 Good afternoon, everyone. My name is Kevin Mullen, Chair of the Green Mountain Care Board and we're going to get started. The first item on the agenda are the minutes of Wednesday, January 27th. Is there a motion? So moved. Second. It's been moved and seconded to approve the minutes of Wednesday, January 27th without any additions, deletions or corrections. Is there any further discussion? Hearing none, all those in favor of the motion signify by saying aye. Aye. Those opposed, signify by saying nay. Let the record show that the motion carried unanimously. Next I'm going to turn it over to Susan Barrett for the Executive Director's Report, Susan. Thank you, Mr. Chair. I have a few announcements. First, to let folks know that on February 1st, the board submitted a report. It's Act 159, section one. It's entitled Price Transparency Dashboard and essentially it is an update on the work that our data team is doing in first validating the data that we have in an effort to move toward a Price Transparency Dashboard for consumers. And that report is located on our website under what's new. It's also located under legislative reports, but the easiest way to get to it is under what's new. If you have any questions, just reach out and I can answer those for you. The other thing I wanted to let folks know is that our press release is up for our schedule for February and that is also located on our home page under our meetings. Yesterday we had a data governance council meeting that went very well. We heard from our lawyer, our general council, Mike Barber regarding the updates on the V-Cures and VUDs rule. So that will be coming over to the board in the near future. We also, next Monday, we'll have the general advisory committee meeting. Is that Monday the eighth? Is that the correct date? I'm wondering, or is that Tuesday? I just wanna make sure that I'm getting this right. I'm looking at my calendar right now. Yep, it is Monday the eighth. And that is at two to four. We also have an addition to this press release and it's being updated as we speak on Wednesday, February 17th. We'll be having a primary care advisory group meeting and that will start at 5 p.m. And the information, as I said, will be updated on the press release for all those who are interested in joining. And that is all I have to update you on. Thank you. Thank you, Susan. Mike Barber, are you gonna tee up the discussion on the QHP or should I turn it right over to Dana? I wasn't planning to, but I could. Okay, feel free, feel free. Okay, so the tee up is that the Green Mountain Care Board is required to review and approve with recommendations from DEVA, the benefit package or packages for qualified health benefit plans and reflective silver plans that are offered in Vermont. So on exchange for the QHPs and off exchange for the reflective silver. There are two categories of plans that are offered, standard plans and non-standard plans. And today we're gonna hear from DEVA regarding proposed changes to the design of the standard plans, which are the plans that are the same across carriers. Pursuant to a 2012 policy, you guys do not need to approve changes if they are minor. And I imagine that Dana and Addy will go over what those kinds of changes are. And that's it. Thank you, Mike. So Dana, if you could introduce yourself and your colleagues. I will. Thank you everybody for having us here virtually. And as Michael said, we will be presenting our proposed plan designs for the standard qualified health plans for 2022. So today I'm joined by Addy Strummelo, who's our deputy commissioner at DEVA and our partners at weekly consulting, Julie Pepper, Brittany Phillips, and Brooke Steiner. So I'd like to first turn it over to Addy, who has some initial comments and get us started that way. Super great. Thanks, Dana, and thank you everyone. It's wonderful to see you all virtually. I thought I might just kick things off by providing a little context around kind of what's going on with QHP enrollment given the extraordinary year that we're coming off of and the fact that we're in somewhat different world than we were last time we were here on this topic. So I wanted to convey that on the QHP and exchange side of healthcare enrollment, it's actually been quite a stable year. You may know that in last March, we opened up a special enrollment period during the middle of the year to encourage enrollment for uninsured Vermonters who weren't eligible for Medicaid. And we had 800 families maintain gain coverage through that special enrollment period that ran until August. And then we had our usual open enrollment from November 1st to December 15th. That also was quite stable. There was very little plan selection. So transferring between plans this time around which is interesting. The overall enrollment numbers I can provide to you today, we are still working on getting the plan by plan breakdown across the market. So from the issuers to include the small group and the off exchange QHP enrollment. But our overall QHP enrollment on exchange is down and this is because our Medicaid enrollment is up essentially. During the federally declared public health emergency, we're not able to terminate anyone for Medicaid. So that means that our caseload is growing steadily and this includes people who under normal circumstances would likely be up in the income levels for QHP and APTC. So last year at this time, we had around 27,000 QHP enrollees on the exchange. We now have a little bit under 25,000 which is about 18,000 households. 80% are still eligible for financial assistance. So that ratio has remained constant. And like I said, we're still collecting the data from the issuers to give you that fuller picture which we expect to have for our next appearance next week. I also wanted to mention that you may have heard that the federal government is doing a kind of a modified open enrollment beginning February 15th, again, to encourage enrollment into qualified health plans. We are looking at reopening our COVID-19 special enrollment period and discussing parameters right now. So we'll have more information to share about that in the next week or so as well. So with respect to plan design, which is our topic for today, I think stability is also the theme. The draft AV calculator that dictates a lot of this work was published without any changes from last year. So you'll see Julie and her team talk through that. The plan designs do reflect one legislative initiative which was around cost sharing for insulin. That did not have a significant AV impact but you'll see that in the presentation today. So I think it'll be somewhat familiar but just wanted to provide a little bit of context for you all since it's been a while. And with that, I think I'll turn it back to Dana. Thank you. Okay, so I'll get started with our presentation slides and ask you to let me know when you can see what I have. We can see them. Well, we can see your email. That's not what I wanted there. Bear with me, please. There we go. I'll get us started. Here's just an overview of how we will progress. I'm gonna provide a brief overview and context for our process. And then I will turn it over to our partners at Wakely to present the actual plan design proposals for the QHPs. We will respond to questions, comments today and return next week for any additional including public comment and then aim for our vote next week if possible. Again, for review today, here's a snapshot of the full array of plans offered on and off the exchange. Today, we'll be focusing on the 14 standard plans that's seven per issuer. One platinum, one gold, two in the silver range and three bronze plans, that's per issuer. I wanna note too that we provided a one major of the showing the 2021 plans available. These plans will carry over into 2022, but just for your reference to see what is currently available on the exchange and there's a brief set of benefits described on that one pager as well. So in November of each year, I convene our stakeholder group. This has really not changed over the years. We have representation from Diva, from each of our issuers, a couple of representatives from the health advocates office of Vermont and representatives from the staff at both DFR and Remount Care Ward. So we meet from November and finish our work in late January. Our last meeting was just last week in fact, and that's very active discussion. Don't necessarily have consensus on each, but we discussed thoroughly and put forth, we know with the best information that we have the, for each plan we will provide you with a preferred option and a backup option as we have in the past. Again, these are not new, but just to bring them before you again, these are the values that guide our decision making. So these are just things that we're mindful of as we make our decisions. And here are the three kind of process highlights that we refer to and that drive our actual decision process each year. It's in particular this year, it's important because as weekly we'll provide more information on this. The 2022 draft AB calculator did not apply any trend so that all of the 2021 plans would have the same AB in 2022, meaning that no changes are required. Our stakeholder group feels strongly that even despite that, we are mindful of the anticipated premium impact that will still take place even without any impact to the AB calculator for benefit purposes. We're mindful of premium impact. So we are proposing changes to each of the plans as you'll see. I won't read this out loud, but I just want to point out that silver loading as has been described will continue into 2022 with the quote unquote loaded silver premium on exchange and the lower reflective silver plans available off exchange through the issuers directly. Here's a high level look at our outline of certification timeline. As you know, aiming to get approval on our plan designs in February, all issuers submit their forms to DFR for review and approval in March. That process is scheduled to wrap up in June. We expect to receive the final payment notice and the IRS limits in spring 2021. And as always, we will inform the board of any plan design impacts that come from that in that timeframe in the spring. Rate submissions are in May, as you know, and that process continues ending in decisions planned in early August. And then following that, it's the Diva plan certification, that formal approval process at the end of August in advance of open enrollment November 1 to December 15. So all these interconnected steps. So if there are no questions or comments at this point, I'd like to turn it over. I believe it would be Brittany, you'll be leading us through the presentation. Yeah, thanks, Dana. Would you like to share your screen? Yeah, I can do that. Let me go ahead and pull mine up, all right. Can everybody see my screen in the presentation? Yes, we can. Great, thanks. So I'm Brittany Phillips, I'm a senior consulting actuary with Wakely. We've worked closely with Dana and the stakeholder group to develop the recommended plan designs for 2022 for the standard plans that Dana walked through. So I'm gonna start by talking through some of the proposed regulation changes and AVC changes that are happening between 2021 and 2022. As has been mentioned a couple of times, stability was really kind of the theme and there are really very few changes, but we will walk through those briefly. And then we'll spend the bulk of the presentation actually taking a look at the recommended plan design changes for each of those seven different plans that Dana had mentioned and going through kind of the decision process in terms of how we landed on these recommendations. So the first piece that I wanna discuss are the changes in the notice of benefit and payment parameters. So this is the regulatory update that is provided each year. Currently it's still in draft format for 2022 or the bulk of it I should say is in draft format for 2022. So all of the changes that we're showing here are still subject to change in the final version. Generally the changes tend to be pretty small, but just a comment that these could be updated. So the annual limitation on cost sharing, this is the maximum out of pocket for all plans is proposed to be 9100 in 2022. This is an increase from 8550 in 2021. Generally this increase has been $200 or so. Last year the increase was a little bit larger I think in the four or $500 range. As you can see this year it's again a substantial increase compared to what we had seen. The federal HGHP minimum deductible and out of pocket maximum limits are not released for 2022 for the high deductible health plans. So these are released separately from the notice of benefit and payment parameters and actually have different limitations than standard plans and non-high deductible plans. So we just wanna note that for 2021 the minimum single deductible is $1,400 and the out of pocket maximum is $7,000. The minimum deductible typically increases $50 every two to three years. The last increase was for the 2020 plan year. So this may or may not increase for 2022. It's difficult to say at this time. Generally these are released around April each year. So we do have a couple months likely until that's finalized. And then the MOOP increases about $100 each year. So we anticipate that the 7,000 will increase to 7100. But again, that's not final or known for sure at this time. So we do have a couple caveats as we're looking at the recommended plan designs around these numbers still being draft currently. There were other changes in the notice of benefit and payment parameters that was released. They don't specifically impact plan designs directly. So we haven't necessarily included them here since our focus is on those standard plan designs, but did just want to mention that. Okay, so the actuarial value calculator, this slide is just kind of a high level overview in case there's anybody that's new to these meetings. But this model is released by SOSIO each year and it's updated, generally updated each year. And this is the model that we are required to use to determine the actuarial value of a plan for purposes of determining compliance with the metal level requirements. So we are required to use this model to determine whether the plans fall within the required de minimis AV range. The calculator includes a lot of different inputs for various plan design features, deductibles out of pocket maximums, member cost sharing. So co-pays and or coinsurance amounts for several different service categories and then whether the deductible applies for those categories. As you can see here, it doesn't, it's not an exhaustive model. It doesn't include inputs for every single service category, but it does include some of the more common ones, emergency room and patient and primary care and so on, as well as pharmacy inputs. Just to note that some plan design features are not supported and not able to be input into the actuarial value calculator. So for these features, if they're considered substantial, an actuary can either modify the inputs to try and closely represent the plan design or they can actually modify the results of the calculator to account for these features. So this does require an actuarial certification. There are some plan designs, some of the standard plan designs that do require these adjustments. And so the actuarial values that you'll see on the following slides for some of these plan designs are the adjusted actuarial values and reflect the adjustments we've made to account for these features that are not accommodated. Another comment, just a note is that the AV from the calculator is different than the pricing AV that carriers will use to determine premium amounts. A couple of the major differences is that the federal ABC is based on summarized national data, whereas the carriers obviously would use their own experience and each carrier is likely to use their own model and that methodology, that underlying methodology may differ from the AVC. And then as already mentioned, not all service categories are represented in the AVC and so the carriers may have more granularity or specification for some of those service categories in their own models. So looking at the changes from the 2021 draft calculator, it's already been mentioned that there were actually no changes from the 2021 final calculator to the draft 2022 calculator. The methodology documentation cited the uncertainty around COVID-19 and trying to ensure kind of stability in terms of plan designs and with so much uncertainty around COVID and trying not to add additional changes to plan designs. So the 2022 draft federal ABC the underlying claims were not changed. There was no trend applied from 2021 to try to estimate claim costs in 2022 and really limited impact. So I believe Dana already mentioned all of the plan designs we're showing here because there were no changes to the underlying calculator there are no required changes to the plan designs in order to meet those de minimis AV requirements and maintain those meta-level certifications. Again, similar to the notice of benefit and payment parameters, I should note that the calculator is also still in draft format. So any potential changes between the draft version and the final version for 2022 could require additional updates to these plan designs. And this is just a chime in from that just to clarify that I think in the past we've done this before when things have been in draft and it's been more unlikely that there'd be changes with the draft being from the prior administration and then the new administration has put a freeze on any kind of draft regulations so they can kind of get up to speed we're still not anticipating any significant changes here but there is probably a slightly increased chance for changes to either the AV calculator or the notice benefit payment parameters given the new administration but we're cautiously optimistic given that the timing of these needed to be final probably won't give them a lot of time to make any significant changes but just wanted to flag that there's a little bit of additional uncertainty this year around that. Yeah, thanks Julie. One note before we start looking at the recommended plan designs, we are showing an estimated premium impact in the following slides. One of the key considerations in determining the recommended plan designs is trying to balance the premium impact of plan design changes along with the consumer cost sharing and trying not to have major changes to the member experience in that sense. So these premium changes that we're showing are based on Wakely's internal model. The actual premium change is going to be different than these values. What we're showing is really meant to isolate the impact of leveraging and the impact of the benefit design changes. We don't include impacts for just underlying medical cost trend, any network changes or really anything else that will go into the final premium determination by the carriers. And again, similar to the ABC, Wakely's using our own internal model but there will be differences in the models that the carriers are using as well. So these are just meant to really show the trade-off between benefit changes and premium impact but shouldn't be taken necessarily as like this is what the premium impact is going to be for 2022. So as we've mentioned a couple times because there were no changes between the final 2021 calculator and the 2022 draft calculator. As you can see in that table below, all of the plans did not have a change in AV. They all continue to be within the acceptable range for each of their respective metal tiers. But as you'll see in subsequent slides, we are still showing some recommended changes this year and we can kind of get into those. It's more to again balance the premium increases as well as the benefit changes. We did wanna note that the AV ranges for the HDHPs have been adjusted. So rather than having a minus four and plus 2% AV range around the standard range, we have a 0.5% cushion on the high end in order to reflect the waiving of the deductible for preventive prescription drugs. We've had that cushion for several years and we did discuss this with the carriers this year to ensure that that 0.5% amount is continues to be appropriate. So we did take a look at that. One other item that we wanted to mention is the bill S296 limiting out-of-pocket expenses for insulin, Adi briefly mentioned this. This limits the members total out-of-pocket responsibility to $100 per 30-day supply for insulin prescriptions. This would be new for 2022. This breaking out of just the insulin prescriptions is not accommodated by the federal calculator and so is a potential feature that could require an adjustment from the AV calculator output to the final AV. We did review national data and utilization information from the Vermont carriers to see if this out-of-pocket limit is meaningful and in order to develop the adjustments to the ABC output. What we found is that the impact is relatively small between the zero and 0.1% impact on the AV depending on the metal level. So the platinum plans tend to be at the lower end, the bronze plans tend to be at the higher end of that range. However, this impact does not push any of the current or recommended plan designs outside of that de minimis range. So the AVs here are not adjusted for this impact but again, this impact is relatively small and doesn't actually push any of them outside of the range. So just wanted to note that we did take a look at that and consider it in these plan designs. In past years, for those of you that have been on these calls before, what we've kind of done is taken a look at the metal level plan designs, the recommended and alternative and then have kind of a discussion around what the stakeholders considered in coming up with those recommended designs. For most of the metal levels, those conversations were very similar. So just as kind of an overview of how we determine the changes and blamed it on these recommended plan designs, even though the 2021 plan designs are all within the range and don't actually require changes from 2021, you'll see we are recommending some minor changes across all of the metal levels to increase cost sharing, which will limit the impact on premium. It also allows if we make some incremental changes this year, the ideas that hopefully in future years, the changes are a little bit smaller as well. So continuing to make some updates, consumers are used to some small changes year over year. So this is in line with what they would expect as well. And overall, the stakeholders are choosing to limit the impact on different services. So rather than spreading a lot of small changes across a lot of service categories, you'll notice we're hitting just a couple benefit features and benefit designs in our updates. So this slide is just a reminder of the changes that require approval from the Green Mountain Care Board. As was mentioned, small minor changes do not require formal approval. So you can see any copay changes, less than or equal to $15, co-insurance less than or equal to 5 percentage points, deductible changes that are less than or equal to $200, and out-of-pocket changes that are less than the federal out-of-pocket maximum increase as well, don't require changes. So we know on all of the following slides, we are showing all of the recommended changes, even those that do not require formal approval, and we've separated those out on the following slides. So any changes are shown in orange, and then any changes that also require approval from the Board are shaded in green to try and kind of separate just changes that don't require approval from those that do. So this slide is just an overview of the changes in the recommended plan designs from 2021 to 2022. We'll be going through all of these changes in more detail as we look at the plans individually. The one thing I do want to point out on this slide is that the only plan that actually has changes requiring approval is the bronze plan without the pharmacy limit, the bronze deductible plan without the pharmacy limit. So on this plan, we are looking at an increase to the medical deductible from $84 to $8,700, which is outside that range. So it does require approval. However, all of the other plan designs, the changes that we are recommending are below kind of those thresholds to require approval. We're also requesting approval of a change to the pediatric vision benefits. So we'll take a little bit closer, look at that on the next slide, but I did want to point out that that's included in the discussion. So for the pediatric vision exam and materials, these are an EHB. I think currently the cost sharing on these services varies based on the metal level. So platinum tends to have lower cost sharing, bronze has the higher cost sharing, so you can see it ranges from $20 to $85 for these services. So as part of the stakeholder group discussions this year, the group agreed to establish uniform cost sharing structure that doesn't vary based on metal level and doesn't vary across the plans. So in this case, the benefit would allow for $20, for a $20 optometrist copay and $20 copay on glasses or contacts per year or for one visit or a pair for the year. And then for the high deductible plans, this benefit would kick in once the deductible has been met per the requirements to be considered an HDHP. So it really improves access to vision care and supplies for children, kind of maintaining this uniform benefit across the plans regardless of the metal level. And the insurers have priced this to impact premiums between $10 and $20 per year at the most, but we have included that as one of the recommended changes though it's not explicitly included in the actuarial value calculator. So it's not necessarily reflected on the following slides with the plan designs by themselves. Okay, so finally getting into the plan designs. We'll start with the platinum deductible plan and kind of the structure as we go through the presentation will be the same for all of the plan designs. So the first slide we have is just kind of a history of the plan design and how this plan design has changed over time. And then on the next slide, we'll show the recommended and alternative plans that the stakeholders agreed upon. So for the platinum deductible plan, you can see that from 2014 to 2016, the plan design actually did not change. Since then, the deductible has increased most years though, not in the last couple. The out of pocket maximum has increased about every other year. And there have been back in 2020, there were some sweeping changes to the office visit copays. These changes were really to made to the PCP copay and specialist copays and other copays as well to maintain similar distinctions between those copays. So again, having a higher urgent care copay to encourage office visit use, that sort of thing. So maintaining those relationships across the different categories. So for 2022, the leftmost column is the 2021 plan design so that you can see the changes side by side. In the 2022 recommended design for this plan, we're really only recommending a $50 increase to the medical deductible. So from $350 to $400, you can see in this case, the estimated premium impact. We are still showing a slight increase to the estimated premium with this change. The 2022 alternative design is actually maintaining the same 2021 plan design. And you can see there, the premium impact is slightly higher because the federal ABC did not change this year. You can see that in the alternative design, there's no impact to the federal AV, but in the 2022 recommended design, there is a small decrease of 0.3%. But again, the theme is really trying to make some incremental changes in order to reduce that premium impact a little bit. Consumers are used to seeing some small incremental changes. And so hopefully making changes this year, even though they're not required, can result in smaller changes in future years. Looking at the history of the gold deductible plan, the changes here have been a little bit more sleeping, I think, than the platinum design. Similar to the platinum design, this plan was not changed from 2014 to 2016. Since then, the medical deductible and out-of-pocket maximums have increased most years. The pharmacy out-of-pocket maximum has increased about every other year. This tends to be somewhat in line with the changes to the HHP minimum deductible requirement. The changes that were made last year, in addition to the deductible and out-of-pocket maximum were an increase to the pharmacy generic and preferred brand copays. So some small changes there. Back in 2020, the PCP specialist office visit copays were increased as well. So here looking at the changes recommended for 2022, we are recommending an increase to the medical and pharmacy deductibles. The medical deductible is a $100 increase from 1100 to 1200 and a $50 increase to the pharmacy deductible, as well as a $200 increase to the out-of-pocket maximum. The alternative design, similar to the platinum plan, is just maintaining the current 2021 plan design. As you can see, doing that, the estimated premium impact is 0.8%, a little less than 1%, just maintaining the current plan design. However, the recommended plan design making those changes to the deductible and out-of-pocket maximum brings that premium impact down 2.3% approximately. Taking a look at the silver deductible plan, this plan has changed each year. So unlike the golden platinum plans, there were changes made between 2014 and 2016. Again, kind of similar story, the medical deductible and pharmacy deductible have increased most years, though they did not increase from 2020 to 2021. The integrated deductible and out-of-pocket maximum have increased, again, the out-of-pocket maximum increased most years. Last year, there were no other changes besides the medical out-of-pocket maximum and pharmacy out-of-pocket maximum. However, in 2020, there were several changes across different service categories, including the coinsurance that applies to inpatient and outpatient and facility services, as well as increases to the PCP and specialist office visit co-pays. So because there were so many changes made in 2020, the desire in 2021 was to keep the changes somewhat minimal. So again, very similar to the platinum and gold recommended plan designs, the recommendation for the silver deductible plan is to increase the medical deductible $200, the pharmacy deductible by $50, and the out-of-pocket maximum by $400. So this puts the out-of-pocket maximum of 85.50 is equal to the federal limit. And that's kind of been the trend on this plan design over the last several years is to increase that out-of-pocket maximum to the level from the prior year. So not taking it all the way up to the maximum, but sort of maintaining that same, a similar increase as the federal limit. Again, the 2022 alternative design is to keep the plan design the same as 2021. That results in a premium impact of about 1.5%. If there are no changes made, again, this is just meant to represent the benefit design impact and doesn't account for other potential changes that will lead to premium changes. So by making some of these changes to the medical deductible, pharmacy deductible and out-of-pocket maximum, that brings that premium impact down to 0.6%. So again, the theme here is really making some incremental changes to the benefit designs in order to balance those benefit, cost sharing changes with the premium impact changes. Looking at the silver HDHP option, again, kind of a similar story. The medical deductible has increased most years as well as the out-of-pocket maximum. The pharmacy deductible and out-of-pocket maximum is tied to the minimum deductible on HDHPs. That's that federal limit that is released in April each year. So that corresponds with those updates. The family deductible and out-of-pocket maximum on these plans, there is an embedded single out-of-pocket maximum that is a little bit different than the medical out-of-pocket maximum. So that amount began in 2016 and has tied to the annual federal limit each year. So for 2021, it was increased to 85.50. You'll see our recommendation is to again, tie that to the federal limit and increase it to the draft proposed of 9,100. The coinsurance rate on this plan has also been increased a couple of times. It hasn't been increased since 2018, but it has increased from where this plan started at 20%. So looking at the recommended plan options, as I mentioned on both the recommended and alternative designs, we are showing an increase to that embedded single out-of-pocket maximum to the federal limit of 9,100. Again, that number is draft. We're not expecting changes, but it could need to be updated based on the final regulations, as Julie mentioned. In the recommended design, we're also recommending an increase of $100 to the medical deductible. Again, this is to try and kind of balance some of the premium impact changes versus the cost sharing changes. So in this case, the 2022 alternative design really maintains the same 2021 plan design with the exception of that embedded single out-of-pocket maximum and results in a premium impact of about 1.3%. Again, based on Wakeley's models, whereas the recommended design is really a small increase to the deductible and brings down that premium impact of 0.9%. So in this plan, we are showing a little bit higher premium impact than we had on the previous plan designs that we have looked at, the platinum and gold levels. I'm still trying to balance those changes. I've kind of mentioned this, but I do wanna point it out. We've got that box here on the right of the slide mentioning the HGHP minimum deductible. So for 2022, that number is not yet known. It will likely be released in around April, sometime this spring. So for 2021, that number is $1,400. The pharmacy deductible and out-of-pocket maximum on these plans are aligned with that amount based on the regulations in Vermont. Therefore, if this number were to increase from 1,400, those plan designs would also need to update to match the minimum deductible. So as I mentioned, that amount increases $50 every two to three years. Generally, that's been the trend on that. The last increase was 2020. So it's possible that it could go up to 1450 this year, potentially next year. So we did take a look at the impact of increasing the pharmacy deductible and out-of-pocket maximum on these plans to 1450 in case it were to increase. And the impact is less than 0.1%, it's very small as far as the impact on AV and the premium impact we're showing here. So moving on, there are three bronze plans. So the first plan is the deductible plan with the pharmacy limit. This one is, again, very similar to what we've been seeing on the other plan designs. The deductible has increased each year and the out-of-pocket maximum has increased each year as well. This plan design has seen, the bronze plans in general have seen a much larger changes year over year relative to the other plan designs. The impact of the changes on the ABC have significantly increased the bronze plan designs historically or increased the AV on the bronze plan designs historically. So much larger changes are needed to bring those designs back into compliance with the de minimis range. In 2021, I do wanna point out that last year, there were actually a couple benefit enhancements to these plan designs. So previously the drug deductible applied for all scripts. Last year, the decision was made to waive it for generic scripts. And similarly, the generic copay was reduced from $20 to $15. So the bronze de minimis range has a upper bound of plus 2%. It actually has an upper bound of plus 5%. So it could go from up to 65% if there are certain plan design criteria met. And one of those is waiving the deductible for significant benefit categories including generic scripts. So by waiving the deductible for generic scripts, we actually are able to have kind of a higher AV on this plan. And so in order to meet those requirements, the decision was made to waive the deductible on generic scripts for the plan design last year in order to get kind of that increased range on the applicable AV. So looking at the recommendations for 2022, again, we're really looking at just increasing the medical and pharmacy deductibles as well as the out of pocket maximum. In this case, the 2022 recommended design is a $200 increase to the medical deductible, $100 increase to the pharmacy deductible and a $300 increase to the out of pocket maximum. This results in a approximately a 1% premium impact. The alternative design actually further increases the medical deductible and out of pocket maximum, but has a smaller premium impact at about 0.6%. So this trend, I guess is a little bit different than what we've been seeing on the other plan designs where the recommendation was really to leave the plan design or the alternative was really to leave the plan design alone. The premium impact that we're estimating for these plan designs of leaving it alone was significantly higher than on the other metal levels. And so in that case, balancing that premium impact and the benefit changes was a lot more difficult, I think, in terms of trying to decide where that balance is. So in this case, we are showing a little bit higher premium impact on this plan under the recommended design than what we were seeing on the other metal levels, but it was really about making sure that the changes to those deductible and out of pocket maximums was limited and ending in that trade-off between those benefit impacts and the premium impact. On these plans, because the deductible and out of pocket maximums are so high, it requires much larger changes in order to make kind of an impact and make a significant impact on that premium amount. One thing I do want to note here, so the 2021 out of pocket maximum is set at 85.50, that's the federal limit. So the draft proposed limit is 9,100. Both of these plan designs are within that range. However, as Julie mentioned that there is potential that there could be some changes between the draft and final regulations. So if that comes in anywhere lower than 8,700, the these plan designs would need to be updated to be in compliance with that limit. So not expected, but did want to mention it as a potential possibility that those amounts could come in slightly lower and would need to be updated. The other thing I want to mention on these plans is the recommended plan design. All of the changes are below those thresholds requiring formal approval. However, under the alternative design that medical deductible increase of $250 would require formal approval. So this is the first plan that we've really seen changes that are above that threshold for formal approval. The next plan design that we'll take a look at is the bronze deductible plan. This one does not have the pharmacy limit applied. This was a new plan that was introduced back in 2018. So there isn't as much history with this plan. And the idea was that it really was to give more access to office visits before the deductible and have an option for members who maybe don't expect to use as many pharmacy benefits or those sorts of things. So to give kind of another option for members under this bronze plan because the changes were so high on the other plan. So the medical deductible and out of pocket maximum has increased each year. You can see that these are set equal to each other. So the idea on this plan is that a member could access office visits for a copay as well as generic scripts prior to having to meet the deductible and then for any sort of facility services or imaging that sort of thing. The deductible would need to be met but once that deductible is met those services are covered in full. So in line with the recommendations on the other plans as well as the changes that we've seen on this plan over the last several years the 2022 recommended plan design is increasing the medical deductible and out of pocket maximum from 8400 to 8700. The alternative design kind of similar to the last bronze plan does still increase the deductible and out of pocket maximum even though changes are not necessarily required. And again, this is to really try and balance the premium impact. So you can see on this plan design even with the $300 increase to the deductible and out of pocket maximum that premium impact is approximately 1.1% which is the highest premium impact we've seen on any of the plan designs we've looked at so far. And under the alternative design it's a smaller deductible and out of pocket maximum but again a larger premium impact. And similar to the last plan that annual limitation on cost sharing is draft at 9100. So these do meet that requirement but if it were to come in below the 8700 that we're showing here adjustments would need to be made to this plan design. This plan design, the recommended design does require a formal approval that medical deductible increase of $300 is above that threshold. So that has been shaded in green here on this slide. The last plan design that we have to look at is the bronze HGHP. Similar to the silver HGHP this has that embedded single out of pocket maximum that is tied to the annual limitation on cost sharing each year. So you can see that has increased every year since 2016 in kind of this middle section here. In addition, the medical deductible and out of pocket maximums have increased most years and the pharmacy deductible and out of pocket maximum again is tied to that minimum deductible for HGHPs which is that federal limit that has not yet been released for 2022. The changes from 2021 were fairly small. The deductibles were maintained from 2020. The only increase was really to that medical out of pocket maximum on this plan. So looking at the 2022 recommended designs the recommendation and the alternative are very similar. So under the recommended design we're looking at a $200 increase to the medical deductible as well as the out of pocket maximum. Again, we've increased that embedded a single out of pocket maximum to the draft proposed limit of 9,100 consistent with where that has been set in prior years. And under this recommended design we are showing the largest premium impact of any of the plans that we've looked at at 1.3%. So again, kind of the trend across the board with the bronze plan designs is that it really requires much larger changes to impact kind of that premium impact and bring that down. The alternative design is the same as the recommended the only difference is that that medical out of pocket maximum is at 7,000. Again, the deductible changes on this plan really have a minimal impact in terms of the premium impact. So under the recommendation that additional $100 increase to the out of pocket maximum really brings down that estimated premium impact a little bit, but again, it's pretty high. So the stakeholders I think went back and forth quite a bit on this plan design trying to determine the most appropriate balance for the members in terms of deductible increases and benefit increases while also trying to keep in mind that that premium impact change. So on this plan design similar to the silver HGHP the pharmacy deductible and out of pocket maximum are tied to that HGHP minimum deductible. So for 2022, if that were to increase from 1400 this plan design would need to be updated to align with that new amount. Again, the AV impact and premium impact of changes there are very small. And then the other item that we wanted to mention is that the HGHP out of pocket maximum for 2021 is $7,000. We anticipate that that will come in at 7,100 for 2022 just based on historical increases and how that amount is determined. However, because that amount has not been released and is not known and finalized yet if it were to come in lower than 7,100 this recommended plan design we'd likely need to move to the alternative design. Again, this plan design does not require formal approval. All of the changes are below that threshold. So the only one that really requires approval is that bronze deductible plan without the pharmacy limit. So that is all of the plan designs. This slide again, just highlights the changes that we went through in terms of those recommended plan designs. As I mentioned, the bronze deductible plan without the pharmacy limit is the only one that actually requires formal approval. And then in addition to these plan design changes we're also requesting approval of the change to the pediatric vision benefits that I discussed towards the beginning of the presentation. So at this point, I'm going to open it up for questions and discussion on the plan designs if there's any slides that we need to go back through or anything, please let me know. Great, thank you. We'll go in reverse alphabetical order and I'm gonna start with Maureen. Maureen. Okay, thanks. Just a couple of questions. I know there's only really one change that we need to approve but just looking at your premium, the estimate of your premium impacts which I know is just an estimate. They're relatively low other than for the bronze plan and just wondering historically how close have you been? And when I mean relatively low they're half a percent increases or less in most of the cases. And so that would seem pretty reasonable for a premium change but just wondering if we look back at last year which I didn't do, how would that compare how would it compare to what actually happened and what you guys were predicting? Yeah, so I don't think that the there it's kind of an apples and oranges comparison to be perfectly honest. So the premium impacts that we're showing on these slides are really meant to show just the impact of the benefit changes. So the leveraging of the deductible and out of pocket maximum and those sorts of things we're not including like this 1.3% that we're showing here on the bronze HTHP doesn't account for just the underlying claim cost trend any network changes or any of those other things that really go into the premium change. So it's not really a direct comparison, yeah. And then just a couple of questions on the out of pocket maximums. When we look at the HTHP plans compared to the base plans for either bronze or silver it's just interesting that over historically if you look back maybe five years ago the out of pocket would be higher for the HTHP and then every year they've had relatively small changes and now the base plan is a lot higher for silver compared to the HTHP or for bronze it just seems counterintuitive and I just wonder why it's not that we're gonna change that but it just seems if I got an HTHP high deductible plan that my out of pocket would probably be higher than it would be for the base silver or bronze. Yeah, so these are really increased based it's formulaic the way that those are increased and it's a regulatory requirement the way that those are increased. So they just, the bottom line is they're different calculations and they don't align necessarily. But yeah, so you can see that we're estimating that the out of pocket maximum for these HTHPs is only gonna be a $100 increase from 2021 to that 7100 whereas on the base plans we're seeing I think it was a $550 increase and it really has to do with the calculations I think underlying those requirements and yeah. Start to consider when you look at what your out of pockets would be for that and I guess similarly the silver seems to be catching up to the bronze on the base plans like over the years it's getting a lot closer than you would see for like the gold and silver has a pretty good disparity. I think it was what like 5400 and the silver is what 87 or 8550 and the bronze is 87. So they're getting pretty close to the silver and the bronze, but there's just a comment. And that's all I have. Thank you, Maureen, Tom. Thank you for all these moving parts. I wanna pick up a little bit on where Maureen was talking about the relationship of these medical deductibles and premiums and in your answer to her kind of you kind of imply that it's very hard to be predictive about the premiums because there's so many moving parts and things you don't know and by the time it gets to us in rate review there will be a lot of activity and input. And so I'm just wondering from the point of view of affordability and thinking about the members out there whether or not having the lower deductible is a fix because that's not gonna change between now and we get to the end whereas the premiums it is there's so many moving parts we won't be able to trace whether or not your calculations hold true or have a lot of merit. So I'm just so that discussion must have occurred to some extent about whether or not to kind of be sure that we're doing the best we can for the members in terms of a lower deductible as opposed to relying on somehow that higher deductible filtering through to the premium. Yeah, so what I will say on at least on the bronze plan designs and what we've heard anecdotally is that members buying these bronze plan designs are really shopping on premium. They're purchasing the bronze plans because they have the lowest premium and so they're very premium sensitive. And so I think that's one consideration on the bronze plans whereas on the silver plans a lot of those members are receiving federal subsidies that the APTC subsidies and so they may not feel the premium impact quite as much as of I think that the considerations between the different meta levels can really kind of vary depending on which meta level you're looking at. And so it's definitely a consideration. I think that the stakeholders are making when we're looking at all of the different plan designs and I should mention that when we were discussing with the stakeholders here we're showing kind of a recommended and alternative but on a lot of these plan designs we looked at several more options and kind of landing on these couple options that we're showing here. Again, trying to really balance kind of the benefit changes and the premium changes but it is a difficult discussion especially on I think the bronze plan design where those deductibles and out of pocket maximum they're so high to begin with. And this is Julia, one thing I'll add I think Brittany covered most of it but in years where they've had a prior year where the AB calculator wasn't updated and then the next year it took a pretty big jump in terms of how much the AB shifted and so then the members saw a huge change in their plan designs. So I think we're also trying to hedge a little bit in case that happens that members see more of a modest increase year over year as opposed to potentially in 2023 seeing or a really large change in their plan designs. Hard to know what's actually gonna happen with the AB calculator next year with the new administration but again based on what we've seen historically. I just want to echo what's been said but bringing up the exact balance that we're trying to reach between out of pocket increases and anticipated premium increases knowing that at least for the population going through the exchange if they're eligible for APTC they will have some significant premium protection there but and then as Brittany said too it's especially challenging in the bronze plans we find there's a lot of discussion among the stakeholders about which leverage to go for among limited choices. Well, I appreciate all that. I just wish there was a solid way as a board member you could follow the bouncing ball through the system. It does seem to me that if the deductibles are lower that's a guarantee that members out there will that will be their experience. Whereas with the premium there's just so many moving parts but I get it. I was also spent some time kind of looking at the kind of five year increase in the medical deductible trends. I know it's not a kind of a flat line but if you look at the platinum medical deductible from 2017 to 2022 the proposed one that's an annual rate increase of 12.5%. The gold is 7.2%. The silver is 9.6%. The bronze with the RX limit is 7% and the bronze without the RX limit is 5.8%. And so though for me those numbers are the growth of those numbers is all part of the affordability issue and your definition of affordability is to balance the impact of premium versus consumer cost sharing. But I'm just caught by the fact that these deductible, medical deductible rates are growing at that kind of rate and premiums are also except for this last year. I think it was a good job was done. So I think you've answered my question. I just wish I could get my arms around, what would be the premium increase if the deductible stayed flat? Something that kind of gives some real insight into that decision. And I'm not sure that it's, as I said we could follow the balancing ball. Another area that I was looking at was the premium cost shift. And this maybe is more for Dana than for you folks as actuaries, but you did do that study for under Act 63 in terms of mitigating to some extent the premium cliff at 400% of poverty. And there was one option in there that for those folks would have lowered their contribution by about 10% and would have cost the state about $2 million in the state share. And I'm just wondering if as part of this process for this year, the conversation came up as to the recommendations into Act 63 and the possibilities of mitigating to some degree the premium cliff at 400% of poverty. Well, to be honest, that really wasn't a lever we believed we could impact this year in our discussion in terms of the premium impacts versus the FPLs. You know, again, there are very limited levers that we have available to us. This is Julie, I mean, I'm not sure if the plan design stakeholder group has the authority to change premium subsidies, but one thing to keep in mind is there is some expectation that the new administration is considering getting rid of that cliff. They're actually considering making several changes to the federal premium subsidies, getting rid of the cliff, lowering the income threshold, fixing the family glitch, I think. What actually comes through is still to be determined, but it's possible there might be some relief, whether that's for 2022 or further into the future, we're not sure yet. Yeah, I've seen that in some of the administration transition literature that is on somebody's screen to look at. I was just wondering whether or not given the work that you folks did as actuaries, whether or not it stayed on the shelf or got pulled off the shelf and there was some life that might have been breathed into it. The other issue is probably again more for Dana, is that I'm interested in the Vermont's benchmark plan and have expressed this now for a couple of years and where CMS has made more flexible the ability of states to change its benchmark plan so far and Illinois, South Dakota, Michigan, New Mexico and Oregon have done so. And I hear through the grapevine that we're starting to explore that opportunity and maybe this is more of a statement than a question, but I'm really hopeful that the focus of that effort is on prevention and maximizing prevention and alignment with our all-payer model goals, rather than opening the thing wide open. And as one of my fellow board members had said that the initial process was somewhat of a food fight and so trying to mitigate the food fight as much as possible in order to emphasize prevention, which to me is also an affordability issue because that's part of the basis of healthcare reform in Vermont that preventing of chronic diseases will save money. So I'm hopeful that Diva and maybe you, but at least Diva can come back to the board in the near future and explain this emerging effort to revisit the benchmark plan and profile for the board, what the moving parts are and what the hope for outcomes are. And with that, that's all I have. Unless Dana has some insight into this benchmark plan process. Abby, are you still on the call? Yep, I am. I'm happy to address that. Yeah, thank you for raising it. We, I think you know Diva doesn't have authority or jurisdiction to look at the benchmark plan in a vacuum, but we have been collaborating with DFR as well as your staff to put together a process to reexamine the benchmark plan. So I think we'd be happy to continue that conversation and in collaboration with our colleagues. So do you think you'll have enough focus on it in maybe a month or so to be able to come for the board and say, this is still a draft of work in progress, but this is kind of what our intentions are. I don't want to speak for DFR or the agency, but I think the hope is that we will have a better handle on the study that we would be engaged in in the next few weeks. Great, thanks a lot. Thank you, Tom, and I just want you to know, Tom, that Susan told me that when the new administration gets rid of that benefits cliff, we're supposed to thank you because you've been the, oh, it's spoken critic on that for a long time. No, no, no, that was not my conversation with Susan. Susan told me that President Biden was a friend of hers and that she had asked him to do this and he was going to get it done for her. Okay, we'll move to Robin. Thank you. I don't have a ton of questions. Thank you for coming back with the enrollment numbers. I always love to be able to see that. So I appreciate that. I think the one thing I wanted to also comment on was really not related to this particular decision, but as things evolve at the federal level, I think it would be particularly if there are any rule changes or guidance changes that happen prior to our QHP premium setting process, it would be good for us to be updated on those things so that when we're making those premium decisions, it's within the new, you know, any new federal context. So we may ask if you could help us with that, Addie, at some point in the future. And then we may not get much between now and then, but it would be interesting to see if we do. But otherwise, I think that's it for me. Thank you, Robin. Jess. Okay, thank you. I appreciate all the hard work here. It looks like there's still some uncertainty, but mostly these are tweaks kind of at the margin that don't require our approval, but for one. So I guess I'm gonna ask you a higher level question here. And that really is Dana, you outlined some benefit design principles right at the beginning of the presentation. And I'm wondering how they incorporate some of the benefits and some of the principles of value-based insurance design. How do we leverage? There's a whole growing literature, right? On cost effectiveness research. So how do you, you know, I didn't see it on that on your benefit principles, but how are you leveraging some of the, you know, evidence that we have about what is high value care and what is low value care as you're designing cost sharing within specific categories, right? Not all radiology imaging is cost effective or high value. Not every ER visit is warranted or cost effective or high value. Not every outpatient procedure is high value. So how do you think about insurance design to start to encourage the high value kind of care that we wanna make sure that people are getting? I know there's often 0% co-pay or, you know, on preventative care, wellness visits. But I'm also thinking about diabetes treatment, tobacco cessation, things like that, where we really wanna encourage people more to do more. But we really, there's certain procedures, diagnostic imaging that we know have low value. And how do we start to discourage that kinds of over treatment or not cost effective treatment within the design principles that you have for these plans? And how much leverage do you have to do that? Well, thanks for raising that. We opted not to make that part of our formal presentation this year, but I can say that we, as a stakeholder group, did take a close look at the federal guidance around that currently exists around VBID options and with Wakeley's help had a close look at what might be potential opportunities for Vermont and discuss that. There were no, and I can say, it would have been easier if there was some clear winner there in terms of which services to focus on first, but there really wasn't. That's not to say that there is no value in the exercise and that we wouldn't attempt something in future years, but between the complexity of studying this and then for issuers to implement some kind of a change, we determined that we needed to discuss it more as a stakeholder group, but we're absolutely committed to that and continuing it for hopefully a blended into our plan designs for next year is our hope. Some kind of a meaningful benefit change that does take up these principles of a trade-off of encouraging certain high value care through cost share manipulation in exchange for perhaps raising cost share for the quote, unquote, lower value services. So I guess I'll answer that right there, go ahead. Is the stakeholder group gonna continue? It sounds like there needs to be more conversation and more time. So I guess what I worry about is that if you wait until next November to have those conversations, it'll be another year and it won't happen. So I guess I'm just wondering, is there expectation or hope that you'll continue these stakeholder conversations over the next few months so that by November, there's hope to kind of hit the ground running on VBid? Yes, we wouldn't pause conversation until next November it would continue between now and then so that we should be prepared with one or more recommendations for next year. And this is just to elaborate a little bit, I think on where our latest thinking is and Dana, if it's changed already, let me know. But as we went over, again, based on what CMS had proposed was based on a University of Michigan study in the 2021 Notice of Benefit and Payment Parameters, they kind of had a list of high value services that they thought should be a kind of a zero cost sharing and then a set of a couple of different brand drugs which be at a reduced cost sharing. I mean, yeah, a list of kind of overutilized services that maybe cost sharing should be increased. So we looked at kind of the impact, particularly focused on the high value services unless so on kind of the impact of raising cost sharing for the low value. And so we kind of originally had the discussion around if there are certain drugs that should be targeted, but where we left off, it was one of the issuer suggested potentially including adding another tier to the drug benefit where some of these high value services might go and we could adjust the cost sharing. But again, yeah, given the timing, the implementation and the analysis around there, it wasn't there. So I think that was the latest thinking but everyone was checking to see if it was operationally feasible to do that and getting some additional feedback. Well, cautiously optimistic. I don't know, Julie, if you're willing to share some of that Michigan study and the CMS recommendations with me, I'd really appreciate that. And as we're thinking about regulatory alignment and really having all of our regulatory processes be focused on cost effective, high quality, low cost outcomes for Vermont or as it seems to me that this contributes to that conversation. So I'd appreciate any materials that you could share with me on that work. Yeah, I think we provided an Excel file that analyzed again the impact of, and it was based on a weekly study. It was not Vermont specific. So it was looking at national data. But it looked at the impact for each of the different items listed in the CMS study. So I don't think there's any problem with sharing that with the agreement on care board. That'd be fantastic, thank you. So thank you, Jess. And just want to say that I think that Robin made a very excellent recommendation to have a future discussion about the federal changes and Susan, if you could mark that on the calendar for whenever people are ready to have that discussion, it would be great. At this point, I'm going to open it up for public comment and I see that Dale Hackett has had his hand raised, Dale. Yes, I've been listening and it's a little difficult to understand all of it. I mean, I could use a few more hours going over this. But I've noticed like with the changes that can be made that don't even have to go before the Green Mountain Care Board. I don't think it's hard to see that for the consumer, you can get an increase in premiums and you can also get an increase in what your co-pays are. And it is an ongoing basis every year that this is going to happen, does happen. And then when I stop and think about other conversations I hear about cost of daycare and so forth, I doubt they get the raises that will cover even these type of increases that happen every year. It's just frustrating. I don't know what to do with this. I just don't think we get it because we work with it and we know how complicated it is. But I really don't know how to explain this to the consumer that this is really runaway costs. On top of that, I was very curious of the benefit for this idiotic vision. I'm wondering, does that cover everyone, including any child that has really expensive glasses or is there a cap? And I'm probably thinking of when I was a child because I probably had some of the most expensive glasses you can make. I mean, that's just the way it's always worked for me. So I'm curious if there's a cap on that. Hi, this is Dana. No, my understanding is that it's not, there isn't a upper limit other than that cost share applied to it in being once per year for the exam and hardware. Okay, thank you for being one a year or two because with children, your vision can change very dramatically from year to year and it's important to keep up with that. That's all my comments. Thank you, Dale. Julie, I see you have your hand up. Is that a mistake, Julie? That was a mistake, sorry. I thought you had something to add there. No, probably just click on a lot of buttons and click the wrong ones. Okay, is there any other public comment? Hey, Kevin, it's Walter. Walter, go ahead. Yeah, I can't keep it on Microsoft Teams so I'm in on the phone. I just want to, more of a comment, well, there's one question and then a couple of comments. The question is, are there subsidies going to equal some of these raises? That's the question because there's absolutely no way that a person making 10, 12, 15 bucks an hour can afford any of this. And I wonder what bubble these, the people who designed these plans live in, but it's certainly not the same world that we are in. And I just want to back up what Dale has said about that and what Tom has said about affordability. These are simply unaffordable and they go up every year. And with all the plan changes and designs, we don't get anything that much or even better for the constantly rising costs that our wages can't keep up with as we don't get raises of 10, 20, 30% every year. So this is a good argument for Medicare for all, really. I just, you know, I can't really. Excuse me, go ahead. But no, that's it. I can answer a portion of your question that the 2022 subsidy levels will be determined once we have the, once the rating, the plan rates are determined because that's all, then that is part of a calculation for subsidy. And I can say that they have had a general increase each year, it's not the same each year. And it's also not possible to know plan over plan exactly how, how we'll change. But, you know, until we have those specific rates for 2022 that factor into subsidy, then we'll know. Yeah, and Dina, this is Brittany. I'll just add that your comments are specific to the premium subsidies, but some of these members will also be eligible for the cost sharing reduction variations on the silver plan, which reduces their cost sharing. We, because the AV calculator did not change, we did not change the CSR plan design. So though the cost sharing for all of those plan designs and the deductibles for those plan designs will be the same as 2021 because these members, you know, it's tied to that base silver plan. We didn't necessarily have to carry through those increases. So I did want to point that out. That is included in the slide deck in appendix A, those plan designs as well, though they don't require formal approval either. Okay, other public comment? And I had a suggestion to that last point, which is I wonder if we could also, I think in the, I don't remember if we get this every year, but in the past, we have gotten the enrollment into the CSR because that will give a sense for folks of, you know, how many people are cushioned essentially from any deductible changes proposed this year since the CSR variations aren't changing. I'll make note of that. I don't believe that would be any problem to provide that. Thank you, Dana. Other public comment? If not Dana, Addie, Julie, Brittany, it's been a fascinating discussion, a lot of information here, not a lot of significant changes and we'll be back on this topic, I believe next week. So we may be in further touch if some things pop up for questions from specific board members between now and then and give you a heads up, but other than that, thank you very much for a very informative presentation. Board members, is there any old business to come before the board? Is there any new business to come before the board? Hearing none, is there a motion to adjourn? So moved. Second. It's been moved and seconded to adjourn. All those in favor of the motion signify by saying aye. Aye. Aye. Those opposed signify by saying nay. Thank you everyone and have a great rest of the afternoon. Thank you. Bye. Thank you all, good to see you. Thanks. Thank you.