Vermont Legislature SmartTranscripts:

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: You're live. Alright. Good morning. This is Senate Health and Welfare, and it is Wednesday, January 21. We're looking at we're beginning to take testimony on some of the bills that we're interested in moving out of the committee. So we've got H-two 37, an act relating to doctoral level psychologists to start us off. And our Reg Counsel is not in here and that's okay. She's been through the bill with us a little bit. So, she'll be careful. We have folks from the Office of Professional Regulation, so

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: Oh, you are. And

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I understand that you'd like to give some preliminary testimony and then that your testimony is That's longer for early childhood educators. Oh, that's Good

[Emily Carr (General Counsel, Office of Professional Regulation)]: morning. Good morning. I'm Emily Carr, general counsel for Office of Professional Regulation. And this is, I'll let another Emily introduce herself. I'm Emily Trita, the staff attorney with the Office of Professional Regulation.

[Laura Cicchino (Environmental Advocate, VPIRG)]: Good to meet you. Good to

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: meet We're gonna go around and introduce ourselves for you, because I don't think you've been in here in a while. Correct, yes.

[Sen. John Morley III (Member, Senate Health and Welfare)]: John Morley from Orleans District. John Benson from Orange District.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Ginny Lyons, Chittenden Southeast District. Martine Larocque Gulick, Chittenden Central District. I live in Burlington. I never know if you all know what the districts are. You say these districts, and it's like,

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: what does that mean?

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Okay. I live in Williston, and I represent all the little rural towns in Chittenden County and a sliver of Burlington in Cummings, Washington District, Washington County, Stowe, Orange, and Braintree. Oh, there you go. Yeah. Awesome.

[Emily Carr (General Counsel, Office of Professional Regulation)]: Well, it's nice to meet you all. Thanks for having us. So, it's my understanding that there are two new members to this committee. That's right. So, I thought I would go and give a little overview of OPR first. But we just want to thank you for the opportunity to testify on this bill. We did testify last spring, so some of the testimony may seem familiar, but we'll just refresh everybody's memory. OPR is an umbrella agency staffed by 40 people and organized under the Secretary of State's office. We oversee about 84,000 licensees in 53 different occupations, including healthcare professionals like nurses, dentists, osteopaths, pharmacists. We also license accountants and architects and tattooists and cosmetologists, so there's a wide range of professions that we oversee. OPR is a public protection agency that accomplishes its public protection mandate by establishing minimum licensure qualifications and enforcing professional conduct standards through its complaint and disciplinary processes. OPR balances this principle protection function against ensuring that individuals have the ability to practice in their chosen professions or occupations without undue government interference. So we really do try to balance public protection with not restricting or proceeding any restrictions on the regulation for somebody to be a profession. So, now what we're gonna talk about, testify a little bit about this bill regarding psychologist prescribing. And back in January 2025, OPR did a Sunrise Assessment, which examined the scope of expansion proposed in 2021 by the Vermont Psychological Association. So this was to create a prescribing specialty for certain doctoral level psychologists working with collaborating practitioners. And as part of that sunset, OPR reviewed requirements in the seven states that have already adopted similar programs. In the report, OPR did not support the scope expansion proposed by BPA, but it did conclude that with some modification, appropriately trained prescribing psychologists could modestly supplement the number of prescribing mental health practitioners in Vermont. Overall, the number of practitioners obtaining the credential in other states with much larger populations has been low. However, four of the seven states have newer programs implemented within the last decade. One way OPR achieves public protection in our regulatory programs is by ensuring sufficient preparation for credentials we offer. OPR supports the creation of a prescribing specialty for doctoral level psychologists You have completed the APA designated post doctoral psychopharmacology degree, passed the national exam, and completed substantial rotations. So this is a perfect example of OPR's typical three legged stool professional qualifications, educational examination and experience. So, OPR does support H237. It greatly improves upon 2021 of BPA's proposal, includes many recommendations from our Sunrise report, and incorporates revisions requested in OPR's testimony last year in the House Committee on Health Care. And Just OPR's perspective is that the expansion is gonna be very important to all Vermonters. This is gonna provide more access and improved access to mental health services, but it also potentially has the ability to increase our mental health workforce.

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: I'd like to comment on a few additional revisions for

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: our testimony to the film. Okay, and you do have page numbers, section numbers, or Yes, that's okay.

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: And this is also in our written testimony, but in 26 ESA 3,001, section 12, the definitions section, we are asking that the committee amend the definition of collaborating practitioner to include not only physicians who have a specialty in psychiatry, which is what the current draft says, but to include other prescribing providers as included by the four eighty. That's largely so that we could include primary care physicians. Because primary care physicians do the vast majority of psychiatric prescribing. If we limited this to board certified psychiatrists, it would be narrow an already limited pool of potential prescribers. And we would still have the opportunity in rule to set criteria and not have it just be any potential MD or any possible osteopath, but specific requirements for those collaborating prescribers. And for the nature of collaboration, which is frequency of check ins and oversight. Those are

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: all things that the current draft would allow us to establish the rule.

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: And the other request for a change comes from conversations with both BPA and BMS. So the existing version of the bill requires rotations in nine practice settings. Do you have a section there? Yes, thirty nineteen, section B-thirty.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Three nineteen. Mhmm. B three? Yes.

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: The 3,019 would be a whole new section about prescribing psychologists. Yeah. And the language asking for nine rotations over fourteen months is something they pulled from the Illinois version of of psychologist prescribing, which is not the use of the model in any ways. But talking to stakeholders, the point was made that not all of these practice settings are going to be relevant or necessary for a prescribing psychologist. Surgery, for example, they are not going to be Nothing about this world expansion would make psychologists or just be in scheduling surgery.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: If you don't mind just talking a little louder. Oh yeah, it's behind me. Also getting older than everybody else. And

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: as well as removing pediatrics and obstetrics, The bill, I

[Laura Cicchino (Environmental Advocate, VPIRG)]: don't believe currently restricts the ability to prescribe to pregnant people or to children,

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: but that is something we likely would want to open a new rule, and making people do rotations in settings where they would not be able to prescribe to those patients is not necessary to make people jump through. The flip side of this, and this isn't requested in this testimony, but there has been discussion about expanding the months of rotations from fourteen months to eighteen months. And we leave that to the discretion of the committee, but that's something we would be in support of if you chose to make that change. You might hear from other stakeholders testifying about that today. The other last change we would request would be to the effective dates. The timing we foresee for this would be to align with an overall reform we're making to mental health licensing in general. The main argument against psychologist prescribing that we highlight in our report and have heard is that there's going to be low uptake. Not that many psychologists are going to go get a very rigorous master's degree and take fourteen or maybe eighteen months out of their professional life to do rotations. And so the question is, why do this when there aren't really that many people? And our answer is, why not? Because we're going to be rulemaking anyway within the next couple of years. So the cost to the public of doing this is just the staff time spent rulemaking and standing up the system. Once it's there, it's there. And in the context of doing an overhaul of psychologist administrative rules anyway, it's really fairly minimal. So even if we have one or two more prescribers out there in the field, that seems like a good cost trade off for us. So the timing we anticipate for that is next session, for 2027, we're going to be proposing a full strike and rewrite of the psychologist licensing chapter, along with the other mental health licensing chapters. This is growing out of a study that we completed at the 2024. That would be next session, '27, and then rulemaking immediately thereafter into sexual mutual needs. So for that reason, we are asking for the bulk of the bill to take effect in 2029, January 1. So to have rulemaking authority prior to that, have that take effect immediately, but to have have the rest take effect then. The reason for the long timeline, like why do this now and that next session, is because it'll take people at least three years to become qualified if they do this. So if they can spend that time even though we're not prepared to, we've seen, we'll maintain, if they can use those here productively, that would be good.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: So the two days that are here in section 4A, you're suggesting that in A, it go in 2029? No, we're suggesting that in B only it go to 2029. Okay, and

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: A would be at July 26. Yes, same as done. Because that way we can start the ruling process before, but then the actual availability of the credential, we've

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: got That's 20 all I'm just thinking. Questions? We'll ask a question. Yeah. Is that '29 date at all negotiable in terms of like maybe getting it up and running sooner? It seems so if we're identifying a crisis to put it off for years is unfortunate. Or did you really, have you really like done the Can I ask that question another way? Sure. If we had b starting in '26 I mean, starting in '26, what are the implications of a starting in '26? I need to ask that. What does A represent in the bill?

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: The A is the powers and duties of the board. So, it would allow us to begin and to complete rule making related to this. So then it would be operational January 2020. So I think, unfortunately, this is what we think is the soonest it can really be

[Katie McLain (Legislative Counsel)]: done. I

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: want to understand then. I think this is where Senator Mubick is going. So you're looking at the full rewrite before you implement the single change of having the doctoral psychologist prescribe.

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: Yes, because we're doing that anyway next session and because we'd be rewriting the rules. So what we want to avoid is doing a round of psychologist rulemaking for this alone. That

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: really would, I think, change the balance of costs and benefits of doing this given the likely level of state. So as a former long term member of the LCAR, I understand that there's a process wherein you could put in emergency rules and have a very simplified version of rules and then do a more comprehensive change. I'm just concerned because this bill has been around for a long time, as has the idea. So I'm just we'll hold that thought. But does that answer your question, Senator Gulick? It does. Thank you. Anyway.

[Sen. John Morley III (Member, Senate Health and Welfare)]: Follow-up on that, chair. So as I understand what you were saying, you they can start the training and preparation in 'twenty six, and that time period here would be about what they would need to be ready to implement in 'twenty nine, but the rules governing this wouldn't actually be in place until '29, so what's the risk in them moving forward with what they perceive to be the required training in '26, investing time and resources, get to '29 and find that the rules don't necessarily match what they've just spent the last couple of years

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: preparing That's a great question.

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: We do anticipate that the lead time could be time people is becoming prepared. The statute, in terms of the education that's required, doesn't leave anything to rulemaking, the proposed building. It is laid out saying programs designated by the American Psychological Association. For whatever reason, they use the term designated and not accredited, but it's basically an accrediting program. There are six master's programs out there right now for the A to A to be designated. That's something really black and white that we wouldn't change in rule. So they can if this were to pass as currently drafted, people could rely on the statute for choosing a master's program because that we're not seeking authority to do anything about that. Those programs, by the way, are the closest one, I think, is in Illinois, but they all have

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: they all have a virtual opportunity.

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: And the rotations, You know, that's a good question because you don't want people to be able to rely on it. We're hoping that people can get started. You know, the rotations, we aren't seeking, you know, the language currently drafted in a March describes those rotations and what they would be. But that's an excellent question, and we could get back to the committee more generally about effective incidents.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Good. Yeah. That'd be good. Other questions? Thank you. This has been very helpful. Thank you. We will go back to it for as we do markups with our Legion Council. So your input will be important. You. Stephanie has stepped out, but we need Stephanie Rutgers. And then I'm gonna ask for one person to leave because we have a lot of things. He just wants to.

[Laura Cicchino (Environmental Advocate, VPIRG)]: I'll meet So, with. Okay. We're switching out. We're switching out. Okay. Sure. I

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: don't know if I have the order link. I'm just Do you want me? Yeah. I don't think order that or not. Okay. We heard from OPR and they made some suggestions regarding, which you didn't hear, but maybe you you I

[Katie McLain (Legislative Counsel)]: think we talked about them last year, it's the fifteen months and the

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: smaller number of sites. Yeah. Right. I'll address that. And expanding to include primary care folks under the collaborative practitioner definition. And then the date change, they did, they took out, wanna take out pediatrics and obstetrics. And then the date change for full mental health system rules changes 2029. Okay, I think I will address most of that. Okay, good.

[Katie McLain (Legislative Counsel)]: Thank Thank you for having me. I'm Stephanie Winters. I represent the Vermont Medical Society. I'm the Deputy Executive Director. I also serve as the executive director for the Vermont Psychiatric Association.

[Stephanie Winters (Deputy Executive Director, Vermont Medical Society; Exec. Dir., Vermont Psychiatric Association)]: And we Vermont Academy of Family Physicians. I wear a lot of hats, so those are the three organizations I'm here on behalf of today. But you'll see me here on behalf of other organizations in the future. For those three organizations, we represent over 3,000 physicians and physician assistants across specialties and geographic locations around the state, so thank you for allowing me to testify on H-two 37. As background, we've been involved in a lot of, in all of these discussions regarding psychology prescribing for years. We participated in the Sunrise Review conducted by the Office of Professional Regulation and included submitting detailed written comments, which I did include with my testimony today what we've submitted to OPR along

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: with some resources.

[Stephanie Winters (Deputy Executive Director, Vermont Medical Society; Exec. Dir., Vermont Psychiatric Association)]: I will just say on behalf of our organizations, while discussions in the bill language have come a long way, our organizations continue to have concerns regarding the benefit, the actual benefit of adding more prescribers to Vermont's healthcare system versus increasing access to the much needed mental health services that psychologists currently offer and have expertise in. We've heard this is being touted as an access and workforce initiative, and that's concerning to us. There's no evidence that authorizing psychologists to prescribe medications will increase access to needed mental health services in Vermont. In other states with prescriptive authority, few psychologists have sought such authority and they've not moved to underserved areas of the state. In fact, across six states that allow psychologists to prescribe, there are just over 200 that have sought licenses to do so. We tried to work on our own chart and pull all of the licensing data from states, and we created our own chart, but then found a great illustration, is included in my testimony, from the Society Clinical Psychology, which mirrored our calculations, and that shows the different numbers of psychologists, the number that have actual prescriptive authority in six of the states. There's a seventh state, Utah, which they don't. We couldn't find numbers for yet. They just passed in 2024. If Vermont followed the ratios of practitioners to population, we would expect to see one to five prescribing psychologists in five to ten years. There are already a breadth of prescribers who receive extensive medical and psychoactive prescribing training. I have a couple of them here today with me. Just to introduce, I have family medicine residents in the room for their advocacy morning. They're just getting a taste of the State House today. So physicians, other than psychiatrists, now receive more psychoactive prescribing training. The number of medical schools has increased and psychiatric residency programs have expanded from 183 in 2011 to three fifty two programs in 2022. Nurse practitioners, or AVRNs, and physician assistants have training more closely aligned with prescribing than psychologists do, and their workforces are growing faster with more training programs poised to train yet greater numbers of prescribing professionals. And then there's a chart in my testimony that just shows the different levels of those prescribing professionals and their numbers compared to population. So I think there, I reference an article in the prescribing psychologist, the Society of Clinical Psychology titled The Prescribing Psychologist Workforce and Not to Matter or Worth the Cost, and I'll just say that in the end, they say their solution is collaborative care. Psychologists are well equipped to work alongside psychiatrists and other physicians, nurse practitioners, and PAs in their interdisciplinary teams. And by leveraging their strengths in psychological assessment, psychotherapy, consultation and research, psychologists are well positioned to contribute to comprehensive patient care that addresses both psychological and pharmacological needs. We strongly support that method and that recommendation and elaborate further down in testimony on methods to expand access to collaborative care in Vermont. And I think I have a portion here on psychiatric medications. I am not a clinician, I should have said that right up front. I represent those who practice medicine, and I know there are a number of them who would love to come in and talk to you about the clinical portion, but I will just say that there are concerns regarding safety and training, especially around psychiatric medications, which are among the most potent in medicine and they affect the entire body. So, would love to have more opportunity to bring in psychiatrists and other health professionals to talk about that. A peer reviewed study of psychologist prescribing found there's no data to suggest that providing prescription privilege to psychologists will increase access to quality psychiatric care. This is particularly disturbing in light of the fact that psychologists have been prescribing for more than a decade in some areas. Current psychology programs are highly variable, and the training lacks some of the preparation and basic sciences, chemistry, biology, and physics, which are required for clinicians prior to medical APRN or PA programs. So I will say access to mental health and psychiatric services is a legitimate concern in Vermont. The good news is that there are evidence based programs and answers that address access to care while maintaining sufficient or advanced professional prescribing. And many of those are already happening in a limited way and expanding them will be significant to the health of Vermonters. So these include the Blueprint for Health. As you know, there was a pilot to assist practices to address mental health, substance use disorder, and social determinant of health needs. The pilot was not funded last year. They are working still based on carryover funds, but beyond that, there is no funding,

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: and that includes the Dulceg program,

[Stephanie Winters (Deputy Executive Director, Vermont Medical Society; Exec. Dir., Vermont Psychiatric Association)]: which is the family specialist in every zero to six month visit. We need to increase retention and recruitment of psychiatrists in Vermont, and unfortunately, we heard yesterday, my first bullet isn't enhancing loan repayment for psychiatrists, but unfortunately, we heard that part of the governor's recommend in his budget is actually cutting loan repayment for physicians, for nurses, for PAs, for a whole realm of practitioners, and so that is very concerning. Reimbursing psychiatrists and primary care practitioners consulting with each other. So currently there's no payment for that, to be able to work together in a team based way to help a patient. This is included in the Rural Health Transformation Grant, so we're excited about that. Increasing access practices to collaborative care models, so that is where our primary care practice can phone a friend. So a great example of this is, and sorry, they just changed their name, the Vermont Consultation and Psychiatry Access Program, it used to be the child psychiatry access program. So pediatricians, family physicians can contact this program, it is staffed by an interdisciplinary group, and they help that primary care take care of that patient with their mental health needs. That could include medication, that could include referrals to services, and the patient doesn't have to leave their medical home. And so increasing that to the adult population through grant funds, it's an amazing way to have that team based care model. And speaking of primary care, supporting S197 and investing in primary care, because we know that up to seventy five percent of primary care visits include mental or, and I know we're not supposed to use this word, behavioral health components.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: So we could use it because have a definition of it. Okay. Okay. Can do it. Okay.

[Stephanie Winters (Deputy Executive Director, Vermont Medical Society; Exec. Dir., Vermont Psychiatric Association)]: So S197 will increase the percentage of healthcare spending invested in primary care, reform the way primary care is paid in the state to decrease burden and increase access, and you will hear more on this and our views on this from my colleague, Jessa Barnard, tomorrow. And then finally, support funding for this psychiatry advanced practice registered nurse program at UVM. This would allow for more nurses in Vermont to receive advanced practice training. So now the language of the bill. The bill is passed, the House does include safeguards with additional standardized training, including the completion of a post doctoral training program in psychopharmacology. We we actually would recommend to add to the OPR rule making to establish a minimum requirement for curriculum of a designated post doctoral psychopharmacology program. Which section is that? Section- It's under A3. So, I don't put a section number on here, but the board shall adopt rules necessary to perform its duties under this chapter, including rules that regulate prescribing psychologists' licensees pursuant to section 3,019 of this title. So A is the settings of clinical rotations, and then we recommend B, the minimum requirements for curriculum of a designated post doctoral psychopharmacology program.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Got it, it's, I think the numbering is different as far Okay. As the house,

[Stephanie Winters (Deputy Executive Director, Vermont Medical Society; Exec. Dir., Vermont Psychiatric Association)]: We have reviewed OPR suggested language on clinical rotations and agree with an eighteen month clinical rotation to include, and I may have these wrong if they've changed since last year, but to include psychiatry, geriatrics, family medicine, or internal medicine, emergency medicine, neurology, and one elective. Separate. We believe this moves forward, that this is critical in providing some valuable medical knowledge and skills. And then having a collaborative practice agreement with an MD or DO who specializes in psychiatry. We feel strongly that this be a psychiatrist. Having a psychiatrist specifically is crucial because they possess the specialized knowledge and training to diagnose and treat mental health medical conditions with expertise in prescribing psychotropics.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: So where does that go? I'm trying to, because going through the bill, I don't think it's collaborating practitioner, one of the recommendations from OPR was to add primary care. So you're suggesting not to add primary care. Correct. Okay, that's all.

[Stephanie Winters (Deputy Executive Director, Vermont Medical Society; Exec. Dir., Vermont Psychiatric Association)]: So in conclusion, psychologists are experts in important mental health interventions and are highly valued members of the healthcare community. While this bill does incorporate safeguards, we continue to be concerned about diverting important time and resources away from professionals doing what we need more of, which is not prescribing. We are also concerned that we're going into this for

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: the wrong reason. This is

[Stephanie Winters (Deputy Executive Director, Vermont Medical Society; Exec. Dir., Vermont Psychiatric Association)]: not a solution for increasing access to mental health, and we do already have important programs that are being cut, partially funded, or not fully utilized to support patients. Again, we do have a number of psychiatrists and family physicians interested and willing to testify, and we hope that we can make space of your agenda to hear from them.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you. Thank you. Questions committee. This is helpful, but before I ask questions I want to say welcome to our visitors. This is great. So wait, are these residents or? Family, yep. Family practice? Yep. There's three of them. Glad you're here. Glad you're doing what you're doing. It's really important. And stay in Vermont. And stay in Vermont. Thank you. Please stay in Vermont. And my editorial comment is I'm gonna work very hard to keep AHEC funding that's so critical to our workforce. Was actually surprised about that omission. Do have a question. So I have heard from folks who have a prescription from a psychiatrist and it's an ongoing prescription. Then, as you know, many of these prescriptions are thirty days, then you have to go back, and sometimes it requires an extra visit or it requires going to your psychiatrist at the same time that you are in counseling or work with a psychologist. And the comment that was made to me is, well, if I could just have my psychologist renew my prescription, my life would be simpler. And I can see that for this type of drug as well as for others, because I know the stress that some people go through, does that tackle this drug? I mean- Your thoughts on that.

[Katie McLain (Legislative Counsel)]: My answer would be, I hope that, especially if we invest in primary care, that people would have access to a primary care clinician. And then the primary care clinician, and I could phone a friend around the room, but then a primary care clinician could be that ongoing renewal of medication and they currently have the the appropriate training to do that. And so there's

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: a coordination between the two. Okay, and to play devil's advocate. Maybe I don't go see my primary care four or five or six times a year, but I do see my psychologist that number of times.

[Katie McLain (Legislative Counsel)]: I hope you don't need your medication renewed five or

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: six times a year. Depends on the- Change maybe, but. Yeah, My

[Katie McLain (Legislative Counsel)]: psychiatrist will be happy to answer those questions.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I would like to hear that. Mean, because that's really a point that's been brought up that I can empathize with a little bit. Yep. All right, other questions? Say you got put you in a hot seat this day.

[Katie McLain (Legislative Counsel)]: Ginny, I was gonna expect to have

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: from you. Thank you. Alright. Is Brandon Ginny Lyons just Oh, okay. It was a very big bird. A very large bird probably eagle. Or it could be a snowy white owl because it's getting cold out. And then we see there is an eagle that haunts their Wodniewski. I did see a biggest talk I've ever seen, a young brown eagle.

[Sen. John Morley III (Member, Senate Health and Welfare)]: It's pretty cool.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: A tree by the interstates. I know. I have seen them here. Oh, me. We're being taken care of. Alright.

[Laura Cicchino (Environmental Advocate, VPIRG)]: So,

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: is Doctor. Campbell? Oh, there you are. Welcome.

[Dr. Brandon Campo (Clinical Psychologist, Stowe)]: Thank you for having me.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: We're get all the sound turned up. You just state your name for the record so we can hear what the sound Sure.

[Dr. Brandon Campo (Clinical Psychologist, Stowe)]: My name is Doctor. Brandon Campo.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Perfect. Why don't you, then introduce yourself for the record and we'd like to hear your testimony. Sure.

[Dr. Brandon Campo (Clinical Psychologist, Stowe)]: My name is, doctor Brandon Campo. I currently practice in, Stowe, Vermont. I specialize in neuropsychological, assessments, you know, in addition to autism and a few other, yeah, things like that. So that's who I am.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Okay. You're testimony.

[Dr. Brandon Campo (Clinical Psychologist, Stowe)]: Yeah. You know, so this is my second time coming before the committee, you know, with regard to having psychologists have prescription privileges in Vermont. Hopefully, Vermont will be the eighth state, you know, that does this. And and it's not a secret. You know, there is a psychiatrist shortage, you know, nationwide, you know, between somewhere the numbers say between, you know, fourteen and thirty one thousand. You know, as it pertains to Vermont, yeah, you know, they're going to need a 13% increase, you know, by by 2030, you know, and that, you know, increase currently puts a strain on the system and other providers, you know, particularly in rural areas, you know, but we're not looking to have Vermont, you know, as the wild wild west and just write scripts all over the place. You know, we have a lot of non pharmacological approaches as well in our toolbox. And this is just another tool in the toolbox. You know, if the only tool in your toolbox is a hammer, well then guess what? The whole world looks like a nail, you know, and I do hear a lot, you know, after I perform a neuropsych eval and, you know, the patient gets the appropriate diagnosis and I make a med recommendation, I do hear a lot of the times, Brandon, this is all well and good, but I can't get in to see my psychiatrist for, you know, three, sometimes six months, or, you know, they're not taking anyone. That's a tough pill to swallow, you know, literally. So then what do I tell these patients? You know, suck it up until you can get, you know, get in, you know, six months later or can I help bridge, you know, that gap? You know, the other piece too is that rather than, you know, senior psychiatrist, whether it's once a month, you know, if it's a controlled substance or, for a three month checkup, we see our patients every week, for at least an hour. So we are able to monitor their progression, you know, on the medication. And if it's not working for them at that moment in time, we can, you know, adjust and shift gears rather than having to wait you know another month you know to get in. You know so like I said you know seven states already do this. I'm hoping Vermont will be the eighth you know. And with this expansion, you know, it has led to, you know, potential solutions for mental health, you know, particularly in rural areas. And that's not me saying that that's the APA, you know. And in addition to that, it has decreased suicide rates, you know, as well. So I'm a huge proponent, you know, of the h two thirty seven. And I think in the long run, because I want folks to think, you know, that this is a marathon. This isn't a sprint, you know, and this is only one part, you know, of the pie, so to speak, you know, in addition with our other, you know, collaborative partners. You know, I talk to, you know, primary cares, you know, and work with other, you know, mental health providers all the time. And I do hear that I'm not comfortable, you know, prescribing a psychotropic med that's a little bit out of my wheelhouse, you know, and I'll refer to a psychiatrist. And that's fantastic if there was a whole bunch of psychiatrists on deck. Unfortunately, they're not, you know, and Vermont has an aging population, you know, as well. So, So that's my 2¢, folks.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Questions. Can you get your testimony written and send it to our committee assistant so we have it on record?

[Dr. Brandon Campo (Clinical Psychologist, Stowe)]: Yes ma'am.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: That would be terrific.

[Sen. John Morley III (Member, Senate Health and Welfare)]: Sure.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: All right. Any questions? So you heard my question previously regarding sort of the update to prescriptions. Is that something that is of concern to you or that you have with any of your folks in your practice?

[Dr. Brandon Campo (Clinical Psychologist, Stowe)]: I'm sorry, what was that update, ma'am?

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: The question is, I've heard from patients that frequently they're given a prescription by their psychiatrist, but they are in ongoing counseling with their psychologist and they would find it helpful to have the psychologist update their prescription. Is that something that occurs with your patients?

[Dr. Brandon Campo (Clinical Psychologist, Stowe)]: I do hear that a lot, that they'll come in and they'll report they're having some sort of an issue with their med, whether it be a rebound effect or or whatever the case may be. And then they cannot get in quick enough to see their, psychiatrist. You know, so if we created, you know, essentially a milieu based system, not only would they be able to come to us, we would be able to then monitor and and track their medication as well. And if an adjustment then needs to be made, we can do it right then and there, you know. And I'm also a huge proponent of not working inside of a vacuum, you know. So a lot that goes into this is collaboration, you know. So with a lot of my folks, I have the release of information to speak to their primary or whomever is their current prescriber. And that takes time too, you know, and folks aren't coming off their mountain to come see their neighborhood friendly psychologist, you know, and that's the issue too. We don't want to be a barrier, you know, for them accessing, you know, their healthcare. We want to be part of the solution, you know, add to the problem. And I think, you know, going back to what you were saying, yes, I do hear that a lot, and I think this would be one less barrier, for those folks, particularly the folks, you know, in the rural areas. So sure.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Okay, and then you also do work with their physician, their psychiatrist, others in sort of Yes,

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: ma'am.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Are you part of any electronic health record system where you are?

[Dr. Brandon Campo (Clinical Psychologist, Stowe)]: The electronic health system that we have within the practice is one that is of our own. You know, it's not like you go to CBH and they punch you into the system and boom, you know, everything is there. No. Nothing like that.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you. Any other questions? Okay, thank you very much for being here this morning. We appreciate Yeah,

[Dr. Brandon Campo (Clinical Psychologist, Stowe)]: thank you folks. Thank you for having me. I appreciate it as well. Thank you.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: And so we have Rick Barnett, who's here from the VPA. Yes. We have lots of VPAs in our state. And We have a testimony.

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: For the record, my name is Doctor. Rick Barnett. I'm the chair of the Vermont Psychological Association Legislative Committee and I'm a clinical psychologist in private practice in Stowe and have been practicing for over twenty years. I want to thank Representative McConne for spearheading this effort with his bill through the session last time, and here we are in Senate, hopefully passing it out. So thank you very much, and to the House for passing it unanimously last spring. And as Doctor. Campo mentioned, it is definitely a marathon, not a sprint. For those of you who are new, this bill has been presented in this building for ten years straight, probedophil, and this bill has been modified substantially. We've heard about all the requirements that are that are embedded within this bill, and that's because of the great work of the Office of Compression Regulation who, you've heard testimony, supports this bill with the added safeguards, which are, I I agree, are substantial. So you know my stance on this bill. I'm very supportive of it. I'll just go back to some of the points that have been made so far. First off, with the date that senator Gulick had mentioned, pushing it back to 01/01/2029 is, you know, knocks the wind out of my sails a little bit, but as you had pointed out, there is a lag time for rule making and to get the education. So just from a workforce perspective, there one psychologist in the state of Vermont right now who has the required training minus the clinical rotations that is made. There are other psychologists across the country who I'm in contact regularly who are happy to move to Vermont to become a prescribing psychologist. So our workforce could, in fact, be substantial within the next few years should this bill pass. But again, there is a two year process to get your master's degree in psychopharmacology after you have a doctorate. Okay, so a five, six year doctoral degree with a license, and then a two year master's degree on top of that, to be able to work towards having prescriptive authority. So if this passes goes into effect July 2026, someone says, okay, 2026, I'm gonna get my master's in clinical psychopharmacology. So by the 2028, they're finishing their master's degree, and this rule making process goes into effect 2029. Okay, that's reasonable. And there's gonna be people coming into the state that will say, I wanna move to Vermont, and I wanna get this training, I'm gonna I'll do my clinical rotations in in Vermont. So, yeah, it's a long time, but, again, we've had this bill for ten years, and if this makes it over the finish line this year, it's it's a win for us. In terms of the line in the bill, whether to strike or to keep with a specialty in psychiatry as a collaborating provider, again, under definitions, collaborating provider, we strongly suggest that we strike with a specialty in psychiatry. It is necessary for this bill to be successful, for this workforce to be successful, to not be limited to only psychiatrists as collaborating providers. We've heard that most psychotropic medications are prescribed in primary care. Primary care physicians are highly qualified to supervise the prescribing of psychotropic medications. There are complex cases that primary care clinicians, of course, refer to psychiatry, and in those cases, it's a team effort. This is definitely an integrated care bill. It's not a silo bill where prescribing psychologists go off here and do their thing and psychotic we're all working together. This bill brings a lot of things together. To your point, Senator Lyons, that happens all the time. You have to go see your primary care physician for that, your psychiatrist for that, your psychologist for that. So much can be done in a psychologist's office that prevents people from having to schlep over here, the copay over here, the copay over there. It's ridiculous. So having, it's just a small little thing that we can do to help people not have to travel around like that. And then finally, with the clinical rotations, super happy to have those nine rotations reduced to five or six, that's fine. If we can leave it at fourteen months to not add an extra four months on top of those clinical rotations, that would be great. But we understand that safety is a primary concern for our psychiatry colleagues, and if that's the hill we die on, that's fine, we'll just go with eighteen months. But as it's written in the bill, fourteen months is fine with us, and happy to answer any questions you might have.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Questions? Go ahead, Senator. Yes, it's just come up to me with the previous witness testimony that you don't have access to the medical records of your so when someone comes to see you, you don't have that whole I showed up at the ER on Saturday and they put me on this drug And I also have diabetes, and I'm yeah. So that information can be crucial to making a right diagnosis. How is it with the consulting physician? How how are you going to know the medical issues with your your patient client?

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: Yeah, there's a long runway here, so I think there's a couple of things there. One is definitely with the collaborating provider agreement, which is a way that prescribing psychologists would naturally have access to whatever their supervising provider has access to in terms of the more robust interconnected technology systems. But again, with a long runway, my hope would be that anyone who becomes a prescribing psychologist could, in fact, be able to apply to link up with these systems so they have access to that information, for sure. That's very important, but I think having a collaborating provider, collaboration requirement, is something that helps people. A prescribing psychologist working with a patient who's got diabetes, hypertension, and a host of other things that is on a bunch of medications isn't going to unilaterally just prescribe a psychiatric medication, oh, take this. It's always gonna be in collaboration with each of the providers.

[Sen. John Morley III (Member, Senate Health and Welfare)]: So that's a great point.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: But right now, you could set up a collaboration agreement with a primary care doctor who does most of the prescribing. That's possible under the present system, right?

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: I've tried, I mean, I was part of the whole Vinyl rollout years ago and that didn't work out too well. Was entered into their system as somebody to be able to access stuff. EClinicalWorks is the thing in Lemoyle County that people use. I've tried to get access to that. It is a little bit difficult right now than it is to access EPIC or any of the other electronic health records that are part of the system, but I guess it could be something to be looked at.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: But if you had a collaboration with a primary care doc okay. But all your patients would have a different primary care. Same. You know, if around here, part of the UVM network, they seem to have everybody in the same building. Mhmm. And they'll send you down the hall to the dietician or the psychiatrist, and it sounds like in those situations you would have that collaboration where you could call down the hall and say I've got this patient, I'd like this, you might get screened.

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: I think with the prescribing psychologist bill, gives a lot of flexibility for someone with that designation to be able to join a primary care practice and join the team, and then therefore be already automatically entered into the electronic healthcare system, or work independently with a collaborating agreement and then maybe get access to that button.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thanks, Sharon. That helped. Yeah. Other questions? Okay, well this is our first crack at this bill. Well, our second. We started it last year as you know and it's a holdover but it is one that we're going to look at again. So, we'll take take more testimony, put it on the agenda. Okay.

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: Thank you.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you. Oh, we're a little behind, but that's okay. We're gonna move right on to S157, the recovery resident's certification.

[Scott Faber (Environmental Working Group)]: Can't bring it easy. What's good there?

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: What do you want? You need a right hand? I do. Oh, I didn't know. There we go. We got the. Natalie, I've been wanting to see you. Hi. We're still alive, but I'm gonna ask you a question about how much we save. Is the question I asked you about savings with prevention? Yes. Have you been working on that? So there is a dollar figure that's understood at the national level. I'm gonna let you, we'll talk later. Okay, good. Get that information, I think everybody will be impressed. Thank you. You're welcome.

[Katie McLain (Legislative Counsel)]: Alright, welcome. Thank you, good morning.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: So thank you for being here and we did go through this, the other bill without your presence, but there were some suggestions made on specific sections. So when we get to a stage of markup, I think we've got most of it and it's in testimony. Okay, that sounds great. So now it would be helpful to walk through 157, a little deeper dive from what we did previously and I know that as we said earlier, Department of Health and AHS had recommendations and we'll get to them. Okay,

[Katie McLain (Legislative Counsel)]: that sounds great. Katie McLinox, the Legislative Counsel. This is our bill on recovery residences and the certification. We did sort of a high level overview of this last week. So, if you remember, the first section of this bill has to do with certifying recovery residences. This would be a voluntary program. So

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: first we

[Katie McLain (Legislative Counsel)]: have a definition of what we mean by recovery residents. It means a shared temporary living residence supporting persons recovering from a substance use disorder that provides care through care support and assistance accessing support services and community resources available to persons recovering from substance use disorder. This is a variation of a definition that is currently in statute. It's just moving to a new location. So the question I have,

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: and it's probably for the folks in the room, is that there's no definition here of the various levels of recovery, and I'm wondering if that is necessary or if there's a reference we can pay out to rules or any other specific definition.

[Katie McLain (Legislative Counsel)]: Top of page two, this is our certification language. Upon receipt of an application from a recovery residence in the state seeking certification, the Department of Health is to issue the requested certification if the following minimum standards are met. Here is our list. Excuse me. The applicant is certified as either a Vermont affiliate of the National Alliance for Recovery Residences or another organization approved by the department. The applicant demonstrates the capacity to operate a recovery residence in accordance with rules adopted by the Department of Health and in a manner that ensures person centered care and resident dignity. The applicant shall fully comply with standards for health, safety, and sanitation as required by law, including standards set forth by the State Fire Marshal, the Department, and the Municipal Ordinance. Once certified, the recovery residents, including the buildings and grounds, are to be subject to inspections by the Department with a ten day prior notice. The applicant is to have a clear process for responding to resident complaints, including methods by which each resident shall be made aware of the complaint procedure. An appeals mechanism within the recovery residence. A published timeframe for processing and resolving complaints and appeals within the recovery residence. And periodic reporting to the department of the nature of complaints filed and action taken. And the applicant will fully comply with the 9BSA chapter 137, Which which all memorized. Residential parental agreement chapter and statute.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Okay, at some point we probably should look at that a little bit.

[Katie McLain (Legislative Counsel)]: You know you may want Cameron Wood, who is our attorney who deals with housing. He has the expertise on housing rental agreements. So he would be the best person to give you sort of a high level overview of what is

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: in that section I can because I know we're gonna hear about this. And chat with him about that if you're interested.

[Katie McLain (Legislative Counsel)]: And subsection C we have language that the certification cannot be transferred or assigned, and it shall be issued only for the premise named in the application. And then we have language about the renewal process. Let's look at

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: this, are there questions about this section? So these are the overall requirements. So, if we're talking about that, this would be like an application that someone submits electronically or in writing?

[Katie McLain (Legislative Counsel)]: It doesn't specify. I imagine the department would, in rule, sort of set up a process by which interested recovery residences would apply.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Okay, and then there's no, is there, are we gonna get to timing here for the time within which the application would be reviewed and approved or not.

[Katie McLain (Legislative Counsel)]: There isn't a time frame.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: There's no a time frame for that? No. Okay those are the kinds of things that you have to get pulled out of. Yeah

[Sen. John Morley III (Member, Senate Health and Welfare)]: I'm sure I guess on that line where I could see the issue come up that there is no timeline and response time. If they're already acting as a home and you have to renew in. I don't want a situation where all of a sudden they're no longer certified because the application has been processed, and the person has to be picked out of the house.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Good point. Any other questions, thoughts on that section? I'm sure we'll hear and we'll also, as we go through any markup.

[Katie McLain (Legislative Counsel)]: Okay. So we're on subsection D and the renewal. Annually the recovery resident seeking renewal of its certification is to submit an attestation to the department that the residents continues to maintain its certification, either through VTAR, the NAMA affiliate of the National Alliance for Recovery Residences, or another organization that's approved by the department.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: So then we want to hear from NAR what have for reviewing the annual certification. Okay. This

[Katie McLain (Legislative Counsel)]: is all new language. This, yes, this is new language.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: What are they using now to guide there? Creation of these recovery residences. I'm looking at 18 PSA 40 eight-twelve.

[Katie McLain (Legislative Counsel)]: Well, right now there's not a certification. So, there could be recovery residences, there are recovery residences that are operating, they have to follow 40 eight-twelve. I would guess many have a relationship with VCHAR, but there is no, I mean, this is a voluntary certification process, but right now that just doesn't exist.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Got it. Thank you.

[Katie McLain (Legislative Counsel)]: Rule making. This just gives the department rule making authority to carry out this section. Then we have reporting requirements. On or before January 1 of each year, a recovery residence that's certified pursuant to this section is to report to the department data from the previous calendar year in consultation with VTAR or the other organization approved by the department. So the recovery residences are reporting to the health department on the number of residents served, the average length of stay at the recovery residence, any exit or transfer of a resident by the recovery residence and the asserted basis for exiting or transferring that individual. The number of residents who gained or lost meaningful employment during their stay at the recovery residence. Any budgetary needs. Any other information the department deems appropriate. And then we have on February 1 of each year, the department aggregating this data and providing it to the general assembly. Okay. So that is the certification language. And now, we're switching to this section nine. This is existing law and this is language about what conditions have to be met for a recovery residence to exit or transfer an individual. We have some language, some notwithstanding language. So, we're in Title IX. We're in the chapter related to rental agreements. So 4463 were not withstanding language that prohibits a landlord from denying a tenant access to possession of the tenant's premises, except through judicial processes. This is already current law. You're not withstanding the length of notice from a landlord to terminate a tenancy for failure to comply with the agreement or for legal activity. And in 4468, you're not withstanding that a landlord may bring an action against a tenant if the tenant remains in possession after the termination of the rental agreement.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: So, Karen would on this part too?

[Katie McLain (Legislative Counsel)]: He might be able to give you a little bit more context on those, great. But the work that was done two years ago, the committees did receive an overview of the different landlord tenant obligations, and these three specific items were set aside for the purposes of recovery residents. So otherwise, the landlord tenant requirements apply except for these sort of three specific items. So, a recovery resident can only type in a transfer resident if the following conditions are met. This is a very dense section. So first, a recovery resident has developed and adopted a residential agreement. And then we have a lot of information about what has to be in that residential agreement. Under existing law, it has to contain a written exit and transfer policy approved by a VTAR or another certifying organization that has been approved by the health department. And that policy itself has to address the length of time that a bed will be held in the event of a temporary removal of an individual. It has to establish the criteria by which a resident can return to the recovery residence in the event of a temporary removal, and it has to ensure that a resident's possessions will be held not less than sixty days in the event of permanent removal. Also in this agreement, there has to be an explanation of program rules and expected residential social standards. That's new proposed language. Current language, it has to include designating alternative housing arrangements for the residents in the event of an exit or transfer, including contingency plans when an alternative housing arrangement is not available.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I have a question first. Sorry, didn't see you. Oh, go ahead. Just, this is the second question I'm asking about levels. So there are five different levels here we're talking So if you're gonna have this blanket coverage for those who are in acute toxicity, that's an interesting thought. Okay, just that all levels are affected here regardless of where the individual is.

[Katie McLain (Legislative Counsel)]: Yeah, our definition doesn't distinguish currently.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Yeah, know, it doesn't distinguish, that's why I asked that earlier and now coming back and reinforcing it. So, congressional budget. Senator Gulick, Senator Cummings. Thank you, Madam Chair. Resident expected residential social standards that would turn the already existing statute or is that no? Okay. We can invent our own social security.

[Katie McLain (Legislative Counsel)]: I was just curious. That's a thank you.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Okay. Now just as I'm remembering, housing worked on this Uh-huh. Years ago. And somebody was in a residence, had a relapse. Mhmm. He got an accident. He's out. And ended up homeless, and bad things happened. Nothing can be prevented up since. So residents and be using because that puts everybody else at risk. And it's it's really trying to find that balance where but I'm wondering if there is alternative housing available. Well, is one of the issues that we have here in looking at the different levels of recovery. So you know if you're in this level of residence and you know you'd be relapse, is there a place to capture you? Is there a place where you can go that's at that other level that you know get There the isn't a bed available there. Then we've got to sort that out. Yeah. Then what happens to you? You can't stay in the recovery house using. That's one of the problems that we're trying to solve with this, but then we're also trying to make it systematic, and I think Department of Health may help us with this one.

[Katie McLain (Legislative Counsel)]: So, we're still talking about what is in that residential agreement that recovery residences must have in order to be able to exit or transfer a resident. The policy has to describe the resident's substance use policy, which shall exempt the use of valid prescription medication when used as prescribed. It must indicate that by signing the agreement a resident acknowledges the recovery residence may cause a resident to be immediately exited or transferred to alternative housing if the resident violates the substance use policy, new language, 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 residents' staff. So, we have a mix of existing language and new proposed language here for what would be appropriate for exiting or transferring somebody to alternative housing. In subsection B, the recovery residence has to obtain the resident's written consent to its residential agreement, and that has to be reaffirmed after seven days. So initially when a person comes in, recovery residents gets that initial written consent, and then seven days later they have to get it again. And there's a lot of conversation,

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: I don't know on which committee,

[Katie McLain (Legislative Counsel)]: on one committee, about how it's, there's a lot going on for somebody who's entering a recovery residence and after they've had that seven days to settle, it's appropriate to review the policy with them again. The resident, we're going back to what's in the agreement. If the resident violated substance use in the agreement, if they regularly refuse to engage in services, commit crime, engage in theft, are mentally or physically interfering with the recovery of other residents, engaged in acts of violence that threaten the health or safety of other residents or staff, that would be a ground for removal. And also that the recovery residence has provided for or arranged a stabilization bed or alternative temporary housing. So those are the grounds, the four grounds, or criteria that have to be met in order to exit or transfer somebody. There has to be an alternative. The person has to have done one of the actions that is appropriate for removing them. There has to be written consent with the policy from the individual, and there has to be a policy. So we've just walked through those four steps.

[Sen. John Morley III (Member, Senate Health and Welfare)]: Question. Go ahead. Senator Cummings comment is, as I read that or as you've just presented it, if the person is using and is causing problems, they can't be ejected from the house if in their agreement they don't have another place to go. So how does that affect the rest of the people in that home? And

[Katie McLain (Legislative Counsel)]: it's not just that the person has another place to go, it's that the recovery residence has arranged an alternative. So it's not just I, the resident, have a different alternative, it's that the resident itself has established a place for

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: the person to go.

[Sen. John Morley III (Member, Senate Health and Welfare)]: And I could see, since it's voluntary, few people wanting to sign on to this because it makes them ultimately responsible for this individual no matter what they do.

[Katie McLain (Legislative Counsel)]: Let me just make one point of clarification. This section two is separate and apart from the certification program. Section one was the certification program, and to get a certification is voluntary. Our recovery residents doesn't have to do this. But in current law, this section two, a recovery residence does have to do all of these things. So this particular piece is non voluntary. We're still in this section. Relapse of a substance use disorder resulting in exiting a recovery residence shall not be deemed a cause of the resident's own homelessness for the purpose of obtaining emergency housing. That is existing law. And then the definition of recovery residents. We're striking through this language and we're cross referencing the definition we looked at at the top of the bill. This has, we're using the same definition of recovery residence in both sections. We've already talked about this section three, but it's worth going over because sunsets are always a little complicated. So two years ago, when the General Assembly adopted section two, they decided that was a stop gap measure until there's more time for certification to be reviewed. So by striking through this line 11, what you're doing is saying that the section two language we just looked at is no longer a stop gap, but it is permanent law. It will no longer be repealed at the end of this fiscal year, but it will stay in statute. That's the effect of that strike through on line 11. And then what you are striking through is there was report on recovery residents exit and transfer data that was also good for two years, but because you will be getting some of that information in section one as part of the certified recovery residents report, this is being allowed to sunset in subsection B. And if that is confusing, I'm happy to go over

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: that piece again. I'll look at it sooner or later.

[Katie McLain (Legislative Counsel)]: I know, sunsets are, they're never straightforward. Okay, and this actually take effect July '26. So that is it.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Questions. I know you did break this bill, but can you just maybe explain a little bit of what problem certification is trying to solve? Like why, or should I wait for a different witness?

[Katie McLain (Legislative Counsel)]: Yeah, I kind of wonder if the other witnesses might be better. I'm sure with, it sort of gives a certain perspective that this recovery residence has been vetted and is meeting certain benchmarks that are the state of Vermont has said is important to it. I think if you want a more in-depth answer, you might want hear from the health department or from the recovery

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: residents themselves. Thank you. So the other thing about this is it was written before the report came to us so it was anticipating a report that we received this fall and I'm going find that report for us to put on our webpage on recovery residents. And the other piece of it is that there was a meeting with the National Governors Association representatives and CSG, CSG, in the fall a council state government or NCSL, if I got the wrong group, NCSL, I should know this because I was fortunate. I was getting good. We worked together with the administration to have the meeting in Waterbury talking about substance use disorder recovery and so a lot of the information that came from that meeting will also inform this bill and should have also informed the report that we received. We'll look at that.

[Scott Faber (Environmental Working Group)]: So a lot of my questions are gonna be answered by reading the report.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I have a question.

[Sen. John Morley III (Member, Senate Health and Welfare)]: I hope so. Yeah. Because I'm with senator Gulick and talking to some of the the residents the recovering. Are

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: we are we gonna

[Sen. John Morley III (Member, Senate Health and Welfare)]: talk to any of those individuals or no? No. Okay.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Of course we are. Yeah.

[Sen. John Morley III (Member, Senate Health and Welfare)]: You're the chair.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: And we're gonna have Jeff Lohr come in who also represents Gulick, not as far. And so, yeah, we can get folks in. If you have someone specifically you'd like to invite, I'll do that. Yeah, there's a ways to go on this bill. It's like a shell waiting to be restructured. But we still have new cabinet residents out there, right? We do. But one of the goals here from my perspective is to have some coordinated system of care for people who are most acute and then stepping down and then stepping down and making sure that they don't go back to the same culture that caused their harm in the first place so that we have that coordinated system of certified and some are not certified but at least we were trying to put our arms around that. My only other question, and I know this is for you, Katie, but I'm just putting it out there so if I can get you all can remind me, but I am interested in the data section that will have to be provided. It does say any other information that department deems appropriate. I'm interested to know what exactly that is, given the world we're living in right now, data and data privacy screening for. So, yeah. That is is that's on the list. That's how the point could do. We won't forget that one. You

[Katie McLain (Legislative Counsel)]: won't forget. I'll try not to. Katie, is there

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: anything else we need to know about the bill? Not at the moment. Not at the moment. You're gonna help us fix it. I am. So I'd have

[Katie McLain (Legislative Counsel)]: to hop out to another meeting. Okay. I just wanted to check-in when you need me back for the next bill.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Do you want Melissa to give you a heads up? Sure. What we'll do is we'll try to get on to schedule at 10:45. 10:45. I'll just come back to him. Yeah, well, you know, but we did we'll see. Yes, if

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: they run that weight, let me know.

[Katie McLain (Legislative Counsel)]: Yeah, my bad. Okay, thank you.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: All right, so we have Emily Krueger here from Department of Health and I know DOH has sent in some language and I shared it with Katie and we haven't looked at it as a committee, but it would be good to just listen to your testimony. Yes, ma'am. Years ago, there was an issue with it wasn't a recovery house. It was place that basically the prisoners need to be released. Mhmm. And part of the deal is you don't use anything, and that was being interpreted to include methadone Mhmm. Drugs. Did we ever get that straight now?

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: Good question for department of health.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I think we did. You can come back. Sorry. You just tried it out. You're coming. So disruptive. You'll get back. Good morning. Good morning. Thanks for having us this morning.

[Emily Krueger (Vermont Department of Health)]: Compared to my last this morning last week, this one will be, I'll do a little bit more because I just want to make I get the fine points. We've covered in-depth. I'm gonna ask you just to speak up a little bit, so I got this thing going on behind me. Will do. It's three seconds. So, I do wanna open this with one part of our strategic plan that was recently published in April is education. So, wherever we are, we're going to work on definitions, we're going to talk about different systems, how we interact. So, the one thing that I did want to talk about this morning is sort of, because the word recovery is used in different ways in different spaces, just to offer up some context within that. So, we have a visual on the screen in front of us, in front of you that talks about residential treatments, recovery residences, excuse me, and recovery centers. So just to give some clarification there, residential treatment are dental and medical services. These services are in a twenty four hour, seven days a week, three sixty five setting, and they have on-site supervision. Vermont has three levels of residential care in the state of Vermont. We have the highest level, which includes medically monitored residential treatment that occurs at Serenity House and Valley Vista in the state of Vermont. Those are the recommendations we hear often as part of that. So that's that high level medical detox, highest level of acuity. Did you send this in? Do we have this? We don't have it on our webpage. Yeah, it's there now. Have to read it. Oh, it's right there. Okeydokey. Apologize for interrupting. Don't worry. The next level down is still high intensity. High intensity is about number of hours and just sort of what the mode of interaction happens with individuals in that particular setting, but it's in a clinically managed space. They've stepped down from the medical need, especially in that heavy level detox, down to clinically managed. The next level, we're excited about, which has only been around for the last couple of years, and we do have a new program that just opened in Virgins, is what they're calling low intensity clinically managed treatments. Much longer lengths of stay, different interactions with the community as part of that, some individuals still working on their recovery journey but still needs a little bit longer time in residential. Lengths of stays can be significantly longer, forty five days, ninety days as part of that mix. They may be engaging in employment as part of that particular service. They're engaging in their community, local recovery center. Again, sort of a step down to the high medical, then high clinical, and then well done. That's part of that. The one that's not on this slide that I think answers some of the questions that were just asked previously is they also provide a service called re engagement beds. Re engagement beds are feds if an individual has recurrence of use or in a recovery residence. So if they are, substances have come back into play, they can step into a bed at either Serenity House or Bounty Vista to sort of reengage with their recovery journey as part of that, and then potentially depending on the circumstances of what occurred at the recovery residence, then return to their bed there. They also may be assessed at that point in time in their engagement, well maybe they need to go back up to one of those higher levels of treatment, but we do have a reengagement space in the State of Vermont that allows for individuals where that may occur. And that is more in the last couple of years. We've been with the legislature that started that program, so we are very excited about that. So that's residential space, and again, customer clinical and medical model. In the center of the imaging property residences, which we're here mostly to talk about today, they are shared living environments that offer peer supports, assistance accessing support services. They may provide case management and outpatient related services. Vermont primarily offers Level two recovery residences. We do have the NAR standards at the bottom, which we'll talk about here in a quick second. There are different levels of recovery residents, and through the Vermont Alliance of Recovery Residences, have adopted the national standards. At the bottom of that, you'll have levels one through four. Level one's being considered, the levels start at the lowest level of staffing and resources provided to individuals living in those residences. The first level is peer run, so the house is essentially doing their own thing. When we move to level two, which is our largest volume of recovery residences in the state, this is where we have recovery support and a staff on restructure. Their staffing is part of the organization, the vendor, BPOR, being one of the largest ones, so people who would be able to potentially joining us today, can speak very well to that particular space. We do have a few level threes from the state of Vermont. So, Jen is promising one of the level threes from

[Laura Cicchino (Environmental Advocate, VPIRG)]: the state of Vermont.

[Emily Krueger (Vermont Department of Health)]: That, again, has a higher staffing level, really starts bringing in more of those life skills components and connecting people to treatment on the outside

[Sen. John Morley III (Member, Senate Health and Welfare)]: of their services.

[Emily Krueger (Vermont Department of Health)]: And then level four, really safe to that's the highest level. Level four and the 3.1 low clinical infancy really in many respects have a lot of things in common. It's a place where an individual is currently residing, they're receiving clinical services, they're having employment services, life skills. It's just what side of sort of, what part of the continuum is directing that's coming from a recovery directed space or is it coming from a safe space? We don't have a lot of farm to stay there on. Right now we have 3.1 that we currently have, but we don't currently have Level four. We have Level 2s and 3s, and I think a couple of are both. Our recovery center, again, the word recovery shows many spaces. Our recovery centers, we have 12 recovery centers across the state. They are open during the day for people seeking support in their recovery journey. Recovery service organizations offer a range of services including recovery coaching, support groups, things like AA, NA, things like that, referral to services and other peer support. There are no residential services that are part of our recovery center. They provide a safe and substance free environment for people in all stages of recovery. I think the most important thing about the system at large is that it's meant to be fluid. They meet the needs of the individual at any given time, and people do, this is chronic relapsing disease, they move in and out throughout the life cycle. So the goal is to set up a system that has all those different intersections and allow them to use anything to ask for the algorithm. Next, we did speak a little bit last week, but just some overall background, some refresh on memories. I had a question.

[Sen. John Morley III (Member, Senate Health and Welfare)]: Oh, sorry. Going to your point earlier, so we've had those different levels, but in the middle, the bill makes no reference to any of those in the requirements for a recovery of residence. And so it seems like there's a missing link. You said there's different levels, but when we look at the bill, there's no different requirements no matter what level you're providing housing.

[Emily Krueger (Vermont Department of Health)]: It would be my hope the certification process through the rule making would establish that we, as a state of Vermont, for example, could choose to adopt the NARA standard. So if we adopt those NARA standards, which, for example, Vutar has for the voluntary certification that's currently happening, within that, as an organization presents as a vendor and this is what we'd like to do and provide, they also have some choice. I'm a vendor that wants to provide level two. I may not be in a space where I can provide level three, but the criteria sit within certification standards, and that that criteria is assessed as they go through that process.

[Katie McLain (Legislative Counsel)]: Just a quick background on

[Emily Krueger (Vermont Department of Health)]: the report, and there's some, I think, caught up in news presses, I am not going to steal any horse thunder, but as of October 2025, we did have eight organizations across the state in 29 locations with 145 rides. Again, those beds were a mix of sort of fiftyfifty men and women, and there were beds also for families, women with dependent children, as well as men with dementia. Oh, the date is February 1. Why did I get this? What's the fall? I don't know. I can't answer that. It's up here. Within those organizations that we have across the state, we do partner with VTARS, the Vermont Alliance of Recovery Residences, that currently facilitates a voluntary certification process in the state of Vermont, and again, they have adopted the NARS standards, which is the national criteria that is currently adopted by most states. We did submit a report to the legislature previously about that, about overall assessment of the current inventory of recovery residences, what the data collection looks like, and what those expectations have done. We do have a certified recovery residence exit and transfer data report. For S157: An Accolade to recovery resident certification, they previously presented the three pieces, so create a recovery resident's certification process, establish data reporting requirements, and modify the exclusion from the memo intent law. We're seeking to create a recovery resident certification process, including specific requirements for the department's authority and goal as a certifier that would be voluntary for recovery residences. It would require certified recovery licenses to report specified data, excuse me, to the department and the department to report that data to the legislature, and it would also seek to modify the existing exclusion from landlord tenant law and eliminate the sunset since it's to occur in of July. The current state for certification in the state of Vermont, we've partnered with VTAR as part of that mix. VTAR doesn't, VDH doesn't oversee the certification process, but we provide oversight through brand agreements to the recovery residences that receive out of funding. Again, that's a subset of the current ranks in state of Vermont. There are no requirements for the residences to be certified. They can voluntarily pursue certification through VTAR. There are several reasons why recovery residents would seek that. I do think that the normal tenant law is certainly an incentive as part of that. Both certified and non certified residences can receive funding currently from the department. The department does not have oversight over VTAR certification, but we are able to oversee compliance, again, with the grant requirements, which have not only expectations and required services and activities, but also has extensive reporting and financial. 24 of the 29 recovering residences are certified by IPTAR and receive funding from any program. Two out of the 29 are certified but do not receive funding from any program. Three out of the 29 do not receive funding and are not certified by Richardson, are not accredited. It is our recommendation that VDH recommends that the legislature grant authority under this section for VDH to establish and oversee a certification process for recovery lessons. This is under 18 PSA, section 4,806. This will align with the way we currently structure our oversight of the preferred provider network, which is W. Benson. Are seeking, instead of the process proposed in S-one 157, the department recommends the legislature give authority to the department in 18 BSA Section 4,806 to oversee recovery residences. Through that process, the department would have the ability to establish rules for the certification and oversight of recovery residences, obviously allows for stakeholder input and voice. Giving the department the story will be more effective in specifying certification process and requirements in statute as currently proposed in FAS 157. There's markup that's being provided. The rulemaking process will allow the department to engage in the public residence community to establish the details of the certification process with flexibility to adapt that process moving forward. The legislature would also have final approval of any rule proposed by the Department. I think just for context of what that looks like operationally, implementation of a new authority like that, The purpose would be to achieve these ends. We would be looking to offer a state based certification to recovery residences still on a voluntary basis. Certification would be based at a minimum on the NAR standards. The VTAR or another organization approved by the department would continue to assess compliance with the NAR standards and the state would oversee VTAR or another organization approved by the department. State funding would be limited to state certified recovery residences. Such a program would incentivize recovery residences to obtain state certification through compliance within our standards. We're looking to set a minimum standard. That's a question that I have. What's the carrot? I know that it feels, if you're a resident, feels like a stick to go through all of this, but what's the incentive to have this happen? I think that there's a variety of things. I think that when individuals are seeking services, I think individuals naturally gravitate towards organizations that are certified or have some type of oversight with them. They're looking for quality of services as part of that. I think the other trick is the funding that would potentially come

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: to them as

[Emily Krueger (Vermont Department of Health)]: part of that. Right now, residences have a minimum of five fund sources that move through the department right now. A combination of federal, Medicaid, state, general fund, and special funds. That's a very complicated, budgetary mix. So it would open up some doors, I think, in those particular spaces as well. Right, and there's some decisions about preference for certified residents when grants are granted. Absolutely. Yeah, okay. This one today, I didn't want to do anything together. Okay. And the program would enable the public to understand the level of support offered by a recovery residence and protect vulnerable individuals by ensuring access to quality care. That quality piece is a big part of that. It's a big reason for our treatment standards that support our preferred provider networks in that similar space. There are expectations that come to us, for example, from the Substance Abuse and Mental Health Services Administration tied to our federal law grant and things like that also do have some expectations for us in those services. We are required, for example, to submit quality plans as part of our overall existing staff. Over time, the department supports creating a unified system of certified recovery residences in Vermont, but would begin by further incentivizing voluntary certification by eliminating department funding and its use of landlord tenant laws to only certified recovery residences. So, that's those sort of.

[Scott Faber (Environmental Working Group)]: It's the first thing. Yeah. Just

[Emily Krueger (Vermont Department of Health)]: checking on any questions. I'm gonna move on to data collection. No, go ahead. Good. Is great.

[Scott Faber (Environmental Working Group)]: So

[Emily Krueger (Vermont Department of Health)]: the current state for data collection happens in two states. So the Vermont Department of Health is one of the few states in the nation that actually collects outcomes data for recovery references. So we already have a leg up on the national stage as part of that. No, it's getting bad. Sorry, it's just a little out. It was just the beginning. It's gonna get worse. It's gonna escalate. Are all the small kids getting I know. They're having fun. You get it when everybody's lined up waiting to go in to testify on the budget. Right. Oh, you've got get it. At the hall.

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: It's not up. Will you be able help me sometime in the landlord piece?

[Emily Krueger (Vermont Department of Health)]: I can try, but they're I yes. I can. But I would bring others now to support that conversation as well.

[Scott Faber (Environmental Working Group)]: I don't appreciate that. I

[Emily Krueger (Vermont Department of Health)]: think the biggest piece within that is the fact it's about eviction. The piece where individuals, when they come to a recovery residence, they're not only coming to a place to live, they're coming to commit to a comfort role. So those individuals are coming to an organization, they're there, they're working on their recovery journey. And part of that, I think about equating it to my children living in dorms in college, when you do sign an agreement, it's not only about living their spouse or behavior and what happens within that. So I was trying to give a real world example instead of having the same thing. If my child was doing something against the agreement they signed to, they also could be removed. We were not subject to that space as well. Again, they come into individuals who are, again, excited on moving through their recovery journey, have made a commitment, it's chronic disease, things happen. I think that's the biggest piece of it. That it's not the safety of the individual or the breach. That would be definitely helpful. So we're starting data point. Okay, great. That was my question. Just in the notes. Currently data is being collected in two spaces. Certification by nature has a data collection piece for that, from the application component of that as well as this data along the way to maintain certifications. The Department of Health also, as part of traditional grants management, we're required to collect data that we think is relevant as well as what may be dictated by the funding source. So there are things, for example, if SAMHSA, the block grant says, You must select this, we must select this. If there is something through Medicaid investments or something comes in legislation, so right now there's a lot of competing, but there's quite a bit of overlap with multiple sources of asking for financial information. We do require funded recovery residence organizations to collect and report outcomes data. That, again, in 2025. The department publishes a data summary with the information reported by recovery residence organizations. There is a link in the presentation at the bottom here that will take you to that report that's currently on our website. VTAR also requires certified member programs to report certain data to VTAR. That includes things like number of residents served. That's a very traditional, it doesn't matter the program. It's not going to ask you how many individuals you're serving. Percent of residents that receive peer recovery coaching or work in that particular recovery center, average length of stay, percent of residents that transition to stable housing, percent of residents that maintain and or secured employment during their stay, percent of residents that experienced relapse during a stay. Kim, question. Sure. So you're talking about secure employment and one of the goals of Turning Point Center, which is non residential, is exactly that. So how do you coordinate the residents with the non residents? So maybe I didn't get a job when I was here, but does it matter? How is this information being used, I guess, when it's not a fit for the primary goal of the residency. I think we try to use a multi pronged approach and different things work for different individuals. There may be an individual in the recovery residence and whatever the services are having there, that's where all the Pistons Fire and everything's clicking. Maybe the connection they make at the recovery center, it may be something they make in their community. There's even spaces where that can occur as well. I think that our goal is to be able, there's no wrong door. No matter how you're getting in there, you can find a path to recovery that includes social determinants of health, we're talking about housing, we're talking about employment, life skills, connecting with your family, whatever that would be. We collect data in all those spaces. I can't necessarily tell you for one unique individual what was causal. Was it the recovery center's intervention that made that happen? Did the recovery residence? We collect that all as a overall bucket of data and try to synthesize that information with our team for evaluation. Greg, is immigration status part of the data that's caught in? I will check on it. Sure.

[Sen. John Morley III (Member, Senate Health and Welfare)]: So the bill that we're looking at requires a bunch of data collection. It sounds like you're already collecting that data. So does the bill, I'm just curious, is the bill really necessary or is a lot of what we're talking about in this bill already covered elsewhere? And I heard you say at the beginning that you felt the oversight should be under modification to an existing statute. I am just trying to see what pieces in the current deal are or aren't being covered already by existing programs.

[Emily Krueger (Vermont Department of Health)]: Why don't we segue these to our recommendation? So the health department recommends the legislature eliminate the specific data reporting requirements that are making the go itself. That the partnership between the health department and the certifying body work together to align and harmonize our data collection efforts, an effort to be comprehensive, but also to de duplicate efforts or reduce administrative burden, and with the understanding that there's multiple sources coming in, that there does have to be some fluidity to that, because for example, if another large federal grant came in, they could ask for something very specific and it wouldn't want that to butt up against legislation. So essentially having faith that the health department and the term in partnership can create the world that you're looking for. Obviously that reporting is still too bad for the legislature. We're just as interested in So should we put in that you will harmonize data collection? Can It's a verb that You're struggling with, so that's

[Katie McLain (Legislative Counsel)]: harmonized. That

[Emily Krueger (Vermont Department of Health)]: was the work that we got to in developing the present picture. And again, Vermont's on the due stage, I've already collects outcome data for recovery residences. We would operationalize that through grant agreements, including the agreement we have with the certified body.

[Katie McLain (Legislative Counsel)]: Sorry, take a break.

[Sen. John Morley III (Member, Senate Health and Welfare)]: Oh, she's covering the process question.

[Emily Krueger (Vermont Department of Health)]: Processor going to coming up. Go ahead.

[Sen. John Morley III (Member, Senate Health and Welfare)]: The the new good idea. So listening to the testimony and modifying and existing. I wish that actually done.

[Emily Krueger (Vermont Department of Health)]: When we get to markup on the bill. So after we've heard all of our testimony, we'll start we'll sit with Ledge Council, and we'll go through the bill and mark it up.

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: Another question I have, Madam Chair,

[Sen. John Morley III (Member, Senate Health and Welfare)]: is I'm guessing that if you, moving forward, perhaps if you, or maybe it's current, if you don't have a certification, will you still be able to receive Medicare, Medicaid? You need listed like four funding sources. Do you envision

[Emily Krueger (Vermont Department of Health)]: That was my question earlier. What's the incentive for certification? Because you're not gonna change if you're right now doing the work. But it will offer an improvement for quality outcomes, systems connection, maybe favorability for certain grants. So that's what I But I don't think it's going to turn off. We're not going to close down. No. The Department of Health will still have oversight overall. We need recovery residences. And there's already a lot of wonderful partnership between them and. I got two residents. I don't know why this is happening at all. I guess it's. It is that when you're talking. Is so take a stride. So the the I don't see that certification is a barrier to services. I don't see it as a barrier to organizations who want me being interested in being what government residences. It's funding. But if anything, to do with open doors in regards to funding.

[Scott Faber (Environmental Working Group)]: That's what I was thinking too.

[Emily Krueger (Vermont Department of Health)]: Yeah. And the if it's not right now Medicaid covered benefits, right now it's supported by Medicaid and has some dollars, so it's still paid through, like, grant agreements. Government. We're not health access

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: or Right.

[Emily Krueger (Vermont Department of Health)]: Like a Medicaid claim for the same. So it's still on the RADS dollars. That's the problem. Thank you for giving me that break. I'll figure out here in a second. The rule making process itself could naturally develop a set of reporting expectations with that. Again, that'll be in partnership with relevant stakeholders across the state so we can build that together.

[Katie McLain (Legislative Counsel)]: Again, we're looking for things that

[Emily Krueger (Vermont Department of Health)]: are meaningful and that we'll use. We don't want to collect data for the sake of collecting data. I think some of those conversations on partnerships can really help us tease that out and create something that's effective and useful. Any questions about data before I move on to the number that and then we'll ask which of you. My kids are gonna watch this. They're gonna be like, mom, what happened to your advice? Wanna I wanna know I'm I'm just I'm conscious of our time, so I just wanna make sure that the last person who's here today gets a chance to testify to, you know, Keith Gulick. I'll be I'll be back. And and I know this is you'll be back. Know he's gonna back. This money chair or something. Money chairs. So the last piece for the laminarctan bond, and you had some questions about that previously. Again, we're looking to remove the sunset and just some slight modifications to the language that has been presented. I I think for the purposes of time, I'll probably write to that. These questions I get submitted previously. The department recommends that the current exclusions be made permanent, with a few modifications. The The criteria for when a resident can be executed should be modified to ensure that certified recovery residents organizations are able to effectively maintain safe and supportive environments for residents by adding the following situations to the scenarios that might cause the resident to be in need of the accident or transferring to alternative houses. The resident regularly refuses to engage in services or programming, commits a crime, engages in theft, misinterfering with the recovery of other residents, or engages in acts of violence that threaten the health or safety of recovery residents' staff. Let me ask this. This would cover all recovery residents or only those certified? I may not be able to answer that question, but it is a question. It's a yes, and I don't know. I would not want to say I'm not authoritative state. I see. Appreciate it. With that, I mean, you do limit to exclusion to certified recovery residents, however. The other piece that I do want to add to the mix, we are proposing that the exclusion should be limited to certified recovery residences as it currently is within legislative body. The last piece I have is our partners at DCF, who unfortunately weren't beginning to be here this morning, but DCF has also recommended a language change for the committee's consideration. It's meeting nine BSA section 4,450 two(two). Relapse of substance use disorder resulting in existing recovery residents shall not be deemed a cause of the resident's own homelessness for the purposes of obtaining emergency housing. This was recommended by DCF since there is not currently a requirement in GA eligibility and is no longer relevant. DCF, again, we weren't able to be here today, people would be happy to come and talk to you

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: about that and answer any questions.

[Emily Krueger (Vermont Department of Health)]: Thank you. So just a quick summary, far as the, we have three consists of certification, data reporting, and the modifications to the landmark tenant law. We are seeking to have authority granted to the Department of Health to establish and oversee a certification process for our recovery residences. We're looking to remove the statutory reporting requirements and allow the Department of Health and the certifying body to come together as part of that process, that's a clean removal making process to allow our stakeholders to participate as part of that, and finally to make the current exclusion permit with some modifications and some amendments. Terrific. Thank you. This is really helpful. And let's start to get our heads into what's actually in front of us. I appreciate that. And we will have you back. It would also be helpful for you to recommend others you think will help. Probably help us. Thank you very much for time. Thank you. And I do want to talk to you about my question from a long time ago.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: And I have an answer. Oh, no. I know. Everybody's been waiting for that one. I know they all they all ask me. So we'll move on to handscale.

[David Regal (Executive Director, Vermont Foundation of Recovery)]: Good morning, Madam Chair. My name is David Regal. I'm the executive.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Oh, wait. So you're not Candace.

[David Regal (Executive Director, Vermont Foundation of Recovery)]: Am a distant second stand in for

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I

[David Regal (Executive Director, Vermont Foundation of Recovery)]: serve as the executive director of Vermont Foundation of Recovery. Candace wasn't able to join today, so I am pinching on Candace's behalf. Know, for the record

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: David, let us we can't see your name right now, so maybe state your name again for the record. Do we have testimony from you on our webpage?

[David Regal (Executive Director, Vermont Foundation of Recovery)]: You do. I'll be reading Candace's testimony and then I will be available to answer questions from the committee as well. Okay,

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: so we'll let you go through your testimony pretty quickly and then because we're now being handicapped for time, but we may have Candace or you back another time as well.

[David Regal (Executive Director, Vermont Foundation of Recovery)]: Yes, that sounds lovely. So for the record, my name is David Regal. I serve as the executive director of Vermont of Recovery. I'm one of the co founders. We started in 2013 and we're the largest recovery residents operator certified in the state of Vermont. I was also a founding board member of VTAR, so it helped to bring VTAR to the state and establish that voluntary certification program. Vifor was the first organization certified to national standards back in, I wanna say it was 2018 or 2019. So this work predates COVID and I couldn't be more thrilled to hear lots and lots of different people show interest, talk about, describe the system that we've been building for twelve years now in the state of Vermont in such articulate and passionate ways. So thank you for the time today. So I'll read Candace's testimony. As you can tell, I've been in this space for a very long time. I've been thinking about the system and supporting Vermonters for a very long time. And so I want to be the best resource I can be to the committee moving forward. Oh, and I live in Glover, Vermont. So I am a resident of Orleans County and probably gonna differ from what I read in Kansas's testimony. So here we go. All right, good morning, Madam Chair and members of the committee. My name is Candace Gale and I am from Barrie, Vermont. I serve as the Director of Community Relations for Vermont Foundation of Recovery, often referred to as V4. Vifor operates 10 certified recovery residences throughout Vermont. This was Emily's comment about stealing thunder. Vifor just opened our tenth home a couple of weeks ago in Fort Ethan Allen in Essex, Vermont. So that's exciting. It brings our number of individuals able to be served up to 79. Our homes are certified by the Vermont Alliance for Recovery Residences and support individuals in early recovery substance use disorder. Thank you for the opportunity to be here today and for the thoughtful work the committee has done on S-one Hundred 57. I'm here to speak in support of this bill and to explain why the language in S-one 157 is important for safety, recovery integrity, and effective operation of certified recovery residences. Recovery housing operates as a structured recovery program, not as a traditional rental arrangement. Recovery residences are not apartments, they are not shelters. They are peer based environments built on shared agreements, accountability, and clear safety standards. Members enter voluntarily with a clear understanding of recovery based expectations that support both their own well-being and the well-being of others in the home. Most members enter recovery housing at a very vulnerable moment. Approximately sixty two percent of our members enter recovery residences from unstable housing. When someone enters one of our homes, we do not just simply hand them a key. We work with them from the beginning to develop an individualized safety net plan. This plan outlines supports, emergency contacts, reengagement options, and next steps if challenges arise. This planning happens proactively, not after a crisis. Recovery residences provide structure, peer accountability, and support during a critical transition. The average length of stay is about six months. These homes are designed to stabilize recovery and help people move forward, not to function as permanent housing. I want to briefly explain why intervention is sometimes necessary because it's often misunderstood. In one example, a member entered a recovery residence after completing treatment and initially engaged fully. They worked, attended recovery meetings, and contributed positively to the home. Over time, their engagement changed. They stopped participating in required programming, repeatedly violated house agreements, and began taking belongings from other members. Eventually, their behavior escalated to intimidation that made others feel unsafe. This was not about relapse alone. Recovery residences understand relapse as part of substance use disorder and respond with support whenever possible. The situation became about ongoing behavior that interfered with the recovery and safety of others. In a shared recovery environment, disengagement does not happen in isolation. When one member repeatedly refuses to participate in programming or shared responsibilities, it erodes trust. It weakens accountability and it destabilizes the culture of the home. Members in early recovery rely on consistency and predictability. When those elements break down, it increases fear and relapse risk for others who are still stabilizing. The language in S-one 157 recognizes that timely intervention in these situations is protective, not punitive. It allows recovery residences to act when an individual's behavior poses a risk to the health and safety of others in the home. Another example involves a member who entered recovery housing while actively unhoused and struggled with significant mental health challenges beyond what a recovery residents can safely support. Because a safety net plan was already in place, staff were able to respond quickly. The member was able to access a reengagement bed through United Counseling Services while appropriate supports were coordinated. While exits occur, certified recovery residences do not simply put people on the street. Vifor works with community partners to utilize re engagement beds, stabilization beds, and other temporary housing options as appropriate. Importantly, relapse or exit from a recovery residence is not treated as the cause of someone's homelessness for purposes of accessing emergency housing. S-one 157 reflects how recovery housing actually functions. Recovery residences rely on shared membership agreements, not leases. Members enter with written consent to recovery based expectations and safety standards when a member repeatedly refuses to engage in programming, commits a crime, engages in theft, interferes with the recovery of others, or threatens health or safety, intervention becomes necessary to protect the rest of the community. Certified Recovery Residences operate under clear standards, policies, and oversight. The language in S-one 157 supports these homes in remaining safe, structured, and effective for individuals who are ready to engage in recovery. Recovery residences are one part of the continuum of care. They are not appropriate for everyone at every moment. S-one 157 helps to ensure these homes can continue to serve the people they are designed for while maintaining safety, accountability, and recovery integrity. Thank you for your time, your continued commitment to health and well-being of Vermonters.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you. That's very helpful testimony. Did you hear the testimony from the Department of Health a little bit earlier?

[David Regal (Executive Director, Vermont Foundation of Recovery)]: I did.

[Katie McLain (Legislative Counsel)]: Okay, good.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: All right. And any thoughts that you folks have on their testimony and how it fits with what you are thinking would be helpful. You don't have to go through it right now, but as we dive into the bill a little bit more, that would be we want to know that we've got folks together.

[David Regal (Executive Director, Vermont Foundation of Recovery)]: Yes, I think generally we're supportive of streamlining the bill to whatever degree possible. I think we would be happy to continue to work with Emily and her team to make sure we fully understand what they're proposing and can come to some agreements if there are questions in any different areas. But overall, supportive of what the department is proposing.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Terrific, thank you. That's exactly what I was hoping you'd say. And that you'll work together with Emily and others, that's awesome. So questions committee. We're good. Thank you. This has been very informative and useful. And next time we would like to meet and have Candice in the room with us at some point, then we'll see how that goes.

[David Regal (Executive Director, Vermont Foundation of Recovery)]: Sounds wonderful, thank you.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you, David. Okay, we're good. So we're gonna turn off S-one 157, but I think we're on a path to move this one forward. We'll pick up additional information and testimony and language that you have and maybe whatever comes from further discussions. Okay? Okay. So we're gonna jump into head first into early childhood. We'll take a little quick hiatus but we don't have a lot of time for hiatus. So if it's eight of three take it and come back, and we're gonna move right into the build page. Sorry. What So did you you want Jessica another time to talk with you about her? Yes. We don't have to do that. I don't want to take your time. Yeah. Yeah. We'll we'll take you. Follow-up. A 50 page report. Yeah.

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: Thank you.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you. Thank you both. She had an emergency. It's good to be. Thank you.

[Katie McLain (Legislative Counsel)]: Okay. So

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: we are looking at 206. How big a walk through did we have last night?

[Katie McLain (Legislative Counsel)]: You did have a walk through. It wasn't it is sort of high level. You know you have a lot of witnesses.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: That's what I was thinking. Maybe we could set you aside. I know that it's something you don't like doing because you never get free time like yourself. Sad.

[Katie McLain (Legislative Counsel)]: If we could have do we have You have a whole slew of people outside.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Oh, well, don't what it's let doing. Them know. Yeah. Allie, why don't you just sit right there? Oh, we're trying to

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: do that.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Yeah. Oh. Sorry. Do you want others with you?

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: Emily will be with me.

[Katie McLain (Legislative Counsel)]: That's okay.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Okay. So we have a limit of 16 people. If you're not testifying I just we're back out. The enforcer. I'll be back out. The enforcer is here.

[Katie McLain (Legislative Counsel)]: Where's our vice chair?

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: We have a 16 person back. If we leave the door open and it's quiet in the hallway, they really wanna stretch it. Oh

[Sen. John Morley III (Member, Senate Health and Welfare)]: my god. It's hard to see. Yeah.

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: Sorry. That would be good.

[Sen. John Morley III (Member, Senate Health and Welfare)]: This chair.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Let's let's do that. And then So are you Yeah. She and

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: I I have to

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: take this one. No. No. I can't take that one, but

[Katie McLain (Legislative Counsel)]: is that gentleman right there? You should give that to you.

[Scott Faber (Environmental Working Group)]: Anything. Oh,

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I can't imagine. Oh, I that I could.

[Laura Cicchino (Environmental Advocate, VPIRG)]: Oh, yes. A practice. No?

[Scott Faber (Environmental Working Group)]: No. Especially now. But, yeah.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Especially now, you're still there. You're good. Okay. We're fine. Right there. Oh, so thank you for being here. We did go through S206 with Ledge Council at a fairly high level, But we're interested in what's happening with the childcare world. I know we did a huge lift and thank you to Let's Grow Kids and especially to you two and others who've worked so hard, Sarah Kenny for one, and who worked so hard on of and all of our healthcare providers. We'd want to know if it's having an effect and then what

[Sen. John Morley III (Member, Senate Health and Welfare)]: your thoughts are today.

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: Thank you so much, John. Thanks a lot. For the record, I'm Allie Richards. I'm coming to you today as actually Board Chair and Strategic Advisor for the Less For Kids Action Network. I'm joined by my colleague, Ann Cummings. We're going do about five minutes high level overview just as you've asked together. I'll start. I'll hand it off to Emily in a moment. But first, I just want to say, just as the chair has said, high level overview about what's happening in the two years since you all, thank you for your leadership, passed the historic Act 76 child care bill. I also just want to quickly set the stage, mention, Let's Grow Kids had a ten year time horizon that ended in 2025, so we sunsetted, having really addressed Vermont's child care crisis as we know. We're very proud of that work that we've done together. There is still more work to do, which is why it's critical that Let's Revive Action Network is still on the scene with these amazing other early childhood partners, such as Building Bright Futures, Virtual Science Vermont AYC, who is also in the room today, to carry the work forward. And you'll hear about the progress and the gaps in a moment. So thank you all so much. So we have made incredible progress. It's very validating to be here, we'll be

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: to share some good news.

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: In the last two years, the passage of Act 76 have fundamentally fixed a broken business model where early educators can afford to make less, parents can afford to pay more by injecting the public investment in the system, and it is working just as we hoped. 100 new childcare programs have opened, 1,700 new childcare spaces all around Vermont, 400 new jobs have been created in the industry through that growth. That's just the tip of the iceberg. Many, many more with interactive tertiary jobs created through that as well. Hopefully, continue to get better and better info on that workforce. Also, enrollment in the state's tuition assistance program, CCFAP, is getting out. The word is getting out to the people. Over 5,000 additional Vermont families are now getting reduced tuition assistance. These are real numbers. I just wanted to point out a trend. More child care programs have opened and closed in every quarter since the bill passed. That means you all moved the aircraft carrier. This was a fragile, delicate system that was a bankrupting proposition. Because of the changes to Act 76, we are changing the trend. That's huge. I just always like to bring in some Vermont voices to this. So don't take my word for it. T Lynch is a mom of twins, so I can really relate. Of Burlington, She was spending her entire paycheck on childcare. Now, because of Act 76, she's gone from $3,000 a month to $1,000 a month. I just want to reinforce this isn't a dime that Vermonters are saving. It's actually really life changing for many. She can have a career hustle now, which she wants to have and save for the future. Another example from the early educator side, Michelle Bishop is opening a new program in Addison that she could not have been without x-seventy six. And even better, she renovated an MD elementary school and is using that for her program. She has opened it, and now she's continuing to expand it. It's a huge success story. She could not, would not have been able to do that without the sustainability of absenteeism. In Barrie, we have a family home, and these are also in your written testimony, you want refer to this. Alexander Whitcomb, her program now qualifies for tuition assistance of the families in her program. So one mom with a kid in her program was

[Katie McLain (Legislative Counsel)]: able to quit her second job that

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: she had taken on expressly just to pay for that job. I also want to say, while I love bringing those stories in, don't take the anecdotes at for just alone. There's really good data at your fingertips now, which I have to really commend you on your leadership. We're not just passing historic transformation bill, but putting accountability measures in to make sure it was going well and we could continue to make force corrections, because this is what we do as policymakers in Vermont. In this case, First Children's Finance has a fantastic supply and demand set. It clearly shows the progress and the gaps. It's shown that between 2024 and 2026, we've had very large functional increases in the incapacity of childcare across the state. It also shows we are now meeting the need of about forty percent of infants who are likely to need care have access, which is up significantly, but still forty percent. Seventy percent of toddlers who need childcare getting access, and sixty nine percent of priests' case students. Those numbers have all gone up, and it shows the work that we have loved to. In addition to the first one science study, there's a pre K monitoring report baked right into the law. Thank you for that, for building bright futures. Key takeaways from their really incredible report that has a dashboard right at the top. I highly recommend approval of that. One is that affordability improvements are really working. In fact, expand eligibility, higher CCFAP rates, these are getting out to folks from Montrose, understand they're eligible and are signing up, and it is increasing affordability for families. The other thing is that the workforce shortage. So this is why I think Barry, thank you for inviting us for an overview as you delve in to this new frontier, this very important work of thinking about this workforce bill. Major takeaway from the monitoring report is that the early childhood education workforce shortages are the primary constraint to access. Expansion of childcare. Workers. Despite the increased funding and the demand, staffing challenges continue to limit programs' ability to expand, especially for infants and toddlers, but I'm really excited to have another transformative, creative solution to this that you all are grappling with. Finally, that program stability, yes, has improved, but it depends on the setting, the geography, the program type. It's not all equal as far as the stability that x 76 has provided. Maybe a little longer than I thought I'd started and I can't stop. I'm very excited about this issue and I'm incredibly proud of the progress. As you can see, there's work left. You have really good tools, though, to continue the work. I'm gonna hand it to Emily to introduce herself and just sort of finish the wrap up, especially in regards to how it fits the context of the bill you're looking at.

[Emily Tennenbaum (Executive Director, Let's Grow Kids Action Network)]: Great. I'm Emily Tennenbaum, for the record, the new executive director of Let's Grow Kids Action Network. And just because it's my first time ever in committee, know I've been around the building a lot. First time ever formally in committee, so I wanted to introduce myself. I grew up in Southern Vermont, proud public school graduate of Harvard High School. Moved away and was very, very happy to be back with my three kids because

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: of the promise of what

[Emily Tennenbaum (Executive Director, Let's Grow Kids Action Network)]: was going on with childcare here in Vermont way before this was all reality in legislation. And I had one kid in childcare as well and two other kids in public school, so really parent advocate in this space as well. So, for Ally's testimony, it's clear there's a lot more work to do in 2026. Just wanted to go over kind of what we're focused on as the childcare movement and the policy priorities. Protecting childcare funding will help drive Vermont further success, strengthening our early educator workforce, which is what we're here to talk about today, and passing the CCE prevention bill. We also wanna make sure we're increasing childcare access and affordability where possible, and fixing delays in fingerprinting of background checks for ECs, which are critical for safety and staffing. So we've provided the committee with a full briefing on the twenty twenty six Child Care Agenda, both with the committee assisted here today, but also in your email boxes. Happy to

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: go into more detail on any and all

[Emily Tennenbaum (Executive Director, Let's Grow Kids Action Network)]: of those things as well, but just really wanted to be here today to talk about the critical next step of this child care progress we're seeing. Just wanted to note that our policy agenda was written and released with our close partners at Vermont Association for the Education of Young Children, Vermont PYC, which Sharon here in the room. It's the state's largest membership organization for early childhood educators. They are the experts at leading the ECE workforce over the past fifty years. And before your committee, Senate two zero six, an accolade to licensure of early childhood educators by the Office of Professional Regulation. The elements of this bill are based on recommendations by a task force of early childhood educators led by Vermont AUIC, and has a multi year feedback process. Really important that it was industry informed and spent years really talking about what this industry needed and how clear it was that this profession was really needing some recognition along with the supports. And this was led by Vermont AUIC. So the earlier papers were able to provide comments through the Office of Professional Regulation and this feedback really shaped both the bill, but also the revisions from the 2025 bill. And that was all seen in that work last year. And I'm sure will be coming in at some point to testify and will be able to

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: be the expert on that.

[Emily Tennenbaum (Executive Director, Let's Grow Kids Action Network)]: I just wanted to note today here as I close-up, long term public investment is helping programs grow and improving quality of early education. So we'll for educators and for kids. To meet the needs of families, we need thousands more educators. We can't get the access we need if we don't have the staffing and the people in the room and that they're qualified and well supported to be there. Really, progress depends on strengthening that workforce, and the best way to do this is pass this ECE profession bell along with a variety of other tactics. So by recognizing ECEs at the skilled professionals they are, I see one in the

[Laura Cicchino (Environmental Advocate, VPIRG)]: room with us today that we worked with,

[Emily Tennenbaum (Executive Director, Let's Grow Kids Action Network)]: we are giving them the clear and supportive career path they need both to enter the profession, stay in the profession, and make it possible to do that recruitment and retention we need to do. Vermont educators have been calling for this recognition for years because we know better qualifications do better outcomes for kids and why all here for kids. We need make sure we back up with a strong system of support, including scholarships, student loan repayment assistance, and apprenticeships. All of this to make sure that early education is a more viable career here in Vermont and will help our childcare system expand. So in closing, easy, professional bills, workforce informed, workforce strengthening, and a legislation that we all support. Thank you.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: You support the bill. We

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: strongly support the bill and I found someone who talks faster than I do. I'm sorry.

[Katie McLain (Legislative Counsel)]: Thank you for that. And and, Emily, if

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: you can send your testimony in, then Melissa will get it up on our web page. I think it's our Yeah. She got it. I don't have the do we have the written? I don't have the written.

[Katie McLain (Legislative Counsel)]: Done a little few anecdotes there, but it should be in Okay. Basically, the agenda.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: It's it. Hard Yes.

[Katie McLain (Legislative Counsel)]: I got it.

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: It's our one testimony as well as our policy agenda is also there, Senator.

[Katie McLain (Legislative Counsel)]: Okay. She could train me in a lot of things, but not to talk. Okay. I'll try my best to work We're We're good. I just don't like to lose anything because then

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: when we go through final markup or someone's reporting the bill, we need to have the data and information to do that. Questions? Not a question, just a desire. We're hearing a lot about kids entering school that are not ready to learn. They have behavioral issues. Is anyone tracking I assume that if you go through a trained daycare, you know how to walk in a straight line, which is what my grandson learned in kindergarten. Is anyone tracking whether or not kids that go to these programs are better ready to learn. So, would talk to Doctor.

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: Martine Frostman, Build the Bright Futures. They are the ones that really are the data experts, I would say, Senator, the data is very clear For a decade working on this issue, we grappled with how to talk about quality and what it put in as, like, the proxy measure of simple way to talk about quality. And when it became clear, the research was so abundant, the level of preparation and support of the early childhood educator in the room was the single indicator, the deep, deep research on how well that kid was gonna do in the program. So this is what we talked about when we talked about quality. And then, when you have quality equals, right, that, like anything center, right, the human in the room supporting that child's growth. Then, it leads to the outcomes which also are well researched. The good news is what we're seeing in Vermont is very good outcomes and increasing for kindergarten readiness, and it's because of the quality and level of preparation support continuing to grow in that zero to five space. I'll also mention that quality's not enough, which it should be, right? It's also the thing that is determining access. So that's why, if we're here before you saying the next huge movement in the animation office work we've done together is this workforce piece for quality and process. Thank

[Katie McLain (Legislative Counsel)]: you. Thank you very much for your testimony. I was going say knee deep,

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: but I'm really up to here in education stuff right now, and as you probably know, we have a really complex governance structure in the state of Vermont and our policy, our sort of bifurcated policy systems are complicated and complex and hard to maneuver. And I think they're making education reform difficult right now, at least as far as I'm concerned. So when I think about what is proposed here, and I really appreciate the Office of Professional Regulation and their Sunrise Report, it's incredible work. Did you ever consider having the Agency of Education sort of fold this into their pre K-twelve, the work that they do already?

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: The main answer I will say is I highly recommend you talk to Sharon Herrington and Romanian YC, deeply expert and leaders on this and can tell you more detailed explanations of yes. There's been a ton of thoughtful work of probing what is the right way to do this national work, Vermont, consensus work, work with the Office of Special Regulation, and what I believe emerged was the most practical straight line that does not have duplication, for variety of reasons that you can hear more of from those folks. It's very much, as you dig into it, it doesn't duplicate what already exists, and it brings in an entire new zero to five world that has been otherwise ignored. There were very good reasons for that. I don't want elaborate too much on because other experts are.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Got it. And we've got folks on the list to come in and testify, and if you have specific individuals, then we will ask them in. I'm just curious what No,

[Katie McLain (Legislative Counsel)]: this has been ongoing for a long Also, the

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: way people have asked about that. Yeah, between DCF or CDD and AOE, it's a constant dialogue and how do we fix it, whatever it is. Thank you. Thank you both. Really is good. We're good. We're getting our

[Laura Cicchino (Environmental Advocate, VPIRG)]: hobby for just getting started.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: And and Shannon M. Essence Balsam is your JP. And just FYI folks, know that there are two people who were wiggling the receipts, so that's something to go to. We're going to finish this bill and as '26 was on our agenda to look at for the first time so we will get to it. We may not do everything that's peered away. We'll come through. Bear with

[Shannon Evans-Balsam (Child Care Manager, Jay Peak Resort)]: me while I get my tespioni pulled up. While I work on logging back into this, I just want to briefly introduce myself. My name is Shannon Evans also. I'm the childcare manager for JPEG Resort, and I'm also a resident of Newport City. I've been working at JPEG since 2013, starting at skiing ride school. My pine bear ultimately led me to a career in early childhood education since the snow kept melting and I really needed a year round job. I earned a master's degree in early ed from Champlain College, achieved my pre K teaching license, and joined the childcare department at J as a teacher in 2018. Now I am a childcare manager and I've served that role since 04/01/2022. It's a

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: really weird day to get a promotion.

[Shannon Evans-Balsam (Child Care Manager, Jay Peak Resort)]: It's also a very unique position at an intersection of private business and public service. My responsibilities include recruiting and retaining qualified staff, ensuring compliance with childcare licensing regulations, and coordinating both recurring and non recurring services. Our employee and local residents center operates year round, serving children six weeks to five years old. We also offer an ACT 166 UPK early learning program. That's what we call recurring care. We see these families every day and serve them for multiple years, even multiple siblings. For non recurring or resort drop in care. We have an additional licensed space in our Ski And Rides Home building, which I operate mid December through the March every ski season. This space serves children zero to four years old. As of this writing, I have sent out 146 enrollment packets for the 2026 season. And by the way, we haven't hit Presidents Week yet. Furthermore, when my year round program is fully staffed, have 23 spaces for infants, toddlers, and pre K children that I can offer to our employees and our local residents. Our department has the opportunity to touch the lives of very many, very little people. My team and I take that really seriously. There's a lot to know when you work with these little people. For example, it's completely developmentally appropriate for toddlers to enter a state of conflict every twenty minutes. That's three times an hour, and three

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: hours. Sounds

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: like the Senna. So you're familiar with this. You can complain.

[Shannon Evans-Balsam (Child Care Manager, Jay Peak Resort)]: As much as 90% of the human brain develops by the age of three. And in 2010, it was estimated that young children spend approximately twelve thousand hours in group care and institutional settings before they go to school. Early childhood educators make those twelve thousand hours meaningful, enriching, and full of play, love, and connection. So that brain that's growing so rapidly from three is nurtured with language, art, music, relationships, and so much more. This helps set the foundation for a young person equipped with self regulation and a grounded sense of self and community. As a center director, I get to invite new people into this career and provide a valuable service to our local community and our guests. When I was interviewed in 2025 by First Children's Finance, I said that offering childcare wasn't a luxury, it's an investment in our entire region. I meant that. Childcare allows our local community to get to work. And a good number of jobs in our region are connected to the ski resort industry, which contributes to our state's economy. JPEG Resort employs on average five fifty people year round. We also experience huge influxes of seasonal employees, and those folks need childcare too. I know, they call me. And yet, there remain huge barriers to recruiting and retaining a quality workforce in early childhood education. So this is where the licensure process envisioned in S206 comes into play. Licensure provides a clear pathway for a career with longevity and value. It creates workforce retention, which improves access to childcare for families. So another way to think

[Laura Cicchino (Environmental Advocate, VPIRG)]: of it is this. I can have

[Shannon Evans-Balsam (Child Care Manager, Jay Peak Resort)]: my driver's license and I can drive my own kid to school. I can even help drive my neighbor's kids to school. But I definitely need a CDL before I drive the whole school bus. So this is where you folks come in. You have the opportunity to help minimize these barriers. Please carefully consider how licensure for early childhood educators and home providers could help evolve this profession. We deserve a career with respect, longevity, value, and fair compensation for our unique skillset and knowledge. I would love a better hiring pitch than we don't do this for money or respect, but we have a lot

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: of fun playing. Right?

[Shannon Evans-Balsam (Child Care Manager, Jay Peak Resort)]: And if nothing else, please become champions of the educators that work in childcare. Because if we worked in daycare, we would do this.

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: All right, that was a great ten hours. See you guys tomorrow.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: No, no, no, no, no.

[Shannon Evans-Balsam (Child Care Manager, Jay Peak Resort)]: We work in childcare. We teach children. We support families. We honor their messy and lovable lives, and we do it with our whole hearts. Madam Chair, fellow senators, thank you all again for your time and your consideration of my story. If there's anything further I can offer, I am at your service.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you, Shannon. It's great. Good. We have your testimony, which is even better. You did it. And congratulations on all your work. You have longevity in this and you've got training and also the experience to help us understand what we're looking at. Absolutely. I really appreciate it. And you do deserve respect. We get that. Yeah. Alright. The question is commit again for for Shannon. So so let me ask you this question. Yeah. This is the passage of our bill. I forget the number. Always Act 76, yep. Have you seen a benefit

[Katie McLain (Legislative Counsel)]: as a result of that? Part of Act 76 was boosting subsidy reimbursement rates up to 33%. And our year round recurring program where we serve members of our local community, we are able to accept CCFAP money because we are a licensed program that follows all the rules and jumps through all the hoops. So that was an instant bump to the revenue that I was able to then bring to our leadership and said, Hey look, you wouldn't have this money if you didn't have us. So our wages need to go up.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Come on. We got it. So, it's

[Katie McLain (Legislative Counsel)]: a fight that I've been fighting a long time.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you. Terrific. Thank you for coming in today and we've kept you from the mountain.

[Katie McLain (Legislative Counsel)]: Absolutely. I thought this would help.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you. Thank you for your time. And we're gonna as we're gonna hear from Danielle Harris from the YMCA. Yeah. I can switch with you. Yeah. Slide it out. Thank you. Thank Welcome. Thank you. Thank you for having me.

[Danielle Harris (Senior Director of Youth Development, Greater Burlington YMCA)]: I don't do this on a regular basis, so I'm gonna read my testimony. That's

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I'm gonna make sure you introduce yourself to the record, then think we add

[Danielle Harris (Senior Director of Youth Development, Greater Burlington YMCA)]: your freshman. We're gonna submit it after. Oh,

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: have it? That's something we could do, right here. Great, this is great. So go right ahead. Thank you. Madam Chair, Madam Vice

[Danielle Harris (Senior Director of Youth Development, Greater Burlington YMCA)]: Chair and members of the committee, thank you for having me. My name is Danielle Harris, and I'm the Senior Director of Youth Development at the Greater Burlington YWCA. Thank you for the opportunity to speak in support of professionalizing early childhood education in Vermont. The Wise shares support for efforts that bring greater clarity, consistency, and professional recognition to early childhood workforce. Spisees educators carry enormous responsibility, and they deserve pathways that reflect the importance of their role. That said, while the Y supports the goal of professionalism, we'd like to share a few concerns

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: we have with this role,

[Danielle Harris (Senior Director of Youth Development, Greater Burlington YMCA)]: as well as offer some suggestions for changes. Our concerns largely focus on demographics and workforce challenges for both proposed licensure fees and quality of care equity. The Y, like so many other programs and professions in the state, face significant workforce shortages. Each year, we seek to fill on average four full time teaching positions and four floating positions in our downtown location. Most applicants are not qualified. Many have little or no experience or limited education. The average time to fill a position is typically three to six months, sometimes longer. Though our programs have retained well, we've had two applicants recently who were technically qualified for our positions that were open, but unfortunately never returned emails about the interview. We see our challenges in hiring as a symptom of the demographics in our city. As you are familiar, Vermont is graduating fewer high school students each year, and we have a limited number of college graduates staying in Vermont and entering the workforce. The Vermont Futures Project reports that Vermont needs to add 13,500 workers annually to improve affordability and ensure maintenance of essential services like childcare. Given Vermont's worker shortage and shrinking graduate pipeline, new barriers to entry could intensify existing workforce challenges, including for qualified educators moving into the state. Additionally, this bill does not go far enough to be inclusive of early ed workers that have significant experience in the field, further limiting their upward mobility within the production. For instance, we have an assistant teacher who's worked at the Y for well over seventeen years. She's a popular staff member who's great with kids and should be a wonderful ed teacher. Unfortunately, she does not have higher education degree and is therefore disqualified from consideration whenever we have an open teaching position. We've asked her whether she'd like to go back to school, but she's expressed concern and is intimidated by the process. With three children and limited funds and time to dedicate to workforce, she's opted to stay in the field at a level that is below her proven ability. Our suggestion is to examine competency based pathways to light gesture. We the experience and demonstrated competencies often equal or exceed degree attainment. This is evident in section 6,221. However, the language is vague on which competencies acquired or experienced would count toward credit, and whether the provider seeking credit would still need to pay for the credits for an educational program. We would prefer that the Office of Professional Regulation create a parallel non degree pathway that evaluates all competencies and experience of providers to obtain licensure. In addition, OPR or the proposed board should have structures in place that enable new residents as quickly as possible to enter the field. The biannual licensing fee suggests in the legislation are relative to typical PC wages. For many of our staff, the fees could be approximately 30% of their rate per pay. While issued by annually, each time a little hubs up, it's about a fee cumbersome. Our suggestion is the team would like these fees to be reduced or otherwise allow for providers to access special funds to help offset the cost of our bill. The Y understands the vital importance of quality, high quality care, and accessibility in childcare, which makes home based care an essential place and piece of the early ed landscape. However, we're concerned that the decrease in quality as it pertains to home based providers outlined in section 6,220 one(four), whereby the family child care provider need only to be in good standing for the child development division as of 01/01/2029 to qualify for licensure. We'd like to see parity and equity in the expected quality of care across the early childhood education center. We'd like to set the expectation that all providers, whether home based or center based, meet the same standards for licensure. We would anticipate a non degree competency based pathway to help with this regard as well. In conclusion, the YMCA supports and commends the committee's intent to elevate early childhood education as a profession and to bring clarity to requirements that are currently difficult to navigate. As a workforce is formally professionalized, we respectfully urge careful consideration to experience based pathways, the minimalization of financial and administrative burdens, and policies that ensure high quality care across the full

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: spectrum of providers. Thank you for your time today. Thank you. I mean you've opened up a whole discussion here with your comments around experiential licensure. I know that's been a discussion in other areas including education, educators who have experience but don't have the application credentials. So this will be helpful. And we'll have to hear from others about this and what the thinking is currently through AOE, CDD and OPR. She used all my little acronyms. I'm with you. You got it. You got it. So questions for Danielle.

[Sen. John Morley III (Member, Senate Health and Welfare)]: I just agree with you a lot because even in our industry,

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: there's some people that don't have

[Sen. John Morley III (Member, Senate Health and Welfare)]: the credentials, but they're so talented and so smart. And so I know that there are individuals probably in the fields that can actually do this job. So the licensure process is a concern, right? Yeah. So I don't want to express that.

[Katie McLain (Legislative Counsel)]: Yeah. I want to be clear. I don't think there should be, we should minimize qualifications or get rid of them. I just want to support those staff that have been with us for so long that just are older, like myself. And if I

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: was told I had to go

[Katie McLain (Legislative Counsel)]: back and get a college degree right now to do

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: what I love to do, I And I'm certainly not

[Sen. John Morley III (Member, Senate Health and Welfare)]: gonna get such an education either, it's just that there are certain individuals out there you want

[Allie Richards (Board Chair & Strategic Advisor, Let’s Grow Kids Action Network)]: to keep.

[Katie McLain (Legislative Counsel)]: Like this one I talked about. Yeah,

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: no, it's an issue of who's there right now as compared with who's coming in by the future and what we can do to build workforce. So if you think grandfathering would solve that problem. Cool. Thank you. Yeah.

[Katie McLain (Legislative Counsel)]: Thank you very much for your time.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I'm looking at our clock here, and I'm wondering, OPR, what your thoughts are at

[Katie McLain (Legislative Counsel)]: this point. How long does the committee have?

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Well we have theoretically five minutes. We have another bill that we wanted to address.

[Lauren Hibbert (Deputy Secretary of State; former OPR Director)]: So I see. What I'd like to say to the committee is, please, can

[Katie McLain (Legislative Counsel)]: we come back to for

[Lauren Hibbert (Deputy Secretary of State; former OPR Director)]: the record, Warren Hibbert, Deputy Secretary of State. I have with me Jen Colon, Director of the Office of Professional Regulation. We're really, really excited to testify in front of this committee. We would be honored if we could be given more than five minutes.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Well, that's what I'm thinking, and it probably serves us well to have that So let's do that. Let's reschedule. I'll have Calista put you up first thing next time. Because we have a number of other folks coming in as well. Thank you very much. And I did want to get to this other bill simply because people are coming in. We'll take a two minute break, and then we're gonna go take a two minute break. We're not on the break. No. I don't need it.

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: I didn't call him leaving.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: I'm not Great here. Yeah. I I have to be in house front. So I'm wondering if you want it's a two page bill. I have to do it real quick. I wanna do a quick okay. And then we've got the caption later. We're gonna take it now. We'll get us started on the bill. We'll go back to. Have you left? No. Please. I'll another minute. This is a short bill. It also may have a need to be looked at in another committee. It came from education, and then we're looking at it. And so my goal is to try to act on it a little quicker than other bills because it has to go back to education. That's why I'm being a little snarky. We go.

[Katie McLain (Legislative Counsel)]: Hello again, Katie McLean, Office of Legislative Counsel. So this is S-twenty six, an act relating to prohibiting certain artificial thyes and foods and beverages that are served or sold in schools. It's a short it's a short bill, but it does a lot. In subsection A, in operating a school lunch and breakfast program under the National School Lunch Act, under the Child Nutrition Act, as amended, or selling competitive food, a school district and an approved independent school shall not serve a food or beverage during the school day containing water or more of the following substances. We'll look at the substances on the next page. I anticipated that there might be questions as to what is meant by competitive food, so I pulled the federal definition. Food and beverages other than meals reimbursed under the National School Unchecked and Child Nutrition Act that are on sale to students on the school campus during the school day. So, food's provided for sale during the school day. So, the prohibited substances are dyes, blue one, blue two, green three, red 40, yellow five, and yellow six. No food loops. M and M's. Subsection A does not apply to foods or beverages sold or served away from

[Scott Faber (Environmental Working Group)]: the

[Katie McLain (Legislative Counsel)]: school, away from the school campus. So, a field trip, for example, wouldn't apply to food provided or served on the field trip. Or at least one half hour after the school day until midnight. So, for example, if there is a sports team or if there's a band concert, those kind of events that happen after school, it does not apply. As used in this section, competitive food, we just went over what the definition is, And then we have a definition of school day. As it pertains to a public school, it's defined in current statute, and I didn't pull that, I apologize. And as it pertains to an approved independent school, it means the hours picked by a school for instruction each day. There's nothing in statute until you set it here. So I will stop sharing and I know that we'll have more time to have a conversation with me about this later. But you have witnesses, so I will get out of this seat. Thank you.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you for your indulgence, and I know you're busy upstairs.

[Laura Cicchino (Environmental Advocate, VPIRG)]: Welcome everyone. I'm Mr. Lyons and members of the Senate. Also, Laura Chittenden, Anna Suberle, I'm the environmental advocate with BIPERD, and the Vermont Public Interest Research Group. Thanks so much for the opportunity to testify on S-twenty six. Just because it's my first time in this community this year, V PERG is the Vermont Public Interview Research Group. They represent more than 20,000 members and supporters across the state in every single legislative district in Vermont, and our mission is simple: to protect Vermont's environment, climate, democracy, and of course public health. That brings me to this bill, we are testifying in support of. I want to paint a picture of our food landscape really quickly and then talk a bit about the bill. I'll start with something basic, and that it's our food is making us sick. Most of what fills our grocery stores are ultra processed foods, stripped of natural nutrients, and powdered sugar, sodium, unhealthy fats,

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: and synthetic diets and additives.

[Laura Cicchino (Environmental Advocate, VPIRG)]: These foods now make up an estimated 71% of the American food supply and a major driver of chronic diseases like heart disease, diabetes, cancer. And So many of these ultra processed foods I'm talking about contain artificial dyes and offer no nutritional benefits and offer really concerning health risks, especially for children. Research has linked synthetic food dyes to hyperactivity and adverse health behavioral effects, adverse behavioral effects. And yet, many of these chemicals haven't been meaningfully reviewed by the FDA in decades. So that said, at a time when we really can't rely on the federal administration to hold powerful food manufacturers accountable, we're really looking to the to do that. Vermont has a long history of this and S-twenty six is a common sense place to start moving our food systems in a healthier direction. Importantly, this bill, as you mentioned, is also practical. The Vermont Agency of Education has publicly stated that they are in support of this initiative and would not have difficulty sourcing compliant products for their schools. And that's in large part because states like California have already started to shift the market with their own policies in this area. So, as you all continue your work on this bill, we would encourage you to consider aligning it with existing house legislation, H260. We think it makes sense to align these two as they both relate to food safety and removing harmful chemicals from our food. So more specifically, H260 as it stands right now addresses other harmful food additives like ruminated vegetable oil, potassium bromate, carboparaben, and red dye number three, which are chemicals linked to cancer, hormone disruption, and reproductive harms. There are also a few other additions that other states are considering, we would ask the committee to also include in this bill, things like BHA, BHT, titanium dioxide, sucralose, aspartame. Happy to get you a comprehensive list of these things

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: that we're asking the team consider since it's a lot of chemical maintenance here. That would be great, if you did that, and then obviously the states are already asking Yes, for yeah, happy to, happy to. And

[Laura Cicchino (Environmental Advocate, VPIRG)]: so, with that said, you know, states are acting in this area and really demonstrating both the feasibility and momentum behind this initiative. So, to sum up, S-twenty six is really about protecting children and taking this important step to a healthier immune system. We encourage you to strongly support this bill and that encourages students who continue to work

[Katie McLain (Legislative Counsel)]: on the session. So just like the bill, I'm happy

[Laura Cicchino (Environmental Advocate, VPIRG)]: to keep it short and answer any questions.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Right, well, have folks to hear from. In fact, we have Scott Favor here today who we'll hear from, but then we'll also hear from AOE and it will go back to education. Thanks for your suggestions and looking at those other chemicals in H260. Scott, you're welcome.

[Sen. John Morley III (Member, Senate Health and Welfare)]: Thank you.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Good morning. But I have two committee members who have commitments outside of the building, so they're gone. But we are here.

[Scott Faber (Environmental Working Group)]: Well, good news for the senator who was worried about Froot Loops. Oh, good. That other countries are making Froot Loops, including Canada, with just natural dust, so students in other states are already still enjoying Froot Loops just without the synthetic colors that scientists are telling us are are making it harder for them to learn. Just maybe step back. So I'm Scott Baber. It's an honor to be here before you. I work for the Environmental Working Group, and I also teach food and farm law at Georgetown's Law Center. Before I worked for EWG, I was the head of government affairs for the Consumer Brands Association, which is the Food Industry's Trade Association. So I've seen this issue from both sides, or many sides, if you will, and I just wanted to make five quick points. One is that overwhelming science shows that these synthetic collars are making it harder for some of our kids to learn. We know that because of human evidence, observing what happens to kids when we feed them dyes, and we know that because of animal studies that show what happens to their brains when we feed them this dyes, not only does it cause microscopic changes to their brains, but it changes the chemistry of their brains in ways that makes them inattentive. And that interferes not just with their ability to learn, but the ability of other kids to learn. So it's really important that we phase these guys out of our schools so that our kids have every chance to succeed. The second thing I just wanted to say is that there's an, unfortunately, the FDA has not reviewed the safety of these dyes since the 1960s, 70s, and 80s, long before toxicological studies could tell us what impacts these synthetic chemicals were having on our kids' brains. The third thing I wanted to share is also unfortunate, which is that the FDA has no plan to review these dives anytime soon. So they've published a list of chemicals they hope to review. These dives are not on this list. The FDA has lost 20% of its workforce. Many of those people would have conducted those reviews. And so if we're waiting for the FDA to review these diets, draw some conclusions, we won't be waiting very long time.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: The

[Scott Faber (Environmental Working Group)]: last two things I quickly wanted to mention

[Emily Trita (Staff Attorney, Office of Professional Regulation)]: was

[Scott Faber (Environmental Working Group)]: that our school food professionals, as you've heard, are already able to replace products with other products that don't contain these dyes in part because other states have taken action. Many states have banned dyes from school foods. West Virginia, just last year, passed sweeping legislation that bans these synthetic colors from all foods sold in the state. So seed manufacturers, the good manufacturers I used to represent, are all now moving swiftly to remove all of these synthetic chemicals, not just from the foods that are offered in school, but from all the foods that you will get at Annifer's or Shaw's or Stop and Shop or when you go for your groceries. And then the last thing I just wanted to mention is that not only does FDA have no plan to review these dives anytime soon, Unfortunately, the current system that we have for reviewing food chemicals allows new chemicals to enter commerce without adequate risk. So since 2000, 99% of all the, I always paid to mention this right before lunch, since 2000, 89% of all the new chemicals that have been added to our food have been approved for safety by the food chemical companies, not the FDA. And unlike pesticides, which have to be reviewed every fifteen years by the EPA, There's no such requirement like that for the food chemicals we feed every day. So I would second Anna's comments about thinking about adding more ingredients to this list, more substances to this list. Just yesterday, the state of Indiana, their general assembly, their house passed legislation that not only bans these diets from school foods, but bans six other chemicals from school foods. Their senate's taking it up tomorrow. Majority leader of their senate is the sponsor of the bill. So I think there's room for more progress, especially in light of the fact that every state, the Senate, regardless of which party is in control, agrees that some of these chemicals, many of which are not allowed in Walmart store brands or Hannaford store brands, are still showing up in

[Sen. John Morley III (Member, Senate Health and Welfare)]: our own sold foods. So thank you. It's a joy to

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: do that. Thank you. You did a great job of just telling a story. Beautifully done. And if you don't mind sending in your written testimony,

[Dr. Rick Barnett (Chair, VT Psychological Association Legislative Committee)]: it's a list of what

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: we have that and questions. I think products

[Scott Faber (Environmental Working Group)]: are we talking about in beginning of the year?

[Sen. John Morley III (Member, Senate Health and Welfare)]: Schools or in Schools. Schools.

[Scott Faber (Environmental Working Group)]: Oh, there are I'm gonna make sure I get this right.

[Sen. John Morley III (Member, Senate Health and Welfare)]: Just a proctor. No. No.

[Scott Faber (Environmental Working Group)]: There So it depends on the so schools have a, both the lunch line, or what's called on the tray, and the a la carte line, which is sort of, I went to high school in Massachusetts, I probably should admit that here, but we would have an a la carte line where you could buy other things, pizza, french fries, soft drinks, etcetera. There are about 1,200 products in the a la carte line. The lunch line is different because it's subject to a meal pattern, for those of you who've served on the education committee or have worked with the school system, you know, most of those products are are free from dives already. It's really the online and the vending machines where where the dives are

[Sen. John Morley III (Member, Senate Health and Welfare)]: And it's not gonna be a big struggle to There's a

[Scott Faber (Environmental Working Group)]: lift in. That's right. So if I'm if I'm a school food play session and I'm I'm buying a lot of my products from Cisco or Aramark or Bon Appetit or the food service companies, they are already selling products without these dyes and other chemicals to be if I ask for pain. Okay. It's the branded foods that might be sold with the a la carte line that would

[Sen. John Morley III (Member, Senate Health and Welfare)]: have I guess the industry's gonna flip pretty quick once the states start doing this. Yes. I can imagine.

[Scott Faber (Environmental Working Group)]: Probably more than you need to know, but if I'm General Mills, I'm making two versions of all your favorite foods, one for you and one that's reformulated especially to meet school food standards because we do set federal and state standards for certainties for certainties Okay. That's actually

[Sen. John Morley III (Member, Senate Health and Welfare)]: what we've So the single's been said. Absolutely. Yeah.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Other questions? Sounds like we have a little work to do.

[Scott Faber (Environmental Working Group)]: Well, wish, I do, I'm hopeful that change is coming to FDA. I don't think it's coming soon.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Well, and just a quick question, because I know we're unfortunately out of time and I'd love to keep you here for a while and just chat, but the EU probably already bans all this and Canada.

[Scott Faber (Environmental Working Group)]: Yes. And

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: so somebody's producing these dyes or sending them in to be mixed in with General Mills or others, and we're at the end of that pipeline.

[Scott Faber (Environmental Working Group)]: That's right. So there are about 2,500 chemicals that you and I are eating that cannot be added to food in The EU.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: Exactly. And the market in The EU is larger than the market in The United States.

[Scott Faber (Environmental Working Group)]: Yeah. And it's all the same food.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: It's all the same food.

[Scott Faber (Environmental Working Group)]: It's the same exact same products. You wouldn't be able to tell they're different. They don't they taste the same. They look the same. They and and I've done the science on this. It turns out they don't love our kids any more than we do.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: So so

[Scott Faber (Environmental Working Group)]: it just it just we probably just lagged behind on a

[Sen. John Morley III (Member, Senate Health and Welfare)]: on a regular 25%.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: It'll help the beet industry. Right? So we've got the beautiful color from the beets. Absolutely. Yes. Absolutely.

[Sen. John Morley III (Member, Senate Health and Welfare)]: That's right.

[Sen. Ginny Lyons (Chair, Senate Health and Welfare)]: That's nice. Thank you. Yeah. Thank you, Diebard, for being in here and helping us. We'll we'll move forward with this and get some more testimony and have your recommendations for making some explaining inclusion. You. You, Michelle. Oh, good.