Vermont Legislature SmartTranscripts:

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah. We are live.

[Sen. Andrew Perchlik (Chair)]: We're live, Senate appropriations. We're gonna go through I'll check everything else out. That have been referred to our committee for the appropriations. First is we will take up the S-two zero six, which is the child care licensing bill, or that's what I call it. I thought we would just have joint fiscal, the legendary Ted Burnett can run us through the fiscal impacts of this bill, which I think will also tell us basically what the bill is. Then Senator Lyons is here if she can tell us anything else about it. And then I will entertain.

[Ted Burnett (Joint Fiscal Office)]: I gotta go. September Okay. Ninth, joined this call. Would you like me to share my screen or do you folks have what they need?

[Sen. Andrew Perchlik (Chair)]: It's sometimes helpful to share. There

[Ted Burnett (Joint Fiscal Office)]: is one table that breaks down expected revenue by the different licensure types. I am clicking on the Zoom link now.

[Sen. Andrew Perchlik (Chair)]: While we're waiting for that center line. Yes. Do you wanna say any opening comments about S two zero six?

[Sen. Virginia 'Ginny' Lyons (Member)]: Yeah. I I think it's a it's a important bill for the profession of early childhood educators. We'll provide them with the credentials of the licensure that they need to work at different levels within their child care centers and establishes a system for for that licensure and provides for time within which the the the system can go into effect. I think the Office of Professional Regulation has done a really good job in delineating different levels of licensure and the work that folks would do once they enter the profession.

[Sen. Richard Westman (Member)]: It's good. Okay.

[Ted Burnett (Joint Fiscal Office)]: Sure. So I will

[Sen. Andrew Perchlik (Chair)]: type our in the current

[Ted Burnett (Joint Fiscal Office)]: fiscal office again for the record. First, talk about expected license licensure revenue when the when the bill when the licensure provisions go into effect in fiscal year twenty nine. So the there are initial applications and license renewal fees. So in fiscal year twenty ninth, folks in the profession will be paying a range of initial application fees. So for early childhood educator one, for example, they'll be paying a $125 all the way up to $225 for ECE educator or ECE three. And so based on the information that worked together with OPR to develop these estimates, The amount of revenue that would be generated in that first fiscal year from the initial application fees is $800,000. And then two years later, folks in the profession would renew their licenses. And so those license fees are higher at renewal than they are at application.

[Sen. Richard Westman (Member)]: And

[Ted Burnett (Joint Fiscal Office)]: so there would be approximately 1,200,000 biannually thereafter. In between, so in even fiscal years, there would be some folks entering the profession. And so they would pay their initial or renewal fees in like an off schedule. And we're anticipating that's a $100,000 in the even years. And these license fee revenues would be deposited in the OPR professional regulatory fee

[Sen. Richard Westman (Member)]: fund. So

[Ted Burnett (Joint Fiscal Office)]: moving on to the appropriations. In fiscal year twenty seven, OPR, the bill would create two positions at OPR. One is a full time executive officer for the Board of Early Childhood Educators. And then there's one full time staff attorney. The bill would appropriate $262,000

[Sen. Andrew Perchlik (Chair)]: in

[Ted Burnett (Joint Fiscal Office)]: the general fund in fiscal year twenty seven to fund those two positions. Since fee revenue would not be available until fiscal year twenty nine, By creating those positions in fiscal year twenty seven, they would not be there's not a funding source yet in fiscal year twenty eight. So just want to flag that in fiscal year twenty eight and a year from now, we would likely see a request for funding of those two positions.

[Sen. Andrew Perchlik (Chair)]: So that the fees would start in

[Ted Burnett (Joint Fiscal Office)]: twenty year? In '29. So there's a bit of a ramp up getting the whole structure in place before fee revenues are available. I will also note that the OPR Sunrise report for regulating the ECE notes that an additional three positions beyond those two that are created in the bill would be required to implement licensure at full scale. They may wish to bring in those positions online in fiscal year twenty eight or they may wait until fee revenue is available. But in total so to the question of why we're looking to generate 800,000 of revenue and $1,200,000 instead of support, a larger set of positions than the two that

[Sen. Richard Westman (Member)]: are created in the bill.

[Sen. Andrew Perchlik (Chair)]: So on the fiscal impact part, it's at 800,029 approximately $1,200,000.02000000 biannually, which I think of as every two years. Every two years. Yep. So why is it more than the first year than it would be annually after that?

[Ted Burnett (Joint Fiscal Office)]: In the first sorry. In the first

[Sen. Andrew Perchlik (Chair)]: First year is 800,000. Yep. And then it's only gonna be 600,000 every year after. I'm doing my math right now.

[Ted Burnett (Joint Fiscal Office)]: So, yes, the 800,000 in the first initial year is because folks are paying their initial application fees.

[Sen. Andrew Perchlik (Chair)]: I'm gonna renew it. It's a different fee that are there. Yes. Right? Yeah. Seems like

[Ted Burnett (Joint Fiscal Office)]: it's more, the renewal fee. The renewal fees are more. But then you think

[Sen. Andrew Perchlik (Chair)]: you would raise more in the years after it's up and going than you would in the first two?

[Ted Burnett (Joint Fiscal Office)]: Yes. So the $1,200,000 would be in fiscal year '31 and then fiscal year '33

[Sen. Andrew Perchlik (Chair)]: with those high And that's only 600,000 a year.

[Ted Burnett (Joint Fiscal Office)]: Yes. So they're Why is

[Sen. Andrew Perchlik (Chair)]: it 800,000 one year, 600,000 years after that? That's my question.

[Ted Burnett (Joint Fiscal Office)]: So the every two years, it's it's basically the way to think about it. So there's $800,000 in fiscal year twenty nine. Yeah. There would be some folks who would pay their initial renewal fees in fiscal year twenty thirty. That would be a relatively small amount.

[Sen. Andrew Perchlik (Chair)]: It's certainly less

[Ted Burnett (Joint Fiscal Office)]: Yep. Than 500 And then in fiscal year thirty one, there'd be $1,200,000 and then a $100,000 in fiscal year thirty two. So you'd have these one year with a lot of revenue. The off years

[Sen. Andrew Perchlik (Chair)]: I didn't get that it was a two year or less.

[Ted Burnett (Joint Fiscal Office)]: Yep. And so then in the gen the collective funding of $1,300,000 would be enough to pay in this imagined structure for the positions in the bill. Or sorry, not the positions in the bill, but the positions when the program is fully up and running.

[Sen. Andrew Perchlik (Chair)]: And do you know how this compares to other the other licenses? Like the appropriate or I guess it would be positions. Positions to to the number of licensees.

[Ted Burnett (Joint Fiscal Office)]: That that I unfortunately don't know. I will say that these licensing fees, as far as I've seen compared to it's comparable with many other OPR professions. And this would I should note this this is operating as a board structure. And so within OPR professional regulatory fee funds, boards are kind of their own structure. So revenue that's raised by their fees pays for the expenses of the board and regulated profession. It's not shared across other professions like advisor

[Sen. Andrew Perchlik (Chair)]: professions are. Okay. That's helpful. Okay. Any questions or anything else you want tell us about the fiscal impact of these, what new license is?

[Ted Burnett (Joint Fiscal Office)]: One other piece of context that may be helpful for a state by state comparison is that this part, this would be the first that regulates early childhood educators. It's probably the number wrong. It's the first day to regulate them in this way. And

[Sen. Andrew Perchlik (Chair)]: maybe it's not a question for you, but I don't know if somebody else in the room probably knows. Is the connection between the licenses and like, CPAP or the other early, you know, childcare programs that we have. Do we is there anywhere where there's a direct connection, or we're just kind of assuming there's gonna be a connection? You know what I mean?

[Ted Burnett (Joint Fiscal Office)]: Not quite. Is there another

[Sen. Andrew Perchlik (Chair)]: Yeah. It would be kind of like, is is there any regulations that any of our other childcare early educators or early education bill that would require

[Sen. Richard Westman (Member)]: a

[Sen. Andrew Perchlik (Chair)]: licensure? You could, you're eligible to get CPAP help if you're having the licensees.

[Katie McLain (Legislative Counsel)]: Legislative council. I'm not sure if I'm answering your question, but these licenses are specific to the child development division. So they

[Emily Hawes (Commissioner, Department of Mental Health)]: would be in programs, specific to programs that are receiving CCPAP. Okay.

[Jennifer Cole (Director, Office of Professional Regulation)]: And a private program could choose not to receive CCPATH.

[Sen. Andrew Perchlik (Chair)]: Right. But to receive CCPATH, you would need to have the staff be licensed?

[Katie McLain (Legislative Counsel)]: Well, if you're working in a CDD

[Emily Hawes (Commissioner, Department of Mental Health)]: program, yes, you'd have to be licensed. Right.

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

[Sen. Andrew Perchlik (Chair)]: So there's that. Okay. I don't have any other questions. Thank you. Does anybody else on the committee have questions for Or for Ginny or Centerline, one of three?

[Sen. Anne Watson (Member)]: So the if I'm understanding correctly, so

[Jennifer Cole (Director, Office of Professional Regulation)]: the ask for this year is 262,000.

[Sen. Anne Watson (Member)]: But then down at the bottom, it says these positions would possibly cost additionally 370,000 annually starting next year. And I guess that was kind of my question because it sounds like as the fees ramp up, it pays for itself. So in the in the interim, it's like we we need to fund it from the general fund to get it up and running. So this year so why is it more it sounds like it's slightly more expensive next year. Is that because the additional staff, is that okay.

[Ted Burnett (Joint Fiscal Office)]: And as you get closer to the program being optional operational, right, they're imagining adding additional staff to get prepared for the profession being regulated. I don't know if this is information pulled from their sunrise assessment. I can't when OPR comes back next year, they may realize that they need a different set of resources. Not speaking for necessarily what they for sure will

[Sen. Andrew Perchlik (Chair)]: need in fiscal year twenty eight. Okay, thank you. So I asked Councilor McCoyland to draft an amendment. Katie, if you want to switch with Sure. Mr. Burnett and describe this amendment you drafted. And I had one question about it. It's

[Emily Hawes (Commissioner, Department of Mental Health)]: on our website.

[Sen. Richard Westman (Member)]: So

[Katie McLain (Legislative Counsel)]: here's the new It's section to the bill. As you know, bill has an appropriation section to it. So this so that the duty to implement the appropriation section is contingent upon the appropriation of funds, which is layer 27 from the general fund to OPR for that purpose.

[Sen. Andrew Perchlik (Chair)]: And okay, so this, when it says the duty in implement six, it's not only the appropriation, it is the staff. So it would mean they don't have to hire the staff as well.

[Katie McLain (Legislative Counsel)]: Yeah, both would be covered in that piece. Correct.

[Sen. Andrew Perchlik (Chair)]: That was my other question. But now that I read section six, I see that that's in here. Any comments, questions, concerns about this amendment?

[Sen. Anne Watson (Member)]: I guess I have a question. So if it's just section six that becomes contingent on the funding, I mean, I I hope that we fund this. I hope that we do it. But should we not thinking about the implications for the other sections?

[Katie McLain (Legislative Counsel)]: So I'm looking at the effective dates and underlying bill. So what would take effect this year would be the first section that adds early childhood educators to the list of professions OPR regulates the board for the new early childhood educator board would be effective, and you have a reporting requirement. So those are the pieces that would take effect this year, but the actual regulation wouldn't start taking effect till July '28.

[Sen. Anne Watson (Member)]: So it could theoretically, for whatever reason, if it didn't get funded this year, could be funded next year.

[Katie McLain (Legislative Counsel)]: It could be with the exception that you could substantively have the board being set up or authorized this year with no positions funded in it. So that would be

[Sen. Andrew Perchlik (Chair)]: Would you be required to send it to the board?

[Jennifer Cole (Director, Office of Professional Regulation)]: Yeah. Who

[Sen. Andrew Perchlik (Chair)]: sets up the board up here? I

[Katie McLain (Legislative Counsel)]: mean, if you're putting into effect the board on a certain date but you don't have any positions do it, I mean, then you have a regulation in place to do something but not the position to do it. So you could let's see. If we want to change the amendment, you could just say the duty to implement this act instead of section six of this act.

[Sen. Andrew Perchlik (Chair)]: The board could be established and they could They could adopt rules. But I guess they wouldn't want to do that without staff to help them.

[Katie McLain (Legislative Counsel)]: One of the positions is the executive director of the board. Let me go back to section six, sorry, I'm flipping between two documents. So the two positions, one full time classified executive officer of the Vermont Board, and then a full time exempt staff attorney. So you wouldn't have that executive officer of the board. So I guess in theory, there could be a board without the executive officer. I don't know how that would work. You do have OPR in the room, who I'm sure would love

[Emily Hawes (Commissioner, Department of Mental Health)]: to talk about how it would work. But

[Sen. Andrew Perchlik (Chair)]: if you introduce yourself to the record and

[Sen. Virginia 'Ginny' Lyons (Member)]: Jennifer Cole is the director

[Jennifer Cole (Director, Office of Professional Regulation)]: of the office of professional regulation. Hello. Thanks for inviting me to speak. So this is gonna be a program that takes extensive work to set up. We're talking about five to 7,000 licensees. And the reason we ask for an implementation date of 07/01/2028 is we need two years of significant work to be able to do this, and we need a general counsel staff attorney and an EO to help us in that work. We're gonna be doing extensive collaboration with the CDD division and other state agencies and stakeholders because right now, the requirements of people who are working in state regulated childcare settings, it's a very complicated system right now, and we're gonna have to untangle that and work with these partners to implement. And we don't have the resources without these physicians to be able to

[Sen. Richard Westman (Member)]: do that work.

[Sen. Andrew Perchlik (Chair)]: Understood. Appreciate that extra context. But the question is, we're gonna remove the appropriation. You also want us to remove contingent on funding because we're not going decide on the funding today. So we're going to take that funding out. And then we could either also take out so right now, our amendment will take out the funding and the two positions. That's the core part of the appropriation. But there's also the section saying the board should be set up. We could also make that contingent on the funding or we could leave that in and the board could be set up but they would just kind of, if for some reason we didn't fund it, the board would just kind of sit there without any staff.

[Jennifer Cole (Director, Office of Professional Regulation)]: I think we can leave it in there and not contingent on the funding, setting up

[Samantha Sweet (Deputy Commissioner, Department of Mental Health)]: the board. I mean, do need the staff, but

[Jennifer Cole (Director, Office of Professional Regulation)]: I think we can leave that in there.

[Sen. Virginia 'Ginny' Lyons (Member)]: Find a creative way to do it.

[Sen. Andrew Perchlik (Chair)]: Okay, well given that, if there's no other questions or comments, I would entertain a motion to move the bill favorably or amend the bill and then move it favorably.

[Sen. Virginia 'Ginny' Lyons (Member)]: I'll move that we amend the bill with draft 1.1 of the proposed amendment for S206. That's just amending the

[Sen. Andrew Perchlik (Chair)]: Okay, the clerk can clerk away unless there's comments on the motion. Comments, questions, debate? I thought it was well done.

[Katie McLain (Legislative Counsel)]: Thank you.

[Sen. Andrew Perchlik (Chair)]: And the motion? Yes. Very well done. It was very official. Okay. What's that? Yeah, I'll set. That's All 206. Bill, Senator Baruth? Yes. Senator Brennan, yes. Senator Lyons?

[Sen. Virginia 'Ginny' Lyons (Member)]: Yes.

[Sen. Andrew Perchlik (Chair)]: Senator Norris? Yep. Senator Watson?

[Sen. Anne Watson (Member)]: Yes.

[Sen. Andrew Perchlik (Chair)]: Senator Westman?

[Sen. Richard Westman (Member)]: Yes.

[Sen. Andrew Perchlik (Chair)]: Senator Perchlik? Yes. Great. Then, let's assume we have a motion.

[Samantha Sweet (Deputy Commissioner, Department of Mental Health)]: You want me to

[Sen. Virginia 'Ginny' Lyons (Member)]: make a motion?

[Sen. Andrew Perchlik (Chair)]: I included it all in your motion.

[Sen. Virginia 'Ginny' Lyons (Member)]: Oh, shucks. Okay.

[Sen. Andrew Perchlik (Chair)]: I think You've got very well done. We amended and you did it at the same time. But you can volunteer to report it on the floor if you want.

[Emily Hawes (Commissioner, Department of Mental Health)]: Okay. With hesitation. Yeah. Not glad to do it. Yeah.

[Sen. Andrew Perchlik (Chair)]: Okay. Wonderful. Okay. We succeeded in passing S206. Now we will move to S219. This is the act relating to energy navigator program that we talked about. We had an amendment drafted by Ellen Chittenden who cannot be here. So I will explain it together maybe with I guess I have my own. So there are three and six of amendments. Thank you. The first two, if you remember, there was things that the navigation report had to do, and we thought the wording in a couple of them were weird. They just said, like, fund the program. And we said they provide recommendations for how to fund the program. And the Second Amendment is similar. Instead of just like grant funds, we're saying recommend grant funds. And then the third is the typical contingent language from the backspace, which is saying we're gonna remove section two, which is your the appropriation and, you know, to say that they don't have to do that section unless they're. We went back and forth with Councilor Chittenden's plans on this. Would entertain is there any questions, comments? Do you want to say anything about this?

[Sen. Anne Watson (Member)]: No, think this works.

[Sen. Andrew Perchlik (Chair)]: Okay. So with that, we'll entertain a motion to amend and pass favorably S-two 19.

[Sen. Richard Westman (Member)]: Okay. Do you want to if you

[Sen. Andrew Perchlik (Chair)]: have a speech to give about your motion? No.

[Sen. Virginia 'Ginny' Lyons (Member)]: Maybe here's a moment.

[Sen. Andrew Perchlik (Chair)]: So this is a motion to move as to 19 voted amended I'll roll. Senator Baruth? Yes. Senator Brennan? Yes. Senator Lyons?

[Sen. Virginia 'Ginny' Lyons (Member)]: Yes.

[Sen. Andrew Perchlik (Chair)]: Senator Norris? Yes. Senator Watson?

[Sen. Richard Westman (Member)]: Yes.

[Sen. Andrew Perchlik (Chair)]: Senator Westman? Yes. Senator Perchlik? Yes. Reporter?

[Sen. Virginia 'Ginny' Lyons (Member)]: Senator Oh, sure. Yeah. That's

[Emily Hawes (Commissioner, Department of Mental Health)]: I guess.

[Sen. Andrew Perchlik (Chair)]: Our current clerk is sort of collegial compared to our former clerk. Yeah. So many instances of I know. My vote being denied. Yeah. I think that the bill that we passed, just was we just passed that. Right. Look at the former clerk

[Emily Hawes (Commissioner, Department of Mental Health)]: and not

[Sen. Andrew Perchlik (Chair)]: tell people when the vote is available. Former clerk, would you hand this to the

[Sen. Virginia 'Ginny' Lyons (Member)]: committee assistant?

[Megan Hope (Financial Director, Vermont Department of Health)]: Thank you, sir.

[Sen. Andrew Perchlik (Chair)]: Providing Paul's information. He's thinking of the fact that he can't come up. Including the purity of my vote. Alright. I gotta hit the road. Everybody have a good weekend here. Alright. You too.

[Emily Hawes (Commissioner, Department of Mental Health)]: Oh, good one. Yep. Thank

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

[Megan Hope (Financial Director, Vermont Department of Health)]: we have EDH. EDH in by six minutes.

[Sen. Andrew Perchlik (Chair)]: Okay. So we will take break or go on mute. This is seventh transportation, March 13. What is it transportation?

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: If it's transportation, I'm in the wrong spot.

[Sen. Richard Westman (Member)]: There's a

[Sen. Andrew Perchlik (Chair)]: lot of health issues we're doing. Yeah.

[Sen. Richard Westman (Member)]: Well, majority of the people at the table are transportation. Yeah. This is almost

[Sen. Andrew Perchlik (Chair)]: this is the core of the transportation. Absolutely. So it's sort of both. What are

[Sen. Richard Westman (Member)]: the rules around us meeting outside of

[Sen. Virginia 'Ginny' Lyons (Member)]: You can't make any decisions.

[Sen. Andrew Perchlik (Chair)]: Talk about transportation.

[Sen. Virginia 'Ginny' Lyons (Member)]: Talk about transportation.

[Sen. Andrew Perchlik (Chair)]: So we're going through FY twenty seven budget presentation. We have the Vermont Department of Health with us today. So I'll let you introduce yourself for the record and give us your presentation.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: Sure. Rick Hillebrand, commissioner for the Department of Health for the record. I am joined today as well by Megan Hope.

[Megan Hope (Financial Director, Vermont Department of Health)]: Megan Hope, financial director.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: And she's gonna tap in at the relevant point and give you much more meat than I will.

[Sen. Andrew Perchlik (Chair)]: Maybe. There it is. Alright.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: So it's okay. I always start by just presenting our mission and vision and values to reconfirm our commitment to the monitors that we stand by them in these challenging times in this challenging space.

[Sen. Andrew Perchlik (Chair)]: I'd like to update them as one of your values.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: Yes, it is. Are I'll touch on that briefly, but data is a big part of what we do at the health department. Health consists of six sixteen positions across our central office and our 12 district offices. I always reference this this, we call it the Chiclet diagram, because it reminds me how much we do. It's a very broad department that touches many parts of our lives here in Vermont, and that can be very diverse from very concrete clinical work, like the office of the chief medical examiner, nursing home visits for new families and laboratory testing to much more public health things such as community based chronic disease prevention, health promotion, endowments of health looking at water and air quality. We have experts in all these fields. I am not an expert in all these fields but we

[Sen. Andrew Perchlik (Chair)]: do have experts in all these fields that we

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: can rely on to help us in these areas and if ever there is a need to speak with a subject matter expert, can certainly have them in this community organ. So as you mentioned, we do have data as one of our values and because we love data, the health department also does a lot of things with data including having our strategic plan with a scorecard that we are responsible for convening and compiling the state health improvement plan, the state health assessment, Healthy Vermonters 2030 dashboard, as well as many other reports. This isn't intended for me to read this off, but it's there for your reference if you'd like to review that. We do have a lot of data

[Sen. Andrew Perchlik (Chair)]: that we work on.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: As you heard from AHS, our budget process is very different. It's my first time taking part in the budget process, but it was very different where we took a holistic approach to the budget and we didn't just look in the silos of each of our departments. That meant and we knew we were looking at a $75,000,000 sort of shortfall that we had to make some challenging decisions in this budgeting process. We did have prioritization of programs with some keys in that process. We were looking at services, we were looking at housing and a number of other things that we wanted to ensure that we kept. It was challenging for sure at times, especially we felt that at the time of fight. But we felt strongly that if we looked at this all together, we can make the right decision for Vermonters. There's not a lot of ups in our budget. And we did work with the Opioid Settlement Advisory Council for increases in substance use disorder treatment. And we'll be working on rural

[Sen. Andrew Perchlik (Chair)]: health transformation projects as well. We'll have some focus. Is that based in another department? Rural Health Transformation? Yeah.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: What department? So yeah. So the central office is the coordinator of the rural health transformation projects. Each department has been assigned some projects because they're relevant to their areas. Some of them are frankly gray and we share those between departments. But as an example, workforce development, we do a lot of workforce development work. So we took up the primary lead on those projects, couple other ones, so substance use disorder, things would be in our round swap. Right, so fiscal year twenty seven governor's recommended budget. Our budget this year is just over $221,000,000 That is a decrease from fiscal year twenty six of about 1.2%. Federal funding is the largest source of funding for our departments and programs. Funds account for 11% of the budget and when you include the state share of global commitment, it's 22% in totality of our budget.

[Sen. Andrew Perchlik (Chair)]: And your overall budget, maybe this is on the sheet later. Can you give

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: me the percentage from FY '26? So it's down 1.2%. Yeah. Compared to '26, our full commitment budget

[Sen. Andrew Perchlik (Chair)]: is Better to Lyons.

[Sen. Virginia 'Ginny' Lyons (Member)]: I'm not gonna ask it. I'll save it.

[Sen. Andrew Perchlik (Chair)]: I'll do it. But senator Watson

[Sen. Virginia 'Ginny' Lyons (Member)]: I do

[Sen. Andrew Perchlik (Chair)]: have a question.

[Sen. Anne Watson (Member)]: Sorry. The maybe you're gonna talk about the interdepartmental transfers.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: Megan is gonna talk about the

[Sen. Richard Westman (Member)]: interdepartmental transfers.

[Sen. Anne Watson (Member)]: Oh, okay. I'm sure you want

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: her to answer those questions when it comes to technical money transfer stuff, but she will.

[Sen. Anne Watson (Member)]: Okay. Well, if you're to be

[Sen. Virginia 'Ginny' Lyons (Member)]: documented any anyway, I'll just hold on the question. So

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: we do have a lower global commitment request of $5,000,000 federal global commitment request this year. And our federal receipts are also projected to be $1,100,000 below. Alright. So why do we have some lower budgets and lower requests? Well, again, challenging decisions we had to make this year. And we did elect to recommend cutting a few programs. I'll start with the maybe the easiest item. The the most straightforward is the discontinuing the efforts to implement the unused drug repository. We have tried to implement this program for a couple of years. We had an appropriation to essentially collect unused drugs and repackage them. We have not been able to find a vendor that would be willing to do that. Essentially, we would require more funding than is in the budget. And we were unsuccessful. So we recommend we never started it, we recommend not continuing that going forward. And the second two are in workforce development. And I will go into a little more detail in the next couple of slides, but the health professionals educational assistance program, which is $4,100,000 and the area health education center program support, which

[Sen. Andrew Perchlik (Chair)]: is $550,000. So you're gonna describe those? Yes. So So

[Sen. Richard Westman (Member)]: you're going to describe what you're gonna do in replacement of them or We're not going to replace them.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: We cannot replace Well, I programs. Yeah.

[Sen. Richard Westman (Member)]: The terminology may not be correct. I understand. It but in a number of the areas that are workforce related in the rural health care, the federal grant, the federal grant, they're doing alternatives to that. Are they doing alternatives to that?

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: Right. So and I will get into that. The RHTT program has opportunities for workforce development. They are not the same.

[Sen. Richard Westman (Member)]: It's it's I understand they're not the same. I'm asking the question is, is there some alternative to those that are proposed? Yeah, so it's not in our proposal. We did not go into detail with RHDB. I understand they're not. What I'm asking is, if there are going to be in the overall proposal in the Governor's budget, and with that grant, if there are alternatives, I think for us to be accepting as a group of that, we have to know what we're gonna be doing in the workforce area to be able to be accepting some reduction in the year. I completely understand what

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: you're saying. And I do wanna share that information with you. I I don't have slides to that here today. I can talk about it in some generalities, and we can absolutely get Well,

[Sen. Richard Westman (Member)]: on Mandeep, when you and I sit down, I'm going to want that information because this committee, particularly Senator Lyons will be asking. Yes, and I absolutely want

[Sen. Andrew Perchlik (Chair)]: to go through that.

[Sen. Richard Westman (Member)]: Think it's not right. You are right.

[Sen. Andrew Perchlik (Chair)]: I think it's important for Doctor. Hillbrook to know that this committee worked hard to get that money for that program. So before we just agreed to cut it, we wanna know the reason why we should cut it. Right.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: I completely agree with that. And this is, again, no one had hard, no one had easy decisions to make. And I think we could all agree if we had budgetary allotments, we would wanna continue both of these, right? I don't think anyone would argue with that. We made some very hard decisions in our budget across all of AHS and this is not one that we wanted to have go below our line. So the sort of two main workforce development programs we have, one is with VSAC where essentially it is used for loan forgiveness for a number of health professions. It primarily does go to nursing, it's $4,200,000 grant, 3,400,000.0 of that goes to nursing, 420,000 is to primary care providers, both MDDOs and PAs. Dentists is about 190,000 and then hygienists is a 100 best. And again, in this proposal, it is proposing to conduct. The second program is AHEC which is the area health education fund, area health education centers, which is $500,000 for supporting the operations of them, which are primarily targeted at getting folks to go into healthcare professions and lower levels of education. So in high school and that sort of thing to encourage them to go into health professions. And then there's a $50,000 grant for UVM medical students and medical residents to work. So a small percentage of

[Sen. Andrew Perchlik (Chair)]: that goes specifically to medical students.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: And again, the third thing that I had already mentioned is the unused drug repository. So those are the three sort of proposed budgetary programmatic cuts. And again, we'll absolutely work with you and explain what RHDP is and what it isn't. Broadly speaking, it's a lot of money for workforce development. It's not all tuition reimbursement. Okay, some of the programs are looking at workforce, what they're calling residency programs, which is more like job training for professions. I can tell you me personally, we do this down in Rutland. We have a nurse residency training program, which is designed for new grad nurses to develop comfort and caring for folks. It's very well received and does provide a lot of help and support for new nurses and looking at that in other fields. It's not that's not a tuition program. There are other others that are looking at scholarships though, specifically to help with the cost of education. There are some specifics in the programs about what it allows, what it doesn't allow. And I think I had mentioned this the other day does not allow for physicians, nurse practitioners or PAs explicitly in that, which is, again, something we currently do fund and it is not allowable in that. But there's also, it's an opportunity for us

[Sen. Andrew Perchlik (Chair)]: as a state because it

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: is a significant amount of funding that we would like to leverage over the timeframe of that program.

[Sen. Andrew Perchlik (Chair)]: We could answer this problem. Something like that. Some of the hospital, I don't know you're doing this around, but they're doing inside the hospital training to get somebody from becoming RN or you know, like is that would that be some kind of workforce that could be supported by providing hospital funds to either increase or start up those types of programs? Sort of depends. So if it's, you know,

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: partnered with a educational institution, a university, there is the opportunity to have again tuition scholarship programs as part of RHDP. And that could absolutely be through that pathway. And there's a critical occupations scholarship program as well for some of those challenging to recruit things that we have here in Vermont. One I've learned a bit about is around dental hygienists. We do not have enough dental hygienists in this state. Was able to go to the Burlington FUHC and they've got this beautiful dental clinic that's staffed entirely with dentists. They can't get any dental hygienists there, which is mind blowing, but true. There's a lot of needs in workforce development. It's nursing, it's ancillary services, it's of course in physicians. There's many gaps that

[Sen. Richard Westman (Member)]: we have.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: Alright, I was gonna pass it off to Megan to take it from here and

[Sen. Andrew Perchlik (Chair)]: I'll step back.

[Sen. Virginia 'Ginny' Lyons (Member)]: Just had one question. So going back up to the cuts to AHEC, which is really has been a significant program for forty

[Jennifer Cole (Director, Office of Professional Regulation)]: years.

[Sen. Richard Westman (Member)]: It's a long time.

[Sen. Virginia 'Ginny' Lyons (Member)]: Yeah. What how is it ineffective?

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: That is a great question that I do not have great answers for. I would strongly encourage the community to hear from APAC and hear what their outcomes are related to that program. Because the truth is our desire to have an effective tuition reimbursement or tuition scholarship program or whatever our workforce development program is that keeps people in Vermont practicing long for long term. And that that is exactly what we want to develop going forward. And I would ask you about what

[Sen. Virginia 'Ginny' Lyons (Member)]: the And programs my understanding and from my work with AHEC, that's exactly what AHEC has been doing. So it'll be interesting to hear more about the rationale.

[Sen. Richard Westman (Member)]: Yeah. And to follow that up, when We're gonna need in here the information, what's covered now, what's not going to be covered in the envisioned new world. Absolutely. Completely understand.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: This is a challenging decision that you all have to make and I wanna provide you with as

[Sen. Richard Westman (Member)]: much information as I can.

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

[Megan Hope (Financial Director, Vermont Department of Health)]: And for the record, Megan Hope, financial director of health. I wanna take you all through our ups and downs. So the health department will you have the AHS ups and downs. We're on page 10. We have three separate appropriations starting with section b three eleven for our appropriation. Happy to take questions throughout. Just let me know. Feel free to stop me. In admin, you'll see we have our net changes for salary and fringe for all of our employees. There are 59 positions in fiscal year twenty twenty seven compared to 62 in '26. Two of the positions are now in our public health appropriations, just kind of an internal shift as to where those positions are reporting. And one position has left the department due to the cancellation of the federal health disparities grant.

[Sen. Andrew Perchlik (Chair)]: Person has left or the you're getting rid of the

[Megan Hope (Financial Director, Vermont Department of Health)]: The position has been wasn't limited because that federal grant was terminated. So that those net changes in positions explain the main difference between our our salary and fringe costs from this year to last.

[Sen. Andrew Perchlik (Chair)]: Okay. This

[Megan Hope (Financial Director, Vermont Department of Health)]: next slide shows changes in our internal service charges from 26 to 27. The biggest item you'll see and that I know the agency has touched on the largest increase we have is our in our ADS allocated charges, and that's due to a just a shift in how those costs are being billed to the agency and then departments.

[Sen. Andrew Perchlik (Chair)]: Did you see it down in ADS's, like, SLA charge or something?

[Megan Hope (Financial Director, Vermont Department of Health)]: That's we're expecting to see fewer SLA charges come through and more costs coming directly to this ADS allocated charge. So that's why there's an increase there and we're budgeting less for that SLA. Okay. The next slide here, we have changes to our grants section and this is where the first three lines are Already.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes. So

[Megan Hope (Financial Director, Vermont Department of Health)]: it does look a little bit alarming. I will try and comfort you that the first three lines reflect the move of our rural health and primary care programs from the administration appropriation into public health. That was, again, those programs are not being eliminated. You'll see a positive side on the public health appropriation. It was really just, again, internal, those programs are much more suited and better operated within our public health appropriation than out of the commissioner's office. So that's those first three lines. The next three lines, will see the area health education center, education loan repayment, and those two are the program eliminations that doctor helped grant. So those are gone? Yeah. Those are gone. I will make us

[Sen. Andrew Perchlik (Chair)]: We're proposing them.

[Emily Hawes (Commissioner, Department of Mental Health)]: Oh, yes.

[Sen. Andrew Perchlik (Chair)]: Did at the time.

[Megan Hope (Financial Director, Vermont Department of Health)]: Good thing you said. Just a small note, the education loan repayment line, the $250,000 federal item will is continuing in the public health administration. That's the state loan repayment grant that comes from to the health partner from PRSA. So that is not, we anticipate continuing to receive that grant.

[Sen. Andrew Perchlik (Chair)]: It would be for those three professions that were on that PSEC slide. Yeah. Do

[Sen. Richard Westman (Member)]: you have any Can you tell us how much is envisioned in the rural health transformation grants? How much money within the broader area of workforce development that would be covered, not exactly by this, but roughly how much many resources are going on.

[Megan Hope (Financial Director, Vermont Department of Health)]: I believe the rough budget for rural health transformation is about $10,000,000 for workforce dedicated to workforce.

[Sen. Richard Westman (Member)]: And is that specifically related to here, or or are you talking about everything? Because there is there's dollars in for example, in Dale for nursing for recruitment around nursing homes. So am I talking apples to apples or what am I talking?

[Megan Hope (Financial Director, Vermont Department of Health)]: In terms of, I know for the health department's budget, this education loan repayment program was geared towards nurses, physicians, dentists, dental hygienists. And my understanding of the Rural Health Transformation Grant is obviously very much still in flux as we negotiate with CMS, but that workforce money is for broad health care workforce. I know

[Sen. Virginia 'Ginny' Lyons (Member)]: there's some primary care. Yes. That's probably yeah. So and and along the lines because trying to coordinate what's happening with RHT and then what's continuing in the state, and then we know we can't replace or supplant what's here. But if we eliminate all this stuff, or some of

[Emily Hawes (Commissioner, Department of Mental Health)]: it,

[Sen. Virginia 'Ginny' Lyons (Member)]: then we don't have a program, does it then become eligible for rural health transformation grant dollars?

[Megan Hope (Financial Director, Vermont Department of Health)]: Again, we can't replace the existing program with RHDP. We're looking to Okay. It cannot be used for loan repayment.

[Sen. Richard Westman (Member)]: It's listed in the rules of RHDP. That's right.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: So we would have to redesign it anyway because it can be used for concurrent or scholarship programs. And we can do it. We don't have to sort of cancel one and restart, but we can't use it for loan repayment, is a lot of, again, the reset. Understood. Yeah. The

[Sen. Richard Westman (Member)]: details of both sides I will be would just say to you, there presently is a program of about 600,000 helping nursing homes with the recruitment of RNs coming out. And the replacement new pro well, not replacement, but the new program that in the rural transformation grant is about an $810,000 program. And and I'm trying to figure out what each looks like. Understanding what you say 10,000,000, and I and I'm looking here that you know, I'm probably looking well, I just lost my page, but it's probably, you know, 5.3 here. And just to get a feel, it it it I'm just trying to understand the two. Okay.

[Sen. Andrew Perchlik (Chair)]: Continuing on.

[Megan Hope (Financial Director, Vermont Department of Health)]: Continuing on this. Any last questions on grants?

[Sen. Richard Westman (Member)]: Okay. We'll be back to you.

[Megan Hope (Financial Director, Vermont Department of Health)]: Yeah, I'm sure. So now we're moving on to our public health appropriations section B

[Sen. Andrew Perchlik (Chair)]: three

[Megan Hope (Financial Director, Vermont Department of Health)]: twelve. And again, here are major changes in our salary and fringe compared year over year. So in public health, there are five ten positions in the 2027 budget compared to five thirteen in '26. So we have a net reduction of three positions. And if you want, I think maybe kind of the ins and outs. There's a few, as I mentioned previously, two positions moved into this appropriation from our admin appropriation, 11 positions moved into this appropriation from our substance use appropriation. And then we had one new position and then a total reduction of 17 positions. And those 17 positions were funded federally, 13 were related to COVID response supplements that the department had received over the years. Two positions for that health disparities grant that was terminated last two years ago in spring. And then two positions where the work itself had ended. So lots of information. Happy to repeat any of

[Emily Hawes (Commissioner, Department of Mental Health)]: that if needed. Sounds good.

[Sen. Andrew Perchlik (Chair)]: And then maybe if you have at some point, like if you have all those positions on one sheet, kind of like the whole department.

[Megan Hope (Financial Director, Vermont Department of Health)]: We do, yes. In our supplemental materials, there is the full list of all the positions, but not it's only the positions that are included in the budget. We can get you something if you're looking for the Kind

[Sen. Andrew Perchlik (Chair)]: of ups and downs. Yeah.

[Sen. Richard Westman (Member)]: When you do that, if in how much of these are just shifts and empty positions now and what's filled, what's not? And and because I suspect most of these aren't filled positions.

[Megan Hope (Financial Director, Vermont Department of Health)]: Of the positions that were eliminated, seven were vacant, so that we reduced them via attrition, whereas 10 actually had to be ripped.

[Sen. Andrew Perchlik (Chair)]: And of the 10 drifted ones, how many were there's a position there was a person in that position?

[Sen. Richard Westman (Member)]: Yes. All of them? 10. Yep. Okay.

[Sen. Andrew Perchlik (Chair)]: And that's already happened or they whether you would It has happened.

[Sen. Richard Westman (Member)]: And so you would but you would have the numbers on how many were offered other positions in state?

[Megan Hope (Financial Director, Vermont Department of Health)]: Oh, that might I'm not sure we would have that information readily available. That might be with the partners. Our next major changes to the public health appropriation. Again, this first line, the no unused drug repository, that is the program that commissioner was speaking about earlier where it really hadn't started. One of our easier areas to identify savings this fiscal year was to stop pursuing that agreement. And then the last two items in our operating expenses are fee for space charges, so increase in our district office space rent costs, and then the medical and lab supplies line that is a move of our NARCAN program from public health into the substance use program. So again, it's a down in public health, but you'll see a corresponding substance use disorder. That program is still continuing just in a different approach.

[Sen. Richard Westman (Member)]: And

[Megan Hope (Financial Director, Vermont Department of Health)]: for our grants line, again, this is where promised corresponding ups here they are. The move of those rural health system improvement and clinical development and support along with healthcare quality assurance, educational and quality improvement prescribing, all of those that were removed from administration are now landing here in public health.

[Sen. Andrew Perchlik (Chair)]: And

[Megan Hope (Financial Director, Vermont Department of Health)]: then finally for public health appropriation changes and subrecipient grants, our immunization line reflects the requested budget increase of about 7.5% of the costs for the Vermont vaccine purchasing program. This program ensured universal access to vaccines for all people in Vermont at no charge to the individual. And the program helps reduce total cost of vaccine by using our volume purchasing contracts. Excuse me, the program costs are funded by an assessment to health insurers, which is then deposited in a special fund and used solely for administering a program. So that is a request and increased spending authority so we can utilize that, the revenues received in that special fund. Our next line, the HIV AIDS service, this was that syringe service program that I noted. Oh, I'm sorry, noted Narcan, I didn't notice syringe service. This again is another program that just wasn't our public health, we're moving it to substance use disorder. So you'll see an increase there. The maternal and child health program grants, the first IDT line, this is an anticipated reduction in what is federal grant revenue to DCF that is coming to the health department for the PDG grants, the preschool development program. DCF is still receiving that grant next year. However, just kind of the shift in who is doing the work between VDH and DCF is adjusting and therefore DCF is kind of taking on more of that work than the health department. So we anticipate a reduction in

[Sen. Andrew Perchlik (Chair)]: So it's kind of neutral, but between two departments? Yes.

[Megan Hope (Financial Director, Vermont Department of Health)]: The next MCH program line, this is a move of the school Medicaid administration claiming program from the health department to the Department of Vermont Health Access. They will be taking over that program with help of the agency of education in the coming year. Our tobacco control program. This is really a budget neutral change. The source of funding for the program is just or we're in the budget, we're kind of we're truing up the sources of funding to more closely match how we actually spend the dollars for this program.

[Sen. Andrew Perchlik (Chair)]: It's not shoving from the tobacco funds specifically it's gonna come from

[Sen. Richard Westman (Member)]: federal funds.

[Megan Hope (Financial Director, Vermont Department of Health)]: We're anticipating a little bit more spending of federal funds in this program in the year and our tobacco spending is going to be even over the, our MSA spending is gonna be even. But just for grants specifically, more of the subrecipient grant money going out has been historically our CDC grant. So we're kind of truing up the funding with this law.

[Sen. Andrew Perchlik (Chair)]: Do you have anywhere just like a page on the tobacco funds?

[Megan Hope (Financial Director, Vermont Department of Health)]: We do. I know our substance use prevention programs was working on putting together a pager of prevention spending and it includes tobacco.

[Sen. Andrew Perchlik (Chair)]: Okay, good.

[Sen. Virginia 'Ginny' Lyons (Member)]: And I just talked with you about that

[Sen. Andrew Perchlik (Chair)]: the Okay. Other Yeah. We'll be interested in that one. That's good.

[Megan Hope (Financial Director, Vermont Department of Health)]: Yeah. And then finally, the emergency medical services line. This is a request to increase spending authority in the emergency medical services special fund. That fund receives a transfer from the fire states fire safety special fund every year. And back in 2024, act 113, the amount of that transfer from the fire safety fund into the EMS fund increased, but this is kind of a cleanup item. We just now need the increased spending authority in order

[Sen. Richard Westman (Member)]: to suspend those dollars.

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

[Megan Hope (Financial Director, Vermont Department of Health)]: That is the last slide for public health. Wondering, pause here, any questions about

[Emily Hawes (Commissioner, Department of Mental Health)]: our public health appropriation? And

[Megan Hope (Financial Director, Vermont Department of Health)]: finally, our substance use programs appropriation. Net changes in salary fringe costs, there's an overall reduction here because of those 11 field based staff that moved from our substance use program into the public health appropriation. So overall, 47 positions in '27 compared to 57 in 26. So those 11 positions that moved and then we actually had one additional position in this appropriation.

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

[Megan Hope (Financial Director, Vermont Department of Health)]: then for our operating costs, this is that Narcan distribution program that moved out of public health and is now into substance use appropriation. Just internal shift. And then finally our grants. And I'm gonna just touch briefly on substance use prevention and then I'm gonna turn it back over to the commissioner because we have some more talking points for you all on that. But essentially our substance use prevention has an overall increase and that increase is from the Substance Misuse Prevention Special Fund. And that is funded by the cannabis excise tax in which 30% up to $10,000,000 comes and is transferred into the Substance Misuse Prevention Fund. Overall, the administration in '27 had about six point or just under 7,000,000 anticipated going into that fund where compared to 9,500,000.0 in '27. So that's the roughly $2,000,000 increase you see.

[Sen. Virginia 'Ginny' Lyons (Member)]: And

[Megan Hope (Financial Director, Vermont Department of Health)]: I'll leave it at that. We have much more in-depth prevention messaging coming for you. The next, the substance use intervention line, that is the syringe service program that was moved from our public health appropriation into DSU. And for substance use treatments, that is again a similar change in kind of how we're aligning our budget with how we've been spending the funding. We anticipate having some savings on our global commitment treatment investment and being able to spend more substance abuse block grant dollars from SAMHSA in this line. So a shift in how that funding is happening for the program. Is no reduction in overall treatment budget, just kind of a shift in where we're able to spend our funding there. And then our last line is the certified community based integrated health centers. And this is funding that is going from the health department to the Department of Mental Health for those providers that will previously have been paid by the health department but will now be paid by the Department of Mental Health.

[Sen. Richard Westman (Member)]: And if

[Megan Hope (Financial Director, Vermont Department of Health)]: there's no other questions on here, I will turn it back over to the commissioner for some information about prevention.

[Sen. Richard Westman (Member)]: Yeah. I it might be a a good time for you to just very quickly in a short in substance prevention piece Mhmm. Talk about this is the first year we've really got the, I think, five councils set up, so it might be a good time to just speak to the committee quickly about where we are in that process.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes. And that is what doctor will present.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: Thank you for setting me up so well. Our Vermont prevention model so prevention is something that's I've seen a lot of interest amongst the legislature about and frankly something I've been educating myself on. It's not one program, not one activity. It's a combination of actions that sustained over time to prevent or reduce something that's as pervasive as substance use disorder, alcohol, tobacco. For them to succeed, they have to reach people holistically in environments where they live, their individual, their family, their school, their community and their state. And this is our visual depiction of this holistic framework. As we had previously noted, the funding for this comes from the substance misuse fund, which is estimated to be $9,500,000 And we have three categories where we use those funds. One is in the Vermont Prevention Lead Organizations or VPLOs, and that's $5,000,000 $3,000,000 goes into school based prevention initiatives, and $1,500,000 is prevention consultant staff is in our 12 district offices for staffing. And I'm gonna talk a little bit more about the VPLOs. So the VPLOs are our four established Vermont Prevention League organizations that were established in '23 to serve as the fiscal agents for community organizations to lead and expand prevention efforts in the region. The intent here is to have it be based in the communities and in the regions and not centrally located. It's a competitive process and we have 66 sub recipients statewide that are getting the grant through the VPL process. They first start by gathering data to inform their their decisions. They develop strategic plan and then they have a competitive process to address the needs that were identified in that strategic plan. And then the board will allocate the fund based on it. So this has been a was developed through an eleven month eleven month planning process with ongoing stakeholder input. And it helps preserve these dollars again in the local regions to try and address the local needs which may be different from region

[Megan Hope (Financial Director, Vermont Department of Health)]: to region.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: I've been very impressed with the way this process has gone and the competitive nature of it and how it directs the funds to where the identified needs are within the data and strategic plan. So broadly speaking, that's sort of where we stand right now. And our hope is to have more outcomes related to the initiatives as Eddie had mentioned, they're really just getting done.

[Sen. Richard Westman (Member)]: Only because a lot of the effort for around that center, around the work that center of the Lyons, Kitchell, and and Sears all put in and and a lot of work that was put in in this committee.

[Sen. Virginia 'Ginny' Lyons (Member)]: So one question I always ask, and I know that Emily forget her last name.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: Emma Truder. Yes.

[Sen. Virginia 'Ginny' Lyons (Member)]: Yeah. Are the savings that we accrue from the prevention work that we do. And so I know I know it's always you put $1 in, we get $13 back.

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

[Sen. Virginia 'Ginny' Lyons (Member)]: Is it possible to get some estimate of the benefit that we've received as a result of all this prevention work?

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: So we are developing a a slide deck that will specifically asking so it's coming soon. And and it's we've been working on it since for a couple of months now. And I am pushing them to give you exactly that because we can tell you how much money we spend in prevention. I wanna know as

[Sen. Andrew Perchlik (Chair)]: much

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: as we can tell you about, hey, this is the impact that it's made. It's obviously hard. This is hard work, and it occurs over decades. But to the extent that we can give you, hey. Here's the difference that it's made with this investment. That's what I wanna do.

[Sen. Virginia 'Ginny' Lyons (Member)]: That would be great. I because it's so it's fuzzy to people. Right. You know? So oh, they'd rather go out and solve the problem where it is right now rather than take a look upstream and sort it out for later.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes,

[Sen. Andrew Perchlik (Chair)]: sir Watson?

[Sen. Anne Watson (Member)]: Thank you. How old is this program?

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: The VPLOs were established

[Sen. Richard Westman (Member)]: in '23.

[Sen. Anne Watson (Member)]: Okay. So not a lot of years of data. But sort of to that point, it would be interesting to see the graph over time of the of the return Sure. As a as a as a ratio or saving just because I I you know, playing that out long term, I can imagine it'd be, like, flattening, but it'd I I don't know that there's any flattening yet.

[Ted Burnett (Joint Fiscal Office)]: Right.

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: So And,

[Sen. Richard Westman (Member)]: I mean, a

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: lot of this a lot of this savings isn't costable. So this is this is challenging stuff to sort of definitively have a straight line like here's what's happening. Right? Right. That is exactly what I'm pushing my team to do is say, hey, I need to show to you all, here's what we're getting from our investment. Okay? I know from the people, the folks who work on the ground, how impactful they see their work to be. But we really do wanna show to the extent that we can, here's the financial impact of

[Sen. Andrew Perchlik (Chair)]: these investments at this point.

[Sen. Richard Westman (Member)]: So it passed in '23, but the councils are really much newer They're good in the last two years. That's like the. The real the upshot of that is the effort was to get prevention stuff back in the communities and out of there. And and the councils were set up to give them, the ability to pull people from regions in to make this as closest.

[Sen. Andrew Perchlik (Chair)]: Seems great. Right. Because, I mean,

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: clearly, you're gonna have different things

[Sen. Richard Westman (Member)]: you need in Burlington versus the

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: Northeast Northeast. They're they're different communities and they need different things. And that's I think

[Sen. Andrew Perchlik (Chair)]: the beauty of this structure. Okay. I don't know if you're gonna try

[Sen. Richard Westman (Member)]: to I

[Megan Hope (Financial Director, Vermont Department of Health)]: was gonna say if you want, we do have some time. I'm happy to go through some of our appendix documents that we created to try try and address the request for additional request for information.

[Sen. Andrew Perchlik (Chair)]: Let's just have these specific but I appreciate that you responded to our letter that we sent in October. Not all departments do. We should give the other departments a hard time, but I just wanna give you a gold star for doing them all. So the committee should look at these pages 47 to 48. But on page 29, you do have to talk about the position changes. But it says that there are no position cuts, but then it talks about reductions. So that's

[Sen. Anne Watson (Member)]: why So in '27,

[Megan Hope (Financial Director, Vermont Department of Health)]: we didn't have to we didn't make any cuts, but the changes in the ups and downs were a difference between what was in the '26 budget and what was in '27. So I can see how you have a question about that. It's

[Sen. Andrew Perchlik (Chair)]: So if there's another way to lay that off Yes. Be more clear. And then the very last slide, right there, where you talk about your special funds. You had a health department special fund?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes, we do.

[Sen. Andrew Perchlik (Chair)]: 41,902, what is that?

[Megan Hope (Financial Director, Vermont Department of Health)]: Honestly, it's kind of a catch all. A number of programs go there, for example, are newborn screening fees where we, you know, hospitals pay for the little blood prick that each newborn gets and then we send off to, I believe, Boston. I'm a financial program person, but we collect the fees from hospitals to do that and then run the program. That, for example, is something that runs through the health department special fund.

[Sen. Andrew Perchlik (Chair)]: So like capital program instead of the special fund, both the funds coming in

[Emily Hawes (Commissioner, Department of Mental Health)]: and the

[Sen. Andrew Perchlik (Chair)]: costs going out.

[Megan Hope (Financial Director, Vermont Department of Health)]: Yeah, correct. Some other things that

[Sen. Virginia 'Ginny' Lyons (Member)]: go into the health care and fresh fund. I'm blanking, but there's there's a there's a whole whole mix.

[Sen. Andrew Perchlik (Chair)]: Whole bunch of things. Yeah. Kind of your miscellaneous account code for

[Jennifer Cole (Director, Office of Professional Regulation)]: Yeah.

[Megan Hope (Financial Director, Vermont Department of Health)]: Both things. Our miscellaneous fund.

[Emily Hawes (Commissioner, Department of Mental Health)]: Can I ask one more question?

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

[Sen. Virginia 'Ginny' Lyons (Member)]: So one of the things that we're looking at in our committee, we have been looking at since January, are the number of reports that we got from folks, and we've asked for recommendations about eliminating some of those reports. I find that they're very valuable, but some are not valuable. So it would be helpful when you have a minute help with that.

[Sen. Andrew Perchlik (Chair)]: Absolutely great. Especially if there's any reports that you're like, this takes a lot of time. I wanna make

[Rick Hillebrand (Commissioner, Vermont Department of Health)]: sure everybody reads it. Correct. That we will make sure to highlight those specifically that these are

[Sen. Andrew Perchlik (Chair)]: a questionable benefit. Or just over that take a lot of time. Yes. Like, the time benefit ratio

[Sen. Virginia 'Ginny' Lyons (Member)]: Or they're out of date. Yes. Someone just had it.

[Sen. Andrew Perchlik (Chair)]: Center walks in.

[Sen. Anne Watson (Member)]: Actually, I can ask this question offline. Have some interest in the lead and asbestos,

[Sen. Virginia 'Ginny' Lyons (Member)]: the vegan season where they come from, but I can ask you another time.

[Sen. Richard Westman (Member)]: I will have an email to you, Todd, seeing of how I want stuff presented and what I I need on Monday. Yeah. Absolutely. It may not be till tomorrow morning. Okay. That's okay. I've been working on it.

[Sen. Andrew Perchlik (Chair)]: Okay. Well, thank you for your time. Both of you. Thank you. Thank you. Good work. Yeah. Okay. We will.

[Emily Hawes (Commissioner, Department of Mental Health)]: You may just hear if you can start with

[Sen. Andrew Perchlik (Chair)]: No. Well, we don't need to take a break. Okay. So we've already picked a break. Only one break a day. Are they

[Sen. Richard Westman (Member)]: out the

[Sen. Andrew Perchlik (Chair)]: hallway or they on the

[Emily Hawes (Commissioner, Department of Mental Health)]: I have a Thank you

[Sen. Richard Westman (Member)]: for taking that. Okay. Speed trap.

[Samantha Sweet (Deputy Commissioner, Department of Mental Health)]: Sorry, 224. We

[Megan Hope (Financial Director, Vermont Department of Health)]: are down

[Emily Hawes (Commissioner, Department of Mental Health)]: on mute.

[Sen. Andrew Perchlik (Chair)]: Center appropriations FY27, Department Good

[Emily Hawes (Commissioner, Department of Mental Health)]: afternoon. Thank you all for having us here today. My name is Emily Hawes and I'm the Commissioner for the Department of Mental Health.

[Samantha Sweet (Deputy Commissioner, Department of Mental Health)]: And I'm Samantha Sweet, Deputy Commissioner for the Department of Health.

[Emily Hawes (Commissioner, Department of Mental Health)]: Great, so real quick wanted to provide some context of the Department of Mental Health. So as you can see, our mission is to promote equitable access for mental health services to our community. As the secretary testified earlier this week, the agency of human services went through a rigorous practice over the summer at taking a look at all of the programs within the agency of human services in order to develop our budget for FY '27. From a DMH perspective, we did this work following our core values. So keeping to the front of our decision making, compassion, equity, integrity, collaboration, and accountability. As a reminder, the department oversees 10 designated agencies. We also contract with two specialized service agencies and we designate six hospitals across the system. We also operate the Vermont Psychiatric Care Hospital which is a 25 bed hospital for adults here in Berlin and The River Valley Therapeutic Residence which is a 16 bed facility located in Essex. A Are they multiple? VPCH has some folks coming and going today but typically at 21 of the 25 beds and they've been at 21 for the past billing since COVID. That's about as high as we've been able to get from a

[Megan Hope (Financial Director, Vermont Department of Health)]: staff. Yeah.

[Emily Hawes (Commissioner, Department of Mental Health)]: We do have a vacancy chart embedded within our presentation to demonstrate the progress that we've made with vacancies and hiring but also that we're in a really challenging staffing situation both there and River Valley. River Valley right now is topped out I think at 12 residents who can be admitted there and that's a combination of staffing and there's some current construction going on there to add a seclusion and restraint suite.

[Sen. Andrew Perchlik (Chair)]: Does your where where else you where if you talk about the staffing, do you talk about what what's needed? Like how many how many what's the unmet needs as far as beds go? Like if you were fully staffed, does that still leave another need for 20 beds even if you could fill these two facilities?

[Emily Hawes (Commissioner, Department of Mental Health)]: We do have some data related to the number of folks presenting for involuntary care both from the adult perspective and the youth perspective over the last years. And we have seen the wait times for treatment to decrease in that folks for involuntary care, court orders, and most voluntary. And just a quick reminder, most folks accessing hospital level of care are voluntary. And so Vermont Psychiatric Care Hospital only serves individuals who are involuntary and we have seen those weights decrease over time. We also collaborate with across the mental health system, numerous hospitals. We hold the contract for forensic psychiatrists through the court. We also do consult psychiatric consultation on primary care. We work collaboratively with law enforcement, courts, other state agencies, you name it, we are probably collaborating in some way. Real quick here is a slide that depicts our organizational chart at the executive level. You'll notice we have two vacancies, one being our finance director. So I am appreciative of Tracy O'Connor joining today. We are without Shannon Thompson. She's since retired, and then we have a vacant director of clinical operations. This next slide gets into the vacancy rates by location and this is specific to DMH staff. So this is not an example of what's happening across the mental health system at large. This is specific to the Department of Health. So as you'll see about a year ago, BPCH was hovering in, I think, it was around 45, 47% vacancies and we've been able to bring that down. That's down from about 60% vacancies on the two years prior. So we are making progress there.

[Sen. Andrew Perchlik (Chair)]: It's good, but it's still, I think, around department correction level. But, no, I think they've gone down below.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah. Their hiring pool is a is a much broader pool of individuals for psychiatric nurses. That's a specialized group of individuals who are trained specifically in both nursing and delivering that care in the psychiatric unit.

[Sen. Andrew Perchlik (Chair)]: And the central office is kind of at all times. Why would you count for the increase there?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, we had several retirements come to the department at the 2025. So we've seen a gradual shift in a few people retired, folks have moved on to other positions where there was an opportunity for career advancement, and some are just regular open positions.

[Sen. Andrew Perchlik (Chair)]: So you're expecting that to go down by 5%?

[Emily Hawes (Commissioner, Department of Mental Health)]: Well, would hope so, yeah. Some of those vacancies that are listed here are already decreased and we do post on the DMH website ongoing vacancy data related to both central office, of central office, River Valley and From a broader system capacity perspective we have around 38 adult crisis beds within our designated agency system. We have youth crisis beds coming in at eighteen, forty two intensive residential, and 148 beds that are labeled as adult residential programming. We also have a contract for 57 level one beds. Level one is how the state of Vermont defines individuals who are under the care and custody of the commissioner and who require additional resources in order to meet their treatment needs at a hospital level. Folks also have access to non level one, both involuntary and voluntary units across the state, as well as children and youth. This does not reflect the project that DMH has with Southwestern Vermont Medical Center to bring another youth bed online. That is still in the early contracting stages and hasn't started construction yet.

[Sen. Andrew Perchlik (Chair)]: How many beds would that be?

[Emily Hawes (Commissioner, Department of Mental Health)]: It's 11.

[Sen. Virginia 'Ginny' Lyons (Member)]: So how many of the hospital beds are filled with folks who could be placed in another type of facility right now? Yes. Any of that acute?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, so all individuals who are in the hospital setting are needing hospital level of care.

[Sen. Virginia 'Ginny' Lyons (Member)]: So there's no one that's being held and waiting for any step down?

[Emily Hawes (Commissioner, Department of Mental Health)]: They're all meeting the definition for needing hospital.

[Sen. Andrew Perchlik (Chair)]: What was that a problem before?

[Emily Hawes (Commissioner, Department of Mental Health)]: It has been. Years ago. Yeah. It has been. It always and flows. And, you know, the requirements for somebody to stay at your highest level of care are scrutinized by our funders and so we are committed to making sure that folks do not stay past their need for that level of care. And so for instance sometimes folks may need a hospital level of care and maybe they transition back to corrections when they no longer have that need. That's very common and folks in corrections if they need a hospital for their psychiatric illness will come to the broader mental health system. And this slide is just a graphic snapshot of our complete mental health system of care and you'll notice at the bottom our foundation is our community mental health system and that's the work that's happening across the designated agency system. There's private providers that serve individuals with mental health and substance use conditions. It also includes all of our mental health urgent care projects that we have done over the past couple of years. 988 crisis line, although you don't have to be in a crisis to call or text or chat 988, that's just the name of it. You can use it if you're having a hard time. And then our assessments for higher level. So I'll get into the good stuff and tough stuff of what we're hearing today to talk about. Would you prefer, I'll do a highlight, and some committees prefer the ups and downs sheet, some prefer a more narrative approach, happy to do whatever works best for the committee.

[Sen. Andrew Perchlik (Chair)]: You don't have to go line by line by the ups and downs, that's for sure.

[Emily Hawes (Commissioner, Department of Mental Health)]: If

[Sen. Andrew Perchlik (Chair)]: you would just go through any things you wanna bring up that's in the ups and downs and just describe it narratively, that would be Absolutely. So

[Emily Hawes (Commissioner, Department of Mental Health)]: from a overall funding perspective for the Department of Mental Health, you'll see that we have a governor recommended budget of $347,000,000 Of that, 70% lives within our global commitment funds, and you'll see from the breakout, it also includes Medicaid investment dollars, general funds, special needs, interdepartmental, special funds, sorry, interdepartmental transfers and federal funds.

[Sen. Andrew Perchlik (Chair)]: What was it last Cool. Or what's the percentage change?

[Emily Hawes (Commissioner, Department of Mental Health)]: I believe it's a well, did you have were you gonna tell me? We don't have it on the we had it in the presentation. It's in the appendix? Mhmm. Okay.

[Sen. Andrew Perchlik (Chair)]: Didn't mind on the appendix sheet.

[Emily Hawes (Commissioner, Department of Mental Health)]: This next slide is a representation, same thing but divided out by programs. So you'll see we have the adult services that is the large darker blue at 33%. We spend about 1% on other inpatient. Vermont Psychiatric Care Hospital is a large screen at 35,000,000. River Valley Children's Community Service along with Success Beyond six. I'll talk a little bit more about the PNMI rates. PNMI stands for private non medical institution, residential institution, and then the departments administrative and other.

[Sen. Andrew Perchlik (Chair)]: So is it slide 20 is your is that where the total numbers? That's the one

[Emily Hawes (Commissioner, Department of Mental Health)]: you Oh yes, yeah.

[Sen. Andrew Perchlik (Chair)]: Whatever that I don't know. You want that percent? It'd be good if I had a percent column. Sure. I'll do that math later. Thank you

[Emily Hawes (Commissioner, Department of Mental Health)]: for having me do that on the spot. Maybe Tracy can because she's our finance wiz today. So I'll start briefly with our an example of our ups and downs sheet.

[Sen. Richard Westman (Member)]: Slide 12 please.

[Emily Hawes (Commissioner, Department of Mental Health)]: Great. So this is also section B3.14 and this is the Department of Mental Health current ups and downs. And so you'll see in here I won't go through the salary and wages. I won't go through things like our fee for service charge or things like that that show up pretty regularly. I'll call out that we still see pressures around transportation costs for you. We talked about that in adults. We talked about that in our DAA, as well as the evaluations related to forensic evaluations. Those are evaluations ordered by the court to determine somebody's competency. The department is required to administer pre admission screening and resident review, which is also called the PASAR, for individuals to be determined as needing nursing home level of care. And then you'll see in here also related to a proposed reduction which is the team two training for first responders. So I'll highlight that now and then I'll come back and talk about our package of reductions and lots. Next I'll highlight some grants that the department does related to our work with nine eighty eight. We also have an initiative for behavioral health link, which is a program designed to support centralized dispatch for enhanced mobile crisis programs. The department is bringing on additional certified community based integrated health centers, otherwise known as CGDHCs. We'll be bringing on five more agencies starting in July. They have an initiative related to that. And then you'll see our rate increases related to the PNMI program. PNMI is the private non medical institution, those are the rate increases related to programs within the state of Vermont, and then there's another line item that we testified about for our BAA and the number of folks who receive that service out of state.

[Sen. Andrew Perchlik (Chair)]: What does PNM mean? What is it that was the

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, private non medical institution.

[Sen. Andrew Perchlik (Chair)]: In the down for the reach up?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes, so I'm gonna move us into the downs now. So slide 17, so these I mentioned, the mental health training for first responders, Team two. So Team two was a contract that the department engaged in to provide mental health training for first responders. We have a proposed reduction related to team two of 109,000.

[Sen. Andrew Perchlik (Chair)]: And are these mental health responders? They're not all first responders?

[Emily Hawes (Commissioner, Department of Mental Health)]: It's not all respondents. It's anyone who is responding to a community. So it could be an emergency services clinician within an agency, it could be law enforcement, Vermont State Police, and our proposal is to take those trainings in house. When Team two was developed and implemented, that was before the department had our own internal training team, and so our proposed reduction would be to end that contract. We would not take the T2 training into DMH, but we would be providing training done by the department to the same

[Sen. Andrew Perchlik (Chair)]: groups of folks. Does that seem like a successful program?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah, it has had a lot of success and I know that first responders have been very satisfied with that program. I know that the secretary talked about that we needed to really think about what we could do internally and this was one of those areas that would allow us to have a higher rate of consistency across our crisis programs and take that training on internally.

[Sen. Virginia 'Ginny' Lyons (Member)]: What happens to Team two as a result?

[Emily Hawes (Commissioner, Department of Mental Health)]: They disappear? You're welcome, sorry? I mean do they disappear? Does this really eliminate them? It eliminates the department, the DMH funding for team two. They could go and contract with the entities on their own and still deliver that, but it does eliminate the department's funding for that program.

[Sen. Virginia 'Ginny' Lyons (Member)]: Okay, do you know if they have other funding right now?

[Emily Hawes (Commissioner, Department of Mental Health)]: I'm not sure.

[Sen. Richard Westman (Member)]: I'm not aware of that.

[Emily Hawes (Commissioner, Department of Mental Health)]: The next reduction comes under the bed board. So after Tropical Storm Irene occurred, we took the ability to have all of the beds across the mental health system in an electronic bed board and that was contracted out. That contract has since ended. We have taken that bed board project internal in collaboration with ABS. That has already happened, and so this would be a $15,000 reduction.

[Sen. Virginia 'Ginny' Lyons (Member)]: So when you bring it in Mhmm. And you're reducing the budget

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

[Sen. Virginia 'Ginny' Lyons (Member)]: Some you're still having to do work. Mhmm. So does this mean that you're adding responsibility onto one or more people who are already in one position, already doing work full time, so now they're doing full time plus? I'm trying to sort out how you're doing that.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah. No. So we used

[Samantha Sweet (Deputy Commissioner, Department of Mental Health)]: to contract with Minnesota Hospital Association for our bed board, and then our research and stats team would take that data and and run a bunch of data from the bed board of like occupancy, beds closed, for everything. So that will continue, so no workload increase, it's just going to continue EDS built at State of Vermont bed board system. So that's already done, it's already running. Our research and stat scheme is going to continue with reporting out on the data. So no increased workload currently.

[Sen. Virginia 'Ginny' Lyons (Member)]: Okay, and then going back to team two, similar question.

[Emily Hawes (Commissioner, Department of Mental Health)]: They have the capacity and are doing trainings now. Okay.

[Sen. Richard Westman (Member)]: Thank you. You're welcome.

[Emily Hawes (Commissioner, Department of Mental Health)]: The next line item is the suicide initiative project management. This was project management support related to the Governor's Challenge, is a suicide prevention initiative. We'll still engage with the Governor's Challenge, but we'll end the contract for the project management of that. That would then be absorbed by our suicide prevention director. And they have the capacity to absorb that. The next proposed production is nursing services at a specific community care home and this is a community care home in the Washington County area. As we mentioned earlier this week, we looked at equity across the system and if one agency had one program and this would fall under that, no other agencies that are having nurses specific to community care homes. That was something that we considered to propose for a reduction. For this particular reduction, those nursing services are being considered as part of their CCBHC rate so there wouldn't be a decrease in services for folks but we would not be paying the capacity for that nurse at Kirby

[Megan Hope (Financial Director, Vermont Department of Health)]: House in Waterbury.

[Sen. Andrew Perchlik (Chair)]: So that would just put the budget pressure on Washington County on the health to come up with that money or change their visit staffing?

[Emily Hawes (Commissioner, Department of Mental Health)]: So Washington County Mental Health will be one of the five CCBHCs that come online in July. And that CCBHC requires a certain number of types of services to be delivered to the community. And one of the goals of the CCBHC is to provide integrated care and so have have a higher ability to provide services that are for medical needs. And so they would be able to shift that staff member into that rate. And then get the higher federal reimbursement rate. The next line item for proposed reduction is community outreach in Chittenden County. The community outreach program County is for the broader Chittenden County areas such as Winooski and Milton, Colchester, Essex Junction, not what's referred to as the Church Street outreach in Burlington. So this is the broader community. Our goal would be to shift the community outreach response to 988 and enhanced mobile crisis. This is another program that is specific to Chittenden County, it is not a statewide program and was implemented before we had a 988 call, text, chat center and was prior to the enhanced mobile crisis

[Sen. Virginia 'Ginny' Lyons (Member)]: response. So explain it. So are these the folks who are embedded within some of our police departments that you're talking about? The social workers who are going out in a response for an emergency that was originally established as a pilot program for the entire state. So now we're saying the rest of the state doesn't have it, so we're eliminating it? No. There

[Emily Hawes (Commissioner, Department of Mental Health)]: is a program where there's social workers embedded within the Vermont State Police. That still exists and this is not that. There are also other types of social work positions embedded in other local law enforcement. Yep. And it is not that program. Okay. These are individuals who primarily do phone interactions with folks in the community. And so we would want to shift that, those phone interactions and those community responses to the 988 and enhanced mobile crisis teams. Anything you wanna add with that? The only

[Samantha Sweet (Deputy Commissioner, Department of Mental Health)]: thing I'll add is that, well, two things I'll add is that we know about 35% of the community outreach is actually face to face, and so we see that as a pretty low percentage, and so we think that enhanced mobile crisis is 20 fourseven. So community outreach is adjusted for chunk of hours per town. So not even a full time position per town. It's a few hours in these towns where enhanced mobile crisis is 20 fourseven access to all the towns.

[Emily Hawes (Commissioner, Department of Mental Health)]: This was a proposed reduction in last year's budget as

[Sen. Richard Westman (Member)]: well. The

[Emily Hawes (Commissioner, Department of Mental Health)]: next up is a trio of outpatient services. DMH So has dollars in our base for supporting the mental health needs of individuals on a TBI waiver. We currently serve one individual under this program. They would still be able to access mental health services. They just wouldn't have it embedded into their waiver.

[Sen. Andrew Perchlik (Chair)]: Same for elder care, Richard?

[Emily Hawes (Commissioner, Department of Mental Health)]: Elder care is a contract that the AAAs have with the designated agencies to provide specific elder care services in their communities. Not all designated agencies provide this service and some who can have not been able to provide this service due to staffing. And so our proposal would be to reduce the specific elder care service line for the mental health supports as a part of our FR27 reductions. If individuals in this age group needed and wanted services they could still receive them through traditional outpatient it just would no longer be a carved out population. And then the next line item is the reach up program. One of the lines that one of the lenses that we looked at when we did our budget exercise was any potential for duplicative service delivery and reach up and elder care in some regards but reach up is case management services that could otherwise be delivered different in way. And so as a whole, 300 individuals are served statewide in the Reach Up program in this way. Most of them, around ninety percent have Medicaid and so those are Medicaid eligible case management services. So we would shift those contacts should they want them away from the reach up program and they would interact with the system in a traditional outpatient model. It no longer be a part of. The next item on the list is

[Sen. Virginia 'Ginny' Lyons (Member)]: So wait so you're eliminating some care services and integrating it in with Medicaid. Are you at the same time moving people and moving the services so that there's a continuity of care? Or is this just a categorical cutoff?

[Emily Hawes (Commissioner, Department of Mental Health)]: They would it's not a categorical cutoff, I would say. They have individual

[Sen. Virginia 'Ginny' Lyons (Member)]: They have to go back and apply and re

[Emily Hawes (Commissioner, Department of Mental Health)]: No. They would no longer be getting reach ups reach up case management. They would have case management that could then, you know, address whatever needs that they have, not just under

[Sen. Virginia 'Ginny' Lyons (Member)]: Will it be a seamless conversion for them?

[Emily Hawes (Commissioner, Department of Mental Health)]: We can work with the agencies to ensure that that occurs.

[Sen. Richard Westman (Member)]: Okay.

[Emily Hawes (Commissioner, Department of Mental Health)]: Sure. Yeah. No. And just a reminder, each agency gets a lump sum for Reach Up and then they invoice the Department of Family and Children and Family for the individual services. And so we would ship those to Bill.

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

[Emily Hawes (Commissioner, Department of Mental Health)]: The next line item is the Vermont Collaborative for Practice Improvement and Innovation Training. These are funds that have already ended in 2025. And we have integrated and incorporated those tasks internally across the suicide prevention director and the DMH training coordinator.

[Sen. Andrew Perchlik (Chair)]: For some of these that are like under $10,000 even though I'm really interested in puppets and education, think you

[Emily Hawes (Commissioner, Department of Mental Health)]: could I'll skip over those. Is fine with me. I'll just highlight the larger number of That's fine. And make sense given our time. So I'll move into the care coordination for children, DPSDT Medicaid admin dollars. This includes a embedded mental health clinician at the Milton Family Practice as well as supports within Howard Center First Call. So this is a program that was implemented many years ago and the Milton Family Practice is the only practice in the state that receives dollars for clinician there. That practice is also a blueprint practice and so they have opportunities to receive the same care under the blueprint. So that would be duplicative and special to that particular primary care office. The next line item is related to the collaborative systems integration project. Outpatient Program for Justice Involved. This program is specific to Washington County and was originally designed as a response to Tropical Storm Irene. They serve individuals who are involved in the criminal justice system, and those individuals are low risk, I would say, for recidivism, And so we would look to shift the specialized program to reduce that. And if individuals want to receive services through their traditional outpatient programs, they're able to do that.

[Sen. Andrew Perchlik (Chair)]: I assume that's supposed to be a common, not a decimal. Yeah.

[Samantha Sweet (Deputy Commissioner, Department of Mental Health)]: I just noticed that.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes.

[Samantha Sweet (Deputy Commissioner, Department of Mental Health)]: We've only seen this about 35.

[Emily Hawes (Commissioner, Department of Mental Health)]: Following along the lines of programs that are specific to one area of the states, this next line item is related to the Safe Haven program at the Clare Martin Center for 136,000. This safe haven is in Randolph. Claire Martin Center serves the Orange County and Upper 500000. This is a line item dedicated to support services for uninsured and non SMI's. So, is it significant or severe? Significant, severe mental illness. And those services instead of a lump payment to the agency would then shift to billable new Medicaid. This is an investment line item. The next line item is youth and transition investment dollars at 183,000. This is part but not all of the funding per year. This segment of funding is specific to the designated agencies. Individuals who are in this program can still receive services, they would no longer be at CarVal. Funding does remain intact for the current contractor, contract holder, Elevate Youth Services, they'll still provide us. We talked a little bit about the Vermont Psychiatric Care Hospital earlier today. You'll see that this line is a proposed reduction of 25 to 21 beds.

[Sen. Andrew Perchlik (Chair)]: Now it eliminates 12 positions?

[Emily Hawes (Commissioner, Department of Mental Health)]: It does. It eliminates 12 positions.

[Sen. Andrew Perchlik (Chair)]: Why would you do that?

[Emily Hawes (Commissioner, Department of Mental Health)]: They're vacant.

[Sen. Andrew Perchlik (Chair)]: Oh, okay.

[Emily Hawes (Commissioner, Department of Mental Health)]: So we don't have to

[Sen. Andrew Perchlik (Chair)]: So these are the, you're to fill them, but you can't. Correct.

[Emily Hawes (Commissioner, Department of Mental Health)]: So what the challenge at BPCH has been is we can either bring on more travel partners and open up the last unit or leave things as they are where we're managing the budget, bringing on more permanent letting go of travel staff as we're able to. But because we have seen the need shift for this level of care, wait times also decrease, we feel comfortable with this for post reduction. Okay. Budget downs continued. We have a transfer of funding, DMH to DCF. The IFS or Integrated Family Services Program, we would move that program back to DCF. So would be an internal transfer. So it looks like a down on our sheet. There should be a co occurring up

[Sen. Richard Westman (Member)]: on the screen.

[Emily Hawes (Commissioner, Department of Mental Health)]: That's the same with the Arch program. That's a net neutral transfer over to Dale. Also with inpatient hospital reconciliation, this is level one reconciliation. We have a proposed reduction at Rutland Regional Hospital and that is that they, at the end of the yearly reconciliation that they did not spend as much as we did projected them to spend. And then the last is lifeline suicide prevention, so a reduction to the administrative drawdown for the lifeline suicide prevention. Those activities would then be folded into the work that our suicide prevention director does, and we have confidence that they're able to do that. Slide 20, the comparative analysis. I'm happy to go through these slides, the examples of grants following the requested budget submission formula or we can answer questions at the moment.

[Sen. Andrew Perchlik (Chair)]: Yeah, think those are great. Unless anybody has questions about your million dollar carry forward for the Southern Vermont. Yes,

[Emily Hawes (Commissioner, Department of Mental Health)]: there is a $1,000,000 carry forward for SDNC that's operational and we're in contract negotiations with them right now.

[Sen. Andrew Perchlik (Chair)]: And the construction funds have already been, they were like last year or even year before?

[Emily Hawes (Commissioner, Department of Mental Health)]: Those are in BGS's budget and they'll still show as a carryover. They're finalizing the construction budget as well or the construction contracts as well right now.

[Sen. Andrew Perchlik (Chair)]: And is it really as if I connected to the SDMC?

[Emily Hawes (Commissioner, Department of Mental Health)]: Yes, it's integrated within their main hospital. The original proposal was 12 and it is now down to 11 due to incorporating the availability of a medical bed. Okay,

[Sen. Andrew Perchlik (Chair)]: thank you. And we can look through the appendices. Is there also an eight eighty eight?

[Emily Hawes (Commissioner, Department of Mental Health)]: 988. There's 888.

[Sen. Andrew Perchlik (Chair)]: Just another toll free.

[Emily Hawes (Commissioner, Department of Mental Health)]: I think that's a commercial I remember fondly from the eighties or nineties. But 988 is our primary number.

[Sen. Andrew Perchlik (Chair)]: Yeah, suicide and other because I always thought it was just a suicide line, but it's as can be other Right.

[Emily Hawes (Commissioner, Department of Mental Health)]: If you're having a hard time, you can call. And they're gonna be able to support you. And that's for both mental health and substance use, which is a shift in innovation for our system so that folks don't have to go to two

[Sen. Andrew Perchlik (Chair)]: different places. Great, that's great. Thank you, any other last things you wanna let us know or any questions from the committee?

[Emily Hawes (Commissioner, Department of Mental Health)]: I would love to highlight with nine eighty eight that we're one of the first states to incorporate a response decision matrix tool between the nine eleven dispatchers and nine eighty eight dispatchers. So our nine eleven responders are able to transfer calls appropriately over to 988. And then we are also one of the few states utilizing the VHL software to support centralized dispatch out to those community teams so that they know where each other are and the closest team can respond to someone in that moment.

[Sen. Andrew Perchlik (Chair)]: Slide 37 real quick.

[Emily Hawes (Commissioner, Department of Mental Health)]: 37, you said?

[Sen. Andrew Perchlik (Chair)]: 37, yeah, about the youth. Can you remind me what PRTF?

[Sen. Virginia 'Ginny' Lyons (Member)]: Sure,

[Emily Hawes (Commissioner, Department of Mental Health)]: yes. And I did not mention that when we went over the pyramid. So the PRTF stands for a psychiatric residential treatment facility and there is one coming online here in Vermont, the Brattleboro retreat from last legislative session. Currently youth who need that level of care go out of state. That's correct.

[Sen. Andrew Perchlik (Chair)]: Which is an issue. So this is just giving us the numbers and what's gonna happen if our retreat would be able to take these this many? Believe You'd still have to use out of state.

[Emily Hawes (Commissioner, Department of Mental Health)]: Yeah. I believe that their bed number is also around twelve. So over 12 would still maybe utilize out of state or depending on what it needs.

[Sen. Andrew Perchlik (Chair)]: Because we have over 100. Yeah. So it's is it the goal to try to not have them out of state? Or is there a

[Sen. Richard Westman (Member)]: That is the goal.

[Samantha Sweet (Deputy Commissioner, Department of Mental Health)]: That's always the goal to keep them as close to family as possible. And so Vermont doesn't have a PRTF. And so this is our goal is to have this level of service So for the

[Sen. Andrew Perchlik (Chair)]: that one, like, which I didn't qualify?

[Emily Hawes (Commissioner, Department of Mental Health)]: No. And

[Sen. Andrew Perchlik (Chair)]: are they sometimes private? Are these hospital connected?

[Emily Hawes (Commissioner, Department of Mental Health)]: The PRTF is a specific designation from CMS or Centers for Medicaid. And it requires you to meet several conditions of participation through Joint Commission and CMS regulation. And so they are typically either attached to a hospital or affiliated with the hospital because there is a higher level of medical oversight. But not a hospital level care medical oversight. Okay.

[Sen. Virginia 'Ginny' Lyons (Member)]: But they're needed. Yeah.

[Sen. Andrew Perchlik (Chair)]: Yeah. No. Because I think I've had some families, constituents that have had their child sent out to stay because there was no place for them. Yeah.

[Emily Hawes (Commissioner, Department of Mental Health)]: Concern. Yes.

[Sen. Virginia 'Ginny' Lyons (Member)]: Yep.

[Sen. Andrew Perchlik (Chair)]: Yeah. Okay. Thank you for all the good work you do on this stuff. Appreciate it.

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