Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair)]: Good morning, It is Wednesday, March 18, and this is the Senate Health and Welfare Committee meeting. And we're taking some time over the next few days and weeks looking at the bills that have come to us from the house. We're also gonna pick up some special topics going along. Prevention, for one, that we talked about yesterday a little bit. So, but this morning we're starting out with H84. It's an act relating to allowing telehealth appointments to be reported with patient and provider consent. I know it's a bill that's important to us. We have one in here and the House has worked on it. You are the reporter and are you the sponsor of the House as well, Representative Rebecca? I am a co sponsor. Okay. Come on up to the chair. I was hoping Ginny was gonna come there. '84 was quite a while ago. We're in '80 It's okay, but you know, our goal here is just to get the overview and why the bill was introduced and so kind of that general significant importance, and the details will come later when we go through with our letter. So as you know, during COVID when we expanded telehealth, it had significant positive impact, especially on mental health services, in terms of improving access. You want to state your name for the record? Daisy Rebecca, a member of House Health Care. Telehealth is incredibly important, especially for mental health services. We also know that administrative burden of providers is crushing.

[Rep. Rebecca (House Health Care Committee)]: We had testimony that told us that patient notes and that burden is basically the biggest challenge that many mental health providers have in their work. However, when they are able to record telehealth appointments, it allows them to go back and accurately complete their notes so that they can be compliant with all of the reporting requirements they have and also in managing their patient care plans. It's an important thing for both addressing the provider burden, making sure that care plans are maximizing the quality of care for patients, and that we're also maximizing client or patient provider's ability to tap into modern technologies. I think that's it in a nutshell. It's really that simple.

[Sen. Virginia "Ginny" Lyons (Chair)]: It is. No, be careful saying it's simple. Yeah, I know, I can say it's not that simple. Yes, understood. Okay, so it's just this little short fill. It is. Wow. Okay. So, question for you, if you're going to the counselor's office, can they record in the office? Can you give consent there? Yes. So this is just that it allows for that telehealth recording? Yeah, allows specifically. Okay. Alright. Yeah. Are there any conditions that are placed on the provider for that? Oh, maybe security. Doing it in a place where no one else can, we have telehealth protections is what I'm asking already that protects the patient's data information. Right, so HIPAA and all of that still applies in terms of confidentiality and data and the way that they store it. They still are bound by HIPAA as well as provider responsibility that they've not heard of. Okay, thank you. And what was the vote in your committee? Yeah, give me one moment. Do you have a question? Yeah, go ahead. It's not really a question, Representative Rebecca, but it's more just a comment and a thank you. I'm the sponsor of the bill on this side, and it came to me from a school board colleague who's also a psychology professor at EBM, and he was very passionate about trying to make this happen. Just wanted to see if they can for picking it up in the house and making it. So you amended it? Was there any amendment that you made? Ten zero one was the vote. Ten zero one. That's right. Thank you. I don't ultimately amended it. I'm sorry, I don't, think of yourself. I'd have to ask Gin. That's Gin. Yeah, yeah, we'll ask. Or it would be Katie, right? We have Jen down for it. Okay. But it could be Katie. She may be here. Yeah. I would have to look. That's okay. Sorry, this again was. You know, January was quite a while ago. It was ten years ago. Thank goodness, right? Thank goodness. What about the floor vote? Was it a voice vote? Yes. Okay, sounds good.

[Diane Harvey (Office of Legislative Counsel)]: Thank you. Thanks for have a great bill.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thanks for taking it. We'll see how quickly we can act on it. Was there any pushback at all from any of the testimony that you took? No. It was pretty positive. Wish you'd hear from someone in here, I think. Yes, there are people in the room here who comes back to Perfect, me and so

[Diane Harvey (Office of Legislative Counsel)]: thank you.

[Unidentified Committee Member]: Good work. Thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: And Jen is on her way down. So what we're going to do is we're going to bring another representative up to go through age six eleven, Representative Rebecca.

[Unidentified Committee Member]: Excuse me. This is

[Sen. Virginia "Ginny" Lyons (Chair)]: a longer bill, but just really, as you get it, we're interested in the problem being solved and what the bill does. And I know you're going back a ways. So six eleven is the annual housekeeping bill for the department that Vermont Health Access, our Medicaid department. Every year they bring us basically a punch list of items that simply need cleaned up in statute. So, that's what this bill is. So, it's more of a technical corrections, technical improvement type bill. Correct. Is there anything out standing in the bill that you remember that we should Yes, we, the one thing that we did take some time to address was the date for the implementation of doulas. Ah, okay. So the doula date is in here. The doula date of this year. So there was some back and forth with the Medicaid policy department and the folks representing the doulas regarding whether how how they could implement doula certification while also spilling Medicaid and meeting Medicaid requirements, which were either to have a physician referral, or for the doulas to have some sort of training that of medicalized what they do. They both agreed, the Medicaid office and the doula teams decided that they would allow. The doulas were fine with either, but we wrote in the bill, I believe, that they would have a referral process. Birthing person that wants to have a doula would have a referral from their general or physician so that the doula could then go by the team.

[Unidentified Committee Member]: So, okay, I get it. Yeah, it's okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: We've heard from, and we'll hear again, I mean we heard from the medical community, OBGYN folks that doulas were important to the care of their patients. So there will be MDs or others out there who would make that referral. So, we'll go here and here.

[Sen. Ann Cummings (Member)]: Yeah, this is reflective on what you've said. I just get nervous, we continue to put more and more on to Medicaid because I think Medicaid's gonna change. The eleven fifteen waiver, I just get nervous about stuff like that, and maybe I'm the only one, but at some point I think Medicaid's gonna change really drastically, and so then those services are gonna be covered by, what, GF? No.

[Diane Harvey (Office of Legislative Counsel)]: General fund doesn't have any money.

[Sen. Ann Cummings (Member)]: Well, that's what I'm trying, that's kind of what I'm trying to say. That's the only thing that I can put in. So

[Sen. Virginia "Ginny" Lyons (Chair)]: So we'll have Veeva come in and talk about that. When we took testimony last session on this, it was a fairly minimal amount. I understand a number of straws had their effect, but this one is one that, we've been through this one.

[Sen. Ann Cummings (Member)]: Okay, I did not.

[Sen. Virginia "Ginny" Lyons (Chair)]: But that's okay. Your comment is very relevant and important. Good. Senator Gulick. I was wondering, the referral, thank you, Chair, does the referral specify specify what kind of medical practitioner would write a referral?

[Sen. Martine Larocque Gulick (Vice Chair)]: Is it a referral to the physician or And Jen's here. Sorry. Yeah, it's Louise. No, I believe we did specify who would do the referrals.

[Unidentified Committee Member]: Good, thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: Alright, thank you. Anything else we should know? What was the, well, out of committee, if you remember that one. It was unanimous, and we took it eleven zero zero. Okay. And then the floor was at similarly

[Unidentified Committee Member]: Thanks. That's always helpful.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you so much. Thank you. Good work. Thanks. Good morning. Good morning. So we've had representative Rebecca give us the overview of both H84 and six eleven, so maybe we can through the bill a little Which ones do you want? With? The 84, that's the long one. Jen. I think she's ever heard the joke.

[Diane Harvey (Office of Legislative Counsel)]: I think she has, actually. Tell her

[Sen. Virginia "Ginny" Lyons (Chair)]: that you're in general. In and out? The stumps?

[Diane Harvey (Office of Legislative Counsel)]: Okay. I sent you I just sent you a new one because I saw you were in it says the meeting was scheduled for tomorrow, but it's on the calendar for today. Okay.

[Unidentified Committee Member]: Just

[Diane Harvey (Office of Legislative Counsel)]: Oh, wait. I'm looking at h 84. All right, good morning, Diane Harvey, Office of Legislative Counsel. So this is H84, an act relating to allowing telehealth appointments to be recorded with patient and provider consent. This fill is pretty straightforward, pretty short. Under existing law that sets out the parameters for healthcare services delivered through telemedicine and audio only telephone. There's specific provisions saying that neither a healthcare provider nor a patient shall create or cause to be created according of the consultation with patient, and this would add in both cases unless both the patient and the provider consent to the recording. I'm take it back to her. There is. I'm happy to tell you more about anything. And that's

[Sen. Virginia "Ginny" Lyons (Chair)]: both for audio only and for video. Right.

[Diane Harvey (Office of Legislative Counsel)]: So telemedicine is the live interactive audio video, like Zoom, which is much harder to explain before everybody started to do some Zoom, and audio only telephone is what it sounds like, just telephone.

[Sen. Virginia "Ginny" Lyons (Chair)]: So, and so, the work that we've done on telehealth, telemedicine previously, that just falls into that chapter and that sort of protection that's around it.

[Diane Harvey (Office of Legislative Counsel)]: Exactly, we have provisions in two different titles around telehealth. One of them is in Title VIII, around insurance coverage, and the other is in Title XVIII, around the actual delivery of healthcare services by telehealth. Telehealth is sort of the umbrella under which telemedicine, audio only telephone, and other forms of telecommunication work for healthcare delivery are certainly umbrella term. So yes, telehealth service delivery is on Title I team, and that is where these two provisions are.

[Sen. Virginia "Ginny" Lyons (Chair)]: You, Caroline. So, this already happens in face to face appointments, right? Between a doctor and

[Diane Harvey (Office of Legislative Counsel)]: a patient? They can. There's no prohibition on it. Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: For in person. Okay, so in a way this is just kind of trying to align the two so that you can do it in person and you can do it on tele.

[Diane Harvey (Office of Legislative Counsel)]: Right, it would be treating the report in the same way that the patient was in person or the appointment was was remote. Thank you. So store and forward means? Store and forward is sort of different because it's not included in this. Store and forward is when, well, if I put it the other way first, telemedicine is the live interactive. Store and forward is asynchronous, it's not at the same time. So it might be an image or a scan or something of a patient that is then provided to another provider at a distant site to read, not in real time.

[Unidentified Committee Member]: Okay, thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: Alright, any other question you have? Okay, so now I'm gonna ask a question for the folks who are in the room who have been involved with the bill previously are and let me know. Are you ready to testify on this bill today? I'm looking at

[Unidentified Committee Member]: group. Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: If you're ready to testify on the bill today, just raise your hand. One person, two people. Two people. Alright. Well, what we'll do is we'll move along to page 611, and we'll go through that bill, and then we'll make a decision about how we deal with We do need to take testimony, in particular on 06/11, from the referred, and that we do need testimony on age 84. I'm not thinking age 84 would be extensive, so I wanna make sure that we have the data to support any decision you made. Okay, so.

[Diane Harvey (Office of Legislative Counsel)]: Okay, moving on to six eleven. H611 is an act relating to miscellaneous provisions affecting the Department of Vermont Health Access. Starts off with a section that is amending the statute requiring, that currently requires health insurers and DIVA, health insurers with more than 5,000 covered lives in Vermont to provide a list of prescription drugs for which the cost has significantly increased over the last couple of years, in a short period of time. And the kind of vision when this was first enacted was that the payers, the insurers, and Medicaid would flag drugs that the cost has gone up for them a lot, and there's significant interest in understanding why. And then the attorney general's, those would be provided to the attorney general's office and posted. The attorney general's office would reach out to manufacturers and get information and report back to the legislature on what's going on. It has not rolled out, I think, as hoped. There have been significant difficulties, I know from the Attorney General's Office, trying to get information from the manufacturers. So you have a report that does get submitted to you every year, but I think it's largely the same things saying, you know, there's a lot that goes into drug prices. So this bill would take, would eliminate the requirement that the Department of Around Home Access create annual lists of its prescription drugs for which the prices have gone up significantly and provide them to the Attorney General's office. And my understanding, some of the rationale for that is also that drug pricing in Medicaid is just different because of federal laws that require manufacturers to give certain pricing to the Medicaid program.

[Sen. Ann Cummings (Member)]: Not because of federal. To

[Diane Harvey (Office of Legislative Counsel)]: some extent, because this one doesn't, why they're asking to be carved out. I do know just separately and something we'll probably take a look at, there's a bill that came out of the house I was not involved with, but it's the reports repeal bill, and that is taking some pieces, some different pieces out of this report requirement. And so I think we'll wanna look at them holistically and see what's left in the statute so you can decide if there are things you wanna keep, or if you wanna get rid of the whole thing, or if you wanna change it to something else. Where is that bill now? I think it's in GovOps.

[Sen. Virginia "Ginny" Lyons (Chair)]: Do you guys see it? So it's in the Senate?

[Diane Harvey (Office of Legislative Counsel)]: Yes, it has come over at H-nine zero seven. H-nine seven, we'll write that one down. Just something for us to be looking at, and what probably would make sense when we come back to this bill is that I can pull out this section of statute entirely and kinda show you what gets crossed out in the two different bills, and we can look at what would be left and what you want to do with this report. But for purposes of six eleven, it is just taking DIVA out. So it is striking the requirement, and just moving this definition of health insurer up here, picking out the requirement that DIVA create annually a list of 10 prescription drugs that the state spends a lot of healthcare dollars on, and the wholesale acquisition cost has increased by 50% or more over the past five years, or 15% or more during the previous calendar year. At least one generic and one brand name, etcetera. Then there were two different lists that Diva was creating. Again, this would get rid of the labor requirement, but not the health insurer requirement.

[Sen. Virginia "Ginny" Lyons (Chair)]: So that is what

[Diane Harvey (Office of Legislative Counsel)]: section one does. So the health insurer requirement is to, health insurers also have to provide a list of health insurers with more than 5,000 covered lives in this state for major medical insurance, which just gets moved up to

[Sen. Virginia "Ginny" Lyons (Chair)]: the definition of action. For the drugs that have gone up more than 15%?

[Diane Harvey (Office of Legislative Counsel)]: Yep, more than 50% over five years, or 15% over the previous calendar year. And then the attorney general's office is directed to look into that. Attorney General's office would identify from these various lists 15 drugs, particularly the ones that appear on multiple lists, and then require certain information from the manufacturer justifying the price increase, and I would encourage you to go from the attorney general's office and learn more about how this has rolled out, but

[Sen. Virginia "Ginny" Lyons (Chair)]: you can also look at the reports that have come into the last several years on the legislative So, when Diva is talking about this, that may be related to their PBMs, you don't know what you're

[Diane Harvey (Office of Legislative Counsel)]: I think so, I was just looking at some of the language that they mentioned, that D. Va mentioned in part of its information. We'll story that. Okay, yeah, you'll wanna hear from D. Va. I think part of what they said is the information supplied by DIVA is unhelpful because DIVA is federally prohibited from sharing drug specific net cost information, so the information was not very specific. So, straddle preemption is. Alright, section two is making a change to a bill from, or to language of the past last year. Those are the things that were at this table last year. You may remember that there was a significant amount of work done around the drugs that are provided through the 340B, general 340B drug pricing program, and those are drugs that are available to, outpatient drugs available to patients of hospitals and FQHCs and certain other federally identified covered entities that can participate, and many of them use a contract pharmacy, and there were some concerns about whether the manufacturers were refusing to provide the 340B drug pricing to the contract pharmacies, even though some of these facilities don't have their own in house pharmacies. So you, legislature, did a bunch of work on that last year. We are currently in litigation on some of it, and this piece of it seems like it may be subject to certain ongoing

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

[Diane Harvey (Office of Legislative Counsel)]: at the federal level that may preempt us. This is language that, under current law, prohibits the manufacturer, I'm sorry, well yeah, prohibits the manufacturer or agent from doing a rebate for the 340B covered entity or its contract pharmacy. So it says you have to do a discount at the time of sale or time of purchase and not a rebate later on, and things have been, there's some shifting federal landscape, but it does seem like this may not be a state level decision, and so this is proposing to take that language out of the statute. Section three, make some changes to the membership of the Medicaid and Exchange Advisory Committee. Would require that the, so we are required by federal law to have both a Medicaid and an exchange advisory from annually per month. Combines them into one, makes for a large committee of at least 22 members, because there are lots of different groups. But a new federal law also requires that our advisory committee include individuals who are also members of the beneficiary advisory committee, which is another federally required committee, so it would allow, it would require the required overlap. It takes out language allowing the commissioner to reappoint members to serve more than one term, but does not prohibit the position of being appointed to serve more than one term. Again, most of this bill was requests from the Department of Environmental Health Access, so you will want to hear from them on their rationale. For these, again, in the existing law, the Commissioner of DIVA appoints certain members, one representative of health insurers licensed to do business in the state, the Commissioner of Health serves, and then at least onefour of the remaining members have to come from certain constituencies, and this is mostly a language change. So under current law, it says, Individuals, self employed individuals, health insurance workers and agents, and representatives of businesses eligible for or enrolled in the exchange. This would change that to make representatives of, so representatives of those eligible or enrolled in qualified health plans, such as individuals, self employed individuals, health insurance brokers and agents, and small business owners and employees. So representatives kind of modifying all of those, although it could be the individuals themselves.

[Sen. Virginia "Ginny" Lyons (Chair)]: Section four. Let's see, just So, onefour of the membership would be, resulting would be Five

[Diane Harvey (Office of Legislative Counsel)]: piece. At least. Is that right? Yes. There's two that are already there. Yes, the committee must be at least 22 members. Yes. So, yes. Could be part.

[Sen. Virginia "Ginny" Lyons (Chair)]: They have a choice. Okay. Section

[Diane Harvey (Office of Legislative Counsel)]: four makes a change to the reflective health plan benefit plan statute. This is a statute that was created,

[Sen. Virginia "Ginny" Lyons (Chair)]: I think it's maybe more than a

[Diane Harvey (Office of Legislative Counsel)]: few years ago, but a handful of years ago, when there were reductions to federal, or discontinuation of federal cost sharing, reduction payments to insurers, so the federal government, I think in the first Trump administration, was rolling back some of the assistance to consumers in purchasing exchange plans, voluntary health benefit plans, and so Vermont created reflective plans as well, so that we could load up the premiums for the silver plans in the exchange with the cost sharing reductions to drive down more federal assistance instead of having missing cost sharing reductions. So the whole point of the reflective health benefit plans was to provide alternatives to individuals. It does affect the employees of small employers. And so this is striking, the language about employees of small employers. This is allowing, still allowing the reflective health benefit plans for people who wouldn't be eligible for premium assistance, but only for individuals. Because that was the, there's no reason to do it for a small group. Section five is the Clinical Utilization Review Board. This is an existing board. Some of the changes here are just cleanup changes that I did. We don't need to say not later than June 1530, because that is well past at this point, but there is an ongoing requirement for Diva to have a clinical utilization review board, and they have asked for a bit more flexibility in what the membership looks like. So now, instead of rising specifically 10 members, it would be a minimum of 10 members. We're correcting the name, the title of the Chief Medical Officer of Diva. It doesn't require, but allows board terms to be staggered, and doesn't specify the length of the staggering, and it still requires the board to meet at least quarterly, and takes out the outdated language around the first six months after its formation. Sure, yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: So these are pretty,

[Diane Harvey (Office of Legislative Counsel)]: I think in this one, pretty minimal changes, but again,

[Unidentified Committee Member]: pretty happy

[Diane Harvey (Office of Legislative Counsel)]: to tell you why they want it.

[Sen. Ann Cummings (Member)]: For Jen, has this board been successful? Has it brought good recommendations? Is it worthwhile? Is it I have no.

[Diane Harvey (Office of Legislative Counsel)]: Think you'll want to get on that. Our most recent report, believe, fairly recently submitted and attached to, or is posted on the legislative website. They do have a requirement for an annual report. I think my recollection is that Diva's testimony was that they are helpful. These are providers who are advising DIVA on emerging trends and services they might wanna consider covering, things from a clinician point of view to advise a commissioner who may not be, you may not have that knowledge for the ones. Alright, section six is a change in B Farm eligibility, And this is a, again, I think a fairly minor change in this case because it has never been calculated this way. So under existing law, an individual is eligible for assistance under B Farm. If the individual lives in Vermont when they apply, they're at least 65 years of age or an individual with disabilities and has some household income not greater than 225% of the federal poverty level. Existing loss as one calculated using modified adjusted gross income. It's my understanding that that has never been the basis on which they have calculated income for D VARM eligibility, and so this is a conforming change that was requested by the Office of the Healthcare Advocate, sorry, called. Seven is an increase to prepaid burial arrangements for Medicaid eligibility purposes. This is, before we actually look at the language, this is an increase in the amount that somebody who is applying for Medicaid can have in their own prepaid burial arrangement that they would have at a funeral home. An increase in how much they can have already put into that prepaid account and still be eligible for Medicaid. So it requires federal approval. This says, subject to approval from CMS, the agency of human services shall amend its rules and procedures, allowing Medicaid applicants and recipients to preserve monies, so set aside, keep those monies, from funeral and burial expenses to increase from $10,000 to $15,000 is the limit on the amount that can be preserved through an irrevocable prepaid funeral arrangement. And then there's certain requirements, so the written contract for the arrangement, which is these arrangements themselves are regulated in Title 26 in the funeral director's chapter, but as long as the written or written contract for the arrangement includes a provision specifying that Vermont Medicaid will receive all amounts remaining after payment of the deceased individual's expenses, up to an amount equal to the total Medicaid amount paid on behalf of the deceased individual. And in the event that the person responsible for making the funeral arrangements for the deceased person fails to have funeral services provided, then after the funeral director gets to eat their piece of it, as allowed under law, Vermont Medicaid would get all amounts remaining up to an amount, the total amount of Medicaid spending on behalf of the deceased individual. So that recouping is part of the Medicaid long term care estate recovery provisions that exist in current law. So again, the whole impact of this is to allow somebody to, I think perhaps in recognition of just being precise to funeral and burial expenses, to keep more money in an irrevocable prepaid funeral account, and still be eligible, or keep their eligibility for Medicaid, but Medicaid gets to recover amounts in that account in excess of what is spent on the funeral if there is anything, or if the funeral alone happened, but Medicaid doesn't get to scoop more than it was actually spent on a person's Medicaid priority. It's not much

[Sen. Virginia "Ginny" Lyons (Chair)]: to predict. Is there any limitation on burial? Could it be cremated? No.

[Diane Harvey (Office of Legislative Counsel)]: We'd have to look at what is in the irrevocable prepaid funeral arrangement statutes.

[Sen. Virginia "Ginny" Lyons (Chair)]: Depends in both. Yeah, I,

[Diane Harvey (Office of Legislative Counsel)]: no, don't. Yeah, we have

[Unidentified Committee Member]: to look. Yeah. You do have to make a change, please.

[Diane Harvey (Office of Legislative Counsel)]: And then this says, subject to approval from CMS, the agency's amended rules and procedures would apply to prepaid funeral arrangements entered into on or after 07/01/2027. Section if

[Sen. Virginia "Ginny" Lyons (Chair)]: Your question made me think of somebody else. There are more and more ways of being buried, being cremated and natural burials. I'm just curious if all of that is covered under this provision and also why they upped it, had it not been increased in a while?

[Diane Harvey (Office of Legislative Counsel)]: Don't, I don't. We've got lots of questions here.

[Sen. Virginia "Ginny" Lyons (Chair)]: You're not a Medicaid, you don't want

[Diane Harvey (Office of Legislative Counsel)]: It to is currently in So that's not in statute.

[Sen. Virginia "Ginny" Lyons (Chair)]: Keep writing your questions down, just doing it as

[Diane Harvey (Office of Legislative Counsel)]: we go. We're almost done, sections eight and nine would delay for one year 07/01/2026 to 07/01/2027, the date by which Diva has to seek a state plan amendment from CMS to allow Vermont's Medicaid program to provide coverage for doula services, and so that's making changes to acts from last year that were requiring Medicaid coverage for doula services subject to CMS approval of a state plan amendment, and DO would like longer to seek that state plan amendment given

[Sen. Virginia "Ginny" Lyons (Chair)]: certain issues at So federal that's an eleven fifteen waiver?

[Diane Harvey (Office of Legislative Counsel)]: No, that is state plan amendment. That's right.

[Unidentified Committee Member]: Yep. That

[Diane Harvey (Office of Legislative Counsel)]: is our state plan. And so we have a Medicaid state plan that spells out kind of how we administer a lot of coverage services and benefits in Medicaid. Every state has a state plan, and we would be looking to amend our state plan. Our eleven fifteen waiver is an arrangement with federal government for how we pay for services in the Medicaid program. Not every state has an eleven fifteen waiver. Don't have to, whereas every state that's out there has a Medicaid state plan. Yeah,

[Sen. Ann Cummings (Member)]: I get confused there. Ginny, so as I recall, federal government or CMS approves so many types of services under Medicaid. And then the state of Vermont, if they want to, can add to that.

[Diane Harvey (Office of Legislative Counsel)]: Right, there's required and optional services.

[Sen. Ann Cummings (Member)]: Right, is this a required or optional?

[Diane Harvey (Office of Legislative Counsel)]: So I believe this would be in the optional category to the extent it's addressed at all in the list of Medicaid states.

[Unidentified Committee Member]: So this

[Sen. Ann Cummings (Member)]: could be another add on.

[Diane Harvey (Office of Legislative Counsel)]: This would be, yes, this would be an added service in our Medicaid state plan. So not so much about how we pay, but what we pay for.

[Sen. Ann Cummings (Member)]: Yeah, thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: Do you know what the timeline is for the state plan amendment? It says whichever one's the leader, either July 1, or the approval of the state plan amendment.

[Diane Harvey (Office of Legislative Counsel)]: Well, is delaying the date by which they have to seek the state plan amendment because Diva wants more flexibility, but can't start before we get the state plan.

[Sen. Virginia "Ginny" Lyons (Chair)]: Right, and do we have a sense of when that might be? That is a deep point. Okay, sorry. Yeah, that's okay.

[Diane Harvey (Office of Legislative Counsel)]: And then finally, the act itself would take effect on July 1.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, so we've got a lot of questions running through the entire bill you can ask. And this was, this is also equivalent with S162, I think I have it insured. I believe so, yes. Mediva, yep.

[Diane Harvey (Office of Legislative Counsel)]: Yes, so Mediva, Bill is a house keeping bill from BUC. Yes, exactly. Mediva house keeping bill, exactly right. And yes, same bills, I believe, identical bills were introduced in the house in the Senate. And then, the changes were made at the House. And I will say, believe that the bill has introduced, this may have been a difference between the House and Senate after I said they're identical, but I believe the bill as introduced in the House for Diva delayed the state plan amendment deadline and the effectiveness of the Medicaid coverage for Gulick until 2028, and House Healthcare changed that to 2027.

[Sen. Virginia "Ginny" Lyons (Chair)]: We've been talking about doulas for a long time.

[Diane Harvey (Office of Legislative Counsel)]: You have, these high folks on the room will be interested.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, questions for Jen on the bill. So we have two bills here that seem like we can take them up and put some testimony together for each of them. DEVA's gonna be really significant, but then there'll be others who have an interest in each of the sections. So we'll make sure we get folks in for that. So if you're interested in H611 for testimony, please let me voice them up and we'll try to make that happen sooner than later. And then, similarly with 84, we'll get people signed up for testimony. We won't try to do it today if it doesn't make sense. If you're interested in testifying at H 84 on the telemedicine bill reporting that's been submitted the police and all new. We'll get it set up. There are a lot of bills that we have coming in. Some are going to be more challenging than others. So these don't feel as challenging. They don't like complexity, but they don't feel as challenging as maybe some of the other ones that we'll be seeing. We'll do that. Nothing for you. And we're scheduling this week a little bit later deliberately because we've been through the mill in this one and done a lot of work and I respect the time that my committee has put into and effort put into all the bills that we've worked on before toss-up. We deserve a little hiatus in that process. I don't know whether Katie is available to do that for three months. I know where she is. Pardon? Am I on the stairs real quick? In a minute. I'm gonna give you a minute to do that. So, what we're going to do is gonna take a short break. We'll be back no later than seven after, ten after, but please ten after, and then we'll take another look at the cannabis bill together. We're gonna get the reporter the bill and talk about it. Then talk to her just to make sure we're not missing something important in there. And if we can get Katie down, even if she doesn't come down, I do have a proposed amendment for S193. Remember that's the forensic facility And so, tell you a story about that. Because we do not have the bill in committee we can't put a committee amendment out so I have an amendment that my name is on but you all have contributed to so we'll look at that proposed amendment I've worked with Katie on it, worked with Karen Barber and others at DMH, and talked with Senator Harrison about it, who's doing institutions. She's agreed to sign on to the proposed amendment that I will put out in front of you. Then we you can decide if you wanna sign on to it or not. And we'll we'll try to move it along. If we can get Katie in here, that would be really cool. That's it.