 You're doing the best. Welcome back to the Vermont House Human Services Committee. And it's first up this afternoon is going over H-711, a walkthrough of the current draft, and a possible vote. All right. Good afternoon. Katie McClendon, Office of Legislative Council. So we are looking at the new draft of H-711, draft 4.2. And I'll just walk you through the changes that highlighted them so you can find them easily. The powers. I want to make sure that everyone has it. It is on our web page, and you can pull it up. And it says draft 1.13422. Draft 4.2. 3.922. Because I was looking at the wrong bill. OK. It's like me. You might have to refresh here. OK. OK. So the first change is on page 2, and we're looking at the advisory committee section. And we talked about having some new lead-in language with regard to who would be on the advisory committee. And there was also language that was suggested by Grace, whose last name I've forgotten. I apologize, Grace. Yesterday, we talked about adding language in addition to having the membership reflect diversity of Vermont. We added the language in ensuring inclusion of individuals with lived experience of opioid use disorder. And Grace's email suggested to add and their family members whenever possible. So that is reflected there. And then on page 3, subdivision J. This was the two individuals with lived experience of opioid use disorder, including at least one of whom is in recovery, one member appointed by the Howard Center's Safe Recovery Program, and one member appointed by the Vermont Association of Mental Health and Addiction Recovery. The next change is in subsection C at the bottom of page 4. And this has to do with the powers and duties. So this first sentence comes from Grace. The advisory committee shall demonstrate broad ongoing consultation with individuals living with opioid use disorder about their direct experience with related systems, including medication-assisted treatment. Oh, I should have changed it to medication-assisted treatment. That might be right. I have to see how we determine Title 18. Residential treatment recovery services, harm reduction services, overdose supervision by the Department of Corrections and involvement with the Department of Children and Families Family Services Division. To that end, this is Department 4. You're right, you're right. Thank you. OK. The second one there. To that end, the advisory committee shall demonstrate consultation with. Can you hold on a second to make sure we're all in the same place? Sure. So that first sentence that we just went through was the language that Grace sent. And then the next sentence starting on page 5, line 4, to that end, this is the sentence that still collectively yesterday, the advisory committee shall demonstrate consultation with individuals with direct lived experience of opioid use disorder, frontline support professionals, the substance misuse advisory council, and other stakeholders to identify spending priorities. OK. Can I ask a question about not this section, the one before? Sorry. The two members yesterday we talked about, or at least I think one of the witnesses and testimony said we should try to make sure one member is actively struggling. And I just don't see that reflected. And I just want to make sure we're OK with that. If I may offer a comment. I think where my trust lies on that one is having Howard Center Safe Recovery. And on that, and they're working with folks who are in active use or trying to get onto into recovery. Thank you. Yeah. OK, the next change is on page six, subsection F, the meetings. This was when the Commissioner of Health was to call the first meeting of the advisory committee and you changed it from May 1st to June 30th, 2022. And then that brings us to section 4773, page seven. And this is the section where we're designating the Health Department as the lead state agency. And we've updated the name of the administrator, the national administrator, who's doing this work. So it's the National Settlement Fund Administrator. And that change is also on line 20, National Settlement Fund Administrator. So they're consistent in both places. And then if you remember on line 12, where department is highlighted, we had state there. And then for consistency, we've changed it to department. Then OK, next, we're on page nine, subsection C. But remember, we spent some time here. This is the priority list of how funds are to be used from the special fund. And so there is a conversation about how do we integrate the idea that reducing overdose deaths is a priority. So we built it into the lead in language priority for expenditures from the opioid abatement special fund shall be aimed at reducing overdose deaths, including the following. There was a place where I had included a qualifier about opioid use disorder. I was asked to remove it. I think that was actually in the previous subsection. But that's gone. That's why you're not seeing anything highlighted there. And I believe that was it for changes in this draft. OK, that's it. Well, I would, before we go any further, I want to ask if there are questions and failing questions. I sort of want us, even if it is silent reading, to read the entire bill before we go any further. I know you would like a change in the DCF title from Department of to Department 4. I can't make the change here because I haven't opened at my computer and the think ladies. While you do silent reading, I'm going to run across and close that document so I can edit here. OK, I will be back. Will that make it in the draft 4.3? It would make it 4.3. Sorry about that. As you mentioned, I came in late and I apologize. That's OK. What was the total amount of the settlement money available? Does it mention that any place or not? It is not mentioned any place right here. Right now what we have heard is it's approximately $63 million. However, there was that discussion yesterday that there is an ongoing discussion about a third or fourth settlement. And so some of that money might come in here. The amount that is available now or at some point, is that over a period of time? Yes, 18, 18 years. 18 years. Yeah, all right. So it's less money than some of us might like. And it is, oh, I'm going to forget the percentage. Maybe someone else can tell there. It's like 70% of the national, 70% of the settlement dollars that are going to come to Vermont. 15% will go to localities. And 15% will morph into the state general fund. And there's also a $3.00 question. This is the third part. The third part is the 70%. And in order for us to access that, the terms of the settlement agreement require that we set up the advisory committee. Thank you. Sure. But I just want us to sort of read. Tapper. Madam Chair, I just want to make sure I'm reading the right one. Is it draft 4.2 each 7-1-1, 3-9, 22, 11-06 AM? Yes, it is. Thank you. And if anybody has a question, just say it out loud. This is the bill we sent back to ourselves, right? Or essentially. Yeah. Yeah. OK, that's right. That's a little convoluted in the beginning. We sent it back to ourselves so that it would be out there in public so folks could see it. Tapper, I see your hand up again. Is that a legacy or? Yeah, I just forgot to take it down. That's OK. Point that I just noticed on H. Where are you? Page three. It's a member of the committee. Page an individual with experience providing substance misuse treatment or recovery services within the Department of Health Preferred Provider Network. I don't know if recovery services are in the Preferred Provider Network. I think that's more so treatment. I know that up above on F. We added a primary care prescriber with experience providing medication assisted treatment. That was a point of feedback we received. And then. So I think that your point is well taken. If we want to if our in what we're looking for is flexibility of an individual either providing misuse treatment or providing recovery services. So Katie, we are on page three. H number eight on line eight. And actually it's line nine to. Delete. Within the Department of Health Preferred Provider Network. Because it was brought to our attention by Dane that recovery services are not necessarily within the Preferred Provider Network. So we've gotten we've gotten to page three. It's pretty long. What do you think just for creating? While you were gone, Katie, I just sort of said, as people read, if they come up to something to say it out loud, OK, I have something. OK, OK. Appointed by the clinical director of the alcohol and drug abuse program. Yeah, this is sort of a tricky one because you've already passed a bill changing the name of the name as well. What? We changed the name of the alcohol and drug abuse program. And so we're about to cite an old name, an old name. So whatever that be changed. You can just change A's and D's and P's programs. I mean, you can have a general reference to. I mean, are we still having a clinical director of ADAP? Well, it won't be ADAP anymore. Oh, but that change won't take I can tell you why if Senate. Yeah, but this is on this is a statute. This is codified. So it will exist forever. I guess you could we could add a little section that gives. And no, statutory revision authority for me to go in and change it over the summer. Yes. OK, whatever we have to do to do that. Or it's predecessor to your A or whatever. Or we could say or it's success or an interest. Yeah, I know you. Successor. Yeah, that's cleaner. Let's do we did do that in another bill. Of course. I know that's very good. So does that make I have another question. Are we still on page three? Yeah, we're on the advisory committee. And it might be later in the bill, but why I'm thinking of I'm just going to bring it up. Is there any place here that provides payment for people participating? Is that later in the bill? Yeah, I think there is. Okay. It's fun to make sure. Because mostly people will be paid in their jobs when everybody will be. Yeah, right. Okay. And this is why it goes to government ops. And some comments on our other bill too. Oh, they did. Yeah. Great. So when we say other on page seven when we're talking about that payment issue. Remember we really mean other members not. They are in their paid capacity. So I think that's a good question. I think that's a good question. Yeah. And I think 32 VSA 1010 addresses that addresses that. That's sort of this standard boilerplate that we use. Thanks. That's a question. Yeah. Bottom of page seven. This is just a organizational question. I don't know if Katie knows the answer to it. So I know that this, I know the special funds. Our, and how they are spent are generally managed by the department department. I don't know the answer to that. I know that. Kind of hard because a lot of us, I think. I know for the fact three of these, they're still on page five. So it's kind of hard for us. Okay. Okay. We're going too fast. Okay. Thank you. Hold your phone. I'll email. See if I can get an answer. This is more definition. I don't know. Are we there yet? 1920 and 21. Is the ongoing challenges that you'll pay increases marginalized populations. And wondering what are the ongoing challenges. Or the marginalized population. We don't say. Is there. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know what the model bills. And what the settlement is talks about is that. Minority. Communities in particular. Are. And communities. Of color and communities. Experiencing extreme poverty are more likely. And to see the need for treatment. There are greater. Barriers. To treatment. To treatment. And so. This is. I just think sort of open. I think I understand. Is really something we have to put in. I mean it's kind of at the expectation that this is. Focused on that. I mean. thank you and chair. Yes, Tupper. On page eight is the only time that these funds are going to be distributed is during the budgetary process. I believe so, yes, as it outlined here. We're at page eight. Where was your question? I got one for page nine. I can't find it now. Oh, right here. It's on the bottom of page seven. Okay. Bottom of page seven. Lines 17 and 18. And it could be held within the meaning of 32 BSA sevens of chapter five, which I don't know what that says. Is the finance management question? Yeah. I got an answer. Okay. So this is from Sarah Clark, works for JFO. Finance and management has overall oversight of special funds. The individual funds can be managed by agencies and departments. Health department in particular manages several special funds. I think it's okay for the health department to manage this fund. Okay. So she said though I'm not sure if Commissioner Gresham has an opinion or should weigh in, but I do remember Monica saying she ran this by him at one point. Everywhere there. There'll be two appropriations committees to look at this. Usually finance and management has an opinion about special. And they may well share their opinion. Is it okay to ask about something on page nine? Are we up to page nine? Okay. So it seems really odd to me that preventing overdose deaths and other harms is number eight on the list. And I realize it doesn't mean it's any less important, but it feels like it should be number one on the list. I support that. But this list comes from the settlement, right? Not from us. They just need to be in there. It's not. Right. It's not. And in fact, you know, to be honest, some folks, some states don't necessarily use the exact words. It was the, I want to say, advice or opinion of the folks, the Attorney General's office that we very, they were very clear. They'd like us to be as specific and as detailed around that. Okay. So on the bottom of page eight, number five says addressing the needs of pregnant or parenting individuals and their families, including babies. I just wondered, there's no other place here where they talk about the children of. And then do you think that covers it if we want, if any, if some of them anywhere to be used maybe for children who are left parentless or, you know, due to. I believe that families are allowed to be allowed to be included and, and maybe on number, I mean, once or twice we could, or whether that could be. We added the number two. Yeah. Support for individuals and families. Treatment and recovery. What do you think? I just want to make sure people see. There are a couple points in which they reference childcare. Oh, in priorities. Oh, in priorities. It seems because it says, and their families, parenting individuals and their families, addressing the needs. It's not just about pregnant and babies. It's about broader families. Yeah, it was going to tell. But not limited to. Right, right. What? For number five at the bottom of the page. It says individuals and their families, including babies. Pregnant or parenting. I mean, I think if you want to add it somewhere else, I think to two. What was the answer to Teresa's issue on preventing overdose deaths in other farms? Were we going to put it earlier? Yes. Number one. I mean, if that would make you, if that, I mean, no, I think if you, as long as it's there and I think it is under five, then that's fine. It's just they seem to focus so much on the newborns and pregnant. So I think, I mean, I think what you, I think you're making a good point. Yeah. Hang in there with that. It's only 14 babies that don't want to make it. Okay. So, I mean, I think Ray had a good idea to support for individuals and their families in treatment and recovery. I might say, isn't it support for individuals in treatment and recovery and their families? Yeah. Yeah. And the good thing you turned off that open file. She's not laughing. Okay, we're on page. I'm going to refer back to page nine, but it's on page 11. So I don't know if we're on 11 yet. Oh, wait. Oh, I had also, while we're talking about adding. We already have age. We have age as an, as a thing at the top. As that's part of the general thing when they said one of the top things around, I forget what it is. And one of the ones where it says in particular, an overall thing in particular about sex, age, gender, and age is in there. On page 11. Can I say something about page 11 yet? Yes. I think on page 11. On page, pardon me. Just checking with the committee. Yeah. On line 14, we say evidence-based program, but if we go back to page nine, line 13, we say evidence-informed and evidence-based. And I'm wondering if we should have the same. Good catch. Sorry, you're on, I think my line numbers don't match you. So for subdivision A, expanding comprehensive evidence-based, say evidence-based and evidence-informed, because that's what we do on page nine. Thank you. Thank you. I also have one on page 11, 3B. For all of the other ones, we use pregnant individual, but for 3B, we say for women with co-occurring opioid use disorders. I'm wondering. Individual. Individual. I think it's still focused on pregnant individuals in that one, correct? Taylor, where are you? I am on page 11. For us, it's going to be a line six. So it's 3B. And change the word women to individual, correct? Yes. Yes. Okay. So Madam Chair. Yes. On what Taylor just brought up. What is that? Is that last phrase for up to 12 months postpartum needed then? Yes. Yes. Only because the section overall is focusing on assisting pregnant and postpartum individuals. So saying that postpartum up to one year. That's great. Yes. On what Dan said though, what about that same thing B, line five on page 11, 14? What did you say before, Dan? It was evidence-based and what? Evidence-informed. Okay. So if you say evidence-based here, but we don't have evidence-informed, I think she added that. Oh, she did. I added it to 4A. Do you want it on 3B also? Yes. Yes. Yes. Good catch, Carl. Thank you. Okay. My academic hat pops in and there is a very difference between evidence-informed and evidence-based. Because evidence-based requires there to have been all this stuff. Stuff is a very academic word. Very scientific. Well, as well. It's much more limited though. It was 12. Right. But again. So I guess everywhere it says evidence-based. It might just need to do a word search. Yeah. Line 14 is the same. Exactly. Okay. I have a clarifying question on page 12. But wait a minute. Let me look at it. Catch up to us. It's more of a question to the committee, not necessarily that I said it. I know, and I assume most of us in the room know, what warm handoff services mean. I don't know if it needs a definition, if that is fine and statute. Just putting it out there. If one day someone will look back on this. It's a warm handoff service. What does it mean? It's not a cold hand-in. For starting on page 11, it's expanding the availability of warm handoff programs. And then it gives examples, but then the following page says again, expanding warm handoff services. So it's a little bit like rather than describing it, it's just saying it again. What do we mean by that? I'm curious myself, like an easel. Well, it's like a friendly. Yeah. It's folks who are in community, who are not the service providers, but are connecting folks to the services that they need. It's a warm handoff because they're still connected. So I was saying. And I'm just saying go over there. Yeah. Yeah. Go talk to them. Go talk to those people. I'm thinking I'll find them over. You look up a warm handoff services on Google. It gives you a whole bunch of stuff that says exactly what you just said. Oh, really? Yeah. Really? I'm not seeing it. You know, I mean, I, you know, synonyms and anonyms. The first thing that came up for me was warm handoff. So transfer of care between two members, blah, blah, blah, where a handoff occurs in front of a patient family. I mean, just there's different definitions, but they're all very similar to the seamlessness and that is, that is transparent and that is there. Here's a suggestion instead of warm handoff. I just assume it as well. The transferring a client from one provider to another in a culturally responsive manner. I wonder if that too much. It's not just about culture though. A seam not. I mean, it's only about culture. It's broader than culture. Maybe we should put the definition. I mean, there's so, I mean, another is so clear to me is so clearly defined. I just found over a dozen sites where it's all dealing with the same issue. It's very clearly defined. I don't know just questions to me. I can find it. I knew what it went, but I think if you're not necessarily in human services, you don't mean it. Well, luckily, you know, yeah, well, luckily in the service community, you know, with Google, you don't even have to specify. I'm not saying that Google it's the end. I'll be all here, but you don't have to specify even in the clinical world. But if you type in warm handoff, there are definitions. Yeah, I mean, there are many years. There is the agency of health care research and quality. And then there's something law that does seem to talk about warm handoff. Okay, great. Well, if there's any statute somewhere else about it or what, I will close. I can't have words. The primary right. This is impacting. No, what this means. Right. You might want to just write down that definition in case somebody asked. It's amazing. It was me. I wouldn't be able to find it when I was actually pushed on the floor. This one here is noted. Madam chair. Yes, Tupper. On page 12A, first line, expanding services such as navigators. Um, we have such things. Yes. Yes. Where are they? And the emergency department. Emergency runners. And that's what they call navigators. Yes, they're actually called navigators. Never met one. Well, um, go ahead. I think isn't representative Gina, a navigator in our emergency room in Chittin County? I think so. He might be. It's called in. And I think Tupper, and I think for in some places they reference, that's the name they use. And in other places that is their function. Which is there is someone who has a different title, but whose job is to help the patient figure out their way. Navigate through, um, through the service for in to the next step. I thought it was because they use bells in the emergency room. Oh, I'm like a triage. That is, uh, page 12. Okay. We're leaving it. Is that, I think we are leaving it. Thank you. Just close that loop. That's all. I was looking at A here about Navigate. On page 12 again, Madam Chair. Yes. Uh, on line 10, E. Hiring additional workers to facilitate the expansions listed in subdivision five. So anyone can hire workers or is it limited or? If I'm reading this correctly, subdivision five is expanding the availability of warm handoff programs and recovery services. And then, so this means. He's on line 10. Yeah. On 10. So just what's listed in ABC. And so. So the money can be used to be hiring more people to be handoff. So in other words, the money can be used for personnel. So in essence, the health department will present in their budget proposal about how they will propose utilizing the funds. Essentially, we'd evaluate that based upon the criteria we set out in statute. And I mean, that, I mean, that's what. So that's one of the things that they could do topper. They could, maybe they'll focus on that. Maybe they'll focus on something else depending upon the advice they get from the committee and from individuals. Individuals in the field and workers and people experiencing substance use issues. And I think this, I mean, I sometimes equate this to the ARPA and the other funds, which have, you know, there's this whole boatload of money and some people go, let's spend it here. And it goes, you know, can't do that, you know, it doesn't fit the criteria. So that may well happen here. And so we'll just between. Yeah. Yeah. It's kind of one of those things that, you know, I suppose it's, this will come under our jurisdiction for making recommendations. Right. Have to evaluate whether they're, what they're proposing needs the intent. Right. Yeah. There's lots of things they can do. So are we on page 13? I have a question. Sorry at the bottom of page 12. Just looking at six a and B. I just noticed, and this could be limited by the statute language, but providing evidence based and I guess evidence informed treatment and recovery support for individuals while transitioning out of criminal justice system. And then B is increasing funding for correctional facilities to provide treatment to inmates with opioid use disorder. And I just wanted to highlight, maybe it's nothing that we can change. But essentially what I'm reading here, while somebody is incarcerated funds can only go to treatment and it's only once they're transitioning that that can also go to recovery services. Oh, no, I think you could do both. So what we add on six B to provide treatment. And recovery and recovery support. So where is that day? I mean, I want to bottom up page 12. That's six, but line seven, 17, okay. There's six a and then 16. Thank you. My only question to that is, are there recovery supports in our correctional facilities or do they only offer treatment? This money could be used to implement one if there is. I want that. Yeah. Treatment is relatively recent. Which is why is there is there recovery supports in there? No, but that might be something that comes out as a priority. Acutement is opposed to cold turkey. Yeah. Yeah. We're supposed to start and then dying. Well, in Chittin County, they have a whole team now working on helping those folks. So that because that was happening so often that they put together a team to work on how do we reach out to these folks. So that's good. So they would be a good team to put some in testify before this committee. But one question I have just at the end, the effective date. Monica say yesterday that she wanted it to take up that further because she needed some time or was that earlier? That was the first meeting. I will wait for everyone to tell me that they're at the end of page 13. There's not even a can of Diet Coke in the cafeteria. Sorry. I was going to go with a can, but they didn't have a can. I think three is mine. Mine 21 on page 12 is another one of those funding for evidence based. They did award first. I think I've caught them all now. Thank you. Thank you. Thank you. That was a good catch. Diana Topper and Carl. And I want to say this reinforces the importance of us even after we've gone through it several times to really do what I call the silent reading. I'd like this process. Unless the bill is 125 feet. That's when I assign it to a group of people. We are at the end of page 13. I would entertain a motion. I'll move to a pro version. I have a bill. 5.1 of H7 11. Second. A motion made by Representative Wood and seconded by Carl. Is there further discussion? Sorry, Representative Rosenquist. Where is he from? I lost my representative set. I don't know if you could hear us talking to her across the way, but when Anne was wishing you happy birthday yesterday, and she was like the representative from Georgia. We all have those moments. I just wanted to say my friend from committee. I know. All these rules is on the floor. Okay. I have one thing that's been grinding in my mind. All the way through this thing. I brought up earlier about having to be in the budget. I'll call you back later. That's what I just did is terrible. You know who that was? One of the autism parents. But I did not do that to them, and I just did it. Where was I? Oh yeah, it happened to be in the budget. What I'm worried about is if something comes up during the year. For instance, if there was a whole bunch of fentanyl deaths in one place and some kind of intervention would have to take place. Do we feel that we've covered all the bases so that the money could be expended somehow? I'm just worried that when we say the expenditure has to be done through the budget of the health department. Topper, that's a pay grade for a committee that I'm not familiar with. But I keep thinking that we have a joint fiscal committee that meets in the summer. And that from time to time, when we pass legislation or when we pass like the budget, we will put something in there. There's something in the budget about joint fiscal committee. Or, you know, if something happens in the interim, the joint fiscal committee meets and can do something. It's a good question, and I'm sort of punting on my answer. But I think there is, and I don't know how it works. I'll look to legislative council if they know. But there is a process that has that we have used in the past for certain amounts of money towards a particular, to fund a particular event. That said, there's usually a limit. The other thing that I would add, Topper, is that departments, when departments have certain responsibilities and they have the charge to carry out those responsibilities, they can get permission to spend in excess of what they have in their budget and then deal with it through budget adjustment as well. So, you know, when we see budget adjustment coming in, lots of times, those departments have already spent that money and now they're getting approval for it because it was in their area of, you know, their locus of responsibility. So, I hear your concern. I think it's a valid concern, but I think that they have processes already in place to be able to, you know, to deal with that sort of emergent issue that you're speaking of. And I'm wondering why that the agency that we've been dealing, you and I have been dealing with, why they didn't use that opportunity when they kept saying they were running, they didn't have any money. Okay, thank you. Yes, Ray, but in the beginning of when we talk about, when the bill talks about expenditures in the categories, it's page eight, line 15 for me, there's evaluation activities are talked about in that section and that's the only place throughout the bill where we talk about evaluation and I wonder if we can add something at the end where, where is it, page 13, line 13 for me, facilitating evidence-based data collection and research analyzing the effectiveness, I wonder if we can add the word evaluation there. So, where are you exactly? I'm sorry, so page 13. It's page 13, number nine. Nine, facilitating evidence-based or evidence-informed data collection, evaluation, evaluation and research. We're analyzing and evaluating. Analyzing and evaluating that. Okay, great, thank you. Thank you. I was so happy that they had it there. You now have support on committing. You can be in government capability next. We have a motion on the floor. And we've had discussion. Are we still on the same draft? I have to wait one. What? I have to wait one. Yes, I put one. Okay, so is there further discussion? Okay, thank you. If the clerk will begin to call the roll. Representative McFawn. Yes. Representative Wood. Yes. Representative Small. Yes. Representative Rosenquist. Yes. Representative Garron-Farno. Yes. Representative Whitman. Yes. Sorry, Representative Payella. Yes. Representative Gregoire. Yes. Representative Noyes. Yes. Representative Bromstead. Yes. Representative Pugh. Yes. 11-0-0. Now, this is a committee bill that does not yet have a number. And it does have a number. Okay, okay. So we're talking about those things. This is why there's 11 of us to keep these up. The process is that... There's 12 of us, by the way. 11 others. 11 others. I believe it's that the reporter brings it to the clerk. Okay, so the reporter is Ray. Yes, Julie. It's all still via email. It is. Yeah, that's very easy. And you just send a clean copy. Yeah. Julie has a clean copy. I'll just send you directly the clean copy. Okay. And you will be asked what the vote is. Thank you. Yes, we'll do that. And it will be on the calendar for... And it will be on the calendar for notice tomorrow, at which point it will be sent to appropriations. And in the meantime, we will hear back you and I will hear back from government operations or a drive-by around the committee, because that is their function. Given that it is Wednesday, I don't imagine it will be before the end of next week that we will be reporting this, if not after. Because I've heard from the chair of appropriations on Monday, she told me that they had 14 or 18 or 22. Anyway, they have a huge number of bills in addition to the budget that they are needing to look at. I think it was 18. My roommate. Now it's at least 19. What? Now it's at least 19. Well, I was saying, and we're sending you four. Oh. And I said so 22, and she goes, no, we're counting. Because I am. Chair, are we done with that one now? We are done with that one. I have a question for Julie. Julie, can you hook me up with the most recent bill on the, let's see, the last thing I have on the disability, developmental disabilities bill, the one that gets sent to the clerk, because I think I'm working with the wrong one. Okay, can you just tell me how to get it? I'll get it. Okay, we're going to, I'm going to, turning to legislative council. Can you change subjects now? I can. Okay. All right, committee, we're going to have, this will be a, probably a walkthrough and we'll get as far as we can of the committee bill and act relating to opioid overdose response. And we have a working draft based on 22-0621. So yeah, this is the committee bill on point two. I know it says, it seems you would turn it back. Before I explain this, I should just like, I have to, I can't hear you. I have to testify at 245 and another committee. That's great. You got it. But across the street, they want me to zoom, sector across the street. They want you to zoom. Oh, because their room is full or something. I'm not sure. Okay, so we will, we will get as far as we can. Okay. So we're looking at draft one point two, and I'll just dive right in. So. And I, for whatever reason, I can't either. If you refresh, it comes up. Oh, okay. Can we do? I have the same message. Okay, so. I was waiting for someone else to say. Okay. Okay. So section one has to do with certain service programs. And the concept is by amending the definition, we're expanding the locations in which an organized, community-based, needle exchange program can operate. So specifically in that subdivision aid to, there's existing language that says in, in defining what a program is, and which is operated by an aid service organization, a substance abuse treatment provider, or a licensed healthcare provider facility. So in removing that language that generates new opportunities for locations and providers that could offer a needle exchange program. Next. Could I just, on that, why are we taking out the aid service organization? Did you just say that? That's okay. I probably didn't describe it very clearly. So right now the existing definition limits can operate a needle exchange program. And by taking that language out, it expands the opportunities for organizations or locations that want to host that type of program. So, so, so. Would it include an aid service organization? It could. It doesn't preclude them at all. Yeah. All right. Okay. Next. Section two, care-delivered syringe exchange. So there's existing law, needle exchange programs, that the Department of Health and Collaboration with the Statewide Harm Reduction Coalition shall develop operating guidelines for needle exchange programs. And the new language is added, including peer-delivered syringe exchange. So this would require the Department of Health to also be developing guidelines for peer-delivered syringe exchange. And then. I have a question. What is peer-delivered? I guess defined later, isn't it? Oh, down here. That's very nice, isn't it? Yep. Oh. Peers with lived experience of injection drug use perform outreach and provide sterile syringes prevention education. Oh, okay. And the resources. I hadn't read far enough. And I actually was ahead. Okay. And I'll just flag back to subsection A, that we're deleting that sentence. Such operating guidelines shall be established no later than September 30th, 1999, because the language is 20 years outdated. I'm going to assume that we have operating guidelines. Okay. Yeah. Okay. Section three report on the peer-delivered syringe exchange guidelines. So I'll walk through languages and I'll explain why this is here. So this says that by October 1st of this coming year, the Department of Health shall submit guidelines for the peer-delivered syringe exchange to the committees of jurisdiction. So as we were creating this section two up above and getting rid of the date by which the operating guidelines were supposed to be established, it's not preferred drafting to have a date certain in the statutes because like in this situation, then we have it, you know, 20 years later and it's sort of irrelevant at that point. So my thought was instead of having a date certain, what if we just had a report date by which the guidelines had to be done and then you're putting in your date that you want it done, but not embedding it into the statute itself, if that makes sense. Okay. Next section four, Pire Authorization for MAT. Okay. So we're amending an existing section. So we're keeping this initial lead-in language in subsection A, which applies to a health insurance plan shall not require prior authorization for prescription drugs for a patient who is receiving MAT if the dosage prescribed is within FDA dosing recommendations or during the first 60 days MAT when the medication is prescribed for opioid or opioid withdrawal. Are we asking questions now or later? I'd like to get through the thing. Okay, why don't we keep track of our questions because I think also as a precursor to this, this is the result of a group of three to four members of the committee putting stuff together. And much like when we sort of began the reach-up discussion, it was bigger than what we ended up with. This may become bigger than what is here or it may become smaller. But so I would keep track of our questions and this because this is draft one. Subsection B, health insurance plan shall cover the following medications without requiring prior authorization. One medication within each therapeutic class of medication approved by the FDA for the treatment of substance use disorders. And second, one medication that is a formulation of a buprenorphine monoproduct approved by the FDA for the treatment of substance use disorders. Next is the patient. So what's the difference between those two? Same like therapeutic class would include two. Yeah, side adventure. The therapeutic classes, my understanding would be basically all buprenorphine products. We heard in our testimony from the provider before we left for a break that a monopuprenorphine product is kind of a separate thing because it doesn't include Narcan. And so a patient's experience of it will be different. So this is just ensuring that we include one buprenorphine product which could be like buprenorphine and fentanyl and the monoproduct is just buprenorphine. Gotcha. Thank you. That brings us to section five. This creates an overdose prevention site working group. The lead-in language in subsection A and recognition that fatal overdoses in Vermont are rapidly increasing with a record amount of opioid-related deaths in 2021. There is created the overdose prevention site working group to identify the feasibility of implementing overdose prevention sites in Vermont. I may have the membership of the group. First, the commissioner of health or designee, commissioner of public safety or designee, attorney general or designee, member of the House, appointed by the speaker, a member of the Senate, appointed by the committee on committees. Two individuals with lived experience of substance use disorder nominated by syringe service programs and appointed by the commissioner of health. And the program directors of the consortium on substance use, the Howard Center's safe recovery program, the HIV HCV Resource Center and Vermont CARES or their designees. Is that supposed to be Vermont CARE partners or is that correct? Vermont CARES. Vermont CARES. That's correct. Okay. Now, this is just setting up a group to discuss this. Correct. It's not forming. No. This is a working group. I'm still concerned about the potential liability too. Yes. That's why there's a working group. I'll turn it back on. Yeah. And I missed a member, a representative of Vermont legal aid. What's there? A representative of the committee. And then. I'm just, were you saying something? I just, she said she missed it, but she, I. Oh, I missed. You made it out loud. Okay. It's there, but I didn't say that loud. Okay. Subsection C, powers and duties. The working group shall identify the feasibility of implementing overdose prevention sites and make recommendations on executive and legislative actions necessary to implement overdose prevention. Assistant, so have the assistance of the health department report by November 15 of 2023. The working group shall submit a written report to the committees of jurisdiction with its findings and any recommendations for legislative action. The commissioner of health or designee is to call the first meeting on or before September 15th of this year and the committee sucks the chair from among its members. Majority of the membership constitutes a quorum and the group ceases to exist. November 15, 2023, when the report is due. And then for compensation and reimbursement, we have a standard language for eight meetings. Oops. And I have a subdivision too. Sorry. I didn't put and and there's a slash there. So it should be entitled to per diem compensation and reimbursement of expenses. And for the legislative members, the appropriation is made out of general assembly's budget and for other members out of the department of health's budget. And then in subsection eight, the overdose prevention site means a facility where individuals can use previously purchased regulated drugs as defined in statute. And I just understand that. But most of these drugs are are not legal. Correct. So but it's saying purchase regulated drugs. But they're they're not legal. So how do we cover that? So this would refer to sites where people are using illegally or drugs that are illegal, but they have previously purchased them and brought them to the site. And this is a working group to sort of work on the issues of whether those types of sites are still the working group. Yeah. I think part of part of Carl's question is that previously purchased regulated drugs. They submit reads that I went to the drug store and purchased them. They sound legal. Yeah. That's what it sounds like. It sounds like that they're purchasing legally and I don't know what has to find in. Well, is there a definition for regulated drugs? Well, yeah, there is. Regulated drugs. Acquires. Well, I think regulated drugs is a term of art. This language wasn't not. I consulted with Michelle, who is the expert. So I feel more comfortable, but I can pull up the definition of 40 to one so we can take a look. So this comes from a chapter on possession and control of regulated drugs. Forty to one definitions. So I have seen elsewhere the definition to be the recreational drugs. And I mean those. The facility described as that. Okay. Thank you. Yeah. I would probably pull in Michelle if you dive into this, but this definition means a narcotic drug, a depressant or stimulant drug, other than methamphetamine, a hallucinogenic drug, ecstasy, cannabis or methamphetamine. I guess it's the word purchased. Yeah. It's sort of made in terms of its legality. Oh, I see. All right. Yeah. That's, I was trying to get at that. I think you and I are on the same thing. Sorry. I missed that question. So individuals. Previously acquired. Okay. I'll make that change now. Okay. Can you previously acquired regulated drugs? Okay. Thank you. Next is an appropriation section. This is really a section of three different programs. They all require appropriations, which why it's sort of titled appropriation. So the first is an appropriation for a mobile medic MAT unit. So for fiscal year 23, an undisclosed amount is appropriated from the general fund to ADAP for the purpose of awarding one or more grants for mobile MAT services. And according to federal laws, the division shall award grants based on the applicant's ability to provide MAT, including methadone, to currently underserved areas of the state. We need to address the name of ADAP or its successor. Um, we could say our successor. I wasn't as concerned here because this is in session law, so it doesn't sort of live on past this fiscal year, but we can put or successor if that just feels better. Katie, I'll say it now. I really hope we can have a if we go down this route that we can have a different heading than appropriation. You know, um, I will flag that, you know, I mean, I realize they're all, you know, um, are they pilots pilot program? Um, might be pilots, um, or, you know, something. And um, why don't I put pilot programs and maybe not start with the word appropriation. Same thing in seven, right? It's the same thing in seven and eight. Yeah, okay. Um, I'll call it pilot programs for now or place appropriation with pilot program and I'll flag it so we can take a second look at it. Yeah. Can't we use funds or could we recommend use of funds from the bill but we just voted out for this type of program? Yeah, the thing is this is intended to be put in place, uh, July 1st and we won't be getting opioid settlement funds until after that day. And the Appropriations Committee may decide to that your idea makes a lot of sense and to put it out. Yeah. If that's what we put appropriate out. So would you like and six or or successor or just keep it as is? It's in session law. So I think I think it's not as important. Okay. Okay. Um, next is the pilot program for section seven. Substance use support for justice involved for monitors. Sorry, I'm trying to keep up with changing to pilot program. Okay. In fiscal year, uh, 23, 250,000 is appropriated from the general fund to ADAP for, uh, to award one or more grants to an organization or organizations providing substance use treatment counseling or substance use recovery support or both for individuals within and transitioning out of the criminal justice system. The division shall award grants based on an applicant's ability to accomplish the following first. Can I just ask there? I mean, can we put in language that references possible other funds than general funds? Yes. And I would say general general fund and or other possible sources. Um, sure. And so the reason general fund is highlighted is because I felt like that was an outstanding question. I just plugged in general fund because I didn't have another other directions. So why don't I keep it highlighted for now? Why don't I keep it highlighted in the drop from now to kind of lag that is something to come back to. Okay. Um, okay. So accomplish the following. First, provide justice well people with direct substance use support services while incarcerated, such as through alcohol and drug abuse counselors or certified recovery coaches or both. Second, support justice involved individuals and their transition out of incarceration, such as through referrals to existing statewide resources for substance use treatment or recovery. Or lastly, third, provide long term support for justice involved individuals such as by coordinating peer support services or ongoing counseling post incarceration. Just real quick. So on line 10 I just want to make sure you misspoke and that I don't have a wrong version. So you said alcohol and drug abuse counselors. Drug counselors. I'm sorry. Alcohol and drug counselors. Yep. That's the term in title 26 licensed alcohol and drug. Is that right? Drug counselors. I think it might actually be. The abuse. Yeah. Now that you're saying that. Yeah. Okay. I need to go. Okay. I'll just highlight it for now. I'll go back and check. Thank you for flagging that. And then just like mine 14. I think it's just a typo. It says such as though referrals is that through through referrals. Yeah. Thank you. Thank you. Okay. Next, I'm going to get rid of and section eight. I'm going to replace appropriation the pilot program. And this has to do with overdose emergency response support. And fiscal and fiscal year. This fiscal year or this coming fiscal year 180,000 is appropriated from the general fund to ADAP to award for equal grants to organizations providing substances treatment or recovery services in coordination with emergency responses to overdose. The division shall award grants based on applicants ability to support individuals at risk of fatal overdose by facilitating warm handoffs and coordinating between stakeholders and public safety emergency medical services substance use treatment and health care providers and substance use recovery centers. And then have the effective date. Warm handoff. I know. What I actually was thinking is in the last draft, we didn't hyphenate it. And this draft, we do. I wonder what happens. There's school back already. I know. I want to be. There's a hole here. And I'm. Teresa would like us to go back to page four. Really? That's when we were holding our question. Yeah, we do. Right. I did follow the instructions. I'm just following instructions right now. Well, you know, it only happens very rarely. Everyone's four. Okay. Page four, we're in that first paragraph in A. So I'm kind of I just I guess any more explanation about what this is doing. So so right now the current language does not require preauthorization. If it's in accordance with the FDA dosing recommendations. And so then we're adding during the first 60 days. So it's going to be prescribed by a doctor, but they're going to do it outside of the current FDA dosing recommendations. Is that what that's trying to get at? I'm going to get them. Yeah, so essentially what this is looking at is how do we increase access, especially during those most vulnerable times when somebody's first considering treatment, right? So prior authorization, that process is basically a point at which an insurance company will review a prescription to take a look at it. And there are a lot of other considerations that insurance companies can take into account other than dosage. And I think we've heard people talking a lot about what's the preferred versus non preferred medication things along those lines and also looking at some things related to cost. I think the reality of the situation while the existing statute falls within, I understand where your question is coming from, but that there's thousands of prior authorizations taking place. 95% of them are being approved. And so this is just trying to look at some additional measures to put in place to ensure that people have rapid access to medication assisted treatment when they need it. So if that's what the intent is, then because I think it could be read and based on Taylor's look, when I ask the question, that maybe is the intent for it to be the way it is. And I guess I just want to know if it's both prescribing outside of the FDA recommendations and increasing access during those for 60 days. So under this, yes, under this description and Katie, correct me if I'm wrong, somebody would within the initial 60 days, if they prescribed over that USDA recommendation, it would not be subject to prior authorization. Right, it's an additional point. So you have, it's sort of like more inclusive of times in which you would not have prior authorization if that makes sense. Crystal. Because there's a difference between quantity and access to the approved quantity, if going over quantity puts you into another category. Right, I just wanted to make sure that when I'm voting on this, that I know what I'm voting on. I think this is one of the pieces. I mean, we need to take some, we're hopefully getting people in tomorrow to talk about this. Because I mean, I do recall the testimony that we had prior to break that spoke about both. And spoke about the, you know, that when we asked what are the things we could do, you know, that was on the list. And it's just, so I'm like said, I'm just trying to understand exactly what I'd be voting on. I thought it had to do with the fact that the normal, what do you call it, FDA prescribed dose might be up to nine strips at a time or something. Or that's the technology. There could be somebody that needs 13. Right. Okay. And would this cover that person? That would, that's the hope. Because what we heard from Blue Cross through SHIELD was that they did not have prior authorization of a drug. But they had no prior authorization. Now of course Medicaid does, but we'll ignore that fact. But that if you wanted to prescribe different than what was usual and customary, that there would have to be some kind of prior. There needs to be approval. Right. So, so can I ask another follow question then related to that? So if, if this stays the way it is and a prescribing authority is able to prescribe something that's not within the current FDA guidelines in that for 60 days, but does this then require them to then go back to the FDA or just require them to make the case about why they're prescribing what they're prescribing? The latter. Yeah. So prior authorization would happen 60 days afterwards. But the 60 days allows for one, finding the right dosage for the individual, but hopefully reducing that barrier to induce someone on to MAT. So not having that prior authorization up front, but getting the person on finding the dosage and then after 60 days, either they're in the FDA realm and they won't need a prior off or that they would have the prior authorization come at that time. Thanks. I think another component of this that we heard in a meeting with Blue Cross Blue Shield is that I think the concern is really, you know, so if somebody's going to be prescribed a higher dose than what's FDA recommended, what are the sorts of processes in place? And there's a separate process called quantity limits, I believe was what they talked about. So prior authorization is prior to even getting your prescription through. There's a separate process. That is, once you go to the pharmacy that there can be a quantity limit that's in place at which point that goes through its own review process, which can then be, you know, appealed. Sometimes it's another quick kind of thing where the provider sort of checks it off and it's okay. But to just keep in mind that that process will still be in place. We're just basically when somebody's in the waiting room of their provider that they won't need to go through prior authorization. So I'll be, I will acknowledge you just confused me because now it made it sound like if the quantity wasn't within, you know, the guidelines that at the pharmacy might get like, I'm sorry, I can only issue X, Y or Z. So are we setting up another barrier? Well, that's just the way we're not setting that up. No, I know that exists. So I guess what I'm saying, are we, are we not removing, are we not really removing that barrier about quantity is my question. Yeah. So we are removing the barrier for prior authorization. Right. And so that's when they're in the waiting room. And then yes, there's another process that people go through when they meet with their basically when they go to the pharmacist under this statute. We're not affecting that in any way. And so I think that's up for consideration. That's something that we want to dive into. I think that we just recognize that that initial component where somebody is in the waiting room of their provider is what we're addressing. We are, but that's not really going to do anything if they get to the pharmacy and they can't get what they need right then. And I want to say this is this is why the pieces are in here for us to have a discussion about what we can do sort of right now. And part of what I mean, Dane and Jessica and Taylor and Kelly and Kelly worked over the over the break over 10 meeting recess on different sort of ideas. I will take full responsibility. One of the ideas that was presented from the person who commented was to remove the sunset on the the on the view bill. And I exercised the chairs thing to take it out of the draft because we don't sunset until 2023. And it didn't seem like it was going to do anything right now. And what we're talking about is right now. And the Senate was the body that put the time limit in there. And I can almost guarantee that the there has been no evaluation. Yeah. So I was like, this is not a fight we need to have. Right. And so I so that was an idea put out. And I was like, you know, there is a process in place for us to evaluate it next year. Right. But it's a little too early. It's too early to pull it out. Right. I mean, I get all that. I just, you know, I think what I am sort of, I am 100 percent OK with the concept. I just, if we're not really doing it, then if we're if we're saying like, OK, here's what the barriers are. We're going to take away half of that. We're not taking away the other half, you know. And we did when we talked about that. I'm going to put. Yeah. And Katie, you need to go. Okay. I'm here to go. And so we can we can continue to have our conversation, but I know you need to be somewhere else. And we'll be giving you mixed messages. Great. So this this draft, just to kind of close a loop on the process, you're coming back to this draft tomorrow morning. Are we coming back after the floor? It says TVC currently in our sample. We do not need a new draft. I guess I mean tomorrow morning we are hoping to hear from from the Department of Health. OK, OK. So you don't need a new draft first thing in the morning. They have seen that. I mean, this draft is on the web page. Thank you. Thank you. Thank you. Thank you. Have a nice day. Have a nice week. Have a nice week. Have a nice week. Thanks. The the TPD was whether we thought it was necessary to come back after the floor without knowing what the floor was going to be, which I still am a little unclear what is happening on the floor. Other people may know. I think we might have time in the morning to continue our discussion around this bill. And what's missing? If anything, you know, what else can we do? Or how do we want to come in? Yeah, I mean for the people who weren't involved, this is the first time that we're seeing that. Exactly. Exactly. Isn't that exactly? I'm just saying two quick things. One, finish up with your question. When we met with Lucrez Blushield, one thing I was struck by exactly what you're saying, but my sense was, and Dean, please correct me if I'm wrong, that the doctor who was on the call and the pharmacist who was on the call were not sure that that's what was happening. And they were going to talk more to each other and let us know whether or not there was that weirdness of it could be approved here and then not approved when the person walked in and gave the script to the pharmacy. And so there's more to come because then they also wondered what Diva was doing and we weren't totally sure. And we said we were going to hear more testimony on that. So I think that's why it's a little confusing. That was my sense. I mean, so these scripts usually go directly from the position to the pharmacy. Right. So it's kind of. Yeah, I just, that's helpful. Thank you for sharing the results of your conversation. I'm still left with a question about whether we're really doing what we think that we're doing. Yeah, and I think we are too. We were too, is my point, I guess. And then my other comment is, again, I held my questions to the end. And I just wondered about on page five of nine, the membership of the working group, is that there's not really one of the groups that's that's pretty active in all of. All of this work specifically is the emergency rooms in the community health centers with the physicians in those two places. And yet they're not represented in this group. And I just thought that they might want to think about that. I mean, who was on the group? And yeah. I had a comment about that section as well in that we just spent a lot of time figuring out who should nominate who and the language and stuff. It feels like we should make our language in this consistent with the language that we just passed out in 7-11. Yeah, right. I agree with you on that one. I mean, there are enough different people, different groups of people who are raising the question of whether or not it's the role of the state whether or not to have these facilities, these sites that I think it is time for us to help direct that by having a study. And as Karl pointed out, there's lots of questions. Whether it's liability, whether it is something that's going to encourage or whatever. And there are places around the country and there's a part of me that would want to be more explicit in their charge, which is to have them talk to I mean, there are places in the United States. There are cities in the United States right now that are doing this. And so to be more explicit about assessing that because this is controversial. You know, people may be worried and sometimes when we say let's look at something, they go, we don't want to look at it because we don't want the outcome. And I don't know what the outcome will be, but there are places and not just in foreign countries. I mean, it used to be, I mean, there were foreign countries that did before that and but there are foreign countries, they're not the U.S. And they're, yeah. So there's and they're not all in New York City. So. And I think that there wasn't many things we could go on. That's why I think that we might need a good facilitator to be appointed to this group because people right now, it doesn't matter who you talk to, it seems they have very strong opinions one way or the other. So putting together those two groups into one group and saying come out with a revolution might be really difficult without strong facilitation skills. Recognizing that we have limited time, I will just say that the large question that is out in community right now is whether there is legislative action that needs to be taken or should be taken around overdose prevention sites. So I think that's why the tasks that I put into this was really the feasibility and looking at is it a legislative thing or as some folks have discussed on community, is this a locality and a municipality piece where actually it's hands-off on the legislature's end and just allowing folks to move forward and what that all could look like. I also know the membership needs to change because in talking with the attorney general's office, they said they would not like to be involved and pass it on down to the state's attorneys. Yes, he does. I'll wrap it up for a couple. That's why we give him a deadline, Carl. This is your first time, you know, many of people's first time seeing it. We have legislative time not, you know, until Friday at five or four thirty to pass something out. If people want to send this, the draft that is on our on our webpage to anyone that you think needs to see it who might have an opinion or might have another idea that is something that we will in fact consider that is focused on immediacy and opioids and fentanyl. Because that's what sort of are this up on our site now. It is it is up on our site. But it's I wonder, Julie, is there a way in putting it up on our site that you can also name it? Sure. You know, I mean, it has the draft number, you know, blah, blah, blah, blah, but it doesn't have, you know, something. Blah, blah, blah is a number. Yes. Yes. Yeah. And and in the few minutes. OK, so now we're going to change subjects. So Representative Khan and I did a drive by through on seven twenty, the D.D. Bill with government operations. And they have a person off the good news is that they did a stop hole and it was unanimous eleven zero. But they do have a suggestion that we prepare an amendment to our bill to specify that the steering committee has a sunset date. They did not feel it was specific enough. OK. So it's an easy thing to do. Yes. Topper, did you have anything else that you thought we should report back? It seemed like that was that they had a lot of questions. I'm going to say they didn't. It was not like, you know, oh, yeah, thanks. They grilled us for half an hour, but it was they were supportive. Yeah. When they grilled you for half an hour, was it on the bill as a whole or was it on the committee? In terms of preparation when you have to go to them again, they asked specific questions about specific elements of the bill. So they asked us to do, you know, an overview about what the what the bill does. And this is actually my first time presenting to go off. So and then so we did the overview and and then we took questions. And so there are questions like, you know, what does plain language mean? What that the steering committee and the dates and, you know, was the report the end of the steering committee? And why do we need this? You know, so those those types of questions. And I was noticing in this bill that there is a there's a date, there's dates and there's all those things that seem to be we said that ended after eight meetings and they were because we say they can only meet eight times, but that was not specific enough for the the vice chair felt very strongly that we needed a sunset day. Otherwise, it's different. It's different. Right. It could be one meeting a year for eight years or whatever. Yeah. So so we we if the committee is in agreement with that we can certainly work on an amendment with Ledge Council to that effect. Absolutely. OK. And that was it. OK. Thank you. Thank you all. Before we go, just want to make sure in the clerk that we let the clerk's office know that the bill is coming. It's on the calendar. All set. OK. We don't have to come back after four. We do not have to come back after four. But we do need to be here at eight thirty. And with that we are finished for today.