Vermont Legislature SmartTranscripts:

[Beth St. James, Office of Legislative Counsel]: We're live.

[Sen. Seth Bongartz (Chair)]: We are live. February 5. Send education in the afternoon or next. So as we've been doing our work this session several times, we've heard an allusion to the connection between the costs of education and healthcare and I think several times questions asked about like what are we actually doing and I along those lines of health care in general, low cost and I am very much aware of the work that the Senate Health Worker Committee has been doing over the last at least a couple years in particular And, so and and senator Weeks actually, you know, made the point of view twice, we should hear something from somebody, and so I I immediately went to senator Hawaiians, at somebody's history. I guess just give us a sense of I think, so one of the senses is that the healthcare is just continuing to rise on check until we deal with that. It's very hard to deal with anything having to do with the cost of increase in education spending. And so probably takes a little time to get a sense of what's actually going on with the ground house or any other community room and beyond because I know it goes beyond, also

[Sen. David Weeks (Vice Chair)]: I know you're well aware of everything.

[Sen. Seth Bongartz (Chair)]: And I really appreciate I'm I'm really well, mean, all of all the moving pieces are gone and some of the things that have been done by birth and stuff with the health care the health care board. So thanks. So thank you very much for volunteering to come in. When I asked her the interview, he said, I'll do it. Probably regretted it later, but you said you'd do it. So here we are.

[Sen. Virginia "Jenny" Lyons]: Well, thank you.

[Sen. Seth Bongartz (Chair)]: We all know each other, so we all

[Sen. Virginia "Jenny" Lyons]: know people more than others. It's great to know you all. For the record, Senator Jenny Lyons, who volunteer is an interesting word. Asked to come in and I'm happy to do it. And I did spend a little time going through some of the works that we've done. I have a handout for you just on the bills that we worked on last year. We'll keep a lot of clean copies. And it's a compilation of, it's a short summary of the bills that we've hacked out of our committee and that we did report on the floor, so a lot of the reporting you've heard. And then I went through and did a quick analysis working with others to try to understand where the savings are coming from each of these bills and then what the results are that we're seeing. There were predictions about what would happen, for example, with what we call reference based pricing. But then there have also been some results that are coming out based on the work that the Green Mountain Care Board and the Department of Financial Regulation are doing. And I do understand that for, so for Senator Weeks and Senator Williams who were on health and welfare and some of the languages familiar, for others of you it may not be less familiar, I didn't do as thorough a presentation. I don't have PowerPoint, but I do have some slides that I've used in the past and ultimately happy to share information with you. So the question is, and it's a question I think we've all been asking, and it was part of the work that we did last year with S-one 126, now Act 68, understood that healthcare has a significant effect on education costs. And so then the question comes out, every time people start talking it's about, oh, if we solve healthcare, we'll resolve the whole property tax problem. That's not exactly true. And there's two reasons it's not true. One is we're not solving healthcare that quickly. On the other hand, it's not true because the property tax situation is related to other things than simply healthcare, so we all know that. All right, so you have these bills listed, and I thought what I would do, and you can ask me questions, stop me and we'll try to make it as clear as possible. I thought I'd talk about each of the bills briefly and I'll try to identify the savings that have resulted from the work that we did. So, there's direct fundamental correlation, but correlation's better cause and effect. But I think there's cause and effect in here. Anyway, we'll look at it and see what the savings are. And this is from looking at the Vermont program that we have called VHI. ACT 126, you're all, a lot. One of the things it did was to establish the development of a statewide plan to have regionalization for healthcare services. Another thing that it did was to put in place work on having electronic medical records that would be accessible for patients and providers. Another thing that it did was to have the agency of human services work with hospitals to reduce hospital expenditures this year by at least 2.5%. That is happening, but that will be for 2026 this year. We are seeing the results of our work on what's known as reference based pricing for hospitals, so paying hospitals a set amount for a set of service, and I'll tell you what reference based pricing is in just a minute. That is also part of that bill. So that was a pretty big bill. It is also a bill that is now reverberating in other states. The other bill that we looked at that we passed was Act 49, which is more about reducing prices in hospitals when there's an emergency and that was to help preserve Blue Cross and Blue Shield's solvency. That has had effect and Blue Cross and Blue Shield's resolving some of its issues. Act 55 was a bill that we passed to put a cap on high cost infusion drugs in hospitals and other drugs in hospitals, put a cap of 120% on the average sales price. And so that bill is also having an effect. All of the bills together, and there was another one, the other piece of Act 126 was something that resulted in a Department of Financial Regulation order to open up contracts between health insurers and the providers. So, I am happy to start wherever. I will start, I think, opening up the orders, which is DFR order. Department of Financial Regulation regulates insurers, so health insurers. When health insurers work with providers and negotiate with providers, they establish contracts, contracts for timely payment, amount of payment, and so on. Prior to this, the bill that we passed, those contracts were black boxes. So, which means that no one can see inside what's going on. And so, you could end up with a price here and a price there. You could end up with a non NDA, exposure agreement and other things that were detrimental to transparency. So 126 sort of opened up those black boxes a little bit and the DFR, the Department of Financial Regulations has responded in putting conditions on those contracts. That's a good thing. And the insurance companies are happy with it too because it takes them out of this conflict in negotiating. So, let's leave that aside for a minute. Can I

[Sen. David Weeks (Vice Chair)]: ask your question? How many insurance companies, do we actually have that are affected by it?

[Sen. Virginia "Jenny" Lyons]: We have a oh, affected by it? I I really can't answer that. I don't know how many. But I know the biggest one was Blue Cross and Blue Shield. And then there's MDPs, which is the other health insurance company. But, so Blue Cross and Blue Shield certainly represents most of the, what are known as our quality health plans for folks. Yeah. And then also administer some of the plans for our businesses, our small businesses. So I think you're most, you wanna hear the dollar figures and I get that. Reference based pricing is something that was, reference based pricing is a benchmark price. So it's a benchmark to Medicare. How much Medicare pays for a specific service. So you could have, suppose you have a Medicare reference face price of 200%, so it be 200% of Medicare. So when what we were seeing and what we know is that the high cost of care is very much directly related to the high cost in hospitals. And we know the result of that is extremely high cost for the resulting premiums. So if you can control and regulate hospital payment to hospitals, then you can begin to lower premium costs. Reference based pricing is an opportunity to put those, put the sort of capitation to slow down the increase. Reference based pricing in some hospitals, the Green Mountain Care Board was seeing as much as 580% of Medicare. And so if you say, oh wow, that's great, so we'll lower it to 200%. That doesn't take into consideration utilization. So if you've got a service that you're doing over and over and over and over again and it's at 300 or 400% of Medicare reference based price, you're getting a lot of money. So part of what will happen next, and I'll give you the next steps, part of what will happen next is for the board to balance how those reference based prices are used depending on services, depending on the utilization of services. So it becomes a fair determination of what real cost might be for our service. So, that's reference based pricing. The point I'm making about utilization is that, and also, I'll say utilization is one. Then there's another thing called, if I get too wonky, let me know, okay? It'll all sugar off soon. I'll have money out there for you in a minute. There's something called balanced billing where if you charge a lot for this service over here but it's rarely used and you're not making enough money, could charge a lot for another higher utilized service. So, trying to balance out how much money is coming in. That doesn't actually reflect the patient needs or the service needs that are within the system and within the hospital itself. Now, I will say, and I'll just say this right up front, this all sounds like all those bad hospitals. The reality is hospitals have been extremely responsive and understand this. So the way to lower costs, one, is how you pay for services. The other way is administrative costs. And hospitals have been extremely responsive to those issues because they understand their financial sustainability is as much related to this work as our patients' access to the care. And on Friday, if you're interested, we're having some hospitals come in and talk about the work that they've been doing since 01/1926 was passed. They've been very responsive and very good. So I wanted to put that up, should've put that way earlier. So, reference based pricing is one thing that we can do to sort of look at costs, hospital costs in particular. And then that will sugar off down to the premiums that folks pay. The other thing that I mentioned earlier is the cost of drugs and so what patients pay for drugs. Without going into all the reasons why we did this, We predicted last year that we would see a $12,000,000 savings for drugs and a 3% decrease in premiums. What we're seeing, and I'm just talking here about education, I'm talking about lives covered by education. The 32 or 33,000 educators and families and staff. What we have seen is a savings on the infusion drugs of, in $14,600,000 that's this projection. For '27, the prediction is $16,000,000 savings. It's happening. Started January 1. And then there are some other savings that will result from a change in which drugs are covered. So the educators predict at least $16,000,000 savings. The other thing that we're seeing is with the Green Mountain Care Board is regulating rates and it's all due to all the conversation that we've been having and the legislation that we passed. The board has begun to look at hospital rates, insurance paid rates differently. So, there will be a savings of about $88,000,000 for budgets, hospital budgets, if you raise hospitals at 3%, the $88,000,000 that will go for those savings, just hospitals, okay, Just if you look at VHI, if you look at educators only, the cost for education healthcare, 55% of it is hospitals. So the total savings, there is math in here, believe me. The total savings for that will be about $9,600,000 for educators and their coverage. Okay, so if you have that $9,600,000 and you have another $16,000,000 and then with the oversight reference based pricing and oversight, the total savings that will be accrued is about 40 to $48,000,000, 40 to $50,000,000. That's what we're talking about with the legislation that we passed. And that's really a fairly, I don't think it's a high number at all. And it's only for this cohort of patients. So we're not talking about everybody else here, we're talking about a small group of 32,000 people. That's what we're talking about. What did that result sound? I know you have a question. Keep going? Oh,

[Sen. Seth Bongartz (Chair)]: okay. So

[Sen. Virginia "Jenny" Lyons]: there'll be more than a 3% decrease in premiums. That's all. I think it's 7% decrease in premiums. I would find that.

[Sen. Terry Williams (Clerk)]: I better be. So are them savings per year, that 48?

[Sen. Seth Bongartz (Chair)]: Yep. Okay. Yep. And

[Sen. Virginia "Jenny" Lyons]: let me try one. Yeah. 14.6 to 16,000,000. Yep. And that will, oh, average premium, and the average premium increase would have been 10 to 15% on the normal conditions. Under the conditions that we have as a result of our legislation, the premium increase will be 7.34%. That increase will also include money for reserves for VHI, for the business that manages healthcare. And because they were going out of, they were losing money too. They're a payer. They're losing money just like Blue Cross and Shield. Blue Shield is losing money. So this will allow for them to become whole or more whole. So there's a lot of, money in here that you should, I think if you're interested in more specific data, VHI is a really good source. They're exceptional organization. Prebound Care Board can help. Remember, this is only about hospitals and drugs, a few drugs. It's not about the whole world about Belzere. We're still working on that.

[Sen. Seth Bongartz (Chair)]: So, my clarifying questions. The numbers you were giving us, were those, was that related to the cost for PIEHAI? Who ordered that rebate to the cost overall for everybody?

[Sen. Virginia "Jenny" Lyons]: PIEHAI.

[Sen. Seth Bongartz (Chair)]: That was just

[Sen. Virginia "Jenny" Lyons]: I'm only talking education This is education. I just wanna make

[Sen. Seth Bongartz (Chair)]: sure I understood which number. So the other number, systemically, a lot bigger than what you're

[Sen. Virginia "Jenny" Lyons]: Well, one of the decisions that we made last year when we put the committee bill together, I felt very strongly. I very much appreciated VHI coming in and saying, let's do a pilot program for VHI, but if you do one cohort and you save money over here, that means the bubble expands somewhere else. So it's for all hospital payment. So if you segregate out then you can start to figure out what does it do for this group, what does it do for that group. So this is what it does for educators. Okay, thank you. It should help other people. The elephant in the room, of course, is the federal government problems all there to deal with that.

[Sen. David Weeks (Vice Chair)]: Senator, can you for your question? I think I'll show my ignorance over here. I shouldn't because I was on your committee for years.

[Sen. Virginia "Jenny" Lyons]: You know what? It takes hundred years. So I

[Sen. David Weeks (Vice Chair)]: think the general perception from a 30,000 foot view out there is that because there are so few insurance companies, providers, that they have a monopoly on everyone. Whether whether it's true or not, I'm not even gonna tell them. And the other thing is if we could take all the groups, just the state government, the state employees, all the classes of employees, including and the teachers who are not state employees, and put them all under one umbrella and get get companies to compete for providing insurance for that, then we can bring the price down. Is that

[Sen. Virginia "Jenny" Lyons]: accurate or? So you've asked two different questions. Okay. Competition has actually gotten us where we are today. And we've got all these little small groups out there, right? All the self insured, all over the place, which represents over 200,000 lives in the state of Vermont. That's a whole lot of small little group. But your observation that making a bigger risk pool will help, it does two things. It spreads risk, changes the clinical profile for people so you can have different types of coverage And it will lower costs. It definitely will lower costs. If you then say, well, let's have competition for all these different payers to come in. Well, then what will that do? That'll split the risk pool up. That hasn't worked. So bringing the risk pool together, bringing more lives together is the right direction. And that's exactly why having it be a hospital based, not an individual group based type reform that we looked at last year was so important. And then similarly, I mean, our next line, we're next looking at primary care and how we do a similar thing here. The bigger the pool you have, the more you spread the risk, right? And

[Sen. David Weeks (Vice Chair)]: we have a aging population certain hospital services are concentrated in a certain area. So I think, again, I think that there's a lot of mis perception out there.

[Sen. Virginia "Jenny" Lyons]: Yeah, there is. Yeah, yeah.

[Sen. David Weeks (Vice Chair)]: We probably need to clarify. I see what you've done, know, what we've done is progress. Oh, it's huge. To reduce the cost that much, It's the

[Sen. Virginia "Jenny" Lyons]: huge, it really is. I'm really happy that we did it and I know there are people who have doubts about it, but other states are looking at what we've done and wanting to emulate. And the savings are real savings. You don't feel it in your pocketbook right now because this is something, you don't turn a ship this size overnight. I won't use the word begins with t, but better boats that you can turn that stay afloat.

[Sen. David Weeks (Vice Chair)]: So how can we take the insured population that we have, just the state employees, and get them together? Why can't we do that?

[Sen. Virginia "Jenny" Lyons]: Well, I'm working on it. Okay. Yeah. Well, why can't we do that? Because it's always more, you know, our little bumper sticker that we have that says it's more complicated than that. It is, but it's all about people. It's all about willingness to make change and do things that are outside of your own place.

[Sen. David Weeks (Vice Chair)]: We had one of our major insurers that was ready to file bankruptcy. And why was that? Can you tell us?

[Sen. Virginia "Jenny" Lyons]: Solvency Yes, it was all because of the black box contracts. Would say all because, but part of it was they had the little black boxes, they're negotiating with a huge hospital that requires a high payment and then they can't make it up somewhere else. So the money goes to over utilization, keeps going out, and then you're left with a lack of reserve money. Who do you blame for that? Nobody, because that was competitive. Larger hospitals competing for survival, other hospitals are in the red. How can they compete at the same time? So if there's nothing, if there's no regulation, we're gonna see a lot of our smaller hospitals die. And so having this level of regulation for the small state that we are makes a lot of sense.

[Sen. Seth Bongartz (Chair)]: So

[Sen. David Weeks (Vice Chair)]: Senator Lyons, I have complete respect for you. Believe you're the current dean of the Senate, the longest serving senator. No. You're up there.

[Sen. Virginia "Jenny" Lyons]: Oh, sorry.

[Sen. David Weeks (Vice Chair)]: You've got long service. With service comes

[Sen. Virginia "Jenny" Lyons]: Vice Dean.

[Sen. David Weeks (Vice Chair)]: Vice Dean. And you've been the chair of the Senate Health and Law Offering In replacing my world, where I came from, my last project was worth about three billion dollars We were judged on results. We weren't judged on, it didn't matter what we said, if our numbers weren't coming out, it was personal. The fact is that Vermont's healthcare costs are roughly three times those of New Hampshire, 100 miles to the east. Now I have a constituent who paraphrase what he believes is the current challenge with Vermont, and that is that we have a 60, forty-sixty rule, meaning we have 40% of the population who pay for themselves for their healthcare, and this healthcare has been specific to Vermont. 40% of Vermonters pay for their own healthcare, and they pay for the other 60%. That's a 40,000 foot view of Vermont's healthcare challenge. Now my question is, do you think that the real problem with Vermont's healthcare spending is hospital spending, or is it in the level of entitlements that we keep adding to each year?

[Sen. Virginia "Jenny" Lyons]: You're worried about supporting people who are on low income?

[Sen. David Weeks (Vice Chair)]: The 60% of providers? Actually,

[Sen. Virginia "Jenny" Lyons]: the largest group that we have in the state of, 67% of the people who are insured the state are self insured, which is private insurance. So, if you wanna get into the numbers, the lowest number of people covered are their quality health plans, but very few who are actually paying in for quality health plans. And then you've got the self insured, which are our business insured, including education. So that argument doesn't go very far. Do we have a lot of people who are very low income? We don't have a high economic standard across the state. And so if you treat healthcare as a commodity and you must purchase it in order to be healthy, then you would say, well, then we shouldn't have a safety net. But the reality is that we don't always have control over our healthcare and our costs. This is the debate, you know, it's a fundamental debate about whether healthcare is a public good or whether it's not. So I mean, I can't answer all your questions right now. If you wanna have more detailed numbers from Muller, we can get those for you. We have those, healthcare 101. I didn't bring that data with me. I brought the data on the savings that we're seeing as a result of the work over February.

[Sen. David Weeks (Vice Chair)]: So let me rephrase the question slowly. So do you think we're attacking the right problems?

[Sen. Virginia "Jenny" Lyons]: I think we're attacking the right problems. Well, you know, until the federal government stepped into the middle of it. Even with the Rural Health Transformation Grant, I think we're solving the right problems because we're lowering the cost of care that has risen exponentially. You identified it perfectly. The answer pays a lot less than we do. Our academic medical center was the highest cost medical center, academic medical center in the country. This is our state health insurance benchmark plan plus. I brought this to show you. Vermont is way up here. Maine is here. New Hampshire is here. The US average is here. What do you do here? What's in here? Okay, administrative costs, increased efficiencies, reference based pricing, lower drug costs, all of those things are in here that are different. And now other states are looking to see what we're doing for each of those. There's others. Primary care. An investment in primary care of $1 yields a $13 savings. And how does that happen? It happens both in the pocketbook going forward, you know, for people who now are getting the care they need and they don't get the cardiovascular disease later on. So, of these things take time, so we're gonna have to wait. But some of these things are paying off right now. That's the money we're saving. And we also should remember, we wanna see public health outcomes. But we're not gonna see that tomorrow. Let's see it.

[Sen. Seth Bongartz (Chair)]: So we have to move. I know. But no, go ahead.

[Sen. Terry Williams (Clerk)]: A couple more. Was there a good analysis of why Vermont is so much higher than our two sister states? Is it because of our 55 and older demographic and there's only 650,000 of us in this state or what, it's just our hospitals are charging for.

[Sen. Virginia "Jenny" Lyons]: It's complicated. And so that's, I can't answer your question without going into every single level. Why are we different from New Hampshire? Is it the way they pay for their healthcare? Is it their population base so they have a larger risk pool that they can work with and they have more money? Is it because they have more taxes? I don't know. Economically, is it economics? Is it because their hospitals are not charging as much as our hospitals? And that really is part of it. I

[Sen. Terry Williams (Clerk)]: spoke with somebody that was in insurance and they said they believe that one of Vermont's problems was is that most insurance companies look for 2,000,000 bodies or in Risk pool. Risk pool. Yeah, exactly, yeah. And it's like, well, gosh, we can't even come to half of that for Vaughan. So, should we open it up to bigger insurance companies that have, that maybe they can take, the risk pool can go outside of our state as well as just a Vaughan.

[Sen. Virginia "Jenny" Lyons]: Wouldn't that be great? So, and I'll let you know that one of the sections of the primary care bill that I have in committee now is to have an exploration of exactly that, to have regionalization. So we talked about regionalization in the state for our rural health transformation. Part of the state, this part of the state, which is great. But then what benefit would we get, exactly what you're saying, from being able to expand and have some kind of financial

[Sen. Terry Williams (Clerk)]: healthcare oversight. Because I believe it's still for us older folks still getting cost with a cost, but younger families might be able

[Sen. Virginia "Jenny" Lyons]: to get a premium that's a lot less. This is what you want, no question about it. Having these large, as you say, we wanna have a large insurance company come in and merge populations. Blue Cross and Blue Shield is a large company, so is MVP. But that's not the way our insurance system works. It's works on the borders.

[Sen. Seth Bongartz (Chair)]: So I have a note in front of me. I have a note here that says they need you in appropriations.

[Sen. Virginia "Jenny" Lyons]: Oh, nuts. I'd go back to

[Sen. Terry Williams (Clerk)]: the church.

[Sen. Seth Bongartz (Chair)]: We'd love to have you back.

[Sen. Virginia "Jenny" Lyons]: Well, you're asking questions that, you know, I think there's some data that you probably want, but will, you know, and I did think about the numbers and the number of people who are covered, but I was, thought you just wanted to hear what the sales were as a result of the work

[Sen. Seth Bongartz (Chair)]: that we did. We would ask you questions all day if you had the

[Sen. Virginia "Jenny" Lyons]: Well, you know, they can't answer them. So, okay.

[Sen. Seth Bongartz (Chair)]: Alright. Senator Rutland.

[Beth St. James, Office of Legislative Counsel]: Well, I I just wanted to say something maybe to watch that would be helpful that superintendents raised is people taking more advantage of family plans now that the subsidies the ACA subsidies are gone. Subsidies are gone. And middle family plans are kind of a $40,000 employee cost to the education fund for many. Watching that trend, if it changes dramatically. So,

[Sen. Virginia "Jenny" Lyons]: that's true. And looking at the cost and trying to sort out how to fix those plans, it's really important. We're not going to do it unless we have systemic changes. And we're not going to have systemic changes until we start doing some of the things that we're doing that are that look like there's not a direct link but you're right.

[Sen. Seth Bongartz (Chair)]: Alright. Thank you. Thank you. You. That was helpful. The the 50 birthday. Money. Yep.

[Sen. Virginia "Jenny" Lyons]: Pretty steady. I'm leaving. I don't wanna hang. Okay.

[Beth St. James, Office of Legislative Counsel]: Are you all ready for me?

[Sen. Seth Bongartz (Chair)]: Okay. Just so I know that you have a fine. I

[Beth St. James, Office of Legislative Counsel]: mean, I could come up with one.

[Sen. Seth Bongartz (Chair)]: Okay. Just wanna help get a decent work.

[Beth St. James, Office of Legislative Counsel]: No. 03:30 is my next Okay.

[Sen. Seth Bongartz (Chair)]: I have to be at Long's house. So we gotta have I think we gotta have some of the best time, so we gotta have good. What else? You're ready.

[Beth St. James, Office of Legislative Counsel]: Sure. Beth St. James, office of legislative council. I think I'm here today to talk about the different operation models in the current technical education universe. I made the most basic of handouts for you all, but I think what we'll do is probably spend some time just looking at the actual law. DTE, and I think you can use the term governance models. I don't love that because the bulk of everything is within a public school system, so even there are two different kinds of operation models that are operated by a local school board, so I think I like to think of it as operation models and not necessarily governance models, but I'm not the expert on fatigue. This is just how my brain is working. So the most common operation model is a center operated by a local school board. A school district that operates some subset of grades K through 12 and operates a career and technical education center. That's the majority of our centers. The school board operates that CTE center in the same way that it operates the rest of the schools in its district. However, it is required to establish a regional advisory board, and we can look at that statute to see what their role is. It is a consultation role, but there is language in there about if the school board does not take the advice the regional advisory board, there is actually a process for for how to rectify that. And the school board is setting CTE tuition subject to the State Board of Education Boards. So this is the vast majority of our Career and Technical Center centers. Then we have comprehensive high school. Bless you. Comprehensive high schools is defined as a public or independent school other than a career technical center that provides secondary career technical education approved under section fifteen thirty three of this title. There are two different types of comprehensive high schools. One are the comprehensive high schools operated by St. John's Prairie Academy and Linden Institute, so two approved independent schools. And then there are two public high schools that have been deemed comprehensive high schools, Canaan and Missisquoi. Canaan and Missisquoi are operated just like those CTE centers by a local school board. They are not CTE centers, they are comprehensive high school, and they do not make a separate assessment charge. There's no separate CTE tuition. If you are a student tuitioning to either the independent schools or the public comprehensive high schools, you're paying the full tuition charged by the school to attend the school. Whereas the CTE centers, you're paying tuition to attend the CTE center, and you're still receiving some amount of education elsewhere.

[Sen. Seth Bongartz (Chair)]: How does that work when it's comfortable part of the day to one of the comprehensives?

[Beth St. James, Office of Legislative Counsel]: To one of the comprehensives? I don't know. I don't know how the proration of tuition works.

[Sen. Seth Bongartz (Chair)]: Fundamentally, they don't separate out the CTE from a portion of what they do from everything else. It's all this one.

[Beth St. James, Office of Legislative Counsel]: There's no, so the CTE tuition is set by state board rule and there's a calculation that our publicly run CTE centers have to follow to set their CTE tuition. And then there's a whole bunch of salary and assistance and tuition assistance. That calculation is not applicable to comprehensive high school. So they're setting tuition under the tuition statutes. How that progression works, I don't know. But there's kind of another question in there, I guess, which is any of these could be half day models. I guess, theoretically, yes. Yep. Because that I mean, it's not, like, set in statute, but I think that ends up being a really big question mark for that area, is there's only a half day, and how does that work with the school calendar of their partner district or districts? And then the last operation model, usually we hear folks talking about four operation models or governance structures, and they're talking about the independent schools, the comprehensive high schools, the regional tech center school districts, and then the locally operated school districts. I've lumped comprehensive high schools into one because they are one. There's just two different types within them. So, I have three operation models here, and the last one is a regional career technical School District, which is a standalone school district. It is a career and technical education school district that is formed by the vote of its member school districts, which are its sending schools. It does not have taxing capacity, so it's not raising its own taxes, but for all intents and purposes, it functions just the way a school district would. It's just the only school it's operating is the CTE center. And I believe there are four of those in existence right now. So, the most recent example is just down the street, I believe, in Barrie. I don't remember the Central Vermont Career and Technical Center, I believe is what it's called. Just a couple years ago, they moved from this first model, a Career and Technical Center operated by a local school district, I think it was Spaulding, right? Two, this regional Career Technical Center school district, where all of their sending school districts got together and had a vote and decided to form this standalone CTE school district. There's no regional advisory body for the regional career technical venture school districts. They're just focused on the CTE venture.

[Sen. Nader Hashim]: Yes, a quick question. Sorry if I already covered this, so these, for these four regional centers, the districts that govern that region, where the CTE is, they all leverage the, they all have the taxing capacity to pay for that CTE? Yeah. And is it based on how many students each district is serving?

[Beth St. James, Office of Legislative Counsel]: Yeah, let's pull it up and look at it. So, here is subchapter, so I'm in chapter 37 of Title 16. This is where everything related to CTE lives, with the exception of tuition for the comprehensive high schools, which lives in our TAP Tuition Program statutes. Everything else lives here. So you've got, these are local, career, and technical education programs, and what's the responsibility of the local school board, what's the responsibility of the sending districts, etcetera. Eligibility on tuition, student financial assistance, and so here is the Regional Career and Technical Center School District. Here is their budget language. So, the board of directors presents a budget every year, and they, let's see. So, board adopts the budget, it's not going to a vote of the voters. And then, subsection is the nitty gritty. So, following adoption of a budget, the board shall calculate each member district's share pursuant to section fifteen fifty two, which is the CTE tuition statute. Upon receipt of the notice of the amount, the share becomes the legal obligation of the member district without need for further vote of the member district electorate and shall be included in the member district's education spending amount.

[Sen. Nader Hashim]: And the board of directors. Well, actually, I'm. Thank you. So

[Sen. Seth Bongartz (Chair)]: what is the basis for when they say calculating is not permissions because I always thought it was for student count.

[Beth St. James, Office of Legislative Counsel]: So secondary student tuition is established by each center, and it reflects the actual cost as defined by rule of the board of attendance in the courses offered by the center. And so then it says, tuition shall be reduced proportionately for students enrolled in a part time program, but how that actually worked, I'm not the math gal. So we would have to pull up the state board rules to look at how they're setting those tuition calculations. Well, I mean, I don't wanna share my screen if it's premature, but I was gonna ask Beth if there was a map of these. And I think John Adams would be proud of me. Both, John. Oh. But I I've I've overlaid the CTEs with the state commute patterns and the districts, and it, so we have the data, I would say, on where gaps might exist or why we have shortages in some areas and overabundance of slots. Deserts? Yeah, all of the above. Deserts await seas.

[Sen. Seth Bongartz (Chair)]: Deborah?

[Sen. David Weeks (Vice Chair)]: We have the tools.

[Beth St. James, Office of Legislative Counsel]: I know, thank you, GIS people. It was easy to figure out.

[Sen. Seth Bongartz (Chair)]: Yeah. So that's something we wanna look at, obviously. So let's go ahead.

[Beth St. James, Office of Legislative Counsel]: If I

[Sen. Seth Bongartz (Chair)]: could thinking about what I'm gonna to spend. I'm thinking about we wanna move other questions for Ben about the models first.

[Beth St. James, Office of Legislative Counsel]: Yeah. I'll just email this to Daphne, and she could tell me if it captures the map layers I put together, and people can take it from there. There's a lot more to CT than just their operation models, but that was what I understood you wanted to learn about today. And as with everything, it's all made up, so you get to decide if you like these, you want to change them, you want to make a hybrid, it's all in your hand. It's all in your hand.

[Sen. Seth Bongartz (Chair)]: So, one of the, what's the comprehensive, so this is the, it's can just treat a class like it's a class. They they can go from their English class to an art form of photo class then back to history.

[Beth St. James, Office of Legislative Counsel]: I don't think that the title sixteen speaks to any of that. I don't think title sixteen is that specific. K. It is a high school that offers CTE programming that is not a CTE center. That's the specific of child.

[Sen. Seth Bongartz (Chair)]: I'm only thinking about how is it is it if kids fit into that model for kids from. Mhmm. And it's because it's a somewhat different operationally they at least I know a couple things operate differently but like we've got Bennington is number three. And that tends to be half day, full day.

[Beth St. James, Office of Legislative Counsel]: I don't know. I think that would be a good question to ask those schools how that works. Yep.

[Sen. David Weeks (Vice Chair)]: Any other questions? Just a comment. We took we took a lot of testimony for the last two years or three years from Saint John's Academy. Yep. Basically, when they were enrolled in CT portion of that, they actually worked in math class. They were involved math. They were. Oh,

[Beth St. James, Office of Legislative Counsel]: I was just if people I've screenshotted it, but it's all because the they did not, but they did not. And it's very interesting.

[Sen. Seth Bongartz (Chair)]: K. Well, we just wanted to get that refresher started point towards RCC discussions. Other weapons that were done. Okay. I mean,

[Beth St. James, Office of Legislative Counsel]: maybe maybe if we want to dig into some of this We'll go through more minutes. Yeah. I don't I don't wanna keep

[Sen. Seth Bongartz (Chair)]: people from

[Beth St. James, Office of Legislative Counsel]: other errands, but I think the and I wanna do this with Beth here because I feel like that you could either be silent on some of these things and then the rest is left for us to fill blanks. I think a lot of our questions going forward would center around how to make sure there are not disincentives for for sending a student to a CTE, you know, wait lists, denials, or trying to keep them in a in an academic center because the the district doesn't wanna lose money or the the high school doesn't wanna lose the money to the CTE. Do you have a sense of past efforts to try and address that through these models? Not necessarily through the models themselves, but you guys last year, and the miscellaneous education bill, tried to address some of that. Let me see if I can pull it up. And I feel like I'm a broken record lately, but Probably important when you're scared to stop. It's really hard to control human behavior. Yeah. Yeah. So you can put get the the language right, and you could get agreement from all the stakeholders that this is what's gonna do it, and still get feedback from the field that it's not happening. And I think anecdotally, that is what I As I sit in your committees and I watch the testimony you're taking, sometimes I think that is part of what you are hearing is that the law is there, but there's something else going on. And so there's no amount of legislation that's going to necessarily fix the problem. That doesn't mean that there aren't ways to legislate around some of barriers to access. Let me just pull up last year's miscellaneous bill and you can see what all tried to do, all of which I think is already allowed under current law and is a good example of trying to really be clear at what is allowed and okay under the law, even when the law kind of already allowed for that. This was a very late edition at the very end of the session. I think it was Bennington Hardy who came forward with it.

[Sen. Seth Bongartz (Chair)]: Oh, they have it for Yeah.

[Beth St. James, Office of Legislative Counsel]: So let's So this was just passed last year, so I have no idea how it's working. So section 18 of Act 72 of last year. We've got some definitions there, but then we've got a whole series of subsections that are trying to address kind of discrete issues. So, one is allowing secondary students to apply for enrollment programs offered at PPE centers outside their service regions when their assigned service region does not offer the program or they're not enabled to enroll in the program of their choice. The school district students, residents shall pay tuition for that enrollment pursuant to an agreement between the sending district and the receiving district. I think you heard testimony that there were wait lists and kiddos were not being allowed in or not being accepted into programs outside their service region. Well, more so may not be told about opportunities outside their service region and not like a concerted effort to make sure they could get there, right? Was the, you're on your own language about transportation that particularly Nicole McCabish was trying to solve by saying we would pick students up. Up. Yep. And so we've got some language here that says a regional CT center may provide transportation to and from. I think there was confusion over whether they could even do that. Right. And so this is saying, you absolutely can. You can go pick them up. Never does. I mean, I sent Daphne the screenshot of the commuter map and you can see why they need to. This is not on the way here or there. For many students, they need help getting there. And then there's some tuition reconciliation language in here that's already outlined in state board rule. Then there was language that requires a school district that maintains a high school to provide requested director information of enrolled students to a CTE center located outside the school's district for the limited purpose of the CTE center providing information to students' parents about their offerings. Again, I think this is already unallowed under current law, but we're spelling it out here. Right. And this this was kind of the opening question in our working group for people like Ruth Sturkey. You know, What tools would AOE need to enforce this? Not just say you may do all of this, but, like, you we should not be hearing about wait lists and denials if there's a way to help those students get a slot for learning.

[Sen. Seth Bongartz (Chair)]: Senator Hashim, got a question.

[Sen. Nader Hashim]: Yeah, isn't a loaded question, but I'm trying to figure out, are we taking a deeper dive on this as it relates to Act 73 or Senator Ram Hinsdale's bill or Okay. Is there okay. I'm just trying to get an idea of why like, what specific changes we're contemplating or what they're trying to learn more in general.

[Sen. Seth Bongartz (Chair)]: Learn more in general if you get set up. Got it. Also, again, also, yeah.

[Beth St. James, Office of Legislative Counsel]: So I don't have any answers. But whatever, whatever legislation we do craft, again, it depends on what your goals are, but it doesn't necessarily matter if we think the language works, if the folks who are in charge of executing it think that it's not going to work to do exactly what you think it will be because, that is important feedback for you all. Right, right. So I think we heard Eric Remmers and Fact Ed come in and talk about some teeth to this, you know, there has to be a way to say this has to happen or else, and hear from the schools about how punitive the or else would be. I mean, aren't they trying to help facilitate those students access to other places?

[Sen. Seth Bongartz (Chair)]: And they may they may think they are. Right. Yeah. So, anyway, senator senator Rutland.

[Sen. David Weeks (Vice Chair)]: So I understand that I may be wrong with the current system that sending schools enough to provide transportation at CTE. So and and I know that CTE centers charge significantly more per per student

[Beth St. James, Office of Legislative Counsel]: Okay.

[Sen. David Weeks (Vice Chair)]: Than what the LEA actually gets. So maybe maybe twice as much. And then is there a reason for that? Why why there are cost to running those CTE servers more expensive?

[Beth St. James, Office of Legislative Counsel]: If you're looking for a policy answer, I can't answer that. Is a formula in state board rules for both, for net cost per pupil, which is what public school tuition, how that is calculated, and for CTE tuition. And so, we would have to pull apart those rules and see what's contemplated in there. But both sets of, both tuitions are supposed to reflect the actual cost of educating those students. The Ruth would probably come in and be able to talk about the specific, rolling average. I think it's over three years or six semesters or Three six or six semesters. That can be really challenging for Hanford, for example, because they have such a high cost per pupil because they don't have enough students. If they added 50 students, that cost per pupil could go down in six months, but it wouldn't register in the formula for three years.

[Sen. David Weeks (Vice Chair)]: Staying back into my foundation formula, is that gonna equalize out under the foundation formula? Are they gonna be paying the same for CTE?

[Beth St. James, Office of Legislative Counsel]: Act 73 didn't make any amendments to chapter 37, which is the CTE chapter where the tuition sections live. I'll just leave that there. I don't want to be wrong, like I'd like to see if this is your understanding that the study, the consulting study group is supposed to come back with some thinking on a CTE foundation formula alongside the other formula. Yes. And if I could be misremembering this, but somebody like Tammy Colby did come in and say, there are models where they might say, here's the formula for aeronautics, here's the formula for performing arts, You know, I remember some reference to like, they do have a way to compare like costs or like programs that involve equipment or don't involve equipment or insurance costs.

[Sen. Seth Bongartz (Chair)]: Thank you. Sure. I'll walk out with you because then I'm trying to face about something else. We have the UBM can't get here until three, so we have a

[Beth St. James, Office of Legislative Counsel]: Didn't they say 03:10 maybe to you?

[Sen. Seth Bongartz (Chair)]: 03:11 maybe. They're about three. They're try to do that. K. Like, somewhere off, we can go up till three.