Vermont Legislature SmartTranscripts:

[Rep. Theresa Wood (Chair)]: Okay, good morning, everyone. This morning, we are taking up testimony on the Department of Disabilities Aging and Independent Living and their FY twenty seven budget. And we are happy to have you here this morning. And thank you, Doctor. Bowen and Deputy Commissioner Smith Jane. We appreciate you being here. And as I said, committee members, you'll see their budget book on our webpage. And

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: the floor is all yours.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Thank you. Hi, yes, I'm Doctor. Bowen Jill Bowen, Commissioner for the Department of Disabilities, Aging and Independent Living. Dale, next to me is Deputy Commissioner Angela Smith Jen. And we move in panels, so we'll also introduce.

[Rep. Theresa Wood (Chair)]: Why don't we go all the way around the room? Sure. That would be good. So we'll let you guys start this time. So Molly.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: I

[Rep. Daniel Noyes (Clerk)]: live in Guildford and also serve Vernon. Doug Bishop, one of Colchester's representatives. Morning, I'm Daniel Noyes, represent Wilkett, Hyde Park, Johnson, Belvedere.

[Rep. Anne B. Donahue (Ranking Member)]: Hi, Anne B. Donahue, I represent Northfield and also Wilkett.

[Rep. Theresa Wood (Chair)]: Theresa Wood from Waterbury, and I also represent Bolton Heelscore in Huntington. And my apologies to Dylan, I keep calling you Jeff. Hello. And Esme, would you like to introduce yourself?

[Rep. Esme Cole (Member)]: Sure. Hello, folks. I'm Esme Cole, rep of Hartford, and apologies, I'm a bit under the weather, but going to try to make it in when I can too.

[Rep. Theresa Wood (Chair)]: Thank you. Thank you. And Representative Nielsen has joined us.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: So, it does seem like we're always chasing a fan.

[Rep. Theresa Wood (Chair)]: Oh, that's fine. I just looked at it.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: I said,

[Rep. Theresa Wood (Chair)]: okay. It's boiling hot water because I need hot water.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Okay. Actually,

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: it's just going be hot water.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: It's Okay. Thank you. So what we have up here? We're going to just go through our testimony document, just highlight a few areas to present to you, and then we're

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: happy

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: to answer questions. So if we can go to page four.

[Rep. Anne B. Donahue (Ranking Member)]: Been found today's. It is. Yeah.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Yeah, you probably have it all. There

[Rep. Anne B. Donahue (Ranking Member)]: we go. Okay, I didn't have Wednesday showing up, now it is. Thank you. So it's a section called department highlights.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: We just want to highlight a few areas for you. There are many things going on at Dale, and you all know, but for the general public, the adult services division, which is inclusive of older Vermonters focus, the division for the blind and visually impaired, the developmental disabilities services division, the division of licensing and protection, which includes survey and certification and the adult protective services, and the division of vocational rehabilitation, which does businesses higher ability and is inclusive of the Employee Assistance Program. Strong Vermont has been a big focus of our work and is a highlight. This is a ten year multi sector, multi stakeholder plan on aging. It is one of a small number of states that have embarked on this level of plan. We have a second, growing, fastest growing demographic in the country. We have now completed year two of implementation, and, in this month, later this month, year two report will be released. And when we have that, we'll get that linked to you. Conflict free case management, which

[Rep. Theresa Wood (Chair)]: You know nothing about in here.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: And the focus has been on both developmental disabilities and in the adult services division programs moving to CMS compliance and the developmental disabilities went live tenonetwenty twenty five with its initial phase. Next page, the developmental disability services supported housing. There were several initiatives that grew out of the Act 01/1986 planning grants. And in Randolph Upper Valley Services, Open Haines Best, the housing project. Waterbury, Marsh House has an anticipated completion date of this spring. In Burlington, the Champlain Housing Trust has worked in collaboration with families and individuals and direct service providers, and are developing a 10 unit service supported model in Burlington. Able House opened Northwest Counseling and Supervisory Services, which was particularly important because it's the intersection between developmental disabilities and aging. So this is a focus. This is these folks' forever house, because it's set up to be able to address aging in the developmental disabilities population.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Can I ask good question, Commissioner?

[Rep. Theresa Wood (Chair)]: So one of the things that's been brought to our attention, actually, some of these newer residential opportunities, but it also impacts, I think, longstanding residential group living situations for the state. That's the licensing and protection regulations and how they define TC, a therapeutic community residence, as essentially not permanent, essentially. And when we're setting up housing for people, we're really looking for permanency and longstanding. Is there any effort underway at the department to revise or develop something that's called something different or a regulatory scheme that would enable permanent housing for people?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: This came out of the Act sixty nine work group and highlighted in that work, and we have created a subcommittee of the standing committee to focus specifically on that issue. What exactly is needed? What would it look like? Do we have what we need somehow in place now that can be used there, or do we need something different? So that's a committee which came out as part of the roadmap for housing options. I don't know if, Jen, you want to say anything further about that, but that work is also underway.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: So we had our first kickoff meeting about two weeks ago.

[Rep. Theresa Wood (Chair)]: Excuse me just a minute, Jen. When people from the side talk I'm okay with, you know, people from the side talking, but I just I identify who you are because it's hard for people to tell on Zoom land.

[Angela McVeigh, Director, Adult Services Division (DAIL)]: Sorry about that. That's okay.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Thanks for the reminder. So I'm Jen Garrigan. I am the Development and Disability Services Division Director. So as to McMurray once I from the ask the NIH subcommittee, the recommendation was to have another committee to really dig into the licensing to do, are there the correct levels of licensing to meet what is needed in developmental disabilities, practices, especially as we look to develop additional kinds of housing, service supported housing being the most prevalent preferred option moving forward, or do there need to be changes or even just a new category developed? So what we've done is the Development and Services Skate Programs Community Committee at the request of the Commissioner's Office has mentioned a subcommittee which had a feedback meeting in January, where we made approximately every three weeks through June to study this interview and talk about sort of what the current state is and how we can move forward to really meet the needs of this population while ensuring proper safety, protections, and quality of safety.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: And they'll make recommendations and

[Rep. Theresa Wood (Chair)]: Have Representative Donahue served on that group?

[Rep. Anne B. Donahue (Ranking Member)]: Yeah, having served on it, with the chairs, I could give a little bit more comfort for members of the committee, an example of what that issue really is trying to resolve attention. Let's do that when we have more committee discussion. Yep.

[Rep. Theresa Wood (Chair)]: So thank you for that update. And then one other question, as we're talking about this new development and things coming online. So that will require, I'm presuming for most of the folks with intellectual or developmental disabilities, the presence of a HUD stipend rental assistance. And from what we understand from the state housing authority, that essentially no new new rental assistance vouchers are being administered until it's

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: sort

[Rep. Theresa Wood (Chair)]: of like this trickle. If somebody leaves, then they're able to send out a new one. But even for project based, So Marsh House, for instance, was one of the ones that we thought had been safe, and it's not really safe. There isn't. So I'm just wondering, has the department included any funds for payment of rental assistance vouchers pending transition to a federal voucher in your budget? On Dale's budget. Not Dale's budget. Okay. How would those we have any idea about how those folks would be supported, able to pay their rent?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Yeah, that would be a question maybe for some of our AHS partners, and we can bring that back and try to see what is already happening there. But it's not something that we have specifically been looking at. What we have been looking at is what's happening like at Riverflow and Yellow House. Unless you have more on this.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: What I would say, again, this is Jennifer Garofano. Yeah, don't need

[Angela McVeigh, Director, Adult Services Division (DAIL)]: to give

[Rep. Theresa Wood (Chair)]: me the title this year. Yeah, I know. Okay.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: There are a lot of partnerships that happen across the state that do allow for the same opportunity. Lincoln Street incorporated one of our specialized service agencies in developing a project in the White River County area and received a sizable grant from the Vermont Housing Authority. They received over a million dollars in order to sort of do their project forward, which would be service of written housing. So there are a number of different public private furnishings that are happening. So while we may not have specific funding in our budget. Housing for volunteers is housing for all of our volunteers. And so there's lots of interesting and innovative projects that are happening, including specifically for investors with intellectual and fellow.

[Rep. Theresa Wood (Chair)]: Sure. Yeah. Most of that money though, is from my understanding is not as much for specific rental assistance. It's more for the development of the project and construction and renovations and things like that. We're just hearing consistently from all the partners that you're referring to that there isn't any rental assistance right now unless we develop a state funded rental assistance, which we have a proposal from the state housing authority to do. I don't know where that will end up in the scheme of things, but I just am putting it out there that that's something for people to be aware of that they, I'm sure, have been counting on that rental assistance. And it may, in fact, not be there when time comes to move into these locations. And that would be a shame if we haven't planned for that. Thank you. Thank you,

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Chairwoman. We're on page six now, and we're looking at the direct care workforce initiatives this past year, we were chosen, to participate in the National Care Direct Workforce Strategy Center technical assistance. Some of the activities that grew out of that was moving forward on a direct care workforce registry and our campaign Careers in Caring. The Careers in Caring had 120,000 visits to the Career in Caring webpage and nearly 200 web outreach inquiries. So it definitely had, an impact.

[Rep. Theresa Wood (Chair)]: I see some of the advertising.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Yes. It's

[Rep. Theresa Wood (Chair)]: it's good. So there to be a registry of sorts, and did it just kind of fall by the wayside or lacked funds to continue it, then now it's sort of being reinvigorated?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Well, the idea was highlight I don't know what happened to it in the past, but there wasn't one. And it was highlighted as a best practice in doing the work with national level work. And so in November, we did release an RFP for the registry. And then the LNA work, again, the money appropriated by the legislature in fiscal year twenty five and in '26. We talked about this a little bit in BAA, but that work is underway now. There are 17 facilities this year who have joined in on those opportunities, and it was impactful last year and expected to be even more impactful this year. You had asked a question in BAA, so I want to answer it now, which is how will that continue going forward? And it is built into the Rural Health Transformation Program, so we will be able to continue a project. It's one of the projects that Dale will be leading. Thank you.

[Rep. Daniel Noyes (Clerk)]: So is that reflected in the budget or not because we haven't really finalized that?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Well, it's the Rural Health Transformation funds.

[Rep. Theresa Wood (Chair)]: Joint Fiscal Committee is hearing on Friday and I've expected that we will approve acceptance of the grant.

[Rep. Daniel Noyes (Clerk)]: Yeah. So if those funds aren't included in the FY twenty seven budget, but they'll be coming in, would

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: that be within the BAA or for next year? I would presume so, probably. Okay. Were two programs that Dale is going to be leading from that. One is the LNA or the training programs, and the other is increasing ventilation and dialysis in nursing homes.

[Rep. Theresa Wood (Chair)]: So Representative Bishop.

[Rep. Doug Bishop (Member)]: A question. If I understood correctly, the LNA recruitment funds are going to be in the Rural Health Initiative. If I'm recollecting correctly, the Rural Health Initiative does not include Chittenden County. Are there, in this instance and maybe some others, is there any plan to try to have this benefit, if you will, this recruitment plan implemented in Chittenden County.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: So the LNA resource would be to build some type of a centralized, coordinated approach. So that could be something that can be used, I don't know if you can go further.

[Angela McVeigh, Director, Adult Services Division (DAIL)]: Yeah, so the nursing homes in Chittenden County won't be able to apply directly for funding through the Rural Health Transformation Program, but they can benefit from centralized training hub

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: that will be developed, where

[Angela McVeigh, Director, Adult Services Division (DAIL)]: LNAs will receive sort of a hybrid training and then be able to be

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: placed in different places around the state,

[Bill Kelly, Finance Director (DAIL)]: if that makes sense.

[Rep. Doug Bishop (Member)]: Placement, is that that can be any of the 14 counties, or is that where that also be limited to where rural health care

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: We're gonna check on that. Yeah. We'll check on that because we're still toasting the water, and it is intended for rural locations, that's funding. But we're happy to at least be able to bring to a lot of the state where there's great need, but we'll get back to you specifically on that. Pathways to partnership between Higher Ability and DBVI, the Division for Blind and Individually Impaired, they are having a tremendous impact in terms of the number of students that they're working with, with some level of disability that is being helped to transition. And you can see the numbers on there. And then the higher ability opioid recovery employment that is, you will see money in the budget for this to be baselines and to continue. It's incredible and incredibly effective work. The outcomes there in terms of recovery, supporting work and work supporting recovery, which I mentioned during the BAA, but is in our fiscal year 2017. Okay. 08/50000, is that right? $8.75.

[Rep. Theresa Wood (Chair)]: $8.75, okay. And that's so we should probably stop calling it a pilot anymore.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: That's right. Almost started on there. Next July, it'll be in the Okay. So Also on page eight, if you're not there with us at the bottom, to bring in mission care up to date, they're at about 89% capacity. They've been bringing in folks from a number of different areas, helping reduce the boarding in hospitals. 29 of those, sixty new residents came from hospitals, eleven from out of state nursing homes, actually coming back home because they were Vermonters. Nine from community settings, five from correctional facilities, five from motels homelessness, and one from an in state nursing home transfer. Can I back up

[Rep. Theresa Wood (Chair)]: just a minute to Deaf Part of Hearing and Deaf Blind Services? We, as you know, I think, know, we have a bill, I think it's H-one 143 is what I'm thinking, but I'm not positive. It's about continuing the service that I think if it has ended, it's about to end for the sister people to provide transportation and assistance for people who are deaf blind. And it's a pretty small amount of money that impacts a relatively small number of people, but it's very impactful for them. And is there anything in this budget that reinstates or continues that service? No,

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: not specifically for that service. We were able to extend it. I know we had talked about it some time ago, and we were able to get funds to extend it, but those were one time funds. So, should

[Rep. Theresa Wood (Chair)]: that officially end it, or is it going to end June 30 or June 30?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Yeah, we were able to get through to the end of the fiscal year, but not beyond.

[Rep. Theresa Wood (Chair)]: And how much on an annual basis is that? For instance, if we wanted to continue that service. So if you can't answer that today, it

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: would make eye on that. Bill has at his fingertips, but we can get you. Okay, thank you.

[Rep. Theresa Wood (Chair)]: Appreciate that.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: And the top three referrals for the Deaf, Hard of Hearing and Deaf Blind services have been information about technical assistance and assistive technology and just general resources. Then I'm on page nine. We are working on stabilization and sustainability for nursing facilities in particular, but the whole long term care continuum. We have begun, a planning process and, have just begun engagement with stakeholders, so we will be doing that. This is not a budget at this point issue. This is just informational that we are embarking on that this year. The five areas of focus are capacity and infrastructure, workforce workforce is a major driver, as you know financial stability, quality of care, and complex care.

[Rep. Anne B. Donahue (Ranking Member)]: We have a question. Yeah, I'm sorry, back to eight. We've been taking a lot of testimony on homelessness and also recognition that AHS is trying to make that in all department. And one of the things we've heard a lot about is the extent of homeless folks who have very complex care needs. So I'm looking at the numbers and seeing five from motels homelessness. And I'm wondering how connected are the systems of outreach and identifying the needs of people who are homeless and connection to something like this that might be what's needed. There's vacant beds. So it is extensive, And I'll turn it over to Angela to give you

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: some more specifics on that. This is just mission care. This isn't the whole nursing home.

[Rep. Theresa Wood (Chair)]: I was just going ask, do you know how many in the other nursing homes have accepted people who are homeless?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: We don't

[Angela McVeigh, Director, Adult Services Division (DAIL)]: have that number off the

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: top of the

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Okay, but we do have data to say where people went.

[Angela McVeigh, Director, Adult Services Division (DAIL)]: We can, yeah, we can

[Rep. Anne B. Donahue (Ranking Member)]: do that. But I'm distinguishing, I mean, my understanding of this program is specialized for those complex care needs that other nursing homes really And can't we're hearing from testimony of homelessness that many of these folks have that level of complex care needs, that they are not able to go into a standard nursing home.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Everybody of the 60 have complex cares. Everyone of the 60. So it may be different kinds of complex cares, but yes.

[Rep. Anne B. Donahue (Ranking Member)]: I'm sorry, I'm not articulating the question right, because I do understand that. I'm wondering, there are vacant beds, we're hearing there are people with that very high level of complex needs on the street or in the shelters who can't be admitted to a regular nursing home? Why aren't they in here to be I mean, that's oversimplified. So I'd go

[Angela McVeigh, Director, Adult Services Division (DAIL)]: back to looking at our data around who is homeless and on choices for care, right? And as of the last data I looked at, it was 27 individuals. A number of them are considering nursing homes. And so they all have a case manager working with them to make that happen. If they're running into barriers, then we work on that, and then we consider mission care as a potential option if they meet the criteria for that. And there are also a number of them who might meet the criteria for mission care but who do not want to go to a nursing home. And so it's a little bit of both to that point. But if they're eligible for a nursing home, they're on choices for care. They have a case manager working with them to consider that as an option, and Mission Care is definitely an option for them.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: And other nursing homes too, are options, as are other long term care continuum options, like assisted living or I

[Rep. Anne B. Donahue (Ranking Member)]: think from the testimony, it seems to be a disconnect in numbers because 27 or pending versus the percentage of body Yeah, think

[Rep. Theresa Wood (Chair)]: that what feels to a shelter or a GA motel as very complex needs may not, and I'm not saying they're not complex, but to a skilled nursing facility or a res care with nursing oversight may not seem as complex. You understand what I

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: mean? It's

[Rep. Theresa Wood (Chair)]: used a lot. They may

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: not meet criteria for choices for care. So to come into a nursing home, they may be

[Rep. Theresa Wood (Chair)]: complex. Yeah. The examples that we've been given, I'm pretty sure

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: meet choices for care criteria. I

[Rep. Theresa Wood (Chair)]: think there's more than 27 out there that meet the criteria for choices for care. And that's of the disconnect we're trying to improve upon. Did you have a question?

[Rep. Daniel Noyes (Clerk)]: Yeah, just quickly, could you talk about the out of state, Levin coming from out of state?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Out of state options were part of the referral process and still could be.

[Rep. Theresa Wood (Chair)]: Different entrees, you said they were Vermonters returning to Vermont.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Oh, they're just people that

[Rep. Daniel Noyes (Clerk)]: were housed out of state are coming back.

[Rep. Anne B. Donahue (Ranking Member)]: Because there wasn't a place for

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: them be. Wasn't a place for them to be that level of care.

[Bill Kelly, Finance Director (DAIL)]: Fine.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Okay, so are we moving on?

[Rep. Theresa Wood (Chair)]: Yes, we are. Thank you.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: All right, so we have done page nine. So page 10, I just wanted to highlight the APS statute, which is in this current year. This is the CMS regulation that we needed to come into compliance with. We did come into compliance with all of it ahead of the game because our Vermont version was close to the federal version, except for the caregiver negligence piece. This past year, we all came together. There were 14 meetings with various stakeholders. It was clear at the outset from Dale's perspective that all positions were of concern for Dale. If it's the workers who are uncomfortable or if it's the need to ensure that our workforce is protected and there's need to ensure that the individuals we serve are protected. We're going to go in and look at how we can all work together. 14 meetings later, there was consensus that was developed. And so we feel like we're on a pretty good track for, addressing caregiver negligence in Vermont in a way that is aligned with CMS requirements, and also has a tremendous amount of stakeholder input. The result is one where everybody is pretty okay with it. So I'm looking and seeing that this timeline wise,

[Rep. Theresa Wood (Chair)]: it seems as though you need a bill.

[Rep. Daniel Noyes (Clerk)]: There is one.

[Bill Kelly, Finance Director (DAIL)]: It's our website.

[Rep. Theresa Wood (Chair)]: That have the agreed upon language? Yes. Okay. Just add it to our must pass list. Okay. You can say it. Yeah, go ahead, Rebecca.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Maybe an amendment point about Rebecca's burning up down.

[Rep. Anne B. Donahue (Ranking Member)]: We're working on that.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: I think we have a

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: It was just a time frame based on what the implement from

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Timeline. It

[Bill Kelly, Finance Director (DAIL)]: was

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: technical time frame. After a conversation with the stakeholders, I have to do a little

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: bit of everything. That's all.

[Rep. Theresa Wood (Chair)]: Right. Thank you. So, it's up there.

[Rep. Daniel Noyes (Clerk)]: It's up there.

[Rep. Theresa Wood (Chair)]: I just don't know what number it is. Those all look like a blur to me right now.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: It's an interesting wall.

[Rep. Theresa Wood (Chair)]: We

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: So should we move on? Yes. Okay. So next we're going to go, where were we, on ten. So let's move to page 17. Okay, so what we wanted to highlight here was were nearly 7,000 people who received choices for care services across all settings. Nine hundred and seventy three were in the moderate needs group, and over six thousand were in the high highest needs groups. This is basically showing the comparison between 2025 and 2024, so you can see areas where there was, growth in the different types of services, enhanced residential care, home acuity based moderate needs, nursing facilities, all had, some growth. And nearly 4,600 are in home based settings, nearly 800 are in residential care or assisted living facilities, and nearly 3,000 in NIPS. And on the next page So just before you

[Rep. Theresa Wood (Chair)]: move to the next page. So Yeah. It's good to see the slight increase in ERC. And I'm concerned about the traditional HCBS and the flip between that and nursing facility. I can't tell from here, and I don't know what page you are in here. 17. 17.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Which is the more recent time period? The blue is 2025. The top one. So it's pretty much There we go. Okay. I found it. Table that

[Rep. Theresa Wood (Chair)]: I can see.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Traditional is pretty much holding. The difference there is quite minimal. They both round to 37%.

[Rep. Theresa Wood (Chair)]: So this brings up something that I just want to float by you that we're thinking about. So given the history of choices for care, it goes back, I don't know, thirty years now, roughly. And the intent and everything that was developed at that point in time for that to all be one budget, because we were really thoughtfully trying to transition and reduce the number of nursing home beds licensed in the state, which we had done over time. I think that we're in the space where we actually don't think that we should we think we need the capacity of the nursing facility beds that we have. We don't think that we should be reducing that capacity any further unless they make a business decision like Green Mountain did recently. But we can't really control that. So we are contemplating the separation of those two things as budget line items. So I want folks to just think about that. I recognize all of the history, I recognize where we're at now. And I think that there is growing concern in the body for people who know about this stuff, that we want to be able to continue to focus on the non institutional services and not do it at the expense of the nursing facility or vice versa. And so, feeling like they need to sort of stand on their own now, recognizing that we were not looking for large scale reduction in nursing facility beds anymore, like we were when we originally started Choices for Care. So it's just something for you to be thinking about.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: I know Bill was thinking of something. Go ahead Bill.

[Bill Kelly, Finance Director (DAIL)]: Bill Kelly, finance director. So I've been with Zales since the beginning of Joseph here, and I understand at least the concept of certainly is a more recent year. Choice for Care started, the nursing home Medicaid bed days that we had was like a million per year. That's been reduced in half and in the last few years that utilization is increasing. We want it to increase to utilize the beds. So it is, while unique, we have to, in my opinion, for the good employment community based, have to remember the savings language and how money is created to be reinvested. And while we're going through this period of call it a nursing home correction, if you will, with the EFRs and the post COVID, two thirds of the Choice of Care budget is nursing home related. So if there, that's a large amount of money that if there is an excess in remembering the language of the statute, the potential that there would be reinvestment for home and community base In the out years to me, if we were to split it, would be sure excited.

[Rep. Theresa Wood (Chair)]: Yeah, we've had the conversation. I understand that perspective. I'm just not sure I 100% agree with it at this point in time. And I'm not just talking about the last few years of intensive EFR to nursing homes. And I go back to the original intent of I don't think that we're going to see the per bed cost decrease at nursing facilities. And so the only savings would be to reduce the number of nursing home beds that we would take offline. And what I'm saying is that I think we have reached a critical point where we actually shouldn't be reducing the number of nursing home beds, which is much different than where we were at the initiation. So I understand what you're saying that lion's share of the money is in skilled nursing.

[Bill Kelly, Finance Director (DAIL)]: I don't think we choose one side budgetarily at the expense of another.

[Rep. Theresa Wood (Chair)]: I'm not saying that that's the intent, but that's the result. Because of the provisions in state statute that allow certain things for one side that don't allow it for the other side. I'm just putting it out there on the table for further discussion.

[Bill Kelly, Finance Director (DAIL)]: One final comment, since COVID, there was a large, as you know, there was a large spike in home and community based spread at the beginning of COVID and we put a lot into the home and community based side of the bus. And for three or four years we haven't had to increase the home and community based side of the budget and even currently halfway through this state fiscal year home and community based side is underutilized. So while we're seeing all the pressure increases for nursing home, just keep in mind that the home and community based side

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: of the budget

[Bill Kelly, Finance Director (DAIL)]: is currently underutilized and not in need of funds. So back to my comment, we're not funding one at the expense of the other.

[Rep. Theresa Wood (Chair)]: We're also not keeping pace with the costs on the home and community based side of things. So I realize it's not a simple conversation or simple answer. I just am putting it out there because as I do every year or two. And I just I didn't want people to be surprised if we start to have conversations about that. Appreciate that.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: I mean, we have to think a little bit about it since

[Rep. Theresa Wood (Chair)]: we You

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: talk about mechanisms that are there to keep nursing homes afloat that aren't necessarily there. I appreciate that. I also do want to say that I've heard you now, you mentioned like two or three times, we are at a place where we need these nursing home beds. We're also concerned that projecting forward, may need more. So that's another conversation. If in fact, with the growing demographic and the increased complexities and folks in the, not necessarily in the 60 to 80 range, but the 80 and above range is growing as a demographic that we may find ourselves in need of additional nursing homes.

[Rep. Theresa Wood (Chair)]: Exactly. You just made my argument for me.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Thank you.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Always happy to make yours.

[Rep. Theresa Wood (Chair)]: I know, I know. You just need to convince Phil now. All right. Thank you.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Okay. So the next page 18. Okay, so here, now I'm going to be making Bill's argument. In 2025, the blue line is home and community based services, and the orange line is nursing homes. We are still serving far more people in home and community based services than we're serving in nursing homes. So, we just need to keep that in our awareness. Let me see where I'm heading next. Page 18, we just did that.

[Rep. Theresa Wood (Chair)]: Ask before you move on to that. And may I haven't I haven't I haven't gone ahead. So if you're gonna address it, then I don't need to. But the meals, you know, so we've we've had some changes in shifts in that. We had the, million dollars, and then we turned into GC. Have there been any hiccups? Do you feel like that has the allocation and reporting? And do you feel like that is working as intended? I do think so.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: We've been working at it really closely. Maybe if you wanted speak to this, not every county does it the same way, and not every AAA does it the same way. So it can be variability in terms of where it's most effective and who's serving the most people with the same amount of money. I don't know if you wanted to say something.

[Angela McVeigh, Director, Adult Services Division (DAIL)]: Yeah, and I do think, Angela McVeigh, Adult Services Division, I do think that the funding has helped bridge a little bit of the gap of the increase in costs to provide meals. And so we are watching that as well, how many meals are served and how many meals

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: are And how many people are served. Yes. Because there's a lot of meals per person per year, which is good.

[Rep. Theresa Wood (Chair)]: Yeah, I think maybe there's a little bit of concern about we are hearing from meal providers that they're not necessarily and again, it's anecdotal and I hate anecdotal information because it's not data per se. It's that there's some issues, I guess. And I'm just wondering if it's because they talk to one another. I'm just wondering if it's because there's differences in how each AAA is administering the funds that come down. I don't

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: really know. The cost of the meals is not the same depending on what mean, they administer it, so it's different across different AAAs. And also some put fundraised money. So there are some counties where they may feel that the provider may feel They all would like They all want more. The work they're doing is phenomenal. And again, I always remind folks about the volunteers that are part of this across the state, because without them, we couldn't do this at all. And to remind people that for many people who are isolated without their visits from meals and meals, sometimes that's their only visitor. I think you want

[Rep. Theresa Wood (Chair)]: Represents steady and then represent noise. My question is at one point in my time, I think I worked for choices for care at one time. They were having trouble getting transportation for the adult day programs. Has that gotten better?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: So some adult, I don't know that it's gotten better. Some adult day programs do have transportation and some don't.

[Angela McVeigh, Director, Adult Services Division (DAIL)]: Yeah, I think it continues to be a barrier for people to

[Rep. Theresa Wood (Chair)]: make it. Yeah, that's the sad part.

[Angela McVeigh, Director, Adult Services Division (DAIL)]: We did hear that one of the, I believe it's Scotland House, was able to purchase a van from another adult And so really hoping that that helps with their transportation. And I think every center is just trying to be creative in how to address transportation.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: How about SSTA or

[Angela McVeigh, Director, Adult Services Division (DAIL)]: GMT? I think that for some people that works and for some areas that works, but there are limitations and stuff. I

[Rep. Theresa Wood (Chair)]: know. I felt bad. Yeah. I represent Noyes.

[Rep. Daniel Noyes (Clerk)]: Yeah. Thank you. Just back on the the Meals on Wheels real quick. So on that FY '24 meal cost analysis, you add everything up, it's about a $7,000,000 difference between reimbursement rates, both the general funds, the Medicaid, and the Older Americans Act. And then if you just take that and look at inflation since then, just to make them level based on, as you know, food costs have been going up, it works out to 1,600,000.0 increase in that time frame.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: You need a question, Roxanne Roy? Yeah, so

[Rep. Daniel Noyes (Clerk)]: you've got that level funded impact at

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: that level. And not increasing based on inflation. Right, in that budget, it's level. There was that increase that the legislature provided, and then the match, the other creative way to bring more money into it, but there isn't any additional. And

[Rep. Theresa Wood (Chair)]: is that at risk at all? I'm trying to remember if that was part of GC investments or my recollection is it was investments, and I know that there's some looking at whether some of those investments are going to go away in the renewal of the global commitment.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Yeah. We're worried in general about investments going away in the 11/15 waiver. Yeah. We heard about that from the secretary.

[Angela McVeigh, Director, Adult Services Division (DAIL)]: We have a number of programs.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Yeah. But this this could be one of them. Yeah.

[Angela McVeigh, Director, Adult Services Division (DAIL)]: But remember, too, Meals on Wheels is primarily funded by the federal government, the Older Americans Act, right? And so we also do, when we meet with the delegation, we advocate for funding increases to the OAA, because that is the primary way to increase services for treatment programs.

[Rep. Daniel Noyes (Clerk)]: But it's still under $4 Agreed.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Yeah. So we are happy that the government shuts down, partial or otherwise, is over. We're happy that funds coming from the federal government have not negatively impacted our operations. So that's our answer for right now. There isn't additional money this year in the current budget.

[Rep. Theresa Wood (Chair)]: And so just while you've asked that question about additional money, I'm gonna ask, is there any COLA increase for any provider included in your budget?

[Angela McVeigh, Director, Adult Services Division (DAIL)]: No. Just the statutory nurse,

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: just the statutory one, right? My point again? Which is just the nursing home.

[Rep. Theresa Wood (Chair)]: It's just nursing homes. Yeah, okay. Thank you. Thank you for putting up with our questions as we go.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: And they're important. Kelly has

[Bill Kelly, Finance Director (DAIL)]: a Your question regarding support services program for DPBI, 115,000.

[Rep. Theresa Wood (Chair)]: 01/2015? Yes. Okay, thank you.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: The annualized? Is that annualized? So let's go to page 34. Can you go first to 30 '3? No. Yeah, I think it's you. Is this '33 or '34?

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: No,

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: this is totally fine. What we're looking at here is the success of the DBBI activities. So we just wanted to so both DBBI and hireability, we can show you. Compared to the nation, we have higher employment rates, we have higher median earnings, and we have higher measurable skill gains. I just wanted to give them a shout out for the work that they're doing locally. And if we go to I think it's page 46.

[Rep. Theresa Wood (Chair)]: So you do on page 33, you do a consumer satisfaction survey. And it's good to see that. Is that done independently? Is it okay. Thank you.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: And then on page 36, we should have a higher abilities version. Page 46. Page 46. Yep. There we go. So you'll see also here higher abilities is also higher, then the nation across the board, and employment rates and median earnings and the measurable skill gains. So just kudos to our vocational rehabilitation team. Now if you go to page 48.

[Rep. Theresa Wood (Chair)]: We're not completely skipping over developmental services, are we?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: In terms of oh, conflict free. So I Well, mean, yeah, you just kinda, like,

[Rep. Theresa Wood (Chair)]: went. I

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: was just doing highlights of each, and I said that we went live with developmental disabilities, conflict free case management. I assume you have questions? Well, are always questions

[Rep. Theresa Wood (Chair)]: on everything. That's kind of

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: our job. I highlighted it as well. So each area that I went to,

[Rep. Theresa Wood (Chair)]: so I highlighted that as well. So I'm just curious what you're seeing in terms of applications, new applications for services. Where are we with we have three case flow dollars each year. How are those one time dollars being used? Are we expected to fully expend caseload dollars? There was no request for caseload in BAA. So I'm just curious where we're at on those types of things.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: In fiscal year twenty seven, we do have caseload pressures and increases in our '27. We're going to go through the numbers. Right.

[Rep. Theresa Wood (Chair)]: I'm just wondering how is that working this year? What what are you seeing for applicants for services, new new applicants, and I guess, increased request for increases? Is there I didn't see in a quick look any kind of chart on that, and I know that the annual report will be coming up soon.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Yeah, sure. That's a great question. We saw sort of the typical requests for new applicants and requests for AP spending in the first quarter, fiscal year twenty six, using our previous focusing models. Previous management from management's first to our business office, but we're just getting some help with the amount of money that we've been tracking in Chequality that we're on track to stay within the appropriation that we have.

[Rep. Theresa Wood (Chair)]: Thank you. And so you said four sixty, 65 or so plus requests, is that what you were expecting?

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: It is. So when we did our validation study for the new model, we expected about 15% of people based on their current service mix. We would need to ask for an assessment outside of what their needs assessment revealed to maintain their service rates, and four fifty five is about 14%. And so really right around what we were expecting to see. So I'm not surprised by this and pleased to see the number that made it in by the time points we made in meetings like this through the review process. And

[Rep. Theresa Wood (Chair)]: you said, I just want to make sure I understood that you're seeing roughly the same number of new applicants in terms of people who haven't received services before?

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Yeah. What

[Rep. Theresa Wood (Chair)]: number is that? I don't really know these days what's the number of new people coming into services.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Yeah, I don't have that number up. Have a minute. I can certainly get it for you. I think really what's a mix of people entirely new to the system, as well as people moving from our ADHD management, which is a lower level of care for those of you who may not be as familiar with our system, to get a higher level of ADHD based services, which provide them more inclusive support. So, exactly what we would expect to see, and certainly as we're gearing up for fresh leafing, we're starting to see that come through. I'm hearing from our recent organization too, so they're starting to get those referrals as well. And have you had

[Rep. Theresa Wood (Chair)]: any lips or issues with the new organization doing the eligibility assessments and initial assessment for eligibility?

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Oh, sure, yeah. So what Madam Chair is referring to is the fact that we moved to a centralized intake and eligibility. So we did, as that was getting online, we did need to work to get some evaluators connected with them. That took a little bit more time than we had expected, so that was unfortunate, but we have evaluators that they contracted with. We have them set up with our fiscal intermediary, ERS Solutions, so that they can go Medicaid directly. Scott have all worked this out, are sort of now that on track to get those eligibility determinations or reviews of their records, so there was a little bit of a delay getting that up and running, but we've worked it out. And so that's now the way we would expect it to that.

[Rep. Theresa Wood (Chair)]: And one of the things we talked about last year and that you were considering, switching gears now, was the returning to the poor indicators or whatever it is it's called now. NCI?

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: But we're working with NCI. We expect next year to actually join, but this year what we did was align our data so we could be comparative with them. So we've been working closely with NCI. We also have a full report due to you on February 15 that is on where we are with the Developmental Disabilities conflict free case management payment reform process. That's only like next week. So that's being finalized, and you'll have kind of a soup to nuts summary of where we are.

[Rep. Theresa Wood (Chair)]: Alright. Thank you. And then I don't know if it's final question, it feels that way. I'm in quality management and oversight and quality assurance and working with that. And I'm presuming we'll get more information in the annual report, but of particular interest is, I guess, whether United Counseling Services is on target to be able to meet the outcomes that you expect. I'm presuming that there has been, you know, work with them back and forth, and that's what they report. So I'm just trying to figure out if we should be preparing ourselves for a designaciation or if you feel like they are on track to be able

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: to actually clear at this point.

[Bill Kelly, Finance Director (DAIL)]: K.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: K? So they submitted the first month's worth of data. There was a lot in there and some questions for them. So I will get a full briefing on that. Based on that briefing, there will be further conversation with the CEO and board chair. There will be a second report that comes out in February, and then a third one in March, at which point there'll be a review of all of the concerns, which are not just about the specific things that need to be checked off. Those are sort of the need to be addressed immediately areas, at which point there'll be a determination of whether up to three more months can be offered to continue in the current provisional with intent to designate, at which point a decision would need to be made whether they are making sufficient progress. So that could happen in March, where it is a determination to designate or to reduce their provisional, or it could happen as much as three months after that. That's the timeline that's in the rules. So we don't actually have the answer yet after the one month of their working on some of the more immediate concerns, but we're also looking at the larger issues at the same time.

[Rep. Theresa Wood (Chair)]: Thank you. Think obviously our chief concern is about the families and individuals receiving services, as I know that's your concern. So I guess I feel like we need some level of assurance that we are working to try to figure out what an alternate might be to avoid interruption services for those people who are receiving services.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: You have certainly considered that and would have a plan should it come to that.

[Rep. Theresa Wood (Chair)]: Thank you. Representative Bishop.

[Rep. Doug Bishop (Member)]: A question for director Garofedian. In the second quarter of the fiscal year, the first with a new system, if I understood correctly, there were four sixty, four sixty five exceptions, I think was the phrase, and that that came in on the expected 15%. How does that vary from orders before entering the new system? So is it normally 15% exceptions requested, or is this anticipated because of

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: new systems? It's a new process. Yeah. The exceptions process is a new Yeah,

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: so that's exactly right. So this is because of the new process, so as we came from the old model under which there wasn't independent, the administered standardized nasal swab measure, led itself to funding tiers and no symptoms, this is a method that says there is a funding here that has a maximum to it, and if the services that meet those needs are above that, then the state has a review process and authorizes the funding over that. For a new person coming into the system, if I have a needs assessment, it puts me in tier three. There's a dollar amount associated with that based on where I live. If the services that may exceed that amount, that isn't necessarily a problem. It just means that the exceptions are best to submit it with justification of why those services are those that best meet my needs. And then they can be approved, assuming that, again, we all agree that that is what is appropriate. Not necessarily a problem, just part of

[Bill Kelly, Finance Director (DAIL)]: the process.

[Rep. Doug Bishop (Member)]: Right. And I'm just, I guess, trying to get a sense as to previously, was it one or 2% exception requests a a quarter, or is it 10%? How much of a disruption were we anticipating? It seemed like it was on target. Yeah. But

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: So this is exactly on target. Previously, each proposal came through and was presented to say, these are the needs, this is the cost associated with In the future, it will be sort of, if as long as the new budget is under that tier, it will sort of, it is sort of presumptively approved at the state level as long as they're below that.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: There were no standardized rates before October 1. And the fifth yeah. In the 15% that we see is exactly what we had projected. So 85%, their budgets came at the same service level that they were previously getting. Of the 15% who could be requesting an exception, 40% of them requested an exception. 40% of the 15%. We have 40% As of the expected

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: of like three weeks ago, 40% have already peaked.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: They all now. 100%. My report is three weeks old. Right. My report is three weeks old, so I'll keep turning it over to Jen,

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: who has the most up

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: to date. So they're all in now. Okay. That's great.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: There's a reason something didn't come in. It's by choice. And so that if there's if people are choosing to adjust their services, that's fine, that it may be they no longer need that level of service.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Yeah, it's up to them if they want to ask for an exception, but most of the exceptions get approved.

[Jennifer Garofano, Director, Developmental Disabilities Services Division (DAIL)]: Thank you.

[Dr. Jill Bowen, Commissioner, Department of Disabilities, Aging & Independent Living (DAIL)]: Okay. So do we wanna go to

[Rep. Theresa Wood (Chair)]: the numbers or Yes. I'm trying to be mindful of your time and also thinking about committee members and maybe the public needing a little bit of a break. I'm just wondering what your time constraints are. They're yours. Okay. So we took a brief break right now, and then we'll move to the numbers. Would that be okay with people? Okay. So we'll take a break until 10:30 and then we'll be back at 10:30. We believe in wellness.