 Good morning. This is a continuation of the morning media of the house appropriations on March 10th, and we are turning to H7 11, which is a an act entitled the creation of the opiate settlement advisory committee and the opioid abatement special fund. And we welcome members of the of the house human services committee chair queue and representative, you know, not there for now. Thank you for joining us. It's the first time that you've been in our committee and delighted to see you and excuse me for mispronouncing your name. What we'd like to do with the bills is we'd like to generally understand what what the purpose of the bill is and why it's been created. But then we try to focus down on those areas that are within our jurisdiction. People have not seen the bill since it just came out of your committee. It was just passed out. So we'll be kind of reading along with you. And so, forgive us if we don't understand kind of the particulars, but that's how we'd like to do it. I think we've set aside now about 25 minutes. So if you can do an overview and then help and then we'll have some questions. I'm sure. So thank you. And we also welcome lunch council for being here. Thank you for taking time. Okay. Over to you. Thank you, madam chair and appropriations committee. This is my first time in your committee of my first time reporting a bill. So I will do my best. 8, 7, 11. As you know, we'll create the opioid settlement advisory committee and the opioid abatement special fund, which was included in the comprehensive national settlement that was reached this past summer in the suits against McKesson and Cardinal and Amerisports. Approximately 64 million is allocated for the state of Vermont in that settlement. The settlements are designed to be allocated in three buckets. 15% to the state subdivisions to be used to evade the opioid crisis. 15% to state to remediate for past expenses for opioid crisis for future abatement and 70% to a statewide abatement fund, which is what this bill covers. The national settlement agreement prescribes the creation of the advisory committee and the special fund. The advisory committee will manage the opioids abatement special fund, which includes the 70% of the needs received from the national national settlement. The national settlement also prescribed the advisory committee have equal number of state and municipal members and make recommendations regarding remediation spending from the opioid abatement special fund. The settlement also prescribes that the state designate an agency as a lead agency as a single point of contact submitting requests for funding to the national settlement fund administrator. 8, 7, 11 will designate the Vermont Department of Health as a lead agency. I stopped there if there's any questions before I go through the rest of the. Thanks. Just I'm looking around the room and I'm not seeing any, but we waited long enough. Yeah. Just I didn't hear the percentage from the sub settlement going into the. Fund 70% 70. Thank you. I should have mentioned the acoustics in this room are pretty rough. And if you can yell at us, we really do invite people to. I can hear you. If I might, the 70% of this 64 million is over 18 years. Yeah. Yes. Is the amount received over 18 years or we have to spend it over 18 years or both? The settlement is for 18 years total that we have is 64. Gotcha. But does it 64 come into the funds this year? It doesn't work anywhere. We have to ask the board. Okay. We're going to learn about this. So it is that the job of the advisory committee and the lead agency. Meet review and come up with recommendations. And then the lead agency will submit a request for money to fund those recommendations. I will now go over the membership of the advisory committee. The advisory committee will be composed of the commissioner of health or designee. And that person will, will serve as chair as a non voting chair. The board of health or designee chief prevention officer of the state of Vermont. One front member of the house of representatives. The speaker of the house. One current member of the Senate appointed work. Pointed by committee on committees. Primary care prescriber with experience providing medication assisted treatment with the blueprint for health. A state wide perspective on the vision of medication assisted treatment services. An individual with experience providing substance misuse prevention. Medication programming appointed by the substance misuse prevention oversight and advisory council. An individual with experience providing substance misuse treatment or recovery services appointed by the executive director of the blueprint for health. An individual with experience providing substance misuse treatment or recovery services appointed by the clinical director of the alcohol and drug use program or its successor. A provider with academic research credentials appointed by UVM. An individual with lived experience of opioid use disorder, including at least one who is in recovery. One member appointed by Howard center safe Howard centers, safe recovery program and one member appointed by the Vermont association of mental health and addiction recovery. An assistant judge appointed by the Vermont association of county judges and 10 individuals each employed by employed by or an agent of a different city or town that collectively reflects Vermont's diverse population and geography. And those individuals will be appointed by the Vermont League of cities and towns. Again, so any questions. We should have we should have a sign on our door that says. Big committees task forces. So we're going to have a lot of questions around why that. Is that where yes, yeah, so maybe let's go through the bill and understand and see what, what the bill proposes, but I think we'll come back to that. And just as a warning, we're going, oh my goodness, that is huge. No, but why don't we keep. I will continue. Thank you, madam chair. I'm going to skip over the term of the advisory committee and. And the removal process and move on to powers and duties advisor committee shall demonstrate broad ongoing consultation individuals living with opioid use disorder about their direct experience with related systems including. Medication assisted treatment residential treatment recovery services harm reduction services overdose supervision by the department of corrections and involvement with the department for children and families family services division. The advisory committee shall demonstrate consultation with individuals with direct experience of opioid use disorder frontline support professionals. The substance misuse advisory counts on other stakeholders identify spending priorities as related to opioid use disorder prevention intervention treatment and recovery services and harm reduction strategies for the purpose of providing recommendations to the governor. The department of health and the general assembly on prioritizing spending from the opiate abatement special fund. The committee shall also consider the impact of opioid crisis on communities throughout Vermont, including communities abatement needs and proposals for strategies and responses. The perspective of and proposals from opioid use disorder prevention coalition recovery centers and medication assistant treatment providers. And the ongoing challenges of the opioid crisis on marginalized populations, including individuals who have lived experience of opioid use disorder. Annually, the advisory committee shall present its recommendations for expenditures from the opioid abatement special fund established pursuant to this sub chapter to the department of health and concurrently submit its recommendations and writing to the House committees on appropriations and on human services and the Senate appropriations and on health and welfare. The committee shall have their first meeting before June 30 of 2022. They shall meet at least quarterly but not more than six times per calendar year. And shall adopt procedures to govern its proceedings and be voting procedures and how the staggered terms shall be apportioned among members. The meetings shall be consistent with Vermont's open meeting law. The members of the General Assembly for serving on the committee are entitled to per DM compensation and reimbursement pursuant to VSA 23. Other members of the advisory committee shall also be entitled to per DM compensation and reimbursement of expenses permitted under 32 BSA 1010. I've already mentioned that the Department of Health shall serve as the lead agency and the single point of contact for submitting requests for funding to the National Settlement Fund Administrator. Approved requests shall be dispersed to the department for deposit into the opioid abatement special fund established in section 4774 of this sub chapter. The abatement special fund will be established and managed pursuant to 32 BSA chapter 7, sub chapter 5 and under ministry divided department of health. The special fund shall consist of all abatement account fund that money is dispersed by the National Settlement Fund Administrator to the department. The department shall include a spending plan informed by the recommendations of the advisory committee established and as part of its annual budget. And as part of their annual budget submission and once approved, the department shall request to have the funds formally released from the National Abatement Account Funds and shall disperse the monies from the opioid abatement special fund to 32 BSA chapter 7 sub chapters. The special funds shall supplement and not flat or replace any existing or future local state or federal government funding for infrastructure programs, support and resources, including health insurance benefits, federal grant funding and Medicaid and Medicare funds. The special funds shall be used for the following opioid prevention intervention treatment recovery, harm reduction and evaluation activities. I will pause again before I go through the list of the permissible expenses for any questions. So regarding the per diem that is paid to the two legislative members as well as the oh roughly 14 other members who are not otherwise paid, is that an allowable use under this fund from the opioid settlement fund? It's all opioid settlement fund money and not general fund money. I will defer to legislative members. I understand. I believe so but let me take a look at the draft to see what might be covered and get back to you. Okay, thank you. And, you know, I don't think you need to. We can read the list in the bill of the appropriate uses of this so. He just gets through that I think you can maybe give us a couple of examples and then move on to the next. The answer to the question about the permissible of the per diem is on page nine. There's a list of permissible expenses and subdivision 13 on line 14 is the cost of administrative technical and legal assistance provided to the advisory council. So that would cover it. Is there a percentage that can be used or is it just our costs? Okay, thank you. Madam chair. As they've relates to the expenditures from the opiate special abatement special fund. This list came from the national statement that was reached with the attorney general. And all the activities are related to prevention intervention treatment recovery harm reduction and evaluation activities. And it's really to evade the crisis and the list again from the national settlement. Any additional questions about the permissible expenditures. I think we can keep going. Great. National settlement also had. Expanded from the special fund, which is that list begins on page nine. I'm 18, I believe. The priority expenditures are appropriate use of on the lock zone. Expanding training for rep first responders, schools, community and support groups and families. Increasing distribution to individuals who are uninsured. And increasing access to medication assisted treatment. I'm sorry. While you're. And we have another question here. So thank you. So on page 10, sub two a and sub two D. It would appear to me that, and this is great is that we need to maintain a maintenance of current effort. And then apply these funds above our maintenance of effort. Okay. Thank you. Yeah. I'm wearing here. I think I saw it. But these funds may not supplant existing efforts that they are on top of. We're in the future. So yeah, so that hence my comment about maintenance of effort. Yeah. Thank you. Prioritization is providing education to school based and news focused programs. That discourage or prevent misuse. Of opioids. Providing medication assisted education. And awareness training to healthcare providers, emergency medical technicians, law enforcement and other first responders. Providing treatment and recovery support services. Residential and inpatient treatment intensive outpatient treatment outpatient therapy or counseling. Assisting pregnant and postpartum individuals. Assisting pregnant and postpartum individuals. Specifically enhancing services for screening brief intervention and referral to expert. Expanding comprehensive evidence based evidence informed treatment and recovery services. Providing comprehensive background services to pregnant and postpartum individuals with opioid use disorder. Expanding treatment for neonatal abstinence syndrome. Standing availability of warm handoff programs and recovery services. And treating and carcinative populations. Prevention programs specifically funding for media campaigns. Funding for evidence based or evidence informed prevention in schools. Funding for healthcare providers provider education and outreach. Regarding prescribing practices for appeared consistent with current Department of Health in U.S. CDC prevention guidelines. And expanding syringe service programs. Solitating evidence based or evidence informed data collection and research and analyzing and evaluating effectiveness of the strategies within Vermont. The bill would be effective upon passage. Thank you. So we are going to have a number of questions. And I think they're going to be around the fund. That's right. Thank you and thanks for presenting this. This is great. I was also doing some math while you were talking about it. It strikes me that the settlement sounds like it was fairly prescriptive in what you could do and what you couldn't do, but in a way is helpful in terms of creating the bill because you're not deciding what you do they're telling you. So I'm assuming that pretty much everything in here is fairly prescriptive. So that kind of leads me back to the advisory group. And there's 22 people I think of which 21 are voting members because the chair is not. And you had said that we needed an equal representation of. I forget exactly, but it's a state representative and this ordinary and municipal and just citizens, I suppose. I mean, how prescriptive was the other than that sort of headline how prescriptive was the the rest of the requirements for the advisory group. And so how did you end up with 22 people? We heard from in testimony. And on who would be best able to represent this community and make recommendations to general assembly and the lead agency on how the funds should be expanded. So a lot of the membership from for the advisory committee came from testimony. And they had the bones of this bill was presented to us by the assistant age and by the governor's prevention officer. I don't know and much council may be able to tell us. What besides the need to be an equal number and the local has to do with those localities and other states that was maybe counties, but for the most part in Vermont, it was, there were some towns. There were I think nine towns. Not that each one of those towns are necessarily identified in the statute. I mean, you know, but it is the league of cities and towns. Part of their job in the diversity of the cities and towns who either participated or whatever. They get to pick a bunch of people. They get to pick 10. And the other is an assistant judge. That's another local. So that's where the 11 comes in. Because in fact, you know, there's probably better than we do. Assistant judges are are happy. Yes. And so other, you know, other than that, many of the members came from the draft that was worked on with the prevention coordinator and the AG in terms of things that were required. Right. So if, for example, with the equal, if we were to reduce the municipal by two, we'd have to reduce the state by two. That works. Okay. Thank you. There are other questions over here. Okay. Yeah. So you're required to set a special fund. This, the national settlement says there has to be a special fund. There's no way around that. I'm asking this and this will be for future when, when there are conversations about other things in this committee, we really don't like special funds. And if there were a way not have a special fund, we would try to do that because we have no choice. So we have to have a special fund. And you've been very clear about the uses of it. And again, that's very prescriptive. So it seems like we don't, there's not a lot of room for a conversation about that. So coming back to what our jurisdiction is, I think we are down to one, just making sure the special fund is created in a way that makes sense to us. And then I think the other area is the task force because that creates an appropriation, even if it is out of the special fund. So we have to think about that as an appropriation. The fact that it's a special fund doesn't mean we don't pay attention to how it, how monies are spent there. So I think those are the two areas of the committee are we kind of focused down there. So Jim, then Pearson and Fred, we've been being informal because we haven't had witnesses. So I forget people's proper names. Yeah. Thank you. And going back to the list of items you can spend out of this one. I noticed one of them, for example, was syringes and whatnot. We just, I thought we just said, I know in the BAA we get an extra appropriation for syringes for recovery center. Could that have been applied to the fund? No, I'm not saying that. I've heard that this was an unusual one above whatever our staff would have been. No, the organization that we provided that to provides syringe exchange services in the state of Vermont and was absolutely left off the list. There are four actual organizations. This one is actually headquartered in New Hampshire, but provides a lot of coverage. But there was also Vermont places we did too. Yes. And it was an extra appropriation. It was an extra, the extra appropriation. I'm trying to remember here was just for that one organization because it was left off the list. Now there is a request for money in the budget, but the BAA was that one organization. It again provides a lot of coverage in the, what do you call it, a Springfield, the valley there. Okay. The money in the budget. So here's the maintenance of effort issues. Yeah. So then people will need to watch that. Yeah. Yeah. Okay. Okay. Was there. Yes, I did. Yeah. Thank you. So when the two questions, when do you envision the first money going out as a result of the work of this group? I believe the health department who will be the lead agency is intending for the committee to meet in this fiscal coming up fiscal year. And then the funding requests to initiate after that. So they can make recommendations and request the funding and get the funding. So it would, I believe will be this year. 24. 24. 24. 24. So you expect them to take an entire year to really determine what should be done prior to requesting funds that would go out the door and 24. So the bill anticipates that it goes through the budgeting process. So the advisory committee is meeting. They're building their recommendations into their, their budget request goes through the appropriations process. Once the budget's approved, then they're authorized to request the drawdown from the national fund. Gotcha. And then the only other question I have is. This is maybe a question for. I think there. Am I wrong to think that the department is able to be part of the budget adjustment. Okay. So in terms of this coming budget adjustment. Okay, good. Then what we need to, this is my final question. Well, we need to authorize expenditures from the special fund in anticipation of receipt of funds because otherwise there's no money to pay these folks. Sounds like yes. I understand the question. Okay, so we will not be receiving any money until after the advisory group stands up, figures out what they're going to do and makes a request to draw down money. But all of the funds to pay the advisory group are embedded within the money that you intend to draw down. So we're going to need to, we're going to need an amendment to borrow in anticipation of the receipt of those funds. Yes. If you would kindly draft that, please. Thank you. I just watched the clock and I just realized we lost a half an hour with it. There were over over time here. But Rep Feltas. This is how the Volkswagen settlement works as well in terms of we got so much money over 18 years. We have to ask for the money and then actually we spend it. Rep shine. Thanks. Just on the, the two 15% so each of those is 9.6 million. It's my math is correct. And one is for like current opiate abatement and one is for just tell me again with those two. Prevention in the future. Abatement. Right. The 1515 is not part of this bill. Yeah, don't ask us about it. Oh, so you're talking about the 40, you're talking about the 44.8 million to set up setting up the fun. That's the money that will come in. Right now, 70% of 64 million is 44.8 million. Right. This is just so there are three buckets coming in through the settlement. A state bucket, a local bucket. Those are both 15% each. And then there's the abatement bucket. That's 70% of the proceeds of the settlement. And those are what is coming through the special fund and what the advisory committee is on. Okay. So those the other 30% won't have anything to do with the general assembly. The state bucket. Second one. That's not. Okay. And so, so you have just under two and a half million every year coming in to spend on these things as the, as the math. So 2.89 billion. Okay. I got 2.8. I got 2.6. Just clarification. There's two settlements there. One of them is like 10 years maybe in the 11 years and the others 18 years. I don't think the whole 64 is out of 18 years. If I remember my notes correctly. And I'm not sure about the idea behind this is that there could be multiple settlements coming in. And then the language is general enough to be able to be a mechanism for all of those settlements to kind of. My question is around the 22 members. And that is enormous and. Interesting issues. I'm just managing such a large group, but why, why could we couldn't be smaller. Would you have that as chair P you mentioned that the bones of this did come from the attorney general's office and the state's chief prevention officer. And I believe the reason for the size is so the perspectives of those who are doing this work is at the table. Making recommendations and the advisory committee was prescribed in the national settlement. Having one was prescribed, but not the number for the composition. So that is something that is in your jurisdiction or our jurisdiction has to. The number in makeup. I understand that there needs to be some proportionality and representation that earlier. So while people have said yes to such a large committee is there some reason why it cannot be smaller. And I'm just the large committees are. Difficult to manage their expensive. I mean that you're going to be spending just under $15,000 a year just to gather people to have a conversation cutting into the other funds available. And just wondering why such big committee. I think on some level it is exactly as. Has outlined. And. One in terms of. As. The chief prevention officer and the assistant attorney general. I had conversations with myself and with the chair of health and welfare. They identified. We have learned for instances that it is important. You have those impacted at the table and that having one person doesn't work. You need to have at least two. Because otherwise it becomes a good. So there you have those kinds of things. So you have, you know, two people with lived experience. You have. And the importance of people on the ground as opposed to. And. Only administer people who are actually doing the work. This is. Yeah. If you tell us we have to do that. We will. Let's have it. This is an ongoing conversation. And we are actively saying. Asking members of the house to really be thoughtful about how necessary is it to have. Committees at all. We understand here that it is. I'm honest and I will. I don't know if there was, I mean, I do think I believe it is. And I'm looking to. To legislative council, I believe that there were nine cities. Who actually were part of the. You know, suit themselves. And so there was some thought that whether or not it was those exact nine, but that's. So you start there. And then you need nine. And so right there, there's 18. And then you don't. That's sort of what I'm. And how much of behind, you know, how much we could. Say take the commissioner of mental health. Because we already have the chief prevention officer and the health department. And I believe. Yeah. And then, you know, that would get down to 20. I mean, but that's not because we would get on one, but I, you know. I think we may want to just have a conversation about that representative. The way we do our work in our committee, each of us is responsible for each of these sizes responsible for a budget area. And then the bill that is associated with that budget area. Is. The people who are involved in the bill. Are. Provided to the, that that recorder. So rep vacant as the health department. So she has disorders and so he'll be asking questions. About this as we understand the bill and. And, you know, form our recommendation for how. For the bill and think about it before we vote. So. Any other questions that just about about the bill or again those two areas that are in our jurisdiction on not seeing any. Yeah, yeah, I'm sorry for long as I was just wondering though, I'm reading. And we says the advisory committee shall adopt procedures to governance procedures, governance proceeding, excuse me, including voting procedure, etc. And in my mind, I was imagining and I don't think we need to say this, but if it would help them. The advisory committee may he were may establish an executive committee. I mentioned that because I remember back a long time ago when the tobacco control board was formed. Commissioner Carney, there was a large number of people similar to this many different concerns. But there was a desire over time to be nimble. Sometimes, even though the group is recommending I think to the legislature how to spend money. There's a back and forth with the administration. They may at some point say we want to use some of these dollars to match Medicaid, the special funds, it's not that it's not federal matching federal, etc. To do ABC and the administration may say yay, nay, how about this and to convene 23 people back to those kinds of back and forth discussion. Yes, it can be cumbersome and a real challenge. So I wanted to ask like counsel, do you think the advisory board has that kind of latitude, should they want to anyways or does it have to be stated. I think they have the latitude they can add to the procedure. Okay, that that could help with the perceived unwieldliness of such a large group. But yeah, it's in statute and they have a chance at all stakeholders to discuss it. Sorry to be so long winded. Thank you. That's very helpful. That's what we try to do here is something worth mulling. You've you've put it into the brains of Rebegan and Rebecca. So, let's let's roll that over committee. I mean, are you are while they're thinking about that. Are there any other questions that you may have. If not, I think we should say thank you very much to the members from the human services committee. Thank you. Thank you very much for your time. I really appreciate your understanding of bill will be in touch about how this is happening or how we're managing that and with that.