Vermont Legislature SmartTranscripts:

[Theresa Wood (Chair)]: Okay. Welcome back, folks. We are gonna take one final look at can make sure I got the right number. Age five thirty four, strike all amendment. And Katie's going to pull it up on the screen, and it eventually will be posted on our webpage momentarily. So Katie, just kind of briefly run through it. Sure.

[Katie (Legislative Counsel)]: So essentially, this draft 2.1 is essentially the same amendment you just looked at in a different format. So now we're striking out the whole bill and putting it in again. And you'll see that the first three sections, statutory sections in sec one, are identical to the bill as introduced. So 39.01, thirty nine point zero two and thirty nine point zero three. Those are all pulled from the bill as introduced. No changes there. The changes that we looked at earlier today are in thirty nine point zero four and thirty nine point zero five. So 3904, this is where we have the Community Action Agency Assessment and Plan. Each designated Community Action Agency shall determine the need for activities and services within the area served by the agency every three years, complete an assessment and incorporate that information into an annual Community Action Plan. The plan shall include a schedule for the anticipated provision of new or ongoing services and shall specify the resources that are needed by and available to the agency to implement the plan. 3,905, again, these are the changes that we looked at earlier today, Community Action Agencies. On line two, we're referring to the plan instead of the Community Services Plan, the Community Action Plan to be consistent with the previous section. In subsection B, the lead in language is the same from the bill is introduced, but the subdivisions have changed around. So you've moved what is currently Subdivision 1 down to Subdivision 2. That's why Subdivision 2 is underlined. It's not new language, but it's in a new place. The current Subdivision 2 would become Subdivision 1, and you're adding the language at the beginning of it, a minimum of one third of the members of the board. And then in subsection C, same changes as the bill is introduced, effective July '26.

[Theresa Wood (Chair)]: Thank you, Katie. So are there any questions or clarifications needed before we move to a vote on the bill? Okay, so I would entertain a to approve version five excuse me, H. Let me start this over again. Okay? I would entertain a motion to approve version 2.1 of H534 pending any potential technical edits by drafting not drafting, by Drafting ops. Drafting ops. Is there such a motion? I'll make a motion. Okay, thank you. Alright, is there any further discussion? Okay. Clerk, please call the roll.

[Daniel Noyes (Clerk)]: Representative Bishop? Yes. Representative Cole? Yes. Representative Donahue? Representative Eastes? Yes. Representative Garofano?

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

[Daniel Noyes (Clerk)]: Representative Maguire? Yes. Representative McGill? Yes. Representative Nielsen?

[Todd Nielsen (Member)]: Yes. Representative Noyes? Yes. Representative Steady?

[Brenda Steady (Member)]: Yes.

[Daniel Noyes (Clerk)]: Representative Wood?

[Theresa Wood (Chair)]: Yes. Excellent. And representative Noyes will be reporting this on the floor. 1001. Great. Okay. Great. Okay. So I'm just wondering if we should be looking moving ahead, Katie, on 05:45 while you're here. Sure. Okay. So people just had a break.

[Katie (Legislative Counsel)]: Yep. I'm just sending this to the editor so you can move this along. Okay.

[Theresa Wood (Chair)]: Version 2.1 was posted 545 was posted on our I and should see if it's there today, but it was definitely there yesterday. So when we get to five forty five, Laurie is going to repost it on today, but you can look on it yesterday if you want. You'll see that the length of the bill has substantially increased, and that is to accommodate a sunset of the bill as introduced. Essentially that means is that another legislature six years from now will need to take up the topic again, see what is happening at that point in time, and they'll be voting on whether to continue what we've done here or whether to revert back or make any further changes. So that's all that sunset means. But it means that there will need to be further action. And whenever you're ready, Katie, you can pull this up on the screen too. Okay. Sorry, I'm still

[Katie (Legislative Counsel)]: No, that's alright. Keep going.

[Daniel Noyes (Clerk)]: I'm gonna switch for a roasting.

[Theresa Wood (Chair)]: Who's the IT person? Is it Scott Block? He's Dan. Yeah. Who's the

[Daniel Noyes (Clerk)]: ledge counsel that does the IGF? Eric.

[Theresa Wood (Chair)]: Eric, I don't know what Eric's last name is. It's Patrick. Eric from? No. Eric down in the no. That's right now. Is that that person? Oh, no. Sorry. Wrong one. It's alright. I'll I'll track it down. Okay. It's Moore's last name. Kevin. Yeah. Kevin. The head of IT? Kevin. Yeah. Mhmm. That's it. It's always asking for

[Daniel Noyes (Clerk)]: phishing scam emails. Good.

[Katie (Legislative Counsel)]: I have 2.1 pulled up, folks there. Yeah, no, we're

[Theresa Wood (Chair)]: ready. Go for it.

[Katie (Legislative Counsel)]: Thank you for waiting. So just to ground you where we are, language that's highlighted in yellow is language you haven't seen yet before. As you will notice, the page length is much higher than last time you looked at it. Don't let that be too intimidating. Basically, what is happening here is because you're requesting a six year sunset of this language. There's no automatic way to just go back to where we are right now. Basically, we have to remove the proposed amendments and reactivate the language that's being struck through. So that's why the language is being shown twice. You're showing language to go back to where you are now after six years. So that is what all the yellow highlighting is in the second half of the draft. I've tried

[Theresa Wood (Chair)]: to

[Katie (Legislative Counsel)]: add some reading headers to sort of make it a little clearer where we are in time and in the bill. So hopefully that helps. Noticed there's one place where I haven't done that, so I'll add that in. Okay, so first we're looking at the immunization recommendations that are in effect on passage through 07/01/2031. So this language you already looked at and the yellow is language that represents changes that were requested. So as you remember, the term immunizations is being replaced with recommended immunization. And there is a suggestion from the health department to the language means a vaccine or other immunizing agent that provides protection against a particular disease or pathogen, And the application of the immunization is recommended by the practice guidelines for children and adults established by the Commissioner pursuant to 1130A of this title. So I think that's language that they discussed with you about why the use of immunization versus vaccine. Next at the top of page two, I'm trying to be more consistent of striking of health after the department or the commissioner because those terms are defined for the title and they don't need to be replicated each time. So that's why that is struck through there. And when we last spoke, there was a lot of conversation about who on line three, who is the population that this program is serving. There were various iterations that were discussed. At the end, the committee decided just to be silent on that point. So the language would read, the ensuring universal

[Theresa Wood (Chair)]: goals

[Katie (Legislative Counsel)]: access to recommended immunizations at no charge to the individual. So just omitting that specific language. Next change. In subsection c, the department is to determine which recommended immunizations shall be purchased under the program. The program shall purchase recommended immunizations consistent with the goals of the program from the CDC or another vendor at the lowest available cost. So there was an interest in not just letting the language about the lowest available cost sit by itself, but be paired with consistent with the goals of the program. Skipping down to subsection G, which is the Before you go there, please.

[Theresa Wood (Chair)]: We had committee discussion about that because we didn't want lowest cost to be the only determining factor. And I'm just checking in with people to see if that language meets the intent of what people had questions about. I'm seeing head nods. Yes. Okay. Thank you. I just will say that if we get to a piece of language that has changed, that's based on the discussions that we had, and you want to have further discussion, now's the time to bring that up. So for further changes. Realize I wasn't clear about that at the beginning. Subsection G, this is the Funding Advisory Committee. I'm 17. I struck out of health, again, to

[Katie (Legislative Counsel)]: be So we're not sort of sporadic if we were you the Commissioner of Health or Commissioner, and it's already a defined term. Then we have the membership of this advisory committee. So on line three of page four, the executive officer of the Board of Pharmacy or designee Subdivision D, the Executive Director of the Green Mountain Care Board or designee. Subdivision C, a representative appointed by the Director of the Vermont Blueprint for Health. And you've removed the language about nominated appointed by the commissioner. Subdivision D, three representatives of health insurers, one each appointed by the state's largest three private health insurers as determined by the number of covered lives. Subdivision E, a representative appointed by the Vermont Chapter of the Academy of Pediatrics. Subdivision F, a representative appointed by the Vermont Chapter of the American Academy of Family Medicine. No changes in Subdivision G.

[Theresa Wood (Chair)]: Okay, so just before we move there, after you left yesterday, the committee concurred with the Office of Professional Regulation's request for an amendment to include a member from the APRN group as well as the pharmacist. Is that

[Katie (Legislative Counsel)]: for the funding or for the

[Theresa Wood (Chair)]: Oh, I'm sorry, for the next one.

[Katie (Legislative Counsel)]: Sorry. Nope, that's okay. It's confusing to have two. No, it's not.

[Theresa Wood (Chair)]: Sorry, I was thinking, I don't wanna miss it. Don't wanna miss it. I'm ahead of it. Yeah, okay. All good. Thank you. You're still living. Okay.

[Katie (Legislative Counsel)]: That brings us to page five on line three of struck through of health. So we're just using the department.

[Theresa Wood (Chair)]: Let's see. I don't think

[Katie (Legislative Counsel)]: there are any other changes in that section. So that's it for new changes in section one. Section two, this is our section of all new language. So this will be sunset on 07/01/2031. Last time we met, the committee was interested in emphasizing the language about recommendations and wanted to add recommended to all of the duties of the commissioner. It now reads that the commissioner shall periodically issue recommendations regarding which immunizations children and adults are recommended to receive, the age at which each immunization is recommended to be given, the number of immunization doses that are recommended to be administered, the recommended amount of time between doses of an immunization, and any other recommendations regarding immunizations necessary to promote instead of ensure the maintenance of public health and disease prevention in the state. No changes in subsection B, which was who the commissioner is consulting with, which recommendations are being considered. Subsection C, that was the immunity language. No changes there. Subsection B, this is the standing order. You didn't make any changes to the standing order section. Subsection E is a new subsection. First, that the department shall prominently display information pertaining to recommended immunizations and other relevant information on its website, including how to access recommended immunizations. Second, any documents produced by the department about the recommended immunizations shall include a disclosure if the recommended immunizations differ from the recommendations of the Vermont Immunization Advisory Council. And then we're just re lettering subsection F. So just before

[Theresa Wood (Chair)]: we go there, is there any comments, questions or clarifications needed about Section E, Numbers one and two? Those were additions that we made based upon our conversations and deliberations here.

[Unidentified Committee Member]: Very, very picky. I'm sorry. And I'll defer entirely, but my sense would be to move the word prominently to behind the information, just move it two words to the right. I don't think we prominently display. Think we display things prominently.

[Katie (Legislative Counsel)]: Will circle and I will ask. That's above my pay grade. I will say that there's

[Unidentified Committee Member]: It might be above mine for me.

[Katie (Legislative Counsel)]: I will ask, though, and see what they think. On line 10, there's a typo. So when you see a new draft, it says scope twice. So I will clean that up next time we'll take a look at this. Section three. Here is the Immunization Advisory Council. So we have the membership. Should we go through it and then talk about the additions? Or We

[Theresa Wood (Chair)]: should talk about additions first.

[Katie (Legislative Counsel)]: Okay. Existing law is a representative of the Vermont Board of Medical Practice appointed by the governor. Subdivision two, the executive Officer of the Vermont Board of Nursing are designee. Subdivision three, the Executive Officer of the Vermont Board of Pharmacy are designee. Subdivision four, Secretary of Human Services are designee. Subdivision five, Secretary of Education are designee. Four and five look like it's new language. They've just been separated. They were an existing law. They are an existing law. Subdivision six, State Epidemiologists are designee. Subdivision seven, Department of Health's Immunization Program Manager designee. Subdivision eight, practicing pediatrician appointed by the governor. Subdivision nine, healthcare professional as defined in eleven thirty of this title who is not otherwise represented on the council appointed by the governor. Subdivision ten, two individuals who are professors, researchers or physicians, or any combination of these individuals with expertise in infectious disease and human immunizations appointed by the governor. Subdivision 11, a family or internal medicine physician appointed by the governor. Subdivision 12, a representative of public schools no longer independent appointed by the governor and any other persons deemed necessary by the commissioner.

[Theresa Wood (Chair)]: Now, the committee recommended accepting the change proposed by the Office of Professional Regulation, which I think you have a copy of.

[Katie (Legislative Counsel)]: Okay, not yet. But it's posted.

[Theresa Wood (Chair)]: It's posted. Okay, I'll take that. And essentially, that was to add an APRN, a specific APRN, advanced practice RN representative and a pharmacist. And in doing that, we would eliminate number nine, which was new language.

[Katie (Legislative Counsel)]: And you'd keep the board of pharmacy?

[Theresa Wood (Chair)]: Yes, so we decided that we have the three boards and then we have the practicing individuals of those professions. So the one question I wanna pose to the members is around who appoints. We have a variety of different things in here. So some are appointed by the association themselves. Some are appointed by the governor. Some are designees. And it feels a little messy to me. And so I'll give you a for instance, right off at number one, two and three. I'm not sure why number one would be different than number two or three. Agreed. In other words, the board appoint whoever it is that they Number want to represent one should not be, in my opinion, shouldn't be appointed by the governor because there is a board. I think the only time you would have the governor appoint is when there is not a board group that represents Like number 10. Right. Yeah.

[Katie (Legislative Counsel)]: You wanted to say the executive

[Theresa Wood (Chair)]: officer? Because we say or designee, I think that's fine.

[Katie (Legislative Counsel)]: I guess I'm asking, do you want it to be consistent with two and three that start off with the executive officer? Oh, And then add designee at the end.

[Theresa Wood (Chair)]: Yes, because, yeah. Got it. And so then I also have had, and this is more of a question for the department. Given the role of the Vermont Immunization Advisory Council regarding the safety of immunizations and immunization schedules, So it being a primarily healthcare and medical related role. I received a question about why the Secretary of Education is there, as well as representative from the public schools. And I guessed at what previous legislators had done that it related to recommendations for immunizations prior to entrance into schools. But that seems to be inconsistent with the purpose of this committee. So, do want

[Daniel Noyes (Clerk)]: me to answer?

[Theresa Wood (Chair)]: If you want to identify yourself for the record, then yes.

[Daniel Noyes (Clerk)]: I'm Mary Plumpton from the immunization program at the health department. And the committee was originally formed to determine what immunizations would be required for child care and school entry in Vermont. So it's and they still are, they still do that. But it's combining these two efforts because it is an existing committee with some of

[Unidentified attendee (possibly Dept. of Health staff)]: the same members rather than asking them to join

[Theresa Wood (Chair)]: a second. Another committee? Yeah.

[Katie (Legislative Counsel)]: So does it say that someplace else in this law? In the charge, does. There are we. So page nine, line six, and it says the duties of the council review and make recommendations regarding the state's immunization schedule for attendance, school and childcare facilities. So that's where that requirement comes in. Okay. That makes sense. You could leave it as is. You could add language that says for the purposes of providing these recommendations, these individuals aren't voting members or something like that.

[Theresa Wood (Chair)]: What are people's thoughts? I thought it was a relevant question for the purposes that we've been talking about in the committee here in terms of the changes that are being made. They're not medical professionals, and that is who we were relying on to make a medical recommendation, a healthcare recommendation. And it would seem inappropriate unless for some reason, the secretary of education happened to be a physician or a healthcare professional and likewise for a member of the public schools. I think Katie's suggestion would help clarify that their role is for that other purpose, of making recommendations for what's needed for school and childcare, and not for recommending just the medical part of the So if there's a way that you can incorporate that, Katie, with relative ease and clarity, Is that okay with people? It seems a little Yeah. It seems a

[Unidentified Committee Member]: little cumbersome probably when they're actually meeting to sort of busy up their work, but it makes sense.

[Theresa Wood (Chair)]: So and Katie, so that would be for the secretary of education and the representative from the public schools.

[Katie (Legislative Counsel)]: Mhmm. I'll call them their nonvoting members for that purpose or something.

[Theresa Wood (Chair)]: Organizationally, I'm not sure if maybe it'd be helpful to put them together. I don't mean in one line, but I just mean in closer proximity to each other on this list. But I'll leave that up to you. And then incorporating the OPR recommendations.

[Katie (Legislative Counsel)]: Oh, yes, the ones we just talked about. Add additional ones. Okay.

[Theresa Wood (Chair)]: And then we would eliminate number nine. Got that. Okay. Yeah, go ahead, Doug.

[Doug Bishop (Member)]: As a refresher, OPR's recommendation with respect to nurses was an APR one.

[Katie (Legislative Counsel)]: And did they recommend who was going to be doing the appointing? I don't remember who they were meeting. I'll take a look, can

[Theresa Wood (Chair)]: reach out to them. And a pharmacist, yeah. The APRN folks wanted two APRN representatives and we settled on one. That was a difference, Doug.

[Unidentified Committee Member]: So then do it'll be our job to sort of if we're concerned about odd or even numbers, we need to make sure that the voting members We'll

[Katie (Legislative Counsel)]: look it again.

[Theresa Wood (Chair)]: Let me see it. I need to write down numbers along with That helps me too. Okay, so are we clear on that section? Okay, thank you, Katie.

[Katie (Legislative Counsel)]: Subsection D, the council shall have the administrative and technical assistance of the department. E, the council shall convene at the call of the commissioner, but not less than once each year. Before we go there, back on

[Theresa Wood (Chair)]: the funding advisory, does it say page does it say? Support. What says what they have from the Department of Assistance. It should say administrative and technical. We want to keep that consistent. It's on the top of page five, line three.

[Katie (Legislative Counsel)]: Do we need to assign someone else? I understood the department not wanting to have that legal assistance, but is there someone else we should designate to have that role? Or is that a figure it out? I think it's a Yeah. Needed. Yeah.

[Theresa Wood (Chair)]: You see where I mean, Katie, at the top page five? Okay. Thank you.

[Katie (Legislative Counsel)]: Okay. And then in Subdivision 2, the council shall select a chair from among its members at the first meeting who shall not be the commissioner, because the recommendations are going to the commissioner. Sorry.

[Theresa Wood (Chair)]: Now I've lost a page number on page nine. Nine.

[Katie (Legislative Counsel)]: Line 16, U17. Okay, great. Thank you. Okay, so we're gonna move on to the next section. So now we're moving to those two insurance coverage sections. And so again, these are changes that are in effect from passage through 07/01/2031. And you didn't make any changes when you walked through this the first time. So a group insurance policy shall not impose any co payment, coinsurance or deductible or premiums for recommended immunizations as defined in 11/30. And we have similar language in section five. Just just to refresh people's memories, the insurance companies were okay with that, and the Department of Financial Regulation was supportive of that.

[Theresa Wood (Chair)]: So This

[Katie (Legislative Counsel)]: is highlighted not because you've made changes, but because your last draft didn't include this piece. This is the pharmacist and pharmacy technician authority that you heard testimony on yesterday afternoon. So this is language that's in effect on passage through 07/01/2031. And I'm guessing you maybe have some changes here now that you've heard testimony on it. But there is language in Roman numerals VII and VIII. The first one applies to patients 18 years of older, and it refers to immunizations generally in subdivision V, sorry, eight. I'm sorry.

[Theresa Wood (Chair)]: Did I lose you?

[Daniel Noyes (Clerk)]: H1, H2L.

[Katie (Legislative Counsel)]: Numerals seven and eight. Yeah.

[Theresa Wood (Chair)]: I just want committee members to make sure that you read through all of the yellow highlighted because this is the first time you're seeing it in this bill. Oh, sorry. That's okay. I can go back up. I think that would be a good idea, Kate. Okay.

[Katie (Legislative Counsel)]: So we have the language for pharmacists about prescribing. A pharmacist may prescribe in the following context. Then subdivision two outlines state protocol. In Subdivision A, 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. And then this is what is authorized. So we have opioid antagonists, epinephrine auto injectors, tobacco cessation products, tuberculin purified protein derivative products, self administered hormonal contraceptives, dietary fluoride supplements. I'm going

[Theresa Wood (Chair)]: to stop right there just for a second. So all of this that you see there is current law. So we're not recommending any changes to that. That's all current law. We're just taking it from one place that is being proposed and putting it into this bill. Okay?

[Unidentified Committee Member]: And we're putting it in this bill so that we can add or adjust a couple of things that we want.

[Theresa Wood (Chair)]: We're putting in this bill primarily because this is in the Office of Professional Regulation miscellaneous bill, and that will take some time to get through all of the process. And this bill is effective upon passage. So we didn't want there to be an inconsistency between timeframes. And the Office of Professional Regulation was fine with that. They testified yesterday. And for now, we'll keep it in both bills. But eventually, it most likely will come out of the OPR bill.

[Unidentified Committee Member]: Thank

[Theresa Wood (Chair)]: you, Katie. Now let's get

[Katie (Legislative Counsel)]: to Yeah, thank you. So now we're on Roma numerals seven and eight. So they're allowed to administer immunizations for patients 18 years of age or older. There had been language referencing the CDC guidelines, and that language is what struck through on lines nine through 12. I would think that we would wanna say recommended immunizations as defined at 11:30 here. Just read my mind.

[Doug Bishop (Member)]: Where that's striking immune I'm sorry. It's underlying immunizations,

[Unidentified Committee Member]: but it

[Doug Bishop (Member)]: doesn't seem to strike vaccine. Was vaccine present in seven?

[Katie (Legislative Counsel)]: Yeah. I bet it was.

[Theresa Wood (Chair)]: What line are you referring to, Doug?

[Doug Bishop (Member)]: Looking at line eight, it just says immunizations, which is underlined, but it doesn't have the strikeout of vaccine.

[Katie (Legislative Counsel)]: Oh, oh, thank you. That was right. Let me

[Theresa Wood (Chair)]: double check that.

[Katie (Legislative Counsel)]: And then I'm assuming a similar change in eight, but I'm not sure if the question was asked yesterday. For 18 and over, we're not listing out specific types of immunizations, but in Roman numeral VIII for patients five years of age or older were listing out specific immunizations. Was that discussed at all?

[Theresa Wood (Chair)]: Well, we didn't really discuss the age breakout. But I don't think that we should substitute our judgment for testimony that's previously been taken on this issue. So I think that we would just be adding the change in language, but not the change in any age. Okay. I guess ultimately what my question is, do we say recommended immunization as defined in 11/30 here? I would guess not because that's broader than these specifically called out immunizations. Well, these specifically called out immunizations will also have recommendations. So I think that there should be a way to say for these specific immunizations as recommended. Do you understand what I mean?

[Katie (Legislative Counsel)]: Yeah, sort of something like in accordance with the recommendations established at 11:30.

[Theresa Wood (Chair)]: Right. So I I mean, I think the modifier would come not not at the beginning of that sentence, but right where it's talking about the influenza and COVID nineteen.

[Katie (Legislative Counsel)]: Subsequence. Yeah, at the end of

[Theresa Wood (Chair)]: the clause. So I just wanna make sure that members understand what this is doing. So in previous action of the general assembly, when pharmacists were allowed to provide immunizations, vaccines, there was a policy decision made that it would be for patients five years of age and older. In other words, those that are younger than that would continue to get that through their primary care, their pediatrician, other healthcare professionals, not pharmacists. So that's what that is doing. And we're keeping that. So that's what this whole conversation is about. Okay, so in the original legislation that allowed pharmacists to give vaccines, there was a decision made that they would only do that for children who are five years of age and older. So that if you are younger than that, you still have to go to your pediatrician or other primary care. And we're not changing Okay, I remember that. So we're not changing that. And that was part of the conversation that Katie and I were having. So what Katie is going to figure out how to do is in the bill that we're talking about now, the panel will be making recommendations to the commissioner about the influenza and the COVID-nineteen. And so that the modifier needs to be in there somehow, as referenced in the previous section that we've already talked about. So she's gonna work on that and we'll see it in a different draft.

[Katie (Legislative Counsel)]: So I think what I'll put at the end before the semicolon is consistent with the recommendations established in accordance with eleven thirty a. So that's the new language. Okay.

[Theresa Wood (Chair)]: And we'll ask the department to make sure that that is representing what we think it is. Yeah. Go ahead.

[Doug Bishop (Member)]: 11:30 a. In this bill. So is that the broader recommended immunizations or is that limited to standing orders and influenza COVID-nineteen?

[Katie (Legislative Counsel)]: That's the process by which all of the recommended immunizations. But why I think it should be eleven thirty A is because that subsection A talks about dosage and timeframes. So we're saying in accordance with that, even though we're not pulling in the term recommended immunizations to mean all immunizations on the schedule. So I'm moving to the next section, which is pharmacy technicians. This is also in title 26. The existing language is that pharmacy technicians shall only administer immunizations. We have language to patients 18 years of age or older as established in the previous section that we just looked at of this title and the resulting state protocol. To patients five years of age or older, influenza

[Theresa Wood (Chair)]: immunization, COVID-nineteen immunization and subsequent formulations or combination products thereof in accordance with the previous section that we just looked at and the resulting state protocol. So that means there will be it's a little bit of a complicated avenue, but it means that it references the one we were just talking about. And in that one, it will be referencing back to the dosage requirements and timing and all of that. I don't repeat it here again, in case you're wondering.

[Katie (Legislative Counsel)]: Then in subdivision three, this language currently references that the immunizations have to be in accordance with the CDC schedule, so that language is being struck. And then we're renumbering. So what is currently four becomes three. And then subsection D is eliminated, current subsection D, which is that pharmacy technicians 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 state clinical pharmacy protocol as established in the previous section. So that language would be eliminated. I just want to take one more look at this.

[Theresa Wood (Chair)]: Yeah. Okay.

[Unidentified Committee Member]: Yeah. Just for clarity, line six, that statute there, is that the one that describes what you were describing earlier that for clients under five or under?

[Theresa Wood (Chair)]: It's on the previous page. Page It's twelve and thirteen.

[Unidentified Committee Member]: Line 13. I see that, but I'm wondering about So I I guess, I mean, or younger. I'm just

[Theresa Wood (Chair)]: Since they're only allowed to go for five or older.

[Unidentified Committee Member]: Right, pharmacists, right, yes. But this 23B, I'm just wondering about people who aren't reading at all, like probably me, and wondering, then where do I go if I have a child who's under five years old, where do I go to get the clarity for that? And I wonder if that's this '23.

[Theresa Wood (Chair)]: No. 20 I just wanna on line six, that very thing right there is, if you look on page 12, it's the it's lines lines 13 through 15. Okay? So if the law stays silent on where you go, you follow your normal course of action, you go to a pediatrician or your primary care.

[Unidentified Committee Member]: I see, okay.

[Theresa Wood (Chair)]: This statute is only saying what pharmacists and pharmacy techs are allowed to do, not what they're not allowed to do. Do you see what I mean?

[Unidentified Committee Member]: Yes, I understand that. I do understand that.

[Theresa Wood (Chair)]: It's not meant as a public information document.

[Unidentified Committee Member]: Correct, there we go.

[Katie (Legislative Counsel)]: Okay. So that brings us to the end of what is happening on passage. And now on page 14, line seven, this is where we start putting language back in as of 07/01/2031. So as of that date, we start going back to what is the current status quo in terms of language. So the first heading on line seven is restoring current immunization recommendations on 07/01/2031. So that puts section eleven thirty back as it currently is.

[Theresa Wood (Chair)]: People understand what we're doing here? Okay.

[Katie (Legislative Counsel)]: And on section nine, so let's see where I am. Page 18, section nine, eleven thirty one. So this is the Immunization Advisory Council. This goes back to as it currently is. You will notice that we skipped a section, the new language that is eleven thirty A. That's because that's new language and it's easy to just sunset it, which we don't have the ability to do if we want to go back to something that was previously there. So we will deal with the sunset at the end of this document, but that is why we've leaped over it. So

[Theresa Wood (Chair)]: This is gonna make life complicated, no doubt. I'm not sure we wanna sunset the membership of the advisory You're not.

[Katie (Legislative Counsel)]: Oh, no. You're not. Are you?

[Theresa Wood (Chair)]: Yeah. It looks that way. Yeah.

[Unidentified Committee Member]: Goes back to what it is.

[Theresa Wood (Chair)]: And I'm wondering if you're saying

[Katie (Legislative Counsel)]: we don't want to sunset the changes that we're making. Correct. 11:30 a is what is being sunset, and that does not have an advisory council or committee in it. What you are doing is 11:31, which is listed on the Immunization Advisory Council, you're going back to as it currently is. If it's your choice to retain the changes you've just made moving forward, we could do that. Yes, that's a great language. Okay. Yes. So you want to retain all of the changes in that section? No, you don't because you want to get rid of the reference to recommended immunizations. We to retain all of the

[Theresa Wood (Chair)]: membership changes. Got it. As well as the language that we are adding about the secretary of education and public school official. I don't think you

[Katie (Legislative Counsel)]: want to retain that because recommended immunization as a concept and as a charge for that committee will go away. Will go away, okay. But I can retain the membership

[Theresa Wood (Chair)]: of the group. Okay, we want to retain the membership.

[Katie (Legislative Counsel)]: Okay, let me put a note for myself before I lose that.

[Theresa Wood (Chair)]: And in the funding so that's the membership of the advisory council. The funding advisory council, I would want to maintain the changes that we made there. So for instance, just an FYI for people, Blueprint for Health doesn't need that two levels of nomination in order to get on this group. That might make the bill a little bit shorter. Because we don't need to put this back in.

[Katie (Legislative Counsel)]: Well, I could put stars there, It might make it a little bit further. But you will need to show some of the other sections. Okay.

[Theresa Wood (Chair)]: I'll keep moving. Okay. I'm sorry, just interrupt for a moment. I just want, in case people have not looked at their agenda, the updated agenda, we are going to be hearing from Doctor. Hildebrandt at 10:30, just to answer any outstanding questions that we may have as a result of the testimony that we have received during the course of taking public testimony on this bill. Since he was the very first witness, we felt we needed to hear from him again. Okay? Yes, go ahead.

[Doug Bishop (Member)]: Related to changes we're making and going back to original language, it includes shifting from recommended immunizations back to vaccines. But didn't we have discussion about the use of the word immunization and how it was helpful to have that, even if we didn't use recommended immunization? There was some value in using immunization rather than vaccines.

[Theresa Wood (Chair)]: Yeah. It's a little broader.

[Unidentified Committee Member]: I don't know what role that

[Doug Bishop (Member)]: is. It is. But we're reverting a little too far back to vaccines, I think, if I followed our earlier discussion correctly, because immunizations is broader than maybe broader than additional vaccines. Okay.

[Theresa Wood (Chair)]: We want to retain that change. Yeah, I'm hearing what people say. I'm just trying to think about how Katie's going to represent that. I

[Katie (Legislative Counsel)]: can do it.

[Theresa Wood (Chair)]: If anyone gives you a hint, it's Katie.

[Katie (Legislative Counsel)]: But we will need more than just my eyes on it when we look at it again. So I think what I would do is we would just go back to the term immunizations instead of recommended immunizations. I would keep the phrasing that the health department gave us about, and then everywhere where we had switched from vaccine to recommended immunization, I would move to just immunization. So I think that's doable. Right.

[Theresa Wood (Chair)]: We'll see what it looks like in France.

[Katie (Legislative Counsel)]: I know.

[Theresa Wood (Chair)]: French. Okay.

[Katie (Legislative Counsel)]: So I'm going to skip through that. I'm on page 20. So now we're restoring current insurance coverage for immunizations on 07/01/2031. So this is the two sections on the group policies and individual policies. So this goes back to the term immunizations. That was the phrase that's used in current law. We get rid of the reference to recommended immunizations and we revert to the existing language, which references the CDC. Same thing in the next section. Where we get rid of reference to recommended immunization, you retain what is in current law around CDC. Then, page 22, we restore the current pharmacist and pharmacy technician authority on 07/01/2031. So this language, this is what we just looked at with regards to pharmacists. This goes back to as it currently appears. And I think that you're right, that should be vaccines. Let me double check that page.

[Theresa Wood (Chair)]: I'm about line six on page 23.

[Katie (Legislative Counsel)]: Yeah. I just wanna see what it says in current law. Is.

[Theresa Wood (Chair)]: Okay.

[Katie (Legislative Counsel)]: Otherwise, it goes back to how it appears now. I know why it doesn't say it there. Because it's just a construct of the sentence. Oh, yeah, you're right.

[Theresa Wood (Chair)]: Vaccinations. It's just the construct of the sentence.

[Katie (Legislative Counsel)]: Pharmacy technicians. Revert back, same thing. We're reverting back to how it looks right now.

[Theresa Wood (Chair)]: And

[Katie (Legislative Counsel)]: then section 14, page 25. Can I

[Theresa Wood (Chair)]: ask a question? So I believe that we just made a decision to keep the new definition of immunizations and the language that the department provided. And so wouldn't we want this to be consistent with that?

[Katie (Legislative Counsel)]: Moving forward? Yes.

[Theresa Wood (Chair)]: Well, it

[Katie (Legislative Counsel)]: would no longer How so? Because this I think this could probably stand on its own as it does now, because currently it doesn't refer And it's still It's all going

[Theresa Wood (Chair)]: back to CDC. Yeah. Okay. Which is what this is the language that's used there. Okay, alright. I guess they needed to say out loud what I was saying,

[Katie (Legislative Counsel)]: but I understand what you're saying. It's legislative gymnastics, so it's a little bit into your mind. I like that. A challenge

[Theresa Wood (Chair)]: to the editing department, that's Yeah. For

[Katie (Legislative Counsel)]: They were very patient. Page 25, section 14. So this is the repeal that I mentioned before. Because it's all new language, we don't have to do anything or revert back to anything. We can just get rid of it after a certain date. We can take care of that in one sentence, where we're just getting rid of that whole section

[Theresa Wood (Chair)]: on a particular date. And, Katie, I just want to make sure I'm referring people to the right pages so that they know exactly what's being repeated, committee members. So 1130A starts halfway down on page one and goes to near the bottom of page five. Is that correct?

[Katie (Legislative Counsel)]: No. It is section two of the bill. So it starts on page five, the bottom of page five. And it goes to the bottom of page seven. Okay. So that goes away. Oh, yes, I was looking at

[Theresa Wood (Chair)]: funding. Sorry, I wanna make sure that people are understanding what that last sentence in the bill is saying. Or Mexico asking. So on line six, seven and eight on page 25, So you know exactly what's being repealed. Look at what Katie just said. It starts on the bottom of page five and goes to where, Katie? Bottom of page seven. Bottom of page seven. That is what's being repealed.

[Katie (Legislative Counsel)]: No, I was gonna jump in and just say something about effective dates. Oh, go ahead. So the effective dates are important, obviously, because we're sunsetting things. I would just encourage more than just my eyes on this. So we have that sections one through seven and section 14 and the effective date section are all taking effect on passage. And then sections eight through 13, those are all the sections where we're going back to something on 07/01/2031. Those are taking effect 07/01/2031. So I just wanted to be clear what that is doing.

[Theresa Wood (Chair)]: So that was a lot. And we'll get another version of this, and we'll have another walkthrough. And I appreciate, Katie, all the work you did and all the drafting, gymnastics, as you said, for sure, involved with this. Trying to represent the conversation, also trying to understand that people wanna see it go back and really have another, whoever's in the legislature at that time, look at this again after some period of time, which is we're choosing as 07/01/1931. Okay. Alright. So, we're going to shift. Do we have not yet? Okay. Doctor. Hildebrandt is okay, Anne, you got a question? Go ahead. I couldn't see you before if you had your hand raised. I'm sorry.

[Anne B. Donahue (Ranking Member)]: No, I just put it up here. I just wanted to reference the the language about vaccine versus immunization, which came up when I when I was there last and I was concerned about confusion or did that expand it. So I really appreciate the language that came back, I guess, from the Department of Health that's now in there. I think that that really creates the clarity that it's not some wide open door that it's still specific to what all of our intent is. So I think that that was great. That had been a little a little knit that I was concerned about.

[Theresa Wood (Chair)]: Great. Thanks, Anne. Okay, so momentarily, we'll be joined by Doctor. Hildebrandt. So stay tuned. Let's just mute the room for a moment. Let's just stay online. Okay, for a moment. Okay, while we wait for the Commissioner of Health