Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. Good morning. It's March 11, and this is the Senate Health and Welfare Committee. We're going to be continuing markup on three bills with Legion Council. We're starting with one eighty nine, so Jan And this is the hospital services. There's a discussion or addition.

[Jennifer Carbee (Office of Legislative Counsel)]: Good morning. Jen Carvey from the Office of Medical. And we are gonna look at draft 2.1 of an amendment to S. 29. This is based on your conversations in this committee of directions to me, and some additional conversations a little bit that I've had with some of the stakeholders since then and some embedded questions for you all that have come up, I think, as part of some of the discussions in here and outside. So I know that the language up on the screen

[Sen. Virginia "Ginny" Lyons (Chair)]: and we can walk you through it.

[Jennifer Carbee (Office of Legislative Counsel)]: So S-one 189 is an act related to an approval process for reducing or eliminating hospital services, at least for now, and you'll see the name change at the end. Post panel change. This is the bill that would add a section on hospital service reductions and required notice as opposed to required approval. And it had said, a hospital that proposes to reduce or eliminate any service shall, and then we get into the notice of intent and public process. One of the things that I've heard talked about is whether you want to define or put some parameters around the scope of reductions that would trigger this notice requirement, or limit to certain types of services, or exclude those that relate to the unavailability of clinicians. The question here, I think really is if a provider leaves a

[Sen. Virginia "Ginny" Lyons (Chair)]: hospital practice,

[Jennifer Carbee (Office of Legislative Counsel)]: is that a service reduction because they'll have less availability? Does that trigger the public engagement process that all of this sets up and possible board budget review? Or do you want to have a higher threshold for what it means to reduce the service? Or if there's one clinician and they leave, and that's, you know That's elimination, I would say, of a, you know, of a service. It may depend if they plan to rehire. But I think those are some questions for you more generally about what kinds of proposed changes do you want to trigger this process? So we can go through the rest of the language

[Sen. Virginia "Ginny" Lyons (Chair)]: Let's and connect do that, come back to that. I think it's the

[Jennifer Carbee (Office of Legislative Counsel)]: overarching question. So then we have the notice of intent that goes to agency of human services, Green Mountain Care Board, Office of Healthcare Advocate, and the legislators from the hospital service area, explaining the rationale and consistency with the strategic plan once established and the community health needs assessment. And we'll get back to the strategic plan here I meant because it affects AHS's role. And then I'm gonna ask you at the end about timing for all of this. So they would I didn't make any changes to that piece or posting the notice of intent on the website. I know we had talked about changes to publishing and newspaper general circulation, but this is kind of a bigger question around media in this day and age. So I would like your direction on where you would like it to be published, if not in the newspaper of general circulation, some hospital service area. Did not make any changes to the public engagement process. So all of the hospital side process is the same as in the last draft with the overarching question about what triggers that process. And then we talked about, last time I was here, changing this to say, beginning on or before submission of the first statewide healthcare delivery strategic plan, the agencies would, and I've changed the language from review to analyze each proposed service reduction or elimination for consistency with the strategic plan. We didn't have to say once established, because we've already basically said once established. And community health needs assessment. And then we get into a We have a couple of pieces now. Considering the community's response and the impact of proposal on access to necessary care and services in the hospital service area. And then I think you had come to some version of non binding recommendations. So that's what is in here, provide non binding recommendations. And I have them provide those recommendations to the hospital, the Green Mountain Care Board, and the public. And then if a hospital chooses to go forward with the reduction or elimination after completing its process, Then within five business days after making the decision to proceed, and that timing can be whatever you want it to be, the hospital would notify, and I've added in the agency of human services to inform that the agency's health shared system transformation efforts and future versions of the strategic plan, and the Green Mountain Care Board to enable the board to review the impact on the hospital's budget. Then we would still have the language of the board budget review statute section two, still eliminating the existing language, language from existing laws that sets out part of the process, and instead says upon receipt of notification, and now it's not by the agency of human services, it's from a hospital, then the hospital intends to reduce or eliminate a service following its completion of the public engagement process. Then the board would review the impact on hospitals for budget and authorize the board to adjust the budget as necessary to reflect the elimination or reduction. Same language having that's built from earlier hurricanes. And then the effective date had been that the action would take effect on passage. I don't know if you wanna keep it on would wanna keep it on passage. If you wanna delay that date and keep the current process, such as it is, in place until closer to January 28, which is when the strategic plan is due. Otherwise, they do have no process between now and January.

[Sen. Virginia "Ginny" Lyons (Chair)]: In the first part of the bill, it was a process.

[Jennifer Carbee (Office of Legislative Counsel)]: I guess there is. There's a public engagement process, but nothing, but no role for anybody else.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. So that's that that goes into effect on past issues. Why why would that be '28? I'm trying

[Jennifer Carbee (Office of Legislative Counsel)]: to figure out you're Right. Because you're creating a a a or revising the roles for Agency of Human Services and Green Mountain Care Board, I just wanted you to be and the the Agency of Human Services role kicks in beginning on or before they submit the first statewide healthcare delivery strategic plan in January 2028. I wanted you to just be thinking about how we wanted the different pieces of it to play out between now and January 2028.

[Sen. John Benson (Member)]: As I read this, so we're getting on or before submission. So why would we have before If we're tying it to the strategic plan, the plan's not in place until then, so

[Jennifer Carbee (Office of Legislative Counsel)]: Well, plan is, first plan is due on or before 01/15/2028.

[Sen. Virginia "Ginny" Lyons (Chair)]: So just leave it.

[Jennifer Carbee (Office of Legislative Counsel)]: So it may be submitted earlier than January 2028, 01/15/2028. In which case, do you want this process to begin? It's just a little bit of a sort of moving target, I think, and so it's hard for the strategic plan date because there's a lot of process that's built into the statute for that. I mean, think you've built in enough process in the statute. It's unlikely to be submitted significantly early.

[Sen. Virginia "Ginny" Lyons (Chair)]: But, or we could say no later than x 2028. That that is clear. No later than

[Jennifer Carbee (Office of Legislative Counsel)]: For the for this AHS process?

[Sen. John Benson (Member)]: Mean, it's just the way I read it. It says it could be implemented for the plan as it goes. That's the way I Yeah.

[Jennifer Carbee (Office of Legislative Counsel)]: Think my my thinking was if the plan was in some largely finalized shape and they wanted to use the plan before submitting it, but we can put in whatever dates we want.

[Sen. Virginia "Ginny" Lyons (Chair)]: That's Honor before is by the means. That's the language we currently have.

[Jennifer Carbee (Office of Legislative Counsel)]: I mean, before is typically our submission It is a little less clear in this context because the agency should start doing something on a date that is dictated by something else. So you could certainly say, you know, beginning 01/15/2028, or 01/01/2028, for this piece if you wanted. Alright.

[Unidentified committee member (likely Sen. Ann Cummings)]: What page is this? Page two.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Alright. So committee. And, senator Gulick, are you on Zoom?

[Unidentified committee member (likely Sen. Ann Cummings)]: She's not She's not there. No. She's not.

[Sen. Virginia "Ginny" Lyons (Chair)]: Alright. Just us chickens. I'm

[Unidentified committee member (likely Sen. Ann Cummings)]: stuck here. That's not

[Sen. Virginia "Ginny" Lyons (Chair)]: No. Yep. So in terms of what we have here beginning on our Oh, sorry. What? Yeah. We're okay with that. Yeah. I'm better now. Alright. So I think we should have a little conversation on the type of services. Maybe the question about when it's a single practitioner who's holding up the world, holding up a single service. So is the service.

[Jennifer Carbee (Office of Legislative Counsel)]: You go, I hope to see Right. You know, think

[Sen. Virginia "Ginny" Lyons (Chair)]: there during that one. Please get

[Jennifer Carbee (Office of Legislative Counsel)]: to decide how you want to proceed. I think there are stakeholders with varying views on that piece and the broader construct of how the bill is understanding Yeah, in front of

[Sen. Virginia "Ginny" Lyons (Chair)]: so let's start with this piece. I see people around the room with an interest and suggestions, I would welcome suggestions from the board, from the healthcare advocate, from the agency, and the hospitals, you're all here. And I

[Sen. John Morley III (Member)]: have questions for the broader group too. Yeah. You want me to

[Sen. Virginia "Ginny" Lyons (Chair)]: Why not over there? Yeah, just pull it over there. We'll try to get somewhere with this one.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Having start. Okay. Let me jump in the chair.

[Sen. Virginia "Ginny" Lyons (Chair)]: Chittenden, it's up to you. We very little time. Think everybody just stayed where you are and then shared, we'll accept it as a formal Yeah. Witness. So in

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Green, Vermont Association of Hospitals and Health Systems, we do want to, in my mind, apply this more to services where the hospital is making a conscious decision to eliminate a service as opposed to circumstances creating that decision for the hospital. For example, at NBRH, they lost their neurologist in November. They expect that it will take years for them to recruit another neurologist to their hospital. If they have to go through this identification and the public process, I'm just not sure what help or good that that will do unless the state is willing to offer resources in that area. One of the suggestions I had was perhaps after a board vote. So if a hospital, you know, votes to eliminate a service, then that should trigger the notification process.

[Unidentified committee member (likely Sen. Ann Cummings)]: Say that again.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: If the hospital's board votes to eliminate a service

[Sen. Virginia "Ginny" Lyons (Chair)]: You said board and I was

[Devin Green (Vermont Association of Hospitals and Health Systems)]: The agreement. Okay. The

[Sen. Virginia "Ginny" Lyons (Chair)]: hospital board. Yeah. Hospital. Got it. Okay. Do hospital boards vote on all production and addition of services?

[Devin Green (Vermont Association of Hospitals and Health Systems)]: I have to check on that.

[Sen. Virginia "Ginny" Lyons (Chair)]: So and I mean, we're asking this for all hospitals. Yeah. So if you put that in and a hospital doesn't have that.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Have that as part of their board votes. I will double check on that. I would also add that the reduction of services is a very vague term and again could be unforeseen circumstances or circumstances beyond the hospital's control where they're just not getting a lot of patients or and so they're reducing the number of days that the provider works for that sort of scenario. And again, we wouldn't want to trigger a whole process for that. But we understand the importance of elimination, you know, a decision by the hospital proactively made to eliminate services, we do think that that should trigger the process.

[Sen. Virginia "Ginny" Lyons (Chair)]: Who would like to go next? Go ahead. Thanks for being here.

[Emily Brown (Executive Director, Green Mountain Care Board)]: Yes, thank for having us. Emily Brown, Executive Director of the Greenmont Chair Board. I think we agree that the reduction or elimination should be limited to intentional decisions. And this actually aligns with our current interim policy, which we've created for the existing process as it stands now. So, if the committee were to adopt an approach where it was based on intentional reductions, not based on a staffing shortage or an issue with recruiting providers, I

[Sen. John Morley III (Member)]: think we would support that.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. Thank you.

[Mike Fisher (Chief Health Care Advocate)]: I'll just Mike Fisher, just say that all sounds reasonable. Maybe with the caveat, you know, and if you intend to replace kind of, you know, somebody leaves and the hospital leaves.

[Sen. Virginia "Ginny" Lyons (Chair)]: I can't hear you.

[Mike Fisher (Chief Health Care Advocate)]: The hospital is scrambling to replace the person, the service, that that wouldn't trigger the

[Sen. John Benson (Member)]: service reduction.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, so intentional decisions, conscious decisions.

[Unidentified committee member (likely Sen. Ann Cummings)]: I mean,

[Jennifer Carbee (Office of Legislative Counsel)]: the language does say the hospital intends to, so maybe

[Sen. Virginia "Ginny" Lyons (Chair)]: you can just focus on that. Okay. What's the difference to that reduced our lung D? Elizabeth?

[Jennifer Carbee (Office of Legislative Counsel)]: AHS supports the language of attention. Oh,

[Sen. Virginia "Ginny" Lyons (Chair)]: good. We're getting some, right? So let John Morley come back up and we'll see about it. Yeah.

[Mike Fisher (Chief Health Care Advocate)]: Madam Chair, again, picture, because I have to step out for another meeting. Okay. Can I say it, I think as I testified before, concerns me to think that there wouldn't be a public process during this interim period for those intentional reductions? Feels important to the healthcare office that we are in

[Sen. Virginia "Ginny" Lyons (Chair)]: To have the public To have the

[Mike Fisher (Chief Health Care Advocate)]: public this interim period, Okay. Have

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. And outside of the interim period, we have the strategic plan which has already been through process. It doesn't preclude the hospital or others having a COVID processed. Seems to me not a bad idea regardless of the time. Okay. Alright. I'm speaking slowly because I see Janice. I see changing. Okay. That's and we already decided on the language at the end for the date. That was just before.

[Jennifer Carbee (Office of Legislative Counsel)]: Sorry, yeah, yes for the AHS role, then my question for you then is for the Green Mountain Care Board reviewing the budget piece. When do you want that? And I think they're all kind of connected.

[Sen. Virginia "Ginny" Lyons (Chair)]: Does the board wanna speak to that? So, yeah, I think. Okay, go ahead.

[Emily Brown (Executive Director, Green Mountain Care Board)]: Sorry, thank you. Emily Brown again. So, I think I would like a little clarification. The language as I read it has AHS offering or presenting the board with a non binding opinion. And so in the interim, before there's the strategic plan, there's this gap period. Is the expectation or is the question that I have, I think is then would the board in that interim period be reviewed, would be still carrying through the budget review process without input from AHS? Because I think that goes back to our original concern around making these decisions in isolation. So I think we would prefer that if the legislation was going to require the board to review this within the budget process as laid out in the proposed changes that Jen had, that we would have some input would like input from AHS on those decisions still. So, in

[Sen. Virginia "Ginny" Lyons (Chair)]: the interim period, it seems to me that AHS could give a non binding recommendation. I'm looking at AHS.

[Jennifer Carbee (Office of Legislative Counsel)]: It be okay for Jill to speak

[Sen. Virginia "Ginny" Lyons (Chair)]: on this? Pardon

[Jennifer Carbee (Office of Legislative Counsel)]: me? Would it be okay for Jill to speak on this, please?

[Sen. Virginia "Ginny" Lyons (Chair)]: Yes, sure. Jill's up on Zoom. Welcome, Jill. Hi,

[Jill (Agency of Human Services) [full name not stated]]: everybody. I'm not gonna go on camera because I am very sick. I think if we, it all works together. So I think if we are reducing the scope of the items that we would need to review, I think we could likely be comfortable with where the Green Mountain Care Board is going. Does all work together. I'm concerned about new ideas coming to us that we have not considered or analyzed before. But I think if we also combine with the scope reduction, that probably does it.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. So what I'm hearing you say is if we go with the the language around intentional Yeah. And then a nonbinding recommendation, that this I think in the interim, it gives gives it an opportunity to get some practice, but to to gear up for when the plan is in place. And it also will help the board with its budget decisions. Yep. Yep. I

[Jill (Agency of Human Services) [full name not stated]]: know that you need to move on this bill this week. We'll, of course, need to take it back to the full team and to the secretary, but I think we're moving in a better direction.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, thank you. Jen, you were gonna

[Jennifer Carbee (Office of Legislative Counsel)]: Well, so I think my question then becomes whether do

[Devin Green (Vermont Association of Hospitals and Health Systems)]: you need to, if you're

[Jennifer Carbee (Office of Legislative Counsel)]: gonna have AHS start doing its review and non binding recommendations now, or upon passage, then do you need this beginning on or before submission of the first state White House to deliver a strategic plan, or do we just go back to the language saying review it for consistency with that plan once established?

[Sen. Virginia "Ginny" Lyons (Chair)]: I like the honor before language.

[Jennifer Carbee (Office of Legislative Counsel)]: But the honor before does not have, I mean it's honor before submission of the first strategic plan, which again takes you to January. So if you want the board to if you want AHS to be reviewing and providing nonbinding recommendations in the interim as well, then it doesn't make sense to tie it to January, because they're gonna start soon.

[Sen. Virginia "Ginny" Lyons (Chair)]: Got it. Understood.

[Jennifer Carbee (Office of Legislative Counsel)]: I think it is. I'm asking if that's your intent, in which case we can just undo the changed committee and have it start.

[Sen. Virginia "Ginny" Lyons (Chair)]: I'm not satisfied with what you're Yeah. Yeah. Good. Devin.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Devin, read from us. So, AHS is going to give a recommendation,

[Sen. Virginia "Ginny" Lyons (Chair)]: A non binding recommendation. After? After the public hearing, after the At the hospital level. And services, yes. And it will be intentional reduction, not

[Jennifer Carbee (Office of Legislative Counsel)]: circumstance. Right, so I'm looking at changing the language here. Oh, actually I already figured out this is my word doc. A hospital that intends to reduce and not proposes, although that's, but intends to reduce. Right. And then we go into the

[Sen. Virginia "Ginny" Lyons (Chair)]: and then we would

[Jennifer Carbee (Office of Legislative Counsel)]: we would pick out the language tying it to the timing of the first statewide strategic health care go through strategic plan. Go ahead.

[Sen. John Morley III (Member)]: And this I don't think this is for you. It may be. I don't know who's gonna answer this question, but I'm getting a little bit confused. Can the pre mapped care board reduce services to a hospital currently?

[Jennifer Carbee (Office of Legislative Counsel)]: Fremont Care Board reviews budgets. Yep. So I will defer to the board, but I don't think they're not dictating which service lines.

[Emily Brown (Executive Director, Green Mountain Care Board)]: So I think in the current language, the language, that is existing in present day, that S-one 189 is modifying. We currently have, a process in place and approval authority over whether hospital don't want to mess up the language, but essentially, if a hospital would like to eliminate a service right now, the board has a process in place.

[Sen. John Morley III (Member)]: Sounds like what you're asking.

[Emily Brown (Executive Director, Green Mountain Care Board)]: Okay, what is your question?

[Sen. John Morley III (Member)]: My question is, can the Green Mountain Care Board eliminate a service?

[Emily Brown (Executive Director, Green Mountain Care Board)]: Proactively? Yeah, proactively. No. We can adjust a hospital's budget, which then may lead to a hospital making a decision to eliminate or reduce the service.

[Sen. John Morley III (Member)]: Okay, and coming in here, I was listening to the chair, and basically there's a push, right, to move services outside of the hospital and in other settings. Right. I'm concerned for the Northeast Kingdom. I have two hospitals and I don't know what those outside settings would be. I'm very concerned about that.

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, but this doesn't do that. This doesn't say

[Sen. John Morley III (Member)]: No, no, no. I understand that. I'm reading this, and I get that. I just want to voice my concern. Yeah. Because that is the push of Green Act care, and others, not just them.

[Sen. Virginia "Ginny" Lyons (Chair)]: Let's let the board speak to that. I think that might be a misinterpretation. Is the board trying to push services out of hospitals right now?

[Emily Brown (Executive Director, Green Mountain Care Board)]: I don't think the board right now, in its current role, is in any way deciding which services should be offered outside of hospitals or that is not part of our budget guidance or review process.

[Sen. John Morley III (Member)]: Okay. So Orin Foster said today on the radio, I was gonna be out there. Oh, cool.

[Sen. Virginia "Ginny" Lyons (Chair)]: That

[Sen. John Morley III (Member)]: it's too expensive to provide certain types of services within the hospital settings. And so you need they need to I think what he was referring to was the Green Mountain Care Board, along with the hospitals, everyone else needs to look at moving some of those services outside of the hospital into other I settings or gets don't have a problem with that if it works. My issue is at NDRH and North Country Hospital and I don't know where those services would be provided to hit my dispatch.

[Sen. Virginia "Ginny" Lyons (Chair)]: I'd like to answer that first. I think I understand. What? I'm sorry. When we talk about the strategic planning process, we are talking about what are the gaps and what are the needs within a regional area. That includes the gaps and needs within the hospital and the gaps and needs within community services like mental health, substance use disorder, recovery residents. It's not the strategic plan isn't the process of saying you've got to take this and move it over here. That's not the strategic plan. So the strategic plan will ultimately drive some of these decisions. It could be that there's a better way of providing services rather than outpatient in the hospital somewhere else.

[Jennifer Carbee (Office of Legislative Counsel)]: But to clarify, I think your question is really about the transformation that the Agency of Human Services is leading. They're also tasked with doing the strategic plan, which will be related to it, but I think the hospital transformation work is really the agency human services side, and and the agreement care board will be reacting through hospital budgets as service lines That it

[Unidentified committee member (likely Sen. Ann Cummings)]: is.

[Emily Brown (Executive Director, Green Mountain Care Board)]: And and I I again, I haven't heard what the the radio program you were talking about in chair Foster's comments, but I would agree with Jen Carvey that I think there's an acknowledgment that things need to change. There needs to be transformation at the hospital level, and part of that might involve some services not being offered at a hospital.

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

[Emily Brown (Executive Director, Green Mountain Care Board)]: I agree with Jen that that is the transformation transformation work that is being led by HS.

[Sen. John Morley III (Member)]: Thank you.

[Jennifer Carbee (Office of Legislative Counsel)]: And this bill is focused on really hospital led efforts.

[Sen. John Morley III (Member)]: Understand. Just didn't let Martine

[Jennifer Carbee (Office of Legislative Counsel)]: That's do fine. Just wanted to make sure.

[Sen. Virginia "Ginny" Lyons (Chair)]: And hospitals have been working really hard to do this. So if there's apprehension, that's a normal process to be apprehensive about what's happening to your organization. Yeah, absolutely. Thank

[Devin Green (Vermont Association of Hospitals and Health Systems)]: you, Devin from Buzz. I'm just trying to figure out what the non binding recommendation achieves. It feels like

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, you can ask to have it taken out, but I don't think I would welcome that. I think it's important for AHS to have done some analysis of where they are, a, in transformation, b, in planning, and I see Elizabeth's gonna answer your question.

[Jennifer Carbee (Office of Legislative Counsel)]: Madam Chair, actually, can I direct you to Jill?

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, Jill, go ahead.

[Jill (Agency of Human Services) [full name not stated]]: Thanks so much. Madam Chair, I've been getting messages from my team about this actually about the question of nonbinding recommendation. I think we would be more comfortable providing the analysis to Green Mountain Care Board rather than providing a recommendation of any kind. We were always a little bit concerned about that creating more of a sort of regulatory or quasi regulatory structure. But if we're doing an analysis, I would envision we would provide the analysis to the board.

[Sen. Virginia "Ginny" Lyons (Chair)]: You're talking about in the interim before the plan is in place?

[Jill (Agency of Human Services) [full name not stated]]: No. I'm talking about the process itself that I think we would we would do the analysis of the potential impact and then provide the analysis to the board. But I think we have testified pretty consistently that we do think that these decisions, the regulator is the board, not in this case, not the

[Emily Brown (Executive Director, Green Mountain Care Board)]: agency.

[Sen. Virginia "Ginny" Lyons (Chair)]: We hear you. Thank you. So, okay, I'm not thrilled with that suggestion. I will just tell you upfront. I know that AHS won't like what I'm saying about that, but I think it's really important, especially as we move forward into the full plan being in place. I think we stick with what we've got in terms of nonbinding recommendations. I don't see the committee revolting on that. Keep it at the table right now. Okay. Jen. Okay.

[Unidentified committee member (likely Sen. Ann Cummings)]: Thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: So we have we have some language we'll be looking at sometime. Yes. Soon. That'd be great. And you'll be coming back in a little bit later to look at one ninety and 197 with us. Yes. Thank you very much. We

[Sen. John Benson (Member)]: didn't talk about your very first question. Which one? This gets revised.

[Sen. Virginia "Ginny" Lyons (Chair)]: This goes on doctor. I think

[Jennifer Carbee (Office of Legislative Counsel)]: that was we changed it to intend rather than propose. Yep. Yeah.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Yes. Well, can I think of on that? No. We're done. Okay. Okay.

[Jennifer Carbee (Office of Legislative Counsel)]: We're done. I mean, there may be a nuance between intent and intentional. If so, I'm open to exploring that with

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

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. So language, you know, grammar. I thought you were going for it.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: No, no, no. Just the word. Yeah, yeah, yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: We got it.

[Jennifer Carbee (Office of Legislative Counsel)]: Yes, maybe we'll say propose as an intentional. Yeah,

[Sen. Virginia "Ginny" Lyons (Chair)]: like it. Thank you. Okay, so Erica was in here earlier. Michelle, you were here. Do we have a new edition of

[Jennifer Carbee (Office of Legislative Counsel)]: February? You do, although I didn't hear back from the other senators about

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, we'll just look at what we've done and then we'll make a decision. Senator Gulick was supposed to be on Google. I don't know if she's gotten there yet. She's not well. So we're gonna have word of a transition and we'll be back to 01/1990 a little bit, hopefully before 10:00. Okay. So don't go back in. Thank you. When you see Jen, you know we're Yep.

[Unidentified committee member (likely Sen. Ann Cummings)]: Thank you very much. Thanks for being here. You text Erica? It's Erica. We have to divide and conquer.

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, you're divided? Oh, you're here. Yeah, thank Okay. And you're gonna testify then? That would be all. Good morning. Good morning. For the

[Michelle Childs (Office of Legislative Counsel)]: record, Michelle Chaoz, Office of Legislative Council. Is it okay if I share my screen? Yes, please, great. Okay, so we're taking a look at S-two 39, which is establishing the child abuse and neglect reporting working group. So there are a few little changes that I made and I highlighted them here and I'll just walk you through them. Perfect. Based on some feedback from senators before the break, but I understand that there are some more things that you'd like to do, but I don't have the details yet, but I can always add those quickly. It's a busy week. So, subsection A is just the establishment of the working group, some owners had asked that I add the language on lines nine and ten, just clarifying that we're talking about the department's rules and policies, that it could be misconstrued that it might be like a mandatory reporter's policies, if we're talking about the state policies. Down, so subsection B creates, identifies the folks who are gonna be on this working group, and there's two more folks who are added at the top of page two. So the executive director of Prevent Child Abuse Vermont, and the Vermont Child Youth and Family Advocate. And then you'll see in subsection C the final changes to the reporting date. It was originally early November of this year. Oftentimes we do that to make sure that the report can come in, we all can consider it, and then ask for draft for introduction. Senators But had asked that that be moved to January 15 instead, and it is the first year of the Biden and Annum, so you still have some time to be able to introduce legislation based on that report. So

[Sen. Virginia "Ginny" Lyons (Chair)]: what's missing here is where the administrative support comes from and who calls the first meeting and then how many meetings are allowed. Right. So some

[Michelle Childs (Office of Legislative Counsel)]: of those kinds of things, but I understood that there were also from Senator Gulick and Buhowski, some they wanted to have some specific asks for the working group. Think senator when she originally had introduced it, it was kind of like right at the deadline. Yeah. It was just kind of just get something rolling. So the, you know, the directive is pretty slim, but you can certainly add to that with regard to any specific things that you want them to report on. But the other things, you're right. It's like, you know, we have I brought a copy just for my cheat sheet. We kinda have a template that we use for working groups. You know, you have flexibility. You don't have to follow and put in all of the stuff that you want if you don't really care what constitutes a forum know Well, who's I think

[Sen. Virginia "Ginny" Lyons (Chair)]: that one is just important. Things like that, but

[Michelle Childs (Office of Legislative Counsel)]: in terms of staffing

[Sen. Virginia "Ginny" Lyons (Chair)]: would be good to note. Theoretically it could go, AHS, DCF is probably the right place for it, so they'll have to testify about that. And there are others who are here who think, you know, OPR is always, or Secretary of State's always open to doing work, but I don't know what their workload looks like. I can't ask them, but I can ask any of Jess.

[Michelle Childs (Office of Legislative Counsel)]: You're gonna have a busy Yeah, and I

[Sen. Virginia "Ginny" Lyons (Chair)]: do know that both Senator Gulick and Senator Dobayakovichowski wanted to add some direct asks. So I don't know that we can do any more except we'll listen to what AHS DCF has to say and then we'll spend a little more time.

[Michelle Childs (Office of Legislative Counsel)]: Did you have an idea of how many meetings or things like that? Mean, I think that for the most part, the folks who are on this list are not gonna They're not per diem. Per diem or expense folks. So, again, the number of meetings is usually tied to your appropriation.

[Sen. Virginia "Ginny" Lyons (Chair)]: You can put in a certain number of meetings if you want, but I think up to eight meetings. Know that for our Joint Justice Oversight Committee we sometimes have 10 meetings. That seems like a lot, But I think for this group they'll be able to divide up the work and to evaluate some of the rules or policies independently, come back together and then, you know, so they can have a subcommittee work on time. So if they had eight, that's two a month for a four month period. Let's suppose they're meeting for suppose they start meeting in August. We also have to say begin meeting no later than August 15.

[Michelle Childs (Office of Legislative Counsel)]: It's up to you. I mean, you don't I'm

[Sen. Virginia "Ginny" Lyons (Chair)]: just trying to brainstorm a little bit about what would be here. Right.

[Michelle Childs (Office of Legislative Counsel)]: Yeah, anyway. Again, sometimes we use the kind of triggers of you have to start meeting at a certain point because we're concerned that perhaps they're gonna jam up at the end of the year. We're especially concerned about that for the second year of our biennium where we're trying to get reports in. Less of an issue here because you pass it, it got until the January. You can leave it up to them. They're big kids. They

[Unidentified committee member (likely Sen. Ann Cummings)]: can get

[Michelle Childs (Office of Legislative Counsel)]: their meetings going. But it's up to you. But you can add that certainly if you'd like.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. If they had their first meeting no later than August 15, then they've got four and a half, five months to get the work done. And if we set up to eight meetings and they have to elect a chair first meeting or we could designate a chair. So I'm just throwing things out that we're gonna have to decide and I'm thinking what before we do that we should probably hear from DCF. You're gonna stick around. I am a

[Sen. John Morley III (Member)]: very great. On line 11 is it's the verbiage, right, in the it's on the first page. In neglect of a child of recommended changes to such to modernize

[Sen. Virginia "Ginny" Lyons (Chair)]: Where are you?

[Sen. John Morley III (Member)]: Nine eleven under section one. Okay. Neglect of each child and recommending changes to modernize them, maybe? Sure. Rules and policies.

[Devin Green (Vermont Association of Hospitals and Health Systems)]: Alright.

[Sen. John Morley III (Member)]: That'll reflect best practices.

[Unidentified committee member (likely Sen. Ann Cummings)]: Know what

[Michelle Childs (Office of Legislative Counsel)]: you're saying.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yep. It

[Sen. John Benson (Member)]: seems like yeah.

[Michelle Childs (Office of Legislative Counsel)]: A couple extra words. Yeah. I mean, we always like to eliminate superfluous words.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay.

[Sen. John Morley III (Member)]: This is just basically getting us up to date. Right?

[Michelle Childs (Office of Legislative Counsel)]: Right. You know, I think there's been a little, you know, chatter in both houses for the last couple years about, you know, is it time for the general assembly to take a fresh look at this? I've been here over twenty five years, and I I used to I'm just filling in on this now because the shin stuff falls into the judiciary. We have, like, three attorneys on our team falls into the third portfolio. We have a brand new attorney this year. I think she's been in para Hillary. Yeah. She's fantastic. But we didn't want to dump the whole portfolio on her, so I'm just doing some of the Chin's work this year. But when I used to do it, you know, like, the legislature would take a look and go through and make revisions and you're always learning new stuff. Best practices, are things working well, are they not working well? I think it's been a few years since there was any kind of substantial digging in with these particular reporting statutes.

[Sen. Virginia "Ginny" Lyons (Chair)]: So, yeah, and one of the policies and the laws that, maybe the policies and rules, at least around for me, mandatory reporting and how that is done and who's responsible for it. Sometimes it's difficult, so it would be good to know if we can improve some of that language. And these are the people who could help us with that. That would be one specific ask I would be looking for is information or recommendations regarding mandatory reporting. Right. So when they're looking at policies and the rules, can carve that out as specific set of work. And I don't know, well, we'll listen to AHS, but then there will be others, I'm sure, from Senator Gulick and Senator Vajozki, and we're going through this. I just want to be thinking it's important. Please come on up. Have you testified in here before? I have not. You have not. So we're gonna have folks introduce themselves. John Morley, Orleans District.

[Sen. John Benson (Member)]: John Benson, M. A. Orange District.

[Sen. Virginia "Ginny" Lyons (Chair)]: Ginny Lyons, Chittenden Southeast in Cummings, Washington. And Senator Gulick, who is in Central Washington.

[Unidentified committee member (likely Sen. Ann Cummings)]: No. Shouldn't. Anyway, she's also subject. Subject.

[Sen. Virginia "Ginny" Lyons (Chair)]: I want this. Yeah, no, central. Yeah. Heart is straight. Chris. Okay. Yes, Chris. Alright, thank you for being here. So why don't you introduce yourself for the record, and we love to hear your gestalt speech.

[Lindsay Baron (DCF Family Services Division)]: Good morning. Thank you. My name is Lindsay Baron. I'm the director of policy and planning for the Family Services Division within DCF. And I was instructed, but I have five minutes.

[Sen. Virginia "Ginny" Lyons (Chair)]: And so Well, we know, we have a few more minutes now because our Ledge Councils are everywhere.

[Lindsay Baron (DCF Family Services Division)]: So we did submit a memo this morning that outlines some of our initial thinking and response to the proposed bill. I have had an opportunity to meet with Jennifer Pullman, who I know was instrumental in making recommendations to move this bill forward. And so we're already beginning behind the scenes to gather information and feedback and just, you know, learn where the rumblings and where the areas for growth are. So again, I appreciate the opportunity to be here.

[Sen. Virginia "Ginny" Lyons (Chair)]: We

[Lindsay Baron (DCF Family Services Division)]: I guess the main point that I was hoping to just draw attention to when looking at this bill is the federal foundation for where the child abuse and neglect definitions are rooted in. Certainly, states have the ability to tailor definitions and adapt them as they see fit. But in order to be sort of engaged with CAPTA and accepting federal dollars for the front end of our child protection system, there are certain agreements that we have as far as what definitions must be. And then there's a few other oversight bodies and stakeholder groups and functions that are born out of CAPTA. And our initial thinking is that those bodies might actually serve this work well if it were integrated or, you know, at least working together in some way, shape, or form. And so those two groups are the Children's Justice Act Task Force as well as the Vermont Assistance Advisory Board.

[Sen. Virginia "Ginny" Lyons (Chair)]: So you're suggesting adding those into the working group? Yes, I would recommend. Yeah, no, it makes a lot of sense.

[Lindsay Baron (DCF Family Services Division)]: Those are the key groups where if we are contemplating huge changes to the front end of our system, or how we go about accepting and responding to reports of abuse and neglect, those tend to be the key stakeholder groups, as well as a few others I listed out some other organizations that we would tend to bring to the table. They don't want it

[Sen. Virginia "Ginny" Lyons (Chair)]: to get too big out the other hand. They don't

[Lindsay Baron (DCF Family Services Division)]: want to lose that. The other option too is the CJA task force as well as BCAB. They have recurring meeting schedules as it exists, and so that could be sort of a liaison group or a way of doing some behind the scenes work, additional research and gathering of input in between official work and group meetings.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, so I'm looking at your coordination with existing bodies. Have the CAPTA and you have the VCAB. So those two could be on the working group without thinking it too large. Then you're suggesting that the working group would reach out to other

[Lindsay Baron (DCF Family Services Division)]: stakeholders, Yes, on the second page I listed, which you actually already added a few that I had recommended with the Office of the Child Evening Family Advocate. So both both CJA as well as WCAB are are multidisciplinary teams, and they have there's some overlap between the two, but they have a pretty wide swath of representation. And so many of the organizations that I've bulleted on the second page, those many of them are covered in the two groups. Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: But they're still important to the process and then folks who would be on the working group would know someone from the family services division to be chosen. Alright. Then in terms of the it it it looks like you're making a recommendation about evaluating responsibilities between and among groups that are currently working on child abuse and neglect or not?

[Lindsay Baron (DCF Family Services Division)]: I think we would want to ensure that our key stakeholder voices are heard. Again, these are

[Sen. Virginia "Ginny" Lyons (Chair)]: the two groups that we often would run major policy changes by any time there's a new amendment to capto, we would review that with My question is this. So when the working group is working, then they're are you suggesting that we evaluate, that that group evaluate rules and policies about how these groups work together?

[Lindsay Baron (DCF Family Services Division)]: Wasn't what I was suggesting. No, I was thinking the rules and policies that are tasked to be reviewed in this bill. Okay.

[Sen. John Morley III (Member)]: You want to change the timeline a little bit, just by a couple months?

[Lindsay Baron (DCF Family Services Division)]: Yes, which it seems like was already adjusted in the updated draft.

[Sen. Virginia "Ginny" Lyons (Chair)]: So January 27 is your recommendation, and then number of meetings. You've had experience with some of this before. Yeah.

[Lindsay Baron (DCF Family Services Division)]: I we haven't spent a lot of time talking about the number of meetings because, again, just the initial introduce draft. I think minimal monthly meetings is probably necessary for a group to be productive within a tight amount. So if we'd said eight, that would be We would be happy to be at the table.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. And you also suggested two members, more than one member at least, or two members of Family Service Division? Yeah. And then in terms of administrative support, So someone has to keep notes and then put together recommendations at the end and can that be something that the Family Services Division accepts? So if we were able to have maybe three seats, think between the three of us,

[Lindsay Baron (DCF Family Services Division)]: we would be able to handle notes and recommendations and even compilation of national research. Well, if

[Sen. Virginia "Ginny" Lyons (Chair)]: we said two seats and then administrative support, that allows you to reach out. Yeah. Are challenges right now that the department is experiencing or the division is experiencing with child abuse and neglect? Are there specific areas that you believe need to be evaluated? Rules updates, policy updates, a lack of continuity between what's in the rules and policies and what's happening on the ground.

[Lindsay Baron (DCF Family Services Division)]: I think your point earlier about the last time reporting statutes were revised is a good one. That was Act 60 of 2015. And I think at the time that created some pretty weighty consequences for individual mandates for certain groups. I think to a degree it encouraged over reporting. And so we are engaged in some other efforts to revise our mandated reporter training. So those efforts are underway, so I think it would complement any look at these statutes well. Like I said, there have been a few amendments to CAPTA that have put some new definition possibilities on the table that we should consider. Based on what I understand, some of the stakeholders who are requesting this working group, it sounds as though there is a desire to look at sexual abuse definitions and how the home perpetrators and how those cases are investigated.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Sort of domestic abuse I

[Lindsay Baron (DCF Family Services Division)]: think over the years, I've heard from our child advocacy center partners a desire to create a

[Sen. Virginia "Ginny" Lyons (Chair)]: child

[Lindsay Baron (DCF Family Services Division)]: torture definition. That's something that has been emerging nationally. For many, many years, we've found that the emotional maltreatment definition is quite a high bar to reach to even accept the case under. So I think, over the years, we're just aware that there's probably room for growth, tightening, disentangling, differences between neglect and risk of harm. I think there's a misperception within Vermont that we're unique by having risk of harm as a definition. But really, in reality, most other states do have a similar definition and it falls within neglect. And so, you know, I think there's opportunity to look at what's working well in other states, what what is more clear and understandable, and just, you know, how does our language and terminology change over time? Right. Does CAPTA hold some of those issues at all? It provides a baseline for required definitions. So it sort of sets the minimum of what states, if it's up to CAPTA dollars, must investigate and respond to. And every few years, CAPTA is amended for, you know, various reasons. And so this most recent actually, the last few amendments have had to do with human trafficking

[Sen. John Morley III (Member)]: Okay.

[Lindsay Baron (DCF Family Services Division)]: And risk of trafficking. And so something that I think we in Vermont are unique in is that our human trafficking definition falls within the sexual abuse category within chapter 49, and that makes it trickier when it comes to labor trafficking. And, again, that has been a recent hapta amendment, giving states the option to grapple with whether to have a definition of labor trafficking. And, again, I don't know that we have to rush to solve that problem, but that is some of the movement that's occurring nationally. And we're part of different impendium groups. So we have a sense of where other states have changed their statutes and policies and its losses. Okay, so there's one, identifying federal relationship between

[Sen. Virginia "Ginny" Lyons (Chair)]: what we're doing in federal and emerging recommendations, but then evaluating what other states are doing and how we might compare. I'm beginning to see that there are some very specific things we might add in without tying you up to just those things, including, right?

[Sen. John Benson (Member)]: Go ahead. Just to comment, would it make sense for them if they're gonna have two members at the table plus chair?

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, I think we could talk about that. I I don't know. I think sometimes it's beneficial to allow for the working group to select at the first meeting. Doesn't presuppose any more. Yeah. This isn't a legislative. No, there's no legislatives on it. Right. Okay, so the coordination with federal and then what other states are doing. Coordination with existing bodies. So the working group would also reach out to others engaged in this and do an assessment of you know, I remember act one one fifty four. I remember 2015. 2015 was a powerful time. Yeah. So it's like reevaluating and looking

[Lindsay Baron (DCF Family Services Division)]: again at the requirements there. I think that mandatory reporting piece for me is really very important. And you've indicated that something you're interested in too. We're also engaged in these national efforts. You're probably familiar with Casey Family Programs. They are leading multi webinar and information gathering working group, if you will, throughout the entirety of this upcoming year about changing policies, about changing how we report, disentangling what can we do to support families versus what is an actual report of abuse and neglect. Exploration of norm lines, seeking support as opposed to for for. Okay. A lot of so it's timely to have this

[Sen. Virginia "Ginny" Lyons (Chair)]: group. Yeah. Alright. Other questions? Did I get that right? Yes. Other questions for. No. Don't go away. Thank you. So, Michelle. Once we just spent a couple minutes thinking about what we just heard and what we said, I think a lot there.

[Lindsay Baron (DCF Family Services Division)]: Yeah, I think there's a lot of research we can do through our partnerships with other states as well to help informants.

[Sen. John Morley III (Member)]: Okay, so your natural or organic. Is it more regional or is it all across The US? I'm just curious, more than anything.

[Lindsay Baron (DCF Family Services Division)]: There's several groups. So there is a state liaison officer listserv, and that is the CAPTA coordinators every state across so the we can be in touch with everyone. Within New England, I would say there's more close working relationship and camaraderie. That's awesome. So I have, for instance, a monthly policy director meeting. We're on a first name basis, right? So the ability to gather information, have a sense of what has gone well, maybe what hasn't gone so well, and changes that other states have made. And then we also have the National Partnership for Child Safety.

[Sen. Virginia "Ginny" Lyons (Chair)]: If you call me the biggest danger here is that we over legislate. These people working together, they they know each other. Mhmm. Yeah. I think we're not paying for the meetings, so they can decide how many meetings it takes. Right. We're I mean, we do that when there's a per deal involved. You're right. And so I I just We Yeah. Do this. So no less than four meetings. I I mean, we want everybody to meet. So As long as they produce it. Produce results? As long as they produce the annual report, maybe they do enough of it so it's just compiling what they already have. On the other hand, there might be some hesitation on the part of some of the people who we listed here. Just wanna make sure everybody gets together and voices are heard. Eight people. So what are your what is your suggestion then on numbers of the meeting? I just and just stay conscious about how many meetings and how many chairs at the table and who sits at the front. All that stuff. All that stuff. Just tell them this is the report we want by when. And I think it was 2015, the hard year, but the biggest thing that came out of it was that they were horribly short staffed. Yeah. And so we can write all the reports we want, but if they don't have beyond the street workers to do it. And when I was working in the area, the word was they didn't show up until there was blood because and that's what we heard. I've got one kid in the hospital and another kid here. And I'm one social worker, and this is one night at midnight. And I think that to me is the bigger concern, make sure that we've got the staff to carry out whatever this report shows. So we're going to add into that policies, rules, and staffing, available staffing, carry out the work, and that links in with our mandatory reporter staff that also And saying, we understand they support the governor's budget. We understand they support the governor's budget. Thank you. That's a given. Okay, and then we also talked about, or Lindsay suggested linking in with the federal rules and guidelines and how that relates to what we're doing, the link with other states. What else did you say? We're adding two people from Family Services Division and we're having the Family Services Division be responsible for administrative support and calling the first meeting and then a chair shall be elected from the working group.

[Michelle Childs (Office of Legislative Counsel)]: Actually, a question there with regard to folks from DCF. So you have right now just the commissioner or designee. So we placed that with two members from the family. I'm just trying to think about

[Sen. Virginia "Ginny" Lyons (Chair)]: how Should we say Family Services Division? Lindsey, I'm looking at you.

[Michelle Childs (Office of Legislative Counsel)]: I mean, could, you know, if it's the commissioner, gonna do that anyway, it's, I can put it for family. So two members appointed by the, who is the head of the family service? It's what's the It's the commissioner commissioner. The committee is the commissioner. Oh, the deputy commissioner. Deputy commissioner. That's what they're So

[Sen. John Morley III (Member)]: you're gonna have

[Michelle Childs (Office of Legislative Counsel)]: No. I think you're just because

[Unidentified committee member (likely Sen. Ann Cummings)]: Add you on.

[Michelle Childs (Office of Legislative Counsel)]: I'd be because there's already one from DCF on eight, you're just adding one more person.

[Sen. Virginia "Ginny" Lyons (Chair)]: One more for so I think you at nine. Right. Okay. Nine's a good number because when you have a vote, if you have to have a vote, got them.

[Sen. John Morley III (Member)]: Right. Well, but you also can be unanimous.

[Sen. Virginia "Ginny" Lyons (Chair)]: And then should we just say, she'll meet as needed to complete the task recommending one meeting, no more than, no less than one meeting. I don't know what I chose. So It's like cookies. And whatever you say, Yeah. Yeah.

[Michelle Childs (Office of Legislative Counsel)]: And so Lindsay's memo recommended that there'd be additional folks who are represented. Do you want me just to kind of take that list and make that, you know, committee shall consult with, you know, work

[Sen. Virginia "Ginny" Lyons (Chair)]: on those we could add all these people and they would take four and a half hours just to get a few introductions, so. We've

[Michelle Childs (Office of Legislative Counsel)]: all agreed to those 17 member committees, either being on them or staffing them. I don't know so well.

[Sen. Virginia "Ginny" Lyons (Chair)]: The wellness committee. And the wellness committee, for the public safety, we were up to, woah, it's a r, or c. No. We've been. We started adding double letters. She's amazing. But everybody wanted to be on it. I know. And they kept coming on. We need to be on this, and it was. It we went through the whole and that was great. Going down, it was fun. Okay. So then we have some targeted recommendations we've listed and started going out to The United States. And you've got some good language in here about coordinating with existing bodies, but the federal alignment. Whereas listed definitions, so just including an assessment of definitions as it relate to federal recommendations and other states. And I don't know that we have to limit the definitions, it's definitions, policies, rules. Rules of policies. Can you help us with that at this point? Is there anything else we need to happen?

[Michelle Childs (Office of Legislative Counsel)]: I think I've got enough to get going. I think probably what would make sense is I'll do another draft and then your committee time is very precious this week. So, I think could send another draft before I appear in committee and send it to Senator Gulick. Senator Bandowski. And Biehosky, and for them to take a look, then I think, you know, if they had additional things that they wanted in there and also a copy of Lindsay on it as well. Perfect. And I'll get some fish and be able to get something to you by the end of the day. So those go So we can all just kind of- And then like once they kind of go back and forth and we get something a little tighter, you can just have me and I think- Perfect. If have time. Perfect.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. Sure. I know this came up last minute, but it's really very important, I think, to everyone. And there's so much going on right now with sinistering in health.

[Sen. Martine Larocque Gulick (Vice Chair)]: Guys, this is Martine. Michelle, did you see the email from Tanya this morning?

[Michelle Childs (Office of Legislative Counsel)]: Has it been since I've been in the committee?

[Sen. Martine Larocque Gulick (Vice Chair)]: Probably it was, yeah, 09/17.

[Michelle Childs (Office of Legislative Counsel)]: No, I've been in here.

[Sen. Virginia "Ginny" Lyons (Chair)]: So my suggestion is that you look at that, we'll all look at it. I guess if we gotta go ahead and then we'll see what comes out of Okay. Is that okay with you, Martine? I think we'll just

[Sen. Martine Larocque Gulick (Vice Chair)]: Yes. That sounds great. Thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay.

[Michelle Childs (Office of Legislative Counsel)]: Thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: We're making progress. Thank you very much. Okay. So you let Jen know that you're ready whenever she is, and we're gonna go offline. It'll take a little seven

[Unidentified committee member (likely Sen. Ann Cummings)]: minutes.

[Sen. Virginia "Ginny" Lyons (Chair)]: Begin. And I don't know how long.