Vermont Legislature SmartTranscripts:

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: We are live.

[Andrew Perchlik (Chair)]: I'm senate appropriations, January 14, one month away from Valentine's Day. Not that that has any impact on We're going through the Budget Adjustment Act, and first off is Diva. Actually, you can introduce yourselves for the record.

[DeShawn Gross (Commissioner, Department of Vermont Health Access)]: Good afternoon. Deshaun Gross. I'm the Diva Commissioner.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I'm Stephanie Barrett, the CFO at Diva. Great. Thanks.

[Andrew Perchlik (Chair)]: Want to walk through the, I don't know if you all want to tell us anything about Veeva or just go right into your needs. I

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: think most judges are.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Veeva? Veeva is the main Medicaid agency for the main medical claims that go through. Obviously, you need to do mental health and the development.

[Andrew Perchlik (Chair)]: Is it always, here's my question about DVED's, was it always called the Vermont Access? When did the word access get done?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Oh, happened about twenty years ago when the agency was reorganized. It used to be Department of Social Welfare, it was where a lot of functions were.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: That's, I

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: wanna say 2002 maybe. Wasn't part of the

[Andrew Perchlik (Chair)]: whole effort to do this thing with tenure.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: It actually predates that. It does predate that. It was the Office of Vermont Health Access within a restructure and then in the Department of Vermont Health Access. There might even be a little bit of history in our budget book when you get it. I'm not sure. So, I just start right in with our ups and downs, our budget adjustment. So, have the ups and downs on your website available to you, and we're going to walk through a PowerPoint that basically summarizes those points and stop me at any time with questions. We'll start with our admin budget.

[Andrew Perchlik (Chair)]: Just letting you know, Stephanie, that mainly we're working on this worksheet that Prashin gave us. So any times you can refer to the B section, we could find it here. If you have your hand on my

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: feet. Okay.

[Andrew Perchlik (Chair)]: What you have I don't

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: have some documents these are, but I

[Andrew Perchlik (Chair)]: can look at that. Baruth, yeah. The

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: the finance management. Yeah. And say they roll up even more. They're gonna be 307 is where we start. No, 306. That's our adamant notice. So B-three zero six, which is one line on your large document that you work off of, but has multiple pieces in it on slide three of our PowerPoint presentation. So there are no changes to our staffing cost in our admin budget midway through the year. But there are changes to contract costs, contracts that we pay for that are controlled by ADS but billed to us. And then we have some operating cost changes in our admin budget. So, we have sort of a modest change related to the extension of our contracts that support our Chief Medical Officer, that's what CMO stands for. So we have one Chief Medical Officer, Doctor. Rapaport, but he does need to be able, the remit is broad and the number of things require a physician to look at. We have a couple of contracts that support that and there have been updates to those contracts. And you'll see this again, you see the annualized version of this when you see the full budget ask for '27. And then there are some significant amendments to our MMIS fiscal agent contract. They're just under $2,000,000 gross. These are matched at a ninetyten rate because they're development. So they're about $200,000 of general loans. Sorry, MMINs. Medicaid Management Information System. That is the big system that supports all the claims processing that we do. Ginny Lyons is the largest share of it, but we also have pharmacy side of that system and some other support pieces within that system. But it's large. Fair enough. And complex. And built changes year to year.

[Andrew Perchlik (Chair)]: What's with the decimal point on this? One point nine nine point three?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: That might mean typo on my heart, or the decimal point, because the three is not supposed to be there. Yeah, I'll get that.

[Andrew Perchlik (Chair)]: It's 199.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: The general plan is just under $200,000 and the gross amount is also just under $2,000,000.2000000,

[Andrew Perchlik (Chair)]: okay.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Yes. So our share is that 100,000 and then the federal government share

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: will be probably That's the 90%.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: And then we also have the ABS health contracts. There's a significant adjustment here and you will see that again as well when you see the state fiscal year '27 as we ask for fully annualized. And that is the Master Data Warehouse and Outlet Solution. The funding for that project began three years ago, was added in the budget adjustment, and that project has gone live. That was built and developed with the one time money that was appropriated. There's still some ongoing testing and work going on with that. But now we are moving into the portion of that contract which is called the maintenance and operations portion, and at the beginning of this month. And that's the portion that doesn't get funded with one time money, gets funded with ongoing base money. And so the request here is an add to our base for five or four or five months, I think it's four months of invoices that we expect to get in this current fiscal year related to the contract for maintenance and operations from ADS, and then you'll see it annualized in the big bill. The other ADS pressure that we have is the cost of our Oracle licenses. Those were up on a three year renewal that support Vermont Health Connect. Those went up in late June, starting in July. And that's what you see. Sherry, you will also see that again in budget build. And then the last piece in our admin budget is, Veeva will be moving to new rented space in February or very late February or early March. Those leases were signed by the administration in December.

[Andrew Perchlik (Chair)]: Where are you now?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: So we're in the State Complex, the main building in Waterbury, and these spaces are across the street in Pilbara Park.

[Andrew Perchlik (Chair)]: Okay, so the apartment health is also moving to Ann Felton's?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I'm not really which one, but we're moving to a couple different spaces on the Pilgrim Park, a couple different spaces in Pilgrim Park, and that's what's reflected here. So because it reflects the spaces that Geneva is moving into.

[Andrew Perchlik (Chair)]: And whenever you have this break, this is federal state?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: So it's not federal state, it's gross state. So, the difference will be by federal or other special funds. We don't do that.

[Andrew Perchlik (Chair)]: Okay.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: So, we give you the gross and we give you the GF. The portion of it, of total.

[Andrew Perchlik (Chair)]: Yes, Senator Washington.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Recognizing that this was an administrative decision, the space that you're in that you're moving to, I assume, is to accommodate people being in person more. And in the prior scheme where people were not in person so much, your your facilities were adequate? Yes. Okay.

[Andrew Perchlik (Chair)]: The move is caused by the RTM.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: The return to office. Yes. Okay. Thank you. And then there's a couple other moves in our admin budget. One is an agency net neutral move, money coming down to pay the overhead costs that we get from ADS from the central office to us. So it's just moving from one bucket to another within the same agency. And then one that is programmatically neutral, but it's not fiscally neutral. And that is the HR one bill that was signed federally has we're not allowed to pay Planned Parenthood with Medicaid dollars for basically our state fiscal year under that. And so this budget is moving. We're continuing to pay Planned Parenthood at the same rate, but we're picking that all up on the state side. And so there's a small amount in the admin budget and you'll see more and there's also amount in the program budget That is a one year ban on the use of Medicaid funds. That's what you're seeing as we

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: go through. I saw that somewhere else. In the health department? Yeah.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: So now we're going move to our big budget, our program budget, and that is across three appropriations, three zero seven, three zero nine, and three ten on the big sheet. So I have combined here across all three appropriations for the consensus update for our base investments. That's a process that most of you have probably heard about. It's been in place for going on twenty years. The joint fiscal office, the NIVA fiscal staff, the AHS fiscal staff, and finance and management fiscal staff come together in the late summer, early fall, and look at what the projection is for our caseload and our cost per case, because that's the basis of our budget bill year to year. We're always looking at what we've actually spent and what does that return for what we need for the current fiscal year and the coming fiscal year. And under the current way we operate, under the current set of rules, that's the process for building the main NEVA programmatic budget. And so that $33,000,000 that you see here is across all three, it's the global commitment budget, it's the clawback and buy in pieces of our budget, it's the iHIP program, it's our CHIP program, and those are different sections of the budget, but we look at the whole budget in this consensus process. We forecast out the caseload. We're actually very, usually very good at forecasting out the caseload. The challenge is always the cost per case. We're always, you know, we're doing this, this analysis is done almost twelve months in advance of when the state fiscal year turns on, so there's always a catch up mid year, but we continue, even though case load has come down, we continue to see a high cost per case. And that in part may be utilization, you know there's pressure on the drug prices, but it's also just the challenge of, you know, we're a year and a half out from the unwind, but what we were forecasting a year ago probably didn't have the full impact of the higher cost per case folks that are remaining on the program and the lower cost folks that come off, you end up with a higher average cost per case. And so that dynamic is at play in this analysis that we do every year. And then we update it. Do that in the late summer and fall based on how the year end closed and the data through the June. And then we wait for another quarter of data to come in to see if that's indicating significant change from what we looked at three months ago. So we do it in September, then we look at it again in early or mid December. And it becomes the foundation for the motion that's adopted at the emergency court. So that we're all starting at the same position the baseline of the Ziva Medicaid budget.

[Andrew Perchlik (Chair)]: And so you know what's causing the cost? Is it pharmaceuticals or just the acuity of the patient?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: It's a combination of all three of those things. Accuity of the patient, pharmacy being a part of that, but also what we were seeing, how we understood the cost per case a year ago and the dynamic of the caseload versus what we see now. We might have got that based on, there's a portion of that in there too.

[Andrew Perchlik (Chair)]: And when, so we have a case load reserve, does that only use an extreme circumstance, like when would would we have?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: So maybe, so you might want to have a conversation during fiscal, but it is one of the reserves of the state and reserves are one time money. And that particular reserve has a statutory structure around it about when you can use it and what it can be used for. And so this is the underlying base budget year to year. Most of your reserves are there for the unforeseeable or like when the dynamic of the economy is changing very quickly, that you, it's very hard for you to keep up. Or after we've left. Or after you've left and the year closes out in some very unexpected fashion. But that's, it wouldn't be typical for you to use reserves to cover you are dealing with as a base budget year to year.

[Andrew Perchlik (Chair)]: Is that like the other reserves, 5%?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: It's a similar dynamic of those reserves.

[Andrew Perchlik (Chair)]: Is it 5% or do you?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: It's 5% or it's, I don't know if you, that's an automatic structure of when you're looking at your balance sheets, see that maintaining the statutory stabilization reserve for the funds happens in that financial construct. Finance and management accommodates it, joint fiscal accommodates it.

[Andrew Perchlik (Chair)]: Just

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: a couple acronyms. I know FQHC, RHC, Rural Health and MBI. Medicare Economic Index. Sorry about that. That's okay. Not letting you know. I'm writing it down.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: I like to look it up. Rural Health

[Andrew Perchlik (Chair)]: Centers have been at QHCs.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: They're very similar, but they're, the FQHCs have a specific designation under the HIPAA and what they are entitled to, but we treat them the same.

[Andrew Perchlik (Chair)]: Okay. So the rural health clinics don't have the same federal support.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: We could treat them differently.

[Andrew Perchlik (Chair)]: But they're better, far as it said, they're treated differently than the Feds.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Yes, they're debiting differently than the Feds.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: I'm

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: sorry, any other one more time? Medicare Economic Index. It's the main index for the federal government related to primary care. There's a requirement in FQHC funding that you keep up with it. We have an alternative payment method with the FQHCs, the RHCs, and we apply that methodology to the FQHCs. Okay. And so you will see that number annualized when you get the big bill in several weeks, when your blood pressure roses in again after the gutters. But that's the item oh, well, we skipped down to FQHC, but we want to go back up to adjust for coding for the applied behavioral analysis. That is a correction to how the providers are allowed to code for the services. It's reduction, taking away the ability to That's the practice to code duplicate code, and I'm gonna let the commissioner explain that one a little bit more fully.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Yeah. So what we're doing is we've seen a lot of sort of scrutiny around concurrent billing within the applied behavior, applied behavioral analysis. So this is us being more proactive in doing that. What we're saying is there are these two codes that providers can no longer bill at the same time. That is part of the reason why we

[Andrew Perchlik (Chair)]: I think I had a good situate now. So it's like you have two people.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Yeah. So, the way that AMA, the American Medical Association, has defined or kind of given guidance on this is that you can still have those two people at the same time, but it is about the patient's time, not the provider's time. And so that is what we're looking at. So they and under us, we bill it our ADA budget is a little different in other states and what should be a lot for a tier level. And so that we are not we're not saying, yeah, you're not going to see the reduced revenue. It's just that you can't do this on a concurrent billing process until that's at the same time on the same day.

[Andrew Perchlik (Chair)]: That's so patient. But you could but you're saying that there other ways of doing it. Yes.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: This represents a half year of that change, the change of the year. You'll see it annualized too when you use some good big bill. And then we just talked about the FQHCs. And then we have last year, the legislature added to the budget a provision in our in our of $850,000 assuming they could draw, funding it with state funds 10% for family planning. But the way that that was directed to us was not implementable. We could not implement a rate increase with a ninetyten match as expected. And so, we did not do that. And we informed Joint Fiscal in June that we're going to need to, we can't do match legislative intent because we can't we can't get the 90% match from the way we've designated this. And so, what you see here is us saying we didn't you gave us the money, but we can't do it, so we're taking out the money. And it's a full year because you you gave it to us for a full year. That work just didn't happen. The the rate increase that and and I believe it was a house initiative when they built their budget did not happen because we could not increase with the $85,000 of match to an 8 and $50,000 total. And then the other piece here, this is essentially a one time adjustment for twenty twenty six, the Planned Parenthood. This is the programmatic cost of us picking up the federal share that would normally have flowed to Planned Parenthood, but because of the moratorium of Planned Parenthood for one year, it's this $1,130,000

[Andrew Perchlik (Chair)]: Now how is that different than what department tells us? It's not gonna be the same thing.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: It's the same thing. It's the federal share that we're picking up. For what they are paying to Planned Parenthood, they're picking up the federal share of, they would have normally paid out a state share and a federal share, but now the state is paying

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: out 100% of

[Andrew Perchlik (Chair)]: the These are just paid for different services.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Yes, yeah. There's different, there's slate of services that the health department pays for, and then there's a slate of services that we pay for in our budget. And then I have a note on the bottom of this slide, every year, January and February, we and Veeva maintain alignment with the Medicare rate schedules. And so all those changes that are fiscally neutral have gone into effect. We set them to stay fiscally neutral to the state physician. So that's that's it for our program budget. And now we're on our one time funding. And let's see. We're in the big financing management sheet, the one time.

[Andrew Perchlik (Chair)]: Was it from the prior thing?

[Virginia "Ginny" Lyons (Member)]: Yeah. It was from the prior.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Yeah. That's fine.

[Virginia "Ginny" Lyons (Member)]: Okay. So trying to pull this. So we're gonna go online

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: with Medicare. Are we, are

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: you talking about the Medicare rates?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Yeah, we, we, different types of our, we have different fee schedules. And we want to make sure that they, you know, they, they align with Not the rate itself, but the, the structure of the way the fee schedule is built. So there are factors in that and we update those factors based on what the Medicare system has done and we do that, we update those factors to stay fiscally neutral. So they're usually relatively minor changes to the rate schedule that we pay to stay fiscally neutral for our budgets, but being consistent so we don't get out of alignment with the way the Medicare schedules are based. Uh-huh. Okay. Thank you. Any other questions on the base budget? No. Our one time funding asks, this is just the general fund share that we are showing here. So, we have a significant 2.7 and change million dollar general fund ask for the cost of the Health Connect cloud migration. We have to stay in security compliance across that system. And so, the majority of these costs are licensing costs, but this is a project that actually has started because we have a deadline by which we have to be up to date and in compliance, and that's what is reflected here.

[Andrew Perchlik (Chair)]: So,

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I am not the person to go into the technical details of that, but it is work that's ongoing and that we will be getting a bill for in order to have that system remain secure and compliant. Part of that is sort of migrating to the cloud in some fashions.

[Andrew Perchlik (Chair)]: It's an existing contract, or do you have to go ahead and

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I think it's several existing contracts. Oracle, Optum.

[Andrew Perchlik (Chair)]: Subaru? Or that's just the name of their cloud.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Oh, Actor is of Microsoft's world.

[Andrew Perchlik (Chair)]: Okay. Do you have a question, Marsh, or are you just stretching? And

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: then the last one time item is a number that is going to change. This is the number we this is the Brattleboro Retreat. We have a contract with them, and under the terms of the contract, the calendar year contract, we pay that we have a base amount of beds that we buy at a given rate. And then if we use more beds, we pay more in a reconciliation process. And in December, the team that tracks this was projecting a number that was at $7,900,000 In the data, there was some miscommunication on some discharge rates that were overstating the number of beds that's over the base by. We are not The Retreat and D VAR aren't seeing it, and we just started working on this on Friday, last week, aren't seeing the likely number in the same way, and the teams are working on checking each other's data. We know this number is going to go down. Hope to have a final

[Andrew Perchlik (Chair)]: The 7,900,000.0 is in the worksheet, right?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: The 7,900,000.0 is in the worksheet, but it is likely, we know that there's enough, you're gonna get a change to this number. We just don't know where it's gonna land yet. And it'll

[Andrew Perchlik (Chair)]: be a change then?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I know it's

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: gonna be down. Okay.

[Andrew Perchlik (Chair)]: Yeah. That's that's all.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: That's that's as much as we got. That's fine. That's just And and hopefully by the end of this week, that number will be clear.

[Andrew Perchlik (Chair)]: And when we talk about bed, it's bed days or bed days?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: It's bed days. So, you know, a patient might have a, some patients have a fifteen day stay, some thirty, some many, many months. And what's complicated about this, for the people that are premeditated, it's not complicated at all. We know what they cost you. For the people that have other insurance, we have a lot of duals that are in the retreat. We have to understand when their benefits exhaust, especially if they've had more than one stay in a given calendar year, or if they have another payer when their benefits exhaust, and what that is. That's the complicated part of understanding the bed days that the state had patients there under the contract common neighbor over the base amount of that contract. That's what we're working through.

[Andrew Perchlik (Chair)]: So you'll let us know and then there's You will be.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: And then we thought we'd give you a few updates on one time money that you provided last year. And the first is the $10,000,000 of stabilization fund that you provided in the budget adjustment last year, or in the budget, May go. I guess it's in May go. We required a report on December 15, that report was submitted. We, at that point, have about $3,300,000 left. Have several large outstanding applications that have come in recently since the November for larger facilities. So, right now we have about $12,000,000 of asks against 3,100,000 of available revenue. We've had different classes of providers, residential care providers, FQHCs, primary care practices. We have several providers that we did not award to. The standard for awarding was severe financial distress. And so, we have had a few hospitals and just recently we've had a few designated agencies. But if you are interested, we can get you a copy, or staff can get you a copy of the report from December. That's the status of the stabilization fund money that you provided last year. And then you also provided significant ACO, transition bridge funding for primary care at SASH. And that was, it was $10,800,000 of global commitment money and then another little over $4,000,000 or almost $4,000,000 of straight general fund dollars. And those Sash dollars and the primary care $10,800,000 should be going out in early February to Sash and to the primary care providers. And then the other $4,000,000 the first payment should be going out. That's been split into two payments in late January, early February, and then again in June. And so those are underway to get out the door. That was the accountable care organization, One Care Vermont, is no longer. And SACH is the program. Centralized in Cathedral Square. It's the supportive housing for folks that need that support in basically the housing agency

[Virginia "Ginny" Lyons (Member)]: facilities. It's Medicare based Medicare based program allows seniors to stay at home.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Thank you. And that would pass through the One Care in the past. I see. And so, you made the choice to utilize the Global Commitment Fund to provide a one year bridge of funding. And I'm sure you are hearing from the agency on the Rural Health Transformation grants and information. That's not part of our budget adjustment. That's part of the Thank phase. Yeah,

[Andrew Perchlik (Chair)]: we'll hear about that later.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Was there something about the rebate program and the pharmaceutical costs?

[Andrew Perchlik (Chair)]: I don't know, but I can't remember

[DeShawn Gross (Commissioner, Department of Vermont Health Access)]: what it was about.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: So we incorporate our projection of pharmacy costs and our rebates that we expect to come in as we go through this consensus process, and those through December are kept up.

[Andrew Perchlik (Chair)]: So there's not an adjustment?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: There's not an adjustment for the cost of the pharmacy services.

[Andrew Perchlik (Chair)]: Where do the rebates come from?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: The rebates come from the drug manufacturers. So, somebody's purchasing, a Medicaid person is purchasing a drug that is trapped and under federal law they have to provide, under the structure. We have a contractor that's part of that MMIS system that does that work for us.

[Andrew Perchlik (Chair)]: Figures it all up.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: It's a lag system, you know, it's usually five months from the time we pay for a drug and the rebate comes through, I think it's about five months in process.

[Andrew Perchlik (Chair)]: I don't want to try to figure out why they would do it that way.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: It is beyond my understanding of the why

[Andrew Perchlik (Chair)]: wait until I get transferred to health and welfare. Okay, any other questions? Thank you.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Oh, the cookies. Oh, thank you. Very good. That's okay. So

[Andrew Perchlik (Chair)]: I had a question. Yes. How much cupboard are you? It's really here. A lot. You get back.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: I do buy Google.

[Andrew Perchlik (Chair)]: Yeah. You must buy all of your ingredients. That's what I'm thinking about that answer. You have, like, one of those giant commercial Mexican stuff.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: That would be helpful.

[Virginia "Ginny" Lyons (Member)]: King Arthur's chef, if

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Yes.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: That's my favorite flower. Okay.

[Andrew Perchlik (Chair)]: So we're doing budget adjustment and traditionaries. You can introduce yourself, so you have somebody else with you.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Yes. Did you feel like the word of attorney is okay to start?

[Andrew Perchlik (Chair)]: I think it's a good suggestion. Okay.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Great. I'm Terry Corsell, the State Party of New York City, who's our Chief of Finance and Administration at the Ministry. And I know we're allotted fifteen minutes and we'll be putting that amount of time. We really just have two items in our budget adjustment line to request. These are expenses that were unexpected, that we submitted our budget request last year. Two items have to do with a change in the share of current event range and also a pilot document that was first explored in the 2025. And Greg was going to first address the share of on this urgent topic. And then we also have an aspect that, just for your awareness, it doesn't involve the figuratively, if you're gonna just become an extension of it, figure out what we're do. Yeah.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: The sheriff contracts, have 11 different sheriff departments under contract, not all fourteens. And we had built in a cost of living increase into our budget request, but we sat down to negotiate a contract, landed a little bit higher than that. So we had built in $51 an hour into our base budget, but came in $57 an hour. What was it? It's $1.54.

[Greg (Judiciary representative, last name not captured)]: It was it was 51. We built in 54. We landed on 57. So there was an unexpected increase in cost there of $552,000. Should be noted that when we go into these negotiations, sheriffs, we do it in unison. So we're negotiating single rates to take quality pictures. And

[Andrew Perchlik (Chair)]: the,

[Greg (Judiciary representative, last name not captured)]: we generally try and maintain the existing level of services. They're the same number of deputies, same contract arrangements. We're not trying to expand services. And so we always go ahead and say, What's gonna keep you under contract? And fortunately, even $57 an hour that we negotiated didn't do that. Another sheriff had and a couldn't go to position, so that's the last position in the contract. So we're down to 11 out of 14. Last year, we had 12.

[Andrew Perchlik (Chair)]: Okay. And this is for all the work they do, whether it be security in the courthouse or transport. I don't know what else to do.

[Greg (Judiciary representative, last name not captured)]: So this is just for courthouse security. So just think of it as the roof over the courthouse and the grounds around. The transports are completely different. I know it wouldn't state attorneys and sheriff So these are positions that are inside our courthouse, and and they'll do walk arounds in their parking lots. But, you know, we try and have one deputy in every courthouse. In some of our larger courthouses, obviously, have a larger number. They can range anywhere from one to six positions. Scotland, for example, there's deputies in there, and it's a big courthouse, plus one over a civil building as well, so seven in the county. And some counties are very stable, and other counties are struggling to.

[Andrew Perchlik (Chair)]: In brief terms?

[Greg (Judiciary representative, last name not captured)]: Yes. For deputies? Deputies. And we have statewide about 30 deputy positions across our 23 courthouses. We also supplement that with about 10 armed guards, private security guards, and then we have about 30 staff positions that are unarmed that also support. So we have an industry of positions, and we have about 80 to 85 positions statewide for all the departments. The sheriffs make up about 50% of the quarrels. The

[Andrew Perchlik (Chair)]: pilot docket, that is the one we there's only one pilot document.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Right. This is the one that's been called the accountability court. It's an epic hotel courthouse in. This was a proposal made by Doctor. Scott involving many different stakeholders in the fall. It was implemented in November as a three month pilot. It's scheduled to end the February. We were asked what expenses do we have associated with that? Basically, it's three personnel. One is a retired judge. And we brought in, it involved setting up a separate court room above and beyond the courtrooms that are typically in operation at Costello. So, was a retired judge, and that's the bulk of the expanse, 128,716 is the total, as well as a criminal courtroom operator, judicial assistance staff offering the courtroom.

[Andrew Perchlik (Chair)]: So it wasn't really a new court. I thought I was just rescheduling those cases, you really created a new courtroom, a new judge.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Basically a separate courtroom that was dedicated to that category of cases. So it was the retired judge, the criminal courtroom operator, and then the security officer. So the expenses that are sought is to cover those expenses for that three month period.

[Philip Baruth (Member)]: Yes, Senator Baruth. Thank you, Jerry. I'm very interested in this pilot court. It's my home city. I'm wondering, is there talk of extending it beyond true months? And do you have indications thus far how it's worked?

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Yes. Well, anytime you can dedicate more of your services, and I mentioned the expenses associated with us. In addition, there was the transport aspect. That was another thing to make sure that when somebody had a hearing, we would be guaranteed transport, which doesn't happen. And then also bringing providers to the courthouse. So that there's more direct handoff. Senator Lyons, I know from the mental health and the courts commission, that's something that you're providing to or something that would be very helpful to ensure people fall into it on the services that might be part of the conditions of their use or otherwise. We don't anticipate extending the separate courtroom because there are quite a bit of expenses involved. However, aspects of the government being carried forward in each unit, each county is asked to also separate out that category of cases for group injury, five plus charges to figure out what strategies would be helpful to dedicate. So in Costello, my understanding, don't hold it to it because I know it's in kind of exploration. But my understanding is that it would be in lieu of a separate courtroom five days a week, one half day a week, it would be used in the existing criminal judge where they would carve out that category of cases. And the providers coming to the courthouse would continue for that scheduling block. And we would utilize the same security officer, wouldn't be an additional court, would be using our existing courts, but carving out that log of time in that category of cases. That's how they're doing it in Costello. For example, in Rottland, they have, I think it's a half day every other week. They're looking at the docket that has that category of cases, how many, and then what would kind of be feasible, and what would be helpful. But having the more focused attention and getting them in more quickly has been really kind of the outcome that we hope to replicate.

[Philip Baruth (Member)]: And do we have any numbers of any kind?

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: There are, there's a whole, David, I'm sorry, don't count that quickly. But certainly the cases have been more quickly because there's been enough focus. The other part too is a number of them devoted to trigger cause. So more of a focus and an exploration of that. And I knew, I do, my, they do show success if you will, that the cases are removed more quickly than they would have otherwise. Judge Zonny had started, had addressed this earlier in the year before the pilot was proposed and the pilot doctor looked out great to be able to kind of emphasize and highlight how it is useful to promote that particular category case, get attention to go over sooner in the hopes that you got care of the numbers that you're the FM ping line. And to hopefully get treatment against COVID or resolution of the cases, disposition of cases sooner than what it occurred otherwise.

[Andrew Perchlik (Chair)]: Was pretty, pretty done.

[Philip Baruth (Member)]: If it turns out you can lay your hands on the mountains at any point, I'd

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Be grateful if you could share that

[Andrew Perchlik (Chair)]: with me. Yeah. I'm

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: talking to send them to the committee. Because I know

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: there were

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: reports, actually, and just spoke briefly in judiciary. And I I think that we're supposed to come and get a more formal maybe when we

[Philip Baruth (Member)]: I'll be in there. So I

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Oh, that's right.

[Philip Baruth (Member)]: I can pick it up there and bring it in here.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Okay. Because I think when it finishes the February is when we thought it'd be a good time to do it.

[DeShawn Gross (Commissioner, Department of Vermont Health Access)]: Just wondering. It's not over the weekend.

[Virginia "Ginny" Lyons (Member)]: Okay. That's a very short period of time.

[Andrew Perchlik (Chair)]: Yeah. Was that just because there wasn't money for it, they wanted to limit the time period?

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: You know, it ended up being sixteen weeks total, when it was first proposed, that was the period of time of two month pilot, so we geared everything towards that timeline. They did come, I mean, all the expenses you would know from the other, was, you know, there was expense involved,

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: so I

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: think they picked that. Tried and see.

[Andrew Perchlik (Chair)]: They're studying in other counties and you're to see what the final numbers from this pilot. But would we see anything in the next year's budget proposal or you can't tell us?

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: I think what the plan is, is to, again, take aspects of this, apply it in the courts, see what success there is, and then if there is request. I know when Amy asked, is there any ongoing expense on the judiciary's part, We're not utilizing a retired judge. Right.

[Andrew Perchlik (Chair)]: I just wanted to next year's budget, would you propose to do something that would cost it?

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Franklin, we did say that the transport is a need now. Yeah. Because you just have a lot more success or chance for resolution if the person's physically there.

[Andrew Perchlik (Chair)]: But we would see that in the sheriff's department.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Yes. Yeah, and I think they will be submitting additional add ons to their VA request associated with the hub talking for that reason. Those transport expenses are gonna continue to bleed in into state utilizing a retired judge. That's why both our expenses are ending now, but we're very hopeful that, again, focusing on that category in all the units will reap benefits.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Okay.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: And then the last aspect of it, in two years ago, we had requested 26 positions with a variety of roles. And the legislature approved those positions along with the statute that resolved it. It had us along with state's attorneys and sheriffs maybe a similar request. There was a total of 35 positions that were approved. It was at the end of the session they were approved, it was funded in the general fund as a base budget, but we were told they were long term limited service. It was a little unclear what exactly It that was suggested we consider it five years, but we were requesting it as permanent. It wasn't a need that would be something that would be over within five years. So, there are those positions. Last year, Department of State's sheriffs came and they were, they asked for permanent tech and he gets in a permanent, and that happened, we would suggest him to come back this session. And asking, from our perspective, why it's critical, the people that were hired in those positions for extended long term reviews in the year 2028, the closer we get now that we're in 2026, recruitment and retention, people we hear already are looking to see, help you this is not gonna last, and we have the need for that between judicial assistance, staging security.

[Andrew Perchlik (Chair)]: They're all until 2028, limited service.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Right. There's no financial impact because it's begun funded.

[Andrew Perchlik (Chair)]: Right, but you have to tell them that the funding will be positions will be approved through 2020.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Well, again, because it's permanent, was our understanding that it would be permanent.

[Andrew Perchlik (Chair)]: Permanent label amendment.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: We're asking for the same treatment that states attorneys and sheriffs received last session when their nine physicians were granted permanent status, if you will. Well, let's talk

[Andrew Perchlik (Chair)]: to our HR professional.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Okay. So again, it's there's no monetary impact, but we just wanted inform her to say get suggested that we identify there's something that we're requesting.

[Andrew Perchlik (Chair)]: Are these all your limited services, at least 35? Do you have others?

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: We do have others. We had some during the pandemic using pandemic money. Those have kind of ended because of some time money that's been spent. Then we have a couple of federal grants that doing treatment targets that because they're grants, they're limited service positions a couple of times. Yeah, there's about maybe five positions in the judiciary that are limited service outside of these

[Andrew Perchlik (Chair)]: It's 26, but then it says 35 plus oh, there's nine.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: The nine were in the state's transition. Okay.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Any questions for you to share?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I have questions about limited service positions.

[Andrew Perchlik (Chair)]: Yeah. We can have a we can have a tutorial with our HR for things. Tutorial. But

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I know that I understand the limited service. I'm just gonna ask you a question. Now that is every time there's limited service position, is a clock associated with that? Do you know what mean? Like, And it's a limited service if this one is two years, and this one is three years, and this one is one. Yeah. They, some of them, they have no clock.

[Andrew Perchlik (Chair)]: They all have

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: a clockwork required to, when they give somebody a letter of hire, have an end date. Mhmm. So there's an end date on all those positions. And in some cases, for those five grant positions, the end date is when the grant is sponsored. A lot of times, the grant will get renewed, and then we give a new letter of hire.

[Andrew Perchlik (Chair)]: There are some people that are limited service, for their whole career for twenty five years in state service.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: That sounds stressful.

[Andrew Perchlik (Chair)]: So just gets get renewed every five years. That

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: is correct. The the problem that it has for us and the person people in the positions considered temporary. So if they're, you you look for, you know, permanent work, we have higher turnover rates, which impacts training them, sort of institutional knowledge,

[Andrew Perchlik (Chair)]: Mhmm. So it's it's different.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I I my my follow-up question to that was this idea of a long term limited service position. That's not a term bar. That is just something that's No. That's just And this was

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: just an unusual arrangement that because normally, it wouldn't be funded out of the general fund that would be a permanent position. So it's almost like a hybrid. So we're asking them to be kind of There is more

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: and more structure being built around it. For example, the union contracts identified with the executive branch union contract that identifies that unlimited service person is stripped of five years, they now have. Mhmm.

[Andrew Perchlik (Chair)]: Right. Mhmm. Yeah.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: So it's starting to get, it creeps in to different places.

[Virginia "Ginny" Lyons (Member)]: That's right.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: It was originally traded to be used for grandchildren. That makes sense. And then also, from what

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: I understand during the pandemic, women's service physicians that were geared to kind of temporary situations or circumstances.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Yeah, we ended up with 56 limited service positions in the judiciary that was funded with one time COVID. We used that for four to five years. We managed to now wind that down just this past year. But as we do that, our turnover rate went up over 30%. So we were able to manage it. So we didn't hit a cliff where one day we had to came to work and there were fewer people. We kind of rammed it down, but the turnover rate and the training that happens, it's difficult

[Andrew Perchlik (Chair)]: with the courts. Yeah, well, we can because this is, if you remember from last year, there was a lot of discussions about moving from limited service to permanent, just creation of good positions. Maybe we can talk more about that. Well, thank you.

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: Thank you all.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: That was helpful. Thank you.

[Andrew Perchlik (Chair)]: Helpful. Thank And then we'll move right into the rural health transformation.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Give me a note?

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Thanks to the hog. There's a little more hay near as they can stain

[Andrew Perchlik (Chair)]: the house and. Turn down. They'll be sitting in my. Anyway, it's moving along. Oh my.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Isn't that? I

[Andrew Perchlik (Chair)]: got it just after I bought the keypad for the old one because it doesn't fit this one. Beautiful. Yeah. But you can tell the north.

[Virginia "Ginny" Lyons (Member)]: The charging cable. Yeah.

[Andrew Perchlik (Chair)]: There you go.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Oh, that's right. Moments. Transfer.

[Virginia "Ginny" Lyons (Member)]: It's a limited service position.

[Andrew Perchlik (Chair)]: Whatever it takes.

[Virginia "Ginny" Lyons (Member)]: I thought it a planned obsolescence. Okay.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I think I did it.

[Andrew Perchlik (Chair)]: Very good job.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: No. I didn't like feedback like I did. Can I do this morning?

[Andrew Perchlik (Chair)]: Yes. We did coordinate it. I know you're doing it twice in one day.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Yes. I've done I'm doing the roadshow now. Yeah. Good afternoon. I'm Jill Mazza Olsen.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: I am the new Medicaid and Health Systems Director for the Agency of Human Services. So, in my role, Monica Ogilby is my predecessor, and in my role, I sit in the Secretary's office. I report directly to the Secretary, and I have sort of broad responsibility for the Medicaid program and for healthcare reform. So, the director of healthcare reform reports to me as does the Medicaid policy director. The commissioner does not report directly to me, but the policy director does. I may look familiar to you. I've been around for a long time in this building. I spent the last about twenty five years representing providers, so this is a big change for me to be in the administration. I've spent about fourteen years with the Hospital Association and then about the last nine representing the health and hospice. So, I have a broad view on the system, but this kind of role in understanding the mechanics of state government is definitely new for me. So, forgive me for the things that you may ask me that I just, some of them may just be too technical and mechanical for me yet. Okay.

[Andrew Perchlik (Chair)]: I just said at the beginning, the reason we wanted to have you in is we're having a lot of people saying, hey, you're getting all this money, we want to use it for ads or blah. So we wanna do this by clearing the record on give us information so when we are when we're told when we're ever get a constituent or constituent group that says, know, Jill has all this money, make sure she sends it to my ex buyers.

[Virginia "Ginny" Lyons (Member)]: We already took it this morning.

[Andrew Perchlik (Chair)]: Okay.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: That helps me. I I probably spent less time on some slides than others. And I so I'm talk about it a little bit more mechanically in a way of how it works. And yes, there's nothing like being the face of a $50,000,000,000 People better call on you. Okay. So just I'm gonna actually start on just the sort of mechanics of what we're talking about here. This is what this is a national initiative from the Centers for Medicare and Medicaid Services passed as part of, we call it HR one, one big beautiful bill, so the July bill. It was part of that, and it's meant to help states modernize their rural health systems. So, it focuses on things like workforce, technology, and other transformations to try to change how care is delivered in communities. So, it gets at ideas of affordability and access that way, but it's not direct funding for premium assistance or for rate increases. It doesn't do some of the typical things that CMS sometimes does through the Medicaid or Medicare programs. It is essentially a giant grant application. So they released what they call the Notice of Funding Opportunity on September 15, so that is the application. We submitted our application on November 5, so we had a very short turnaround time. And what we did in order to sort of achieve that timeline was Vermont is a place that's done a tremendous amount of healthcare reform. There's a lot of experimentation going on already, things that we're interested in that we wanna scale up. And so we really worked from, I would say, previous work and ideas that were already on the table when we thought about what we wanted to propose. And we did propose specific initiatives. So we have proposed ideas to CMS to say, if you give us these dollars, we're gonna spend it in this way under these giant headings. So the plan is already essentially opposed to them.

[Andrew Perchlik (Chair)]: But in a big setting, like the deep

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: equity Pretty big buckets with sub buckets. So, like, an initiative is workforce, but under workforce, we actually propose specific ideas, like a tuition assistance program that comes with some strings attached so that people have to stay in Vermont for five years if they use that funding. So, there's probably There's about 40 total initiatives in five or six buckets. But the idea, I think the thing I can say is that for people who just have sort of new ideas, we've already submitted a plan to CMS.

[Andrew Perchlik (Chair)]: But could they have an idea that's within one year's sub?

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: They might have an idea that fits an RFP that we will eventually put out.

[Andrew Perchlik (Chair)]: So you will be issuing some RFPs under some

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: RFPs and will yeah. There's some things that are gonna be grants. Most of the things are through grants, RFPs, few things we have to procure through. It'll be contracts.

[Andrew Perchlik (Chair)]: Most of unknown now, or

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: you still have more work

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: in place? Lots of work left to do. Lots of work left to do. So, we received the notice of the award on December 29, with just a little bit of contact with CMS in between. So, they did send us a series of four questions. Most of them, two were technical. One was a little bit of an elaboration, and one they said, it doesn't

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: look like to us like

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: this is allowable at all, which was the housing workforce housing proposal, which I thought was very creative. Mhmm. And they said, we don't Too creative. We don't want capital stuff. I mean, they essentially if you go back to the grant application, they don't think about housing at all. They did think about facilities. And on the facility side, they said you can't increase the value of the property. Like, you can only do minor renovations that don't increase value. It's It's hard to renovate housing meaningfully without so that we actually in that little go around, we removed it from our location. We resubmitted a budget that didn't include it because they were making it clear it was not allowed. More things would change. So, I'm not actually not sure if it was crisp enough about this this morning, Senator Lyons and your committee, but more things could change. We're submitting a revised budget to CMS on thirtieth. So, we had we asked for $200,000,000 that we were supposed to ask for $200,000,000 We received $195,000,000 for the first year, which is a terrific award for Provodoille and speaks to the strength of our application. The first $100,000,000 all states were gonna get. Second 100,000,000 was based on three things. One, two of which we could not control. Metrics of how rural Vermont is. And while we score highly in some ways of defining rural, we did not score high in the way that was defined in this particular application. So, we couldn't change those. And then, various policies that CMS prefers and Vermont didn't score especially well on those preferred policies.

[Andrew Perchlik (Chair)]: Can I

[DeShawn Gross (Commissioner, Department of Vermont Health Access)]: ask, the reason, part of the reason we didn't score highly that Chittenden County was included?

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: No. It was more that, like, things like the square miles of the state mattered. Like, literally our number of square miles, so we're not that physically big even though we are so much of our population lives in a rural place. We numbers of facility, rural facilities, mattered, so we just don't have that many of anything. And so, kinds of things made a difference.

[Andrew Perchlik (Chair)]: I see. But you still got 105, 200.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Well, is what I'm saying. So, we didn't do super well on those metrics, we didn't do super well on the policy metrics, all that was left was the strike of our application. And so to me, the fact that we got a $195,000,000 since we actually presented a pretty strong application, and and we did as well as we we did really well on the content.

[DeShawn Gross (Commissioner, Department of Vermont Health Access)]: So, Baruth, did you have that further? And and maybe you can address this at some point. It doesn't have to be right now. Sure. But my understanding was that Chittenden County was not covered by this program or the or it's not

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: I'm gonna get to this question. Okay. Yes. I will get to it. And I will not fully answer it. You will not be confused. Spoiler alert. Yeah. Yeah. But I will partially answer it based on what I know now. So let me keep going. So some things that I think are helpful to know. We had areas of focus, and we also had certain there was known restrictions. And how we're thinking about these dollars is essentially as one time funding. And in fact, we're only guaranteed really the first year award. We don't know what the subsequent awards will be. We're hopeful that Five years. It's five years. So we're hopeful they'll be similar, but the award is one year at a time, and there is a re up each time. So, when we think about how we use the funding, we're really thinking about sort of one time funding, how to launch things, to start things, how to buy things.

[Andrew Perchlik (Chair)]: I assume it's a reimbursement, right? You're not getting the 195,000,000.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: No, we have a lot of work to do before they ever release dollars to us. Yes, exactly. We can't plant the state budget. We generally can't fund otherwise billable services, although for some, there is some nuance there for some things that are new that aren't being billed now. We may be able to actually help something start up, but it would need to then be sustained. And we generally can't fund clinician salaries. So there's a lot of ongoing operations that are definitely not intended to be funded with these dollars. Do have, even though it's the first year award, we actually this just came out. We had clarification this week. We do have until September 30 to spend the dollars the first So, the first year is gonna be more like twenty months, not eight. But, we do have to report in on October excuse me, August 30 this year, sixty days before the end of the first year. And so we're just the whole question of how does what we've done between now and August impact our second year award is not clear. It's going to be hard to spend lots of dollars in that period of time, not just for us, for all states. Let's see. Okay, now I'm getting to the Chittenden County piece. So, first of all, the way they were in the scoring, all federally qualified health centers and community mental health centers were moved for all the DAs. They counted as part of our scoring. That was just in the statute. They said it doesn't matter where they are. If you have an FQHC in a non rural area, you can still count it. We could not count our non rural hospital, but we We could count our rural FQHC. As we understand it, everyone, there's no provider who isn't eligible to apply for RHG funds if we put out an RFP or procurement, mostly via grant, but it's more RFPs. But CMS has made clear that the dollars are designed to impact rural communities. So we have to impact rural communities. That then creates this next question of, well, what's a rural community? And that, where it's still not clear. So, so far, they've been using the HRSA definition that also our Office of Rural Health tends to use. That excludes Chittenden County. But exactly what they're gonna say about what we can and can't do in an RFP is not yet clear. And of course, we have providers in Chittenden County who have an impact on rural communities. So if you've got a UVA Medicine Center, take care of people from all over the state. And so that is, I think, there's going to be a lot of details that we just don't have worked out yet, and we have to follow the rules set by CMS. We don't have a choice. If we want the dollars, we have to you know, we have to adhere to their rules. So lots of states are asking these questions, And we are, this is maybe a good time to say, we're working closely with other states. So, we created a little New England consortium. So, all of our HG teams in all of the New England states are meeting on a regular basis to just sort of grapple with with things. It's nice because we just have sort of, like, close partners to say, what do guys think about this? Or what did you get a question like this? Or is this you know, and it's very comforting because this is a very, like, very new process. And then we have national partners who are also creating the who are also creating sort of like a national information group for states that are working for essential services agencies. So, we do have some partners as we continue to work on this. So, we're going to submit our budget on January 30 that will reflect a $195,000,000 award instead of $200,000,000 award. Right now, whole budget is in the other category. So, they didn't assign it to the various buckets they asked us to apply for. And we don't know for sure if what will come back to us will be what we send them or if something will come back that's different or if there'll be a line item removal of things. All of those things could happen. Many things could happen. We just don't know. We do know that we submit January 30, and they have a month to ask us additional questions.

[DeShawn Gross (Commissioner, Department of Vermont Health Access)]: Senator Baruth? I do have one more question, maybe paranoia on on my part, probably the federal government. Is there any chance that they might condition these funds in the last moments, let's say, whether a state provides gender affirming care or something like that?

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: So, it's hard for me to speak to every potential thing that could possibly happen. I will say this process feels as though It feels like they've set up a special office just for rural health transformation. The questions they've asked has been very reasonable, very thoughtful related to our application. What they're looking for us to do in this grant is very much related to things that I think we have a lot of shared interest in, like technology and workforce. So it is moving along in a way that feels, I think, Like the technical people are talking to the technical people, is what's happening. So, at this point, we are feeling very positive about this and, you know, appreciative that there's, I a lot of support for

[DeShawn Gross (Commissioner, Department of Vermont Health Access)]: So rural there's not a further, at least so far, it's not contemplated that there would be further parameters laid out?

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: No, there really aren't, and in fact there were already policy there was, in fact, sort of policy scoring. In effect, we've already been scored on policies, and those policies are known to us, and they've been very good scored on them.

[Andrew Perchlik (Chair)]: Fair enough. Thank you.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Yeah. Good question. So I'm not going spend a whole lot of time. This is not really programmatic committee, but this is my big overview. And I realized earlier today it still says housing because I think I made these before we had that. Knew that was the slab. But imagining, just to give you a flavor, this might be an opportunity to build out more mental health urgent care, more complex care in nursing facilities, dialysis and ventilators. You've lots of people who have high acuity or get stuck in hospitals. Part of it is because there's just nowhere to discharge them, even if they're appropriate for discharge, because there's no appropriate space. There's technology, AI transcription, shared EHR for some interested providers, remote patient monitoring, lots of work to do around our blueprint, which is our primary kids essential support for primary care, and a lot of workforce that I talked about a little bit earlier. So, I feel like the workforce proposals are probably the ones who are failing it off the ground the most quickly because they're just a little more straightforward, there should be more partners involved, and we have more experience and build various programs. EHR? Yeah, so the EHR, so there's some Oh, health record. I'm sorry, I always forget. I speak to such fluent healthcare that it is hard to remember when Yes, electronic health record. Thank you. Apologies. And HR means senior resources. AI does. A one. No. It means AI. AI. Yeah. Yeah. That's what it's AI. Yeah. I think that's and then EMS emergency medical services. I'm just looking at the other brackets. Yeah. So so as you most of them, I think, are pretty in the Yeah, EHR is one that actually very hard to type it. All of the word corrections don't want you to type EHR. Switch it. It's like you have to train every time

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: you get a new version of it,

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: have to train it. So I'm not gonna just keep going from the proposals unless people have questions about the ideas. We do have actually, I will say here, actually, I'll get to it anyway. So we have a website and we do have on it our actual application. So, people who really wanna read 70 pages, they can. Most days ended up releasing their narratives. We also have a very high level summary, and then we have I call it the list for the list people, which is a lot of the interested parties, which is this is just really a spreadsheet within every project and a short description of the project. So, for people who wanna get a little more granular without reading 70 pages, it's a really nice way to sort of, tick through and see like, oh, see what getting at.

[Andrew Perchlik (Chair)]: So that would be helpful maybe to share. I'm looking at it.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Yeah. Those links are live on on buying them. It's the three things I just said are those three.

[Andrew Perchlik (Chair)]: So that's 12 pages, but they could like, if somebody has an idea, like, have an idea x, they can look through here and see if it fit in.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: If it might fit in. Yes. The the other thing we're doing, just to talk about communications a little bit. So we've got a lot and this you will get this too. We've got a lot of people who are afraid we're gonna move so fast that we leave them behind. And I think there's little chance that that's going to happen. We are really working now on the sort of infrastructure that we need in place at AHS in order to make this a reality, to move from here to reality. Part of that is setting up more communication streams. So, one of the things we're doing is setting up a listserv so that people can subscribe for updates about what's happening with rural health transformations. It's not set up yet, but it will be. We'll put it on the website so people who want to know, we just released an RFP on blah blah blah, will get an email at least, so they don't have to keep checking back to the website. We are planning some listening session webinars for provider groups so that they can start laying in for us on how they what they might like to see in some of the RFPs and the things that are their ideas that they'd want to make room for. So, we are going to do additional public engagement. I think we did a good job on public engagement in advance of this because we had we had so many, we had some various work groups that already existed. We're just a healthcare reform of state, so we have a lot of mechanisms for obtaining information, but I think we need a more iterative process, and I think we have a little bit more time to do that. So, we won't get ahead of people. I'm definitely hearing from a lot of, not as much the provider community, but kind of the vendor community. And I'm actually honestly not really taking those calls because I feel like you need to have a clean procurement process. But we will have mechanisms for people to see where what they might be able to apply for. Yeah. So I hope that's at least reassuring that people Yeah. We take it seriously. I think that is Oh yeah, and I think

[Andrew Perchlik (Chair)]: I said all these things.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Just, I maybe didn't say the range. So, the states got between 147 and $2.81. We're sort of in the middle third.

[Andrew Perchlik (Chair)]: Like a flight of 200, but somebody got two eighty one.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Yeah, so they said, yeah, exactly. I think it was Texas. So, could, we all had to apply for 200, and then you could see they had to add up to their total to the

[Andrew Perchlik (Chair)]: 500.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: The the yeah. Or or really a 100,000,000. It was one year award. I don't know. And then and so all the awards did sort of cluster around the $200,000,000 mark, but some were below and some were above. Yeah. But for Vermont, it's, you know, it's a high per capita and also high per rural resident. So there's various ways to look at it, but it's certainly a significant significant award for a state of Vermont size.

[Andrew Perchlik (Chair)]: Center lines.

[Virginia "Ginny" Lyons (Member)]: Center lines. Yeah. And then it says thank you. So that's good. So, just want to say we have Joe Mazza Olsen in this morning with Sarah Rosenblum who's also in charge of healthcare reform and so there is a lot going on right now and AHS is taking a huge step forward and reading in this area. The work that they did in putting this grant together and now having it be accepted and then the next steps to develop the RFPs and have projects go forward It's a huge task and happened so quickly. And I saw the grant in November, I guess, anyway. It looked terrific. It represents a supplement to a lot of the work that's going on now including EHR. Some of the Act 68 work that we have started as a result of last year's legislation and previous year's legislation. This dovetails with that very nicely. It doesn't replace it in any way, but it will be a huge help. I'm saying all this as a way of saying thank you to work for Jill, this huge amount of work. And I think we all need to recognize that.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Yeah, need to recognize the whole team of people who work really hard to make this happen. None of them had, they all had day jobs already. So, so everybody just jumped in.

[Andrew Perchlik (Chair)]: So if there is, we do have constituents like vanderpasituents, should they just hold time?

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: I think they should,

[Andrew Perchlik (Chair)]: they're missing anybody they should can talk to.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: No. They are not missing anything. I think that I think the fear that people are gonna miss it is is strong. They they don't need to worry. They can keep an eye on our website. We will post this the subscription to our listserv, think, in the next week or two, so that people can then sign up to receive our notices, so that they'll know when we're on various projects. But it's gonna be a little while before we're really ready to actually release an RFP or release a report to the procurementorg.

[Virginia "Ginny" Lyons (Member)]: And we also had representatives from Chittenden County, the FQHC, we had by state primary care who oversees all FQHCs as well as Howard Center and Vermont Care Partners, our DAs and our SSAs coming in talking about the Chittenden County question that Senator Baruth asked about. So I'll let him know that there's information about that in a Q and A type event in our committee. So there

[Andrew Perchlik (Chair)]: is a step that you have to go to check this book in,

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Yeah, so, yes, there is. I believe in the positions, I think, is what we have to

[Andrew Perchlik (Chair)]: Just to accept the grant, yeah.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Yeah, so I believe that is underway, that the business office people at AHS are talking to the direct fiscal people, but I don't understand that process, so I'm not gonna speak to it in any detail other than I know

[Andrew Perchlik (Chair)]: Well, two of us are on that.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: A thing has to happen and the people are trying to make it happen. That's as much as I know to the extent you can move it along, certainly if you have a

[Andrew Perchlik (Chair)]: I just know that because sometimes some grants, the Joint Fiscal Committee won't meet, we'll just approve it. This is such a large grant and so many people are interested in it. The committee will meet.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Yeah, think our top priority right now is getting positions posted. Really need a project. We need someone who's full time thinking about how to take the next steps. Because right now, it's a lot of us doing it as peaks of what we do. So we really need someone. I think we've went through to, two positions, business office position and project director to get us going. That's not all the positions in the Grand Isle, really. We need a dedicated brain. Mine is divided. Doctor. Terrence is even more excited. Yeah.

[Andrew Perchlik (Chair)]: Okay. Thank you.

[Jill Mazza Olsen (Medicaid and Health Systems Director, Agency of Human Services)]: Thank you so much. I appreciate the opportunity. I'm gonna not leave this behind like I did in health care the other day, and then I ordered two more, so I have extras.

[Andrew Perchlik (Chair)]: Okay, and we're back on. We're gonna continue our BAA testimony. This is from criminal justice national. And I don't know if we should go first. Probably Christopher, Lyons, you can introduce yourselves and then Run us through your budget adjustment. Requests.

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: Afternoon, Thank you for the invite. For the record, my name is Christopher Berchlik, the executive director of the Vermont Criminal Justice Council. With me today is Lindsey to verge our director of administration and Jason Bernard, our budget analyst. This shouldn't be complicated. Hopefully it'll be fairly simple and painless for you all. You can tell by our very abridged document, which is essentially only two pages, one considering our budget numbers, but the other, essentially, the actual language that went into our budget adjustment request that we are essentially looking to increase $300,000 from the 1.2 that was appropriate for us to 1.5, which was actually to complete the three years of financial support for a three phase accreditation process, which included a job task analysis and curriculum development and piloting. And just for a little bit of background for the committee, we requested back in fiscal year twenty four, 1,400,000.0 of an investment into law enforcement training over a three year period, and that plan essentially included a job task analysis, which at the time, the figure was $200,000 to complete that in the essential first step. And then the curriculum development and overhaul, which was going to be 600,000 for each of the following two years for a total of what we had asked for, which was 1.4. And during, that year, the governor expressed his support for almost $2,000,000 in investments in law enforcement and victim services, but specifically to improve the training curricula and expand resources for fair and impartial policing here at the Academy. And then following the completion of the JTA, the Council contracted with I Atlas, who is the International Association of Directors of Law Enforcement Standards and Training at a cost of actually 1,500,000.0, which was the contract for that three years. The original contract estimate that we had was 1.8. We actually had to bear it down to the 1.5, which gave us the bare minimum of reaching the goal that we wanted to. But the legislature ultimately approved 1,200,000.0. So we were we have been short $300,000 to complete this contract with I Atlas. And over the last two budget sessions, I have requested the 300,000 in one time funds needed to complete The work that, you know, both we and the governor identified as critical to enhancing the quality and defensibility of our law enforcement training, and we were not able to successfully argue for those one time funds. So this is why we are before you down with the budget adjustment request to fill the gap of that final $300,000. So that's essentially the story behind it. I'm happy or perhaps Jason or Lindsey to answer any questions that you might have relative to that adjustment act.

[Andrew Perchlik (Chair)]: Is this for all, this is just to develop the training, it's not for the training? Like you'll have a training packet, for lack of a better word.

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: Correct. This is for the, total overhaul of what the basic training recruit looks like and what they actually get when they come through basic training to make sure that they're appropriately situated to go out and enforce the laws once they leave as a basic recruit. This does not include any enhanced in service training or training beyond what basic training education is.

[Andrew Perchlik (Chair)]: Okay. This is the academy, whatever that four month training?

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: Correct.

[Andrew Perchlik (Chair)]: And and from all law enforcement, all different kind. Any any officer that's credentialed would come to training?

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: Any law enforcement officer that's certified through the Vermont Criminal Justice Council, which is every law enforcement officer in Vermont.

[Andrew Perchlik (Chair)]: Okay. And will there be are you expecting other expenses? Because, like, so, like, this new training says you have to do x, but you don't have the equipment to do x, you'll have a budget request to meet the new training requirements?

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: To answer your question, we will always have hopefully some asks for future needs for our training, but this is really essentially a soup to nuts overhaul. This includes the actual curriculum, all the learning objectives, all the competencies that we're going to be testing on. It allows for us to work with iAdalysts so that we're actually piloting the program, and they will come and sit in on the academy class when the curriculum is completed so that they could actually witness the delivery of the curriculum that's been overhauled and make sure that it's being delivered appropriately. It also allows for us, which, as I'm sure that most of you are aware, the majority of our training instruction staff are volunteers from out in the field in law enforcement. So this is going to be a change to them as well that we acclimate them to what the new mode of training will be, their comfort level in delivering it, and all the documentation that they'll have to support them in doing that.

[Andrew Perchlik (Chair)]: And so the it's kind of an open question about whether you would need new supplies and materials to meet the new training requirements.

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: We're not going to be requesting additional funds to meet what this ask is for. Any additional training that we will be using is enhanced through other means. Okay.

[Andrew Perchlik (Chair)]: That all makes sense. Wayne, do you think this will end? I assume since you're asking in the BAA, you're assuming it'll be done by July 1 or no?

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: No, no. This actual contract will be completed by likely the 2027. We plan to begin piloting, mid mid July, I believe, in 2027. As this project has been working, they have taken all of our legacy materials that we currently teach basic recruits at the academy that has been reviewed, vetted, reformatted, and made to be legally defensible. Then each program that they get through and complete gets sent back to us where we have a curriculum advisory group here in Vermont that meets with Iadalyst to go over what those changes are. And then we also add to that subject matter experts that look at all the things that we do that are Vermont specific so that it might meet the defensibility test. But are we meeting things that Vermont law enforcement officers need to know that are generally specific to Vermont? So all of that gets reviewed by all of them and then goes back to iADALIST for a final review, and then we are we are sent each piece of curriculum as it's done for each topic of training. We're about, I would say from the last estimate that we got from the program manager between 6065% complete on that now.

[Andrew Perchlik (Chair)]: But he needed an amendment now for them to finish the last part of the work even though the whole program is going to go through twenty seventh?

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: That's correct.

[Andrew Perchlik (Chair)]: Okay, that's pretty straightforward. Do you always have recruits or is it only like two or three times a year?

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: Well, we always have recruits for basic training recruits. We do currently two classes per year. That's all that we have time and space for. We have a class that's gonna be starting here in about three weeks with I think I just heard the number reduced maybe from 50 to 48 this morning that we're gonna be hosting. But we typically do a a class in February and then one in the fall. In between those two full time basic classes, we also do level two trainings that are staggered throughout the year and then all in service training and instructor development and recertification and everything else that goes along in the calendar year.

[Andrew Perchlik (Chair)]: And you flex the maximum amount you could take in a basic recruit class?

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: I'm sorry. Could you repeat the question?

[Andrew Perchlik (Chair)]: How many how many recruits could you take in one of the basic classes? Like, you said you had a 50 or 48. Could you take 80, or is it 55 is the max? What's the max?

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: No. The ideally, we would like to cap that at a number of 44 just because it allows for a better interaction between the crudes and instructional staff. Beyond that, it gets hard to manage just logistically based on the rooms, the the cafeteria size that we have. We are, however, and have been for a number of years taking whatever law enforcement will send us to meet the need that is so desperately needed in the state. So we have had classes that are much larger in size. This one started at 54. We're already down to 48 and the class hasn't started yet, which it will in three weeks.

[Andrew Perchlik (Chair)]: Okay. Because I thought because of the difficulty we've heard about recruiting and maybe the classes were smaller, but maybe that's where we're on the tail end of fixing that problem with larger recruiting class.

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: We're doing everything that we can to take all the recruits that are able to be identified from agencies that desperately need them.

[Andrew Perchlik (Chair)]: Yeah, okay. Makes sense. Good to hear. Any other questions from the committee? Okay. Well, thank you for your clear explanation and all it made sense.

[Christopher Berchlik (Executive Director, Vermont Criminal Justice Council)]: Thank you for your time and the invite today.

[Andrew Perchlik (Chair)]: Yeah. Have a good day.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Take care.

[Andrew Perchlik (Chair)]: Okay, so we are gonna change gears from budget adjustment to have a chance to speak with one of the nitrogen general candidates. So do you wanna come sit up here?

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: I will, sir, yes, thank

[Andrew Perchlik (Chair)]: you. Just introduce yourself while you're here, we can go around the room and introduce yourself. Senator, do you want to start?

[Anne Watson (Member)]: Sure, Senator Walton, Anne Watson, Washington District.

[Andrew Perchlik (Chair)]: Senator in Baltimore, Franklin County, and the town of Albuquerque. Andrew Perchlik from Washington District.

[Virginia "Ginny" Lyons (Member)]: Ginny Lyons from Chittenden Southeast. Patrick

[Andrew Perchlik (Chair)]: Pat Brennan, Grand Isle County.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Well, thank you and thank you for that introduction. My name is Brigadier General Retired Henry Harter. I'm the Deputy Adjutant General of the Vermont National Guard. Think you like to, you have to spell my name. Is that for clarity for the No. Okay.

[Andrew Perchlik (Chair)]: We have it written down.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Okay. And Senator, know I've been the deputy for a couple of years, so part of that portfolio is to be down here and testifying on behalf of General Mike Ripken. So I think we know each other. I just want to thank you for your time. I think I'm the last thing between you and the German. I'll try to be concise, but I want to make sure that you have an opportunity to ask me any questions you may have.

[Andrew Perchlik (Chair)]: So,

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: like I said, hey Carter, I really appreciate this opportunity. I come before you today with a great passion for service. I have the same passion for service I did when I raised my right hand in 1989 to swear our vote to the Constitution of The United States and the Constitution of The Bronx. A little bit of background, I come from a family of service. So my dad was a naval aviator in World War II and two of his brothers were also aviators in World War II and then one brother went to the service league in the Navy. And definitely the greatest generation. So my grandfather on my mother's side also served during World War II. And then my grandfather on my father's side actually was in World War I. I didn't get to meet him because he died in '64 and I was born in '65. And he was a United States Army combat engineer on horseback in World War I. Some pretty interesting stories. So family of service, I grew up, my dad worked on a pilot and then graduated college after the war and went into business. But he kept his hand in aviation. So I was kind of interested in aviation as a young boy. By age 10 I knew exactly what I wanted to do. I wanted to serve and if I could do it through flying, that's what I wanted to do. So I kind of had that eye and goal as I proceeded through school. As it turned out, know, I came up here to UVM and graduated from college as a civilian pilot instructor for a couple of years and I applied to the Vermont Air National Guard to be commissioned and go to the United States Air Force and Outreach. Got lucky enough to be selected and was gone from Vermont for about two years of training and then came back and enjoyed an eighteen year flying career with the Vermont Air National Guard. What did you fly?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I flew the F-16s. Oh, the whole time?

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: The whole time. Yes, sir. When I was at UVM, they had the F-4s, smoky engine F-4s and, you know, certainly was very aware of their mission and the women and men of the Green Mountain Boys and their reputation. So I flew the F-sixteen, four combat deployments and two with boots on the ground in Iraq. Iraq was responsibility for my time. Then I diversified my career, came up through the leadership in the operations group, which is the flying mission, but then they asked me to lead our cyber operations group down at Norris University, so Information Operations squadron it was called. And that is where I got to work with the Army really for the first time together in one area because the Army information operations battalion was at the same place. So I got to know the Vermont Army Guard and worked collaboratively with them at that time. That was a lot about cyber education. We did courses, mostly unclassified courses for depending on the whole of government, a lot of State Department and US audit agency, and so real education for me, and then got to know the Army Guard. And then that's where we started work on being able to do state cyber defense. So when UVM had their malware attack of some of those professionals, we the ones that went out.

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Screen here, mute.

[Andrew Perchlik (Chair)]: Okay.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: So that's, then my career progressed back up to County back again and I went up to staff assignments up at Camp Johnson. And so I've done a few of those back over to the fighter wing in a support role, a support commander when we were getting ready for the new mission, the F-thirty five. And then I finished my full time career in the Air Guard as the Vice Wing Commander of the Fighter Wing as we welcomed the F-thirty five to Vermont as the first unit to get the F-thirty five, the first US Air Force operation unit on

[Andrew Perchlik (Chair)]: the East Coast. Did you get to fly? Did I get

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: to fly? There's no. They put me out in the pasture by the point flying by a step. But I got to cheer them on from the side. I got to sit in the simulator obviously very capable and very busy mission now. So just spending time doing that just to show a little bit of the diversity of my career. And then General Mike asked me to be his Assistant Adjutant General Air twenty twenty. So that's the one star general on the air side and also commander of the air. You're a primary advisor to the Adjutant General. But you are working at Camp Johnson with the Army in a joint

[Andrew Perchlik (Chair)]: He got elected in 2019?

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: He got elected in 2019. Yes, sir. So I did that as a traditional bargeman and then in late twenty twenty three he asked me to be his deputy. Ken Gregg, who you may remember, it's a full time state position so you don't have to be currently serving in the deputy role. So Ken was a retired Chief Master of it and when he was getting ready to retire, I applied for that position to decide. So for the last two years I've been a debt manager. So just a little bit so you know my background. What distinguishes me and makes me uniquely qualified for this position is the breadth of my career. I had a question from a legislator I called the other day and I really appreciate it. She cut my point, what distinguishes you from your point of opponent? And I kind of gave a C plus answer and could tell I'm kind of wordy, but I should have just said experience. Then see what that really is the discriminator and the breadth of my career. Working with Major General Knight, I have been at headquarters for the flood response in 'twenty three, 'twenty four, the pandemic, that was the longest state of emergency in the history of the month. Real point of pride. I will say, as a career guardsman, helping our fellow Vermonters is the most rewarding. Amongst many rewarding missions, that is the most rewarding we can come out and help in a supporting role, our troubled admirers.

[Andrew Perchlik (Chair)]: So

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: got a lot to do with that and a lot of challenging times, but I think we responded very well. As you all know, Guard has had also short notice of appointments, particularly the Air Guard. So this is the

[Andrew Perchlik (Chair)]: Are they

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: still deployed from They they are. Yeah. And we don't know exactly when they're gonna come back. We, you know, we know, obviously, that there's been a lot of press. I'm allowed to say they're in the Southern Command region, but that

[Andrew Perchlik (Chair)]: We don't know what the worst

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: capes kept secret around where they actually are.

[Andrew Perchlik (Chair)]: There's not a lot of bases. No,

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: no, sorry.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: But we hope to get them home soon. Absolutely. And also I just want to say, I think you all know this, but your guard is the best in the nation, Army Guard and the Air Guard. We're little old Vermont, we punch above our weight class, but the main formation of the Army Guard, so the eighty sixth Brigade team is the battalion, is ICBT that I'm still trying to get through a lot here. So infantry brigade combat team, thank you. But they were known as the best of us. We have the out and out for prayer school in Jericho. As the deputy, I've gotten to know this body and all the professionals in this citizen legislators in this state house and it's really been instructive to me and I think I said, I meant to say thank you to you all for what you do because I don't think a lot of Vermonters really know. I think there's a smaller percentage that stay very in tune with what you all are doing, but a lot don't know how much work and they see the headlines and they can have their opinion on what comes out, but I don't think they see what all the workers do. So what will be my priorities if I get elected to the estrogen position? A lot of them vest with what General Knight's priorities have been. Strength. What do I mean by strength? We still have vacancies. So that's an area where we've been working with the state and would like to and I'd like to continue. Workforce development, we've got about 500 vacancies, mostly our traditional guardsmen, part time in the Army Guard, and then we've got about 100 in the Air Guard.

[Andrew Perchlik (Chair)]: And how does that compare to the last five or ten years? Is that about where we've been or?

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Well, for the last ten years we've had a challenge. Really 2008 was one of our best recruiting years, and as you know, we were in an economic downturn for The United States. Typically, that's when the military become more attractive to certain folks, and so it's, you know, we're in a challenging environment. We have low population density. We're not like the New Hampshire Garden near major center like Boston. So there's challenges, but our retention rates are great. Once somebody joins us, once a soldier ever joins us, they generally are pleased with the jobs they're doing and the culture of the Vermont Garden. We work hard to keep that going, But we need help with recruiting and so that's one area I'd like to work collaboratively with this body. Readiness, state readiness and federal readiness, always a priority for a National General. Our soldiers in the Army need to be ready. You know, the Air Guard got an eleven day notice before the holidays go out the door. So it's my job, almost with the rest of the subordinate commanders, make sure that our women and men have exactly what they need and they have the opportunity to train and be ready for the department so that we can get it back safely. And that federal readiness helps us with our state readiness. So if we have the equipment and the people that are trained, they can respond to a whole assortment of potential state emergencies. Resilience, and I'll just say resilience is what we all kind of

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: have to work on I think

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: in these days. It's a 20 fourseven news cycle. We have these phones and tablets that help us stay connected. You can't go home anymore and if somebody needs you at work, they just had to call the landmine. So I think we all have to manage that. So we have to help our soldiers in the air manage that. And that's a challenge and I want to address that. And then finally and certainly, you know, last but certainly not least, and probably rises to the top, is respect. Respect for each other 100% of the time, all the time. What does that mean? Zero tolerance for sexual harassment, sexual assault, hostile work environment, and any kind of discrimination. You know, Aid has done a very good job with that. I tend to keep that going and we have some really, really great professionals that, and I'm gonna email in the next few days our whole curriculum. My apologies. You do ultimate frisbee, right?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: I do. We'll talk about that. My son is the captain

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: of the Middlebury Ultimate Frees. Oh my god.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Just do the nationals for listening. Pranksters? Pranksters. Yeah.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Yeah. So I have a word to talk about.

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: Yeah. Okay. I've heard you go through that. Oh. Yeah. Thank you. That was hard to mention that.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: So, know that was a lot, and I really, you know, I look forward to seeing you all either again or individually, but don't know if you have more time for questions, but.

[Andrew Perchlik (Chair)]: Yeah. Go check us.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Go ahead.

[Virginia "Ginny" Lyons (Member)]: Thank you for coming at us.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Yes. Thank you for the invite. Yeah. Yeah. And I look forward to maybe sitting with you in in the.

[Andrew Perchlik (Chair)]: Yeah. Senator Brown. Just one quick one. Yeah. When you when and if you're selected, who picked your deputy? You? I do. Yes,

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: sir. Actually, a good question. General Mike, and I will do the same, it can be a direct selection, so he can bring people in and he or she can direct who they want. But General Mike chose to do when I was selected is he kind of put it out to people that would be qualified and they had a hiring board with him and some of the other senior leaders, so I had to go in and interview and I think that's a good process.

[Andrew Perchlik (Chair)]: I'll just ask if you could comment on trying to recruit women in particular because I had a couple constituents that joined but didn't stay. But did not stay. They didn't have a good experience.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Okay.

[Andrew Perchlik (Chair)]: But it was in the state. It wasn't really an experience here in Vermont. But I thought nine did a good job of responding

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: to that. Oh, absolutely sir.

[Andrew Perchlik (Chair)]: You've already mentioned it, so I appreciate that, but I didn't know if you had anything like what strategies to get them to feel comfortable, whether it be women or other people, non traditional people that would be maybe not normally joining.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Sure, that's a great question and I will say once again, know, demographics and data, that's what they are and they sometimes can be instructed, but our Vermont National Guard, our Marine Air, have a higher level of diversity than the Vermont populations and that's gender diversity and ethnic and other categories. So the Air Guard right now, because they were the right people at the right time, have more women in leadership positions than we've probably ever had.

[Andrew Perchlik (Chair)]: So

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: the state man chief, the senior enlisted person is Chief Master Sergeant Jillian Rola and she joined from the Connecticut Guard as an F-sixteen Crew Chief. She had worked on A-10s down there. She's had a great career. I've got the privilege of working with her. Just one reason I became retired, knowing I still was going to run for this seat, is I wanted to make room, there's only two general officer positions. Brigadier General Laura Caputo was promoted just recently. So she's the second female general ever in the Air Guard and Martha Rainville was the first Virgin to Ag nation. But to answer your question, we always have to be just a general outreach, but I would say, you know, we'd have to do a better job of marketing ourselves. It's instructive to me to hear when somebody has a bad experience and things that happened in basic training, have a vehicle and a voice to go to the training command and say, Hey, we had two airmen come back and they didn't have a good experience. Do you know, did they serve for their enlistment men guy?

[Andrew Perchlik (Chair)]: There's only one that actually went to basic training, just it was a sexual harassment.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Oh really?

[Andrew Perchlik (Chair)]: And I know the whole story, I thought General Knight responded very well when I called him about it. He couldn't tell me the whole story because it was confidential. She kinda wanted to get she wanted the guard to come and get her and get her out of there.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Get her out of there. Okay. Wow. Okay.

[Andrew Perchlik (Chair)]: That really explains why Okay. He couldn't do that at the time. Right. Situation. Okay. But but I think having women in those leadership roles helps maybe getting them out there more is a strategy so wouldn't know that there's, there's, there's, and-

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Yeah, and if you have the opportunity, we have legislator days, we usually do two a year, sometimes one at the army base and one at the wing, and obviously we've got armories spread across the state, but you know, when you come to the base and you get, one of the things at the end of the tour is you get to have lunch with airmen. And one of the best things I ever did was meet with airmen every Sunday morning of drill. Call it forty five minutes with a general officer, a bad name really, because it was really mixing with air. It was really hopefully more beneficial for us. The last time I did it in my prior role, I had five young women lined up and there's usually 10 to 12 folks from one particular unit. And every single one of them, the reason why they joined was the Vermont National Guard Tuition Benefits Program. Thank you all But for it's just always really, it pumps you up when you see these young faces. They're so excited about what they were doing and they were across different fields, medical, some were over in maintenance. And so I think, you know, if you come visit us, they are doing the same thing at the arms side. General Lamoille very passionate. He opened up the combat arms to women earlier than other guardians did and said,

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Hey, if you

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: are qualified and you want to be that battalion commander, put your hat in the ring. So I think we

[Teri Corsell (Chief of Finance and Administration, Vermont Judiciary)]: are doing okay, can go

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: and do better. I don't have all the answers, but we do have a lot of women in leadership positions at Wilhelms.

[Andrew Perchlik (Chair)]: Thank you. Okay, no. Well, you, General. For coming in and thanks for your service and for stepping up for this possible new moon.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Appreciate that. I hope I can burn your vote. I will hijack you in the cafeteria and spend some more time with you, hopefully. I do have one question for you, sir. You were in the Peace Corps?

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Yes. Where can I ask you? In

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: In Panama. I was in Panama with F-16s on an account on drug. We weren't blowing anything up. We were working with law enforcement covertly coming up suspected drug planes and getting their channel numbers and then giving those to-

[Andrew Perchlik (Chair)]: Before Norgega or after?

[Unidentified/varied speaker (attributed to multiple individuals due to diarization overlap)]: Before Norgega.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Actually, I'm sorry. I'm sorry. No. I'm sorry. After. Because this was in the mid nineties. So after the

[Andrew Perchlik (Chair)]: Yeah. Was there in the March. Remember there in St. Moiau?

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: We probably were. I don't want back and tell you that.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: So I know I've got two subjects, Ultimate Cruze me and

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: happy that that. Thank you very much.

[Andrew Perchlik (Chair)]: I appreciate your time. Thank you.

[Brigadier General (Ret.) Henry Harter (Deputy Adjutant General, Vermont National Guard; candidate for Adjutant General)]: Do we have some

[Stephanie Barrett (CFO, Department of Vermont Health Access)]: wrap