 And welcome to Talk of the Town, looking a little bit different than Talk of the Town usually does because everything is these days. Anyway, a familiar face is joining us today for a regular legislative update, which we are conducting remotely, of course, as everything is these days. But anyway, welcome to Cindy Friedman, our state senator, and one of my favorite people to talk to and check in with regularly throughout the year. So Cindy, thanks for joining us. Jane, how are you? I am doing okay. Probably very similar to you and to the rest of our audience kind of squirreled away here in my own home office, as I'm sure you are, and getting business done as best we can. So let's get right to that. Actually, I and others are curious just about how are our legislators conducting business these days in the coronavirus and social isolation environment? So tell us a little bit. How are you getting things done? A lot of conference calls and a lot of Zoom. I think one of the silver linings of this is that we have amazing technology. And in fact, I probably spend more time in meetings now than I did before the coronavirus because we're all in one place, we're all at home, we're easy to get to, we don't have to worry about, well, I can't come out here because I have a meeting over here and so I don't have the time, everything's just bam, bam, bam. Everybody's right there. So lots of conference calls, lots of Zoom and lots getting done, I have to say. Yeah, I can appreciate the fact that to the extent that what you're doing needs conferring and needs you basically just to be in consultation and deliberation and processing with others, that as you say, this is a bit of a silver lining because I have certainly found, as everybody else has, people are on the other end when you call in general because it's not hard to track you guys down. What is missing though? What do you find that you're just not being able to get done because of the current constraints? Well, anything outside of an issue addressing this virus is something that we're not getting done. I mean, it is this work to address this pandemic every minute of the day and there's really not bandwidth right now for anything else. Yeah, I was wondering also whether there might just be not having access to, I don't know, objects or sites or things like that. How big a problem that might be for you. Anyway, it just sounds like your lives are being dominated as are all of ours by the virus. So let's talk about legislation that is either already been passed in process or that we can expect related to the virus. So I can ask you about specific areas or just kind of invite you to share with us in your own order of priority some of the things that are being tackled. Okay, so I think the first thing that I would say or the first context I would put things in is we are looking at anything, any legislation, any activity by the Senate that requires immediate attention. That is something that is facing the Commonwealth at this moment and that we need to respond to. So that's fallen recently into a few areas. One of them is healthcare and we did the scope of practice bill. We also did a telehealth bill. We did a prior off bill and then the governor. Let me just jump in and say scope of practice, that's not self-evident to me. So what do you mean? What we've done is we have legislation to ensure that everybody in the medical profession is working to the top of their license. So I'll give you an example. A nurse practitioner by license can do treatment. They can do diagnostics. They can prescribe. They can admit people to a hospital. But our licensing, our rules say they have to do that with the supervision of a doctor. So they have to be under the supervision. So that means that every nurse practitioner needs to be working for a doctor or under the supervision of a doctor. We really need nurse practitioners. We need them out in the field and we need them to do the work that is going to keep people healthy, not only the COVID-19 positive people but people who need care. So their ability to be able to prescribe is really important because then we don't need the doctor can be working or looking at something much more detailed or needing more experience. And so what we've done in our bill and then the governor adopted and did it through executive order was say, okay, all nurse practitioners can work to the top of their license. So now they can prescribe. Now you can see a nurse practitioner and if you have a strep throat, she can say, okay, I'm going to give you some antibiotics and then she can do the scribing and you can go and get the antibiotics. And she doesn't need a doctor to be supervising that. And so that's really covered in nurse practitioners, advanced psychiatric nurse workers and the other one is just went out of my head. Oh, a CNA certified nurse anesthetist. Okay, excuse me, I'm going to close the door. Sure. Okay, so that's a scope of practice, okay? Yes, and I know you had mentioned a number of other things as well and happy to get you to elaborate on those. But I did want to say that that's a great illustration what you just told us, great illustration of a couple of things, it seems to me. One is, you know, what it is that we need our legislators to be doing in terms of addressing this phenomenon, you know, we need as a society, obviously, to give the maximum flexibility to our medical establishment as they can have at this time. That's in everybody's interest. So the fact that you in the state house, you're the ones who can, again, as you say, affirm or legitimize this broadest possible use of people's skills, that makes a lot of sense. And then the second thing that it reminds me of is the fact that, of course, we are all consumed all day every day with news about the virus, et cetera, and consciousness in our own lives about it. But we need to remember that doctors and nurses and nurse practitioners, et cetera, are all taking care of a lot of different maladies, all the same ones that they always have. And I think that, again, it's a great illustration and reminder that part of what you're doing is just enabling those in the medical establishment to do the work that they generally do and still need to be doing even in the face of this. Right. So that's just an example on the health care side. Then another piece that we've been looking at and actually did a bill was a municipal bill around elections and pushing out some of the elections allowing for more mail-in ballots. That was something that was passed and signed by the governor. So there's the whole kind of municipal piece and the pieces of how we keep local governments moving. We have another bill that is being worked on by the Senate and the House to expand that around things like remote meetings, notaries. All of these things that you just don't even think of because they're part of your daily life. And now, all of a sudden, how do you have a selectman's meeting when you can't come into a building and you need to follow the open meeting laws? Exactly, yeah. And obviously, everybody listening in here is going to know that this directly pertains to Arlington, both in terms of the election and needing to have some more flexibility around when to reschedule our local election. Yeah, and then we've got select board meetings and other meetings going on. Where are you meeting? We have, you know, we are required by law to have a balanced budget in by July, you know, but done for the fiscal year. Well, how do you do that when you can't meet? How do you do that when, you know, when all of these offices are closed and people can't do their work? We have to allow for life to go on. So those are those are that that's that area. And that's the Senate and the House have been working on together. The safety net issues, OK, around unemployment, insurance and homeless and homelessness and shelters and the whole financial piece of keeping our health care system up and running during this time. So those are the areas that we are focused on in the Senate and anything we can do in as quickly a manner as we can do it. That's what we're focused on. And I know that there's a great connection between the Senate president and the administration. So sometimes we do this work and it feels like we say, this is what we're doing. And then the governor goes, OK, we'll do it in executive order, which, you know, for a minute is frustrating. And beyond that, it's like, great, it's getting done. It's. Right. Obviously, the most important thing is that the stuff get done, however, however it happens. Yeah, I mean, a couple of other areas that that we want to make sure that we touch on is I know that there has been some legislation recently around kind of landlords and tenants as well, who are obviously, especially in a stay at home environment. Obviously, there are going to be issues arising there. Right. So the how the Senate is, I think either we've released it today or tomorrow, we're going to bring it up on Monday is a housing bill. So the first part of the housing bill, my understanding is, is that it will put a moratorium on evictions and foreclosures. And it will have some other pieces in it about Airbnb rentals and hospital and hotels and creating spaces for health care workers to be able to, you know, rent a place by the hospital or or make it easy, but otherwise closing those some of those down so that we don't have people coming into the state and increasing our chances of infection. So that's happening. I know in the Senate is supposed to or we will be bringing that up on Monday. And then and then so that will be the first. I mean, the other piece to know is that that will be the first iteration. And then after we do that, there'll be a next iteration and a next iteration, right? So we're doing immediate chunks and and the the pieces at the top of the priority list. And then we're going right back and going down the list. So I know there's a lot of people that want to prohibit foreclosures completely, for instance, or prohibitive evictions. Well, that's a little more complicated to do than put a moratorium on them. Moratorium on them. So instead of saying, well, we're going to have to work everything out before we do something, let's do the let's do the quick things first. And then we'll keep working on the more complex issues. That's what we've been doing in the Senate. That's a it's a great point. And I'm just curious, has that been at all a hard sell with any of your colleagues? Do you have anybody who's resisting because they want to get more done on the initial stages? Or do you does everybody recognize that you need to do this in an over a number of steps and stages? Hard for some people. I mean, some people see this as an opportunity and, you know, maybe rightly so, doing things that we should be doing. We should do anyway, right? And so, yeah, there's a pushback. I mean, the advocates are pushing for as much as they can get, which advocates do and should do. That's their job. And it doesn't sit well with everybody. But in the Senate, but but it is there's a pretty general agreement that we're going to keep moving. And I don't think anybody is to the point where they're going to try and stop something from happening because it doesn't have enough in it. I think they're going to keep pushing and that's their job is, you know, keep pushing, keep get I do it. I try and get everything I can get into something. And then at some point I say, OK, that's it. I get it. Do this. I'll come back and bother you about the next thing. Right. And as you say, that is the job. So doing it right requires that. Yeah. So I wanted to just ask you, obviously, everybody is very aware of this unimaginably large two trillion dollar spending package that the, you know, that the federal legislature has passed. And it's been signed by by the president. Obviously, some of that money is going to be coming to Massachusetts. How how does that kind of thing happen? How how much are you going to be involved in the in the state Senate with rapidly figuring out how to take X chunk of money and apply it to Y area in a way that's effective. Is that going to be taking up expected to take up a lot of your time and energy in the next little while? Greater minds are thinking about this than I. OK, we'll start with that. I think it really depends on from my understanding is it depends on what the what the chunk of money is for. So unemployment insurance, lots of that is federal. So it's just going to it's part of the federal unemployment insurance piece. Now, the state has pieces of unemployment that they do, but a whole bunch of that is federal. OK, now you apply through the state and that's an issue. But in terms of the health care space, some of that is going to go directly to let's say there's money. There's a billion dollars. I think that's going to come directly to hospitals. And I know the first round of that 25 billion is going to be sent to hospitals directly based on their number of beds that they have and whether they're in a hot spot. OK, so I'm I'm sorry, the hundred billion dollars of that is for is for hospitals, if I didn't say that right. And I think that's going to be done by a formula. Now, there is more money coming to hospitals for safety net hospitals or disproportionate share hospitals, just disproportionate shares for hospitals who have more Medicaid and Medicare than commercial. That's we're all kind of trying to figure out, OK, how is that money? How is that money to be allocated and how do we want that money to be allocated? Can we can we influence the feds in how that money comes? So those are two examples of money that we're going to be seeing and some in some ways we know that how it's going to be proportioned and in some ways we don't know yet. So things are up in the air. But you can be you can rest assured that the state is looking very, very carefully at that because they want to make sure that they get all the money they can that they that comes to Massachusetts. Right, of course. And I appreciate your being able to answer that question to any degree because, of course, there's so much uncertainty about, you know, exactly when things arrive and how how it is that that's going to be processed. I think those of us out here just kind of we hear that such a package gets passed. And then we just assume that, oh, we're well, we're awaiting our checks in the mail, but also, you know, that it's just going there's going to be some kind of smooth flow of that into the needed areas. But no, that's that's a lot of the sausage making that you guys do, right? Yeah, it's one thing that out. Yeah, it's one thing to say, let's do it. And then the second piece is OK, how? And so I think the house kind of still up in the air. But some of it and I think some of it will work smoothly and some of it will be. There'll be have to be a lot of wrangling or changing systems. I mean, just some of the things that we're allowing today, for instance, the federal government is now allowed or has made people with 1099s are self-employed, you know, sort of focusing on the gig economy to be eligible for unemployment. Well, that's great, except none of our unemployment systems when you go on them are able to deal with that. That's never been an option. So those systems have to be changed, nothing running. So I could go on to the unemployment system and file and they would be accepted. Right? It's like all these minute details. You know, when you're a nurse and you go on to get your license, and you're a nurse practitioner and you say, I'm a nurse practitioner, I want my license to be the top of, you know, at my license, there's nothing in this. The system asks you for what doctor is supervising you. Well, there's no doctor supervising you anymore. That system has to be fixed. So the level of detail that is, you know, that has to be addressed once these decisions are made. Or they're they're pretty they're pretty big. You know, you had mentioned earlier that you're concerned and legislation is being developed to address the needs of social safety net type populations. And we talked a little bit about the homeless, about folks applying for unemployment, etc. I'm wondering about undocumented people and families. Is there anything that is specifically trying to address the kinds of things that might be of particular pertinence to people in that situation? I know there are people working on this. I know this is a big issue. It's not only an issue because it's. Kind of morally, it's not only a moral issue like do you take care of people when they're in need, regardless of where they're from. But it's also a public safety issue and we need to know who's out there and we need to know if somebody's ill and we need to take care of them because it's all part of keeping us all safe. I'm so I know this is an issue that's being worked on. I am not personally involved in it. But I know I was on a conference call the other day where the working group, the Senate working group, that is working on the safety net issues brought this up and they were working on some potential solutions. Okay. How about allocating any extra money from the state for mental health assistance? Because obviously we're all, I think, aware both on a very personal level. And as we think about it, that the solution, you know, as we've many have noted, the solution or a solution or a way, a path towards the solution to this involves this deliberate isolating of ourselves from each other and that we know that that can't be good for us as a species and as a society in general, even though we need to do it right now. So clearly that means that there are all kinds of, again, mental health ramifications for this. Is there, obviously there's an awareness of that. Is there, are you aware of specific legislation or general programs that are intended to address that? In the very, very short term telehealth and the expansion of telehealth and the requirement that it be covered, telehealth be covered in the same way as an in-person visit has, I think, done a lot to relieve some of the issues around access to mental health. So the fact that I can now talk to you as my provider by either video or phone has helped that somewhat so people can continue to have their care on that level. That's a big deal. It's certainly just the first step. And I think we are having, I think there's some real concerns. When somebody comes into an emergency room and they have a serious mental illness and they may be positive, a COVID-19 positive, it takes a different protocol to deal with that than if you're just somebody coming in and you don't have a serious mental illness. And I think this is something that hospitals are grappling with right now and that we're trying to ensure that there is the right care and the right follow-up that can be provided for people who are in that level of need. And I don't, I'm sure it's not where it needs to be. And it's something that we are concerned about, really concerned about. In the long-term, we're gonna have a lot to deal with because people just talk about PTSD alone from this kind of event. And it's serious, it's really serious. And so I don't, but I don't think we've really started to look at that yet. We know it's out there, but we haven't really, I can't tell you that we've done a good deep dive and have a great plan. Well, you know, one of the things in this area, one of the things that some folks have mentioned to me is because it seems like a somewhat simple thing to address is the number of visits that you can have with a mental health provider, a mental health care provider or some other, you know, whether it's therapy or something else, whether that number is just can be raised from what insurance companies usually allow or, you know, and whether legislation would be the way to do that. Yeah, I mean, that could very well, I know that very recently, there has been a number of settlements with the attorney general and the health plans around their usage of prior authorization and limits to mental health care. And I know there were a number of fairly big fines and especially around inadequate provider networks, limits on office visits. And so some of that's been relaxed and there's much more focus on ensuring that there's parity between mental health and med surge health. And we also passed what I think is a great mental health parity bill in the Senate recently. And I would hope that that's something the house would take up with seriousness. So some of that needs to be addressed because it's, you know, needs to be addressed at the state level because it's illegal, right? And then we need to look at where are those limits in terms of, you know, preventing people from getting access. But I think it's a combination of enforcing the parity rules we have and then seeing what legislation might be needed to make sure that we're making that access available as it needs to be. A lot of it is around, you know. Sorry, go ahead. A lot of it is around rates and increasing the rates for that providers get paid for mental health care. I have to say this conversation is a, you know, it's perfectly representative of most of the conversations you and I have in our lives at this point. And that is we can't get away from the virus. Let me, let me, let me at least invite you to tell us about the kinds of things that were going on for you a month, two months, three months ago. And that, you know, you haven't had a chance to share with us up till now. If you can even remember back then. I can't remember. A lot of stuff were going on in the communities. You know, I was, you know, this is the season of wonderful events and, you know, graduations and getting ready for the summer. There were spring, you know, there was a great event in Bellrica for the council on aging. There has been enough, you know, those kinds of things where people are, you know, doing wonderful fundraising and gardens, community gardens are opening up. And, you know, so I had a great calendar full of events of town meetings, another big one that we were getting ready for at the community level. And that's all just disappeared. Right. And then in my particular area, we've had a lot of healthcare lined up. We had scope of practice preventing, you know, telehealth was one out of network billing. We have a bill to stop surprise billing where you don't know a person is in your network and then you get to bill. In fact, I think we're going to try and push that in the next couple of weeks because that's going to become an issue. So we were working on that and pay parity between the academic hospitals and the community hospitals. These were the things that we were working on and the, I know the big transportation bill was going to come out of the Senate. Not sure where that is. The budget. Yeah, so I mean, really all of the normal business of the Senate has been kind of put on hold. What are the ramifications of that, do you think? We'll let you know. I guess we'll all find out, right? Because every single day is another step into further uncharted territory for all of us. Obviously, I did want to ask, and I know our time is short, I just wanted to ask one more quick, specific question and then we'll wrap up. And that is one, and this is in part because I have... Sorry. Sorry, that's fine. Partly because I know so many people who are caring for their parents right now, as well as children, et cetera. And in many people as well, who can't access folks in senior homes in other kinds of facilities, even in hospice, it is much more difficult to visit people who are sick and dying. Is it even possible, and if so, is there any move towards creating more access in this way, Zoom, FaceTime, et cetera, for people to be able to access, again, those who they can no longer visit in person? I don't know the answer to that. I really don't. I mean, it's a really good question. And I know some people are, some facilities are working hard on creating that space, but I don't really know whether there's an overall plan or for how that's being addressed in any large-scale way. It's a big problem, it's a real issue. Yeah, clearly so. And for me to throw the laundry list of, hey, how about this and how about that at you is not exactly fair, but it happens, I apologize for that. So last thing, just wrapping up, obviously we know what you're doing on our behalf, or we have a better idea of that right now and want to express our appreciation for it and the fact that you guys are finding a way to do what you need to do even in this environment. What about your message, either as our state senator or as Cindy? What's your message out to the community of Arlington and beyond right now? What would you like to, I don't know, see from others or at least express? I think what I want to convey is how incredibly grateful I am to everyone in my communities who are taking this so seriously, doing the things that they're being asked of doing, doing the things they're being asked to do to the amazing, incredible amount of kindness and thoughtfulness that I see going across all my communities to help people and to keep that sense of community alive. I think it's so important and get through this and we will get through it, follow the requests that we're making to stay apart, to self-distance and people are doing it and they're taking it really seriously and that is wonderful. And I just, one people know that this is, we're gonna be in this for a while. There's no, we don't see any short path out to try and keep the faith and to stay patient, find ways to find joy in your life and if you really are in need to reach out and to reach out to your community, I know every one of my communities has a website and they have lots of information on it, they have lots of contact information and if you need anything from us that you let me know, our office number is 617-722-1432 and you can go to our website as well. So I just wanna thank everybody and tell everyone to keep the faith. Great and I know that you've got a number of other resources available through your website, et cetera, whether it's CDC guidelines, WHO, et cetera. So we do wanna encourage people, we'll be making those available on screen or otherwise for people to be able to access. So those are wonderful words for the community and right back at you Cindy with those and best of luck in continuing to do the hard and very, very important work you're doing right now. And we look forward to talking to you again soon either in this format if necessary or back to what we're more familiar, comfortable and enjoying most of the time being in person with you. So thanks for joining us, appreciate it very much. And everybody have a wonderful rest of the day. Okay, thanks very much for everybody out there. This is James Mulan, this is Talk of the Town. We've been talking to our state senator, Cindy Friedman. Thanks for joining us and we'll see you later.