Vermont Legislature SmartTranscripts:

[John Kirby (Legislative Counsel)]: We are live.

[Sen. Andrew Perchlik (Chair)]: Amen. This is sent an appropriations committee on Thursday, March 19. We're going all bills day. Bills all day. No budget testimony. So we have to get all the bills out that we have by tomorrow. So those we have another two bills that are coming, three bills today. So then tomorrow, we'll get those out, and then, hopefully, we get all these out today. So we're gonna start with s two seventy eight, although I do not see senator around in the mail. So I wonder where she is. Will you move a chair up to the witness? She'll know where it is. Thank you for your help. Perfect timing.

[John Kirby (Legislative Counsel)]: Great. Yeah.

[Sen. Andrew Perchlik (Chair)]: We are live and ready to hear your Sorry. Do you physical note? You think We sometimes print those out, but we have not printed that out. That's a small. I have not give us like a overall high level

[John Kirby (Legislative Counsel)]: Yes.

[Sen. Andrew Perchlik (Chair)]: What the bill does. Yes. And that's council can read this read this through detail.

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: Great. So pardons to Senator Lyons who heard this in her committee, a little more public health focus. S-two 78 is, I would say, the first time the Senate Economic Development Committee has had the chance to say this is a legal substance. We had the debate in the past about whether or not to tax and regulate it and create a market that operates within the law around cannabis and we had received some bills from the House in the past around trying to figure out some of those challenging details of how this all unfolds, but we had not been able to say how do we create a coherent market that pulls people out of the illicit market and is somewhat harmonized with other states from a commercial perspective. This all becomes, I think, far more important given the overtures from the federal government that they may reschedule or change their federal relationship with cannabis. I did say in health and welfare, that's something I think we're going have to consider sooner than later is the already regulated industries that may want to get into THC beverages. You know, that's like the consumption of those otherwise might take place at the same place alcohol is consumed, etcetera. Regulation, I think, to make should things unfold. But I have tried to follow the money and there are cannabis companies like Curaleaf or ones out of Ohio that have a lot of ties right now to the federal government. And I don't think, let's just say if changes happen at the federal level, they would not benefit small craft growers in Vermont. So the thrust of our bill is really in many ways to do what we've done for beer, wine, spirits, and particularly there's a lot of parallel to spirits where we turn the dial very slowly and allow consumption in more and more places over a very long period of time. And we now have an incredibly robust and nationally and internationally known spirits industry. Our Vermont brand in cannabis is high quality, it's a respected brand and it signifies to people local farms and rural vitality. Much of the bill, I would say almost all of the bills, the CCB was written in collaboration with the Cannabis Control Board. And they have study after study of ways to pull people out of the illicit market. The illicit market is often where children are harmed, right, or really anybody where you have products that aren't labeled well, people DIY ing their doses or, you know, so it is it should be all of our goal to pull people into a regulated market that has proper labeling, is taxed so that we get the money back from that to do good things to reinvest in our communities and our kids' mental health, but that otherwise we're not pushing people either to the illicit market or out of state. So what you see remaining in the bill are either pilots or increased purchase access that really just harmonizes us with largely Massachusetts, New York, Maine, even Connecticut to some extent. Most of these states are looking once again at their cannabis market in light of what's coming from the federal government. And there is active consideration in New Hampshire and they would be likely to put their cannabis products in their liquor outlets on the highways leading to and from our state. So like many things in economic development, we are not having the debate about whether or not this is right or wrong, but how people have the safest and most regulated experience and how it benefits our communities. We have a lot of I don't know why I'm pointing at Richie but he's the second lead sponsor of the bill. We have a lot of you know, rural communities that are thriving because of spirits, beer, and now cannabis, legal cannabis. We can feel however we want about that, but they are bringing far more revenue into the state than we

[Sen. Andrew Perchlik (Chair)]: had

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: forecast when we began this market, and we want that revenue back from other states and out of the illicit market.

[Sen. Andrew Perchlik (Chair)]: Okay. Do I say anything about the two?

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: There's money. Yeah.

[Sen. Patrick "Pat" Brennan (Clerk)]: There's money on the well, one particular there's

[Sen. Andrew Perchlik (Chair)]: a million dollars from the general fund of the cannabis business development fund. Yeah. And 1.68 to the land access access option. Option.

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: Right. Well, I could also wax poetic a little bit about, you know, the feelings that the Economic Development Committee has largely from a policy perspective about how the Cannabis Control Board, as of I believe last year's budget falls under the governor's purview and they don't get to take in the money that they believe is needed to statutory work that we've directed them to do and then get the rest to the general fund. I understand, you know, the pressures on our budget, and I wonder if our committees can work collaboratively in the future on some way for them to room it quarterly but still keep the resources they need. We are asking them to do more to help if we do end up passing pilots in delivery and on-site consumption. That is going to add to their charge, but it also is something that adds to how our local craft market can reach people. So we think it's an important economic good to help our local industry do, you know, pilot weddings that feature cannabis instead of alcohol, know, to have small festivals, farmers markets. I don't want to get us into territory that we literally change every year a little bit even for alcohol. But if we pilot some of these things, they have more work to do and they're consistently doing it with fewer resources once they are a part of the governor's budget. So they, as you know, cannabis brings in more money than they're asking to spend in their budget, and they used to be able to take what they felt they needed in a dynamic changing market.

[Sen. Andrew Perchlik (Chair)]: They're not changing their budget.

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: Well, I just wanted to have the bigger conversation that that was a big change that we're learning about as a policy committee that every time we talked about a policy change, it certainly came up that they can't guarantee a safer or better experience with the staffing level that they have. Specific to the bill, there's the million dollars for the cannabis business fund. The original cannabis business fund as it was envisioned not necessarily the same doesn't necessarily have the same need now that the market, you know, has some saturation. We really are thinking about it as there are a lot like a small craft producer or grower has a lot of legal challenges they need to meet, needs a lot of technical assistance, and we feel that that fund needs more money, but we also don't need to put certain parameters around who gets access to

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: that money.

[Sen. Andrew Perchlik (Chair)]: Who runs the fund where does the money go?

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: It goes into DHCD and is it DHCD or just ACCD? Somewhere else than DHCD. Think it's so that person spoke to us and said, We don't have a great need to give out $5,000 grant, but we would love to be a pass through, for example, entities like the Vermont Law School Business Clinic, because they can't serve cannabis businesses right now with the federal requirements they have on their runs. So it came up that there are a lot of entities that support businesses that currently can't help cannabis businesses who probably need a lot of help, especially if federal regulations change or we create some kind of cooperative relationship with states around us, a lot of legal and technical support is needed in the industry. That's what that would be directed towards. The money Tucker looks pain, so I don't know if, like, I'm sounding really confident but wrong, but No.

[Sen. Andrew Perchlik (Chair)]: That's good. The the LAOB, it is the 1,600,000.0 in this budget on top of their Yes. The governor's budget.

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: Yes. So so some of us have been here a long time, actually a lot of people in this room have been here a long time, and you know as I recall since before we legalized cannabis and in every year since we've talked about what it means to repair the harm done to people who were caught up in the war on drugs and the decimation of communities and households and families over the criminalization of cannabis. Meant to bring this to health and welfare, but Pew Research just released a study that of a lot of the taboo topics in the world and things people think are morally unacceptable, after the very high number of people in the world who think that cheating on your spouse is the most morally reprehensible thing you can do at 70 something percent, 52% of the world still thinks cannabis is the next most morally unacceptable thing, well above other things that have have lost their taboo nature because they've been out in the public and destigmatized. He was watching an illegal war

[Sen. Andrew Perchlik (Chair)]: in another country while on the island.

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: You know, unfortunately, it was not. Was things like homosexuality and alcohol and contraceptives and stuff. Cannabis remains a very stigmatized product and topic in the world. And the reality is many people harmed by the war on drugs do not want to go into cannabis production. They don't want their repertory offering to be your first in line to get a business license for producing cannabis. The Land Access and Opportunity Board, I think you all can judge for yourselves, but you know our committee feels they've done a really incredible job with their charge which was in this realm to reinvest dollars that had been divested or taken away from communities that have not been able to build generational wealth because they've not had land access or access to certain types of opportunity. So they gave a brief presentation to us on what they would do with those funds and it sort of met our intent always that when we saw cannabis raise a significant amount of revenue, we would be reinvesting some of that in the communities that were most harmed.

[Sen. Andrew Perchlik (Chair)]: Okay. Any questions for senator on who yes. Senator Norris?

[Sen. Robert Norris (Member)]: I'm I'm at the the fiscal mode. Don't if there's a plan to

[Sen. Patrick "Pat" Brennan (Clerk)]: ask the questions or whatever. Yeah.

[Sen. Robert Norris (Member)]: On on your bill summary, you listed several sections in here. Did the cannabis control board have any problems with any one of these sections? And if so, which one and why?

[John Kirby (Legislative Counsel)]: Tucker, do you I

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: don't we took out so we took out the sections that were most problematic to others. The Cannabis Control Board did not want to change our advertising policies right now. You know, we took a good hard look at how cannabis is being advertised nationally or from a neighboring state to our state, etc. They, since some recent legal activity, have made some changes to how much they expedite those advertising, the preview they get of people's advertising. So we felt satisfied enough with that. They did not want us to change the advertising policies at this point and we did not change any of the caps on product concentrates. So actual cannabis flower or solid concentrate or liquid concentrate. We are on the more constrained side of limiting the THC concentrate that a product can have but were not complete outliers so we took that out and that was most of what made up public health concerns. But almost everything else in there and even some of those things, even including I think the concentrate THC cap which Senator Sears had a lot to say about in past years, they have studies that show where we're losing people to the illicit market. We should constantly be refreshing our understanding of those studies. Where we lose people, that's where they are more likely to have some kind of psychosis or some kind of effect on their health that requires hospitalization. So they do try and tell us both is the ongoing public health research, but here is also the behavioral research we do as to where people buy their products and what they buy.

[Sen. Robert Norris (Member)]: So what you're saying is all these sections they agree with presently? Just a yes or no. Is is that so

[Tucker Anderson (Legislative Counsel)]: Representative legislative counsel, I do not wanna offer testimony on behalf of the CCB, but you can refer to the testimony that they've given in Senate Economic Development and Senate Health and Welfare about their support for and concerns about the bill. Just from the chair's testimony this morning, it seems like their concerns have been immediately.

[Sen. Robert Norris (Member)]: Because I mean, going from one ounce to two ounces, I mean, that's backpack material. I mean, you're just getting a lot, I don't understand the reason for that increase and the purchase transaction amount to two ounces. And I can see the cannabis business development fund, but I don't understand where the LAOB comes into this play here when we're talking about cannabis and marketing and

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: Okay, so let's start with the increase in purchase limit. That in many ways does feel like a very commercial consideration, right? How much can someone purchase from one store at one time? There is really nothing stopping someone from going into multiple stores and purchasing different amounts. And there are people who cross state lines specifically because they just wanna have one of those interactions maybe, like we talked about how stigmatized it is. Not everybody feels like walking into their local cannabis shop. So if they do, they're not, you know, purchasing more so that they can consume more immediately. They're purchasing more so that they can come back at a much later time for to meet their consumption needs. It's we would call it maybe like the Costco, you know, effect.

[Sen. Patrick "Pat" Brennan (Clerk)]: Like Like three cans of beans when

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: you Exactly. Yeah. Like, you know, we like, if you're ever behind someone at Costco who's from a rural part of the state, chances are they have huge sacks of, you know, pancake mix and bacon and they are not coming back for six months. We have rural parts of the state that have absolutely no retailers. So Maine similarly has this purchase limit. You see them increase their caps more because rural states, it's just we're trying to meet consumer choice and consumer demand for how often people feel like going to frequent a cannabis retailer. So the LAOB, you know, again, the CCB has specifically named them as an ongoing partner in their work to improve economic opportunity and reduce substance misuse or reduce, illicit activity or mental health impacts associated with the social impacts of cannabis. Like all substances, they can be exacerbated, your experience can be exacerbated by poverty or by continued economic distress. And so it was just simply always part of our consideration that we would think about those most impacted by the previous criminal nature of cannabis and that we would try to help those who have been justice impacted, who are extremely rural and isolated, who are in poverty, or who come from communities that were historically targeted in the criminalization of cannabis. So that's always been part of our conversation. We always came to the very edge of directing a percentage of cannabis revenue to that cause and then said we don't know how much it's going to be and how stable it's going to be. It's an incredibly successful market at this point. There's a lot of revenue coming in and the CCB for years has said to fulfill their charge to try and repair social harm, they see that LAOB as one of their best partners to do that. LAOB was talking to us about their resilience hubs and other ways they use the funds that in a lot of ways speaks to like really what we envision for repairing harm from cannabis, rebuilding community, know reconnecting people with community and resources and having vital downtowns, vital organizations that come from the community. They've simply had a lot of success.

[Sen. Andrew Perchlik (Chair)]: They testified here on their budget about the resiliency grants and other

[John Kirby (Legislative Counsel)]: things I that they're

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: know there's been conversation in here about how do we keep communities whole and intact before you know some kind of crisis event might occur like frankly what we saw in South Burlington, would call it crisis event. One of those events is extremely expensive. I mean, one of those events is probably the cost of, you know, the entire amount that LAOP is asking for. They're asking for people to have strong relationships and resilient community before there's a crisis that ends up being very expensive because people don't have trust and they don't have relationships.

[Sen. Andrew Perchlik (Chair)]: Okay. Thank you. Any other questions? Yes, Amber.

[Sen. Patrick "Pat" Brennan (Clerk)]: You touched briefly on beverages. Yeah. You didn't I don't see anything in here about beverages, but they are allowed now currently.

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: There are up to a certain

[Sen. Andrew Perchlik (Chair)]: Ten milligrams.

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: Ten milligrams of THC beverages.

[Sen. Patrick "Pat" Brennan (Clerk)]: Okay. So I don't know if that's per 12 ounce can.

[Sen. Andrew Perchlik (Chair)]: If I may. Please identify yourself.

[Mr. Sullivan (Owner/Operator, Flora Cannabis, Middlebury)]: Sullivan. I own and operate Florida Cannabis in in Middlebury. Yes, 12 ounce cans up to ten milligrams per can. That is all we're allowed to sell.

[Sen. Patrick "Pat" Brennan (Clerk)]: Ten milligrams per can. The reason I ask is there's a fairly large grower in the islands who, I guess cannabis control board put out a document that people thought originally was going to be cast in stone and award was guidance, it turns out, right? Yes, sir. So are they still allowed to sell a case at a time to somebody coming over from New York to purchase that?

[Mr. Sullivan (Owner/Operator, Flora Cannabis, Middlebury)]: I believe you're referring to their draft guidance that they put out purchase limits that would have limited up to 10 cans transaction that's been extended. And so yes, a person could get a case even two cases of cans that's very small amounts, ten milligrams is in almost all states considered the standard certainly. Okay, thanks.

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: And I kind of brought that up without closing the loop, whether or not it impacts the provisions of the state, we have a section on having far more municipal guidance and control because we felt like that was the real missing link when you allow for cannabis retail in your community, you then don't have significant control over citing or time, place, and manner. So we try to include that in the bill and I think there's some future hope that like spirits, we can take less of a cut at the state level and give a little bit more of a cut to the community that's doing a lot of the regulating. And I close that loop with on-site consumption because eventually if we see on-site consumption allow places that it functions like a bar, we right now don't have anywhere that you can consume cannabis on-site in a licensed bird space. So municipalities need to be able to manage that.

[Sen. Andrew Perchlik (Chair)]: Okay. We're gonna move

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: along. Yeah.

[Sen. Andrew Perchlik (Chair)]: So thank you. Yeah. And and we'll ask

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: less council to come up

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: to talk. Great. I'm gonna go.

[Sen. Andrew Perchlik (Chair)]: Yeah. Okay. Thank you. Counselor Anderson, can you I don't know if there's anything else you wanna say about the bills, you can, but otherwise, I wonder if you would walk us through the amendment. I can absolutely do

[Tucker Anderson (Legislative Counsel)]: that and good afternoon for the record Tucker Anderson Legislative Council. What I'll be walking through is draft 1.1 of a committee amendment to the bill. It focuses very specifically on the appropriations. You've heard about them. The appropriations in the committee report from Center Economic Development included $1,000,000 to the cannabis business development fund, which to confirm from the earlier testimony is a fund that is administered by ECCD. And some of the primary functions of that fund are to provide low interest loans to certain qualifying businesses as well as grants. And under a different section of the bill, eligible participants for the low interest loans is expanded to include different types of licensees. Along with that in the appropriations you had the $1,000,000 going to the CBDF and the separate appropriation for the LAOB. The amendment is fairly straightforward. There are two instances. The first is something that I caught when I reviewed the report from Senate Economic Development. I had failed to update an internal cross reference to two sections in the bill. So there's a technical correction in the first instance of amendment updating those section numbers. The second is completely removing the appropriations from the report.

[Sen. Andrew Perchlik (Chair)]: And there is one tax credit in here, but fiscal notes that it was de minimis, so we're not gonna deal with that. It allows them to deduct their business expenses from state income. For purposes of calculating the property tax credit. Only for the purpose of the property tax credit. Okay. Any questions about the amendment or the bill? Vice counsel? Okay, I will entertain a motion to

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: I'll move the amendment.

[Sen. Andrew Perchlik (Chair)]: Move the amendment and the bill favorably. And the bill favorably. Okay. Any questions of the make sure of the amendment and the motion? Yes. One

[Sen. Robert Norris (Member)]: quick one. Had brought up the governor's what was his recommendation for the LAOB?

[Sen. Andrew Perchlik (Chair)]: This amount 1.68. So they're doubling They're doubling it. Yeah. So this amendment strikes that section.

[Sen. Patrick "Pat" Brennan (Clerk)]: And it also strikes the delivery permit section?

[Sen. Andrew Perchlik (Chair)]: No, does not No, I think

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: it was business development.

[Sen. Andrew Perchlik (Chair)]: The delivery and the event fees would still be collected. Okay. But the million dollars to the business development would Yep. Good.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: And our committee took testimony on this with Pepper and Tucker and most of the things that I was concerned about that were in the bill initially that we were going to have to deal with in our committee were taken out. So

[Sen. Andrew Perchlik (Chair)]: Did you guys actually take possession of yourself now?

[John Kirby (Legislative Counsel)]: No. No. No.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: We would have. You didn't have

[Sen. Andrew Perchlik (Chair)]: a budget?

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: Yeah. We might have. It may have been, you know, additional.

[Sen. Andrew Perchlik (Chair)]: So, like, when the THC

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: Yeah. The committee is on.

[Sen. Robert Norris (Member)]: So this amendment deletes section 28?

[Sen. Andrew Perchlik (Chair)]: Yes. K.

[Sen. Patrick "Pat" Brennan (Clerk)]: It is attacking. Becomes hard

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: to take it when it passes across over.

[Sen. Andrew Perchlik (Chair)]: Yeah. That's okay. Any other questions?

[Sen. Patrick "Pat" Brennan (Clerk)]: Okay. K. It's two seventy eight. Senator Baruth. Senator Brennan Yes. Senator Lyons

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: Yes.

[Sen. Patrick "Pat" Brennan (Clerk)]: Senator Norris Yes. Senator Watson Yes. Senator Westman Yep. Senator Perchlik? Yes.

[Sen. Andrew Perchlik (Chair)]: Okay. Does anybody want to report it? Anybody who's, like, a sponsor of the bill or anything? I'll do it if I'm willing to do it unless somebody wants to do it. You wanna do it? I'm not I'm I'm willing to do it. I don't know if want is the right word, but I will do it. Do you wanna fight him for it or No.

[John Kirby (Legislative Counsel)]: No. I got enough.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: Okay. I've got enough.

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

[Tucker Anderson (Legislative Counsel)]: Thank you.

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

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: should be across the line. I actually. Okay.

[Sen. Andrew Perchlik (Chair)]: We were muted, though. We

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: Well, she's also one forty two.

[Sen. Andrew Perchlik (Chair)]: Yeah. So you can you can start us off.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: I will try. Okay. We're go off. I don't have it in front of me. We're back.

[Sen. Andrew Perchlik (Chair)]: We're off mute. We're gonna take up

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: We don't have it.

[Sen. Andrew Perchlik (Chair)]: $1.42. We don't have it now.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: It's in appropriations. Let me just I'll just pull it up so refresh my head.

[Sen. Andrew Perchlik (Chair)]: So we're not gonna vote on it today since center lines won't be here tomorrow.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: And I'm happy to report whatever you need me to

[Sen. Andrew Perchlik (Chair)]: do with it. Well, if you just tell us the basics of

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: what I'm So the bay basically, the bill is

[Sen. Andrew Perchlik (Chair)]: It's one forty two.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: It's the development of a pathway for licensure for internationally trained physicians and medical students. So it's a way that they can demonstrate their credentials and validate their profession in Vermont and then be granted a license based first on working with others in the health care environment. Oh, and then secondly, then gaining a transitional license until they become fully licensed in the car. So that's basically what it is. But within that there was this bill has been in the works for a couple of sessions and initially the Board of Medical Practice within the Department of Health was resistant to looking at, to working on it. So the group went back and did additional work, came back and the board still didn't respond with, didn't provide testimony to us that would improve the bill. Finally, very close to the time we were passing the bill, the Department of Health came in with the commissioner and is looking for a pathway to work on this issue. And honestly, the Board of Medical Practice, Department of Health, in order to establish a program like this, will have to do a lot of work. There's a lot going on in other states. It might cost some dollars to do the work. So we put in both the pathway that was developed by the working group in Southern Vermont and also a report from the Department of Health about what they would recommend. The there is a little hitch there that the report will come in. And regardless of the the report will come in, and I forget the timing on it. Jen's gonna help me with that. If there isn't any action in the legislature by a date certain, I think it could be July 27 or '28. I forget where we put it. The program that we have

[Sen. Andrew Perchlik (Chair)]: 07/01/2020.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: Yeah. '28. Then the program will go will will begin regardless of what the department tells us. So it probably makes sense to have the report come in first and then influence the final product because there will be a lot of information about administrative costs, administrative timing, and exactly how to measure the proficiency of the folks who will apply.

[Sen. Andrew Perchlik (Chair)]: Who who would have to administer, like, so it came here because people thought there would be a cost to

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: There there is a report in here. Don't know what my money is in here. It's gonna be on

[Sen. Andrew Perchlik (Chair)]: Senator Bloomberg said something about is did OPR testify on this bill? That they it's not an OPR thing.

[John Kirby (Legislative Counsel)]: It's a board of medical.

[Sen. Andrew Perchlik (Chair)]: But So maybe the board of medical practice

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: Well, yeah. They they testified that it will cost them some money to do the work. But they

[Sen. Andrew Perchlik (Chair)]: didn't ask for that.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: No. To do the work once the program gets up starts going forward.

[Sen. Andrew Perchlik (Chair)]: Told me today that I was coming here, but I don't remember him actually saying why.

[Sen. Patrick "Pat" Brennan (Clerk)]: I thought

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: I don't know

[Sen. Andrew Perchlik (Chair)]: why. Oh, no. That was he was talking about the ophthalmologist bill. Oh. The OPR might have some expenses on that.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: But this one okay.

[Sen. Andrew Perchlik (Chair)]: Alright. But we don't have possession of this bill, so we can't vote it out.

[John Kirby (Legislative Counsel)]: No. It has not been taken up. John Kirby legislative council has not been taken up across the call yet. I believe that is happening

[Sen. Andrew Perchlik (Chair)]: today. Okay so we will take it up and vote it out tomorrow. It looks like we don't need an amendment and we will we'll do that tomorrow. If

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: you want to change the date I do have one question. I

[Sen. Robert Norris (Member)]: think I think it's really gonna make a lot

[Sen. Andrew Perchlik (Chair)]: of talented individuals who want to come to do this. Exactly. I think I found my

[Sen. Robert Norris (Member)]: answer to one of so does this mean they're gonna act like as an intern on the supervision of another provider or because they said they have to carry their own provisional malpractice insurance? And how do they

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: They don't carry it. No. The facility does. The practicing the supervising physician. The supervising facility.

[Sen. Robert Norris (Member)]: So so they do they operate as a as a intern, Jen, or how does that work?

[John Kirby (Legislative Counsel)]: Do I don't know how much of this you want me to go through. Have to say I'll

[Sen. Andrew Perchlik (Chair)]: I'll go ahead and do it tomorrow.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: Go ahead.

[John Kirby (Legislative Counsel)]: Floor that is now having an amendment on it, so I'm trying to figure out how to be

[Sen. Andrew Perchlik (Chair)]: Two places at once. Two places? We we can we can do it tomorrow.

[Sen. Patrick "Pat" Brennan (Clerk)]: Yep. And we can learn more

[Sen. Andrew Perchlik (Chair)]: about the details, but it seems like they're gonna be they'll be like an employee. They'll be on the insurance. Right.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: They'll be

[Sen. Kesha Ram Hinsdale (Chair, Senate Economic Development)]: they'll be working.

[Sen. Andrew Perchlik (Chair)]: They couldn't open a practice.

[John Kirby (Legislative Counsel)]: They can't they can't practice on their own they have to work as you know I think that analogy that I don't know to an intern I'm not sure if that's accurate or inaccurate because medical interns or something else, but this is a sort of supervised supervised and evaluated practice. Collaborate position. For two years. Well, it's not called. Yes. That's a different different part of health girls.

[Sen. Andrew Perchlik (Chair)]: So we'll do it. Vote up on that tomorrow. So Yeah. Good. This is probably in your community too, councilor Harvey, do you wanna walk us through January? Or any Yeah. Is there a clear financial

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: No.

[John Kirby (Legislative Counsel)]: I don't believe there is. I don't

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: think there's any money in there. Don't think there's any money in it.

[Sen. Andrew Perchlik (Chair)]: January. Yeah. We have it. This was another one where we weren't too sure why we got

[John Kirby (Legislative Counsel)]: Yes, that's 01/1997. Is

[Sen. Patrick "Pat" Brennan (Clerk)]: there a potential

[Sen. Andrew Perchlik (Chair)]: impact on our Medicaid or something?

[John Kirby (Legislative Counsel)]: I mean, there is the potential that as things develop down the road, there could be implications for the Medicaid contribution to the Blueprint payments, but none of that happens yet.

[Sen. Andrew Perchlik (Chair)]: It could happen in the future. Yep. That's probably why. I think whenever they see anything whenever they just see the word medicated.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: Well, the underlying bill talked about a fund, a primary care fund.

[Sen. Andrew Perchlik (Chair)]: The bill was introduced? Yeah. The bill was introduced. Yeah. They also

[John Kirby (Legislative Counsel)]: Although it was just gonna aggregate money. Yeah. I don't understand. Joining

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: your Zoom. Talks about payment methodologies. Spending charge. Was

[Sen. Andrew Perchlik (Chair)]: this a committee bill or?

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: No, it was introduced 01/1997 and then we amended it going through this.

[Sen. Andrew Perchlik (Chair)]: Alright. Here you go.

[John Kirby (Legislative Counsel)]: Perfect. Thank you. It's my. That's okay. Great. This is s one ninety seven and act relating to was an act relating to establishing a primary care payment reform program, although that name changes. At the end, it expresses legislative intent to invest in I should say primary care just as primary streamline primary care payments building on the blueprint for health and will promote the public good by increasing access to primary care to improve health and reduce health system costs. It makes some changes in section two to the blueprint for health statute or chapter mainly around requiring health insurers, private insurers to submit comprehensive information necessary for the blueprint director to do a comprehensive fiscal analysis of the total cost of care in Vermont and to implement payment models addressing health care capacity volume quality and clinical outcomes. It requires a blueprint payment before methodologies to this current law include per person per month payments. This would be not just to medical homes but to participating practices including medical homes and primary care providers. So I suppose there's potential that there could be additional per member per month payments to non medical home primary care providers. By each health insurer and Medicaid for attributed patients and for contributions to the shared costs of operating blueprint initiatives. Again, maybe broader than the existing community health teams. And there's some fairly technical changes in here but does specify that the amounts from insurers shall be in amounts at least equal to Medicaid payments beginning in 2027. Medicaid is currently the largest contributor to Blueprint. And this is language requiring the director of the blueprint to strive to achieve or maintain parity across payers and payment methodologies when formulating recommendations to the Secretary of Human Services. The rest of this is really technical reflecting that the blueprint is now at AHS not just in the Department of Vermont Health Access. There's a new provision requiring the Agency of Human Services to establish a target for the amount of health care amount of per person per month spending on Vermont residents that should be for primary care services and come up with a schedule that increases that target over time, allows the targets to be adjusted to reflect payer specific differences, and directs the increased spending to the per person per month payments established in the blueprint section. Section three it has the director of the blueprint reporting by January 1 to the House and Senate Health Committees and the charges to payment amounts or payment reform methodologies that would be necessary to transition the blueprints per person per month payments to primary care practices to include payment for the routine primary care needs of attributed patients covered by participating health plans. So this isn't the idea of kind of using our existing blueprint structure to have a more global payment for routine primary care needs instead of fee for service. The report would define which services would be considered prime routine primary care, address differences in methodology for different practice types, make recommendations on risk adjustment and attribution methodologies, describe ways in which the methodology will balance capacity, volume, quality, and outcomes, include mechanisms to ensure that plans make accurate and appropriate payments to practices in a timely manner and make recommendations on participation or quality measurement requirements or both. I guess there's more. Analysis of cost sharing amounts and analysis ways to incorporate primary care spending allocation targets into the methodology and provide an operational plan and any additional legislation that would be needed to start this no not later than one year after 01/01/2028. Section four is a report from the agency of human services with the baseline spending per person per month spending on primary care services for Vermonters overall and by the various payers including Medicaid requires the agency to use a particular definition of primary care providers and services either from the federal AHEAD model or what's used by particular organization. Section five is a report on the primary care spending targets requiring on or before 01/01/2028 the agency of human services reports to the health committees the per person per month primary care spending targets that they developed and what we looked at in section two and a schedule for increasing that target over time. Any recommendations for payer specific adjustments and any additional legislation needed. Section six requires the Green Mountain Care Board to update a couple of reports by 01/01/2027. One is an updated version of its 2017 clinician landscape study looking at the current climate among practicing clinicians in Vermont and the other is an updated version of some of their previous work around site neutral reimbursements citing the acts that address those. Section seven is a report from the agency of human services by 01/15/2027 in consultation with others and this highlighted and came out for the version that's in the calendar report to the committees with recommendations on ways to accelerate appropriate transition of hospitals from hospital patients from hospital care to care in a community setting, including trying to expand the ways in which primary care services are delivered in the community rather than in inpatient hospital setting after surgery or other acute care. It would be as or more effective and less costly to deliver in community. Section eight is a report directing the Office of the State Treasurer and the Agency of Human Services to collaborate with other Northeastern states to explore the possibility of a regional universal primary care program that would be available to residents of all the member states and report by 01/15/2027 on the interest from other Northeastern states legal and regulatory obstacles and recommendations for next steps. Section nine would remove the 2027 07/21/2027 sunset on a primary care medical student scholarship program that is in statute. There there is language in that enabling in that statute itself that allow us funds to be carried over. It's my understanding there's about $475,000 in it already that could could be carried over and spent but would not be fully spent by 07/01/2027 so this would take off wouldn't add more money at this time but it would take off the sunset to allow those funds to be fully expended. I think the language this provision may also be coming or maybe getting included in the health budget. That's a recommendation.

[Sen. Andrew Perchlik (Chair)]: Okay. Well, we can deal with them. Do you have a question, sister Lane? No. Okay. Section

[John Kirby (Legislative Counsel)]: 10 would amend insurance laws to require health insurers to give patients at least sixty days advanced notice before they remove a prescription drug from the formulary and they would notify all the patients who fill the prescription for that drug within three years twelve months so that they and let them know when the coverage will end so people are not surprised. The act would take effect on passage and the title would change to an act relating to payment reform for primary care.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: A lot of money in there.

[Sen. Andrew Perchlik (Chair)]: Okay, so we don't know provide Medicaid or that future spending on the fund. Why it's here, but I don't see a need for amendment. Does anybody have any questions? We're gonna vote on this. What are we voting? To vote it out of committees? And we've had that as

[Sen. Patrick "Pat" Brennan (Clerk)]: not affecting the budget of

[Sen. Andrew Perchlik (Chair)]: the state expenditures in the state. Because it might have a future impact on Medicaid. Not

[John Kirby (Legislative Counsel)]: match just Medicaid and

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: this one we do have possession.

[Sen. Andrew Perchlik (Chair)]: Do have possession. Now so. There's no question I'll entertain a motion to move in favor of mine

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: so I

[Sen. Andrew Perchlik (Chair)]: also sounded like a reporter.

[Sen. Patrick "Pat" Brennan (Clerk)]: So

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: s one ninety two, we didn't do that.

[Sen. Andrew Perchlik (Chair)]: Yeah. We'll end up with later. We could do it. We need to Oh, it's there later. We'll vote

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: on this. Yeah.

[Sen. Patrick "Pat" Brennan (Clerk)]: All set? Yeah. Okay. S one ninety seven. Senator Baruth. Senator Brennan. Yes. Senator Lyons. Yes. Senator Norris.

[Sen. Robert Norris (Member)]: Yes. To move it out of committee. Mhmm. Senator Watson. Yes.

[Sen. Anne Watson (Member)]: Senator Westman. Yeah. Senator Perchlik? Yes. Ginny, are you Mhmm.

[Sen. Patrick "Pat" Brennan (Clerk)]: Sure. Okay. So,

[Sen. Andrew Perchlik (Chair)]: Jed, you're not doing anything else for

[Sen. Patrick "Pat" Brennan (Clerk)]: us today, so we can you you can you're

[Sen. Andrew Perchlik (Chair)]: you're free to go to do that.

[John Kirby (Legislative Counsel)]: Send another Oh, no. I think you're.

[Sen. Virginia "Ginny" Lyons (Member; Chair, Senate Health and Welfare)]: We're

[Sen. Andrew Perchlik (Chair)]: hoping to have let's do the forensic facility. We will