Vermont Legislature SmartTranscripts:

[Sen. Ann Cummings (Chair)]: We are live. This is Senate Finance, May 1, happy May day. And, that's why I didn't get the pump back and find out why I can't get it. Like Depends on my experience. So we are going to start out with age five eighty eight. This is the Department of Professional Regulation, regulatory office of Professional Regulation, and is with us.

[Joint Fiscal Office analyst (unidentified)]: Thank you very

[Tim Bevil, Legislative Counsel]: much for having me, committee members. For the record, my name is Tim Bevil, legislative council. Let me share a copy of the bill of the one on the screen here. So this is the OPR of miscellaneous policy, short handle mutual aid. Well, there's not too many new fees this year compared to some other times last year. Of note New fees. New fees. We have a academic dentist fee, which is actually $0, but That's a good pay. Pull that rather than just covering it. That's a good office. There are, let's see, a new fee structure for massage therapy establishments and some additional pieces there. And then I should say there's some statutory rearrangement, I guess, is a good way to put it, where we reorganize some existing fees, moving them at least more appropriate length of clarity. There are really two sections of import here. One is 12 a. Actually, that's under 12. So let's see if I have the committees. Okay. So this is your new

[Sen. Ann Cummings (Chair)]: Can you Did you at some point take us through section by section? Oh, I'd be happy to. Yes.

[Tim Bevil, Legislative Counsel]: Yeah. That was the And for committee's convenience, I provide an overview, which is shorter and concise than the entire bill. I can really take a very high level and just do a synopsis for it to provide medium granularity for her and get this degrees.

[Sen. Ann Cummings (Chair)]: Okay. Medium grade.

[Tim Bevil, Legislative Counsel]: Sure. The

[Sen. Ann Cummings (Chair)]: body needs go lower. So

[Tim Bevil, Legislative Counsel]: actually, in that case, believe you may prefer that I switch over to the overview rather than having a labyrinth up here

[Sen. Ann Cummings (Chair)]: with Whatever chat works. Is this basically a housekeeping bill? Or are we doing new things? There are,

[Tim Bevil, Legislative Counsel]: I don't know if I would describe it as a housekeeping thing at all. It is a variety of varying changes to the powers of the OPR, Office of Professional Immigration, in general, in Title II, Sporting and Finance that apply to how they regulate all professions. And then we have numerous profession specific alterations there. So I would say it's part and parcel of the, it's in line with the typical nature of updates that will be requested in the legislature every year, but I don't know if I can describe the term. Okay. Regular.

[Sen. Ann Cummings (Chair)]: Committee, would you like to start with the overview? Sure. Go down there. Okay.

[Tim Bevil, Legislative Counsel]: Whatever keeps us inside this building longer on this beautiful Friday afternoon. About four ms.

[Sen. Ruth Hardy (Member)]: I know a lot more about, security than 19 regulation. Is

[Tim Bevil, Legislative Counsel]: anybody else having trouble with public today? I'm not. Can't I can't. I don't. It's just bunch of.

[Sen. Ann Cummings (Chair)]: Couldn't get any expenses.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: They told me my passport was. What

[Sen. Ann Cummings (Chair)]: do you

[Joint Fiscal Office analyst (unidentified)]: what do you need now? What do need now?

[Tim Bevil, Legislative Counsel]: Bill. Well, you're you're working too hard. Yeah. I am. So I'm going to skip the first page, which really just kinda helps. My high or do you skip writing? So in part one of the bill, we'll see sections one through seven, we have amendments being made to the general powers of the Office of Professional Regulations. And these are located in Title III versus Title IV, Central and Professional specific ones. So the first kind of bucket of amendments we have has to do with how OPR will go about, this enables them to rescind licenses in certain limited circumstances. Really, you can kind of see this in section three, where we have, oh, sorry, should just say that the red text indicates what the Senate change from the House of Merchants came up with. So rescissions will be eligible, being able to rescind a license if a license was issued because of an administrative mistake, application fees were not paid in a timely manner, or essentially a compact dissolves or a compact license becomes otherwise deplored. But there's grace period in employing those individuals in practice here, have reciprocal license privileges in the state, not something they can do here, to obtain remote licensing at certain time. There's two different procedures laid out depending on how long the licensee has had the license. The longer they are, they've had the license, the more due process there are for this shift. So if they have it for less than thirty days, it's an expedited procedure. If they have lessons more than thirty days, additional classes involve, both have procedures being done. Now, the effect of lysine zine. Then we move on to section four. Okay, risk of clarity.

[Sen. Ann Cummings (Chair)]: Recision is different than revoking?

[Tim Bevil, Legislative Counsel]: Yes, it contemplates a situation where, during various, one of those three circumstances that really the licensee maybe shouldn't have had a license if it was, again, an administrator's sake, or it was issued but never was a payment, so it's kind of, removed quite quickly. The one that doesn't quite fit that as well is there's Vermont withdrawals from an interstate compact or the compact kind of includes because the member states Okay,

[Sen. Ann Cummings (Chair)]: it's not if you lose your license in the compact, it's if the compact goes away in order because right now if you have a compact license you can practice in Vermont. Yes. So, if you have a compact license and you're practicing from Vermont, compact goes away, you have thirty days to get a full Vermont license.

[Tim Bevil, Legislative Counsel]: Yes. Okay. Yes, and it also conflicts, should add that if a compact license or privileged holder loses that credential without a home statement, that they would then have to indicate a verbal message as well, same kind of bill coming back. Section four, we get to disciplinary action to be reported to the office, and this rephrases I know we've disputed it, that was a double negative, or there is actually. We get into section five. Let's do with the unprofessional conduct statutes, and this will add an attempt to fraudulently or deceptively procure a license, not only the actual success of doing that should be considered unprofessional conduct. And then it gives the director some discretion in certain circumstances where there are, okay, licensee has substance use disorder or some other professional practice issues, to essentially go through like a form of divergence without necessarily having the, to go through workers' own license, termination of other procedures. But again, that'll be at the discretion of the director or manager of the adoption of rules outlining that process. The section six, we'll change it so that all board members must be adults.

[Sen. Ruth Hardy (Member)]: Were there board members who are not adults? I think they're applicants. Really? And how do you define them? It's 18 from an

[David (Deputy State Treasurer)]: age perspective.

[Sen. Ruth Hardy (Member)]: Okay, so it's actually about age maturity level. Correct.

[Tim Bevil, Legislative Counsel]: Show section seventeen eighty seven, I'm sorry. Let's see. Make some clarifications to the uniform process for credential verification. Let's see. Correcting some cross references, as well as preliminary denial of this case. So then we move on to the part of the bill, starting with sections eight through 10, which are profession specific. This bill will touch on accountants, dentists, fielding spaces, dentistry nurses, pharmacists, psychologists, radiologists, language pathology assistants, and massage therapist. So we'll start off with those accounting changes. 8310 will, let's see.

[Sen. Ann Cummings (Chair)]: Removes the definition of good character. Yes.

[Tim Bevil, Legislative Counsel]: Testified that has become rather subjective criteria. And so they opted to rule them, but I would defer to over here on the witness testimony because they don't exactly have behind that. Other sections can be summarized by just stating that they introduced additional combinations of prerequisites. Prerequisite safety would be lessons by examination. Additional combinations of education and experience, and what's right there the body disease. I think it's three different options. And then updating some of the terminology on the ground from what's across the industry mobility to more pockets. How does it happen? The company weighted in for certain extent for one they have to attend the campus. That's qualified.

[Sen. Ann Cummings (Chair)]: So

[Tim Bevil, Legislative Counsel]: moving on to part three, dentists. This is section five twelve. A new limited academic dentist license. The idea behind this is that I think there's some interest in starting a dental school somewhere from the state. You can refer to the PR and provide you details with that. Plus you provide a, essentially a teaching license from that dental academy, and to be available to full time dental instructors who hold sufficient dental degree and stay, I should say, complete necessary courses, and to be able to supervision from someone who's best in The United States. Well, here's where I note that out of all fee, it's a $0. That's gonna be found in section 12. Part four, funeral services. Change the definition of the Whole Four Constitution's practice of funeral services to include providing for the disposition of dead human bodies by cremation of harmful hydrolysis or natural organic production. Not volunteering to report this, but I have to ask if somebody asked me, why

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: do we have fees that are for $0?

[Tim Bevil, Legislative Counsel]: Yeah. We typically don't, but the way the language is phrased, it was a license, zero, only license in the section that there would be no language speaking to whether there was a registration or a application fee or non involvement. So rather than depicting a moving question or there being ambiguity around, okay, so seems OPR or something else, subsequently determine what that fee is, just set it as zero fee hyper expert.

[Jen Harvey, Office of Legislative Counsel]: It's for clarity's purpose. All the fees are listed in the statute, for all licenses. So if there was no license fee listed

[Sen. Ruth Hardy (Member)]: for this for dental, what do they limited academic dental license, then I I think it would be unclear what what the fee is or if there is a fee. And so by putting it at zero, then it's clear that it's zero. That's what it is.

[Sen. Ann Cummings (Chair)]: My assumption is

[Sen. Ruth Hardy (Member)]: the reason they're setting it at zero is because one, they probably not have any of these, but also they wanna encourage people to do it. Okay. Because they want we have a dentist shortage and they're trying to get more people to be trained as dentists.

[Joint Fiscal Office analyst (unidentified)]: Chittenden at North District office is connected with a new dental school in Colchester, and so they're looking to attract, essentially, it's envisioned for dentists from other jurisdictions who are coming to teach at the school. They would need to have a specific Vermont dentistry license. And so given that the dental school will have a clinic for folks who are receiving free or limited class dental services, they may tend to send it to think the thinking there, I don't wanna seem like I'm advocating for it, but I think that was the specific application of that license item.

[Sen. Ann Cummings (Chair)]: It's in. We had a dental hygienist school. It was at what was that? Vermont Tech. They asked to move to County because they couldn't get enough walk rooms. We passed the dental test that would allow an advanced degree hygienist to keep people filling. I don't have any update on that. So these

[Tim Bevil, Legislative Counsel]: are new fees that we're just setting at zero? Yes. None of these are fees that we're bringing down to zero to make it Correct. Yeah. It's a new fee, just a singular one, and if you set it to

[Sen. Ann Cummings (Chair)]: zero. And

[Tim Bevil, Legislative Counsel]: actually, this correct thing, as I said before, I must speak to the for those applicants, they would be serolent. There's

[Sen. Ann Cummings (Chair)]: a definite therapist on the list. That's a pretty sure that we haven't last night, heard you haven't given any update with that physician.

[Tim Bevil, Legislative Counsel]: So then, let's see, we're at part five, advanced practice registered nurses, and so we need the requirement for adherence. License renewal to include documentation and completion of those practice department. Pharmacists, let's see, is sections 14, A, C, and three of those. These sections will enable pharmacists and pharmacy technicians to test for influenza, streptococcal meningitis, and human immunodeficiency labs in addition to Crohn's for pharmacists to and for pharmacists to prescribe treatment for these diseases. So we're going. So we have psychologists, this is in the team. And this will create a new session law that will enable OPRs to make temporary policies for a three year period regarding supplementation and educational appointments for the psychologists licensure. Again, blind at sunset and some of the acquired OPR, updated the change in the program.

[Sen. Ann Cummings (Chair)]: There is a bill in health and welfare, well, we already passed it, we passed it, that would allow pharmacists to prescribe

[Sen. Ruth Hardy (Member)]: Oh, prescribing pests? Breast. Oh, yeah. No.

[Sen. Ann Cummings (Chair)]: We we Pharmacist. Is that Is that if we're doing this Oh, yeah. We ought to make sure that that goes in here. Yeah. These are aids, either preventative or pre exposure or post exposure. That was in there today. We voted it out. We voted it out, so it's gonna be on the floor next week. Can we hear someone in the room seems to have information?

[Christina McLaughlin, Vermont Pharmacists Association]: Christina McLaughlin on behalf of the Vermont Pharmacy Association. The secretary of state requested that this piece be separate from what's in six eleven now. And so and we're supportive of that. Okay. This allows pharmacists to prescribe PEP PEP PrEP and PEP, whereas the insurance piece is in six eleven since that's a DIBA bill. Yeah. So it makes sense to keep them separate.

[Sen. Ann Cummings (Chair)]: Okay. I just wanted to make sure that it it's in this bill. Yes. Okay. Because they'll send us updating this if it looks like that one is going to pass. So

[Tim Bevil, Legislative Counsel]: we moved down to midwives and midwives. This will dissolve the midwife advisory committee to the director and the commissioner of It will also remove the requirement that licensed midwives submit individual practice.

[Sen. Ann Cummings (Chair)]: Dissolves the mid advisory committee to the directors of the commissioner?

[Sen. Ruth Hardy (Member)]: Or they advise the director?

[Tim Bevil, Legislative Counsel]: Yeah. Yes. Okay. So the advisory

[Sen. Ann Cummings (Chair)]: committee I specifically aren't thinking of that.

[Tim Bevil, Legislative Counsel]: Would defer to the men

[Sen. Ann Cummings (Chair)]: OPR, of course. Individual, that may be birthing centers.

[Sen. Ruth Hardy (Member)]: I don't I don't think so. You don't think so.

[Sen. Ann Cummings (Chair)]: Okay. We have the director over to that. Okay. Speech and language.

[Tim Bevil, Legislative Counsel]: Yes. So this will require OPR to perform a sunrise review. So in the setting, suggested level of credentialing for speech language pathologist assistance, office pathologists, and such. Part of the management move on to massage therapists, body workers, health professionals. Obviously got truncated at massage therapists. And these sections together will mainly require the registration massage establishments and the existing modified general neuroplastic business, expand the operational requirements, and related professional conduct. Of note, we have these sections here. And is where we have in most of that reorganization as well as the introduction of a new fee and instruction. So a few things this does is that first, it reorganized some existing piece so it would look at the language itself, period, such as some new Ungolam texts and trichot, just so know that it's kind of shifting it to a different section, It does not necessarily create, it does not create a new piece. And this, see, I've got it here, I've got I've it, provided that context for the community. We can move from subdivision B to subdivision A, which will have the effect of clarifying that these fees apply to all board professionals and advisor professions, rather than only advisory professions. And again, the reexertification, the board profession is one, the board usually confines professional peers and members of the public generally regulates the profession. And an advisor profession is one and appointed advisors generally assist the director of OPR and regulate. Yes. So

[Sen. Ann Cummings (Chair)]: what are we doing with massage therapists? Are we checking them board regulated making Well, them not board

[Tim Bevil, Legislative Counsel]: this right here is introducing the fees here. I have to double check exactly which one, I don't know off the top of head, Paul, just for the answer to your question. Section 18A, as well as I think two different other sections here recommended here, Infra is basically AAT. Three part fee, not three part fee, but three different categories of which, depending on the size of the operation, they'd have to pay different rates. So the registration fee is $90 for massage therapists, but as a reduced registration fee for the practice of massage or the practice of bodywork, it is provided by only two massage therapists. And then same reduction for biennial renewal. And then here I'd like to say that solo practitioners do not have to register as establishments, and let's see, establishments with more than two therapists will pay the default fee of $100 Okay, that's

[Sen. Ann Cummings (Chair)]: Can we kind of clear what's up there? Yes, these are existing fees, right? $90 to $50.75. The establishment fee is new. The establishment fee is new.

[Tim Bevil, Legislative Counsel]: Yes. And it will be invert rate depending on the size of the operation. So if it's just a one person establishment, there'd be no fee.

[Sen. Ann Cummings (Chair)]: It's It says it oh, okay. So it establishes a new fee or fees, it looks like, for an establishment. What I'm having trouble figuring out is is the $90 registration fee current are all of those new fees? Or are all of those And Then it

[Tim Bevil, Legislative Counsel]: Let me switch over.

[Sen. Ann Cummings (Chair)]: Sounds like those are new fees, and then it moves fees around. Yes. So you've got three new fees or a $100, four new fees for a massage bodywork establishment, and then it moves other existing fees around?

[Tim Bevil, Legislative Counsel]: Yes, so I'm gonna pull this up. Okay, so here we have 18 papers for modifying here. So, a, board again, board positive. Have here Okay, these are the movements. These are the movements. Ones that over here are because of strong people. So we strike limited, temporary license requirement, apprenticeship application, special enrollment system license application, and we'll meet them over here.

[Sen. Ann Cummings (Chair)]: Okay. About. Are these new fees and the fees that you're removing related, or are they just separate actions in and of themselves?

[Tim Bevil, Legislative Counsel]: They're best to be understood conceptually separate, but because they're embedding the same statue, we have them together here.

[Sen. Ann Cummings (Chair)]: Okay, are the ones who are removing, are those piece that are presently on body workers, massage therapists, whatever?

[Tim Bevil, Legislative Counsel]: No, they are just limited temporary lessons for work permit application.

[Sen. Ann Cummings (Chair)]: Okay, so we are removing some fees, we are putting in some new fees, but they're separate, they're not linked at all?

[Tim Bevil, Legislative Counsel]: No, they just go inside of the, here on the page. Right, okay. Yeah.

[Jen Harvey, Office of Legislative Counsel]: I think my understanding is that for the massage therapist stuff, because this was just a bit, I've worked on this before. So, the massage therapists were started, we started regulating them I think five years ago,

[Sen. Ruth Hardy (Member)]: and then, but now we're adding establishments. Yes. And so we're adding new fees for establishments. That I've got,

[Sen. Ann Cummings (Chair)]: it was the moving other fees around. I'm trying to just figure out, know, these are all separate lines.

[Sen. Ruth Hardy (Member)]: Right, and those things that are moving are just moving to clean up the order in the statue, is

[Sen. Ann Cummings (Chair)]: my, I believe. Okay, that's

[Sen. Ruth Hardy (Member)]: only new fees are for massage therapists. Okay, that's all I need to know. Is that right? Yeah.

[Tim Bevil, Legislative Counsel]: And so here we have the really new fee we have here for application, massage establishment, which qualified for a juicy need. That's not $50 This is not new. Just move from here to there.

[Sen. Ann Cummings (Chair)]: Massage therapist licensed?

[Tim Bevil, Legislative Counsel]: I'm sitting in a No. They are. I'm just, like, registered right now. I believe. Just that.

[Sen. Ruth Hardy (Member)]: Yeah. Regist. Some people think they should be licensed. Some people may be in this for a minute now.

[Sen. Ann Cummings (Chair)]: Those are the emails I've got. Okay. So they have to be licensed, but not

[Sen. Ruth Hardy (Member)]: They're not they don't registered

[Sen. Ann Cummings (Chair)]: They have to be registered. Not licensed. And so I could say I was a could register as a massage therapist without crating? There I

[Jen Harvey, Office of Legislative Counsel]: think there are some requirements for registration, but it's not

[Sen. Ruth Hardy (Member)]: a fully licensed profession though although I think they there aren't any who would like it that way. Yes.

[Sen. Ann Cummings (Chair)]: I'm sure people do both.

[Sen. Ruth Hardy (Member)]: Exactly. Obviously, these things are. Have two sides. Yes. At least.

[Sen. Ann Cummings (Chair)]: That's why we do sunrise. Alright. We have your professionals. Okay.

[Tim Bevil, Legislative Counsel]: Switch back, doctor. There

[Sen. Ann Cummings (Chair)]: is. Yeah. We don't touch So Can you bring it back up? Okay. So a little Similar to Oriental thief, relaxation. Wow. Intriguing. Something to do with dowser. The dowsers. It's all for a lot. So

[Tim Bevil, Legislative Counsel]: section 19A of the bill returned now to Board of Medical Practice, and this rewords and restructures the powers and duties of the Board of Medical Practice in particular, language surrounding how they conduct criminal background checks. And this, for the most part, brings the instruction in line with how OPR conducts criminal background checks. So the language will now look much more similar to what's OPR's general powers specifically to Asabic O, and three, you need to say 1.36.

[Sen. Ann Cummings (Chair)]: Is there any general background check for massage,

[Tim Bevil, Legislative Counsel]: patch therapy? But this is just for medical

[Sen. Ann Cummings (Chair)]: No, I know that's medical, but I mean, the complaints with massage the massage therapy, that might be one

[Tim Bevil, Legislative Counsel]: So then, the section, this brings us basically to the end of the film where we have the various effective dates in section 20. Yes. And most of it will go into effect upon passage. Dentists shall go into effect on September 1, and then massage therapist language

[Sen. Ann Cummings (Chair)]: will go into effect on December 1. You're now about seven minutes over. I think we will have the direct we will have the LPF people in the phone we spoke to each other. Able to explain their thinking and doing this. Any questions right now? Okay. You. Awesome. Chad, do you wanna?

[Tim Bevil, Legislative Counsel]: Sure. One for Tim. Where's your Yeah. I'm supposed to see a pinch. Oh, I know. Get brushed off the door.

[Joint Fiscal Office analyst (unidentified)]: Fiscal office. I am going to run through the fiscal note. There is not a huge amount here. The first piece is the new establishment fees for massage therapists, pet professionals, etcetera. Under that graded schedule where solitary practitioners aren't paying a fee, establishments with two professionals would pay the registration fee of $50 and the renewal fee of $75 and then establishments with a higher number of professionals would pay 100 at registration and $2.75 biennially. That structure would generate approximately $15,000 when those establishments first register. That would be the first year this would be in effect. And then their biannual fees, so they would renew in fiscal year '29, and that would generate $40,000 approximately at those two fee amounts. You would also see minimal revenue in the even fiscal years when you have new establishments coming online. There'd be a few here and there. So that's it in fee revenue, and that would go into the professional regulatory fee fund at OPR. The next piece is there would be a very given that this is primarily a vision to be a licensed type that would be connected with dental schools, This is OPR estimated six dentists. I saw updated testimony for them that indicates that the number might be closer to 20, but still we're not talking about a lot of universe. And in many cases, this wouldn't be the type of situation where you would have a dentist who's currently paying the $655 fee dropping down to zero. It's folks coming from other jurisdictions who aren't paying fees per month.

[Sen. Ann Cummings (Chair)]: They were not dentist who is retiring from active practice and not renewing his full license. Exactly.

[Joint Fiscal Office analyst (unidentified)]: Yes. Exactly. That type of situation for sure. So we're not really anticipating much of anything in the way of a fiscal impact. From that provision, two more budgetary concerns, but wanna flag them since they're fiscal and they are in the note. The sunrise assessments that OPR does for either an evaluation of adjustment of regulation of a of a particular profession or whether to bring the profession online can be a substantial amount of work

[Tim Bevil, Legislative Counsel]: for them. They put a lot

[Joint Fiscal Office analyst (unidentified)]: of effort into it. These pages are these reports are hundreds of pages long, so we wanted to make sure that they checked in with OPR, they do have the resources to conduct this type of assessment through the already regulated speech language pathologist profession, so there's no budgetary concern there. And then very technically, the advisory committee on midwifery, the folks who are on that committee can receive per diem, so if you dissolve the committee, you no longer pay per diems to that.

[Sen. Ann Cummings (Chair)]: Save money.

[Joint Fiscal Office analyst (unidentified)]: Yes. It's a little bit of savings. I forget the exact it's it's very minimal.

[Sen. Ann Cummings (Chair)]: Fee is a tax, so we have cut taxes. No, no. I'm just reminding some members of this board, on the floor tomorrow, this This I have. Yeah. While you're there, do you wanna tell us the fiscal note on alcoholic beverages before we have Tucker tell us what it is? Then I think I just to Tuesday. Okay.

[Joint Fiscal Office analyst (unidentified)]: Hey. Can so given I would normally say no, and I'm looking to Tucker for his thoughts on this. Our fiscal note is very short on this bill. And what you mean, it's not going to really steal a lot of Tucker's thunder. So I am going to

[Sen. Ann Cummings (Chair)]: I don't think this is a thundering bill, is it?

[Joint Fiscal Office analyst (unidentified)]: So pulling that fiscal note up, really, the only fiscal impact is there is a provision in the bill that would move the sunset on special venue serving permits. These were a new license type that would allow places like galleries, public library museums. All of those

[Sen. Ann Cummings (Chair)]: are places we've allowed to liquor

[Tim Bevil, Legislative Counsel]: on a limited.

[Joint Fiscal Office analyst (unidentified)]: Yeah. On a very limited basis, these permits are $20 each, and so it contained a since it's a new permit type, it contained the sunset for 07/01/2026, the bill would appeal that sunset, and so we would receive Kermit revenue beyond that date. It's exceedingly minimal. We're talking a couple thousand dollars.

[Sen. Ann Cummings (Chair)]: Okay. That's good. Thank you. Mhmm. So, Tucker, this is this is the thundering one. Right? Yes.

[Tucker Anderson, Legislative Counsel]: Spring thunder.

[Sen. Ann Cummings (Chair)]: Spring thunder.

[Tucker Anderson, Legislative Counsel]: The turkey. There you go. Okay. Alright. Yeah.

[Tim Bevil, Legislative Counsel]: You see?

[Tucker Anderson, Legislative Counsel]: All right. Do you like me to share my screen? Sure. Despite potential life of other Good afternoon, Tucker Anderson, Legislative Counsel. Gonna take a look at the H921, and the path by the House, alongside an amendment from Senate Economic Development, Housing, and General Affairs. I'll do a summary overview, very high level, because as Ted noted, there's really no amendments here that are directly impacting fees, taxes, fiscal picture broadly. First instance of amendment updates the terms of the Board of Liberal Lottery. Members will serve four year terms instead of three year terms. The second instance of amendment amends the fourth class license statute. It does a couple things here. The first, there are serving limits, how much an individual can get served at these fourth class license locations. The limitations are staying in place for farmers markets, but for the tasting room and retail shop locations, it's increasing the per serving volume that can be given to a customer to what's known as a full pour, globally, volume, for each of the beverage categories. And then finally in this section, current statute, there is a limit at, of how many of these locations a license holder can serve beverages from other manufacturers, and that is increasing from one to not more than 10.

[Sen. Ann Cummings (Chair)]: I guess the question is when do you become a bar?

[Tucker Anderson, Legislative Counsel]: That has always been the question about this particular subsection of the fourth class license statute, and if the members have any questions about that, I would refer you to my testimony in the house, whereas it's a little more together. Fourth and here today, we have fewer children.

[Tim Bevil, Legislative Counsel]: Do they sleep these days?

[Tucker Anderson, Legislative Counsel]: Yes. Sleep

[Sen. Ann Cummings (Chair)]: is always helpful. Especially seven hours in a row. Fourth class license. Status?

[Tucker Anderson, Legislative Counsel]: License issued to a manufacturer.

[Sen. Ann Cummings (Chair)]: This was our working with our local breweries, distilleries, right, that allowed them to do tastings or to serve on their premises, and then we allowed them I have a patient of some place in Brooklyn that the the premises was in the middle of nowhere, so they opened an establishment in town. I'm remembering that correctly.

[Tucker Anderson, Legislative Counsel]: The fourth class license used to have, I believe it still does, a contiguous location requirement. Okay. As we're talking about retail locations that also hold another form of license, I want to pause to just note that manufacturers can acquire multiple types of, on-site, on premises consumption licenses first and third. You've brought up the brewers. Brewers who could potentially get a first class license to serve just like a bar or restaurant. Okay. This is the sampling and tasting room. Okay.

[Sen. Ann Cummings (Chair)]: And that, so this says they

[Tucker Anderson, Legislative Counsel]: can sample up to 10 other, so you come there at At 10 locations. At locations they can serve beverages from other manufacturers and there will not be a limit anymore on the number of other manufacturers that could be featured. So

[Sen. Ann Cummings (Chair)]: they could have 10 locations. Would that locate one of those might be a market where you would do a tasting, and it's 10 locations a year, or if you're at the Farmer's market every week, is that one location?

[Tucker Anderson, Legislative Counsel]: I would defer to the Department of Labor and Lottery on how they are constraining what a location is for purpose of the limit on the issuance of these licenses.

[Sen. Ann Cummings (Chair)]: Yeah. We did a lot of this because these were emerging industries and we wanted to support them, but there comes a point in which they are at least adolescent, if not mature industries, and okay.

[Tucker Anderson, Legislative Counsel]: Another thing to note is that, as I brought up, there are a lot of different overlapping permits and licenses that could be taken out by a manufacturer for these purposes, so it might be useful to understand how the industry is using the fourth class license plate, particularly for things like the farmer's market when there might be other permits that could be used to accomplish the same thing. So I'm thinking specifically of the special venue

[Sen. Ann Cummings (Chair)]: permits. Yes. Alright. So, what we have this? Yeah. So, to that point that that's

[Tim Bevil, Legislative Counsel]: why they're getting rid of the

[Sen. Ruth Hardy (Member)]: special venue permits because it's basically redundant in some other kind of

[Tucker Anderson, Legislative Counsel]: So not to make it even more confusing, but that's totally separate special venue serving permit, and it's not being repealed the sunset of the expansion of that permit. Very specific. It was expanded to that permit can be pulled out by any type of retail establishment. And prior to 2024, it could only, be issued to libraries, museums, and art galleries.

[Sen. Ann Cummings (Chair)]: So Three years somebody sent something else, and then it was the bookstore. We're having a book reading, and we'd like to be able to serve wine and cheese and

[Sen. Ruth Hardy (Member)]: Okay. So what is the bill doing? I'm confused now. It's

[Tucker Anderson, Legislative Counsel]: For purposes of the special venue serving permit

[Sen. Ann Cummings (Chair)]: Yeah.

[Tucker Anderson, Legislative Counsel]: We will get to

[Sen. Ann Cummings (Chair)]: Oh, I'm sorry. Have I thought you were going through the whole bill.

[Tucker Anderson, Legislative Counsel]: I'm sorry. It's removing the 2026 Sunset expansion of that room. Oh, there many. See.

[Sen. Ann Cummings (Chair)]: Okay. And then

[Tucker Anderson, Legislative Counsel]: It's making it

[Sen. Ann Cummings (Chair)]: On the shots, it has a testing when they're showing screen seats. That's not good.

[Sen. Ruth Hardy (Member)]: And then the the hours section three? Mhmm.

[Jen Harvey, Office of Legislative Counsel]: Yes. That's where you keep going. Okay. Sorry. That

[Sen. Ann Cummings (Chair)]: that Oh.

[Tucker Anderson, Legislative Counsel]: I'm sorry. My I scrolled faster than the conversation had gone.

[Jen Harvey, Office of Legislative Counsel]: Yeah. So that's why I was confused as

[Tim Bevil, Legislative Counsel]: to where we are.

[Jen Harvey, Office of Legislative Counsel]: Oh, so that's why is

[Sen. Ruth Hardy (Member)]: it that are they getting rid of the hours? It's just so you can serve alcohol at 6AM?

[Tucker Anderson, Legislative Counsel]: So this would, this was a very specific limit on a type of permit that was created initially during COVID to allow first, second, and third class licenses to provide all beverages by delivery or curbside pickup as part of their The pickup is Martine. It was codified here, and when the COVID pieces were put in place, these were the hours that applied only to this type of license. But there are general restrictions in another statute in title seven that relate to restrictions on the underlying license. Okay. So, like, your bars and restaurants, first and third class licenses have limited hours of sale. Those stay in place. Same for your retail locations, second class licenses. They just won't have specific limitations on the curbside pickup and delivery. It'll fall back to whatever their general restricted hours are. Got it.

[Sen. Ann Cummings (Chair)]: Thank you. And you can still buy martinis in a can.

[Tucker Anderson, Legislative Counsel]: 20 fourseven. Provided that they fit the beverage alcohol definition of a ready to drink spirits beverage at seven BSA section two.

[Sen. Ann Cummings (Chair)]: Yes, they probably do. Yeah, that's right. Alright.

[Tucker Anderson, Legislative Counsel]: Seven BSA section two fifty two, this is a conforming amendment. The definition for the special event permit required approval of the local control commissioners, but the actual statute did not. Okay. So, it's just moving that language into the statute covered in the license. Right. The notice period for retail pacing permits is amended, reduced from five days to one business day of notice to, deal log in. Alright. Section six amends, seven days a section two seventy one to add a new subsection that allows malt beverage manufacturers to distribute not more than 3,000 barrels of the beverages they produce annually directly to first or second class licenses. This is direct self distribution of 3,000 barrels or less by brewers annually. As it passed the House, there was a sunset. So section seven was repealing that new language in subsection G, allowing for that self distribution, but your Senate Committee on Economic Development is proposing to just not do the sunset at all and allow this to go into statute. Eight removes the requirement that applied only to the solicitor's license that payment of fees for this license be made by certified trade.

[Sen. Ann Cummings (Chair)]: Solicitors.

[Tucker Anderson, Legislative Counsel]: Happy to come back to the committee to discuss the solicitor's license.

[Sen. Ann Cummings (Chair)]: To me, a solicitor is a lawyer. I get it. Since why is it in the liquor stage if the kids

[Tucker Anderson, Legislative Counsel]: use or sell alcohol? Solicitor's license is a for purposes of the alcohol alcoholic beverages industry in Vermont, separate from Kearny's or Georgia Georgia. Alright. What

[Sen. Ann Cummings (Chair)]: did they do? Well, let's

[Tim Bevil, Legislative Counsel]: bring up the title slide. Hello?

[Tucker Anderson, Legislative Counsel]: Alright. The boulder of the license may by canvassing or interviewing holders of licenses issued under this title solicit orders for and promote the sale of all beverages, finest beverages, already drink spirits beverages, and promote the sale of spirits and fortified wines. Salesperson. And advertising between licensees.

[Sen. Ann Cummings (Chair)]: Okay. So this is you should buy my wine and liquor to be in your establishment or conserving a party or okay. Okay. That makes sense.

[Tucker Anderson, Legislative Counsel]: Happy that I went to the statue instead of trying to work from memory and then embarrassing myself. Okay. Session nine. This gets back to senator Hardy's question. These sections remove the sunset of the expansion of the special venue serving permit. Okay. So the expansion to all retail establishments will stay in place. Excellent. How wonderful. Okay.

[Sen. Ann Cummings (Chair)]: Cool. And we have it because by expanding and doing away with the sunset, we will continue to collect the fee.

[Tucker Anderson, Legislative Counsel]: That is correct. There were a few amendments already noted, most of them. Senate economic development reduced the number of locations we discussed for the fourth class license from 10 to five. Required, reporting concerning the self distribution by all beverage manufacturers. Got rid of the prospective repeal of the self distribution subsection, and then within the caterer's license, added express authority for the holder of the caterer's license to serve alcoholic beverages located on premises that the holder that the license has another license for it. Solving an issue apparently where licensees who will hold a first, second, third class license also have a caterer's license Yeah. Are prohibited currently by the definition of the caterer's license from catering events on their own property.

[Sen. Ruth Hardy (Member)]: Wow. Okay. Yeah.

[Sen. Ann Cummings (Chair)]: Because usually yeah. There's always Alright. Committee, do we have any questions? This is here because of doing away with that sunset. The fee revenue will continue to come in. You'll get a few more $20. We'll get a few more $20. You could pass that to the clerk.

[Tim Bevil, Legislative Counsel]: I would move favorably draft number 1.3 as a achievement of one as received from the Committee on Economic Development Housing and General Affairs.

[Sen. Ann Cummings (Chair)]: Okay. Senator Chittenden has moved favorably 1.1, yeah, H921 as not relating to alcoholic beverages as it came to us from that. Lady and housing and general favor. Any further discussion? Are there any amendment? If not, all those in favor say aye. Aye. All all those opposed say no. That's seven zero zero. You check off everyone's name. Who would like to report that. Did you did you report the event today? You were both there. So you know? He didn't put me on. Okay. You go right beside the problem with that. Okay. Because then you're on a roll. Wow. Our looked this up online. I have done it. Yes. Not came to the pharmacy yet. It's quite exceptional. Three. It's there was a significant difference in the price of the one drug I looked up That's right. Between my three local pharmacies. First name?

[Joint Fiscal Office analyst (unidentified)]: No. Last name insurance.

[Sen. Ann Cummings (Chair)]: So it's the same way.

[Tim Bevil, Legislative Counsel]: It? Well, that's the same way.

[Sen. Ann Cummings (Chair)]: Okay. Let's go. We're a little rowdy. It's Friday. Maybe it'll 06:00 last night.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: So Charlie, would you mind sending the Zoom link, please?

[David (Deputy State Treasurer)]: For the record, David Chair, deputy treasurer. Peter Trombley, director of legislative affairs.

[Sen. Ann Cummings (Chair)]: Okay.

[David (Deputy State Treasurer)]: So I'll turn it over to Peter, our director of legislative affairs, in a moment, but just wanted to open and he'll give an overview of the program and how it operates and some of its benefits which we believe are significant. But just to start us off, I wanted to know that this is a top priority for Treasurer Pichette. Sorry he couldn't be here himself today to talk about it, but I wanted to make sure to convey that message. Obviously, as we all know, healthcare costs are a really significant challenge in Vermont. They're a real driver for a whole number of challenges and costs that we face as a state. ArrayRx, as you can see in the letters that Peter handed around a minute ago, really has an opportunity to make a concrete dent in some of those costs. And we think that in an area that is can be very challenging to wrap your arms around and make a real dent, This is an opportunity to lower cost for Vermonters. If there were just 1% uptake over 1% uptake in Vermont and we see the same savings that folks are seeing in Connecticut right now, that would be 20,000,000 more dollars per year back in the Vermont respondents. So, and we can start with the presentation here, but just reiterating the point that I made a moment ago about how significant healthcare costs are, prescription drugs are a major driver of those costs. I'll turn it over to Peter to take it away with the program.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: So what we are proposing is for Vermont to join a multi state collaborative known as ArrayRx. ArrayRx runs a variety of programs. One such program is this discount card option that can be made available for free to any resident of a member state, and that is the specific program we are looking to join in the treasurer's office. ArrayRx was founded over two decades ago by Oregon and Washington, and the discount card program has been operating between those states since, I believe, 2005 or 2006, and since 2023, they've been expanding it to other states, recently Arizona, Nevada, and most recently Connecticut have joined as well. The basic vision behind this sort of collaborative is that states, when working together, can achieve things that they simply can't alone for all of their constituents. A few features of this discount card program, there's no cost to Vermonters to enroll, you don't pay a fee when you sign up, or any ongoing annual fee to be a member of the discount card. There's incredibly broad coverage for all FDA approved prescriptions and several over the counter items as well. The savings average up to 20% on brand name drugs and up to 80% on generics. It's accepted in more than 65,000 pharmacies nationwide, as well as the vast majority of pharmacies in Vermont. There's very transparent online tools that Vermonters will be able to use to look up pharmacies that accept the program and what price they would pay for different drugs as those pharmacies. It's a very privacy focused model. There's no selling of consumer data, which is something that we see quite rampantly in the private sector alternatives, in those discount cards business models. It provides really significant support for individuals, particularly if they have a gap in their insurance coverage or a lack of coverage for prescription drugs in particular, and the pricing model is designed to be much fairer to pharmacies and many of the private sector alternatives, and the governance structure is designed to balance as many interests as possible. So how will the program administration work? Well, the ArrayRx Collaborative will handle much of day to day administration of the program, they negotiate contracts with pharmacy benefit managers that manages the program and with the nationwide pharmacy networks. They operate a customer service email and phone line for tomorrow's may have

[Tim Bevil, Legislative Counsel]: an issue with the card.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: They actually administer the cards and verify eligibility and distribute them, and they maintain the IT and data security. Who is actually doing that work? It's public sector employees of the Oregon Health Authority whose salaries are in part funded through the ArrayRx program. What would our office be doing? We would be driving outreach and awareness of the discount card to make sure it's actually utilized, developing partnerships with on the ground entities across the state to make sure that they are getting it out into their communities, and participate in the steering committee that governs the collaborative budget, its contracting process, etcetera, looking out for Vermont's interests and Vermonter's interests in this program. How is the program funded? Why is it in your committee? The program is funded by a simple fee model where there is a small fee baked into the advertised price of the drug, so if you are a consumer and you see that a drug is gonna cost you $10 at your local pharmacy, that $10 includes a small amount of money that is remitted in that transaction up to ArrayRx. It is used to cover ArrayRx's operating costs according to the budget that the member states agree on, and any remaining funding left over at the end of the year that is not needed for the operating budget is redistributed back to the state, which we would receive in a special fund. Jen Carvey and Nolan will walk you through that in the text of the bill, And we would be able to use this funding to offset program costs. For us, it's really about, you know, whatever paid marketing we're able to do for the program. We anticipate that this fee revenue to be minimal. Connecticut, much bigger state, far more users than we're likely to have, receive it in the thousands of dollars a year, and that's because the fees are really set just to cover the costs of operating the program, they're not trying to generate substantial revenue out of Vermonters in these transactions.

[Tim Bevil, Legislative Counsel]: You keep saying small fee. Are we talking $10? Are we talking about pennies? We're talking in the few dollar range for most transactions. So a couple dollars for any transaction or like I said, you have a $10 prescription, is it $2 and if you're a $100

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: prescription, it's $2 The fee is static, but always less than the discount. Okay. So how does the card work? You can visit arrayrxcard.com, you can sign up, you can enter your name, your date of birth, and Vermont address, and then cards can be delivered to you instantaneously by email or by physical mail, if you would prefer. They tell stories about folks arriving at the pharmacy, going over to the pharmacy counter, either remembering the program or being made aware of the program, pulling out their phone, signing up, and having the card to use with that transaction right in and there, so it's incredibly vast and efficient. On the website, you can use these tools to find pricing for the specific drugs that you utilize and how those prices differentiate across pharmacies. You can see whether your pharmacy participates in the program, the vast majority in Vermont do. Here's an example, this is a tool you could use to find your prescription, so say you're trying to find some Adafacet and Calcium tablets, you would look up the drug, you would see on this map these pens are each representing pharmacies that accept the card, and you can see the pricing at various pharmacies. This is some data from Marea Rex that shows some sample drug price differentials, so you see on the left here the name of the drug, the formulation of the drug, and what the average cash price for a thirty day supply would be, with ArrayRx's average retail prices for a thirty day supply, and over on the right with ArrayRx's average prices for a ninety day supply. So you can see some really substantial savings for these commonly used drugs. Adavastatant is what I was looking up in the previous slide, you can see average price, 9, categorized $32 So who does this card benefit? Well, anybody is allowed to sign up for the card and can check on a case by case basis whether it's going to save them money on certain drugs, but there are a few groups that we think are particularly poised to benefit from this program. Uninsured Vermonters, those who lack coverage of any kind. Unfortunately, I think we're really concerned with premium rates rising if they happen, that we're gonna see more Vermonters foregoing insurance. Underinsured Vermonters, those who have really high deductible plans, limited coverage for prescription drugs, are very much exposed to month to month drug costs. That's about 31% of the state, we estimate. Seniors, without any pharmacy coverage, we saw, as I'm sure you all watched closely, over the last year, the Medicaid Advantage market largely collapsed throughout the state. We were very concerned as we were vetting this program that there may be a lot of seniors who in that transition failed to pick up prescription drug coverage. And if your insurance does not cover specific drug, so a class of drugs we can think about a lot people we're having in this conversation is GLP-one drugs for weight loss, which insurers are largely pulling back from covering unless diagnosed for specific reasons. But for anybody, there could be a case to case example, even if you have insurance, where this card will offer you a better deal. So here's a couple sample constituents. This is some data we could find on pricing and data we found from Mireorex and what it might cost for various hypothetical individuals. So this is a young woman who has a really high deductible bronze plan. She pays a lot out of pocket for drugs. She takes sertraline generic, as well as Adderall brands, it's a very expensive drug to be picking up without coverage of the brand medication, and you see here, if she's taking these two drugs and paying cash versus paying for a Rarex, might save about $153 a month. Here's another example of a senior Vermonter who has no pharmacy coverage. They take three very common medications for seniors. They try to find the cheapest available option they can, three generic medications, so they're already not spending too much a month on drug, but even with a Rarex, they could save another $50 a month. And this is an individual who perhaps his insurance used to or never did cover GLP-1s for weight loss. They want to use this medication for weight loss. It is simply unattainable at a $1,000 a month retail price without insurance, but with a RayRx, it's still expensive, but maybe then budget for this individual, it could save up to $820 a month. So the legislative journey of this legislation to date passed out of House Health Care eleven-zero, made its way through that body in a favorable floor vote, and was voted out, I believe last week, Senate Health and Welfare, five-zero, and of course there are folks in this room who are gonna test me on that. I'm happy to answer any questions now, but I also wanted to put contact information up myself and Deputy Treasurer Sher, who opened this up today. Always available to answer any questions.

[Sen. Ann Cummings (Chair)]: You may not remember, but what was the reason given to by the no voters, you know?

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: So, have to talk about that. When we first presented this option, there was a mixed reception from small independent pharmacists. A couple small independent pharmacists come forward and said that they liked the program, they wrote letters of support, which we can make available to the committee, but if had others concerned, then it may eat into their margins, because these private sector alternatives quite often do, and quite often do them aggressively. You know, we've been in a lot of dialogue with those pharmacists. We've had a number of conversations. I don't believe they testified in opposition to the bill in the Senate, and there are a few reasons why we think that this is a, you know, a good policy for Vermont and the right balance of interests. You know, I mentioned before that public sector governance model and why that was so important. When we talked to pharmacists in Oregon who've been using this card for over twenty years, they pointed to the fact that, you know, they are represented on the Arraya Rex Steering Committee by public sector officials who care about pharmacy networks and pharmacy access just as much as they care about consumers. That's not the case in private sector alternatives, so we have absolutely no incentive to try to balance the needs of pharmacies. Another important thing to consider in this program is that nothing in this bill makes this program mandatory for pharmacies. Nothing in this bill requires them to contract with PBM who manages the card. Most already do and would accept this card if brought it from out of state, but there's nothing in this bill that makes you nor is there anything in this bill that requires you to process a transaction or fill a prescription, even if you do contract to accept the card, so it's entirely optional for other pharmacists, and for those reasons, it's important to continue to afford

[Sen. Ann Cummings (Chair)]: them. So,

[Tim Bevil, Legislative Counsel]: I can sign up. I can go home today and sign up for this card. That is correct. Okay. And the state's not involved at all right? So I understand it.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: Okay. Oh, so excuse me. Sorry. At at the moment, you would not be able to sign up. If we passed this law, you you would be able to.

[Tim Bevil, Legislative Counsel]: So I can't sign up for an ARRAY, a REX card, not right now?

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: Not right now

[Tim Bevil, Legislative Counsel]: at the moment. Because I live

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: in Vermont. Yes. Vermont's not a

[Tim Bevil, Legislative Counsel]: fair state. So this bill solves that. Yes.

[Sen. Ann Cummings (Chair)]: Thank you.

[Tim Bevil, Legislative Counsel]: Doctor. Brock? I've had

[Sen. Randy Brock (Member)]: experience with this kind of program before, and there are probably 10 or 11 different cards that are available that provide very good levels of discount in Vermont. There was a time five or six months ago when I was trying out those cards versus my private insurance. It's the typical UnitedHealthcare Medicare plan for prescription drugs. What I found is I could buy my prescription, most of the prescriptions I had, for almost 50% of what that discounted Medicare prescription drug card would cost us. Those were available just over the counter without doing anything about signing up. Everything from GoodRx to those types of programs They're available in Vermont. The problem is people don't use them. One of the reasons people don't use them is A, there's not an easy computerized way to find the cost of the drug that you want. You have to get it from the pharmacy because the pharmacy has the computer lookup to be able to lookup the drug. That's one. And two, pharmacies are annoyed. They don't like to have tons of people come in and everybody asking for all the discounts that are available to us. That's one of the major problems that we have. Whether we can solve it legislatively, I don't know. This program, I'm assuming you have the ability to find out what the cost of your drug would be versus the cost of any other insurance that you That's a major, major advantage.

[Sen. Ann Cummings (Chair)]: I just looked up lisinopril just before you did, and it's right there. It tells me where my pharmacies are. There was a significant difference in price between pharmacies, so it allowed me to shop around. If you're a senior who doesn't do computers, which are getting to be fewer and fewer, you would have a problem, but I could do that. I'm not sure what my where I'd find out what my insurance covers.

[Sen. Randy Brock (Member)]: Mhmm. But Talk about it. You know, a transparency bill.

[Sen. Ann Cummings (Chair)]: But the numbers I got were, I would say, lower than I've been paying on my insurance.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: You're quite right, Senator Ann, when we were vetting this proposal we encountered this same problem that it could be really hard find out how much a prescription drug costs, and we were going through that process as we try to figure out how much would people save if they used this card, and one of the reasons we like it is the real price transparency for consumers.

[Sen. Ann Cummings (Chair)]: Average wholesale price is known fondly as eat what's paid. Yep. To try and find out the actual cost of any pharmaceutical is virtually impossible. And I think we may look. We spent two years at least in this committee working on pharmaceutical prices. Did one thing with data mining and lost gloriously, I'm told, in the Supreme Court. And I think but, yes, this is it is the most frustrating thing to deal with. And if you wanna get really frustrated, go online and look at Canada Pharmacy Yeah. And their prices. Yeah.

[Sen. Randy Brock (Member)]: But you don't wanna look

[Sen. Ann Cummings (Chair)]: at Canada. The one I looked up because my husband just had a new drug, so I know what he pays online. It was the lowest price he was double what I could get on

[Tim Bevil, Legislative Counsel]: a

[Sen. Ann Cummings (Chair)]: RayRx. That but that's this country versus the rest of the world. I I

[Sen. Ruth Hardy (Member)]: ask a question. Sorry. I missed the beginning of your pitch. But but this is, you use this card instead of your insurance?

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: Yes, that's a very important detail. When we introduced this legislation, no state allowed, you use it instead of your insurance, an entirely different way of processing the transaction, and no state state had allowed money you spent through this card to be counted towards your deductible, although Connecticut is in process of making that change. House health care amendment bill has made it so that if you have insurance and you get a better deal for Rarex, you can buy the card for Rarex and file a claim online against your insurance company, and the money you spend with Rarex will be counted towards your deductible.

[Sen. Ann Cummings (Chair)]: Okay. Does this bill do that? Yes, this bill does that. Okay. It can count against your deductible. And

[Sen. Ruth Hardy (Member)]: I'm just looking it up as you guys were talking, but this is essentially a public consortium of states. It's not a private No. There's not somebody There aren't investors behind this that are making a ton

[Sen. Ann Cummings (Chair)]: of money off of all of us.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: Yeah. This is a collaborative of states, you're quite right. Five states today, Oregon, Washington, Arizona, Nevada, Connecticut, actually Ohio as well, though they have prescription.

[Sen. Ann Cummings (Chair)]: Is it a red and blue? And

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: the stat work, the actual administration is done by public employees of the Oregon Health Authority, whose salaries are funded in part by the ArrayRx budget, which comes from the fee revenue paid through transactions, and the oversight of those staff and that budget and the contracting process is done by the steering committee of member states, of which Vermont would be a member if

[Tim Bevil, Legislative Counsel]: we were to pass this legislation.

[Sen. Ann Cummings (Chair)]: Got it, okay.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: It's entirely helpful, sir.

[Tim Bevil, Legislative Counsel]: Okay. Is there, hasn't been

[Sen. Randy Brock (Member)]: any negative experience with other states in which public private insurers that are now also in business depart those states or raise prices at those states, or do anything else that is anti consumer as a result in order to make up

[Tim Bevil, Legislative Counsel]: the profits that they lost through what?

[Sen. Randy Brock (Member)]: A raise to leave.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: We didn't hear from any of the individuals we spoke with in any other states about issues of their insurance markets. Change. Blue Cross Blue Shield testified in support of the legislation. Cigna sent in a letter of support as well, if I'm calling correctly. At least we spoke to them. And that's because it actually can reduce their costs, because if somebody who is a member of those insurance companies is using a rarex because you're getting a better price, a lower price, and you can look at some pretty clear scenarios where if you have major savings, even though that's still counting against your deductible, if you're on these higher prescription medications, maybe you hit your deductible early in the year after paying sort of good prices out of pocket. That's a big loss an insurance company. And if that individual can find a much cheaper alternative with this card, it's a benefit.

[Sen. Ann Cummings (Chair)]: Do we have any more questions with the treasurer's office? We'll let Jim walk us through really quickly and we'll let Helen give us thing and our COVR is here, so maybe we'll get to hear from them.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: Thank you for your time. Very final thing I'll mention is there's

[Sen. Ann Cummings (Chair)]: We're trying to roll loading things out.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: District level projections on your

[Sen. Ann Cummings (Chair)]: Yeah. I don't know if we're gonna get to 07:53 or three eighty five today. I'll Since the openness came out. See. Five. Yep. Okay. I think we're on a roll, chairs. Great.

[Jen Harvey, Office of Legislative Counsel]: Good afternoon. Jen Harvey from the Office of Legislative Counsel. Oh, that's cute. I'm ready to go here. So we are looking at H577. I'm mostly showing you that the bill has passed the House because the amendment from the Senate Housing Law Fair Committee is pretty minor, but I'll show you that in a moment as well. And I'll just give you the high level version. Section one establishes the Vermont Prescription Drug Discount Card Program in an existing chapter on prescription drug cost containment. It has it administered by the office of the state treasurer. It describes some of the parameters that the treasurer's office went over with you. It has the monies that are received by the program from any source goes into what gets retitled the Financial Literacy and Economic Empowerment Trust Fund. As introduced, bill would have created a new special fund for the money to go into. The House Ways and Means Committee wanted to use an existing special fund, so we expanded the purpose to reflect some of the other activities by the treasurer's office. There's language that refers to this idea of the amount paid for a prescription drug after using the card by someone who's covered by a health insurance plan being attributed toward their deductible and out of pocket responsibilities, and the next two sections of the bill amend the insurance and pharmacy benefit manager statutes to make that happen. And it requires an annual report starting in 2028. You'll see there's a one time report, twenty point seven as well, but detailing the activities of the program during the previous year, including how many Vermont residents and pharmacies participated and what the savings was on the drugs. This is where the health welfare amendment comes in, so we'll look at that again in a moment. Section two is the health insurance statutes provision, doing the actual change to ensure that the amounts paid by or on the covered individual, including through this prescription drug discount card, would be counted toward their out of pocket responsibilities and deductible under their plan. It also requires the health insurer or pharmacy benefit manager, or both, to make readily available on their website a downloadable proof of payment form and provide notice to covered individuals at least annually that they are responsible for providing the proof of payment if they paid out of pocket without using insurance to ensure that the health insurance plan can properly attribute their spending to their out of pocket responsibilities. It also gives the potential for them to use an online mechanism that isn't just a downloadable form. Section three is the same language, or similar language, the pharmacy benefit manager statute.

[Sen. Ann Cummings (Chair)]: And then

[Jen Harvey, Office of Legislative Counsel]: section three amends the financial literacy and now becomes an economic empowerment trust fund, so a lot of it is just updating the name and expanding the purposes beyond the existing purpose about financial literacy to also support other economic empowerment opportunities for the founders, and referring specifically to the funds being available to defray costs associated with administering Vermont Prescription Drug Discount Card program. Section four has the one time report due by January 2027 on implementation of the program, including any recommendations for improving program administration, and an estimate of the projected cost to the state in the event that additional financial support is determined to be necessary to support the program. If there is found to be a need for additional funds. Section five appropriates $50,000 in fiscal year 2027, and I believe this included in both house and senate versions of the budget, to the Office of the State Treasurer for cost of developing and implementing the program, and the act would take effect on July 1. And then all, if there are questions on this, I'll answer those, and then

[Sen. Ann Cummings (Chair)]: pop up the health and welfare amendment. It's actually five's in the budget? It's in the budget, right? Yes, okay. The chair of health and welfare is on vocational. Yeah. Good question. I was gonna Listen to you.

[Tim Bevil, Legislative Counsel]: Never have.

[Jen Harvey, Office of Legislative Counsel]: And then here is the brief amendment from Senate Health and Welfare. This does The three first is to take out that annual report requirement briefly in order to make a change, and put it back in with the change. So, the change is adding to the annual report the impact, if any, of the program on the viability of Vermont's pharmacies. So there had been some concern about whether there would be a negative impact on pharmacies, so that would be part of the annual report. So they would report annually at least how many, the number of Vermont residents and pharmacies participating, amount of savings on prescription drugs, and the impact on the viability of Vermont's pharmacies. And the second is just adding in a missing word in one of the sections that was referenced to the drug discount program without saying correct discount card program, so fixing that. I see that.

[Sen. Ann Cummings (Chair)]: I guess question for the treasurer's office, is there anything that prohibits independent pharmacies or maybe the Vermont Independent Pharmacies Association from joining this? Do you have to be a national chain?

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: Peter Traumaleed, obviously the state treasurer. You do not have to be a national chain to be a part of this program. The vast majority of Vermont pharmacies already accept the rarex card, so someone from out of state were to bring one, but there's also nothing in this bill that requires them to enter into a to accept it, nor even if they have a contract, they're legally obliged to fill a prescription if they feel like it's not doable for them.

[Sen. Ann Cummings (Chair)]: Okay.

[Tim Bevil, Legislative Counsel]: I could probably also question the trick. How long

[Sen. Randy Brock (Member)]: will

[Tim Bevil, Legislative Counsel]: it take you to set this all up if this bill were to pass and when can Vermont start taking advantage?

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: I mean, the the biggest holdup will be the state's contracting process because we have to enter into a legal contract with their Air Act Collaborative. Our hope is to have that done by the end of this year so that it can be launched sometime late twenty twenty six and be up and running as soon as possible. But that's the real barrier. As soon as we've got the contract in place, folks can sign up instantaneously.

[Sen. Ruth Hardy (Member)]: Thanks. I don't know if this is special for Jack or for Peter, but there I'm looking again on their website, there's a steering committee. Does the bill say who is our representative on the steering committee?

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: The state treasurer would have the authority to appoint the steering committee member for better rest.

[Jen Harvey, Office of Legislative Counsel]: Is that in the bill? No, but the treasurer's opposite administers the program under any of

[Sen. Ann Cummings (Chair)]: Okay, got it, okay. Okay, we're ready to hear from Nolan? Yep. Okay, thank you, Jen. Sure. Nolan? No, we're gonna get rich.

[Nolan Langweil, Joint Fiscal Office]: For the record, Nolan, will join this long list to steal a line that has been used from the legislature, I think everything about this has been said, I just haven't said it yet. Okay. Which is, basically there's $50,000 appropriated, it's in the budget construct. The treasurer's forgetting the word out,

[Sen. Ann Cummings (Chair)]: if you

[Tim Bevil, Legislative Counsel]: have it

[Sen. Ann Cummings (Chair)]: With the advertising, basically, isn't Yeah. Getting the word out to people.

[Nolan Langweil, Joint Fiscal Office]: What we heard is the success of the program, it depended on people knowing that it's there. Yeah, right. So the other thing I'll just reflect, this went to ways and means on the other side initially because there was some language that was taken out about the treasurer having the ability to raise a fee, ways and means took that out. I know that's not why it's here. It's here because you guys got our insurance.

[Sen. Ann Cummings (Chair)]: Any questions?

[Sen. Ruth Hardy (Member)]: Yes. Actually, was the fee to cover the costs and instead they go with an appropriation, or what? The fee

[Sen. Ann Cummings (Chair)]: Do you want me to answer that? Yes.

[Jen Harvey, Office of Legislative Counsel]: So, there was language allowing the treasurer's office to impose a fee if a fee was determined to be needed and as more information was learned about the program, we learned that the fees are included as part of the amount the patient pays, and so there was no fee amount needed to be established. So that also was raised concerns about whether to delegate the legislature's fee setting authority, etcetera. So,

[Sen. Ruth Hardy (Member)]: if the fees are embedded in the program, they're embedded in the amount that the consumer pays. Right. Is there transparency on what those fees are anywhere? We've talked about them. Turn back to you on that.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: Okay, and I'll note that it was never our intent for our office to be setting a fee separate from the fee existing in the program. We proposed the language that we thought was necessary to make that doable, then more narrow language was viable as well. We were happy to support that. The exact value of the fee is not typically disclosed because it is negotiated in a competitive marketplace against other private sector companies. Oh, sorry, PBMC? It is a couple of dollar range, always smaller than the discount provided and always baked into the price you see on Ararex's website. If it sells you a drug, it's gonna be $9 at Kenney Drugs, it's gonna be $9 at Kenney Drugs. It's not gonna be a fee at a

[Sen. Ann Cummings (Chair)]: a Okay. So you know going in if your fee is bigger than the

[Sen. Ruth Hardy (Member)]: Than when you pharmacy next door. Or that one you could get when using your allergens. Yeah. Well,

[Sen. Ann Cummings (Chair)]: just know that I have to figure out how to

[Tim Bevil, Legislative Counsel]: make a culture. One of things when you

[Sen. Randy Brock (Member)]: go to the pharmacy to buy, because of drug, the fees do vary presumably because they're embedded in the price that you actually pay. With Array, do you find that you're paying, in effect, a standard fee for each prescription or the the fee varies depending upon the total cost of the prescription itself?

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: My understanding is that fee is standard and the price variance between pharmacies is due to the negotiations with the PBMs and not the fee varying on the Rarex incentive.

[Sen. Randy Brock (Member)]: So then you still have, you then have part of the fee, the price that you're actually paying, the fee that already is charging, the fee that is there, I assume there's a PBM involved somewhere, as well as the fee that ultimately gets paid to the company that is the manufacturer drug.

[Tim Bevil, Legislative Counsel]: So there are three parts of the fee, is that correct?

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: There are two parts of the fee. There's a portion that goes to the PBM that administers the program under the direction of the steering committee. PBM's called Navitas. There's a portion that covers the ArrayRx costs, so largely the public employees in Oregon who are administering the program, the legal fees per contracting.

[Sen. Randy Brock (Member)]: You're saying that, in fact, Array has a PBM that is in, as opposed to the intermediary that Kenny Drugs or Walmart and so on are using. Yes. So they're using separate PBM. Okay.

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: So that PBM takes a piece, a rate takes a piece, whatever's leftover is returned to The States.

[Sen. Ann Cummings (Chair)]: Okay.

[Sen. Randy Brock (Member)]: Have any amount of speaker

[Sen. Ann Cummings (Chair)]: Ready for a lotion? Do we need more testimony?

[Tim Bevil, Legislative Counsel]: I would able say for the age five seventy seven has received an amendment from the Senate Committee on Health and Welfare.

[Sen. Ann Cummings (Chair)]: Okay. Senator Chittenden has moved that we approve, what is the number of this one? Age five seventy seven as we received it from the Committee on Health and Welfare. Is there any further discussion? Are there any amendments? I'm gonna do this. All those in favor, aye. Aye. Opposed, say no. That's seven zero zero so you can check all our names. Okay. We're on the floor.

[Joint Fiscal Office analyst (unidentified)]: Just gonna take

[Sen. Ann Cummings (Chair)]: this one for that Let's see. Okay. I don't have

[Tim Bevil, Legislative Counsel]: What? Yeah. Okay. You know what?

[Sen. Ann Cummings (Chair)]: Are you doing with my health and health care? No. Yeah. Jenny? Jenny's doing that. Okay. Stan, did you want to come up and maybe we can get the OPR bill out? That would be perfect. Thank you. I think we just weren't totally here. Midwives and Well, yeah, exactly what was happening. So wanted to just give you a chance to answer some questions and maybe help us understand what is going on. So let me we were working primarily off of the overview. Is that the best place, or should would it be better to just do a what 2,000 foot section by section?

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Whatever works for you. I don't have the overview of the front

[Sen. Ann Cummings (Chair)]: of the Why don't we just do a section by section, and you can tell us what you were doing there or what to do there. And we have draft 4.1. I assume it came from the house.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Okay. So I have draft that's 3.1 dated for 2026, but I don't think there was much change after that. So I'm happy to go ahead. And for the record, Jennifer Colen, I'm the director of the Office of Professional Regulation. Good to be with you all today and happy to answer any questions as we go along. So in section one, basically, we're adding rescission to the authority of OPR. Sometimes we have to rescind the license administratively because we pushed the wrong button in the system and inadvertently issued a license, or somebody paid a fee and the check bounced or something like that.

[Sen. Ann Cummings (Chair)]: So this is not quite as revoking a license. It's not our practice. That's correct. It is a technical, we're gonna rescind it. That's right.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: And so, we give, if they've had the license for less than thirty days, there's a notification that resending, and then we rescind, and then there's an opportunity for them to ask to be heard in front of a board or an administrative law officer. There's due process when it's less than thirty days, or if they've had the credential for more than thirty days, there's more due process. Give them notice and an opportunity to be heard before we rescind. That's built into this change and you know, been administrative.

[Sen. Ann Cummings (Chair)]: Because you didn't pay your fee and you came in and paid your fee.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Yeah. The most recent example I have is we inadvertently issued someone an RN license just prior to them graduating from school. They had a they had another credential from us, but they hadn't quite finished up the RN.

[Sen. Ann Cummings (Chair)]: So you rescinded it and said, when you finish your classwork.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: That's right. And we'll turn it back on. And that person did request to be heard in front of the board. The board listened to their request and said, we're gonna wait until you graduate and finish your course. Okay. So she did try to get it

[Sen. Ann Cummings (Chair)]: out on her. Yeah. They got kind of a jump on the system. That's right. I'm gonna go to work day one. That's right. Okay.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Yeah. So then section two also deals with this rescission process and section three. I'm happy to go through that in greater detail, but I think you

[Sen. Ann Cummings (Chair)]: guys That's really not.

[Joint Fiscal Office analyst (unidentified)]: Okay. Section

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: four, we made a small change to the mandatory reporting requirements for healthcare facilities. We changed a double negative to a positive so that it's just a little clearer for facilities what they have to report to our office when someone engages in unprofessional conduct when one of their licensees. Section five, we made an attempt to oh, section five. Sorry. Have to say the. We made an attempted fraudulent procurement and unprofessional conduct. Right now, fraudulent procurement of a license through misrepresentation is unprofessional conduct, but now we've made attempted unprofessional conduct.

[Sen. Ann Cummings (Chair)]: I tried to find one, but you didn't say no. We don't think so. So I failed in spite of You

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: failed, but you you tried to do some Right.

[Sen. Ann Cummings (Chair)]: You should stop. Yeah. That's okay.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Section oh, section five also references the authority of the office to create through administrative rules a program offered for people with credentials from our office to enter into alternative to discipline programs. Right now, we have this in nursing. We have what's called a practice remediation program, where if someone makes a mistake at work that doesn't quite rise to the level of unprofessional conduct, but is a problem in their practice, they can go through this program, take coursework. There's no public being on their license, but it just ensures that they understand That's what that problem right. And so we don't offer this for people who have engaged, you know, had multiple instances of this. It's kind of a, you know, you made this one mistake. And then the other thing we wanna have, which we also have in nursing, is a program where if someone self reports a substance use or alcohol issue to the office as a practitioner and they want they want OPR to, to do some monitoring of them, where they have to have UAs and, you know, get substance use treatment, we can monitor their progress through a program. And it's really an accountability measure for someone who wants to make sure that it's not impacting their practice. Okay. So, section six, we want board members and advisors to be the age of majority. That's pretty simple.

[Sen. Ann Cummings (Chair)]: Yep? With terms that you had people applying who weren't of the age

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: of majority. We had someone who was a high school student who wanted to who was interested in a profession and wanted to be on one of our boards as a public member. And we

[Sen. Ann Cummings (Chair)]: deal with a

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: lot of serious topics, and there's an ethical oath, and there's confidentiality involved in what what we do with our team. So it just didn't Yeah. So we just wanted to clarify that, Paul. Yeah. Section seven had a reference to a preliminary license denial process that we actually changed years ago. We no longer have a preliminary license denial process, so we just needed to remove the word preliminary. And so that's just a little bit of a cleanup. Section eight has to do with accountancy and mobility for CPAs across jurisdictions. And that national mobility is something that already kind of exists in that CPA profession under CPAs. So we wanted to recognize that this section also has an additional pathway for folks to become CPAs. So the changes allow for folks to be licensed if they have a post bachelor's degree with a focus on accounting plus one year of experience or a bachelor's degree with a focus on accounting and two years of experience. Right now, you have to have a master's plus in order to get a CPA, you have to pass the exam. So the coursework that's required is beyond a master's degree. So this allows this removes some unnecessary barriers in that profession. And our understanding is that there is somewhat of a CPA shortage. So this is being done nationally so that folks can.

[Sen. Ann Cummings (Chair)]: Operator, the auditor has a question. Curious as to why the good character is taken out of that.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Yep. So we're taking the the good character provisions whenever we open up chapters, chapters that have that, we remove that because we already when someone applies for a license, they have to disclose to us their criminal involvements and their

[Tim Bevil, Legislative Counsel]: criminal

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: history, and we go through an analysis of like, is that criminal history related to the practice of the profession? Is that something that the public needs to know about in order to be safe with respect to this practitioner. So we already kind of go through that process. It's baked in. Jurisdictions that have good character provisions are kind of moving away from that because it's a very subjective standard.

[Tim Bevil, Legislative Counsel]: I thought it was you were

[Sen. Randy Brock (Member)]: just going into accountants specifically.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: No. No. No. Whenever we open a chapter Do you understand? Nope. We we have different ways of looking at that instead

[Sen. Ann Cummings (Chair)]: of a subjective. It's good idea.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Section 11, dentists. So there's this academic limited academic dental license. I heard you speaking about that earlier. We do. And it's a zero fee, which you you made the great point that the reason we have that in there is because if there was no fee, people would be wondering about paying the regular dental fees. They'd call you. Yes. So rather than get those phone calls, we just wanted to make it real clear. There would be zero fee. Section 13. Section section 13, incarcerations as I kind of flip through. Yeah. New York services. So we just wanted to clarify, and and we we had some questions in our about whether alkaline hydrolysis and natural organic reduction of human remains, if that was part and parcel of You the practice of

[Sen. Ann Cummings (Chair)]: just looked it up, it's pretty wild.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: It it's a just in simple terms, and I'm sure there's a Okay. Greater technical way to explain it, but it's basically cremation by water.

[Sen. Ann Cummings (Chair)]: It's I'm going to burial at sea. Is that alkaline hydrologic?

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: No. But, yeah, alkaline hydrolysis, you know, rather than traditional cremation, which puts particles into the atmosphere and is like Oh, okay. More environmentally friendly. It's not It's okay. Right.

[Tim Bevil, Legislative Counsel]: It speeds up the decomposition.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Oh, right. Okay. Don't think too much about it. Twenty four Twenty four hours.

[Sen. Ann Cummings (Chair)]: What? Section 14. Keep going. Thank you. It's Friday. Yes.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: So section 14 for APRN renewal, we are removing the active practice requirement. So APRNs have national board certifications, much like physicians do, and those national certifications require them to have a lot of continuing education, and that's the way we measure their ongoing competency. To have an active practice requirement, we're moving away from that. It brings it more in line with what's required for RNs and LPNs and other professions. That's that change. Pharmacy, section 14.

[Sen. Ann Cummings (Chair)]: Okay. Oh, this is the tab. Yeah. This is the one I want to make sure since we're doing allowing pharmacies to prescribe prep and pep. Yes. While we're changing it, so that is because I think that's gonna go through. Haven't

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Yes, that is in here. So, section 14A, we have a pharmacist can prescribe pursuant to state protocol that's kind of created in collaboration with OPR and the director and the commissioner of health that allows pharmacists to prescribe certain medications. So section And 14 let me just turn to the right page here. So allows 14 a for patients at 18 years of age or older medications for the prevention of HIV virus, including those for pre exposure post exposure prophylaxis. That is included And in that would be pursuant to a state protocol. We would work with BDH too. Section 14 also expands pharmacists prescribing authority in the practice of clinical pharmacy to test and treat, to test and prescribe drugs for treatment of COVID-nineteen, flu, and strep. This has been part of the Rural Health Transformation grant process. Test and treat for these three limited conditions, COVID, strep, and flu was also included. That's in section 14 b. And then you'll see in section 14 c, we wanted to make sure that pharmacy technicians would be able to do the testing that's permitted in 14 b. So that just adds the testing. And and pharmacy technicians are doing that testing when a licensed pharmacist that is on-site available to assist. So there are guardrails around when they can do that.

[Tim Bevil, Legislative Counsel]: Section

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: 15, psychologists. You may have heard that we're kind of engaged in a mental health licensure reform process. We've done a mental health licensure study that was two years in the making.

[Sen. Ann Cummings (Chair)]: It

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: included psychology. Basically, the point of that study was to identify barriers to licensure of mental health and to streamline our processes because we need more mental health practitioners in the state. So we engaged in that work. We're going to be coming next year with some proposed legislation to do that streamlining and reform work in our statutes. But until then, in the field of psychology, there is really strict rules around post degree supplementation of coursework. So, very limited opportunities if you've earned your master's or Doctorate in Psychology to supplement coursework to meet the exact requirements for licensure through OPR. And so, if you miss, you know, three courses that add up to nine hours, you may have to go back and start completely over if you want a license from us. We've had a couple of petitions from people who have been through educational programs, who would be perfectly competent and safe to practice, where we could not deviate and issue that license. They petitioned us to actually engage in rulemaking, which we will be doing after our statutory reform next session. But in the meantime, we have this section 15, which allows OPR to consult with the Board of Psychological Examiners, and through policy, allow for greater flexibility for master's and doctoral degree applicants to supplement that coursework if it's needed. So this is just kind of a fix in the meantime, and you'll see that this authority expires after a couple of years. So, we this was just a a fix in until we can get that statutory reform, completed. Next section section 16 midwives. So the first changes that you will see is that we are eliminating this advisory committee. So midwives are an advisor profession at OPR. That means there's no board. We We engage with advisors to provide us with subject matter expertise when we're doing rule making or in our enforcement cases, when we get a midwife case. We use those advisors to help us assess that case and decide, should we charge this person or is this not a problem? But we have, in addition to that, an advisory committee that required reporting to OPR and to the Commissioner of Health. It was born, I think, out of distrust of midwives when this profession was first onboarded. This advisory committee is supposed to have physician members also. And I'll just say that it's been really difficult for us to fill the seats on this advisory committee. It hasn't really been a functional committee in some time and really hasn't been a value. So we would like to eliminate that. We will still have advisors just like we do in any other advisor profession. And so this was also a little bit duplicative of what the advisors do, which is provide us with subject matter expertise. So we'd like to eliminate that.

[Tim Bevil, Legislative Counsel]: That was really helpful. Thank you.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Yeah. No problem. And then section still in section 16, I believe.

[Sen. Ann Cummings (Chair)]: I think we can.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Are you are you good with midwives? Do you

[Sen. Ann Cummings (Chair)]: have any other questions about midwives? I don't think so.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Okay. No. Because this does the the the main other changes for renewals, we're just saying midwives have to maintain a current certification with national organization that certifies midwives. So they just have to be named that. Next section, section 17, we're doing a sunrise report for speech language pathologist assistance. We're happy to do that, and actually that report is in process already.

[Sen. Ann Cummings (Chair)]: You get to seventeen, which

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Oh, good. Is here. Excellent. Ready to, yes, talk about massage therapists. That what we

[Sen. Ann Cummings (Chair)]: have questions about? There's fees in here.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Okay. So, yes, there are fees in here. So what we're doing this session, or just to remind you actually, massage therapists are a registration. It is not a license. A registration is something that requires no qualification for. We studied whether massage therapists should be registered or licensed. We've done multiple Sunrise studies on this, and we've determined multiple times that registration appropriately protects the public because really the concern that we have in massage therapy is human trafficking and sexual misconduct. We don't get complaints about massage therapists giving a bad massage and hurting someone. If we did see a lot of complaints like that and if there was a ton of national data around that, then that might say, People need to be more qualified to do this. But we don't see that. What we see is, in our enforcement data that we have, shows that we're getting sexual misconduct complaints. And so we address those, we've removed practitioners from practice, and registration is working just fine at this last year. This fact this chapter, or these changes regulate establishments now. So now we're registering establishments. And the reason we're doing this, again, is to have another tool in the toolbox to fight human trafficking. So this gives us authority to inspect massage therapy establishments, and it requires massage therapy establishments to provide us with business registrations and who their principals are and information so that we know who's operating this establishment. And again, tool and human trafficking, combative human trafficking. So, the fees for massage. So the the regular fee for registration is a $100 for an initial fee, and that's set out in three days day one twenty five. Let me just turn. Actually, I'm going a little bit out of order, and I don't

[Tim Bevil, Legislative Counsel]: want it confused at all.

[Sen. Ann Cummings (Chair)]: 18A is speed. Okay. 18.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Yes, eighteen eighth fee. Great. For registrations, the initial fee for registration is $100 in any profession. That's what the fee for an establishment is. The renewal fee is $275 That's the normal fee for any renewal of a registration. Now, we heard testimony in House Ways and Means from a practitioner about husband and wife practitioners and practices that have only two people, and how the burden of those licensure fees might disproportionately impact establishments with only two people. In ways and means, there was a change, or on the house side, was a change to reduce the fee for practices with only two professionals from $100 to $50 That's the initial fee, and then the renewal fee would go from, instead of being $2.75, it would be 75. That's for practices with only two people. If you're a solo practitioner, you do not have to register as an establishment. Really, the establishment registration is for two people or more, and if it's two people, you're going to get a reduced fee. You good on that? Yeah. Okay, great.

[Tim Bevil, Legislative Counsel]: Yes. Is this common in other states that they're starting to register sites too because it's proven efficacy to address the concerns that you've been hearing?

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: That's a great question. Think other states, you know, human trafficking is prevalent in every single state, and we're all grappling with how can we get tools in the toolbox. So I do think establishment registration is something that's happening elsewhere,

[Sen. Ann Cummings (Chair)]: Yeah. Issue in Vermont. Yes. I think we're gonna do this one. Yeah. You know, I do two more.

[Tim Bevil, Legislative Counsel]: You don't have this one worn for a boat today, but This

[Sen. Ann Cummings (Chair)]: Yeah. To warn it for both. I don't think so. Best practice is to update everything. Think it's gonna happen.

[Jen Harvey, Office of Legislative Counsel]: Refresh your screens, everyone.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Did y'all have

[Sen. Ann Cummings (Chair)]: any- It's the end of the session.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Did y'all want me to continue, Doctor. Biller, with that, did did I really answer all your questions?

[Sen. Ann Cummings (Chair)]: There's really, yeah, that is helpful. I'm at the, he says a couple fee changes in here and things. Well, part of the conventional endorsement of existing license, a $100.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: We moved we had some fees that were in an incorrect section of our fee bill in '3 BSA 01/25. So we had to move several of those from section b into section a. So that was, I think, the confusion earlier. So the only new fees in here relate to massage therapy establishments. That initial registration fee is a $100. The registration fee is already in there, but we had that special reduced fee for practices with only two people. Okay. So, that's really the only Okay. Fee in That's right. Except for the zero fee. Except for the zero fee, and then whatever savings we're going get from this midwife advisor committee being Well, it

[Sen. Ann Cummings (Chair)]: doesn't end, you're not gonna get any savings for not meeting. Yeah. Okay. Committee. Questions? What's your pledge? Do you feel ready to vote on this one, or would you rather let it purple? I approve H58

[Sen. Ruth Hardy (Member)]: draft 4.1 as recommended by the Senate government as amended and recommended by the state government operations team.

[Sen. Ann Cummings (Chair)]: Okay. Senator Hardy, has you moved that we h 5 five eighty eight, and it was sent to us by the government operations committee. Is there further discussion? If any amendment? If not, all those in favor say aye. Aye. Opposed to say no. That's 700, and you can put a check next to everyone's name. Okay. Thank you, committee. I can report it in the morning. Yes. That would be great.

[Lauren Hibbert, Director, Vermont Office of Professional Regulation]: Okay. And that

[Sen. Ann Cummings (Chair)]: one is out. And we've done 77, which gets us to the bottom of the page. The first one is 753, which is we've got two of them up there. I'm getting emails on 753 now. I don't know. I've I don't know who's put the call up because the calls are coming in, and I'm getting cards. Yeah. Here's what. He's passed age seven fifty three out of committee. Oh, you're getting that. I'm getting that. I've gotten several. This is 753. This is the one we had one in here. We didn't do it. Basically, tells the PUC and utilities to do what they're doing, which is not disconnecting your electricity during a heat wave, a heat advisory. If I could find a copy of it.

[Sen. Randy Brock (Member)]: I thought I remember hearing from the

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: or utilities. They don't

[Sen. Ann Cummings (Chair)]: think it's necessary. I believe was

[Tim Bevil, Legislative Counsel]: We what you're hearing from utilities is that anything that we do that allows people to get murdered, it doesn't end up well.

[Sen. Ann Cummings (Chair)]: We did hear that, and we heard that they worked very hard to keep people from getting disconnected. That's what I want to make sure. I don't think this it asked for a study, but I don't think anything really bad is going to happen if it doesn't come out. So maybe we'll put this off till next week. And I have a small amendment to the breast also. Did this work? Yeah. Okay. So the other one, as people are here, but, you know, we get out of this age three eighty five, which is probably a little fresher in our memories, that it's coerced dead. Okay, we do have seven fifty three on our website, so we can take a look at that. This is That's $7.53 that you just talked about.

[Sen. Ruth Hardy (Member)]: Oh, wait. $7.53 is the course debt. Right? No. No. Great. That's the.

[Sen. Ann Cummings (Chair)]: Okay. Let's give ourselves then time to work on this, and we'll get Maria in. We've got. There was a we've got an amendment. The other one is up there is the coerced debt. We did that yesterday. I've got people in the room. It sounded like this was democracy at its best. Everybody went to the hall. Everybody gave a little. Everybody got a little. And there is not complete comfort on any side, but everyone thinks this is worth giving it a try and it basically would send the parameters for how someone could have a worse debt forgiven going to court, which they'd have to do now. And it also would allow financial institutions to put a hold on suspicious transactions. Yeah. That one, there didn't seem to be any controversy over. Are we comfortable enough to move that one or would you rather I feel motionable. I'm good. Yeah. I move that we approve H. That we concur with H. Three eighty five. Okay. Her current approved H three eighty five as it was sent to us. Some from health and welfare?

[Peter Trombley, Director of Legislative Affairs, Office of the State Treasurer]: Judiciary had it in the judiciary. They

[Sen. Ann Cummings (Chair)]: spoke it there. So Two sections that had to do with the court and released it to us. So it's as it came to us, and they, I don't believe, amended it. It's as it came from the house. That's right. Alright. So this is as passed by house. Is there further discussion? Senator Hardy has moved. Any further amendments? If not, all those in favor say aye. Aye. Opposed say no. I'm not hearing any no's, so I'm gonna call it seven zero zero. Okay. Who would like to report this one? You wanna do it? Sure. Plus you do. No. I have a feeling I am off to my eyeballs in committees of conference. I didn't know what the meeting been created for including this one, but Will it go to a props or anything? No. No. It's not. So it'll be

[Tim Bevil, Legislative Counsel]: alright. Wednesday? No. Still okay.

[Sen. Ann Cummings (Chair)]: Of course. Sure. Unless you really want it.

[Sen. Ruth Hardy (Member)]: I mean, if you don't wanna do it, I'll

[Sen. Ann Cummings (Chair)]: do it. Martine, you have other things. But if you don't, I if you can't have any next week,

[Sen. Ruth Hardy (Member)]: I have two bills next week so far on Tuesday, probably on Wednesday. But I'm happy to do it. I'm sure I can get an outline from somebody that will make it easier. You called her. You have too much.

[Sen. Ann Cummings (Chair)]: Why don't you? Because things have a lot. Okay.

[Sen. Ruth Hardy (Member)]: Do you wanna put yeah.

[Sen. Ann Cummings (Chair)]: Maybe change that. We have finished, I think. No. I can work. No. I think so. All significant. Nothing on the back. We have finished our work. It is 03:30. Uh-oh. We are getting out of here

[Tim Bevil, Legislative Counsel]: before

[Sen. Ann Cummings (Chair)]: 06:00.