 This is a joint meeting between House Health Care and Senate Health and Welfare. Senate Health and Welfare has already been meeting, so this is a continuation for us, but one of the, and as you know, we will be meeting together again tomorrow. I'm going to, I'm going to look at the times at 10, 10.30 tomorrow and then again on Thursday we'll be meeting together beginning at 9.30 and going through some fiscal issues with Sarah Clark and then listening to North Country Hospital and David Green from VAZ. So I think this is important for us to continue to work together. Bill and I have talked about how to structure some of this and we'll continue to do that. We can't, we're not always going to be on the same page in terms of what we would like to hear, but when we can, it helps us work smoothly together as we did with H742 and I want to thank the House Committee. While you're all here, the Senate very much appreciates the work that you did in getting that bill to us so that we could work quickly and efficiently on the bill. So this is a thank you from our committee to yours. Thank you. All right, and before I introduce Secretary Smith, Representative Lippert, did you want to say anything? Yes, I want to just acknowledge as well that Ginny and I have spent some time talking together and I very much appreciate being able to collaborate. I think it's going to be responsive to the needs of very, very busy witnesses such as Secretary Smith and others in this critical time that we as much as possible coordinate and we have as the House joined the Senate during the morning period that they have scheduled and we will continue to do that when we can have a joint meeting and when we're having separate health care committee meetings, it will be in the afternoon and I'll talk to our committee more about that later. But again, I want to express my appreciation to Senator Lyons for helping us think how to collaborate throughout this week and into the future. Terrific. This is great. So Secretary Smith, what would like to welcome you to our joint committee meeting. Thank you for being here. We know how busy you are. We probably don't know how busy you are. I can only imagine. And so our initial goal is to hear from you about the implementation of H742. There will be questions. I'm going to suggest to our committees that we hold off for a bit. Let Senator Senator, I didn't want to demote you. Secretary Smith provide information and then we'll have to raise our hands and be judicious about the number of questions we have. We'll begin with the chairs and then vice chairs and then go from there. So Secretary Smith, I'm simply going to turn it over to you at this point. Well, thank you Madam Chair for the record. Mike Smith, Secretary of Human Services. And I thank you for getting together. This is a good format in these unprecedented times. And I thank you very much. I'm going to start out talking about the implementation of H742 Act 91. And then, if it's okay with the Madam Chair and the Chair of House as well, I'll open it up to whatever anybody wants to talk about. I'm willing to talk about anything that may be on your mind in terms of what's going on because there's a lot going on. And if I can't answer some of your questions, I'm sure Candace will write it down and we'll try to get answers to your questions. But in general, and taking it at a high level, because I know that many of you have had some testimony from people like Corey Gusterson, our Commissioner of DEVA, who's done a really good job sort of outlining some of the steps that DEVA has taken during this crisis. And they've been quite substantial. So I'll sort of bring it together at a high level. At the same time, Candace is ready to submit a memo that really gets down into the detail of the various things that this agency has done. At the outset, let me just tell you, I couldn't be prouder to be Secretary of this agency. It is amazing what people have done over the last six weeks, with little sleep or little rest in terms of what they've been doing and how they've been doing it. I have a 3,600-person agency there, approximately. I'm proud of every darn one of them as we move forward. So I'm here to talk about how it's worth to implement the various provisions of Act 91. Let me start by thanking you and the federal legislators for taking quick action in a time of crisis to enact legislation to allow us the necessary flexibility to respond to this crisis. As we have talked about, the COVID-19 pandemic is unlike anything our state or country has experienced. It has required all of us working together to help our state and neighbors, and we will need to continue to work together to make sure we fully recover from this unprecedented event, like I said. In the week since we've had our first confirmed case, we have been working to continue our mission of supporting Vermonters as well as to make incredible adjustments to how we do business. We continue to make those adjustments every single day. The legislation that was enacted in quick response to this crisis has both directed and permitted our agency to do the necessary work to respond quickly and thoroughly during this time. I will, like I said, Candace will leave you with a memo that includes the response from each department on how they have implemented the different provisions of Act 91, and it's been pretty extensive. But here is just a sampling of some of the work captured in the memo. We issued guidance to our community providers on how to protect their staff and clients. We did rule variances along with emergency rules when appropriate. Directions and announcements were put out by the Health Department on how qualified Vermonters can obtain a temporary license during this crisis. Major expansion and continuation in telemedicine, telehealth with a variety of providers and services, in particular, Vermont Medicaid has expanded payments for telephonic services, furnished during the emergency response to COVID-19 to specific services including applied behavioral analysis, physical therapy, occupational therapy, speech therapy, choices for care, home health, hospice, family supportive housing, and children integrated services. There's others, but I just highlighted a few. We launched also a Medicaid retainer process for providers that are experiencing cash flow challenges during this crisis. To date, 13 providers, provider organizations have applied and have been awarded financial assistance through February of April 10. The total dollar amount is about $825,000. As of Monday, April 13, the total of 35 provider organizations have submitted applications. I want to stop right here and just sort of explain what we're doing because if you look at this as a three-lane highway, what we're trying to do is make sure that our healthcare system doesn't collapse. That's basically what we're trying to do. As we look at it, we have one lane that's providers, FQHCs, other providers that are in that lane and there's a variety of providers that we can look at. Those are the providers I was just talking about in the first tranche of financial assistance that we provided and another tranche that we're looking at right now. Then the next lane is the, I like how I use my hands. I've never seen that before. The next tranche is, excuse me, the next lane are the hospitals. We have some hospitals that are in crisis that we have helped out. Springfield being one of them. We've issued $1.3 million to Springfield. Grace Cottage has requested $725,000 and the Brattleboro Retreat has requested money as well. We're still working the specific arrangements out of what that will look like, but it's not going to be a small sum. I'm going to be honest with you on that. There are other hospitals, I would say those are in the red area. There are other hospitals that are teetering between orange and red as well as this goes on. There are some hospitals that we'll have to look at as we move forward. The next lane that I've been looking at are the DAs and SSAs because they're critically important to our healthcare system as we move forward. One of the things that we've done, we've looked at this in phases. Again, I've got to stop using my hand, but we've got to look at this in phases. Phase one, with the DAs and the SSAs, we provided monthly prospective case rate payments and provided flexibility within the daily rate billing and adjustment to the end of the year reconciliation process to reflect changes in utilization and delivery of services due to COVID-19. We also, through DMH, implemented emergency case rate for success beyond six. That's the school-based mental health services program to allow continued provision of services and support fiscal stability for DAs. We've also, through DMH as well, provided expedited payments for electronic medical record implementation. That's phase one. Phase two, we're just starting to put together and that's the look at a request from the DAs and SSAs on a financial relief process, mainly because of staffing issues that they're having and some of the issues that they're doing along that line. Three lanes, trying to make sure that we keep our healthcare system viable during this time and continuing during this time. We need the beds. We need our system to come out of this in a way that maintains healthcare in this state in somewhat similar stance as we went in it. There are going to be changes along the way. I mean, there are always some changes when you have the incidences that we've had in terms of stress along our system, but we're trying to move forward. The other thing for the individual, obviously, you know that we extended the special enrollment extended. We launched a special enrollment period on March 20th. We currently are discussing, we're going to extend that. My notes say we're discussing, we're going to extend that. The special enrollment period, one of the questions that keeps coming up and some have asked about this, will the stimulus checks and how they will they impact eligibility for Medicaid and CMS has indicated to Diva that stimulus payments will not count for any Medicaid eligibility, but the department is waiting for written guidance to confirm we've been told it will be addressed in the next set of FAQs to be published. I think I want to, at a high level, I want to stop there. The memo that you're going to get is pretty detailed on the various things that we're doing, but I haven't had the opportunity to sort of sit down and talk with you about the various things that are going on and there's a lot going on. I just want to take some time and not a lot of time, but some time and answer some of your questions that you may have. I mean, we've expanded our testing, you know, we've, we have looked for, you know, one of the things that we've been doing right lately is looking at those, besides the fact of trying to make sure that our healthcare system doesn't collapse under the physical stress that it's currently under, but also looking at what I would say populations that are affected by COVID-19, whether they're healthcare workers that need a place to recover or healthcare workers that are positive and need a place to recover, whether it's disabled, whether it's homeless, looking at those special populations, and as you know, yesterday we announced that the Holiday Inn in South Burlington is one of those places. I want to say this too and I want to sort of emphasize this. I wish we had more time to move dialogue at a normal pace. I wish we, I know Plainfield was a little upset with us in how quickly we were moving. I know St. Johnsbury was upset at how quickly we were moving, although we did notify the community of the surge site there. The, you know, the normal pace of a dialogue in the placement of facilities, you know, is months, maybe even a year or so. We just don't have that time. And so, you know, conversations that would normally be held over months by necessity, you know, conversations and action are done in days. And as we look to handle all the populations in a safe and responsible and caring manner, we try to do as much as we can to inform people. And some, and I would say the bulk of the time we get it right, we get some things wrong. I mean, in St. Johnsbury, we should have informed the hospital of our transportation plan, which was to move patients in case they got sick in our prison population there, because we moved them from St. Albans. Those are tested positive St. Albans to St. Johnsbury where we had set up a surge site that we should inform the local hospital that we had a transportation plan to move them to UVM and not have them feel that they were going to be overwhelmed with patients. And that wasn't the case. We own that. And we are, we are, you know, we're not perfect in how we're moving forward. But with that said, the reason I've launched into this and, and sort of off topic, because I'm so darn proud of Vermonters. I mean, we opened surge sites at Patrick Jim at the Champlain Valley Fairground at a hockey rink in Rutland, a surge mental health facility in Essex and possibly in Springfield, a special population facility, like I said, in South Burlington and others around the state. And Vermonters have rallied to their fellow Vermonters. And that's, that is something that is amazing to see. Now, I have been disappointed in a couple of comments that I've seen in, in newspapers in particular, and some of the things that have come back to me, like we should put up fences around these temporary sites that we're putting people into you know, an isolation and recovery facility, or they should wear special uniforms or something like that. We're not doing that. You know, we have a history in this world about doing things like that. We're not going to do that. We will be as safe and as responsible as possible. We will provide PPE for those people who are caring for these people. We will make sure that we will test where we can along the way as well. But we are not going to put a scarlet letter on people who unfortunately could be any of us sitting here, you know, broadcasting here. It could be any of us. So we're not going to do that. But that very, very small minority, I don't want to cast because the vast and cast, you know, aspersions over the vast majority of Vermonters who have been compassionate. And, you know, some of the things that we have done, we met with local officials in St. John's very last night. We met with people in Plainfield. They have done a pretty good job. In terms of state facilities today, we are finishing up testing the entire vets home. I want you just to be aware of that. We have, there was a March 15 case of a staff person who tested positive for COVID-19. That case was that person isolated for 14 days, had two negative nasal swabs after that fact. And we had no patients or no other staff test positive. But out of an abundance of care, I ordered that the veterans home be tested over the weekend. And we're in the process of testing 122 veterans there and 200 staff. That should be done today. I'm just trying to think if there's anything else that I may want to talk about. We have expanded our testing. This is something that we did last week, last Friday. We said that we have brought in our approach to testing. We'll do universal testing for nursing homes, corrections, those homes that house disabled or people with disabilities, residential treatment facilities, assisted living facilities, state psychiatric care facilities when we've detected a case or cases in those facilities. The other thing we've done is to bring you up to speed on some of the things we've done just recently. And I want you to be aware of it is that if you're transferring from a hospital to a nursing home, for example, or to a long-term care facility, you'll be required to test. And as you enter that long-term care facility, our guidance is you've got to be quarantined for 14 days into this. We think, and as we go back, the areas where we had issues within long-term care facilities were from transfers that were either coming in or going out of the facility. We've finished testing at what is called Decker Cows. That's in downtown Burlington, fairly large senior living facility. It's not a long-term care. It's not a care facility. It's a senior living facility. And the reason why we're testing there is because there had been two recent deaths. And we have just discovered through testing that none of those deaths were COVID-19 related. But we did have a person self-report that they had COVID-19 within that facility. We have tested 139 people in that facility. And I think I should have the results today on what is going on. So I'm trying to get you up to speed as much as possible. And that's where we are. Thank you. Thanks for bringing up the prison issue and also Plainfield. And before we move into questions, I just wanted to thank Candace Morgan for the work that she did on Plainfield and bringing some of the local senators and reps together on that. That was extremely helpful. And I'm hoping that the same thing is happening with St. Johnsbury so that those folks are reassured. We, Madam Chair, we had corrections met with the select board last night. And it was a very good meeting. That's very helpful. Senator Cummings is here. And I think she and I agree that the work that was done with Plainfield smoothed the waters quite a bit. Right. And by the way, Senator Candace runs the agency just so you know. I got that impression. I don't know. I don't know. She's a good right-hand person. I know that. The very good right-hand person. So I know a lot of questions. You've covered some of the issues, I think, that people are interested in. I would have questions. I have a lot of questions. And I think that as we go forward on some of the fiscal issues, we'll be diving into that in our committee. So I will hold off on some of those questions for now. But just knowing that the Health Care Committee in the House does not, Bill, and correct me if I'm wrong, you don't have oversight over the Department of Health. That is not in your jurisdiction, yes or no? You're muted. That is correct. We have a bit of a permeable boundary between our Health Care Committee and the Human Services Committee in the House, and they primarily have public health jurisdiction in their committee, although we sometimes are involved. But having said that, the protocols that we're asking to have put in place for all of our health care workers and people who work within the health care environment, if they're environmental services workers or whatever, those protocols I think are important to all of us. Absolutely. I guess one of the questions that I would ask, because we've heard so much about it, is what protocols, common protocols, are we going to be seeing distributed out to places like grocery stores, places like res care facilities, and are those protocols, A, have they been developed? I know we can find them sometimes on a website, but the frustrating part is having done all the work and knowing everything that has to happen and all the good things Department of Health is doing, and how that gets conveyed out into the community. Just maybe you could help us with that. That's a very good question, because writing protocols and just putting them up on a website isn't the complete answer. Through Dale, through DMH, through the Department of Health, we've been holding regular meetings with stakeholders on protocols when they're developed and when they're put out. Not only that, we've also developed rapid response teams to go out and check, especially in our long-term care facilities, go out and check and make sure, A, they have the PPE that they need, and B, that they're adhering to the various standards that they need to do in terms of protecting their clients from COVID-19. We continue to do that. We've been doing outreach. We did that over a weekend. We went out to 39 long-term care facilities, plus those are nursing homes, plus others as well. I don't have the complete number in my head in terms of what they did, but we will continue to do that. The commissioners from Monica Hutt to Mark Levine, usually in conjunction with Mark Levine at Health, have been reaching out to the various constituencies that include Sarah Squirrel as well as the commissioner of the Department of Mental Health. The other thing that we've done is make sure that we stay in communication with hospital CEOs out there and have had regular conversations with them on what we're seeing and what we're doing and what they're doing and having what they need, mostly money from the federal government, by the way. We are in constant communications with those various entities. For example, when I put the visitation policy into place because that came out of the secretary's office for hospital visitations, I was in close contact with the hospital association to make sure that they understood where I was coming from and some of the things that we did. One of the, somebody asked me this the other day, they said, what was the hardest decision you had to make here? There's a lot of decisions that you have to make, but one of the hardest decisions I think I made was closing access to nursing homes. That affects people in an awful way because you can't see your relative. You can't visit your relative in these times. That was a pretty difficult discussion and decision at the same time when we had to do that, but it was the right thing to do. We had to make sure that we stopped the spread going into those long-term care facilities because we knew that older people, my age group, by the way, is the vulnerable population. I never thought I had to say that. I used to be the youngest person in the room, now I'm the oldest person in the room, but I, and Dick McCormick, he and I used to have dark hair, but the, wait, wait, you're only as old as you think you are until you're in a pandemic and then your age gets. Yeah, I've aged about eight years here in the last six weeks, but these decisions we tried to convey, we try to have meetings, we have constantly upgraded and communicated with PPE in particular, making sure that everybody is fully stocked. And by the way, our PPE in this day, we're in pretty good shape, as well as our testing, by the way. We, I got to tell you, through ingenuity, through luck, through hard work, through monitors being strategically placed throughout the country, we've been able to turn a fairly limited testing protocol into a very robust testing call. Now, do we have unlimited testing? No, but we have really good and robust. That's why we opened it up to nursing homes and corrections and, and residential treatment and all those others that we opened it up if we found a case. So Secretary Smith, I don't, I want to make sure that we have some time for others to ask questions. I have a bundle of questions. I'm holding on to them. I'm going to turn, I've got a list of people and I'll let you know who they are, who have indicated they'd like to ask a question. And this is after Representative Lippert. But I have Brian Smith, Mary Cordis, Lucy Rogers, and Senator Ann Cummings, Ann Cummings. So I've got that list. And if I'm hoping that these will be very clear, concise questions so that we can get the answers similarly. Yeah, I'm hoping that, I'm hoping that the answers will be the same way. Representative Lippert. Let me very quickly acknowledge the extraordinary work that the agency is doing that the Department of Mental Health, we've worked very closely with Commissioner Squirrel and Diva and Commissioner Gustafson and his staff. They've been very responsive. I should, I will acknowledge I was, I've been communicating with Commissioner Gustafson about extending the open enrollment period off. We've been doing that offline over the past week. And just this morning he indicated that they're very close to making that formal announcement, which you alluded to as well. I guess I said I wouldn't announce until he had told me, but I think we're saying it. I also want to acknowledge the very, very important role that DFR has been playing, that the Department of Financial Regulation in issuing bulletins has been absolutely critical. And I understand they have several more bulletins that are in the works about insurance. And that part is, has been very, very important as well as the Department of Department of Health. I think I'd just like to, maybe one question I have, and it has to do with finances. I was on a call yesterday with, I was invited to join the call for the legislators with the Counseling Service of Aston County, one of the DAs. And they indicated, as I've heard from numbers of other settings where they're having to frankly offer and wanting to offer additional compensation to workers, particularly in residential settings, where it's critical to keep the group homes and residential settings whole, to keep this, keep them fully staffed and the sum of the conflict, both by fact of the difficult work, and then the conflict that has risen through the federal unemployment insurance, which is undermining in some ways, or pushing us to frankly compensate workers at a higher level. And what they described as appreciation pay, a bump, so in some cases $2 an hour, et cetera. I want to, I want to ask and know if that type of action on the behalf of whether it's a DA or whether it's another setting is going to be reflected in keeping them financially whole. Before you ask that question, I will say that the Senate Health and Welfare Committee has spent an extensive amount of time on this issue and just in trying to understand who it affects and who would want to quit work and go to UI. So there are a number of folks in Dale and other areas. So this is a critical issue. So Secretary Smith. Yeah, let me answer that question. And it's a very good question and one we're on top of. Like I said, we've looked at this in two phases, phase one, you know, all the prospective case rate, the implementation of the emergency case rate and getting money to them in most expedited manner that they can, including the emergency, the electronic medical records. But phase two, which we're working on right now is, and I would think that we would have something fairly soon, real soon, by the way, that addresses the issue that you have talked about. The staffing issue at the DAs is exasperated by just about what you just said, the federal government UI sort of situation, but it's also in the early stages by fear. I mean, people didn't want to show up and fearful about what is going on. There was a lot of, you know, a lot of things going on in the early stages of this virus. We aren't over this. I don't want to say that, but there were a lot of things happening there. We're trying to get some relief out to them. I think I'll have more details by the end of the week. Good. Thank you. I think I'll hold my questions. Again, I have my, but there's many of our committee members who would like to chime in. I'll leave it to you to call on people. I've got a list. I've added, after Cummings, I've added Durfee and Page. So I've got you folks. So, Senator Lyons, Representative Lippert asked my question. Okay. So you can take me off for now. All right. We'll take you off for now. And Senator Cummings, thank you very much for your help with Plainfield as well and getting legislators together. We really appreciate that. Brian Smith, you have a question. Where's Whistler? You're muted. There we go. Thank you. Thank you very much, Secretary Smith, for having this meeting today. I've had a number of calls from people in the area, wondering, you know, the whole big model right now is stay safe and stay home. But you moved over 20, I don't know how many prisoners you moved into the Northeast Kingdom that are infected with coronavirus. And Orleans, Essex and Caledonia counties are very, very light with infections as compared to some of the other areas in the state. Why would you do that? Well, why would the state do that, I can say? Well, we had surge capacity in that facility, and that's one of the reasons we had capacity in that facility, and we separated out the infected into a facility where we had capacity. I think it was the last part of March, we informed both the town and the appropriate legislative committees that we were going to be using that facility as surge capacity. But you could also ask the same question. Every town could ask that same question. I mean, the people of Essex could say, why did you put a surge facility in Essex? Actually, two in Essex. The people of South Burlington could ask that same question. Why did you put an isolation center in our facility? The people in Rutland could say the same thing. Guys, we're all together. And the fact is, just let me finish, Brian. The fact is that if you don't think, you could make the same argument about people coming out of a healthcare facility, for example, in terms of what's going on. Now, we have moved people from St. Albans where we didn't have capacity to a facility in St. Johnsbury where we did have capacity. And we have put in extraordinary precautions in that facility to make sure including, and I think the town would agree with us on this, including decontamination of people entering and exiting that facility. The PPE is there. Would I rather not done that? Yeah, but it had capacity and we had to do what we had to. Where they were, there wasn't the capacity to handle what was going on with them. No, we had to isolate them from the people that were negative and that's what we did. And so we have four negative pressure rooms in St. Albans. We exceeded the capacity of those negative pressure rooms right there. It's surge capacity. That's what we're talking about in all these facilities. If we exceed the capacity within a certain facility, we can move them. That's what surge is all about and that's what we did in this case. Now, did we expect 28 people to be moved all at once? No, we didn't, frankly, but we had the facility ready for it in case they did and that's what we did. They are completely quarantined? Yeah. Prisoners aren't going to get out, I hope. They're not having family members coming to visit them or anything? No, we had stopped visitation long ago with correctional facilities. Matter of fact, we had gone to video visitation long ago. It was way into March that we had stopped that because we didn't want this to become a facility become infected. Unfortunately, St. Albans did and that's unfortunate. All right. Thank you very much. Thank you. Thank you. Good questions. Representative Cordes. Thank you and thank you, Secretary. I agree with you. I'm very proud of the work that the state has done that Vermonters have done. I see it both as a legislator and as a nurse working at UVM Medical Center and I'm so grateful to all who are pitching in, including my own union, the union representing state employees and frontline retail workers. It's someone who's worked extensively in disaster relief. This is what needs to happen and I'm grateful for it. I have some questions that I will touch on very briefly and then if I may, I will send as an email because it goes into more detail and I don't want to take up more time right now. My suggestion is if you have those questions and if the secretary has time to respond by email, which, you know, perhaps it would be his right hand person, that we would get that sent out to both committees. You could send it to Nellie and the response at least to Nellie and Julie or Demis, probably Demis and Julie and Nellie. Yes and can I be helpful. Go ahead. Can I just touch on the issues and then send the email? That'd be terrific. Thank you. The first issue is around EMS providers who are having issues with not having N95 testing, fit testing capacity. They are spending money that they're not getting reimbursed for yet and I recognize things are moving quickly. So as I say this and share this information from my constituents, I realize that things may have changed. Decontaminating ambulances, federal money, is that going to be coming to frontline EMS workers? And the last comment is that from this local EMS service, the only support that they've gotten is 20 expired N95 masks, old Ebola suits from the last crisis and 10 face shields. So I will send an email about, in more detail, about the EMS issues and especially since it's a little ironic that the H742 was the vehicle we used to do all this amazing COVID work, but the underlying bill was about making sure that existing funds from fire safety assessments get to frontline local volunteer EMS folks immediately. And I love an update on and I've been asking but haven't gotten answers yet on when that money is going to get to them. The last question is about migrant workers and I realize I'm crossing committee boundaries. So I'll just put it out there and put the rest in my email. There's housing, healthcare. These workers provide us with the dairy that we all love in Vermont and other products. So I'm going to jump in here, Mari. Let me jump in. Go ahead, Bill. Say that Senator Lyons and I are in conversation about scheduling testimony about dairy workers and health access to healthcare. So it's already on our agenda looking ahead. Thank you so much. Thank you, Secretary and your right-hand person, Candice. Thank you so much. Hey, you know, let me talk about PPE for a minute. We have developed through a lot of sources a fairly good supply of PPE and there is a process of requesting PPE for EMS and others that are out there. I would urge them to contact the State EOC to get their PPE if they feel that there's insufficient PPE because we have enough to distribute out there. I'm going to be talking to the hospitals tomorrow because I've heard some issues with frontline hospital workers saying they're not getting the PPE that they need. We've got PPE and if that isn't the case, then I need to talk to the hospital CEOs, which I'll do tomorrow, to say where at your facility is there not getting the PPE that you need because we've got it. You've got it at the hospital level. Why do the frontline, if there are people out there that don't feel that they're getting it, either they haven't been informed of the right PPE they should be getting or number two, they're not getting in for a specific reason. We need to communicate that out there in terms of what is going on and how it's going on. I want to say we have PPE and we're monitoring burn rates, we're monitoring everything. We're in pretty good shape as a state with PPE as I mentioned as well as testing as a state. Secretary Smith, thank you. I think that is one of my overarching questions. I'm not going to ask it right now, but it was the reason that we invited you in to talk about the implementation of H742 and that is the overarching concern, the more of a question about communications and how that information gets out to boots on the ground. I think this is very helpful, but it's important. I know in the Senate, the Senate GovOps is working on funding for our EMS folks. We also in our committee have passed out an EMS bill as well. Someday they'll be over to you folks. Can I jump in and say yesterday I spoke in response to questions around ambulance reimbursement. I spoke with DFR. They are issuing a bulletin. They have already been enforcing this. I'm not sure where the miscommunication happened somewhere between constituents in the Senate, but DFR is going to be issuing a bulletin that they already had in draft form so that the ambulance associations will be getting direct reimbursement as is required by Vermont statute. That has been resolved. Thanks, Bill. I do want to give kudos to DFR. You are absolutely right. I'll extend my time, Madam Chair, because I'm kind of hogging it here for everybody. They have done an amazing job. Not only have they done an amazing job in what you're talking about with directives. They've done an amazing job with modeling. That is extremely important as we were talking about surge and getting ready for surge, the modeling that they have done. As the modeling has shown, we're doing pretty good in comparison to the earlier models, which scared the living heck out of me as we entered this thing. The actual sort of predictive modeling is something that's essential for us as we move forward. Thank you for that. The modeling has been great. Representative Rogers, you're up next. And I do have Representative China, you are on the list. Thank you, Secretary Smith. And thank you so much for spending your time this morning with us. I have a quick series of questions relating to the cash flow assistance for Medicaid enrolled providers. I think what I heard you say before was that you've had 35 providers submit applications and have already distributed $825,000. I'm curious if you could give me a sense of what is this the type of situation where any applicant that qualifies will be receiving money? Is there a high amount of competition amongst the applicants? Out of those 35 applicants you've had so far, has it been a high percentage that's been accepted? Yeah, let me just get the numbers. 13 provider organizations that have applied and been awarded, another 35 are waiting and submitted applications. So we've already sent out about $829,000, I think is the closest figure. It's about $829,000, if I remember. We aren't giving it to everybody and in the amounts that they've asked for. We have a sort of process that we've gone through in terms of what money that they have available, what money they may be getting in Medicaid reimbursement. There's a whole formula that we've been using in these times. So will everybody get everything that they asked for? The answer is no. Will they get some? I don't know if we've rejected any. We may in the future, but I don't know if we've rejected any yet. Okay, that's helpful. And then is there a cap on the amount of money that's available in this fund or is it kind of on a rolling basis, depending on that application? It's sort of on a rolling basis right now. I mean, we're not unlimited, but at the same time, we're hoping to recoup some of this money through future Medicaid payments that once stability gets back in the system, recoup it in future Medicaid payments, as well with the hospitals as well. If they get payments from the federal government or through future Medicaid payments, some of that money, I won't tell you that it's not at risk. It's at risk, but some of that money hopefully will get paid back. And this, I'm sorry, I didn't mean to interrupt you. Go ahead. I'll ask just a couple more questions. Go ahead. Is there a kind of normal amount of wait time applicant should expect between submitting their application and either receiving money or being notified of the decision? Representative Rogers, I don't have a specific time here. We've been trying to turn these around as quick as possible. With 13 already paid, it sounds like that's been the case. Yeah, it's been real fast. So it does have to go through a process. And I still want to make sure that it does go through a process. But the turnaround time has been real quick. Great. And then my last question is just to clarify, it's my impression, but just to clarify that the intention is that this money would be available for independent practices as well as FQED. Yes. Yes. It's a wide variety of providers that we would put this on. And is there a priority ranking based on type of provider or not so much? Not right now. It would be on the need that's out there in the community. Thank you so much. These are all prospective payments. There are payments that we hope that when stability comes back in, maybe we can recoup some of this money. But I'm not going to sit here and say we'll get all of it back. Got it. Okay. So Representative Durfee, you're up next. Representative Sheena, I think, has been waiting. I've got him on the list. He's after Representative Page. Thank you. And thank you, Secretary Smith. Just a couple things. We had a conversation with Tom Dee and the folks at the hospital down here in Bennington last week, and there was some conversation about PPE. It followed an article that ran in the local paper that morning or the previous day asking community members to supply to help contribute masks and skull caps, possibly gloves too. So I might just want to clarify with him what the status of their need is. I will because we can turn around PPE very shortly on deliveries. So I will clarify on that. Okay. Good. Thank you. Quick question. How long do you think the open enrollment period will be extended? I don't have an answer for you right now. Go ahead, Bill. May 15th. May 15th. There you go. That's tentative, not final, but that's what essentially we've opened it up. I'm going to talk about it. I approved opening it up. The Secretary asked you. It's okay. Yeah, I approved opening it up. I didn't approve what the date is. So we'll make it the 15th of next month. So there you go. That works for me. And then Secretary Smith, you mentioned transfers in and out of the long-term care facilities as being potentially the source of problems that we've had. Could you just elaborate on that a little bit more? Not really. I'm just sort of speculating at this point. That's why we've put in place these extra sort of guidelines that we're talking about long-term care facilities. A, if you're transferring into a long-term care facility, you have to be tested before. Now, you've got to understand the limitations of tests. You can test one day and be negative and test the next day and be positive. So we've got to understand that, but also putting the quarantine aspect of it into place as well. So those are the two things that we're doing in order to make absolutely sure that we're not spreading it from one facility into another. Thank you. All right. Very good. Representative Page and then Representative China, you're next. Thank you, Mr. Secretary. I was glad that you mentioned some work that you're doing at the Bennington Soldiers' Home based on what's going on in just south of us in Massachusetts and Holyoke area. A couple of questions. The Newport Prison, if prisoners test positive there, will they also be moved to St. Johnsbury or is there an area there at Newport in which you can isolate them? And then finally, it seems in the past, you know, states have looked to the feds for assistance in various crisis and they've led the way. The feds have led the way generally. Now, there seems to be a trend where states tend to lead the way in being proactive. And I'm just curious, are there policies in which we could be proactive in relation to, you know, our hospitals, say, like my own here at Newport or the northeastern regional hospital in St. Johnsbury? And I'll listen for your response, sir. Thank you. Well, you gave me a wide lane there. I'm pretty proud of this state and the governor and all of you of how we've reacted to this crisis. I don't want to claim victory. So don't misunderstand me, but we're in pretty darn good shape compared to a lot of other states that are surrounding us right now, primarily because we acted early and we acted on our own. We expanded testing when the CDC wasn't recommending it. They were recommending only testing for people that were hospitalized. We said no. We said we're going to test for people that had symptoms. And frankly, we came very close to running out of test supplies at one point because we had that policy in place. When we needed more data, we tested more. We didn't stop testing. We tested more when we needed more data to make sure that we were on the right course in moving forward. We went out and got our own supplies. We went out and found test and found testing capability. We ran an airplane from Burlington to Rochester, Minnesota to the Mayo Institute to get our tests on a daily basis. We did a lot by ourselves. And the fact is we've expanded testing to the facilities that I talked about. In terms of Newport, if we strip out of our capacity out of Newport like we did in St. Albans, there's a chance that we would move COVID positive patients if we had the space in St. John's Berry as well. Like I said, if we get a case or cases like we did in St. Albans in a facility, we'll test the whole facility like we did. This is not a small undertaking, by the way, as well as well as the veteran's home. These facilities are good size. We test within 28 to 48 hours. We have a lot of people on the ground that are testing. I'm holding my tongue a little bit on the federal response because we've done a lot by ourselves. You all should be proud of what you've all done here, all pretty much by ourselves as we move forward. We've done by ourselves together. I must say it's really critically important to keep lines of communication open between administration and legislature. That's right. When I met by ourselves, I met all of us. I understand. I completely understand. Representative China, it's your turn. Thanks, Senator. I have three questions I'm going to ask, and then, Secretary, if you need to follow up later with answers, that's fine, but I'll put them out there now. One question has to do—you mentioned the different lanes. I'm even doing your hand motions, the different lanes. One of them was the designated agencies and specialized service agencies. In the last few years, the state has stepped up and tried to improve funding for designated agencies for the hard work we asked them to do, but we didn't do the same for the specialized service agencies. What we're hearing, I'm hearing from constituents and colleagues that they're having an even harder time keeping staff and recruiting staff now that there's more hazardous working conditions. One question would be, what can we do to improve funding for those agencies so that they not only can pay workers what they deserve equal to the designated agencies in the state, but also what kind of hazard pay or hazard benefits could they get? The second question has to do with how we're helping homeless people during the crisis. I know that in Burlington, there's a camp that's being used for people, and then also the hotel that you mentioned for COVID positive people who are experiencing homelessness, but my concern is what are we going to do when the pandemic subsides about the people who are being housed in these temporary facilities, and this ties into the specialized service agency issue of what might we do after so that we can end homelessness now that so many people are engaged in services to be safe during the crisis. The last question has to do with what's next. I'm also grateful for all the hard work that the state agencies have done to prepare for a surge, and it does seem like we're well positioned for a surge, but if we can prevent that surge in order to maintain public health, we're going to need a long-term strategy. And we've been hearing a lot about what's working and not working around the world in terms of following up this phase with contact tracing and more testing and antibody testing, and I've heard you and others speak in press conferences. I'm one of the regular followers of your press conferences. So I've heard some of this before, but I'm wondering if you could speak a little more about what are your thoughts about the long-term plan, like not just the next three months, but like the next 12 to 18 months, in terms of how the state can manage and control the spread of COVID-19. And also, I'm curious if there's any talk about coordinating with surrounding states, like there's a pact of states in the northeast trying to coordinate their efforts about reopening, and that seems like a wise strategy. So I'm just curious about that as well. Thank you. Let me try to answer those one at a time. When I talk DAs, I talk SSAs as well. I mean, we are looking at how we're funding both entities, recognizing that they're both important and they have unique roles that we do have to recognize during this crisis. On homelessness, I gotta tell you, we've spent enormous amounts of time to make sure that people are not going without a home at night. With COVID positive, obviously we have facilities. We talked about the holiday in. For COVID negative, we have the North Letty Beach in terms of what's there. But we also have opened up another hotel in Chittenden County for homeless that are not COVID positive. And our hotel voucher system has been robust, to say the least, as we move forward. As we as we talk about the sort of the next phase in this and the various testing that will be done, we formed a task force in terms of various testing that can be done. And there are various ways to test that are different in terms of looking at the future and those with the antibodies within their system and things like that. I gotta tell you, I've never known how much I use my hands, but the antibodies that are out there, but that's not for right now. But looking at the future in terms of contact tracing, we never gave up on contact tracing. Actually, we bolstered our contact tracing during this crisis because we never gave up on confinement and confining this. Mitigation was all the things that the governor put in place. The shutting down in the school system, the stay home, stay safe, those sort of things are mitigation, but we never gave up on confinement. And you're starting to see that now with sort of our expansion with nursing homes and corrections and designated residential treatment facilities in terms of what's going on. As we get ready to even think about restarting, and I think that's the word that I would use, restarting our economy, it's not going to be flip a switch on as the governor has talked about. It's going to be a turn here as we start doing it. And if we can learn from those other states that are doing it, that's fine. I don't mind. And I'm sure the governor doesn't mind collaborating, but we've been doing a pretty darn good job with what we're doing. And we should continue to do what we think is best for this state and how we can move forward on our restart. But again, as SSAs we're looking out for homeless, we've got to put a program in place, and we started to put the elements of those in place before this hit in terms of a long-term strategy for homelessness. And then third, we've got to move to other strategies. And I'm hoping that there's either a vaccine or a, I'm hoping for a vaccine and a test that will help us in those long-term strategies. Thank you. Right. I guess one of my questions in terms of the second wave and the long-term strategy, I continue to come back to the need for therapeutic treatment or vaccination. We know that the vaccination is probably 12 to 18 months away, regardless of what anyone is saying. We also know that there are some really excellent clinical trials going on, including in this state on some therapies. And I'm hoping that some of those will pan out. But as we look at turning things back on, I would, I guess the question is, will the state to continue to allow those workers who are among the vulnerable population populations, will the state allow for those workers to continue to work remotely until we have some vaccine or some proven therapies? Yeah, I think if they, you know, there's a lot of vulnerable people in that group. I mean, there are people that, for example, that are on cancer drugs that are vulnerable. There are other people, they're going to, they're going to continue to work remotely until we can figure out what is the final, what is the solution here? Because we are going to have a rebound unless we have a vaccine. We're going to have a, we're going to have a rebound at some point in the future, whether it's next flu season or, you know, this acts like a flu is just more contagious and in some regards deadlier. So we're going to have to figure this out as we go forward. Right. Thank you. Thank you for that. That is actually reassuring to a number of people who have contacted me with that question. Very helpful. So any other questions for Secretary Smith? Could I just name a couple of quick things and whether we can respond to that? And then one comment that I want to make sure I share. One is just for the committee and for the secretary to know that we are meeting tomorrow as again as a joint committee with representatives from the Department of Health around racial justice and equity issues and that the collection of race data, which apparently wasn't happening early on really does need to happen and we'll be talking about that in some testimony tomorrow. I'm not sure. And a question that's been raised in our committee a number of times is directives and help for those dealing with remains for folks who have tested positive and how to have workers stay safe as we have the unfortunate circumstance, which we have of people passing on from COVID-19 and how to stay safe throughout the entire process of removal of bodies. And I was I was shared with me. There is a protocol that I think DL has issued, which I have not yet had a chance to share with our full committee or perhaps with both of our committees. But I think there's still some remaining questions there. Again, I don't think we need to address it right now, but I think it is an issue that people are asking about. And I don't think there's particular awareness of. And then the last thing the last thing last point I'd like to make before we finish is to acknowledge the significance of our payment reform efforts and how that has in fact been incredibly positive for sustaining our hospitals as well as our DA's and our folks who are working through payment reform where monies in fact have been able to be put forward on a regular basis rather than on a fee for service, which has just dropped out from underneath us. And I think we need to we need to be unabashed in acknowledging the important impact that many of these payment reform efforts have made during this type of emergency. Yeah, I just, Mr. Chair, I couldn't agree more than what you just said. I mean, the payment reform effort has allowed us the flexibility to do many of the things that we're we're doing right now in terms of the remains there has been guidance that has been put out by the medical examiner's office and we'll share those and we'll see what what what can what we can do better in terms of going on here. Thank you. Thank you. Thank you for that. I want to reinforce what Representative Lippert has said about our payment reform and link that with the ACO and how critically important it is to maintain some cohesion and cohesiveness for that organization going through this emergency. And I encourage all of us on our two committees to be supportive voices for payment reform and for the and for the ACO. I know that is sometimes difficult for some people, but it is it is we are ahead in so many ways of every other state that we need to recognize that and and thank Secretary Smith for your persistence on this and others for for the work that they're doing. So I think unless there are other questions or comments that we could all make comments all day we're not going to allow that but if there are other questions. This has been great. Great. Thank you Secretary Smith and thank you for all the work that you are doing. It is very much appreciated and I'm seeing the person on your left. We appreciate the work that your office is doing very much. So thank you very much. I appreciate all of what you're doing as well. Good. We'll get the other people up. Okay. Thank you. All right committees I think that is it for the day. I know that a couple of the senators had to leave for another meeting. We will be meeting again tomorrow. Tomorrow at 10 30. And again I want to say Senator Lyons I think our work to do this jointly has proven to be very valuable and efficient and effective. So I'm glad we've put the energy into doing that and thank you to all the committee members who participated in a way that allows everyone to have a chance to participate because doing these doing joint committee meetings between the house and senate is often a work in progress and I think we've been successful today. So thank you very much so and we'll be doing our agenda planning tomorrow for next week. So as will we get good. All right. See you all tomorrow.