 Good afternoon everyone and welcome to the Green Mountain Care Board. My name is Kevin Mullen, Chair of the Board and the first item on the agenda is the Executive Director's Report. Good afternoon Mr. Chair and your lovely dog. So I do have a couple of updates to the public comments and schedule as well as the upcoming schedule. First I wanted to let folks know that we are currently accepting public comments on the Essential Health Benefit Benchmark Plan proposal that was presented on January 26th by the Department of Financial Regulation. We are extending that public comment period so we want all public comments should be submitted by close of business February 25th in order to be considered by the Board before voting and the Board is now scheduled potentially to vote on this on March 2nd. So then that also updates the schedule for next week we will be getting additional updates from folks at DFR as well as the Director of Healthcare Reform and then we will take this back and vote on March 2nd. So all of that information is on our website. Also we have ongoing public comment regarding a potential next agreement with CMMI and we are taking those public comments and have been for the last year or so. We are sharing any comments with our partners at Agency of Human Services as well as the Governor's Office as they are leading the negotiations on a potential next agreement with our federal partners. And just a quick announcement about next week the primary care advisory group will be taking place from 5 to 7 or 5 until when it ends next Wednesday, February 16th. And that is all I have to report. I'll turn it back to you Mr. Chair. Thank you very much Susan. The next item on the agenda are the minutes of Wednesday, February 2nd. Do I have a motion? So moved. Second. It's been moved and seconded to approve the minutes of Wednesday, February 2nd without any additions, deletions, or corrections. Is there any discussion? Hearing none, all those in favor please signify by saying aye. Any opposed signify by saying nay. But the record shows that the minutes were approved unanimously. So the agenda item for today's discussion is the DEVA 2023 proposed update on the QHP. So Dana or Sean, I'm not sure who's teeing things off, but whenever you guys are ready go ahead and take it away. Good afternoon everybody. Thank you. I'll start us off. Thank you for having us back. Following up on last week's meeting to present the proposed plan designs for 2023 for the standard QHPs. So today I'm joined by Sean Sheehan from DEVA and our actuarial partners from Lake Lee Consulting, Julie Pepper, Brittany Phillips, and Brook Steiner, I believe this as well. So we do have a few things prepared to discuss today with you and then obviously we'll go to questions, but if it's all right, I'll start things off. Sounds great. Okay, let me share my screen. So first I'd like to circle back to a question that we remember lingerie's last week about why the choice was made to propose the three office visits, primary care and behavioral health at the silver and bronze level and not the platinum and gold. So I'd like to revisit that and show you some modeling that you did not see last week. So this was in the handout that was distributed to you folks, I believe yesterday or late Monday. So what we talked about last week, this is the platinum plan design. We have the recommended plan and the alternative plan here that stakeholders were putting forward. Want to point out that this is modeling for three PCP visits that is like the recommended plan with the same changes here, the addition of the three PCP or mental health visits. And so it raises the AV probably behind the scenes, it's a rounding thing and then really no difference with the directional impact on premium. We wanted to model that out for you. As I said last week, the way we approach our discussion around each plan is we start at the platinum level and work our way down to the less rich plans and early on stakeholders made the decision that at least at the initial presentation, we would not go with proposing PCP visits at the platinum or gold level thinking that for these richer plans is less of a valuable add to the benefits. And then also not knowing exactly how the board would react to the proposal for these visits. Again, we felt we would start with proposing it in silver and bronze, not platinum and gold, but here they are for you to see. Then moving on to the plan. Again, this alternative plan two over here is identical to the recommended plan with the addition of the first three PCP or mental health visits without cost share. And this one just want to point out that brings the AV to the very top of the acceptable de minimis range here at 82%. But for both platinum and gold, it is in fact it can be accommodated in compliance with the AV ranges. As Brittany said last week, but for the reasons I mentioned, we did not propose those, but certainly wanted to show that to the board as one additional alternative beyond what the stakeholder group has recommended with the recommended plan. And the first alternative, there's the second alternative plan for those two. So I hope that's helpful. Are there any other questions about the platinum or gold deductible plans? Any questions from board members? Not a question, but I did want to say thank you very much for bringing back the modeling. It's super helpful. Okay, good. Brittany or others from Wakeley, are there any things that you wanted to add that I may have missed? All right, good. I'm glad that was helpful. We certainly wanted to present things transparently. There was a lot of discussion at all of the all of the metal levels. And you know, again, we can see the value of the free PCP visits, but it comes especially at the silver and bronze levels. It comes with some tradeoffs that can be a little bit uncomfortable in terms of other cost share. So good. I think now, Sean, I would turn it over to you to give us a walkthrough of the 2022 January enrollment picture. Sean, do you have that to share or do you like me? Do I have it right here? Sorry. Yeah, Dan, if you want to share it, that'd be great. Here we are. Okay. Can you just tell me when you'd like to advance, Sean? Can everybody see that? Yes. Absolutely. And so this should look familiar format we've done in past years on the on the left. You have the covered lives. This is a snapshot as of January 2021 fluctuated in enrollment. This is this is the individual enrollment on on exchange enrollment here. So it's not not including the direct the direct enroll qualified health plans, which is last January was it was about 7500 or so. And then on the on the right, you have the as of last month, the January 2022 covered covered lives. So a couple, couple things to point out there at a high level, just in terms of numbers of overall enrollment, you'll see the see the uptick there, which we attribute largely to it's about a 5.2 percent increase from that 24,215 enrollment up to the 25,470. A lot of that is going to be the the direct enrolls transferring over we both Blue Cross and MVP. In addition to the state have been reaching out and getting the message out about more people being able to take advantage of the subsidies. So we still have more work to do on that front. The issuers are continuing to conduct outreach to their members, letting them know that they're not tied to to open enrollment to transfer their plan they can do at any time of year. We put out a press release from diva to that effect a couple weeks ago as as well. And but the other the other kind of overarching factor or behind the scenes factor maybe is is the continuous coverage requirement with with Medicaid. And and so that that was what led to kind of put this in context the numbers you would have looked at last year looking at January 2020 to January 2021. That was a 7.6 percent drop in enrollment from 26,219 in 2020 down to this 24,215. That that drop largely attributed to with the public health emergency and that continuous coverage requirement means that the the Medicaid to qualified health plan churn which is usually two directional for the last two years has just been one directional. So anybody who qualifies for Medicaid at any point moves into the into Medicaid but when their income moves above they don't don't move out of it. So as a result the Medicaid caseload is up over 30,000 in the last two years once that unwind happens we we expect a proportion of those to come in. So I think that that drop big drop we had from 2020 to 2021 the overall QHP individual both through the marketplace through Vermont Health Connect together with direct enroll should be pretty stable from from 21 to 22 and the reason we expect not having that drop even though the Medicaid numbers were continuing to grow but the people that moved into Medicaid were offset by like the way people coming into qualified health plans hopefully in in response to those expanded subsidies which Vermonters benefited from more than any any other state according to a federal report this this fall. So that's the overall context we have the numbers on on this on this slide as far as raw numbers of covered lives in the plans. If we go to the next slide we have the proportions here the percentages so you can see in terms of each types of plans which ones are you have the biggest enrollment and then on the next slide will be we don't have to go there yet but the next slide will show the you know the change from the from the year to the year so you don't have to do the do the math in your head looking at these at these pieces but you can see those standard deductible plans you know still are the biggest you know the biggest in terms of the largest proportion of of plans with high deductible plans having having smaller but but you know are gaining there going up to you know 22.7 between the between the standard and non-standard high deductible plans but still you know over over three quarters of people in deductible plans and they're close to half well over over half in the in standard plans between the deductible and the and the high deductible if anyone wants to talk here ask questions we can always flip back to it but they know let's let's flip to the next slide first just to see the see the heat map here of what's what's hot and what's what's cold looking at 20 the change in in covered lives from January 21 to January 2022 which actually I should have referenced earlier as well the one other kind of wild card in addition to people transferring from direct enroll into the marketplace the issue with the subsidies the issue with the the Medicaid continuous coverage the other factor is that open enrollment was longer this year than in most of the last few years open enrollments ended on December 15th meaning that January is typically the the peak of the highest you know highest enrollment of the year with this year with an open enrollment running through January 15th we people who came in between December 16th and in January 15th will have a February start date as a result we would expect those February effectuated enrollments to be the high point of of this year as opposed to to January and as I referenced it was just January over January in the marketplace was up just over five percent we expect the February over February to be up you know six to seven percent based on the number of plan selections we had in kind of applying if we have a consistent proportion of people actually making their their initial binder payment and effectuating we should be about six to seven percent up February over February looking here starting at the catastrophic you can see that drop there again it's not big on the right is only a drop in 73 covered lives but it is a 31 drop as we don't have many people in catastrophic plans that's one to call out that during this open enrollment we we did more active outreach and and hold hand holding to a few groups of people one of those groups was people enrolled in catastrophic plans because of the expanded premium tax credits under the American Rescue Plan Act people who people could have quite quite a high income and receive premium tax credits that they could apply to a bronze through platinum plan but they still can't apply it to the catastrophic plan that's a similar dynamic to what we had before but before when you had that subsidies capped at four times the federal poverty level if your if your income was above that four times the poverty level about fifty thousand fifty one thousand dollars for an individual a catastrophic plan could make sense now with those higher subsidies you'd have to have a much higher income and you'd still be able to get a bronze plan for a lower net premium than a catastrophic plan so we did phone calls out outbound and emails outbound to people in catastrophic plans encouraging them to look at the plan comparison tool look at all their options and and that's where you see that thirty one percent drop I think part of that is the impact shown there the one of the other pieces you see really with the the silver variations in the the silver seventy three percent seventy seven percent eighty seven ninety four percent those are the cost sharing reductions level levels which the increasing generosity is at the lower income levels so people at ninety four percent and eighty seven percent are the people whose income would be less than twice the federal poverty level so for an individual about under twenty five twenty six thousand dollars for a for a family of four under fifty fifty one thousand dollars or so people just over the Medicaid level and so as I was referencing before with that one-way churn going into Medicaid but not coming back we saw our overall numbers from twenty twenty one to twenty twenty two increase at the higher income levels kind of hold their own at the two hundred to three hundred percent level and drop in the under two hundred percent level again that wouldn't be a really be a surprise when you think about those income churn and people you know being more likely to move from the lower income levels into into Medicaid and not come back but when you see that silver eighty seven ninety four the drop you know those are the people who when they are in are eligible for the eighty seven and ninety four percent we do significant hand holding to them as well if they happen to be in a bronze gold or platinum plan letting them know the benefits of that silver plan and particularly under the American Rescue Plan Act how they're virtually guaranteed to have lower total costs being in a silver plan but that that drop is more more due to the overall drop in people at that income level as they're moving to med to Medicaid so we expect when the when we start unwinding from the public health emergency those numbers to come back up and we have plans in place to help people with their plan selection and seeing the benefits of the cost sharing reductions as well beyond beyond that and we have the one more slide Dana right on the the yes this is the focused look on the on some of the particular plans great perfect yeah thanks so yeah so this is looking at the plans that that Dana was was referencing before or I guess as you're looking to 2023 these are the plans that currently have zero dollar cost share you know the pre pre deductible zero dollar cost share for those initial primary care mental mental health visits the from Blue Cross Blue Cross is non-standard preferred plan at the bronze gold and silver level for all the silver variations with the exception of of silver 94 and then MVPs for Mount Plus Bronze five plan as as well and we see that really looking over the last two years from from 2020 to 21 and then again from 21 to 2022 that the the growth and enrollment in those plans outpaced the the enrollment in in the marketplace overall as we referenced there was that nearly eight percent drop in enrollment overall from 2020 to 2021 and yet these plans had a three three percent gain and then from this year looking at that just over five percent gain and about a 17 percent gain for these plans so they were you know out these plans were outpacing overall enrollment by by 11 to 12 points over those those two years and and you see some differences in the two years between MVP and in Blue Cross I think largely attributed to the fact that in in 2021 from 2021 MVP had smaller premium increases and they have relatively larger premium increases and in 2022 while while Blue Crosses were were lower and had more more movement and in that direction so we wanted to share this information as as well I've thrown a lot of information at you may or may not be in the direction you're interested in happy to talk about any other components or any other pieces that we can either answer now or circle back on thank you Sean members of the board do you have any questions or comments for Sean or Dana hi it's Robin thank you Sean you know I love the enrollment report you and even a little Christmas present right when we get the data at the beginning of the year see how we did I love it and it it's particularly helpful to me this year when we're looking at this issue around the zero cost share and which plans it makes sense for because it's it's just important to understand where people are buying and which plans have more enrollment and so that we can factor that into our decisions so that's super helpful I know that you VHC does not have the direct enrollment information directly because folks are enrolling with the carriers but I'm wondering and this isn't entirely fair to ask you but I'm wondering if it's possible to get the breakdown for the for that part of the population because you know 7000 is still a significant chunk of people yep yeah absolutely yeah we can we do get it from the issuers we haven't gotten the January figures yet we we just got the December figures I think last last week is the is the time frame that they're reported to our team so we will get them later on this this month for I think the end of February will be when we will should get the issuer numbers final numbers for for January and then when we put out our quarterly health insurance map we'll bake those numbers in there and as far as any you know breakdowns or plans or doing something similar to this I believe we'd be happy to do it we have that data as as well and when we said the 7000 I think some of the preliminary numbers would look at it I think the seems like the the direct enroll numbers should be more around 6000 maybe it's just a hair under 6000 for for January of 2022 based on some other preliminary non non-final non-official numbers but that's great looking at there thank you thank you very much great and I'd appreciate getting that when it's available and I love the quarterly health insurance map too so absolutely thank you okay other board members questions or comments yeah I have a in general now question okay I have a couple I'm kind of like went back through and kind of looked at all the there's like 21 adjustments across all these four plans that you presented us that's assuming that the ones for the primary care physician kind of net out with the changes to the specialist so I kind of view them as one bundle but in that population there are eight that have increases of 6.3 percent or more all the way up to 100 percent I think it's the emergency room one for the silver one of the silver plans is up from 250 to 500 dollars um and so that's you know that's uh that's all interesting but I'm wondering if if you during your process have a uh do some kind of a calculation that figures out what is the gross number of of of these uh adjustments um you know because when we go through rate review on the same qhp plans you know we can see the the gross premiums up and down and and kind of see the the top side moving parts but here it's broken down into such small little corners that it's hard to see so I'm wondering if in your process uh do you calculate what what the impact is of these cost sharing changes on members I can start to respond to that and and then I might I'll uh ask Wakeley to add anything that I may have missed but to start with I think in our process we are first of all I think looking toward you know to take your example of the increase in emergency room that is an area where we you know not to say that it wouldn't be used but we want to encourage utilization of the um of primary care and in other settings over our emergency room wherever possible um and so that's more why that particular benefit or service was selected over any other reason and I the dollar amount is really much more a function of the magnitude needed to move the needle on actuarial value than it is anything else so is that you know to double that one cost share is an uncomfortable tradeoff that we've spoken about you know in other areas but um having to double that was what it took to get the A.V. within range if we're going to focus on that benefit and so it's much more about that than um and I would say too that I don't really think it's possible to draw a straight line between a decision like that and the actual impact on the rate the premium rate which is taking in so many so many multiples of factors than just that one increase so Brittany what else would you add or Julie add to that that be helpful yeah the one thing I would add is that it really depends on the member each member is going to feel these increases a little bit differently depending on their personal needs and the types of services that they use the A.V. factorial value is meant to be an estimate of the portion of services that the the carriers are paying versus the members so those changes in in A.V. can be used as as kind of an estimate in terms of the portion that the member is paying versus what the carrier is paying for services on average um as we've talked about there are some caveats with the actual value calculator um and the the premium impacts as well but but the intent is really that that's supposed to kind of show on average how those uh how those distributions um play out in in terms of the previous plan designs and the new plan designs and those changes I I follow that 85 percent of that but I'm still I'm still wondering is that when I'm talking to a member of the public about cost sharing um and we go through this process and they know that we go through this process and they ask well how much did you raise uh cost the the the cost of cost sharing yield by these changes um and I I don't know whether we're in a $2 million world or a $15 million world or and and that's the kind of that magnitude we get you know what would be helpful I've got a couple of other related questions but so um so that's not that's not a number that's not a value that that you calculate off this process as to what the net increases um um you know in these cost sharing uh adjustments no it's something we have not calculated um okay so my next question um I only have two or three questions here um was just I'm just looking at some of the you know the language that was in the slides and these are kind of quotes from the slide uh increased cost sharing will limit the impact on premium that's one and making incremental changes each year can help to avoid larger changes in future years and so my question is how do we can we track I mean because it it seems like a a um kind of a Rube Goldberg process here in a way is that we have this process and it has its integrity um but then when we get over to the carriers they use their methodology and so I'm just trying to figure out is there a way to understand as we're going through rate review what these changes mean in in our rate review process because that's mostly premium focused and uh you know and I actually think sometimes you forget that there was this whole other process that preceded the the rate review process where um you know that that dealt with the cost sharing side of revenues associated with this so is is there a way to have some clarity as to how some linkage between this process and the rate review process so that we can see what we're doing holistically you know to folks out there in terms of both premiums and cost sharing simultaneously I think it's very challenging to draw a straight line between the this process and the rate process they were premium proposals because of the you know they're very I think they're just so different when the focus for ours is to use whatever levers we have to influence the actual real value to bring that into compliance um the it's difficult to explain but the data point that Wakeley gives us of the directional impact on premium is you know again as as Wakeley has explained it's their own internal calculator that does that premium estimate in a directional viewpoint understanding that the issuers will use their own data and experience and factors within the same av requirements to estimate or to propose their rates so I just think it's a very difficult thing to tie together with precision um I hope that's helpful as an explanation I don't know what else you would add Brittany but I hear your question I'm just struggling to clarify how or if or how those two efforts can be tied together because I the reason I asked is that the the thought kind of came to my mind as I'm going through this that there are some increases here and I think that has to do with maybe cleanly with there's a couple of plans in there where where the issue of premium impact was the only reason for the adjustment it seemed and I'd have to go back to the slides to find those two but it was making me wonder whether or not this process should be in the premium alignment business um in that it is so obscure or that it goes from your process to the av calculator and then it goes over the carriers and then it goes through their calculator and it's pretty much mashed potatoes by the time you get through you know the whole process and I'm just wondering you know whether or not we should be doing premium related impacts i.e. changing cost sharing in order to affect premiums in this process um because the the the ability as a public sector figure to follow that I don't think exists I I don't I mean you just tried to explain it to me and I understand the narrative but I don't I don't find the numbers and um so I don't even know the scale of it I mean how much how much cushioning is there in in these these plan designs that are geared toward premium I mean Blue Cross Blue Shield and MVP would be very interested in that because it's it's their bundle but um how much is it and I I guess I guess we don't know at this point in time. One other example I can think of too that may be helpful is that as you remember there were some plans among the seven that we have reviewed last week in this where between 2022 and 2023 the plan design is still in av compliance but even with no changes to any any cost share amounts with from using one year's av calculator to the next is likely to increase the that directional premium that weekly would calculate for us simply because the underlying costs and of services within those plans would go up so by changing nothing even um there's a there's a chance or a likelihood that the premium will go in that direction as well. If I might just jump in I would say we have seen it in rate review so for example uh when we there is a discussion around the PTOT and Cairo copayments we did see that impact in rate review as a line item so the fact that it's not typically called out as a major shift in premium to me is proof that like having those tweaks in this process is minimizing the impact on the premium because otherwise it would show up as a benefit change impact in the rate review filing. Like I I remember the Cairo pack I remember that and so you know at the kind of micro level surgically I think you're right I the questions I'm asking are more systematically so I can just get a sense of scale last question but uh I agree with Robin. The um I'm just wondering um kind of looking forward how this process might evolve relative to healthcare reform in terms of fixed perspective payments and the different payment methodologies you know that we're trying to migrate toward um does does where where does this design this system the planned design fit into that future is there any discussion in that regard that you folks are having? We haven't factored that in at this point I think the you know this process is very much driven by federal requirements around the actuarial values but the um payment mechanisms that may influence the plan design decisions that we would make would be factored in sometime later. Well thank you all this is very every year this is uh you know a very complex web and it's hard to kind of uh swim through it and and uh and very hard I think to explain to the public but these cost sharing things are a big deal to the public and that's what you hear about and uh and this is where it happens and and uh you know I I I guess I guess if I were would ask could I have one wish is that next year as we go through this can we have have as part of the presentation the de minimis plan this is this is from a a cost sharing point of view impact on on on patient this is the uh this is the plan that that affects them the least on the cost sharing side I'm sure I'm not phrasing that right but I I I just feel you know when I'm looking at increases that are 6.3 percent there's eight of them that are between 6.3 percent and 100 percent changes and then on the other hand when we go into hospital budget cycle we're looking at three and a half percent and we're trying to stay in that ballpark in terms of premiums these things jump out at me but I I don't know if there's any problem there that can be solved and that's pretty scary that I don't even know whether or not there's a problem but um because I I've worked with you folks a little bit over the years and I I trust you work you do good work and you know Sean was very helpful in terms of putting together those charts that profile the folks about 400 percent of poverty and I was very grateful for that um but I I wish I I had a better handle on this so that I could explain it to members of the public when I run into them into the co-op because it's it's not so much I hear about the premium it's a cost sharing thank you very much thank you other members of the board comments or questions I'm not hearing any um at this point it might be better if someone is prepared to make a motion to make one and then I would go to public comment so if they could comment on um what they've heard and the motion does anybody make a motion go ahead make a motion Tom Walsh look like he was about to jump in so oh I'm sorry okay no it's okay all right so I will um Dana could you pull up the I think it would be easier to do this with the slide that has the changes on it so we can all see it yes give me a moment to get my yes no worries in the right place and maybe while we're getting there I I think I think uh what I'd like to do is two motions thank you that's perfect Dana um so that'll be fine because I think that like the first issue is whether or not to me the first issue is whether or not we would like to accept the zero cost share the three zero cost share visits on just silver and bronze or apply it to all the plans um so it might make sense to to have hash that piece out first and then typically what I have done in the past is do motions to approve um the plan designs that that need changes as described on the slide plus whatever else we changed does that sound okay chairman it sounds perfect okay so then I'm going to move um that we uh approve three zero cost sharing visits for primary care and mental health for the deductible plans at every level meaning bronze silver gold and platinum I will second that and before I open it up to the public Dana or Sean do you want to comment on that no that's understood for some concern okay okay so I'm going to open it up for a public comment both on the motion or anything related to the QHP proposals so members of the public please raise your hand or um if you're just on phone just start talking in the first hand that I see is Walter carpenter Walter faithful as always right Kevin yes um thanks to Tom for what he said in his comments I was thinking almost the same thing as Tom if he's having difficulty understanding this imagine what the general public who has to pay all of this is trying to understand about it and now I wanted to make a comment to the diva people is that when they talk about carriers paying versus public paying and all that they should remember that we are the ones who are paying it no matter what always think of that carriers don't pay anything we pay it carriers just distribute plus what they take off for admin expenses profits all the rest of it we pay it all of it thank you Walter is there other public comment is there other public comment hearing none I'll go back to the board is there further discussion I would just like to say that the reason why I think it's important to offer this benefit at every metal level even though I recognize the justification is certainly being a thoughtful one is that I do think it's just much easier to be able to communicate that the benefit exists to the public and there's you know with 28 or however 22 plans that we have now it's I appreciate the difficulty of the public and shopping and so my main intent here is to ensure that people seek and use the primary care and mental health benefits at every level and that they know that that's available to them so I just wanted to explain my rationale thank you and Dana and Sean do does that keep us within the actuarial values that we have to keep within yes everything presented is is within the um compliant ranges perfect other board members comments or questions that just one quick question I I think I support this I'm 90 percent there I'm just wondering is there is there any impact on um primary care physicians on this I mean is there any risk to their cash flows well uh by not getting the cost sharing from the um platinum and gold folks no they would still be reimbursed by the by the insurance company for their services so it's just a matter of um you know for those particular services that wouldn't be a uh a cost to the enrollee if anything Tom I would think would be less of a paper chase well I I created these things so complicated I just had one day asked the question just do just to be sure and not find out later that I'd really messed up so um I'm on board I'm on board too I mean I think reducing barriers to entry to you know um primary care and mental health is so crucial and and we need to do that at every possibility for every metal level so I'm supportive of this okay not hearing any further discussion I'll call the motion all those in favor of the motion for um the three across all uh uh metal levels please signify by saying aye aye any opposed signify by saying nay let the record show that the motion carried unanimously and Robin will go to your second motion yes so I would like I move that we approve uh the want to put that chart back up Dana yeah that that might be easier um but let me get started anyway um I move that we approve the 2023 qualified health plan designs uh as uh presented by the department of Vermont health access with the modifications uh just made in particular the plan designs highlighted in uh green on slide 39 of the presentation is there a second I see some head shaking but sorry I couldn't get to my mute button fast enough but I will second it thank you um so um just to make sure that everybody has a chance if they have any further comment I'll throw it open to the public for public comment one more time on this particular motion does anybody wish to offer public comment on the motion just made by board member lunge hearing none is there further discussion from the board hearing none all those in favor of the motion please signify by saying aye aye aye any opposed signify by saying nay let the record show that the motion carried unanimously if I can just break in for one clarification just to make sure um so the approval is for um the the zero cost share options for each of the four metal levels that's understood and in other instance instances it's the recommended plan design yes thank you for clarifying yes just want to make crystal clear got it thank you always good thank you Dana yeah okay well thank you Dana thank you Sean thank you uh to your consultants as well and um with that is there any old business to come before the board today is there any new business to come before the board today I just want to remind all the board members that uh we do have a deliberation session scheduled for 10 minutes after the uh end of this meeting um so please don't forget and um with that I wish everybody a great rest of the day thank you everyone great thank you thank you do you need a motion to adjourn Kevin yes I do I move that we adjourn okay all those in favor please signify by saying aye aye any opposed signified by saying nay thank you everyone have a great day thank you