Vermont Legislature SmartTranscripts:

[Senator Virginia "Ginny" Lyons (Chair)]: Far. What's going You had the best joke on the floor. So good morning. This is Southern Health and Welfare and it's March 26. We're looking at bills that have come over to us from the house, and we are on So this is telehealth appointments using store and forward. Yeah. So we have testimony this morning. It's a very short bill. So let's see what we can do with it. Amy, Yeah. Well, listen. Yeah. Can do this with.

[Amy Johnson (Vermont Care Partners)]: Good morning. Good morning. The record, I'm Amy Johnson, Vermont Care Partners. I will keep my testimony brief. Okay. Care Partners supports age 84 in its current version. I know that when representative Rebecca was here, she talked about the value of the bill connected to administrative burden. I just want to add a couple of additional points from the designated and specialized service agency perspective. So, from our perspective, this bill will help with workforce and professional development. As we know, our workforce is very challenged right now, and we are the training ground for clinicians, or one of the training grounds for clinicians. So, we help to build the clinical bench, and one of the ways that we do this when folks are at our agency and they're working towards their master's and clinical degree, often one of the requirements is that they need to have a recording of counseling session with somebody in the office. And so, right now, we're able to do that in person. However, we know that telehealth, since the pandemic, telehealth has really opened a lot of doors clinically. When somebody's sick or a clinician can't get to somebody or they can't get to us, we're still able to see them. It's not our primary service delivery method, but it is a service delivery method, so this will allow us to be able to provide that recording that then goes to the schools, but then the professors are able to analyze and support that person on their clinical journey. So, building a professional bench is one thing that I think is really important. The other piece is around professional development. So, we have a variety of therapeutic modalities that clinicians use. It's one thing to be working with your supervisor and talking about what's happening in a clinical session and how you're working on fidelity to a therapeutic model. It's quite another when somebody's able to review a session and have that conversation with you about how it's going, know, what's working well, what needs to shift. So, it's a real benefit to clinicians in their professional development journey, as well as the folks that we serve, because we want to provide the highest level of clinical care to folks. And so, again, this would allow folks to be able to record, analyze, and then these sessions are deleted. Obviously, we are adhered to HIPAA, FERPA, 42 CFR, so all of that. So these are sessions that are protected, using HIPAA compliant software, and then are deleted and are not able to be accessed by other folks. But this just allows us to continue to build the clinical workforce because we do know that in person sessions are different than telehealth sessions, and we want to make sure that both are high quality. So, we're building a clinical bench and supporting professional development of therapeutic models, and so, I think that's all I wanna say.

[Senator Virginia "Ginny" Lyons (Chair)]: You've lot. You've a lot and

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: a little That amount of was the plan.

[Senator Virginia "Ginny" Lyons (Chair)]: Just one clarifying question. Would believe that this could be the required to notify each time.

[Amy Johnson (Vermont Care Partners)]: Thank you, yes. A per patient basis. No, it's, we, the clinician consents and the person being reported consents each time, yes. Thank you.

[Senator Virginia "Ginny" Lyons (Chair)]: Are there any insurance requirements that might limit the ability to do this? Let me think about, are there any Medicare rule about using telehealth or Medicaid or commercial insurance rules about doing this? I'm not aware of

[Amy Johnson (Vermont Care Partners)]: that though there might be I see everyone couple in the room.

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: Yeah. Great. Thanks, team.

[Senator Virginia "Ginny" Lyons (Chair)]: I'm gonna ask them. Thank you. It's great. It was basically the saying that is what we that's our asked bill. Yes. Yeah. This is what happens when you have people putting bills in and then somebody else saying, that's it. I actually

[Jen Harvey (Office of Legislative Counsel)]: was that my bill? Super senator of June.

[Senator Virginia "Ginny" Lyons (Chair)]: Yes. With Gulick, yeah. We had all talked about it. And Rebecca won. It's okay.

[Amy Johnson (Vermont Care Partners)]: It's good.

[Senator Virginia "Ginny" Lyons (Chair)]: As long as it happens. So, Devin, thank you for being here. Sure. It's good. I hope you can. And I do have

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: a PowerPoint. I Oh, good. Have the

[Senator Virginia "Ginny" Lyons (Chair)]: sharing capacity unit. Oh, no.

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: Thank you. Okay, great. Thank you for having me today. Diana Green, Vermont Association of Hospitals and Systems. And I am going to echo a lot of what you just heard from the prior witness and add another piece to this as well,

[Amy Johnson (Vermont Care Partners)]: which involves the sort of ambient

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: note taking software that has really made a difference in providers'

[Amy Johnson (Vermont Care Partners)]: lives and well-being and accuracy.

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: So, before I dive into that, I did want to just level set with where we were in our telehealth bills. We passed a lot of telehealth law in 2017,

[Amy Johnson (Vermont Care Partners)]: which was very helpful when COVID hit in 2020.

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: We were well prepared, but understandably the technology sort of rapidly increased from that point, and so it was a lot different than what we were talking about in 2017. And now one of the tools that providers are able to use is ambient AI technology, where there is software that is listening and then able to take notes that's not just a transcript, but actual notes. So, the provider does not have to go back and you know, weed through a bunch of words and ums and all different words. They absolutely have a good set of notes that they can look over and edit from there. The way this typically works with providers, and you may have dealt with this already in some of your visits, is that the provider will ask for consent from the patient and say, is it okay if we're reporting and using the software for note taking? The provider then does an interview and examination of the patient. Once that is complete, the recording goes through for processing and then the notes come out. That's all done in pretty much an instant for the provider, which is way different than it has been. I think we've all also been in appointments where the provider has been looking at the computer and not looking at you and trying to take notes. This allows the provider to sit down with you, make eye contact, and have a conversation. And then the notes will be available to the provider. They look at the notes, they edit them, and then they sign the note and the visit is completed.

[Amy Johnson (Vermont Care Partners)]: So

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: UVM UVM Health actually did a pilot study on this in 2024, where they took the vendor that they were interested in, and they used it with a group of about 50 providers, they compared it to another vendor, and they compared it to actual provider notes too, and they found that the vendor that they were interested in was actually higher quality in terms of the note coming out then than provider notes. So this is great for both the provider and the patient moving forward.

[Senator Virginia "Ginny" Lyons (Chair)]: And then so, when someone's in a study like that, they probably keep better notes than they would, apparently.

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: Yeah. So, it's already a higher option. And then, so it's good for the patient, it's also good for the provider. The real impact that we've seen is just a lot more work satisfaction from providers with the use of this tool. So, much improvement in terms of burnout rate and also fulfillment and satisfaction on the job. So this has been huge, this has been a game changer for our providers, and we're finding that because they're allowed to do these in person to person visits, but they're not allowed to do it, to use it in telehealth visits because there's only that prohibition against recording for telehealth, there's this weird disparity between in person and telehouse visits, and so that's what this legislation is trying to correct. So we support passage of H84, and we think it's great for both patient visits and quality of patient visits, as well as lower burnout and greater provider satisfaction,

[Amy Johnson (Vermont Care Partners)]: so we urge you to support it as well.

[Senator Virginia "Ginny" Lyons (Chair)]: Any suggestions for a change in the bill? No,

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: we have kept the, we have purposefully kept the bill very simple. Of course, we want patients to consent to this, but as long as they consent to it, then reporting is allowed as opposed to a blanket prohibition.

[Senator Virginia "Ginny" Lyons (Chair)]: All right, questions for me. How many providers are well, don't wanna say anything. Thank

[Amy Johnson (Vermont Care Partners)]: you. Thank you. We're good.

[Senator Virginia "Ginny" Lyons (Chair)]: All right. And we are fortunate to have Doctor. Ann Morris here. Why not? Thanks for being available. Oh, you're very welcome.

[Amy Johnson (Vermont Care Partners)]: For

[Dr. Ann Morris (Milton Family Practice; UVM Associate Dean for Primary Care)]: the record, I'm Doctor. Ann Morris, a family physician at Milton Family Practice. I'm a residency core faculty member, and I'm the associate dean for primary care at the University of Vermont. I very much appreciate the presentation that we just had for Devin Green, and I hope that my comments can supplement what she has to say. I would urge you to support this bill. We have been using ambient AI technology for the last year at the University of Vermont. I was hoping to talk about the two studies. First was this study that was just referred to in 2024, which with that pilot study, it showed up to a 60% reduction in burnout rate with the use of ambient AI technology for the attending physicians who were reviewing that. Last year, Doctor. Alicia Jacobs and myself and a couple other faculty members studied the pilot implementation of the ambient AI technology amongst primary care residencies, so the family medicine residency, the internal medicine residency, and the pediatrics residency at UVM Medical Center, and then also the CVPH, the UVM Health Family Medicine Residency at CBPH. And what we found with residents that took on and started using the ambient AI technology was that they also had improvement in their patient satisfaction. They feel like the mental load to complete notes has decreased. They feel like they have more time to spend in face to face with the patient, meaning there are actual richer patient physician interactions. And they are able to complete other duties throughout the clinic session, meaning they may be able to actually spend more time in terms of learning and staying up educational things that they need to know or completing inbox messages, or things, so that administrative tasks, with the use of the ambient AI technology during a clinic day. We also know from some work that we were doing around telehealth provisions and the CMS question that you were asking. Yeah. So there was, the ability to use telehealth had been removed from the CMS language, and it was passed and continued with the passage of the FY twenty six budget by the federal government. So we are still able to use telehealth for Medicare patients, which as we know then, it slows down the line to allow for everyone. So that's very important. We know that in Vermont, twenty five percent of patients started using video visits for telehealth on a regular, on a monthly basis or a regular basis, and up to 92% of providers are engaging in telehealth communications. That was some data that we pulled back in 2025 when- Can you

[Senator Virginia "Ginny" Lyons (Chair)]: give me the data again?

[Dr. Ann Morris (Milton Family Practice; UVM Associate Dean for Primary Care)]: Can you send in the data? Yes, I did mine. That was data that we used when Senator Welch was working on the Connect for Healthcare Act, and that was around telehealth, we That can find

[Senator Virginia "Ginny" Lyons (Chair)]: would be great, thank you.

[Dr. Ann Morris (Milton Family Practice; UVM Associate Dean for Primary Care)]: The reason why I think it's important now to combine these two things is to recognize the data that we found with the residents, being able to use the ambient AI technology improves the patient encounter with the fact that video visits are a little bit cumbersome when you are doing them on a computer. Meaning you have the video visit or the Zoom link up or whatever application you're using for the video, plus you have your EHR. And so the ability to use the ambient AI technology would allow us to focus more on the video and not have to be trying to take notes during the encounter. So I think that that is one of the most important reasons for us to be thinking about this bill. Using this in the last year, I would say that it has significantly improved my ability to work with patients and give them my attention. I also feel that speaking to the equity, often the patients that are being seen on video visits are being seen for conditions that include mental health. And so the ability to really give 100% of your attention to the video screen really improves the ability that they know that you are listening and completely and future. So,

[Senator Virginia "Ginny" Lyons (Chair)]: those would be my thoughts today. Terrific. Good. Questions? Oh dear. We can't do anything to this bill. Well, Senator Gulick isn't here, and Senator Morley isn't here, but I'm thinking that we've heard a lot of testimony. You. And I'm thinking that we'll probably put on our agenda pretty quickly. Could even be as early as tomorrow for a possible vote. There's no reason why we can't do this. This first year. Is true. No. I know. It could be. Okay. I'll have to get the the EFR, the housekeeping, so is a great Thank you. Does anyone else wanna contribute at this point? Good. So, this is from a person who's been I lost my primary care physician. Uh-oh. After many years, she retired early because as I transitioned to computer note taking Yeah. She grew up where you took Right. Hand or notes. One of each. Uh-huh. And she said she found that she was at home at night until ten or 11:00 every night, transcribing her handouts onto the computer, and

[Jen Harvey (Office of Legislative Counsel)]: she just couldn't keep it up.

[Senator Virginia "Ginny" Lyons (Chair)]: Which is why HIT is so critical across the board for administrative savings. May

[Amy Johnson (Vermont Care Partners)]: I add one other thing? Absolutely.

[Dr. Ann Morris (Milton Family Practice; UVM Associate Dean for Primary Care)]: The other thing that I would add is that I would say that ninety percent of patients consent in the exam room to using ambient AI technology. And it has become very, very quickly routine to their care such that they anticipate that we are going to be using it and the consent process becomes very simple with recurrent visits and continuity with the patients. So really at this point, I say I'm using AI technology today and they say okay. That would be a natural extension into the video visit because it's not a new concept. It's now the standard practice.

[Senator Virginia "Ginny" Lyons (Chair)]: Absolutely. Becoming the new one for practice. Okay. Alright. Well, let's look at we're gonna move on and we'll look at with Jen, we'll go through H5-eighty two and then after that we're gonna take those breaks. So be ready to vote on this bill. Make sure you go through it and read the whole thing. Good

[Jen Harvey (Office of Legislative Counsel)]: morning. Morning. Jen Harvey from the Office of Legislative Council. And if you do pass H-eighty four without any amendments, it will be one of the first times I've ever had a bill that has not changed from one of us introduced to one of us.

[Devon (Devin) Green (Vermont Association of Hospitals and Health Systems)]: Oh, this is

[Amy Johnson (Vermont Care Partners)]: exciting. We

[Senator Virginia "Ginny" Lyons (Chair)]: will not change other record.

[Jen Harvey (Office of Legislative Counsel)]: But it is. It was passed as introduced in the house. So they can't make any changes. Read it

[Senator Virginia "Ginny" Lyons (Chair)]: carefully so there are no little commas and the dates.

[Jen Harvey (Office of Legislative Counsel)]: This is sure we can come up with something if

[Senator Virginia "Ginny" Lyons (Chair)]: you would like to message. Gonna be competition to report this one. Alright.

[Jen Harvey (Office of Legislative Counsel)]: So I will put on page five eighty two. Okay. This is H582, an act relating to adult protective services. Sorry, switching gears here a bit. This is amending some provisions in Title 33 around adult protective services. The first being an amendment to the definition of neglect. And you'll hear more from, I'm sure, from the Department of Disabilities Aging and Independent Living, Dale, at some point, but it's my understanding that this definition reflects changes that are required to comply with federal law. So this would change the definition to say that neglect

[Senator Virginia "Ginny" Lyons (Chair)]: Go on to the next page. Right, as we're speaking of fail.

[Jen Harvey (Office of Legislative Counsel)]: Neglect means, and under the bill it would say, the failure of a caregiver, agent, or fiduciary to provide the goods or services that are necessary to maintain health or safety or both of the vulnerable adult. And my notes from the House were that the head of decision of licensing and protection from Dale said that the federal government said that neglect should not involve levels of consciousness, so that's why it's taking out language about purposeful knowing or reckless failure or omission, etcetera, and it's just a pretty straightforward definition, failure to provide the goods or services necessary to maintain the health or safety or both of a vulnerable adult. As under current law, neglect does not include self neglect, and then there's some specifications here that the actions or inactions of a caregiver or fiduciary shall not be considered neglect if the caregiver or fiduciary is acting. Then there's a few possibilities to pursue it to the wishes of the vulnerable adult, or at the direction and authority of the vulnerable adult's representative, or in accordance with the terms of the vulnerable adult's advanced directive. We've got definitions of some of these terms coming up. There's an amendment to the definition of a report, because the bill broadens where the statements may be provided from a reporter, that's just taking out a reference to specifically being statements to adult protective services, although they likely will end up there. Definition of reporter is amended because in this bill it could be to a licensing entity, you'll see coming up in the language. So a reporter is someone who has either submitted a report to adult protective services or to a licensing entity in language that we'll see coming up in this bill. A representative, this is just modifying the definition of representative to strike the reference to advance directive because we're putting in a definition of it. So it's not an advance directive specifically executed pursuant to 18 VSA chapter two thirty one, but just as you can see in the new definition in subdivision 35, adding advance directive having the same meaning as in that chapter. And then there's a definition of fiduciary. That is an individual or entity with the legal responsibility to make decisions on behalf of and for the benefit of someone else and to act in good faith and with fairness. And that term includes a trustee, guardian, conservator, executor, agent under empower of attorney or advanced directive, or representative payee. These are not generally terms that are either used or defined elsewhere in statute. Section two changes some of the language around the report of suspected abuse neglect or exploitation of a vulnerable adult. So except as otherwise provided for certain reports of neglect that we'll see. A report shall be made to the commissioner,

[Senator Virginia "Ginny" Lyons (Chair)]: the commissioner of Dale, or their designee.

[Jen Harvey (Office of Legislative Counsel)]: It provides and does not make changes to the information that has to be included in a report to the commissioner or designee. But then as we go further down on page four, this is the new language. If neglect is alleged to have been perpetrated within a facility that is licensed by the state, or a program licensed by the state, or by an individual licensed by the state, then the report will be made to the relevant licensing entity or entities specifies how. So neglect in a licensed facility or program would go to the applicable state licensing unit in accordance with state and federal licensing rules and regulations. Neglect by an individual licensed by the Office of Professional Regulation would be reported to that office, and neglect by an individual licensed by the Board of Medical Practice would be reported to that board. And then it requires that if a licensing entity receives a report of alleged neglect under subdivision one, then that licensing entity must notify adult protective services that the licensing entity has received a report and is acting upon it accordingly. And then it says if the licensing entity identifies neglect allegedly perpetrated within a licensed facility or program or by a licensed individual, the licensing entity shall make a report to adult protective services in accordance with subsection A. Section three amends the assessment and investigation provisions in the Adult Protective Services statute specifically around investigation to give some changes for timing and process. So under current law, within thirty calendar days after the date of notice advising that a report has been substantiated, an alleged perpetrator may apply to the Human Services Board for relief on the grounds that it is unsubstantiated, and it requires the Human Services Board to hold a fair hearing. Under current law, there's some language saying unless the commissioner agrees otherwise, the Human Services Board would give the hearing priority and provide an expedited hearing not later than thirty calendar days after the notice, but you can see it has to be held within thirty calendar days after the notice, advising that the report has been substantiated. So this would instead require the Human Services Board to hold a fair hearing within sixty calendar days after the date of the alleged perpetrator's request for a fair hearing, and it specifies that the prior, that priority would be given to appeals in which there are immediate employment consequences for the person who is appealing the decision, and the hearing officer's written findings and recommendations must be issued within fifteen calendar days after the hearing, not setting, as under the current law. And the act would take effect on October 1.

[Senator Virginia "Ginny" Lyons (Chair)]: Is there a reason why it's October 1? I believe that was

[Jen Harvey (Office of Legislative Counsel)]: the date requested by the department. Okay. And I recall if there was

[Senator Virginia "Ginny" Lyons (Chair)]: a reason, but just a different date.

[Jen Harvey (Office of Legislative Counsel)]: Yes. It was gonna be on passage and as in the middle as of the same time, and and Dale wanted to Okay.

[Senator Virginia "Ginny" Lyons (Chair)]: Move that vehicle. Okay. It's just okay. Yeah, so as you're going through, I remember we had quite a discussion about some of these things, including definitions. Yes, yeah,

[Jen Harvey (Office of Legislative Counsel)]: and it's my understanding. I think Katie was handling it that year, but- Right. But yes, I think there was a lot of work done on the definition of neglect and now it is changing again. Helping Let's hope and make sure. And

[Senator Virginia "Ginny" Lyons (Chair)]: then there'll also be questions we'll wanna hear about complaints that are made and how those are handled, so understand the process. And when, and how frivolous complaints are excluded and then how all complaints are responded to, so it gets to be addressed and balanced. Okay. Alright. Questions committee for Jen. So this is this is an update of where we've been on ensuring that adults who are in care are adequately cared for. Okay. Okay. We don't have anyone on the agenda to testify, and I was gonna take a little break at this point, but is there anyone, if you're here, and I know Rebecca you're here, and I see National Society Hospitals, Amy, you're all here, I'm assuming that you're gonna want to testify on the bill. We'd like to have that. Mhmm. So, let's see.

[Rebecca Silbernagel (Department of Disabilities, Aging and Independent Living)]: I would, for the record, Rebecca Silvernaigledale, I would request that, John Borden and Joan Nussbaum be asked to testify. Mean, that perfectly quit. They're the ones, this is their baby.

[Senator Virginia "Ginny" Lyons (Chair)]: Okay, well no, just let Melissa know, we'll put it on the agenda. We'll try to get this one moving along because I know it's important. Great, thank you. Yeah, we can do that. Anything else? Okay. So I don't know when Martine is going to be back again. Don't know the next bill that we have is a Katie bill. It's not scheduled until 10:15. So we're going to give ourselves, in this time of pressure, a little break. And so we'll go off live. Come back at