Vermont Legislature SmartTranscripts:

[Virginia "Ginny" Lyons (Chair)]: Chairs up there. I think that's okay if I just sit here. I've been Okay. Alright. Alright. Amy's

[Amy (Fiscal analyst/staff)]: Alright.

[Virginia "Ginny" Lyons (Chair)]: Alright, we are live. This is Senate Health and Welfare and it is Friday, February 6 and the temperature isn't any higher than six. Little cold out. In here it's nice. And in here. It is getting a

[Amy (Fiscal analyst/staff)]: little warm in here.

[Virginia "Ginny" Lyons (Chair)]: I do. I I will admit that. I will admit. So this morning we're gonna go through the budget adjustment act and what is in it relevant to our area. And we'll just, Amy, we'll just let you take us through. Do we have Yes. You like,

[Amy (Fiscal analyst/staff)]: I have some copies. That would

[Virginia "Ginny" Lyons (Chair)]: be great. I think that would be helpful. You wanna put it up on the screen?

[Amy (Fiscal analyst/staff)]: I will.

[Virginia "Ginny" Lyons (Chair)]: Yeah. There's an updated version than what I've provided to you. So you might wanna go to the use the excuse me.

[Amy (Fiscal analyst/staff)]: Why don't I get started and then

[Virginia "Ginny" Lyons (Chair)]: I might try to rejoin my parents' church.

[Amy (Fiscal analyst/staff)]: I think one of the biggest fears of staff is when you silence.

[Virginia "Ginny" Lyons (Chair)]: Oh, we could talk amongst yourselves. Yeah. I'm happy to talk about my collar.

[Amy (Fiscal analyst/staff)]: Gosh. This is not working. I don't know why this is here.

[Virginia "Ginny" Lyons (Chair)]: I'm going to For the heat in the room. Yeah. I did. I coughed, you know, eight degrees. Ultron's the absurd sniper. There we go.

[Nolan Langweil (Joint Fiscal Office)]: Loggers know how many trees they've found?

[Virginia "Ginny" Lyons (Chair)]: Oh, perfect. Oh.

[Nolan Langweil (Joint Fiscal Office)]: They keep a log.

[Virginia "Ginny" Lyons (Chair)]: That's a good one for a couple. That's a good one. Alright. Thank you

[Nolan Langweil (Joint Fiscal Office)]: for your So,

[Amy (Fiscal analyst/staff)]: you know, the House passed the budget adjustment last Friday. It's now in the appropriations. So, what I've done is I have a couple of documents that you can go through to help identify what is in the budget adjustment that is sort of in the purview of your policy committee. So, there's two documents I'm going to go through, and then I'll reference other documents for you as we talk. So the handout that I provided includes changes that the House appropriations and House made from the Governor's proposal for the budget adjustment. So as you're looking through it, you'll see on the left side, there's the VA sections of H790, so if you want to find out a little bit more about that item, you can go to the bill and read more about that section. And then, just for reference, sometimes it's good to see what the reference is in Act 27, because the budget adjustment is amended Act 27. And then just remember the title of the section, and just a little bit about what that change is. So We can just get right into that unless you have any questions. The first section is an addition above what the governor recommended. It's $45,000 general fund increase to providers for HIV and harm reduction services. There's always an appropriation every year, and this increased each of the providers in that section. Then we went to section 37 in the bill. There's a $30,000 increase for Meals on Wheels, and I think it's specifically to independent living. And that's a breakout to them. And then section 40, there's sort of two things happening in this section. Dale has request in appropriation for extraordinary financial relief for 14,500,000.0, but the House reduced that by 200,000, and then moved that into rate increases for Tier one enhanced residential payers and the AAA case manager. The next section is 51. There's a couple of items, and this is really the one time. So, we were just talking about changes in face. This is just a one time appropriation that will have to be discussed again in the twenty seventh fiscal year. So this one is for non emergency medical transportation funding. So the $800,000

[Virginia "Ginny" Lyons (Chair)]: gross request. Had heard, for the record,

[Nolan Langweil (Joint Fiscal Office)]: one was going to distal office, we had heard that they were, this is to help with a shortfall for the providers for fiscal year twenty five, so it's kind of helping them back up their shortfall. And they said one of the reasons that it's coming in higher is that because some closures of practices, they have to drive people to bar in the room so the costs are a little higher. So that's where this request is making.

[Virginia "Ginny" Lyons (Chair)]: See a lot of this on the floor with me.

[Amy (Fiscal analyst/staff)]: The next section of one times is 167,000 general plan for the Bridges to Health Program, which my understanding is that it's moving from being UBM and it's moving to another.

[Virginia "Ginny" Lyons (Chair)]: And rubbish registration. This is sort of a program, yeah. Yes, so there's sort of like a bridge funding for that.

[Amy (Fiscal analyst/staff)]: The next one was substance misuse for recovery centers. In the bill, it specifically identifies what providers will receive what specific amount of money.

[Virginia "Ginny" Lyons (Chair)]: Right, and within the bill there's a list of the actual recovery centers across the state and how much money they need in order to true up their budget from last year. Well,

[Amy (Fiscal analyst/staff)]: can we see the booster? I

[Virginia "Ginny" Lyons (Chair)]: can pull it up. It's in the $7.90. I

[Amy (Fiscal analyst/staff)]: thought that you had asked that question, so I It's right here. Well, I'm doing all the pages. But you can look at $7.90, and I have the section on the handouts that helps you find it. Great, thank you. But here are all of them. The turning point sectors are the primary

[Virginia "Ginny" Lyons (Chair)]: So it really is about how much more money they needed to cover their costs for the twenty sixth fiscal year. And so the budget adjustment allows allows for the administration to begin to double the college of them. And then the house was actually, the house actually was responsible for building this particular section, putting the towers in for each of them. And there's language with it, so it can be a little less fun. And this

[Nolan Langweil (Joint Fiscal Office)]: has got a full substance of this

[Virginia "Ginny" Lyons (Chair)]: huge special puppy. Yeah, have the embryology. Yeah. You can come to the special Sorry, what page is that on the actual bill? Oh, yeah. This is not related to the opioid settlement. Right, yeah.

[Amy (Fiscal analyst/staff)]: Around page 30. Okay, great, thank you.

[Nolan Langweil (Joint Fiscal Office)]: I'm sorry, Ginny was talking about, I'm just not sitting over there because I don't have space, partially codentifying, but I wasn't paying attention because I was more bedhansing, but when Amy was talking about the long term care rates, That one was, there was some information that they had received. We did a 2% increase for home and community based providers last year, and it was based on a rate study. When And we got the rate study it just showed what it should be, but when the deed was implemented, they, in the rate study there was some who got increases, but the ERC ones actually got a decrease, and it wasn't apparent to legislature when that happened. So that money is to hold them harmless by not giving them 2% last year, at least making sure they don't go back below where they were. But this has annualized, it's 300,260 ks this year, but it's annualized, it's a million dollars. So if you do this in BAA, you have to carry a million dollars in the budget for the twenty seventh as well. And I also knew that and said fine with that. And then the triple As, that was because of the way it was done, they got rate increases for some stuff, but then not for others. They're trying to hold them hard unless it's young.

[Amy (Fiscal analyst/staff)]: Right, so now we are, it's time to

[Virginia "Ginny" Lyons (Chair)]: The

[Amy (Fiscal analyst/staff)]: next item is another one time program to the Vermont Food Bank, and their original appropriation was $500,000 The House added $400,000 for a total of $900,000 for fiscal year '26. Never getting into sort of the language, and this is just a repeat sometimes of what's happened above, specifically for this one. But this just sort of, the one we saw before, the B-twelve is the actual appropriation and E-three 12 is the language that specifies which entities will receive the foundation and the breakdown by organization. The next one is some language around DCF OEO. There is that the OEO had a proposal to provide, sort of, of this money, provide the community partners funding for staff associated with shelters to help plan the shelters. And the House redirected the purpose of the money to sort of the same community partners. Maybe there's different ones, but they identified the actual specific 13 community partners and to restore their grants to the fiscal year 'twenty five level. So I think there may have been some misunderstanding between what the legislature's intent was and what the proposal was before by the partners. The House has made this list. And then the next few sections are just language. Section 83 is a progress report. I think it's due in April to identify solutions, how to ensure uninterrupted services for individuals receiving supports during fiscal year. Payment reform.

[Nolan Langweil (Joint Fiscal Office)]: What this was, it was a placeholder language. We had heard from DAs in the house about how with the new DAs payment before, they're having some cash flow issues, timing, the way it's paid, and some of the agencies are struggling. So there's some language that we were working with DAs and DAO to try to come to an agreement on that would try to boost the rates and try to make things self solve cash flow and some of the risk concerns that they have, but we ran out of time. So this was a placeholder alignment to get some, and we're still working on it.

[Virginia "Ginny" Lyons (Chair)]: Still working on it. Okay. That's helpful because I I do hear that sometimes the truing up is takes, you know, a year and a half or you know, thereabouts which is really difficult. Yeah. So, I will be big day. Yeah. We're we're we're trying to do that. And

[Amy (Fiscal analyst/staff)]: the next two items I have, I most definitely will have, I mean, go in to explain. They're not necessarily direct appropriations, it's more language around

[Virginia "Ginny" Lyons (Chair)]: Oh, this, you're looking at 'eighty four? 'eighty four and 'eighty five. Yeah, so that relates to Frattleboro and In 'eighty one? Right they got captured in a language where they were if they have a clinical trial going on and it would upset the work they were doing with the grant they didn't have a language. Sorry. Before we move on, would it be possible to to go to the language in the bill that speaks to the harm reduction services? Sure. John Benson, South Central Yeah.

[Amy (Fiscal analyst/staff)]: Yeah, '77. So this is the language. We call this sort of annual language. It's been every appropriation bill for many years. And so they've increased the appropriation to 340,000

[Virginia "Ginny" Lyons (Chair)]: in general fund. Yeah, okay. It's different from 25, which is the HIV Environment Reduction Services. Okay, so this is different. Yeah. It adds more. Then it's distributed to each of the services that provide protection services. Got it. Alright. Thank you.

[Amy (Fiscal analyst/staff)]: Now, if you'd like, can kinda take you anywhere from here. I thought I would go over the highlight document that the house provides on the floor that identifies some other things that are in the Governor's recommend that I haven't talked about that they may be interested in, that the House agreed to. So, a lot of the bill is very technical in nature in that, so one of the items, for example, is about case load and utilization around Medicaid. And so those are, that's typically a number that's agreed upon with JFO and the administration and CEVA. And so there isn't really much, there isn't a lot of change that can happen around those. I didn't specifically talk about those. And that's some of the stuff that the governor and the house agreed to, but I wanna be transparent at the same time to your committee. So, I can go over those items, or can read the bill and ask, read the web report, and then just

[Virginia "Ginny" Lyons (Chair)]: do what you had in mind that you thought would be helpful.

[Amy (Fiscal analyst/staff)]: It shouldn't take too, and this may look somewhat familiar to you because the Senate also does a highlight document when you're talking about the bill on the floor.

[Virginia "Ginny" Lyons (Chair)]: So, let's see if we can get this in the bottom of the slide.

[Amy (Fiscal analyst/staff)]: I'm not gonna go over every item, so we won't go over statements Yeah, over that's fine. So, we talked about the extraordinary financial relief, the $14,100,000 that's in the budget adjustment for Dale. We didn't talk about the, there's $390,000 of general fund for traveling nurses. So Amy, what would would be

[Virginia "Ginny" Lyons (Chair)]: be to link that money wherever possible with what we've just talked about here. The extraordinary relief would be part of that 2%. That's right. So that one's part of section 40 on

[Amy (Fiscal analyst/staff)]: your handout. Yeah. And so, for the Department of Mental Health, that's not on your handout. And that one is part of the contract. Right. So their contract is higher than budgeted and therefore there's an adjustment.

[Virginia "Ginny" Lyons (Chair)]: So it adds $390,000 to the current contract, then it brings it up to, I forgot the level, it's about 4.5 in labor, I think.

[Amy (Fiscal analyst/staff)]: Let's see, we talked about the 1,300,000.0, and that is on section 81 of your handout, this for housing opportunity partners. We did not talk about the Wind of Centered Crisis Stabilization Program, and that's at DCF, for price expense for you. So that's an increase of 1,900,000.0. And then again, that's sort of part of their contract and work that they're doing. We talked about the Medicaid rate increases. So again, that's back up into section 40. We didn't talk about EOCs, and I don't know what your area is.

[Virginia "Ginny" Lyons (Chair)]: No, it's okay. I think there is the WellPath contract in there but we haven't dealt recently. Yeah. We do it.

[Amy (Fiscal analyst/staff)]: Yeah, so this is just based on population. Yeah, I

[Nolan Langweil (Joint Fiscal Office)]: could just add something to section 40. The governor for the nursing home extraordinary financial relief, or you have what I call it, EFR, the governor proposed $14,500,000 And then the House to pay for the ERC wanted the AAA case management increase, was they took it out of that. So that's 14.2 now, so it's just 300,000. Now they're both magical under global commitments, there's no loss of federal money. Just shouldn't have about Just how it's used. Yeah, so there's still, logistic and assets, 300,000 less for the EFR.

[Martine Larocque Gulick (Vice Chair)]: Okay, thank

[Virginia "Ginny" Lyons (Chair)]: you, Melanie.

[Amy (Fiscal analyst/staff)]: John Morley, this is, The next part is an audio handout, the funds caseload utilization, as I mentioned before, dollars 34,300,000.0. Uh-oh, that's probably gross.

[Virginia "Ginny" Lyons (Chair)]: Then

[Amy (Fiscal analyst/staff)]: we have about $270,000 general fund for two limited service positions that I think was previously funded through federal grants, and that money is no longer available. So now those positions are very integral to the work that do at DCF around the House of Opportunity Program. So, it's net neutral. It must have gone from grants up to personal services. Alright, so that's all in the case. And now we're talking about one time general fund appropriations. We'll go to third bullet. And that would be connected to section 51. These are all section 51. So, we're back to the non medical emergency management for the $800,000 We talked about purchase to health. We talked about So,

[Virginia "Ginny" Lyons (Chair)]: there's an increase for the non emergency. Correct. That is the increase to what's already been Because of the travel needs.

[Amy (Fiscal analyst/staff)]: The next bullet we can talk about is the general fund to migrate, sorry, the Health Connect to a cloud based platform to maintain compliance with federal requirements. It's sort of a must, a necessity for the Department of Defense.

[Martine Larocque Gulick (Vice Chair)]: Speaking of question, can any of this one time money beams be covered underneath the federal grant or the rural hospitals?

[Virginia "Ginny" Lyons (Chair)]: No, this is not the, this would not involve the Rural Health Transformation Grant funds or process, that's totally different, This segregated, is only truing up the budget from last year to help folks out and make sure that everybody has what they need to go forward. You could have said that. So talk about the transportation because that's a significant amount of money. Do you have details on that purchasing vehicle, or is that just paying for the volunteers that we Yes. Yes. All of it. I don't know about buying vehicles, but I do know about Paying for the Paying for gas. Yeah. Okay. Yeah. And

[Amy (Fiscal analyst/staff)]: I think the last one is, which we've already spoke about, which is the

[Virginia "Ginny" Lyons (Chair)]: report from Dale to

[Amy (Fiscal analyst/staff)]: the legislature on sort of

[Virginia "Ginny" Lyons (Chair)]: that placeholder language around the current work.

[Amy (Fiscal analyst/staff)]: So that's, I think, the general grand scheme of bigger requests. There's, I won't go over this other document, but I wanted to let you know, this is on your committee page. It's the worksheet that the governor proposes, and there are, it really gets into the weeds and details of every single item and ups and

[Virginia "Ginny" Lyons (Chair)]: downs. But

[Amy (Fiscal analyst/staff)]: I think what we've gone over is really the highlights of what's requested. You know, and

[Virginia "Ginny" Lyons (Chair)]: I guess the question for us is, is there anything there that looks totally unacceptable or that we wouldn't want to support? This is the.

[Amy (Fiscal analyst/staff)]: And that's on the Senate Appropriations webpage. Any

[Virginia "Ginny" Lyons (Chair)]: questions? I mean, I'm happy that there's language in that we're gonna be supporting language for, to support the DAs, but is there any appropriation attached to that? Not at this time, no, but you know, I'm working on it. We'll keep working on it. This is an issue, conflict free case management issue and a payment reform for the EAs now has been going on for a year and we heard about it here, we heard about it in joint fiscal and it hasn't been resolved through the budget or through the budget BAA, budget adjustment. So the house put in language that would say, okay, come up with a plan by April 15. That's the language that's in the bill now. I'm continuing to work on that and the issue is once you you put in place some money to cover services for a period of time for utilization then we have to know do we have the money so so all of that in what I'm trying to do over until it's open and sorry one other question Does the farm reduction services, does that include needle change, or is that something different? I think it does. Yeah. We're have an increased need. And in different places at least. Okay, any other questions for Amy or Nolan? Just if we, you know, the appropriations committee has been walking through this and really understanding where the money's coming from, where it's going, what are the money, what monies are contracts that are, you know, you can't really move money around from contracts, need it to go forward. What money is needed based on some oversight from the previous year, 2%, the Valbro issue, all of those things, trying to fix some of old problems along the way. This is actually, I shouldn't say this, but it is a more benign BAA,

[Amy (Fiscal analyst/staff)]: it's a big fat in the

[Virginia "Ginny" Lyons (Chair)]: past. What is your sense

[Amy (Fiscal analyst/staff)]: of this? Yeah, there's budget adjustments should really not have a lot of policy in it. It surely should just be an adjustment to the bill that you've already agreed to based on new things and new data. So, that's really how this budget adjustment feels. Yeah, it's more in line with that. K. Questions?

[Virginia "Ginny" Lyons (Chair)]: No. Good work. You're sweet. Well, no. Thank you. Thanks for putting this together. This is really great. It helps with explanation. It's all great. Sorry. So, Dominique, if you have any specific urgent questions, you can ask me there, Nolan, and I'm happy to guide you if you need that. And then if you have concerns about what's in here, certainly bring it up People bring it up and prepare for some patients. Okay. I have a card that we received, and I will pass it around so you can see it. Are you allowed to hold? He's doing it.

[Martine Larocque Gulick (Vice Chair)]: And it still works.

[Virginia "Ginny" Lyons (Chair)]: Charlotte. I've never replied an email last night about 09:00 from representative Burke who wants to testify on 08/05/1945. If he's available, you know, we could ask him if he's available at 10:15 if he's there at 09:30, you know, Anytime between 09:30 and ten or a little after ten. He's on the floor now, so it's probably not they will have him be down. You only have me in. Yeah. So, okay. So, we have Katie. I don't know if that. Yeah. We are not going put anybody else in that chair. Okay. Is he brethren-in-law? Ask her. As you know, sometimes our agenda changes, and I don't know. 05:45. Just in case. Yeah. Just in case. Yeah. Just in case. Okay. Yeah. She's the secretary of state's office. And you can The health department. Oh, she's from the health department. Oh, that's my brain. I gotta put her in the. It's Friday. Really? And the Olympics is starting. The Super Bowl Sunday. Whoo. That's our happiness today. Lauren, thanks for being here. We're going through 05:45 and we may reach out to a friend as we go through and if you feel there's something you'd like to share, just raise your hand.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Great. Thank you so much, Senator. I appreciate it.

[Virginia "Ginny" Lyons (Chair)]: Good. And I do understand you are at the Department of Health. This is taking a while to drink.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: I wrote it in my caption so you can

[Virginia "Ginny" Lyons (Chair)]: see. Okay. Katie, we're walking through 05:45. Do we have recommendations for amendment in the bill we need to look at?

[Amy (Fiscal analyst/staff)]: Good morning. Thank you. I'm happy to walk through the bill that came over from the house again if you wanna take another look. Yesterday, we looked at instances of amendment so I could start there. You can, whatever's best for the committee.

[Virginia "Ginny" Lyons (Chair)]: Let's start with the proposal of amendment and make a decision about including those in the bill. Okay.

[Katie (Legislative Counsel)]: So just to refresh your memory, this is an amendment to H. Five forty five that contains instances of amendment. So this is different than a strike all that integrates all of the amendments in the document, which means that in order to sort of see how some of these pieces fit together, you will need your bill as introduced.

[Virginia "Ginny" Lyons (Chair)]: The

[Katie (Legislative Counsel)]: first instance of amendment is in section three of your bill is introduced, and that is where the existing Vermont Immunization Advisory Council authorization statute exists. This language is striking out the existing subsection B that is in the bill that passed the House and putting in a new subsection B. You'll see that it contains most of the language that the House sent over. The change here is removing the executive officer of the Vermont Board of Nursing or designee, and the executive officer of the Vermont Board of Pharmacy or designee. Although originally requested by OPR, OPR felt that it was more appropriate to have the practicing APRN and the practicing pharmacists in Subdivisions 10 And 11 solely instead of having both somebody from the board and a practicing provider. So, they requested that those two items, those two members come off the list.

[Virginia "Ginny" Lyons (Chair)]: Okay. What page of the bill? That's we have different documents. Here we go. So it's section three subsection b. Section three. Section three of Your. Thank you. Okay. Thank you. Alright. I think I'm a great spot. Okay. Should

[Katie (Legislative Counsel)]: be a list of members. Yeah. And then in your document that you're looking at, the subdivisions two and three are the two positions that would be

[Virginia "Ginny" Lyons (Chair)]: removed under this proposal. Okay. And then we're putting people who are active participants. They're already in. They're Yeah. So taking these two out. Yeah. And we're reducing the number. On the Okay.

[Katie (Legislative Counsel)]: Okay, we'll take that. The first instance of amendment. The second instance of amendment is to section seven of the bill that came over from the House. This is a section specific to pharmacy technicians. Station James. Great. So, we have some reorganization happening to this language, but what is new is this list of authorities for a pharmacy technician to administer immunizations. So, this list under two. So, it reads that a pharmacy technician shall only administer immunizations when a licensed pharmacist who is trained to immunize is present and able to assist with the immunization as needed pursuant to a valid prescription by a practitioner, a standing order made by the Commissioner of Health, or a protocol approved by the Commissioner of Health under subdivision twenty twenty three(two) of this title, which is the section six of your bill specific to pharmacists. And to patients eighteen years of age or older and five years of age or older seeking an influenza immunization, COVID-nineteen immunization, and subsequent formulations or combination products thereof. So that would be the whole rewritten phrase, keeping that, adding that authority, list of authorities in. So that is the change that OPR is requesting. And then, in the third instance of amendment, striking out section 13 in the bill as it came over from the House. That is also a section, that's the corresponding section on pharmacy credits. Hang on a second. Page 22.

[Virginia "Ginny" Lyons (Chair)]: Just break up the whole section. It

[Katie (Legislative Counsel)]: deletes the whole section from the bill. The effect of doing that is that there will not be any changes to the section we just looked at on 07/01/2031. What is being proposed in that second instance of amendment would become the new status quo and it wouldn't revert back to anything. It would, that would just be the language moving forward, which is why we wouldn't need section 13 anymore because that section takes effect 07/01/2031.

[Virginia "Ginny" Lyons (Chair)]: Alright. Okay. K. Questions? Okay. So it probably would be helpful for us to digest this over the weekend. And then we're coming back to it on Tuesday. And then we'll do our final markup on our proposed amendment and I'm looking to vote on Tuesday. I know that Representative Bert, as I understand, had a proposal on the floor for an amendment that wasn't accepted. He also was involved in test I think he testified upstairs. I'm not sure.

[Katie (Legislative Counsel)]: He definitely presented his amendment to human services. I don't know

[Virginia "Ginny" Lyons (Chair)]: if he presented it anywhere else. Yeah. So he asked he sent the bill last night. If Charlotte, if you wouldn't mind sending representative for a note and if he's available he'd have to get off the floor. I hate doing that to people, but if he's available this morning by we get right before the go to. By 09:15. Before 09:15. That would be great. And then

[Katie (Legislative Counsel)]: I mean 10:15. K. Thank you very much.

[Virginia "Ginny" Lyons (Chair)]: 10:15. And if he's not available then, then perhaps he would be available on Tuesday at 10:00? Yeah, sure. When we begin.

[Katie (Legislative Counsel)]: Is there an interest in having this as a strike all instead of instances of amendment with that? Committee, what do

[Virginia "Ginny" Lyons (Chair)]: you think in terms of presenting it on the floor? I think that would be nice, but let's just be. Okay, how difficult is it to do so we can look at it on Tuesday? It's not difficult. Let's do it. I think it's much easier for us, and then it's much easier for the other senators to understand what's in the bill. I don't anticipate anything additional, but we'll certainly listen to you.

[Katie (Legislative Counsel)]: Okay. So, it'll essentially be the same amendment. It'll just

[Virginia "Ginny" Lyons (Chair)]: be presented as strike off. Thank you. We'll be done. Alright. Anything else? Not for me unless you want to look at the underlying language. Let's do that. Let's go through it. We have a little bit of time and then we'll take a break before we go into Room 11. Okay. We're going into Room 11 at 10:30 with the house healthcare.

[Nolan Langweil (Joint Fiscal Office)]: Hope they'll be there.

[Katie (Legislative Counsel)]: Okay. So here is the version of H545 that passed the house. I'll go high level because I know we've gone through it, but I know you like to refresh your memory on it. So the first half of the bill takes effect on passage and the language only stands for six years. So as of 07/01/2031, most of the language reverts back to the way it is in current law, although not all of it does. So, in section one, we have the definition of recommended immunization. And again, this definition means something very specific to mean that the Commissioner of Health is making a recommendation about the recommended immunization schedules for children and adults. Then we have amendments to the existing immunization program in terms of how immunizations are purchased and how they're funded. There are some changes here. A lot of it is updating the language around recommended immunization. And then you have some technical changes. Okay, that brings us to section two of the bill. This is all new language in this sunsets on the 07/01/2031 date. So this language is in effect, would be in effect for six years. That the commissioner is to periodically issue recommendations regarding, then we have a list about what those recommendations are, which immunizations children and adults are recommended to receive, the age at which each immunization is recommended to be given, the number of immunization doses that are recommended to be administered, the recommended amount of time between doses of an immunization, and any other recommendations regarding immunizations necessary to promote the maintenance of public health and disease prevention in the state. And then, subsection B is the guidance on how the Commissioner is making these recommendation decisions. First, the commissioner shall consult with the Vermont Immunization Advisory Council, that's the membership we just looked at. And then in subdivision two, considering recommendations for immunizations issued by a variety of groups including the CDC and various professional organizations. In C, this is the language that creates the liability immunity, a healthcare professional prescribes the defenses or administers an immunization in accordance to the commissioner's recommendations are to be immune from civil and administrative liability for immunization caused adverse events unless the professional's actions in prescribing, dispensing, administering constitute gross negligence, recklessness, or intentional misconduct. And D, this gives the commissioner a standing order, authority to issue a standing order authorizing healthcare professionals, including pharmacists, to prescribe, dispense, or administer recommended immunizations as long as they're acting within the scope of their professional licensure. In subsection E, the department is to prominently display information pertaining to the recommended immunization schedule on their website, including how to access those recommended immunizations. And in subdivision E2, this is language that if the advisory council and the commissioner were to have different recommendations, if those weren't aligned, then any documents the department is producing has to note that. In subsection F, we just start cross referencing definitions from the previous section of the bill. Section three is the language with the existing Vermont Immunization Advisory Council. We looked at the membership already this morning, I'll skip over that. We have some changes in C to the council's duties because now they would be looking at the recommended immunizations. For the first time, that language is being added. And then subdivision C2, we

[Virginia "Ginny" Lyons (Chair)]: have

[Katie (Legislative Counsel)]: a provision that the Secretary of Education or their designee and the representative of a public school is not, those two individuals are not voting on the recommended immunization schedule. So this subsection C here all reverts back to the way it currently is as of July 1. Then we have some language about how the meetings are organized. Next, you have two sections.

[Virginia "Ginny" Lyons (Chair)]: Wait, it reverts July 1, what year?

[Katie (Legislative Counsel)]: 2031. Yeah, thank you. Yep, sorry. At top of my page 10, we have the next two sections on health insurance coverage. So both of these sections currently reference CDC recommendations. The change is to instead reference the commissioner's recommended, the cross reference for the commissioner's recommendations. The immunizations would still be at no cost to the patient. So, I'll skip over those two. The next two sections, sections six and seven, also take effect on passage. The first section has to do with pharmacists. Section seven has to do with pharmacy text. This decouples the link between pharmacy authority and CDC recommendations, and instead the link would be with the commissioner's recommendations. So that is what is happening in section six. You'll see that here that what's authorized is recommended immunizations. And we have it, that's a defined term to mean those that the commissioner has recommended instead of language about the CDC. Section seven, we already looked at in your amendment. So the proposal is to change this for the OPR recommendations. And then we get to section eight. Section eight is where the timeframe kind of switches. So, we've reached the halfway point in the bill, and now instead of things taking effect on passage, the sections are taking effect on 07/01/2031, with the goal of reverting back to the current status quo, again, with some exceptions. So, you have the definition of recommended immunization going away, and instead you're using the term immunization in this draft, instead of the recommendations made from the commissioner, they'll once again be based on CDC recommendations. What you are keeping from section one is this language that an immunization means a vaccine or other immunizing agent that provides protection against a particular disease or pathogen. Most of the changes are in this section are to revert back to where the language currently is. So I will skip through this.

[Virginia "Ginny" Lyons (Chair)]: Oh,

[Katie (Legislative Counsel)]: there on my page 17, G1, you'll see that there are these ellipses here in line seven. That means there's statutory language here, but we're not changing it. So what those ellipses signify in this case is that there were some changes to the list of the membership for the Immunization Funding Advisory Council. Most of those changes weren't substantive but sort of structural, but those changes are being maintained is what those ellipses signify there. The next section, section nine,

[Lauren Lehman (General Counsel, Vermont Department of Health)]: is

[Katie (Legislative Counsel)]: the Vermont Immunization Advisory Council. You see these same ellipses on line nine. So subsection B is being maintained the way it is under section three of the bill. But subsection C, as I said, is going to revert back to the way it currently is, and that's why we have to show that change. Next are the two sections on insurance coverage, and these two provisions go back to the way they are under the current law. So that's sections ten and eleven. Section 12 wait. Ten and eleven. Go back to the to the status quo, the current status quo. Section 12 is the pharmacy section. This is reverting back to the way it currently is. It's reverting back to the status quo, so referencing the language about the CDC. And now if you accept the OKR amendment, you will no longer have this section 13. It will say deleted because it is their goal that the language that we looked at for section seven would be maintained moving forward. So section 13, when you see our strike all, it say section 13 deleted. And that's why because there's no change to be expected on 07/01/2031 for that section. At the end of the bill, section 14, this repeals section eleven thirty A. That is section two of your bill. That's all the new language that allows the commissioner to provide recommendations and outlines what the commissioner has to take into consideration. So that section of new law will go away entirely on 07/01/2031. And then you have the effective dates. And we have this section, meaning the effective date section, and sections one through seven and section 14, they all take effect on passage. And then sections eight through 13 take effect on 07/01/2031. So I think we've kind of covered that as we went through.

[Virginia "Ginny" Lyons (Chair)]: Good. Question.

[Martine Larocque Gulick (Vice Chair)]: So what I remember, we went through this the last time, is if Vermont's recommendation of what what people should get is different than the CDC. Uh-huh. And if if a vaccination that we recommend is not on the CDC's list, then if in fact there is an issue that whatever that fund is or whatever that individuals would be able to tap into would not apply to the vaccination that is not on the CDC's list, is that correct?

[Katie (Legislative Counsel)]: Are you talking about the federal program? Yes. Currently the federal program is still covering the immunizations that

[Virginia "Ginny" Lyons (Chair)]: that they are, have. Well,

[Katie (Legislative Counsel)]: on the CDC's list prior to them reducing the list. That program is still covering all of the immunizations. It sounds like from experts in the field that they're it's anticipated that it may not always cover those, and it may as Right.

[Martine Larocque Gulick (Vice Chair)]: That was the part I was concerned about. And and if in fact that were to occur Mhmm. On the whatever they're posting that says here's the recommended vaccines Mhmm. That maybe there should be an asterisk next to those that make people aware that that federal program would not apply to the

[Katie (Legislative Counsel)]: The immunization.

[Martine Larocque Gulick (Vice Chair)]: Just so that they are aware.

[Katie (Legislative Counsel)]: Right. That is a policy decision.

[Virginia "Ginny" Lyons (Chair)]: So I see Lauren Lehman of the Department of Health. Lauren, can you comment on that, Chittenden?

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Yes, thank you. Lauren Lehman, General Counsel, Department of Health. So the Vaccines for Children program is actually purchased through the state. So we pay the federal government and then we distribute the vaccines for free to providers. So in this situation, and then because we're a universal state and also provide vaccines to adults, you may recall Meredith Plumpton's image where there's all these funding sources kind of going into the funnel. So there's also health insurance funding as well as this vaccines for children funding and a little bit of grant funding for certain populations. That if the vaccines for children program no longer offered a vaccine, such that it was covered under the state contract, the insurers would pick that up in their cost of putting that in their cost. So it wouldn't go onto the patient. The patient still would be receiving the vaccine cost free.

[Virginia "Ginny" Lyons (Chair)]: So it is a different question, Lauren. So maybe state your question again.

[Martine Larocque Gulick (Vice Chair)]: Yeah, I am not concerned about the cost of the actual vaccine. It is if in fact the patient has some adverse reaction to that vaccine as I understand it. If in fact it is on the CDC's list or the current list, then there's a fund or something through the federal system that protects the individual. They wouldn't have to sue by themselves the vaccine manufacturer. But if in fact down the road, if it is not on that list, when it is on Vermont and they had an adverse reaction, the only recourse, because they cannot go after the physician, the only recourse that the individual would have would be to directly sue the pharmaceutical company itself. And so all I was interested in is making sure people were aware that there is a different level of potential exposure, not the cost of the actual vaccine.

[Katie (Legislative Counsel)]: So Lauren, I think the proposal that is being raised is whether, and you can correct me

[Virginia "Ginny" Lyons (Chair)]: if I'm

[Katie (Legislative Counsel)]: wrong, whether what the health department's position would be on flagging on public documentation those immunizations that are recommended in Vermont, no longer recommended at the federal level. So as at some point in the future to potentially not be covered under the federal vaccine injury program.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Thank you. Sorry, I misunderstood before. So you're correct that it would, I mean, now you have to get your own lawyer and petition the vaccine injury compensation program. So the distinction between doing that or going through the court system is, I don't know if there's a significant difference. And right now, everything is covered still by the vaccine injury compensation program. So I wouldn't want to anticipate that something might be removed at a later date by providing an asterisk right now. I think, again, it could be a deterrent. And so I'm not sure that the Department of Health would support that. But if that is something that the public needs for information, we could consider it.

[Martine Larocque Gulick (Vice Chair)]: I don't think we need to do it if it's still covered. When it gets to that point, because I think there is a huge difference in an individual having assumed directly that pharmaceutical company has a huge undertaking.

[Virginia "Ginny" Lyons (Chair)]: Could we ask for an illness? Wouldn't that happen? What? And is that if they if there is a difference between recommended vaccines at the federal and the state level, that this committee should be notified or the emergency board be note I mean, we should know. Who should know? Somebody. I if that happens, then, yeah, probably would wanna put a little footnote somewhere and then test if you have an adverse reaction to this. Oh, how does the Department of Health handle that if you have an how is that handled and how do you know I'm trying to sort out how you understand the cause and effect relationship between a vaccination and a specific negative outcome? I know there are some that are very clear, Gulen Barre for one, certain flu vaccinations, but how do you know cause and effect with this stuff? Lauren, so the question is having a notice about where to go if there's an adverse reaction. Where does that fit within either the advisory committee or the department's information itself?

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Yeah, thank you. There is a vaccine adverse event system that you can report anything into. So folks, whether it's associated, whether it's not even associated, but somebody thinks it's associated, it gets reported to the system. The actual studies about adverse events are distinct from that reporting system. So if one, you know, right now the Vaccine Injury Compensation Program at the federal level has a list of common, not common, but of events that are caused by the vaccine, like Guillain Barre, for example. And if you come in and you petition and have that event, then you would be entitled to compensation pretty quickly without having to show causation. Causation. Otherwise, if it's a different injury, again, you're part of a litigation system and a tort system. It's just more internalized to the government and outside of our typical civil court system. So it's not hugely distinct. You still have to petition, you still have to go before a judge, you still have to show causation between the vaccine and the injury, and it can take years and often the maximum is 200 to $250,000 for a life event.

[Martine Larocque Gulick (Vice Chair)]: Go ahead. I think if I follow what you were suggesting was when and if a recommended vaccine falls off that federal protection piece but it's still recommended by the State of Vermont that this committee being notified that that has occurred so this committee could decide at that point in time whether they felt there was some notice or something required. That where you were at? That's

[Virginia "Ginny" Lyons (Chair)]: what happens to people. So there is the vaccine information sheet and I'm setting up on who can comment on the VIS and where that is located?

[Lauren Lehman (General Counsel, Vermont Department of Health)]: That's at the CDC level. Anybody can comment on it, the public comment, and then

[Virginia "Ginny" Lyons (Chair)]: No, no, who can comment it for purposes of our understanding right here? Where does it live and how does it influence a patient decisions or whatever? That's the thing they give you every time you get a flu shot. Every time I get a flu shot get a dandruggy. Oh, yeah. You want to? Please, yeah, go ahead. Stephanie Winters, I'm the Deputy Director of

[Amy (Fiscal analyst/staff)]: the Vermont Medical Society, as well as the Executive Director for the AAP, American Academy of Pediatrics, Vermont Chapter, and the Vermont Academy of Family Physicians. I think Meredith Plunken, who's our immunization program manager, is listening, but probably not able to respond. But there are vaccine information sheets currently, and they already talk about the National Vaccine Injury Compensation Program and they do not name which vaccines, and they do say certain vaccines are covered and can be compensated through this program, so they don't call out every one of them and they say certain. So I think it's already on the vaccine information sheets, are federally required to be given to every patient and they don't currently call out every single vaccine.

[Virginia "Ginny" Lyons (Chair)]: But just clarity, if there is a difference between the CDC list and the Vermont Department of Health list, which we will be going by, and there is an adverse reaction, is that reaction still covered under the federal funding system? Or in that one event, is that family person that have the adverse reaction, their only option is to hire a tort attorney and go to court, which would be long and expensive. This is Lauren.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: This is Lauren Lehman again for the department. So right

[Virginia "Ginny" Lyons (Chair)]: now,

[Lauren Lehman (General Counsel, Vermont Department of Health)]: all the vaccines are still covered by VICP. So there's no distinction. And as long as they're covered, they would be. To your point, they wouldn't be able to go through the VICP. But I want to be clear that the VICP process is not easy and is not short and easy. And there's some ways to shorten it if it's a known event. But it still takes years. And you still have to hire a lawyer, and you still have to go through that process. It's a different venue. And in that situation, your damages are capped, you can't, so you're actually getting less relief. So it's different. It would be a different process for that vaccine at the Vermont state level, but your potential for recovery is much higher as well.

[Virginia "Ginny" Lyons (Chair)]: Okay. So the short answer is right now there's a fund that's set up, and I have to hire a lawyer, and it's a long and probably expensive process to go through that. If the vaccine is on our list, if at some point in the future, but not on the federal list, then I would have to hire a lawyer to go to court and sue the vaccine manufacturer

[Amy (Fiscal analyst/staff)]: because the

[Virginia "Ginny" Lyons (Chair)]: physician is protected, which is okay. So I would have to sue the manufacturer?

[Amy (Fiscal analyst/staff)]: Yes.

[Lauren Lehman (General Counsel, Vermont Department of Health)]: Okay. Unless there was gross negligee at the physician Yeah.

[Virginia "Ginny" Lyons (Chair)]: Knew this child was allergic to eggs. I still gave her flu shot. Mhmm. Still That's it. Yep. Okay. Okay, the thing I think the underlying proposal that we have from the Department of Health, and this is the administration's proposal, preserve the current status for vaccinations in the state of Yes. The I think that underlines what we're trying to do. It does help expand some of those who can administer vaccines and very specifically through the, you know, pharmacists and then it also puts in the advisory committee at the state level to help preserve that, the data informed science based information. Right. Yeah. But we're doing this because we're anticipating at some point Exactly. In the next few years Exactly. Flu shots might be Right. Or whatever. Right. That would not work for the but that does change I guess the question is, is it significant? If you have to hire a lawyer now and it takes you years of legal fees to get money from this fund, it might actually turn out to be shorter if you had to hire a lawyer. And direct The point, say manufacturer, but there would the question is, is there a significant difference? Am thinking there probably isn't. Okay. Okay. Allison, do you want to say something? I do,

[Amy (Fiscal analyst/staff)]: if you don't mind. Might help clarify one thing. Allison Descate, Health Choice Vermont. I just wanted to say two pieces. One is there is at the federal level with the Vaccine Injury Compensation Program, a table that acknowledges that if a certain vaccine causes this reaction and you report it and it happens.

[Virginia "Ginny" Lyons (Chair)]: That's what we've heard that.

[Amy (Fiscal analyst/staff)]: But in two or three days, you're immediately covered. So that would be a very quick turnaround time for those accepted pieces. And the other thing is a vaccine information statement sheet as put out by the CDC for decades has been known that this is not informed consent. So you get that sheet to be able to report to your VAERS, but it's not informed consent. So thank you.

[Virginia "Ginny" Lyons (Chair)]: Good, thank you. And okay, so yeah, there's a lot of as soon as we start talking about vaccinations and immunization everything sort of percolates to the top and we start all over again. What we're trying to do here with this bill is to ensure that if there are federal changes that are significantly different from what we have in the state that we can preserve what we have in the states going forward. Good. You know a car stopped at office. We'll talk about that in a minute. Alright. Thank you. You're welcome. No. It it's tough. We get into these conversations and they're really good conversations from every single point of view. I appreciate that. So, on Tuesdays, we'll come back to this and we'll do what we can do. I'm hoping that we could vote the amendments, propose amendments out with the strike ball. Okay. I'll have that ready, babe. Alright, terrific. Alright. Vinnie, Charlotte, did you hear that? I did not. Okay. If I hear back about Tuesday morning, all that. Yeah, thank you for that. We don't have time for, you know, it's always, it's always the time issue but well if he wants to testify and bring his proposal amendment in here we're certainly willing to look at it. I suspect that you know if he doesn't do it someone will bring it up on the floor but I'd like to consider it before we get to that stage. Alright, so we are going to take a little break. Thank you Lauren for being with us. Thank you. And we'll take a break and at 10:25 we'll be going back into, we'll go into Room 11. We're gonna hear from some of the hospitals who have been working

[Amy (Fiscal analyst/staff)]: really hard,