifically pediatricians and family internal medicine physicians are included on the council. This section fails to recognize the valuable role that advanced practice registered nurses and registered nurses have in the immunization infrastructure and the values that nursing paradigm promotes in holistically caring for our patients and families. Nurses now for just announced yesterday for the twenty fourth year in a row have been named the most honest and ethical of professions. This is incredibly beneficial as nurses have a unique role that aids patients in making decisions about their care and nurses can provide accurate non coercive information to ensure patients are making informed decisions about immunizations, Including advanced practice registered nurses and registered nurses on the Vermont Immunization Advisory Council will promote trust within our communities and provide the state immunization plan the benefits of nursing's knowledge and expertise. So for these reasons, the American Nurses Association of Vermont supports the proposed amendment that VNPA has offered to include nursing representation on the Vermont Immunization Advisory Council. Thank you.

[Theresa Wood, Chair]: Thank you. Okay. And we heard other testimony from the Office of Professional Regulation in support of having nurse and pharmacists represented, both who offer some professional availability to people who are seeking vaccines and immunizations. So my question is, so if we were to do that, we probably would not, I'll be honest, give two seats. So I am just wondering whether you're specific to APRNs. And I'm just wondering if we were to be that what you would want to see? If we were to give one nursing space, would it be APRN or would it be something broader?

[Betsy Hassan, American Nurses Association Vermont (Immediate Past President)]: I'll jump in, Michelle, because I'm the So yes, I would definitely support if there is one registered nursing or nursing role on the advisory council that it be an advanced practice registered nurse. I think that, you know, they are raised within the same paradigm. They're registered nurses as well. The benefits of having at least the APRN would, you know, be, I think, worthwhile for and the American Nurse Association would support.

[Theresa Wood, Chair]: Thank you. Questions for these witnesses? All right. I think you're pretty straightforward, and thank you for being

[Michelle Wade, President, Vermont Nurse Practitioners Association]: here all day. I appreciate it, Michelle. I appreciate you taking the time to hear us. Thank you very much.

[Sandy Reider, MD]: Of course.

[Katie McLean, Office of Legislative Counsel]: Thank you. Of course. Thanks, Betsy.

[Theresa Wood, Chair]: She's gone in a flash. Okay. Why don't we take up this issue right now so we can get feedback to Katie and she can get us straps back. Because this is one of the questions. If you look at the version 2.1 in our inboxes here, not inboxes, but on our webpage, you'll see that it says healthcare professional, which was something similar to that. Me just pull it right up so I'm not seeing it out of line. This is to the Vermont Immunization Advisory Council. So we do have the executive officer of Vermont Board of Nursing. So I just want to be clear. It's not that we don't have any nursing on here. So just to be clear. And the Executive Officer of the Vermont Board of Pharmacy. And I'm not sure people were responding or reacting to version 2.1 or version

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: one. Yes. Are both new changes.

[Theresa Wood, Chair]: These are new changes that we made, so they may not have been responding to that. People can take a look at page eight of version 2.1. I guess,

[Unidentified Committee Member]: can I ask

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: you a question?

[Theresa Wood, Chair]: Yeah, this is committee discussion right now.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: For number nine, are we now considering taking that out and then adding the APRN? Is that up for discussion? That's what I would be suggesting. Adding another seat, then just replace that because then we feel like we have a representative of the experts that are needed.

[Theresa Wood, Chair]: Yes. And then I guess I would ask people to think about whether we wanted the executive officer of the board of nursing and the executive officer of the board of pharmacy, or whether we would want the nurse or a pharmacist, which is what the Office of Professional Regulation is recommending.

[Sandy Reider, MD]: It seems like we'd

[Unidentified Committee Member]: be consistent with those others listed who are medical professionals by taking someone from the profession. We referenced practicing pediatrician in number eight, and then number 11, a family or internal medicine physician. Those aren't physicians from a board or an association, those are actual. So it would seem consistent to change it from what we have in this draft of the board of nursing and the board of pharmacy to actual practitioners. Not that these people may not be practitioners.

[Theresa Wood, Chair]: Yeah, go ahead, Dan.

[Unidentified Committee Member]: Well, and we also spoke that the or designee gives that option for that individual to assign someone who has the expertise, whether or not they would do it.

[Theresa Wood, Chair]: The question, so I'm just gonna call people's attention to line seven. So the board of medical practice, which is not I'm not sure if that's all physicians or not, to be perfectly honest. Do you understand what I'm trying to get at? So we got the Board of Medical Practice, the Board of Nursing, and the Board of Pharmacy. And then we have, down below, we have individual physicians. So I'm questioning, I'm just putting out there, is it a substitution or an addition? And I'm not sure why we would have some appointed by the governor and some not. Would it be the executive officer of the board of medical practice? So I have an answer. Yeah, that would Vermont be

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Board of Medical Practice, they're not all doctors. There's nine licensed physicians, MDs, one physician's assistant, one podiatrist, and six public members.

[Theresa Wood, Chair]: One podiatrist is a physician. So they're members of the public. Yeah.

[Unidentified Committee Member]: Do we know about composition of the board, nursing and We're

[Theresa Wood, Chair]: gonna point out in a minute.

[Unidentified Committee Member]: Representative Garofano, Google catch up.

[Theresa Wood, Chair]: Vermont Board of Nursing.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Six registered nurses, two LPNs, one nursing assistant, and two public members.

[Theresa Wood, Chair]: I'm sorry, what did you say? There's APRNs that sit on the

[Unidentified Committee Member]: board of nursing as well.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Yes, at least two of the six registered nurses must be APRNs.

[Theresa Wood, Chair]: Okay, and then, so again, they contain people other than nurses. And I'm going to presume the same is true for pharmacy, but we'll find out. I guess what I'm trying to do is that we have three professional boards that are listed, and then we have individual professionals who Five and two. Five and two. Okay. I think that what we do with one, we have to do with the other. I guess that is my I

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: guess my preference would be to say the actual expert, rather than leave it up to, it wouldn't be chance, I don't think, but to be explicit that we want a pharmacist or we want a nurse rather than a member of their board that could potentially be a member of the pandemic. Well, I

[Theresa Wood, Chair]: think that's the purpose of adding the language that the LPR is suggesting. In other words, if we left it as numbers one, two and three here, then we would be eliminating a practicing pediatrician and a family or internal medicine group. Do you understand what I'm So I'm going to suggest that we make these all equal. So we have, and I don't know if the executive officer, I'm not sure why we would have had a representative of Vermont Board of Medical Practice. I think we were talking about who designated and who is not.

[Joshua Davis, Executive Director, SEVCA (representing Vermont Community Action Partnership)]: So

[Theresa Wood, Chair]: I guess that's Are people okay, let's put it this way, with adding a specific seat for an advanced practice registered nurse and a pharmacist? A specific seat. Okay. Yeah. So I will tell Katie to incorporate the language from the office of the yeah. OPR. The OPR testimony. Okay. Would we

[Unidentified Committee Member]: keep the size of the board a little smaller and possibly change it so that Vermont Board of Nursing designates an APRN?

[Theresa Wood, Chair]: That's what Ray was sort of leaning towards, but if you do that, I'm not comfortable saying that's only for nurses and pharmacists. We would do the same thing for doctors. And that means we would eliminate pediatricians and internal medicine.

[Unidentified Committee Member]: Unless we have the Vermont Board of Medical Practice designate a pediatrician and a family practitioner.

[Theresa Wood, Chair]: Right now, you just look at the number of spots, you have the representative from the board of medical practice, you have a pediatrician and you have internal medicine. So they have three spots. That are MDs potentially. Yes. First one might not be an MD. I don't think it's a bad thing when we say represent the board of medical practice. They have informed members of the public. Members of the public are on those boards for a reason. So I don't think it's a bad thing that it leaves it open that it could be a member

[Unidentified Committee Member]: of the

[Theresa Wood, Chair]: public that's representing those. So I just am aware of trying to be equitable in the healthcare professionals representation. And I do understand the need for a pediatrician and a family practitioner. I get that, I guess. But I think if we're gonna have boards represented from those boards, then we either need to say that they're gonna serve in the role, or we're going to say, yes, you're gonna serve, but then we're also going to add people who are practicing.

[Unidentified Committee Member]: I think it's okay to include more people because if you look at what they're tasked with, they're just giving recommendations to the commissioner. There's different, some may weigh in on a particular topic, others may not. And it just, that circle of people providing information, they may not all weigh in or it's not like this is.

[Theresa Wood, Chair]: So here's what I'm gonna do, folks, because I am seeing some like, you know? That's official. Don't know what it's called, but I'm going to ask Katie to prepare language that incorporates the OPR recommendation, and then you'll have a chance to look at it again. And then you can count and compare. Okay? So I feel like we will have given credence to the input that we've gotten both from OPR and from the nurses associations. And then I think we still need to think about executive officer versus representative. And whether or not they all need to be appointed by the governor or if they can appoint themselves. We talked about 's appointing their representative themselves, which I think makes the most sense to me.

[Unidentified Committee Member]: I agree. Okay.

[Theresa Wood, Chair]: So that's where we're going to head on that. Okay. And there's a whole bunch of other changes in here that Katie did, so she'll walk through those tomorrow. But right now, we have a last minute witness who approached me today. Actually, thanks to representative Nielsen. Put this gentleman on the spot, but it's all good. And he stuck it out, we're a few minutes before 03:45. So just for the record, can I have your name again so Laurie can put it down?

[Sandy Reider, MD]: It's Sandy Reyder, r e I d e r.

[Theresa Wood, Chair]: R e I d e r. And Sandy with a y or an I or a?

[Sandy Reider, MD]: S a n d y.

[Theresa Wood, Chair]: D y, okay. Sandy, would you please join us and share your comments?

[Sandy Reider, MD]: Well, thank you. I know it's late in day, everyone wants to go home, and I can promise you I'll not acquire a hallucination like Alison was. Like Alison, I've been on the board of Health Choice Vermont for actually a long time now.

[Theresa Wood, Chair]: Health Choice Vermont.

[Sandy Reider, MD]: Just as a way of introduction, my name is Sandy Reyder. I'm a practicing physician. I've been practicing in Vermont for fifty five years now and graduated from Harvard Medical School in 1971. I'm a founding member of Physicians for Informed Consent and been on the board of HealthChoice Vermont since it was formed back in 2012. So there's I know I'm I'm gonna be very brief because it's the end of the day. I know you all wanna go home. There's three points I'd like to make, and it it kind of stems from the testimony that I heard on the sixth in this committee from Commissioner Hildebrandt, from Stephanie Winters, and from the pediatrician. I don't remember her name. Yes. Can But the main topics that struck me were trust, science and reliability of science, and informed consent. Those are the three things. So one of the I've lectured a lot on vaccines before to lay people and parents and obviously discussed it in the office quite a bit. And one of the things that most people don't know, and they assume that vaccines stamped out infectious disease, which was the real scourge in this country back in the early part of the twentieth century. Children were dying right now, but that's not true. Maybe you already know this, but in 1960, this is before the advent of vaccines, including the measles vaccine or any others except diphtheria had been around for sporadically for about ten or fifteen years, that the incidence of infectious disease this includes measles, whooping cough, scarlet fever, tuberculosis any infectious disease you can think of was decreased by ninety, ninety eight percent before vaccines were ever given. So it's not correct to say that the vaccine saved millions of lives because what really saved lives was public health, hygiene, clean water, refrigerators to keep food fresh, sewage disposal, and better medical care all around, I'd say, by that time. So those are the things that really move the needle on infectious disease. And I do, I haven't checked in recent years, but Vermont was, when I first started this work back in 2012 with HealthChoice, Vermont had the lowest incidence of infectious disease of any state in the country. And for a few years after that, it was second. So it's always it's never been a big problem in this state. I don't know how long. I've lived here for, what, fifty years now, and most of you have probably lived there as long as that or longer. But I just wanna make sure that it's clear that the vaccines did not stamp out infectious disease. It was public health. One of the outliers of that is polio, and I I don't know your name, You just mentioned polio. But if you go to the CDC schedule, it'll tell you that polio does not prevent infection or transmission, Period. So it it's not a protective vaccine in the sense the oral polio vaccine used to be, which did provide mucosal immunity in the gut so that polio virus couldn't replicate. But the the injectable polio that we use now does not do that, so it will not prevent either infection or transmission. It's very much like the case with pertussis vaccine or the COVID vaccine, if you wanna bring it up to date, which didn't prevent either of those. And the other point that struck me when Stephanie was talking, and this is not a criticism of Stephanie. I know she's smart. She's been around for a long time. But she said what she said really surprised me. It was so honest. When she said, when we're relying on information from the AAP, the American Academy of Family Practice, American Academy of Obstetrics and Gynecology, and ACIP, the advisory committee at the CDC, that they look at all those sources and of course, the whole thing about this bill is to make Vermont its own CDC, which has been something I've been wanting to call them that for years. Maine already does. They don't have a Maine Department of Health. They have a Maine CDC, and it's been that way for years. So this is being more honest. But what she said, what surprised me, was that they would accept expertise from all these sources, including these medical trade organizations, including the ACIP, the ACIP committee, as long as it brought forward more vaccines. So that is the bias that they're under. Anything that contradicts vaccines will not be permitted as recognized as good science. They'll only focus on those things that promote vaccination. So that's a very clear bias, and I was so surprised to hear her say that, but happy that that's finally out in the open. Terms of informed consent, I'm a huge advocate of that, as Alison mentioned, with health choice, we all are. And it is the ethical bedrock of practicing medicine. But you should realize, and I don't know if you made this connection while Alison was talking, that if informed consent was mandated, that would mean all school requirements and mandates would go away also, because informed consent means not only that you consent to the medication or whatever it is, it also allows you to refuse it. So it would cause quite a stir in this house if that was passed. I just wanna warn you. I I I hope that happens, but I'm skeptical that it will because of that particular issue with education and so forth in the state.

[Theresa Wood, Chair]: As I said earlier, when our previous witnesses were testifying, it could be a whole bill in and of itself and what constitutes that. So it's not gonna make it into this bill. Yeah. But I understand the presentation of the issue.

[Sandy Reider, MD]: Of course, HealthChoice has had that as a bill that's been on the wall for a long time now because it's so important. And keep in mind that when you're vaccinating kids, you're vaccinating healthy people. It's not like someone who's sick and has offered treatments that might carry certain risks. Then they need informed consent. But with children who are really healthy, it's especially important to make sure that the safety profile is extra good. And as Alison pointed out in her testimony, the safety studies are really poor with vaccines, even though we're assured that they're not. Never been a study with placebo controlled on these childhood schedules ever. And the last thing I wanna say, and then I'll close it up, is that there have been, you know, the one way to determine whether the vaccines are really helping, you know, we have a chronic disease epidemic with kids right now. Sixty plus percent of kids have a chronic illness, and back in, before 1980, it was less than ten percent. So it's gone exactly the wrong direction while our vaccine schedule has exploded, the chronic disease epidemic coincided with that removal of liability from the drug companies, and then the vaccine schedule exploded, and the incidence of autism exploded, and all this chronic disease. So that's a correlation. It's not proven causation, but it's something to be aware of. And along those same lines, you probably haven't heard about this, I'm sure it hasn't been reported in the media, is that there have been quite a few studies comparing vaccinated with unvaccinated children, which is the only real way to get to the truth of this, just like in the study for hep B, where they didn't do any comparisons and so forth. So the safety studies are hard to swallow. But you may not know that Bobby Kennedy, now secretary of HHS, and Brian Hooker, who is the chief scientific officer of Children's Health Defense, wrote a book called Vaxxed versus Unvaxxed. And in that book, they found about, I think, 80 I didn't read the whole thing because I sent it to my son who was just having a child, so I thought you gotta read this. But they found about 80 studies. There were smaller observational studies that compared vaccinated versus unvaccinated children. They all showed the same thing, all of them, with not small effects, but large effects with multiples of incidence of asthma, ADHD, autism, neurodevelopmental disorders, speech delay, and so forth, autoimmune disease. All this was much more marked in the vaccinated population. And so there's a vaccine safety data link, which has about, I think, twenty million people in it that the CDC had in house, but they got rid of it so you couldn't FOIA the information. It would be easy to run the numbers on that. And Bobby Kennedy was keen on doing it, but he can't get it. Even as secretary of HHS, they won't let him have it because it's been privatized. And you can't FOIA it since it's not in the CDC. But they recently there's a Henry Ford Health Organization, which is a large organization in Michigan, comprises, I don't know, 10,000,000 people or more, which has similar records. And they were approached in 2017 to look at that and do the study of vaccinated versus unvaccinated, because there were a lot of unvaccinated kids in that group. And the guy who is the lead investigator who they were meeting with was so sure of what he'd find, he said, We'll do it. And they did, and they found out exactly the opposite. That just like these smaller studies showed that there was many, many times the incidence of chronic illnesses of various kinds. And this could be hearsay, but they actually taped them saying, if I published this study, I would lose my job. I'm not gonna do it. So the bottom line in this is that unvaccinated children are much healthier than vaccinated children. And if you talk to physicians who have treated both groups of people, they'll all say the same thing, that the unvaccinated are healthier. It doesn't mean all vaccines are bad. It means that you really need to be careful about which ones you give to these healthy children. Thank you. So that's all I wanted

[Unidentified Committee Member]: to say.

[Theresa Wood, Chair]: Thank you, Doctor. Reyder. You go home. Thank you for being here, appreciate it. Thank you.

[Sandy Reider, MD]: Thank you very much for letting me speak. I

[Theresa Wood, Chair]: hadn't expected to do this. Well, sometimes that happens. So sometimes you take advantage of the opportunity when it's here, right? Thank you for being here.

[Sandy Reider, MD]: All right, thank you.

[Theresa Wood, Chair]: All right, have a good evening. Okay, folks. So at this point, we were going to be looking at reviewing the budget memo, but we're not, Because it's not done yet. So those of you who are waiting around for the budget memo can be informed that it's not happening. Okay. Any other questions? So we will review with Katie tomorrow at ten. At nine, our vice chair will be in charge because I have to be out of the room for a little bit, but I want to vote on H534.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: I'm gonna ask that. We'll review the

[Theresa Wood, Chair]: You can review and just hold the vote until I get back. That'd be great. Thank you. And if you need to take out Why don't we start at 09:15 tomorrow? That's good.

[Lily Sojourner, Director, Office of Economic Opportunity (DCF)]: Because we won't need that

[Theresa Wood, Chair]: much time. We won't need that much time. Yeah, I know. Sorry. Laurie's been changing the agenda like a gazillion times today. Yeah, at least.

[Unidentified Committee Member]: So

[Theresa Wood, Chair]: you get a little bit later start tomorrow, 09:15 tomorrow. Okay? And so just to review, we're going to be voting on 05:34 tomorrow. That's the quick and easy bill regarding community action agencies, provided we're all okay with the language that they all went away and agreed to and we'll come back with. We're gonna take up 05:45, and we have some time in the agenda. So where it says explanation of budget process, we're going to do some committee discussion about what Zon was asking about earlier, as we come into the FY 'twenty seven budget and preparing ourselves for how we're going to tackle the difficult decisions ahead. And also at that time, I hope to have a draft of the BAA memo to review. Okay? So that's what's up for tomorrow that's a little bit different than what you see on the calendar. Yes. Okay. Then in the afternoon, we're taking up our favorite subject, is homelessness. So we'll be having a presentation by the bill's lead sponsor, which is Representative Maguire. And we'll have a walk through by Danny.

[Unidentified Committee Member]: I don't agree with that.

[Theresa Wood, Chair]: It says so right here, Representative Eric Maguire, Bills sponsors. Okay, all right folks, that's it for today. Thank you. Thank you.