 recorded and so I want to welcome everybody to the Thursday morning House Appropriations Committee meeting. This morning we're going to start with House Bill 611. We have a few members that are leaving to go to another Zoom meeting and so what I would like to do with 611 is to have Jen from Legislative Council to walk through a proposed amendment from a group that has been working on Section 5 and 6. The sections that were the reason why the bill has come to House Appropriations. So those of you who are leaving we're going to discuss this amendment. If you have questions about the amendment I would get in touch with Jen Carby or Teresa Wood or Diane has been following the amendment and will not take a vote on the amendment. It would be we have to figure out the procedure to see if we're going to take an official vote or if it's or depending on which which path the amendment comes to the floor. Okay so those of you if you're all staying terrific if some of you are bumping off I will see you as soon as you're done with your meeting if you're done before 1030 or we'll check back in at 1 o'clock. Is that good with all of you? Okay welcome Jen thank you for coming and that's through this language that has been worked on that would replace Section 5 and perhaps redo Section 6. Great Jennifer Carby Legislative Council so this amendment to H611 would actually delete sections 4 and 5. 4 was the definition adding a statutory definition of home and community-based services that would go in the chapter where section 5 was going to add a new section so we don't need sections 4 section 4 and we're deleting section 5 and then this would amend section 6 which had been the home and community-based service provider rate study report this would add in an inflation factor component and some other language as well. So the first thing it does in this section is to add in that same definition of home and community-based services that had been going in section 4 and is used elsewhere in the bill so that everyone has a common understanding of what kinds of services and service providers they're supposed to be looking at in doing this report. So that's subsection a subsection b has starts with the same language as in the original bill having the departments of Diva and Dale conduct a rate study of the Medicaid reimbursement rates paid to providers of home and community-based services their adequacy and the methodologies underlying the rates and the department's shall and then I've added in a new first one that reflects I think some of the conversation in this committee so the department's first determine Medicaid reimbursement rates for providers of home and community-based services that are sufficient to recruit and retain individual service providers while creating a fair and equitable balance between cost containment and high quality care. So this borrow some concepts from some of our workforce development language in the healthcare human services context it borrow some language from the nursing home rate setting statute around finding that fair and equitable balance between cost containment and high quality care. So that's the first part of the study that's new and then we go into the rest from the bill as you'd seen it before so establish a predictable schedule for Medicaid rates and rate updates identify ways to align the reimbursement methodologies and rates for home and community-based service providers with those of other payers limit the number of methodological exceptions and communicate the proposed changes to providers prior to implementing any proposed changes. Then we have in this new subsection C that's in bold and highlight and this directs Diva and Dale to develop criteria and a process for calculating an annual inflation factor for potential application to the Medicaid rates for providers of home and community-based services in future fiscal years. In developing the criteria and process the department shall consider inflation factors applicable to payment rates for providers of home and community-based services in other agency of human services programs and may include elements of the inflation factors in and this is the official name of the agency of human services nursing home and long-term care facility rate setting rule. So it's an agency of human services method standards and principles for establishing Medicaid payment rates for long-term care facilities and it has the citation. Then subsection D has the report coming in on April 15th that was the extended date from the amendment that you'd looked at from the individual members of the Human Services Committee. It would be reported to the Human Services Committee and to this committee and to the Senate counterparts and that would be with the results of the rate study conducted pursuant to subsection B of this section and the criteria and process for calculating the inflation factor as set forth in subsection C of the section and then finally I made a change in the effective dates. It was no longer necessary to spell everything out. If we could just scroll down to the next. There we go. Thank you. It was no longer necessary to refer to all the different sections because everything would take effect on passage except for the one piece in section one of the bill relating to the state plan on aging. We could take out all the rest. Thank you, Jen. Teresa, could you scroll back up to the language, please? Could I just make a statement? So if anybody has anyone that wants to get in the meeting, I'm going to send the link because I think it's me. I think everybody should be allowed to come into the meeting. I'm going to send the link. They just need their name showing or I'm not letting them in. So I'm going to send this link out and you can hear it with anybody that's asking, okay? Okay, so we have Candace Elmquist in the waiting room. Do we, Teresa? I've just let her in and I sent her the link intentionally. So anybody, if you have any constituents asking, I'm going to send the link and you should share just that link with them and tell them they must have their name showing before I let them in. That means we have to be paying attention to our emails at the same time. I don't see anybody in mind. All of you may want to look at this. Did I lose my members that are going to the economic development group? Yes, I know the two of them left. Okay, I just had a question, but that's all right. Let's just go back to this. So, Teresa, can you scroll down a little? I want to get to the about the inflator, please. And the intention of those go up. Bill in the background, is everybody else? That's something on in the background. We're hearing the meeting. Oh, okay. Sorry, that's me. Sorry, I'll yourself. Can you just yourself, Mary? There we go. Yeah. Oh, am I not muted with you? That's my Okay, let's go to the page. Am I in the right place? I don't know where. No, no, I want to scroll. I don't know what my up is your down. So I want to go some more to the next page. Okay. Right here. Stop. This is like, please. So for the committee, this is where we were having the discussion this week and last week about the automatic inflator that that would have gone the intention of the committee. We were told that the inflator would be set in place. It would be mandatory. So the language takes out the mandatory piece and puts in for potential application to be considered by future fiscal years. So it is it's simply developing criteria and developing a process for the calculation and and would be brought back to human services. Is appropriations on there? Yes, appropriations gets the report. Okay, and two appropriations. So are there questions on this part of it? This this is the part I believe that that that we have been zeroing in on. I can't see any members for hands. I have hands and I've got to find you. I have and we have action circles. Teresa, I can action circles. Fine. Dave, your hand is looking. Yes. Whenever you're ready. Am I okay? I'm ready. A question says in letters C. Hold on here. I want to help everybody. Okay, there's a b b 1 b 2 b 3 4 5 and then we come to C in bold letters on mine. It it alludes to shall consider inflation factors applicable to payment rates for providers of home and community based services in other AHS programs. Could you could you tell me what you think could someone tell me what their thinking is about that and what what does that mean? Hello, Teresa or Jen could Jen, do you want me to take that or? Yes, please. Okay. So in in looking at this language, represent Yacoboni, we we did not want it to only refer to an institutional regulation. So the the regulation at the bottom of that paragraph is referencing the nursing home regulations and how the inflation factor is calculated there. As as the committee knows, there are other factors that are considered when services are being provided in the home and community that may differ from that being provided in an institutional setting, such as a facility based setting like a nursing home. And so the other home community based services in the agency of human services. Recently, the division of rate setting has been completing rate determination calculations for developmental disability services in the mental health field. And they may have done others those are two that I'm aware of. So we wanted we wanted this process since it is actually more similar to that than it is to the nursing homes to make sure that it included elements of both. If you are you understanding it or did I make it too complicated? No, I have a follow up. I I think I understand me. I just when I read it, I said, Oh, does that mean if other home based programs, which is what it says home if other home and community based services, such as children's integrated services, haven't received an increase in many years? Does that mean these folks would have a hard time getting an increase? Same thing with foster care parents, you know, they they sometimes get an increase they often don't they're providing home and community based services. One could argue that I guess. No, that's not that's not your point. Correct. Correct. No, the point is probably the opposite of that. So that's another you gave another fine example. Recently, rate setting has done a rate audit and methodology for children's integrated services. That's another good example. So what we want them to do is to consider the elements of that rate setting process that they have done in previous work for other home and community based services. It's it's not delaying anybody else's increase because that you know that all comes before you folks. It's just saying in developing the criteria and process, consider inflation, consider the elements that you have used in other home and community based service rate setting procedures. Okay, so so if they haven't given any increases, it doesn't mean they wouldn't necessarily give one here. It's just try to be consistent is what you're saying. That's consistent in the methodology. In the methodology actually gotten an increase. Okay, thank you. And I would just add that I think to the it says consider inflation factors applicable to rates to the extent there is not an inflation factor that's applicable to a rate. There's nothing to consider there. So it's not it's not a useful part of the exercise. So I think in requiring them to affirmatively look at inflation factors that are applicable in developing the criteria and process it it I think sort of by definition excludes those that do not have an inflation factor. Thank you. May I Katie, may I continue with another question? Can I just drop one second, Katie, you're not letting people in, are you? Only if it's people I recognize their name. Can you not do that? Can you let me do that? Because I don't I'm watching people disappear off my screen before I have a chance to listen. I will do that. Thank you. So fun answering that doorbell, Teresa. I know I know it's interesting to open it, but just let me do that. Right, thank you. Dave, we'll go back to you and I have Peter and Diane. Thank you. Let's see. ABB1 says in determining Medicaid reimbursement rates for providers. Wait until we're all there, Dave. The screen, so B1. Okay, we're there. Yep. In determining rates for providers of services that are sufficient to recruit and retain individual service providers while creating a fair and equitable balance between cost containment and high quality care. Did your committee talk about, obviously, it's very important to be able to address recruitment and retention, but many people need training. The system needs quality assurance. There's other needs of the system. There's supplies, etc. So if I'm a let's just stay home health agency, I may have the money to hire you, but I may not have the funds to train you or to equip you certainly in periods of today. Did your community, did your committee talk about, when you think about reimbursement rates, you seem to be not a criticism and just trying to clarify, you seem to be focused almost exclusively on the employees. Did you talk about the other needs that are necessary to address quality? So first off, Representative Yacoboni, our committee has not seen this language yet. We will be reviewing it at 1 30 this afternoon. This is language that Jen put together after listening to the discussion in Appropriations Committee the other day about wanting to see some sort of intent or purpose statement in the in this part of the bill. So as she said, she pulled this language from bits and pieces of a couple of other areas of statute. So I'm not wedded to this particular language, although I would point out to you that I believe that and we can reverse the order of the, you know, of how this is written, but the things like training and retention and supplies, all of those things to me point to high quality care. And those are the last three words of this paragraph. Those are all involved in high quality care from my perspective. That's how I believe that those are included within the context of what you were asking. I appreciate that and that Jen's done a great job based on what she heard. The notion I want to leave with your committee, Representative Wood, is whether the concept, as is in nursing homes, should be applied to home and community based services. And that concept is that providers are obligated to assist the people they serve to quote, attain and maintain and quote the highest level of functioning. That's a different standard than whether you can recruit people and retain them, though that is mightily important. I just I just leave that thought with you. Madam Chair, I'm not trying to complicate this, but I'm just trying to make sure if we're going to have objectives in here, they are the the right one. Thank you. And Representative Yacoboni, if there is language that you want to suggest that your committee consider this morning, that's that's fine, as long as Jen has the opportunity to change it between now and one thirty, which I'm not totally sure of her schedule. Yeah, well, I guess I would suggest to my our Appropriations Committee. I'm not trying to I'm just trying to put the concept in play for the policy committee to consider. And whether you come back with it or not is that your policy jurisdiction is I don't think it's ours. Okay, thank you for your input. Yeah. Thank you, Dave. Peter, I think you have your hand and then Mary. No, Mary with Diane. I am good. Thank you. So I have a question back in C, back in C, so wherever that is B, we need to we need to move down the document, please Teresa. There we go. Thank you. So I want to the second line there, develop criteria and a process for calculating an annual inflation factor for potential application. And there that's the question that I have. Why are we using that instead of and calculate an annual rate increase? What's the difference, please? Are you looking to me? I whomever can answer it. I don't know. I mean, Jen or Teresa, who would ever have that the choice of wording between rate increase and annual inflator? To be honest, I get we didn't really consider that other language that you just mentioned. Representative, we talked about annual inflation factor and annual because we were presuming that the rate study would determine what the rates should be, whether or not we were ever able to get there as a whole nother story, but what the rates should be. And then we're looking at, we thought that an annual increase should be based upon inflation once you determine what the rates should be. That was the thinking behind it. Yeah, I think I would just add that I think an inflation factor creates a rate increase. I mean, that's sort of what it does. But to me, the idea of inflation factor is something where you potentially have a methodology that gets applied. The expectation is that that would be applied on an annual basis rather than a periodic rate increase. Okay. So I'm philosophically opposed to an annual inflation factor. It bypasses the appropriations process and thus abdicates the responsibilities and the authority of legislators to do their job. That's plain and simple. That's the reasoning behind my question here. However, I will probably support this because at least removes the concept of, in fact, we shall apply an annual inflation factor and replaces it with determine what it ought to be and put it in the process. My concern is that on down the road, a future legislator might decide to combine themselves to an annual inflation factor for which I am philosophically opposed. Because of that, I'm going to reserve the right as to how I'll vote on the bill when I get to the floor. Thank you. Thank you, Peter. Diane and Marty and Dave. So I don't know if it's important, but I just thought I would, I would bring it, bring up that in the definition, it was one of the things that I asked to not just delete for, but it was important, or I think it's still important and could change in time. But why you, why you see at the end there the definition to include home health and hospice services, assistive community care services and enhanced residential care services. And you tell us where you are, Diane. Oh, I'm sorry. At the very, very, very beginning of A. One A. Yeah, one A. That you see that last, last line that's highlighted in A. Not section one A. What's that? Just A. Yeah, she's got it right there. Okay. I'm pointing it. Okay. Go ahead. There, there, there will, there could be potentially and probably will be changes in what at the federal level in the waiver 1115 considers as in, in and their definition. And right now, enhanced residential care services, the ERC's are included. And but the assistive community care services are not that's the A. C. C. S. But in it's beginning to look like it has a potential out of Washington that they're going to in the next waiver exclude the the ERC's from, from that waiver. So we would want to make sure that when we were looking at this, that our definition includes not just the 1115 waiver, but these other entities as well. Does that make sense? That's why I want to make sure that that was in there. Right. These are spelled out in there. So the definition means long term services and supports in the choices for care program and specifically include home health and hospice, A. C. C. S. and ERC. Right. Thank you, Diane, for that clarification. I have Marty and I guess my concern is back on Section C again, where we determine the inflation factor. And it it sets up a process for calculating an inflation factor that may be applied. And then it also reports the house appropriations on what that process is. The way I read this, it does not app automatically trigger the application of the factor. And I'd like that clarification. But then it would what would the trigger be a budget request? They come in and say we would like to apply the inflation factor this year. And then that would be part of a budget request. Or is there some other mechanism that that inflation factor could be applied? So as written, the language is just part of a study and a report. So there is nothing in here that actually applies the inflation factor. It was my understanding that the committee was interested in informational information on an inflation factor, but nothing that would actually trigger it. So it would require some sort of legislative action, whether that was in the form of an additional appropriation amount or codifying language similar to what we'd seen in the earlier version of section five that would create it still subject to annual appropriations. It would take some other affirmative action of the legislature before an inflation factor would be applied or some I suppose some other way that the agency chose to use money that had been appropriated to it. But this inflation factor would not absent somebody doing something else, give anybody an actual inflated amount. So you think that would be something that the legislature would do as opposed to within the agency? Do you believe the agency could do it on its own? I suppose it's possible the agency could do it within its available appropriations, but that would potentially suggest they had more funds than they had obligated. Right. It would rec... Sorry. Theresa? The way this was written was to take into consideration the concerns that House appropriations had earlier in the week so that there would not be any automatic inflationary increase. It's only for informational purposes to see what it would be if it could be applied. For instance, it would be left up to the appropriations process to determine whether or not something would be included or not. It would give the basis, however, for calculating what it should be as opposed to, now, you know, we just sort of guess at it periodically. Okay. Thank you. Thank you, Marty. I'm going to go to Mary and then back to Dave and Peter because I'm trying to get people who haven't waited yet. Mary? Thank you. So as I understand it, what has been accomplished here is kind of a broader, more in-depth look at the criteria, a broader, more in-depth look at how we do rate setting and that it is a report back to us on so that we have the information, so the legislature has the information necessary to make appropriate decisions or to weigh everything as opposed to the original language, which said, figure out what a rate will be and apply it in 21. So I think this nicely addresses, this proposed amendment nicely addresses what some of our concerns were about being obligated to make a future appropriation without understanding everything that we needed to understand. It makes sense to me to strike out the existing language, I think in section five, allow the Human Services Committee to consider this amendment. Dave asks some interesting questions about, you know, did it need to be expanded, but that's way beyond our jurisdiction. If we strike the obligatory language in five, Human Services can drop this in as an amendment on the floor. And and I think we've accomplished both of our goals of both committees. Does that make, does that make sense, folks? Do you see where I'm going? Thank you, Mary. I think that's really the simplest approach, knowing that there may be the Committee of Jurisdiction needs to look at this language and there may be additional ask. I think as far as our committee is concerned that, you know, we're looking at the inflator. If we remove section five, it removes the inflator from the language, and then we could take a straw vote once we have the the the finished amendment from the Committee of Jurisdiction, and then it can just get dropped in on the floor. I'm thinking also how it's less the least amount of confusion on the floor, because it's really different working with Zoom. And I think that that does it. What do other members think? But that's a process question. And Dave, you had your hand up, I'm sure not on the process piece, but on another piece. Yes, I did. And this is maybe for for the Policy Committee of Jurisdiction and for Jen's guidance. To me, there is a distinction between a rate increase for providers and an inflation increase for employees. I don't think this language dictates what assuming the process has completed and they come back, whether it's next April or whatever. I don't think and this is a question. The language is attempting to say what should employees who work in these services get for an inflation increase for the next fiscal year. It may be. If it is, I have concerns because as many of you know, if my employees are granted a two or three percent inflation increase, I have increased workers comps related expenses whenever that happens. My share of FICA and FUE state unemployment taxes and social security taxes, I go up and if I don't have a rate increase to accommodate that for some providers, probably all, that can be very challenging. So I guess what I'm trying to invoke here for one of us, better word, is the notion that whether the Committee of Jurisdiction was exclusively thinking about pay for employees because it talks about retention. And I know it's not your language. It's a proposal for you. It talks about employee retention and recruitment, which made me think about this was focused on employee pay. And if it is, I just wanted you to be aware of other associated costs for providers and the possible unanticipated consequences. Thank you. Thank you, Dave. Teresa, I see your virtual hand. Yes. Thank you, Representative Yacoboni. It is not the intent to dictate salaries for employees of home and community based service providers. This the the language says that an inflation factor for potential application to Medicaid rates, so it is still referencing back to the rates as as you were commenting on. It's not it's not intended at all to be to call out any specific component of the cost for providers. So it is not a employee salary bill at all. Thank you. Thank you, Teresa. So now I would like to go back to the process with the committee. And there was a proposal put on the table by Mary to to strike the sections that has the that refers to the inflator in the committee to take action on a bill. The the amendment would go back to the Human Services Committee where it may it may be voted on as is or there may be some additional changes to the amendment. And then that way I see it as a cleanest path forward. And then our committee can take a straw vote on us on on the amendment when when we see it in its final form. Do any other committee members have any thoughts on that process? And I would ask Jen, Jen, would you tell me if if we would need to strike just five or should we strike five and six? It appears just five in this version. So so you've I've actually in this one I've struck four and five and amended six and eight. No, I just meant as the bill is now if our committee is considering striking the inflation, is it four and five that we would strike or just five? Yeah, four and five is better. Four is the definition that goes with five. Okay, thank you. So it's not the end of the world if, you know, if four happened without but thank you. I just wanted to say I think the process, the procedure as you and Mary outlined makes up a lot of the sense, clean, straightforward and if everyone's liking gets the job done. Thank you. I caught the end. You were some funky was happening with your connections. Okay, I support what you outlined and Mary outlined. Yes. Thank you. Thank you. Any other hands, Teresa? Teresa Wood. No, you okay. Hi, Mary. Yeah, thank you. Peter, you had expressed a concerned about about this as written in terms of obligating us to a rate increase. Well, I absolutely understand this does not obligate us. My concern is that it starts us down a path towards it. And there's no guarantee that that path will continue, but there's no guarantee that it won't continue. If we strike four and five as is being discussed right now, I'm fine with that. And then and then the the Human Services Committee can work on a an amendment to the bill that reflects what they would then like to do. You know, I yeah, we need to help folks that are in this situation absolutely concur. I just go back to my my concept. It's the responsibility of the legislators, the legislators to to take in information to ask questions, understand what the problems are, and then to work to address those problems and not put it on some automatic pilot. That's that's my concern. I do understand this is not automatic pilot at this point in time. OK, thank you, Mary. Did you have a follow up, Mary, Peter? We only have two members that are not at the table. And so I think we can move forward. I think we have the information we need at hand. We don't need to understand the final amendment because as soon as that comes in, we'll take our position on the straw vote. If there's no other opposition or any additional information that is needed, a proposal was put on the table by Mary and and made a affirm that Peter, you just talked to it that we would move forward with the bill by striking sections four and five. Is that is the committee ready to take a vote on that and we'll leave the vote open until the other two members can join us. OK, so if so, Diane, would you like to entertain a motion? May I just clarify, Katie? Yes, Dave, are you asking us to vote on the bill now? Yes, I'm asking us to vote on the bill striking section four and five if that is what the motion is. That's what the discussion would be. And then it would take a straw vote on the amendment. They're coming back. Actually, we're voting on an amendment first and then we could vote on a bill. Well, we're voting we're voting on the strike all. So we're voting on 6 11 as as how it arrived in our committee actions four and five. May I just briefly then before so we're voting we're about to vote on whether to delete the original five and six, correct? No, I'm sorry, four and five. Yeah, if I can just quickly explain why I'll be voting the way I am. As policy, as you know, legislators receive an automatic pay increase whenever the collective bargaining unit gives state employees an increase that to me is a modified automatic inflator. The in the transportation bill town highway funding has an automatic inflator. Nursing homes have an automatic rate increase. Yet on the community side of the ledger, we choose not to treat similarly employed people the same way. So for those reasons, I'll be voting no on the formal deletion of four and five. Thank you. Thank you, Dave. Mary, don't your hand was off. OK. Diane, would you prefer the motion came from someone else or are you? Well, let me just see if I've got this right and maybe Jen or Theresa could just cue into Theresa because all right, so it would be a motion and I can do it or somebody else can to move favorably H 6 11 and act relating to the older Vermonters Act as amended by the Committee on Human Services and further amended by House Appropriations Committee. I don't think so. Further amendment is the removal of section over and that's not an amendment. We're just striking sections. But that's an amendment. That's an amendment. We have to strike those sections first. I think you just can ask a question. Yes, Theresa. Yes. I understood what you were saying, Kitty, was that you were voting on H 6 11 as it came to your committee. Yes. Yes. OK, so that's not the motion that Diane just made. So you have too many amendments in there because we're not too many amendments. Yeah. Forget forget forget the strike all amendment that you got from us previously. You're just voting on the first bill that you received H 6 11. OK, I believe first we would have to vote on striking sections. And then we will on as presented and then further amended by House appropriations. Right. So somebody needs to make a motion to strike. Sections for four and five. And so move. So move. You have a motion on the floor to strike sections four and five in House Bill 6 11. Is there a second? I'll second the second. OK, is there any discussion? We're not voting on the bill at this time at this time. We're voting to strike sections four and five in H 6 11 in the entirety. If there's no further discussion or questions or comments. So this is a roll call to strike sections four and five out of H 6 11. 6 11. Representative Conquest representative Fagan. Yes. Representative Feltas. Yes. Yes. Representative Helm. Yes. Representative Cooper. Yes. Representative Jessup. Yes. Representative Lanford. Yes. Representative Myers. Representative Townsend. Yes. Representative Yacoboni. No. Representative Toll. Yes. All right. Leave it open or we're going to leave that open for the other two members. And and next the direction will take and I'd entertain a motion to to to vote favorably on H 6 11 as amended by the representative would at all at all and and further else appropriated is it's not a committee bill. Right. Theresa it's not that you're not you're not voting on that amendment. Not yet. Not yet. We're voting no we're voting on the bill before us which is from you and the bill be amended by striking all. So we are voting on the bill. And so you don't so you don't have that at the moment you just voted to strike sections four and five. Now you need to vote on whether to support the bill or whether to as so amended the bill should pass or whatever the motion is for that. That's the action that you have later you may take a straw poll on whether you would support. Yeah. No we wait till this afternoon. Wait wait wait I'm not talking about the second bill. I am talking about 6 11 the one we have in our possession is an amended by representative would at all. It says. Yes but you don't but that's not the bill that you have in your committee. You have H 6 11 as passed by House Human Services and your committee. Right. So this copy that I have in front of me is an old copy. No the copy that you have in front of you is what is what House Human Services that doesn't have possession of the bill would like to do. Right. But but we're going to redo that this afternoon. I'm going to redo it right. It's not should we should we wait to vote on that this afternoon that are full. Yeah I need to get clarification. You probably you probably do want to wait to see if House Human Services actually supports the language. Right revised language that you all looked at this morning. They haven't seen it yet. Well it it it doesn't whatever that revised language is will be an up or down straw vote by our committee. Our committee's on four and five at this time. But I think all you have done so far is strike out sections four and five. You haven't actually done a vote on whether to send the bill to the floor without and that's what I want to do now. I'm not talking about the amendment that they're going to be taking up this afternoon. I'm talking about the bill that was sent to us which amends age 6 11. The bill humans the human services amendment to the introduced bill not the wood amendment. They the human services I don't the one before me that is dated May 20th. No that's the wrong one. Right. That's my problem. OK. I'm working off a May 20th bill. OK. So you need an older one. You need a March 13th bill. Is that what it is. OK. And that is a human services bill. Yes. Yes. OK. That's that's my issue. OK. So let me put this one aside. This and so the one that was away I'm confused. The one that was sent out to us on March 13 is a human services bill and not this. OK. Got it. So I would support I would ask for to pass to vote favorably for age 6 11 as passed by human services and further amended by house appropriations. So moved. Is there a second. Thank you. So the motion has been made by Representative Fagan and seconded by Representative Townsend Are there any further comments or questions. OK. Go ahead Diane. I was just going to that's representative Fagan seconded by Representative Townsend move favorably age 11 and that relating to an older Vermonters Act as passed by the Committee on Human Services not amended. Correct. Right. Just passed. Yeah. Yeah. And further amended by house appropriates. Right. And further amended by. Yeah. And then I put parentheses section four and five removed. And I write so human services did amend the bill as it was introduced. So it's not this they didn't pass out of human services as introduced. They amended it. This. So the further amendment from this committee language is right. But it was amended by. OK. Human services as a committee. Just want to get the word right. I've got to jump in here and I just so online house human services committed the bill to house appropriations. So there is no amendment from them is the way it's written online. And if that is incorrect then they need to fix that. So it's it's just age 6 11 no human services. OK. That's it. So OK. So move favorably age 6 11 an act relating to the older Vermonters Act as amended by house appropriation. No appropriations. Yes. But I meant to write no further. OK. Thank you. No further. So it's just an act. I just want to make sure I get this right. All right. Move favorably age 6 11 an act relating to the older Vermonters Act as amended by house appropriations committed. And I do have a question before I vote on this. I am looking at right now and I've been working off a May 20th draft. What is what differences would I see on this May 20th and I would have seen on the bill that passes out of human services. I'm voting on the bill that's not before me. And you want me to do that or you want to do that. Why don't you go for it. I'll pull up the I think I even have a markup document. There's not much. It's it's because of COVID we we had more aggressive due dates for some of the reports and some of the actions in there. And so we moved those out further. So we changed dates due dates like for the the age well plan is now a year further out. And the rate setting was January 15th. We moved that to April 15th for them to submit a report back to the legislature. And then I don't have it right in front of me. I'll make a video and then we added then we added language that says the system should be designed to address the needs and concerns of older Vermonters and their families during normal times and in the event of a public health crisis, natural disaster or other widespread emergency situation in this state. So oddly enough our original bill didn't have any language about emergencies in it. So that changes. Those will all be in your amendment then they were all be in the amendment that you take a straw vote on later today because they're no longer reflected if they're in the one in front of us to the date changes, the April 15th date. All of that will be in your amendment now. Yes. That clarifies that. I do have a markup version or pretty close to complete markup version if that would be helpful for you to see the differences. Otherwise committee I followed it with Teresa do any committee members want to see if you've been working off the the the May 20th, which is not what we're voting on it's the date changes that Teresa went over moving to the April date and the COVID related information will be at their amendment. We're going back to the original. We set to vote on this. I it does any if you have any confusion put up a blue hand and let's solve any confusion. I'm seeing no blue hand. So the clerk shall call the roll. Thank you madam chair. Representative Conquest. Representative Fagan. Yes. Representative Feltas. No. Representative Helm. Bob you are muted. And oh no. Representative Hooper. Yes. Representative Jessup. Yes. Representative Lanford. Yes. Representative Myers. Representative Townsend. Yes. Representative Yacoboni. Yes. Representative toll. Yes. Seven to two and we leave it. We're going to leave it open place for this afternoon. Thank you. Thank you. Thank you Jen. Teresa thank you for coming in Nolan you're behind there somewhere. Thank you. Can I ask up a detailed question that at the risk of confusing you but in the amendment striking sections four and five do you want me to also make the conforming sections to the effective dates or just leave it as four and five knowing it's a little bit messy but expecting the human services amendment or the wood amendment. I think that we should absolutely make the effective dates reflect our our decision. OK. So so make it work even though it's only going to last for potentially only last for a few minutes. Yeah that's that's my preference but OK great. Yes please do that. Thank you. Thank you Jen. We're going to move Teresa did you have something. We're going it's 10 o'clock we have about a half an hour. I'd like to move to letter that we