 So just before we start, were there a lot of changes in S7? I thought it was a strike all, right? Yes. So I can tell you off the top of my head. So it went to two committees in the House. It went first to health care. And the major changes there were date changes in terms of when the reports were due. And then there was language in sections one and two, which are both reporting sections that say stakeholders have to be consulted when coming up with the report. So those are the two changes from health care. And then the change from human services are two changes. In section four, which was the section on the report back on Dulce model and on the home visiting, that section was struck. And then in section one, which was the report that's required by CMS about ACOs and that the Human Services Edit Language that said take into consideration future plans about integration of long-term services. Okay, we'll look at those two. I'm just... The internet is not working. Here we are. We have a seven is passed by the Senate. We have S146 proposal of amendment. Let's look at that first. Can I have her copy? I'm sorry, I can't get mine. Is that working? Yeah, maybe we should each get a hard copy. Because this is so slow. We were considering a cloud tax and it's gone. I said it's her. We were considering a cloud tax and it's gone. Okay, it popped up. We got it. Okay, let's look at it. Okay, so what this amendment does is it strikes out the whole subsection on membership of the new council and adds and replaces it with your changes. So the changes that you requested are in yellow. So first, with regard to the executive committee, we have the commissioner of health serving as chair, not as a co-chair. Second, in subdivision B, we have a community leader in the field of substance misuse prevention, jointly appointed by the speaker of the House and President Pro Tem. And that person is no longer a chair. Next, with regard to the members of the council more generally, we have language that members of the council shall collectively offer expertise and start over. Members of the council shall collectively offer expertise and experience in the categories listed below with the understanding that a single member has the expertise and experience in multiple categories to capture that idea that one person could serve. Okay, let's go through it all and then we'll make a suggestion. Okay, good. And then there is just one last change on page three, line four, and that was replacing substance use disorder, substance misuse prevention with youth Vermont population. And now it reads community-based nonprofit services. But we still have substance use disorder or substance misuse prevention in the older population. And what did that replace? It replaced the one about youth in a substance... I think it contrasts pretty closely. Substance use disorder, substance misuse prevention within the youth population. Oh, okay. Okay, all right. All right. So let's go through each one of these. And I did have a conversation with the administration about the sum of this. And I think that there... I think that if we go back to the governor appointment but lead the community leader as a member, that would be probably better received instead of having a pro tem and a speaker. Well, okay. Yeah, I do think one of the most important things is that we don't have co-chairs because I just don't think that... Not having the co-chairs, I think, was the important piece. And the other thing is we can... We're going to look at this thing unfold and sort out what happens. So as a proposal of amendment KAH do this, but can we appointed by the governor? No. I'm sorry. I hated to do this. No, it's nice to have your mind made up, isn't it? That's why people born in September like this. Never make a decision. So, the other question I would have is, okay, right now we have a chair but no vice chair. Do we want to suggest that the community leader be the vice chair? That's no big key. Yeah, I don't know if I need to roll up. I don't either. Whatever you'd like. I don't. You have three votes. Yeah. How does Sheila Livingston care about that? That's the jailor from the health department. That's fine. Okay, let's put vice chair in. We still have some leadership identified. Now she gets four votes. Yeah. She promoted Sheila to senator history. I know what she's saying. Deputy commissioner. Okay. Is that it? All right. There are two. Ensuring that the categories might be represented by one multiple categories for one member. That was good. Do we want to say anything about ensuring the wilderness? The size of the council. The total size of the council. Is manageable. Something. Do we want to say that or should we just not say anything? Yeah. I feel like it's a little micromanaged. It seems like that. We'll just avoid that then. That's good. Just so you have it straight. And then the last one. The last one. Is there a problem with that? I think. Actually, that's what representative from Kelly. Kelly. That's right. Yeah. Suggested anyway. So let's do that. So this will be our proposal of amendment. A further proposal of amendment. Back to the house. When we get it. And it is on the calendars. So we could do it this morning or this afternoon depending on your schedule. Probably this afternoon it feels like. I could probably get it too by 10. Okay. And just so you know, I may want to run it by the house. Just to make sure that we're not running into a brick wall. Okay. All right. Thank you. So now on to S7. Okay. Okay, we need Linda's going to get the one past my house. I don't know if I've got that. Okay. So it's about today. In the house. So there is an aversion as past house. It's just a committee report. It's just a committee report. It's the house health care committee report and the house human services committee report. And we have this fiscal note from no one on 146 this December. I think it will be great to have S146. Yes. Is there a reading? I need a overview of what S7 is. Remind us where we are. Sure. So this is an act relating to social service integration within Vermont's health care system. If you remember, it started off as just a single section bill that was asking for about the integration of social services with the ACO. And so that section is still in there. Section one, you added asset or report that's required of the agency by CMS. Also come to this committee and to the committees upstairs. Then as I said, section two is that report about service integration. Section three added no, there is a section two A which dealt with the budget review of the accountable care organization and added a new criteria. And then section three, which was the director of trauma prevention and resilience development, the responsibilities of that individual and you added a duty for that individual. Section four was the report on the Dulce model and the home visiting programs. And that was it. So... Okay, and so we'll look at the changes. Human services make changes to section four. Yeah, so there are two committee reports. I almost wonder if it's easy. I pulled up the calendar, the house calendar for today. Both committee reports are one right after the other. So if you were to pull up the calendar for today and go to page 2726. Let's do that. Then... Because we don't have the bill yet, but obviously times of the essence. 27... 2726? Yeah, it should be an easier way to get to that. A word search. So is this on... I didn't chat. Is this on notice today? No, this is up for second reading. Okay. Okay, so we're not that... Okay. Do you have it, Rick? You'll find it. Okay, go ahead. Okay, so the first report is the report of the health care committee. And as I said, the main changes here have to do with date changes. So in section one, subdivision A1, the report is due on or before January 1, 2021. Had not aligned with when CMS was requiring the report. So now, this is more an alignment for the agency with when the report is due. And then there's a new subdivision A2. This is in preparing the report. The agency shall consult with individuals receiving services and family members of individuals receiving services. So that is the number two is a new addition? Yep, A2 is a new addition. Similarly, in section two, there is a date change for when this report is due. It's now due December 1, 2019. And I'm not a lost for what the original date was. But again, in this section, let's see, in the big first paragraph after the cross-reference to 18 BSA 9382, there's a new sentence. In preparing the report, the board shall consult with individuals receiving services and family members of individuals receiving services. So it's that same sentence being added in both places. Okay. And then the next section is 2A, Oversay of Accountable Care Organizations. And this is the budget review process. And I don't believe any changes were made to this particular section. Section three, the Health Care Committee did not make any changes to the Director of Information and Resilience. So that is the same. Similarly, section four, the Health Care Committee did not make any changes to the report back on Dulce and Home Visiting. So that's the Health Care Report. And then next is the Human Services Report. And as you'll see, there are two instances of amending the Health Care Committee's report. So the first change is in section one, striking the whole first paragraph and inserting a new paragraph. But the only change is the last clause at the very end of that paragraph is in addition, after All-Pair Financial Target Services Common, including future plans for the integration of long-term care services with the Accountable Organization. Okay. And as it reads currently with the Health Care or with ours, I would suppose that how do we, what do we say about that? Anything? Okay, we'll have to look at this. It's on our website now. I'm going to go to that because it's easier from here. I have to go back and go back. I lost where I was. Okay, so we can look at the Human Services Separate from the House. Thank you. I haven't voted on yet. So the Human Services Report amends the Health Care Committee's report. Yeah, okay. So, but essentially the Human Services Committee the Health Care Committee didn't do a whole lot to the bill as compared with what Human Services... So Health Care made the date changes and they added that language so... Yeah, stakeholders. Human Services again, they struck the whole first paragraph but they replaced the paragraph of nearly identical language except the last clause and that first paragraph is new. The clause including future plans for the integration of long-term care services with the Accountable Care Organization. But then they strike out a section four in its entirety. Yes, so that's the second instance of amendment that has gone. So that's the language that don't even know visiting. Why did they do that? Do you have any sense? I mean, once we have the bill we'll have someone come in and talk with us about their rationale for that. Yeah, I think that would probably be the best thing to do. I know the liaison to Health Care spoke in the Health Care Committee and referenced the fact that the Director of Trauma Prevention is already looking at some of these issues and has, you know, general direction to be looking at this. So, like any more specific information that I suggest you have somebody from that committee come in and chat with you. Okay. All right. When we get this from the House from you on our website page can we have the bill with the changes highlighted in the bill as a whole? Yeah. I'm trying to think of a better way to do that. Yeah, I could just highlight the new language for you so you can see that. Because then we can determine what might or might not be missing based on our original intent. Okay. Okay, let's just say that let's go through this one more time. Sure. You've got seven minutes. May as well use you while we've got you. Yeah. So you want to go back to the Health Care report? Is that what you were thinking? I think let's go, let's start with the Health Care report. Okay. Let me find it. I've got two human services. Okay, time out. Oh, hang on. You have a House Health Care report. But why does it say Human Services? What do you mean? I don't have it. Two different reports, one from Human Services and one from Health Care. Yeah, but it didn't come up. When I say Health Care, I'm getting Human Services. And here, put Human Services and see what you get. You got that too? Yeah, I got both of them. So I have two of the same. Okay. Wait, wait, maybe it's not. Hold on. No, they're both the same. Yeah, they're both the same. So you need to have I have passed by Senate. Yep, passed by Senate. Yeah, and I have Human Services but with that. Just coming in, House Health Care report. So between now and when we go through this thing again, we should probably read what we did and then read what they did. It looks like our reports were way earlier. Yeah. For what then? 2021 is when it's after the next election. People will forget. Why did they put the reports later? Who knows? I know we'll have to get the report or the billing. The first one, there was testimony that that report was required by CMS and I believe it's not required until December 2020. And so they were trying to align the dates more closely. I understand. Yeah, that's understandable. And the second one, I don't recall specifically why that date was changed. Okay. She's got it. She's doing it. Okay. I can speak to why the date was changed. I don't know what to speak about. You have an expert in the way that's why the date was changed. Oh, okay. For the record. Well, as miles of the Green Mountain care board for the record, the date was changed from September 1st to December 1st to align with the quarterly reporting that we received from one care and to give more time for claims and more pressure. Okay. The integration. That's understandable as well. Good. Okay. Thank you. Are we good or not? Almost. I'm going to have you guys do it. I know. You missed me. But the internet hasn't been normal since the little outage thing. Yeah. Should we have a decision to say health care, health may report it. Yeah. I'm going to say that. House health care report. Okay. That's what we want. Yeah. I do the health care report. I'm just going to refresh. Okay. Nope. Oh, it's actually under human services report. That's the health care report. It's the last one and the line up there. Got it. Okay. We're good. No worries. Yeah. I mean, let's just go through. We're not doing any voting or anything. Okay. So the health care report. Section one is the report that is due and it's due to CMS. It's from the agency of human services in collaboration with the board. It's going to the appropriations committees, health care human services in this committee and it's a plan to coordinate the financing and delivery of Medicaid mental health services and Medicaid home and community based services and the all pair of financial target services. That's all the same except for the data. And then the new language is subdivision A2 and preparing the report that the agency is to consult with individuals receiving services and family members of individuals receiving services. Subsection B is the interim status presentation, which is January of this coming year and it's to include update on the agency's progress, the process for the plans development and the identities of any stakeholders with whom the agency has consulted. Go let's see. Section two is the report on integration of services. So that report is coming December 1st of this year from the board and it's coming to this committee human services and health care and it evaluates the manner and degree to which social services including services provided by the parent child center network DA's and SSAs and home health and hospice agencies are integrated into ACOs certified ACOs and preparing the report at the board is to consult with individuals receiving services and family members of individuals receiving services. It's that sentence that's new. That's the change. And then the evaluation addresses the number of social service providers receiving payments through the ACOs and for which services the extent to which any existing relationship between social service providers in the ACO address childhood trauma and resilience building and recommendations to enhance integration between social service providers and ACOs if appropriate. Next is section 2A. This is the budget review process and you've added a criteria subdivision P, the extent to which the ACO provides resources to primary care practices to ensure that care coordination and community services such as mental health and substance use disorder counseling that are provided by community health teams are available to patients without imposing unreasonable burdens on primary care to providers or on ACO member organizations that has not changed. Section 3 is the director of trauma prevention and resilience. This list is all of this individual's responsibilities and subdivision 8 was added by this committee serving as a resource and ensuring new models used by community social service providers are aligned with the state's goals for trauma-informed prevention and resilience that has not changed. Can I ask you if this has changed in human services? No, that's not. That's been retained. Thank you. Section 4 is the report of the director of trauma prevention and resilience development and the director of maternal and child health reporting on the Dulce model and the home visiting programs. Health care did not make any changes to this and human services removed this section. Okay, we'll find out why they did that. Okay. Okay. So briefly, the human services report does. So it strikes that one section. And then in section 1 in the first paragraph it adds a new clause at the very end of the paragraph. So part of this plan that H.S. is working on for CMS would include future plans for the integration of long-term care services with the ACO. Okay. I don't know how that's possible for others to plan for what the ACO is doing since they're an independent organization. Huh. Okay. Well, we'll have to talk about that in a little bit. Okay. Good. Thank you. You're welcome. Now we have to wait for a quorum. To move on. So we've done two of the three bills that we're going to do. So if we, when we have Michael Grady we can finish at 55. Okay. Looking at that, because they're all up on the floor, but we don't have a whole lot of time. So thank you. You're welcome. And I think that amendment's here. Excellent. Yeah, good. Soon it'll be better. I think. Okay. Yeah, good. So we're on break. There's someone that's going to come in. We'll just show us the places. Right. So on page one. Line 19. The Human Services Committee wanted the fact that the commissioner has to request the working group to review chemicals for additional listing. They wanted that removed. They want the working group to review the proposed chemicals for additional listing. Okay. They want to see a power and duty of the working group. With that said, on page two line 16, they want the working group to meet more often if they're going to have additional duties and that they're going to be providing serving and advisory capacity to the commissioner. They want they want them to meet. They've only met once in the past two years because that's all required to do. The House Human Services would require them to meet at least two times a year. Okay. And then on page three in what is being provided as a notice by the manufacturers regarding the chemical by concerning the children product. This is the language that passed the senate. The branding product model and universal product code. If the product has such a code. On page four this is changing the time frame for manufacturers to provide notice right now. They provide notice by annually. So every two years and the Human Services wants them to report annually. So beginning August 31 2020 because that's the next deadline for reporting that the manufacturers will provide annual notice thereafter. And then in the rulemaking section on page five page four going on to page five the standard for the commissioner to add a chemical of high concern. Current law says on the basis of the weight of credible scientific evidence you have changed it to on the basis of credible peer reviewed scientific information and they like credible scientific evidence they looked at the standard in other states specifically Maine and Washington and they think credible scientific evidence is more consistent with those two states. And there is a purpose section in the chemicals of high concern chapter that says the purpose is to maintain as much consistency with other states and so they will. But they wanted to reference or include some reference to peer reviewed study. So on the basis of credible scientific evidence including peer reviewed studies. Can we stop there for a minute? So understanding that peer review is the way that science is validated, scientific data and research is validated. Does this open the door to study from a manufacturer that has not ever been peer reviewed except maybe within the manufacturing company itself to being thrust into the working group or placed into the conversation that may be a biased study. I think the existing standard weight of credible scientific evidence allows for that right now. So your proposal that that's the senate having a peer review condition was the first insertion of that concept instead of standard. So right now. So actually that's a good point and meaning they define credible scientific evidence as being in part like one of it is including being peer reviewed. So it is included as a concept of me Washington doesn't Washington doesn't have that. Included allows for evidence that is not peer reviewed. That's including but not limited to. Yeah. It's a concern. It's a concern. Okay. Just wanted to talk about that a little bit and when we we're going to have to obviously go through this is it on the 4th or 2nd reading. So it was supposed to be on the 4th or 2nd reading yesterday and 3rd reading today because of the length of the debate on a couple of those yesterday they went home at 55 with the condition that everything is going to move through the calendar through all remaining stages of passage today. Okay. So we'll get S-55 tomorrow. We'll have that. Okay. It is up first or second. And I do probably need to be there in a few minutes. Okay. We're not going to keep you. I know it's just about the end here. Okay. Good. So and then on page 6 the current rule the standard in order to for the commissioner to adopt a rule to regulate the sale or labeling of a product requires a recommendation from the working group and that is being struck and changed to consultation that was in your bill. What was also in your bill page 6 line 7 the standard when for that rule is the commissioner needs to be a determination that children currently will be exposed and that certainty of will was always a concern and you wanted that changed in May. You have also struck on page 6 lines 9 through 13 eliminating the requirement that there be a determination that there is a probability to the degree of exposure that the exposure could cause or contribute to one or more of their self-defense. The Health Human Services we agree that probability is too high of a standard but they do like this concept that yes there may be exposure but will exposure lead to one of the adverse effects so they wanted that built in and so they replaced probability with possibility. So my only concern here is sort of the quantitative assessment of the degree and frequency if they had taken out those two phrases and just let possibility of exposure might fit better but we will talk about that. This is fresh and this is language that just stepping back and looking at it in an idealistic policy way which makes perfect sense and then you realize how it can be used. Yes. This is meet for years of delay. So removing on page 6 line 14 because you changed will to may on line 7 you want to change will to may on line 14 and then in one of the criteria for determining if there is exposure on page 7 line 1 they wanted to change frequency to potential and likelihood of exposure and then on page 7 line 16 because the working group this is language that was in your bill the working group isn't recommending or doesn't have that conditional authority over the commissioner so if they provide a consultation to the commissioner and the commissioner doesn't follow it what is their authority. This gives them the ability to submit to you their recommendations to provide a check on a commissioner that just ignores their recommendations. Now on page 8 line 3 this was striking the obsolete date the commissioner has adopted these procedure and process rules the date is no longer relevant and then page 8 line 13 to 17 this was language in your bill about what when should a manufacturer who's introducing a product between a reporting deadline have to provide notice that the product has a chemical high concern to children in it and so is it prior to sale or is it at the next reporting period deadline. The director of the department of health to address that and the requirements for when and how a manufacturer of a children's product that contains a chemical high concern provides the notice when the manufacturer intends to introduce a product for sale between the requirements for reporting. And so that the house left that as is but and they left the director for when that rulemaking needs to be done around 2020 and then there's a requirement on a report regarding implementation of the program that was in yours as well the only other change that they made was in the effective dates they wanted that the the rulemaking to take effect on passage to give them an extra month in order to go to rulemaking. Okay. So some improvements and some and a couple of questions that we have and we'll have to the peer review we're going to have to think about a lot but we'll look at that see what comes over tomorrow. Okay. Thank you very much. You're welcome. You too. We did not want the peer review. We just wanted to have there were indications of possible problems that the commissioner would act on that. At least to identify as a chemical concern. We didn't want the I as standard. Well, peer reviewed analysis is really important. Critical scientific information then if Washington State truly has that that's something we could consider. So let's think about it. Again, to think of what the words actually mean is one thing. Think of how it could be used because it seems to me you could say that there is no credible scientific information without the review. Exactly. By definition of peer review. But then we get into the if I were the lawyer, if I were the Sleesbag lawyer for the chemical guys, I would say the legislature could have said peer review and they didn't. So obviously this means something different. Well, Maine has a definition of credible scientific information as including peer review. That is another avenue that we might take. So let's think about that. I don't want to I know that the houses work very hard on this bill. They want to make it a bill that will get signed and pass into law. But I don't want to pass into law something that has a whole 10 foot feet wide. So we need to think about how to do it. A part of me is just thinking, you know, no matter what we do the bad guys are going to hang us up and they're going to delay. No matter what. So let's just pass the damn bill and see them in court. We want to do it right. We want to do it right. We did. But we don't want good to be the sacrifice for the sake of perfection. Yeah. Well that's sort of what I'm saying. I'm willing to live with that one I can't. As a scientist I have a really difficult time. But I think we're going to court no matter what we do. Oh probably. I think our goal is not to give them any more wiggle room than we can. I think that's my concern about credible scientific information. I think I've said this before in here. The EPA just came out saying that life I say does not cause cancer. All the peer reviewed literature indicates it does cause cancer. If you look at the work that comes out of industry you might get a different that's the kind of debate that we really would like to avoid in our state. You know that life, I've been saying life is safe for years. If you can say it any way you want. Well I've been saying Abednake for years too. I've never heard that. But you know I have always resisted the idea of seeing opponents of environmental protections as inherently evil. I tell my students a person can be wrong without being evil or stupid or crazy. Getting along with the people you disagree with is an important thing. I've got to tell you that thing. Like phosphate. That is evil. It is evil. Detection of that is clearly causes it. We'll know it's okay because industry it's a lot of profits being lost if we tell you. There's a lot of cancer being caused. If we tell the truth it's going to cost us money. Destroys our healthcare system and this is what's wrong and right now the company that produces the most chemicals in the world to expand to Latin America, South America continent of Africa, India and to build an increase of between 15 and 25 percent of their production efforts without having standards in place. And that's one of the one of the things that's going on right now with free trade agreement negotiations across the globe. It's sad because we're destroying our water and our land. We're placing stuff into the food chain that is not biodegradable but is bio cumulative and will cause some debilitating diseases. I'm hearing from people how you I hear from people I respect and trust that 5G stuff is just a lot of alarmism and it's all fine but I once was denigrated as a new cook and the cooks were right we were right and I was denigrated as a climate alarmist we were right we are right and so I'm just reluctant to totally blow these people off people I like and respect and trust they're just really crap on stuff it's aluminum foil ass stuff and there is no problem there just past the damn bill which is probably what I'm going to do but in the back of my mind have I gone over to the dark side of the earth? We'll find out okay we're done we're finished