Vermont Legislature SmartTranscripts:

[Speaker 0]: You're live. All right, so this is Senate Health and Welfare. We're back on April 1 and we're picking up some testimony on H611, which is the bill relating to miscellaneous provisions affecting Department of Vermont Health Access. And Tess Betler is here from Compass Pathways. And Tess, why don't you introduce yourself for the record and let us know what Compass Pathways is and then your interest in the bill.

[Tess Betler (Associate Director of Government Affairs, Compass Pathways)]: Absolutely. Again, thank you so much for your time. My name is Tess Betler. I'm the Associate Director of Government Affairs for Compass Pathways and Compass Pathways is a biotechnology company investigating synthesized psilocybin for treatment resistant depression and post traumatic stress disorder. And I'm happy to continue with my testimony.

[Speaker 0]: Please go ahead. Thank you.

[Tess Betler (Associate Director of Government Affairs, Compass Pathways)]: Excellent. Good morning, Madam Chair and members of the committee. My name is Tess Betler, and I'm the Associate Director of Government Affairs at Compass Pathways. Thank you for the opportunity to testify once again to our amendment request. We respectfully ask the committee to include language in H611, the miscellaneous Department of Vermont Health Access Bill, which will automatically align Vermont law with federal scheduling decisions, allowing FDA approved psilocybin therapies to be prescribed and administered in a medical setting in Vermont without delay once approved and rescheduled. Vermont is facing a significant and ongoing mental health crisis with treatment resistant depression and post traumatic stress disorder continuing to impact thousands of residents who do not respond to existing treatments. As outlined in prior testimony, investigational COMT360 psilocybin treatment has shown promising clinical results and has received FDA breakthrough therapy designation. If approved, it would represent a fundamentally new treatment option for patients with VUE alternatives. However, without proactive state action, Vermonters could face unnecessary delays in accessing this care. Because psilocybin is currently a Schedule I substance, state statute must be updated following federal approval and DEA rescheduling before it can be prescribed. Vermont has taken this step before with cannabidiol, ensuring timely access to new therapies. Including the proposed language now in H611 ensures the state is prepared. It creates a clear regulated pathway for prescribing, dispensing and administering this treatment under medical supervision while maintaining appropriate safeguards. Most importantly, it prevents avoidable gaps between federal approval and patient access. We urge the committee to act now to ensure that if approved, this innovative treatment is available to Vermonters as quickly and safely as possible. Thank you for the opportunity to testify and your consideration to our request.

[Speaker 0]: Thank you. Questions?

[Sen. Martine Larocque Gulick (Vice Chair)]: Can I let her comment? Just a comment really, so that I'm obviously very much in favor of this. I have been trying to work towards the therapeutic use of psilocybin for a while now, just given our mental health challenges and it's being more and more trials are being done on how it's for PTSD and treatment resistant depression. So

[Speaker 0]: I'm hoping that we can look at it as we go through the markup So of the just remember the comments that were made here and we'll see where it fits. What's problem we're trying to solve? Why? So Tess, can you tell us what problem it is we're Absolutely. Trying to solve with your

[Tess Betler (Associate Director of Government Affairs, Compass Pathways)]: Yes. The problem underlying all of this is the scheduling of psilocybin. So federally and in Vermont, psilocybin is currently illegal. At the federal level, it is Schedule I. If this treatment was to be FDA approved, it would move at the DEA level from Schedule I to a lower schedule, essentially making it legal within United States. However, in Vermont, an additional state action needs to be taken in order to make psilocybin or an FDA approved psilocybin product legal, which is what this bill would solve for. We cannot ship and prescribers cannot prescribe within a state unless and until the scheduling is taken care of. I hope that answers the question.

[Speaker 0]: Does the scheduling No. At the state level. I'm trying to figure out, do we need to take action now because we have to come back next year and approve it, or is it just the state agency that's here and active? Yeah. We're not in session.

[Tess Betler (Associate Director of Government Affairs, Compass Pathways)]: Right. I believe that the legislature needs to take action on this. And then the department also needs to do some rulemaking, but ultimately something needs to change in statute before this can be administered to the public, to patients.

[Speaker 0]: Okay. So we'll have a discussion about that. Yeah, I'd like to hear. Right, and we'll hear testimony. Obviously the department and others will have to testify on that. Okay, thank you. Any other questions for tests? All right, terrific. So we'll move on to Laura Byrne. Also up here on our screen. Welcome.

[Laura Byrne (Executive Director, HIV HCV Resource Center)]: Thank you. Good morning. My name is Laura Byrne and I'm the executive director of the HIV HCV Resource Center. And I'm here to testify on behalf of the three AIDS service organizations. That includes us, Vermont Cares, and AIDS Project of Southern Vermont. And we're back to ask that you include our proposed amendment related to PrEP, pre exposure prophylaxis for HIV, and PEP, post exposure prophylaxis, in H611.

[Laura Byrne (Executive Director, HIV HCV Resource Center)]: Since I previously testified before your committee on this issue, I'll just briefly reiterate our support for the amendment, which has been submitted for your consideration. PrEP remains significantly underutilized in Vermont despite the fact that it meaningfully reduces the

[Laura Byrne (Executive Director, HIV HCV Resource Center)]: risk of HIV infection associated with sex and injection drug use. PEP can prevent an HIV infection if it's used within seventy two hours of exposure. Access to these medications is a proven health public strategy that also produces significant cost savings. Preventing a single HIV infection can save a healthcare system approximately $554,000 in lifetime medical costs. Given the ongoing instability at the federal level, Vermont must establish its own legislative authority to ensure that access to PrEP and PEP is broad, reliable, and free of unnecessary barriers. Barriers such as cost sharing, prior authorization, and limited prescribing continue to delay or prevent care for people at risk of HIV. I'd also like to mention that we support allowing pharmacists to prescribe and administer PrEP and PEP, as many states already do. This will increase access, particularly in rural and underserved communities where timely care can be difficult to obtain. Thank you for your time and for your consideration.

[Speaker 0]: Okay, so there's obviously an expense to adding this in.

[Laura Byrne (Executive Director, HIV HCV Resource Center)]: The spend.

[Speaker 0]: Cover out of pocket being covered. As it's draft.

[Laura Byrne (Executive Director, HIV HCV Resource Center)]: We just feel this very important to get the legislative language in right now in case the federal guidelines change.

[Speaker 0]: Federal Okay. Government is just not predictable. That's why we're here. Is it covered under federal guidelines now? Ask her that question. Is it covered now or would this be a new expense to the state?

[Laura Byrne (Executive Director, HIV HCV Resource Center)]: It is currently covered.

[Speaker 0]: By Medicare, Medicaid? Medicare, both I think.

[Laura Byrne (Executive Director, HIV HCV Resource Center)]: We're concerned that the guidelines might change.

[Speaker 0]: And so your concern is the guidelines might change, so let's put it into coverage right now for our Medicaid program?

[Laura Byrne (Executive Director, HIV HCV Resource Center)]: That's what we'd like to do. And we'd also like to expand prescribers and allow pharmacists to prescribe, which would increase access.

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

[Speaker 0]: All right. Good. We'll have to get we'll get further testimony on this. It's just not something that happens overnight. But thank you for the proposal.

[Katie McLinn (Office of Legislative Counsel)]: So Thank you.

[Speaker 0]: So, same thing with psilocybin. We're gonna have to, you know, look at both of those together. And then look at the number of folks who would be subject to this and then what the coverage costs would be. All of that information we're gonna have. Okay, thank you very much.

[Katie McLinn (Office of Legislative Counsel)]: Thank you.

[Sen. Martine Larocque Gulick (Vice Chair)]: All right,

[Speaker 0]: so now we have the Director of Public Policy at Bi State Primary Care, Mary Kate Coleman. Adam Schaff, welcome. We haven't seen you recently. Let you.

[Katie McLinn (Office of Legislative Counsel)]: Let go next to the table. So let's see if I can share.

[Speaker 0]: Sorry. Wasn't that what goes the last week? I know. It was

[Sen. Martine Larocque Gulick (Vice Chair)]: just yesterday. It was. Right.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Alright, thank you. Madam Chair, members of the committee, my name is Mary Kate Mollin, I am director of Vermont Public Policy with Five State Primary Care Association. As a reminder, we support Vermont's federally qualified health centers. We also support Vermont's pre referral clinics and Planned Parenthood. So we are here to propose an amendment to H six eleven, specifically section two. This is the section of the bill that amends has a current currently has an amendment on or repeals a section of act 55, which this body passed last session, which provided protections for the three forty b program, for covered entities participating in the three forty b

[Speaker 0]: program. I

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: will say on the onset, like, that repeal repeals the rebate program. We don't love it. But given everything that's happening at the federal level, we're not going to oppose that repeal. However, we would like to add a an amendment to act 55, which closes a loophole we think is important for our members. So just briefly, on a brief forty day program, I know Jen often comes in and walks everyone through high level for manufacturers to participate in the Medicare and Medicaid programs. They must also participate in the 340B program, which means they must offer reduced or prescriptions, drugs, to covered entities, which are fairly qualified health centers, the Ryan White clinics, certain hospitals, other safety net providers, offer those drugs at a reduced price. So those entities buy those drugs at a reduced price, and when they prescribe them out, they then get reimbursed at the full rate. And so that savings, that savings they have by not spending the full amount when they purchase the drug, is then used to support care in other ways. So, that's the high level. If you want to dig in a little deeper, we've got this nice kind of flow diagram which walks you through how the savings works and how the different parts of the system. I don't want to get too deep unless the chair would like me to. But essentially, federally qualified health centers are required by federal statute to use these savings to benefit patient care. We use these to reduce the cost of prescriptions for those who qualify for financial aid. We increase access to oral health care. This can go to free care for people who are uninsured, or even Medicare individuals. This dental is not covered under Medicare, so if they can't afford it, then they can get some support through our federally qualified health center, dental services. It can go to expanding mental health care, substance use disorder, treatments, nutritional security, transportation, translation, and other host of services that patients that federally qualified health centers get access to. So Act 55, what did it solve? It really helped protect covered entities participating in the 340B program, and specifically it protected their ability to contract with community pharmacies to continue to be part of the 340B program, and it also prohibited manufacturers from requiring burdensome reporting obligations at contract pharmacies. It also, one of the criticisms of this program has been the lack of transparency, so Act 55 addressed that by requiring hospitals to submit significant reporting for how they the money they re received through the program and how they spend it. Again, the FQHTs were left out of that because we are required by law to use for patient care. What the loophole that we have since identified, and we did not include it last time because manufacturers at the time were explicitly excluding in house pharmacies from reporting. We are now seeing manufacturers requiring in house pharmacies and as well as contract pharmacies to go through all of this owners reporting requirements. In Vermont, the contract pharmacies are now explicitly prohibited from or the contract pharmacies are exempted from those reporting, our in house is not, and we're starting to see that to be a problem.

[Speaker 0]: We Can you tell us give us an example of a contract pharmacy? It could be, I'm trying

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: to think specifically, it could be like Walgreens. Yeah, like

[Speaker 0]: a CVS. CVS. Some of them.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Like Yep. PBMs. PBMs are also prohibited. We did pass a law that prohibited PBMs from

[Speaker 0]: pick pocketing this program as well. Yeah.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: So how are we asking to close the loophole? Five five little words. That's all we're asking. Taking this section b in in act 55, adding after contract pharmacy or a three forty b covered entity. That would include our in house pharmacies and close the loopholes.

[Speaker 0]: So questions? Who's against this?

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: I imagine I'm sorry. Manufacturers.

[Speaker 0]: That was so retorable. Wow, okay. It's great. I don't have it. Questions? Okay, so it simply closes the loophole and just everyone's covered the same, yep, germs can't afford it, yep, helps that problem. Yeah, go ahead.

[Sen. John Morley III (Member)]: Trying to get this right. So the manufacturer's getting less money. Who's getting the less less money? You had a kind of a chart there.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Yeah. The the manufacturers by

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Are taking in less money.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Through this.

[Sen. John Morley III (Member)]: Yeah. Through this program, three forty b.

[Speaker 0]: Yeah. So

[Sen. John Morley III (Member)]: I'm only guessing, but I'm guessing the manufacturer's gonna get that money back. I mean They're going to do is increase pricing perhaps. So

[Speaker 0]: maybe go back to the program was established to ensure that low cost drugs are available at the patient level and it's done through various pharmacies that qualify. So maybe you could begin with that because I think that helps. It keeps the pharmaceutical manufacturers from setting a price that is not in any

[Sen. Martine Larocque Gulick (Vice Chair)]: way regulated. We don't. Yeah. So,

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: this is a very complicated

[Sen. John Morley III (Member)]: I should've asked. Go ahead.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: No. No. It's a good question. I wanna reiterate, this is if you were to start from the beginning, this is not how anyone would want to fund our healthcare system. No. Oh. Yeah. But it is what we have, and it has then critical to keeping the doors open for our safety net providers. This is if you this money were to go away, we'd see fairly qualified health centers close it and provide. So but to get to your question, it's a little more complicated than that. So they so the federal government requires manufacturers if they are going to participate in the Medicaid and Medicare programs, is a pretty substantial book of business. Yeah. They then have to offer these reduced prices to these safety net providers.

[Speaker 0]: And

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: my idea here is that this becomes then a source of funding that our safety net providers can use to support patient care and let the federal dollars that they receive and other avenues also stretch a little farther to support patient care. So it's if you read the federal statute, it is says, not sure how to get the quote exactly right, but it is to stretch federal, scarce federal dollars further.

[Sen. John Morley III (Member)]: I guess my only point is, okay, so they're not, they're protecting through Medicaid, Medicare, federal government, all that stuff, but the commercial side of things, is probably gonna pay all of them.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: I can't speak.

[Speaker 0]: So

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: go ahead. And there's also, like, if they increase the rates, if manufacturers increase the rates by a certain amount, then the savings become exponentially bigger for you.

[Speaker 0]: Yeah. So if you

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: see if you see manufacturers losing

[Speaker 0]: a

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: lot of money, it's because they're increasing the money the price faster. I don't wanna get too deep. If we

[Speaker 0]: need Here's what we're gonna do.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Some experts. When Jen comes in Yep. They have do

[Speaker 0]: 03:40 b so that so that you understand, senator, a little bit better Okay. That we we have been through this in here as recently as last year at this time, before.

[Sen. John Morley III (Member)]: I just see a question on the floor Yeah, coming up on

[Sen. Martine Larocque Gulick (Vice Chair)]: we'll be good.

[Speaker 0]: So, the issue isn't so much who's losing money as how can we protect it folks who are within our safety net. And so, yes, so there are savings at the 340B. So what happens is the drug is sold at a lower price here and then the pharmacy within the 340B organization can sell it slightly higher. And then the difference between that is money that is profit. And that profit is taken and invested in patient services. So it lowers the cost overall for two things. Drug itself and the services. And there's always been this big tension about taking money from the manufacturers or how can we guarantee that this little bit of, that this extra income is going for patients. And we debated that and we did that, we've been through that. So this question is about who should be reporting about that lower drug cost that they're getting. And so the larger organizations like Walgreens or CVS or others are getting this benefit and this, but they're not reporting back. So we're just trying to understand what's happening between here and here with those few organizations. That's what we are. You've lost me. Okay, I caught you. See that, so I thought 340B went to hospitals, not to Walmart. Yep. And hospitals, this was the drugs that when they charged me an outrageous price for an aspirin, they're paying a lot less for. They're supposed to put that profit differential into the patient Patient service, the HQAHCs do dental, which is Or you wanna see a portrait monitor? Look for someone with no teeth. So dental service is very expensive and people don't get it. So the question you're asking is what we'll How did Walmart get it? So, I didn't. We had it. But, so, what we'll do, Senator, because this is the question of the day, what does or a 340B covered entity mean? Who's in to That's put it in why I asked that question. So Jen will come in and then Griller comes back and we'll get the answer.

[Sen. John Morley III (Member)]: It's just how the money falls. And then you also said, I lost it. Okay.

[Speaker 0]: We'll get it. They'll we'll get it. You'll it'll come back to you. Write it down. Yeah. And then we'll we'll have we'll come back and look at the bill again, and we'll look at the language as it may or may not fit in the bill.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Yeah, and I will mention just the burden. We were talking about this yesterday with our members. The administrative burden is significant. We're talking about one of the two FTEs needed to figure out all

[Speaker 0]: of the reporting around the reporting program. Wow. That's really sweet.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: You're in the wrong speed.

[Speaker 0]: It's like it's keeping people. Yeah. Make this up.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Alright. Well, thank you.

[Speaker 0]: Well, no. Thank you. It's it's helpful that we now we know where we're headed and what your interests are and we we do want to fix a problems with prior legislation. So, it's just one of those. I view it as a technical

[Sen. Martine Larocque Gulick (Vice Chair)]: It is truly as a technical understanding. Correct.

[Mary Kate Mohlman (Director of Vermont Public Policy, Bi-State Primary Care Association)]: Right, thank you very much.

[Speaker 0]: Thank you. So, we have Logan Davidson, Logan Davidson online. Logan, thank you for being here.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Thank you, Sharon. Let me

[Speaker 0]: Yes. So, Logan, why don't you introduce yourself for the record, then do we have your testimony?

[Logan Davidson (Legislative Director, Veterans Exploring Treatment Solutions)]: I have my screen shared with it, and I can email it over as well after If patient

[Speaker 0]: you can enlarge it just a tiny bit, we'll be able to read it better while you're going through. A little more.

[Rep. McGuire (House Human Services Committee)]: How's that? Is that good?

[Speaker 0]: Very good, thank you.

[Logan Davidson (Legislative Director, Veterans Exploring Treatment Solutions)]: Okay, perfect. And my name's Logan Davidson. I'm the Legislative Director of Veterans Exploring Treatment Solutions, which is a five zero one c three nonprofit organization with a mission to end the disproportionate incidence of suicide among American veterans by underwriting treatment grants for Special Operations Forces veterans seeking psychedelic assisted therapies for PTSD, traumatic brain injury, and other mental health conditions, and we are here to support the proposed amendment to six eleven that would automatically align Vermont law with federal scheduling decisions, allowing FDA approved psilocybin therapies to be prescribed and administered in a medical setting in Vermont without a necessary delay. We thank you we thank you for the opportunity to speak today about the urgent need for new treatments for veterans struggling with post traumatic stress, traumatic brain injury, and other service connected conditions. Since 2019, Vets has provided financial and organizational support, including preparation and integration coaching to over 1,000 veterans and veteran spouses through our foundational healing grant program, enabling them to travel outside The United States and access life changing psychedelic assisted therapies. The fact that these veterans must leave the country to access potentially life saving treatments underscores exactly why legislation like this amendment matters so deeply. The veteran mental health crisis has reached staggering proportions. Since 2001, over one hundred and twenty five thousand veterans have died by suicide, and twenty nine percent of global war on terrorism veterans are known to suffer from PTSD. The disproportionate incidence of PTSD among veterans is a direct driver of the disproportionate incidence of suicide among them. We lose no less than seventeen and by some estimates as many as forty four US veterans to suicide every day, nearly double the rate of non veteran Americans. This urgent crisis demands swift action to expand access to novel effective treatments. Existing treatments for PTSD and treatment resistant depression often fall short for many veterans. Dimensional therapies provide limited relief and rarely address the root causes of these conditions. The only FDA approved drugs for PTSD are selective serotonin reuptake inhibitors, SSRIs. And while they show an overall response rate of approximately sixty percent, only twenty to thirty percent of patients achieve complete remission. Far too many veterans continue to suffer without effective care. Fortunately, we are seeing significant progress in the field of psychedelic research. Psilocybin has received FDA breakthrough therapy designation with clinical data demonstrating promising results for patients with treatment resistant depression and PTSD, conditions that disproportionately burden Vermont's veterans. These therapies offer a level of potential effectiveness that traditional treatments cannot match. But without proactive action by this committee, Vermonters could face avoidable delays in accessing this care once it receives federal approval. This amendment takes a responsible evidence based approach that Vermont has used before. The state has already enacted this kind of proactive scheduling framework for cannabiol. This amendment applies the same sound forward looking logic to FDA approved psilocybin therapy. It does not legalize or decriminalize psilocybin. It simply creates a clear regulated pathway for prescribing, dispensing, and administering this treatment under medical supervision, ensuring that once federal authorities have determined the therapy is safe and effective, Vermont's laws will not stand between a patient and their doctor. Other states have already taken the step. Arizona, Colorado, and South Dakota have all enacted similar trigger legislation, and they did so with bipartisan support. It is important to recognize that this is not a red state or blue state issue. It's not a matter of Democrat or Republican, liberal, or conservative. This is an American issue. Veterans from all walks of life have sacrificed for our country, and it is our responsibility to ensure they have access to the best possible care as expeditiously as we can provide it. Our government sent a generation to war, and now it is our duty to care for the invisible wounds they carry home. After two decades of sustained combat, our veterans deserve the best possible care. We urge this committee to include the amendment in h six eleven and position Vermont to provide timely access to therapies that can truly heal those wounds and save lives. Thank you for the opportunity to address the committee and for your leadership and commitment to our nation's heroes. Vet stands ready to assist in any way possible to support the successful implementation of this initiative.

[Speaker 0]: Thank you, Logan. Very helpful. Questions? Go ahead, sorry.

[Sen. John Morley III (Member)]: I didn't know what

[Rep. McGuire (House Human Services Committee)]: psilocybin was, I just looked at it. Mushrooms.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Yeah, didn't know that.

[Speaker 0]: I didn't even know that. Oh, we should have done that. Logan, I mean, I

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: have no idea what it was.

[Speaker 0]: Oh, golly, Ned. Okay. Logan, from your perspective, can you share with the committee what your understanding is what psilocybin is and what it does, how the active ingredient might, what you know about it?

[Logan Davidson (Legislative Director, Veterans Exploring Treatment Solutions)]: Yes, yeah, absolutely. Psilocybin is a naturally occurring compound found colloquially known as magic mushrooms. What we're talking about here would be pharmaceutical psilocybin, which is a synthetic compound. And the way that it's delivered traditionally, so for example, veterans who we have internationally to countries where it's legal to access, the psilocybin is administered under medical supervision and with support from a licensed mental health care provider. And so what that usually entails is a treatment room, a little bit more comfortable than your traditional doctor's office, right, better lighting, more comfortable chairs, closer to a therapist setting than a physician setting. And then folks are able to take the medication. There's some time where you wait while it takes effect. Sometimes folks listen to a specially curated playlist. Sometimes folks just sit and kind of meditate with their thoughts or have conversations with that licensed mental healthcare provider. And then different folks approach the treatment differently. Something we've actually found with a number of combat veterans is the PTSD does not originate in combat. It actually originates much earlier in life. And there may be a correlation between that early trauma and their decision to seek out a combat facing role, especially a special operations combat facing role. And folks are able to confront, you know, and process whatever those traumatic experiences were with the support of that licensed mental health care provider. And what we found is it's the addition of this medicine that allows them to engage with those experiences, process that trauma, and find long lasting healing. And also, in addition to the mental health side, there is a physical health component. Psilocybin is very positive, on brain activity, and can actually, increase neuroplasticity, which allows the brain to learn. Again, we get older, our neuroplasticity goes down, so it allows you to learn and so you can relearn things. So if you fell into a fixed negative thought pattern about yourself, about your experiences, say a moral injury component, this allows you to reengage and re understand how those things happen and find long lasting healing. And that's what's so important is that it's not a medication that you take every single day. It's not a maintenance drug. It is a medication and a treatment that allows folks to reach remission on their post traumatic stress disorder symptoms, for example, and then fully reengage with their family, with their community, with their work. And that's what we're really looking for is that kind of foundational healing. It's why we call it the foundational healing grant program that resolves these issues at the source rather than just treating the symptom.

[Speaker 0]: Thank you for that, that's helpful. It was what you've described as a very special therapeutic process for folks with TBI or PTSD.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Absolutely.

[Speaker 0]: Yeah, so this committee has heard testimony previously about the use of psilocybin. I know that California has quite a system for doing that and training for folks who work with people with this psychoactive drug. It's a good question and so I know. So Logan, thank you for that clarity. We will consider your recommendation and as well tests. Did you want to comment at all about this further?

[Tess Betler (Associate Director of Government Affairs, Compass Pathways)]: I just wanted to make one final comment just reemphasizing that the language that we're asking for would ultimately just provide access to an FDA approved treatment, right? Something that is approved at the federal level that has been proven to be safe and effective by the Food and Drug Administration and then rescheduled by the Drug Enforcement Administration.

[Speaker 0]: So, and then the question is, without having really looked at the language thoroughly that you are recommending, are you also recommending special training for folks, professionals who utilize the drug with patients? Because that's one of the things that we had talked about in our committee previously.

[Tess Betler (Associate Director of Government Affairs, Compass Pathways)]: Yes, absolutely. Whilst training is not specifically mentioned in this bill, all training and everything related to training and administering of the drug will be determined by the Food and Drug Administration at time of approval with something called a REMS, a risk evaluation and mitigation strategy. So all of that will come down from the federal government at the time of the potential approval.

[Speaker 0]: Good. And then we are also going to have to look at that in the context of our state. FDA can say one thing but then we always improve it.

[Sen. John Morley III (Member)]: So we'll hear from the Department of Health.

[Speaker 0]: Oh yeah, yeah, definitely. Do you mind? In a minute. Yes, we will. And we'll hear from others who have comments to make about this. Yeah, was

[Sen. Martine Larocque Gulick (Vice Chair)]: just gonna sort of echo what Senator Lyons just said, which is he worked here a few years ago, but we did get a lot of testimony from practitioners who just, it's already, it exists. People are already getting help from suicide. And it was really compelling testimony.

[Rep. McGuire (House Human Services Committee)]: I

[Speaker 0]: mean, and stepping out ahead so that we know that when FDA does whatever it is it's going to do, we're in sync with it. Let's hope it's not something a step backwards. Okay, so that's it for age six eleven. We have a lot of time on our hands this morning, so I'm gonna suggest to the committee two things. One, is today Monday?

[Rep. McGuire (House Human Services Committee)]: Yes.

[Speaker 0]: K. Gulick, when are we doing budget?

[Sen. Martine Larocque Gulick (Vice Chair)]: Friday. Friday. Okay.

[Speaker 0]: We have the budget coming in Fridays with Nolan and Amy. We'll look at that. And now we're gonna ask folks if we if we have time Friday. Otherwise, we'll do it another day. We'll be scheduling people. Here's the way we're looking at the budget. We're doing just a a pre not in-depth look. We're just we're looking at the budget overall. We're looking at what was in the governor's budget, what the house has passed, and then there are other things that have not been included and we'll be hearing from people who were either, in their opinion, underfunded or not funded. So we'll be looking at that separately. So when Nolan and Amy come in, we'll just be getting our arms around what's there in budget. Our goal is to try to make some recommendations down the hall. So I'll carry them down there. There are some things I think important to us. So you have to think about everybody right now is contacting us. I know and I keep saying no I can't talk. So we'll hear from who's And do we have something else on our agenda? Looks like it. What else is on our agenda? Oh well that's after adjourn. No, it's not public. It. Thank you. So we're going to move on to that but just so you know that's what's coming. You don't have to dive deeply into the budget it's really what your thinking is about what the needs and gaps are within your district or when in here the things that we're hearing. And we do have a little bit of work. That was wonderful. The other thing I'll ask of you is to look at the bills that we have up on the wall and let me know the ones that are important to you. Try and get through as many as we can. Okay. So now that I can see how my agenda is structured, we can move to age. That was your April fools. That is fooled on your head. Punishment. Okay, so we're going to move on to page six sixty. We have not been through the bill. We're going to sort of, is key coming in? Yes. Okay. So we'll start with the reporter. Are you the reporter?

[Rep. McGuire (House Human Services Committee)]: That I am.

[Speaker 0]: That's wonderful. So why don't you come up on H660 and I will say to the committee right up front that I have a lot of interests and suggestions and a lot of work for us to do around that within this bill. Representative McGuire, good to have you back.

[Rep. McGuire (House Human Services Committee)]: It's good to be here, Chittenden Lyons. Thank you for having me.

[Speaker 0]: So, what I would ask of you is to give us the of overview of where it was and what's in it, just generally, then we'll go through it in detail with you.

[Rep. McGuire (House Human Services Committee)]: Yeah. I'll lay off the how everything's been appropriated and forth and walk through. So the record representative, Maguire, House Human Services Committee. Again, John Morley, chair, thank you for having me. It's something just give a brief overview of age six sixty. Age six sixty, the bill that directs the fiscal year twenty twenty seven appropriations for the Vermont's Opioid Abatement Settlement Fund and the Substance Misuse Prevention Special Fund. The goal of this bill is to ensure that settlement dollars continue to support a balanced statewide response to opioid use disorder, strengthening prevention, treatment, recovery, and hiring adoption services while building long term sustainability within the system. H-six 60 allocates funding across the continuum of care with investments in community outreach, recovery housing, syringe services, peer recovery coaching and correctional facilities, and transitional and shelter based supports. This includes funding for 26 outreach and case management positions, expanded recovery residence capacities statewide, syringe service programs, and peer recovery coaches in both facilities and probation and parole offices. The bill also supports shelter based harm reduction programs and the creation of additional NAR certified recovery residence beds in underserved regions. The bill further includes youth focused prevention investments in substance misuse prevention special fund, directing funds to community programs in Barrie, Connecticut River Valley, Wyndham County, and Munozie to expand youth engagement, prevention programming, and family centered education. Age six sixty also strengthens statutory requirements for the Opioid Settlement Advisory Committee, which I have the opportunity and pledge to serve upon, ensuring board consultation with individuals with lived experience of opioid use disorder, frontline professionals, recovery centers, and the Health Equity Advisory Commission. Bill requires that ongoing funding requests include a sustainability plan, recognizing that settlement funds are time limited and must be used strategically. Quickly to see our program review and stewardship. Also, bill is to ensure long term fiscal stewardship. The bill temporarily pauses the acceptance of new funding proposals for FY '28, except for initiatives already designated for annual support, and directs the Department of Health and the advisory committee to conduct a thorough review of prior appropriations, program outcomes, and sustainability. Revisions in unspent prior year funds are also returned to the ultimate abatement special fund, and age six sixty will take effect 07/01/2026, aligning with the start of our fiscal year of '27.

[Katie McLinn (Office of Legislative Counsel)]: Thank you

[Speaker 0]: for your work on the Advisory Committee. Maybe it's what you could share really briefly with the committee is how you go through and listen to folks making a request of what's in the science test.

[Rep. McGuire (House Human Services Committee)]: Well, this year, committee took 67 applications were submitted to the committee through a review process. We were then tasked with reviewing all 67 of them, and then more or less pulling out a total of the ones that you're seeing funded here, which was 15. It doesn't mean that all these applicants weren't eligible for the funding. We have a, it is a finite bucket, and therefore we have to allocate wisely. What we see as the most effective approach is that way, it is equitable across the state, different regions, whether it's through the ones that are aligned on heart reduction, prevention service, treatment service, recovery vest. After we get done going through the initial review of the applications, we came back as individual members with our recommendations through that. Then a more or less consensus was taken, and the majority then got reviewed, and it was 15 of them. We brought each one of them on in. They provided their overview of what they needed the funding for, and then we made the recommendation on to apply it or not. It was difficult and challenging at times because we are limited to the amount of times that we can meet. So usually, the first couple of meetings are then designing what the application process is gonna look like, and then the applicants start coming on in. Then the next meeting is getting together and we're throwing this. Then the following meeting is at to where you really are overloaded with information. And at times, not getting all the information can result in maybe knocking out a couple agencies that really could have fit the need much more than the next. But that's needed, and so it's And I believe that's why we looked at stepping on back this going around and saying, Hey, let's use the committee to oversee what's already been provided, get some feedback, get some data, get to know whether or not how we're funding these things are working, are being productive back into the community, and then CSAT and just keep the funding going for those four initiative things.

[Speaker 0]: Okay. Thank you. And the opening committee?

[Rep. McGuire (House Human Services Committee)]: Oh, yeah. Pass out of our committee. 11 will hold.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: 11

[Rep. McGuire (House Human Services Committee)]: Madam chair, I am short.

[Speaker 0]: Was it eleven zero zero?

[Rep. McGuire (House Human Services Committee)]: I am short. Okay. Believe one person on. Am in. Baby, help me out with this.

[Speaker 0]: Oh gosh. Don't worry about it.

[Sen. John Morley III (Member)]: 1001.

[Speaker 0]: 1001.

[Rep. McGuire (House Human Services Committee)]: Okay. Yes. Pass out to

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: you 1001.

[Speaker 0]: And then voice vote on the floor?

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Pass.

[Speaker 0]: Yes. Okay.

[Rep. McGuire (House Human Services Committee)]: Yeah. Was on roll call. Okay.

[Speaker 0]: We have the That always helps us.

[Sen. John Morley III (Member)]: This is a special fund, so this money came in from something.

[Speaker 0]: We're gonna hear from Nolan and Katie, and so we'll get the historical data on this, and I can also go over that.

[Sen. John Morley III (Member)]: I figured.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Yes? For the record, Nolan, want to ask Bill Wedgey, know if that's a sheet that has the history OSAC recommendations, the health department recommendations, what human services recommended, what passed the house. Excellent. So you can do a side by side and a historical of what's been funded of those before. This is exactly what we need. So you decide whether you want to hear that or the language.

[Speaker 0]: Oh, we're gonna start with you on that. But any questions for representative flyer? Really brief question,

[Sen. Martine Larocque Gulick (Vice Chair)]: if you share lines, it sounds like the decisions you made were all dated for them and you can use evidence that you have and Yeah. Yeah. It's great. Thank you.

[Rep. McGuire (House Human Services Committee)]: No. Just a quick also back. Sorry. We did submit, as the OASAC committee, we did submit recommendations to human services. Also, AHS submitted also a set of recommendations. So we did we were responsible for kind of bringing them all together. Most of them did align, so. Yeah.

[Speaker 0]: That's a new process. Anyway, that's interesting, AHS. But your recommendations go to the Commissioner of And then the Commissioner of Health makes recommendations for purposes of appropriations. Just thinking procedural. Okay. Thank Thanks for your work on this.

[Rep. McGuire (House Human Services Committee)]: Yes, and there was also an amendment to the bill that's in the new bill, yes. The amendment to the bill was to remove, and I think Nolan may be able to explain a little bit better, there was a three that were allocated out of the prevention, three recommendations, and we designated them over to the prevention on the amendment that was put on and puts those back into the the OSAC. Sounds like a

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: counted that in my spreadsheet. Oh,

[Rep. McGuire (House Human Services Committee)]: yeah, yeah.

[Speaker 0]: Yeah, so the substance use prevention fund is a different fund, and we're not was Maryland here. I'm sure that everyone would like to get to it. That's the same thing. That who doesn't like free money? I know. It's money. Hey.

[Sen. Martine Larocque Gulick (Vice Chair)]: Look for a brief.

[Rep. McGuire (House Human Services Committee)]: Alright.

[Speaker 0]: Thank you very much.

[Rep. McGuire (House Human Services Committee)]: Thank you very much, Ann Cummings. See you all tomorrow.

[Speaker 0]: Alright. Now we're here. So I'm looking at Katie and Nolan. How do you want to do this, Katie?

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Do you want to run through the bill and then have me

[Katie McLinn (Office of Legislative Counsel)]: go it? Think either way it works. I can give you a little overview about the Let's do that. Okay.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: I should do that.

[Speaker 0]: And then have Nolan come up and show us the pictures. And I just will say upfront that because we've been focused in here on substance use disorder prevention, residents, recovery services, that there's a huge amount of interest in accessing the opioid settlement fund to use for any bill that comes in or any idea that comes in. So it sometimes can get a little bit confused. Our goal is to try to sort all that out. The Substance Use Prevention Fund is another fund that we also need to sort out in here. What are the criteria for use? What are the guidelines? So this bill raises a significant number of issues for us that we want to look at. I know that the administration would like to use all the money. The advisory committees would like to use all the money, we would like to use all the money, the recovery residences wanna use all the money, so it all lands right here. Here we are. So let's look at age 66. Sure.

[Katie McLinn (Office of Legislative Counsel)]: Can you make that, Office of Legislative Capital? So, there's the opioid abuse special fund that was established, I would say maybe five or six years ago at this point, and this is funds from settlements from litigation with pharmaceutical companies that produce opioids. Sure. And every year there are appropriations from this fund. When this fund was initially created, one of the requirements of getting the funds was having a advisory group to weigh in on how the funds should be spent. So, in our statutes, we have several provisions about who is on the committee. There's also language in statute about how the money can be spent. There are parameters that were part of not only the litigation agreement, but they were adopted into statute about how the money can be spent. So, the practice has been for the past several years that this money has traveled alone in its own bill to make it easier to keep track of where the opioid appropriations are happening. So, this is this year's iteration of expenditures from that fund. As Nolan was sort of teeing up and as his chart shows, sometimes the health department and the advisory group that's in statute have maybe different recommendations. So, that happened this year and you'll have that chart to work through to see where the differences were. Obviously, the House made decisions and those were policy decisions. Representative McGuire is also talking about using the Prevention Misuse Fund, the committee report that Human Services passed out did have some of the items in the list in subsection A coming from that fund. Appropriations changed that and has everything coming out of the Opioid Abusement Special Fund, but language was added to have work done off session and by the advisory group to take a deeper look at what and when the prevention fund should be used instead of those. Goes to

[Speaker 0]: the advisory committee and the budget, I did read that last thing. So the advisory committee is being given the charge to decide how to use the subject I can't remember if it's the department or the advisory committee

[Katie McLinn (Office of Legislative Counsel)]: or both, but we'll get We'll a change to that. Okay. So, let's start with this subsection one. This is just the fiscal year twenty seven appropriations. Subdivision one, four hundred and fifty five thousand to the Department of Health to fund 26 outreach case management staff positions with the preferred provider network for the provision of services that increase the motivation and engagement with individuals with substance use disorder in settings such as police barracks, shelters, social service organizations, and elsewhere in the community. This will look familiar to you because it has traveled, this has been an ongoing appropriation, and you'll see in this B, it is the intent of the General Assembly that these positions shall be funded annually with this fund unless and until the special fund does not have sufficient monies to fund this expenditure. There are a few items in this list that have that subsection B notating that there are ongoing appropriations, and that becomes significant. I especially want to point out because there's a report, or maybe a change of practice next year that is specific, kind of creates a carve out for the ongoing items on the list. So, I want to flag for you where those are.

[Sen. Martine Larocque Gulick (Vice Chair)]: Hey, can I ask you one question?

[Speaker 0]: Who's the committee that was

[Sen. Martine Larocque Gulick (Vice Chair)]: put together, are they also in, do they keep going until money is back? I believe so.

[Katie McLinn (Office of Legislative Counsel)]: Don't think there's a sunset date, but I mean, I could double check if we put a sunset

[Speaker 0]: date. One of the things we might wanna think about is how to have other settlement funds go into this fund. It's not just that initial set of attorney general's office about including more of the settlement funds. So you've got a process going on.

[Katie McLinn (Office of Legislative Counsel)]: You've received, this is way better for knowledge to answer than me, I know that since you've gotten the initial funds in this special fund that there have been other settlements and more funds that have come into it.

[Speaker 0]: You So, it's continuing to Yeah, I think that's maybe

[Katie McLinn (Office of Legislative Counsel)]: That's going to be an ongoing thing, but One of the

[Speaker 0]: I don't know whether it's an issue or not, but I know that when the initial settlement came in and I read all the guidelines, we're clear of things that we should, we could do, things that we might do and things that we had to do within the appropriation of those funds. And I do not know what's in the new set of guidelines through the AG's office. Maybe we look at that or maybe we ask that advisory committee to look at it and think about it. You may want to have testimony from the AG's office. I suspect that if we have not heard from them, then

[Katie McLinn (Office of Legislative Counsel)]: the language we have in place is probably sufficient to capture what is in the agreement. I may just ask them that question. Okay, next appropriation is 1,600,000.0 to the Department of Health for Recovery Residences certified by VPART. And again, we have that language to indicate it's an ongoing appropriation. On top of page two, dollars 850,000 for syringe services. Again, the subsection B identifies this as an ongoing expense. Subdivision four, 1,100,000.0 to the Department of Corrections to provide peer recovery center coaches in Vermont correctional facilities and in probation and parole offices to provide group and individual coaching and reentry support, which will not be used to cover administrative expenses. $2.50 to DCFs, Office of Economic Opportunity to support long term programs as shelters for individuals experiencing homelessness, including harm reduction supports, transportation to recovery meetings and appointments for clinical nursing programs. Subdivision six a, 900,000 to the Department of Health for the creation of new recovery beds that are NAR certified at level three or above. Remember when we did our recovery residence bill, I know you spent a lot of time looking at that chart with the different levels. 300,000 to the Department of Health for the creation of new NAR certified recovery beds in Brattleboro, Middlebury, Addison, Randolph, Chester, St. Albans, or any other identified region of the state. Top of page three, two hundred and forty eight thousand to the Department of Health for the pre hospital Vermont EMS buprenorphine treatment program to expand training for emergency service providers on carrying and administering buprenorphine after administering. Subdivision eight, thirty five thousand to the Department of Health to subsidize room and board for individuals in Rutland Mental Health Services Transitional Housing Program. Subdivision nine, two hundred and thirty seven thousand six hundred and forty six to the Department of Health for distribution to Springfield Project Action to support public safety enhancement team coordinator positions in Bennington, Springfield, Brattleboro, Saint Jay, and Central Vermont for the purposes of providing administrative support, meeting facilitation, data tracking, outreach event coordination, and sustainability planning. 288935 to the Department of Health, for distribution to Elevate Youth Services to support the creation of a low barrier drop in teen center in Berry to provide food activities, positive adult role models, peer counselors, prevention and recovery programming, and direct connection to treatments. Subdivision 11, nearly 125,000 to the Department of Health for distribution to Greater Falls Connections to enhance youth engagement and education and to expand prevention focused staffing and youth programming space in response to increasing community needs. Top of page four, four hundred thousand to the progress held for distribution to Interaction Friends for Change to increase access to community based therapy, housing, crisis medical recovery, and employment supports for youth in Wyndham County. Lastly, 26 and a half roughly for the Department of Health for distribution to Winooski Partnership for Prevention to provide funding for staff time and stipends for partners to deliver medicines, safety education to elementary aged youth during school, family engagement. Then we have language that unless reverted by a future act of the general assembly, the appropriations that are made under the section carry forward until fully expended.

[Speaker 0]: So there's nothing in here about the opioid protection, the LTC enrollment that is due, was supposed to be funded in an ongoing way. That's not in here.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: That's not in here. Have for the record, no landlord's rent fiscal. They received two appropriations, I believe, $1,100,000 took the last two years. They have money. They're still on They haven't opened yet. So the appropriation has been made. There's money there for when they do open. I think the thought is they'll need to give out money again when they haven't actually opened it.

[Speaker 0]: Well, we'll have to take testimony on that if they're, I mean, it might be that when they open they do need that money. We can't go back on a promise made. The money is there's still money there. No. I understand. But it was money that was there for the last for previous years. And so all of a sudden, the dam opens up and they run out of water or run out of money. So this is we'll we'll get to that. We'll get to that. It's just a question I have. I

[Sen. Martine Larocque Gulick (Vice Chair)]: don't see any prevention funds going to first. Sorry. Is it on your list? I'm

[Katie McLinn (Office of Legislative Counsel)]: not. It's just over the sheriff. I

[Speaker 0]: mean, I don't think that number

[Sen. Martine Larocque Gulick (Vice Chair)]: of people with I mean, okay. Well, I'll rephrase my question. I don't see any funds going through here.

[Katie McLinn (Office of Legislative Counsel)]: Is it anything?

[Sen. Martine Larocque Gulick (Vice Chair)]: Well, because I mean, lot of other places like Rutland is specified and Wyndham County and.

[Katie McLinn (Office of Legislative Counsel)]: There was at least one place where it said where it's open ended. I know it's any other any other service that? We want the 300,000.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Is there any money?

[Speaker 0]: Okay, well these are quoted, Senator. That's what I have. Is there anything else here, Katie? That's right.

[Katie McLinn (Office of Legislative Counsel)]: Okay. Section two of the bill, there are three reversions in this bill from past appropriations that were either unspent or the program concluded without spending all the money. Different reasons for each one. Those are dealt within another section later on in the bill, but so this number changes in a different portion of the bill, but there are language changes for this particular version to conform with the monetary change. So this would now read, so this is an appropriation from fiscal year twenty three. Dollars 1,500,000.0 instead of divided equally between four opioid treatment programs would just be 1,500,000.0 to cover costs associated with partnering with other healthcare providers to expand satellite locations for the dosing of medications, including costs associated with satellite locations, physical facilities, staff time at the satellite location, etcetera. Subdivision B, the satellite locations established pursuant to the subdivision one shall be located in Addison County in Eastern Or Southern Vermont and striking through DOC. That's where we get the strike through of four, what's equally funding four, that's why that is struck through. And then we have this language, 500,000 to establish a satellite location in Northwestern Vermont instead of a second Chittenden Clinic Addiction Treatment Center. Okay, that brings us to section three. This is the Opioid Settlement Advisory Committee. As I mentioned earlier, this is statutory language that is already codified. It was the advisory committee that was created when the special fund was first created. This is the powers and duties of that advisory committee, and there's a proposal to change some of that language. Right now the advisory committee is to consult with individuals with direct lived experience, etcetera. There are a bunch of different entities. So being added to the list of entities that the advisory commission would consult with is the Health Equity Advisory Commission that exists in statute. And then we have this new sentence being added on page six, line five through eight. Each ongoing funding proposal considered by the advisory committee shall include a sustainability plan from the applicant to ensure consideration of future expenses and available resources apart from the opioid abatement special fund. So this is saying if there is an applicant that is bringing a proposal forward to the advisory committee and it's not a one time ask, it's something that would be ongoing, that part of the application process is to think through what future funding would look like for that. Okay. Section four. Okay, we have two provisions here. Subsection A. On or before December 1, the Department of Health is to review all previous appropriations from the special fund and make recommendations to the advisory committee and the policy committees regarding which appropriations could be funded in future years by the Substance Misuse Prevention Special Fund. So this is where we had the conversation and I couldn't remember who was doing the reviewing. So it's the health department that's doing the review and that information is being recommended to the advisory committee.

[Speaker 0]: And the recommendations are about future? Yes. Because I've wrote

[Katie McLinn (Office of Legislative Counsel)]: a note about So review previous appropriations But from the special

[Speaker 0]: then which appropriations could be funded in future years? So I wrote a note down myself to ask about how this all fits in with the strategic action plan that we have going in place, which is critical. Subsection So I'm just thinking, maybe a different way to do this. That's all. I don't know.

[Katie McLinn (Office of Legislative Counsel)]: Okay. In subsection B, the advisory committee is not to accept new funding proposals from the special fund for fiscal year '28 unless a proposal was previously identified in statute as a dependent for annual funding. So that's why I was pausing at those three items on the list where the general assembly designated those are for ongoing funding. Those are exempted from this. And instead shall review the outcomes of programs and initiatives previously funded through the special fund to assess effectiveness, long term sustainability, and the appropriateness of the special fund as a funding source where applicable.

[Speaker 0]: So I probably should have asked representative McGuire this question, but where did this come from? Did the recommendations here come from the advisory committee? This pause? The whole thing. The the these these last sets of recommendations. They came well

[Katie McLinn (Office of Legislative Counsel)]: That's because that's not part of their Is that part

[Speaker 0]: of their charge? I guess

[Sen. Martine Larocque Gulick (Vice Chair)]: it might be the part

[Katie McLinn (Office of Legislative Counsel)]: of their charge to make recommendations. Well, came from human services. A, came from appropriations, because there's a back and forth between human services and appropriations about the use of the prevention fund. So that's where those two pieces came from. Section five is the reversions, and I will very happily let Nolan walk you through those. That'll be fun. And that's it. That takes us back

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: to July 26. And see if I can, the addition of looking at substance misuse fund came out of require, there was four appropriations that were, that they had said, we don't want that to go into OSAC, we want them to go to substance misuse. Appropriations said, Actually, we think it should be in the OSAC, but let's do a review of the substance misuse. So they added that language into that. That's where that history Yeah.

[Katie McLinn (Office of Legislative Counsel)]: I looked at the language,

[Speaker 0]: it's in the budget, pretty big deal, but the question is, I think we're gonna have to wrestle with the question about these two funds and how they fit together. And I'm not real keen on giving all of that money from the substance prevention fund to an advisory committee set up for something else. So we're just gonna have that conversation. And we need to know what the guidelines and criteria currently are for our substance misuse or prevention fund. Because the advisory committee, it's great, and you get good people on the committee and they have lots of good ideas and want to make recommendations and then we start to see mission creep. I feel like mission creep all through this bill. So, yeah, that's going be sorry. All right, Katie, any questions for Katie? Thank you. Okay. All right, so no one. No, obviously we're gonna have to come back to this one. Katie, we're gonna have to come back to this bill and do some work on that. And I do share the Senator Gulick's question regarding Burlington, I'll tell you for a couple of reasons. One, the OPC has gone through and there was money for it, and now it's been cut off. Whether that is an accurate belief or assessment, that we're supposed to get the next step, that's one. Two, we have a very high density of people needing services in Chittenden County. Not mentioned in the bill except when you're speaking. Three, there's a rural health transformation grant that for some of these things is quite available in every county except in every county. So I don't know if the advisory committee had that in mind when they did this. They probably didn't know about it. So, Oh. Okay. Like, heavy lifting. Someone, thank you for being here.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: For the record, we'll end with this philosophy. I've made hard copy of this because it took a lot easier to follow as we deal with things. Oh, you've done. You can stay in if you want one. Wow. Nice. So what what I so before so I'm not gonna go over my fistula note because I think the fistula note really is just like reiterating what Katie said is in the bill. Yeah. The one thing I will orient you to on the fiscal note is for the last page of fiscal note, I have this. This is the estimated allocations to POV and vacant fund till it's done. Just to give you a sense of,

[Sen. John Morley III (Member)]: gosh, Robin, you're charming.

[Katie McLinn (Office of Legislative Counsel)]: Oh, sorry. That's good. Can

[Speaker 0]: we introduce you? Are you here for us to be introduced?

[Katie McLinn (Office of Legislative Counsel)]: Well, I'm here because I have a colleague from D. C. This is Erin Doty. We work at Senator Welch's office on Round And Blunt, everybody knows me. Erin is new to the office. She's been working for Senator Welch in DC for six weeks. She's been on the hill for twenty ish years, but she's new to Vermont, so I'm dragging her all around and brought her to the state house.

[Speaker 0]: So I'm gonna start. I'm Senator Ginny Lyons. I represent Chittenden Southeast, which includes a teeny bit of Burlington and a whole lot of rural towns in Chittenden.

[Sen. Martine Larocque Gulick (Vice Chair)]: I'm Senator Martine Larocque Gulick. I live in Burlington and represent Burlington that used to be at 6th Junction, at 6th Town, a little bit of Rochester.

[Speaker 0]: I'm Ann Cummings. I represent Washington County right here, and Senator Welch has said I've been a supporter of loss.

[Katie McLinn (Office of Legislative Counsel)]: He served up. Well, him hello from his former boss. From everybody.

[Sen. John Morley III (Member)]: John Morley from Morley's District representing 20 towns, and Senator Welch sent me a very nice letter wishing me well in the Senate, so it

[Sen. John Benson (Member)]: was nice to meet you. John Benson, I represent the folks of Orange County.

[Speaker 0]: So there we are. This is Senate Health and Welfare. We're going through some money that comes from the opioid settlement fund that based on litigation with the pharmaceutical industry and we're trying to sort out what's in the bill before us and then what we need to do further.

[Katie McLinn (Office of Legislative Counsel)]: Great. Thought we'd just leave it for a few minutes and

[Speaker 0]: then I'll bring her on the Thank you very

[Katie McLinn (Office of Legislative Counsel)]: much for being here. Thanks for having me.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: So far, was sort of rudely into it.

[Speaker 0]: So to finally give our best to Peter, Rob. Sure.

[Sen. Martine Larocque Gulick (Vice Chair)]: Wow, some stagehands.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: So what I have here, it's gonna orient you a little bit. So what I have here, this is in the fiscal notes on the last page, and this gives you a sense of the estimated allocations to the Opioid Abyssalon Special Fund through 2037. It has all, it accounts for all of the allocations we're expecting to get in except for the Sackler Purdue settlement, which hasn't quite come through. Hasn't happened yet. We don't know how much it's gonna be and how it's going to be. Most of the settlements are, some are one time, some are over time. When I spoke to the AG last about this back in November, December, they estimate, they didn't give me a number, but they said it could be in the 20,000,000 range, it might not be, and it could all come at once, or maybe not. But we don't book it until we get it. So it's not on here. So when I get the question like, oh, how much money are we expecting to get? This would give you a sense. But to the other point, the notice is diminishing. So this is a fund, and this is what the Human Services Committee had in mind. They were thinking about, this is not a permanent fund, it's going to start with dwindle. So when they came up with the idea of having the recommendations for the future, want the OSAP to be mindful of what should be ongoing and what should not be ongoing. And also for the health department too, and they've already started doing it, then their recommendation is what is an OSAP, what is an opioid special fund thing that could be switched to general funds or become base budget. I know the administration has at least one for both them that switched over from being a special fund to a base appropriation because they said, this program's working. I'll let them talk more about that in the future, but it was in their budget.

[Speaker 0]: Oh wait, is that in the bill or is that in the budget?

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: It's in the budget. It's in the budget proposal and the House didn't do anything, didn't adjust it, so it's there. I think it's an employment program. Yes. Yes. So now to go to the sheet. So let me read the sheet. Uh-oh. I unzoom myself? So I'm just gonna put it on the screen, but I'm not gonna move it around. I'm gonna just do the old fashioned way, and I'm gonna orient you. So it's broken up into multiple sections. So first you have, these are existing ongoing initiatives. And you can see going across, you have EDH recommendations, health department, the OSAC recommendations. Each of them provided separate reports, recommendations to the committee. That's, I'm sure that you think we can get copies of that, you can hear from each of them. I went to that report and I compared what each were saying. So you can see some of the appropriation recommendations were saying, like outreach and engagement, they both said four fifty five. Some of them were not. For instance, emergency shelters, BDH said, we wanna do emergency shelters. So that's not the one for emergency shelters. And then you have the third column, which is the house poll. So sorry, the human services proposal. These are the things that they said, okay, we've heard from BDH, heard from OSAC, we've heard from other folks, this is what they're putting in their bill, and then you have what passed the House, essentially their filings. And where the key difference are between the Human Services proposal and what actually passed the House were the things that represent a Maguire flag. And that would be under the new funding, and I'll get to that in a second. So the top is existing ongoing projects. So off to the right, you can see of those existing ongoing projects that were in any of the recommendations or reports, how much was spent on the past on those things. This does not include things that we have spent money on in the past and are not being recommended going forward. There are a lot more of those. This was only focused on, hey, here's what's in the bill to go forward, and here by the way, here's how those things have been funded in the past. So you won't see the OPC in there.

[Sen. John Morley III (Member)]: So your number one known basically on the right hand side in 2025 you did 1.9 and then nothing in 2024, and then in 2023 you did another 1.9 for

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: a total of about four. Yeah. Got it.

[Speaker 0]: And so there's no APC OPC in here?

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Not listed on here because it's not in the current recommendation. So it doesn't count to that. There's other sheets that have all the other things from the past. Is that on? I don't care anymore. No. It's not in here. Oh, it

[Speaker 0]: sort of disappears. Well,

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: I actually, no, I'll take it back. It is on the last page. Alright. At the very, very, very, very, bottom. This was initiatives. So this is under section called initiatives, recommended for future funding, but just not in 2027. So the OVC, so the health department did not recommend funding in the future. The OSAC said we want to recommend in the future, we're just not recommending it this year. You can see the history of it off to the right. The 01/2001 in '24, 1.1 in '25. I

[Speaker 0]: did meet with the mayor about this and others, so we will probably have to have a conversation.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: All right, and then the second section, we'll jump around, is the new funding. So these are all things that have not been funded in the past and are funded in this bill. And again, I laid out by health department recommendations, OSAC recommendations, human services, and then what passed. I'm not going go through each of them again, but what I am going do is I'm going to flag the things that went between substance induced use plan and the opioid side. Understood. And the first one would be

[Speaker 0]: Okay, and we're gonna come back to this. A lot.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: So if you start to go to number 11 on the list, because I number it on side, you'll see Elevate. So you can see BEH did not make the recommendation. OSAC made a recommendation. Let

[Speaker 0]: me be clear here. The opioid prevention committee made a recommendation. I want to be clear. They made recommendation about using the other fund. No. Okay, they

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: didn't. So let's clarify that. I want me to The OSAC, again, to your point, the OSAC only made recommendations about the opioid fund. Thank you. Where the conversation about the substance abuse fund came in when it was in human services. Human services committee said, you know what, we think that these things really belong in the substance abuse fund.

[Speaker 0]: And they added it in.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: And so they moved it over into the substance misuse fund, and said, know what, we think it's more appropriate there, but the corporation ripped it out. Appropriations took that out because the health department had already allocated all the money in the substance misuse fund. There wasn't And no they

[Speaker 0]: did have without our input.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Well, you could always adjust that in the budget. So we're back to the original. So it's back to, everything's back in this, there's nothing in this bill that recommends anything to the Substance Fund. Part of the reason the appropriations committee put it back, they went back and forth, what should we do? Ultimately, it came down to, we were trying to get a clearer accounting of the substance abuse fund. What has been spent, what has not been spent. And we couldn't quite get there in the time we had. I've worked really closely with the health department. They're very, very helpful. But we couldn't quite reconcile things. So the appropriations committee said, well, look, we don't have the time to get into, well let's put it in the substance use fund, but then what's been allocated by the health department? Where do we take that out? Because the health department made the case and said, okay, well here's how we're spending those particular things. So the appropriations is like, there's just not enough money that's not some misuse fund. We don't have time to get into what should change because there was enough money left unless they made changes. So that's why they said, let's just keep it in the OSAC, but let's have a recommendation where people look at both, what's appropriate. And to Senator Lyons' point, you guys can say, let's keep the future of the OSAP in the OSAP, but maybe have a different group look at prevention funds in general and special funds and whatever. So you can get there in the future. But that's the history of how they got here.

[Speaker 0]: And so I did ask joint fiscal for a cost accounting of what's in the fund, the misuse prevention fund, and how it's currently being used. So this committee can provide guidance down the hall or further. So it could be added in. We could make some comments within H663, is a separate formula.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Yeah.

[Speaker 0]: Yeah, so just so we know. This is really helpful. Thank you for clarifying.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Yeah, also, so to be very clear again, just to reiterate, the bill only appropriates money from the opioid settlement. There's no appropriation from any other fund. There's only the recommendations about looking at in the future how to deal with the funds. Human services had four appropriations. They had the Elevate Youth Services, which is 11. They had 12. They had 13, and they had 15. And a total of $640,000 They said, You know what, we think that's more appropriate than substance abuse funds. And that's the substance? So, appropriations, for the reason by etcetera, said, Well, there's not enough money in that fund. We don't have time to get into the other fund. There's plenty of money in the other fund. Let's put it back for now, and so everything is just one fund. So that's the only difference. The laughing part is

[Sen. Martine Larocque Gulick (Vice Chair)]: Nope, I'm just Okay. Just stickulating.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: So what I do is I break out, so the column, I break out the total funding for the areas without the reversion. So it's total 2.3 in new funding, there's 4.2 in ongoing existing funding, and then the subtotal is 6.6. So there's 6,600,000.0 in spending proposed. Now you have the reversions. The reversions were recommendations from the health department saying, this program is done, or we spent all we're gonna spend, and the contract came in under, and the committee said, great, we agree with that. And so you take the 1.4 off the 6.6, and you come down to the bill being a gross of 5.163.

[Sen. Martine Larocque Gulick (Vice Chair)]: Why is it being called reversions?

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: It's okay, but always. Versions call when you take the money and you revert back to the fund because it's not We paying do it all the time in six That half

[Speaker 0]: sounds good. Got it. Okay.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: So the bill is proposing a spending of $5,163,000 We'll see the reversions.

[Speaker 0]: And so as passed by the House, the reversion is that we've got that the recommendations rather, 5.1. The then you That's have the house passed. HHS was 4.5.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Because they had

[Speaker 0]: Because they took it out and they plopped it into the other fund. Almost puts

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: it back. So that was a four appropriation for $640,000 and this puts it back in. Then you have estimated unappropriate balance as of twoeleventwenty six. This is how much was in the fund. And so it's 11.8. So you take your 11.8 and you minus the 5.1, after you pass this bill, would be $6,700,000 on the bottom line until the next allocation comes in from the settlement. Right, I mean I was just trying to give people a sense of the money flow.

[Sen. John Morley III (Member)]: Is this an annual?

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: So, it should be great.

[Sen. Martine Larocque Gulick (Vice Chair)]: So, it's the 6,712,741, those are available monies? Yes.

[Speaker 0]: That the advisory committee is following the law about making recommendations. Sorry. I'm sorry. I saw dollar signs.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: But,

[Rep. McGuire (House Human Services Committee)]: Nolan, as I understand it, that 6.7 myth is accounted for in your chart that says how long the fund will

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: be available. The 6.7 is how much would be on the bottom line after you spend this money based on how much is in the fund today.

[Rep. McGuire (House Human Services Committee)]: Right, I understand that, but what I'm saying, when you gave us the chart that said, here's how much money will be available in the fund each year going you're assuming that 6,700,000.0 is available for the following year. 6.7 plus would ever come. Correct. Yeah. So if we put that away, it would mean short number of years. Run out of money. It's much sooner.

[Sen. Martine Larocque Gulick (Vice Chair)]: But in all fairness, 2028 was high. You looked at all the years. Yeah, 2028 was the highest,

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: I think.

[Speaker 0]: Wasn't it? I like this.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Know. '29. Your

[Speaker 0]: plus is

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: actually 2029, but by like '2, like, twenty thousand dollars.

[Sen. Martine Larocque Gulick (Vice Chair)]: It's naughty. The decline is a straight line.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: The decline starts around 2030. Yeah. Drops. 2030. Okay. A big drop in 2033, and another big drop in 2034. Now again, that doesn't include the 20,000,000 or the estimated, it's roughly 20,000,000. That may or may not come from the cycle.

[Speaker 0]: Yeah, know, yeah. Okay, so we'll go through the last bit because we're getting to And the

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: then, so the last bit, we jumped to it quickly, but these were initiatives. The way that these reports came from the OSAC and health department and said, here are things that are ongoing that we think should be funded. Here are things that are new proposals that we think should be funded. And then here's some other initiatives that we think are important that you should fund in the future, just not now. And so that's how I broke this out. This last piece is recommendation for future funding, just not for 2027. So that has the contingency management, Both OSAC and OSAP, sorry, and Health Department agreed with that. The Syringe Services Program, and I'll get to that in a second, and then the OPC, which only OSAC recommends. Now, I just quickly want to go to the Syringe Services Program, where both the health department and OSAC says, you know what, we think this should be funded in the future, we just don't think it should be funded now. And human services said, we do. So they put it in, so even though it's down there, you'll see it's actually carried online. It's in the numbers. So it's in the numbers off the glove. So again, they said we don't think it can fund it this year, and human services, we think it's in priority, and the house said it. So they put that in.

[Speaker 0]: So, there's nothing in here that allows for the Joint Fiscal Committee to approve the continuing funding for the OPC should that become operational when we're out of session. That's a thought.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: What I will say, Madam Chair, there was a period where there was a flurry conversation around, as you know, the OPC has been trying to find a place to home itself. And so that's the moving piece. Once they find a place, then things will happen quickly.

[Speaker 0]: But I do know this, I know that it's getting close. And my conversation with the representatives of Burlington in this, that once it happens, it's gonna happen. It's like a damn break. So we need to have that conversation in this. And I will say, look. All of these decisions were made in, what, August or September. That was a last meeting they had for the advisory committee. It was made a bunch of time ago. So, you know, we we need to kinda look at updating where we are. Did OPC, that's the OSAT?

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: No, there's an opioid overdose.

[Speaker 0]: The overdose prevention is very controversial. There are some people who would wish it would go away, and I think there's some bias against it, but I can't. We did pass it in here and we took a long time getting it right based on data. We don't want to go back and relitigate that thing, but we do want to make sure that it gets supported appropriately.

[Sen. Martine Larocque Gulick (Vice Chair)]: It may not be everybody's favorite thing. But it's also one of those things that is very, like, matters at the OPC. It's about saving lives like now. It's not in concert with recovery, obviously, but it was always supposed to be that we needed now because we were in the midst of a crisis. It just makes me sad to see that the years were too good by and, you know, how So anyway, with

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: whole thing I wanna

[Speaker 0]: say, one more thing,

[Sen. Martine Larocque Gulick (Vice Chair)]: go ahead.

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Just really, really quick, this handout I gave you is a living document, and so if there are typos, which I continue to find, just let me know and I'll give you a chance.

[Speaker 0]: We won't be too grateful.

[Rep. McGuire (House Human Services Committee)]: Yeah John,

[Nolan Langweil (Senior Fiscal Analyst, Joint Fiscal Office)]: Rep. Sarah Morley is gonna be looking for them.

[Speaker 0]: Everything On top else you're doing, this is absolutely amazing. Really appreciate, and I appreciate your comment about the Department of Health and others helping you get. Thank you. Thank you everybody. Well, we are calling it a wrap now. Thank you for the day. We'll come back to all of these things.