Vermont Legislature SmartTranscripts:

[Speaker 0]: That's not a good thing to You are live. All right, good morning. This is Senate Health and Welfare. Is January 12, hard to believe. We're moving right along. And we're meeting a little bit early today we're going to start talking about the bills that we would like to or interested in topics that we're interested in and sort that out by bills and Jen and Kate are both here to help us if we have any questions and then just let's see. All right. What brings about time to work and then we'll come back to this. Hopefully we'll have some time today to finish it off a little bit. So I don't know, I'm thinking we each spent some time over the weekend looking at bills we'd like to hear about. So who would like to start?

[Martine Larocque Gulick (Vice Chair)]: Happy to get us started. Go for it. So just bills or I think we had said like what's our what's your focus going

[Speaker 0]: to be? Yeah no that's fine but I think if you can link it to some of the bills that are on our committee that is helpful. We have this was online that the So poster gave

[Martine Larocque Gulick (Vice Chair)]: generally I just think we need to continue to focus on bringing the cost of healthcare out of the state of Vermont down. Our education system keeps getting blamed for all of our ills, but the fact is that healthcare costs are one of the big issues when it comes to affordability in our state. I think many of us will agree on that. So that's number one. Number two, I think a lot of our bills are focused around getting care out of hospitals and in schools for local and less costly facilities. So, think that's important, really investing in primary care and getting some of the expensive care out of hospitals and into primary cares and birthing centers and PT and you name it. And then specifically, let's see, I have some bills that I hope you can focus on. One, the income, overtime nurse, I don't even know if I've put it in yet, but

[Speaker 0]: I don't know. Is one in by, I think Senator Viejkowski.

[Martine Larocque Gulick (Vice Chair)]: Okay. Well, banning mandatory overtime for GERSA is one of the ones I have here. Okay. We have oh, the AI counseling, AI therapy, putting guardrails around AI therapy, which we know can be extremely dangerous. There's many horror stories about the effects of damaging AI therapy. What else?

[Speaker 0]: Those are the ones that

[Martine Larocque Gulick (Vice Chair)]: are coming to mind, I'm looking forward to taking out some of those bills that again will lower costs, which I think of as the optometry bill and so on. So exciting. We have a lot to do in a short amount of time, so looking forward to speaking in.

[Speaker 0]: Yeah. We are gonna do you. Yeah. Thank you. Well, who's next?

[John Benson (Member)]: Go next. Mean, just like Senator Garrett, I sort of focused at cost, and I kind of tried to look at three things, something that brings cost down or controls the rising cost, improves access, and also I feel, you know, we need to support our rural health care facilities. And so I developed at those, in my limited knowledge of what all these bills are focused on, and so I identified several that I thought would be good to dive into further. S-sixty four, which is the optometry piece, 'seventy '6 and 'seventy seven.

[Speaker 0]: '77 was more often.

[John Benson (Member)]: Is an act related to fiscal year May 25 appropriations from the.

[Speaker 0]: Opioid, is that

[John Benson (Member)]: the invoice?

[Speaker 0]: We passed that one. Oh, okay. Yep, that's good. That's the one that we, remember we were talking with Katie a little bit about the opioid settlement We'll see another bill related to that, either coming from the House or integrated into the budget.

[John Benson (Member)]: There's a House of 70 seven up there that's

[Speaker 0]: It's still there because what happens is that there, if there's a bill here and then the same bill in the House, this time it started in the House and it starts in the House because it has an appropriation So in that's all. It's the same thing, but a good shout out for that because that is one we're looking for from the House.

[John Benson (Member)]: Okay, and then I did it at 166. 180, not more about 190.

[Speaker 0]: 190 and?

[John Benson (Member)]: 166.

[John Morley III (Member)]: Hundred sixty six. I

[Speaker 0]: think once again,

[Martine Larocque Gulick (Vice Chair)]: They're working on it in the

[Speaker 0]: House, their companion bill. What's the name of the bill? Immunization recommendations. Oh right, and that's starting first in the House. But this is good, I'm glad you've identified it because we're gonna

[John Benson (Member)]: be seeing it, hopefully. That was gonna buy agency. How was

[Speaker 0]: Okay. Who's next?

[Martine Larocque Gulick (Vice Chair)]: I

[John Morley III (Member)]: don't think anyone's gonna like it, but

[Speaker 0]: It doesn't matter whether we love it or not.

[John Morley III (Member)]: I'm hearing quite a bit of it back home. It's S21, the cell phone free sloops.

[Speaker 0]: Oh, but we did that. Oh, okay. We did it last year, so that's good. I mean, of those that we have there from last year, and I've got, you picked up. Katie, was it in education? Yes, wasn't me, might Okay, have been went into education, and so they did it, something her And went into

[John Benson (Member)]: I, in my mind I question is that a healthcare issue or is that an education issue? Guess you could argue both, but that's why I didn't certainly.

[Speaker 0]: That's okay. It's good to know because if something comes up related to it, we're gonna pick it up.

[John Morley III (Member)]: The only other one that really intrigues me is the one Senator Benson discussed, that's S90. Just like, do you not care given what reference based pricing?

[Speaker 0]: $1.90. Yep.

[John Morley III (Member)]: I think I would like to look into that more.

[Speaker 0]: Okay. And

[John Morley III (Member)]: those are the two that I guess we'll need to worry about. That's 21. If it's passed out of here, you've got the sister bill in the house, is it passed out of the air committee?

[Speaker 0]: It's all done. It's in law. Oh. Yeah, it's in law.

[John Morley III (Member)]: Okay, so why isn't it?

[Speaker 0]: Well, because we didn't okay, let's go back here. Okay, those are the bills in our committee. If we pick a bill off the wall and we act on it, it moves over to the other side. If we do nothing with it, it stays on. If the house has the same bill, they do the similar. Ours just stays where it is. Yeah.

[John Benson (Member)]: So The good month's been passed. It's gone.

[Speaker 0]: And what we should do, what we've done in the past is just take a little check and put an X on it, meaning that it's been incorporated into another bill or in the budget. Gets confusing or could. So

[John Morley III (Member)]: those are the two I was interested in but that's what I'm curious about. Alright. Okay.

[Speaker 0]: Well, I'll go through and then we'll hear from Senator Cummings when she gets in. We'll try to have Jen and Katie come in and talk about some of the bills. Obviously I've been talking about the bills that I'm interested in from the beginning and I will continue to do that. But I went through and I thought cost, access, quality. Those are the things that are so critically important to us. Workforce development and support is important to us. Aligning insurance payments to make sure that we have equitable reimbursements and that will help patients with access. And then I think also looking at what we did last session and if there are some fixes that we can make that might help along the way. So I use sort of that level of filter and I have a huge list of bills. As you can imagine, I'm probably familiar with some of them more than others, the top of my list are the primary care bill, S197, the recovery residence bill, S157, which by the way, the administration has made some recommendations and I'm gonna send those along to Katie so she can look at them. And then we owe it to both the house and advocates for the prescribing by PhD psychiatrist. Those are some starter bills but I and the optometry bill will pick up sooner or later. Then there are a number that I think are important to us to pick from 2025 and that includes the dyes in foods and educational institutions. We also should look at some of the others like hospital salaries for administration. I think those things have started to be taken care of as hospitals have done the work towards transformation. They're making their own decisions. I think it's hard for us to dive into individual hospital decisions. Similarly then with Senator Gulick's concern about banning overtime for nurses, I think that is a really worthwhile discussion and we could look at that as well with all effects of our workforce. So I have this long list. I want to look at the APRN in Ponce Gulick, that's also workforce. There are some bills that have been brought to us by Green Mountain Care Board with respect to governance, S-one 188 for example, that end. Then outsourcing care and reference based pricing S-one 190 which you have mentioned and I'm glad you mentioned it because that's an important note for us to look at. There are others so I think what we'll do is we'll make a list, we won't go through S77 because we already did that last year and we won't do the cell phone school S21 because we've done that but we'll pick up the other bills that you're interested in and we'll have Jen and Katie come in and do a we have what are known as 50,000 foot, 10,000 foot and one foot level. We don't go one foot right now, but we will go 50,000 feet and 10,000 feet and look at the bills just so we understand what it is we're asking to look at. Yes, ma'am. There's one other bill I wanted to mention. Go for it. It's it's not currently here.

[Martine Larocque Gulick (Vice Chair)]: I hope it eventually gets here but it is the the ban on paraquat which is a herbicide that is directly related to Parkinson's disease and also lymphoma but really Parkinson's disease and it is a health issue for sure and I do hope that it makes its way to our community at some point.

[Speaker 0]: Is it right now it's in agriculture? Yeah, that's right. So I'll talk with Senator Ingalls and maybe we can take a look at that one as well. There's a bill in natural resources that also has chemicals that cause health problems so we'll do a run through that one at some point. DEHP is the one we're interested.

[Martine Larocque Gulick (Vice Chair)]: And can I just add that Paraquat is banned in over 70 countries including the three that manufacture it China, Switzerland, Great Britain? Yeah.

[Speaker 0]: It's like they're making money in The US. Yeah, but we're making people sick. No. So, I will tell you, I have listed the International Physician Bill, S-one 142. A lot of work has been going on in the southern part of the state on that bill, a lot of folks looking at what kind of requirements would need to be in place to have physicians who have studied outside of the country and outside in the country and have them practice medicine in Vermont. The bill is the 2025 bill. But I've been in communication with folks down in the Battleboro area and they've been working hard on that. So we'll look at it. It could help with workforce access. Met recovery business, PhD, dies, I mentioned. I'm curious about the gender ID on the birth certificate and what that means for the Department of Health. Then I mentioned the next two, health equity data, should look at that because there are very distinct differences between ethnic groups with respect to their health needs and so looking at how that data is collected and how it is utilized clinically might be helpful. The Department of Health's legal network. We have a bill from Viva, Medicaid, for their technical corrections, 01/1962. I mentioned the APRN bill. There's a governance bill from Green Mountain Care Board, 01/1988, and then 01/1989 also from the board, and it's something we've been interested in here, and that is when a hospital makes a decision to cut a service or add a service, this goes into the regional issue, the rural health that you guys are talking about, we've all been talking about. But when a hospital makes that decision to add or subtract, then what criteria are used and how does it fit into the budget decisions at the board level. So there is a bill on that. The recommendations have come pretty much from the Remountain Care Board, but we may wanna talk about that and hear from hospitals and hear what the transformation work is that's going on that'll help us. S-one 190 that you picked out, which is the outsourcing of care is pretty important from my perspective at least if you're gonna outsource a whole emergency department or other service, we wanna know what are the guidelines, what's a contract look like, what revenue losses are a result of that and that's where we need to get Nolan in to talk about provider taxes because we do, we may lose provider taxes there. Then there's a little tiny bill on the payment for designated agencies. I have a meeting with the administration about that. This is a controversial bill. It's also a controversial issue, but it's something that we'd also look at and provide oversight on how our designated agencies are reimbursed or paid up front. And then my favorite bill, primary care. And then one that no one has mentioned which is the early childhood licensure bill which is important to the professionals who are providing childcare in the state. So that's a short list of mine. There's a lot of linkage. We have a lot of linkage and I think as we go through those bills maybe we'll find some things we can pick out of one and put them to another. Do our own things. So the other thoughts that you have, so as you learn more, as we look at the bills and you become more sort of familiar with the whole area that we're in then you'll find other ones that you like. Me know.

[John Morley III (Member)]: I'm sure. Typically other committees have been, the administration tries to put forth some form of bills, some kind. Does that happen here in this committee as well? Have they?

[Speaker 0]: We we don't have the administration's bill in here yet. I met with them pre session and they did say they had a bill that I think Senator Beck is putting in. I think Representative McCoy has put the same bill in in the House and so we'll be having that dialogue.

[John Morley III (Member)]: I wondering, something Yeah, like

[Speaker 0]: oh yeah. And there's some things in there that we'll have to wrestle with. We'll see how much is palatable for all of us. Make sure we know what's there. In the house it's not, you send, you may confirm the history but send it the person. There's not a sent in version. Not yet, the administration. Oh, there isn't? Okay, then we'll Okay, so. Try to make they must have decided after we had the conversation. Okay, good. Anything else? So, some of these bills I'm hoping are less difficult and I mean that by less complex and perhaps a little easier for us to begin with so I'll try and put some of those in first. Some of the bills have already been worked over pretty well in the House, for example the PhD psych prescription prescribing, we'll probably put that one up right away and Hopper actually, our representative McFawn did come in and present that bill to us last spring, but I'm gonna invite him in again anyway. We'll go. Be good? And then the recovery residents will pick that one up because it is really important. These are all what's in most of these bills are really important for moving ahead in the areas that we're addressing. Katie or Jen, you want to add anything? We took care you. No. But I think we will need some clarifications on which bills you want us to be wanting to through later. So, we can just talk about that. Yeah, we'll do that. I'm glad to. I think I sent Calista a couple of mine and I'll add, I think we might add S-one 190 in there. We're gonna have the Fremont and Cure Board in and department of financial regulation in just to understand medical and that'll be important for this. So we'll add that. What's 166 again? Immunization. Immunization. Oh yeah, that one was in the house. And then the rural health, we're going to hear about the rural health transformation grant tomorrow. I wanted to ask a question about that. Sure.

[Martine Larocque Gulick (Vice Chair)]: Or make a comment. I'm excited to talk about the grant, but I was hoping that we could also get at the same time or maybe beforehand, you know, what's been cut, right? I know we're going to be getting something, but I think something has been taken away also. And I'm wondering if we can talk about what's been taken away so that we

[Speaker 0]: have better context for what we Right, so that was the testimony that we heard and then we'll have folks come back in to reinforce that about what's happened with that bill that was passed on July 1 And the loss of Medicaid and the work requirements and the sixty day renewal of all that.

[Martine Larocque Gulick (Vice Chair)]: Yeah, will we be able to see actual numbers? Sure, I mean

[Speaker 0]: we can ask you those, but it's difficult prediction wise and we also will want to know how many people have not signed up for QH quality or health plans and so that will come forward as well. It's hard, we can't cover everything. Right. I mean, money wise, dollars 65,000,000 is a big chunk and we're also looking at $75,000,000 more or less for educations. And then if that becomes an ongoing commitment, how can we I do have a lot of questions in there. Sure, yes, answer your question, yeah. Thank you. I

[Martine Larocque Gulick (Vice Chair)]: think I just ripped the bell.

[Speaker 0]: Yeah, so we're good. We'll come back after the floor if we have time. A couple of folks from Schuylkill have come in And I will also say real briefly, I do plan to have the hospitals in and to talk about what they've been doing during as a result of transformation It's a lot of work and it's really great to see. Okay.