 Welcome to the Vermont House Human Services and today is Friday, February 11th, and we are this afternoon having a sort of introduction to a bill that has been developed related to the opioid settlement and how to distribute the largesse that is coming from there. But before we have a walkthrough of the bill or anything like that, I thought it would be important, we seem to have just lost Josh Diamond. Have we lost Josh just the attorney general? Okay, we will wait a second or we also have Monica Hut who is our prevention policy person out of the secretary's office. Okay, and you are back. So actually, did the two of you have an order of which they were presenting or was, Joshua, were you going to start us out? I'd be happy to do that and maybe provide you, Chair Pugh and members of the committee, a background of how we landed here that that talk to the committee. That would be very helpful. This is all new to most of us in terms of what we are doing and why we are here. All right. Well, Chair Pugh, members of the committee, I am Joshua Diamond, deputy attorney general. And let me just start by acknowledging which I think is probably evident to everybody that while we have achieved a meaningful settlement to bring dollars into the state of Vermont to help with the abatement of the opioid crisis, I want to recognize that there really is no amount of money that was sufficient to truly compensate those who have lost a loved one or have had their lives upended because of this terrible scourge on our state. And if we don't have someone in our family or a friend who's been directly impacted, it's likely that we've got someone one further degree of separation who has. And so this is, this touches a lot of folks here in the state of Vermont. And I just want to recognize that and I don't want to lose sight of that. So when attorney general Donovan was elected and came to office back in January of 17, he made holding industry accountable for those who caused and furthered the opioid crisis, one of his top priorities. As a result, our office engaged and is engaging in a number of investigations against those who have caused and furthered the opioid crisis. But we also brought suit against two of the largest distributors of opioid drugs, McKesson and Cardinal, as well as bringing cases against Purdue, Pharma and the Sackler family for their actions in causing and furthering this crisis. As a result of that litigation, intense settlement negotiations that were pursued not only by the state of Vermont, by all of our sister states, as well as over 2,500 other localities, cities, towns and counties, a comprehensive national settlement was reached late this past summer. And that is in some ways why we are here. The general terms of this settlement agreement were the three largest distributors, which are McKesson, Cardinal, and Amerisource, Burden. We did not sue Amerisource, but we had an investigation that related to them. They have agreed to pay approximately $21 billion nationally to settle claims for their activities related to the opioid crisis. And that is one of the settlements that we're going to talk about. Another is with the company called J&J, Johnson & Johnson, or Janssen. They have agreed to pay $5 billion for their responsibility. What is not really going to be discussed in much detail today, because the case is still ongoing, is the litigation, which is now in bankruptcy court, or technically on appeal to the Second Circuit Court of Appeals, involving Purdue, Pharma, and the Sacklers. But we are working hard on those cases as well to help bring money back to the state of Vermont to help abate the opioid crisis. For Vermont, those are big numbers, but we're a small state by population. And even though we got a greater share than our population base, the numbers that are coming back to Vermont are about $53 million from the distributors paid out over 18 years. And then with J&J, it's about $12.2 million over 10 years. And in both these settlements, the monies are going to be divided into three different buckets. And this framework really represented a negotiation, if you will, between the states and the localities. The localities, Vermont's cities, towns, and counties will be able to get up to 15% of those monies that are coming to Vermont. There will be a state bucket that also represents 15%. That money will come straight to the state. And then there's the largest share, which is 70%, which will go to an abatement funds bucket. And the abatement fund is really why we're here today with this legislation, because the settlement agreements require a framework by which we can access these monies. First, there's got to be a designated lead agency who will work with the National Settlement Fund Administrator. That's the administrator that's going to cut the checks to the state or cut checks pursuant to this abatement fund. And the lead agency will be the only entity authorized to request funds from the settlement fund administrator that is dispersed from the abatement account, which is different than the state account. So the 15% will come to the state in any given year. The intent is for that money to be used for opioid remediation. The AG's office has an additional ask, which I'll talk about towards the end of my presentation. But that's in contrast to the abatement fund that required this mechanism with a designated state agency. As part of the negotiations, the localities wanted to have input in how that largest pot, the abatement fund would be spent. So to accommodate that interest, an advisory committee needs to be set up to provide recommendations to the lead agency about how those monies should be spent. And the framework with that, according to the settlement agreement, requires that there be an equal number of representatives on this advisory committee, both from the state, but also from the city's towns and counties as well. And there's got, according to the settlement agreements, there has to be a process by which the recommendations can be made and considered from the advisory committee. So before I talk about the legislation and some of the areas that we've noted, do folks have questions about the overall settlement agreement or settlement agreements, I should say? Thank you. And I'm looking around. Can I just ask? Yeah. This is Representative Wood. Mr. Diamond, are you, maybe I should check on this first. I saw the proposed legislation there. Do you have something that's going to, do you have something in writing that we can see that lists all those numbers and percentages and stuff like that that we could see that would be helpful? Yes, I will send along. We've got an executive summary that's been circulating and we can send that to the committee. Thank you. We have another question. I just didn't quite hear it correctly, but can you just repeat the amounts of money that we're getting from the two, two settlements that have been finalized, if you will, Johnson and Johnson the other one? Yes, approximately $53 million from the distributors paid out over 18 years. And then $12.2 million approximately paid out over 10 years. Thank you. Over 10 years. Over 10 years. Now, not to get too far in the weeds. I'm sorry. Unless you were continuing to answer Representative Rosenquist's question, we have another question. Okay. Or not. Go ahead. Thank you, Madam Chair. The $53 million, that was the McKesson and Cardinal, just to clarify. Those were the two entities. There's actually a third. It's called a Merisource Bergen. Those are the three that signed onto that settlement. Thank you. And perhaps, Mr. Diamond, because some of us got lost, can you go over, I know you're going to just, can you, the three buckets, there's very clearly. There's a localities, I'll call it the Muni bucket, which is 15%. 15, 15. Yep, 15. There is a state bucket, which is 15%. And then there's the abatement fund bucket, which is 70%. 70. But what was it called? A bait. Okay. I'm sorry. Something from time to time, technology is getting in the way of some of us hearing. And so I was adding it up to more than 100, because I was getting 15. And then 50% as opposed to 15%. You look like you have a question. Yeah. Thank you, Madam Chair. And thank you, Mr. Diamond, for being here. I'm trying to get a sense of what the sort of practical difference will be between what this abatement fund will look like. I understand that it will have the advisory committee attached to it, but say once they create those recommendations, what's the sort of, how are those, how are those recommendations put into practice? Just I'm going to interrupt for a second. Is that part of the rest of the story that you're going to get to later, or that's in the bill, or is that? Yes. I mean, I can talk about it in the context of the bill. I think that's one of the things that I think still needs a little tweaking in the bill. But so maybe if I can address that in terms of what I believe the settlement documents require, and then we can talk about it in the context of the proposed legislation, if that makes sense. Yeah. Okay. So the settlement agreement contemplates, as it pertains to the abatement fund, that the designated state agency will make a request for purposes to use that fund, that 70% bucket, to the National Fund Administrator. And there's an exhibit in the settlement agreements. It's called exhibit E, I believe, and many of those areas have been identified already in the bill before you about what are appropriate uses. And the precise mechanics are still being worked out, but essentially think of it as an invoice that the designated state agency will say, for example, I need $100,000 for safe injection sites. And that money will come back to the state of Vermont, presumably for that purpose. It's likely that the lead agency will need to keep an accounting of that at some point to know that the monies were used for that as opposed to roads and bridges or something such as that. But I think that is what the settlement documents require, generally speaking. That's helpful information. Thank you. Mr. Drummond, please go ahead. So, and I don't mean to steal the thunder from Ledge Council, who I know has done a tremendous work on putting this bill together, so I could talk about things, maybe section by section, and maybe just highlight some of the issues from the Attorney General's Office's perspective, if that's helpful. That's fine. So, starting off with section two, which is the purpose, and this will reflect probably some of my comments later, that it appears that the purpose is to create a designated fund for which all the settlement monies will funnel into. And I think what may need some tweaking is some of the nuance of what the settlement agreements require, which is this idea that the biggest part of those settlement dollars are going to involve this kind of iterative or interactive price process between the designated lead agency and the national fund administrator. So, it's not as if in year one, we're going to get, let's call it two million dollars that are going to come into this fund and then that can be appropriated. It will require the lead agency saying we want to use this money for that purpose and then the check coming back to the state of Vermont. The Opioid Advisory Committee is... We have another question. That just, the process, I'm understanding the process that you're outlining. Does that authority, whatever it is out there, do they have approval over the plans? I mean, is there a discussion back and forth? Or is it like there's presumptive recognition that the state will be following what the uses are intended to be? I mean, is it... I'm trying to figure out, is it a bank out there essentially that says, okay, here's the state, we're requesting money, you give us the money? Or is it an oversight authority that sits out there where the state needs to make some sort of case that it's spending the money appropriately and then it's released? I think it's going to be more flexible than prescriptive, but there's going to be some requirement. The settlement agreements say you can only, for the abatement fund, here are 12, 15 pages of subject areas that you can use the money for. It's very broad, but it has to be used for abating the opioid crisis. It can't be used for roads, bridges, creating electricity infrastructure, what have you. And so through that process, yes, there will have to be some accountability that we're using this money for the intended purpose, but I don't think it's going to be an onerous process. However, I say that until they hire the National Fund Administrator, we're not going to know particularly all the hoops that are going to be needed to jump through. Generally speaking, yes, but I don't think it's going to be that prescriptive. Thank you. We have another question. Thank you, Madam Chair. I just wanted to clarify the prescribed uses. I'm guessing it's something that's already been determined, or is that also still in the process of being there? No, those areas have been determined, and I can send to you all. It's exhibiting. Mr. Diamond, those are explicated, I believe, in the bill draft. That is correct. On some level, you are giving us the broad overview and the context. And then I don't know, Monica Hutt, if you would like to then add to that, or we then can have a bill walk through. Okay, sorry to interrupt, but that's what I do. No, I defer to you, Madam Chair. However, I can be helpful here. Okay. So the short answer is yes, the subject areas have been defined. We had input from ADAP and the Department of Health when we were creating those exhibits for purposes of settlement, so Vermont had some opportunity to be heard on the topics. So section 4772 outlines how the advisory committee will operate and its makeup. Section 4773, I believe, defines who the lead agency will be. We are recommending some tweaks to that to expressly reflect that as the lead agency that it will be authorized to request funds from the settlement fund administrator to have the monies just dispersed from the abatement account and happy to work with Ledge Council and others to get you that specific language, but that's what's required in the settlement agreement. One issue that goes along with this in how the abatement fund, which is in section 4774 is defined, our office had to hire outside council to assist us with the litigation. These were a significant undertaking with companies that had in some ways unlimited resources to further litigation. And as a result, we do owe attorney's fees on a contingency fee basis for the settlements that were reached. Jeff, I'm sorry. You keep cutting out. I don't know if it's where your head is turned that way. If you could speak right into wherever your microphone is. And if you are now talking about where the office has suggestions for change in the bill as introduced, we will need that in writing. So I presume you have it in writing. I can offer some red light changes shortly after this hearing. Okay, but saying is, I guess partly, Mr. I'm saying is that we have not had a walkthrough of the bill. So you are talking about that you are the first. We know nothing. You are giving us the introduction. Fair enough. May I suggest maybe turning it over to others to do the walkthrough and then I would be happy to provide comments afterwards. Perfect. Because that's right. I'm sorry if we weren't clear. And before Katie, Monica, do you want to say anything? Ms. Monica. Good afternoon. Thank you, Madam Chair. I'm happy to have Katie do the walkthrough first if this committee feels grounded enough in the concept. And my testimony was really specific to the bill itself as well and the work that we've been doing together. So. I think that would be lovely. Katie, we are going to turn it over to you, Legislative Council. Great. Good afternoon. Katie Mclin, Office of Legislative Council. Let me pull up the document for you. I believe we have it on our web. And is it your preference to? Yes, our preference is to be able to look at you. Oh, goodness. Okay. Let me pull up the document for myself then. I'm sorry. It's Friday. Okay. So I am looking at draft 5.1 and I'm starting on page one and you will see that in the first section we are creating a whole new chapter in title 18. Excuse me. We're not creating a new chapter. We're renaming an existing chapter and then creating a new sub chapter within that chapter. So right now there is language on the treatment of opioid addiction where the proposal is to kind of generalize that language instead of treatment. This language will be focused on opioid use disorder. All of the existing language in this chapter would stay in this chapter. That's what the ellipses online 13 mean. And we're just giving that portion of the chapter a new name. So that would be called sub chapter one treatment of opioid use disorder. And again, that's all the existing law in that chapter. It's not changing. It's just all being organized in one sub chapter. Then there's a new sub chapter two created within this newly renamed chapter that is specific to opioid settlements. So the first section of this bill is the purpose section. And the purpose of the sub chapter is to comply with any opioid litigation settlements to which the state or municipalities within the state were a party regarding the management and expenditure of monies received by the state. So some of the thinking that went into this particular section was that a lot of the language, especially when we get down to looking at the appropriate uses of the money, were taken directly out of the settlement exhibit E of the settlement. And there were some small changes made here and there to make the language a little bit clearer, more concise or more specific to Vermont systems. And as we were making those changes, the conversation that we had is overall the intent is to comply with the settlement. So when in doubt, the idea is that it's the settlement that is kind of the grounding document for the language here or the guiding document. So overall, the idea is to comply with the settlements. And I should know for you that I keep saying we and you might be wondering who I'm talking about. So when this work was initially being pulled together, I think at the first meeting, we had a representative from the AG's office and Monica. And then at that point, Monica and Jen Carby and I continued to kind of move forward and continue to tweak this draft to have this version that we have right now. So that is the purpose section. Next is section 4772, page two of the document. And as Mr. Diamond said, there is a requirement in the settlement that there has to be an advisory committee. So this creates and statute that advisory committee, it's the opioid settlement advisory committee. And its purpose is to provide advice and recommendations regarding remediation spending from the opioid abatement special fund, which is a special fund that is established further down in this sub chapter. So we haven't gotten there yet. But the idea is that the advice is about spending the money in the special fund. So one very important thing about the settlement, as Mr. Diamond noted, is that there has to be an even balance between members who are representing the state and members representing a municipality or a locality. So this particular grouping was structured to kind of reflect that balance. So the lead in language here is that the advisory committee is to be composed of the following members and shall reflect the diversity of Vermont in terms of gender, race, age, ethnicity, sexual orientation, gender identity, disability status, and socioeconomic status. And then the first subdivisions on this list are all individuals meant to represent the state on that 5050 split. So first, we have the commissioner of health or designee who is to serve as a non voting chair. The reason for the non voting chair at one point, there is a comment that one of the settlements was going to require that the chair be non voting. So that is why this non voting language is here. Second subdivision be the commissioner of mental health or designee subdivision see the chief prevention officer subdivision D member of the house appointed by the speaker subdivision E a member of the senate appointed by the committee on committees subdivision f an individual with experience providing substance misuse prevention services and education programming appointed by the substance misuse prevention oversight and advisory committee that's an existing council that was adopted I think two to three years ago. And so that group would be doing the appointing and that's to provide a statewide perspective on prevention services and education. So this last language. I'm looking at page three lines one and two there's the phrase to provide a statewide perspective on prevention services and education, and you'll see that language repeated in the next two subdivisions. There was a lot of conversation as we're putting this draft together. If a person isn't like holding an office that is meant to represent the state for example a commissioner of mental health how do we communicate the fact that this position is meant to represent a state perspective. So in the end, the proposal was made to just incorporate that idea that this person this member would be offering a statewide perspective into each of the appointments so that that 5050 match between state and local was very clear. A subdivision g an individual with experience providing substance misuse treatment and recovery services within the Department of Health's preferred provider network appointed by the clinical director of ADAP to provide a statewide perspective on the provision of treatment or recovery or both. Subdivision h a provider with academic research credentials appointed by the University of Vermont to provide a statewide perspective on academic research related to opioid use disorder. And then an individual with lived experience of opioid use disorder appointed by the governor to provide a statewide perspective on the experience of living with opioid use disorder. So that was nine individuals that I've gone through so far. And then this subdivision g nine individuals each employed by a different city or town that collectively reflect Vermont's diverse population and geography, at least one of whom is an assistant judge appointed by the Vermont League of Cities and Towns. Katie, I'm sorry. Can I interrupt? So all nine of the individuals have to be appointed by the Vermont League of Cities and Towns or just the judge? Nope, they all do. Great. Thank you. And perhaps a benefit perhaps not a benefit depending on on your perspective of having the Vermont League of Cities and Towns doing that appointment as it removes the responsibility of having to of the General Assembly having to pick and choose which town should be represented. Instead, it gives that responsibility to the Vermont League of Cities and Towns, which might be more in tune with creating kind of that correct balance of diversity between larger communities, smaller communities and different locations of the state. I'll have another question. Katie, I have another question about that one. Do elected officials count as employed by a city or town? Well, it doesn't specify. So just generally speaking, looking at this language, if they're drawing a paycheck from that city or town, we've seen that they would be employed by that town. So I think it could be read that way. If you had a strong opinion, oops, sorry. The question might be the best representation from a particular town might be, for example, the city clerk. And the clerk is a an elected position and or maybe a select board member who is elected and maybe gets a stipend but isn't employed necessarily. For smaller communities employed by the town, there are few and far between, unless you're talking about, you know, road crew members sometimes. Yeah. Yeah. Okay. I hear what you're saying. That's something worth flagging and kind of playing with the language a little bit more as we move forward to make sure we're capturing the correct group of people. Okay. So next we move to subdivision 2A, which is at the bottom of page three, top of page four. So one thing that the settlement required is sort of a description as to how members of this committee were to be appointed and also how they were to be removed from office. So this section covers that the term of office for each appointed member is to be for four years of the members first appointed nine are appointed for a three year term and nine are appointed for a four year term. This is to ensure that not everyone is rolling over at the same time, but there's still a little bit of legacy to the group when the first term expires. Members are to hold office for the term of their appointment until their successors have been appointed and vacancies are to be filled for the balance of the unexpired term in the same manner as the original appointment. And members are eligible for reappointment. So members aren't limited to just one term subdivision B talks about how somebody's removed. So a member may be removed from the advisory committee by the members appointing entity for cause, which includes only neglect of duty gross misconduct conviction of a crime, or inability to perform the responsibilities of the office. The chair of the advisory committee is to simultaneously notify the governor, the speaker of the house, the president pro tem that the member has been removed from the advisory committee. And then we go on to the powers and duties of the committee. So the committee is to receive testimony and advice on the following for the purposes of providing recommendations to the governor, the Department of Health, which is the designated agency, the lead designated agency that Mr. Diamond discussed earlier, and to the general assembly on prioritizing spending for the opioid abatement special fund. That's the fund we haven't looked at yet. So they're taking testimony and seeking advice on the impact of the opioid crisis on communities throughout Vermont, including communities abatement needs and proposals for abatement strategies and responses, perspectives of and proposals of from opioid use disorder prevention collisions, recovery centers and medication assisted treatment providers, and the ongoing challenges of the opioid crisis on marginalized populations, including individuals who have a lived experience of opioid use disorder. The draft bill specifies that the advisory committee is to have the administrative technical and legal assistance of the Department of Health. And instead of an annual report, there's an annual presentation required from this group. Annually the Department of Health is to present the advisory committee's recommendations for expenditures from the opioid abatement special fund to this committee to send a health and welfare and the two appropriations committees as part of the annual budget presentation. And then we have language governing the meetings. The commissioner of health is to call the first meeting of the advisory committee to occur on or before May 1, 2022. The idea here is that this would take effect as soon as possible to so Vermont could begin drawing down funds. So I believe I hope when we get to the effective session section, it takes effect on passage. And the idea is that the group could start meeting and drawing down funds before July 1, 2022. They have to begin their work before the funds can be drawn down. So that's why there's this date before the beginning of the fiscal year. Subdivision two, the advisory committee is to meet at least quarterly, but not more than six times per calendar year. The advisory committee is to adopt procedures to govern its proceedings, including voting procedures, and how the staggered terms shall be apportioned among the members. And in subdivision four, all meetings of the advisory committee are to be consistent with Vermont's open meeting law. And the committee is to meet at least four times a year. Compensation and reimbursement, this is sort of the standard language that you've seen before. The first paragraph has to do with the two legislative members. You'll see that they are receiving per diem compensation and reimbursement for not more than six meetings per year. And these payments are appropriated from the special fund that's being created in this subchapter. And in subdivision two, this governs other members. The compensation and reimbursement again is for not more than six meetings, and it's appropriated from the opioid abatement special fund. And then at the bottom of page six, we get to section 4773. This is the designation of a lead agency. This language designates the Department of Health to serve as the lead state agency and single point of contact for receiving requests of funding from the opioid settlement special fund, which is to be funded by any opioid settlements received by the state through litigation. And then we get to the special fund itself, section 4774. So this section sets out the special fund itself and then discusses how the different funds should be used. So first, we have the creation of the special fund and it's managed pursuant to the existing statutory language that governs special funds, 32 VSA chapter seven subchapter five, and it's to be administered by the Department of Health. The special fund shall consist of all monies from the opioid settlement fund administrator received from the opioid settlement fund administrator, which is meant to reflect not a particular position in Vermont, but the national settlement fund, which is dispersing money to the states as requested. And then the department is to disperse monies from this special fund, according to language already set out in statute. So this is saying the monies are dispersed from this special fund through the appropriations process that this still has to go through the budgeting process, where the general assembly gets to weigh in on the final use of the funds. So the next two sections of section B and C. First, and I should say that both of these sections reflect language and exhibit E of the settlement, which states how the money is to be used. The first subsection B gives kind of general categories that the fund shall be used for. And then subsection C goes on to list in a lot of quite a bit of detail exactly what the priority uses are for these funds within the allowed activities set forth in subsection B. So the special fund, the money in the special fund shall be used for the treatment of opioid use disorder, support for individuals in treatment and recovery, connecting individuals who need help to the help needed, addressing the needs of criminal justice involved persons, addressing the needs of pregnant or parenting individuals with their families, including babies with neonatal abstinence syndrome, preventing over prescribing and ensuring appropriate prescribing and dispensing opioids, preventing the misuse of opioids, preventing overdose deaths and harms, educating law enforcement and other respond first responders regarding appropriate practices and precaution when dealing with fentanyl and other drugs and providing wellness and support services for first responders and others who experience secondary trauma associated with opioid related emergency events, supporting efforts to provide leadership, planning, coordination, facilitation, training and technical assistance to abate the opioid epidemic, researching opioid abatement, implementing other evidence based or evidence informed programs or strategies that support prevention, harm reduction, treatment or recovery of opioid use disorder, and any other co-occurring substance use or mental health disorder. And then subdivision 13, the cost of the administrative, technical and legal assistance provided to the advisory committee by the Department of Health. So I'll just pause there to say that language is taken almost word for word from the settlement agreement. The only addition is subdivision 13, then I just went over including the cost, which is the cost of administrative, technical and legal assistance provided to the committee by the Department of Health. There were maybe a couple of wording tweaks here and there, like I said, to make it more specific to Verma or language more commonly used in our statute. But for the most part, this draft really reflects sort of lifting and being consistent with the language in the settlement. The same is... Legislative counsel, in what is outlined from the settlement agreement, is there anything in the guidance that says states can't use this new money to pay for things that they're already doing? Can this new money supplant the dollars that were already doing? I would want to look again as exhibit E didn't indicate that there was a restriction on using it for ongoing expenses, but I don't know if there's another place in the settlement where such an exception exists. Okay. That would be something I'd be curious if there's anything around supplanting existing funding. Yes, Josh. I think at least the intent of the settlement agreements was not to supplant previous expenditures. It's a forward-looking use. So if that provides any additional clarity. If I heard... I only, for whatever reason, I only hear every other word that you say. So could you try again? Yes, my apologies and I'll lean into the computer. I just... if it helps for clarity, the intent of the settlement funds pursuant to the agreements is not to reimburse for previous expenditures, but forward-looking expenditures if that helps provide clarity. A bit, yes. Thank you. Okay. So I'm moving into subsection C. This is quite a long section of the bill. So this, we just looked at what the funds shall be used for. And now we're looking at within that group of authorized expenditures, what are the priorities? So first we have promoting the appropriate use of naloxone and other FDA approved drugs to reverse opioid overdoses, especially expanding training for first responders, schools, community support groups, families, and increasing distribution to individuals who are uninsured or whose health insurance does not cover the needed goods and services. Subdivision two, increasing access to MAT and other opioid-related treatment, specifically increasing distribution of MAT to individuals who are uninsured or whose health insurance does not cover the needed goods and services. Providing education to school-based and youth-focused programs that discourage or prevent misuse, including how to access opioid use disorder treatment. Providing MAT and awareness training to healthcare providers, emergency medical technicians, law enforcement, and other first responders. And providing treatment and recovery support services such as residential and inpatient treatment, intensive outpatient treatment, outpatient therapy or counseling, and recovery housing that allows or integrates medication and other support services. In subdivision three, priority given to pregnant and postpartum individuals, specifically enhancing services for expanding screening, expert services, and non-medicaid eligible or uninsured pregnant individuals. Expanding comprehensive evidence-based treatment and recovery services, including MAT for women with co-occurring opioid use disorder and other substance or mental health disorders for up to 12 months postpartum. And providing comprehensive wraparound services to pregnant and postpartum individuals with opioid use disorder, including housing, transportation, job placement, training, and childcare. In subdivision four, priority is given to expanding treatment for neonatal abstinence syndrome, specifically expanding comprehensive evidence-based recovery and support for babies with neonatal abstinence syndrome. Expanding services for better continuum for care to address infant needs and support the parent-child relationship. And expanding long-term treatment and services for medical monitoring of babies with neonatal abstinence syndrome. In subdivision five, priority is given to expanding the availability of a warm handoff program and recovery services specifically. Expanding services such as navigators and on-call teams to begin MAT in hospital, emergency departments. Expanding warm handoff services to transition recovery services. Broadening the scope of recovery services to include co-occurring substance use disorder or mental health conditions. Providing comprehensive wraparound services to individuals in recovery, including housing, transportation, job placement, training, and childcare. Hiring additional workers to facilitate expansions that are already listed in this subdivision five. And then in subdivision six on page 11, priority given to treating incarcerated populations, specifically providing evidence-based treatment and recovery support, including MAT for individuals with opioid use disorder or co-occurring substance use or mental health disorders while transitioning out of the criminal justice system and increasing funding for correctional facilities to provide treatment to inmates with opioid use disorder. Subdivision seven gives priority to prevention programs, preventing prevention programs, I think that's a typo. Specifically funding for media campaigns to prevent opioid misuse, funding for evidence-based prevention in schools, funding for healthcare provider education and outreach regarding best prescribing practices for opioids consistent with CDC guidelines, including providers at hospitals, funding community drug disposal programs and funding and training for first responders to participate and pre-arrest diversion programs. Post-overdose response programs are similar strategies that connect at-risk individuals to mental health services and supports. And subdivision eight priority given to expanding syringe service programs, specifically providing comprehensive syringe service programs with more wraparound services included including linkages to opioid use disorder treatment, access to sterile syringes and linkages to care and treatment of infectious diseases and facilitating evidence-based data collection and research analyzing the effectiveness of the abatement strategies within Vermont. So that is the list of priorities in the special fund that brings us to section two of the bill in the very last page. And as I mentioned before, the act is to take effect on passage with the idea that if the bill were to take effect before the new fiscal year, the advisory group could begin meeting sooner and Vermont could begin drawing funds sooner. Okay. We have a question from Representative Small. Just one clarifying question. It might be for Ledge Counselor. It might be for you, Madam Chair. The priorities section, is that priorities that we're identifying in the state of Vermont or are those priorities from the settlement itself? That list comes from the settlement. Okay. Thank you. And go ahead. Thank you, Madam Chair. And the prevent the section line 13 on, where am I? Page 11. So preventing programs specifically, and it kind of talks about schools, funding for evidence-based preventions in schools. Does that include after school? It doesn't specify. So I don't have a great response. I would assume if it were to apply to after school, then there would be language specifically referencing after school programming. This seems specific to schools. And this language, go ahead, Mr. Diamond. I believe the intent was to read these subject areas in a broad manner. And you go into your, can you lean into them? You need a new microphone. Yeah, the subject areas from which are identified in the legislation that come from the exhibit E were meant to be interpreted broadly. So I would view flexibility would most likely be applied. Okay. Thank you. We have a question from- Can I just comment on that on evidence-based prevention in schools? So after school is a really broad term, right? So there are some after school programs that are more academically based. And then there are some that are sort of specifically geared towards prevention efforts. So it wouldn't be probably available to all after school programming, but specifically in programming that is geared towards prevention efforts. Go ahead. So realizing a lot of this language comes from settlement documents. One of the questions that Rep Noyes and I have is around substance use programs and treatment for older Vermonters. I know you're surprised by that. I was surprised. There's so much data around substance misuse for older Vermonters and directly correlates and relates to suicide prevention and mental health in older, not just Vermonters, older people in general. And I realize it looks like only pregnant women and babies are really sort of called out specifically. Everything else is sort of general. So I guess I can say that generally they could probably fit into some of these other areas. It's just such a large issue. Is there any room for any potential specificity around populations such as what they have done here with pregnant moms and babies? So if the question is, do the settlement agreements allow for a broad interpretation for the purpose of implementing opioid use abatement? I think the short answer is yes. How do you? Yeah, that wasn't the question. I can see that I can see that it allows for broad interpretation. Sometimes when things are so broad, specific issues don't get dealt with or maybe even talked about as potential issues to potential ways to use the resources, I guess. So my question is more the opposite. Can specific other than the ones that have already been called out here, pregnant moms and babies, can specific populations be enumerated beyond what is here already? I think that's a question that has stumped. Again, I think, you know, these are policy decisions that you all need to make. I think what you're asking is, can you have that flexibility within the context of the settlement from an attorney general's perspective? The answer is probably yes. How do you want to implement that through line by line suggestions on the legislation or broader topics? I would defer to you all the policy makers and the administration for suggestions. Thank you. Representative Noyes. Oh, sorry. Representative McFawn, you have a question. Thank you, Madam Chair. Wouldn't the advisory committee come in there and make recommendations in answer to the representative Wood's question? Oh, I thought he was talking to me. Sorry. I think he's, Topper, were you talking to Representative Wood or were you looking for a response from? I'm making a statement, Madam Chair, that I think in answer to Representative Wood's question, the advisory committee could make a recommendation to deal with that age group. I think you're both right. I think you're on yet today. Representative McFawn, I believe that you are right and I believe that what Mr. Diamond is suggesting is that there is some policy, I want to say flexibility or I'm not quite sure that's the right word for us to add or how we word. It is limited and if the interpretation is it is broad, then we can add some more specifics if that is what the group decides. So you're both right. I just bring it to your attention, Madam Chair, because when I read it, it says the advisory committee shall receive testimony and advice on the following for the purpose of providing recommendations to blah, blah, blah on prior to rising spending for opioid abatement special fund. If I read that word for word and I interpret it, it means that the advisory committee gives recommendations for prioritization of spending of the money. Maybe I'm wrong. I don't know. No, I agree with your Representative McFawn. The only thing I would say is that older Vermonters are often not thought of in the context of opioid use and substance use. And I'm going to stop this conversation right now because we are advocating for changing and we are using today to ask questions and then we can go about changing. I was trying to answer a question. We're advocating for the same thing again. I will not use that word, but I do have. I'm interested in the so I ask it. It's actually, I just was wondering if the advisory council participation is part of this, the settlement, like who is listed in the advisory council, whatever they whatever they are, if that's fixed in the settlement. So anybody, any wait, so we have I think three, the question is members of the advisory council. Is that prescribed by the settlement or how much of it is prescribed by the settlement? And we will go in order of who started to answer as I'm looking at you all on Zoom. We'll start with our our legal counsel. Katie McClendon. Sure. So the settlement is prescriptive in that there has to be a match of state representatives and local representatives. It is not prescriptive in terms of who those members have to be. And I've looked at some of the advisory committees that are set up in other states, and there's a bit of diversity in terms of the types of members that are appointed to the particular committee. I am seeing responses from Monica White and Josh Diamond, if you could say those responses. Oh, Monica, what did I say? Oh, sorry. That's right. We call her Monica Hutt. Madam Chair, Monica Hutt. I was almost questioning that for a second. Monica Hutt, Chief Prevention Officer. Yes, I agree with Katie. The only prescription is the 50-50 split. Thank you. Joshua. I concur. There are a couple of other items in the settlement docs, but as far as the membership is concerned, that is the general framework that's provided. Okay. We have two more questions, and that's okay. I gave two more questions. And then I believe that Joshua Diamond had some specific comments he wanted to make now that we've had to walk through. So, Representative Rosenquist and then Representative Whitman. Maybe I missed it when I was out of the room for a few minutes, but I didn't see anything in here about funds for interdiction of illegal drugs, opioids in particular. So it didn't look like any money was directed or could be directed to interdiction of opioids. So I'm just curious if I missed it or if it's not in here. I am reading the room, and I believe people are sort of believe that Monica Hutt is looking at things, but your question, I think, is around, I want to say for lack of a better term, criminal justice responses and prevention. And I think you may have, at this point, this may need some more research or taking a guess in terms of reading unless one of you jumps out. I will say that this is a health, it's being directed to the health department. So treating it, but I could be wrong. But it's, you know, it's quite a list of things that relate to health could be useful, but it just interdiction was not mentioned or maybe I missed it. Right. And it's not, and I'm looking to Monica White or Joshua Diamond to comment. Monica Hutt, I'm going to, but we need you. I apologize. No offense taken whatsoever. Thank you, Madam Chair. Representative Rosenquist, I don't believe, and certainly Mr. Diamond has had the most familiarity with the settlement. I do not believe that there are any allowances for any funding for criminal justice. The design of this settlement is related to exactly as Madam Chair indicated to kind of the health impacts and to abate the impacts of the opioid addiction crisis versus the criminal justice aspects of it. So I don't think it leans in that direction at all. And so I would agree with your assessment that it doesn't appear to allow for that. I think we can dig into it more just to make sure, but I don't think it's an allowable expense as I've read it so far. In one area, it's mentioned that training would be provided for people that are handling fentanyl. And that's a no legal substance. So how would they come in contact with it unless they were confiscating the drive, I guess, as well? Thank you now. So that's what made me think about this, that there wasn't any real positive statement about interdiction, but they're going to train people on fentanyl, which is no legal substance. Anyway, for just a comment, I guess at this point. Thank you. Thank you. Are we done? Yeah. Thank you, Madam Chair. I have two questions. And I think the second one I should save until I hear from everybody. But the first one is pretty straightforward. I noticed that there's drug disposal programs and then there's also syringe service programs. And this is actually a question that we've received on a prior bill. It does syringe disposal. Is that included within the priorities? Somebody to think. I'm sorry. My understanding about the syringe service programs that we have in the state right now is that they are already allowing for disposal. I may be wrong about that though. So I'd love to follow up on that and get back to you so I don't misspeak. Yeah. And just to provide a little bit more context for where my question is coming from. So medication disposal programs are pretty accessible. We've just passed the bill to make them at every pharmacy, for example, whereas syringe service programs are pretty limited. You're talking about syringe disposal. Syringe disposal. Syringe services, which is clean needles. Correct. So it's, yeah, I hope that context just helps clarify my question. Thank you. Thank you. Okay. Joshua, you have feedback around this draft suggestions in terms of content? Yes. I think there are two thrusts for my comments. And again, happy to work with Ledge Council and Ms. Hype with regards to the specific language. But I think with regards to the establishment of the design agency, designated agency, expressly stating that it's authorized to request funds from the settlement fund administrator to have those monies dispersed from the abatement account is would be a good addition because that is what is required under the settlement agreement or agreements. The second has to do with access to funds to pay attorneys fees. And while the funds to pay what I didn't understand. Attorneys fees. Okay. So in order to successfully pursue and prosecute these cases, the monitoring general's office had to procure outside counsel to assist in those efforts. We have a contingency fee arrangement with the firm that we engaged with was entitled to a percentage of the recoveries. And we probably cannot take from monies through the abatement fund to cover those, but from the dollars that are coming through the state fund bucket, those could be available to cover those fees. So edits would probably need to be made within the context of this bill to make sure that that is permitted. Josh, might I also suggest that the Attorney General's Office work directly? I guess we have to figure out whether that goes in this bill or whether in terms of that or whether that is something that the Attorney General's Office works directly with the Appropriations Committee since that's a different bucket. And that bucket is not what we've created here, right? That's the 15% to the state. Correct. And typically in a settlement that would let's say flow through our Consumer Protection Division, if we have costs that are associated with that litigation, that comes off the top before it flows back to the general fund through our special fund through the AG's office. So we can't use that process if the monies are coming straight in to the special fund that's being created here. We might, or I have a question, is the 70% abatement fund, it's pretty specific. And then we have these two smaller buckets, one which we have nothing to do with, I guess, although my question is the 15% is, I guess you're figuring that for local, somehow goes to local. And then there's 15% that goes to state. Okay, where it is, what is state? And is there any specificity in the settlement as to what that means? Yes, there is language in the settlement agreements that describe that the intent for the state funds bucket to be utilized for remediation of the abatement crisis. That is the intended purpose. We believe it's a reasonable interpretation, as discussed amongst those who negotiated this settlement agreement, that that money could also be used to cover gaps in the monies that are owed to attorneys outside counsel. There is some money that has been set aside for outside counsel in the distributor settlement, at least for the state of Vermont. But unfortunately, that won't cover the full amount that is owed to our outside counsel. So we need to cover the gap. Mr. Diamond, I can, I think we may need to see the language in terms of that, not in bill form, but to see the actual language of the settlement and what is the best way for the Attorney General's office to get their costs addressed? Understood. This is a quick question, I promise. So I'm a little confused about if this fund would be, is the recipient of 100 percent, or if it's just the 70 percent that's for abatement? Because I'm thinking about the 15 percent that's going to local entities. That seems to be the reason why there are so many local people on the advisory committee. No? Okay, I just, I have a question, I just didn't know. So the intent of the agreement, well, expressly the 15 percent that goes to the municipalities is going to the municipalities directly, based upon a formula that was reached, and those who sign off on the settlement. The municipalities negotiated with the states because they were concerned that the 15 percent was not a fair split to them. And so the grand bargain that was reached was that they would have a voice in how that largest bucket would be spent by virtue of the advisory committee. Okay, thank you. That answers that question. Representative McFawn. Thanks Madam Chair. I was trying to flip through to find it. I thought somewhere in there it said that there was one agency or one something that all of the money was going to come to in the beginning. So for purposes of the abatement dollars, those are being flowed through a national fund administrator. In order to access them, the designated state agency has to make that request for those monies for a purpose that is consistent with those items that are put forth in the bill, but also found an exhibit E of the settlement agreement. And would be attorney's fees be one of those things that could be spent on? Not from the abatement fund. No. That is on top of that is something that is in the draft that we are being educated about that needs to be removed from the abatement fund list of expenses. If I recall, is that right? Your suggestion, Jeff, or that needs to be reworded? I think it actually needs to be added somehow. I believe subject to alleged counsel's correction that the payment of the attorney general's office legal fees is not included within the list. And we're not asking that it be added for purposes of the permitted expenses by virtue of the abatement fund, but for the state dollars that are coming in that second 15% bucket that there be flexibility built in to allow us to cover our attorney's fees from those source of funds. So maybe is there a way that the requesting agency says I need $10? I need my money. I need my $10. So the $10 comes into the state and then the decision is made off the top comes the attorney's fees. And then the split is made 70, 15, 15 after that money is captured. Is there a way to do that? No, the settlement agreements don't contemplate that kind of mechanics. The 15 is going straight to the municipalities. Arguably, the state fund 15 is coming straight to the state and then this abatement account or bucket, this largest bucket, requires the lead state agency to identify its use first before the money comes back. Okay. Well, it seems like we're going to have to make a decision. Sam Branstad. Thank you, Madam Chair. I was just curious if the Attorney General's Office had any information on the municipality's interest in the funds and were they thinking they wanted to cover costs, which is what you're saying the abatement fund can't do. And I just wondered, it seems odd that they really dug in their heels on this one. And I wondered what your sense of that was. Representative Branstad, if I might remember, this is a national suit. Right. And Vermont is unique. Across the country, they have county government. And so it is county government that oftentimes runs programs and does things. So that is what the local is directed at. So we have to, when we looked at some of the terms of this agreement, Vermont is a bit of an outlier in terms of the only local, the only county government, we don't have county government. We have assistant judges. That's our, that's our county government. And a clerk. Right. There's a county clerk. Oh, sorry, there's a county clerk. And there's cities. That is across the country. We don't get to say, our locals don't get to say, we don't want this. And in fact, I just meant, so our city government doesn't get to talk about this either. There's, I mean, there's rural states all over. Right. I don't want to speak for, let's say the city of Rutland, but let's say hypothetically, they get a piece of that 15% bucket, but they might need or want additional monies to run a safe injection site or create a prevention program after school for kiddos, vulnerable kiddos. So that at least to have the mechanism. And that's why having representatives on the advisory board to do that is, is why it's, it's set up that way. Okay. Thank you. Representative. Thanks. Joshua, did you have additional, there are, I want to say, perhaps wording that doesn't reflect policy. And I, you know, so that please talk to Katie, let's counsel about then there are and have her, you know, incorporate, but then there's some, there's some decisions that we have to make. And it, one of them has to do with your request around payment of attorney fees. And putting that in this legislation. I want to say, I'm not sure I want to put it in this legislation, because then the bill will have to go to appropriations. Just thought, you know, I mean, if we have to, we have to, but that puts it in a whole nother kettle of fish. And it might be, if you have not already, I would encourage you to have this, have a conversation with appropriations. But are there other policy kinds of things that you have, you'd like us to consider? No, I believe those were the two overarching big picture issues that I think from our office's perspective need a little tweaking. And maybe some other nitpicks that I can work with, with lech counsel, but those were the two big ones. Monica Hutt, from your, from your vantage point in the secretary's office, what would you like to add? What, what is, yeah. Thank you, Madam Chair. So for the record, Monica Hutt, I'm the chief prevention officer for the state of Vermont. I don't know that I have a lot to add to what you've already heard. I guess what I would say is that it's from the administration's perspective, we've welcomed the opportunity to work really collaboratively with your legislative council with Katie to draft this, the bill that's in front of you. And I've appreciated the invitation to be a part of that. So thank you for that. I think as you've heard today, it is, it's the best work product that I think could come before you at this point in time. It is very much a little bit, there's still some flux. And even as I heard Mr. Diamond speaking just this afternoon, I wrote down at least three different questions that that we need to sort of think about and imagine how they may play into the legislation itself because there are things that are still a little bit unknown. The settlement still not finalized. We understand that there are still some potential changes. There's a third suit that might factor into this legislation. And as Mr. Diamond spoke to, the settlement administrator hasn't been hired. And so they're going to have their own process. So I think our interest collectively was getting a little bit ahead of the game to design a process that would enable Vermont to move quickly to take advantage of this as soon as we could. I think, and I believe that the bill achieves this, but the goals that were certainly most important from the administration's perspective is to speak to those really quickly. I think we're ensuring that the dollars could go to immediate the crisis that we have in front of us as quickly as possible and as efficiently as possible. So we really skewed this process to be timely and a small enough group, I think from the advisory council perspective so that we could get through conversations efficiently and effectively and really move towards decision making. I think that the other thing of importance is that from an authority and allocation perspective, utilizing the budget process enables both the governor and the legislature to weigh in and to ensure that there are good decisions made about the dollars being spent and that felt important, I think, to us collectively. There are a couple of unknowns, again, that I've noted prior to this testimony and then during the testimony. So the role of the settlement funds administrator, I believe, will be a wild card in terms of how we create the bill to support that and what they decide their authority and practice will be. We'll need to know that before or need to leave some room for accommodation of that. I'm also, as I was listening to testimony today, realizing that we will need to figure out a timing strategy so that the timing of the request of the lead state agency to the administrator with some sort of a plan can factor into our normal budget process. So a governor's recommend and a legislative review of that budgeting process, which may create some delays, but I think will be is an important process. So we will need to figure out how to factor that in and I hadn't necessarily considered all of the timing in advance, not realizing that we needed to request dollars before they came to us. I was misunderstanding how that was going to flow. So I did not give Ledge Council good advice on that front. And then finally, I think clarifying this, the three different funds, one bucket, which goes to the municipalities, we created the idea of a special fund for the that large 70% abatement dollar fund. I think we need to decide how the state fund comes into state government and I'd love to have the opportunity to consult with finance and management on that because again, I was imagining is one fund for all the dollars coming into the state and not bucketing them out in that way. So there are a few things I think yet to be decided. I can go back and do a little bit of research, continue to work with Katie if the committee will allow me to do that. But I feel like this has been good work to date and really effective collaboration and I'm very grateful for that. Well, thank you. Thank you, Monica. And we look forward to getting feedback and your continued work with this. And we are only the first stop in terms of the body. As things change and as you get more information, assuming the bill gets over to the Senate, if new information occurs, you know, we can sort of do that. One of the conversations I want to have with the committee is to who we need to hear from in terms of this. So everyone knows in my head my timeframe would be that perhaps we would maybe take maybe some a little bit of testimony next week and that we would take testimony next week. We would use the following week for other bills and that the week after crossover, in the week after vacation, town meeting recess, it's not vacation, the week after town meeting recess, which is crossover week, we would finalize and be voting this bill out. But that this would be one of our bills that we saved for that last week to before crossover, the crossover week, to give a Monica, I want to say to give you and just the most time to get the most information and to give it some time to percolate. So before we wrap up this off the top of your head committee or Josh or Monica, are there people who you think it would be advantageous besides perhaps the commissioner of health that would be important for us to hear from? Perhaps the Vermont League of Cities and Towns. Okay. I can tell you anecdotally we've heard from localities about their interests and this as we went around the state trying to procure settlements. So sorry, can you? Yes, as part of the process of finalizing or getting these settlement agreements effectuated, we had to visit some of the larger cities and towns to ask them to sign off in order to maximize the proceeds from the settlements. And I think many of them do have opinions and thoughts on this. So I think reach out through the League or directly to some of the communities would make sense. Thank you, Josh. And if you could provide our committee assistant, Julie Tucker, with the names of those nine communities, that might be helpful if we decide to go the individual route or whatever. Committee, from your perspective, do you think that there are other groups? Well, you can percolate over the weekend in that context. Madam Chair, in terms of getting the names of the nine individual cities, I would suggest that we just leave that up to the Vermont League of Cities and Towns. That should give us the name, shouldn't it? I think that's a very good point, Representative McFawn. I personally might like to just because I have a mind like a civ, know who those nine towns are. I think you would make a very good suggestion. And I might like that information to keep in my back pocket. I might also hear from people that are going to be delivering these services, whether recovery centers or, you know, who are on the figure out a way how to get the subsequent prevention council oversight and from that group might be good to hear from. I'm sorry, Representative, can you repeat that? The substance misuse oversight and prevention council. Okay. Well, thank you. Thank you, Monica, and thank you, Joshua and Katie. Thank you very much. And I think this ends our committee hearing on this draft committee bill on the opioid council. So thank you very much. Thank you so much. Thank you.