Vermont Legislature SmartTranscripts:

[Virginia "Ginny" Lyons (Chair)]: Alright, we're back. Senate Health and Welfare is still February 11 and we're moving on to S-one 190 and we're going to hear from DFR so welcome. Introduce yourself for the record. All right, I'm Mary Block, I'm Deputy Commissioner of Insurance from the Department of Financial Regulation. Thank you for having me.

[Mary Block (Deputy Commissioner of Insurance, Vermont Department of Financial Regulation)]: The short answer is that we have absolutely no objection to S-one 190. We oppose what they do about care board. With respect to the section on records based pricing, we certainly support moving records based pricing along as soon as possible with consumers and insurers and our entire healthcare systems combined. With respect to the outsourcing sections, we also fully support that. We believe outsourcing can be very valuable where it can improve affordability and accessibility. But it needs to be transparent, and needs to be accountability. There's been a lot of work that's been done by the CARE board, and by DFR and AHS and lots of organizations here in Vermont to manage rates and hospital budgets, you know, reference based pricing, Act 55, budget and rate orders, all being done to manage this problem that we have with healthcare costs. I've done a lot of work to push insurers to negotiate heavier with the hospitals. So all of that work is not gonna be effective if there's a lack of transparency and accountability for outsourcing, and it potentially undermines that work. Hospitals should be able to delegate functions, but they cannot abdicate their responsibility for those functions. So, if they're outsourcing a hospital function, then that vendor is acting as them, and the same rules should apply, the same transparency should apply.

[Speaker 1]: With respect to section six and

[Mary Block (Deputy Commissioner of Insurance, Vermont Department of Financial Regulation)]: seven, we really don't have any comments to make there. We have no objections to section, section eight relating to appeals from care board. Appeals to VFR orders also go straight to the Supreme Court. It's a very similar structure to other agencies. And then with respect to their audit, the audit request, it's very similar to what we have in DFR. And our audit function is vitally important to me to post the work that we do. The ability to go in dig deep and ask those questions was very helpful to us in the way of the insurance community. And I presume that it would helpful to the Sherwood as well. And I think that's it in a nutshell. That's it in a nutshell. So and I do have some questions. I do have a question for you. So in terms let's start with the reference based pricing. So I'm pleased that you said reference based pricing should move along, especially if possible, because I believe it should as well. What role, if any, do you play in helping working with the board on reference based pricing? How does that sort out with the insurance oversight? So at this point, the care board hasn't engaged us in the work that they're doing, because I think they're still very preliminary in network. Obviously, it comes to mind to be thinking about how insurers are gonna process those claims with reference based prices, how they're gonna incorporate that into contracts, we'll be more involved in conversations with the care board. And then obviously we will audit to those things as we normally do during the exams of the insurance. Yeah, contract piece seems critical because a negotiation would happen a priori, you know, before the rate setting always happens that way. I mean, they're just finishing up the details of the negotiations for this year. It always brings over, but they have know, sort of the agreement from school and medical language. So yeah, would be, you know, they'd be working on the negotiations for next year, probably, involved, sort of right now, if rates come down, they would be working on, they could have the contracts from executed. There's a provision in the pending spill that would require you to put that in there anyway. You just need to be out of details amongst the parties. Okay, good. Thank you. Then the outsourcing piece has said transparent and accountable. One of the concerns that sort of rides along with outsourcing is what happens to our provider taxes. And that I don't, that's a big question. It is a big question. Yeah, and I am not a tax expert, so I think have that one. Yes, we need to sort that out. But what you were saying is that they can delegate, but they can't aggregate the responsibility, so it still holds as part of our hospital. Yes. So we're gonna have to sort out how to define that so we don't lose financially. Yep. And that's the way we view the insurance world too. Think insurers delegate, you know, outsource things all the time. Yeah. Our expectation is that they're responsible for that outsourced relationship. So if something goes wrong, it's the insurer's problem. Okay. They're responsible to to make the consumer whole or handle whatever consumer issue it is and then they argue out with the vendor in the background based on the contract. Anything else that you need to share with us that we need to know? I mean, we don't know what we don't know. With respect to this bill, can't think of anything. Mean, it's very straightforward and didn't seem to be an issue from our perspective. You make perfect sense. Okay. And Senator Cummings is gonna help us with the private taxes. Doesn't say tax. That's going down to my house. Any questions, Chittenden? This is helpful. Thank you very much, and we know where you are. How much do you how much typically, what's the price cost of an audit that you go through individual audits? It varies greatly on the insurer and the complexity of their business. So, we charge back for our things. Yeah. We contract out, use contract resources as well as our internal resources and charge that back. I mean, exams can go upwards of 300 or $400,000 depending on the complexity of the insurer. You know, some are a lot smaller than that. We have some very small insurers that are, you know, maybe $50,000 but There are some big ones that take a long time to do. We're looking at almost, in some cases, a full year of completing exam because of the complexity of the business and what we look at. Any other questions for DFR? We're good. Thank you, Mary. It's well Very good. I know you brought your friend.

[Speaker 1]: Oh, he was. I've got one.

[Virginia "Ginny" Lyons (Chair)]: Thank you. Didn't have the phone today. No. Might get there. We might get there. Alright. Thank you very much. It's snowing, but warmer. Oh, it was it was so nice. Yes. So much better. And last week, there were some red spaces that showed up. Yes. We were here last night. I had to get on my face before I could testify. Lost you. It was the whole. Thank you. So, today, thank you. Thanks for coming in. We are for S one ninety. We will have the board and the hospitals come in to testify. They've been working together on finding some language that we can consider. So with Jen, get there. And today's a big day. It's Recovery Day, it's Disability Advocacy Day, and it's Vermont two eleven. So, Sarah Longerville is here. Thank you for being here. Thank you for having us. And, you know, just take a couple minutes to talk with us about the Provence Center for Okay.

[Sarah Launderville (Executive Director, Vermont Center for Independent Living; President, Vermont Coalition for Disability Rights)]: I did prepare some testimony to hear a little bit of That would be terrific. Yeah? Okay. Just to sort of give you a good afternoon. My name is Sarah Londerbelle. It's good to see you. It's been a while since I've been in the It is. Nice to see you. And I am the director of the Vermont Center for Independent Living. We're a disability justice organization, and we serve people statewide. And I'm also the president of the Vermont Coalition for Disability Rights, and we are here today celebrating Disability Advocacy Day. We're presenting in front of 17 different committees, if you can believe it. And so people are kind of all over and sort of sharing our message. And I'm also a person who likes my disabilities. The theme of this year is disability rights into every building. And so we're trying to you're a little more familiar with disability rights because of the nature of your committee, but I was in agriculture this morning and sharing about that, and it was wonderful. So thank you for being curious about and agreeing and letting us speak today. BCDR, have five principles. Disability is a natural part of the human experience, putting community and supports before institutions, supporting self determination and independent living, supporting for community based living and peer support, and dignity and respect for people with disabilities, which includes access to education, housing, food, work, and inclusion. These principles are particularly important here because the bills you take up around public health, mental health, primary care, hospital oversight, children's service directly shaped whether disabled or mothers can live safely, independently, and with safety. So for the disability community, what we try to do in each of the committees is look at some of the bills that you're currently working on, or the ones that you've just passed, and sort of give some comments and feedback. So, wanted to highlight community access to immunizations that matter deeply to our community. It's highlighted in age five, after the state of emergency for the pandemic was lifted, VCIL peers struggled with access to immunizations because while the state had moved on from protections, those who remained immunocompromised were less protected in the public than ever before. So through a lot of hard work in gaining access to funds through a US aging grant, ACIL operationalized the only statewide in home vaccination program in Vermont, ensuring that people who could not leave their homes because of their disabilities, chronic illness, immunodeficiencies or transportation barriers could still receive those life saving vaccines. So we did that for about a year and a half, took as long as we could and then the money, of course, had gone away, so we're done with that for now. Many Vermonters told us it was the first time they had been included in public health response, And our teams traveled across every region of the state providing vaccines in the home. If not available, those peers of ours would not have gotten the vaccine at all. And this bill has parallel in how people with disabilities and others can be blocked and need access to vaccines overall. S-one 189 is another example of a bill that matters deeply to our community. When primary care practices shut down or relocate, the impact is not evenly felt, and police able garments are often felt first to lose access. If you say I have recently received a call from an individual who suddenly lost their primary care provider because the practice had shut down, and they had been warned, they knew it was coming, but it had shut down. And for someone with significant disabilities, there was transportation barriers to the next closest primary care physician to rely on regular care to manage their chronic conditions. And this isn't just an inconvenience, it was a complete loss of access for that person. Finally, I'd like to share a part of a story related to a bill that was passed last year, protecting healthcare workers. This past semester, we still ran a paid internship where we connected with disabled students, and they wrote their stories about their experiences in education and also other healthcare systems. It was really left up to whatever they wanted to write about. The 17 year old student wrote about experiences in the local emergency department while seeking support during a mental health crisis. This person says, Let me share this part of the story. I've never screamed so loud in my entire life. My voice is already sore, but screaming for my mom and demanding the workers put me down became a spectacle of the entire unit. After searching the room with my eyes and seeing my mom was nowhere in sight, I glanced out towards the ceiling. I could see two nurses smiling at each other as if it was amusing for them. None of these nurses cared about me. None of them physically stopped me from slamming my head against the wall, and now I was seen as a show phone for them in the hospital. I became enraged with anger and tricked the woman holding up my right limb. One of my limbs was actually in my control again. Another nurse took the place of the woman I had tripped, and the man holding my left leg had repositioned his hand near my inner thigh. I started spacing out to a flashback again when I felt the tear in my shoulder. The pain continued, but so did the flashback, and my body was tired and exhausted from fighting everyone who was supposed to try and help me. I remember passing out. I don't know for how long I was out, but I woke up back as we entered the room towards the back of the building. My arm was aching, and I screamed that my arm hurt. The nurses lowered me onto a bed. I took my right arm from the woman restraining it, pushing my arm towards me, to which the nurse screamed to her coworkers that I had attempted to scratch her. She bent over, screamed into my face that she was pressing charges against me. To give a little bit more context, the hospital had removed this teen's mom from their room, and when the mom arrived home after supporting the teen through the crisis, they let go that day, they were left with a phone call from a local police department with an officer wanting to come by to issue a citation for the 17 year old who had just spent an entire day trying to seek medical treatment. Last year's bill saws took great safety, It resulted in a vulnerable teenager being re traumatized. The workers also had thoughts that they could personally pass charges, which is not accurate. They created a power dynamic that is troubling. The bias of people in mental health crisis continues to be very present, and in addition, the teen's personal information of why he was in the emergency department is now also shared with the police and not protected and kept confidential. The teen sought support from the civil rights Vermont, the state attorney general has decided not to press charges. If the parent is in a similar situation and doesn't understand that they could ask questions or assert themselves, the outcome could lead to a criminal justice system, including potential for jail time and passing on a gun. This committee is so important to the lives of people with disabilities, especially people with disabilities, sorry. I appreciate your work, all of your work, and I know that you care and need to take time to think about these systems. Thank you again for this opportunity to share with

[Virginia "Ginny" Lyons (Chair)]: you today. Thank you. Thanks for the story. Sitting behind you is the representative of hospitals who

[Sarah Launderville (Executive Director, Vermont Center for Independent Living; President, Vermont Coalition for Disability Rights)]: I think we were talking on it. Think recently, maybe. Thank you, Sarah.

[Virginia "Ginny" Lyons (Chair)]: You've identified some of the bills we're working on that are important to that. Really very helpful. We'll also be looking to see what the disabled housing recommendations are. They've worked very hard on that.

[Sarah Launderville (Executive Director, Vermont Center for Independent Living; President, Vermont Coalition for Disability Rights)]: Amazing, and there's a joint hearing today, god, I can't remember when it's my time starting at one I think for now, we're gonna see, talked about those all of those recommendations. That's true. That's happening over Exactly, yeah.

[Virginia "Ginny" Lyons (Chair)]: It's good. As long as it happens, it's important. So much interconnection. You.

[Sarah Launderville (Executive Director, Vermont Center for Independent Living; President, Vermont Coalition for Disability Rights)]: Thank you so much. Have a

[Virginia "Ginny" Lyons (Chair)]: good afternoon. And are we, is this Alison? What?

[Speaker 1]: Time?

[Virginia "Ginny" Lyons (Chair)]: Allison, I need you to come sit in the hot seat. Okay. Right there. We've got just a couple minutes. Senator Cummings has to go to another little button. Think he will listen to your Hi.

[Speaker 1]: The United States Of Vermont? Yes. You can be Alison. I can be Alison. I said you can see Alison all the time. Yes. We're neighbors. Oh, terrific. Have a good day.

[Virginia "Ginny" Lyons (Chair)]: Bye bye. Okay,

[Speaker 1]: ready to go then. Absolutely. All right, well thank you so much for giving me a few minutes of your time. So for the record, I'm Allison Lavanya. I'm the executive director of United Grizzo Vermont and Vermont two eleven.

[Allison Lavanya (Executive Director, United Ways of Vermont; Vermont 211)]: United Grazzo Vermont is the home to Vermont two eleven. And so, I'm here today to talk about Vermont two eleven because it is National two eleven Day, February? It is the national day that we celebrate. It's one-sided. Yeah. I want to talk a little bit about two-one-one and our value and our impact on the community. I am not here today to talk about funding and budget, and I realize that our time is limited, but I also just want a complete flag for this committee that two eleven's funding is at risk this year. The Governor's proposed fiscal year twenty seven budget reduces our funding by 3 and $32,000 Thanks to the legislature last year, we received a sustainable level of funding at 1,640,000.00, and we really need to maintain that sustainable level in order to perform our core services and functions. We need to be able to respond to the changing needs in the community with different costs and benefits changes, and be able to have appropriate staffing levels during our busiest call volume times a day, as well as to be able to respond during times of disaster after all the things that are expected at 02:11. With a reduction of this amount, these services and functions are absolutely in jeopardy. So, know that our time is limited and, Chair Lyons, if there's a chance to come back and talk more about that when your committee is having a bunch of conversations, you'd love to

[Virginia "Ginny" Lyons (Chair)]: do that. That's a suggestion. Okay. Yeah, because we won't get the budget until after crossover. Okay,

[Allison Lavanya (Executive Director, United Ways of Vermont; Vermont 211)]: Alright, thank That'd be great. We're celebrating 02/11 today, and this is the National Observance Day celebrating the three digit resource that helps people all across North America connect to health. Here in Vermont we provide free statewide access to resources by phone, text, and a 20 fourseven searchable database online. Our mission is to promote the health and well-being of all Vermonters through a statewide information and referral system that streamlines access to community resources. Vermont two zero one is also a nationally accredited information and referral service, and we serve as the centralized trusted source of health and human service information for the state. We are often seen as the front door to those services for the community, and to be able to provide confidential, non judgmental, and barrier free support, including interpretation services for callers who speak languages other than English. We are also an integral partner in disaster response and recovery, and we have risen to the occasion to support communities as far back as during tropical storm and rain and COVID and the recent flooding events of 'twenty three and 'twenty four. Today, our database includes over 11,000 services, and in 2025 alone, we responded to more than 61,000 contacts from Vermonters. We made over 22,000 referrals from those contacts, most often for housing, but also we do more than that. We provide support for utilities, tax preparation, public assistance, individual and family supports, veteran services, disability services, mental health services, services for older adults. We're the one stop shop for all of that. Across Vermont, people are told to call 2113 times a week. That's the message loud and clear, and demand is rising. We see spikes in call volume whenever there are a crisis or a change. For example, with the staff crisis back in the fall, and we need to be able to respond during those times. We anticipate more of that coming

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

[Allison Lavanya (Executive Director, United Ways of Vermont; Vermont 211)]: the line. Many people are finding themselves in need of help, sometimes for the first time, due to all the changes that are

[Virginia "Ginny" Lyons (Chair)]: occurring. Two zero

[Allison Lavanya (Executive Director, United Ways of Vermont; Vermont 211)]: one is critical state infrastructure, and we, our group Vermonters, will turn to in those times of difficulty and crisis. We're expected to absorb increased demand and adapt quickly to all the changes and deliver accurate and real time information consistently. We have a warm person on the other end of the line when someone calls and they are trained specialists, so they're also certified by the National Accrediting Organization on how to deliver information referral services and support individuals to not only address the primary need for which they call, but also find the underlying needs and provide services to them. So I know our time was quick. That's sort of all I have, but I'm

[Virginia "Ginny" Lyons (Chair)]: happy to answer questions. This is terrific. Thank you for the reminder, and obviously, as we get into the budget discussion, it'll be important to have you centered in on exactly what funds are that are needed. Okay, that would be appreciated. Chittenden. Chair Lyons, thank you for your presentation. That's really helpful. I'm Martine Larocque Ginny I live in Burlington. I represent the University of Rochester. And I'm curious, you mentioned that you have interpretive services sort of embedded in 02/2001.

[Martine Larocque Gulick (Vice Chair)]: Do you ever contract with or work with Vermont Language Justice Project? I just wanna make sure

[Allison Lavanya (Executive Director, United Ways of Vermont; Vermont 211)]: gonna ask about that. I know you're sponsoring the Yeah. Bill We just entered into a fiscal sponsorship relationship with them. Okay, great. So as of October, we are now officially the fiscal sponsor of the Vermont Legal Justice Project, which is just a huge value add. I mean, we're not overlapping in services at the moment, but we're collaborating, and Allison, the director, and I have been talking quite a bit about language access at Suwon Tan and beyond, and so we're really happy

[Virginia "Ginny" Lyons (Chair)]: to be supporting the projects. Yeah, that's great, thank you. You did? Well, no, I don't think I did it, but you did spell I didn't tell

[Allison Lavanya (Executive Director, United Ways of Vermont; Vermont 211)]: your name the same way. So it's Allison and Allison. One L. One L. Yeah, no, it's great work, and I think the missions are so incredibly aligned because what they're doing is getting information, critical information to Vermonters, and so are we. The access, when you combine the two resources, the access that is amplified is just really valuable. I'm so happy to hear that. That's great. I can send some more information if you want a rig related to the funding either after this meeting or just at your request in the future. Hold on and put

[Virginia "Ginny" Lyons (Chair)]: it in the budget. It'll get lost in the spoof work that

[Allison Lavanya (Executive Director, United Ways of Vermont; Vermont 211)]: you're And obviously there's too much to explain here around the context and what we're asking and our needs, but essentially level of funding is what we're seeking. So has the call volume increased as a result of some of the changes that we're seeing at the federal level? Have you seen them? Yes. This year we had more than 61,000 contacts. In the last few years, it's been around fifty fifty to 55,000. So, you know, it's gone up. And when we look at a chart of our call volume per month, between 2022 and 2026, you can see where there's always a spike, when there's some sort of crisis or change that impacts people's health and well-being and the services that are available. In November, we had a spike when SAMP was threatened. When housing rules change, we see spikes because people are calling to find out if they're eligible. When there's obviously a disaster, we have spikes, and we really want to be able to remain nimble to have the systems and the staffing in place to be able to respond during those times without a patient, always a crisis and a struggle.

[Virginia "Ginny" Lyons (Chair)]: It's destabilizing times. Exactly. You're have to shop, but are you 20 fourseven?

[Allison Lavanya (Executive Director, United Ways of Vermont; Vermont 211)]: We are currently 20 fourseven, and one of the ways that we're looking to improve services and manage our costs in a fiscally responsible way is by looking at staffing up during our busiest times, which is actually 4PM to 10PM. That may look like reducing other times, but in order to work within level funding and remain responsive during the critical times, that's one way that we're answering that. Can maybe please, I know that we were a couple of, yes, you do. Community members, so easily. So thank you. I appreciate the time today. Thanks for speaking, Ann. Thanks for being here. Yeah, love to be happy with you more.

[Virginia "Ginny" Lyons (Chair)]: 211. 211, thank you All very

[Speaker 1]: right, thank you so much.

[Virginia "Ginny" Lyons (Chair)]: That was significant. Thank you very much.