Vermont Legislature SmartTranscripts:

[Sen. Virginia "Ginny" Lyons (Chair)]: Your last Alright. Good morning. It is the last day of April, April 30, and this is Senate and Health and Welfare. We're looking at a bunch of bills this morning that we'd like to begin to fine tune and and vote out. And so we're going to begin with h six eleven. And, Jen, you're here with some language for us. Yes. We've been working on this one for a while.

[Nolan Langfeld (Joint Fiscal Office)]: If you do.

[Sen. Virginia "Ginny" Lyons (Chair)]: This is the.

[Nolan Langfeld (Joint Fiscal Office)]: Six eleven.

[Jen Cargill (Office of Legislative Counsel)]: So do we have a new You have a new New addition. New draft. Yes. So Jen Cargill, Office of Legislative Counsel. There's a new draft 2.1 on your webpage. I've added some new language from the chair for your consideration. And this does not include the HIV trap pep language because it still seems to be in flux.

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, I think we had asked for some consensus language from folks by Monday afternoon. Today is Thursday. We'll

[Jen Cargill (Office of Legislative Counsel)]: have to make up my Right. We received a couple of items overnight, but don't have don't know where you want to go with the different That's just Okay.

[Sen. Martine Larocque Gulick (Vice Chair)]: Different one. So

[Jen Cargill (Office of Legislative Counsel)]: this is h c 11 and aggravating to miscellaneous provisions affecting the Department of Access. We have the two provisions we looked at last time, which is adding in some language specifying that the drug manufacturers can't require certain information from a 340B covered entity as well as their contract pharmacy in order to receive acquisition of the 340B drug. We still have the structure language in subsection D from the House, And the second instance of amendments was striking the 2026 and moving it to 2027 for OPR's role in the DOLLA certification. This is a new potential amendment. There hasn't been any yet either, so I'll just walk through it. This is a potential new section directing the Department of Financial Regulation to report to FIS committee, the Finance Committee, House Healthcare, the estimated amount that health insurance premiums would increase if Vermont were to enact legislation requiring health insurance plans to cover GLP-one medications, the full official name, for all USDA approved indications, including the amounts of the state's financial obligations for defraisal of premium increases for qualified health benefit plans and for premium increases in sustained health. So I basically use similar language to what you've had in the biomarker bill that you set to the house for this analysis, but having DFR look at what it would would cover, what the state costs would be for requiring plans to cover GLP-one drugs for all FDA approved medications.

[Sen. Virginia "Ginny" Lyons (Chair)]: The reason I put this in is there are some concerns by folks who are using GLP-one that coverage for the drug has been shut off and they're very dependent on it and it's important to the patients. If we put in, I asked Jen originally to put in the coverage for medically necessary use of GLP-one. And your response was that would cause So there would be

[Jen Cargill (Office of Legislative Counsel)]: a fiscal impact. There would be state affraile the comp for the state employees plan. They may have stopped covering for certain indications and the teachers' plans passed. That's a drug. Pardon me?

[Sen. Martine Larocque Gulick (Vice Chair)]: It's a very expensive drug. Right? Well,

[Sen. Virginia "Ginny" Lyons (Chair)]: I've heard from some folks it's $400 a month, so it's a lot if you're on a budget.

[Jen Cargill (Office of Legislative Counsel)]: And I don't know, part of the reason I asked Nolan to be here is I didn't remember from the conversation on the biomarkers whether DFR think this isn't actuarial, requires actuarial analysis for them, and whether that's something they can, may be able to do within the

[Nolan Langfeld (Joint Fiscal Office)]: Yeah, there was one case where they could do it, and there was one case where they couldn't. I to figure out Okay. Where this

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, I mean, I think it's important for us to understand the effect. The cost for the patient is significant and if it's a life saving drug, make sure that it's available when it's medically necessary. So

[Sen. Martine Larocque Gulick (Vice Chair)]: can you just tell us what this will do exactly? I'm worried about our premiums, obviously.

[Jen Cargill (Office of Legislative Counsel)]: So that's what that's what it would have DFR come back with. It's information on study. Yes. This is right. The original request had been put in and I said that will have a physical impact of unknown quantities because it's having DFR crossed out then. Thanks, Joe.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, so that's there. We can say yes or no as we go along.

[Jen Cargill (Office of Legislative Counsel)]: And that's all I have for this amendment. As I said, the HIV medication issue still seems to be That's our amendment. A bit in flux, and I don't know if you wanna hear from the stakeholders to try

[Sen. Virginia "Ginny" Lyons (Chair)]: to figure out Let's take a minute to hear briefly. I see the two stakeholders are Courtney's

[Jen Cargill (Office of Legislative Counsel)]: in the hall, I think.

[Sen. Virginia "Ginny" Lyons (Chair)]: Courtney is in the hall. So Courtney, thank you for coming in. Gail is here, and I know that we had sent you off to come to consensus on Captain Pep, but Janice indicated she had two separate notes. So what would help me is to hear from each of you very quickly. Sure. And then this committee can make its own decision.

[Courtney Harness (Blue Cross Blue Shield of Vermont)]: Okay.

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: Gail says on behalf of the AIDS service organizations and on this issue, I'm also representing the Network Against Domestic and Central Violence and Plan. So there are four parts to our proposed amendment. We have reached complete consensus with DIVA on the Medicaid. So there's no contention around that.

[Sen. Virginia "Ginny" Lyons (Chair)]: And this is a DIVA bill. So this

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: is good. And that would be what I sent to Jen sections one and three. Sections two and four are the ones that are a little bit in flumsy. And I have a suggestion for that. And Emma, please jump in if you provide it. In this amendment that's being proposed to the committee right now that Jen just reviewed, There's a piece in our proposal that would require DFR to study the impact of including CREF and CAPM in insurance plans. So perhaps we could add something related to PREV and PEP to the amendments that you are looking at. There is an important thing on this. We have not reached complete consensus on number two in the amendment that we provided to Jen related to coverage of only PrEP, pre exposure prophylaxis. We're not touching PrEP with private insurance because that triggers defraile. But PrEP is already mandated to be covered by the feds. So there could be no defraile issues. So we had proposed that the language state that without any coinsurance, etcetera, co pays that the insurance companies cover. We use the exact language that DFR had presented to us in our amendment. And so that's where

[Nolan Langfeld (Joint Fiscal Office)]: we're at.

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: For for Medicaid, we're all set. And then we have the private insurance using DFR's language proposed and the possible study. One or the other of those last two items would be acceptable.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. So I know that Mary Block is here from DFR and Courtney.

[Courtney Harness (Blue Cross Blue Shield of Vermont)]: It's okay with the committee, I would prefer for our regulator to

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

[Matthew Bernstein (Child, Youth and Family Advocate)]: So then I'd be happy to add anything as we need it.

[Jen Cargill (Office of Legislative Counsel)]: No, it was emailed to me last week.

[Sen. Virginia "Ginny" Lyons (Chair)]: We haven't looked at it. I thought we would have it Monday, so this is hard for us right now. Mary, thanks for being here. So you want to comment on this whole issue for us insofar as DFR is effective?

[Mary Block (Deputy Commissioner of Insurance, Department of Financial Regulation)]: Sure. Mary Block, Deputy Commissioner of Insurance for DFR. Unfortunately, I have to slightly disagree with Gail because the language that she's using is not exactly the same as the language that we proposed. She's changed the language around, and I think that change has impacted the effect of the language. And so we could probably work through that with, ledge counsel, but we would still need to do that. I have not seen the latest version that she sent, to ledge counsel unless it's no different than what's been going what what the latest version was yesterday. Unfortunately, I didn't I didn't get a copy of what was sent to ledge counsel this morning, I believe. So there's some there's some defraile implications that are that I still question. Obviously, the committee can choose whether they want to do defraile or not. But the way the definition of HIV preventive drug reads right now, it would require the coverage of every single HIV preventive drug that is that is approved by the FDA. That is not what the ACA requires, and that is not what's recommended by the by the US Preventive Services Task Force. It requires that PrEP drugs be covered. It does not require that every single drug be covered with no cost share, no co payment. It's a slight variation, but it's a variation. And given that we are in an uncertain, shall we say, environment with respect to how Dufryo will be defined, I'm trying to be very exact right now. We have an outstanding notice of benefit and payment parameters rule from from CMS that would require us to pay defraile on everything that we've done since 2011 every mandate that we've added since 2011. And that will change the guidance on what a defraile means. And so we don't yet know what that impact will be. We should have gotten it by now. It is very late. And so it we I

[Sen. Virginia "Ginny" Lyons (Chair)]: I can I can relate to that one?

[Mary Block (Deputy Commissioner of Insurance, Department of Financial Regulation)]: Yeah. Every state is waiting with bated breath to see how this thing comes out at this point. We are supposed to, you know, be doing rate filings within the next two weeks, and we don't even have final rules from the federal government. So so we may be able to tweak the language. I can work with with Jen to tweak the language to see if we can get it to a place where we're pretty sure we won't have to frail.

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

[Mary Block (Deputy Commissioner of Insurance, Department of Financial Regulation)]: understand quite right.

[Sen. Virginia "Ginny" Lyons (Chair)]: Understood. So it's been not every drug, but it's some drug that would help cover Ann. So we you know, we're running out of time, and we don't have I've continued negotiation on this thing. This is really upsetting to

[Nolan Langfeld (Joint Fiscal Office)]: me

[Sen. Virginia "Ginny" Lyons (Chair)]: and hugely upsetting because we had and, Leggett Council doesn't have the luxury of the time that you're talking about. We asked for some consensus information on this, and we So haven't gotten I'm gonna say we're gonna leave our amendment as it is. We will vote tomorrow morning when we come into committee at 08:30. If we don't have anything then that everybody can agrees with, it's gone. That's the end of it. This has really gone on way too long. And I know that with the grains working together, because there are good heads in this room that are working on this, that we can come to consensus. So I'm asking you to do that. And that so we're gonna move on to the next bill.

[Sen. John Benson (Member)]: Can I ask one question? Sure. Corey, you then indicated to us, going back to Senator Gulick's comment, that coverage of all this could run $100,000 to $200,000 Is that still bearing me on? I would just

[Courtney Harness (Blue Cross Blue Shield of Vermont)]: say Courtney Harness, Blue Cross and Blue Shield of Vermont, I would say, first, I share the frustrations of the chair, and second, also would say that I agree with deputy commissioner Block that the language needs to be precise. And if the language is not precise, we risk the frail to the state. We also risk additional expense to Blue Cross Blue Shield to the amount that we did testify to, and that would, as we know, increase premiums for Vermonters. I

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. We get this, and we've heard this. And that what we what we know is that Jen received language late last night and early this morning. We had asked for Monday. So I'm asking you all to go off and come back. And tomorrow morning at 08:30, if there's nothing, there's nothing. And we will put in perhaps what we would like. Because there's some folks around this table that think PrEP and PEP is critically important for people who are exposed to HIV. So, and we know that there's a solution to this, so it has to come back. That's it.

[Nolan Langfeld (Joint Fiscal Office)]: Thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah, thank you all. Thank you, and good luck.

[Jen Cargill (Office of Legislative Counsel)]: All right, gents. Thank you. Yes. Thank you, Jeff.

[Mary Block (Deputy Commissioner of Insurance, Department of Financial Regulation)]: I'm sorry that I missed the phone.

[Sen. Virginia "Ginny" Lyons (Chair)]: Quick question I have for you. Any of the bills we had on the calendar bill? The calendar bills, Katie, they're your bill. Okay. Okay. How many people are in the room?

[Jen Cargill (Office of Legislative Counsel)]: I

[Sen. Martine Larocque Gulick (Vice Chair)]: don't care for, yeah, I care for

[Jen Cargill (Office of Legislative Counsel)]: about 06:60, six 57,

[Committee Clerk (name unknown)]: one or two. There you go.

[Sen. Martine Larocque Gulick (Vice Chair)]: One Oliver, and that's not sitting there.

[Matthew Bernstein (Child, Youth and Family Advocate)]: Are you

[Nolan Langfeld (Joint Fiscal Office)]: are you on 536?

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. We are. Let's do that. Kate, we have a new draft. We put that up. We do. Wonderful.

[Katie (Office of Legislative Counsel)]: Katie with the office of our society council. Here is draft 2.1 of five thirty six. You were about to vote yesterday. Some issues were raised, so there's some new language highlighted in blue. First, in subsection two not subsection, section two. The added phrase, Nothing in this section shall be construed to conflict with federal law or regulation. Sorry, that was section one. Section two, you have that appearing also, because that is the same section being amended at a different date. And then you have a new section on page seven, section three infant formula stock supply. The provisions of section two, which is the infant formula provision of this act shall not restrict the continued sale of infant formula inventory in stock in Vermont prior to the effective date of Section two pursuant to 4B, which is the contingency. So this is saying that anything that's in stock in terms of infant formula before the effective date of section two can continue to be sold

[Sen. Virginia "Ginny" Lyons (Chair)]: after the effective date.

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

[Katie (Office of Legislative Counsel)]: then the third, so here we're having that section three that we just added take effect July. And then the last issue that was raised was the contingency took effect on the enactment of legislation in other states, and now this has it taking effect not on enactment, but when the other state statutes take effect. So, for example, if California's legislation takes effect September or is enacted 09/01/2026, but it doesn't take effect till 01/01/2027. This would line up with the 01/01/2027 effective date, not the enactment date. Gotcha. So that's it for changes.

[Sen. John Benson (Member)]: I have suggested there as opposed to California, it's just have it two states with a population of 50,000,000 or not.

[Nolan Langfeld (Joint Fiscal Office)]: It doesn't matter. And we're not

[Sen. John Benson (Member)]: tied to the single state.

[Sen. Virginia "Ginny" Lyons (Chair)]: So I think we're gonna leave it like this, because we've been talking about this one right along, and I understand that that's a suggestion that came to us from some of the advocates, but I think this one this will serve as well. California is very close. The other states that are involved are high population states. If we're not looking at Wyoming, then we

[Sen. Martine Larocque Gulick (Vice Chair)]: Yeah. Thank you. Wow. James, exciting. It's exciting. It's good. Is

[Katie (Office of Legislative Counsel)]: there anything else for me? Those are the changes.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. Okay. And then It's a okay. Questions committee.

[Sen. Martine Larocque Gulick (Vice Chair)]: No. Do you, entertain a motion? I do it. So this is draft number 2.1. Okay. Would lose that we pass favorably about the committee. We got draft number 10.1H536. The date for that is 04:29PM, and it was, sorry, 04/29, '26, and 01:56PM.

[Committee Clerk (name unknown)]: So it's version 2.1 and the date on the draft is

[Jen Cargill (Office of Legislative Counsel)]: Yesterday. Yesterday. Okay. So Twenty ninth. Great.

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

[Committee Clerk (name unknown)]: I I'll be I'll get them all now. I'll go and just do really in some form. Okay.

[Sen. Martine Larocque Gulick (Vice Chair)]: So all all the Yep.

[Sen. Virginia "Ginny" Lyons (Chair)]: Role of mister Clark?

[Committee Clerk (name unknown)]: Senator Benson? No. Senator Cummings?

[Sen. Ann Cummings (Member)]: Yes.

[Committee Clerk (name unknown)]: Senator Gulick?

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

[Committee Clerk (name unknown)]: Senator Morley? No. Senator Lyons? Yes.

[Sen. Virginia "Ginny" Lyons (Chair)]: Three two. You interested in presenting this? Sure, think we need to. Okay, and I will say this, you know, sounds like an awful thing to do in baby formula, but there are very few manufacturers and the manufacturers of formula are producing product for the European Union in a way that is different from what we're seeing in this country. We don't like the idea of our little babies being exposed to things that babies have been wrestling over and

[Committee Clerk (name unknown)]: I think we're rushing it. Okay. That's my take on that.

[Sen. Martine Larocque Gulick (Vice Chair)]: I'll think

[Sen. Virginia "Ginny" Lyons (Chair)]: about rushing things. This one's been going on forever. Thank you, Katie. So that's good. We'll get a clean copy to Senator Good. Okay, the next bill we have is H660, the Opioid Abatement Special Fund Appropriations. And we've lost touch with this one a little bit because we've been doing other things. So do we have a new Yeah. Yeah. So let's It is in the budget.

[Nolan Langfeld (Joint Fiscal Office)]: I think so. No. No. Actually, it's not good at the home. Sounds good. Because it's all under the This is funds.

[Committee Clerk (name unknown)]: Yeah. Oh, oh,

[Sen. Virginia "Ginny" Lyons (Chair)]: I understand. And I

[Jen Cargill (Office of Legislative Counsel)]: thought that

[Sen. Virginia "Ginny" Lyons (Chair)]: it's all in the budget. You understand?

[Committee Clerk (name unknown)]: Yeah. Out of the fund.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Yeah. This is the opioid fund. The fund is in your budget.

[Nolan Langfeld (Joint Fiscal Office)]: And There's one thing in the funding budget.

[Sen. Martine Larocque Gulick (Vice Chair)]: Okay. I don't think things were up yet.

[Nolan Langfeld (Joint Fiscal Office)]: Except at one time, I can show

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

[Jen Cargill (Office of Legislative Counsel)]: So here's draft 5.1. You have your reader assistance heading. If you remember, you moved some of the appropriations that had been in the Opioid Abatement Special Fund to the Substance Use Prevention Fund. So, you're seeing that items that had been on this list are no longer there. Last time we met, we looked at this 1,100,000, to, Department of Health, rewarding grants to Burlington for the Overdose Prevention Center, provided that the department does not distribute funding until a location for the Overdose Prevention Center has been procured by lease or purchase, the Overdose Prevention Center is being fed up for its intended use, and the Overdose Prevention Center is currently or will imminently become operational.

[Sen. John Benson (Member)]: So I understand what you said about the commitment. What I'd like to see in that was a clawback if they are not up in operation by 2028, that we just don't sit on that money because there's a lot of other things that could be

[Sen. Virginia "Ginny" Lyons (Chair)]: That would be a good suggestion. I think we'd have to go back and take testimony on that to understand where they are. At this point, they're looking, still looking for venue and there's a lot of discussion that's going on. Cornelia, I might agree with you if we had some time to sort it all out. And that is something that the advisory committee is going to have to deal with when they look at the, there's a little section in here that has a hiatus for the advisory committee where they take a break and then they evaluate what they've done and what they're doing. And I guarantee you that we'll be sure that we'll part of that discussion. Yeah, what do we do when things still go forward? That's a good point.

[Jen Cargill (Office of Legislative Counsel)]: Okay, we have our intent language around the fact that it is intended to be annual through at least fiscal year '28. No changes in two, no changes in three. Just to refresh your memory, three was,

[Nolan Langfeld (Joint Fiscal Office)]: had

[Jen Cargill (Office of Legislative Counsel)]: to do with the opioid abatement settlement advisory committee and, who they're consulting with and their process for looking at sustainable funding, from applicants. Appropriation review, you made a decision to go back. This blue is to go back to language that the house had proposed, which is that next year, fiscal year twenty eight, the advisory committee would only be looking at funding proposals for things that in statute had been identified as annual priorities. These are older changes. Quarterly reporting, inversions. Here is the Substance Misuse Prevention Special Fund. This is for appropriations that had been in the opioid abatement special fund section that are moving down to this prevention misuse special fund instead. You have language, with regard to the substance misuse prevention fund being added in statute that is part of its annual budget presentation. The department reports to appropriations and policy committees on its specific spending proposal for the fund in the coming fiscal year, and the report is to conclude include an estimate of the monies in the special fund anticipated to remain unallocated at the end of the fiscal year. And then you have your effective date, which is 07/01/2026, and you're updating the title of the bill to reflect that money is now being appropriated from the Substance Misuse Prevention Special Fund. So this is 5.1. We've walked through most of these changes. I think we made a one word change the last time we met, I and can't remember what it was, but I think that is what got us

[Sen. Martine Larocque Gulick (Vice Chair)]: from 4.1 to five point I vaguely remember this.

[Nolan Langfeld (Joint Fiscal Office)]: That's what

[Jen Cargill (Office of Legislative Counsel)]: know. It's gonna work. Well, you don't mind. Let me see if I've marked up.

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

[Sen. Virginia "Ginny" Lyons (Chair)]: There is also language in the budget regarding the substance misuse prevention special fund, the definition that we had talked about in here and sat down the hall. And the definition that's in there I think is somewhat incomplete. We'll probably be negotiating that with the House during the conference process. Keep you informed on that when you get your ideas. The other piece of that is that the guidance document for the opioid funds is pretty clear about the use of those monies for opioid, not general substance use.

[Sen. Martine Larocque Gulick (Vice Chair)]: Is there a date by which all of the bodies and the opioids that have to be dispersed or No.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Committee. I know how you think. I know you're thinking about it. But there's time in there. You saw that section there for a consideration. So I think it's important. There's no question that it's not important, but I think in this case where the bill has come from, the advisory committee and the Department of Health working together. So we have to, we understand that that work is important. Then, Ginny, just wanted to look at one last Oh, That was the, just go quickly through the appropriations that are in there. Do you want me to I would like that. Yes. That would be a good idea. I mean, do you represent the Joint Fiscal Office?

[Nolan Langfeld (Joint Fiscal Office)]: I don't have Gulick stepped out because I asked her to pick up I made fresh coffees for you.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. She just went to get them.

[Nolan Langfeld (Joint Fiscal Office)]: I know. She went to get them. But she can't get to the Zoom without her. Actually, it probably could. Let me get it to the Zoom. Okay. That you would think of. Is it you or me? No. Katie, is it you?

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: That's me. Oh.

[Sen. Virginia "Ginny" Lyons (Chair)]: She has Okay.

[Courtney Harness (Blue Cross Blue Shield of Vermont)]: I'll tell you what. Why don't you

[Nolan Langfeld (Joint Fiscal Office)]: get off of it, and then I can drive it. Sorry. That's okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: Although, my computer's being soundtrained to me. Maybe

[Nolan Langfeld (Joint Fiscal Office)]: I should use yours. No. Seriously, my computer's being really weird. Actually, if you don't mind, could I use it? Sorry. I know. I've been a hot mess. I'm sorry. Can I

[Sen. Virginia "Ginny" Lyons (Chair)]: don't believe that? The an epidemic is that.

[Sen. Martine Larocque Gulick (Vice Chair)]: Normally, I'm more

[Nolan Langfeld (Joint Fiscal Office)]: organized, but I'm you know?

[Sen. Virginia "Ginny" Lyons (Chair)]: It's been of thing to do with stress.

[Sen. Martine Larocque Gulick (Vice Chair)]: Yeah. I was prepared to be unprepared.

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

[Nolan Langfeld (Joint Fiscal Office)]: So what you have here Alright. What you have here is this is 5.1. So I'll just highlight the change. Okay. Everything that's changed from 5.1 is in red. So you'll see the first one is we have this six. Numbers, by the way, on this do not match unless they're in the middle, just to be clear. Yep. So they will in the fiscal. So six a, we added recovery centers. There's the VDH. This is the $8.70 5 that we moved. It's not in this bill, but this is an opioid fund sheet. So you can see this is the eight seventy five that's in

[Committee Clerk (name unknown)]: the budget. That's the appropriate office size.

[Nolan Langfeld (Joint Fiscal Office)]: Yeah, and so I put that in here because again, is an opioid plan balance sheet and not a six sixty balance sheet. And then you have the 1.1 for the opioid prevention center. Next change is the combination of the 900 to the 304,200,000 students. Then you have the PCET, the Public Safety Enhancement Team. You have added back 287,000. And then these next eleven, twelve, thirteen, and fifteen, those are the ones you move out into the Substance Abuse Fund. Initially, the House had recommended, just for the history of the House, Human Services had recommended this at the time we were told there was no money fund, in so appropriations put it back. We've now learned that we think that the fund can accommodate this, So that's why it's going back to substance misuse fund. And then the bottom line difference is for this spending, it doesn't include the convergence, but you can see the 6,600,000 versus your 8.1 plus $8.07 5, which is budget. So it's 8.9 plus 9,000,000. If you go to that's here, this is all the changes. So the house spent 5.16. Yeah. 5.16. You're spending 6.7 plus the $8.75 in the budget. So you're spending a little bit more out of the slots. Any big pieces of that, so as a reminder again, are the $800,000 and the $1.1 and the $875 So that's the recovery centers, opioid employment, moving that over, and the 1.1 for the OPC. So those are the big changes to the fund compared to what was in the house budget. The reversions are the same, and then the bottom line, you'll have $4,200,000 left in, $4,300,000 left on the bottom line until the next settlement payments show up. What does that mean? Yes. Okay. Not sure. I I actually know the cycle of how they Oh. Though, from one point a year. I believe that they are annual. There's a lot of different settlements in that, because again, that doesn't include the pharma, Purdue, which is already a lump sum. There's the appropriations. I think it's easier to just kinda run through it on a sheet than to have changes run through it the belt to give you a sense of how it fits within the land line of things. So when

[Sen. Virginia "Ginny" Lyons (Chair)]: when we're looking at the reversions, can you talk about what that means a little bit? Oh, is this money that was appropriated from the fund and now hasn't been used? So it's going back into the fund. So I'm just trying to help Senator Benson with his concerns about having money committed and not used.

[Nolan Langfeld (Joint Fiscal Office)]: This came from a request from the health department. And he said, hey, look, these monies, we didn't need this much, or whatever. We'd like these money to revert back to the fund. Now it can be spent for other things.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Question, mister. This is not the bill. This is the fund.

[Nolan Langfeld (Joint Fiscal Office)]: Yep. And I will have a fiscal note that will line up with the sections of the bill. Okay. Just like I had one with the house and these up to the floor.

[Sen. Virginia "Ginny" Lyons (Chair)]: And the money for the the $8.75 that was being moved into the base, but it's now back being taken from the settlement fund It's in the big bill, not in the bill in front of us.

[Nolan Langfeld (Joint Fiscal Office)]: Correct. That's why I sent you that. My pleasure. It's a balance sheet and thought.

[Sen. Martine Larocque Gulick (Vice Chair)]: Thank you. This might be this is late, I think, I know, but there's money for recovery. There doesn't seem to be money for treatments. And my understanding is that that forecast was 1,200,000 for six hundred thousand for aggressive births, recovery, and then others, and some day for treatment.

[Sen. Virginia "Ginny" Lyons (Chair)]: So that I know that there were some who were interested in having that money split out so that it could go to different types of recovery residences. So this goes to a three or higher level and if it were split out it would be perhaps at a different level. But that would happen and that's what the house actually recommended. On a request, we put it together, and I think the house may have something to say about that. They may have something to say about a lot of this. I don't see it as a big issue. I

[Sen. Martine Larocque Gulick (Vice Chair)]: just think treatment is Right, I agree.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay, any questions for Zola? The

[Nolan Langfeld (Joint Fiscal Office)]: balance

[Committee Clerk (name unknown)]: on 60 Gilgirls Prevention Center, the 1,100,000 is coming out. What's the balance of that button? This is all good. This is all good. I thought one was coming from one fund and one was coming someone's coming from another fund.

[Nolan Langfeld (Joint Fiscal Office)]: No, this is the whole thing with the subsequent chiefs fund. So that's the ones that are on Brandon's page two. We pulled that out. Red ones. Yeah. So those are going back. But the opioid, the OPC is coming out of the O2.

[Sen. Martine Larocque Gulick (Vice Chair)]: I think the confusion is substance misuse versus voguing with settlement. Yeah, yeah, yeah.

[Nolan Langfeld (Joint Fiscal Office)]: That's what I've talked about. Okay, so the substance misuse fund is a separate fund, and it's funded through cannabis. The percentage of the cannabis tax goes here, and a percentage goes elsewhere, and this money is used for There's a whole list the health department has, and there's various things that are being used to put this fund.

[Sen. Virginia "Ginny" Lyons (Chair)]: And so there's also language in the big bill, not just to define the fund, the substance abuse fund, but also to look at what's in the fund, how much has been expended.

[Nolan Langfeld (Joint Fiscal Office)]: So that's

[Sen. Virginia "Ginny" Lyons (Chair)]: what our budget We've asked for that in the budget because it's gotten very confusing and we don't want to have an overlap for several reasons. One of which is legal requirements for the use of the opioid fund. We start to mix things up, we get Exactly. A

[Nolan Langfeld (Joint Fiscal Office)]: That's why those four things, the housing services committee doubled, it's not appropriate for those things to be And you guys are agreeing with that. The only reason the house overall appropriations didn't is because there was enough money. Right. No, I

[Committee Clerk (name unknown)]: get it. I just think there's two different things you want

[Nolan Langfeld (Joint Fiscal Office)]: to do they're doing the mistakes.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. So we have this. We've got a fiscal note

[Nolan Langfeld (Joint Fiscal Office)]: Yeah. To the bill. Once the bill's passed, whoever's reporting, they'll make sure they get a copy the fiscal note because they'll have to approach.

[Sen. John Benson (Member)]: Just

[Sen. Virginia "Ginny" Lyons (Chair)]: have to go down the hall. Yep. Yeah.

[Sen. Martine Larocque Gulick (Vice Chair)]: Can I offer a magnet first? You can offer a magnet. That would be. Yeah. And I think it's a bit by the parties, but then so to split us well, we've got 1,200,000 into six and six. And six would go to the Department of Health for Substance Use Residential Treatment, beds of the American Society of Addiction Medicine, Level 3.1.

[Sen. Virginia "Ginny" Lyons (Chair)]: I actually like that suggestion. I don't know if it's what So, Subdivision 6. So, what's point 2? I move

[Sen. Martine Larocque Gulick (Vice Chair)]: What would you like? So, split it to leave 600,000 where it is and then move half of it, so 600,000 to the Department of Health for substance use residential treatment. It has

[Sen. Virginia "Ginny" Lyons (Chair)]: to be opioid? For opioid use disorder? Opioid misuse treatment.

[Sen. Martine Larocque Gulick (Vice Chair)]: Yes. Yep. This is a problem at the American Society of Addiction Medicine level 3.1. Do you have that?

[Jen Cargill (Office of Legislative Counsel)]: Do you want me to do that right now? Sure.

[Committee Clerk (name unknown)]: So I need a different version

[Nolan Langfeld (Joint Fiscal Office)]: to build up the.

[Sen. Virginia "Ginny" Lyons (Chair)]: 6.1? Oh, no. Let me do that right now. Take a minute and do it. Yeah. Seriously, let's just get this. Okay. I'm running.

[Sen. Martine Larocque Gulick (Vice Chair)]: There's no subject line. Just.

[Sen. Virginia "Ginny" Lyons (Chair)]: Jessica, did you wanna say something?

[Jen Cargill (Office of Legislative Counsel)]: I did, if you would allow me to do that. Thank you. I'm Jessica Chittenden, Department of Health Policy Director. And we were just made aware of this amendment this morning about the split. Just to clarify, in the House version of the bill, they had 900,000 for new recovery residences at Level 3 or above, and then 300,000 for new recovery residences in certain geographic areas.

[Jessica Chittenden (Vermont Department of Health, Policy Director)]: And the department has recommended putting that all into 1,200,000 total, that we could have more flexibility to use in conjunction with the RHT funding that is gonna come through recovery residences. And so, there's, with RHT funding, we can only fund some of the things, like we can't fund like the infrastructure and some of the startup costs. So, we would recommend keeping that 1,200,000 for recovery residences specifically and not carving out the 600,000 for treatment, because that's going to be needed to support the expansion under our HTP. And if you all are interested in adding 600,000 for more residential beds out of this, we're not opposed to that, but it's just going to put more budget pressure on

[Sen. Virginia "Ginny" Lyons (Chair)]: Understood. Account. Yes. I know. And we've been going through this one for a bit, lot of discussion about it. So, I think we'll take Senator Gulick's recommendation at this point to send it back. We wanna make sure that different treatment levels are provided appropriate funding. And I think that's that's what we're getting to. Not sending all out to one organization. There is RHT funding. And I understand that the grants are beginning to, the RFPs are going out and that requests are coming in. Talked with the director yesterday, and she's she'll come in whenever we would like, but not doesn't have a lot of good it doesn't have a lot of new news. Yep. So this will change the fiscal note. Sure will. That's okay. Oh, I'm sorry. Yes. Yes. Yes. It won't accomplish. What's the number?

[Jen Cargill (Office of Legislative Counsel)]: It'll be 6.1. So here, 600,000, and now this is a subdivision 6A, and now you have a B, 600,000, to the Department of Health for Ovary Use Disorder Residential Treatment Beds at American Society of Addiction Medicine Level 3.1.

[Committee Clerk (name unknown)]: American Society of Addiction Medicine Level. Oh, no. It's

[Jen Cargill (Office of Legislative Counsel)]: when you vote, you vote pending edits. Because I will have to run

[Sen. Martine Larocque Gulick (Vice Chair)]: this. Yeah.

[Nolan Langfeld (Joint Fiscal Office)]: I'll be able Hopefully,

[Sen. Martine Larocque Gulick (Vice Chair)]: you know, Okay.

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

[Committee Clerk (name unknown)]: What's American Society of Addiction Medicine level 3.1?

[Sen. Virginia "Ginny" Lyons (Chair)]: Remember we looked at the different levels? Yes. Going from one up. I don't remember 3.1. So who would like to help us understand level 3.1? I can give it a try and once we can put treatment on.

[Jen Cargill (Office of Legislative Counsel)]: Mean, this is so what is being added to the bill? So, Jessica Chittenden, the policy director, Department of Health. What's being added to the bill and level three point one is residential treatment. It's low intensity

[Committee Clerk (name unknown)]: residential Okay, so the level is too low.

[Jen Cargill (Office of Legislative Counsel)]: So, as opposed to the different levels of recovery residents that we talked about, there are the NAR levels one through four, and NAR level four is very similar to the three point one residential treatment, where there is an integration

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: of treatment services. Yep. And then Maxwell's action circles just a little extra clarity. So, we don't have many, right now, John's promises are only levels being residents. Oh, and that's so we don't have anything higher than a level three of a a great residents. I asked, which has said once you move path to the minimum UBR?

[Jen Cargill (Office of Legislative Counsel)]: Can't hear you.

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: Once you move path level three and recovery resident standards, you're getting very similar to the same as level 3.1 in treatment standards, which are different.

[Sen. Martine Larocque Gulick (Vice Chair)]: On behalf of the Recovery Council.

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: So the actual definition I have of ASM 3.1 is low intensity clinically managed residential. Currently, the reason that we talked with the Department of Health about removing the or above part of Section six is that there currently are no level four recovery residences in Vermont and they were in agreement. I don't wanna speak for you. It's because that they

[Sen. Martine Larocque Gulick (Vice Chair)]: were in agreement with removing the.

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: Okay.

[Sen. Virginia "Ginny" Lyons (Chair)]: The recommendation that came from the advisory committee included the split of the 1.1 in the original underlying bill? It was 300 and What came over from the house? 993, I think. Three. That was the original. This really goes back to the recommendation from the advisor. I honestly feel very uncomfortable in deviating too much from what the advisor made because they've worked really hard. Okay. That's nine and three.

[Jen Cargill (Office of Legislative Counsel)]: Go ahead. Yes. I just wanted

[Sen. Virginia "Ginny" Lyons (Chair)]: to make a

[Jen Cargill (Office of Legislative Counsel)]: clarification that OSAC did did recommend the nine three split, but the 900 was for recovery residences level three or above, and the 300 was for new recovery residences in certain geographic locations. Understood. And that was what the House had in

[Sen. Virginia "Ginny" Lyons (Chair)]: We're their version of the gonna do this and then the bill will go back to the House and they can evaluate the difference between our language and their own language. We don't have, yeah, so we'll do that. And I'm sure that there are members of the house Human Services Committee who are very interested in this. Okay. So do we have the draft?

[Jen Cargill (Office of Legislative Counsel)]: I just sent it to Calista. She's running to print a copy, maybe multiple copies. And now the editors are looking at So can look at it.

[Sen. Virginia "Ginny" Lyons (Chair)]: Alright. So knowing that oh, golly. Now the next bill that we're gonna be picking up, we'll have discussion as well, and that's gonna be $6.57. We have which one is each which one has the least? Probably $8.16. 816. Yeah. We might we might just jump to that one. We need a little break from the intensity of. Okay. And when when that comes back in, we're just jump back to it. So it's eight sixteen.

[Jen Cargill (Office of Legislative Counsel)]: Okay. Here is your latest draft of eight sixteen. This is draft 3.1. Thank you very much.

[Matthew Bernstein (Child, Youth and Family Advocate)]: Yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: Tell me when you're ready to do six sixty. I'm ready.

[Jen Cargill (Office of Legislative Counsel)]: 06:60? Yeah. We're gonna we're gonna. We wanna I'm go through ready.

[Nolan Langfeld (Joint Fiscal Office)]: Okay. That's good.

[Jen Cargill (Office of Legislative Counsel)]: As long as you vote pending edits.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. Okay. If we vote, we'll vote pending edits.

[Sen. Martine Larocque Gulick (Vice Chair)]: Does anyone else wanna make a motion, or I'm happy to? Yeah. He's ready. Okay. I move to ask a group of the age six sixty pending amendments. It's so it's draft number 5.1

[Nolan Langfeld (Joint Fiscal Office)]: now. 6.1.

[Sen. Martine Larocque Gulick (Vice Chair)]: Hold on. Let me finish. Oh. It's draft 5.1. Pending edits, it will be 6.1.

[Jen Cargill (Office of Legislative Counsel)]: No. No. You're voting on draft 6.1. Okay. We're voting on draft

[Sen. Martine Larocque Gulick (Vice Chair)]: 6.1. Depending on it.

[Nolan Langfeld (Joint Fiscal Office)]: And

[Sen. Martine Larocque Gulick (Vice Chair)]: that will be, obviously fourthirtytwenty six. Yep. Okay. Makes sense. Are

[Committee Clerk (name unknown)]: you all set, madam chair?

[Sen. Virginia "Ginny" Lyons (Chair)]: Oh, yeah. Any further discussion? No one will get us at this vote? Okay.

[Committee Clerk (name unknown)]: Senator Benson. Yes. Senator Ann Cummings. Senator Gulick.

[Sen. Virginia "Ginny" Lyons (Chair)]: Actually, cute. Like,

[Sen. Martine Larocque Gulick (Vice Chair)]: know it's hard to say.

[Committee Clerk (name unknown)]: I know. But I apologize.

[Sen. Martine Larocque Gulick (Vice Chair)]: It's good that no one gets it hard. Very cute to look at it right. But yes. I think it's Yeah. Exactly.

[Committee Clerk (name unknown)]: Senator Morley. Yes. Senator Lyons. Yes.

[Nolan Langfeld (Joint Fiscal Office)]: Oh, no.

[Sen. Virginia "Ginny" Lyons (Chair)]: Probably gonna fall on top of my shoulders. Is there anyone who would like to report this? Okay.

[Sen. Martine Larocque Gulick (Vice Chair)]: I'll report it. Well,

[Sen. Virginia "Ginny" Lyons (Chair)]: challenge is that the advisory committees will not stand up to you. I have something to say.

[Sen. Martine Larocque Gulick (Vice Chair)]: Thank you. Sorry.

[Nolan Langfeld (Joint Fiscal Office)]: Let's look. We did a different version.

[Sen. Virginia "Ginny" Lyons (Chair)]: Thank you, Katie. Doctor, was good. So let's jump over to jump to h eight sixteen

[Jen Cargill (Office of Legislative Counsel)]: Okay. If we could. Sure. Here it is. Here it is. You have not made any changes since the last time you looked at this. Do you have a walk through last Thursday or Friday? So I can break you through the latest changes again if that would be helpful there.

[Sen. Virginia "Ginny" Lyons (Chair)]: I'll just go through it. Yeah, we're on draft 3.1. You are. Yeah, okay.

[Jen Cargill (Office of Legislative Counsel)]: So you have a purpose section. It is the purpose of this act to safeguard individuals seeking mental health services in the life of psychological harm, including death by suicide, by ensuring that these services are delivered by mental health professionals and not independently by AI systems. And you have your section two, which has where there's a list of unprofessional conduct by professions regulated by OPR, and you're adding to that list for any mental health professional engaging in the prohibited use of AI pursuant to section three. Section three has a series of definitions. You have some changes in your definition of mental health services, including, well, that you're adding in including clause, that includes therapeutic decisions, therapeutic communications, generating treatment plans or recommendations, or detecting or interpreting emotional or mental states. Can we say emotion? Emotion. Interpreting emotion or mental states. I guess that could stand.

[Sen. Virginia "Ginny" Lyons (Chair)]: Therapeutic communication. Why am interpreting emotional?

[Jen Cargill (Office of Legislative Counsel)]: Well, it could be either, I think. Okay. Interpreting emotion or emotional states. It depends. Got it. So, we've had it as emotion. Okay. If you would like to change it, you can. That's okay. Therapeutic communication means written verbal or nonverbal interaction. And you have a such as list, a list of examples. So we've been through that. Subsection b, an individual corporation or other entity shall not offer or provide mental health services through artificial intelligence without the review and approval of a mental health professional. Yeah. In subsection C, we have language that a violation of this section by a corporation, an entity, or an individual, so we're tracking what we have here on line sickness, who is not licensed, certified, or rostered as a mental health professional is a violation of the Consumer Protection Act. We've added in a penalty of $10,000 for each violation. In subsection D, that nothing in this section precludes a mental health professional who's operating within the scope of their professional practice from utilizing AI tools that are HIPAA compliant, provided that the professional reviews and approves any mental health services. So that references back to your definition of mental health services. And then section four is the Board of Medical Practice. One of the professions within the list of mental health providers is regulated by the Board of Medical Practice and not OPR. This is sort of putting in parallel language that engaging in the prohibited use of artificial intelligence pursuant to 71.15 as unprofessional conduct. You added a report coming back in January asking OPR and the Board of Medical Practice to look more broadly at the use of AI in regulated professions. That would have recommendations for legislative action. And then your effective date is on passage.

[Sen. Virginia "Ginny" Lyons (Chair)]: And that's it. Left just

[Sen. Martine Larocque Gulick (Vice Chair)]: for saying who? Sorry. Dropped the shot.

[Sen. John Benson (Member)]: So I had raised the question, or it is to whether or not if AI is out practicing

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

[Sen. John Benson (Member)]: They're not a licensed professional, then that would be illegal to begin. And and so the question I had was, do we need the bill or are we already covered because if because we're trying to make sure AI is not out there practicing, and so AI doesn't have a license. So isn't that already an illegal act? So

[Jen Cargill (Office of Legislative Counsel)]: we talked about possibly hearing from OPR on that. Right. So your question is, basically, is AI, because it's not a licensed mental health practitioner already violating the law in Vermont. Think that that is a difficult question because all of the professional regulation statutes regulate people, and this is sort of regulating a a service, a technology in a way that I think the OPR statutes hadn't envisioned. So I I guess I struggle with that question because it is sort of not exactly apples to apples, but I think what your question is raising is that this is new technology that, you know, our statutes when they were passed didn't necessarily account for. So that's not I sense that you're wanting a yes or no, and I

[Nolan Langfeld (Joint Fiscal Office)]: don't have any answer.

[Sen. John Benson (Member)]: Just raising the question

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

[Sen. John Benson (Member)]: Because we're yes. We're in new territory, and it's something out there practicing without a license, basically.

[Jen Cargill (Office of Legislative Counsel)]: Yeah. Yeah. I hear the question, and I'm I'm wrestling with it, I think. Well

[Sen. Martine Larocque Gulick (Vice Chair)]: yeah. I would agree it's not a human being, so it's not falls in a different category.

[Nolan Langfeld (Joint Fiscal Office)]: I

[Committee Clerk (name unknown)]: spoke to you at some point 80 on page four of six, small b. Right. And I'm still struggling with it. An individual corporation or other entity shall not offer or provide mental health services to artificial intelligence without review and approval

[Sen. John Benson (Member)]: of a mental health professional.

[Committee Clerk (name unknown)]: My question kind of was if there was someone that was seeking treatment and they were on an AI, whatever, and they were thinking about hurting themselves, the AI said, no. Please don't do that because of a b c d. Would that go against this provision, small b?

[Jen Cargill (Office of Legislative Counsel)]: This language in subsection b is is point neutral. So whether the AI system is responding with something that the practice the mental health providers would find as problematic or they find, actually, that is in line with what we would recommend. It it doesn't matter. It's The ban on the provision of mental health services without review and approval of a mental health professional is neutral on the viewpoint that's being presented by the AI system.

[Nolan Langfeld (Joint Fiscal Office)]: Does that

[Sen. Martine Larocque Gulick (Vice Chair)]: help? Can you give me an example?

[Jen Cargill (Office of Legislative Counsel)]: So regardless in your example, somebody is entering into a chat box. Mhmm. You know, I'm having these thoughts. Right. If the chat box responds, yes, you should commit suicide or no, you should go seek professional help from a mental health professional, both of those responses are prohibited by this language because they have not been because it's mental health services that not have not been reviewed and approved by mental Right. Exactly.

[Committee Clerk (name unknown)]: So 50% is good, 50% could be bad. We don't know.

[Sen. Virginia "Ginny" Lyons (Chair)]: Or the chat box won't call 911 and say, you need to do a wealthier check on this person. Abnormal. Right. Know, I mean, there's so many if it's connected with a mental health professional, then the mental health professional gets involved.

[Committee Clerk (name unknown)]: No, no, no. I completely agree with that, Senator. My question just is, what if this individual is at home and this occurs and there's no professional around, no one's gonna connect to the professional and

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: this

[Committee Clerk (name unknown)]: individual's of the chat box, the chat box says, no. Please don't do this. That's great.

[Sen. Virginia "Ginny" Lyons (Chair)]: That's great.

[Committee Clerk (name unknown)]: But if but this decision is being done without approval of a Metropolitan Community. Right? Just

[Sen. Virginia "Ginny" Lyons (Chair)]: please don't do this is not generally enough.

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

[Sen. Virginia "Ginny" Lyons (Chair)]: You know? Like, this this is really a bad idea.

[Matthew Bernstein (Child, Youth and Family Advocate)]: Right. Right.

[Sen. Virginia "Ginny" Lyons (Chair)]: Does it go forward? And

[Committee Clerk (name unknown)]: So there's positives there's positives to the

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

[Committee Clerk (name unknown)]: And there's negatives. Yes. And and so I'm just trying to make sure that a negative is solved. I wanna make sure

[Jen Cargill (Office of Legislative Counsel)]: I think you're trying to

[Sen. Virginia "Ginny" Lyons (Chair)]: harness the Trying

[Jen Cargill (Office of Legislative Counsel)]: to I

[Sen. Virginia "Ginny" Lyons (Chair)]: know that truth. Representatives of Google had reached out with this question. Mhmm. And has recommended that we do a study. But it is another world of regulation and understanding. So all we're looking at here is making sure that whenever there's counseling it's through a licensed professional. That's what we're doing here. So by going to the next step and looking more thoroughly at chat boxes of the world and inquiry into Google or other places. That is another that's a next step. That's something I think we could all some of us could get our arms around, but it's it's gonna take a a lot of arms. Okay.

[Committee Clerk (name unknown)]: So there's a lot more stuff in development.

[Sen. Virginia "Ginny" Lyons (Chair)]: I think there's a huge amount to think about. I think it's a great question, and I know that this brought to my attention as well, I'm just trying to keep us focused here. When this bill started, it was like this and now it's here, so manageable.

[Sen. Martine Larocque Gulick (Vice Chair)]: Just wanted to say, think you bring up a point. Think the technology's moving so fast. It's like the neurological brain I mean, it's in a year from now. Who knows? So we're trying to get in front of it, but also knowing that it's all gonna change, and a lot of

[Nolan Langfeld (Joint Fiscal Office)]: these pills probably have been for changes. Sounds good, sounds bad. It's so hard for me to

[Sen. Virginia "Ginny" Lyons (Chair)]: So where are we with this, though?

[Committee Clerk (name unknown)]: There's a lot of color on it.

[Jen Cargill (Office of Legislative Counsel)]: There's a lot of color on it. Yep. So you've walked through this version twice without changes.

[Sen. Martine Larocque Gulick (Vice Chair)]: Okay. I have no motion. Person today. So it's draft number 3.1. Is that right? 3 0.1. Okay. So I move to see the people's behalf. The both fingers we have may draft number 3.1 at page eight sixteen, which was from April 22. We can pick her vote. He can

[Sen. Virginia "Ginny" Lyons (Chair)]: pick her vote up, she's gonna give it us. Discussion? Any more discussion? Okay. Senator Clerk.

[Nolan Langfeld (Joint Fiscal Office)]: All

[Committee Clerk (name unknown)]: right. Senator Benson. Yes. Senator, we'll this open, you said about two?

[Sen. Virginia "Ginny" Lyons (Chair)]: Yes, we will. Yeah.

[Committee Clerk (name unknown)]: We'll wait for Senator Cummings. Senator Gulick? Yes.

[Nolan Langfeld (Joint Fiscal Office)]: You're gonna have to continue your.

[Committee Clerk (name unknown)]: Senator Morley? Yes. Senator Lyons? Yes. We'll wait to hear back from senator Cummings.

[Sen. Virginia "Ginny" Lyons (Chair)]: So so right. So right now, it's closer than. Yeah. Okay. So check who is gonna report this one? This was You wanna report it? Yes. Oh, goody. That would be great. That is

[Gail (AIDS service organizations / Vermont Network Against Domestic & Sexual Violence)]: one of the key rules.

[Committee Clerk (name unknown)]: I know, I'm sure it is. I'm sure it is.

[Sen. Virginia "Ginny" Lyons (Chair)]: Alright. So, Senator Benson is our reporter for that one. That's great.

[Jen Cargill (Office of Legislative Counsel)]: Okay. I'll get everyone putting copies on all of these when I have a chance to clean up the bed. Yeah, know.

[Sen. Virginia "Ginny" Lyons (Chair)]: So we're just a little bit overtime. We have 06:57 to look at with Katie, and then we're gonna take a teensy break and go to H 938. So we're gonna go to Mount 657

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

[Sen. Virginia "Ginny" Lyons (Chair)]: And see where we are with that. Okay.

[Katie (Office of Legislative Counsel)]: There's a big. You

[Sen. Martine Larocque Gulick (Vice Chair)]: don't have to say. You have.

[Katie (Office of Legislative Counsel)]: But they're tiny. And one was Tricky. Tricky. My quotes are being up changed, so that one is really super exciting. So you're looking at graph 2.1 here. Let's see. Okay. Kinda changes. The first change was in section four, the proof of certification for the unaccompanied youth. The version that left the house designated elevate youth services as preparing the documentation. And I should have caught this before it left to the house, but we really don't specify in statute a specific nonprofit organization. So, I've rewritten it that the department shall contract with a community organization that serves homeless and runaway youth in Vermont. So, that was my corrections. And then you heard testimony. Oh, here we are. So this is the list of how a youth can use the certification form, that an unaccompanied youth can use the certification form, and you heard testimony and I was asked to add this proposal to the list. Participate in a court diversion program or in a youth substance awareness safety program. And that was presented to you last week. Willow Farrell. Right. Yeah. That's right. So those are the two changes that I've been asked to make or have asked to make with regard to this first one with the using more generic language.

[Sen. Martine Larocque Gulick (Vice Chair)]: Okay. We don't seem to have this version. I see 124. No. Right? 7?

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. This is two plus one. Right. It's That's just okay, Katie. So Katie, this is a proposal amendment, what we're putting in. We're not doing strike off? This is a strike off.

[Katie (Office of Legislative Counsel)]: It is a strike off. It is, yep. And you have received other testimony and request for changes from different groups, but this is

[Sen. Virginia "Ginny" Lyons (Chair)]: this is what I'm about to do at this point in time. Okay. I mean, we've had so much coming at us in a short period of time. It does it is challenging. This one is challenging. I think it's almost 70. I know that DMH sent some information in with concerns about restraints when they're in make putting contracts together for out of state. And I was a little confused. I was. By that.

[Sen. Martine Larocque Gulick (Vice Chair)]: You're glad to hear that.

[Jen Cargill (Office of Legislative Counsel)]: So, well, I'd be I mean, it might be clearer if I got a little bit more information, but the section that they're referring to refers to children in DCS custody, not DMH's custody. And I think the Child Youth and Family Advocate raised that too. So maybe more clarity around there. And then the second thing they raised is with regard to how a youth could use the certified form in front of mental health services. They asked us to have it say outpatient mental health services, but that's already allowed in statute, outpatient mental health services. And the rationale is that a child should have, if they're engaging in other types of mental health services, have assistance from their parent or guardian. But the point of the section is that they're so I think I just need more clarification to understand those recommendations.

[Sen. Virginia "Ginny" Lyons (Chair)]: From DMH. From DMH, yeah. I'm gonna look at the family advocate, Matthew or Lauren, in terms of the language that we have here. And I know that you have put some recommendations again, but as the bill as Katie do you mind playing the bill back up, Katie?

[Sen. Martine Larocque Gulick (Vice Chair)]: Oh, I'm sorry. Yeah. Shannon? As we've

[Sen. Virginia "Ginny" Lyons (Chair)]: gone through the bill, do we have any specific comments you'd like

[Matthew Bernstein (Child, Youth and Family Advocate)]: to make? About this last Matthew Bernstein Child Youth in Family Advocate. The last thing that Katie said about the Start company Okay. So I'll go backwards. Think I agree with the rationale the current law does allow for outpatient, and the whole point of this bill is to provide a broader array of access for youth who are living on their own. You know, I sent a fairly detailed You did. Legal interpretation. I think it gets technical. It gets technical, but I think, you know, the and I could look at the language, but in the restraint and seclusion section, the definition of child, it boils down to it's a youth in custody or it's a program regulated or licensed by DCF. And so and then the contract revision refers to to this section, so that same definition of children. So therefore, I don't think it pertains to DMH placed children.

[Sen. Virginia "Ginny" Lyons (Chair)]: That was section 13. I believe that is correct.

[Jen Cargill (Office of Legislative Counsel)]: Trying to find the definition.

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, the the definition is

[Sen. Martine Larocque Gulick (Vice Chair)]: So does it need to change itself? No.

[Matthew Bernstein (Child, Youth and Family Advocate)]: That's why I haven't looked at the Well, the CARES

[Jen Cargill (Office of Legislative Counsel)]: child so child or children means child or children in the department, meaning DCF's custody or receiving care services and program regulated or licensed by the department.

[Matthew Bernstein (Child, Youth and Family Advocate)]: I'd also point out, is this is all chapter 51 of title 33, which is the juvenile judicial proceedings chapter that sets the with the French. And I think, you know, I think the simple answer is, you know, we we this is this bill is there's been a lot of compromises already. There's still some things in this bill we don't like, but I think voting it voting it out and onto the next stop is is our is our recommendation. If there's any other questions, we'd

[Sen. John Benson (Member)]: be happy to answer.

[Jen Cargill (Office of Legislative Counsel)]: Thank you. There's Terry White. Hi. Deputy Marshall, Department of Mental Health.

[Sen. Martine Larocque Gulick (Vice Chair)]: Is available to answer questions about the contracting issue in terms of our concerns of us being able to put DMH people to contract for out of state presidential placement because the contract for health. She's obviously my family residence.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Laurel's up there then? Why don't we

[Jen Cargill (Office of Legislative Counsel)]: hear from Laurel? That's fine.

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

[Laurel Omland (Director, Child, Adolescent & Family Unit, Department of Mental Health)]: Thank you. Hi. Laurel Onland, director of child, adolescent, and family unit at Department of Mental Health. It is correct that the language speaks specifically to children in state's custody, But the Department of Mental Health, Department for Children and Families have worked really closely together over the years to align our contracting process so that we don't have multiple contracts from the state with the same residential program for the same purpose and services. And so there is typically one contract from the AHS department that includes coverage for the other department. So DCF holds the majority of contracts with residential programs in state and out of state. And so if this is, setting prohibitions for DCF, it will potentially have impacts on DMH funded placements as well. And so that was our concern that, especially for out of state placements, what impact might these requirements have with those contracts? Will this will those programs simply decide not to contract with the state of Vermont, and therefore that impacts our ability to use those programs as well?

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Thank you for that. The language here is DCF and the the I think the fact that DCF and DMH are working together to have agreeable contracts with one another is a good thing. This might mean some further discussion between the two departments to have the contracts aligned with one another. So I don't think we're gonna solve all the problems with this within the bill itself. Some of the administrator problems I think are gonna have to be sorted out. I don't know how we can do that to be quite honest with you. And I did read what you sent in, whatever it was. And it was just recently, it was yesterday or the day before the credit Yes, Yeah, yes, I had an issue. Agreed, and I think we do have it posted, but Calista will have it posted for us.

[Sen. Martine Larocque Gulick (Vice Chair)]: Thank you.

[Sen. Virginia "Ginny" Lyons (Chair)]: Laurel, I appreciate everything that you're saying and understood the difficulty and the complexity of trying to sort out a contract with another department and then not to mention with another state entity. As

[Sen. John Benson (Member)]: I

[Sen. Virginia "Ginny" Lyons (Chair)]: said, no way we're gonna solve all of these problems within this one bill.

[Laurel Omland (Director, Child, Adolescent & Family Unit, Department of Mental Health)]: If I may add one other component to this, which is related to the unaccompanied minor status and access to beyond the outpatient level of care that you just spoke to. So if we are talking about being able to have youth under that status sign and, you know, request residential treatment, that will also impact our ability to you place youth out of state in residential programs in other states under the interstate compact for children because that requires a legal guardian or parental signature. I don't know if those states would accept a an accompanied minor signature for that process, and so that could potentially inhibit us for using any out of state program for these youth as well. So it's just another ramification we're trying to make sense of in how this would play out.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. I'm gonna turn to Matthew Bernstein. So it's a little tiny reply to that. I have my own sense about it, but I think the expert is needed. I will just say that in general,

[Matthew Bernstein (Child, Youth and Family Advocate)]: it is a feature, not a bug of this bill, that this bill explicitly says these these protections for these youth are a baseline, and they are too important, even if they affect contracting, even if they affect the ability to place the youth. And I think what we wanna be talking about is not how easy or hard it is for the state to place a youth, but how do we get these youth the treatment that they need? And I think that that is in everybody's interest. And I understand, like, it's it's hours in the day and hair, like, that's what happened to my hair. Like, contracting is a pain in the butt. We have to do it in our office. Right? I understand that, and I think and and I recognize that, and I think that is a you you could call that a side effect of this bill, but but this this bill explicitly says this is a baseline. This is too important. This this is safety and due process for youth. And, ultimately what we wanna do is have a more responsive system, not not make it easier to place youth. Right? And so I think that's that's the core of this bill, and so that's where I keep coming back again and again.

[Sen. Virginia "Ginny" Lyons (Chair)]: Alright. Thank you. Okay. Madam Chair. Oh, Erica Radke. Go ahead.

[Sen. Martine Larocque Gulick (Vice Chair)]: Thank you. Erica Radke, deputy commissioner for Family Services Division. I do agree with almost a child, youth, and family advocate in terms of the intent of the bill is safety of children. And the issue I wanted to sort of pivot from the idea of we're talking about contracting. Really, we are indeed talking about the safety of children being able to find appropriate placements for them, whether in state or out of state.

[Erica Radke (Deputy Commissioner, DCF Family Services Division)]: And that things in the building that makes that more difficult. It may not simply be more time. It may be we may not be able to find appropriate placements. So ultimately it is all about safety. Understood.

[Sen. Martine Larocque Gulick (Vice Chair)]: Yeah, I think it's always more complicated.

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah, I was looking at the sign we have over there. It's always more complicated than that. Can I? Can I? Mm-mm. Now? Say it now. I know. I know. I think we're we're at a stage here where we're trying to get to this and I you're going to have plenty of time with us when it comes right back to you. Understood. Okay, so

[Jen Cargill (Office of Legislative Counsel)]: yeah, so we hear the balancing and

[Sen. Virginia "Ginny" Lyons (Chair)]: the juggling that's going on and the difficulty of really providing protections for kids, for juveniles who don't have a guardian or a parent. Just really couldn't imagine that we saw. It's very difficult. Maybe at some point, I'll talk with you folks about establishing a guardianship program, a general guardianship program through the Office of Family and Youth Advocate that would adhere to the protections for these kids in a way that we don't have right now. I mean, I think about what the Secretary of State does for people who have been sexually abused and they have an address and they care of them over there, and I would see something similar if there were some place that we could put these kids and offer the protection that they need like that. That somebody else can think about that. So Katie, give us a look one more time at what we have in front of us and then we'll go ahead. Sure. Perhaps this is the main area. Oh. Are you voting on this? I'm sorry.

[Nolan Langfeld (Joint Fiscal Office)]: Are we

[Committee Clerk (name unknown)]: gonna do you plan on voting on this?

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. We got a motion on Yeah.

[Nolan Langfeld (Joint Fiscal Office)]: That's what I was thinking.

[Sen. Martine Larocque Gulick (Vice Chair)]: Oh. Can we have a motion? Can you make a motion? I I think, you know, I Oh, I I might have missed it. Just 3.1. Do we have a Yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: We should go. Home.

[Sen. Martine Larocque Gulick (Vice Chair)]: We have a member of the working group that is a a family, like a

[Sen. Virginia "Ginny" Lyons (Chair)]: Yeah. We can't We do. I'm looking

[Committee Clerk (name unknown)]: at it.

[Sen. Martine Larocque Gulick (Vice Chair)]: She was asking. Yep. What number? I was gonna drop. We don't need

[Committee Clerk (name unknown)]: That's right. She's getting it right now.

[Sen. Virginia "Ginny" Lyons (Chair)]: It's 21. But it's 21.

[Jen Cargill (Office of Legislative Counsel)]: But I'm I'm looking at the I

[Sen. Martine Larocque Gulick (Vice Chair)]: only have one. Lifting spans being one of the.

[Sen. Virginia "Ginny" Lyons (Chair)]: Just tell us. Because you were paying.

[Sen. Martine Larocque Gulick (Vice Chair)]: Yes. Okay. I will make a motion. I move to I'd like to move about 2.1? 8.1. Six fifty seven out of committee and this draft was four twenty seven twenty six.

[Sen. Virginia "Ginny" Lyons (Chair)]: Okay. Is it 2.1? 2.1. 2.1. The date was May 6, she said. Yes. 04/27.

[Nolan Langfeld (Joint Fiscal Office)]: Well, '7.

[Committee Clerk (name unknown)]: Oh, 01/26, I thought you

[Sen. Martine Larocque Gulick (Vice Chair)]: said. No. 04/27. '26. The year is 2026.

[Committee Clerk (name unknown)]: That's '11. No. I gave that

[Nolan Langfeld (Joint Fiscal Office)]: to

[Sen. Virginia "Ginny" Lyons (Chair)]: her. You used to be on association. She's in the back. Oh, okay.

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

[Sen. Virginia "Ginny" Lyons (Chair)]: Any more discussion? And we'll hold a vote for senator Cummings, Where is she? She's testifying on the yield bill Oh. At. Yeah.

[Sen. Martine Larocque Gulick (Vice Chair)]: That's a partaker. Do you

[Sen. Virginia "Ginny" Lyons (Chair)]: have any more questions?

[Sen. Martine Larocque Gulick (Vice Chair)]: Just have a comment, but I think this is a it was a no. I'm looking for us in a better direction, and I I hope we can strive to someday not have any out of state placements and take care of children here to stay home. Just like our special education extraordinary costs that we have in the education field, in the education world, right? It'd great

[Nolan Langfeld (Joint Fiscal Office)]: to be able to take care of

[Sen. Martine Larocque Gulick (Vice Chair)]: kids here. But I know that is, that is aspirational at this point, but it's good to have aspirations.

[Sen. John Benson (Member)]: I would agree, but I'm still concerned about the unintended consequences of putting some of these things in here as we heard about being able to place children at the right places out of state. Yeah.

[Sen. Virginia "Ginny" Lyons (Chair)]: Well, the DCF piece is pretty clear, and they're already doing that. Yeah. And so this is dealing with those in DCF custody. So I think there's some reassurance. This stuff did not take a step into the Department of Mental Health. So the concerns that we're hearing now are internal administrative concerns about how to draft contracts when kids move out of state. Not in the bill, it's an important issue and we'll hope that A, it could be relieved administratively or B, that we'll see additional legislation going forward. It's never easy.

[Sen. John Benson (Member)]: Excuse me, about the excellence field. I

[Sen. Virginia "Ginny" Lyons (Chair)]: can say one thing to the senators question about collaborations. No. Go ahead. Matthew,

[Matthew Bernstein (Child, Youth and Family Advocate)]: you can tell me. Just wanna say, if in fact, if if this bill passes and there are unintended consequences, we as we always do, we'll work collaboratively with DCF to to address those, and I can see how should there's a lot of moving parts in this bill, and there could be. But I think the data is strong in the other direction, showing why the protections are necessary. And I understand we have concerns about contracting, and it's hard to prove a negative. We don't have any hard evidence, but if something comes up, you know, we are realistic. We're not out here trying to just say, you know, tough luck. Right? Like, we understand that this is policy and there's daily operations, and that's our job within state gov is to address those as well. So that's all I'm just

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

[Committee Clerk (name unknown)]: Senator Benson?

[Nolan Langfeld (Joint Fiscal Office)]: Yes.

[Committee Clerk (name unknown)]: We wait for senator Cummings. Senator Hewlett?

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

[Committee Clerk (name unknown)]: Senator Morley, yes. Senator Lyons? Yes.

[Sen. Virginia "Ginny" Lyons (Chair)]: And we hold it open? Yep. Thank you all. This is a difficult pill. I know it's controversial pieces to it, but I think we've done really good work on it, I appreciate that. And I'm looking for a reporter. Yeah, somebody else had

[Nolan Langfeld (Joint Fiscal Office)]: to report.

[Sen. Virginia "Ginny" Lyons (Chair)]: So I'm gonna be I'm gonna get Your body. You already

[Jen Cargill (Office of Legislative Counsel)]: have one to do.

[Sen. Martine Larocque Gulick (Vice Chair)]: Oh, I'm gonna go. Silly yourself. Alright.

[Sen. Virginia "Ginny" Lyons (Chair)]: I'm doing this. I got I didn't write down. Okay. So we're gonna take a a

[Jen Cargill (Office of Legislative Counsel)]: break until