Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair)]: Alright, we are back with the Senate Health and Welfare. It's still January 8 and we're going to go through reports with our alleged counsels. So for the record, go pay it.

[John Harvey, Office of Legislative Counsel]: Great, for the record, John Harvey, Office

[Katie McLean, Office of Legislative Counsel]: of Legislative Counsel. Katie McLean, Office of Legislative Counsel.

[John Harvey, Office of Legislative Counsel]: Alright, and so we have, and if you don't currently have this on your website, you will. We have a list of all the reports due to this committee. So we called it late twenty twenty five and early twenty twenty six, although there's a few that are earlier in 2025 and we have some future ones that go out beyond 2026 just to, for us to keep track of them and for you to remember some of the things or to learn about some of the things that the legislature has asked for. So if, and if there is a blue, if it's in blue and underlined, then it's a live link, which means we have the report usually on the legislature's website, Ginny Lyons posted somewhere else, but I've included the link here so you can easily access. So the first report that is on here is an expenditure analysis from the Green Mountain Care Board covering years 2021 and 2022. This is a little bit historical at this point, but they had taken a pause on the expenditure analysis, which is supposed to be a more frequent requirement. And they've kind of, I think, overhauled their methodology and approach. And so now they're going back and doing these reports for some of the years they missed. So this is the 2021 and 2022. The report itself is dated March 28, but it's posted on our website as having been received, think sometime in June or July. And so this is the It analysts the expenditures on healthcare, both for Vermont residents and for services delivered by Vermont providers. It gives you a really good sense of what kind of healthcare activity is happening that affects Vermonters and Vermont providers. Is one of the reports from Act 68 that we talked about this morning. So this is the one time report that was due on July 1 from the Agency of Human Services on the hospital spending reductions that they had approved as of that date.

[Katie McLean, Office of Legislative Counsel]: Next, there are quarterly reports regarding the Burlington Overdose Prevention Center. So the status of those grants using the Opioid Abatement Special Fund money. So in the July report, city council had approved the center. They're working on insurance coverage. So you'll see these quarterly updates throughout this presentation.

[Sen. Virginia "Ginny" Lyons (Chair)]: It's on our website now.

[John Harvey, Office of Legislative Counsel]: I just wanna go and

[Sen. Virginia "Ginny" Lyons (Chair)]: see how Okay. Thank you. There.

[Katie McLean, Office of Legislative Counsel]: Next is a report from Dale on the progress report on developmental services payment reform. This is the design of developmental services payment reform model for potential implementation in October, and then the final report was due in September. So this was sort of an update prior to that final decision. And it went to dry and dustbills. Right, a lot

[John Harvey, Office of Legislative Counsel]: of these reports that came in over the summer and fall were due to committees that meet when the legislature's not in session, but when they were on topics that were relevant to this committee, or in some cases they have future reports that come

[Sen. Virginia "Ginny" Lyons (Chair)]: to this

[John Harvey, Office of Legislative Counsel]: committee. Next we have the Vermont State Health Improvement Plan, which may be of particular interest to the chair. This is an existing report requirement that we've talked about in the past. It's technically required of the agency of human services, but it usually comes from the Department of Health, and it sets forth the health goals and values for Vermont. And this one, I wasn't specifically expecting it in any particular time, I was pleased to see it show up on the website. And it looks like it covers the period 2025 to 2030, so it may be of interest to you to see what things identify. Next is

[Katie McLean, Office of Legislative Counsel]: a monthly report on general assistance emergency housing. These reports are sort of covering the same topics. We've had monthly reports for a couple of years now, so you'll see these monthly reports coming in throughout the presentation.

[John Harvey, Office of Legislative Counsel]: Next, and this is our first one that doesn't have a live link, this is supposed to be quarterly choices for care report. So these are services provided to individuals who need or could use a long term care setting level of care, are able to receive services in the community. This is utilization and expenditures are what's supposed to be covered. I did lag this for someone from the Department of Disabilities Aging and Independent Living yesterday. I couldn't find any of these reports on our website, so they might need to resubmit. Next we have the first of the monthly reports from Act 68 on an update on the outcome measures for healthcare transformation that the agency identified. I'm used to using our voices this morning. I have. Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: We go.

[John Harvey, Office of Legislative Counsel]: So this is the first of the monthly reports. You'll see this show up many times as well on outcome measures for healthcare and transformation. And I'll just note them and not talk them across them. Me see then. So, you know,

[Sen. Virginia "Ginny" Lyons (Chair)]: as we're going through, I'll say it now, I was gonna save it for the end, but there are significant number of these monthly reports and then there are quarterly reports and then there are annual reports. There's a lot of reporting and the folks who are doing it are very busy reporting. Sometimes it might be better to have them doing other things. So there may be some of the monthly or quarterlies that could be eliminated. I still saw the report on the deaths in hospice coming through again. That was my signed report to report on when Claire Eyre was chair. I know. And I don't know why we need a report on deaths in hospice.

[John Harvey, Office of Legislative Counsel]: Well, so we'll It's a report on deaths in various settings and use of hospice prior to death. That had been a particular priority of the Human Services Committee for a long time. I don't know if they still want that report, but it does measure the use of hospice If we had, well, if we had, Here,

[Sen. Virginia "Ginny" Lyons (Chair)]: you have to go to Colchester to find a hospice.

[John Harvey, Office of Legislative Counsel]: Is hospice, people receiving hospice services in the home as well. Right. Yeah, and they do break it down by where the deaths occurred and including whether it was at a hospital.

[Sen. Virginia "Ginny" Lyons (Chair)]: So my suggestion was to look at the reports that you had concerns about and identify, perhaps we'll take some time to identify some of those whether they're quarterly, monthly, annual, biannual, whatever it is and then we'll ask the reporting entity what they what how it fits with their work, and we'll think about how it fits with our work, and maybe we can make a recommendation down the hall to GovOps. We used to get and maybe we think about GovOps. They'll know

[Sen. Ann Cummings (Member)]: how we do it. Every year they're doing it. Yeah, they'll do every year. They send us a list and

[John Harvey, Office of Legislative Counsel]: sometimes we're in trouble getting out of Yeah. Yeah. The ops committee. But even if they don't, we can still prepare or repeals the reports you don't want to receive anymore. Whatever he's saying. And I'm sure you'll make some of your friends in the executive branch very happy if you revisit and repeal reports you don't want to receive. Okay. Alright.

[Katie McLean, Office of Legislative Counsel]: Next, General Assistance Emergency Housing and monthly report in August. Then we

[John Harvey, Office of Legislative Counsel]: have the September report on the outcome measures for healthcare transformation, as well as a quarterly report on Medicaid program enrollment and expenditures.

[Katie McLean, Office of Legislative Counsel]: Followed by receipts, expenditures, and balances in the Health Information Technology Fund, June annual report. Another monthly report on general assistance in September, and then a report on changes to the administration of Supplemental Nutrition Assistance Programs, SNAP. There is language and statute that there needs to be a report from our DCF ninety days after any changes

[John Harvey, Office of Legislative Counsel]: at the

[Katie McLean, Office of Legislative Counsel]: federal level and SNAP loss, so that's what this report is. And it covers some of the changes like cost sharing of administrative costs for SNAP and work requirements.

[John Harvey, Office of Legislative Counsel]: Next we have the Green Mountain Care Board annual bill back report. Under statute, the Green Mountain Care Board can bill back to the regulated entities for a portion of the costs of regulating them. So this is health insurers, hospitals, and I guess that's it at this point, it had been accountable care organizations that last year was removed. They report annually on expenses that they could have billed back and what they did actually bill back. Next we have an annual report we did not receive from the Department of Disabilities, Aging and Independent Living, again around choices for care. This one is the calculation and allocation of savings. And they're supposed to report annually on the difference between what was appropriated to them and what they actually spent in the choices for care program, less a 1% reserve to avoid having a waiting list for high needs group in the future. And then for that identified difference between the appropriated amount and expenditures, make a recommendation on reinvestment of those funds and their certain parameters for what they use them for. And Choices for Care is a state

[Sen. Virginia "Ginny" Lyons (Chair)]: program. Choices for Care is

[John Harvey, Office of Legislative Counsel]: a state program. It's now part of our eleven fifteen waiver from federal government that allows us to get Medicaid coverage for services that might not otherwise be matchable, including long term care services provided in home or community settings.

[Sen. Virginia "Ginny" Lyons (Chair)]: People who are stuck at home because of illness or fragility. Right, this

[John Harvey, Office of Legislative Counsel]: is really avoiding nursing home level. People can avoid nursing home care. Works better by receiving services at home or in the community, which is often more of a emergency food thinking.

[Katie McLean, Office of Legislative Counsel]: Earlier we looked at the progress report for the Developmental Services Payment Reform. This is the final report that came in in September to the Joint Fiscal Committee. And we have a report at the September for general assistance emergency housing. And then an evaluation of early childhood workforce programs. This was required in 2021 and evaluates the effectiveness of a scholarship for early childhood workforce providers and also a student loan program for individuals entering the field of early childhood education. After that, there's a progress report on child protection registry reform, child abuse and neglect substantiation recommendations. And I believe that human services will be hearing about that report tomorrow.

[John Harvey, Office of Legislative Counsel]: Next we have the October reports. The next two are on implementing and achieving hospital spending reductions from Act 68 and the update on outcome measures for population. Next

[Katie McLean, Office of Legislative Counsel]: we have the next quarterly report on the Burlington Overdose Prevention Center.

[John Harvey, Office of Legislative Counsel]: And I noted for Katie when I was pulling in the links for these, the dates required for these Overdose Prevention Center updates are very different from when they're submitting them. It was a little, we sort of had to make a judgment call though. There was one that came in, it was supposed to be July and October and that came in in May and August and nothing after that. We'll I put the August one with the July date, and don't have anything

[Katie McLean, Office of Legislative Counsel]: to show for the October date.

[John Harvey, Office of Legislative Counsel]: Next we have the annual list of global commitment investments. These are uses of federal matching funds that were allowed under our Global Commitment Section eleven fifteen demonstration program to use that we would not otherwise in the absence of that demonstration. And so this is a list of all of those authorized investments and what the money, what the expenditures were in those programs. Yep, and then we have the hospice twenty twenty three-twenty four deaths and hospice care report. It's a pretty short report, but it does give some information about members of deaths in various settings in Vermont and the extent to which people were receiving hospice services during the nine day period. Yeah, are 13 pages of reports.

[Sen. Virginia "Ginny" Lyons (Chair)]: This is why I'm asking, remember put this in context. We put a lot of work out in our laws and we want to know what We to got to have oversight, but some of this goes on for a period of time where it's no longer being a good proposal. Who could prioritize this?

[John Harvey, Office of Legislative Counsel]: Do. This really loves

[Sen. Virginia "Ginny" Lyons (Chair)]: reports more than any other. There are some I know. Act 68, we need to have those reports, but we need some of these things coming back, but I'm also one of those who thinks maybe we can limit some of them. And I know the administration would be happy to work with us.

[John Harvey, Office of Legislative Counsel]: And we did try to note for you when they're annual or monthly and the ones that don't say that are one time. So there may be some where you're hearing one time about some things and others that are ongoing that maybe ones you don't need to receive better.

[Sen. Virginia "Ginny" Lyons (Chair)]: I think the Department of Health needs to monitor that one, but I don't know that we do unless there's something that we should Put that on your list, Senator. That is good.

[John Harvey, Office of Legislative Counsel]: Alright, next up we have the pharmacy best practices and cost control program report. This is the annual report on the Medicaid prescription drug cost containment efforts and prescription drug programs. At the October,

[Katie McLean, Office of Legislative Counsel]: you received the General Assistance Emergency Housing Monthly Report.

[John Harvey, Office of Legislative Counsel]: Then November 1, you had the two Act 68 reports around hospital spending reductions and outcome measures for transformation. Next is one you did not reset, could not find, I didn't see it for the previous year either. This is coming out of the 2023 Legally Protected Healthcare bill or act around gender affirming care and reproductive care and some protections for providers and patients. And you had asked the Office of Professional Regulation and the Board of Medical Practice to report back on Vermont's participation in interstate contacts and how that, whether there were any challenges related to our legal and protective factor activity laws, particularly around interstate nurse licensure contact and the interstate medical licensure contact. That was a one time. That was a one time. That is not, it's not a schedule. So, yes, I'm sorry, when I said previous year there's another one good and a half later that's an ongoing. Okay.

[Katie McLean, Office of Legislative Counsel]: In '23, you're required to a plan for elevating the status of early education in the agency of education. So this plan would be to achieve greater parity for early childhood education with K through 12 education in terms of roles, decision making authority, and their reporting structure.

[John Harvey, Office of Legislative Counsel]: After that, implementation plan for

[Katie McLean, Office of Legislative Counsel]: they did come in, Implementation plan for reorganizing DCF to increase responsiveness to elevate the status of childcare and early education services. So, similar topic.

[John Harvey, Office of Legislative Counsel]: Yes, and so those two are put under from whom it says, submitted jointly with the NHS, submitted jointly with AOE. It's one report where they address both and it looks like they worked on it together. Can highlight some next item is recommendations for re envisioning the agency of human services. This was based on long time efforts by former Senator Kitchell to look at the scope of the agency of human services and whether it should be split into two agencies or otherwise reorganized. The result of the legislation was to direct the agency to take a look at itself and then come up with recommendations. I will give you the spoiler that they did not recommend splitting themselves up, but they did propose some potential changes or of revising focus.

[Sen. Virginia "Ginny" Lyons (Chair)]: I she was saying for critique. Yeah, so we won't do that, but I will just say one thing. Right now, what that agency does not need is to be put into a greater strap.

[John Harvey, Office of Legislative Counsel]: From White Walk.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. They're already She was first secretary of the HSI. Oh,

[John Harvey, Office of Legislative Counsel]: yes. She was running inside out, yeah, yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: And she said it should be held at human services. Was

[John Harvey, Office of Legislative Counsel]: too much. Suggested splitting it to an agency health care administration and an agency health That is not how it came out of the legislature and it was not the recommendation that came back from the agency. Next is a report from the Department of Financial Regulation based on Act 68. We talked about this a little bit in our OVA this morning, looking at domestic health insurer sustainability. Again, that's Blue Cross Blue Shield of Vermont, their solvency issues and proposing a plan to ensure their sustainability going forward. And then, oh, I'm sorry, that's okay. And then we have choices for care quarterly report, Again, not posted.

[Sen. Ann Cummings (Member)]: Next

[Katie McLean, Office of Legislative Counsel]: is the State Housing and Residential Services Planning Committee. They work to create a plan for creating permanent affordable and service supportive housing for Vermonters who participate in developmental disability services. Some pieces of this report include a schedule for creating an additional 600 units of service supported housing and addressing the funding needs for providing this type of housing.

[Sen. Virginia "Ginny" Lyons (Chair)]: That's an extra scenario. Okay,

[Katie McLean, Office of Legislative Counsel]: next is an annual report from the Agency of Education on After School and Summer Learning Program grants. Oh, this is me also? Okay. Annual Report of the Child Fatality Review Team. This team looks at providing systemic recommendations by looking at unexpected child fatalities and patterns and lessons learned that could inform the community of providers. Oh, and that's also me. November report on general assistance emergency housing.

[John Harvey, Office of Legislative Counsel]: The next one came from last year's budget bill. We're starting the Green ninety Care Board to report on the distribution of settlement funds from a settlement it entered into with the University of Vermont Medical Center, particularly those related to primary care providers were not affiliated with the University of Vermont Health Network. There was not a date specified. I understand. Not a discussion about this topic at one of the health reform oversight committee meetings. Yes, it was. But there's not been anything we've received that I'm aware of from the board. So it might be something you just want to add.

[Sen. Virginia "Ginny" Lyons (Chair)]: It was difficult, I think, to put the date on because it's really, the University of Vermont network, dollars 11,000,000, that they are giving out and we were interested in having them connect with the agency human services and others to understand where the dollars might be needed.

[John Harvey, Office of Legislative Counsel]: We can't direct them. Plans for how it was to be distributed, I think there were some mechanical issues with literally, practically how to get the money from the university to the providers. That was part the of issue.

[Sen. Virginia "Ginny" Lyons (Chair)]: So, situation

[John Harvey, Office of Legislative Counsel]: Oh, you're stuck. Sure. I don't have

[Katie McLean, Office of Legislative Counsel]: it highlighted. Review of Medicaid payment model for residential substance use disorder treatment. That's a one time report due in December required by last year's Act three.

[John Harvey, Office of Legislative Counsel]: Another report from Act 68, this is a one time report as well. This is from the Department of Around Health Access and what we're directed to look at the capabilities, we talked about those as well, accountable care organizations that were funded in whole or in part with state dollars, and see if there were some that could be preserved going forward, particularly those around comprehensive payment reform and other approaches. Then we have a one time update on Hospital Transformation Incentive Grant awards. We talked about this morning, there's $2,000,000 to the Agency of Human Services to provide grants to give hospitals an incentive to participate in transformation activities. The agency was to report by December 1 on monies that were obligated or expended as of November. Then we have the December 1 reports on hospital spending reductions and transformation outcome measures. And the quarterly report on Medicaid program enrollment and expenditures.

[Katie McLean, Office of Legislative Counsel]: You get an annual report from the Child Youth and Family Advocate. I remember seeing that they were asking for an extension on this. I think that the report will be forthcoming.

[John Harvey, Office of Legislative Counsel]: Next is an annual report from the the Attorney General on prescription drug cost transparency. This relates to some efforts from a number of years ago on looking at drugs for which the cost has increased significantly over a fairly short period of time and directing the Attorney General to talk to manufacturers about why there have been some limitations on their ability to access the information. I think the report has turned into something fairly general and similar from year to year. Next we have, as a result of some 2024 legislation, a one time report from the Emergency Medical Services Advisory Committee with an inventory and assessment of emergency medical services that are available in Vermont. That's a one time. That is one time and has been submitted. Right. That's It's part of some additional work that they are doing at the DLC County Hospital.

[Sen. Virginia "Ginny" Lyons (Chair)]: That also went down the hall to GovOps, think, Yep,

[John Harvey, Office of Legislative Counsel]: yeah, it was largely handled in the GovOps committee stuff, but included in the health care area. A little bit of both. Also, from the Emergency Medical Services Advisory Committee, although I do not know if you are going to receive this this year or not because this was also revised as a result of the 2024 legislation. You've asked them for an update on their statewide plan for coordinated delivery of emergency medical services in Vermont. They're supposed to talk about their progress toward meeting the goals identified in a five year plan that I don't think they've had an opportunity to develop yet, and their goals for the coming year. So you may receive some form of that, but they may still be working on the larger statewide.

[Katie McLean, Office of Legislative Counsel]: Next is a report that you heard yesterday, the assessment on recovery residences. There was an inventory that was conducted about what recovery residences exist in the state and the current capacity to collect data. So that, you are already familiar with. The next two reports were required by the same bill from last year. It was a bill actually, it became kind of a Christmas tree bill because their Medicaid payment reform was in it, and the public inebriate language was in it also. Oh, right. But this had the Human Services Board language. Human House Human Services started with the bill last year on human on the Human Services Board. In the process of working on it, they realized they had a lot of questions that they needed answered before they could really dive into that work. So, what they required are two reports, one from the Agency of Human Services and one from the Human Services Board to answer a whole variety of questions that will inform what they anticipated to be working on this year. So the report from AHS is going to look at attorney training for attorneys presenting before the board, Also, recommendations for legislative action. The Human Services Board report is going to provide proposals to improve understanding of the board proceedings and process for laypeople. Also, a process for exchanging periodic feedback among practitioners in front of the board, and also whether there are any opportunities for a person raising a concern before the board to present a personal narrative.

[Sen. Virginia "Ginny" Lyons (Chair)]: Jenny. You are one true newbie. A Christmas tree is a whip. Oh boy.

[Sen. Ann Cummings (Member)]: I am the best decorator here. Miscellaneous tax intensity and broad range of germaneness and other things can

[Sen. Virginia "Ginny" Lyons (Chair)]: Tacked onto it.

[Sen. Ann Cummings (Member)]: Yeah. Tacked onto it. Miscellaneous tax is very broad, and anything that has to do with revenue that doesn't

[Sen. Virginia "Ginny" Lyons (Chair)]: Fit somewhere else. Thousand. Yes. Yeah. Yeah. That's kinda what I'm speaking to.

[Katie McLean, Office of Legislative Counsel]: Yeah. It

[Sen. Ann Cummings (Member)]: doesn't happen very often in other committees, but

[Sen. Virginia "Ginny" Lyons (Chair)]: my You'll say John.

[Katie McLean, Office of Legislative Counsel]: And I

[John Harvey, Office of Legislative Counsel]: do think either one or both of the New England Services Board reports has just been submitted and posted on the legislative website, but we haven't had a chance to update. I think it was posted this morning, so I haven't had a chance to update. Put the links in, which is well. Next we have from last year's budget bill. So I was not involved with the language, but I wanted to flag it for you that there is a report required, was a report required that has been submitted from Diva on nursing home extraordinary financial relief, and looking at reducing the need for an amount of extraordinary financial relief that nursing homes are asking for.

[Sen. Virginia "Ginny" Lyons (Chair)]: Which I think is pretty significant in nursing years.

[John Harvey, Office of Legislative Counsel]: Also from last year's budget bill, there were $10,000,000 in Medicaid provider stabilization grant funds appropriated, DIVO is asked to report on the grants that they've distributed and some information about the recipients, what the outcomes have been or expected outcomes are of those grants, and any recommendations for further stabilization of those providers. In December,

[Katie McLean, Office of Legislative Counsel]: you received the General Assistance Emergency Housing Monthly Report. There is also a requirement. There's an emergency service wellness, emergency service provider wellness commission. This was the commission that was created five five years ago. Yeah. And the the concept behind it is that emergency service providers are often have traumatic experiences in their line of duty, and that this commission is to look at how to provide wellness resources and mental health services to bolster that community. So they provide an annual report on their activities and any legislative recommendations. Similarly, you have an annual report from the Agency of Education and DCF on the evaluation of universal pre k programming. Also an annual report from the Mental Health Crisis Commission. This commission is a little bit different. It looks at usually a single incident where law enforcement and mental health crisis workers are responding to a particular incident, and they'll evaluate how that incident was handled for the purpose of making more systemic changes and recommendations to how future incidents are handled by those two groups. Next, in 2023, there was a request from the Department of Labor to provide data on Vermont wages for early care and education providers. This looks at what the current minimum wage levels are based on Vermont and other state data for this particular group of providers. And after that is the next iteration of the quarterly report on the Overdose Prevention Center.

[John Harvey, Office of Legislative Counsel]: Also the January 1, I-sixty eight reports on hospital spending reductions and information outcome measures.

[Katie McLean, Office of Legislative Counsel]: Next is an annual report from Substance Misuse Prevention Oversight and Advisory Council.

[John Harvey, Office of Legislative Counsel]: Also the annual report from the Office of Healthcare Advocate. We should have asked him where it was, because I don't have it as a client right now. Just because he was.

[Sen. Virginia "Ginny" Lyons (Chair)]: Next

[Sen. Ann Cummings (Member)]: is a

[John Harvey, Office of Legislative Counsel]: report at least quarterly to be posted on the Attorney General's Office website when there is notice of introduction of new high cost prescription drugs. The requirement that the Attorney General's Office be notified by the manufacturers when they're getting ready to introduce immune high cost, which is defined in the statute prescription drug. And so I posted the most recent link that was available. It's kinda hard to find on the attorney general's website, but they had a link from the April to June 2025, that quarter. So that's the link that

[Sen. Virginia "Ginny" Lyons (Chair)]: I prepared. So what I'm gonna suggest is that we draw a line right here and call it a wrap for the day and we will come back to looking at these reports. My suggestion to all of us on the committee is to go through the reports. As I've said before. There are some that we're going to find really critically important others we're going to question so maybe check off of us. I don't know whether which way you want to do it and when we come back to it we'll go through all the reports and see what you think and then Jen and Katie will elaborate a little bit on my eat. I don't know we can go through 12 pages. That's what I read 12 pages of reports. It's a lot. Some of the reports are put in during the budget process so they end up in appropriations or another committee will put it in as a reference to us and we have to decide how worthwhile is it either for oversight