 And we're now live streaming on YouTube. So this is the official start of our meeting. This is the continuation of the appropriations committee morning meeting. And we're continuing now with the schedule at 11.30 for the disabilities aging and independent living. So we have Commissioner Hutt with us. And I'm assuming you brought some of a team. I'm looking around my Hollywood Squares commissioner to see who you have brought with you. I believe that me. I know that Megan Tierney Ward is on the line. I thought I saw, I hope I saw Bill Kelly, but I'm not seeing him now. I'm not seeing him either. He may be joining us. He may have got kicked off. Sometimes people get kicked off. Bill Kelly. I see Bill Kelly. I see Bill Kelly. He's at the very bottom. Green just isn't on. No, I don't have him. Do we have a page? At the very bottom. No, he's on page two. That's why there you are, Bill. There he is. Thank you. And of course, Sarah Clark is here as well from the agency. Thank you, Sarah, for joining us as well. So we have this is going to be a joint meeting with the House Human Services Committee. Welcome back. We had you yesterday, Representative Pugh. You and your committee, we're glad that you're here so that we're all on the same page more quickly. Just as a reminder, the information we're going to see is the changes from the governor's 2020 proposal from January. And so we're not going to see the entire proposal. Those are still on the table as was presented in January and February. However, these are the changes that they're recommending from that. So we are getting to committees of the list of 2020, the list of the quarter budget, and then the list of the delta. And the delta can be from the January proposal and also from the quarter budget. So there's a lot of moving pieces here. And we're looking for recommendations from the policy committees by the first or second of September, which is not very far out. But we'll manage to get it done together. And I wanted to tell the policy committee that on Monday at 10 o'clock, House Appropriations will be walking through all of the language. And we will see the entire packet of language, what was proposed in January, what has been deleted or delayed from January, what changes have been made from January. So if anyone wants to jump in, be in touch with Teresa or jump in on the YouTube video. And you can hear the language. You're not going to want to listen to all of it, but you're more than welcome to hop on and off and catch the pieces that are related. So until 12 o'clock, and we have the commissioner here. And so I'm going to turn it over to Commissioner Hutt. And we can walk through the changes to the 2021 proposal in January. Oh, great. Wonderful. Thank you so much, Representative Toll. And I see that Teresa has shared her screen. So as is typical for Dale, we tend to put, we always put our budget into this sort of a narrative so that we can walk through the numbers. The numbers that you'll start to see correspond to the ups and downs. They're just easier to look at in this format, but just so that you know that they do correspond. Teresa, would you mind scrolling all the way down to page three? Because I think most of this information, both house human services and house appropriations, is really familiar with. Thank you so much. It's incredibly hard for me not to have control of that movement. So I'll try not to keep flinching. Thanks all for having us in. What you're going to see here as Chairwoman Toll stated is the restatement budget, so the changes from the FY21. This very first section of the document summarizes all of the changes across all of the appropriations in Dale. So this very first section is a summary. I won't dwell here, but I'll go right into the different appropriations. But just so you know that that's there. And as you can see on that summary that the gross change gross dollars change is about $309,000. I'm looking for the 309. We're at the very top of the document. OK, thank you. Thank you. Sure. So thank you, Teresa. So for Dale administration, there were a few things that we did to try to manage the situation that we have in front of us with the reductions in revenue and the pressure on the state. So for Dale, we elected to increase our vacancy savings. This amount brings our percentage of vacancy savings to about 3.25, which is still a pretty reasonable amount. We had worked hard over the last few years to reduce that altogether. But this has enabled us to utilize this as a way of managing the pressure that we're seeing as a department. And those vacancy savings are being achieved really just through the hiring freeze that exists across state government right now, slowing down some of our recruitment. But we're not at this moment in time reducing any positions. Commissioner Mayasker, just a clarifying question. Were you given a 3% target on top of you were not given a 3% target? No, no, no, no. The whole exercise was just related to reductions that we needed to try to achieve, obviously just to address the budget situation across the state. This was just, I'm just giving you the 3% as to let you know what it stands at for Dale, what this vacancy savings is doing. You were given a 3%. I'm sorry? You were given a 3% target to find in reductions. In total? Yes. Was your department asked to find 3% savings off the governor's proposed budget from January? Bill, was it 3% that we were targeting? This is Sarah Clark. If I may, kind of typical with any budget exercise, we are issued a target to start with. In this case, it was actually a 5% reduction target. But remember that was kind of well in advance of when we knew what the revenue picture actually was going to be. So we started there and then it's iterative at the agency and then working with finance and management to the budget that you see before you today. Okay. Great, thank you, Sarah. So the next reduction in the administration appropriation is a decrease to the internal service funds allocations that we have. So those include the costs for agency of digital services, human resources. So those were given to us across the board. And then we added in a travel reduction. Again, pretty reasonable considering the amount of telework that's happening right now. I don't think that this will be a hard target to hit within Dale as a department. So our committee is very familiar with the internal service fund allocation reductions. We're understanding about travel. Are there any questions on these three reductions for Dale administration from either members of either committee? Representative Pugh. Thank you. Monica, in terms of the increase in, sorry, commissioner, in the increase to vacancy savings, whether it's through attrition or retirement, I am struck by the fact that the population that your agency addresses is as we relate to COVID, one of the most vulnerable. And so I am wondering where these vacancy savings are as we talk about abuse and we talk about elder abuse as we talk about visiting congregate care settings for both elders and people with disabilities. And so I'm wondering where these vacancies are and how that is impacting the work that the state is supposed to be doing in protecting people with disabilities and people and older Vermonters. Thanks for the question. I think what's the positive about this is that we are not decreasing any positions here. The intent is to try to achieve these vacancy savings through just slowing down a hiring process. So no positions are being reduced in this proposal at all. It's just a slower hiring process that's proposed. Typically in Dale, most of our positions in our vacancies, we have about 279, 280 total positions. Our vacancies tend to be generally in vocational rehabilitation. That seems to be where we see most of the churn. And so again, it's not necessarily reductions to any positions. Some good news that we do have is that we did get permission to maintain our surveyors as a class. So the higher those surveyors as a class considering the pressure that we have on our nursing facilities right now or long-term care facilities. So the surveyors, we did receive blanket permission to hire. So there will not be delays in that particular class of employees. Does that answer the question for you? Thank you. Thank you, Representative Pugh. Representative Wood and Representative McFawn. Thank you, Representative Toll. Commissioner, just following up on the nurse surveyors and long-term care facilities and the decrease in travel. Are nurse surveyors continuing to do in-person site visits at our long-term care facilities? They are. There was a gap in that per CMS regulations for a period of time, but those have restarted. And so that is happening right now. Thank you. I just want to say that the longer it goes on for there not being outside visitation allowed. And I realized the Secretary was making some sort of statement about that as I was coming online here. But when we have insulated facilities that don't have any outside eyes on, it causes me concern in any kind of facility type. People trying their best and doing their best, but it is when there are no outside eyes on that bad things start to happen. And I just am anxious about that. Absolutely, I couldn't agree with you more. It's important to remember that the surveyors don't necessarily fall into those visitor restrictions that the Secretary might be speaking to. The nursing homes are in phases and as they move through their phases, they're enabled to allow for more visitation. But the surveyors, if they needed to be in there, even at the height of the epidemic, and even when there were outbreaks, they were moving into facilities when they needed to be there. So that wasn't curtailed, but it was based on a real need to be in there. So not necessarily, although even now the more quality level surveys have restarted for a period, that was what was suspended. But looking at harm or risk of harm continued regardless of the epidemic. And Commissioner, as a follow-up to that comment, have you seen, what does the data show in terms of the number of reports? Have you seen a steady, roughly the same as what you saw pre-COVID as it increased? Do you have anything on that? There's a little bit of feedback, but if you want to read everyone's recent, or did anybody know about this until you saw it? James, can you represent it in Gregor? Can you mute your iPhone? So Representative Wood, that's a great question in terms of the reports from facilities. I don't have that information off the top of my head, but we can find that out for you. Thank you very much. Sure. Thank you. Thank you, Chair. We had Representative McFawn. Thank you, Madam Chair. I would like to know if, with all the problems at this point in time, that autistic kids facing with the situation in the school the way it is, the changes and the kinds of things that disturb autistic children, this decreased in internal services funds, is that where that money would come from to work with these kids in terms of the caregiving? No, no, Representative McFawn, no, absolutely not. Where does that come from? Those are the dollars for fee for space from the building and general services and from ADS for computer for IT charges. Okay, all right. All of those internal charges. All right, so I'll wait on the answer to that question. So I get to the right section. Yep. Okay, thank you. Thank you, Representative. I don't see any other questions on this section, so we can move to the next unless you have anything else to offer, Commissioner. No, I'm happy to move down. So thank you so much. So the next appropriation is under the Dale grants and you'll see two reductions here. Part of our Dale grants is the Medicaid attendant services program. And we are proposing here $100,000 underutilization reduction in that Medicaid attendant services program. So that does still leave us with some headroom. We're trying to be very, very careful of that. Although as always any reduction decreases that headroom a little bit, but we are feeling confident that that will be sufficient for the coming year. The second decrease that you see is a $250,000 reduction in the adult day programs. As most, as all of you know, adult day programs closed down in March, early mid-March due to COVID-19. We have been able to offset their losses through the Coronavirus Relief Fund from July through September. So this is a reduction that we think is easily achieved. It will not harm them at all. They've got full operating expenses through till the end of September. And I want to highlight, you have written, that's a one time, so it's not a full, it's not a base reduction into 2022. Correct. Offset by the CRF dollars. Exactly. We have two questions here. First, representative Lamper and then representative Wood. Great. Thank you. It's nice to hear your voice, commissioner. You too. So when we're looking at this variety of space, which I'm glad that my desk is a little bigger, that I'm looking at the January, looking at the new restatement and your statement. When I went in this area on the attendant care services, in January, there was a recommendation of 181,000 reduction in general fund, but nothing in no reduction on that line for global commitment. So this $100,000 reduction is on top of that correct and it's out of global commitment, which we'll have a little bit of JF in it, but so if I was to take this in its totality, this section is down 281,933. You're speaking just to the general fund, representative Lamper. Well, if I look across that line, so when I take the $100,000 here from the global commitment and the 181 that was recommended out of the general fund in January, that section is really, it's a 281, which I don't think anybody disputes. This program has been frozen since 2014 and so it's been seeing the reduction. I just wanna make sure I've got my numbers lined up correct. So just to clarify and I apologize, I realize I know everyone's working on multiple pages and multiple budgets. This is the Medicaid program, not the general fund program. So the general fund program in attendant services has been frozen. This is the Medicaid program. It is true and you are accurate in that the FY21 budget also proposed a reduction, an underutilization reduction in the Medicaid attendant services program. I don't have, I'm afraid, the general fund portion of that. I have the global commitment fund portion of that. So I've got the gross numbers. So two different, they're two different. One is the general, okay, that's good to know. And the other question I have around the adult days is we, you guys have done a really good job of working with them since the closure and trying to figure out how with the percentage of being able to be open is. And we were very successful in getting them the dollars until September. So I was hoping to maybe see either in here or in the request of the Joint Fiscal Committee for dollars for to offset their closure from October, November and December. Is there a proposal? There's not a fully formed proposal at this point in time. We are working on that. Megan has been taking the lead on the adult day program specifically recognizing that they are gonna, most will need to have some sort of a census reduction in order to open safely. And we've been working really closely with the association on that. So they have a reopening plan that has been sort of blessed by the Vermont Department of Health, which is how we make sure that all of our planning is accurate and up to snuff. And we are working through, there was in the July, August and September dollars that were allocated to them. There are, we believe some additional dollars there. And so we're going to, we need to assess that and then work to determine what they might need for a 50% census until that, right? And we're just not there yet because they are literally just starting to grind back open essentially. Right, right. And I just know the timing because at that September end I was kind of, do you anticipate, and I'll end with that, that before we get to the final budget here in September that you'll come back with or someone will come back with that dollar amount that's going to be needed to see them through to the end of the year or however time, yeah. I think absolutely an assessment of what they will need through the end of the year. And then we can determine if that turns into a request and maybe that we are already there depending on what the actual needs are. Okay, all right, thank you. Sure. Thank you, Diane. I have a question from Representative Wood and then Representative Hooper. Thank you. My question is with regard to the adult day services as well. And as y'all know, we've had two, I think two maybe more now, but two that I'm aware of close. And so I'm just wondering what planning the department is doing to try to make those services again, accessible to people in those two parts of the state that now have lost them. And I'm just wondering since this is a one-time decrease, whether we should be looking at that one-time funding that's available to try to jumpstart two new programs in those areas. So I can certainly speak to the planning component. It's interesting and obviously unexpected to have two close at the same time. And it's not something that there's any precedent for within the department. So we are working actively with the area agencies on aging. There are two different agencies on aging that are impacted, one in the Rulland area, one in the Barrie area, to consider sort of the options and the plans and who might be interested. We've had multiple conversations with entities. I don't wanna sort of names at this point in time because there have been a couple of entities that have approached us and indicated their interest. I think that there are some opportunities for some collaboration in those communities across a couple of different entities that are interested in restarting the adult day programs. There is certainly a need to consider the payment structure for adult day programs, I think, going into the future. And I have actually been out most of this week, but I know that Angela Smith-Jane, who's the director of our adult services division, sat in on a national call around adult day programs just globally because there's not, every other state is experiencing the exact same thing. Services are really necessary. And I think we've been able to be really creative with them in terms of how they're delivering some of their services. But the bottom line is that they're very much an in-person service and that's really what's required. And so trying to understand how that continues into the future, seeing the vulnerability that we have to virus like COVID, but even other viruses as they may come along has been kind of a national conversation. So very long answer to your question. We certainly are working with both communities to try to establish if there are providers that are interested in rebuilding and rebeginning the adult services and working with the association more globally. In terms of the one-time startup, that's honestly not something that I had thought about. So I'm not sure that I can speak to that representative would. Can I ask the question, I guess maybe an adjunct to that question. So if there's 250,000 that's been identified as one time because CRF is offsetting, is there headroom as you spoke to in the attendant services program, is there additional headroom there on that side of global commitment in order to be able to, I'm just wondering if there's any flexibility there because it's obviously a very needed service and if we have some flexibility to assist with startup of two new programs, that would be something that I think we'd be interested in. I don't know that I can speak to that right now but that's certainly something we can get back to you on. Okay, thank you, Sarah Clark. From a global commitment headroom perspective, it is not an issue. If that was what your question was, Representative Wood, I believe. It is not an issue meaning that there is additional headroom. Yes. Thank you. And then I just wanted to follow up to make sure I'm following along with this, that we do have this one time decrease due to the CRF offset. If there may be headroom with the global commitment, however, the GF portion, if we're starting something up and it only needs startup money, that's one consideration. But if it's ongoing, we're using an awful lot of one time money to keep assisting programs going into 2022 so that we don't make unnecessary reductions, not knowing what the future is going to look like. But if we know we're putting one time money into starting something new, we may not have the general fund that it's not looking like we're going to have any extra general fund. We're going to be looking at probably reductions in 2022 to start it up and not be able to fund it in 2022, or unless we didn't fund something else. I guess that's why you're... Representative Toll, I think that what I'm referring to is the money that theoretically has now been freed up because we have had the closure of two programs that were existing prior. So it wouldn't be new money, it wouldn't be additional new global commitment or new general fund. I'm still talking about working within the parameters that the department has had. Okay, but I think then they would have to find the reduction somewhere else in their budget because they've used those closings to balance this budget. Is that correct, Sarah, or Monica? Yes. Well, what we're proposing to use here, I'm sorry, Monica, that's okay, is the one-time savings that are freed up because we're paying for the operating costs for adult days using Coronavirus Relief Fund in the first quarter, state fiscal year 21. That is what is included here as one-time savings. So that's a different savings. So from the closing of the two adult days, where have those ongoing savings gone? Just into the bottom line? So adult days are funded both through day health rehab and direct Medicaid billing. And they're also funded as part of our Choices for Care program. They're kind of multiple funding sources that go into adult day programs. So you would see a little bit of headroom potentially in our Choices for Care program, although when we get to that appropriation, you'll see that we're actually asking for an increase in that caseload because we're seeing some increases there. So it is tight. I mean, I think that the point that you're trying to make, Madam Chair, is that it's a tight budget for sure. Certainly in Choices for Care, that is true. I think that the idea of one-time startup, just kind of for operational things is a little bit challenging only because I'm not sure that that can actually be Medicaid because it's probably more of a bricks and mortar kind of a startup. But if we had two new programs operating, if they could get up and running on their own and be operating, that is certainly already part of our vision and our package. And so we would anticipate being able to support those replacement programs. Startup costs that are one-time, that are more bricks and mortar might become more challenging just because I'm not sure that that can be Medicaid. Thank you. So this conversation will continue with the Policy Committee. Also, Diane, you'll be part of that conversation about the two that have closed, the possibility of getting anything in place in this budget and then what funding implications that would have. Let's see, do I have any other questions from, let's move on to page four. We see that the Department of, those were not adjusted. So let's go to developmental services. Thank you. Yes, so thank you so much. So in developmental services, what you will see is a budget to actuals adjustment. This doesn't represent any service reductions or provider reductions or impact to individuals. It's a result of the way in which we fund developmental services. So that's pretty straightforward, I think. Are there any questions on the DS? Yes, we do have Topper, Representative McFawn, please. Is this where my question about the autistic children would come in? So potentially, I think when you're talking about services in schools for children that are on the autism spectrum, that's typically in the success beyond six world. And I know that you had Commissioner Squirrel already into testify and she probably spoke to that. So those are typically school-based services. There are not a lot of children, as you all well know, on the developmental services caseload. This is primarily an adult caseload, but we do have some, but not very many. So most of those school-based services are happening through success beyond six and partnership with schools and, so that's where the socialization problem that caregiving activity would take place. No, I'm sorry, I thought you were talking about school-based services, my apologies. In terms of support for families, right. So those supports are built into the developmental services budget. This reduction doesn't impact those supports. Those are based on individual service plans and individual budgets. Certainly it has been challenging through the pandemic to get those services to kids. And part of what we've been able to do over the last few months is to authorize crisis payments to families, to enable them to convert some of the dollars that are available through their service plans so that they can utilize those dollars in some other way or to pay family members to get that kind of respite. But I think that the lack of school and the very slow restart of community-based supports for kids has certainly put an impact on families. But those services from developmental services agencies are restarting right now. In fact, they had a deadline of August 15th to sort of re-begin billing appropriately for that. And so we should start to see those ramping back up. Okay, so Commissioner, what I'm trying to get at is I've been talking to people who have autistic children. And the problems they're having is the changes that are taking place in terms of how the education system is being changed for these kids and the anxiety that's developing in them. And then you say now the designated agency type services are ramping up. My question is, do we need more help for them? Do you understand what I mean? I do. It's a really fair question. One of the conversations that we've just started to have is with the Agency of Education because we're really concerned that there are appropriate accommodations for kids with disabilities, not only on the autism spectrum, but just globally, that there are appropriate accommodations as schools are creating this sort of hybrid model. What are the accommodations for those students with disabilities? And I think that that is a conversation that we need to have with Agency of Education. You know, I'm not at all trying to pass the buck, but I do think that we need to consider how the ed fund factors into this as well, because these are the school services are the pieces that are being impacted. And I really want to understand how that's working for kids with disabilities specifically. I'm not sure that we have, you know, available dollars in our budget. I know that we don't have available dollars in our budget to supplant what education has been providing. I think that we need to think about how to partner with them effectively to make sure that there's a full component of services and accommodations to make sure that kids can still get their educational needs met. I think this is, I appreciate that. I think it's very important. I know what's happening in the school system that I represent and they have one room where if something happens during the day, these kids gonna go. Now, that's not adequate. We all know that because it's not gonna be just one kid that's having a problem with these changes. So, okay, I'm glad that I'm glad to hear. I think that's an extremely important effort on your part to make sure that that happens because these kids are in trouble. Thank you. You're welcome. Thank you, Representative McFawn. We have Representative Yathavani, Jennifer and Wood. And we are over our time and I'm fine with being over the time. I'm just hoping that, Monica, you have a few more minutes that, okay. Of course. Dave? Yes, thank you. Thank you, Commissioner. My question on the Developmental Services Adjustment, the 1.6 million, is that an adjustment? Because in FY20, the program under spent, can you just help me understand it? I'm gonna, I can, and I'm actually maybe gonna pass the baton over to Bill because this was not necessarily because of under spending. This is that, the cash accrual that is created in Developmental Services because of the way that it's funded. Bill, do you wanna jump in? I know he's here. I know he's here. Bill, you may have to unmute yourself. I'm looking to see, there you are. I see you talking, but we're not hearing you. Theresa, I'll, tech help? Tech help. He's been muzzled. You know, Bill, can you call in by phone please? You do have the number and if you could call in by phone, that would be helpful. He's not muted. So I think it's on, it's on his end. So did you accidentally mute the, can you go in the system tray down in the right-hand side if you're in a computer and look for the little, what it looks like a speaker, a little speaker? Can you, you can wrong side click on it or if you have speakers there, turn them on or nothing. Is your volume all the way down? All right, so yeah, it's something on the computer. So Bill, if you look at the invitation that you got in your calendar, there's a phone number. And if you want to use that to call in, you can leave your face on the screen and call. We're going to wait for Bill to call in, but I'm going to move to Representative Lamper's question and go back to yours, Dave, in the, to save time here. Absolutely, I'll do that. Diane. The very first number that you see in the invitation, do you need to send it again? We're going to go ahead, Teresa, Representative Lamper. Sure, thank you. Thank you. I know that we're running short of time. So I think my question is very much in line with where Representative Yakovoni was going. So on the 1.6 here, this is in addition to the 3.4 in January, correct? Correct. Okay, so, and those were just, those were in January, those were also budget to adjustments, you know? And in January, we'll have to keep in mind that we also had a $6.5 million up and a $1.1 million up in the other. And then this was a, this was not a service reduction. I was wondering on this 1.6, and I don't know if you can answer this, but it's something was like the, who's concerned that the stay at home or kind of orders of staying in and what that did to people's budgets for this community not being able to access the full opportunity of their service budgets? Or was this strictly, you know, I'm just thinking was there savings within budgets because they couldn't access it or this was just bills accounting? So this is not related to any lack of service delivery that happened because of the crisis and it's not, it is, it doesn't represent an overage in our funding or a caseload. This is really an artifact of the way that we accrue dollars and it's, which is unique to developmental services, which is really why I wanted Bill to be able to explain that. I believe he is on now. So Bill, if you make sure that your computer is now off so that we're not looping, we could listen, we could hear you by phone. I think he's okay. We can see him and he can talk on the phone at the same time. Okay, perfect. Can you hear me? Yes. Can you hear me? Yes. So the appropriation is built on everyone's individual waiver that's approved on an accrual basis. So if a certain percentage, 30% of the consumers come in, say in the last quarter of the year, they're obviously not gonna have a full year of expense. So the appropriation's been built like they would spend on a cash basis, the full amount by June 30th and that's just clearly not the case. So that's what this budget to actuals adjustment is. Thank you, Bill, but nobody, I'm just wondering like the individual budget. So if somebody, this isn't just saying, oh, you had $1,000 in your budget but because you didn't, I don't know, partake of some sort of community service because of stay at home, you were, you know, there was a $200 unused portion. That doesn't mean their base budget next year will change, but there's, okay. There's clearly no reduction to any consumer or to the DA. Okay, that's what we really need to know. Thank you. Thank you, Representative, let's go back to Representative Yakovoni. I'm okay, I'm listening. Thank you. You're good, you're good, Dave. Yes, I am. Okay, Representative. Thank you. This was along my line of questioning as well, so I'm not good, but I'm okay. So the 1.6 and the 3.6 from January does not reflect any reductions to services or to individuals who receive services. No, correct. Okay, let's continue then to the next, to TBI please. So again, there's obviously a feeding throughout the entire presentation here. This is another underutilization adjustment in the traumatic brain injury program. It is on top of a proposed reduction in the FY21 budget as well. It does leave us with a little bit of headroom still and just looking back at past budgets for the TBI program, we are confident that this will be sufficient. Again, remember that the TBI program is designed to be rehab. It's very unpredictable how many people come in and what we've done over the last several years at this point in time is for those long-term needs in TBI, they shift into our Choices for Care program as necessary. So this is really a very short-term rehab component program, which I think is appropriate. Monica, can you remind us of the amount in January of the underutilization dollar? Or Diane, I bet you have it right at your fingertip. I do, Madam Chair, I take. So it was a BAA in January. It was a $285,000 for customers, but that was actually a BAA item. BAA and not in the governor's proposal. Thank you. I had actually forgotten that. Thank you, Representative Lampe. You're welcome. If I don't see, I do not see any TBI questions. Let's move to Choices for Care, please. So this is the one spot where there is a requested increase. Choices for Care, our caseload is built on a three-year average caseload build. Essentially the estimate that we had for FY21 is just too low. Our actuals in this program are demonstrating not only a slightly higher caseload amount, but a higher cost per case amount. And so this is adjustment to that particular budget. Are there questions about the increase for Choices for Care for home and community-based activities? Representative Wood. Sorry, almost lost my iPad. Commissioner, can you tell me what portion of that is community-based services versus nursing facility services? I can't, off the top of my head. I'm not sure that we, Bill, do we have that broken down like that? Well, I'm not sure this is exactly what's being asked, but from my perspective, it's all home and community-based, so I'm not sure. Nursing home, it's all home and, no. If it's all home and community-based, then that does answer my question. I just didn't know if it, because Choices for Care also includes nursing facility. And I didn't know if we were seeing the free concept. I'm sorry, I didn't understand what you were asking, and Bill's accurate, yes. This is all home and community-based services. So, yeah, although nursing homes are part of the overall appropriation, we typically look for those increases and decreases separately as we have in the past. So this is all HCBS. Okay, thank you. Sure. Just add, it's also the enhanced residential care. So on the crosswalk, it says home and community-based services and enhanced residential care. So what would not be in here, and you can tell me, is the ACCCD or something? The ACCS, which is actually part of the DEVA budget, that's the state Medicaid payment for our residential care facilities, but the enhanced residential care, so that additional money on top of that for folks in the Choices for Care program is a part of this HCBS, yes. Thank you. So at this time, we're significantly over, but it's important that we complete our work and we know the direction we're traveling. Representative Pugh has ordered up that let's take some time right now to review the, or in order to know what our next steps are, what additional information does the member need at this time to make decisions on this budget? And I do believe there are questions about the adult days with the two closing and whether two more could be open with the money from the two that have closed. So that would be an ongoing discussion. Are there any other open questions that people need more clarification on that has to do with the Dale budget? My only would be the CFR dollars if there's gonna be needed, if there's more and how would they, are there plan to bring them in? CFR dollars would have been reflected here if the governor had, he combined his CRF dollars with the 21 budget. So I'm assuming there's no additional CRF dollars since they're not reflected here. Is that accurate, Sarah? Yes, as is currently contemplated. Okay. But I think Representative Lanfier, you were talking about a potential proposal to fund the adult days for this second quarter. That's an ongoing conversation. Okay, CRF for adult days. And any representative McFawn? Yes, I think it's still an open question about the Department of Education and Dale getting together to deal with the problems that are arising with those autistic kids. And so if that is language that would request that the two committees work together and is that something that your committee within policy would connect with education and work on possible language if it's needed? Yes, although it might be more, I believe that health care somehow deals with as oxygen. I'm not sure. Still in his personal care. What? Mary's wave of her hand, I think she doesn't answer. Go ahead, Mary. If this is a success beyond six question, it's a Department of Mental Health, thus, Health Care Committee and AOE question. And it has been raised with when we were meeting with the Health Care Committee and DMH, we raised this issue. Did not ask specifically about autistic kids, but we certainly have been having a conversation about services provided to children via the success beyond six. Dohtopper, if I may, this is not something that human services and appropriations would be dealing with in terms of language. This is something for you to connect with representative Lippert or representative Donahue in terms of health care. And if you want, I can help you write an email to them and to the chair of education and put you all together. Okay, thank you. Thank you. Thank you, Ann, for that assistance in Topper. It's an important question. So I look forward to getting resolution to it. It's in every community, these services to kids that there's an impact. Representative Wood? Thank you, Chair Toll. Commissioner, I would be interested in additional information regarding the DS cut and how that might impact one-time allocations going out to designated agencies. And then my second question is at your presentation last week to Joint Fiscal on Meals on Wheels, you said that there was potentially a second request coming. And so we didn't see anything in your budget for CRF funds for Meals on Wheels for another request. So I'm just wondering, is there one coming or not? So I can, oh, should I answer both questions? Well, that's for additional information that we need, I guess. Okay, I will let you know that it won't, the DS reduction won't impact the one-time dollars that go out to designated agencies. I'm sorry, I'm still misunderstanding. Am I meant to answer or I should just wait and put that in my head? Go ahead with the Meals on Wheels. Okay, so there was a nutrition adequacy report that was requested by Joint Fiscal and we submitted on the 18th, I believe. I'm not sure, it absolutely was submitted on the 18th. That indicated that the one need that still existed and at the area agencies on aging was if we wanted them to continue an increased rate of reimbursement to senior centers and meal sites for the provision of meals, that there, we estimated about $565,000 and CRF funds would be necessary for them to continue that to the end of the calendar year. I, as I said, I've been away this week, so I have not followed up yet on whether or not we're going to roll that into a request. I expected, I think, to hear a little bit from Joint Fiscal about how that report was received and if they believed that that was a reasonable request to make going forward. Because we were putting it into a report and making the recommendation or giving the information, I think I was waiting to hear back from Joint Fiscal. Okay, so Madam Chair, Madam Chair, I guess that's... Theresa, you're muted somehow? Like I'm muted. You're back. Okay, so Madam Chair, I'd say that's an outstanding question for us in terms of what will happen for meals and nutrition programs for seniors. Okay, so what I have, I have the outstanding questions are the adult day questions with the two closing and whether CRF dollars would be appropriate here and Diane, you'll work on the jurisdiction on this, the meals on wheels question and we'll connect with the Joint Fiscal Office and determine where that is at. And I do not, do we have any other questions? DAs will not be impacted with the reduction. I'm going to use the word reduction instead of cut. A cut sounds like it goes to a program. A reduction sounds like the ebb and flow of money depending on the number of people utilizing a service. And so they're adjusting to the need without any reductions to any individuals or to the program itself. And so are there any open questions on the DS at this time? For this budget, maybe way into the future or in the 22 budget, but for this budget, are there open questions for DS? I'm going to take DS off the table and we're the two pieces that are left open are the CRF for adult days and the meals on wheels. Is that correct? And we don't have any issue with the increase to the choices for care. I'm going to take that out. Madam Tolle, this is Megan. I have a question. I wrote down the number of reports that licensing and protection and whether that has changed. So we'll look into that as well. Okay, thank you. And that's for informational purposes. I'm just, I just want to make sure I don't miss a budget piece. And Diane, you'll do the cross-checking for proposals from the January proposed budget. Okay, and so does that give you, that gives you some direction whether we're doing something with adult days and with meals on wheels and the other piece we should probably go back and fully review at this point, I'll catch up with you with Kimberly, the DCF budget. Is there, there was a lot of moving pieces there. Thank you. There's a lot with that. And I just want to say to my committee there's lots of language. There were some language in the January budget and what I'm understanding from what Teresa, Aten just sent me in terms of the color code. Gray means it was in the governor's recommendation in January. And so that still is a recommendation. And blue is new things. And of the gray some of, and some of it has been deleted but our committee had gone through almost all of the language and had weighed in with the policy committees. So we're going to match up with decisions that we've already made so that we don't have to rehash those decisions again which we would have made with the policy committees knowing. And so many of those areas we're going to cross-check all the language that we had closed off is we had finished up I think way close to 98% of the language. So just in terms of the folks on human services you don't, you don't need to spend your weekend looking at the language we will wait for part B. Well, you might want to look at their new language. Right, right. The new language. Right, okay. Okay. I think that that closes this and I know that we're a bit over. And nice to see all of you. Thank you commissioner for coming in. Thank you healthcare committee and we look forward to working together with you and solving this budget as expeditiously as possible. Okay. Thank you. Thank you. Thank you. You're ready to go live. Thank you.