Vermont Legislature SmartTranscripts:

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: I this is the health and welfare committee and the senate transportation committee, and we're here to talk, with public transit. I'm Rich Weston. I'm the chair of Senate Transportation. And with me is

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: Ginny Lyons, chair of Senate Health and Welfare. And the committee is all here. Can I give a housekeeping? Sure. There are a couple of reports that we asked for last year that are on the transportation committee webpage, and they'll be put up on our webpage very shortly, so you'll have those. And then Calista has let me know that the testimony that you folks will be giving will be posted on our web page coming up soon. They're not yet posted, some of them. So they'll all get here sooner or later. And I'll just say one other thing and then turn it back to senator Westman. This is the issues that we're talking about are so critical for our rural health transformation grants and also for the transformation process that's ongoing now between AHS and other agencies, in particular hospitals. And we know patients need transportation to and from, particularly in the rural parts of the state. So this is our first opportunity to work together on this and look forward to hearing what folks have to say, and then we can help make some decisions or just learn about the good work that's going on.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Well, I I would jump in and say we're hoping that what we're going to hear today is some success in getting volunteer drivers, which was an initiative of both of our committees last year. And with the consolidation in healthcare across the state, and with the pressures that the Medicaid budget isn't under, transportation is vital for those people that, you know, older, disabled, disadvantaged economically. This is, I will say for the Transportation Committee, a priority, and I know it's a priority in health and welfare. So we're hoping to hear good news on our efforts, and we're gonna continue to be looking at this area very close. So I think we're gonna start with you, Ross, and we're looking for you to help give us an update.

[Ross MacDonald — Public Transit Program Manager, Vermont Agency of Transportation (VTrans)]: Thank you, McDonough, madam chair. My name is Ross McDonald. I'm the public transit program manager. I've been with the agency for nineteen year, program manager over six. And I'm here today to introduce the section 28 report. And then we have some of these partners who've been participating in the working group to weigh in and share their perspective. So far, we've been able to use this forum to confirm efforts that have been done to date, as well as unlock some opportunities and some opportunities that have revealed themselves on future work. And so we'll hear through the recommendations, but this work is planned to continue, and we'll look forward to these continued conversations and updates. We have not prepared a full report on the volunteer driver efforts, but I can tell you that we've picked up about 20 volunteers since June, and we just started those investments in the last few months through our Mobility Transportation Innovation Grant program. So more good news on that front, we expect. But for now, I'd like to get right into the presentation and introduce Steve Fobble. He's joining us by Zoom. He is our lead consultant for the agency of or for our program. And with that, Steve, if you could go ahead and bring us to the report, and we'll bring it to the next folks on your list. Thank you.

[Steven Fobble — Lead Consultant to VTrans Public Transit Program]: Thank you, Ross. Good morning to all the senators and other esteemed guests there. I'm sorry I couldn't be there with you in person, but family commitments kept me at home this morning. I will share my screen and begin the presentation. It's a relatively brief presentation, so I will spend about fifteen minutes or so on this and then happy to answer questions and then happy to share the floor with our partners in the health care sector who are critical participants in this committee. So this first slide obviously has a ton of text on it, but it's just a reminder of the law that you helped pass last year that required this working group and the report. And I highlighted the key sections of it that we would the VTrans and AHS would work together to convene a working group to improve the coordination of health care and transportation services. And there were two main objectives. They were to look at opportunities to coordinate the scheduling of health care appointments and treatments to maximize the use of shared rides and to improve communication between the public transit agencies and the health care providers. So, this working group which I'll be describing and about 20 page report or so which I believe has been submitted to the legislature summarizes the work that was required in the legislation last year. The members of the working group are listed here by name. There are several organizations that are represented. The Agency of Transportation, Agency of Human Services, VPTA, the Association of Hospitals and Health Systems, University of Vermont Health, and the Bi State Primary Care Association. I won't read through all the names, but several of the members of the committee are there, are here with you this morning, and we'll hear from them about what what they participated in in the working group. So just to summarize what has happened thus far since the law was passed in your 2025 session. This working group was formed and met five times from October through December 2025. In addition to this the working group meeting, the partners have been engaging in the activities that the legislation envisioned. So UVM Health has been enhancing and expanding their care management practice. And in January 2025, they instituted what they call the health related social needs screen for all primary care practices. And and they've been screening for health related social needs before, but this was expanded to all primary care practices. And every time a new patient comes in and on an annual basis, they update the information in their electronic health record. And this screen asks a number of questions about health related social needs and any positive result, means if the patient says, yes, I have this kind of need or I face this kind of barrier, that generates referral to UVM Health's care management team. And transportation challenges are always one of the most common reasons for referral. So UVM Health is taking a proactive stand on this, and we'll hear later from, Karen Vestine and doctor Withers about what UVM Health has been doing and and answer any questions you may have on that. In addition, there was a specific, case study, if you like, on coordinating dialysis appointments and rides from a transit provider. And the participants here were Tri Valley Transit, Portical Medical Center, and UVM Medical Center. And TVT, as you know, this is based in Middlebury. It was their Middlebury practice and Middlebury does not have a dialysis clinic. So, people in Addison County go either to South Burlington or they go to Rutland for dialysis treatment and those are are long and expensive trips. So, in July 2025, these partners began to work together to increase the number of shared rides because there were several people who are just taking solo trips with a volunteer and so through coordination and through working together and some adjustments to the treatment schedules of these patients, four of these dialysis patient patients transitioned from solo trips to shared trips. And they may that might not seem like a big number but that saved over $1,300 per month and it frees up volunteer driver time to run other trips. So, two of those volunteers who used to be doing dialysis trips three times a week are now available to do other types of trips. And as you know, those are the most cost effective trips. So that's just one example of the progress that's been made so far. Another key element of what the working group has been doing is outreach to medical facilities. And there are four specific regional health systems that have been engaged so far. And actually, we can add one to that list just last week, which Devin can speak about. UVM Health was one of the leaders here, and that includes, the Medical Center in Burlington, Central Vermont Medical Center in Berlin, and Porter Medical Center in Middlebury. Beyond that, there's Northeastern Vermont Regional Hospital in St. Johnsbury, Springfield Hospital, and Rutland Regional Center. So these four were engaged early on in the process, and Dartmouth Health has been engaged just recently. It's starting last week, I believe, but Devin can speak to that a little more. In addition to the outreach, a volunteer sharing, excuse me, was another important initiative of the working group. And as senator Westman said at the beginning, increasing the number of volunteer drivers is a critical initiative, and Ross spoke to that a little bit. But the idea of volunteer sharing is to leverage the volunteer pools that already exist in many hospitals. And these volunteers may come in one or two days a week or any number of things and do various things to help patients and to augment the service that the professionals provide. But the concept here was that because the transfer providers have a ready made process and infrastructure to promote volunteer driving including liability insurance, including reimbursement mechanisms, background checks, all sorts of things. It's ready made for new volunteers. The idea was to do outreach to the hospital volunteers and see if any of them would be willing for part of their time to do some volunteer driving whether it's just restricted to getting people to the medical center where they work or some broader potential volunteer driving. So that's outreach that's continuing to communicate to the hospital volunteers to let them know that there's this opportunity to be of even greater service through transportation and to get them into the system that the transit providers have set up. The last example here and the last function of the working group has been the travel coordination, and the example that I gave you before with TVT and Porter and UVA medical centers, was a a case of this. We're connecting medical facilities with regional transit providers and pursuing opportunities for shared rides. So taking a step back for a second, you know, thinking about the opportunities for increased ride sharing and increased efficiency in getting people to their medical appointments, we divided the whole universe of trips to medical facilities into these four quadrants. And you can see on the long the left hand side, it divides distance wise between long trips and short trips. And there's not a strict threshold here, but you can think of maybe 15 miles or twenty minutes or something as distinguishing long trips from short trips. And then frequency across the top, high frequency and low frequency. High frequency, obviously dialysis trips. Anytime you have multiple trips per week or per month, those are high frequency, versus low frequency, which might be one or two trips per year, something something, you know, relatively infrequent. And so in terms of what the priorities we set on these quadrants are, the primary target were high frequency long trips. And one of the best examples, as we mentioned already, are dialysis trips to distant clinics because those need to happen three times a week. And for many parts of the state, there is not a nearby dialysis clinic. So those trips end up being quite long. So that was the primary target thus far and will continue to be the primary target within the next year probably. There are two quadrants shown there in green as medium priority, and that's high frequency short trips, and that could be dialysis trips to nearby clinics or other critical care, you know, cancer treatment trips, which when someone's in cancer treatment, they may need to go every day for a couple of weeks or a few weeks. And then the other low priority trip sorry, medium priority are low frequency but long distance trips. An example here are infrequent trips, maybe a couple of times a year, to UVM Medical Center or Dartmouth from rural parts of Vermont that are that are far away. And we'll we'll talk a little more about examples of how that can work. And the low priority are low frequency trips that are short distance. They could, of course, be grouped into shared rides, but that won't be the focus of effort, at least in the near term, just because the benefit from grouping those is relatively small. So the group set some near term targets about how to improve the efficiency of transportation and healthcare coordination. So we collected data. VPTA collected information from all of the state's transit providers looking specifically at dialysis trips to begin with. So in October year, there were 188 riders who took frequent trips for dialysis, and that could be funded both by the Medicaid program and by the OND program. We didn't distinguish between them for this purpose. Of those a 188, 57 of them traveled regularly in shared rides already. So, you know, that's about a little less than a third. That's examples of the progress that the transit providers and health care facilities have made over the years. But obviously that leaves two thirds that are not in shared rides, that are taking solo trips. We looked in a little more detail at those trips, and we thought that about 30 of them could be grouped with relatively minor changes to their schedules. You know, maybe a half hour shift, an hour shift in when their dialysis appointment is, and then, excuse me, then their appointment would be nearly at the same time as somebody else coming from the same town or the same geographic area, which would promote sharing. In addition to those 30, we, counted 52 riders that could be grouped with more significant changes, and and that means instead of going Monday, Wednesday, Friday, maybe they go Tuesday, Thursday, Saturday. Or instead of going the afternoon, they go in the morning. Or maybe they even change which clinic they go to because there are some cases where patients are not going to the closest clinic to them, and that could be for any number of reasons. So the limits on potential sharing are a couple of them, the capacity of the dialysis clinic. So in some cases, they may not be able to change the appointment times or they may not be able to take more people in a closely clustered time just because of their capacity, and that includes both the capacity of the dialysis equipment and also having some waiting room facilities because there are some dialysis clinics that have no waiting rooms. Another limit on potential sharing is the discomfort felt by dialysis patients. This is not a simple treatment for the patient. That can often result in significant discomfort afterward. And if we wanna group the trips, then somebody is probably gonna be waiting for at least, like, half an hour, and then their ride home may be longer than it would be otherwise. That is a burden on those patients. Obviously, there are benefits to doing that in terms of providing more transportation resources, but, it's not without some sort of compromise and sacrifice by the dialysis patients themselves. So, obviously, I've talked about dialysis thus far a lot. That's not the only area. Substance use disorder trips, are a significant piece of the public transit puzzle here. Analysis shows that almost 40 of trips in the Medicaid program are for substance use disorder. That's a very large piece, but the transit providers and the SUD clinics have already worked very strongly to group these trips, and already more than 90% of these trips are grouped, the transit providers continue to look for opportunities. Cases where somebody's doing a solo trip may be because of behavioral issues that they are they are not suitable to ride with other passengers or just because where they live is just nowhere near any other people going to the same clinic. So that's that's some of the limits. But as you can see, we're ready most of the way there in grouping all of those trips. And then the last thing are trips to major regional facilities, and I've mentioned this before. These are those low frequency long trips and one example that came up from the transit provider in Bennington County, Green Mountain Express is that they go nearly every day to Dartmouth for trips even though it may be different people every every day but they are making trips there every day and those are long, very expensive trips for them to operate and if it were possible somehow to group those trips and and like I said here, narrow the scheduling window so that the medical offices at Dartmouth could say, someone coming from Bennington County, we're gonna try to put them on Tuesdays and Thursdays, and that would allow for those trips to be grouped. It might mean that Green Mountain Express is only running there two or three times a week instead of five times a week. There's an important caveat here that this assumes that there's no significant impact on the medical treatment. We're not going to say you need to go to the hospital Monday. No. Sorry. We're not we don't do Mondays, you have to go Tuesday. We're not going to say that. But if there's no significant impact difference for the patient going Tuesday versus Monday, then narrowing the scheduling windows by geography can allow for much more coordinated service and savings on the transportation side. Longer term goals beyond those near term targets to work with the patient scheduling process. As I mentioned before, how UVM Health is doing this health related social needs screening to make sure that all patients are screened for transportation challenges, and that's at every medical facility in the state, and in addition to doing it on sort of an annual basis to ask for general terms, just every time a patient schedules a trip, it would be great to incorporate into that process the question, do you need help with transportation? Do you face a transportation barrier? Just so, because a patient may be reluctant to share that unless they're asked about it. And then once those people are identified, to work with the regional transit providers to coordinate those trips where possible, to say, oh, well, we know where that transit provider is already making a trip here you know, next Wednesday. Can we schedule your appointment for next Wednesday so you can be in that trip that already is scheduled? To make that work, we have to establish communication channels, and we want to ensure that all medical facilities have direct contact with a regional transit provider. This could involve at least one in person meeting between, say, the head of dispatch or the community relations manager from a regional transit provider to go to that medical facility, whether it's a hospital or a doctor's clinic or a dental clinic just to say, here we are. This is how the system works. Here's the phone number to call. Here's our website. If you if you run into any sorts of transportation barriers, just reach out to us right away so we can, make it happen, get the patient there, and do it in the most efficient way possible. The final longer term goal is to think about incorporating scheduling software into medical facilities. As most of you are aware, the state is in the process of rolling out a new paratransit scheduling software for all the transit providers that's already implemented in two or three of them. But this technology would allow, in theory, for a portal to be shared to medical offices sort of just through a web browser to say allow them to monitor what scheduled trips exist already. And so instead of having to call the transit provider, which, you know, it takes time and and is a sort of a point of friction, It would be great if you could imagine they could just glance at the screen, see all the trips already scheduled for next week, and then without having to even make a phone call, say, oh, well, you're coming from this area. We know there's a trip there already next week. Let's schedule you for that time. Then they would have to call the transit provider to actually schedule the trip, but just having that information readily at hand can make this process much easier and more efficient. So just to wrap up here, what are the recommended next To make the working group permanent, a recommendation that they meet quarterly. They had been meeting pretty much monthly through the fall, but the recommendation is to meet quarterly going forward. To set a target for each transit provider to achieve three new shared rides per quarter, essentially one new shared ride per month. Then the working group with that data would report to PTAC on a quarterly basis. The working group would report to the legislature each January to summarize what has transpired during the year, achievements, barriers, any way the legislature can help. And the other thing the working group needs to do is continue outreach to medical centers with Dartmouth Health being a priority. But as I mentioned, Devin can speak about outreach to Dartmouth already occurred last week. So obviously, they are a major player in health care in Vermont and getting them as involved as UVM Health has been involved is is critical to making this successful. Finally, recommended steps for the legislature to monitor progress. And and part of this is is to think about the participation of for profit dialysis clinics. And Caleb Grant, who's in the room, can speak a little later if you like about some of his experience, but the for profit dialysis clinics may be an extra hurdle to climb to get them to participate in this sort of coordinated scheduling because that may not be their primary motive in how they schedule patients. And the legislature may need to get involved those for profit dialysis clinics don't want to play ball with the public transit providers. Another recommendation, hold a joint session, which you are doing today on the senate side. The house side could also do that later in the session to continue to monitor progress. Another recommendation is to consider holistic accounting of health care and transportation expenses. And this you know comes from most recently the Green Mountain Care Board report from October 2024 to think about the impact of consolidation and specialization on public transit because, as you know, consolidating services, making these centers of excellence and removing functions from some regional hospitals is going to have significant transportation impacts and raise the cost for transportation. And so any accounting of what the savings is on the healthcare side from doing those consolidations needs to also account for the extra expense on the transportation side and consider that holistically. And then final point, as the legislature invested last year in, volunteer outreach and coordination, to consider an investment in mobility management to help, manage demand. So what what this means, sort of analogous to the care management team that I mentioned before for UVM Health where you have dedicated professionals working with patients. A mobility manager at a transit provider is is a dedicated individual who work with a rider to figure out ways to make that rider's needs met in the most efficient way possible. To coordinate not just health care trips but shopping, other types of trips to manage the demand so that it'll make it easier for the transit providers to improve their efficiency, fill more seats, and thereby save costs and be able to stretch the available dollars much further. With that, I will stop sharing and invite any questions. Thank you.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Go ahead.

[Senator Becca White]: Oh, thank you, chair Westman. And thank you so much, mister Fallible. If I mispronounced your name.

[Steven Fobble — Lead Consultant to VTrans Public Transit Program]: No. That's very good.

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: Oh, hey. Here we go.

[Senator Becca White]: You win some, you lose some. So I

[Grace Johnson — Medicaid Policy Unit, Vermont Agency of Human Services]: have a couple of thoughts.

[Senator Becca White]: So the first one was I just I was surprised you didn't reflect on canceled trips because something I hear from constituents is that they think they're going to have transportation and then they don't. And then they have to cancel a visit to the hospital or a visit to their primary care last minute. So I think there's a lot of benefits to providers as well for this. If we have consistent transportation, they'll see fewer frequencies of people having to cancel because a ride dropped out, or they couldn't make it that day because the scheduling got confusing for them. And I also wanted to just say, I really appreciate that you're working with Dartmouth Hitchcock. That is a huge issue in our area where folks don't have the ability to get there. And that's what's delaying their service. And then they end up getting picked up by the ambulance because they have no other It gets to the point where they have no other opportunity to get there, and they're having to basically use local or private ambulance services to get to what could have been preventable services. But I had one main question, which is I've heard from constituents who have had to stay extra nights at the hospital because they're unable to find transportation to leave the hospital, which feels like a miss on everybody's part. So I'm wondering if you found in your research, if there were folks who were using the services to schedule departing the hospital, whether you stay there for a few days, maybe a slight fall, and you can leave. You could potentially take the bus, but the walk from the fixed route station to your house isn't possible. So having door to door service is necessary. How many of the trips that you saw or that could be combined could have been someone leaving the hospital after a short stay? Yeah, how does that factor in?

[Steven Fobble — Lead Consultant to VTrans Public Transit Program]: Thank you, Senator. That's a great question. That's not something we looked at specifically because we didn't have data on that. We had data on when people's appointments were scheduled for. Hospital discharges is something that transit providers deal with all the time, and, you know, we have Jim Moulton here is on the screen, and Caleb is they can speak to their experience in that. A patient is eligible for Medicaid and Medicaid transportation, then the providers generally, provide those hospital discharges, and they can be in the middle of the night. And, all of the transit providers have either dedicated volunteers who are willing to do those middle of the night trips or sometimes have to pay an agency driver to do those. But, again, I I can let them speak to that. If if a patient is not eligible for Medicaid and is not in the OND program, then they, you know, are not covered by existing subsidy programs. So, that's, you know, transit advisor would have to try to find a way to to fund a trip like that and again, they can speak to that a little better. I guess I'll stop and let maybe Jim or Caleb speak to that issue.

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: Thank you.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Other questions?

[Senator Becca White]: But wait, do want to go speak to that point?

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Yeah. I don't see either raising their hands. They are gonna they're gonna they are gonna be on the schedule later. So if why don't we do it, Annette? Is Devin, are you next or?

[Caleb Grant — CEO, Rural Community Transportation (RCT); Chair, Vermont Public Transportation Association (VPTA)]: I have a question.

[Senator Thomas Chittenden]: Yeah, Mr. Chittenden. It's a comment and a question. I really, really appreciate this study. It's wonderful. And connecting the, hospitals with the transit providers, that alone, I think would benefit the system. When we say consider a holistic accounting of healthcare and transportation expenses, I don't want us to leave it at that because I think the transportation system needs revenue, as we So, I don't want to put it in more of a deficit. I want to have the expectation be that the transportation system receives revenue for this. I mean, that's a long term thing, but I just want to set that table. At some point, and we can do this as part of the Public Transfer Advisory Committee, hear from from riders, about this and, I would think that there could be, social aspects, not super social, but you know, there could be multiple benefits to riders. There could be issues that we don't know about, but I'd like to hear from riders. But thank

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: you so much.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Perfect. Are you

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: I actually know Karen's next on the list, but

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: my on my list

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: Karen was

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: first, and and I didn't see Karen, Ross said he was. So I either way.

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: Okay. What's work what works best for you? Because you have the time to train.

[Karen Vastine — Senior Community Relations Officer, UVM Health]: So good morning, and it's nice to see you, Chair Westman. It's been a while. So I wonder if it would be all right for Doctor. Withers and me to just quickly testify first, as I believe she needs to go back to clinic in about ten minutes. Does that work for us That just to have a chance to weigh

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: would be great. And then we'll Okay,

[Karen Vastine — Senior Community Relations Officer, UVM Health]: and we'll be quick. So for the record, my name is Karen Vasteen and I am the senior community relations officer at UVM Health. And I'm joined here by my colleague.

[Dr. H. Withers — Primary Care Physician (Middlebury) and AVP Medical Director of High Value Care, UVM Health]: Hi, Withers. I am primary care doc in Middlebury, Vermont, also AVP Medical Director of High Value Care at UVM Health.

[Karen Vastine — Senior Community Relations Officer, UVM Health]: So we'll actually be really quick and I'm happy to stay online as questions come up. But as you heard, this has been a really exciting collaboration and we just wanna say on behalf of UVM Health, how much we support the recommendations in this report and how much we've enjoyed having the chance to participate in this real time problem solving that Stephen described. And I particularly want to note regarding the volunteer community driver program that we are just kind of starting to scratch the surface on ways that our volunteer coordinators at our three hospitals can actually support getting the word out because we know that some of our volunteers are actually interested and have noted for themselves that patients need rides and so we're actually exploring ways that we can support both getting the word out for recruitment and also encouraging our own volunteers who would be interested in doing this just because it's kind of a ready made partnership and so really I think we just wanted to share how much we're looking forward to the continued partnership and we really hope that this group will continue doing its work whether it's through quarterly meetings or just some of the work that we've been doing behind the scenes with the partners. And I'll pass it to you, Doctor. Withers.

[Dr. H. Withers — Primary Care Physician (Middlebury) and AVP Medical Director of High Value Care, UVM Health]: Thank you, Karen. So thank you so much for the opportunity to speak. This has been a really fantastic partnership. As mentioned, we have been starting to screen for transportation needs and to be able to have a place, where we can bring these issues that are coming up with our screenings and to connect with our transit providers has been really an amazing partnership. I do want to highlight that some of this work was happening prior to this group coming together, but really strengthening those bonds and having sort of regular meetings with the two parties has been really powerful as you saw in the presentation from Steven. So I've really appreciated being a part of this and really looking forward to other opportunities. We've certainly identified a few other opportunities at our health system where we could potentially have some additional successes like we did in the dialysis world. So I'll echo what Karen said, we really would like to continue this relationship and this work. I think it's really important and powerful work. So So thank you so much for the opportunity.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Thank you. Questions? We hope that Dartmouth comes on board the way UVM Health gets. Pet. I don't know I can get it up there. Thank you.

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: Good morning. Devin Green, Vermont Association of Hospitals and Health Systems. Thank you for having me in today. And I'll echo what the folks before me have said and say thank you for setting up this committee. It's been very eye opening to us. It's been very helpful. And I think it'll be extremely helpful going forward. As Karen said, we've sort of just scratched the surface at this point. We started learning each A huge thing that came out of our discussions because what's been a roadblock to hospital volunteers in the past has been the liability issue, the insurance issue, and those sorts of things. And it was so wonderful to hear from the transportation folks that those things are covered through their program. All they really need are just those connections to the volunteers and the ability for the volunteers to understand that that opportunity is out there for them. And so we have six hospitals, the UVM Health, which includes Porter Medical Center, CBMC, and UVMMC, Rutland Regional Medical Center, Northeastern Vermont Regional Hospital, and Springfield Hospital working on this already. As was alluded to, Dartmouth is not a member, but we have Dartmouth Hills Hospital members. I reached out to Dartmouth. They're also interested in this opportunity. And so I think this can be really helpful going forward. One thing that I will just sort of touch on is that we have typically had a very robust hospital volunteer network to pull from that. COVID really changed that. A lot of folks are more elderly, and COVID sort of decimated our volunteer programs, but we're working on building those up. And we still see a lot of opportunity here. The other piece that was highlighted is opportunities with the scheduling software. This is something that has a really good synergy with the Rural Health Transformation Fund work and bringing new technology into healthcare. And we are looking at ways to sort of combine that software. We know that our healthcare providers work best when they can do as few puts as possible. So we want to see, is there a way that the transportation software can match up with our electronic health records? We think that there might be some opportunity there, so we're going to look into that as well. And I think we're pretty excited about that. And then finally, I think you all touched on this. I think going forward, one of the things keep highlighting and try to bring into the committee is just the patient experience. We've been talking about technology and questionnaires and that sort of thing, but as was alluded to in areas of like dialysis and other treatments, we need to make sure we don't overlook what the patient is experiencing and their comfort and try to manage that as well. So I think we'll try to bring the patient voice in a bit more going forward. But otherwise, we appreciate the opportunity. We think this is really good coordination, and we look forward to doing more work on it.

[Senator Becca White]: Could you see asking patients directly questions framed like, How are you getting here today? Do you feel comfortable that you will make Is there a way to phrase the question every time they're scheduling a trip? Or is there any kind of concern that that's private information? I don't think there's too much

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: of a concern that there is information. So I think the opportunity there is sort of standardizing that process. We know that folks do it. We don't know if they all do it the same. We don't know how often they do it. So really just getting education to know it to people about best practices and standardizing that process a little bit more.

[Senator Becca White]: Yeah, I mean, even just asking, how are you getting here today? And if they say, I don't know, then it's like, Okay, well.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Exactly.

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: And I think in the past, we're still in is what providers hate the most is having to ask a question but not having a solution to it. So if a patient is saying, we don't know how we're going to get there, then it's like, well, we can't help you out. But now that we have these opportunities and

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: we have

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: resources to point patients to, that will help in asking of the question.

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: So your comment at the end about EHR integration with this information. Is that something that hospitals have reached out to the working group for the transformation, not RHT, but the transformation process?

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: That's a good question.

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: Yeah, no, because it is, it's all very much a part of the hospital transformation that we're currently doing. Right. It's not a separate issue from applying for funds. Mean, there's a process going on. Just wondering if if you've connected in with our folks in

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: You know, we had In that regionalization transformation process, we've certainly talked about transportation. They've done a lot of work more on the inter facility transfer piece in that area. We haven't actually I don't know if folks have gotten into the discussion of the EHR and the appointment piece. We can sort that out. That's a good suggestion.

[Senator Thomas Chittenden]: I'm looking for that.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: My notes were very much in the same category, in that for us to push that along, we really are gonna need proposals in how do we get to. And I think I'm speaking for both of our committees, but both of our committees are gonna be interested in the concrete stuff. And Stephen, your recommendations that we're gonna need to flush those out and figure out where we would place language, what we would do with language in that piece. So the concrete pieces on top of this, I think our committees would be willing to meet again to talk about how to push that along.

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: Happy to see that. Yeah.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Thank you. Thank you. Caleb, are you and Jim next?

[Caleb Grant — CEO, Rural Community Transportation (RCT); Chair, Vermont Public Transportation Association (VPTA)]: Whenever you tell us.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: I think you're in the chair and you and Jim can.

[Caleb Grant — CEO, Rural Community Transportation (RCT); Chair, Vermont Public Transportation Association (VPTA)]: Thanks, senators, for allowing this opportunity. For the record, my name is Cale Grant, Rural Community Transportation and chair of the Vermont Public Transportation Association. I wanted to begin the discussion with really grounding in the experience of the transit provider. As I was sitting in my chair, live time pulled up my tracker of all of our vehicles and can share that currently there's three RCT vehicles in the UVM parking lot

[Senator Thomas Chittenden]: and two of

[Caleb Grant — CEO, Rural Community Transportation (RCT); Chair, Vermont Public Transportation Association (VPTA)]: Dartmouth parking lot. And that is just any given Friday. On any day, we receive about 800 to 1,100 trip requests. Those are then given to our dispatchers to try to accomplish. And it's a complex system of navigating Medicaid regulations layered on top of which vehicles we have available, the personal quirks of our volunteer drivers and when they're available. And our goal is to accomplish as many of those trips as possible. So you can imagine the benefits of having partners in the health care system who are actively engaged in considering transportation solutions in trying to get as close to that request capacity as possible. But it continues to be an epic challenge in on demand transportation. It's one of those areas where while trying to navigate the realities of driving Vermont roads and the complexities of passengers and regulations and all these sort of things, I mean, the end of the day, it's getting people the care they need. I did want to speak to a couple issues that have been brought up specifically, one of which being the for profits that is an area that I think will only continue to expand and is something that it's hit, RCT specifically, the privatization of care clinics, specifically dialysis in our area where oftentimes the prerogative of those providers is to find the most cost efficient way of delivering that and at what cost. So in the St. Johnsbury area, privatized to the dialysis clinics, the dialysis company then realized,

[Steven Fobble — Lead Consultant to VTrans Public Transit Program]: you know, this would be

[Caleb Grant — CEO, Rural Community Transportation (RCT); Chair, Vermont Public Transportation Association (VPTA)]: a lot cheaper to operate in New Hampshire. So they kept all of the appointment times and just said, these are in Lancaster now, which you can imagine the efficiencies of being able to drop someone off in St. Johnsbury and go and pick someone up at the hospital and then having that vehicle within the rotation. And now we're sending vehicles. The other thing that I want you to be mindful of, and this relates as we regionalize our healthcare system, is within two weeks of shifting to the Lancaster dialysis treatments, we had two cardiac incidents on the trips home. It is an extremely foaling treatment to then get on a four fifty and have to be transported the hour and a half home. It's a traumatic event. So not to lose focus on the clients, think as we consider all of this transportation is not only logistical but also the lived experience of passengers is critically important. As it relates to discharges, that remains an incredibly complex and difficult challenge. The two a. M. Discharge individuals who may be medically sound but not entirely sure what their home situations are. Our drivers are not health care providers. They're transportation providers and trying to accommodate whatever situations need to happen on those calls, which really intensified the need for a good working relationship with medical providers as we try to navigate these at all hours of the day. Just through that relationship building you start to see the seeds of overnight discharges tend to kind of taper a little bit as they know, hey, you know this will be a lot more feasible if I called at five a. As opposed to two a. M. Working with individuals. And I also wanted to address the cancellations conversation. I think one interesting thing that has come out of this partnership is looking at an open communication, working with a FQHC in our area who had cited the shortcomings of our transportation system and being able to operate clinics was able to work with me and provide a number of trips quantity of about 90 trips

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: that

[Caleb Grant — CEO, Rural Community Transportation (RCT); Chair, Vermont Public Transportation Association (VPTA)]: were canceled for lack of transportation. As we went through all of our notes, it only ended up being about five of those individuals who were unable to have transportation provided. And in often cases, RCT had a vehicle sitting outside their door in time for that.

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: So

[Caleb Grant — CEO, Rural Community Transportation (RCT); Chair, Vermont Public Transportation Association (VPTA)]: as you close that communication transportation becomes a less convenient excuse. We can better understand when people's actual appointments are and you start to provide much better care and understanding between to have more efficient and effective systems both in health care and in transportation. And just lastly, I wanted to bring up again the conversation as it relates to funding. In our region, the regionalization of health care is a critical issue which we often think about because what is efficient for the health care system is often not true cost savings. It's marginally cost shifting to transportation providers. We have worked closely with providers in our area to actually provide real numbers of, hey, if you shut this facility, we can still make all the deployments time, but this is the real cost. So one potential opportunity is not just the holistic accounting and the net savings calculations, but the possibility of a Pugobian tax as we now do health care reform to offset and invest in our transportation to ensure equity of access. So just something for you to consider and the complexity of the challenge ahead of you. With that, I'd be happy to answer any questions as it relates to my testimony or the efforts in general.

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: That was terrific. Thank you. And you have identified so many different places where work needs to be continue to be done, but thank you for the work that is ongoing. I think it's a step at a time. Having the the working group or the committee expand and continue is probably first step to addressing some of the issues you're talking about. So I was going to ask about your thoughts on funding. You mentioned the word tax. And I know that right now, you know, we're at a level of thinking about how to utilize the resources that we have, and we'll we'll continue to do that. There is a report on both of our web pages on inventory and assessment of emergency medical services that will help maybe there'll be some infill there. There's also a report on how to pay for services in a new way and have Medicare, Medicaid cover up to Medicare costs when services are not delivery on spot for EMS. And so it may change the way we look at EMS as well. So there's a lot embedded in all of this conversation. And I'm really glad that you brought up FQHCs, our community health centers, and then that travels to our hub and spoke system where folks can receive their substance use treatment perhaps, and someday mental health expansion. So there is a huge landscape out there right now for patients. Well, thank you for the work you're doing. That's all. You just stimulated a lot of thinking on this. It's great.

[Ross MacDonald — Public Transit Program Manager, Vermont Agency of Transportation (VTrans)]: Thank you. Thank

[Senator Becca White]: you. So I was really grateful to see actually a poster promoting sign up to be a volunteer driver. I was so excited. I took a photo of it. I'm wondering if you found that there are certain types of outreach that is bringing in those drivers. I think I heard the number 20 new drivers and that was, it's a good number, but it made me a little sad because I was hoping if I'm seeing posters and I'm seeing stuff, get a little more than 20. Are you seeing anything with those hospital volunteers? Love that idea. Where you're actually seeing people start to sign up to be volunteer drivers. Is that fruitful for you? Are there other outreach techniques that you've tried?

[Caleb Grant — CEO, Rural Community Transportation (RCT); Chair, Vermont Public Transportation Association (VPTA)]: I think generally we find there's several categories of volunteers, right? There's your traditional volunteers which you know oftentimes find themselves in hospitals or doing meals on the meals, but the ask is pretty incredible, right. You're opening up your vehicle to strangers in pretty challenging circumstances. The difference between a volunteer willing to do a grocery trip and the one willing to do the situation which often times people are very difficult about mental and emotional challenges, that ask is pretty big. And you find that oftentimes we have enthusiasm at the beginning and as the realities of the experience, those kind of additional layers of, well, I'll only do grocery trips or I can only do Tuesdays or, you know, whatever those regulations and you can imagine what that looks like for our dispatchers. The other category is individuals who really see transportation volunteerism as an opportunity. It is reimbursement for mileage on your vehicle that doesn't count towards income and is an opportunity for those under benefits to receive some form of payment throughout the week, even though it is reimbursement. And those we find are more willing to take on the larger challenges in the situation we're faced with. Statistically across the nation, the largest category of transportation volunteers are 60 80 year old veterans who are on some form of disability. We see a lot of luck in legion halls, again, competing on that category. I've picked up my own volunteers taking my kids to the bowling alley, right? Like it's when you're in the community and you find individuals who want to benefit themselves but also benefit their community, it really finds that sweet spot. But volunteers, as a dispatcher, it's really much easier to go, all right, I've got a professional driver in a vehicle with a tracker, and they work from eight to five and they're on call on these nights. Volunteers, although the most cost efficient, really increase the complexity. I'll share that we do often struggle with what lever do you pull, right? Do we build out our dispatching team in order to find those most efficient and effective ways to do it? Do we build out the drivers to make that job a little bit easier, but you lose a little bit of those efficiency? So I think as a system, each provider has really fallen on the balance of where they can find the most efficiencies in those levers, but those volunteers are a critical and important way. I think continuing to advertise on the radio, which, you know, kudos to VTrans and their efforts for the Community Driver Campaign. We have actually been able to track because there is differences in the applications that come through the state outreach with ours, and I will share that VTrans efforts in that category have been phenomenal, and we have received quite a few good applicants through that.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: I will say that in detail, we'll want to hear what those efforts have been, because we haven't had any report of what those efforts are and what the 20 or so and where we are to roll this out further because I know we're just getting started. At this point, I'm gonna ask Jim to to speak.

[Jim Moulton — Executive Director, Tri Valley Transit]: Thank you, Chairman Westman. For the record, I'm Jim Moulton. I am the Executive Director of Tri Valley Transit, which sees overseas services in Addison, Orange and Northern Windsor Counties currently and will be officially operating Washington County services after July 1. I wanna thank both committees for your commitment to both these ideas around volunteerism and coordinating with the healthcare providers. I would like to just say, we've had a great working relationship with UVM, Karen and Doctor. Withers in particular, we've made a lot of progress there as Steven reported. I can add a little bit to that. One of the things that can happen in coordination is, I can say that every dialysis rider coming out of Middlebury, is paired up with at least one other dialysis patient, at least one way. They can't always do it both directions and that depends upon their individual care. Some dialysis treatments take longer, some are shorter. So we're making definite progress, incremental progress. I also wanna note that approximately a year ago, we had six dialysis patients coming out of Middlebury, until recently we had nine, so on the one hand, coordination and pairing people up definitely can save on the cost per trip, but when we add dialysis patients into the mix, it then generates additional trips as well. So there is an impact, a negative impact when the number of patients goes up, so that can offset some of those costs, But we are doing everything we can and again, we have great partners with UBM and continue to look forward to the partnership there. I do wanna also note, it was brought up earlier about the need for substance abuse treatment, we've known about that for years, there's opportunities for coordination there as well. As an example, coming out of Bradford, we have six coming by bus to Berlin, three going to West Lebanon, out of Randolph, have five going to Berlin, three to West Lebanon and five or six going to White River Junction. So because of the limited ability of the treatment centers in terms of their numbers, we can also get, on the one hand, we're grouping all these people, on the other hand, that's a lot of different directions and a lot of opportunities for additional coordination. So bringing the substance abuse treatment centers into the conversation, I think would also be important. I did wanna also speak briefly, Chair Westman, you asked about the volunteer coordination, not coordination, but the volunteer recruitment efforts. I can say briefly, know in prior testimony before you, I talked about in Washington County, we've helped GMT bring on their volunteer coordinator as a new position, started part time in October and has recently moved to full time. To give you some details there, that person has successfully recruited 11 new people into the system. However, it's a very complicated system, three applied, but then they decided that they didn't want to follow-up and become volunteers. Two more were actually onboarded, we went through the training process, brought them fully into the system and then they backed out due to personal changes in their lives. Two others were from Chittenden County, not in Washington County, so we referred them to SSTA. We've successfully onboarded and have active three people out of those 11 and the last person is in process. So it's a slow, long, deliberate process. It takes time to bring people in, it takes time to recruit them and partial success doesn't always lead to full success. So I just want to make sure that the expectations of everybody are matched up with the realities of how people come into the system. And as Caleb just noted, the highest percentage of volunteers are aged 60 to 80 and as they get older, their personal circumstances change quickly and they may be in the pool and then out of the pool. I think one of the most important things I'd like to say around that process is that I'm hopeful that the committees will continue the $600,000 investment this year. We have just recently hired new staff members for Middlebury and Randolph sites, but again, even hiring people takes time. The program went into place officially October 1, we were advertising immediately, doing a lot of interviewing and screening of people. So they're now on board, and they're in the training process, and we'll see what additional efforts can come out of that. So it's a long slow process, but we are actively engaged in it. I think one of the things that I always keep in mind is someone taught me a long time ago, many problems don't have a silver bullet solution, they have a silver buckshot solution, it's a lot of little things. And what I'm actually excited about is you've heard about a lot of the little things here, whether it's the hospital volunteers or just the active conversations or looking at dialysis. And it's really exciting to be part of that process. And I'm happy to answer any specific questions that you might have.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: It's really good to hear about the process. Really sounds like the money really hasn't hit the ground and we got people out until October. So we really are just getting started in this process in in in the overall. What would be helpful, though, is on average, and I know that, you know, these are really hard to come up with at but as we talk about moving forward and explaining what some of the success, and I know it's incremental. Mhmm. The average driver so you added three drivers. How many rides a year would you expect three drivers to perform? And and those will be additional. So something in that and you may not have that those figures right now, but that will be helpful for us to be able to talk about this and explain to people the incremental successes that we're having.

[Jim Moulton — Executive Director, Tri Valley Transit]: Certainly, I would say across our system, a full time volunteer, full time, Akhil alluded to those typically are those drivers who look at the mileage reimbursement as a potential source of income. On average, we can probably get four trips a day because of the different varying lengths. So if we add three in, that's 12 a day, that's 60 a week, that's up to 3,000 a year from just adding three full time volunteers. So that is not an absolute number, but it's a ballpark enough number to give you a start to give you a sense of the potential impact. Many of our volunteers, they might volunteer once a week. So we might only get four trips out of them instead of 60 trips or 20 trips per person, I'm sorry. So it can vary, but that can just give you at least a sense of the possibility.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Well, we'll be looking as we go forward in the future to see and would encourage you to track what you see is the increase over time.

[Jim Moulton — Executive Director, Tri Valley Transit]: Absolutely.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Go ahead.

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: Thank you.

[Senator Thomas Chittenden]: All of this is just terrific. I'm really happy with the progress that we're making. And did you say instead of a silver bullet,

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: shot?

[Senator Thomas Chittenden]: Yeah, yeah. It's a little violent, but I like analogy. And I think about it in terms of diversifying, but it's the same thing. But just something that I don't want to lose track of is that In my area at least, and this might be happening in other areas, folks use the fixed route to get the methadone clinics and I'm sure other places. So as you go through your work, please include, fixed route because, including that in the medical system is an even less expensive way and helps the rest of the system too. Thank you.

[Jim Moulton — Executive Director, Tri Valley Transit]: You, Senator Harrison. I can say we, our dispatch teams are trained to look to get people on our fixed route system first. It is by far the cheapest mechanism to get anybody anywhere because the routes are out there, the cost is sunk. So everybody that can be put onto those systems is essentially, the marginal cost is zero to do that. Secondly, in Middlebury, roughly a year and a half ago, we introduced microtransit, which you've heard a lot about in the Montpelier region. One of the things that we were looking to do microtransit was to decrease the burden on the, in particular the OND and Medicaid systems. We have quarterly meetings with our OND program partners and we heard very clearly earlier this week in our quarterly meeting that our human service partners are finding that their clients are using our micro transit system greatly, and so that is starting to reduce the pressure on the OND program, at least in the Middlebury area. So just an example of how we do use our fixed route systems, and I include micro transit in that, it's technically a blend of demand response and fixed route, but it is part of the solution in trying to take cost pressures off of the bigger dialyri programs.

[Senator Thomas Chittenden]: That is great,

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: thank you.

[Jim Moulton — Executive Director, Tri Valley Transit]: You're welcome.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Thanks, Jim.

[Jim Moulton — Executive Director, Tri Valley Transit]: So

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Ross, is Dan Currier not? He's in your And I don't see Michael Fisher here. Grace Johnson? Oh, there's Mike.

[Senator Thomas Chittenden]: Here I am. Perfect. Thank

[Mike Fisher — Vermont State Healthcare Advocate]: you, senators. Mike Fisher here, healthcare advocate. I think I caught the state house cold, so I'm protecting you from that and nursing myself. Good to be here to talk to you for a moment about transportation issues from the healthcare advocate's perspective. First, want to say it's been enlightening to me to listen to this testimony. Sounds like a good and important work group effort to improve systems. And I don't really I was not a part of it nor and I'm happy for that. I get assigned to enough committees. But so I don't really have comments about that specifically. The other thing you have you know, I always have to make the disclaimer, nobody ever calls us to say transportation or healthcare or their visit or their Medicaid worked perfectly and they had no problems. People always call us with problems. And so that's what we hear. So recognizing that we do continue to hear problems about Medicaid, non emergency medical transport. I think generally they are more lately, they are more about the Medicaid rules than we still have some complaints about transport, but I think generally I would say that the more centralized dispatch efforts have improved things. I think that it is more responsive to when we call and I think when Vermonters call. So I think that there's a positive, but I can't help but mention the, you know, prior authorization if over 30 miles rule is problematic for Vermonters. People move, providers move, people want to maintain connection with their provider and that has been problematic for for mantras who reach out to us and we support them through an appeals process sometimes even. So that's one thing I wanted to mention. The other another just sort of high level structural thing I want to make sure you're aware of. Very appreciative of the legislature's move to improve MSP, particularly the QMB program. That's a significant improvement. It does not include medical transport. It includes a lot of things, and it's a very important step forward, but for that population that is newly eligible for QMB or is eligible for QMB, now up to 150% of the federal poverty level, they don't get the transport or dental benefit of Medicaid. For, of course, it is a higher eligibility than MABD Medicaid, but for many Vermonters, it is the asset test of MABD that prevents them from getting it, and so if we were looking for ways to improve access to transportation challenges for very low income Vermonters, addressing the MABD asset test would be a place I would look to. Finally, responsive to the conversation that's been happening today, I wanted to just recognize in order for the healthcare transformation process to be responsive or planful with the transportation sector, it's going to have to be planful itself. And, know, wherever the sort of this review lives for, you know, when there's service line reductions, it has to be from our perspective, it has to be done well and reflective of this conversation. It has to recognize the challenges that are created when a service line is reduced and and recognize others have made this point, recognize the the hidden costs when we now have to transport people to care. And so, you know, it's just another opportunity for me to say how important it is that we be planful about this process and make sure that we have a, from my perspective, a regulatory structure that really addresses the impacts of service line closures. Thank you, chairs. Happy to answer any questions.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: I think we have one other witness and thank you, Michael. I think what our goal here is mostly is we always know that you get the complaints and you have to deal with the What we really wanna start with is make sure you aren't getting calls saying we can't get any service. And that's our primary first goal. Everything else, if they can get service, at least we can work on the problem. Yeah, But so we have one other witness, and Grace Johnson, you are, I see on the screen.

[Grace Johnson — Medicaid Policy Unit, Vermont Agency of Human Services]: Yes, sir. For the record, my name is Grace Johnson. I work with the Medicaid Policy Unit at the Agency of Human Services. Thank you so much for the opportunity to be here in committee today, and thank you to Steven for walking us through the presentation and the Section 28 report. I'd just like to echo everything that's been said so far, and on behalf of the Agency of Human Services and its departments, just note that we appreciated opportunity to be part of the collaborative effort, and we look forward to working with this group moving forward to ensure that we're providing the best services possible to Vermonters. And Chair Westman, to speak to your comment earlier and to what other our other partners have stated, if the committee would like to hear testimony from DIVA and VPTA on the work we've been doing related to section 26 of Act 43, the examination of volunteer drivers for NEMT specifically, and potential background check variances by the PTA. We can arrange for that separately at a later date if that's of interest.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: You will hear for Megan, and and you'll be on the schedule.

[Senator Thomas Chittenden]: Very soon.

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: Thank you.

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: I have a question. Go ahead. Grace, thank you for being here and for being part of the working group. So going forward, one of the things that we've heard today is that there are places we can go to improve outcomes for patients who are being picked up and transported. It would be helpful for you to share with chair Westman and myself what you see as next issues to be covered. Because I I've got a little list I've been keeping of things that you will be looking at. I hope that if you have suggestions from the Medicaid perspective, that would be really helpful.

[Grace Johnson — Medicaid Policy Unit, Vermont Agency of Human Services]: Yeah, I mean, I'm happy to take it back to the rest of this human diva and solicit more suggestions. I think we look forward to continuing to work with the group and connecting the group to other folks at the agency who are working on rural health transformation. We've already made some connections to hopefully help connect this group to those folks at the agency who may be able to come up with some more creative solutions that don't have necessarily the same requirements that Medicaid funding would have to see if there are other opportunities for expansion.

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: Thank you. That'd be great.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Thank you. And, Ross, we're gonna be looking for we'll look for language to be developed. And I think Grace is probably gonna be very helpful in that and working with Damian and Jen at Ledge Council. So we'll be looking for what vehicle you would suggest and how we would do that.

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: And and let me add to that. I think that the work that's going on right now is so collaborative. We don't want to get in the way of it. But there are a lot of good suggestions about what, you know, the things you might look at and then you pick and choose and bring back recommendations.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: And if I can make, speaking for myself, if we can make IT systems work together to help coordinate all of these efforts better, I think that's critical in this whole piece, particularly as we move forward.

[Devin Green — Vermont Association of Hospitals and Health Systems (VAHHS)]: I wish I could promise that.

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: Well, I'm just you know, all we can do is try.

[Senator Virginia "Ginny" Lyons — Chair, Senate Health and Welfare Committee]: Let me share how many years we've been working on this. We're gonna do it. Good. So

[Senator Richard "Dick" Westman — Chair, Senate Transportation Committee]: I think we're getting close to the time where it's floor time. So I wanna thank everybody for coming, give us the update. We will be looking for for details in senate transportation about what we've actually done on the ground and then talk about how we produce language going forward and maybe honoring some funds. Thank you. Well, you know, the transformation of the transformation stuff. RHT will be great. Thank you all. For