Vermont Legislature SmartTranscripts:

[Rep. Theresa Wood (Chair)]: Okay, welcome back to House Human Services. Thank you for coming back up from the floor. We've learned since we left here that H. Two ninety three has passed the Senate on third reading. And since it's a bill that left committee a long time ago, and some of us, probably everybody except for Representative Maguire has forgotten all about it. But Katie, if you could just review with us the changes made. We have Jessica Gefano on from the Department of Health if there's any questions.

[Katie McLennan (Office of Legislative Counsel)]: Good afternoon, Katie McLennanoff's Legislative Counsel. Again, this is the Senate Health and Welfare Committee report that is marked up with the changes. So let me sort of refresh your memory. This bill is coming back to you a bit longer than as you sent it out the door. So there have been some additions. And this is bill that was requested by the health department, and the changes were requested by the health department. What left here had some changes to reporting requirements with regard to the health equity data question. And there were also two registries, the ALS registry and the cancer registry. And there was some language around how there would be approval for research academic research use of data where there were some changes. So those sections are still in the bill. I think the senate accepted the changes that you sent over, and now they're sending it back with some more. Mostly, the new language has to do with changes to reporting requirements that the Department of Health has requested, either maybe lengthening the time between reports or removing some of the reports. And then there is a report added around recovery service organizations. So you'll see that also. So first we

[Rep. Esme Cole (Member)]: think Mike was here, so Got it.

[Katie McLennan (Office of Legislative Counsel)]: So first, there is an existing report on the Community Violence Prevention Program. Here is the language the the language about that's being removed is that the Commissioner of Health in consultation collaboration with the chief prevention officer, DPS, director of violence prevention, executive director of racial equity, council for equitable youth justice shall report on the Community Violence Prevention Program on or before 09/01/2023 and 12/01/2023 to the Joint Legislative Justice Oversight Committee. That's already gone, that's easy to strike. But here's the annual requirement. On or before 01/15/2024 and annually on that date thereafter, the policy committees would receive a report. Page two. The report required by this subsection shall include a complete description of the Community Violence Prevention Program grant application and award process, guidelines for the award of grants developed under the subdivision B2, the number of applications submitted and grants awarded, and the amount of each grant awarded, detailed descriptions of the programs and purposes for which all grants were awarded and the impacts and outcomes of funded projects and descriptions of any grants applied for or awarded. So that would remove that reporting requirement. Does the project still exist? I'm not. I can't answer that.

[Rep. Theresa Wood (Chair)]: Okay. I'm just gonna hear from Jessica. Alright. So Jessica, you list oh, I was just gonna wait till you were done. Oh, okay. Yeah. We'll just go through it all. We'll hold all our questions, and then maybe you can answer them at the end.

[Katie McLennan (Office of Legislative Counsel)]: Okay. So next, section two is the Cancer Registry Disclosure Requirements. You can see that this hasn't changed. Some of the work you did was changing that the commissioner shall first obtain from such state registries, agencies, or researchers an agreement to keep in writing. And instead, it's being changed to a written assurances acceptable to the commissioner. Identifying information shall be kept confidential and privileged as required by law. Obtaining written evidence of approval of an institutional review board or privacy board in accordance with federal regulation. The background on that is that HIPAA requires researchers to obtain institutional review board or privacy review board approval for disclosure of PHI, Protective Health Information, without an individual's authorization. And Vermont law only allows for disclosure currently of registry data if the researchers obtain an Institutional Review Board approval. However, this Institutional Review Board approval is no longer available for public health surveillance studies. So this change allows the Commissioner of Health to disclose registry data containing protected health information to researchers to obtain either the Institutional Review Board or the Privacy Board approval. So that opens the door to public health surveillance for researchers. So you made the same changes in section three, same rationale. So this is the ALS registry, and you have nearly identical changes with written evidence.

[Rep. Theresa Wood (Chair)]: All coming back to VNet.

[Katie McLennan (Office of Legislative Counsel)]: Yeah. The Institutional Review Board or Privacy Board. And then there's this new section four that's a report on the ALS.

[Rep. Esme Cole (Member)]: I don't want to

[Katie McLennan (Office of Legislative Counsel)]: say it's on the registry, but on maybe data collected from the registry. The health department asked that January 15 was too soon after the end of the calendar year to collect all of that data. So instead, they will report on the previous year of November 1. So that gives them almost a full year to collect and aggregate that data and prepare a report. Section five, this was in your underlying bill, the house's bill to the Senate. So there was a this is the Health Equity Advisory Commission. There was an annual report reporting requirement. So the change here was instead of having a report annually, having it on odd number years, so every other year. I'm not sure if this actually was in the underlying report. This, no, I I can't remember. Section six also has to do with health equity. There is language that the department submits a report looking at an analysis of the data equity collection that's happening in Subdivision B1. So analyzing health equity data using the smallest appropriate units of analysis feasible to detect racial and ethnic disparities, etcetera. Right now, that report is required annually. And then this says every three years beginning 2029. So you'll be on a three year cycle after this if you're to adopt this proposal. Next is the Emergency Service Provider Wellness Commission. This commission was established maybe five ish years ago, with the idea being that they look at ways to support emergency service providers who may have been exposed to traumatic experiences during the course of their work. Right now, there's language that the commission is to report its conclusions and recommendations not less frequently than once per calendar year. And this proposal is to remove that requirement. So it doesn't prohibit them from submitting a report if they would like to, but there's no annual reporting requirement for this group. Next is a report about service members and veterans and their sort of specific knowledge and experience that might enable them to obtain a food service license. So this is the language that would be repealed. It requires the Commissioner of Health each year to submit a report to various policy committees regarding the number of service members and veterans who during the previous calendar year were deemed to have knowledge of the prevention of foodborne illness, be able to apply the hazard analysis critical control point principles, and have met the criteria for demonstration of knowledge requirements set forth by the Department of Health in rule for the purpose of obtaining a food establishment license. And the total number of licenses held by these service members and veterans. So the proposal is to remove that reporting requirement.

[Rep. Theresa Wood (Chair)]: It wasn't in the original bill.

[Katie McLennan (Office of Legislative Counsel)]: It wasn't in the original, yeah.

[Rep. Esme Cole (Member)]: You're proposing these They're just, put these in to take out. Section

[Katie McLennan (Office of Legislative Counsel)]: nine is the new reporting requirement. So this is recovery service organizations. By February 15, the Department of Health in consultation with AHS departments and recovery service organizations shall submit a written report to the House Committees on Appropriations, Health Care and on Human Services and I don't have to read all the committees containing information on the actual, on the total actual income and expenditures for recovery service organizations in fiscal years '24 through '26. Specifically, the report shall address public funding sources, including all appropriated state, federal and municipal funds, recipients of this Recovery Service Organization funding, an analysis of Recovery Service Organization grant performance measures and outcomes, any recommendations for enhancing the financial stability of Recovery Service Organizations? Does recovery service organizations mean both recovery centers and recovery housing? It's not defined. I'm not sure how it was intended to be used here.

[Rep. Theresa Wood (Chair)]: We don't use this term normally, or at least we haven't up here. Okay, I'll ask the

[Rep. Esme Cole (Member)]: health department when we're done.

[Katie McLennan (Office of Legislative Counsel)]: Next, there are two more repeals of two more reports. Because the whole sections are being repealed, we don't have to show all the language. Everything else we've looked at is a subsection, so that's why I could show the straight through. But I have both of them pulled up so you can look at the language. So the first is report on statistics. That is on death statistics where individuals die, the location in which they die and whether they're on hospice. The second is a lead screening annual report. And then this is updated to 2026 because of course you sent it over in 2025 and updating the name of the bill after passage to an act relating to miscellaneous amendments to the Department of Health reporting and programming requirements. Let me pull up those two reports so you can see what is in those.

[Rep. Esme Cole (Member)]: Okay.

[Katie McLennan (Office of Legislative Counsel)]: Okay. Here is the first one. So you'd be repealing this section that there is a report required every two years from the health department, according to the policy committees regarding the number of persons who died during the preceding two calendar years in hospital emergency rooms and other hospital settings in their own homes and a nursing home and a hospice facility in any other setting for which information is available, as well as whether each decedent received hospice care within the last thirty days of their life. Beginning with the 2013 report, the Department shall include information on the number of persons who died in hospital intensive care units, assisted living facilities or residential care homes during the preceding two calendar years. Okay. Let me switch documents. Okay. So next is the annual report on lead poisoning prevention. Requires the commissioner annually to analyze, summarize all aggregate lead screening and testing information provided by physicians, health care facilities, laboratories, and provide this information to all other local and state agencies involved with case management and lead hazard reduction. Requires the commissioner to at least annually provide to the general assembly the health community and the general public, an analysis and summary of the data, and a progress report on the commissioner's efforts to prevent lead poisoning in young children in a format that's easily understandable to nontechnical readers, includes the number and percentage of children under six years of age who have been screened and tested for lead poisoning and the number found to have lead poisoning at various levels, estimates of the public and private costs, an analysis of barriers to universal blood screening of children under six years of age, and recommendations for action. So those are the two reports that are just listed.

[Rep. Theresa Wood (Chair)]: Okay. Thank you. Any questions for Katie on what she just went through? We'll ask Jessica for content questions,

[Rep. Esme Cole (Member)]: which we have a few.

[Rep. Theresa Wood (Chair)]: It passed the Senate, and we got done on the floor a little bit early, I decided to set this afternoon. Although I will say, I think we have a few more questions than maybe you're anticipating. Unless you want Why don't I give you the floor first and you can explain these additions? I don't think you need to go through the timeframe things on the ones that we had originally in H293, but if you could review the rationale behind the reports that you are wanting to be relieved of, that would be helpful. Sure. And as well as the definition of recovery

[Jessica Chefano (Policy Director, Vermont Department of Health)]: service organizations.

[Rep. Esme Cole (Member)]: Service organizations. Absolutely.

[Jessica Chefano (Policy Director, Vermont Department of Health)]: Thank you for the record. Jessica Chefano, Policy Director, Department of Health. And the Department of Health this year did 17 different reports to the legislature. We definitely welcome Senate Health and Welfare's invitation to streamline some of those requirements to make our work more sustainable. While we're requesting some of these report requirements be adjusted or repealed, our intention is that we will still collect the data and we will still be reporting that data publicly on our website. It just won't be in the same format that we report to the legislature, but it will still be available for anyone to be able to have access to. And we're certainly always happy to provide specific or tailored information to the legislature at your request on any of these topics or others. Want to just make it clear that we're not trying to stop collecting or analyzing any of the data. It's just the reporting that we are hoping to streamline. So for those reports that we've asked to revise, The first one was the Community Violence Prevention Program report, and you had asked whether this program still exists and that the funding for that program runs out this year and the information that we provide in this report we can. We're still planning to analyze the outcomes from the program and can make that available as needed as opposed to on an annual basis. Our rationale for changing the deadline for the annual report for the ALS data, but happy to answer any questions about that. It will just give us the opportunity to provide a more complete and thorough report to the legislature on those cases that we receive reports of. Let

[Rep. Theresa Wood (Chair)]: me just stop there for a moment.

[Katie McLennan (Office of Legislative Counsel)]: Sure.

[Rep. Theresa Wood (Chair)]: So does anybody have any questions about the Community Violence Prevention Program? The funding for that program is winding down. This is an opportunity to update the statute about things that are not gonna be in existence anymore after after what date did you say?

[Jessica Chefano (Policy Director, Vermont Department of Health)]: I would have to get back on the exact date, but the majority of those requirements were about the granting process and program descriptions. And that happened three years ago and none of that has changed. It's really just the outcomes and evaluation of that program that we would be reporting on and we we plan to do that regardless of whether there's the requirement in statute or not, because it's a really important program for the department and we want to showcase the great work that we've done over the last few

[Rep. Theresa Wood (Chair)]: years. Anybody have any questions about that? Alright, thank you.

[Jessica Chefano (Policy Director, Vermont Department of Health)]: So I will jump to Section five, which is the Health Equity Advisory Commission's report, and this one was a Senate edition. So the Health Equity Advisory Commission is required to do an annual report on recommendations for legislative action. And in their work over time, they think that it would be more impactful and useful for the legislature if they were to issue any recommendations that you have every two years at the beginning of the biennium to align with that legislative calendar. So that's what this is asking for is instead of an annual report to do it every two years at the beginning of the new legislative session. Section six was adjusting the frequency of the health equity data report, and this was in the original bill that you all passed last year. And happy to give more description about that if if there are questions. The repeal for the reporting requirement for the Emergency Service Provider Wellness Commission. We do not think that there needs to be a reporting requirement. The Commission can still report if and when they have recommendations to share, which I'm sure they will, but we don't think that that needs to be a required annual report to provide that feedback to the legislature.

[Rep. Theresa Wood (Chair)]: Section So it's still an active

[Jessica Chefano (Policy Director, Vermont Department of Health)]: It is still an active commission. Yes. Yes. And we expect that as they do have conclusions and recommendations to share that they would be reporting those to all of you.

[Rep. Theresa Wood (Chair)]: And Okay. Thank you.

[Jessica Chefano (Policy Director, Vermont Department of Health)]: Yes, the Section eight that repeals the requirement for the Department of Health to report on the number of service members or veterans who were deemed to have knowledge of the prevention of foodborne disease for the purpose of food service establishment licensing requirements That rarely occurs and the Department of Health can produce the data as needed, whereas we would still be collecting that and just not reporting that on an annual basis to the legislature.

[Rep. Theresa Wood (Chair)]: Do you have any idea about what the origin of that was?

[Jessica Chefano (Policy Director, Vermont Department of Health)]: It was a 2018 session law, and I think there was a requirement that we had to, in our licensing requirements, allow service members or veterans who could demonstrate that they have knowledge to be able to kind of feed into the established licensing requirements for food service establishment. And I guess the legislature was just interested in tracking how many people availed themselves of that. And like I said, it rarely occurs and we would still be tracking that and could produce the data if needed.

[Rep. Theresa Wood (Chair)]: Does it give a service member an option of gaining information through their service, military service, I'm presuming, to be able to bypass some regulations?

[Jessica Chefano (Policy Director, Vermont Department of Health)]: Requirements. Yes. I think that's the case. Yeah.

[Rep. Theresa Wood (Chair)]: We're not removing that.

[Jessica Chefano (Policy Director, Vermont Department of Health)]: We are not removing that. That would still exist. It's just the tracking and reporting to the legislature on how many people took that pathway.

[Rep. Theresa Wood (Chair)]: And do you know if you provide any information to any veteran services organizations that that possibility exists for veterans?

[Jessica Chefano (Policy Director, Vermont Department of Health)]: I would have to get back to you on that one.

[Rep. Theresa Wood (Chair)]: Okay. So I I I guess I'm making a request that you do that not only get back to us, but that that veteran services organizations are made aware of this so they can pass that on to their members. Lots of times we do things and people don't know about the availability of them. So that could be one of the reasons. Although, I imagine this came up for a very specific reason, I would think. But but I don't I don't think we need to get a report on it every year.

[Rep. Esme Cole (Member)]: Okay. Okay,

[Rep. Theresa Wood (Chair)]: thank you.

[Jessica Chefano (Policy Director, Vermont Department of Health)]: And then the last two that Katie walked through were the death and hospice care report and the lead screening and the childhood lead prevention report. For both of these, we understand like the the data is really important, and we still plan to collect it and make it publicly available on our website for the death and hospice data. We plan to make that available through our annual vital statistic report, which is publicly accessible. If this report requirement is repealed, we would modify what we do in our annual vital statistic report to parallel the sort of information that we're already presenting in the biennial death and hospice care report for the blood lead screening information that's collected and reported. We will still be collecting this data, and we plan to make the data available through our environmental public health tracking website, which is publicly accessible, and you can already see previous years of childhood blood levels data reported on that website, and there's actually like an interactive portal. You can sort the data and you can see it. We would still continue to collect that information and make it available in a way that's very accessible.

[Rep. Theresa Wood (Chair)]: Okay. And I know on the access to hospice, that report, that was at a time when we were concerned that there weren't enough people really accessing and understanding the knowledge about how to access hospice. And I know the home health agencies and the hospitals have taken a lot of effort to inform people, and we've seen an increase in those numbers. So that would seem logical. Yeah. The lead screening, I remember we did have I mean, the changes we made to that one is are relatively recent in 2023. I remember us having some discussion, but I don't remember the exact I can't remember if it was in the can't remember which bill we made that change in, but but it's still all available. You're collecting the information. It's available on the website. It's it's not we wouldn't have to ask you for a special report. We'd be able to see it right there if we needed it.

[Rep. Esme Cole (Member)]: Yes. Absolutely.

[Rep. Theresa Wood (Chair)]: Mhmm.

[Rep. Esme Cole (Member)]: So do

[Rep. Theresa Wood (Chair)]: people have any questions? Any other questions about these items? Okay. Let's go to then the report on recovery service organizations.

[Jessica Chefano (Policy Director, Vermont Department of Health)]: Yes. And just for clarity, recovery service organizations are what we typically refer to as recovery centers. Recovery service organizations is the term that we use in the department's rules that set out the certification requirements for recovery centers. And so we have, over the last couple of years, really strengthened these recovery supports and have worked with them towards certification and that continues. So when we're talking about like the definition that we use of recovery service organizations are non residential and non clinical facilities providing recovery support services to individuals in recovery from substance use disorder. So that is what we're talking about for this report.

[Rep. Theresa Wood (Chair)]: So, and is this something that I can't imagine it's something that the Department of Health asked for or is it?

[Jessica Chefano (Policy Director, Vermont Department of Health)]: It is. And we have had a lot of conversations over the course of this session about the financial aspects of recovery centers, and we've been working to put together that information in as complete a picture as we can. And we have been working in collaboration with the recovery centers to do that. But we feel like over the course of the last few years, as I was mentioning with the move towards certification and that these organizations have increased the services that they have provided. And we've invested more money in this part of the continuum of care. So anytime when we are making these types of investments and system changes, we really think that a thorough financial analysis is needed. And as my colleague Emily Truter testified in Senate Health and Welfare that we have done this for treatment, we've done this for prevention. So this is kind of following in that vein to offer transparency and also to help maintain the viability of these organizations. That's what we'd like to do with this.

[Rep. Theresa Wood (Chair)]: Thank you. Katie, I do notice on line 19, there's a type line 19 on page seven. It says Heath care instead of health care. Pretty sure everybody else will know what that means. Okay. All right. So are there questions? Yeah, go ahead, Representative Cole.

[Rep. Esme Cole (Member)]: Thank you. On this subject, I'm curious about how the background conversations are

[Rep. Theresa Wood (Chair)]: with the recovery centers

[Rep. Esme Cole (Member)]: and just making sure everybody was on the same page and on board before agreeing to this language.

[Jessica Chefano (Policy Director, Vermont Department of Health)]: And I I'm assuming that was directed toward me. I can't see exactly

[Rep. Theresa Wood (Chair)]: what you're looking at. So

[Rep. Esme Cole (Member)]: yeah. Sorry. Yeah. I'm, like,

[Rep. Theresa Wood (Chair)]: could you use this screen? But

[Jessica Chefano (Policy Director, Vermont Department of Health)]: Yes. So we have certainly been collaborating with the recovery centers and meet with them on a regular basis. I think, you know, for the Department of Health, we wanted to make sure that we're able to get the information that we need to fully understand the financial picture. So we want to do that in a collaborative way and want to make sure that we're all working together in the same direction for this report.

[Rep. Theresa Wood (Chair)]: And we have a representative of the not representative of somebody who represents them in the state house. Meg, you're happy to speak if you would like to.

[Meg (Action Circles, representing Recovery Centers)]: Yeah, think that's action circles. The recovery centers okay with this language. It is not something they knew about what was presented in the subject. So this was a proposal from the development and recovery service organizations was not made aware of the language ahead of time,

[Rep. Theresa Wood (Chair)]: but they have seen it and They're not opposed to it.

[Meg (Action Circles, representing Recovery Centers)]: That's fine. They don't love it, but they're not interested.

[Rep. Theresa Wood (Chair)]: Can understand that perspective. Okay, any other questions? Okay. So the bill is significantly different than when we sent it over there. Are there any thoughts about this is a bill that the health department is interested in seeing passed, although we had given up on it, I think, because we'd forgotten about it. So just to summarize, so we would be doing away with reporting requirements for the Community Violence Prevention Program, which is going to be ending, for but which there will be a program ending summary report that will be provided. We would be doing away with the reporting requirements to the, I should say, the legislature. On the Emergency Service Provider Wellness Commission report, Again, I'll be honest, we have not looked at these reports. So I think they were actually on my list that I sent to a couple of them. My list that I sent to the House Government Operations Committee when they asked for what reports can we do away with, and a couple of these were on my list. I know. So there's that one. That one goes down through there. And then the the two that we just talked about, about lead screening and on hospice. So and then we would be adding one on recovery service organizations. And then the rest of it is pretty much as we sent over. So I would like to see by a show of hands those people who are agreeable to concurring with the Senate version of house bill two ninety three. Representative Steady, are you considering? Is

[Rep. Brenda Steady (Member)]: there a cost involved?

[Rep. Theresa Wood (Chair)]: No. Okay. I concur. Okay.

[Rep. Brenda Steady (Member)]: Yes. Do you wanna see my hand?

[Rep. Theresa Wood (Chair)]: I I can I I saw a virtual hand and I'm hearing you say it out loud? So Okay. I think that's

[Rep. Esme Cole (Member)]: okay. Okay.

[Katie McLennan (Office of Legislative Counsel)]: Struggle with these butt.

[Rep. Theresa Wood (Chair)]: So representative Eastes will give our committee's report on the floor. And, Zon, just be prepared. It could come up at any time. So the other thing is getting late on time, and I know people need to move their cars and things like that before things take off. So we need to take action on 06:57. We can wait until tomorrow to do that. I'm sure that there'll be a break in between. And, Laurie, we have something scheduled at eleven, but I can't remember what it is. Urine. Eleven is S 193 for Eric and 1130, Katie, 293, but you don't need to know that. Right, but we can put 657 there. Exactly. Okay. So just so you know what's happening down in judiciary on one ninety three, there was a motion to approve version 4.1 of the bill. It failed on a five five vote. Version 4.1 was a much earlier version of the bill that still, I think, had the Department of Corrections pretty much in control. So they are continuing to work on it. They have not voted it out of committee, and we will see what happens. There is a newer version on our website. So I encourage you to look at it. I haven't had a chance to read through it, but I know some of the things that were deleted are now back in and vice versa. So not so much on the Katie stuff, but on the Eric stuff. And Eric is gonna be here tomorrow.

[Rep. Esme Cole (Member)]: There is a draft 6.2

[Katie McLennan (Office of Legislative Counsel)]: now. And my understanding from Eric is that house corrections and institutions adopted their portions of 6.2 on a straw poll.

[Rep. Theresa Wood (Chair)]: Okay. And So we'll I'll ask Laurie to post version 6.2. So don't read 6.1, read 6.2. Okay? But we we will need to decide whatever action that we're going to take on it tomorrow. Okay? So we'll be done in the review phase of that. Okay. Thanks all for coming back up after the floor. And thank you, Jessica, for popping on quickly. We appreciate it. And you as well, Katie. Appreciate it very much.