 So Katie, but let's start with seven because I think there are a lot of people in this room who are interested in seven And we just have seven and fifty-five Sandy is okay Yes And if anyone has sent me an e-mail of the weekend, I had no idea about that, so it's not an interesting experience. Oh, at your house? They still... They severed the line, they spliced it, and now the splice doesn't work. Okay, can we start with the highlighting house changes? That might be the most useful, and we've seen this. This was posted last week as well. This is what? This was posted last week as well. Yes, yes, I was reading it. We just missed each other. There we are. Thank you very much. Okay, so let's go to... Let's start with all the yellow changes that were made. Why don't you run through those one more time for us, and then we'll... Sure. So section one was the section with the CMS report, and what this language does is ask that a copy of that report come to the legislature as well. The date has been changed since the last last Senate. It's now coming to the General Assembly on January 1st, 2021. The word behavioral health services, the phrase was changed to mental health services. And then there's a new clause at the end of that sentence that says, including future plans for the integration of long-term care services with the accountable care organization. And then there's a new subdivision, too. This is in repairing the report, the agency shall consult with individuals receiving services and family members of individuals receiving services. So those are the changes in section one. In section two, this is also a report. This is the report on the integration of social services with the ACO. It had a date change here. I believe when it left the Senate was either September or October 1st. And the Green Mouth Care Board asked that it be moved back to December 1st. And then, again, that same new sentence was added in House Health Care that in preparing the report, the board shall consult with individuals receiving services and family members of individuals receiving services. So this stuff right there, is there any concern about anything that you've... or changes? Section 2A is the budget review for the ACO, and there were not any changes made to this section. Section 3 was the responsibilities of the Director for Trauma Prevention and Resilience Development. And again, there were not any changes made to this section. Section 4 was the report regarding the Dulce model and the nurse home visiting. And that was deleted in the House. And then, section 4 is the effective date and there were changes July 1, 2018. Okay. We do have written testimony from two years ago. Yes. And is that... This is where I couldn't access what was linked to it, so I'm just saying this first. So those... I had it. Would you like me to... Yeah. And maybe Sandy, do you have a sense of... Well, the reason why section 4 was deleted in S7 on the... Let's see what Teresa says. Okay. That'd be great. So section 4, HHS deleted section 4. HHS appreciated the additional responsibility to the Director of Trauma Prevention and Resilience Development enacted last year in Act 204. The committee believes that the addition, along with the ongoing work of the new position, captured the intent of section 4 without need for an additional report. Perhaps a joint memo from the chairs of Human Services and Health and Welfare to the Director of Trauma Prevention and Resilience Development to emphasize the need to assess the effectiveness of embedding social service provider in pediatric primary care, I think, practices. That's supposed to be the word. And sustaining a high-quality home visiting program could be sent. So in essence, what this is saying is that in section 3, the new responsibility that was added in this bill for the trauma director and Director of Trauma Prevention and Resilience Development is that this person is to serve as a resource and ensuring new models used by community social service providers are aligned with the state's goals for trauma-informed prevention and resilience. And I believe this comment is meant to say that that new responsibility of the director would encompass reviewing Dulce and the nurse home visiting partnership specifically. But it doesn't say that right now in the duties. Well, the duties of the resilience, average duties don't include doing this review. It's just that they're going to happen. Specific to those programs, correct, but the added language would be that the director serves as a resource in ensuring new models used by community social service providers are aligned with trauma-informed prevention and resilience. So there's that responsibility that maybe is broader or pertaining to other programs, but not specific. But it's not specific to primary care, nor is it specific to home visiting. Correct. Okay. Yes. So then I'm looking right now at our section 4, and it would be mindless walking us through our section 4, so we can see what's being changed and what the request is for a letter. So if you want to see it on your iPads, you can go to the report of the care committee. I have... Oh, you have ASPAS done it? Yeah. Perfect. Well, the language is the same. So in section 4, we have that by January 1st of this coming year, the director of trauma prevention and resilience development and the director of maternal and child health shall submit a report to the House committees on healthcare and human services into this committee in consultation with stakeholders assessing the model in which a social service provider is embedded within a pediatric primary care practice and the strong family sustained home visiting programs. Then in subsection B it says that this report is to include recommendations for further development and expansion of the models described in A-1 and A-2 Dulce and the home visiting in coordination with any proposals for a form resulting from the CHIN's review that was conducted pursuant to last year's budget. Okay. So, Sandy, can I have a virtue, Senator? Sorry. Is it okay if I ask you a couple questions about the ultimate mess? So did you take testimony from folks on the home visiting and the Dulce program, about expansion that's going on? So we spent a fair amount of time on that last year and we had a little bit of testimony about it on a standing contraception. It's this day that we did the following of June 27. I think this was a chair who is very concerned about putting into law things that seem to elevate certain very specific programs over others. We hope that actually quite successful in our committee in doing the letters. So as we looked at this it seemed to us that it would be totally appropriate to ask the trauma coordinator to do what you're asking as part of your job. Okay. And then in terms of the Department of Health would you bring any green at home, Senator? I'd like to talk about the home visit. I did not have green this year. Okay. Okay. I'm kind of ambivalent about the letter. Obviously we're not a full cohort here but we took significant testimony including from Scott Johnson on, Yeah. Sorry. That is his program. Yes. He has the programs I understand. But he's now in a different position, a different national position for consulting on some of the home, these programs. So it's not the same thing. And then the commitment of the agency to home visiting is very strong. We really need to reinforce that. And then finally the chins, using the connecting with the chins review that's going on, it is also credible. So. Simon, it's our understanding that there were actually several home visiting programs in place during this year. Yes, there are. But the strong families family sustaining home visiting program is one that I think is being evaluated as a pilot. So we probably need to look at that. Okay. So this is the section I think that we work very long and hard on. So we'll have to think about whether or not we want to relegate it to a letter or to have something in the bill. And obviously anything we put in has to go over to you guys today. All right. Okay. So we'll maybe just have to sort that one out. Is there anyone else who wants to comment on section four or S7 as it currently stands from the house? Okay. All right. Silence means something. I'm not sure what it means. So Senator McCormack, we just went through section four and the house. I'm not sure. I listened to Representative Haas when I I think that probably. Did I miss your testimony? This is a different bill. This is a different bill. This is section four of S7 that they deleted and that we would like to consider. I think our testimony might have been slightly different from yours just because of the time that we had to work on the bill and that's pretty standard. Knowing life. So I'm going to just I'm going to charge the three of us who are sitting here at the table with Katie to think about this section and perhaps our changes that can be made to it that are less onerous. For example, she'll submit a report. Perhaps it's a presentation. And then then perhaps I think the concern that I hear from the House members and representatives is the notion that we're identifying a single type of embedded practice and that maybe there is some latitude in evaluating other types of practices where we get social service and primary care integrated. I think that's what I'm hearing from you. Is that right representative? That's one issue. Another issue is for the chair in particular who is a social worker is to not medicalize too much. I understand that. I know that's always been a concern. We did take a field trip some of us to the Aperture Clinic in Stowe where social services and primary care are fully integrated. It felt more to me like the primary care was embedded in social services. So I think it's also in the eye of the holder. The whole goal is to integrate the two together, not one over another. So I think that this model actually begins to do that. It's where it sits. I understand that if it sits in St. Almond's and it's sitting in a primary care docs practice then people feel as if it's medicalized. What we're seeing though is that medicine is becoming, let's see, socialized. So it is a perspective. And I do appreciate your chair's perspective on that. We've had conversations. Okay. So let's consider this and maybe this will sort out what we can do and what we might want to do in terms of a letter or in terms of appropriate calls to the amendment. Thank you. I appreciate your comments. So good morning. So I am here to ask you please to concur with what we did. I know that it's tempting given the vote in the House to think that this was a slam dunk but it was not. We had, last year when this issue came to the floor, we had, we fought for hours and my recollection is that it passed on a party line vote before it was vetoed by the governor. I looked back at the record in the Senate before you sent it to us and it was very close to a party line vote in the Senate. Somehow we managed to make just subtle enough changes that we were able to bring our colleagues on board. I actually did not expect it to come out of our committee on the strong and long debates in committee about the text of the bill. And what I was finally able to do especially on the House floor was get people to understand that we're really talking about a rulemaking process that what we care about here is are the guidelines for the rulemaking process which is in itself incredibly rigorous and time-consuming and involves stakeholders and all of that. You know well not all of my colleagues in the House I think were so clear. And you will recall that they're really two different processes that the working group is involved in. The first one is any new chemicals to be added to the list of 66 and of course it's been five years and that number is zero. And then the second layer is okay I have this chemical in my doll. You know should the doll be labeled or should that be restrictions on sale? That's an entirely different process with a different set of criteria. And we tweaked all of those. I think we have a much improved process. We have the working group now meeting twice a year instead of every other year. We have the working group always being consulted on both the addition of chemicals and the other criteria that was that appeared under the existing law that that was the commissioner of health's discretion and we took that away. We also have asked for in addition we loved the addition that you made that allows the working group to come directly to the legislature to so I see it as yet another failsafe on the rulemaking process. So something starts to go through rules and the working group says oh we really were on board with this and they did come to us. And given the time that it takes to get something through rulemaking that's an effective backstop I think. So you guys did that and we went along with it and we also supported your requirement that they make a rule on how we might have prior notification in the state before a product is introduced and we tweaked the language on that to make it more likely that we'll get something. In addition we asked for a report because there were members of our committee who didn't just want to know that chemical X is in the product they wanted somebody in the state to say this product is safe and we understand that that's a big hurdle for the Department of Health so we have asked them to include that in a report back to us and to make I don't know if you guys got to visit the website but we did we had somebody take us through the website of the reports it is to call it user unfriendly would be an understatement it is almost impenetrable for people like us whose job it is and I can't imagine doing it as a grandmother. I use the store on the website and trying to find the toy and whatever right. So we believe that what we have right now is a much improved process we can argue all day about making it stronger in this way or that way but I would really like to see this bill go to the governor and with 137 to 4 vote out of the house I think that we're probably going to get a bill signed and so I would like us to do that. So I think the question can help us a little bit because I know that the changes that you made are not unreasonable changes you left the UBC code in yes and the dates have changed because of the time including peer reviewed studies you've added critical scientific information or evidence so you did change the word evidence and then including peer reviewed studies from ours yours had peer reviewed before before so and Senator McCormick had a conversation about this and I think that the critical scientific evidence cannot be ignored by whomever is using this including peer reviewed studies I don't think that we're are we opening the door did you talk about opening the door to studies that might be coming directly from a chemical producer that number one keep in mind the peer reviewed was part of your language we moved it around of course we expect manufacturers to have studies and that's the reason for credible and that's the reason for peer reviewed that's and that's the reason that all of that gets considered by the group and then I'm just going through the bill after consultation makes a lot of sense we put that in and you were conferred that the commissioner in consultation with the working group and then you've changed the word probability of possibility which does make sense do you, did you consider all the phrase due to the degree of or frequency of so I believe that we address that when we when we added in subsection D likelihood potential and likelihood of exposure okay rather than frequency the that is the report there's also the allowance for the working group to submit anything else here that we need to understand your perspective I do I do get it that it was a very strong vote in the house that you've made some modifications that help I I believe you've done that and I have to be really clear that at this stage in the process I'm not entirely sure that there's a change that we would necessarily be able to get rule suspension as I told you I was surprised by the strength of the vote and if there's we're the bill to change I'm not sure that we would have that kind of support and we don't force rule suspensions in quite the same way that the Senate the Senate is very local isn't it it's just different it's different so I mean the worst thing the worst thing that can happen is if we provided approved proposals of them and that was not automatically accepted then it would sit calendar it would remember we would get it out this year why I just wondered if we had a credible peer-reviewed evidence that the governor would go on with this version do you have any sense from the administration all I know is we had a long fight about that in our committee I think that's just a good point what you think is as a better change we felt that it was really important to not do the same thing we did last year I'd like some clarity I'm exactly what the phrase means including peer-review does that mean it's a list that has things that are not peer-reviewed but also things that are and it includes peer-reviewed along with everything else that is the concept yes that is the concept yes as we are taught by the legislative council including means but not limited to peer-reviewed evidence okay because that certainly doesn't matter what we do we're going to have to trust the administrators you know the working group and the commissioner of health in particular that in my view if it's not peer-reviewed it's probably not credible on the other hand when you're talking about children's safety maybe it doesn't need to be driven home you don't want the case of Eric because it might hurt I mean that's usually how to deal with child safety that's not an unusually cautious approach that's apparent I don't need ironclad proof that something bad will happen to the kids and there's a trick doing double blind studies with children yes okay anything else we need to know that's what I have thank you thank you so the one last question on S7 the as you can tell around the table we are very strongly committed to that section 4 that was deleted and so maybe it's a conversation with the chair she's on her own today I believe she is teaching today yeah okay thank you very much thank you all right committee let's start with the motion it might be easier to look at you want a motion I move the committee recommend to the senate that I concur I mean I like I feel like this is not quite as strong as when we sent it over and I was sorry it's me a little bit can we hold that fine well we just had we were just sitting here with representative so we went through a little bit of S55 and senator McCormack made a motion that we concur with a proposal from the house and so we're just in discussion mode but I want to make sure that we have a chance to ask you any questions and I think the one question that stands out more than others is on the credible credible scientific evidence including peer review and trying to characterize what that means including peer review and then what else would say on the long side do you want to sit down sure so you know one of the examples I would think of something that isn't necessarily peer review is is for example the NIOSH or the EPA list of substances that have potential to cause cancer so they develop those lists from multiple sources but they're not necessarily peer review so if the commissioner wanted to rely on one of those lists or a listing of a chemical under one of those lists I think that this language gives the commission that ability so I think that's one example other examples would be independent privately funded studies as well Michael that's very helpful so may I complete my thought yes you may complete your thought it does frustrate frustrate me sometimes when we kind of negotiate with ourselves to try to avoid having a direction but I realize that this is the nature of the process and especially at this late date it would be better to have something that will sort of reluctantly concur so and in this legislation look at how many times has this legislation been in front of us no we do not ever want to see it it would be nice to get there okay so thank you for that I think we're all good on this one so we'll take it upstairs as it is and support it and I know that there are people in the room who will be relieved that this is going to be going on you may never see some of you when you're here again no that's not true thank you Michael okay thank you may I have a you know oh sure no we're voting we're going to vote sit there oh no there's no no no I forgot oh shoot hold on we'll see if I can find everything once again Kayla had one in the bed she did yeah I wonder if that was the last one yeah probably so I'm going to suggest that on S7 that I would you allow for me to talk with the chair of the committee and see if we can get something that might support both of us I know she's concerned about medicalizing social services but at the same time to have some social considerations in medicine that's I think what we're moving from here I'll see what I can do I'm representing the cause will help me no you do what you do we'll see what we can get to are you around a little bit today I wasn't planning to can you hold on for just a bit so we can just chat afterwards Sandy did you come up today for the purpose of testing? he did and we greatly appreciate him I was absolutely surprised yes dedication but it was time well spent we were well spoken let's just take a boat here very good at filling your forms up so I think this is not here yes absolutely yeah 302 302 if we don't put the boat up on this okay so I'll get that up thank you