 Thank you and good morning. It is Thursday, September 17th. This is a joint committee meeting with House of Health Care and Senate Health and Welfare. So this morning we're going to take testimony and hear from, get a report, an update from Chair Chesbro and Shayla Livingston of the Department of Health on some of the use of stabilization funds within the diversity package. And then we will be moving on to other areas of the Agency of Human Services with Sarah Clark and Ina Bacchus and looking at the distribution and use of those stabilization funds. So, Shayla, I see that you're here and Sarah, so welcome. Well, thank you so much. I'm gonna let Sarah take it away. Good morning. Thanks everyone for having me back. My name is Sarah Chesbro. I'm the equity technical coordinator for our Health Operations Center at the Health Department. I testified a couple of weeks ago with House Health Care about our decisions around the coronavirus relief funding. And I wanna thank you so much for all your attention to funding, designating funding to mitigate health disparities. It's such important work and I'm glad we have your support. I think that I'm here today. I can give updates on the current awards that are out or going out. I can also answer questions about the supplemental money that is being considered. I don't have a reporter presentation but I'm just here for a question, hopeful. Okay. Are there questions from any members of the committees at this point? I would like to hear just a quick update if you don't mind of where we are and how much of the money has been expended and then also the consideration for, I'd like to hear about the supplemental as well, if you don't mind. So a quick update. Absolutely. And I might pivot to Chair Lippert to explain a little bit more about what's being considered with the supplemental funding but the half billion dollars that was funneled our way in, let's see that was July is going to be all spent on five different awards and House Healthcare has heard this already so I'll be brief. The funding is to mitigate health disparities during COVID for different subpopulations that experience them or are experiencing some adverse outcomes currently. So funding is going to Spectrum Family Services passing through to Dr. Avila who actually testified with me last time an expert on health disparities and she runs a program called Cultural Brokers. She'll be doing needs assessments, focus groups, training and a lot of community work with her cultural brokers. The concept here being that community health workers are the best way for the health department to interact with communities in need some of whom speak English as a second language or have other limitations and are marginalized. So that funding will support refugee and new American populations statewide. Other funding is going to support migrant worker advocacy agencies, Bridges to Health, which is part of UVM Extension and Open Door Clinic which serves migrant workers in Addison County. So with those two awards that'll serve migrant farm workers and employers in our state and then the two remaining awards are two United Ways one in Wyndham County and one in Rutland County. Those organizations are also acting as pass-throughs to their social service providers who serve folks experiencing disparities. So among those are racial and ethnic minorities, refugee and new Americans, LGBTQ plus, people experiencing poverty or living in rural areas. And then I think what's being considered is the awarding of more money to specifically target some populations in geographic regions that weren't reached in the first round of funding. I might pause and see if anyone from health healthcare has updates there or questions for me. This was in the budget, Bill, Representative Lippert. Yes, the House Healthcare Committee recommended an additional million dollars be allocated of CRF dollars to health disparities, particularly focusing on continuing to focus on community, BIPOC communities, people of color, as well as LGBTQ youth, mental health system survivors, peer issues, which did not seem to be fully addressed in the initial round. And actually some members of your committee are on appropriations they made. I understand that the Senate has made some changes in the language there. I haven't had a chance to catch up. Yeah, they have. I read it all last night. But so I think rather than go into the budget right now, I think we ought to just ask questions of stabilization you mentioned you'd receive $500,000. I believe the recommend from Human Services and Health and Welfare and Health Care Committees was 700,000 that made it into the budget. So I don't know what happened to the other 200,000. And that's a question for you, Sarah, the answer. Oh, sorry. I don't think I'm able to answer that question. I don't know about the amount of funding that's being considered. OK. I think Senator Lines, we were assured that there was additional dollars in a special grant and epidemiological grant that the Department of Health had where they were going to make some additional grant awards. I don't believe those awards have been made at this point. That's right. That's the ELC money at the Health Department. Right, but that's not the appropriation that was made, the 200,000 other dollars that was made. So that's still out there. We'll see what happens. We'll have to ask a question of the Secretary to see perhaps what the thoughts are there, unless Shaila, you can add additional information. How are the, how are the, how are the? I don't know additional information, sorry. OK, thank you. All right. Sarah, just one other question that I have, and that is how are the funds being distributed? Is this an RFP process? Or have you simply looked to see the previous, yeah. Yeah, the previous election, we did not choose to do an RFP. We have to submit an application to the Agency of Administration to say exactly how we plan to spend this money and how we're making our decisions. This time around, if there are supplemental funds awarded, I think we would, we would review that process again with our business office and potentially do an RFP. I'm not sure at this point, but the previous funds were made based on serving our district office staff, our district directors in the offices of local health, and doing some statewide scanning of racial and social justice organizations, trying as much as possible to get a good geographic spread. OK, all right, thank you. Representative Page has a question. Yes, I was curious, and I think we brought this up last time. What other geographical areas are you considering, such as other remote areas of the state, not just the Northeast Kingdom, but throughout the state remote areas? Because these categories that you did mention are important, but they're not just important for Burlington or Rutland. They're important for all of our rural areas. Thank you. Thank you for the question. I absolutely agree. I think we can provide more attention to geographic spread, and the thing is that having to do a needs assessment takes time, so I'm not sure I'll work with Shayla to figure out exactly how we'll know where the need is for these populations. I will say that part of what we have to consider is organizations that serve these populations that are well established and have good relationships with their community. So we'll be looking for those service organizations and to find out what their capacity is and who they serve. OK, other questions? I'll just make one comment, and then I think we do need to move on. But in conversations with the Department of Health, I think we need to recognize that there's a bit of a circular issue here that if you don't have well established organizations, because in fact you haven't been able to grant them monies previously, and then you conclude that they can't receive monies because they're not well established, it's just a circular argument of, I think, an evidence of what systemic issues. And so I have had some conversations with the Department of Health about this issue. I don't think we should try to get into them this morning. Very good. Thank you. Maybe we'll have some time next week. OK, any other questions? Because I agree we should move on to Ina and Sarah. Thank you very much, Sarah. Appreciate your time and update. Thank you very much. Keep us posted. All right, Shaila, thank you. Thanks to you. OK, all right, so I think Sarah, you and Ina are the point people on the report for us. And why don't you just take it away? And I will represent a page your hand is still raised. So you may want to take it down, unless you have another question. Great, good morning. Good morning, thank you for having us. I just, Commissioner Gustafson is also available as we move through the presentation and the updates for your reference. I was going to give him a day off, but we'll make him work. I sent over. We sent over this morning two different documents. One is a PowerPoint presentation that continues broader updates across all of the agency's CRF programs. Today we can focus on health care stabilization. In addition, we sent over a detailed listing of the health care stabilization awards that have been issued and paid to date. So I will go ahead and share my screen. We'll jump into the presentation. Can everybody see my screen? Yes. Great. OK, so just as a reminder, we're here today talking about the $275 million appropriation to the Agency of Human Services for the Health Care Provider Stabilization Grant program. As these committees are aware, AHS working in partnership with the Agency of Digital Services stood up a Salesforce application to help us facilitate this grant process. The applications opened on July 17 and closed on August 15. A broad array of health care and human service providers are eligible for the program. AHS is administering this program in two different cycles. The first cycle, as I just referred to, closed on August 15. And it covers the time period March 1, 2020 to June 15, 2020. AHS is actually in the process right now of preparing for a second cycle of application that will likely be open to applicants in October. It will cover the time period March 1, 2020 to September 15, 2020. As a reminder to these committees, the legislation required AHS to develop a needs-based application process. Conditions of the grant funding are that the grant funds have to be spent by December 30 of 2020. The funds have to be used to cover cost and lost revenue associated with the coronavirus with COVID-19 pandemic. All of these grants are subject to single audit. And where applicable, provider organizations must continue their current participation in value-based payment initiatives through 2021. Can I ask you a question here? How you said that there are the notices being sent out to workforce, to the workforce. How extensive is that? I mean, it goes beyond folks who are currently in the all-payer model. It goes to all practitioners is what I'm thinking. Is that accurate? Ena, can I defer to you for that question? Yes. Can you hear me? Yes. The question is, how are providers becoming aware of the opportunity? Yes. The providers, this is a broad array of providers that are eligible for this grant opportunity. It is by no means only eligible, including only eligible providers who are participating in payment reform. The spectrum of providers includes even those providers that accept only private pay, for instance. The health and human services providers have all been made aware of this opportunity through various communications by the agency and the departments that have regular communications to these providers. And there's also been information shared through press conference and media advisory to make it known that this opportunity exists. There's also information available on the AHS website, as I think you are aware and have learned about those materials. Of course, it is those notifications that are important to drive people to the website to apply. Thank you. And we would anticipate with most certainly with the next cycle of application doing all of that communication that I just described again and also communicating with any providers that have registered for updates through our website. OK. Thank you for that. Sorry to interrupt the flow. Great. Continue with the presentation. AHS received roughly 351 applications from eligible providers in this first cycle of relief. Of those that applied, 78% were new to AHS relief. And what I mean by that is they didn't come through our door when we stood up in the immediate aftermath of the crisis initial relief efforts. So 78% were new, 22% had received relief previously. Applications that we received were across a broad array of provider types. Just for a point of interest, 22.7% reflect dentists, which was our largest group of applicants. The pie chart that you're looking at on this slide is something that we update daily for the secretary and the leadership team to reflect where the agency is in our review process of these 351 applications. So as of September 15th at 5 PM, which was roughly two days ago, there were 42% the green slice of the pie where all of the reviews of the applications had been complete and were in some various state of recommendation to the secretary for grant award. 44% of the applications had had their second review complete and have been flagged for additional information needed from the providers that have applied through the program. This is something, as I said, that we actively monitor each day to ensure that we're making progress through all of the applications. And you can. I'm sorry. If there's a question, you're going to have to speak up because neither, oh, it's represented. Leper, go ahead. Can you just, again, I think this is key, can you go back that slide and say that 42% are the review is complete? And if the review is complete, does that mean money has been distributed? Not necessarily. And the next slide will talk about where we are in terms of money going out the door. OK, because I think it's important for us to understand what's actually happening on the ground. Yep, agreed. OK, so big picture, though we have not completed all of the application reviews, primarily because we do have some additional follow-up that is required from the applicants. Big picture, we're anticipating that this first cycle of relief payments will be in the neighborhood of $100 million. So with information that I know today, I'm going to walk you through the status of funds that have gone out the door. So the first category on this slide is, as you're aware, the Agency of Commerce and Community Development, I think, was the first agency to stand up an economic recovery program. So as part of that, what we learned is that there were health care providers that were coming through that door, I think primarily, because it was the first door open. And so in conversations with ACCD, because of the magnitude of the health care stabilization program at AHS, we agreed that we would reimburse ACCD for those health care providers that had come through their door initially. So what you see here is roughly $1.8 million of awards that have been issued and funds that have been issued to a variety of health care providers through the Agency of Commerce and Community Development's programs. One of the detailed sheets that I provided to the committees does list each of those award recipients. So you'll be able to see a flavor of which organizations and how much they receive through that program. Sarah, it's maybe a trivial question, but the criteria for making awards and the amount, was that consistent with what you're currently doing and you've done with the ACCD versus AHS? Yes. So my understanding of the ACCD program, it's, I'd say, consistent criteria. But for ACCD, I would say it's more simplified and it's focused on lost revenue from 2019 to 2020. It also capped award amounts at $50,000. And so because of the lower award amount and the more simplified process, I think they were able to stand it up sooner and make determinations more quickly than through the Health Care Stabilization Program. So in our program, we also take into consideration lost revenue from one year to the next, but there are other considerations that factor in our evaluation process. Things like COVID-19 related expenses that a provider could have experienced as a result of the pandemic. We also factor in other relief that they may have received from the federal government or potentially other sources, as well as if a provider may, for example, staff changes that could have resulted in savings, we take all of this into account in our formula to make the award determination. One last quick question. It is consistent. Oh, a quick question on that. Is there any technology included in the award? So I know some docs had to purchase special equipment either for themselves or their patients. Is there an award provided for that? Or is that not included? Or does that go somewhere else? So if a provider had to purchase equipment that was needed to help them deal with the pandemic, it would most certainly be an allowable expense underneath our program. Thank you. Can I add one more point about the interaction between the ACCD program and ours? As you heard, the program award is capped for the ACCD program. If a provider had additional need beyond the capped amount, that provider could come through the AHS program and have that need met and acknowledged. And the provider also has the opportunity to come through the AHS program in the second cycle for additional need beyond June 15 of 2020. OK, thank you. The next tranche of cycle one payments that I'll talk about, and I refer to several categories as just general health care providers. I use that broad terminology just to reflect it could be a whole array of non-hospitals that are included there. So we have issued awards and made payments in the amount of $4.3 million to, I believe, it's roughly 90 providers in this kind of first tranche of payments that have gone out. The other detailed list of providers that I've given to the committee will give you the specific details on which organizations and how much funds that they have received. We are in the process today of issuing another $1.4 million of provider relief. As part of this program, I expect that we will have those awards issued in checks cut by the end of the day tomorrow. There's another category for assistance to general health care providers of roughly $25.6 million, where the applications have been reviewed, but it's been determined the additional documentation is needed from those providers. Agency of Human Services is in the process of performing that outreach to be able to collect the documentation to make the final award determination. We expect for that work to be ongoing over the next week to two weeks. So right there, so the next week to two weeks, meaning that potentially by the end of those two weeks, this money will have been spent. Yes, potentially. It is a little bit more complicated because we are dependent on these organizations providing the needed documentation in order to make the awards. And so we hope to be able to complete this work within two weeks, but it will be contingent upon receiving the documentation. We are going to try to set the standard of a five-day turnaround so that we can narrow the time to be able to issue the awards. Let me ask that, how is this timing and this work affecting the next round, getting the information out for the next round? That's a great question. We are kind of firing in all cylinders right now to be able to complete the current reviews and prepare for the next round. So we are trying to allocate resources to be able to complete both past that once. I think primarily prepping for the second round does, though there is some kind of project management program definition that the Agency of Human Services is involved in, we are relying on our colleagues at ADS and the developer to do the technical portion of the Salesforce development that will need to be completed to make sure we're ready for the second round. OK. And just for awareness for the committees, I think it's been a very collaborative effort across the Agency of Human Services. We have pulled kind of technical financial experts across all of the departments to kind of pitch in and help evaluate these proposals, these applications, because they are actually fairly technical. And the level of knowledge to understand, let's say, profit and loss statements, financial backup from all of these providers is a pretty high degree. And so it's been a great team building expertise. That's great. That's actually great. That's good. Has AHS needed or requested any additional support in order to actually complete this program? So we are, as we prepare for the second cycle, we are going to be looking outside of the Agency for additional resources to help us complete these reviews. Primarily, we're relying on all different types of staff, but a lot of financial staff are participating right now. And I think as the committees are aware, we're going to be embarking upon a pretty rigorous budget development cycle shortly. And so we will need backup. And so we have already begun those conversations to make sure we have the resources we need for the second cycle. And so I believe that there were administrative dollars in CRF administrative dollars for AHS, but I don't know. I forget, honestly, how they might be used. So can't just keep us posted. Yeah, we'll do. OK. Can I just say similarly with what we talked about in terms of moving the health disparities of money out through the Department of Health, it occurred to me after the fact that we had not allocated any additional support for the administrative costs of basically requiring staff to take on a whole new task while not backfilling the current needs. We'll come back to that. Yeah, I think there was language in the budget, but I don't remember exactly how it was targeted. So we'll have to sort that out. The next tranche of funding I'll talk about is roughly $65.6 million that will be going to hospitals as part of the health care stabilization program. We are in the process of actually issuing awards and making payments. You will see down below that I've pulled out Porter by itself, because we are still, I think we've just recently kind of finalized the inputs from that hospital. And we are in the process today of actually reviewing that application and hope to be able to issue an award in the next couple of days for that hospital. So that's roughly how we get to this $98.7 million dollars of estimated payments in the cycle one for the health care stabilization program. OK. Yeah, I have a lot of questions about that category, but they're not necessarily related to the application process as much as to where the losses have been expressed. So let me quickly question one of our goals is to have a greater integration with community services for mental health counseling as an example. And I'm wondering if any of those losses are expressed within the application that you've seen. You probably can't answer that off the top of your head, but it would be interesting to know. I cannot. I don't know, Ena, if you do have a sentence. If I understand your question correctly, I can answer it with that not being information that we collected through this application. We did not collect service line information through this application process. OK, right. OK, get it. Thank you. All right, Sarah, back to you. Great. The next slide that I have for you is just the depiction by hospital of the award amount. And so you'll see across all of the hospitals what the recommended award amount. Not all of the hospitals did receive an award, but one of the things that we realized as part of this health care stabilization program is that the federal government has actually issued significant amounts of funding to health care providers that not only has happened in the past, but is ongoing. And so it's a challenging thing for us to estimate what the impact of that will be across the system. I think the good news is that we're not alone in trying to shore up the health care system in Vermont that our federal partners are also helping. But I wanted you to have this information at a high level. So one of my questions is on that point exactly, because we know that there were direct grants to hospitals that we, at the time, were told were woefully inadequate in terms of the burgeoning losses. Is there any kind of accounting that will be available at some point where you, as an example, particular hospital has received X millions of dollars through other federal dollars? Therefore, that needs to, as the criteria are, that needs to be taken into account in terms of understanding what losses would be reimbursed through this fund. Yes, part of our funding formula is that we collect that information from not only the hospitals, but all of the providers that receive that assistance. So it is a component of our formula. So we'll be taken into consideration when we make a recommendation for the award amount. And that type of information would be also available to understand. So for instance, an organization might have $30 million in losses, but $10 million had been reimbursed, had already been paid by a different federal program. So therefore, the amount you considered here would be $20 million, potentially, just an example. Yes. Is this, can I ask this question? This is about $200 million for this cycle. Is this consistent at all with any estimates that had been anticipated? Because I know you had been collecting some data initially. And I'm interested in actually getting to the, I think there's a projected number for the next round. And I think the projected numbers I've heard. But let me ask you what that projected number will be. Let you present that. But I think everything is less than the $275 million that had been appropriated. So maybe we can move to just get a big picture of where things might be projected to be in the next round. Sure. And what I will say is that we're still analyzing what the next round could potentially be. It's actually very hard for us to come up with a solid estimate for the second round, because I think it's obviously going to depend on the applications that we receive. And hard for us to kind of put a fine point on it exactly. But I will say, building off of your comments, I think that based our original estimate of need, roughly $275 million, I think what we have seen in the first round, that it's not coming in as high as we originally had anticipated. I think there are several reasons for that. One, we've already talked about the level of support from the federal government was greater than we were originally anticipating. And that was a hard thing for us to know with certainty when we were building the foundations of this program. The second factor is I think utilization across the health care system has rebounded in a way greater than we originally expected when we were developing this program back in April. And I think that's primarily because in Vermont, we have not seen the level of COVID-19 patients as we were perhaps anticipating back in the spring. And so that's good news for Vermont. Another factor is that when we designed this program, we weren't as familiar with the requirements of FEMA and organizations that are potentially FEMA eligible have to go through the FEMA portal to secure FEMA funding for roughly 75% of any of their kind of eligible COVID-19 costs. So when we had the original estimate of spending for this program, we did not take that into consideration. And so that is another factor that's kind of reducing the overall estimated need in this program. As we look, and maybe Ina or Corey, I'll pause if you have anything else to add. I was just going to say, go ahead, Ina. Go ahead. I was just going to say, for as a corresponding data point, the federal government has right now, I believe the windows closing soon, but a Medicaid provider fund available or funding opportunity available. And it's an application process. And the uptake on that availability has been fairly low. So there's a little bit to Sarah's point about the, there's always two things. There's always concern about taking federal money because there's always a risk of it being taken back. So you want to be very careful, which I think is also part of our process, which we've become more and more careful. But the second thing is just that fact that the system is functioning. We see in our Medicaid claims that it is has rebounded strongly now. So. All right, thank you. One final point to offer is that as we work through this program and we are implementing the program consistent with the guidelines for the coronavirus relief funds that we understand those guidelines more clearly and that those guidelines certainly do require that we execute the program in particular ways that may be limit some of the funding potential from what we originally estimated. Question about that as well. And then we've got some hands up. Can you, are you keeping track of the percentage of people who apply or percentage of organizations and businesses that apply for the funds as compared with those who have been sent a notice? So you know what the sort of the response has been. How many people have actually applied as compared with a number of notices that have been sent out? A number of people have received notices. Trying to get the count. So we do know that we've received 351 applications to date for the first phase. I would say that's a pretty small proportion relative to all of those that are potentially eligible for this program. So I guess. Yeah, so my concern has been the complexity of the application process for some of the smaller and sole proprietor type businesses, independent folks, and even some of the larger clinics where time has been compressed as a result of patients returning. So are you hearing anything about that? And is there anything that can be done to help? I'll just say that if there was an application submitted and if there was a request for information, we had one person dedicate 15 minutes at a time to make sure that with different providers along during the application timeframe to make sure that their questions were all answered. And in some cases, walked through filling out the application in real time with them. So yeah, concern acknowledged and have done, I will never say everything we could possibly do, but we have really worked hard to make sure that anyone that needed help got it. I should just say that anecdotally, I've spoken with one of the providers, a sole proprietor provider who said to me, I said, have you applied? And they said, with our trying to reopen our practice, serve our patients without having dedicated financial people for our sole proprietor staff, we concluded it was just not possible. And then they commented further that we do not know of any of our colleagues who have applied as well. Yeah, we understand that. I'll say that's part of the reason that we have the second opening going back to March 1 so that all providers, if they weren't unable to get through, because of the reopening, as you stated, they could. Probably all of our calendars look the same, but I was just sharing mine with someone. It's like generally triple book. So I can just totally understand the feeling of overwhelm. And that was, as I said, that's why we are having a longer opening period for the second trial. Can I make a suggestion? I mean, so these practices have been shut down sometimes for days on end without income. I think let's make a suggestion that they shut down for one day that's reimbursable through the grant so that they have time to go through and make the grant application. I mean, something's got to give because these people really do need the support. And some of them that I've talked with at least are not wanting to stay in business. So if there's a way that we could say, you get a full day of reimbursement for filling out the grant if you are an independent or a small but single proprietor, can you do that? We'll take that away and look at that. I mean, the sounds like a really reasonable, compassionate sort of approach to a problem. I think that this just really shines a light on the challenge that we have been facing. We wanted to get these apps in, get them processed, and get them out. As we regularly consulted with GuideHouse, which has been helping the agency of the administration in the state on making sure that the money that goes out does not have to be given back, we have been not only becoming clear about the rules, of course, but also the level of audit that we have had to employ in just this program alone. I think we would probably have had the goal of 15% audit sort of like, yeah, these are mostly coming in. We're literally at probably 85% audit. That's why that chart, I mean, Replipper, you were kind of looking at it going, so what would these different things mean? We have the initial review, we have a second review, then if there are any discrepancies in those two reviews, then we have to ask for more information. That's that provider delay. But we have to do that. We have to really take a second look at most of these applications. And so I'm doing two things here. I'm telling you some of the challenges, but I'm also telling you that sounds like a great idea. We could run into another, you know, clients issue. If it doesn't happen, I think that would be the reason. It wouldn't be an opposition to a good idea. OK, thank you. I've got three questions that I can see. We'll start with Representative Donahue, and then we'll go to Representative Durfee and then Representative Smith. So in that order, so Ann, you're on the line. The other two were ahead of me. Oh, they were. OK, well, then I'll reverse order. I did not see the order. Representative Smith. Thank you. Thank you, Representative Donahue. Could I see that chart again, the hospital appropriations? There we go. It's quite apparent to me which hospitals in Vermont are the most important and the one to the least important. When I'm seeing $32 million going to Burlington, I don't see North Country Hospital on there at all. And I'd like to know why. Maybe they didn't apply for this, but I bet they did. And I'd like to know why there's no funds coming to one of the two hospitals up here. So I'll start maybe and just say that this is a needs-based application process per the legislative language. And it is also the inputs lead to a funding formula that leads to these funding recommendations. And so that's why the award amounts are in the way that they are. It is actually very mathematical once we receive all the inputs and validate the documentation. Ina, I will defer to you about North Country Hospital. Thank you for the question. I wanted to raise this issue relative to the last discussion about the application and whether or not smaller providers found the application daunting. And that was a factor in their decision not to apply. What I wanted to point out was that we've seen both smaller providers certainly may not have come in for this funding. But we've also seen that what we would consider to be large providers with sophisticated accounting arms of their business also did not apply. So Representative Smith specifically, we didn't receive an application from North Country. And that's why they are not here in this funding disbursement. We only received nine applications from Vermont's 14 hospitals. We do understand that it's likely that hospitals that did not apply may apply in the second cycle of funding. Some of those considerations for them may have been the concurrent application process with their budget preparation for their annual Green Mountain care board review, for instance. That's something we can surmise. But we have seen larger providers that also did not apply for funding. What about Springfield Hospital received nothing as did Copley Hospital in Marshall? Can you tell me how much they applied for? The application does not ask. The application is a formula that does not include the hospitals asking for a specific amount. Because this is a needs-based distribution of funding, the application looks at the losses that hospitals have. I'll give a very broad brush explanation. The application looks at the revenue losses that the providers experienced during the eligible period, which was June 15. It looks at the increased expenses that providers experienced also during that time that are directly attributable to COVID-19. And the application looks at the funding that providers have received elsewhere from other sources to offset those expenses and losses. And in the instances where you're seeing the zero award amount, it means that through the formula, the losses and expenses experienced by these hospitals are not greater than the other assistance that they've already received. And so therefore, there is not an award amount for these hospitals. Thank you. It looks to me like we put too much faith in a formula. Can I add one data point to that as well? The rural hospitals got greater proportional federal assistance as well. I believe there were almost two distributions to Medicare hospitals than to rural hospitals. I'm not positive of that, but I do know that rural hospitals got a solid federal distribution compared to other types of hospitals. The other piece is just hospitals did a lot as utilization dropped. They did a lot to manage their expenses. So there was furloughing going on. And so that contributes to the outcomes as well. All right, thank you. That's all I have. OK, Representative Durfee. Yes, thanks. I'm not sure if it was Sarah who was speaking at this point, but someone referred to FEMA eligible organizations and a process they would have to go through. Can you explain a little bit more what that means and who those organizations might be? Are they hospitals? Are they the smaller the dependence? Yes, that was me. So our estimates are working closely with the Department of Public Safety, who is the single state agency for FEMA. So they're kind of the FEMA experts. There are roughly 34 health care providers that are FEMA eligible applicants. I would say that those primarily, like all of the hospitals, are considered FEMA eligible. But there are other organizations beyond just hospitals. And it has to do with their kind of role in providing a critical service through the pandemic in terms of whether they are FEMA eligible organizations or not. In addition, there's also FEMA eligible expenditures, which are also kind of very closely defined by FEMA and DPS. And so not only do you have to be an eligible FEMA applicant, you also have to have incurred eligible FEMA expenses. And there is an application process to FEMA. FEMA does provide 75% funding to all eligible applicants, all eligible expenses. The Coronavirus Relief Fund is providing the 25% state match. That is part of the US Treasury's Coronavirus Relief Fund guidelines that you can use CRF as the match on FEMA. And so as we went through this application process, for any of the applicants that could potentially be receiving FEMA funds, we issued an award for only 25% of those potentially FEMA allowable expenses. Then that organization will have to go through the FEMA portal to get the 75% funding. That is one of the requirements that the state of Vermont has issued governing our federal funds in response to the COVID crisis. The reason for that is it allows us to maximize our use of federal dollars. I will say that as we look to what's needed in our estimates of expenditures for this program, we are holding a reserve for any of these FEMA eligible applicants in case they don't receive the 75% FEMA award. Because I think it, and I'm not an expert on FEMA, I think it could be a relatively complex process. There are resources. Guidehouse is helping these applicants go through the FEMA portal, so there is technical assistance for that. But in case they don't receive that 75% funding from FEMA, our intent is to provide Coronavirus Relief funds for those expenses. Great. Thanks for that explanation. Thank you. All right, thank you. I want to be very aware of our time. Senate Health and Welfare is going to have to leave within the next five minutes. But we have three more hands up. And I want to make sure that those questions get asked to the McCormick and then representative Page. So representative Donahue. Thank you. And I apologize if this question was already answered. I was distracted by some IT problems. I didn't see anywhere on the list applications from or awards to any of the designated agencies. Did none of them apply or are they in a smaller subcategory that's not broken out? Representative Donahue, they did apply through this process. And their applications are still under review. They are another example of FEMA eligible applicants. And so that is a complicating factor for them. But I will say this week we have a focused review team looking at the applications to be able to make award determinations for the DAs and the SSAs. So they're not reflected in the, what was it, 95 million? That's 98 million. That's been reviewed and approved. That would be an additional amount. So I should clarify that 98 million is an estimate of what we think we're going to issue potentially in awards this first round. It has not been all reviewed and approved. They are included in a bucket, the 25.6 million that's still under review. There is a portion of that that is the DAs and the SSAs. OK, so it would be as part of the 98 in other words. Correct. Thank you. Senator McCormick. You're muted, Senator. Sorry. The comment was already made that Springfield got zero, presumably because of money they've already gotten. But the money they've already gotten was because they were on the edge of bankrupt. Well, in fact, are bankrupt. And I'm wondering, yeah, they've declared bankruptcy. And I'm wondering if that was taken into consideration of the fact that the money they've already gotten speaks to a particular situation. That's my question. Senator McCormick, similar to other hospitals, Springfield did receive support from the federal government, not just limited to their bankruptcy status, but as part of the overall relief that came from the federal government. And I will note related to your question, I am seeing on the chat similar questions wanting to get an understanding across the providers of how much other relief they've received. So really like the input into our formula, which are very kind of telling as you look at those details. So I noted the question and taken it to take back and get that information. So the other monies were monies other than the aid they were given with their underlying problems. OK, thank you. That's a very good question. It would be great to get information back. I think Representative Page was next. Well, I think Sarah has already responded to what Senator Westman's thoughts were as well as my own. I'd like to have a look at those to see what funds have been provided previously and compare that to what the chart that you just showed, Senator, or excuse me, I promoted Representative Brian Smith. So that would be very helpful. Thank you very much. So I'll just add a comment on that. I believe that at one point, we heard from the Green Mountain Care Board, or perhaps it was from you folks, on monies that hospitals have received from the federal government. I'll have to go back and look through. But it would be very helpful to get all of that in a broader context. All right, any other questions? This has been very helpful and really appreciate the time that you've taken to bring us this information. I know that there are a lot of questions that we have that we'd like to dig down further into the weeds and no more. But this is, I think, this is the place we need to be right now. Right, can I suggest I don't know, given everything that's on our plates over the next between now and adjournment, but I do think it's at some point it's going to be important for us to be able to look at this with more time available to our committees to understand and ask questions. Yes, we can talk about doing that perhaps next week sometime. If that's possible. Seeing how long we're around. OK, all right. So at this point, I think we're going to switch gears. And we will leave your Zoom. It's been a pleasure. Thank you all for being with us. We enjoy it. Thank you. I'm going to suggest that we so I just just to acknowledge that there have been several people who apparently who requested to be on the background in Zoom in order to be able to hear us live. And I think it's important that we did that. But we the House Healthcare Committee members should sign off so that the health and welfare can can proceed with their other business. OK, thank you very much and take care, everyone. We're Center of Health and Welfare will continue on. Thank you, Ina, Sarah, and Corey. If you want to stay on, you're welcome. Aw, shucks. Center with the medium bill, it's high and everything. I know. I told you not to. I just pointed out that he didn't have one. You made it feel guilty. Well, we're still being recorded for live display. So OK, we are moving on to the child care financial assistant aid for providers overview from Sarah Truckel and Commissioner Brown and welcome, Commissioner Brown. I know you and I have been playing phone tag and apologize for not being able to have a conversation ahead of time. But here we are. I apologize as well. Don't apologize. I know what life is like. Good. Do we have anything from you online for this? We do not. Earlier this week, we did testify in House Human Services in this area, and we provided a chart. And unfortunately, as we were reviewing and approving the award letters for the parent child centers, I noticed a discrepancy between what we were granting out and what the chart had for data. And so we reviewed that chart and we found some calculation errors. And so it's over-inflating some of the numbers and make. And so we are re-verifying and rerunning that spreadsheet. And we will provide an update to the committee when we're through that process. So we're unfortunately not able to share that data with the committee this morning. Are there implications to that in terms of awards being granted? Does that influence? Well, in terms of the testimony and the data we provided to the House Human Services, it seemed like we had a very large denial rate for what was requested versus what we approved. And some of that was due to an inflated number we found in a calculation that made it seem like they requested more funds than they did. And so as a result, that that is going to change and the approval rate will go up considerably. And so which is, I think, a point of concern among the PCCs right now from that testimony. And so you will see that the approval rate will go up significantly once we verify and update that data. OK, because thank you for this. This is an important conversation. I think the questions that I have received, the greatest number of questions and the most compelling have been around the Parent Child Center awards. And can you, it would be helpful for you because we are being recorded. This will go out online on YouTube for everyone. Can you explain one more time what the glitch is, why there are apparently lower awards? Yes, we found a miscalculation. What's happening? Yeah, we found some miscalculations in the spreadsheet that we were using to track and compile the data. And so that miscalculation made it appear that there was significantly more funds requested than there actually were. And then the approval data seemed accurate. But what that did is it inflated then the denial rate or the approval rate. And so it made it seem like we only approved a small portion of the request. And what triggered us to look at that is the other day when I was signing the award letters for the Parent Child Centers in terms of for the expenses up through the application deadline, not anticipated expenses, but actual incurred through the end of August, we'd approved 90% of those requests in those award letters. And so that was a signal to me that something wasn't right in this spreadsheet. And so we've been reevaluating and found some errors. And we're recalculating and verifying that data this morning. Thank you. This I think will be somewhat reassuring to the people I've heard from. I think the somewhat extends to the question about their survivability, their sustainability right now. They're feeling very pressed for resources. So thank you for that. And so maybe there's some hope for me. And for further information for the committee, we are just to reaffirm everything, we're re-reviewing those 14 requests today just to double verify. And we'll be reaching out to the Parent Child Centers individually after that review and having a conversation to make sure we're all on the same page. And then also to have a conversation to give them more certainty on their future expenses, as well, and what will be eligible. Because I think there was some miscommunication around that on our earlier testimony this week, as well. And I just want to give them some assurances that what's going to be reimbursable or not so they can make those expenditures in a timely manner to support their operations. OK, thank you. Questions, committee, on this topic? I know we've all probably received communications regarding PCCs. OK, can we talk about the CCFAP, the child care? Yeah, so you are the hazard paypiece? Well, hazard pay, but we also have, Nolan Langwell is here only until 1030. And can I ask, Nolan, can I ask you to walk through the CCFAP with us a little bit? And then we can talk about that and then also talk about the hazard paypiece, as well. Sure. For the record, Nolan Langwell joined fiscal office. The piece that I was going to talk or highlight for the committee was to help because the piece that we're talking about the budget proposals in DCF. And one thing that had come out on the House was kind of some confusion about the CCFAP move, the eligibility move. So I had worked with Sarah to try to, Sarah Truckel, to try to lay it out in a way that was a little cleaner for us to understand. And I don't know if I have access or if Nellie wants to post it. Do I have access? Do I have access? You do. You do. OK. You're good. All right. And it should be online. But what we tried to do here was try to lay out two pieces, two numbers that I want to flag. The top is this is the 662,727. That's the total impact that the providers will feel from moving from this particular piece. So they'll see a reduction in $662,000 by no longer providing this particular service. If you go down to if I lower the bottom, that's gross because they get the state and the federal combined. So they're just feeling the gross piece. The budgetary impact on this is $613,000. That's the general fund savings from this. The reason why it's all lumped together is because in the ups and downs in the budget, there's multiple components that go into this proposal. And so when you're looking at it from the budgetary standpoint, there's a piece here and a piece there, but they're not all together. And so what this does is this tries to just lump it together saying, this is what the proposal looks like. So you either do all of it or none of it because this is all the moving pieces that go into this particular proposal. And their proposal basically, the reduction would save $613,000. Now, just so you know, the house rejected that proposal and put that money back into the budget. They did not like this proposal. So the budget that has come from the house rejects the DCS proposal to do this. So with this, again, this handout is just an attempt to try to explain or help people understand the numbers better. I think also, and Senator Westman correct me, or Senator McCormack correct me if I'm wrong, but I think that the Senate also rejected this proposal. Is that accurate? That's accurate. OK. So we're after the fact. OK. Yeah. But this is very helpful. Thank you. Thanks, Nolan, for putting this together. Well, is it understandable? At first, you have to really study it for a bit, but it is extremely helpful. That's why I say you really have to look at only those two members. And I want to thank Sarah again for their help on helping me put this together. They were very super helpful working on this. Sure. Sarah or Commissioner, Sean, Commissioner Brown, do you want to make any comments on this? I know we've talked about it before. Yes, we have discussed this in committee previously. And it is, as Nolan indicated, this is a very complicated financial proposal in terms of how the funding and the movement of money and the different debt IDs works. So I really appreciate his work with Sarah to kind of lay it out here and explain it in the way he did. Nolan is correct that the House undid this proposal in the governor's recommended budget. And I believe the Senate budget does as well. And we certainly appreciate the committees thinking, the both chambers thinking and rationale for doing that. And we do not have any objection to that being restored in the budget moving forward. And based on the committee discussions, we kind of put on hold any preparation plans in terms of the staff that would have been impacted. We didn't start the process for any reductions in force that would have occurred. And so understanding where it looked like both chambers were going with this proposal. OK, good. Thank you. That's helpful. And it's also consistent with what this committee had sort of decided along the way. All right. Nolan, anything else? That's great. Thank you. And thanks for being here. Well, we'll give you six minutes. OK, so let's move on to the child care financial assistance for providers and then the hazard pay issue. Go back to any of the comments that you were prepared to give us. Yes. And so we did testify in this earlier in the House as well. This proposal originated with Let's Grow Kids, indicating that child care workers have been left out of some of the earlier hazard pay bills passed by the legislature and into law. And with the understanding that this conversation took on new urgency as we stood up the online learning hubs for school-aged kids and to recruit a workforce very quickly, the bonuses that were being provided for new staff coming on to help support those, we certainly had a concern that we did not want to destabilize the existing child care system and having staff who staff the 0 to 5-aged child care system out there moving to these online hubs. And so Let's Grow Kids put forth this proposal in the Senate. We support it. We recognize that child care providers from their early days of the pandemic and through the summer and even now have stayed open and available to serve the urgent need for child care for first responders and health care workers and other critical staff around the state for services. And so I think this recognizes those contributions and the risk involved in that and with the pandemic. And so we do support this proposal. OK. Questions committee for Commissioner Brown. OK. Senator Westman, Senator McCormick, can you give us, do you have a quick update for what is in the budget currently around this? Or is this going into the hazard pay bill? Do you know, Commissioner Brown? Or go ahead, Dick, yeah. No, I was just going to say I was going to defer to Rich. Essential retailers, too. OK. He's he's drifting off. Commissioner Brown, is it your understanding that this is in the hazard pay bill going in the hazard pay bill? Well, my understanding is some of it is included in an amendment to S-353. That's what I thought, yeah. Yes. Yes. OK. All right. And I think our committee does not have a problem with this unless I hear differently. OK. Any other questions for the commissioner or for Sarah? It would be extremely helpful if you could keep us up to date. You could you can send an email out to the committee as a whole and include Nellie in that, our committee assistant in that. And we will be able to post information that you send us onto our web page so that it's available for folks. Because we're getting a lot of questions, in particular around parent trial centers. And it would be helpful to know that the glitch is fixed. And what the outcome of that is in terms of expenditures to specific PCCs. So getting the chart, the list, and the similar to what we saw earlier from Sarah Clark on the stabilization grant for providers. Absolutely. We will provide that to the committee. And again, we regret the alarm that this data glitch has created and caused. And we're working behind the scenes to provide the accurate and up-to-date data. And we'll be working closely with the PCCs today to make sure they understand where they stand. The question that I have, that is the question that I've asked earlier, and understanding that the PCCs are trying to work as a network and have distribution of resources through the network, is that something that's being considered? And is that allowable under the federal guidance? And so that. Well, there's the federal guidance. And then there was also the legislation allocating these funds and for what purposes. And so we'll certainly look at that. But my understanding is based on it was to reimburse them for cost and expenses and loss of revenue and curvy to COVID that that would look different for each organization. And that's why it's an individual application process. But we certainly want to be consistent in how we review and consider similar cost across the parent child centers. And so we certainly would be consistent in that way and uniform in that way. OK, thank you. I think going forward, we're probably going to have to consider some relationship with the network itself and how that might play out. But next question, that'll be the next step. OK, committee questions on any of this for the commissioner? And then we're going to give him some time off. No question. Yes, I just. Senator Anglum. So I was just wondering if the commissioner's confident that the glitch is being fixed quickly. And I mean, is it you've got all your folks doubling down on it? I know it's a concern to, of course. Yes, we're working very hard throughout. We will be working very hard throughout the day to verify. I want to make sure the numbers we do release in response to this are accurate and up to date and current and reflect the awards that will be going out to each parent child center for their for their costs and expenses. So you're anticipating being corrected by the end of the day for the parent child centers. Yes, I am at the end of today. I agree. OK, I've asked those staff working on this who are teleworking to come into the office this morning so we can huddle in a socially appropriate, distanced way, but to work through each request and make sure all the numbers are reflected in the spreadsheet. So when we provide updated information, it's current and accurate. OK, thank you. OK, anything else? All right, this is very helpful. Thank you for taking the time to be with us and clarifying the questions that we have. Giving us some answers. Anything else, committee for Commissioner and Sarah? OK, what I'm going to suggest is that we move on. I do have a question, a discussion question for the committee based on the work that was done on H611, the older Vermonters bill. So, Commissioner, you are free to go. Yes, thank you. Unless you want to stay. No, I got some work to do here. Thank you for the opportunity this morning. All right, thank you. OK, all right. So we have some time before our next topic. But I wanted to ask about H611 because of the change that was made, I've had a question about why hearing wasn't included, but dental health was. Was there a discussion about that last Friday when my internet went out? No. No, I don't recall that. If there was, I would recall. OK. I think the difficulty with this one is that hearing is seen as the physical health generally. And it makes it really difficult. We know that as we get older, there are certain developed, during each developmental stage, there are specific health care needs. And one of the ones that really stands out, and it stands out to me in something I've been concerned about for many years, and shows how far I've been able to get, introducing bills is about it. And having hearing aids covered and treatment for a hearing loss covered, at least some portion of that covered in health care dollars. So I think that the concern that we're hearing from others is that concern. And why isn't it expressed in the Old River Monarchs Act? I think the Old River Monarchs Act, for me, if I can answer that question. And I don't know whether it's a satisfactory question for anyone, including myself. But this bill is more about establishing broad systemic policies and building a cohesive system across state government rather than identifying individual developmental needs. So the next step, I think, is to build from the broader system. And so we can look forward to this discussion going forward. That's why it wasn't that, Senator Ayer, that you always said that health care stopped at your neck. Of course. Right. And well, which is why having dental in there is a good thing. Because at least we can begin to think about dentures and dental care that Old River Monarchs are sometimes lax in getting. All right. Committee, our next topic doesn't begin until 11 o'clock. Oh, I'm sorry. May I ask another question about 6-11? Absolutely. You're the reporter. Yeah. So I was just wondering, process-wise, I guess that it was sent to approach because of the podiums for the working group. And is this group's going to be able to, I feel bad because I know they're overburdened. But do we think that'll come out pretty soon? Natalie, you've done. Senator Westman. I think we talked about it on. And I think it sounded like maybe Friday. It sounded like Friday. I don't want to be held to that. But it's what it sounded like to me. Does that mean Friday it'll be on the floor at 11.30? It'll be up. No, I got appropriations would take it up. Because with the floor report today at noon and having to report the appropriations bill this afternoon, I think our committee's not going to really meet this afternoon. But so Friday would be the first time that we would meet. OK. All right, so Debbie, it looks like you're off the hook until Tuesday. I mean, I have communicated with the House. And it does sound like they are going to concur with the bill as we propose it, which is a good thing. But it also is going to take them some time. So the sooner this can get on the floor, the better. If there's any way to pop that out for tomorrow, for a floor report, that would be extremely helpful. And I don't know how you do that, given where appropriations is and has been. I know it's been a nightmare in some respects. Maybe a quick review. At last they meet Friday morning for, yeah. Well, if there were, yeah, if there were a quick review. I feel the floor. I don't know. Maybe you can accelerate that process. But we will understand if it doesn't happen. OK. OK. The other issue is, and then we are going to take a little bit of a break, but you'll notice that there is a proposal. There may be a proposal of amendment on H795. This, that we can look at, it relates to the public records access section and the language of that, maybe to make it more to consolidate it somewhat. Jen is looking at it along with others. And I'm hoping, including Tucker Anderson, who's our expert in that area, our Ledge Counsel in that area. So we'll look at that and see whether or not we would want to have a proposal of amendment offered. I think it makes sense for us to be the ones to do that. If there's any change to be made to make it as expeditiously as possible so that the House Committee doesn't have to do that on its own, they've been looking at this as well. So it's not like it's coming out of the blue. The House is also interested. All right. And then a proposal amendment from Senator Ballant regarding the public safety mental health issue and a question for Senator Westman and Senator McCormick. The money did flow to the public safety and the budget. The difference between Senate and House is money goes to public safety in the Senate and to the mental health in the House. Is that right? Yeah. Is there any language in the bill consistent with what the House offered on establishing a broader systemic approach in the future? Is that also in the Senate bill? Ask your question again, Jenny. So there was language that the House sent over, recommending that as a look across the state at all the programs that are offered for integration between mental health and public safety, whether it's state, police, or local, going forward in the future to look at components of the system and how the system would be influenced. Not saying that well. Yeah, I think we get what you mean. Is there language in the budget for that? I haven't looked that far yet. I don't think there is. Do you think, Dick? I would have to ferret through my notes. I mean, we've had dealt with so much. I remember the discussion of whether where the emphasis should be, but Jenny, I need to get back to you on that. OK, I'll go look at the budget myself and look at the language. I think, I mean, for me, as a member of this committee, I think our committee really yesterday, as we were talking, we said how important, for the three of us who were on the Zoom, we said how important it was that this be considered as a mental health issue rather than a public safety issue. The money can go to public safety. I think they're perfectly capable of utilizing it effectively, but having that MOU between Department of Mental Health and Public Safety, I think, is an important one. So I don't know where that is. Yeah, I think the argument on the other side, Jenny, was that you want to integrate mental health into police work, that there are times where police officers are called upon to do mental health work. That's not the issue. That is not the issue. That's absolutely categorically correct. You are absolutely right. And having mental health services integrated with public safety is key. But having standards and criteria and oversight from the health care world, I think, is also important. This isn't a public safety. Mental health counselors are not public safety people. No, but the argument was that they are ought to be involved in what are now public safety. Someone is behaving in a bizarre way, and perhaps a frightening way. And someone calls 911. OK, that's public safety. And that's what people are going to do. Right, we're with you on that. We're with you on that. Totally with you on that. And if we see community service municipal programs through public safety at the local level, those programs are highly effective with social workers and other counselors. And now we're talking about state police. And we know that the counselors are very well trained in mental health areas. But we're talking about a significant amount of public dollars going forward. And how do we coordinate that? My concern is, if you look at the Department of Corrections health care and you see how it has become segregated from the real world of health care, maybe that's a good thing. The delivery system is different. And we want to make sure that we have an integrated system. So I'll leave it at that. We can put it on the agenda at some point. All right, let's take it. Rich, in your view, did I do justice to that at you or in your perspective? Yeah, I think you both made your points. Well, I think that sending the money over to public safety is a good thing. And having them establish a relationship with the Howard Center, Washington County Mental Health, or others is also a good thing. But as we look ahead. I just say, I think that's long overdue. But the formal relationship between those organizations and how that looks is, I think, an appropriate question. Yeah, very good. So we'll deal with that at some point. And I know that it's not it isn't forgotten in appropriations. At least I hope not. OK, any other issues that we need to take up? So we're back on 11. We are come back on in 10 minutes at 1055, if you don't mind. And then we'll be set up and ready to go. I'm just going to mute everything and not go off. Yeah, we don't leave the meeting. We just no, no, we're still recording. Now, can you put the screen up? And then we will take our mute. We'll mute our soft pause. All right, we are recording. All right, thank you. And Jen, thanks for being here. And I know there are others who are interested in this topic. And Nellie, you might receive requests from people to to log on. Just let me know and we'll make sure that people get into the meeting if that's if they have that desire because we are recording and YouTube is still not efficient at this point. All right, Jen, can you please show us the potential amendment to H795 with the markup? Yes, I think maybe it would be helpful to to give a little bit of context for for what this is. So the amendments and and this is what you'll see is a modified version of what was up yesterday are making some changes to the confidentiality and Public Records Act exemptions for the material to be submitted to the Green Mountain Care Board in the context of hospital sustainability, planning, health insurance, rate review, and hospital budgets. So I will now put up. So what I'm going to show you first is a markup version. And with apologies to Senator McCormack, it's in a few different colors. But we'll walk through it. So so the green is because I made additional changes after feedback from the Green Mountain Care Board, who they suggested a more streamlined and straightforward approach to making the changes that we were looking at. So the first first thing that would be affected here is in hospital sustainability planning. And it would just simply take out the language saying that information submitted by the hospitals would be exempt from inspection and copying under the Public Records Act and kept confidential. The upshot of this is that and then there were some exceptions. The upshot of this is that it would be subject to the same Public Records Act exemptions and balancing tests as exist would otherwise exist in the law. So it's not creating anything different. So things that are trade secrets or our confidential business information could be withheld under an exception to the Public Records Act. But the board would have to undertake the balancing test to determine the public's interest versus seeing the documents versus the hospital's interest in keeping them confidential. So that is the first potential change. The second one appears in section six, which is the health insurance rate review section. And this would give some narrowing and maintain the confidentiality in the same context as what the Public Records Act does. So this would tie it into the existing Public Records Act exception around confidential business information and trade secrets. So this would still require insurers upon request to provide the board with detailed information about their payments to specific providers and then would specify that confidential business information and trade secrets received from an insurer under this subdivision would be exempt from public inspection and copying under. And then it cites to the specific Public Records Act exception for confidential business information and trade secrets and kept confidential except that the board may disclose or release information publicly in summary or aggregate form if doing so would not disclose confidential information or business information or trade secrets. Actually made it business information in the amendment. Because we're tying it to an existing exemption, we don't need to have language in about this new exemption not remaining in effect or remaining in effect and not being repealed through operation of law. And then we get to the hospital budgets language, hospital budget review. And this would kind of narrow, again, narrow the exceptions from the Public Records Act to maintain the status quo for the most part, which would be that information required to be filed in accordance with the hospital budget review sub chapter must be made available to the public upon request. This citing specifically in accordance with the Public Records Act. And then under existing law, it says accept individual patients or health care providers shall not be directly or indirectly identifiable. This changes that up a little bit to say that information that directly or indirectly identifies individual patients or health care practitioners would be an exception to that disclosure. But this then is language that my colleague, Tucker Anderson, who works on Public Records Act issues, wanted me to flag for you is if you want to just have that information that directly or indirectly identifies individual patients or health care providers be kind of automatically redacted and kept confidential without the board having to undertake the balancing test as it relates to that information, then you could put in this language here in blue that would specify that that information would be kept confidential. Otherwise, it would be subject to the same balancing test around public interest and hospital privacy, or in this case, individual privacy. So it would take out all of the separate language specifying that reimbursement information would not be made public sensitive financial information and subjected all to the standard Public Records Act balancing test and exemptions list and existing law. So it takes out all of that. It also takes out the language requiring the board to provide guidance on which information would be kept confidential because, again, it would be individualized determinations based on the Public Records Act. I think that's it for changes. So it's much easier to see it in what I had drafted as an amendment, which I will now put up, but I wanted you to see it in context. So these would be the amendments in the hospital sustainability planning section. It would just strike out that subdivision two and its entirety and make number three, which is about the health care advocate getting access to the information, make that number two. The second, and I don't think it showed in there, but had to do is just an error. On my part, I had left. We'd taken out essential to describe community access to essential services based on a request from the Hospital Association. And I did that in subsection A, but I forgot I repeated that phrase again in subsection D. So that would just take out essential there to make it consistent. Then in the health insurance rate review section, it would just clean it up. So just strike out the one that's in there right now and put in this clean version, saying confidential business information and trade secrets would be exempt from public inspection and copying and kept confidential except in summary or aggregate form and then would put in a clean version in section nine, the hospital budgets, striking out subsection A as it currently is and putting in instead a new one that would just say information required to be filed under this subchapter, the hospital budget review subchapter, shall be made available to the public upon request in accordance with the Public Records Act, accept that information that indirectly or indirectly identifies individual patients or health care practitioners, shall be kept confidential. I would take out that and the shall be kept confidential if you didn't want to do it that way. And then that's it. OK, so that's great. I think, is this, Nellie, can we get these two up on our web page? I believe they are. OK, that's good. I think that's helpful. I think people out in the real world want to see that. So committee discussion, for me, this is a cleaner way of looking at the confidentiality of information and consistent with the Public Record Acts makes a lot of sense. Committee, are there questions for Jen? And I see Robin Lunges here from the Green Mountain Care Board. And they've been involved in helping clarify this. Robin, thanks for being with us. Questions for Robin or Jen? Comments. Looks good. OK, I know we don't deal with the Public Records Act all the time. We do deal with it quite a bit. But it makes sense, I think, to keep this as clean as possible, as streamlined as possible. OK, Robin, did you want to make any comments? Further comments on this? Me too, unless there's questions for me. I think, obviously, this wasn't our first choice, but we're happy to proceed this way. And I think that including the language is helpful. OK, yes, it's not quite as broad. It doesn't give the board discretion, it's great discretion in making decisions about confidential information. But I think for us, it does adhere to the Public Records statute currently in existence and may give reassurance to people who would like to either access or not have information accessed. Yeah, definitely. OK. Committee, this is a proposal of amendment that would be offered on H795. Currently, where is it? I don't have it up. I don't have the amendment up. Jen, whoops, I don't have it anyway. Nellie, oh, wait, hang on a second, folks. I'm just refreshing my page. There it is. So what I was going to say is currently, the proposal amendment comes from me as reporter of the bill. And I think if the committee members would like to sign on to this, that would be extremely helpful. Do you want to sign on? Sure. OK, Senator Ingram, Senator McCormick. OK, that's good. Senator Cummings is not able to be here today. So let's do it that way, Jen. And then if I can get a clean copy of that and send it, I'll send it to the secretary Bloomer as a proposal of amendment. I don't, you know, sometimes people want to see these things for a day before we take them up. But let's see if we can deal with it this afternoon. If not, we'll deal with it tomorrow morning. Did you want that language about the shall be kept confidential as it relates to the individual? Yes. I think so. I think that's important. You know, if an individual waves a right to that confidentiality, they can always do that. I know that happened in one hospital budget review that Robin shared with us. OK, I'm going to send this for a quick edit. And I will tell them it needs to be quick. And then I will get it to you to get to the secretary. OK, that's good. That's good. So we're all comfortable with that. I'll do my, you know, Robin, Jen, if there is any way that you can get me a quick summary of the amendment, that would be helpful. You know, I get it. But be sure to get quite. Yes, I'll work with Tucker. I'm coming up with something. All right, that would be helpful. Thank you so much. I really appreciate this. And I know that it was a concern in the House. And I know that the Green Mountain Care Board was deeply engaged in helping us with this one. So we'll do what we can do. All right, we are early. But do you need time to get that work done before? You're not doing the next one, are you? No. I don't think so. What's the next one? No, it is on the mental health issue that Katie's been involved in. But Katie's not here. So we'll just hold off and hear from Department of Mental Health and Senator Ballant on her proposed amendment for the big bill. So let's committee and others. We are going to take a 10-minute break. So you have 10 minutes. Nellie, can you put our screen up? And then we will be back at 11.25. Great, I'll pause the recording again. Thank you. And we are recording again. OK, thank you. And thank you, Senator Ballant, for being here. Your proposal amendment would attach to the big bill, H969. And as we understand it, the Senate position is significantly different from the House position so that the $595,000, more or less, dollars would go directly to public safety, not to mental health. And the language that came over from the House on the mental health public safety issue or the broader issue, the systemic look in the future, apparently that language is not in the budget. We'll have to clarify that, because we don't have our ledge counsel with us. But the Department of Mental Health is here, and they can help us understand what might be there as well. So please present your amendment. OK, so I will wait until Katie is able to take you through section by section. But I will talk about what led me to this, if I could, some background and why I felt it was important. And of course, I leave it up to you and your committee to figure out how best to address this issue. So last Friday, the House passed the budget, and it would allocate roughly half a million dollars from the general fund to embed mental health clinicians in state police barracks. And since then, I've been in contact with Wilma White, the, excuse me, Wilda White, who is the inaugural chair of the Vermont Mental Health Crisis Response Commission. And I know you all know her. She knows you, former executive director of Vermont Psychiatric Survivors. So what Wilda and I discussed was how systemic racism operates at the intersection of mental illness. So we've been talking about a lot in terms of the criminal justice system, but often the mental health system is overlooked in these conversations. We really wanted to make sure that it was part of this broader conversation that we're having. And I'm sure it won't surprise you that the same disparities that we see in other American institutions also appear in mental health systems. So for example, black or African-Americans are much more likely to be misdiagnosed with schizophrenia, for example. Doctors diagnosing it at a much higher rate for black patients, specifically higher for black men, for times as often as for white patients. So significant. In Vermont, non-white Vermonters are disproportionately represented in the highest level of involuntary hospitalizations. So at Vermont Psychiatric Care Hospital, for example, 15% of the patients held there are non-white, and that does not reflect the population of non-white Vermonters. So I'm here because of our fear of how systemic racism might play out. So I'm saying might, want to be clear, might play out when embedding mental health clinicians in state police barracks. And I understand what you're saying, Madam Chair, may not take this form, the appropriation may not take this form, but it has the potential of being a combustible mix. So resulting in either an increase in racial disparities in diagnosing mental illnesses or an increase in racial disparities in divergence. So with white Vermonters with substance use issues, for example, being diverted away from the criminal justice system, while non-Vermonters with the same issues being processed through the criminal justice system. So the proposal is pretty straightforward, though I'm sure Katie can take you through all the ins and outs, but it's really an amendment directed at making sure the Department of Public Safety and the Department of Mental Health are collecting statistics by race on all the 911 calls that relate to an individual's perceived mental health condition, because that's where the decisions are being made. They're mental or emotional condition, they're developmental or intellectual disability and or complications involving drug or alcohol consumption. So I know from my work, you were wonderful, Madam Chair, along with your committee of looking at the issue of how disparities play out with maternal health. So along those same lines is that we cannot assume that when we make one tweak in a system that it's gonna play out the same for people across racial experiences here in Vermont. So that's what we're trying to do. I hope it's possible to do this or something like it so we can start tracking the data. Okay, so what we have here is your proposal of amendment, you're asking to have data collection as 911 calls are made or as people are supported during a mental health crisis through public safety. And then the Department of Mental Health collecting data as well as public safety. I'm looking through it, I'm looking at number three. All of these things are things that I think are critically important as we move forward with a more integrated set of programs across the state and in particular with our Department of Public Safety at the state level. Questions for Senator Ballant? And just FYI, as you may know as in your conversation with Will though we did have her testify. Yes, she said that. Yeah, her testimony is always very compelling. We're caught here in a situation where we don't have the bill but we do want to influence what happens going forward. Questions from Senator Ingram, McCormick or Westman? Okay. I hope you're gonna take this to appropriations. I would think there'd be some sympathy for this. I don't know about the details of the tracking and how that would be, but I would think that we'd all be concerned about this. So, yeah, I think before we get to that next step, any other questions? Cause I do want to hear from Morning Fox who was on the Zoom with us, Senator McCormick. Thanks. Becca, would you just go over briefly again what exactly the bill does about the problem? It's we're collecting. We are collecting data. That's what we're doing. We are tracking. That's really it. It's pretty straightforward. It is how do we address the problem if we don't, if we're not even able to look at the data and say how are we getting to the point where the number of people who are involuntarily committed, the racial proportion of Vermonters in that institution does not reflect the Vermonters on the ground. And what is leading to that and how do we prevent that from happening? So it is not something that's supposed to be onerous or very expensive. I think given the charge that we've been given from the governor and Susanna Davis around being more aware of these issues, it all starts with a lot of it with data collection. So we know what we're talking about. I think this is comparable with what we did in collecting data around COVID treatment with the Department of Health, Senator Ingram. Well, also depth tails with data that's being collected by law enforcement now, which is fairly extensive and is under the purview of the racial equity panel. And changes need to be made in that. I introduced a bill about that. But absolutely, this is just additional data that should go into the mix. Okay. Deputy Commissioner Fox, are you on with us? I am. Oh, terrific. And so is he. We can hear you. There you, we can see you. There you are. Thanks for being here, a short notice, but we understand that there's a difference between the House and the Senate in the budget and the proposed language that's not there. And before we get to the proposed amendment, can you answer this question? Regardless of what happens in the budget, will there be an MOU between DMH and public safety? I will, for the record, Morning Fox Department of Mental Health Deputy Commissioner. And thank you for having me to speak about this because I agree with all that's been said so far, the importance of all of this. And so I'm very happy to be able to speak about it. In regards to MOUs, I would assume, not knowing exactly what we're looking at as far as the program, because it seems to be a little bit in flux as it's changed from the original DPS proposal of embedded workers to what was recently in the big bill, which kind of took away that language and made it a bit more expansive to kind of programs as developed regionally. And so, but as long as there's going to be a collaborative working relationship between law enforcement entities, such as the state police and a designated agency, I would be pretty confident that there would be the need for MOUs that really clarifies the roles and the positions and other work of all of those pieces so that people aren't stepping on each other's toes, if you will, and that we're just making sure that all of that work is happening not only efficiently and effectively, but in the most appropriate fashions. And so that the mental health people are doing mental health work and that the law enforcement is doing law enforcement work and that the two are not co-mingling, if you will, because there is that concern and I do appreciate that. So in fact, I've been working with representative from the state police working on a, we have a draft MOU at this time. I'm working on trying to get a copy to you all for your review, but just to understand that it is, it's a pretty comprehensive document at this point and so it's still in draft form and I just want to try and clean that up a little bit before getting to you. Oh, that's good and thank you for that. I think that on our side of things, for our part, we are very appreciative of that work and hope that it can go forward. And so on the proposed amendment that Senator Ballant has brought, comments that you might have. Sure, sure. Well, I wanted to start with, by just commenting that the Department of Mental Health, we are still in support of the original Department of Public Safety proposal in regards to having embedded mental health professionals working with law enforcement in a co-located fashion. In regards to the amendment, I want to start off by saying, I agree with everything that Senator Ballant, you Madam Chair and Senator Ingram, et cetera, have all commented on that. This is extremely important data as we move forward. Senator Ballant is right in the information that Will the White presented in regards to the percentages of non-white people being hospitalized in our level one system of care, which is the highest security part of our system of care, that they are disproportionately accounted in our system compared to the overall general population of our state. And so that is an important piece for all of us to not only take note on, and I think what Senator Ballant's proposed amendment is getting at is collecting that data so that we can then clearly move forward in how to start to change the systems that are all interacting together, and that's mental health, law enforcement, and other social services as well, ADAP services, Dale services, et cetera. In regards to the specific comments the data that's being sought to be collected is great data to collect. There's no question there. Some of the thoughts that we have is just helping folks understand some of the potential hurdles that we'll have to get through in order to use this data. I think in section three, it speaks of a vendor chosen by the council with the goals of collecting uniform data. And in talking with our research and stats folks and our data folks, that could be a tricky thing. And it's not gonna necessarily be just an easy thing as we start to bring in data from different places and bring into a central repository if you will. And so I just wanna make sure people are aware that this is not something that necessarily can be set up in short notice. And so that is it workable? Probably, and from the conversations I've had with our folks and our research and stats division, it is something that can be set up and done, but it's not something that happens overnight. And so I think people just need to be aware of that as we work on that to try and sort those pieces out. And I think an important piece to understand here as well is that the data that's gonna be coming in is really gonna rely heavily on the individuals who are in these positions. If it does go forward with kind of a co-located, embedded clinician, if you will, or professional, it will be reliant upon that individual in each area to ensure that they're collecting all that data. The race of individuals, I think there has to be also, I think we have to make note that there may be some folks who's, that their race is not necessarily apparent just by their skin color. And so that's a delicate line for any kind of professional to go down the road of needing to ask someone's race or something of that sort, similar to asking about gender or anything else. And so that's a tricky piece. And so I think there should be some expectation that there will be some folks that may not want to give that information. And that it's within individuals' rights to not be able to express what race or ethnicity they are of origin. The other type of pieces that we're looking at, we have some clarifying questions I think we'll need to kind of work out when we talk about looking at the number of individuals who are referred, who are already a client of a designated agency. I think some of the questions that we'll have will be things like a client of any part of the agency, a CRT client, an outpatient client, an ADAP client, if they've had one contact, does that make them a client in the past or is it more than one if they had contact in the past but are no longer actively in treatment? Does that count? So I think we'll have to sort out those pieces. It's definitely a doable piece. And I think it's good information to have similar to the information that we look at when we talk about the suicide data. When we look at suicide data and we look at, we do look at have they been connected with a designated mental health agency in past times because that's a significant piece. As an aside, a significant percentage and the majority of folks who complete suicide in our state have not had contact or have not been connected with designated mental health agencies. And so that speaks to outreach, that speaks to access, things of that sort. And then I'm gonna just speak briefly and then I'm going to ask our General Counsel Karen Barber to speak a little bit more about this, but we also have to keep in mind protected health information and who has access to this information is law enforcement really should they know where someone was referred to? Should they know if they've been a past client of a designated agency and things of that sort. And so we have to be careful of that. And I also think we'll be able to report out on this information. It will take some operationalizing to get, pulling this together and collect that data and then the work of the data folks or the encounters however you wanna term it, that the folks who to try and extract that data will have to be worked out. And I think we have to be, I just wanna be cognizant of the fact that since our population in Vermont is so predominantly Caucasian and that black indigenous people of color is such a small percentage of our overall population that there may be times within this that we're unable to report out on some of these pieces. As an example, if we have in Orange County a fairly small rural community that has a very small population of people of color and we note that there was one person or three people just by commenting on one or two people who were referred to X or referred to Y that could potentially be identifiable and that would run us into HIPAA violations because it's not just mentioning someone's name, it's that it could potentially be identifiable. And so those are some of the kind of the overall pieces that we would be working on and some of the roadblocks that we would have to kind of get around. But I think I'll leave it at that for right now but I thank you for the time and as I said, I think our general counsel, Karen Barber can speak a little bit more eloquently about some of the HIPAA pieces that will have to be cognizant of. Okay, thank you. And I wanna be aware of our time. We have nine minutes left and I wanna make sure that we get to some closure around this knowing what the timing is for the big bill but Karen, thank you for being here and just a couple of minutes if you don't mind your comments on this and then we might turn to our ledge counsel, Katie McClendon, who's joined us. Sure, for the record, Karen Barber, I'm general counsel for the Department of Mental Health. You know, I think as Fox said, the information you're seeking is mostly protected health information which means that it can't be given in any sort of form that's identifiable and given that, you know, Vermont as, you know, as Deputy Commissioner Fox mentioned has kind of a lower percentage of individuals that are non-white. It's very likely that there is a lot of data here that you're asking for that the department is not gonna be able to provide because it would be identifiable. So, you know, we just wanted to make sure that you are aware that, you know, we can of course try to comply with this but understanding that often probably we wouldn't be able to provide that information. In addition, so the Department of Mental Health doesn't have access again because it's protected health information to know if someone is a client of a DA receiving DS or ADAPS services, we wouldn't have that information because again, we wouldn't have a right to it. So when you're asking, you know, where there were further if there are clients just kind of being aware that that's not necessarily information that the department could provide. Touching briefly on kind of a vendor. So it's pretty complicated to share protected health information and if you're trying to have it in a server that's not kind of part of the Agency of Human Services, there's just a lot of kind of legal complications to that and it wouldn't be something that can be done quickly. You'd really need to put a lot of thought into whether or not it's possible what information could be shared and how it's gonna be protected. So, wanna be really quick but just aware that there's, there's I think significant HIPAA issues that need to be worked through. Okay, thank you for that. I know Senator McCormick has a question and I want, Katie, are you there? Yes, I'm here. Okay, great. So Senator McCormick, why don't you ask your question and then I'm gonna make a suggestion that includes Katie and Karen and Becca and the rest of us. I recently filled out a candidate forum and one of the questions was, what do you think the state should do about racial inequity? And I had answered there, I said, well-intentioned white people need to listen to actual people of color rather than listening to each other and our theories about race. We need to, so I'm wondering, has anyone from the community of people of color, Susanna Davis for one, expressed an opinion on this? Okay, I'm aware of. Okay. So Senator, this is all moved so quickly because as you know, it just, the budget just got voted on the house. Willa called me literally yesterday morning to talk about this with me and Willa is a person of color. She's- Well, exactly. What I'm saying is- No. We don't have that- A particular experience. And so we wanted to get this in front of you as soon as possible before we, as you know, we're doing a walkthrough at noon for the budget for the Senate. And so time was of the essence. So were we able to do absolute due diligence in hearing from stakeholders? I will be the first to admit, absolutely not. So let me comment on that and then Senator Ingram, you're up next. We have taken testimony on this. The house healthcare took extensive testimony on this and wrote up a proposal which they put into the budget. That proposal was taken out of the budget. I think there's a sense of expediency here within the Senate to get money out to help embed mental health workers in public safety. I see, I don't see a problem with that. Yeah, I expect to vote for it. I expect to support it. I'm just- Can I, let me finish Senator. But so what I do see a problem with is not having the longer view. I think what Senator Ballant has brought us is another way of looking at the longer view so that we don't throw the baby out with the bathwater. And so Senator Ingram, if you have a quick question, fine, I wanna make a comment before we have to disintegrate. I just had a quick comment actually. I mean, I just think you're working with advocates who are people of color and represent organizations that look at racial justice. And one of the main things they always say is we need to collect more data because people, white people, whoever cannot refute hard data. When there's actual information that they're being discriminated against, makes things much easier. So- I'm glad you- Well, that's an answer to my question. Thank you. That's good. Okay, here's my suggestion. My suggestion is, I think, I don't know how the rest of the committee feels, but I wouldn't mind signing on to an amendment that Senator Ballant would carry forward to the Appropriations Committee. I think what probably needs to happen is that our Ledge Council, Katie McClenn, work with Becca and with Karen Barber of Department of Mental Health to put something together that's realistic, that doesn't fall under HIPAA every time somebody tries to report something. And that sets us on a pathway forward so that when folks come back in January, there's a longer conversation. And I think that this will help build on the work that's been done and will help as the MOU goes forward. So I'm happy to sign on, Becca. And if you think that having Katie and Karen work together with you is the way to go. That would be great. It's gonna be quick. I understand. I'll sign one, too. Anyone else wanna sign on? Senator Ingram, McCormick, Senator Westman. So Becca, if I would hope that you would get a chance to come before the Appropriations Committee, I'd like to hear more about the HIPAA stuff, but I'm inclined to wanna sign on as soon as I figure out from them that we're not running right into HIPAA. Right, understood. I think that for me is absolutely key. We need to do this in a way that doesn't put individuals in jeopardy. And so let's, Becca, does that, we're putting a little bit of work on your shoulders along with Katie and Karen. That's all right. I'm eager to do the work. If I could, Madam Chair, before we leave, I just, I wanna make a recommendation. Any group I have to talk to in the last month, I just recommend this book to read before we're back in session. It's called Cast the Origins of Our Discontents by a wonderful New York Times journalist, Isabel Wilkerson. And once you read it, you will never look at the world the same way again. And so this is work that is continuing out of that framework. So I appreciate your time very much. Terrific, and I will share with you that my family and I have been reading, in addition to having a history of working on this issue myself, but my kids have been sharing books around in there. It's absolutely great. This one is on my daughter's reading list. So I'm gonna- Yeah, it's phenomenal. I will read it, it is. Katie, are you able to help Becca put something together with Karen? Yep, I don't know how we wanna proceed but maybe Senator- I don't know either. So email with a little bit of guidance and we can start working to put something together for you. That sounds great, Katie. Thank you so much for your time. All right, that's Senator McCormick. Yeah, I expect to vote for this measure. I think probably because the Appropriations Committee is gonna have to consider it, that it's like a juror deciding in advance. I think I should not be a cosponsor, but I just, because I'm gonna be sitting in judgment on it in the, in a probes. You can be an advocate for an approach. I will, I will indeed. All right, as a member of the committee. Okay. All right, thank you all. We have reached 12 o'clock. Thank you, Madam Chair. I very much appreciate it. I'm thrilled that you, I've thrilled you brought this forward and we look forward to having you speak up in appropriations on our behalf. Okay. Absolutely, bye-bye. Thank you everyone. Okay, Nellie, I think we can end recording. All right, I'm ending recording now.