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[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. It's pretty bad. Just to see if this is worthwhile reading. Aw. Have we had this one before? Watch puppy videos online. No. This is definitely good. I I think we have kitties. Look at my whole testimony.
[Sen. Martine Larocque Gulick (Vice Chair)]: Amazing. Come right up.
[Sen. Virginia "Ginny" Lyons (Chair)]: So let us go live, Melissa. Go live. Terrific. So we are Senate Health and Welfare. It is Wednesday, March 25. We're marching along, really amazing. And we're picking up 06:11 with some testimony. We did a sort of quick walk through with Ledge Counsel and now I have a chance to hear folks' comments. I know some of you have, at least one person has a proposal to bring to us and we may or may not get to that today. So this may or may not be the last day to hear testimony, but I'm thinking that from what I understand we'll be able to move through the bill fairly expeditiously and hopefully we can get it out sooner than later. So we have Maria Rossy, who is a doula social worker, Washington County Mental Health. Maria? Hi, Maria. Oh, I know
[Katie (Legislative Counsel, Office of Legislative Counsel)]: you're She over there. That's fair.
[Sen. Virginia "Ginny" Lyons (Chair)]: I thought. Okay. Please come up. Come on up. Thank you. And do we have your, for everyone, if you have your testimony online, it's very helpful to us. If so, as we go along, just send it in to solicitor.
[Maria Rossi (Doula; Co-founder, Doula Association of Vermont)]: Thank you. Thank you for allowing me the time to talk with you all today. My name is Maria Rossi. I've been a doula for about fifteen years and I'm also a social worker. As you said, I work for Washington County Mental Health, and I coordinate a dual program out of that agency that I helped to develop almost fourteen years ago. I'm here today providing testimony on behalf of the Dua Association of Vermont, or DAV, a statewide group that I cofounded. I was here last year when this committee took up the Dua Bill, and it's nice to see some of our doula champions as we like to call you, and it's also a pleasure to meet some new senators. And I appreciate the opportunity to provide you with some information about this bill in doula care in Vermont. Dual Care is an evidence based cost effective service that is unfortunately out of reach for many, if not most, of Vermont families, especially those who stand to benefit the most. We see Medicaid coverage not just as a way to improve outcomes for children and families, but also as a way to increase health equity in our state. Dualists are trained individuals who offer non medical, non clinical, interpersonal support to birthing families. Doula care is emotional, often mental health support. Care is provided before, during, and or after childbirth. Over forty years of studies show that doula care leads to a thirty percent reduced risk in labor inductions, a twenty eight percent reduced risk in unnecessary cesareans, a fourteen percent reduced risk in newborn admission into the NICU, And a growing body of evidence is showing the doulas' role in mitigating perinatal mental health outcomes. Normally, or sorry, nationally, doulas have received bipartisan support, and currently over half of states have enacted Medicaid coverage. All but four states are in some some place in the process of implementation. Three states have submitted state plan amendments in the last year alone, and are now covering dual care, and that would be Pennsylvania, South Dakota, and Utah. By the 2026, we expect that our neighboring states, New York, Massachusetts, and New Hampshire, will all offer Medicaid coverage and get Maine's not part of the kind as well there. We've come quite a long way in the process. Over the last two legislative sessions, incredible work has gone into a thoughtful and thorough process for implementing Act 50. OPR, as directed by Act 50, has worked to develop the professionalization of dualists who would like to provide duplicate services. They worked collaboratively with DWA, DAV, the DWA community, and other stakeholders to develop draft regulations. OPR is working diligently with DWA to ensure their rule aligned with federal CMS guidelines. We support the regulatory solution proposed by DWA of obtaining a referral for our doula services to ensure reimbursement for Medicaid approved doulas in Vermont is consistent with CMS criteria. As we understand it, this referral could come from a range of licensed clinicians, including OBs, midwives, and social workers. We remain committed to the further professionalization of DUAs in Vermont, as well as supporting both the DUO community and families to access and engage in service. We also understand that this clinical touch point is something that every state has had to contend with in their way. DAV supports the recent work of OPR and DIVA to work collaboratively with the doula community to find a path forward to bring services to Vermont Medicaid birthing families in a timely way. We support the process that has resulted in seeing a path forward for the SPA for doula services. While questions remain about the details, we are satisfied with the language in age six eleven to support successful and timely implementation. I'm confident as a state, we want to do all we can to support young families in Vermont, ensuring they have access to doula services that would improve health and mental health outcomes for girthing individuals and their babies, as well as provide cost savings to Vermont's healthcare system by reducing rates of perinatal mood disorders, cesarean births, and NICU sleeps. Doctor. John Kendall, a pediatrician and researcher, once said, If a doula were a drug, it would be unethical not to use it. Let's not further delay providing access to this critical service to more Vermont families. I'm happy to answer any questions.
[Sen. Virginia "Ginny" Lyons (Chair)]: In the bill itself, do you have a comment about any specific section of the bill?
[Katie (Legislative Counsel, Office of Legislative Counsel)]: We support the bill as as I was saying. Yeah, following, yeah.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: That's great, thank you. Well, thanks for
[Sen. Virginia "Ginny" Lyons (Chair)]: all the data because I know there's an increased interest at the hospital level for utilizing doulas more frequently.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Yeah, the hospitals, we're really lucky in Vermont. The hospitals have a very collaborative approach to welcoming doulas into the space. Good.
[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you. Hey. Thank you very much. And who's next?
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Good morning. I'm your health care advocate and we also support the bill at CRAB. This is what we
[Sen. Virginia "Ginny" Lyons (Chair)]: love to hear. We'll go through the bill more closely with markup and
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Yeah.
[Sen. Virginia "Ginny" Lyons (Chair)]: Put our own fingerprints on it, maybe or maybe not, but it's really great to know.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Just just a little bit of the history over on the house side. We did bring a couple of proposals to the house side, one of which we became convinced after talking to Anita didn't make sense. And so we withdrew one of which I believe is now your section six in this bill. Section six? Yeah. It is just a technical cleanup. And this was language that was given there for some years, but never actually implemented, never actually practiced about defiling eligibility. But, again, we split the bill as we was painting from the house. And and then I'll also say, while we were not directly involved in the dual discussion in the upstairs, We watched it, and I watched it and that it represented good compromise work between the various parties in the Chicago. So to get good outcome. Terrific, thank you. And
[Sen. Virginia "Ginny" Lyons (Chair)]: in section six, can you just explain what this relates to? This is Flimbee?
[Mike Fisher (Chief Health Care Advocate, Vermont)]: This is, I believe, V. Farm.
[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, it's V. Oh, it was a Yeah. Oh, '32.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Okay. So I think, I believe that this language here that's crossed off has been in statute for a long time. Okay. And it is not how eligibility is calculated. And so it is just cleanup language. Okay. Great. Thank you.
[Sen. Virginia "Ginny" Lyons (Chair)]: Just a technical building, could put some technical corrections. Alex McCracken, come on up. Eva? And Abby is not here, that's okay. Welcome, good morning. Good morning, Good evening.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: It's wonderful to be here. Hold on, gonna go over my computer. I have some slides that I will share for the committee, and I will walk through the bill as written section by section. Are
[Sen. Virginia "Ginny" Lyons (Chair)]: we gonna be able to get these slides on our witness? They should already be with you. Okay, I'll refresh.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: If not, I'm happy to send them over.
[Sen. Virginia "Ginny" Lyons (Chair)]: Yes. We do. Okay. Perfect.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Is that coming through? Alright. Wonderful. For the record, my name is Alex McMacken. I use she, her pronouns, and I am the director of communications and legislative affairs for the Department of Vermont Health Access. It's wonderful to be back with you all. I have very fond memories of being in this committee as a committee assistant years ago, and it's wonderful to see some new members join as well. So thank you for having me. And I will walk through each section of the housekeeping items we put forward in h six eleven, explain why these changes are being proposed, and we will certainly have time for questions and discussions. If there's if you if there are questions, feel free to interrupt me as we're at section. The I don't mind repeating, we'll have a fourth conversation.
[Sen. Virginia "Ginny" Lyons (Chair)]: Can I ask one quick question before So you get will Ashley Berliner also be testifying relative to Lisa?
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: So I have our colleagues from AHS Medicaid Policy. Oh, they're right here. They're right here. They jump in with anything that needs clarifying, and they're also here to talk about the doula section in more detail.
[Sen. Virginia "Ginny" Lyons (Chair)]: Excellent, thank you. Okay.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: So starting with section one, this section reveals an unnecessary pharmacy reporting requirement. This was brought to us by the Diva Pharmacy team. The current statute requires Diva Pharmacy to annually construct two lists of drugs experiencing larger than normal drug price increases. This information is then sent to the attorney general's office for their drug transparency reporting. The most recent report from the attorney general's office concluded that the information supplied by Diva is unhelpful because DIVA is federally prohibited from sharing drug specific net cost information. So it's confusing. It's opaque. It doesn't help them for their purposes of reporting. So we would propose that, we repeal the statutory requirement for DIVA to provide that data to ease the administrative burden of our pharmacy staff.
[Sen. Virginia "Ginny" Lyons (Chair)]: I understand the AG's office has found it not useful to have this data, so that's Correct. How
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Section two is a section repealing three forty b discrimination language that was passed as part of h two sixty six or act 55 last year. This language was added by the house, and Diva has no issue with repealing this language.
[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, and I think there'll be other comments on the three forty three.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Ahead. Section three provides technical updates to the Medicaid Exchange Advisory Committee, or the ME Act. Recently, the federal government promulgated rules that change a state's obligation around the the Medicaid Advisory Committees. We have recently instituted the Beneficiary Advisory Committee or the BAC, which serves alongside the MEAC as a sister committee. So we propose updating the statutory language around the MEAC to reflect the new federal rules as well as the existence of the Beneficiary Advisory Committee.
[Sen. Virginia "Ginny" Lyons (Chair)]: K.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Section four is a change on the definition of reflective health plans. When we passed Act two in 2025, it separated or unmerged individual and small group health insurance markets in perpetuity. They were already unmerged, but that clarified that there was no sunset on that. And we should have had a technical fix that removed references to reflected plans. Now that the small group market is separate from the individual market, small employers and their employees don't need reflected plans since small group coverage doesn't offer federal subsidies, and the loaded premium issue only affects individual market plans sold on the exchange. That's a lot to say. We should be clarifying that reflected plan definitions are that reflected plans are for the individual market only. So
[Sen. Virginia "Ginny" Lyons (Chair)]: this we've we've heard about this one ongoing, and it will also be, I think, important for finance to get it to take a look as the bill goes along. Yeah.
[Sen. Martine Larocque Gulick (Vice Chair)]: Can somebody please refresh my memory on what a reflective plan is? I honestly
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: I so wish Patty were here for this question. Right. Okay. Can provide you a more fulsive definition once I have an opportunity to create one. Great. Thank you. So we will we will look at that. Yes. But we will get you that.
[Sen. Virginia "Ginny" Lyons (Chair)]: Unless anyone's pregnant. Mike Fisher. My chopping under that I don't mind
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: if Mike wants to answer.
[Sen. Virginia "Ginny" Lyons (Chair)]: Not at all.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: It it it is a near identical with just with with the smallest possible difference between the and and the non reflective plans in order to be able to grade those plans separately.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: That does no. That's really helpful. That that didn't help me at all. I'm sorry.
[Sen. Virginia "Ginny" Lyons (Chair)]: So we'll go through and we'll get a very strong definition.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: We can send a summary to the That we can provide that.
[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you for your time. I know finally I just looked at this recently. We have not looked at this recently, but it's important for us to understand what's here. Absolutely. As we get to move ahead.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: So Section five changes Curve membership requirements. The Curve is the Clinical Utilization Review Board, and this was a request that came from the Curve, which is a body of medical professionals and clinical professionals who advise the DIBA clinical unit on coverage matters as well as clinical matters. So they have come to us with the request that the current statutory language, passed their membership at ten, be amended to allow for flexibility. So change the language to say a minimum of 10 members rather than just 10. They believe this will allow for greater flexibility with memberships, serve staggered terms, as well as encourage greater diversity and participation at the current.
[Sen. Virginia "Ginny" Lyons (Chair)]: And this is going to be important as we move along with changes to primary care. Thank you.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Yes, we appreciate the work that the PERC does and they serve a very vital function. Section six removes MAGI methodology from the farm statute. This is what the healthcare advocate referenced earlier. This is a technical cleanup. We have never used MAGI to calculate e farm eligibility, so it is removing language that is not being used. That's section six.
[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah, that we just talked about. So that's what we need.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Section seven is an increase to the burial funds limit, burial fund limits. This is certain funds can get set aside to cover future burial costs and be excluded from Medicaid financial eligibility. So the current limit is 10,000, and that has not been changed since it was put into statute in 2002. So it's been a very long time since we've been we've increased the amount of eligibility or amount that can be excluded from Medicaid eligibility. The proposed solution in age six eleven would increase that cap to 15,000, implementing a use of a Medicaid payback requirement. And current $10,000 cap would continue to apply to other variable fund arrangements such as designated savings account. That would be yeah. Go ahead. We have we have consulted with OPR on the implementation of this to ensure that funeral directors that they regulate are able to take advantage of this change, and we've also been in communication with the Vermont Payroll Directors Association. So,
[Sen. Virginia "Ginny" Lyons (Chair)]: how would the payment go? Because we did hear about this in appropriations. So where does the increase, where does the money come from for these
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: burial payments? Well, is money that people can set aside future costs around burial, and that's excluded then from their Medicaid eligibility.
[Sen. Virginia "Ginny" Lyons (Chair)]: Was there an earlier discussion in this bill, or perhaps it was in the proposal in the appropriations, to have the money come from the funeral directors?
[Mike Fisher (Chief Health Care Advocate, Vermont)]: That is not gonna come. No. No. That's different.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: That's different. And I feel comfortable saying that they don't have conversations with the funeral directors. Cemetery.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: That's what you're dealing with. I know. That's it.
[Sen. Virginia "Ginny" Lyons (Chair)]: There's a lot of squirreling around here about cemeteries, dead people, and and funeral directors. We really need that happiness day at the state center. That's why we have the little toughest issue.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: No, to be clear, the Funeral Directors Association has signaled support for this. Okay.
[Sen. Martine Larocque Gulick (Vice Chair)]: Ahead. Alex, is there a definition for what burial is? Does this include cremation and green burials and things like that? There's a whole lot
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: I believe it does. I would wanna double check with the funeral directors association, but I believe that it would cover various methods. Okay.
[Sen. Virginia "Ginny" Lyons (Chair)]: I asked the same question. Don't know it's same question already said.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: We will, I will double check and follow-up with you, Senator.
[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Okay, thank you. That's good.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: And the last section here, section eight, which you've heard a little bit about already, is the delay in Medicaid coverage for doula services. This is responding to Act 50, which requires AHS to begin pursuing a state plan amendment for doula coverage by July, which is this year. The department supports covering doulas, but we have significant concerns remaining around CMS approval for coverage and the potential for federal scrutiny. We have worked very closely with our colleagues at OPR and BH, in the doula provider community, and with the advocate community to come to a solution that works for all parties, and we very much appreciate that collaborative effort from all sides to ensure that we can provide coverage for doula services in the future. So the proposal is to push back the DLEEP to seek a state plan amendment to July '27, which would create more runway to properly implement. I would also note here, there is a slight language change that will be needed from the house version. This was brought to our attention from OPR that their section also needs to be amended to be 27 rather than 26. So that is one small change that we would request on the current bill.
[Sen. Virginia "Ginny" Lyons (Chair)]: Do you know where that is in
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: the bill? It's section eight. That's very Oh, it's OPR specific language.
[Sen. Virginia "Ginny" Lyons (Chair)]: So that would change to 27. To match ours. Right. Well, there's one thing we can do there. I
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: I will also note that we're continuing discussions with OPRA to ensure that burial fund language in the previous section is doing what it needs to do. So we will follow-up with the committee, hopefully, later this week with confirmation that that language does not need to change. Okay. That that's helpful. Yeah. Thank you.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Senator Morley? Yeah. Could we go back to section three? Sure. Just I don't want, just to educate me a little bit on on this, the federal government obligated rules. I don't know what MEAC really is or does.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Yeah, absolutely. I'd be happy to speak to that. So the MEAC is an advisory committee, made up of, many different individuals from around the health care policy space, including the health care advocate and others who are in this room.
[Sen. Virginia "Ginny" Lyons (Chair)]: I appreciate. And take care.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: They advise the commissioner of Diva on policy as well as provide kind of an outside perspective on Medicaid and marketplace exchange activities. We're a little unique in Vermont because we do have that integrated system with Diva. Like, the the Medicaid exchange advisory committee is not just the Medicaid advisory committee, so they do work on the ACA marketplace side of things as well. And then the federal rules are largely around the institution of the beneficiary advisory committee, which is made up of entirely Medicaid members, current, former, or family members or caretakers of Medicaid members. And they then serve jointly either, solely on the back or on the back end in the act, and then they can provide their advisory function to the DEVA commissioner. So this is this language change is really mostly about incorporating that new beneficiary advisory committee language into Vermont state statute because it's not currently there.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: So these individuals are also probably gonna help with like primary care and figuring out some of those issues moving forward.
[Sen. Virginia "Ginny" Lyons (Chair)]: To the extent that Medicaid is involved in changing the payment Correct. So there's also primary care workers, there's also the blueprint, there's also the strategic plan primary care advisory committee, there are a lot of groups feeding into that S197. Okay. Yeah.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Sometimes too much is not good.
[Sen. Virginia "Ginny" Lyons (Chair)]: It is, yeah, but the good news about this, about that one, going back to 01/1997, is that everyone is really rolling in the same direction of And there's so, D. Va knows the folks that they need to hear from so that they don't a, cause a problem.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Thank you. And I would say again, the Clinical Utilization Review Board is probably more the primary care advisory committee for D. Va, but anything that crosses into the I
[Mike Fisher (Chief Health Care Advocate, Vermont)]: just need the Medicaid portion of this, just going to Tide, there's something for it. So,
[Sen. Virginia "Ginny" Lyons (Chair)]: and just looking across room at Grace and Ashley and about a lot of that work, the payment work will be modeling, It will be less interesting to you, I think.
[Sen. Martine Larocque Gulick (Vice Chair)]: Along with real pros.
[Sen. Virginia "Ginny" Lyons (Chair)]: Why don't you introduce yourself for the record? Did you want to come up and testify? I have questions. I will have questions for you. Oh, sure. Are you good? I'm good if you're good. Yeah. Okay.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Thanks so much.
[Sen. Virginia "Ginny" Lyons (Chair)]: Well, we can wait on the weather. We're good. If you all So are
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: any of us good?
[Sen. Virginia "Ginny" Lyons (Chair)]: Should we'll We'll we'll we'll hear back from you on those couple things.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Thank you.
[Sen. Virginia "Ginny" Lyons (Chair)]: New. Yeah.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Oh, I don't I don't think it happened.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: I will make it happen.
[Sen. Virginia "Ginny" Lyons (Chair)]: Alright. So, Ashley, thanks for being here. So why don't you go ahead with the
[Sen. Martine Larocque Gulick (Vice Chair)]: For the record, Ashley Bruebner. I'm the director of Medicaid policy for the agency of human services. It's good to be here in person. I really don't have anything to add to the testimony that Alex already provided. We are very happy with that compromise that we were able to agree to in the house around the Gulick provision, and we'll be spending the next year working on the state plan amendment.
[Ashley Bruebner (Director of Medicaid Policy, AHS)]: Moving that forward, happy to answer any questions, and I also hope Grace Johnson here, who's the who's the policy subject matter expert
[Sen. Virginia "Ginny" Lyons (Chair)]: on So when you're talking about state plan amendment, you're talking about the eleven fifteen waivers No. What does
[Ashley Bruebner (Director of Medicaid Policy, AHS)]: that mean? Yeah. So the state plan amendment, the state plan is essentially the contract between the Centers for Medicare and Medicaid Services and the state of Vermont. And it is the who, what, when, where of the Medicaid program. So what services are provided, who is allowed to provide those services, and
[Sen. Virginia "Ginny" Lyons (Chair)]: who are eligible for those services,
[Katie (Legislative Counsel, Office of Legislative Counsel)]: that is
[Ashley Bruebner (Director of Medicaid Policy, AHS)]: all spelled out in detail in the State Plan Amendment. So whenever we add a new service, we have to amend our State Plan. It is an approval process with CMS where we have to go through a public notice process, so that will be posted for public notice. There'll be a comment period for anyone to provide comment on our state plan amendment, and then it gets submitted to CMS for their work review and approval.
[Sen. Virginia "Ginny" Lyons (Chair)]: What's the timing on that application? Plan to submit it next year in 2025. What? So spring. About Which which Chinese year? Oh, spring. So we have We like spring. Yeah. So we have time to think about every everything that we hear from folks once you put out your information. So
[Ashley Bruebner (Director of Medicaid Policy, AHS)]: we are going to be storming because we have, as you know, IT issues. I don't know if you've heard of that, but
[Sen. Virginia "Ginny" Lyons (Chair)]: I'm just trying to remind you.
[Ashley Bruebner (Director of Medicaid Policy, AHS)]: So everything takes a while. So we're gonna begin from starting that process this year. Like Yes. Setting up the the the service in the system, figuring out what rates look like, figuring out how we're gonna draft our state plan. And then in 2027, we will be submitting a SPA. It will be effective 07/01 for the legislation.
[Sen. Virginia "Ginny" Lyons (Chair)]: Sure. Right. A lot of work between now and then. IT. We would love to have IT not be a problem. So, questions on the state plan process. And so, the implications in this bill for state plan include? We have to ask for
[Sen. Martine Larocque Gulick (Vice Chair)]: a state plan amendment, or CMS has to approve it. We don't think it will be controversial. It is a process, it is an administrative slog to get through that, but we think as the first person who testified, Maria, out, other states passed us through. We're not, like, out on a limb here, so we feel confident that we'll be able
[Sen. Virginia "Ginny" Lyons (Chair)]: to get the statewide Amazing what we have to go through to help our constituents and citizens.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Am I gonna have a chair? Are there other, I don't know if
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: you can answer this,
[Sen. Martine Larocque Gulick (Vice Chair)]: are there other procedures or health care issues being brought up when you're looking at the Medicaid. Sorry, I'm trying to stay on my thoughts. For the state plan, thank you. Or is it just the That's a great question. So, what we do is we submit a specific page to CMS that is what they are supposed to review. If that page touches anything else in our Medicaid program, they have license to go explore that. So we try to structure it in a way to limit their purview as much as possible to the topic at hand. Sometimes we're not able to do that based on just the structure of our estate plan. We've gotten more sophisticated as we've gotten along, but if we touch old pages, it becomes harder to kind of narrow the scope.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: I don't know off the top
[Sen. Martine Larocque Gulick (Vice Chair)]: of my head. I I believe we would just do a brand new page here, so I don't I don't anticipate any, unnecessary investigation, but that's always a risk of the safe way of doing that. Any
[Sen. Virginia "Ginny" Lyons (Chair)]: other questions? I have two questions that are related to Medicaid and whether you or Alex can answer them that could be bringing back questions. Where are we on Medicaid prior authorization to end? We still have prior authorization for primary care in the Medicaid program? We do not have primary care prior authorization right now. We haven't sunset
[Sen. Martine Larocque Gulick (Vice Chair)]: that. It is still We don't have primary care prior auths. We have the prior authorizations for a very limited set of students that we feel like need more utilization management. Primary care is not.
[Sen. Virginia "Ginny" Lyons (Chair)]: That's correct. Yeah, so okay, that's all of them, you know, that's one question. Okay. Then the other question is something that is coming up and is fairly new and that we're going to be caring about on Friday and that's long COVID and how long COVID is being handled within our public system. And then coverage of, you said certain drugs, so there are emerging drugs, we won't talk about them. So what conversation, if any, are you folks having, this is a broader question for Medicaid, and maybe it's the Medicaid Advisory Committee on long COVID, because it is new and it is devastating and there are a lot of people in the state who are affected by it. So, don't know what you're seeing for that and the burden you're seeing both on patients and then on the services we're able to offer. Yeah,
[Sen. Martine Larocque Gulick (Vice Chair)]: I can't speak to the burden that we're seeing. We don't have any pharmacists on staff that certainly are more plugged into that. We also have a drug utilization review board similar to the clinical utilization review board that looks at drugs and drug coverage. So we can definitely set up conversation with the right people to talk more about
[Sen. Virginia "Ginny" Lyons (Chair)]: And that's drugs, but then in terms of the primary care, I know that a lot of primary care docs are now becoming really knowledgeable about treatment and referral. Whether it's cardiovascular, there's pulmonary, there's all kinds of different consequences with long COVID. So just curious about what the conversation might or might not be, but anything you can provide is something I would be
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: happy I'm not sure I can speak to any specifics, but I'm happy to follow-up with some of the relevant folks in Diva and see if we're seeing an impact.
[Sen. Virginia "Ginny" Lyons (Chair)]: Good, that'd good. I know we have this rare diseases bill that we'll be looking at, Rare Disease Advisory Council today. But long COVID isn't a rare disease now. It's predominant, more like a lot of other chronic diseases. So not a question you just a question. Yeah. It's not reportable but and thanks for being here and offering comments. Any other questions? Well, have the director of Medicaid here. This person here, Medicaid policy, it's really important. Grace, would that be awesome? Did you want to introduce yourself for the record, Grace? My name
[Katie (Legislative Counsel, Office of Legislative Counsel)]: is Grace Johnson. I work as a senior policy analyst on the Medicaid policy at the NHS.
[Sen. Virginia "Ginny" Lyons (Chair)]: So you've heard our questions? Anything? We can help us with?
[Grace Johnson (Senior Policy Analyst, Medicaid Policy, AHS)]: I don't know. Anything more than action? Okay. No.
[Sen. Virginia "Ginny" Lyons (Chair)]: So, wow. This is too easy. Thank you very much, and I appreciate your tucking in today.
[Sen. Martine Larocque Gulick (Vice Chair)]: It's gonna add some complexity here.
[Sen. Virginia "Ginny" Lyons (Chair)]: We need complexity. It's all our business is. All right, well, unless there are other We don't have other Did you wanna comment? I've got five minutes left before age 46. Sure. Why don't you come up and offer your here?
[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Sure, for the record, Mary Kate Mollman, Director of Vermont Public Policy with Bi State Primary Care Association. We support our federally qualified health centers, our Vermont Green River Clinics, and Parenthood, which they're having a legislative day, Just wanna flag that. What we I would like to call attention to section two of h six eleven. That is the repeal, the rebate. We don't love it, but given what's happening at the federal level, we're not gonna make a huge stink over it. It is a huge administrative burden and upfront costs for our covered entities, but, again, there are other things where we'd like to spend more of our capital. So on that front, since we did open up Act 55, we would like to propose an amendment that would close a loophole that we did not unfortunately proceed when we first passed Act 55.
[Sen. Virginia "Ginny" Lyons (Chair)]: And Act 55 was? Was Thank you for that.
[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: A bill that included a lot of several protections for covered entities in the 340B program. Briefly, what the three
[Sen. Martine Larocque Gulick (Vice Chair)]: So, I'm sorry. We just passed the
[Sen. Virginia "Ginny" Lyons (Chair)]: 340B bill.
[Sen. Martine Larocque Gulick (Vice Chair)]: That's what you're Right. I don't know if they're up to speed. They do a quick, like, primer on what three forty theme?
[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: I will send the thirty second three forty summary. I am happy to also talk a little more offline or come back later.
[Sen. Virginia "Ginny" Lyons (Chair)]: And is this repealing what we did last year? Is that what this repeal
[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: repeal is? Means? So, the repeal that is currently in six eleven repeals the rebate program prohibition.
[Sen. Virginia "Ginny" Lyons (Chair)]: So, let's go back to Senator Gulick's very good question
[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: you folks and a refresher, 340B is? 340B is a program that says for drug manufacturers to participate in Medicare and Medicaid and get that book of business, they need to provide drugs to safety net providers, so FQHCs, certain hospitals, Ryan White clinics, at a reduced price. Then when those drugs are prescribed, and the FQ- I speak for FQCs, so when FQCs then get reimbursed, they get reimbursed the full general reimbursement rate for that pharmacy. And so, that savings, that differential between what they purchase the drug for and what they then get reimbursed for the drug, is a savings that they can use to provide free dental care, different outreach, geriatric care, also reduce co pays for pharmaceuticals for those that are struggling to pay their co pays for pharmaceuticals. So, it is a key program that allows federal entities to stretch their federal dollars further by having this reduced drug prices?
[Sen. Virginia "Ginny" Lyons (Chair)]: So what I'm gonna suggest is that we'll come back to this. We'll have alleged counsel come in and talk a little bit about 340B, and then we'll have you come in and share with us your recommendation. Okay. But at least we got a look at concerns that you're bringing in from a community health center. Yes, yes. All right. Good, thank you. Thank you. Great. So if you're sitting in a spare reserve, you need to get up. And
[Mike Fisher (Chief Health Care Advocate, Vermont)]: We'll move our crew
[Mary Kate Mollman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: out. So
[Sen. Virginia "Ginny" Lyons (Chair)]: ledge counselor needs to put her work down on the payroll. We're gonna move on to six, so age six eleven, we'll continue work on. I don't hear anyone that's not happy. Yeah. Interested. Yeah. Three more of these stuff. It's good. Yeah. So We moved you from last week to this week. Thank you for your understanding. People. This is good. Yeah. Thanks for being here. Of course. So, do you know everyone on our committee? I don't think I've met. We're gonna introduce ourselves. John
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Morley from Orleans District. Nice to meet you. And I'm Benson from Orange District. She's John's. Who knew John? Yep. I know. It's easy, right?
[Sen. Virginia "Ginny" Lyons (Chair)]: There you go. Right? Ginny Lyons, Chittenden Southeast. Ann Cummings. Thank you. So you cleared the room. Thank you for being here. Why don't you share with us, I know you're the reporter of the bill, and just give us the overlook of what's here and why it's important.
[Unidentified House member (Reporter of H.46, Rare Disease Advisory Council)]: Sure. So we passed H-forty six out of our committee in the House last year, and it's been accolating to the Rare Disease Advisory Council. It's a super simple bill with a lot of impact. Approximately 60,000 volunteers this will impact who have a rare disease. So the bill establishes a rare disease advisory council in Vermont. Right now, we're the only state in New England that does not have one. A little background, a rare disease is a disease disorder illness or condition that affects fewer than two hundred thousand Americans. Over ten thousand rare diseases affect more than thirty million Americans. According to the National Organization for Rare Disorders, approximately one in ten Vermonters, over sixty thousand, are living with a rare disease. Which is a significant number, right? And this advisory council will really help support that group of individuals. So Rare Disease Advisory Council or RDAC in short, is an advisory body that gives this community a stronger voice in state government. They address the needs of rare disease patients and families by giving stakeholders an opportunity to raise awareness and make formal recommendations to state leaders on the most important issues that they face. There are thousands of known unique rare diseases and it's difficult to have an in-depth understanding of the rare disease community's needs. The RDAPs used their diverse membership and brought community support to identify barriers and applicable solutions to help the rare disease community. And then lack of awareness contributes to common and harmful obstacles that rare disease patients face, such as delays in diagnosis, misdiagnoses, lack of treatment options, high or out of pocket costs, and limited access to medical specialists. This advisory council will really help educate this community and their families so they can overcome some of these obstacles. Right now, last year it was 29 states and this year it's 33, I
[Sen. Martine Larocque Gulick (Vice Chair)]: just looked it up before
[Unidentified House member (Reporter of H.46, Rare Disease Advisory Council)]: I came down, states that have enacted legislation to support
[Katie (Legislative Counsel, Office of Legislative Counsel)]: their rare disease community.
[Unidentified House member (Reporter of H.46, Rare Disease Advisory Council)]: Proven that the RDAC can be an invaluable resource. And as I mentioned, Vermont's the only state in New England that does not
[Katie (Legislative Counsel, Office of Legislative Counsel)]: have
[Unidentified House member (Reporter of H.46, Rare Disease Advisory Council)]: one. So this advisory committee will support the state in strategically identifying and addressing barriers that prevent individuals living with rare diseases from accessing adequate and effective treatment and care for their condition. It will be composed of the following members to individuals with rare diseases, a parent or guardian of a person living with a rare disease, the Commissioner of Health or their designee, the commissioner of disabilities, aging and independent living or their designee, a representative of the health equity advisory commission, an academic researcher that has experienced or conducts rare disease research, a physician, nurse and pharmacist practicing in Vermont with experience treating rare diseases, and a geneticist or genetic counselor. And what they're going to do is convene public hearings, soliciting comments from individuals, providing testimony and comments on public legislation that impact this community, and consulting with experts to develop policies that identify conditions to recommend to the Newborn Screening Advisory Committee, and supporting timely patients' access to diagnosis services, treatment, and enhancing quality of services. They'll meet quarterly and the Department of Health will support them at mainstream. Thank you. You're welcome. So it's super simple, but it really will have a huge impact on a large number of our lives.
[Sen. Virginia "Ginny" Lyons (Chair)]: As you know, the challenge here is there's so few people, they don't have a voice. Yeah. So there's There's no way to have a voice. People who need to be heard. Yeah. Particularly. What was the vote in your committee at the time?
[Unidentified House member (Reporter of H.46, Rare Disease Advisory Council)]: One zero.
[Sen. Virginia "Ginny" Lyons (Chair)]: And the and the floor was it? You know? Questions for Representative Gulick? Nope. We're good. Great. Thanks so much. Thank you
[Katie (Legislative Counsel, Office of Legislative Counsel)]: so much. Thank you for your patience So with our
[Sen. Virginia "Ginny" Lyons (Chair)]: Katie's gonna walk us through in detail, and then we'll move on to page two seventy. I can go back. You you may leave. Oh. You have.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Katie, thank you for being here.
[Sen. Virginia "Ginny" Lyons (Chair)]: No problem. Good morning. Can do that? Thank you.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Good morning. Okay. So, I feel like representative Garifano has already done my job for me.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Gave me lot time. Thanks for understanding.
[Sen. Virginia "Ginny" Lyons (Chair)]: Why don't you just go through it all?
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Okay. What
[Sen. Virginia "Ginny" Lyons (Chair)]: I have to do with.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: It is conceptually a very simple bill that creates this council. There are some findings prior to getting into the creation of the council. The General Assembly finds that lack of awareness contributes to common and harmful obstacles that rare disease patients face, such as delays in diagnosis, misdiagnosis, lack of treatment options, high out of pocket costs, and limited access to medical specialists. And with the support of the National Organization for Rare Diseases, various patient organizations and stakeholders in the rare disease community, Rare Disease Advisory Councils are enabling states to strategically identify and address barriers that prevent individuals living with rare disease from accessing adequate and effective treatment and care for their patients. So that is the findings. And then we create this new chapter for rare diseases. And in section nine eighty one, we're creating the council. So there's created the Rare Disease Advisory Council within the Department of Health to provide guidance and recommendations to the public, general assembly, and other government agencies and departments as necessary regarding the needs of individuals living with rare diseases in Vermont. And then we list the members. Two individuals living with a rare disease, at least one of whom is an older Vermonter, one appointed by the speaker, one appointed by the Senate Committee on Committees, a parent or guardian of a person living with a rare disease, appointed by the Committee on Committees, a Commissioner of Health or Designee, a Commissioner of Dale or Designee, representative of the Health Equity Advisory Commission.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: I'm gonna spell it.
[Sen. Virginia "Ginny" Lyons (Chair)]: Do I? I don't need that spells. Oh, thank you.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Okay, well, guess we're
[Sen. Virginia "Ginny" Lyons (Chair)]: gonna have an amendment.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: That's gonna be an easy one, Ginny.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Yeah. Wait. Well, I missed that. There's a type of.
[Sen. Virginia "Ginny" Lyons (Chair)]: What is it? There's not a. Where is that?
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Under e.
[Sen. Virginia "Ginny" Lyons (Chair)]: The type of the Heath. Heath.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Equity. Heath. Wow.
[Sen. Virginia "Ginny" Lyons (Chair)]: Heath. I
[Mike Fisher (Chief Health Care Advocate, Vermont)]: don't know. I was just really quick.
[Sen. Virginia "Ginny" Lyons (Chair)]: There she is.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: I'd know about them.
[Sen. Virginia "Ginny" Lyons (Chair)]: I wonder who did that.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Me. No. I have to
[Sen. Virginia "Ginny" Lyons (Chair)]: say the editor did that.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: No.
[Sen. Virginia "Ginny" Lyons (Chair)]: Somebody's gonna question what Heath is. Yeah.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: That's what I was thinking. Yeah.
[Sen. Virginia "Ginny" Lyons (Chair)]: Okay.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Yeah, an academic researcher who conducts rare disease research appointed by the Speaker of the House. A physician practicing in Vermont with experience treating rare disease, appointed by BMS. A nurse practicing in Vermont with experience treating a rare disease, appointed by the Vermont Chapter of the American Nurses Association. Top of page three, a pharmacist practicing in Vermont, appointed by the Senate Committee on Committees, and a geneticist or genetic counselor appointed by the Senate Committee on Committees. Subdivision two, this council shall collaborate with any other relevant stakeholders it deems appropriate, including the National Organization for Rare Disorders. In subsection C, this is the responsibilities of the council, so the council may conduct the following activities for the benefit of individuals impacted by rare disease in Vermont. So, notice that's a may in not a shell, I just wanted to emphasize that. Convene public hearings and solicit comments from individuals impacted by rare diseases to assist the advisory council with creating a needs assessment, identifying gaps and services for individuals with a rare disease in Vermont, and the needs of their caregivers and providers. And two, provide a testimony and comments on pending legislation and rules that impact Vermont's rare disease community before the general assembly and other state agencies. Was there any discussion about, maybe it's Vermont, keep going. Okay. Consult with experts on rare diseases to develop policy recommendations that identify conditions to recommend to the Newborn Screening Advisory Committee as part of the Vermont Newborn Screening Program. And top of page four, that support timely patient access to diagnostic services and treatment and enhanced quality of services provided by rare disease specialists. Maintain a webpage on the Department of Health's website to serve as a resource for individuals with a rare disease that contains notices of upcoming meetings, meeting minutes, public comments and previous annual reports, and any other activities identified by a majority of the advisory council. Advisory council has the administrative, technical, and
[Sen. Virginia "Ginny" Lyons (Chair)]: legal assistance of the Department of Health.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Report as needed, the advisory council may submit any recommendations for legislative action to House Healthcare, Human Services, and Senate Health and Welfare Meetings, the commissioner or designee shall call the first meeting. Annually, the advisory council shall select a member to serve as chair. The council shall meet quarterly. Meetings may be held in person or remotely on an electronic platform as determined by the chair. Majority of the membership constitutes a forum. For reimbursement, members who are not otherwise compensated for their participation shall be entitled per diem compensation reimbursement for not more than four meetings annually. We have this taking effect on 07/01/2026.
[Sen. Virginia "Ginny" Lyons (Chair)]: K. What's that? I had a question. It's a little odd. Go ahead. How many total numbers are on this board?
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: I didn't add them all. No.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: No. No. I can do it. I didn't know if you just knew my dad. No. No. Excuse me.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: But notice this, a is two. Right.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Very good. Yeah. And then the only other question was I oh, nothing.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: I just got 11.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: 11? Yeah. Okay. The bottom of page three A says, Identify conditions to recommend the Newborn Screening Advisory Committee.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: So you may wanna hear more from the Department of Health. They have a screening program, and they have a list of conditions that newborns are screened for right after delivery.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Okay, so this is before rare disease. Is that kind of what you're getting at here? Is kind waiting for some rare diseases?
[Sen. Virginia "Ginny" Lyons (Chair)]: It could be. Okay, thank you. There are some that are easily screened for A little prick on a toe and get the blood and make them out. Yeah. I know. Little ones. Yeah. Wait, Senator Benson first, then Senator Collins back.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: So does the pharmacist have an organization?
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Yes. To do the appointing?
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Yeah, I was curious why the pharmacist being appointed by the committee on committees that opposed to the pharmacy organization appointing their own representatives. You're trying to And
[Sen. Virginia "Ginny" Lyons (Chair)]: we could we could think about that. I mean, could be the board of pharmacy. I don't know. There is a pharmacist. There is. A pharmacist from Brooklyn. Right. That's what they associate. And Theo Kennedy was the lobbyist representative. So they had they had an equivalent to EMS.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: I'm just thinking they may have a better idea of who the right person is than.
[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. Yes. And we would. We would have to reach out to them to ask for suggestions. Maybe Yes. Look at that. The appointments by the committee on committees and the speaker for professionals. Although I will say this, it's really important to have the legislative process involved in the selection. Try to be, sometimes you get it. Thanks. You didn't talk about that. I'm sorry. Sandra, go ahead.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: I was trying to look through I was wondering if there was let's see. The human services worked on with last spring, so it's not entirely fresh in my mind, but I was trying to remember if there was some effort to try to have people appointments from the house side and the senate side, but it actually looks like there maybe are more senate appointments.
[Sen. Virginia "Ginny" Lyons (Chair)]: There are two there are two on the senate side and one on the house side. So I
[Katie (Legislative Counsel, Office of Legislative Counsel)]: think there's more than that on the senate side. Yeah. I think there are four.
[Sen. Virginia "Ginny" Lyons (Chair)]: That wouldn't work for me.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: So I can't I
[Sen. Martine Larocque Gulick (Vice Chair)]: didn't I didn't say that. I didn't even hear it.
[Sen. Virginia "Ginny" Lyons (Chair)]: Senator Cummings had a question. Yeah. I may have missed it, but is there a parent or caregiver on this commission? Yeah. Alright. There it is. If they have time. That is true. Yeah. Okay. Well, it will be interesting to get testimony on this and figure out what the rare diseases are in our state, and you know, the list of rare diseases. Figure that out. Is there anything else we need to know here? I don't know,
[Katie (Legislative Counsel, Office of Legislative Counsel)]: nothing comes to mind.
[Sen. Virginia "Ginny" Lyons (Chair)]: Well, one thing that I do like is where they have the report as needed, I was gonna suggest one proposal of amendment would be as needed or upon request. Isn't that
[Katie (Legislative Counsel, Office of Legislative Counsel)]: the same thing?
[Sen. Virginia "Ginny" Lyons (Chair)]: That's they need to do or upon request. From the legislature. What call them in and ask them to tell us. All you have to do is say, come give us an update. Yeah. I don't know why we need to Well, you just need to be clear that you want information. That will void your confrontation. Oh my god.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Yeah. Okay. As needed, suggest that the council is deciding what That's that's what I thought. Request, in hers that the legislature is asking for the price drop.
[Sen. Virginia "Ginny" Lyons (Chair)]: That's exactly what I you need to get the tax bill. Alright, alright. So, committee, shall we pick up this one, keep going on this one? Sure. Okay, alright. Yeah, will there be
[Sen. Martine Larocque Gulick (Vice Chair)]: a fiscal note at some point? Because there is a Oh, there is already.
[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah, and it did go through. There is It was passed last year, so it must have gone through last year's budget. Okay. So, now it's gonna
[Katie (Legislative Counsel, Office of Legislative Counsel)]: have to go through Well, no, it wouldn't have. They worked on it after crossover.
[Sen. Virginia "Ginny" Lyons (Chair)]: No. Think it's a
[Katie (Legislative Counsel, Office of Legislative Counsel)]: big crossover. Okay. Gotcha. So it'll go through
[Sen. Virginia "Ginny" Lyons (Chair)]: the budget process this year. It's pretty minimal. What was it? This, though? The the per diem.
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: Yeah. Just at the very end.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: The per diem to pay the
[Sen. Virginia "Ginny" Lyons (Chair)]: the They they just stick out. It'll it'll be. Eventually, they do. Yeah. No might tell you that
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Yeah. Know that.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Nolan may tell you that it could come out of the departments. Like, it's I de have to see how many of the professionals Or how many people aren't showing up in their professional capacity? Say two individuals, one parent. Everyone else would seem to
[Unidentified House member (Reporter of H.46, Rare Disease Advisory Council)]: be showing up in a professional capacity.
[Sen. Virginia "Ginny" Lyons (Chair)]: That is de Yeah. Minimis. Okay. So, are you here for two seventy?
[Katie (Legislative Counsel, Office of Legislative Counsel)]: I was nosy, because this is my bill. Four, you've been shepherding for yeah. I just wanted to hear.
[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, okay. Well, we're gonna keep working on it. Good deal.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Ethics are changing. Okay. Alright. I gotta go to the floor, but I'll take
[Sen. Virginia "Ginny" Lyons (Chair)]: this Well, we might we'll I know that we have a bill that you're thinking about on baby food, so we'll have you wait a second.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Yeah. Yeah. We'll just be living here. Aw.
[Sen. Martine Larocque Gulick (Vice Chair)]: Okay. Nice addition. Okay.
[Sen. Virginia "Ginny" Lyons (Chair)]: Cool. Thank you.
[Unidentified House member (Reporter of H.46, Rare Disease Advisory Council)]: Bye. Thank you.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Alright. So
[Sen. Virginia "Ginny" Lyons (Chair)]: why don't we move to age two seventy and see what that would be. We could try and finish a little bit early. We're on the floor at 10:30.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Should Should I jump in? I didn't know if you had somebody from the house come
[Sen. Virginia "Ginny" Lyons (Chair)]: in for 02:17. Who's the reporter on this? Because this is the end of each two seventeen. Well, we've got them in. We'll have them in regardless.
[Sen. Martine Larocque Gulick (Vice Chair)]: Costa, thank you for
[Katie (Legislative Counsel, Office of Legislative Counsel)]: the copies. The hardest copies. I appreciate it. Okay, so this is H-two 70, an accolating to confidentiality and peer support sessions for emergency service providers. So this, maybe I should back up a little bit. A couple of years ago, there was a bill creating an advisory council emergency service providers, recognizing that there's at times a lot of traumatic incidents that could impact their mental health. This, I think, is an offspring of that. And this is that there are sort of in house, often peer to peer support sessions for emergency service providers, maybe to debrief after a certain incident. Sometimes it's individuals who are on staff who are trained to lead these peer to peer programs. Other times, a department might contract for the services of entities that do this. So this creates confidentiality for the communications that happen during those peer to peer programs. Human service, no, this wasn't healthcare. Healthcare, there was a lot of conversation about who was doing these services, and you'll sort of see where they landed, that it is not necessarily somebody who's certified as a peer support provider to do that, so they created their own term of emergency service peer support provider to distinguish from somebody who might be certified in doing this, acting in this role. So, one thing to keep in mind as you look through this. So, who is an emergency service provider? A long list, somebody currently recognized by Vermont Fire Department as a firefighter, a person currently licensed by the Department of Health as an emergency medical technician, an emergency medical responder, an advanced emergency medical technician or paramedic, somebody who is certified as a law enforcement officer by the Vermont Criminal Justice Council, including constables and sheriffs. An individual who's currently employed by DOC as a probation, parole, or correctional facility officer. An individual currently certified by the Vermont Enhanced nine eleven Board as a 911 call taker, or employed as an emergency communications dispatcher providing service for an emergency service provider organization. Individual currently registered as a ski patroller in a Vermont ski resort with the National Ski Patrol or Professional Ski Patrol Association. An individual currently working as a mental health professional in a crisis setting who is licensed, certified, rostered respectively to provide mental health services as a physician, APRN, specializing in psychiatric mental health, psychologist, a peer support provider, a peer support recovery specialist, social worker, alcohol and drug abuse counselor, clinical mental health counselor, marriage and family therapist, psychoanalyst, applied behavior analyst, or anyone who is non licensed or non certified psychoanalyst, non certified psychoanalyst, or any other profession that provides mental health services. Would've also made it easier to list who isn't.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: That's a
[Katie (Legislative Counsel, Office of Legislative Counsel)]: huge list. So these are all individuals who, the qualifier is that they're working as a mental health professional in a crisis setting. So this isn't a person who's operating a practice. This is somebody who's maybe going out with a police officer to respond to an incident. And H, somebody who's currently serving as a medical examiner or assisted medical examiner, as appointed by the chief medical examiner. We have a definition of employer, means an entity that employs or oversees an emergency service provider, is working in a paid or volunteer capacity. We have definition of what we mean by a peer support communication. That means oral or written communication made in the course of a peer support session, a note or report arising out of a peer support session, or a record of a peer support session. Peer support program means the program to provide services to emergency service providers. Peer support session means an individual or group session by a peer support specialist for emergency service providers who have been involved in a potentially traumatizing event or suffering from cumulative or chronic emotional stress by reason of their employment or volunteer service or related to other personal matters. So just note that four is like the overarching program, five is the individual session where the peer support is happening. And then we have a definition of emergency service peer support specialist. This means an individual who has been designated by an employer to serve as a member of an employer based peer support program, or designated by a peer support program to act as a peer support resource, somebody who has received training to provide peer support to emergency service providers who have been involved in potentially traumatizing events by reason of their employment volunteer service, or is otherwise a member of an organized or recognized Vermont Care Support Program. So any of those criteria and the person would be considered an emergency service peer support specialist.
[Sen. Virginia "Ginny" Lyons (Chair)]: Doesn't have to be everybody in an organization. It could be one
[Katie (Legislative Counsel, Office of Legislative Counsel)]: peer support specialist. It is not requiring that each department has a peer support specialist. This is just saying to the extent that these peer support counseling sessions are happening, This is what we mean by peer support council, I shouldn't say counseling, this is what we mean by peer support session and confidentiality attaches. Got it, yeah. Page four. Emergency peer support specialists shall not be construed to have the same meeting as a certified peer support provider, because we know when you worked on that bill several years ago that a certified peer support provider has a special meaning, there's a special certification program that's approved through OPR with particular clinical standards. So, is somebody different. Subsection B1, accept as provided in D, any peer support communication made by a participant in a peer support session of a peer support program led by an emergency service support specialist shall not be disclosed by any individual participating in the peer support session. So that is the sort of the rule, and then there are some exceptions. And B, any peer support communication relating to a peer support session led by an emergency service peer support specialist between the specialist and another staff member of the program, or between staff members of a peer support program, shall not be disclosed by any individual participating in the peer support communication. Under two, written support peer support communications are exempt from public inspection under the Public Records Act. They shall be kept confidential. The Public Records Act exemptions created in this section shall not be subject to the repeal provisions of the PRA Act. So there's an automatic review to repeal PRA exemptions and this would not be subject to it.
[Sen. Virginia "Ginny" Lyons (Chair)]: Do you know if gov ops, we'll have it when the reporter comes in, we'll ask this question, did gov ops look at this section in the house?
[Katie (Legislative Counsel, Office of Legislative Counsel)]: I did not go to gov ops. Okay.
[Sen. Virginia "Ginny" Lyons (Chair)]: But the bill go there. I would think the bill didn't go there.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Maybe they informally looked at
[Sen. Virginia "Ginny" Lyons (Chair)]: it. That's what I
[Katie (Legislative Counsel, Office of Legislative Counsel)]: was looking I wasn't in
[Sen. Virginia "Ginny" Lyons (Chair)]: the room. We'll find it.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Except as provided in D, any peer support communications made by a participant or emergency service peer support specialist during the support session led by the specialist shall not be admissible in a judicial, administrative, or arbitration proceeding, including during any discovery conducted as part of the adjudicatory proceeding. The limitations on disclosure imposed by the subsection shall not include knowledge acquired by an emergency service provider from observations made during the course of employment or volunteer service or information acquired by the emergency service provider during the course of employment or volunteer service that are otherwise subject to discovery or introduction into evidence. So, does that mean? So, that means, well, comments and communication made during the peer support session are not discoverable as part of a judicial proceeding. If there is, let's say you are an emergency service provider and you are observing just in your day to day work that somebody's behavior is becoming more erratic, and maybe you learn during the peer to peer session that that person is struggling with a substance use disorder, You probably wouldn't be able to say anything about what you've heard in the peer support session, but your observations that the individual's behavior have become more erratic could potentially be disclosed in a judicial setting if they're otherwise discoverable. It could be there are other bars to that information being shared. So we had lots of language that says, does provide LIDD. So here we go with our exceptions. Confidentiality protections described up above in B and C shall not apply to the following information as it pertains to individuals designated to receive such information in normal course of the individual's professional responsibilities. So this is information that can be disclosed. Any threat of suicide or homicide made by a participant of a peer support session, or any information conveyed in a peer support session relating to a threat of suicide or homicide. Any information relating to the abuse of a child or vulnerable adult, or other information that is required to be reported by law. Any admission of conduct likely to pose a risk to public safety. Any admission of a plan to commit a crime. So, if those were disclosed during a peer support session, are items, those are topics that could be disclosed to the appropriate person in the person's organization.
[Sen. Virginia "Ginny" Lyons (Chair)]: But it doesn't impose a mandatory report to the victim, that it could be.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: It just says that the confidentiality shall not apply. Top of page six, nothing in this section shall prohibit any communications between specialists regarding a peer support session or between a specialist and another staff member of the peer support program. So basically, two support specialists can have communications with each other. A specialist and somebody who's otherwise staffing the peer support program have communications with each other, even if both parties were in the same session.
[Sen. Virginia "Ginny" Lyons (Chair)]: In
[Katie (Legislative Counsel, Office of Legislative Counsel)]: subdivision B, an emergency service provider specialist or an emergency service provider participating in a peer support session from disclosing personal experiences or emotions discussed during a peer support session to the extent that such disclosure is consistent with the participant's obligations under HIPAA and associated regulations. So this is language that healthcare sort of added and had a larger discussion on. This is saying that if the provider was in a peer support session and they maybe talked about an incident that had caused trauma to them. This doesn't prevent them from sharing their experience or their emotions surrounding that experience with somebody else because they're talking about themselves as long as what they're saying doesn't contain HIPAA protected data. So, you know, if it was about a certain person and it's identifiable, that would be a problem. But if they're saying, I responded to a call and it really went badly and it's, you know, like that could be disclosed to another person even though they already disclosed it in their session. In subsection E, an employer, emergency service support specialist, or peer support program is not subject to civil liability for any injuries, damages arising from the provision of the services or for any disclosure made in violation of this section by an emergency service provider who participates in the session, unless the conduct of the employer, support specialist, or program constitutes gross negligence, recklessness or intentional misconduct.
[Sen. Virginia "Ginny" Lyons (Chair)]: Wow. Yeah, so I think the genesis of this bill goes back to PIVONG, Remember that committee we had that is 30 people and it was the I forgot the name of it but it was a request on the part of emergency responders. They need help in our PTSD, our concerns about the work we're doing. And then the next bill, which was the last session, I heard from folks in my community that we don't know how to respond when we're in an emergency situation and help people so then we try to put some language into the emergency guidelines through the Department of Mental Health and they've been working on that. And now we have this, which I think is really a good place to go. Sounds like it's a good place to go with peer support. There's a lot in here. We need to hear from the reporter of the bill and what transpired. We have just Senator Morley and Senator Cummings.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: I was just wondering, because like our fire personnel and sanitary services, there's policies and, that are in play here within so that if an event, a traumatic event does occur, then there's service available to that individual already. Something's driving this.
[Sen. Virginia "Ginny" Lyons (Chair)]: Sounds That's like it. It's that. It's that we need support when we respond to something difficult and we need someone to talk with.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: I'm surprised they're not getting it now, though. That's surprising.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: They may be getting it, but they may
[Sen. Virginia "Ginny" Lyons (Chair)]: not be getting it in a trained They don't have people who really understand how to deal with people who have these types of problems. So they have to have some skills in interviewing and communicating that don't exacerbate whatever the person's going through.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: Can I just issue a clarification? So this doesn't require any type of programming. So if it's this isn't weighing in that all departments have to have some
[Sen. Virginia "Ginny" Lyons (Chair)]: type of code of code
[Katie (Legislative Counsel, Office of Legislative Counsel)]: code of of of That makes code of code. When there is a program, you have this confidentiality protection.
[Sen. Virginia "Ginny" Lyons (Chair)]: Okay.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: As long as, you know, these guardrails
[Mike Fisher (Chief Health Care Advocate, Vermont)]: That's that's that's that
[Sen. Virginia "Ginny" Lyons (Chair)]: is the one they had. Thank you. Thank you. Senator Cummings, this we joke about committee who went through the alphabet, but it was because the Newport News wanted to be involved. It grew out of a grant called
[Katie (Legislative Counsel, Office of Legislative Counsel)]: And the former commissioner Yeah, of
[Sen. Virginia "Ginny" Lyons (Chair)]: he was a state police officer, chief in Broughtland, ended up as head of DOC or head of corrections, and he got this, it was a couple thousand dollar Con Hogan Public Service Award, and he wanted to do something because he was very concerned about police officers, that was his, all public emergency personnel. The thing that brought a lot of people out was there was a dryer fire in Essex and, like, a family of four died. Okay. And they said the the the volunteer people got there, and you're dealing with dead kids. Here it was the Barry Fire Department who had four children die on Christmas Eve from smoke inhalation. Heart wrenching. You know, they had to go home the next morning and deal with their kids, and they fought with it because now why didn't smoke alarms go off? There were smoke alarms, so you now have to have photo volcano smoke alarms because they're more sensitive to smoke than heat and the smoke kills you before the fire does. We heard from a lobbyist who was an EMT, and she said, you know, at least if you're a firefighter or police officer, you go back and you hang out with the guys, and then she said, you're an EMT, You go through some awful things. And you go back the next day, and you're in the State House, and no one knows, and there's no one to talk to about what you saw. So this group is supposed to help set up programs to make sure that these folks get the counseling. If you have a full time unionized fire department, you usually have something.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Very rare, I'm sorry.
[Katie (Legislative Counsel, Office of Legislative Counsel)]: But if you're
[Sen. Virginia "Ginny" Lyons (Chair)]: a volunteer, if you volunteer in rural parts of the state or even in my district, those are the ones that have the biggest concerns. I wanna let Senator Well, I just said we should hear from them. Oh, we will.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: I can
[Sen. Virginia "Ginny" Lyons (Chair)]: judge. We're just, this is our first rep. Yeah. I forgot to do the question. All department resigned. So, Senator Gulick has
[Katie (Legislative Counsel, Office of Legislative Counsel)]: a question, then we wanna wrap. Well, need to add to the list of folks.
[Unidentified House member (Reporter of H.46, Rare Disease Advisory Council)]: Oh, well. And in
[Sen. Martine Larocque Gulick (Vice Chair)]: places like Burlington, and I don't know about some of the other larger cities, but we have folks like the downtown ambassadors. Right. And we have the
[Sen. Virginia "Ginny" Lyons (Chair)]: cares teams. Yeah. I wonder if it should be included. Yeah. We'll ask that. Okay. It's a good question. Just the general We'll move on. Yeah. We'll hear from the reporter. We need to hear from the reporter because there's a lot here that gives us that.
[Mike Fisher (Chief Health Care Advocate, Vermont)]: Don't know why he has story is with one of your I
[Sen. Virginia "Ginny" Lyons (Chair)]: got stories. We all have stories in there. We're gonna what we're gonna do is we're going to
[Mike Fisher (Chief Health Care Advocate, Vermont)]: young child.
[Sen. Virginia "Ginny" Lyons (Chair)]: Hold it. Hold it. Hold it. What we're
[Alex McCracken (Director of Communications and Legislative Affairs, DVHA)]: going to do
[Mike Fisher (Chief Health Care Advocate, Vermont)]: is we're going to track
[Sen. Virginia "Ginny" Lyons (Chair)]: it for the day because we need to get up onto the floor, and and then we'll we'll come back