Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair)]: We're live. We're live. Okay. We're back and we're going to go through HH16 with an item markup on the bill with a new draft that Cater's brought us. And what I'm gonna suggest is that if you have an interest in your inner room and you have an interest in the bill of straighture, so we can have that conversation. The next time he does work, we'll all work together. Yes, sir.

[Sen. Ann Cummings (Member)]: As to Swat's question, mister Chittenden, I I remember with the art concern. So I assume you may provided some input to you on this latest draft or you heard from them?

[Sen. Virginia "Ginny" Lyons (Chair)]: I have not heard from them from

[Katie (Legislative Counsel, Office of Legislative Counsel)]: this latest draft. I don't

[Sen. Virginia "Ginny" Lyons (Chair)]: think they've seen it.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: The my directions were not to include OPR's recommendations, and instead, there's that new report that asks them to look at the issue of AI and

[Sen. Virginia "Ginny" Lyons (Chair)]: professional regulations. So, yeah, so I it's my understanding, Katie, correct me if I'm wrong, OPR's suggestion was to really expand professional

[Katie (Legislative Counsel, Office of Legislative Counsel)]: coverage. It was to not sort of limit AI regulation to mental health professionals and to look at the issue of AI and misuse and all regulated professionals a little bit more broadly. So this doesn't do that. It keeps But it also removes the section from Title 26 that is specific to mental health professionals and regulating mental health professionals. Instead, it's focused on regulating entities that would provide mental health services without a mental health professional providing those services.

[Sen. Virginia "Ginny" Lyons (Chair)]: And we can have OPR in again if you'd like to

[Sen. Ann Cummings (Member)]: do that. I just wanted to understand Sure. What they play. Seems like you'd have to take advantage

[Sen. Virginia "Ginny" Lyons (Chair)]: of some other people they want to do. I think there are so many professions that and actually, of them don't belong here. Right. So this bill could go on for another

[Sen. Ann Cummings (Member)]: six months. Okay,

[Katie (Legislative Counsel, Office of Legislative Counsel)]: so your first section is your purpose section. In previous versions, you had language that was also about regulating mental health professionals and talking about the administrative support that mental health professionals give you. That type of language is no longer in the bill. Instead, your purpose is focused on preventing psychological harm, including death by suicide, by ensuring that mental health services are delivered by mental health professionals and not independently by AI systems. Then you have the section two on professional conduct.

[Sen. Virginia "Ginny" Lyons (Chair)]: So let's go slowly because if there are any questions or comments about the language we should get about. Looking across

[Sen. Ann Cummings (Member)]: a little bit.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Okay. Alright. Next, you have section two. This remains unchanged from the house. This gives a list in title three of all different types of behaviors that constitute unprofessional conduct. And being added to that list at the top of page two is for mental health professionals and misuse of AI.

[Sen. Virginia "Ginny" Lyons (Chair)]: And that's the new section below. And

[Katie (Legislative Counsel, Office of Legislative Counsel)]: then in section three, this is a section in title 18. This has prohibited uses of artificial intelligence. So first, we have our definitions. Section one is artificial intelligence, means an engineered or machine based system that varies in its level of autonomy and that can, for explicit or implicit objectives, infer from the input it perceives how to generate outputs that can influence physical or virtual environments. The house version also contained a sentence along the lines of that this would include generative AI and then a definition of generative AI that has been removed from this strategy.

[Sen. Virginia "Ginny" Lyons (Chair)]: Can you remind me? Oh, what you're trying to say.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Can I remind you why? Sure. I was asked to remove it, but the sort of concern that a house healthcare received right as it came over, or right as they voted it out, and that they didn't they were hoping that there would be more work done on it, is that House Commerce told them that that sentence, that AI includes generative AI, is circular, but health health Post Healthcare really wanted to include a definition of generative AI, and the only way to do it, because it wasn't used anywhere else in the bill, was sort of referencing it. So that I don't know. That was the issue with the language. So

[Sen. Virginia "Ginny" Lyons (Chair)]: we're probably just missing out for an actual exam.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Two, these two and three have to be swapped. They're alphabetically adequate. So they're numbered correctly, but they're not. So I'm

[Sen. Virginia "Ginny" Lyons (Chair)]: gonna swap those. Oh, do

[Katie (Legislative Counsel, Office of Legislative Counsel)]: you see 8.3?

[Sen. Virginia "Ginny" Lyons (Chair)]: The numbers are out. Yeah. It has noticed that. So we had number 22 between two out of three screening centers on 57 to 58 appropriations yesterday, so it makes it just fine. So go ahead. Is there 110? Do there are

[Sen. Ann Cummings (Member)]: efforts that can influence physical or virtual environments? I understand that virtual environments how AI change

[Katie (Legislative Counsel, Office of Legislative Counsel)]: physical. I'm not in person to that sort of. I'm sorry.

[Sen. Ann Cummings (Member)]: No, no, no, I didn't know if you remember a great testimony.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: I remember that they were, the recommendation of House Commerce was a full language from California in terms of AI, so I believe this definition came from AI. We have an attorney who works with House Commerce who spends a lot more time on AI issues, so.

[Sen. Ann Cummings (Member)]: I just end up seeing this ball.

[Sen. Virginia "Ginny" Lyons (Chair)]: I was wondering if you could treat

[Katie (Legislative Counsel, Office of Legislative Counsel)]: me a better answer than that.

[Sen. Ann Cummings (Member)]: Doctor. Baragoff.

[Sen. Virginia "Ginny" Lyons (Chair)]: Who is that? Who's the expert? Great. Oh, maybe we could just get his comment on that. Yeah. Need to volunteer him,

[Katie (Legislative Counsel, Office of Legislative Counsel)]: but he might have a better sense I of know. I can write him an email just confirming Right. This came this language came from California. Okay. And asking how AI can influence a physical environment. Well, I mean,

[Sen. Virginia "Ginny" Lyons (Chair)]: a physical environment is a body. It's a human body. Right? I don't know. It's a living. Yeah. You've seen the virtual. Yeah. It's just the. Entitled. Let's find out about that.

[Sen. Ann Cummings (Member)]: But I'm sure you're crying.

[Sen. Virginia "Ginny" Lyons (Chair)]: It is it is.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Not perfect. But, yeah. Gotcha. Yeah. So, I'll just go in order for now. So, mental health services, this means counseling, therapy, or psychotherapy services used to diagnose or treat an individual's mental or behavioral health, or provide ongoing recovery support, including, these are examples, providing therapeutic decisions, issuing direct therapeutic communications, generating treatment plans or recommendations,

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

[Katie (Legislative Counsel, Office of Legislative Counsel)]: detecting or interpreting emotional mental states. So those are all mental health services, which is important because that subsection B says you can't provide mental health services. For AI, you can't provide mental Then health we have our definition of mental health professional. So it's a person licensed, certified, rostered, is a physician, an APRN specializing in psychiatric mental health, a psychologist, a peer support provider or care recovery support specialist, social worker, an alcohol and drug abuse counselor, clinical mental health counselor, a marriage and family therapist, a psychoanalyst, an applied behavior analyst, or a non licensed or non certified psychotherapist, or a non certified psychoanalyst, or any other professional who provides mental health services. So it's very broad. Maybe I ask

[Sen. Virginia "Ginny" Lyons (Chair)]: a question. I'm always one step behind it seems, but if you look at so the page two where we just were, line, well I guess lines 14 is 15. When it talks about prohibition on generating a treatment item, that's not going to bump up against the recording of a session that then gets transcribed into notes. You just have that in another bill. I just want to make sure that that's Generating a treatment plan. I

[Katie (Legislative Counsel, Office of Legislative Counsel)]: would read generating a treatment plan, it would sort of be the comprehensive sort of the comprehensive manner.

[Sen. Virginia "Ginny" Lyons (Chair)]: So what's your concern on the issuing direct therapy? Generating treatment plans because if your appointment is recorded and then that AI recording generates notes. Part of the notes. You can't You go to the page without That's what I wanna make sure. The interface. The human has to take the notes and turn. It's just something that let AI take the notes and turn the. Right. That's the problem. Right. Yeah. That's not enough. Okay. One thing with my point Okay. Think about The people most likely would say I. We're setting up a few mental health care tiers for the one's most likely to go to the chat box and say, so and so said this and thinks that and what do you think is her problem? Dad. That's just something I keep. So whenever you're writing a bill about peer support counseling, that's something I was going to have to link in with. This question. I'm looking at my boy. Okay.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: So did you get what you needed on this

[Sen. Virginia "Ginny" Lyons (Chair)]: treatment plan? Just so as long as

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Jessica Barnard, Vermont Medical Society. I think the main point, I think those services would all still be allowable because what the main sort of prohibition is, is providing services without the involvement of a mental health professional, so as long as the mental health professional is reviewing and signing those as their notes or their treatment plan, that you could use it to support that work but not do the work entirely for you. So I think that's, you're gonna get

[Sen. Virginia "Ginny" Lyons (Chair)]: to that on page four, which is the, I can't use it. Thank you. That's helpful.

[Sen. Ann Cummings (Member)]: Thank you. Don't be logic. Feature fear. That's the beauty matter for professionals. You can slow the pain high.

[Sen. Virginia "Ginny" Lyons (Chair)]: Right. It's not gonna you shut that down.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: So, went through the definition of mental health professional. One of the examples of a type of mental health service that would require involvement of mental health professional is therapeutic communication. So, we have a definition of that. It means written verbal or non verbal interaction intended to diagnose or treat any type of mental or behavioral health concern, provide ongoing recovery support, or provide any advice related to diagnosis, treatment, or recovery, such as engaging in direct interactions with clients or patients for the purpose of understanding or reflecting the client or patient's thoughts, providing guidance, therapeutic strategies or interventions designed to achieve mental health outcomes, offering emotional support, reassurance or empathy, and response to emotional or psychological distress, collaborating with a patient or client to develop or modify treatment plans or therapeutic goals, and delivering feedback intended to

[Sen. Virginia "Ginny" Lyons (Chair)]: promote growth or address mental health outcomes.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: And you have a definition of therapeutic decision. Again, decision.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Okay. And and I've been swimming. Perfect. Alright.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: So next is the therapeutic decision. The therapeutic decision was an example of a mental health service. It would require mental health professional involvement. So that's defined to mean a final clinical determination regarding diagnosis or the selection, modification, or termination of treatment or care. Therapeutic decision does not include algorithmic risk scoring, data analytics, or other clinical decision support tools when used under the supervision of a licensed mental health professional.

[Sen. Virginia "Ginny" Lyons (Chair)]: There it is.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: I'm sort of wondering out loud if the second sentence is needed in this new version because it's saying that it doesn't include this risk scoring or data analytics when unsupervised or authorized by a mental health professional. We're saying that all therapeutic decisions have to happen at the relevant of a mental health professional. Yeah, that's a

[Sen. Virginia "Ginny" Lyons (Chair)]: good question. Why would those be identified separately? Support tools. I mean, if

[Katie (Legislative Counsel, Office of Legislative Counsel)]: you wanted to allow algorithmic scoring and data analytics without a mental health professional laying in, then you would sort of end the sentence there. Therapeutic decision is not an algorithmic scoring or data analytics, period. By having the sentence, you're sort of saying, this doesn't include therapeutic decision doesn't include these things so long as they're provided. They're under the supervision of a mental health professional, but already a therapeutic decision has to be under a mental health professional. Am I making sense?

[Jessica Barnard (Vermont Medical Society)]: Yeah, just so far, I'm with the medical society. I actually do, I agree with Katie. I think the second sentence actually really complicates what we're trying to define or not define and what does or does not require supervision. Don't even, well, I'll just add to that, if we're looking at this definition, I'm not even honestly sure if this definition is needed with the expansion of the therapeutic communication definition, because that therapeutic communication includes written or verbal interactions intending to diagnose or treat. So to me, that actually encompasses therapeutic decisions, but I certainly think the second part of that definition of therapeutic decisions is confusing.

[Sen. Virginia "Ginny" Lyons (Chair)]: Either way, I'm fine with taking it out. Show somebody Alright, take it out. Then

[Katie (Legislative Counsel, Office of Legislative Counsel)]: the question becomes, do you take out Admin Health Services in reference to We just took out that one sentence.

[Sen. Virginia "Ginny" Lyons (Chair)]: We didn't take out therapy. Oh, I was right there. Why would we take out therapeutics? He'll ask them they have for the enhanced W command. That's totally up to you. When we were working on our draft we used the word decision but didn't feel that it needed to be defined but if you feel that it would be appropriate to define it, just the first section of sentence of number five would be fine. First sentence. Because sometimes those decisions have legal standing. Okay,

[Katie (Legislative Counsel, Office of Legislative Counsel)]: so what I've heard is to retain the first sentence in subdivision five and stretch the sentence outwards. Is that right? Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: Your decision can be based on subsection B.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: An individual, corporation, or other entity shall not offer or provide mental health services through AI without the involvement of a mental health professional.

[Sen. Virginia "Ginny" Lyons (Chair)]: My question about this one is, is this the right place for that as opposed to over everything, overarching. Overarching, I think.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: This is really

[Sen. Ann Cummings (Member)]: Sketched to it.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: This is in some ways the only thing of this section, because you have all the definitions and penalties to enforce those fees. There's also the D with the social language, so I don't want

[Sen. Virginia "Ginny" Lyons (Chair)]: to minimize that. I get it. It's probably, it's okay to have it. I say, I was putting it before the definitions. Can't do that.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: I mean, it's your bill, but

[Sen. Virginia "Ginny" Lyons (Chair)]: My question is before the briefing. I was just gonna read it. That was my next question. I

[Sen. Ann Cummings (Member)]: don't think it's it's okay. Don't know. It's somehow financially tied in to this and therefore uncover. I don't think that's what our intentions. I think it all about this laws over. Over sight of the over the supervision.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. Overall. Okay. That'd be very strong. Yeah. That'd great. It's a provision

[Sen. Ann Cummings (Member)]: for safety. Well, it's

[Sen. Virginia "Ginny" Lyons (Chair)]: just save without a mental health profession.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: But we have to have

[Sen. Virginia "Ginny" Lyons (Chair)]: it involved, but just without a mental I suppose you could do

[Katie (Legislative Counsel, Office of Legislative Counsel)]: it that way. I guess I was I I think you have to tell me what your intent is, but I I think what you're trying to get at is you want the work product of the AI to be looked at and, assumed responsibility for. So it's not just, it's sort of two pieces, in my mind. One, you have to check it over, and two, you have to assume responsibility for what you've seen.

[Sen. Ann Cummings (Member)]: When you go back to work, it's the coming study about the body just and we're proposing somebody to put something up on medicine. There's no oversight or supervision of what's happening. It's all about it when we hit that market.

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, and I'm not saying this would ever happen, but you could imagine that a health professional and this is a bizarre experience where they can just they can say, you know, use this app. Get back. It's just you don't really want that either. Right. You want direct connection. Yeah.

[Sen. Ann Cummings (Member)]: It's right. You could say there'll be threats if it's on.

[Sen. Virginia "Ginny" Lyons (Chair)]: Correct. And it's it's a day involvement or something like that. A regular involvement. No, I think it works. You ever say financially, very

[Katie (Legislative Counsel, Office of Legislative Counsel)]: broad. If that is your goal, then that word works. If you're trying to indicate the degree to what that involvement might look like, it's a, you know, I I typed it into AI, and here it is. I was involved because I was the person inputting the parameters. And that

[Sen. Virginia "Ginny" Lyons (Chair)]: think if if you make it clear that the professional is responsible, I'm thinking more of that. Legally responsible as you know, if they're legally responsible for their practice, what they do with their clients. If they can stay up in that process, I would assume their license and their legal responsibility, they're legally responsible

[Sen. Ann Cummings (Member)]: for the outcome. This is pretty broad involvement. Yeah. And I think what's really striking is just taking that up a little bit. They're absolutely sure that they are

[Sen. Virginia "Ginny" Lyons (Chair)]: What about right through my phone? What about mental health professionals? We've got all these great definitions, so I'm gonna say that the receiving Our mental health service, go ahead.

[Jessica Barnard (Vermont Medical Society)]: Jessica Barnard, Vermont Medical Society, I'm just wondering if you could pull the language from the top of page five, which is what's defining what mental health professionals can do, which basically is saying using AI provided, the medical professional reviews and approves any therapeutic communication that refers to

[Sen. Virginia "Ginny" Lyons (Chair)]: the exclusion. Exactly where I was going.

[Jessica Barnard (Vermont Medical Society)]: Sorry, not to take a word step down, but I, because that seems to be what you're getting at, and

[Sen. Virginia "Ginny" Lyons (Chair)]: Provided that the mental professional reviews through a therapeutic indication or therapeutic decision because then it integrates the definitions that we've had previously. It says exactly what the involvement is. Okay. And without the involvement the involvement.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: So could you instead of involvement without the review and approval of the mental health professional? Yes. Sorry. Like, that.

[Sen. Virginia "Ginny" Lyons (Chair)]: I watch it. No problem. I never do even 2,001 space eyes. Yeah. It depends on what it's if you film.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: So what do we have, Katie? Okay, so

[Sen. Virginia "Ginny" Lyons (Chair)]: now you have an

[Katie (Legislative Counsel, Office of Legislative Counsel)]: individual corporation or other entity shall not offer or provide mental health services through AI without the review and approval of a mental health professional. So that needs to be more fleshed Well, I'm wondering that they pull also the, of any therapeutic communication or therapeutic decision. Yeah. I, I

[Sen. Virginia "Ginny" Lyons (Chair)]: think so. Well, we're about mental

[Katie (Legislative Counsel, Office of Legislative Counsel)]: health services.

[Sen. Virginia "Ginny" Lyons (Chair)]: Say it again. I'll push again. Say it again.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: I mean, mental health services includes therapeutic decision and communication. And I feel like adding that feels like it's like some muddying water from me that you only need review and approval for certain aspects of mental health services.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah, got it. So say what you said again, please. An individual, corporation,

[Katie (Legislative Counsel, Office of Legislative Counsel)]: or other entity shall not offer or provide mental health services through AI without the review and approval of a mental health professional.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. Be unspecific. Yep. What's wrong with that? It's good. Anything wrong with that? Okay. Let's let's. Okay. And then you're you're.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Then you have the violation. The violation of this section shall be deemed a violation of the Consumer Protection Act. The AAG has the same authority to make rules, conduct civil investigations, enter into assurances of discontinuance and rights of all actions. And private parties have the same rights and remedies as provided under the IDSA 63 step chapter one. So I will make the same strike through that the AG requested in the identical language. And then a policy question for you is the inclusion of this civil penalty. Each violation of this section shall carry a civil penalty of 10,000 as set forth in night BSA. So where would the strike through begin? Authority? Same authority. Yeah. It would start there.

[Sen. Virginia "Ginny" Lyons (Chair)]: And that strikes at all

[Katie (Legislative Counsel, Office of Legislative Counsel)]: the way over to Toucan private parties.

[Sen. Virginia "Ginny" Lyons (Chair)]: That's where I it would pick up don't expect you to have the answer to this question. I'm assuming that the mental health professional code of ethics is dealing with the graph of AI, Right? I don't know. We should find that out. I am We should ask them to do it in this way. Yeah. Because we're assuming that they Why don't we ask them to do that?

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Soon as if they're feeling

[Sen. Virginia "Ginny" Lyons (Chair)]: But they don't refresh the regulation. Go

[Katie (Legislative Counsel, Office of Legislative Counsel)]: ahead. Jessica Barner from Medical Society. Not a comment on that, a quote about that specifically, but on the violations selection, if I may. So the social workers had some, an earlier version that you would support the approach of differentiating between companies and unlicensed entities violating these provisions versus unlicensed professionals, so that if you've got the chatbot run by an AI company, that's a CPA violation that's enforced that way, but you could have an instance, because we're talking about all these examples of using decision support tools where a mental health professional does make a mistake and uses something without approving it, that those would be an unprofessional conduct violation be pursued and go through all the OPR or Board of Medical Practice unprofessional conduct route rather than consumer protection violation group. So if you would be open to that consideration, I think Gail has language to bifurcate the penalty. Can we do that, Katie? My concern is that we get into title 26 and that we just removed that whole section that regulates so it wouldn't be tied to anything. Well, I guess I'm just wondering if you could do it in subsection c, saying something like a violation of this section by a corporation or other entity or unlicensed mental health and then be silent, unlicensed, and assume that section two will pick it up. Well, what was gonna say. Section two addresses the well, right. Maybe you don't even need to say it because it's there for the license. But it wouldn't if they're professions regulated by the board of medical practice. Yeah. That that would pick that up, though. Right?

[Sen. Virginia "Ginny" Lyons (Chair)]: Or OPR. Well, it would

[Katie (Legislative Counsel, Office of Legislative Counsel)]: pick up the OPR in section two.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. That's section two.

[Sen. Ann Cummings (Member)]: So, year, I think this list.

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, sorry. This is a. It does look like the American Psychological Association said they have some data to code that things to include AI. So the standards emphasize that while AI can be used to improve accessibility and administrative efficiency, it cannot replace the human therapeutic compliance, clinical judgment, or the ultimate responsibility of the professional for client care. That is helpful. That's good to know. Good for you, thank you. So, now, going back to the oversight of violations. So, I'm happy to talk to

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Katie offline if that works Why don't we agree so we can look

[Sen. Virginia "Ginny" Lyons (Chair)]: at something instead of trying to smooth that out here. It does run into a couple of different things. Let's do that. Yeah, I'm just making your note for myself. It's easier. Okay.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: So then you have the subdivision that nothing in this section shall be considered to include or substate any other statutory or common law remedies. Subdivision, subsection D. Nothing in this section shall preclude a mental health professional who is operating within their professional scope of practice or utilizing Oh gosh. Did everything miss?

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

[Katie (Legislative Counsel, Office of Legislative Counsel)]: My computer started showing lots of other pages. I thought they were popping up on the screen, but they're not, so that worked out well. Okay. So nothing in this section shall preclude a mental health professional who is operating within the professional scope of practice from utilizing AI tools that are compliant with HIPAA or authorized by the US FDA, provided that the mental health professional may abuse and approves any therapeutic communication or therapeutic decision. So since we were last talking about this, it sounds like the MS has information that the FDA does approve some AI tools. I wonder if HIPAA has to apply to both, if it's an or. The tools have to be HIPAA compliant. Well, I don't know that all of them are that's what I

[Sen. Virginia "Ginny" Lyons (Chair)]: was thinking. But I don't

[Katie (Legislative Counsel, Office of Legislative Counsel)]: know if all of them are FDA approved. So I'm wondering if they're either

[Sen. Virginia "Ginny" Lyons (Chair)]: HIPAA compliant or HIPAA compliant and FDA approved.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: I don't know enough about

[Sen. Virginia "Ginny" Lyons (Chair)]: it to be able to make a recommendation on that. Well, if the FDA approved and subsidy, you don't apply it. True or false? Why don't you

[Katie (Legislative Counsel, Office of Legislative Counsel)]: give me somebody who's gonna own that? That's a thousand plus. So, Jessa Bonner with the Medical Society, I believe all FDA approved AI tools, it would be things like in medical device software, would be HIPAA compliant, but not all HIPAA compliant AI tools are FDA reviewed or approved, if that makes sense. AI Scribe technology does not get reviewed by the FDA. Some, if it's a part of a medical device software, then I believe it does go through that pathway. So did that answer the so I think the or, I it think would need to be the or, not and, because some so

[Sen. Virginia "Ginny" Lyons (Chair)]: they're all HIPAA compliant. I believe

[Katie (Legislative Counsel, Office of Legislative Counsel)]: they would still have to be used in a HIPAA compliant manner, I believe. I don't for sure know the answer to that right now. So could they could you just say HIPAA and remove reference

[Sen. Virginia "Ginny" Lyons (Chair)]: to FDA? I think so. Could. Don't want that to be able to conform.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Right. Period. So why don't I flag that, and maybe I could hear back if we could remove the FDA piece? Yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: Can. Okay. We do. I apologize.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: For anything else? Where are we? So we just went through this last subsection D, and it sounds like your stakeholders will get back to me on whether we can just eliminate reference to FDA if everything would be covered under HIPAA and not need the two references. Okay. And then I have to ask, and I hope I don't open up a Pandora's box here. So, is the term therapeutic communication and therapeutic decision correct on page five line, page four line, sorry, page five line four, or should that be mental health services, which is inclusive?

[Sen. Virginia "Ginny" Lyons (Chair)]: Right, right. I think

[Katie (Legislative Counsel, Office of Legislative Counsel)]: that will help. We do save individuals after you run through mental health services,

[Sen. Virginia "Ginny" Lyons (Chair)]: not just decisions and for medications. I'm gonna suggest that we close out this conversation because we've got some folks paying to testify Okay. From AOE. But maybe we could bridge this that one. I like mental health services, but I would listen to the professionals in that one.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Okay. I will make the change for now and if it

[Sen. Virginia "Ginny" Lyons (Chair)]: affects feedback then we can take the other thing. Okay. So the next time we look at this bill, we'll have an eye to find a markup and possibly. There's a lot of changes in there. Yeah. It's a lot of good work. He's. You're a lot of help. But I think is out. Yeah. So I'm it might be better. You, both. Are

[Katie (Legislative Counsel, Office of Legislative Counsel)]: they coming in?

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. They're coming. Making their way. Are they commenting on the perimeter? We don't know. Budget discussion. Budget on it. I made the I made the mistake to say whenever you're ready. I guess that's No. We're ready.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Here they are.

[Sen. Virginia "Ginny" Lyons (Chair)]: We're gonna. Good morning. Okay. Alright. Good morning. Good morning. So we have ten minutes.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: I know that

[Sen. Virginia "Ginny" Lyons (Chair)]: you be efficient. We ask you you ask to come in,

[Katie (Legislative Counsel, Office of Legislative Counsel)]: and we're happy to have you with you all three wanna sit together. Why don't I do I'll do a very quick introduction, and then I'm going to actually have Katie Smith come in. So because we don't know what it is. Absolutely. So should I jump in, senator Lyons? Go for it. Go for it. Okay. So for the record, Jill Briggs Campbell, deputy secretary of education and chief of operations. We appreciate the opportunity to come in today to speak about some language that was in this original proposal.

[Jill Briggs Campbell (Deputy Secretary of Education, Agency of Education)]: We're transferring the school based Medicaid program from the Agency of Education, its administration over to agency of Human Services. There was a really important piece of the work that still remained with the Agency of Education, and that was in the original proposed language. It was cut out without opportunity to provide a test, and there's some implications and consequences for that remedial. Katie Smith will come up in just a moment. She has a lot of experience in school based Medicaid, but she's our new director of special education finance.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: And so she'll kind of tell you about what the language said, why it's important to have in there, and our specific request. Understand this word, under the

[Sen. Virginia "Ginny" Lyons (Chair)]: gap. Thank you.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: I have

[Sen. Virginia "Ginny" Lyons (Chair)]: to read Okay. I get it. So, and what we're talking about, find that they have an advisor. Yes. Got it. Okay.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: We've got the exact language. It existed in the original. Hi. Thank Robert. I'm Katie Smith, special education finance director.

[Katie Smith (Special Education Finance Director, Agency of Education)]: Over the last year, I was the managing director for the education, so I've been working on this. Current state for what the statute requirement is right now, there's a requirement for school districts to reinvest the revenue from the school based Medicaid program into prevention and intervention programs. Our programs would serve all students regardless of disability status or health insurance. Some examples are the Snack Sack program at Slate Valley. There's funding of positions like school nurses or staff that provide mental health and behavior supports, programs that address attendance and connect social work services to students and families. That leads us into rule making authority and why we're asking for this through school districts. We have been asking the agency of education for guidance on how to use the funds, and we only have a few sentences in the statute to refer to to give them guidance. Rule making would give us structure to collect better data on student supports. And we were really intentional with this request to strike some of the statute to balance the rule making so we can make sure nothing gaps and that additional details are clear to the field. Okay. And the consequences of it, this language doesn't come back in. We don't have goal making authority, the state produces data on spending that supports student success. We're tracking outcomes, goals that school districts have to meet student needs. It no and it no longer links the funds to meet the district quality standards, which is a whole series of ways. Breaks the fiscal capacities that, a, we have in place for state based student payments. There's a connection in there that was switched to the claims phase data, but now we're moving through capacities. So that ruling really allows us to address the methodology for capturing these costs and prevent duplicative payments to school districts. And the last consequence is that we backtrack thirty years of national leadership in this field and the investment in essential wraparound supports to all students.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you for that. So the language that was taken out is in a simple matter of having the language put back into the budget. So can I get a copy of that? Yeah. And then the committee will look at it. I'll share it with this committee as well. And then we'll also be talking with Joint Fiscal about any budgetary implications for that so that as the Consensus Committee goes on, Doctor. Chittenden will review.

[Sen. Ann Cummings (Member)]: So we don't have this bill or anything like that? Gonna take this to appropriations? This is an appropriations issue. But

[Sen. Virginia "Ginny" Lyons (Chair)]: honestly, we did have a bill in here. There was a bill to transfer all Medicaid expenditures from AOE into Diva so that it was all consolidated in place. And there's still some decision making left at AOE around this in your area, especially at other areas where nursing from the health intervention and intervention. That would be helpful to see that language.

[Jill Briggs Campbell (Deputy Secretary of Education, Agency of Education)]: We think that there's a little bit of a misunderstanding. So AHS will have rule making around the actual administration of the program and then AOE retains a small portion of rule making that points to the things that Katie was just speaking to. So we really are doing that split of roles and responsibilities. But the consequence here, I mean, if we're sort of speaking plainly about it, is that if we don't have requirements around these reinvestment funds, the way that it's going to be used, you just have to be very practical and clear clear eye about this, is that it will be used to reduce the property tax rate. Because that is what a business manager should, you know, should do if they

[Sen. Virginia "Ginny" Lyons (Chair)]: get sort of this this extra dollars. Understood.

[Jill Briggs Campbell (Deputy Secretary of Education, Agency of Education)]: And so it it does unfook from the lady intent and purpose of these funds. And it's something that they currently do, but not necessarily to greatest effect and without our authority to have the quality, like education and district quality standards about it.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Alright. Is there anything else that we need to Simple. Simple request. Yeah. So you've

[Katie (Legislative Counsel, Office of Legislative Counsel)]: got that language. We'll ensure we'll ensure that Please

[Sen. Virginia "Ginny" Lyons (Chair)]: please send language along. And I think copy l and as well as the list of Okay. So that we have. K. Alright. Now I've got five minutes. And did you wanna offer?

[Unidentified fiscal analyst (likely Joint Fiscal Office)]: I think what helps to understand the background a little bit more, what happens is that schools provide services in the schools for Medicaid students. What the state is able to do is say, Oh, we can draw a match on that service. It's sort of called the certified management. So what the state's doing is saying, well, the schools are going to provide that service, they've already spent the money on it. So we, as the state, are saying, well, it's Medicaid eligible, so we're gonna certify that and draw a federal match on that. And what we're doing is we're giving the schools back some of that money, not all of it, but some of that money that brought the federal match. And what AOE is saying, they want to use that money for quality based, whatever, for their the Deputy Secretary's point, if they don't do that, then this matter will just say, Great, we've already spent this money. We just want to use that money to reimburse us back, and we could either use it for whatever we want, or bring down the property. What AOE is saying, we'd like to take that money and use it to incentivize Yes.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: Health and learning are inseparable.

[Unidentified fiscal analyst (likely Joint Fiscal Office)]: So that's a policy decision. Do you think that money, AOE should be able to tell that they should be able to use that money for incentives, or should the business manager be able to decide for themselves how to money? That's the underlying decision policy decision. That makes it easier to understand. Totally.

[Sen. Ann Cummings (Member)]: I understand it, but it's not simple as

[Unidentified fiscal analyst (likely Joint Fiscal Office)]: Adversimple. But there's some context that

[Sen. Virginia "Ginny" Lyons (Chair)]: I just thought was helpful. So what would be helpful is to understand how the money is currently being used and what your request is regarding future use of the money because that sounds like that's part of the use of the money. And you don't wanna deprive you to work with the. It's where the decision is made, I think, and it's made by their by physical office. Yeah. I mean, I I think

[Katie (Legislative Counsel, Office of Legislative Counsel)]: yeah, I think it wouldn't surprise you to learn that there is blind variability in how the problems occur in these cells. Right? Yeah. That sounds

[Sen. Virginia "Ginny" Lyons (Chair)]: true. Right?

[Jill Briggs Campbell (Deputy Secretary of Education, Agency of Education)]: Part of our reason for making this policy a choice when we

[Sen. Virginia "Ginny" Lyons (Chair)]: were looking at moving the program at Oprah is

[Jill Briggs Campbell (Deputy Secretary of Education, Agency of Education)]: part of the sort of constant need that is being expressed by school districts is that they have growing costs associated with supporting student mental health, wellness, and well-being. This is a significant amount of funds that could be appropriately directed towards a pretty broad bucket there. But being very clear about that, and that that's sort of the intention of these funds is intervention and prevention. So that was the impetus behind doing it, and there is a balance between sort of giving districts more flexibility versus having a broad bucket of uses, but sort of aligning them with both a clearly defined need that districts have, and it also gives superintendents, school boards, and business managers the ability to say, Oh, we can't just use these funds for anything. We do actually have some guardrails, and having that clarity actually is supportive of their budgeting processes and communication with our public. So we're responding to something else that we're hearing from business managers as well. Whenever we can sort of offer them some clarity on guardrails, they tend to to appreciate that because then it doesn't put them on

[Sen. Virginia "Ginny" Lyons (Chair)]: the front line of very challenging budgetary conversations. Thank you. So what would be very helpful is to get some of this in writing and we'll put it up as testimony on our webpage and then we'll have it as we make decisions before. Absolutely.

[Jill Briggs Campbell (Deputy Secretary of Education, Agency of Education)]: Think we sent that over. Can you do There was a written testimony. Yeah. Written, you just wanted to get more detail to that?

[Sen. Virginia "Ginny" Lyons (Chair)]: I'm sorry.

[Jill Briggs Campbell (Deputy Secretary of Education, Agency of Education)]: Are you wanting more details for that?

[Sen. Virginia "Ginny" Lyons (Chair)]: We already have the testimony, and I haven't looked at it. So I will look at it.

[Jill Briggs Campbell (Deputy Secretary of Education, Agency of Education)]: Thank you. But any of

[Sen. Virginia "Ginny" Lyons (Chair)]: the any of the background information at this point will be.

[Jill Briggs Campbell (Deputy Secretary of Education, Agency of Education)]: Yes. That's good. And for context, so there's about $50,000,000 of unsent funds currently. The whole program has been steady around $30,000,000 in federal funding. But with this new change to a different payment model, there's a potential to have even more funds here and see how this year plays out. But right now, there's absolutely about $15,000,000, and they're asking us what is the best way to spend these funds, and and we just don't have detailed information to give them. Will still be in their hands to really design those prevention and addiction programs. It's still up to them. It's just setting those parameters and kind

[Sen. Virginia "Ginny" Lyons (Chair)]: of framework for it. Understood. Okay.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: It's indicative of the fact that it's not being managed. Okay. I don't think I pay. But I think that's a fair indication that the pro like, it's not being managed. Right?

[Sen. Virginia "Ginny" Lyons (Chair)]: Yes. Understood. That they would

[Katie (Legislative Counsel, Office of Legislative Counsel)]: leave a penny on the table

[Sen. Virginia "Ginny" Lyons (Chair)]: is Understood. Yeah. Okay. Thank you. Thank you. Thank very much. Elucidating. It's good to meet you. Very nice to It's good meet you. Okay? Alright.

[Katie (Legislative Counsel, Office of Legislative Counsel)]: So we are gonna call it a wrap for the

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

[Katie (Legislative Counsel, Office of Legislative Counsel)]: We promise to be efficient.