Vermont Legislature SmartTranscripts:

[Sen. Ginny Lyons (Chair)]: You're live. Alright, good morning. This is St. Patrick's Day, March 17, Senate Home and Welfare, and we are looking at an amendment that Katie has put together for us. Just on the miscellaneous judiciary bill, S-one 193, and we've talked about this in here with the secure forensic facility and how to deal with some of the more difficult cases that come out of judiciary. I did talk with Dale, DMH or HS General A. And I did talk with council after our last meeting on this and we had made some comments about what might work. So Katie's put together some language that might work but we'll have to go through it. The other part of this is that the institutions committee is very interested in that because it's a DOC forensic facility. They want to weigh in on it. If we can get into a place in here where judiciary is okay, where institution is okay, and we are okay, then we might have proposal that can go ahead for everyone. We'll have to look at it and see and we'll have to wait and see what our peers say. Amy, do you want to start us off? Sharon, with what you've got? Is it posted yet? I think it's yep. Not posted yet.

[Unidentified staff/host]: You're in silent.

[Sen. Ginny Lyons (Chair)]: Not yet. Okay. Good morning. Good morning. Ginny Lyons, the legislative council. Pull it up. Okay. So, this is an amendment.

[Katie (Legislative Counsel)]: After hearing some of the concerns, I raised some of those concerns with DMH. DMH provided some draft language that I taken and modified and put an amendment structure. So that is where we are today. I would not say that this is DMH's proposal because I think there are enough changes that were requested that it has It has morphed a bit. It's morphed. It's

[Sen. Ginny Lyons (Chair)]: okay. We'll all morph together. Okay. Uh-oh. See what we can do.

[Katie (Legislative Counsel)]: So, this is an instance of an amendment because we are not making changes to the whole bill. We're sort of making isolated changes related to clinical standards. So there is a section in the bill, section four, where forensic facility is defined and a person with a qualifying condition is defined. In that section, there is a subsection B, and what this first instance of amendment does is it strikes out the subsection B that's in the House Senate Judiciary's version of the bill, and puts in this new subsection B. You'll see there's a mix of unhighlighted and highlighted language just to show you what came over from senate judiciary and what is being added by this new amendment in this first instance.

[Sen. Ginny Lyons (Chair)]: So

[Katie (Legislative Counsel)]: it would read, that the Commissioner of Corrections shall establish and operate a locked secure forensic facility or the secure evaluation, treatment, and care of individuals who have been transferred pursuant to Sections 4815A and 4819A. Those, if you remember, there were two ways to get into the forensic facility. Somebody not competent to stand trial and somebody who was found not guilty by reason of insanity. So those cross referenced this paper. The commissioner shall operate the forensic facility in a building that is separate and apart from a correctional facility, including both a separate entryway and dedicated staff to serve persons transferred to the forensic facility. The Forensic facility shall be designed and operated in a manner that supports a therapeutic recovery oriented and trauma informed environment comparable to a community based residential treatment setting while maintaining appropriate levels of safety and security. The forensic facility shall not refuse any persons that is ordered to admit and shall not require any clinical or diagnostic prerequisites for admission. Page two, the friends and facility shall provide for the safe housing and management of persons, including the ability to separate the population by sex and to otherwise address clinical safety or operational considerations as appropriate, including the possible operation of multiple facilities if required by the clinical needs of transferred persons. Fourth, the forensic facility shall employ a clinical services director to oversee all forensic clinical and competency restoration services provided to transferred persons. Subdivision five at Forensic Facility shall implement staff qualifications, licensure training, and supervision required, requirements, sorry, that are sufficient to ensure that persons transferred to the forensic facility have access to clinically appropriate care, treatment services and supports consistent with individual needs and with applicable professional standards. And ensure that persons receive clinically appropriate assessment and treatment planning, including the development of a person specific treatment plan within seventy two hours following transfer, which shall be reviewed periodically as clinically indicated. So those are the changes to that subsection B, sort of describing what a forensic facility might look like in terms of physical settings and staffing, planning, treatment planning. And then, the second instance of amendment starting on line 17 is a new section that has not previously existed as part of the bill. So we're amending the same section that had been previously amended, which is the sort of the definitions where the forensic facility is defined that it amended in the first instance of amendment. And this is adding an annual report about the forensic facility. It's being added at a later date because we know that it will, one, take a while for the forensic facility to be up and running, and then it'll be a while before there is data to report back on. So this is an annual report that's being added to the green books, but at a later date than when everything else takes effect, which is why it's in its own standalone section. So this adds the subsection G, the annually on or before January 15, the Department of Corrections in consultation with the Departments of Mental Health in Dale, she'll submit a written report to the House Committees on Infections and Institutions, Human Services and Judiciary, and to the Senate Committees on Institutions, Health and Welfare and Judiciary, addressing the number of persons served at the forensic facility during the previous calendar year, and the types of clinical services and treatment provided. That's an annual report. Line 10, this is our third instance of amendment. Right now the bill contains language about emergency rulemaking. This proposes to strike out that section about emergency rulemaking that came over from Senate judiciary and put a new rulemaking section in. Part of what the rationale for the difference here is the version of the bill that is coming over from senate judiciary has the bill bill taking effect this year, which is why there's language about emergency rule making, so that rules go into effect right away. However, as this has continued to move and there have been continued conversations, it sounds like the various departments involved will not be ready to have a forensic facility up and running anytime in the next, you know, twelve months. So, there's really, if we push the data out to align when the work will actually be ready to be done, then there's no need for emergency rulemaking, and you

[Karen Parker (General Counsel, VT Department of Mental Health)]: can just do regular rulemaking. So that's sort

[Katie (Legislative Counsel)]: of the change that's happening here. This language says that the Commissioner of Corrections in consultation with Departments of Mental Health and Dale shall adopt rules to implement the provisions of Sections one, three, and four of the Act that was all due to the Forensic Facility. Specifically, the rules shall establish clinically appropriate standards governing the provisions of services at the Forensic Facility, including requirements related to staffing patterns and ratios, staff qualifications, licensure and training, clinical supervision and the delivery of safe, effective evidence informed care, And standards for quality assurance and improving clinical oversight, documentation and reporting requirements, safety and risk management protocols, and mechanisms for monitoring compliance. And any other provisions necessary to ensure safe, effective, and clinically appropriate implementation of the three sections on the forensic facility. Oops, and then I need to speak sparing. Okay. And that brings us to the fourth instance of amendment, which is on page four, line six. This is striking out section seven of the Senate Judiciary Report, which is just that the effective date is July '26, and it replaces that section seven with a section seven and eight. So a new section in section seven, a reporting section, and then a section eight, an effective date section. So there's an interim, a new interim report requirement under this amendment that by October 1, Department of Corrections in collaboration with DMH and Dale is to submit a written interim report to the same policy committees containing draft rules required pursuant to Section five. The interim report shall also address the status and anticipated timeline for the adoption of rules under the Act, forensic facility planning, including space considerations and design elements necessary to support a therapeutic and secure location, initial staffing considerations, including anticipated staffing levels, required qualifications and potential contracting needs, and an anticipated timeline for the development of a forensic facility, including preliminary cost estimates and initial operations. All part of a one time report that would come to you this October. And then a new effective date section, because we talked about how we have some tearing happening. So, this section, meaning the effective date section and section two of the act, which doesn't apply to the forensic facility, takes effect 07/01/2026. Section two, I should maybe skip to three. Three has most of the sections taking effect 01/01/2028. So, that's when the all the language about the forensic facility would take effect. And then, the subdivision two, talking about section 4A, that would take effect on 07/01/2029. So, that would take effect a year and a half. That's the reporting requirement,

[Sen. Ann Cummings]: the annual reporting requirement.

[Katie (Legislative Counsel)]: So, a year and a half after a forensic facility could be operational. So, there'd be no annual reporting until the facility has been operable for those eighteen months.

[Sen. Ginny Lyons (Chair)]: We're probably gonna have to go through it all again. Sure. Because And I'm looking at Karen and Claire and your comments on what is here. So why don't we go through it a little slower this time and look at each section? Okay. We understand what's there and then raise your hand if there's something you're gonna need to see that should be discussed.

[Katie (Legislative Counsel)]: Okay. So, our first instance of amendment. Mhmm. Again, we're striking out a subsection b that's in the senate judiciary version. We're putting a new subsection b in, and our highlighting shows what language came to you from Senate Judiciary and what you're adding. So we have language that the Commissioner of Corrections shall establish and operate a locked, secure forensic facility for the secure evaluation, treatment, and care of individuals who have been transferred pursuant to the Act. The Commissioner shall operate a forensic facility in a building that is separate and apart from a correctional facility, including both a separate entryway and dedicated staff to serve persons transferred to the forensic facility. Is that me? Thank you, Chair Lyons. I just wondering because last week we heard

[Sen. Martine Larocque Gulick (Vice Chair)]: from WellPath and we're talking a lot about the commissioner and the agency. What can you remind me what WellPath's role will be in this?

[Katie (Legislative Counsel)]: Maybe a better question for the administration, but it sounds like WellPath will be providing the services, including competency restoration services for this population.

[Sen. Ginny Lyons (Chair)]: Got it. Well, just to comment,

[Sen. John Morley III]: I'm not sure where the separate facility has come from. That's my question. And and I'll hear more in my other seat and institutions. But by example, I know we're desperately working to look at a new women's prison, and that's gonna take three, five years. And when I look at this and I go separate building, separate staff, I don't know where that comes from and under the time frame that we're also looking at this bill. Okay. So

[Sen. Ginny Lyons (Chair)]: Good question. Yeah.

[Sen. John Morley III]: No. I I was just wondering kinda the same thing and the same vein as, Senator Benson. The Chemistry shall operate the forensic facility in a building that is separate, you know, part of a correctional facility. Can it be, can that just be a wall in the same building?

[Katie (Legislative Counsel)]: I think potentially. I think it could be on the campus of a correctional facility, separate and apart from a correctional facility. But I I

[Sen. John Morley III]: I don't know what that means exactly, separate. Yeah. I mean, I I I'm just envisioning it one big building with some form of separation within it where you could do something perhaps. I think that's possible for a time frame. I agree with that's a completely separate Well, that's why. Yeah. I'm not sure.

[Katie (Legislative Counsel)]: Seems like there could be no mixing of population.

[Sen. John Morley III]: Right. Separate entrance ways. That's why that's what caught my attention was. I think it could be in the same building.

[Karen Parker (General Counsel, VT Department of Mental Health)]: So for the record, Karen Parker, General Counsel, the Department of Mental Health. So this is not our language and we do not support this language. We feel like it is putting the cart before the horse. The idea, we propose the language starting in line 16 through 19. This language takes away the ability of AHS and DOC to look at its facilities and determine where is the best placement. It takes really all of that ability away. And what we had wanted was the ability to look as an agency with facilities that DOC has. Again, remember, many of these folks are already in DOC. We're also talking about three to five people a year, so it's a very small population. And we wanted to make sure that we had the flexibility to determine where is the best location for these individuals, taking into account therapeutic recovery oriented and trauma informed environment. And so we would ask that we continue to have the flexibility to make those decisions. Again, that's something that would have to be reported back before any action was actually taken. And that's something that we would put in that interim report, but we are asking for the flexibility to determine what is best for us.

[Sen. Ginny Lyons (Chair)]: Okay. So I understand institutions is talking about the paragraph that's above your paragraph, the lines 12 through 15. So, without that, what guarantee is there that there would be sort of separation of populations?

[Karen Parker (General Counsel, VT Department of Mental Health)]: So there's a focus on this separation of populations, which I guess we're not Many of these folks are already in our systems. They're already mixed. Again, like if in the mental health context, right, everyone is all together. We don't separate based on populations, and so it's not like these folks are any more dangerous than other folks or somehow are vulnerable. DOC needs the ability to manage its population in a way that's safe for everyone, and this kind of artificially separating folks because there's some idea that because they're incompetent or insane, they are not they can't somehow be in a situation where they are maybe around other people. I think it's too soon to say that. Again, I think what we are really asking for is the flexibility to design the program based on the realities of DOC and the realities of staffing and the realities of facilities. Again, this is such a small group of people, right? Three to five people a year. We're not talking about a large population. We're talking about putting a party in these situations. And we're talking about how do we get them more supports, not less. And just because they're separated doesn't guarantee that they're actually getting better care or better services. It's kind of an, I think, an artificial thing to separate on. What we're trying to say is let's focus on the quality of services. Let's focus on safety and clinical needs, and then let's let the agency and the departments really think about what makes sense for the rest of it right now, because again, this is more a broad authority to design a program.

[Sen. Ginny Lyons (Chair)]: Okay, before I go to you, I'm gonna ask a question I had when we started. Go

[Sen. Martine Larocque Gulick (Vice Chair)]: ahead. Understand the question or the tension between the location of the facility. What about lines 12 to 15 that says that the commissioner shall operate the forensic facility? Are you all okay with the commissioner operating? Yes. Okay. Yeah.

[Sen. Ginny Lyons (Chair)]: So it's just really a

[Sen. Martine Larocque Gulick (Vice Chair)]: question of the location. Of the location. How it's designed. Yeah. Would it would it fix the problem if it said like the commissioner of corrections in consultation with AHS and all of the various parties? Would that be a possible resolution?

[Karen Parker (General Counsel, VT Department of Mental Health)]: I think the issue for us is is the lines thirteen and fourteen is the separate and apart. And the and the separate entryway and dedicated staff. It will have staff, but of course, but that doesn't mean that, you know, the staff couldn't also be serving other people. I think we have to remember the economy of scale. Right? We're we're not talking about a large population, so to try to carve out and have to pay for everything over here may not practically or financially make sense. And so what we're really asking for is the flexibility to allow DOC and its departments, sure, I think this will be done when you get down to kind of the rulemaking. It would be all of us, but we could certainly add it here if there's a concern that DOC is the only one looking at it because that's not the idea, but the idea that we need flexibility to determine. Does that kind of answer your question?

[Sen. Ginny Lyons (Chair)]: Yeah, it does. Thank you. Two questions. One, knowing that the issue around separation is going to continue, is it possible to say something about shall consider? Absolutely. Can we put that in, embedded in with line 16 through 19? Some somehow. Shall consider whether separation makes how, if and how.

[Karen Parker (General Counsel, VT Department of Mental Health)]: Yeah, I think leaving it flexible, I think it's certainly something that it makes sense for us to look at. But we

[Sen. Ginny Lyons (Chair)]: don't know where it is right now.

[Karen Parker (General Counsel, VT Department of Mental Health)]: We don't know where it is right now. Right.

[Sen. Ginny Lyons (Chair)]: We do that. Okay. So try that. Then the other Okay. Sorry. Go ahead, Jamie.

[Katie (Legislative Counsel)]: Doesn't quite fit in there. But where it is? I don't think that right now. Okay. Sorry.

[Sen. Ginny Lyons (Chair)]: You're the lawyer. You go ahead. I Okay. And then the other one is So some of these people can't stand trial, so they're innocent, but they're incompetent. Yeah, they can't They like confidence. They stand trial, so they're innocent. And I've heard this complaint time and again that gee whiz, they're innocent, they can't stand trial. Why are we putting them into a secure facility? I know some of the answers there, but I want to hear the answer from you. Sure, sorry.

[Karen Parker (General Counsel, VT Department of Mental Health)]: I was trying to see everyone. Because the court has made a determination that there is no less restrictive option to preserve public safety. So again, remember, we are only talking about individuals that have been charged with the most serious crimes and who are being held without bail. And the court has found they remain a danger to the public. And so what we're trying to do is address that gap. If the court says they could be in the community, then they would be in the community receiving services. The reality is some people, even if they're incompetent, are dangerous. And we have to have a way to address that. And that is what we're trying to do. That's the gap. That gap address is current. It's right now. We've seen negative outputs of it, and if we don't do anything, that gap will make. Thank

[Sen. Ginny Lyons (Chair)]: you. It's really helpful. And I know that judiciary worked very hard on that specific in that specific area and looked at other states. Always presented a teacher over Caledonia County. That was kind of a thrill murder. Oh, okay. And I believe the person that actually committed the murder is found incompetent. But the mastermind, it was in the woman's prison. And remember that I'm not sure that those are people you want out until you're quite sure, you know, that they're safe. Okay. So we're we'll we'll move past that and then go to the next section.

[Karen Parker (General Counsel, VT Department of Mental Health)]: Can

[Katie (Legislative Counsel)]: I that I just say what I think I heard and where I think I'm gonna add changes? Is that okay? Mhmm. Okay. So I think I'm gonna add this concept to the And rule I'm also wondering, you have an interim report coming back, and it seems like when we get there, that might be a place to ask for a a more detailed plan as to the physical facility. Or because you have a kind of reduction of rules. So, yes, add that.

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

[Katie (Legislative Counsel)]: And so you have your list of the forensic facilities shall be designed and operated in a manner that supports a therapeutic recovery oriented and trauma informed environment comparable to a community based residential treatment setting while maintaining appropriate levels of safety and security. Do not refuse any persons. It is ordered to admit and shall not require any clinical or diagnostic prerequisites for admission. Provide it.

[Sen. John Morley III]: But through that, it says in a residential treatment setting. So, that again comes into that whole play of what is the facility. That's kind of preached on it.

[Katie (Legislative Counsel)]: It is. It is giving guidance as they plan. So that's a policy decision. That was

[Karen Parker (General Counsel, VT Department of Mental Health)]: not the image language. That was not what? That was not our language. We wanted it to be a little bit more flexible so we could determine. I mean, I think what we've heard from well, Pat, is that they're essentially providing outpatient services. You know, there's lots of levels of residential services, so it's kind of unclear frankly what this means. You know, we do have one secure residential, but that's the only residential that is locked. Again, I think instead of focusing so much on those, I think the pieces that we're trying to focus on are what kind of treatment is provided to you or the clinicians, how do we do it in a therapeutic environment without without pying the hands of the agency in terms of how we're designing it. We could work with that language, but since you're raising it, I just wanted to highlight that it wasn't something we added, and it's it's a

[Sen. Ginny Lyons (Chair)]: bit more prescriptive than we had initially hoped for. Where did that language come from? That here? That was in here? You asked for it. I did. Yeah. I don't know why we have the clinical or diagnostic prerequisites not required because that's the point. Oh, that came from Senate Judiciary. That's what my question was.

[Katie (Legislative Counsel)]: Oh, I thought you meant about 30 So two

[Sen. Ginny Lyons (Chair)]: let's leave it. I don't wanna change it. Okay.

[Katie (Legislative Counsel)]: That sounds like I have to go up to the house floor in a minute. Okay. Three, provide for the safe housing and management of persons, including the ability to separate the population by sex and to otherwise address ethical safety or operational considerations as appropriate, including the possible operation of multiple facilities if required by the clinical needs of transferred persons.

[Sen. Martine Larocque Gulick (Vice Chair)]: Was a point.

[Katie (Legislative Counsel)]: I think that's fine. Subdivision four, employee clinical services director to oversee all forensic clinical and competency restoration services provided to transferred persons. Implement staff qualifications, licensing, training, supervision requirements that are sufficient to ensure that persons transferred to the forensic facility have access to clinically appropriate care, treatment services, and supports consistent with individual needs and with applicable professional standards.

[Sen. Ginny Lyons (Chair)]: Ensure that persons receive clinically appropriate assessment treatment planning, including the development of a person specific treatment plan within seventy two hours following transfer, which shall be reviewed periodically as clinically indicated. So, the seventy two hours was fine. Previously, there was just nothing. There was no pine in there. So I suggested to have a timeframe within which there's some attention. I wonder if

[Karen Parker (General Counsel, VT Department of Mental Health)]: I might suggest adding the word initial just because it will be Yeah, exactly what You'll need more time, but I think that's a fine time to have an initial just knowing that would be kind of preliminary. They wouldn't have enough time to really develop a relationship

[Sen. Ann Cummings]: with them, but that makes sense to me.

[Sen. Ginny Lyons (Chair)]: Yeah. We didn't want them be left sitting there for months and months

[Karen Parker (General Counsel, VT Department of Mental Health)]: and months. Wait a minute. I think I said reasonable, but yes, if that makes sense.

[Katie (Legislative Counsel)]: Then you have the addition of your annual reporting requirement by January 15 to the Department of Corrections and Consultation of DMH. Dale, she'll submit a written report to the policy committees addressing the number of persons served at the forensic facility during the previous calendar year and the types of clinical services and treatment provided. Maybe that should also say during the previous calendar year.

[Karen Parker (General Counsel, VT Department of Mental Health)]: And our only concern with that one is it leaves out BDH again. We had moved to ADH up initially. It's fine if you want to list the departments, but substance use is a major component of this, and so we want to make sure that we're acknowledging that, and so the Department of Health

[Sen. Ginny Lyons (Chair)]: should be named. Okay. Thank you. Five,

[Katie (Legislative Counsel)]: wondering if this is the same thing about rulemaking. Think That each

[Sen. Ginny Lyons (Chair)]: was my only comment on that one.

[Katie (Legislative Counsel)]: Commissioner of Corrections and Consultation of Various Departments shall adopt rules to implement the provisions of the Act related to the forensic facilities. Specifically, they shall address clinically appropriate standards governing the provision of services at the forensic facility, including requirements related to staffing patterns and ratios, staff qualifications, licensure and training, clinical supervision, and the delivery of safe, effective evidence informed care, Standards for quality assurance and improvement, clinical oversight, documentation and reporting requirements, safety and risk management protocols and mechanisms for monitoring compliance. And any other provisions necessary to ensure safe, effective and clinically appropriate implementation of this act, and this is where I'm gonna add, including potentially requiring the

[Sen. Ginny Lyons (Chair)]: provision of forensic facility services in a unit that is separate from other correctional populations. So that's where I'll include that idea. Okay, that would be good. Okay.

[Katie (Legislative Counsel)]: Then you have your interim report by October 1. The department, terms of patient health,

[Sen. Ginny Lyons (Chair)]: need to be back into this too? Yes, please. Okay. Department of Health. Lieutenant. I got it. I knew

[Katie (Legislative Counsel)]: it, you bet. Shall submit an interim report to the policy committees containing draft rules required pursuant to section five. It shall also address the status and anticipated timeline for the adoption of rules, forensic facility planning, including space considerations and design elements necessary to support a therapeutic secure location. I'm wondering if that's where you wanna be more specific about what the plan is for the physical facility.

[Sen. Ginny Lyons (Chair)]: I hesitate to do that simply because I know institutions is gonna look at this. Okay. And they do physical facility. Know this, I'm gonna be trying to sit in everybody's jurisdiction right now. I will, I will hold off on that again. What would you put there, Katie?

[Katie (Legislative Counsel)]: Let's see, forensic facility planning, including a detailed proposal of where the frenzied facility would be located, the timeline for having it set up, design elements necessary, something like that.

[Sen. Ginny Lyons (Chair)]: Okay. I wouldn't mind that being added. We will let institutions approve or make improvements. I guess this might be for the Department of Health. Where are they now?

[Karen Parker (General Counsel, VT Department of Mental Health)]: So, it depends.

[Katie (Legislative Counsel)]: Some are in corrections and some are in in the community.

[Sen. Ginny Lyons (Chair)]: Which is one of the places where we had a problem. And it's can you can you share with us the expense for someone in a community facility twenty four seven as compared with what might happen here? Just what, if someone's in the community, what does that mean for the security of that community place?

[Karen Parker (General Counsel, VT Department of Mental Health)]: So, if someone, say, been found incompetent for reasons other than mental illness, it is mental illness and maybe they're on an O and H, that doesn't necessarily guarantee they're in any type of housing. Those orders are really meant to If it's an order of non hospitalization, they could be in a residential setting, but they also could be living on their own and receiving services at a designated agency. If they're not connected to the mental health system, it could be that they're receiving outpatient substance use treatment. It could be they're receiving outpatient services through the DA for intellectual and developmental disabilities or a TBI or dementia. So, it really looks different based on the person. There's, as I said, there's only one walk facility for mental health. No other department runs any other secure facility, so that's the only one outpatient secure facility. So, if you're in a residential setting, it could be in staff 20 fourseven, not necessarily though.

[Sen. Martine Larocque Gulick (Vice Chair)]: Got it. Page first. Sorry to interrupt

[Sen. John Morley III]: you all. There were two different ways that these individuals go through the system. One was yeah, they get put into a facility, and the judge says, no. You gotta be much of a danger you're going to see, I guess.

[Katie (Legislative Counsel)]: I wanna clarify what you mean. Are there

[Sen. Ginny Lyons (Chair)]: two ways for people to come

[Katie (Legislative Counsel)]: into the forensic facility? Yeah. Okay. Ahead. So I just wanna make sure you don't mean that there that somebody with a mental illness has a clinical need for hospitalization.

[Sen. Ginny Lyons (Chair)]: No. No? Okay.

[Sen. John Morley III]: So go ahead and explain the two ways that

[Sen. Ginny Lyons (Chair)]: they can. Okay.

[Katie (Legislative Counsel)]: So there are individuals who are found not competent to stand trial. That's not a clinical diagnosis. That means that the judge is finding that they can't communicate with their attorney or they can't understand what's necessary to mount a defense, so they're not competent to stand trial, they could be transferred to the forensic facility and there would be competency restoration service to try to make that person competent to be able to have their child. The other way is that a person is found not guilty by a reason of insanity. That doesn't have a bearing on their competency at the time that decision is made, that is a decision about the person's capacity to understand what they were doing at the time the crime was committed.

[Sen. John Morley III]: So how are we getting together at the community to accept?

[Katie (Legislative Counsel)]: Well, if somebody is found not guilty by reason of insanity, then

[Sen. Ann Cummings]: that's

[Karen Parker (General Counsel, VT Department of Mental Health)]: the end

[Katie (Legislative Counsel)]: of their trial, they were found not guilty, they could go back into the community. Unless the court finds that at the time that that decision is made, that person has a clinical need for, let's say, mental health treatment, in which case the court could order somebody to have involuntary mental health treatment for however long their medical condition lasts. But again, being found not guilty by a reason of insanity isn't a decision about the person's mental state at the

[Sen. Ginny Lyons (Chair)]: time that that decision is reached. Time to be brief. Clive,

[Sen. Ann Cummings]: you will hear.

[Sen. John Morley III]: And this is the limpole that we're trying to address.

[Sen. Ginny Lyons (Chair)]: This is a problem. Yeah. It's ongoing. It's ongoing. It's a problem. Here's what my suggestion will be, I think we've been through this a couple of times. Our comfort level, I hope, has gotten a little bit better. What we'll do, we have this on schedule tomorrow morning. Yes. Well, we will. So we do have we have Katie in at 09:15 and we do have one bill that we're gonna be taking off because it's longer.

[Katie (Legislative Counsel)]: That's Thursday, though. No. That's just sort of I know. I'm not thinking Thursday. Okay. I had the same thought. So you don't have me at all tomorrow, looks like.

[Sen. Ginny Lyons (Chair)]: I don't have you. What about, Eric?

[Katie (Legislative Counsel)]: You I could do let's see, I could maybe do an 08:30 or 08:45, something like that, if you wanted to just look at the changes that I'm making right now. If the house, my bill is in, I don't know. I'm too away from my bill, but I could sit here and do your changes now. Okay. Give you something to look at this afternoon. This later this morning. Let's see what we

[Sen. Ginny Lyons (Chair)]: can do with that. Okay. Let's see what we can do. We'll we'll try to come back to it.

[Katie (Legislative Counsel)]: And even if we don't have an edited draft, maybe we could just look at

[Sen. Ginny Lyons (Chair)]: So far, the the changes that we've made are well are okay with the agency. That's that's good. Okay. Great. Thanks. That's great. You. Out of all. Alright. So what we are looking at now is with Tucker, who is here. Thank you. Have you been in this committee this year? Have. Once. A week for the resource? Do not. Glad you're here. And I think we'll introduce new members for you because you haven't been here.

[Sen. John Morley III]: John Morley. Morley. John Benson Orange.

[Sen. Ginny Lyons (Chair)]: Ginny Lyons. Chittenden Southeast.

[Sen. Martine Larocque Gulick (Vice Chair)]: Hello, Red Table Rock King of Chittenden Central.

[Sen. Ann Cummings]: Ann Cummings. Well,

[Tucker Anderson (Legislative Counsel)]: wonderful to meet you and re meet the committee in general. For the record, Tucker Anderson, legislative counsel. But what I understand, I'm here this morning to help candidates.

[Sen. Ginny Lyons (Chair)]: Is that right? That is accurate. Ann, let's be as narrow as possible with respect to the sections of the bill that are within our jurisdiction. So anything to do with dosage, anything to do with marketing to children or marketing that might be considered going to use? And I don't know what else you might have in store for us. Well,

[Tucker Anderson (Legislative Counsel)]: I think you will be glad to hear that if you're taking a look at draft 3.2, which is the recommendation from the Committee on Economic Development, Housing, General Affairs, you'll note that all of those issues have been

[Sen. John Morley III]: removed from the bill as introduced.

[Sen. Ginny Lyons (Chair)]: Oh, wow. And so what about the excise tax or the prevention dollars? That has also been removed. Oh.

[Tucker Anderson (Legislative Counsel)]: So the the THC content limitations were removed. The advertising updates were removed, and the lowering of the excise tax was also removed. Now, the individual transaction limit, which is not related to dosage, just how much individual can purchase in a single transaction has been raised, and so has the possession limit that might trigger, for example, civil or criminal penalties, has proportionally been increased based on the transaction limit. Packaging limits have been increased so that an individual package, it can have twice as much a THC as it formerly would have under current law, but otherwise, the concentration caps aren't adjusted, the advertised provisions.

[Sen. Ginny Lyons (Chair)]: Okay, so basically what is in the bill relates more to economic development and finance than it might to this committee. We can go through and look, maybe do a 10,000 to 25,000 foot walk over, walk through, walk over. Terrifying to walk at 25,000 feet, but I will try

[Tucker Anderson (Legislative Counsel)]: to do it. The first section of the bill increases the packaging. The way that that was described, Senate Economic Development, is you are no longer saying that you have to exclusively purchase six packs,

[Sen. John Morley III]: you can now buy a 12 pack.

[Tucker Anderson (Legislative Counsel)]: Transaction limits are increased from

[Sen. Ginny Lyons (Chair)]: Just to, I know, know, we're gonna get to these places, I'm empathetic with what you're chuckling about, just to remind ourselves that while there's an interest in changing the cannabis at the federal level from schedule one to something else, still THC still has pharmacological effects. And so we've had a fairly robust regulatory environment in Vermont to start. And so this is really continuing that look. Change hasn't happened in Congress yet. So, we're still under the same regulatory umbrella at the federal level that we have been. Is that accurate?

[Tucker Anderson (Legislative Counsel)]: Yes. Thank you. The status of cannabis at the federal level has not changed. There's been an executive order indicating that the federal agencies are going to rapidly reschedule cannabis, but that would not be the key scheduling, they came as a commodity and general commerce federal agencies lowering schedule

[Sen. John Morley III]: we want.

[Tucker Anderson (Legislative Counsel)]: Sections two, three, and four all deal with the transaction limit, which is being increased from one ounce to two ounces, and Sections three and four, what's happening there is that it gets increasing the amount that an individual carry on that person without being subject to civil penalties.

[Sen. Ginny Lyons (Chair)]: Can I ask a question here? So these changes are all legislative changes. What role, if any, would the board, the cannabis board, ordinarily play in making these decisions?

[Tucker Anderson (Legislative Counsel)]: So, I can point to one thing that is not changing with the status of the transaction when the CCB is involved with, just as an example, and that is that the transaction limit is calculated based on weight measurement for cannabis flower, but there are also cannabis products that are manufactured. And the CCB has discretion to determine how that transaction is calculated for purposes of the cannabis products. So you might have the transaction limit of two ounces for cannabis flower, but what does that mean for vape cartridges and edibles and other products? Well, the CCB determines approval what that transaction limitation would be and then communicates that to the retailers who put it into a system that calculates based on a person who is potentially purchasing both flowers and products so that as they're scanning through, they know when you come to the individual transaction.

[Sen. Ginny Lyons (Chair)]: Okay. So that just dives right into our jurisdiction. So you said they

[Sen. Ann Cummings]: I

[Sen. John Morley III]: don't know the stuff very well, I take it hashish is a derivative of marijuana. It is concentrated. Yeah. More concentrated. We're doubling that to

[Tucker Anderson (Legislative Counsel)]: five grams to 10 grams, proportionally, to reflect the transaction limits.

[Sen. Ginny Lyons (Chair)]: Sections

[Tucker Anderson (Legislative Counsel)]: five and six establish two pilot programs. The programs are slated to be effective for a two year period. The first is an event permit. There will be 20 of these issued per year for two years, and the events are fairly broad. And what they would cover is limited to 10, public events and 10 private events per year. And those could be catered events on the private side, such as a wedding. And on the public side, you could think of something like the brewers or winemakers fests, where you have individual stalls. Could be farmer's market permit if it is issued.

[Sen. Ginny Lyons (Chair)]: Anyone 21 years or younger would not be eligible to participate in any of these products, whether at an event or otherwise. Correct. And so,

[Tucker Anderson (Legislative Counsel)]: within the bill, is there some guarantee that that's being overseen? Yes, it's restated in each of the permit sections. The CCB ultimately oversees these events. There's a requirement for security built in each of the permits, and the CCB is given procedure authority that will operate with the same force of law as rules in order to put certain restrictions and requirements on the issuance of these permits. Okay. So it's not dissimilar from what happens with alcohol. That is correct. And in fact, the next permit that I'll describe to you is taken directly from the Title VII regulations. For the delivery of alcohol, there's going to be 15, not more than 15, delivery permits issued per year as part of this pilot, and that would allow individual licensees to deliver from their licensed establishment to an individual who is 21 years of age 12. First

[Sen. Martine Larocque Gulick (Vice Chair)]: of all, where are we exactly?

[Sen. Ginny Lyons (Chair)]: We on George, you give it a hug?

[Tucker Anderson (Legislative Counsel)]: I can certainly try to join.

[Sen. Ginny Lyons (Chair)]: Are we on September? Are we looking at delivery permits or are we Yes. Okay. That's on the- And I have another question. 7.

[Sen. Martine Larocque Gulick (Vice Chair)]: 7. Woah. 7. Wait behind. So you ready for my second question? Yes, I'm gonna try them both if ask for it. Or I can wait. So with the delivery, is there, upon delivery, is there a requirement, maybe there is, I just haven't seen it, to show identification that would, know, showed the age of the person who's receiving the package? I don't think so, but let's put it on this report together. Delivery permit, page seven. Okay, section six.

[Tucker Anderson (Legislative Counsel)]: There is not an express call out for checking by three. The holder of a delivery permit may deliver cannabis and cannabis products sold from the licensed premises for consumption off the premises to an individual who's 21 years of age or older, and then later on Subdivision 4. An employee or agent who's making the deliveries, shall complete a training program approved by the CCB. Similar requirements exist for those who are making deliveries from, second class retail establishments to individuals in Vermont under the alcohol beverage statutes, and the requirement is part of that training from DLL, and I can only tell you what happens in reality, is that checking identification, verifying identification is part of the training that an individual has to go through before they can sell or furnish alcohol or deliver it under one of these permits. So same structure, not expressly called out. The assumption would be that, yes, identity identity verification.

[Sen. Ginny Lyons (Chair)]: Senator Gulick, and Senator Cummings.

[Sen. Martine Larocque Gulick (Vice Chair)]: I have never received alcohol in the mail, but I do know people who have, and they have told me that the person who delivers the the alcohol takes a photograph of their of their ID. So it's like, it's verified. There's a photograph. I don't know what they do with the photograph, but I'm just letting the committee know that that is a procedure that I've heard, and I'm wondering why it wasn't included in this. So to be clear, with alcoholic beverages, you

[Tucker Anderson (Legislative Counsel)]: have a much more open market, including the issuance of licenses in this state for direct to consumer mail delivery of alcoholic beverages. So those are third party common carriers like FedEx, UPS, DHL, whatever, that are delivering those boxes, taking a photograph of the ID, transmitting those records back to the individual licensee who's selling the alcoholic beverages. That is not contemplated here. Why? Because cannabis is still illegal at the federal level and can't be transmitted through the US Postal Service, and some of those larger national delivery companies are apprehensive to participate in this market. This permit only allows an employee of an entity that is already licensed and regulated in the state to transport in a vehicle that is owned by that establishment cannabis to the end users. And the employer agent is going to have to go for training. You could absolutely add something in there stating that part of that training or part of this process has to be some sort of identity verification, but that is already happening with the license held by the entity who's delivering the product if they were selling it from their licensed Yes,

[Sen. Martine Larocque Gulick (Vice Chair)]: they have to get the so at the point of sale, there's an ID, but not at the deliveries? Could be Got it. Okay. Thanks.

[Sen. Ginny Lyons (Chair)]: Go ahead. I was on economic development when we a lot of these laws, We started out with the goal of helping our local breweries, and so we, you know, we had distributors that wouldn't carry the local things because Budweiser dominated the market or somebody. I'm not sure. I'm not so sure, my fault. We allowed local delivery of alcohol, but we found out because it wasn't illegal federally, but cannabis may not be illegal federally a year from now that we had to devour out of state delivery. So you go to California and I did do a wine tour in California and I was asked how come we can't ship to Vermont. You can now go out to Napa and you find something you like. You can have it shipped to you with regularity, and it was in the laws I remember that the UPS driver did have to get IT. I'm not sure that if we're doing this, we want a I think we need to recognize that the possibility that cannabis could become legal and that would mean, you know, nationally burdens that we would have to allow. We allow in state shipping. We're gonna have to allow out of state to Woodford. I'm gonna get when I go to my farmer's market. And as the number of farms has declined, the number of distillers and brewers seems to have increased. And it's some point, I'm not sure what I'm really at. Is it a farmer's market, or is it a beer in alcohol tasting event at 07:00 on Saturday morning? And I just think we need to consider what we've learned. Is that what we really wanna do? So my suggestion is that we go through the bill and then we had because we're gonna have two more folks testifying from department of health. Oh, thanks a And I am not in detail. No, you've got it. I understand. You're raising important points. Ahead. So where are we?

[Tucker Anderson (Legislative Counsel)]: We're moving through section six, which was the delivery permit pilot program. Section seven ensures that the holders of these permits during this two year period are going to be paying the excise tax. Moving all the way to section 10, at the end of the first year of the pilot program, the Cannabis Control Board is directed to report back to the general assembly on any issues that have come up, whether or not the program is successful, and whether it should be allowed to repeal at the end of the two year pilot, or whether title seven should be updated to or brief either the entire program or some portion of it indefinitely. In section 11, there are updates to the local government provisions, specifically allowing individuals to petition for the opt in vote, which is not something that is currently contemplated under seven BSA section eight sixty three. So this would extend to the voters of the municipality the opportunity to petition to put the opt in vote on the ballot. And then further on in that section, there's an existing exception from conditions on the issuance of a local permit for purposes of nuisance abatement for outdoor cultivators, and this is amended to extend that to indoor cultivators and tier one manufacturers. Section 12 changes the schedule for the distribution of license proceeds to municipalities. Section third

[Sen. Martine Larocque Gulick (Vice Chair)]: yes. Madam Chair, this you may not have an answer for this, but I know that in my senate district, there have been issues around the conflict, I would say, between right to farm and nuisance. That is coming that sometimes comes into issue. Well, I mean, you know about this too and you're just not with cannabis, but is that, is there, do you know if there's any work being done around the, that there is around that conflict? Okay. I have people nodding, so it sounds like there is working. Tangled in a separate pillow for Right. The Yeah. Okay. Thank you.

[Tucker Anderson (Legislative Counsel)]: In section 13, there's an adjustment to the terms for employee licenses and extended product registration for shelf stable materials. There are a whole bunch of repeals. So the integrated license is going away, and because it is going away or potentially has already gone, we are repealing references to integrated licenses throughout title settlement, which brings you all the way to the bottom of page 20, the top of page 21, which deals with cannabis business development grants for cultivators, manufacturers, and economic empowerment businesses. It expands the type of entities that are eligible for grants under this CE Media Fund. The next three sections, starting from section 24, all deal with updates requested from the Department of Tax, specifically related to cannabis business expenses from household income, the use value appraisal program and its applicability to outdoor cannabis cultivation, updating a reference from parcels of land to definitions from the CCB, And finally, allowing the department to share return information from some of these cannabis licensees with the Cannabis Control Board. So it's an exception from the mandatory confidentiality that's applied to tax return information.

[Sen. Ginny Lyons (Chair)]: So, I have another question here first. Within the original bill that's introduced, there was a stamp being placed on vapes. No, that's the other bill. Sorry. I have that one. Yeah, you have that one. That's my question. I had one. This is the next bill. Does this committee have it? This is an ash bill. Yes. Does this committee is it in this committee, or is it in mine? Which bill? This one. This bill is not anywhere except being voted out of economic development up on the floor. I don't know whether it was referred to your committee or not. I hope it was because Probably all that number is passed up in it. I haven't had a chance to go over anything that was working on. Okay. So it's on the floor, and we are looking at it, but we do not have session. Yes. Okay. It's on the floor. We're we're taking a look at it. If the sections that have been taken out were still in it, we would probably be wanting to have a longer look at it, and we may, after we hear from the department, can give you some more things to say. Questions for Dave? Fucker.

[Sen. Martine Larocque Gulick (Vice Chair)]: I know. Hi. Thank you, madam chair. I may have missed it but I don't think I did. So, I'll ask the question. Is there any contemplation of adding any kind of further educational programs, and I know the excise tax goes to education, but is there anything in here that is explicit around educating our children on the complexities of, no, okay.

[Tucker Anderson (Legislative Counsel)]: No change to whatever the status quo is. Got it. Thank There are some other bills in play that deal with after school and summer wraparound programming. And so that's the deal. It's in the four corners of

[Sen. Martine Larocque Gulick (Vice Chair)]: February. Got it. Okay. Thank you. And I have had a conversation with

[Sen. Ginny Lyons (Chair)]: director of prevention department of health about how we can wrap our arms around the prevention fund that is here and what the current requirements are for it and then what more we may want to do. So we're going to have that discussion. It's a really good question. Good, I

[Sen. Martine Larocque Gulick (Vice Chair)]: can't wait. I will hold my comments until that time. On

[Sen. John Morley III]: appropriations, she said, in 2027, a million dollars is transferred from the general fund, cannabis business development fund?

[Tucker Anderson (Legislative Counsel)]: Is that a question or? Well, I'm reading in Section 28.

[Sen. Ginny Lyons (Chair)]: Well, when it gets to appropriations, we'll look at that million dollars and we'll make a decision about the best place. So the million dollars in here is for?

[Sen. John Morley III]: You got two, there's two parts of the appropriations. You also have 1,680,000.00 going through the multi lane access and opportunity department. Yeah. So

[Sen. Ginny Lyons (Chair)]: I think they're investments in the business itself, so it's all, it's business development. It would not be appropriate to take this out of the excise tax that goes into the prevention funds. Is in my position, not the other position, I think, of the committee. I thought it was sales tax that went to the professions of the exiles? Yeah, sounds like. Exiles tax

[Tucker Anderson (Legislative Counsel)]: goes to the education related funds, including the universal app for school level and Yes. Okay.

[Sen. Ginny Lyons (Chair)]: That's the one that was the big four. I know. Because sales tax got sent to the the education funds between this bill took a long time, been in the past, between when the cannabis bill first was discussed and agreed in concept and when it actually got passed. So so it's the excise that goes to prevention, you know, sales that goes to after school and other. But I thought that was being raised as prevention services. We're gonna look at that. We'll look at that. We've got a lot of We've But I do think it's sitting on my wall, so we'll look at it. Let's move to the the other folks who are here to testify. There's Sheila Livingston and Helmy Solon, and both each of you from Department of Health. Hello? Thank you, Tucker. We may not be finished with you yet. Well, we'll see. Hi.

[Sheila Livingston (Advisor to the Commissioner, VT Department of Health)]: I'm Sheila Livingston. I'm the advisor to state commissioner at the Vermont Department of Health, and Tony Falland.

[Sen. Ginny Lyons (Chair)]: Tony, do want to introduce yourself for the record?

[Tony Folland (Clinical Manager, VT Department of Health, Division of Substance Use)]: Hi. For the record, Tony Folland, clinical manager for the Department of Health, Division of Substance Use. Nice seeing everyone.

[Sen. Ginny Lyons (Chair)]: Thanks for being here. Appreciate it.

[Sheila Livingston (Advisor to the Commissioner, VT Department of Health)]: Okay. So do you want me to

[Sen. Ginny Lyons (Chair)]: just Go

[Sheila Livingston (Advisor to the Commissioner, VT Department of Health)]: for say my piece? Okay. That would be great.

[Sen. Ginny Lyons (Chair)]: I will

[Sheila Livingston (Advisor to the Commissioner, VT Department of Health)]: do that. So we really wanna start by saying we like the version that came out of Senate econ, but much better than the version that was introduced for many of the reasons that you've already heard, but I'll just summarize them briefly. Yep. We are looking to maintain some of the public health safeguards that were originally put in to Vermont's cannabis regulation law. Critically, we would like to maintain the existing THC potency caps, concentration limits, and single serving package limits. We would really like to maintain the existing purchase and concession limits, and we would like to meet in the advertising goals to decrease any chance that you have both seen advertising about the regular. Yeah. A couple of those, the most important two are not in the bill that got past the week. Sorry, Sheila. What'd

[Tucker Anderson (Legislative Counsel)]: you say? I'm sorry.

[Sheila Livingston (Advisor to the Commissioner, VT Department of Health)]: Yes. I will say that again. So of those pieces, the potency caps and the advertising were taken out of the bill. And so we really appreciate that. So I won't I won't dwell on that unless you all have questions. Because the the bill as currently in front of you no longer has those needs and the meds. So appreciation for that to start with. Would like to, ideally, maintain the single serving package size and possession limits, and those are raised, as Tucker just explained, in the current information I'm gonna give today. So substance use prevention is similar regardless of the substance, for the most part of rate, and when you increase the amount available to people, and that is therefore available in the ecommon environment, people just have more substance use that people could use more of, and they're at one time knowing that a younger person could impact those at one time. And and then the other piece of the bill we're we're not particularly focused on, I think just generally, again, for public health, when you increase access to a substance, whether that's the number of outlets that sell it, the number of places where you can obtain it, just increase additional exposure and use in society, but we don't have specific edits there. There's not at this time. Happy to answer questions.

[Sen. Ginny Lyons (Chair)]: So you're asking to have change made. So was that was the change discussed in economic development? So we sent a version

[Sheila Livingston (Advisor to the Commissioner, VT Department of Health)]: of the bill with some edits to both Southern Econ and to you all, and they took, again, the most important ones. So, again, just wanna appreciate that. The pieces that they did not take from the changes we recommended were the purchase and possession limit increases. So those would mean an amount. So, and I'm kinda looking at

[Sen. Ginny Lyons (Chair)]: Tucker, are those are those increases as part of a pilot program or are they permanently?

[Tucker Anderson (Legislative Counsel)]: They are not part of the program. They are permanent adjustments.

[Sen. Ginny Lyons (Chair)]: Okay, questions, other questions for Cheryl? Thank you for your comments.

[Sheila Livingston (Advisor to the Commissioner, VT Department of Health)]: We can't wait to come in and talk to you about prevention. Let's

[Sen. Ginny Lyons (Chair)]: go to Tony Tony, do you have anything else you would like to add? I know you've been here before. You have a lot to offer, and I appreciate it.

[Tony Folland (Clinical Manager, VT Department of Health, Division of Substance Use)]: I do not, Chair. I really was hoping that just to be able to answer any kind of more technical or substance related questions that the committee might have to support Sheila in this.

[Sen. Ginny Lyons (Chair)]: Okay, so I do have a question, I guess, as we're talking about this, but what data is there that demonstrates if you increase the quantity available that we're going to see sort of misuse. We actually

[Tony Folland (Clinical Manager, VT Department of Health, Division of Substance Use)]: have some of that data that we've seen within the state using both National Survey of Drug Use and Health, as well as behavioral risk surveillance data. What we've seen actually since the decriminalization of cannabinoids, that adult use has tripled. So as we've seen the reductions in risk, we've seen a tripling. What we've seen since the decriminalization or since the legalization in the open market is we've seen a slight uptake in numbers across the board. And when we did surveys of people who are using the market, they said sixty five percent have reported that they are likely to either start or increase their use.

[Sen. Ginny Lyons (Chair)]: Thank you. Senator Gulick, but along those lines, have you also collected data on the increased number of sort of the, we've heard and we know that there are sort of mental health consequences to utilization of cannabinoids over time. And so, one illness being schizophrenia. And so do you have data on that that you could help us understand? And knowing that the questions that we're asking now will be helpful when we start talking about prevention, do you have that data also?

[Tony Folland (Clinical Manager, VT Department of Health, Division of Substance Use)]: We don't as a formal link in the state of Vermont. What we do know by looking at just national research is that the correlation between the onset of folks with experiencing psychosis is often related to a level of substance use. It doesn't appear to be causal, but it's certainly correlational that folks who use cannabinoids are more likely, if they have an underlying propensity for a psychotic illness, to have that triggered.

[Sen. Ann Cummings]: I think that the other thing is that that's not, that is a rare outcome, and that there are much more common health impacts that we see around depression and anxiety and dependence. I think there is still this myth that you cannot become dependent on cannabis. And Tony, I don't know if you have the stats on that off the top of your head, but I think that those are much more common and those are the things that we could be tracking and potentially seeing an impact here in Vermont as that use, like Tony says, goes up so much.

[Tony Folland (Clinical Manager, VT Department of Health, Division of Substance Use)]: Yeah. I think what we've seen is, and I believe it was the breakfast data, that looking at particularly adolescents who use marijuana more frequently, so I think the number was 20 or more in a month, that we see almost twenty five percent of those folks experiencing suicidal ideation. And so the link between depression and cannabis is quite high, particularly for folks who are using cannabis regularly. And then with certainly the potency limits, which is less of a concern now, the higher potency cannabinoids, you start seeing thirty percent of folks developing cannabis use disorder, which then you have to consider the more available, the more folks are going to use themselves, higher the health impacts that are going to occur.

[Sen. Ann Cummings]: And health of us, yep.

[Sen. Ginny Lyons (Chair)]: Tender grew with several

[Sen. Martine Larocque Gulick (Vice Chair)]: decades ago when I was a teenager. Cannabis

[Sen. Ginny Lyons (Chair)]: was not

[Sen. Martine Larocque Gulick (Vice Chair)]: decriminalized at that point and people were obviously using, so my general sense of the war on drugs doesn't work. In theory, believe in decriminalization because it has worked in some countries actually when there's enough of an investment in education and in healthcare. So my question is, I'll make that statement and I'll ask my question, which is when you look at the data since we have made the changes here in Vermont, what's the increase if there is one in like team usage? Do you have numbers around that?

[Sen. Ann Cummings]: We do. And we can get those we can get the data that Tony was saying and the data that we have to you, and we'll not misspeak on the exact in both categories. The increase has been much greater in the adult population than in the youth population. So I can tell you that off the top of my head. I think one thing, the harm drugs are great, like, we know that was not an effective tactic, and I think I wanna really impress on that committee again, like, when we think about prevention and regulation of substances that are legal, so now cannabis is legal in Vermont, so nicotine, I'm gonna use nicotine, alcohol, and cannabis, right, Helpfully, the the tactics are simpler. And so we can say from our experience with those other two substances that have been legal for a lot longer is potency matters, density of outlet matters, you know, places that sell at being attractive to kids matter. Right? All of these things have real consequences for initiation of use, which we're really worried about, and frequency and potency of use. And so, I think to try to bring it into the history of those substances where we have a lot more experience regulating, when we come to you with some of these recommendations, if we have that kind of decades of knowledge from those other pieces. I don't know if that's helpful or not.

[Sen. Martine Larocque Gulick (Vice Chair)]: It is helpful. Also was part of the discussion a few years ago about the prevention money and you know students in Vermont spend the bulk of their day in school and the folks who teach about drug abuse and about how drugs work, etcetera, are the student assistant professionals, the SAPs. I've been talking to a lot of folks in the field because they feel like they're losing this battle right now. And they feel that there aren't enough SAPs in our schools. I know in my district we have three and they are it's just not enough to do a proper job of educating kids on what this is all about. And I'll just leave it at that. I feel really torn, and I don't want to punish the cannabis growers and the cannabis retailers. And at the same time, if we are inadequately funding the prevention in our schools, which is where We always say in education, meet kids where they are, that's where they are, and they just don't have the resources to get a proper education. And so I'm just going to send that out there is my concern right now.

[Sen. Ann Cummings]: Yeah. We are going to come in and do kind of a full conversation about that, the funding that we have and those types of programs, and it is, those programs are really critical, and I think this committee is just eyes on making sure that that money, like the chair said, stays with prevention. It's very, very important to us and to Monica Hutt, the governor's office, we want to make sure that funding is

[Sen. Ginny Lyons (Chair)]: used for So just so you know, I pointed them all in the hallway and they all promised to come in. We're going to do that. That's an important part of our job. Yeah, thank you. Okay, we're good. I think we're gonna have to come back to this tomorrow and have a short discussion about what we do if anything with respect to an amendment on the bill and thank you for being available. So that's the end of that discussion. We have two people in the hallway who wanted to share with us something about a very similar business that they have in County. And senator Let's set these arrests.

[Sen. Martine Larocque Gulick (Vice Chair)]: Be alright. Move with lacrity. And

[Sen. Ginny Lyons (Chair)]: Katie did send another graft, and I'm gonna just quickly we'll we'll look at it we'll look at it today. I'll get get it to you to everyone, Karen, you, and Claire, and us around the table, and then see what we can do to agree. Good morning. Hello. So our time is legislative time and I especially need to be somewhere at exactly 12:00, but we've invited you again, Robert Squire and Howe. Mike Howe are here to share with the committee a prexis. And so help us understand what that is and you can move up together or sit where you are.

[Tucker Anderson (Legislative Counsel)]: Sit here.

[Sen. Ginny Lyons (Chair)]: I'm in support Okay, of That sounds good. Well, thanks so much

[Unidentified staff/host]: for having us. I really appreciate the opportunity to introduce ourselves. My name is Rob Squire. I'm a founder of a company called Precious, a pure based company, a healthcare company. My pal is also a co founder or chief clinical officer, Carrie Wacombs.

[Rob Squire (Founder, Aprexis)]: Couldn't join us today, but thanks so much. Wanted to just introduce a Prexis to tell you a little bit about what we do as a Vermont based company in the field of healthcare. It's a very innovative company. We're doing some interesting things in the space throughout the rest of the country. We don't yet work here in Vermont. We're going to change that sometime in the future. I don't know if anyone is familiar with the field of medication therapy management. That is what it says, where we help manage medications therapies. Our client customers on Medicare plans want to improve health outcomes and find cost savings. Probably everyone else knows somebody who's on an awful lot of medication, right? How do they get on all this medication? What does the pink pill do versus the blue pill? Is there an opportunity to do prescribe some of these medications? Are any of these medications interacting with one another to cause you to get back to the hospital? Is there a more cost effective alternative? All of these are the questions that medication therapy management addresses. And when we address them, we can improve health outcomes and find cost savings. Simple as that. CMS requires every Medicare plan to have an MTM program as part of its design. They contract with companies like the Prentiss. And we provide this service today for the largest Medicare plan in Puerto Rico, the fastest growing Medicare plan in Florida, other Florida plans, the smallest on the other side of the spectrum, the smallest upstart Medicare Advantage Plan in Massachusetts. They also have customers in Arizona, York, and elsewhere. But where we don't yet apply the most innovative aspects of MTM is in Medicaid. What we're hoping to do is to bring MTM and medication optimization to from on Medicaid to unlock all of that health outcomes and cost savings. Thus we all know an aging population and the rise of chronic disease, people are gonna be taking more and more medication. Her mom had a 54% increase in your pharmacy spend in three years from '20 to '23. How do you stop that if you don't pause to look at the medication therapies and say, where can we improve this? How did this person get on 12 medications? What better therapy optimization could we apply to get those savings and avoid all those downstream hospitalizations? So that is what we do. And we have actually done this work in Wisconsin. We were the original MTM provider for Wisconsin Medicaid. And because we were the technology partner that created the backbone of that bellwether program that proved that this works in Medicaid environments. We actually have the lived experience to know what works and what doesn't work. And if we had the opportunity to speak to the State of Vermont and the Medicaid department, we could create a really great program.

[Unidentified staff/host]: Can you tell us what MTM means? Medication therapy management. Thank you. No. And to that we add optimization. We're not just managing the therapy, but we're optimizing it. I'm sure

[Sen. John Morley III]: does this somehow tie into Blueprint or could it essentially tie into

[Sen. Ginny Lyons (Chair)]: the Theoretically it could tie into Blueprint or any other layer. It could be within a payer organization, it could be at the provider level which is Blueprint. Yeah, it could. But it's a business that's up and coming and Senator Perchlich introduced me to both of you folks and suggested this would be something helpful for us to understand. And we have talked in here and continue to talk about quality metric analysis and this is certainly a piece of it. Yeah. And

[Unidentified staff/host]: it's also important because it's also economic development too. Sure. Because we have the opportunity to build good healthcare industry jobs here at Vermont. Obviously low environmental impacts, good paying jobs, good career paths. And so we are a venture backed company and the venture capital firms that invested in a prexis were almost all Vermont venture capital firms. So it is actually a very interesting story. State gave money to the venture capital firms. Venture capital firms invested in a prexis. A prexis would like to work for Vermont Medicaid to provide health outcomes and cost savings and build jobs that will build revenue back to the state and a dividend on their investment. It is an economic development win win win, but we have to close that last piece of

[Sen. Ginny Lyons (Chair)]: that gap. We need to be

[Unidentified staff/host]: able to prove this out with a contract to Vermont Medicaid.

[Sen. Ginny Lyons (Chair)]: Thank you. So where are 12:00? The pumpkin's appearing, and we're gonna call it a wrap for today, but appreciate your coming in and sharing your vision with us. Thank you, Chittenden. Alright. That's it. We go off live. I've tried