Vermont Legislature SmartTranscripts:

[Virginia "Ginny" Lyons (Chair)]: Good morning. This is January 16, thank you, and the Senate Health and Welfare Committee. And this morning we're going through a number of bills that we have in our committee that we have an interest in. And the first one is S241 and we have the two co sponsors here. So I will ask you to introduce yourselves and then tell us why we have this bill.

[Sen. Tanya Vyhovsky (Chittenden Central District)]: Senator John Biehlowski from the Chittenden South Level District. Senator Martine Larocque Gulick, also from the Chittenden Central District and Vice Chair of this committee. So, nice to see all of my colleagues here. So, Senator Gulick and I are introducing us to 41. It came to us from the National Association of Social Work. And it came to us because of concerns about AI providing therapy to people, and some of the, frankly, really awful things that have happened in other places due to that. AI is really meant to engage in a way that is affirmative to what people are saying. Some of the things that I certainly know I have heard is there have been instances where people have been talking to AI, particularly around feeling suicidal, and the AI's response, because it is meant to be affirmative, is, yeah, you should do that. Because it's not, it's not a human, it's not responsive to human emotions, it's simply meant to kind of give positive response back. And so if you say, hey, I really wanna do this thing, the AI, rather than thinking about what, because it can't think, just affirms. And so really dangerous things can happen when we're allowing algorithms to work with people who are in mental health distress or mental health crisis. As someone who does that work, it takes a lot of deep thought and a lot of real connection that an algorithm simply can't provide. So this bill proposes to prohibit in the state of Vermont any entity, whether that is a person, a corporation, from providing therapeutic services utilizing AI. Yeah, I would just add, both Senator Mikovsky and I have worked in schools, we've worked, we've spent a large part of our careers working with young people. We understand that mental health needs have been on the rise, especially since COVID. So we certainly understand the pressures and we understand that folks are grasping at anything they can get to help the situation, which is frankly, as we all know, caused increases in spending in schools. At the same time, the safety and the health of our young people is absolutely the most important thing that we can assure in anything that we're moving forward with. So that's why I think we're both extremely interested in this study. And young people are particularly vulnerable to this type of engagement, that given the lack of development to their prefrontal cortex, they are in a particularly vulnerable space to not be able to really differentiate necessarily in those moments of crisis that this is not a real human being. Yes, they logically know this, but what we know about the prefrontal cortex is that it inhibits the manner in which we process information under what's known as hot cognition. So in a crisis moment, someone with an underdeveloped prefrontal cortex, because they're young, simply cannot process the impact of what is being said and the long term consequence of how they may act because of that. And so for that reason, I know we both believe that AI really has no place in providing direct mental health treatment. I can't remember if it's in this bill or another bill. There is places where AI might be useful in therapeutic services, perhaps transcribing notes, or really perhaps transcribing notes. Think that's probably the only place. And even then- And I think there is another AI bill saying to that, stumbling over from the Yes, and that should be done with informed consent, again, just because we need to really be careful about how we're protecting everyone and how we're investing in supports and services that work and are responsive to those needs. Terrific, thank you both. Questions?

[John Morley III (Member)]: So, one question. You mentioned youth, I don't believe, as I scanned the bill, that it's limited to youth, right?

[Sen. Tanya Vyhovsky (Chittenden Central District)]: It's all services. AI really, it's dangerous for everyone, but because of youth's brain development, it's particularly dangerous for youth. But it does prohibit it in all instances, yes. Good. So question, so you had talked about, it came from the social work group, and then obviously a lot of counseling there. This is also included mental health counselors. I gave it to my daughter, who was a mental health Ann'sburg and she said, This is great. Sounds good. Good, that's what we wanna hear. That's great. I think there's a lot of, I mean, the profession, I think, agrees with that from the treatment perspective. And the way this has rolled out in other places, it's not licensed professionals that are utilizing AI to provide therapy, because I think any ethical licensed professional understands that that is unethical and dangerous. It's larger corporations that are going in, frankly, to make, to just make money off of people's suffering. We have enough of them. Okay. Thank you. Anything else that we should know about this? No, I think Katie's going to run through the bill with us and yeah, thank you. Sounds good. Thanks for listening.

[Virginia "Ginny" Lyons (Chair)]: And if we combine this with vaping and nicotine and we really stunt the prefrontal cortex and cause impulse control loss and we have a compound fracture. Yes, yes. Very true. Thank you. Thank you.

[Katie McLain, Office of Legislative Counsel]: You're right. Thank you for taking up

[Virginia "Ginny" Lyons (Chair)]: a really nice session. Yeah, we are. We're moving. Hey. You get this uncomfortable chair. Sorry. I'm sneezing. Unless you walk out. I'm in the back chair. I know. It was great. You think you exercise?

[Katie McLain, Office of Legislative Counsel]: Good morning, I'm Tina

[Virginia "Ginny" Lyons (Chair)]: McLean, Office of Legislative Counsel. May I pull up the draft?

[Katie McLain, Office of Legislative Counsel]: So this morning, I know you're looking at a lot of bills and you are looking for sort of the very high overview of each of these bills. So what I will say is that there is a lot more ground to tread on this particular bill that I'm gonna cover, particularly I think the definitions are pretty dense and there's a lot to unpack there. But just for the purpose of the high level overview, this bill, as you heard, says that a person, a corporation, or an entity shall not offer, provide, or advertise mental health services in the state that use artificial intelligence and pull it apart. And then there are some exceptions. There's also language specific to mental health providers. It prohibits a mental health provider from using artificial intelligence to make therapeutic decisions. Issue direct therapeutic communications, which is a defined term, generate treatment plans, or to detect or interpret emotions. It also prohibits a mental health provider from offering, providing, or advertising mental health services that use AI, but with two exceptions. The first you heard about earlier, which is transcription and reporting of patient or client conversation and counseling, but that can only be done with informed consent. So that is outlined in the bill. The other exception is to provide administrative support services to professional. So long as that professional reviews the AI administrative support services that are being provided, any outputs that come of those services, any tasks performed by those services, and ultimately takes responsibility for those AI administrative outputs. So, a nutshell, that is what this bill does. We can sort of, I know you don't want to get into the language too much, but I'll just kind of give you a flavor of how this is set up. So you have a binding section, and we can go over that in more detail when we take up the bill again. You have a purpose section. And then you have a section under unprofessional conduct. That it would be unprofessional for any mental health professional to misuse artificial intelligence pursuant to 20 six-seventy one-one, which is a new section created in this film. And then in title 18, we have language about the prohibited uses of artificial intelligence. Within that, we have the definition of artificial intelligence. I will note that I have had so many conversations with my colleagues about the definition of artificial intelligence, because lots of committees are looking at the issue of artificial intelligence in lots of different contexts throughout the building, and I don't think there's been a decision on one is is there one definition of artificial intelligence? So I will just flag that, not just for your conversation here, but throughout the building. What do we mean when we say artificial intelligence? We have a definition of mental health services. We have a definition of therapeutic communication. This is just a cross reference. The longer definition is elsewhere in this bill. And we have our language that I started off with that prohibits a person's corporation or entity from offering, providing, advertising services, mental health services that use AI. And then we have violation language that's tied into a violation of the Consumer Protection Act. And that's too bad. At the top of page five, we have another new set of language. The previous language we were looking at, it was in Title 18, that's the health title. This is in Title 26, which is the regulation of professions title. So, we're creating a new chapter here called Artificial Intelligence and Regulated Professions. The idea being that this might not be the only profession where there's legislation at some point on artificial intelligence, so we're creating a new broad chapter where this could fall under. We're using the same definition of artificial intelligence that was used up above, and then creating a new subchapter that's specific to mental health professionals with regards to the use of artificial intelligence. And then this is the language that is specific to what mental health professionals, how they can use artificial intelligence and what is prohibited. So we have a definition of administrative support, consent with regard to that transcription service. We have a list of who is considered a mental health professional. It's a long list, so like I said, there's a lot to unpack in the definition section.

[Virginia "Ginny" Lyons (Chair)]: We probably should have OPR in to help us with all

[Katie McLain, Office of Legislative Counsel]: of this, too, I'm sure they would have comments. We have a definition of mental health services that was reflected up above. Here is the longer definition of therapeutic communication, previously in the bill, was just cross referenced. But here is a much longer definition where it's laid out. We have a subsection on the permitted uses of AI by mental health professionals, and these are the two items that I already chatted with you about, which is the administrative support and the transcription and reporting services. We have some language about confidentiality with regard to those transcription services or any administrative support tasks that use AI. And then we have prohibited uses, and again, is what we already covered, which is not using, a mental health professional cannot use AI to make therapeutic decisions, issue direct therapeutic communications, generate treatment plans or recommendations, or detect or interpret emotions or mental states. And also, they can't use it to provide, offer advertised mental health services in the state, except as provided up above. And then Bill takes effect on passage. There's a lot in there. So there is a lot. I know when we do a longer talk, we'll want to really spend more time with the definitions. Okay.

[Virginia "Ginny" Lyons (Chair)]: Do we know if other states are looking at this? Oh, I believe so. Yeah. Yeah. They're looking at it. Yeah.

[Katie McLain, Office of Legislative Counsel]: If you want a summary of who has passed what, I would have to pull that up. But I know other states are looking at it, I would imagine there are a few other states who have already acted on it. Okay, that would

[Virginia "Ginny" Lyons (Chair)]: be good. Maybe we can check-in on what they have for some sort of Yeah, I'll make a note of that. The other question, how is this enforced?

[Katie McLain, Office of Legislative Counsel]: We have language that ties it to the Consumer Protection Act. Well, twofold. So the AG. So the first part where it talks about a person, a corporation, or entity shall not offer or advertise, that is the Consumer Protection Act, so AG's office. Second part of the bill is OPR, so it's tied to somebody's mental health professional's licensure through OPR. Okay.

[Virginia "Ginny" Lyons (Chair)]: I thought I saw a civil penalty.

[Katie McLain, Office of Legislative Counsel]: Yep, that was under the Consumer Protection

[Virginia "Ginny" Lyons (Chair)]: Language Protection. Oh, okay, okay. That's $10,000 or something. Yeah, yeah. Where is that? Right So

[Katie McLain, Office of Legislative Counsel]: this is sort of standard language on the Consumer Protection Act that appears throughout the VSA. So that's where this has been pulled from. Ties up to the Consumer Protection Act. Attorney General has the same authority to make rules, conduct civil investigations, enter into assurances for discontinuance, bring civil actions, etcetera. So, yes.

[Virginia "Ginny" Lyons (Chair)]: That's it. Good question. So,

[John Morley III (Member)]: gotta understand where this is trying to go, but my question would be if you're a a buyer and you have a client comes in and you used AI to query similar cases to give you some background on how treatments or successful treatments have been administered in other places, Is that allowed? The AI is not actually administering the treatment or directing it, but it's being used by the professional to get background information that may be helpful in actually providing the care?

[Katie McLain, Office of Legislative Counsel]: Yeah, that's a good question. I think it will come down to what we have under the definition of therapeutic.

[Virginia "Ginny" Lyons (Chair)]: Oops, that what I wanted to have. And we'll bring in therapeutic I

[Katie McLain, Office of Legislative Counsel]: think the short answer is if there is a person who is a licensed professional who is doing research and ultimately is responsible for making the therapeutic underlying decision about a treatment plan, then that would be authorized. I think it's when AI judgment is substituted for a licensed human professional person where this bill would be drawn on the line at this end.

[John Morley III (Member)]: What I would assume, it's just that I just Yeah. Scan it wasn't quite Yeah.

[Virginia "Ginny" Lyons (Chair)]: We'll do the deep dive, but that's a good question, and that's one that we'll hear from folks about. Anything else? I know there's a companion bill to this in the house. It will be an interesting and we haven't made a decision, is it starting here or there? I'm just giving us all a heads up. We're going to keep working on it. It's a really important topic. I do have one question. So how do we distinguish, how does anyone distinguish between the chat application and AI therapy? Would chat be included in that if someone who had suicidal thoughts started talking with a computer something? It's an entity that is providing

[Katie McLain, Office of Legislative Counsel]: a mental health service, if it's providing

[Virginia "Ginny" Lyons (Chair)]: Well, if it's not defined as a, so Chad's not defined as a mental health service, it's just a, is it? It's a conversation. So, this is something we're gonna have to sort out maybe with somebody who's in charge of that. That's a really good question. There we go. I worry about it a lot because then, oh, I can't go get my talk about my mental health problems here, but I can have a nice conversation. The computer tells me to go do what I shouldn't. Yeah.

[John Morley III (Member)]: We had a little conversation about that in institutions yesterday, and as I understood it, there was a bill that was passed last year that protected at least children with that. Yeah.

[Virginia "Ginny" Lyons (Chair)]: I'm not sure if that's an option. Okay. Good. We don't have oh, I don't I I'm the sponsor of the next one. We can just go with it. Okay. Do you have a glass? Okay. Yeah. We're doing S157, an accolating recovery resident certification. Actually, the lead sponsor is no longer in the Senate and we're going to take this up anyway because a lot of work has been done outside of the building on recovery resident certification and looking at a systematic approach to recovery residences. This committee began the process two years ago or three years ago S-one hundred eighty six. Anyway, we've done a lot of work in this area. And we did have testimony recently about the different levels of recovery. So, you know, the acute level for toxicity and then down, stepping down into the residential facilities and one of the things we did last year was to expand the number of days that someone could stay in a residential facility and be covered by insurance. And then there's a lot going on outside in the real world with trying to fill the gaps. Jenna's Promise does one thing and we have other places doing other things, whether it's Valley Vista or Serenity House or you know just so we're trying to get our arms around all of that. The licensure, the certification, who's there, who's doing what, is it a peer support facility. That's where we are, I guess. You'll tell us where we are.

[Katie McLain, Office of Legislative Counsel]: Okay, let me pull this one up.

[Virginia "Ginny" Lyons (Chair)]: And we know we need this desperately. Yeah, I do. Okay.

[Katie McLain, Office of Legislative Counsel]: This is S-one 157, our Recovery Residence Bill. Yes, there has been a lot of work in this area. There has been previous legislation in this area, particularly around how a recovery residence is and is not like a regular rental agreement, and particularly with regard to when somebody can be removed from their recovery residence. That language is set to sunset, that previous work that the General Assembly has done is set to sunset 07/01/1926, and this bill removes that sunset. So we can look at that. But in general, this bill allows a recovery resident in the state to request a certification from the Department of Health if certain criteria are met, including that they, there's a long list, but items like that they are already certified by VTAR, Vermont Alliance Recovery Residences, and that there is a process in place in the recovery residence for any complaints about how it's operated. There's language in here requiring the health department to establish rules, and there's reporting from the health department based on data collected from recovery residences in the state participating in the program. This expands the list of reasons that a resident could be immediately exited or terminated from our recovery residence program. And as I said, it also removes the sunset exit policy that's currently in place. Those are some of

[Virginia "Ginny" Lyons (Chair)]: the big items. Have you just said what that exit policy means for the resident? Yeah, I

[Katie McLain, Office of Legislative Counsel]: think we'll have to look at it. It's long section. So, two, I wanna say two years ago, there was a big conversation about where we were with recovery residences. Was a conversation that certification would be coming but wasn't here yet, and this language was sort of, fill a gap until we go further along in the certification There is a long section of existing law in this bill that requires recovery residences to have residents sort of fill out an agreement and be made aware of all different types of issues related to the recovery residence. Specifically within that is the reasons for which they can be terminated, like certain criminal activity. And this expands that list, and we can look at that, and I will highlight it for you when we get there.

[Virginia "Ginny" Lyons (Chair)]: I think that it's problematic for some folks in the field. That list was expanded. That's why we're looking at it. Yeah. That's why I asked the question. Yeah, right.

[Katie McLain, Office of Legislative Counsel]: So, first section is setting up the certification. Again, I'm not gonna, I'm gonna try to stay high level. There you go. Which is very hard for me. So, we have a definition of recovery residence, and then we get at the top of page two into the certification language, and I said there are all different criteria that have to be met to be able to have received the certification from the health department. So that's what this list is here. All the different items that have to be met or achieved by the recovery residents to receive that certification from the health department. I will refrain from going through the list. And then, one of them is that they have to applicant has to comply fully with nine BSA chapter 137, which is our residential rental agreement chapter. There's language about how to renew a certificate annually through the department. Here is our rule making language, the department has to set up rules for this certification process. And then we have a reporting section that requires all the certified recovery residences to provide certain data to the health department every year. And with that data, here's all the data that has to be submitted right here. And then with all of that data, the department is compile a report for the general assembly of February of each year. So they have about a month to put that data together to submit to the general assembly. So that is the new language with regard to the certification process. This section two is the language I have been referring to that is currently an existing law, but it's time limited. It's going to be repealed, this subsection B would be repealed as of July '26. And we will get to it, but the proposal is to not repeal it. So this language says, notwithstanding these three subsections in rental residency law, a recovery resident may immediately exit or transfer a resident if all of the following conditions are met. So one item is that the recovery residence has developed and adopted a residential agreement. And that agreement has to identify all these specific terms. They have to contain a written exit and transfer policy. They have to explain program rules and expected residential social standards. That's new language that's being proposed. The residential agreement ah, this is what you're looking for. Would specify that by signing a residential agreement, a resident acknowledges that the recovery residence may cause a resident to be immediately exited or transferred to alternative housing if the resident violates the recovery residence and substance use policy, regularly refuses to engage in services or programming, commits a crime, engages in theft, is mentally or physically interfering with the recovery of other residents, or engages in acts of violence that threaten the health or safety of other residents or recovery resident staff. So you can see that the language that is highlighted is being proposed as an addition to the existing language that's been in effect for about a year. And then that language is mirrored again here so that the person would have to acknowledge that if they violated the substance use policy, and then this whole list, that they could be immediately terminated or exited from the program. Let's see. And then we have a definition of recovery residence that just cross references the definition that's being established in section one. So here is our sunset. So we will have, this would sunset the language we just looked at in subsection b on 07/01/1926 by striking it out. We are saying this language would stay in place. There would be no sunset. The language would stand with the additions proposed. What would still be sunset is right now there is a two year report. I didn't say that clearly. There is a report, an annual report for two years about recovery residents exit and transfer data that was meant just to capture the time period where this sort of interim language was being used. So that would go away and what would, that reporting requirement would go away. And what would replace it is the certification report data that we looked at in section one. So you might wanna look at the report and see, is this a report that you want specifically on exit and transfer data or is the new report in section one going to be sufficient the needs of the committee?

[Virginia "Ginny" Lyons (Chair)]: When we start going through the bill, we can do that? Yeah.

[Katie McLain, Office of Legislative Counsel]: And that takes back July '26.

[Virginia "Ginny" Lyons (Chair)]: Okay. So, and I know the Department of Health has talked with me and shared some recommendations for language change that we should look at and just be or hear. I appreciate you doing that. I've shared those with Katie. So as we go through the bill more in-depth and understand exactly what's there, can listen to see what the Department of Health's recommendations are. And I will say that the Deputy Commissioner and others have worked very hard in this area, so see what their thoughts are. Any questions for Katie? I'm just I can't say anything. I share a comment this Friday morning. I I'm one of the co sponsors of Bill but I am concerned, you know, after having signed on and speaking to people in the field that it is potentially unnecessarily punitive and I just want to make sure that we look closely at the language and. You're talking about the? Yeah, the expansion of reasons to be exited, I'm a little concerned about. Well, yeah, we'll hear from VAR, we'll hear from the recovery residents folks, government folks who are in the field, they'll have to do that, make sure that they get the band and then understand what it means for people, patients, others. And there are different levels, remember. So, it's not like, this covers all residents.

[Katie McLain, Office of Legislative Counsel]: All residents.

[Virginia "Ginny" Lyons (Chair)]: All All of them. So, there may be a totally different story at level five from what it is at level six. Right, yeah, so I think it's

[Katie McLain, Office of Legislative Counsel]: a more nuanced

[Virginia "Ginny" Lyons (Chair)]: discussion probably Bill has. Could be. Okay. And so, can I ask Jessica, do you want to speak to the bill at this time just briefly, or? I think

[Katie McLain, Office of Legislative Counsel]: we can wait until the co worker on Wednesday and actually do our testimonies. Okay,

[Virginia "Ginny" Lyons (Chair)]: good. You for the opportunity. Well, you, thanks for that, and we appreciate your sharing what you had with us. Okay. Is there anyone else who wants to offer comments? The room is filled with people who are here and I haven't done this with 02:41, so if you have a comment to make about either 02:41 or one hundred fifty seven, If you'd like to do that, just raise your hand. Okay. Stephanie Winters. I am the deputy director of Vermont Medical Society. I don't have

[Katie McLain, Office of Legislative Counsel]: a comment on this one.

[Stephanie Winters (Deputy Director, Vermont Medical Society)]: I think the comment made by the new senator about two '41, just looking into some of the ramifications in practice of use of AI, because I know and again, this is off the cuff, but I know that UpToDate, which is a software that a lot of practitioners use to get scientific medical information now has an AI function. And so making sure if they use that informing their treatment plan or, you know, diagnosing, that that is not prohibited by this bill. So just flagging that for myself that I need to look more into that and making sure that as Katie said, that that wouldn't be prohibited, but just really flagging to make sure that that's and we'll come back and talk to you. Good, that would be great. And, I mean, our goal is to hear from a practitioner two so we can understand basically what the request would be.

[Virginia "Ginny" Lyons (Chair)]: But we do appreciate the bill obviously for its protection. Thank you. My proposed action circles, all of you will read upon this bill. I represent Recovery Partners at Vermont, which includes all certified recovery residences in the state as well as the recovery centers. They are all in strong support of this language. I encourage committee members, if you're curious about a language, to connect with your local recovery center about why it's important. So we can get some practitioners and we can get some Yes. Okay. Thank you. Anybody else? Good. Alright. Are a captive ledge counsel right now.

[Katie McLain, Office of Legislative Counsel]: Yes. I'm awaiting an email, then I'll be back into the floor.

[Virginia "Ginny" Lyons (Chair)]: We are on to so can you see if Copper McFrom is available? Because he's the sponsor of the next bill. And before he comes in what we can just jump over to, no, that wouldn't be a good idea. We could jump to autopsy. Okay. But senator Hardy's coming in later, so we won't do that. She's gonna But it's 206. Hold on for that. Hold on. Okay. That's $2.00 6 is huge, so let's not dive into that. Okay. Let's just take a minute and see if representative seems to be able to Okay. We'll go up live for a minute. I'll do that.