Vermont Legislature SmartTranscripts:

[Sen. Andrew Perchlik (Chair)]: Okay. Okay. Okay, Commissioner, you can introduce yourself for the record and

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: Grove. Hi, I'm Doctor. Bowen, I am the commissioner for Gale, and just a few current statements about the DAA. Dale is the Department of Disability, Dating and Independent Living, the mission to make Vermont the best state in the nation in which to grow old and live with a disability with dignity to Spectrum to either attend the meeting. Just a quick reminder that there are five divisions within the department. The Division for the Blind and Visually Impaired, the Adult Services Division, which focuses on older Vermonters, Developmental Disability Services, Division for Licensing and Protection, and Fire Ability. To go to the numbers, the Dale overview for BAA is $30,313,848 That includes the Internal Service Fund increase for the Agency of Digital Services at $312,378 The AFF Act Me Collective Bargaining Agreement bonus for the direct care workers. All appropriations together is $2,396,001 and that is made up from the adult services division at $151,483 the developmental disabilities services division at $1,188,481 the traumatic brain injury program at $4,711 and at the Choices for Care, 1,041,326.

[Sen. Andrew Perchlik (Chair)]: So

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: together, that's the APPS

[Sen. Andrew Perchlik (Chair)]: main collective bargaining. Why does this, coming up from the budget adjustment acting bad and the right thing to do? Are these workers?

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: Those are direct care workers that are not connected to an agency. They're the IRS paid that are connected to families or that they're the stuff higher. Do you want to explain why it's a BAA?

[Unidentified AHS/DAIL budget or rate-setting staff]: Actually asked that question

[Sen. Richard Westman (Member)]: last So,

[Sen. Andrew Perchlik (Chair)]: it's

[Unidentified AHS/DAIL budget or rate-setting staff]: a two year agreement. So, one year it's in the base and then the next year it's in BA.

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: We're on the second year. For choices for care, we have estimated nursing home pressures through the EHR, the Emergency Financial Relief, at fourteen point five million. Choices for care utilization pressure at two point five million. Choices for care nursing home Medicaid day pressures, which is an AHS net neutral, we can explain that at $9,642,000 and Choices for Care, the Vermont Veterans Cost Settlement, our portion, is, it was most of it already in the base budget. The difference that wasn't is $963,267.

[Sen. Andrew Perchlik (Chair)]: And why does it go all the way back to '24?

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: State fiscal year cost of which okay. So the cost settlement to the state fiscal year '24 costs of 4.8. Do you wanna explain why that goes back to '24?

[Unidentified AHS/DAIL budget or rate-setting staff]: Sure. So division of rate setting, collects their cost reports. And so by the time they get all the cost reports and and summarize the state fiscal year basis, this is the the timing of that cost settlement.

[Sen. Andrew Perchlik (Chair)]: Are we also we thinking about when we do this with the veterans?

[Unidentified AHS/DAIL budget or rate-setting staff]: Correct. Yeah. I knew we did it, but

[Sen. Andrew Perchlik (Chair)]: I didn't remember if any of that Nearly

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: $4,000,000 of that was already in the base budget. So the difference is the 900.

[Sen. Andrew Perchlik (Chair)]: And on the emergency financial relief, we talked a little bit about this with commissioner Gresham and we pointed out at the center Westman that at least it's a lower number, but we're I hear a lot of concern about it. I don't know if there's any words of encouragement you want to say about why we shouldn't be concerned about continuing EFRs every year?

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: So what we shouldn't be concerned about is the instability of our nursing home system as a whole. We should be quite concerned about that given the growing demographic. We are embarking on a planning year this year as we deep dive into the projections to truly understand what is it that we're going to need between now and ten years going forward. It's not just the nursing homes, the whole long term care continuum, residential care, assisted living facilities, adult family care, etc. The whole continuum. But nursing homes right now are shaky and that is to a large degree the several factors, all part of what we are looking very closely at. But the biggest one is still the workforce and the percentage of our workforce that continues to be travelers or contract staff, which is very costly, is higher by far than the national average, which has come down quite a bit. So nationally, it's about 5% of the nursing home workforce that is traveler contract staff not going into that. In Vermont, it's now about 25%, and it came down from 30%. So if you're looking for hope,

[Sen. Richard Westman (Member)]: it's glimmer. Right. That's the that's the down for the emergency aid from 20 to 25,000,000 that has been in the last five years. You told me that the Emergency aid in the budget as a line item in the budget adjustment. Five years?

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: So I can tell you what the VAAS were over the past five years. So in '22, was zero. In '23, it was 9,300,000.0. In '24, it was 17,000,000. In '25, it was 21,000,000. This year, it's 14,500,000.0. So the ask is definitely lower than it was last year. It's even a little bit lower than it was two years ago. So there is that glimmer of hope, but we have a significant to get to even be awarded an EFR, the forensic financial analysis that's done is very involved and Veeva does that, straight setting. And you have to be at risk for closure. Every bed or any bed that we lose in the system right now is really moving in the wrong direction.

[Sen. Andrew Perchlik (Chair)]: And do we ever get new bed, or we're only preventing beds from going away?

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: So we did you wanna say something?

[Sen. Richard Westman (Member)]: Me Well, answer that. Okay. You know, I mean

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: So we need to hold on to every bed that we have and we need to add some. We do on occasion add some beds, increase some beds. We did Mission Care was a big expansion and our focus on complex care, which is another of our factors that we're concerned about terms of stability, which is the capacity for the nursing home to serve that complex population. Because there are some beds right now that are empty that can't be used because that nursing home doesn't have the skill or the equipment or the ability to provide. The other issue we have is that we don't have people lining up to purchase or build nursing homes in Vermont for innumerable reasons that you're probably aware of. There's housing issues, affordability issues. And so when a facility closes, it's hard to find an owner. And we've had several ownership transfers recently and that has its own challenges. So there's a number of reasons why we should be concerned about the stability of the nursing home system. EFR is not withstanding.

[Sen. Richard Westman (Member)]: So, did put money in this committee and it was an initiative in this committee for recruitment of particularly nurses to try to help turn around the fact that we're in this piece. Not knowing what will be in the budget of the governor and knowing that you can't say anything, would say to you that we'll be very interested in this committee, and particularly I will, around the issue of making sure that that money does not go away. Again, as we continue to help nursing homes address the issue of their abnormal nurses and see if there is some way to help them recruit staff.

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: That initiative. And

[Sen. Richard Westman (Member)]: will say health and welfare was very much behind that.

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: We also have LPNs. So what is the level of nursing that we're looking for for nursing homes that we need to really reinforce overall? Okay, so I'm going to respond to a couple of different things. Go ahead. And thank you for the funding and everything for that. The program that you funded was focused on LNAs. LNAs are the backbone of the nursing home system. It's a little bit different than what happens, let's say, in a hospital. There were 11 facilities in the first go round that received the grant in state fiscal year '25, and there were about 200 LNAs who were impacted by that. And the training and the mentoring and the recruitment and retention seems to have had an effect. It's hard to make a direct line, but going from the 30% to the 25%, we do think that this had some impact. This year, we don't have, this is just rolling for this year, we're in the midst of the roll, but 17 facilities have received grants in today's fiscal year '26. And when we do the report in June, we will have the intent to come back. And so the fact that the agency contract has decreased by 9% based on CMS data is a good thing. One other thing I want to say about Vision Rate LPNs. So another project that Dale is working very closely with CMS on is the opportunity to use compensatory monetary penalty funds with some federal match funds to address nursing home workforce, particularly LPNs and RNs, with a focus on rural areas. So we have submitted for that. Our staff works very closely with CMS on this and we are hopeful to have that roll out in addition to the focus that has been on the LNH12, LPN and the RN. So we are very closely looking at workforce and continually working on how do we keep them. When I go to the nursing homes, I go and I talk to people who are traveling nurses or traveling LNAs and I go and I talk to the permanent and I try to get a sense. We're to do this more formally. This is my informal listening tours, but we're going be doing this more formally by bringing different groupings again to talk about what the bigger plan for stabilization and sustainability is, our SNS plan, which if we consider that a ten year go forward, it's planning phase right now. So we will have different groupings in. If you saw the EFR report that Diva prepared that was submitted in December, There's a number of initiatives that are projected there or proposed there. We need to do the engagement with the stakeholders, and so we're going to do that together with rate setting and Diva so that we can get the groupings in the room to look at the long term care and see which of the proposals. Some of them have to do with the smaller nursing homes, may need a different type of an adjustment to their rate because they have some of the same sort of administrative costs, but they get paid less because of the number of individuals they serve. Also, if you remember last time we talked about why we thought there would be a reduction in BAA, not an elimination of, I mean, a BFR we would be talking about right here, we are right now, was because the two year cycle of the nursing rebates was coming up. And so it's always rebased back to previous year. And the last rebase was pandemic impacted. And so it didn't really match the reality. This rebase matches it and most, not all, saw an improvement in their rates. But the report, you haven't seen it yet, you're going read the EFR report, it also talked about should there be more frequent rebasing and should there be a rebasing alignment with the different parts? So there are indirect costs, there are medical directed costs, there are late residency costs and there are nursing. And one gets recycled on a four year cycle and one gets recycled on a two year cycle. So to really align it and shorten it so that you're as close as you can be reasonably to what's happening on the ground. Does that give you some COVID? Yes.

[Sen. Richard Westman (Member)]: I'm hoping, and I suspect that the health and welfare can be moved right here. We're hoping that as the budget comes forward, those initiatives that have been started will be continued.

[Sen. Andrew Perchlik (Chair)]: So,

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: concern is not just about EFR, it's a symptom of a bigger concern.

[Sen. Andrew Perchlik (Chair)]: Are you working on bigger? Yeah.

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: I love that.

[Sen. Andrew Perchlik (Chair)]: Yeah.

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: So that's our report.

[Sen. Andrew Perchlik (Chair)]: The on the ADS service plan increases, I guess it's another question of why the time I thought last budget we brought by the ADS increases so that we wouldn't have this. Did we try

[Unidentified AHS/DAIL budget or rate-setting staff]: to fix that last year? We did. Right?

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: Yes.

[Tracy O’Connell, Agency of Human Services (AHS)]: The record, Tracy O'Connell, AHS. This is those net neutral adjustments that were coming out of E three hundred to the department. So, they are just net neutral. We just didn't know what Dale's portion

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: was going be at the time we built the budget.

[Sen. Andrew Perchlik (Chair)]: And did ADS charge you as an agency, not by department? Correct. Then you just

[Tracy O’Connell, Agency of Human Services (AHS)]: have Yes. Our overall invoice is 13,800,000.0 that we have to parse out by department.

[Sen. Andrew Perchlik (Chair)]: Okay. I like your hand up on this four pager that just says it's very simple, because sometimes looking it up in the up and down sheets and the spreadsheet are difficult, and then you did a very good job of when you laid it out. Thank you.

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: Rocks where they are deserved. Yeah.

[Sen. Andrew Perchlik (Chair)]: Yeah. No. Was very good.

[Dr. Bowen, Commissioner, Department of Disabilities, Aging and Independent Living (DAIL)]: It's actually easier for me to, and it all makes some sense.

[Sen. Andrew Perchlik (Chair)]: I just Yeah. Yeah. Good job, though. Thank you. Okay. Any other questions? Thank you so much. Thank you. Yep. Okay. We succeeded.