Vermont Legislature SmartTranscripts:

[Unidentified Committee Chair]: This is Senate Appropriations Committee. It's Thursday, January 8, and we're gonna be going through Budget Adjustment Act, recommendations from the governor. They have HHS with us today, so for the record, introduce yourselves and you can start your presentation.

[Christine McClure, Deputy Secretary, Agency of Human Services]: For the record, I'm Christine McClure. I'm the Deputy Secretary of the Agency of Human Services.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: And for the record, I am Tracy O'Connell. I'm the Chief Financial Officer of the Agency of Human Services.

[Unidentified Committee Chair]: Thanks for being here.

[Christine McClure, Deputy Secretary, Agency of Human Services]: And as I mentioned, the Secretary sends her regrets she would like to be here, but she is on vacation with her family, and she'll be back next week. In the meantime, I will take you through the overview, and Tracy will go into a little more detail. As you know, the departments will be in here providing you more detail. So, the Agency of Human Services, just as a reminder, it's comprised of the Secretary's Office, which includes healthcare reform, and six departments. Those six departments include VAIL, which is the Department for Disabilities, Aging, and Independent Building, DCF, which is the Department for Children and Families, DOC, Department of Corrections, BDH, which is the Vermont Department of Health, and DIVA, we have to call it DIVA, is Department for Vermont Health Access, and DMH, Department of Mental Health. You may hear in some of the commissioners' testimony a reference to the HS executive leadership team. So that's comprised of six commissioners, the secretary, deputy secretary, and the Medicaid director. So collectively, as we've gone through this process, the executive leadership team has been the table for the VA discussion and budget discussions. So, As a reminder for state fiscal year twenty six budget, it was 5,800,000,000.0 across all funds. Of that, was 1,400,000,000.0 for general funds. And for the DAA request, it's 33,200,000.0 for the general fund. So again, I'll go through the broad strokes of this. So of that 33,000,000, we have about 500, sorry, 50,000,000 in pressures, and about 16.3 that offset that to get to that 33. The pressures include case loan immunization, required rate adjustments, contractual agreement, and other operating items that Tracy will take us from. The savings and offset are from revenue and caseload amortization. So I'm hand it over to Tracy. Okay,

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: thank you. And again, I will give an overview of the different areas of pressures that we've made, but each of the AHS departments will be able to speak to those individual pressures more specifically. In the space of caseload and utilization, we are seeking $23,200,000 general fund in budget adjustment. The primary drivers of this is DIVA, Medicaid consensus, and also the clawback payments to the federal government. In the Department of Mental Health, we're seeing caseload and utilization pressures at the private non medical institutions. In DCF, there are some caseload and utilization pressures in the sub adoption and general assistance support services area. Support services covers burials, dental, and abortions. And then in Dale, choices for care, we have some bed day utilization pressures. And then finally in DOC, we had a trip to send incarcerated individuals out of state back in November. So those beds were budgeted for us, so we're asking for an adjustment there. Now we are also seeking $6,600,000 general fund for required rate adjustments. For DIVA, the Medicare Economic Index, that is required for us to align rates for the federally qualified health centers and the rural health centers. It reflects about a 2.7% increase in their rates. And then for Dale, Choices for Extraordinary Financial Relief, and also for the Vermont Veterans.

[Unidentified Committee Chair]: Can I ask you a question about that? Sure. Is that the normal cost and settlement that we do in the veterans home, but that we were gonna switch it?

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Oh yeah, great question. So yes, we did try to build that into the base. We built, on a gross level, we built 3,900,000.0 into the base in '26, but after the state fiscal year '24 costs were settled, still need about $963,000 of gross.

[Unidentified Committee Chair]: And are we assuming that wouldn't happen next year, or it could?

[Emily Hawes, Commissioner, Department of Mental Health]: It possibly could, right.

[Unidentified Committee Chair]: That's something. Okay.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Now onto contractual agreements. We're seeking $14,800,000 general fund for some pressures on contracts related to Diva, the MMIS contract with Gainwell and the Diva Medicaid Data Warehouse Analytics Solution, also known as MDWIS, with Deloitte. We're seeing some transportation pressures at both DCF and DMH, as well as from DMH, travel nurses, an increase in forensic evaluations. And then at DCF, we've recently signed a contract for a provider to provide services at the Wyndham County Sheriff's Office facility for crisis stabilization beds. And then for DOC, the WellPath contract, we are seeking to increase due to an increase in the average daily population. When the contract was originally negotiated, it assumed an average daily population of twelve fifty, and right now the current level is at 1,500, so we have to renegotiate that contract.

[Unidentified Committee Chair]: And then traveling nurses, and I can ask Commissioner Anne Haas, why was it miscalculated? Was there a change in personnel that required more travel nurses, or more just patient pressure?

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: I believe the Commissioner will be able to speak more, but my understanding is because of ongoing vacancies within the department.

[Unidentified Committee Chair]: That they thought they were gonna, they weren't Correct. Able

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: And the value of that adjustment is 386,000. Okay, moving on to other and operating. Dollars 4,800,000.0 general fund request. 109,000 is related to the Pilgrim Park lease for DIVA, for more office space for her return to office. And then for DIVA and BDH, the Planned Parenthood Medicaid backfill with HR1, there is currently a one year prohibition on buying now Medicaid for the Planned Parenthood provider, so we're seeking a backfill for that. DCF Income Verification System, the federally provided system is no longer available, so DCF needs to procure a new vendor. That's about $50,000 And then related to the HOT shelter expansion investments, we stood those up with one time startup funds, but now the operating costs for some of those shelters, we need a $2,000,000 adjustment.

[Unidentified Committee Chair]: And then, do you go over the DOC utilities?

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Nope. And then, lastly, DOC utilities that were not budgeted, that is $100,000 and then some staffing supports associated with DOC, dollars 285,000.

[Unidentified Committee Chair]: What does that mean, non budgeted utility?

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: The commissioner will be able to, yeah, to speak for, but my understanding there was an agreement down in Springfield for a utility

[Christine McClure, Deputy Secretary, Agency of Human Services]: I believe it's water, but, again, I'm sure. Seems

[Unidentified Committee Chair]: like something to do with normally, but so we have a finance. And on Pilgrim Park lease, I assume that's just what you need to finish, since the new lease is just for this fiscal year. But this is return to office kind of meeting, right?

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Correct. This is a prorated amount for the lease that we signed back, or that administration signed back in December.

[Unidentified Committee Chair]: So it'll carry you through this fiscal year in your budget, either requested? Correct.

[Emily Hawes, Commissioner, Department of Mental Health]: Okay.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: We do have a few areas where there are some savings. One is with the in global commitment. We receive 90% federal matching percentage for the childless new adult group. And so their utilization is higher, so you don't have to match it at the normal FMAP rate. So that actually is a savings for us. And then we also had some general fund carryforward from the end of last year that is able to reduce our request. And then for DOC, we have a global commitment investment called Community Rehabilitative Care. This is where we can claim Medicaid for some of the case management for the probation and parole officers, and so we're seeing an increase in their time that can be allocated with Medicaid. So this is a good thing. And then we have a variety of savings in the DIVO buy in caseload, and also some other DCF caseloads, such as AABD, essential persons, and free chat. Okay. We do have a few one time requests in the budget adjustment. One is the return office fit up cost for both for Waterbury and Pilgrim Park, 385,000. This is to help purchase desks, chairs, conference room technology and furniture, and partitions. And then for Vermont Health Connect, we need to move the vendor over to a cloud based system. Right now, it's on the servers, and we must move over to the cloud in order to maintain the connection to the federal data services hub for real time eligibility. You can see more detail about that. We also are seeking a one time adjustment for the Radical Retreat alternative payment model that we have. We are currently budgeted at 20,000 400 forty bed days, but we're seeing an increase in the number of bed days actually used, and this is the amount over the corridor that we are responsible for paying.

[Unidentified Committee Chair]: This came up in Commissioner Gresham's walk through. It was unclear if the payment, When you got over a certain amount of bed days, you just had one large new payment, or was it somehow prorated over those bed days?

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Yes, it's prorated. If could speak to that, but yeah, it's above the unknown corridor. That then

[Unidentified Committee Chair]: But it looks like you get one bed date more and you gotta pay $7,000,000 No.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: The current estimate is 3,000 beds over right now. And then lastly, dollars 150,000 for an upgrade to the DCF Child Abuse Hotline in order for it to be compatible with the surgical requirements. So, that concludes our overview.

[Unidentified Committee Chair]: And you know how this compares to other years, like this thirty million or 33,000,000 of general funds? I mean, when you have such a large budget. Yeah. 33,000,000 seems like a big number, but you're over a billion dollars.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: Yeah, it represents 2.35% over, and it was comparable to what we had requested previously. It? Kinda normal. Really, some of the, like, for example, Medicaid, the pressures are related to what we saw at closeout, and we had a few areas of savings, one time savings, and a few spaces that were able to cover that in the of last year.

[Unidentified Committee Chair]: Okay, nice. Did

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: you wanna go through the ups and downs of the particulars for the secretary's office?

[Unidentified Committee Chair]: I don't think so unless there's something that you wanna highlight.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: No, just one reoccurring adjustment you would see is from the ADS service level agreement. We had budgeted what we were projecting to be the increase for '26 in the Secretary's office, and now that we've gotten the final bill, we know where to parse it out to the department. You'll see net neutral transfers for the EDS service level agreement. It's not an increase, it's just putting it in the right spot.

[Unidentified Committee Chair]: Do you know which section on the Zig worksheet that Gresham hands up? Which is B-three 12, and where that is on the sheet? B-three 100. Well, it's all B-three 100. Yeah, we're moving

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: it from B-three 100 to all of, really, the administrative appropriations within the AHS departments. But

[Unidentified Committee Chair]: the Secretary's office is B-three 100. Correct. I don't think so. I don't think we need to go through the ups and downs. We know the general situation.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: The bulk of the request is actually in three zero one, which is the Global Commitment Appropriation. Just as a reminder, this is what is referred to as the mixing bowl for Medicaid. It includes both the state match and the federal match that help pay for global commitment. Out of all the previous requests I described, anything associated with Medicaid, the general fund is appropriated in B-three zero one. And so out of the 32,000,000 we're requesting, 17,000,000 general fund is in the three zero one Medicaid.

[Unidentified Committee Chair]: Yeah. We might have questions for the commissioners. I know there were some questions about the release funds for the nursing homes. We can get into that later. I saw Commissioner Hans come in. How are you?

[Emily Hawes, Commissioner, Department of Mental Health]: Good. How are you?

[Unidentified Committee Chair]: Great. Thank you for joining.

[Emily Hawes, Commissioner, Department of Mental Health]: You Well, you unfortunately just had me today. The VMA does not have a finance director. I'm sure that Tracy

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: I will be your phone number.

[Emily Hawes, Commissioner, Department of Mental Health]: Will be my phone, my friend. We need

[Senator Virginia "Ginny" Lyons]: that. Sure.

[Unidentified Committee Chair]: Well, sounds like a vacancy statement.

[Emily Hawes, Commissioner, Department of Mental Health]: This is true for now. And if you don't mind, I'll just join the Internet.

[Unidentified Committee Chair]: Yeah. Your handout was on your system of health, system of care.

[Emily Hawes, Commissioner, Department of Mental Health]: That's correct.

[Unidentified Committee Chair]: But you must also have something in.

[Emily Hawes, Commissioner, Department of Mental Health]: Yes. We it's in a larger worksheet. Yeah. And I can give you it's B 314 under the DMH.

[Unidentified Committee Chair]: Let's

[Emily Hawes, Commissioner, Department of Mental Health]: start off there. Yeah.

[Unidentified Committee Chair]: Okay. And when you're ready, then introduce yourself for the record. And takes that money to share the the one who sits for this. Right? That's. Not like The one who sits closest to you. Okay. There's only a different veteran. Or we've set up a Venmo. And does he actually Who doesn't have Venmo? Our Venmo, for real.

[Emily Hawes, Commissioner, Department of Mental Health]: Our medical director didn't have Venmo, and she looks looking for something.

[Unidentified Committee Chair]: And then these changes of you or I having to I can't. To my daughter. You just stay at that. I'm very. I'm very. I do. Oh my I think the No. Just check or two. Just barely. I don't know. But What's the pay penalty when they're on the credit credit card. Card or. I have no idea, but Oh. The Venom and Diamond pieces are bank the bank, so it's a lot safer. Yes. I remember the days of money by West Union. They were charging, like, 15% worth time. That by the Express? It like the first electronic transfer.

[Emily Hawes, Commissioner, Department of Mental Health]: He has to deal with the grocery store.

[Unidentified Committee Chair]: Actually, the best way to send money out of the country still is is Western Union. Oh, yeah. Really? Yeah. Yeah. I know. You should have a message. This year, can talk more about it.

[Emily Hawes, Commissioner, Department of Mental Health]: And it comes down. Let's just take a while. I I know what our website is like.

[Unidentified Committee Chair]: So, have one slide.

[Emily Hawes, Commissioner, Department of Mental Health]: It's our systems of care, which I should be rather familiar with. So, I'll go ahead and get started. For the record, Emily Paz, Commissioner for the Department of Mental Health. Thank you for having me today to talk about our DAA FYPVS. So, I thought I'd start out with just a brief overview of the current system of mental health. And so, as you'll see by this slide, the foundation of our community mental health system is here at the bottom. And without those community mental health supports, the rest of the pyramid doesn't exist. And so Down here at the bottom, we have our micro residential programs, which are for youth. We have youth group homes, otherwise known as a PNMI. We'll talk a little bit about that as we get through our ups and downs. We have adult group residential homes. DMH also holds a variety of shelter plus care vouchers for individuals. And then all of our traditional individual family based outpatient services. The next level up is our crisis response components, which include crisis stabilization programs, also youth hospital diversion. It also includes adult integrated care beds, which are crisis beds that can serve individuals experiencing both the mental health and substance use challenge. We also have mental health urgent cares across our state, which this group has worked with us on. 988 which is the 20 crisis line that folks can talk, chat, and test. It also includes our mobile crisis response, a two person response in the community across the age span, serving individuals with both mental health and substance use service needs and crisis supports. The next level up is our intensive residential programs. That's examples of those are our youth residential programs, intensive recovery residential for adult, peer run residentials, and then coming online in the next year is our youth psychiatric residential treatment facility, which will be at the Tree.

[Unidentified Committee Chair]: Is that the one that

[Emily Hawes, Commissioner, Department of Mental Health]: we had trouble setting? Southwestern Vermont Medical Center is an inpatient unit, which is not on here yet, that's a little bit further out. But that was a project that we did a lot of testing on the other side.

[Unidentified Committee Chair]: There's also, isn't there a secure residential facility that's attempting to be? That's what I was

[Emily Hawes, Commissioner, Department of Mental Health]: Oh, that's under DCF, so you'll hear more from them about that. That's the Woodside. That falls under the DCF budget. We do have a secure residential for adults. That's the River Valley Therapeutic Residence in Essex. That's the next level of residential.

[Unidentified Committee Chair]: Beds are there?

[Emily Hawes, Commissioner, Department of Mental Health]: There are 16 beds there. But

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: that's not for

[Senator Virginia "Ginny" Lyons]: anyone who's been judicially involved? Or someone who's been affected of a major crime?

[Emily Hawes, Commissioner, Department of Mental Health]: They could be. That is based on the treatment need. And so, somebody's forensic status doesn't equate whether or not they need that particular level of care.

[Senator Virginia "Ginny" Lyons]: So, then we could say then that we have a forensic facility for those?

[Emily Hawes, Commissioner, Department of Mental Health]: We would not say that.

[Unidentified Committee Chair]: Just a forensic facility that we have up by Central Vermont Hospital?

[Emily Hawes, Commissioner, Department of Mental Health]: The state of Vermont does not currently have a forensic facility. So next to Central Vermont Medical Center is a 25 bed adult inpatient hospital, and that's for adults who are under the care and custody of the commissioner of DMH. Folks there can be involved in the criminal justice system. They can be there for competency evaluations and such, but there's also individuals there who are not. So again, time is

[Unidentified Committee Chair]: this Do you call it a secure facility? What do you call it?

[Emily Hawes, Commissioner, Department of Mental Health]: It's a hospital. It's an inpatient psychiatric facility. Access to it requires an individual to need hospital level of care as defined by CMS and admitting physician determines that an admission there is required based on that individual's medical needs. Also, the folks need to be under an involuntary status. So you can't, for lack of better terms, just go check yourself in. Or out. Or out without going through a particular process. We also have inpatient hospital beds down at the Brattleboro Retreat, serving both youth, adolescent and adults. And then, like I said, VPCH is a level one hospital, which that language or definition was put into play in our system after tropical storms are made to define those individuals who might need more resources in order to appropriately serve their clinical needs. And then we also have inpatient units at Rutland Regional Grand Isle Center, And then folks can also access inpatient hospitalization at UVMMC, at Wyndham Center, and then we also collaborate with the VA for some adult medicine. And that is a snapshot of our mental health system.

[Senator Virginia "Ginny" Lyons]: I have question for you. So, level one is at the top

[Unidentified Committee Chair]: of the pyramid.

[Emily Hawes, Commissioner, Department of Mental Health]: It is.

[Senator Virginia "Ginny" Lyons]: The acute care. And And if you look at recovery residences, it's just the opposite. It would be level five or more. So I'm wondering, is there a way that we can

[Emily Hawes, Commissioner, Department of Mental Health]: From the ASAM criteria and how they define recovery residences, yeah, they use two different models to define that level of It does. Does. Yes.

[Unidentified Committee Chair]: You might need a level of one and one and level of five in the

[Emily Hawes, Commissioner, Department of Mental Health]: other There are individuals who come to say the Vermont Psychiatric Care Hospital who are co occurring, but they are there because they have a major mental illness that needs psychiatry to serve. They need to stabilize and then discharge and require some follow-up substance use services from the broader substance use system. But they do use two different approaches to determining that level of care. Great. So, I'll move on to the ups and downs sheet if that works for you all.

[Unidentified Committee Chair]: I don't know if I saw the ups downs sheet. We have a big It's

[Emily Hawes, Commissioner, Department of Mental Health]: a Is it part of this? It is. It's part of the larger. I don't know. Page 10.

[Unidentified Committee Chair]: Page 10.

[Emily Hawes, Commissioner, Department of Mental Health]: Page 10.

[Unidentified Committee Chair]: It was not on this.

[Emily Hawes, Commissioner, Department of Mental Health]: You might have those folds of it too.

[Unidentified Committee Chair]: Oh, that's part of it. I see. So it's not gonna be good that

[Emily Hawes, Commissioner, Department of Mental Health]: Didn't give you a lot of choice.

[Tracy O'Connell, Chief Financial Officer, Agency of Human Services]: This is more feel for mommy. I'm sorry.

[Emily Hawes, Commissioner, Department of Mental Health]: Took a bad bar. Are we set?

[Unidentified Committee Chair]: Yeah.

[Emily Hawes, Commissioner, Department of Mental Health]: Okay. So, you'll see this is a fairly small number of items. I'll start with personal services. We experienced an increase in transportation costs for both youth and adults. These are transports related to inpatient hospitalization, also out of state placements, if a youth is traveling out of state, folks waiting in emergency rooms to the next appropriate level of care. We've seen a gradual increase in transports for a variety of reasons. One, there's more people presenting for needing care. And also, we are experiencing less family members' ability to do transportation.

[Unidentified Committee Chair]: Who do you use to do this? Sure.

[Emily Hawes, Commissioner, Department of Mental Health]: We use a couple of folks, our sheriffs. We have a contract with the sheriffs, and then we also have a private contract with a company called YTA, Youth Transport Authority, although they transport across the age space.

[Unidentified Committee Chair]: Do you need somebody like a sheriff to make these transports, or could it be?

[Emily Hawes, Commissioner, Department of Mental Health]: It could be anyone. We're required to transport folks in the least restrictive, and so we want to make sure that we have a variety of options. We use a sheriff only when they really need to.

[Unidentified Committee Chair]: And this is like the particular treatment.

[Emily Hawes, Commissioner, Department of Mental Health]: Yep, or PBCH. It could be a few classes. The next line item is for forensic evaluations. For this group to know, forensic evaluations are evaluations for individuals that are ordered by the court because their ability or competency to stand trial is in question. So, the fourth orders those, we've seen an increase in the number of competency evaluations that have been ordered. And so, that has gone above what we were originally now looking at. The next line item you'll see is a net neutral transfer 51284. That's the internal service fund to cover for ADS services. So, goes to the central office. Thank you,

[Unidentified Committee Chair]: Sarah Lyons.

[Senator Virginia "Ginny" Lyons]: I just want to go back to the increased cost for the forensic evaluations for competency. Yes. Is causing that? I know it's the number of evaluations, is it ongoing evaluations for one individual or is it multiple individuals coming in and increasing the load overall or is there a timing piece to this?

[Emily Hawes, Commissioner, Department of Mental Health]: Yes, that's a great question. So for the most part folks are receiving one competency evaluation. Unless they have multiple crimes and the court hasn't combined all of those together, so it depends, it can depend. For the most part, it's that more individuals are being ordered for a competency evaluation. Historically, ordered for such evaluations were individuals experiencing a serious mental illness, for example, schizophrenia. We are seeing orders for competency evaluations have expanded past that group in the last several years to include individuals with TBI, dementia, substance use disorders, individuals that don't necessarily fall into the category of a serious mental illness. Yes,

[Unidentified Committee Chair]: now let's the chair. Can I ask a question? Sure, sure, you may. On the transportation, you have the increased costs. You have an up of three twenty, but a down of one fifty from the global commitment. Are you just switching to adding different funds? Or is there increased, is it increased cost against more general fund or is it increased utilization?

[Emily Hawes, Commissioner, Department of Mental Health]: Let me check my notes. Increase in utilization. In addition, oh, there's more adults also who don't meet the definition of serious mental illness needing transportation. Okay, covered. Thank you. If there's more though information that you need. I'll go to transfer. Thank you.

[Unidentified Committee Chair]: Next

[Emily Hawes, Commissioner, Department of Mental Health]: is our federal grants. So, our federal revenue reconciliation is also an AHS net neutral. And then the PNMI increase, and the PNMI increase relates to those 20 fourseven facilities, both in state and out of state. So, we certainly don't have a lot of control around rates for out of state placement, And if a youth needs a certain level of care, that's not offered in Vermont if you get out of state. But we have seen a use increase in the use of PNMI as well as a rate increase.

[Unidentified Committee Chair]: Go ahead.

[Emily Hawes, Commissioner, Department of Mental Health]: Okay. Next we'll shift to section B315. This is the session that's directly related to the two facilities that VMH runs, Vermont Psychiatric Care Hospital and River Valley Therapeutic Residence. And so, you'll see in the first line, the GS block for GC, the Medicaid billings at VPCH saw a decrease this last year. We were unable to capture as much as we had anticipated from a billing perspective. The next is VPCH special fund revenue reduction.

[Unidentified Committee Chair]: Turnover savings, vacancy savings?

[Emily Hawes, Commissioner, Department of Mental Health]: We do have vacancy savings as the next. It looks like they forgot to take out that online. Vacancy So, turnover savings is up next. That's a 4,000,549.

[Unidentified Committee Chair]: And how does that compare to the It seems like a large number, but I mean Yes, 40

[Emily Hawes, Commissioner, Department of Mental Health]: and so we've separated out the vacancy savings with the travel nurse contract so folks can compare the amount that we're spending on travel nurses, which we should do, and the overall vacancy savings for the hospital. We were over by quite a bit from a travel nurse contract perspective, and our vacancy savings didn't match that.

[Unidentified Committee Chair]: Is it because it's hard to hire these type of nurses?

[Emily Hawes, Commissioner, Department of Mental Health]: It is challenging to hire. We are seeing improved hiring as of the last quarter, but we rely heavily on travelers to run the facility. We have less travelers now than we did a year ago, and even more so a year from there. So, things are improving, just at a very slow pace. We're also working with our contractors to decrease the hourly rate that we had been paying. We've gone from the initial spike that happened during COVID to coming down every year since then, so that we can come into a more reasonable contract.

[Unidentified Committee Chair]: And nationally, is that bearing now?

[Emily Hawes, Commissioner, Department of Mental Health]: Coming down from the use of travelers?

[Unidentified Committee Chair]: Yeah, but the delta between what they get paid as a traveler and what they get paid as a state.

[Emily Hawes, Commissioner, Department of Mental Health]: It depends. We are seeing some leveling out of the use of travelers nationally. For VPCH, it also acts as one of our primary opportunities to recruit. And so, we often have a traveler start and then we talk them into applying for a permanent position and they make that switch.

[Unidentified Committee Chair]: I've met a couple of nurses that are dedicated to Vermont as traveler state.

[Emily Hawes, Commissioner, Department of Mental Health]: Yes, and that works really well for us because they already have a place to live and they already know what the facility and some orientation because then it's costly, because they're already providing service. There are some hospitals that refuse to contract travelers in other states, but we want to make sure we have as many beds as possible. So, you want that, it should be.

[Unidentified Committee Chair]: And

[Emily Hawes, Commissioner, Department of Mental Health]: then the next line down is the cost of room and board at River Valley Therapeutic Residence, and that is a line item to support dollars that are not Medicaid reimbursable for residents that are sick at the facility.

[Unidentified Committee Chair]: That's all your. That

[Emily Hawes, Commissioner, Department of Mental Health]: is that is it.

[Senator Virginia "Ginny" Lyons]: How can we get rid of tremors?

[Unidentified Committee Chair]: You've been trying after years. I know. Well, how long have you been there, Patricia?

[Emily Hawes, Commissioner, Department of Mental Health]: This is I've been in this position for four and a half years and then I ran for four years before that.

[Unidentified Committee Chair]: So like, then that eight years, was there a time when travelers were a very small part?

[Emily Hawes, Commissioner, Department of Mental Health]: Yes, we had around 14 or 15 travelers prekindled.

[Unidentified Committee Chair]: And now how many?

[Emily Hawes, Commissioner, Department of Mental Health]: 47. So it's really shifted.

[Unidentified Committee Chair]: Have we made progress by offering better pay?

[Emily Hawes, Commissioner, Department of Mental Health]: Yeah, we've gone through, we've moved to twelve hour shifts, which was helpful for folks to manage their work life balance. We've worked with HR around shift differential improvements for pay through that way. We're also working with the talent acquisition folks with HR to be able to hire and arrange for new staff coming in. Although, if you're an existing state employee, you don't have the options of a hire to arrange if you're taking internal position. And VPCH shares the same contract as the rest of state government from a collective bargaining agreement.

[Unidentified Committee Chair]: So have you had an issue where you wanted to bring in a nurse a range, but then that would affect all the other nurses of that class?

[Emily Hawes, Commissioner, Department of Mental Health]: Yep, and we've addressed that. Where we run into an issue is if an internal candidate wants to move into a higher position, but we're not able to offer them a higher step. They don't have that negotiation if we're hiring internally.

[Unidentified Committee Chair]: Any other questions, mister Hernandez? Alright. Thank you.

[Emily Hawes, Commissioner, Department of Mental Health]: Thank you.

[Unidentified Committee Chair]: Thanks for your work. Important work for the state. Yes.

[Senator Virginia "Ginny" Lyons]: Yeah. No.

[Emily Hawes, Commissioner, Department of Mental Health]: We should be here. They might be in the. You would like to check.

[Unidentified Committee Chair]: Like to check.