 Let's move on to H 46 that we have had in committee and we can pull that one up. Katie, do you mind walking us through again. That bill. Let me pull it up. Hey, how did we do are you seeing it. Yes. H 46. Okay. Okay. Hearing that you're not seeing it. I was muted. Okay. Perfect. So just to give you a refresher, this is the version that came over from the house of H 46, but this has various provisions. As the title indicates of health mental health law. So we have some language about. Different in the second half we have some language about some reporting and the first few sections deal with some notice to be given. So I'll go through each of the sections. So the first is you'll read in this lead in language that before person can be admitted as a voluntary patient. That person is to give his or her consent and writing on a form adopted by the department. And then there has been some language rewritten here one, two and three. So I've just been broken out into a list. This was all part of one paragraph before. So when we added this item number four, it started to get very confusing. So it seemed like breaking it into a list was the way to go. So the consent. Is to include a representation that, and this is the new language. The person understands that inpatient treatment, maybe on a locked unit. So the person in need of treatment is kind of a term of art. It's a defined term to mean that you meet criteria to be held and voluntarily. So that is part of the notice that's being. Proposed here when a person is admitted voluntarily. So that is section. One. Section two also has to do with notice being given to. Patients and there's existing law about what the head of a hospital must provide in terms of information to patients. So that they post excerpts of relevant statutes and forming patients of their right to discharge for other rights and for assisting them in making and presenting requests for discharge or for application. This is a new language. This is a new language. This is the new language that the individual has to be notified about by the head of the hospital. So that is section two. Section three. We have language to discharge for other rights and for assisting them in making and presenting requests for discharge or for application. This is a new language or for application to have the patient status changed from involuntary to voluntary. So this is. This is the new language that the individual has to be notified about by the head of the hospital. We have language. About the. Well, we have new language about the collection of information. So in this subsection, we have existing language that the department. Establishes standards for adequate treatment, including requirements that whenever possible, the staff be used as a primary source to implement. EI keys, seclusion and restraint. And then there's this. The department has the ability to review and review. The department has the ability to review and review. And then there's this reporting language that the department shall oversee and collect information. And report on data regarding the use of these EI P's seclusion and restraint. For patients who are admitted to a psychiatric unit. And this is kind of the important part, regardless of whether the patient is under the care and custody of the commissioner. So regardless of whether or not the commissioner has custody, the department has the ability to review and review. And then there's this report on the EI P's seclusion and restraint. Are. Are used on an inpatient unit. And then we move down to section. For. So you'll see that this is session law. This was a reporting requirement. From a report that was adopted in 2018. So the proposal here is to amend this reporting requirement. And it's being amended in a couple ways. So that's the change in B and then you'll also see. In the subsection. Three years of reports 2019 through 2021. And now we're asking here. For additional years of reports. So we want the report to come in in 2022 and 2023. So that's the change in B. And then you'll also see. In this subsection. A three that we're striking out one of the criteria that was supposed to come in from the report. That's data. That's data. So that's data. And emergency departments on individuals seeking psychiatric care. And the testimony that I believe you heard was that. The hospitals were, were unable to. To access that data to. To, to provide that data to the department. So that has been removed from this report. I believe that's the last section. Yes. Our last section is section five. Effective date is July 1, 2021. Thank you. That was good. And, and thank you for reminding us about why that section was crossed out. I, I, I do remember that I should we're talking so. Committee. Questions for Katie. I did have a question about the application to change involuntary to voluntary and how that intersects with the knowing the person knowing that the treating physician may determine that that person is in need of treatment. So, like, what does that application do. And is it sort of negated if the physician or the provider decides that they're a person in need of treatment. So I think the concepts are kind of separate concepts but they, I guess they could potentially overlap in one particular patients case but I think on the one hand, we have the ability who somebody for an individual who was admitted on involuntary status to petition to say that they would like to be on voluntary status and what that would mean is a medical determination that the person is no longer meeting criteria, and they don't have to be held and voluntarily but they can continue to receive treatment but they're not considered a danger to sell for others so I think that's one aspect. And I think the notice requirement that's here that says, you know, if you come in on voluntary status if you're voluntarily entering treatment. If things are true you might be treated on a locked unit, and also if a meant if there's a medical determination that your status has changed that you were not a person in need of treatment when you came into the hospital setting, but then a physician means you now are a patient in native treatment, then your status while you're in the hospital could be changed from voluntary to involuntary and you wouldn't be able to leave the hospital until you know the, the medical professionals treating you found that you are no longer meeting that that medical criteria of person in need of treatment. Okay. Okay. Thanks, Katie. That's all based on medical determination clinical determination. Other questions. Senator Tarenzini. Thank you, Senator Lanzi. My curiosity is sort of peaked by this bill I mean they're, they're a lot of this you would already think would be in place. And there must have been something that has happened previously to have the house draft a bill of this nature, I was just surprised by much of it seems common sense already and things that would be in practice. Do we know why this bill was originally created or the history of how we got to this place, Senator Lanzi. Thanks. Thanks for that question. Let me go. I'm not sure that I can answer it completely. I do know that the issue, the issue about patients rights has always been, I just lost the bill has always been important. And so this is an updating to patients rights. Katie, and then also then the crossing out the line is based probably on a request that. My phone is ringing that we can that the hospitals cannot track that data. So it, it, to me it reflects a cleanup and I think there's always been concern about seclusion and restraint issues. So, I, who was the lead sponsor on this one. It was probably representative Donahue. Donahue. She's always had a in depth interest in the treatment of those with mental illness in the, in the system. So I would suspect that this is part of her ongoing interest. And we've, you know, in this committee we have looked at the emergency department issue for mental health folks having to remain in emergency departments and whether or not they are voluntary or involuntarily treated and and that whole issue gets to be extremely complex. I think we're almost blessed with a bill that is fixing a few sections of law, and that we've heard from folks are relatively not controversial. So I can't help you any more than that. Oh, it just, it seems, it seems straightforward to the point. Yeah. Thank you. All right. Senator Hardy. Yes. I'm, I'm, I'm, I'm chair. I'm hesitant to say this because I just have a specific language change potentially in the very first paragraph B on page one. There are some changes when you did the enumeration that got rid of he or she and it doesn't get rid of he or she in that first paragraph so I'm wondering if it makes sense to say before the person may be admitted as a voluntary patient. The person shall give written consent in it shall give consent in writing on a form and that gets rid of to he or she's just to keep the language consistent I know we're trying to avoid the gender pronouns. Katie, does that make sense. I can make that change. Yeah, good. Does that make sense Katie though I mean. Yeah, I'm looking at subdivision one two. Oh, right. You are referring to subsection be but correct but subdivision one also probably that one. I don't know how to change it subdivision one is tricky which is probably why it stayed the way it was but in section B. You could say the person may be admitted as a voluntary patient. Well, let's see subdivision one you would you just take out and just say the person understands that treatment will involve. Okay. Yeah, I don't see a need for the his or her they are either. Okay. I can make those changes for you. Okay, can we have a strike all bill or are we going to do an amendment. It seems like we could do an amendment for those little changes but I don't I don't care that much I just was looking for consistency. I would, I think it's sometimes easier for the person reporting the bill to have a strike all but Katie I leave it to you. You could just strike that one section, instead of having to strike the whole bill. And we'll just do a clean strike out of one and propose and Luther have a new section one tree just follows. Would that work. Yeah. Okay, we'd still have one through four. I'm not sure I follow. I have a section one. What are you do explain again. I'm just saying that instead of doing a whole straight through the whole strike all of the whole bill just striking section one and putting a new section one with the changes and. Okay. Perfectly fine. Okay, I will take care of that. Perfect. And so then that would be the that would be the last iteration of this bill, hopefully. Okay. Let me see if I can get that to you. I'm not sure what your plans are for today but maybe I can get it to you before you adjourn. Okay, if you can do that we can, we can hold a vote on the bill. Okay, we've got Jen is here and we've got a lot of bills to go through with her. We're going to be early tomorrow morning along with 210. So, however it works, we're going to be moving quickly. Thank you. I have a question before you go Katie. And that is, if we moved our time to 830 tomorrow morning. No, I have another appointment. I'm just, I'm talking to the, I want you to hear this, but I'm sorry. Yeah, no, you're good. You're good. So you, you aren't on the agenda until later in the morning and that can happen. So you're already on the agenda later with this bill and the and the others. Why is it Senate floor gets stuck in there. Committee can we meet at 830 tomorrow morning. Look at and I am. I might be a few mislead center lines, we have a caucus, we have a caucus in the morning. Okay, well, Nellie let's put 830 up on our agenda for tomorrow and hopefully we won't need all that time but you never know. It's, I think it's good to do it and Katie you come in when possible and then we'll hear from Jen in a minute about her situation so thank you. All right. So we're going to move on to the bills that we have from Jen and Jen. The good news is that I did hear from house health care, and they were fine with H430 as we have proposed, we are proposing it so why don't we jump to that one. Great. All right. So I had sent Nellie some new drafts just a little bit ago and I don't know if she's had a chance to put them up yet but I can put the language up. Okay. They are posted. Oh okay. Great. I just wrapped posting them. Oh you sure did I only saw. I saw the numbers I saw there was still three documents and I thought it was the same ones. Thank you. What are we looking at Jen. We are looking at H430. Thank you. I will put that up. That's a strike all amendment. That's right. Okay so it's not as passed by house. Can't hear you. No, we had looked at she was saying it's not as passed by house we had looked at some potential language yesterday that wasn't in amendment form and now I've put it in amendment form with some additional changes to reflect your discussion from yesterday. Senator Cummings if you refresh your page it will come up. That's what I'm doing. Let's just say draft 1.1 422. Yep, I've got it strike all amendment it came up. Yeah. Great. So for the record Jennifer Carby legislative council. I did go over that language yesterday that we had with the house health care committee after we had looked at it in the morning here. They had asked some other questions that I've been following up with diva on about some more specificity in the types of as far as what's covered under hospital medical dental and prescription drug coverage and also potentially tracking. Instead of using the specific income or federal poverty levels and the time the duration postpartum. They were interested in the house was interested in potentially trying to tie that in more to what's done in Dr. dinosaur which is a little tricky because we're trying not to tie it in too much of Dr. dinosaur because of the eligibility issues so I'm still working with diva on that but they are have been looking at that and we've been having some correspondence on that. And I think they also wanted to note that some of that would be a policy decision because they fiscal estimates were based on the specific points, the poverty level and the 60 days postpartum. So I just wanted to put that out for you. What I have shown yes. Yeah, so all of which is to say that we'll probably see some language changes before we vote on this bill tomorrow morning. You may. Right. Okay, but I will show you what I have done so I've marked in green just to try not to confuse us with what we've looked at as different stuff yesterday. The language that I have changed as a result of our discussion in here yesterday. So the first has to do with confidentiality. So we're right in that section in title 33 that requires the coverage to be provided. We would have language that says the confidentiality provisions set forth in section 1902 a of this chapter which are the ones that apply to Medicaid records and applications shall apply to all applications submitted and records created under the authority of this section. I think I was going to change that to pursue it to the section but I must not have done that, except that the agency of human services shall not make any information regarding applicants or enrollees available to the United States government. And that is because there is language specifically in 1902 a that says all this information is confidential and shall be made available only to persons authorized by the agency the state or the United States because it's a Medicaid program. So in this case, we're carving that US government piece out it's a state only dollars program information would not be made available to the federal government. Okay, you're making me feel like a sensation us but we'll go with it. I think that that language is really important for the people who will be using the program so thank you. Sure and then I've put some language in the outreach and education or outreach and information piece about it as well. I don't know if I'm looking at, I don't know if I'm looking at the right one still is my version should have the green highlight on it. Yes, yes, you should so I just went up to the top it should say draft 1.1 h430 422 21842 amp. Refresh your refresh your browser refresh your page. If your says as introduced by the house or as passed by the house at the top it's not the right one. Okay, I refresh I took senator lines of vice refresh and I see it now. Okay, great. Thank you. All right, then we get into section two that is the outreach and provider grants. And so the change we had discussed in here yesterday and I did make these I didn't show you all of the little punctuation changes I did make make these standalone sentences because I'm adding a second sentence on number two. I have grants to Vermont, Vermont organizations that work with members of Vermont's undocumented immigrant community or members of the health care provider community to provide, and then you had requested yesterday culturally and linguistically appropriate outreach and information. I'll pause there and just say that they, at least one of the members of the health care committee particularly commented on liking that language and appreciating that addition. So this outreach and information regarding opportunities for children and pregnant individuals in Vermont by an immigration status for which Medicaid coverage is not available to access health care services at low or no cost in fiscal year 2022 and thereafter. And then a new second sentence that says the outreach and information shall include information on the confidentiality of records pertaining to applicants and enrollees. And that will be part of what's getting communicated to people who would be applying for the coverage. And then I think that's it. Yes, we had, I think Senator Hooker had pointed out an important change in the name that I have carried over here so it's just eligibility and it's not expanding eligibility. Okay, that is that. So you're still working to fine tune the. You're still working with diva and and the House committee to see if there's language that can or should go in there. And as I mentioned diva pointed out that this is to some extent a policy decision because it may affect the fiscal and fiscal impact, going forward, if these numbers change in the underlying reference program which is the Madam chair. I'm not sure I understand what they're looking for, and whether I would think it's a good, good move, you know, what the house is looking for. Yeah, what can you do the issues that yeah the issues that were brought up it are. Well, what if the 317% of fpl or the 213% fpl changes for Dr. dinosaur, and then this program would not be aligned with the eligibility levels for Dr. And similarly, under ARPA, there is a state option to provide coverage for pregnant individuals for 12 months postpartum, but I think we can elect next year for up to five years. So what if we did that and then we would need to change this statute if we wanted to align. So so my, my thinking about that is, just as we have made changes early in sessions that we seal feel are really important, we could, we can come back and make these changes. So, I don't think we can legislate for every possible expected change in the future. If that maybe there's language that can do that but once we once we link it to changes within Dr. dinosaur, I think we put the recipients in jeopardy. Again, and the program in jeopardy is that. I mean, I think David was more comfortable not having specific specific reference to the Dr. dinosaur program because it is so specifically not the Dr. dinosaur program, even though I believe they understand that your intent is that the benefits would align. But I mean may have to come back and pass a quick little statute. Can I ask a question. In section three, the fiscal year estimate thing. The agency of human services is providing information on the fiscal year 2023 costs to our committees. When is that supposed to happen. Is there. Well it's part of their FY 23 budget presentation. I think that will be during the next legislative session. Could we just add language in there that says something about and any changes to eligibility that may be necessary or something and be done with it there. Just, you know, asking them to, if they're updated eligibility recommendations and then we don't have to reference anything else and we all kind of know what that is. I don't know if that covers it or not sufficiently but it's just an idea of a way to get around it. Yeah, I think some, some of the concern was not necessarily that there would be a change in the eligibility in the next year but further potentially further down the road. I'm not sure having the recommendations come next year necessarily addresses the problem, maybe something you want to address offline with, you know, the chair may want to address offline with the house to see where they're at. We'll do that. Okay, is there any other questions on the draft in front of us. We're going to have a discussion center lines on this further or are you looking to move. No, I want to have discussion further I was waiting to see if we could take the build down before we did that. So my only other point I think I would prefer I worked on some of this language of diva as well I prefer to change this piece right here to pursuant to this section, rather than under the authority of this section. If that's okay with everyone, I don't think it's a, it's a has a substantive distinction but I think it's more in keeping with our language. Sounds good to me. But yeah so why don't you do that and we'll then we can take there we go. And now we can have our discussion it, it sounds like we're going to be seeing some language changes tomorrow morning and then possibly entertain a vote. So, discussion committee, Senator Terenzini. Thank you. This added language. Well, let me back up. I, you know, spent a lot of time yesterday and last night thinking about this bill. And thinking myself, you know, we're talking here 100 or 125 children who are here in Vermont right now, do not have the means to have a doctor's appointment procedure medicines if they needed it. And that's one of my four kids who are blessed to have health insurance and then I said, you know, these are in my mind. They're all God's children. And they're all special. And I'm going to support it for that reason. However, I'm a little uneasy about this new added language. Because, you know, it's one thing for us to provide the health and I'm sorry the the second. So you've shown green on page two that talks about my here. Now you are. You're going in and out. I'm back. Yep. Let me, let me turn my camera off, Jenny hold on. Okay, that's good. Is that better. Yeah. My concern really here is this this added language on page two and green about the confidentiality provision. I mean it in my mind and I'm being I'm trying to be very sensitive here but it, we are, we would be providing coverage for children who are here undocumented. In other words, we're also, this is suppressing if the immigration department or the federal government wanted to come here and follow federal laws about immigration we're suppressing records that the federal government might might want. In other words, myself and all of us as citizens of the United States. We don't have this kind of individual protections and privacy rights if, if the federal government was looking for us so unless I'm looking at this completely wrong I just, I think we're taking it too far. The children are here, they need to be healthy, but I don't, this is just very this isn't settling well with me and I just am very uncomfortable about this, this whole section. So, so think about this. I think right now we also have a driver's license program through the DMV that allows for undocumented workers to drive, but that information is not reported. This one would be a confidentiality of healthcare information that would not be reported. And it, it isn't. We're not. We are allowing for some, I would guess it's comfort level on the part of the recipients. So the mother taking the child into the pediatrician or the pregnant woman who's being going to the clinic. She may be very hesitant, either one of those could be very hesitant to going into the clinic or see the physician or the nurse practitioner, whomever it is, because she's afraid that just by going into the office she'll be reported as an undocumented immigrant. It protects that person in that one instance it doesn't in any way eliminate the federal government's authority to identify someone and and move them as the federal government will. So it is, it does become a policy choice but I think it is a choice that allows for people to access healthcare. While they are here, whether or not there are documented. And so I can't say I couldn't say further about that. Senator Tarenzini but I think it does get to the point that you made early on it allows for all children, regardless of their documentation to be in, in healthcare. You know, and one last thing, let's, let's, let's put a hypothetical in place. If the federal government passes a law that says all healthcare providers must report the whether or not a patient is documented. I don't know what that means. It means people won't access care. I appreciate your comments and, and just so the record straight and my committee members know you know my heart and you know where I'm at, and I come at this from a place of love, but not. I'm not suggesting here that I want to see the federal government or ice or anyone sweep in and, and, you know, and move people out of Vermont these folks are here for a better life and they're here working jobs that quite frankly a lot of people don't want these jobs or choose not to work these jobs. I'm, I'm not suggesting that I just, you know that this this language caught me off guard. Yeah, I felt like we were taking it a little a little further. I am encouraged just this week that, you know, President Bush has come out of retirement a little bit and he's on the, he's on the stump for immigration reform because we know as a person we need desperately to stop being so partisan and we need bipartisan immigration reform in this country, badly and this could help. If we did this could, this could help our problem here but anyways I appreciate your comments it's still a little bit of a sticky point but these kids deserve health insurance and in my opinion to be able to get to see a doctor gets medicine to make sure that they don't get a nail or whatever it is that they need you know. Senator Cummings. Okay, look, little history. We did the driver's license in part to prevent human trafficking that migrant workers are very vulnerable. There's a lot of traffic if a farmer takes their documents they can't get off the farm. And we did several pieces of legislation to prevent that kind of abuse. The farmers need the workers and if they were only picking apples for six weeks they could get a green card, but the cows need to be milk 365 days a year and we haven't allowed that. My base question is I'm assuming that the Dr dinosaurs are confidential information under HIPAA. Yeah, so the health data is general have to answer that question. Right, so I treatment information is I don't know that necessarily application for coverage. Under Dr dinosaur is HIPAA protected it is confidential under nine section 1902 a which is the one that we're piggybacking all right so we're doing equal status. I'm also assuming that if the federal government wanted the information. They could go to court and get a subpoena. If they tried to I mean, you know, then there would be the court. Right. It isn't. I don't know what the, I don't know what the, what the result of that would be. So that would be a court decision. Right so so in general you're treating them the same as under Medicaid with this difference that the information is not available to the federal government. And it is also a state fund state only funded program as opposed to a state federal funded program the way Medicaid is. So, I also got the impression because we were worried during COVID, when we were trying to do some things. And there was a, and it was the advocates I think they were running the clinics that said, I, they know we're here. They're just they're hanging around. I, you know, but if they wanted to. They could. They wouldn't have to go for health records. Senator Hardy and then Senator Tarenzini. Thank you Madam Chair and Senator Tarenzini I do appreciate how you always speak from the heart. And that you have been supportive of this bill since the beginning. I, I just want to reiterate the importance of having this confidentiality language in there in order for women and children to be able to access this program. There's a history, recent history and current history of families being separated from each other, mothers and children being separated because of immigration status. And I know that people will not use this program if we don't provide them, you know, some guarantee of confidentiality as best as we can and I think this language does that. And so if our goal is really to make sure that children have access to health care and expecting mothers have access to health care, we really need to have this language in here and it is consistent as Senator Slion and Cummings have said, with the law that we did or prior to my time here but that was done about driver's licenses and also recent legislation that we passed related to stimulus equity payments for people regardless of immigration status. That was a try partisan supported by the administration and the legislature, and it included similar language so I think it's really important to the goal of this legislation to have it in there, and ensure that the people not only have access to health care but also access to protection from having their families torn apart so I appreciate your comments but I hope that you'll continue to support the legislation as is thank you. Senator Tarenzini had your hand. Thank you Senator Liza thank you Senator Hardy I appreciate the comments. The last thing I want to make clear the last thing I want to see is a mother and child or children separated. I mean I think it's a, I think it's a crime what's happening on the southern border right now with separation of families and the. I think several administrations have been guilty of it both parties and send us a disgrace I think it's a failure on both both sides. And I certainly don't want to see these Vermont kids get separated from their, their, their parents. So, I think I'll stop there and I appreciate the dialogue and it's an opportunity for us to do something good at the end of the day for these kids that need to see a doctor so Okay, thank you. Jen, I think what we'll do is we're going to shift gears. And then we'll look for language changes when we come back tomorrow morning on 430. And if you have something before then, maybe you could send it out and have, we'll have the committee be able to look at it ahead of time that would be helpful. Sure. Okay, and so I think what we should do at this point, because we have a story. It's called spam risk. That's what I just got. The, I think we should move to s 120 and, and go through the bill and we heard a lot of testimony yesterday, I have some suggestions for change to the, to the bill. And I'm so can we committee my my comment is this, we've heard a lot of testimony. I've put in a proposal, and I'd like to make further changes to that proposal on s 120 I pulled out some s 132 sections and put it into 120 and I'm hoping that we can work from that, unless I hear a human cry. I'm sorry, can you repeat that center of alliance. I'm, I'm, you're all preoccupied I got that message. I'm, I'm asking if we can work from the proposed amendment to s 120 that I put out on the webpage yesterday. As we go forward and I then we also heard testimony from folks yesterday about making changes to that, and I also have some suggestions that I would like to make, and I'm sure that each one of you does as well. That's what I'm saying. Okay, great. So, I put what you looked at yesterday into a amendment format so we can be sort of working from the same document going forward. And I did put in that additional section Senator lines that you asked for. Last night or this morning in this new draft, and it's new. And so what, so I know that the insurance companies are here. And we've asked for them to, to provide Charles star was here Sarah teach out is here. And I think that we should hear from them very briefly you have sent us testimony in writing I did hear from Jean Kennedy representing Sigma, who was said that to do the hearing aids would have been. And is a great deal of work and they don't have that data so let's hear. We have 15 minutes left 16 minutes left so let's hear very briefly from MVP and blue cross and blue shield and so I don't know who wants to go first. Always. It's always a coin toss. I think I'm going to be a Chuck store here from lean on public affairs on behalf of MVP I'm more than happy if this teach out goes first, but I'm happy to speak to the Sarah's got a more comprehensive sort of message than I do. So I'm happy to and suggest that she go first. Okay, and what I'm going to do is I'm going to limit you very much in time, since your testimony is in writing but please go ahead only want to hear about hearing aids. There were a couple things one is that I can't remember which draft that you had January 1 2022 for large group fully insured to include hearing aids. I just wanted you to know that that's pretty much impossible to do the rates have already been filed the hearing has been waived. All of the comments are done and we are awaiting the Green Mountain care board decision on May 11 about those rates so it's just really too late for 2022. I did want to be very clear that the actuaries worked on this estimate before any final, you know, decisions were made and the bills were released so some of the assumptions that they made do not align with with what you have been discussing. And also no group in the state of Vermont has chosen hearing aid coverage to date so none of our data is specific to Vermont. So I can just tell you that quickly we use information about the number of people with hearing loss and the adoption of hearing aids nationally, and we adjusted for the population that we're covering. And the one point there is that clearly it's the age of the population is important for that type of coverage. We use just a pricing survey data to try and determine how much people will spend on hearing aids. The range is between $1,600 and $2,600 per hearing aid so you have to double that if you have to. We estimate it's about 2000 per user not every person requires to hearing aids. The same cost sharing is for all durable medical equipment. And then this is key, we assumed a three year benefit period which I don't believe is in your bill. So this is a three, an estimate over a three year period so keep that in mind. For a three year period the increase to cover hearing aids for fully insured members is estimated at $7 and 52 cents per member per month. That's 9024 a year but we're not talking about a year we're talking about a three year period. It's equivalent to a point 8% increase in premiums over a three year period again, and due to pent up demand, it's possible that the majority of these claims, maybe in the first year of the benefit period. I was told by our actuaries that I can't take that number and divide by three. So that's why I've given you a three year estimate and I'm sorry I can't do that but that would make the data inaccurate. So I did provide some information about other states coverage on the chart below I don't know if you've ever seen this before, but I would note that almost every state in some way caps the cost of the hearing device, and then most of them have a frequency for how often they be replaced. So, those are two methods that these states have done to rain in the costs of hearing aid coverage. So, Blue Cross does not oppose in any way, the coverage of hearing aids we just want everyone's eyes wide open to the impact on premiums. All right, thank you and Nellie do I don't see. I've refreshed but I don't see the testimony up I have I've seen it myself but I don't think it's on our web page. Where's Nellie Nellie. I'm here. I apologize. I'll check it out and work together and the same with I think also. The truck star is not MVPs is not up either so that testimony. So also Sarah thank you for that and is there any section of 1213 or 14 sections of 132 that fit or not in terms of moving forward I know we did put language in our budget bill our budget recommendation to support the work that DFR is doing with a variety of folks on hearing hearing aid coverage. And do you support that we're very supportive of that approach. All right. Okay, thank you. Chuck. Chuck star again for MVP. You know basically will echo what Sarah said MVPs and has not been able to actually crunch the numbers and come up with an estimate. Their presence in the large group market is relatively small, but it does stand a reason that if you add benefits, it will have pressure on premium. In fact section 13 of s 132, excuse me. I do have one question though, in section 12 of 132 on page 18 line three subdivision to a covered individual may select a hearing aid that exceeds the limit set forth in subdivision one of the subsection and pay the additional cost. And I just mean I'm missing something but subdivision one which is right above doesn't set forth any limit. It just says that the only coverage limit is is medical necessity so that's really that's the, that would be the limit. So if somebody wanted something more than what is medically necessary, they can get something fancier something but they have to pay the additional cost. Okay, all right, that makes sense. Okay, I was looking for a numerical limit or something. But as, as Sarah pointed out, you know, other states that do this do have dollar limits or frequency of replacement limits. So those would be appropriate to try and manage the costs in all of this. With respect to, you know, individual and small group plans, you know the effort here would be to get CMS to modify the benchmark plan that would essentially include them as an essential health benefit. I'm not in a position to give a numerical estimate of the impact on that. One thought that does come to my mind though and I could be wrong but I have it in my mind that if you add benefits, there's exposure on the part of the state for the additional cost of subsidies for people buying exchange I'm not sure if that's at play here. And it's beyond my knowledge as to whether or not that's an actual factor but I would suggest that you take a look at that issue. Essentially, my recollection is states add benefits mandates then essentially the states pay for it in the form of the increased subsidies that are needed. And as we set forth in that memo it does seem appropriate that if DFR is going to conduct an actuarial analysis of changes to the benchmark plan and if that's specifically going to be including the issue of hearing aids that you know that go forth first before any application is submitted to CMS. Okay, thank you. That's helpful and I think, I think we're all worth the leaf is falling to the ground slowly, and where we got it, we understand. Thank you. Yes. Okay. So, Jen, we are. We have eight minutes. My, my suggestion is this let's look very briefly at the. Well, no, I'd like to open it up for committee discussion I think and listen to what your thoughts are based on the testimony that we've heard around the, the proposal and I am sticking with the s 120 proposed amendment that I put in yesterday. And I'm going to, I'm going to start first. Chair before, can I address the state defrayal piece because I think there has been some confusion around that. Yes. So as Chuck mentioned there is a requirement for if states have, if states add benefit mandates after 2011 the state is on the hook to defray to pay the cost of the additional premium not just the subsidies but the additional premium attributable to those additional mandates for the individual and small group market. That's the reason that the bill, as you see it has coverage start for the large group which is not subject to the state defrayal. And then looks at changing the state's benchmark plan to build the, to build the hearing aid mandate in with the mandates which also would require then some reduction, a commensurate reduction and other benefits to account for that there's a process that all part of what DFR and, and the others are going to be looking at and doing that benchmark plan review. But if you just required hearing aid coverage starting next year or the year after and the individual and small group market the state would be on the hook to pay that additional $90 and 24 cents or whatever it ended up being that that Sarah mentioned for each. policy holder each covered life. So, again, it's it there was at one point in an early version of what became the Affordable Care Act that that state defrayal was linked just to the additional subsidies. But it as codified as enacted and as codified, it does apply more broadly, so that the state defrayal applies to everyone enrolled in the plan. Thank you, Senator Cummings. Okay, if we do this is the end effect we are adding to the cost of essentially state employees and teachers health insurance. They don't have any way to negotiate out of this. I'm going to add this as a mandate for the large group, including the so as written in the bill it would include the state employees and the teachers yes it would be a required benefit. So they could look to reduce other benefits to balance it out if that was, if that was the desired result, but it would make this a required covered benefit. Thank you, Senator. Maybe we should hear from the state employees and the teachers vs. Yeah, and the NEA. We had them in but that this was not. They didn't comment on that specific issue specifically given all the issues with potential increased pension cost. I'm not sure how well received this might be. So my suggestion I think is to that we have done a lot of work to add the benchmark discussion into the our budget recommendations. And my suggestion that we use that as our position on hearing aids I think this is, this is much too. It could be much too costly for people, and it is more complicated. Oh, I forgot that's our. That's our bumper sticker. Oh, I think yes, it is our motto. I was gonna say it's a bumper sticker in the in the committee room so you know I think that unfortunately everyone loves the concept of adding hearing aids and and making them available I I've been trying for this one for a while so I think we. I think unless I hear differently that it comes out of the bill. Those sections 1213 and 14 that were in somewhere. Madam chair. Yeah, go ahead. Thank you. It would be good to get the data from DFR and that analysis from DFR before we move forward. And since we can't do it for the next plan year because we're too late along the line we do have a little time before the following to correct Sarah if we. Yeah, so for the 2023 plan year. So, but I wanted to just inquire madam chair if you know did the appropriations committee accept that recommendation to include the language in the budget. Now that was my next comment I don't know. And we certainly could add language into this bill. Were you in committee with them yesterday. I have not been no I've not been asked to be in there. Yeah, okay because I do know they went through at least some of the provisions in our recommended memo and think this was the least shocking. I mean this doesn't I believe I heard the word catatonic from the chair. Oh, nice. I just want to make sure that they accepted it. And if we need to. So somehow reiterate it through this bill we could add the same language in this bill if necessary but I don't know. So, and I do have a phone conversation coming up with the chair of appropriations so we will find out my ears will be filled. So, the documents from Blue Cross and Blue Shield and MVP are now up on our web page we were we're out of time but tomorrow morning, Jen, our. Where did Jen go. Oh, earlier. This terrible when the screen shifts around. So we're we're beginning our work tomorrow morning at 830. Okay, I would like to have a Katie can't be in until that later. So you are on for nine. Can you be here tomorrow morning at 830 to to dive into hs 120. This week I can at school vacation weeks I don't have to do the school run in the morning. So yeah, terrific. Oh, all right. So let's do that let's start out with one I know we have all those bills on our list. We'll do 120 then we'll circle circle circle back to the other bills that Jen has been helping us with my suggestion for on 120 is to look at the testimony that we've had yesterday I do have some documents that we could make and some sections that we might delete and I would like for you to do the same. And we'll, we'll dive into it I may send an email out to the committee later today on the on this bill. So, Senator Harding. Could I just make a suggestion that we start with h 104 tomorrow morning because I think that we could probably just pass that one out and it's the telehealth and then move to 120 which will take a lot more time. Let's check something off our list person so I think that would would take five minutes, and then we could go to 120 which will take a lot. That's fine with me I just think that 120 is going to take a little more time and we also have 430 we want to go through and then 210. Yeah, 46. So, there are a lot that we could check off but if we haven't looked at h 104 today so that's fine we can start with that Jen that is your bill is it not. That is my bill, and I have a very short amendment for you. Yes, it's on your website. Yeah, Katie just sent us madam chair that amendment for what 46 the mental health bill that we just might be able to check that one off quickly but we'll have to do that when Katie comes into the committee so we'll start with Jen. And well then we'll move on to the to the other bills that we have we'll start with 104. That makes a lot of sense. Okay. And if the center lines my caucus is not over by 830 I'll leave caucus to be here so we can take that can take the roll call votes and do my clerk job. Okay, if. Keep me posted on that if something urgent comes up in caucus. Yeah yeah no, I think we'll be fine so. Now we're we're finished we can go off.