Okay, I think we're live on YouTube at this point. So this is the House Healthcare Committee meeting on Tuesday. And our primary agenda today is to look at, to get updates on where we are with federal dollars, which some ways I've used the CRF dollars a shorthand for all federal dollars. I hope that hasn't been a confusion for folks who've asked to update us, but some are technically CRF dollars and others, there are other federal dollars in play here as well. And just as a reminder when we adjourn, well, when we recessed at the end of June, we had passed a number of bills allocating dollars, not exclusively, but primarily to the agency of human services. And some were to sub departments of the agency as well as the agency generally. So I think, I appreciate everyone joining us today. I hope we have not asked you to be here in duplication of what we're going to do on Thursday, which on Thursday we will turn to budget issues. So I apologize, I didn't look as carefully to the list of those invited today. Let me actually just check. Is there anyone here on our agenda or on the screen who believes they have been invited to look at budget issues versus federal dollars issues in which case I would want to make sure that you're not spending time waiting to hear about something that we're going to do on Thursday. We will be meeting immediately after, just to say, immediately after this, our committee meeting today at three o'clock, we will be meeting as the leadership group of the committee with staff to try to determine who we most need to hear from on Thursday. We had budget hearings with the Health Appropriations Committee jointly last Thursday with the Department of Mental Health and then on Friday with Diva. And I think we have some questions probably in both areas for Thursday. So we will anticipate the possibility of wanting to hear from you on Thursday. But I think with that, I think the, okay, seeing no one saying, well, I'm on the wrong screen today. I think the place to start, I think Sarah Clark is here with us from the agency. And I see that you've prepared a memo that is quite comprehensive. And I think we really provide us with the overview, begin to provide us with the overview that we need. And then perhaps as there are questions about any particular section of that, others can be resources does that seem to make sense to you, Sarah? Yep, that's the plan for my perspective, Representative Lippert. Okay, great. So welcome to those who have joined us. So I think what I'd like to do is turn this over to you, Sarah Clark. And I believe you've sent that memo to Demis who has shared it, but perhaps putting it up on the screen would be a good place to start. Yes, Demis has actually given me the power to be able to share my screen. So I am gonna do that with you now. Can you see my screen? It should be a PowerPoint presentation. Yes, I can see it. A few others that I can see on my screen, can others see the screen that's being shared? Yes, I think I can. Okay, great. Okay, so why don't we start with the overview and then we'll start walking through it section by section and have questions present within each section. How about that? That sounds great. So good afternoon for the record. My name is Sarah Clark. I'm the Chief Financial Officer for the Agency of Human Services. What I've prepared for you today is a broad agency-wide overview of the various Coronavirus Relief Fund appropriations that the agency has received from either the Joint Fiscal Committee process or appropriated directly in a variety of bills that passed earlier in the session. My comments are focused on Coronavirus Relief Funds Representative Lippert and so, but I think that as you potentially hear from some of the others that are on the call today, there may be some additional information they would have about specific other federal sources. I'm also happy to kind of update the presentation that I think I gave to this committee back in the spring about other federal funding, perhaps later this week if that's helpful. But today I was planning to focus on Coronavirus Relief Funds. And just this slide here kind of gives you at a snapshot the funds that the agency has received from the Coronavirus Relief Fund. The top section of the chart illustrates at the various Joint Fiscal Committees, the levels of funding that were approved across the Agency of Human Services. So starting back on May 11th was that kind of initial round of Joint Fiscal Committee funding that was approved for the agency. The agency received in that round $116 million almost. I wanted to update this committee to let you know that as of the end of last state fiscal year, as of June 30th of 2020, across the Agency, we've spent roughly $91 million for the purposes that were approved at that Joint Fiscal Committee meeting. Subsequent to that initial round of approval, the agency went back three other times as recently as yesterday, as Representative Lippert is aware. Yes. More narrowly defined scopes of funding requests that were approved by the Joint Fiscal Committee in early June, $10.2 million related to the Brattle War Retreat in late July, $500,000 related to suicide prevention. I believe Commissioner Squirrel will be updating the committee on that topic today. No, it was yesterday. Go ahead. I would just say that was in lieu of the receipt of the $800,000 grant that had been discussed. Correct. And then yesterday, the committee approved almost $12 million for remote learning in school-age care that was critical yesterday as school is starting, I believe in a little less than two weeks. The countdown is on for me personally. So today I'm not really gonna, I'm not planning to dig into the details of the JFC approved funds, but I wanted to give you that broader scope across the agency of the funding we have received. As you move down to the second box on the slide, I have detailed out for the committee at a high level in each of the bills, the funds that were appropriated to the agency of human services and its departments. As we go through the subsequent slides, I have it detailed by each department, the various programs that were stood up, funded by coronavirus relief fund and myself and others are prepared to give you an update on the status of those programs. This presentation includes all departments, but if the committee doesn't necessarily want an update on what's happening in the department of corrections, we can quickly move through that information. But as you're aware, there right now are five different legislative vehicles where there were coronavirus funds appropriated to the agency of human services starting with act 109, which was the budget adjustment number two for state fiscal year 20. In that bill, the agency received funds to support EMS providers as well as some community investments in the department of corrections. The legislature also passed a one quarter budget bill last year, act 120. That included a $6.75 million for a variety of programs at AHS, including legal aid, the blind and visually impaired, adult days, micro business support and some additional funding for the department of corrections. One of the, I say the largest bill affecting the agency of human services and coronavirus relief funds was act 136, which was a bill specific to health and human services needs related to the coronavirus relief fund. That included $323.1 million of funding for the agency of human services. I'd say the largest by far included in that bill was the $275 million for the healthcare stabilization program. The second largest after that was $28 million for hazard pay for essential employees. And we'll give you an update on those programs later in the presentation. In addition, act 137, which was the coronavirus relief funds for broadband. I have a spelling error there, my apologies. And housing included $17.35 million in appropriations. The largest was $16 million towards a kind of homelessness package and kind of dealing with the impact on our homeless population as a result of COVID-19. As representative Lippert indicated earlier, this committee will be taking testimony on Thursday related to the FY21 restatement budget. So in addition to the bills that passed the last legislative session, the governor recommend for the restated budget includes $10.9 million of funding, coronavirus relief funds to support a variety of programs across AHS to include the reach up caseload increase as a result of the COVID-19 pandemic, Department of Corrections staff that are substantially dedicated to the pandemic response and some investments of the Department of Mental Health. So all told across the JFC approved and the appropriated amounts of the coronavirus relief fund, the agency of human services has received roughly a little bit more than half a billion dollars of coronavirus relief fund appropriations. That's a lot of money. So I thought that would be kind of a good place to start to give you a broad overview from here. I wanna talk a little bit about the process that the administration has stood up to kind of evaluate and move forward with these various grant programs that have been stood up by the legislature and the administration and partnership. The agency of administration created a COVID-19 financial office to oversee the distribution of money from the coronavirus relief fund. This office, some of the kind of key members of this office is Brad Ferland who pulled in some financial staff from around the state to offer additional support to the agency of administration in administering the coronavirus relief fund. Any agency or department across state government that receives an appropriation for to stand up a coronavirus relief fund grant program essentially to receive approval from this COVID-19 financial office of the proposed grant program before starting. Towards that end, the COVID-19 financial office is CFO for short. But before the CFO developed a grant program questionnaire to help them understand the details of each program and to help warrant compliance with coronavirus relief fund guidance and regulation. It's essentially a risk assessment of the program and agencies and departments have to include additional details about the type of COVID-19 related costs they will be looking to reimburse. Whether or not a program is looking to provide support to providers for revenue loss as well as details on how the program will be administered and managed. It was actually a very useful tool for the staff at the agency of human services to kind of help us put to paper the details of the programs that we are going to be administering. So each of these questionnaires is reviewed by the agency of administration along with Guide House who I believe at least chair Lippert is familiar that Guide House is the agency, the administration's consultant over kind of the coronavirus relief fund and other federal fund sources. They review each questionnaire and actually issue a formal response to agencies and departments. So it's very helpful to receive the feedback from this CFO and Guide House before we move forward. And so for each of the programs that we're going to review now we have had to submit a questionnaire and receive their approval prior to moving forward. So it might be worth just noting for members that Guide House was contracted with coronavirus relief funds as a specific consultant to help guide guide decisions to avoid frankly to avoid the potential what's referred to as clawback where if there's a future audit of course all these funds have to be used before December 30th and must be used within the criteria of the coronavirus relief fund. And there are guidelines that have to be met. And so Guide House has been engaged to help provide direction to the agency of human services frankly in order to avoid the potential for future clawback because if clawback becomes, if there is a clawback it was required that it must be paid by state funds. Am I correct? Correct me if I'm wrong. Yeah, they've been a very useful partner for us as we've done program design. And so it's essentially been additional resources with some key expertise for the agency of human services as we've moved forward with some of these pretty significant grant programs most notably the healthcare stabilization program. Yeah, extraordinary amounts of money. Yes, yep. So with that I was going to turn to the specific appropriations that were established in one of the bills that we just reviewed and give you kind of some brief updates on where we are in the process. I would say at a high level we not a lot of cash has gone out the door yet just kind of across the board and we'll talk about in some instances where the money has gone out the door but across the board not a lot has gone out the door. We are right on the cusp of starting to issue some grant awards through these various programs. And so I expect over the next three to four weeks that'll be a different update, different story but there's been quite a bit of work that's happened at the agency to stand up these programs. So the agency of human services if you all just kind of quickly go through and then if folks have questions. Yeah, I think there's some sections that will be very brief. I think the first several we can just quickly go through but there may be some interest particularly around the EMS providers on this first page because that was actually something our committee was involved in as well. Sure. So the first two on this page and can folks read it okay? Is it big enough? The font? Yeah. Okay, so the first two are actually two different grant programs that were directed to Vermont Legal Aid through the Agency of Human Services. The first one is related to additional costs associated with providing access to justice services. The second has to do with providing legal and counseling services for those who are or are at risk of becoming homeless. And so the Agency of Human Services is kind of the conduit for all of the funds I think at the agency to Legal Aid. And so we have executed two different grant agreements with Vermont Legal Aid for these purposes and are actually in the process of reviewing invoice and financial report and do anticipate making an actual payment to Vermont Legal Aid by September. So that's in process. The next that I'll talk about is there was a $3 million appropriation to EMS providers. That $3 million was broken down and I'd say two kind of main chunks, 400,000 plus 500,000, so 900,000 in total. Though it was appropriated to AHS, it was transferred to the Department of Health for the purposes of establishing some training programs for EMS providers, paramedics, kind of anyone associated with EMS providers. And so that transfer of funding has happened. It is now with the Department of Health and they have started an application process where individuals can apply for kind of funding to receive the type of training as detailed in the bill. And so that program is underway for students that are currently enrolled in these programs. Can you tell us, can you give us who the lead person would be at the Department of Health if we might want to come back to this later? I think this is not our main focus but I have some personal interest in this, having helped write some of the language, see how it's implemented, who would be the lead person. Yep, and I may pronounce his name wrong but you may recognize it, Dan Bastis. And I can follow up with his kind of contact information if that's helpful for folks but he is normally in charge of the EMS program and he has been kind of leading the efforts as it relates to the training for EMS. Great, thank you. If you just give us his name and contact information there. Can do. So the balance, 2.1 million, 100,000 was available for AHS in partnership with the Department of Financial Regulation to engage a contractor to help facilitate the EMS providers applying for the $2 million of relief. So AHS working with Department of Financial Regulation did a simplified bid and have executed a contract for that technical assistance. We anticipate to be underway shortly to do the outreach to the EMS providers to essentially provide them with the technical assistance to be able to apply for the financial relief. And I'll just note here that there was some issue, our committee had looked at some issues around training, EMS training, and one of our concerns separate from these dollars as well with these dollars is that some of the smaller organizations are not really in the position to easily apply for grants for training. And we wanted to make certain that they were available to all levels, both those who hire professionals as well as volunteers. So we'll be interested to see how that plays out. Yeah. I think this is another one of those areas where in like three to four weeks we'll have a more fully fleshed out update for you about how that work is progressing. Right. So if there are no other questions about EMS for now, I can move to the next. I don't see any other hands at this point. And I would just encourage committee members, use your blue hand to indicate interest in raising a question if you can. I'll keep an eye on it. Great. The next program I'm going to talk about is the hazard pay for essential employees program. You recall that was the $28 million appropriation to the agency of human services. The language had kind of very prescriptive, was very prescriptive about the types of employees and the types of employers that would be eligible to apply to this program on behalf of their employees. It is a first come, first served program. Similar to what's happening with various CRF grant programs across the government, the agency of human services working with ADS stood up a sales force application process. This is what was done for agriculture, ACCD, as well as in the healthcare stabilization project that we'll talk about shortly. The applications for this program opened on August 4th, as of, I think actually more recently than August 14th, we've received 460 applications as part of this program, estimated at about $30 million in total. So if you recall, the $28 million program we've received received roughly $30 million in applications, but of that 30 million all may not actually be eligible. And what we're seeing is a significant amount of the applications were not complete on the first go round. And so as we reviewed the applications, there has been a kind of iterative back and forth process with some of the applicants that needed to submit updated documentation to have a complete application. So as I said, we are in the process of reviewing the applications now. It is still an open program, though we received, because it was first come, first serve on August 4th, I think over those that couple of days that was a significant influx of application and it's been more of a kind of handful a week as we've gotten further away from the start date. We do anticipate starting to make awards in the next two weeks as the review team is completing their work. And I'll pause now if there are questions on that program. I can see any hands, well, two comments from me. One is, I believe there's some discussion about possibly amending the eligibility during this period of our legislative session. I'm not directly involved in any of that. So I don't know that personally, but. And can you comment at all, Sarah? Because I think the issue is here and it won't be in the provider stabilization funding, but to comment on the logic of having first come, first served programs as opposed to applications by a certain date certain and then reviewing the process of what are the cumulative applications. I've had people raise questions with me regarding that, saying that that seems to favor those who have the ability to respond quickly from financial having significant financial staff available to them more so than those who might not. But I've never really heard the rationale for that. Yeah, I will say for this particular program and Ina, please update me if you have anything to add that it was written in the legislation as a first come, first served program. And so that is the manner in which AHS is administering it as opposed to the healthcare stabilization was not kind of written in that same manner. Well, it was clearly written to not be that. I mean, that was one of our concerns. Okay, thank you. Representative Rogers has a question. Thank you. I just wanted to clarify that we're talking about the entirety of the hazard pay program that's being administered by AHS. It's not that different agencies are administering different components of the program. Is that, am I understanding correctly? That is correct. I do, I think that one of what Representative Lippert was referring to earlier, I think they're. Yeah, I'm referring to funds outside of AHS actually. I believe. For hazard pay? I don't, perhaps I'm just confusing the situation but my understanding was that there was some concern that there was initially certain occupations such as stark lurks I believe were understood to be ineligible and therefore were not included in the authorization but subsequently a new federal guidance or practice or whatever, turns out that there were some employees in certain settings that are now seen to be eligible and that there may be a modification needed. I'm not sure if, is this all the hazard pay money through AHS? Cause I think some of it may have gone through different parts of state government or is this everything? To my knowledge, this is everything that's currently been appropriated has been appropriated through AHS. I think you're exactly correct Representative Lippert about the conversations happening now about whether the program could be expanded to other types of employees and employers that would potentially be outside the scope of the agency of human services. For example, grocery store workers. Right, right. You know, I think that that will be a TBD. Yeah, right. Lucy, does that use your question addressed? I'm not sure if it is or not. I see you're shaking your head. Yes, okay. Why don't we move on then, sir. Okay, so we're still in the agency of human services. The next program and Act 136 is the $275 million healthcare provider stabilization program. I think this committee is very familiar with the parameters that were established in legislation surrounding the implementation of this program. I'd say that this has been quite a significant amount of work since we've seen you last at the agency of human services. Similar to the hazard pay program, we developed a Salesforce application in collaboration with ADS. The application for this program. Salesforce is the name of an app. It's not like, yeah, so that people understand what you're referring to. Yes, it's a platform, I guess. I'm creating a Salesforce. Software, I think. Yeah. Is there another question? I don't think we see one. So the application opened on July 17th. The first round of applications closed on August 15th. We felt it was important to give providers full month to be able to submit their applications for this program. The kind of scope and breadth of information that we need to collect and validate is significant. And so we wanted to make sure that providers had enough time to come into this first round. We do anticipate assuming that funds are available. And at this point, we do assume that funds will be available. We do anticipate a second round of funding in October. In the initial round of applications, we've received 343 from eligible providers. Interestingly, of those 343, 78% of them were new to coming to AHS asking for COVID financial assistance. 22% had participated in our prior relief efforts. And if you recall, that was the kind of sustained monthly payments, the sustained perspective payments, and a few other avenues that were open to providers. Applicants included a broad array of providers across the entire healthcare spectrum. I just noted for you, I think the biggest providers were dentists at roughly 23 or 22.7%, the largest group from a number of providers perspective. We are in the process of reviewing those applications now. To be able to make recommendations around grant awards. It's a pretty significant piece of work at the Agency of Human Services. We anticipate being able to make awards, hopefully at some point starting within the next two weeks. Similar to the other programs, I expect we'll have a more fully fleshed up update for this committee within three to four weeks in terms of award amounts and whom. Corey and Ena, I want to, if there's anything that you guys want to add to this kind of high level overview. Great. Thank you. Nothing for me, Sarah. Yeah, okay. Okay. So then, Sarah, can you, are you at the point where you've indicated you think there might be money available for secondary? Can you, do you have a dollar amount of what the total applications were if they were all fully funded, which they may not be, we understand. But if they were, what is the dollar amount of the applications from the 343 applicants? Sure. I very kind of specifically haven't mentioned a dollar amount here yet because of the kind of due diligence and the process that we have to go through in reviewing the applications. I think it would be preliminary to share with you that it's X amount of dollars that we've received in applications because there are a significant portion of the applications that are potentially not complete and where the validation of documentation still needs to occur. However, saying that we do feel strongly that there will be funds available for a second round. So I guess I can commit to that with an update as soon as possible. Yeah, well, we would look forward to that update and okay, are there questions from committee members given where we are or given where the agency is? This is in fact far and away the largest single program that we worked with as a committee along with the House Human Services Committee and the Appropriations Committees. Are there questions? I see Representative Durfee has a question. Yeah, thanks. And Sarah, just one little clarification point. The applications all included a place for the providers to indicate how much funding they were looking for? Yes. Okay, thank you. Representative Cordes. Do you or does anyone else have access to information about whether or not practices had to close into direct relation to stress related to COVID? So maybe, Ina or Corey, I can defer to you. My understanding as part of the governor's executive order, right in the start of the crisis is that some provider types had to close, similar to what happened with restaurants and retail. But Ina or Corey, please add to that. I think she's referring to a different definition of the word close. Am I correct Representative Cordes? Go out of business. Yeah. Go out of business, I think she's meaning. Well, Sarah, I'll just maybe hop in a little bit, but I don't have, we don't have, I wouldn't say whether or are specific. This is how many, and this is, I do believe. And we, of course, we have Sarah Squirrel on as well, but I think it would be Monica hot. We'd wanna ask, believe there were two adult days that did close their doors. And I don't know that the, I mean, I think that it was a little bit of a difficult situation for those providers before the state of emergency or the pandemic hit. But I, that's, I mean, I'm really speaking off of something that we, you would wanna investigate a little bit further to get to, but not in terms of providers, medical providers or providers that are registered, I would call them Medicaid providers, necessarily healthcare providers. So I, I mean, I can take that one part of the provider scope and speak to that. I don't have information of provider that has let us know they're going out of business and we needed to assist with, read, you know, patient movement or access. So I don't have anything specific. Thank you, commissioner. Representative Houghton. I just wanted to clarify when you say healthcare providers, does that include dentists? Yeah, yeah, I'm trying to, I'm just not positive that adult days are Medicaid enrolled providers. So I was kind of trying to make that sort of distinction, but yes, dentists are Medicaid enrolled. Okay, thank you. So I don't see any other hands yet. I would just say that I have, you know, it's the informal anecdotal comment that you hear just by being part of the communities in Vermont, but I had heard that some providers chose not to apply because they felt like the application, smaller providers, and specifically actually dentists. So I was interested to see this percentage of dentists. I've heard that some dental practices felt that they did not have the wherewithal to complete the application in the manner that was required in terms of comparing costs from a year ago to costs now, et cetera, and that they were, they decided to forego the process. So I am interested to see that some practices clearly did apply. I don't know if you have any, if there was any feedback about the application process itself. One of the concerns that I should say that our committees had, our committee in particular was for smaller practices, who don't have like full-time accounting staff, et cetera. And that's what had been, again, conveyed to me that they said, look, we're all direct providers. We have someone who helps us with our financials, but we don't have accounting staff. And we felt it was not going to be in our interest to try to sort everything out. Yeah, I can make a comment to that. Yeah, it's a, you know, it's a good comment, Chair Lippert, anytime you have an application, it involves giving information and finding information. And especially when the goal is to ascertain the difference in revenues from a previous year to a current year. That means going back to look at things that happened over 365 days ago. It was a known issue as the, you know, when the legislation came through and the implementation was initially imagined, knowing that we had to do a need-based program and not just a, you know, the federal government did a calculation where they did 2% of total revenues for some Medicare distributions, like federal distribution. I don't know that that's perfect, but it's cleaner. I think that the agency knew from the outset that it was going to be difficult to create an application that wasn't complicated. The level of complication, you know, it's, I'm sure that's in the eye of the beholder, but I think you've hit the nail in the head when we said, it was one of the reasons that I think that the legislation said it wouldn't be a first come, first serve, that we would do a month long opening so that providers would have time. I will say that our project lead spent hours and hours on the phone helping providers with what was necessary to be put into the system. So there was assistance. There was, there's obviously recognition that an application requires a lot of effort, especially one that looks for information as far back as a year. That's one thing that, I mean, the second thing is this is being no surprise to anybody that's been in this healthcare committee for any period of time, all the providers really function differently. Their reimbursements are different. So there are a lot of differences between how providers function and how they bill and how they get paid. And so having an application that really spoke to each of their different nuances was obviously something that's been a bit of a challenge too. So it's part of the reason we are still reviewing those applications and in process and trying to balance really detailed accounting and documentation with speed of fund delivery. That's really the challenge at hand. And I think from the onset, knowing that the smaller providers were gonna be more challenged than the larger ones who had accounting staffs, there were decisions made to try to assist. But once you have an application and once you're asking for a decent amount of information, you're gonna have that response that it was a lot of work. So that we hear that feedback for sure. And have heard that. Let me make a comment. Then we have some more committee questions. Given that it appears, and frankly, I did not anticipate personally that there would be a second round. I assumed that most of the monies would be accounted for in the first round. But given that there's some possibility of a second round, part of what I heard from small provider was that particularly dental practices were in the process of trying to reopen, trying to do everything that was involved having had to close down their practice and then suddenly being kind of simultaneously faced with, well, how do we apply for money that we don't, how do we compare what we did a year ago to now, et cetera, et cetera, under the pressure of a timeframe that they could in fact apply in the second round if they found that given the time that has gone by that they've established the process of reopening a practice, whether it's a dental practice or some other type of practice, a medical practice. That particular, smaller medical practices, they could in fact reconsider their choice of not applying and still apply initially in the second round. Is that correct? That's true. You do not have to have applied in the first round in order to apply in the second round. No. I'm asking that, yes. So that is the case then. So I think that having that information- The risk, obviously, I'm sorry, Chair. The risk is obviously that as you said, the anticipation that potentially the money would not be available anymore. That was the risk by not applying. But I think Sarah's right. It does appear that there will be dollars left for a second round of assistance should, whether just that will be an opportunity. Yeah, okay. Thank you. I see. So Representative Cortis and Houghton, both of you have your hands up, but you asked questions. I'm gonna go into the others and then come back if you still have further questions. Representative Page and then Representative Christensen. Yes, I don't know whether any of our speakers can answer this question. And I don't really remember when we dealt with it initially some months ago. Can you speak up a little, Woody? Okay. Does this have any effect upon one care? I'll let them speak to that. All right, that's, I mean, in what way? I mean, that's a, I don't have an automatic, here's how. So I don't wanna say no necessarily, but I'm not sure if I understand exactly what you- I guess maybe keeping providers in one care versus perhaps leaving the program. Well, there was a provision in the legislation that I'm sure you know better than I do that participation in this program, the provider stabilization program, there's a provision requiring that if providers were engaged in healthcare reform prior to the program that there would be an expectation that they were engaged after the program or you know, in the next, in the coming, in the future. I don't know the exact words, but that's- And that was a proposal that came from the agency Human Services to the legislature in the final round of negotiations. I'm sorry, I don't know the exact language that it ended up with. Ena can step in if she feels like she has a better characterization of that. Can I ask that as, because we're gonna want an update later before this session is over, because of course this is preliminary information, particularly around the stabilization grant program. Can I ask that that question in terms of, did that become an issue for providers who had participated in healthcare reform and where that was a criteria? Maybe you can give us a more full update and that would be part of responding to Representative Page's question. Yeah, I mean, sure, easy answer, of course. Okay. Representative Christensen and Representative Rogers. I just came back to a previous question. I can't scroll my screen, but I think it was the EMT program had $100,000 to assist them in filling out these applications. Why wasn't such a program included in this one? Some money for that. I'll say that I think that the EMS program, there are a lot of input was provided, potentially by the EMS providers that the technical assistance was going to be needed. And so it was built specifically into the legislation that the legislature passed. There was not that specific language for healthcare stabilization. I will say that as Commissioner Gustafson referenced, I think our staff across the agency have been spending a lot of time with providers trying to provide responses to questions and work with them to the extent possible, but we did not have a specific set aside for a technical assistance consultant. Did you find that there was a need for it in the stabilization, especially from the smaller independent people? Providers. I mean, I would never say no to something like that. I mean, when it is the smaller providers, there's an assumption that they are doing their own, their own books in a way. And if they have someone do it, I mean, I think Nicole, who's the project lead, spent a lot of time with the smaller providers. And they know, I mean, there's a little bit of a thought in my mind that they know their business best and that I don't know that a third party assisting would have necessarily produced better results, but I wouldn't say no to it was there, there was definitely questions about how to go about the application. And I think Nicole felt she got to everyone that was asking questions, first of all, but it would be someone helping on the provider side. I'm not, I guess maybe a provider might be able to respond to that better than we would. Okay, thank you. Okay, I have a note here from Jennifer Carby, legislative council who said she would be happy to help with the language from the act about participating in payment reform that was going back to representative Page's question and the discussion that followed. Jen, would you just join us to clarify that language? You're muted, Jen. Thank you. All right, try that again. Jennifer Carby, legislative council, in the prioritization methodology that the agency has to have developed in order to determine grant amounts, one of those prioritization methodologies that must be considered is the degree to which the applicant maintains participation in value-based payment arrangements if applicable. So it's one of six, I believe, six criteria. So it's a prioritization issue. Right. Okay, well, again, if there's any feedback that we can have about how that has played out when we get our subsequent update, that would be helpful. Absolutely, I don't know of any initially for this point. There's not something that we had heard so far that that was a sticking point, but we will, like, as you said, when we have more information about the disbursements and the totals, we'll also have that on our radar as something to report on. We collected information about those, we asked the providers to indicate naturally if they were participating in payment reform. So we have that information collected and that was a factor that is considered when we consider their application and the review of the application. So we can share those statistics with you. Okay, thank you. And maybe while we're, before we go on to represent Roger's questions, I know any other questions, let me ask Sarah and it's my understanding, but am I correct in understanding that, excuse me, that this, that once disbursements are made about any disbursement that's made with federal dollars, that it's a transparent process in that is public information as to which entities, which healthcare provider entities receive money and the amount of money that they receive, is that accurate? Yes, that would be public information. Okay. And if someone has applied, but was not granted money, is that public information? I would want to refer to the legal counsel at AHS unless somebody else on the call has the answer. I just don't know for certain. Okay. We can follow up. Thank you. Representative Rogers has a question. And again, Representative Houghton and Christensen, if you have further questions, keep your hand up, otherwise I'll circle and I'll circle back. So Representative Rogers. Thanks. My question actually fits in really closely with what we were just discussing, which is I was just hoping to hear a little bit more about the anticipated procedure for determining which applications are granted and if it seems like there will be money left for a second round, should I accurately be interpreting that to mean that all of the complete and eligible applications will be granted? Or I just was hoping to hear a little more about plans for that side of things. Understood. I think the issue for us right now is kind of timing of where we are in our process to be able to give you a more kind of full update on actual grant awards, number of applicants awarded, total dollar amounts. The process is set up to evaluate both the increased expenditures that providers experienced as a result of COVID-19, as well as assessed lost revenue. And so both of those components will be factored into the analysis to issue grant awards. And so we should, we're still kind of right in the middle of reviewing the applications, trying to understand the scope and some of the challenges that we're dealing with from a documentation perspective that we've discussed here. And so, I would hope that in the next three to four weeks we're gonna have more solid information for you in terms of amounts awarded and to what providers. And as you would expect other grants and assistance received to date are also factors in that calculation. So it is not simply the losses and expenses. It has to be looked at with that full picture. Yeah, in fact, you know, that I was reminded as Sarah was talking of that very fact that I think the, one of the places where some of those other dollars have been accounted for is, I think there's a, I'm reaching for the right word, but an accounting of all federal dollars received in healthcare, can you remind me where that, because I've seen something from the auditor's office as one point of reference, where all federal dollars that have come in have anything to do with the pandemic have been referenced. But I believe there's also a different accounting for all federal dollars. Is that, can you direct us to where that would be? I believe that finance and management maintains a spreadsheet of all of the various federal dollars coming into the state. I can kind of connect and see where that updated information lives. I think what you guys, yeah. Well, I'm just gonna say, I think it's, I think I'm on the same page with what Ian is talking about. Like there were some direct grants to hospitals at one point, which was referenced earlier where, and it was distributed, but based on a percentage of Medicare billing or patients and those dollars would need to be accounted for in any applications for healthcare provider stabilization grants. So that we're not, we, you know, obviously we're not going to try to pay twice, but we're, and at the time, we knew full well that those direct grants, in this case to hospitals, or they wasn't just hospitals, it was providers, I think generally, that those were not going to meet the needs and that was part of why this program was created, but they, but there were, in fact, some millions of dollars that came into Vermont, separate from the coronavirus relief funds and they need to be put in the balance of what the need is that's evaluated by this program. Yeah. Isn't that fair to say? That's what Ina and Corey were referring to. Yeah, the HHS funds, yes, two different group, rural hospitals, FQHCs, hospitals, disproportionately, yeah, I've used disproportionate, I know that has another connotation, but it's hospitals across the country that were hit especially hard by corona. I don't know that we had any that fit that criteria, but there are, there have been another number of federal disbursements direct to providers. Tracking them hasn't been that easy, but I think Sarah's right. I think that over time, we've at the administration level been intent on distilling that in the application. I believe we do ask, have you had other financial relief from the federal government or other sources? There, I mean, and also to the fluidity of the process to rep Rogers, I mean, there is actually a Medicaid provider, health and human services, federal level, health, human services, disbursement application that is closing this Friday. We've been engaged in reaching out to a list of providers that the federal government has told us are potentially eligible. And there hasn't been huge response to that. It's been a bit of a challenge and a bit of an enigma for the federal government. We've been back and forth as a Medicaid program with the federal government about getting providers to apply who the federal government believes are eligible. It's been tough, I just say it's been tough to get to the real our arms around just that particular application process itself, but even more just as equally as the earlier disbursements to it has, it's not like there's a clearinghouse that has all that information for us. So, okay. Are there other questions from committee members? Representative Houghton, you have a follow-up question or further question? I do, so it kind of involves all this conversation. I wanna confirm that the loss and expense information that would cause a provider to apply for this loan the time period because I believe it doesn't take us all the way through August, correct? So there's gonna be a segment of people who may not have applied because their losses happened in the second part of the COVID pandemic. So this first round is targeted for March through June. So losses experienced March through June. And I just, I do wanna say it's not alone. This is a grant program. Sorry, I'm sorry, I didn't mean to. I think the idea of the intent would be that the second round in October would be for either losses or costs incurred for the period from June to September. Thank you. Okay, so that's actually important to know as well that the same entity that applied in the round one might apply around two for additional losses incurred. That's not, it would not just be for people who for entities that had not yet applied. That's correct. Okay, that's actually very important to understand. Okay. Laurie, any follow up on that? Yeah, thank you. So this is, I think this is very helpful to that, even though this is, we realize it's preliminary and we knew when we were asking you today to try to help us understand where we were that you would not be likely able to provide all the information that you will eventually have. But I think this is quite helpful. Are there other questions, before we move on, are there questions from other committee members about the stabilization, provider stabilization program? I don't see any of the other than Laurie's hand, which I think she's already spoken. Woody, do you have a follow up question? I see representative Christensen. We'll go ahead Woody and then representative Christensen. Sorry, Anne-Marie, I'd be happy to defer to you first. Yeah, please, you just need to speak closer to the mic, I think Woody. Okay, maybe you've already asked this, but as far as following up on the monies that go out, is there any measurements that are being done to see what the quality of the care is and the relation to the costs that are provided? Is there any information that's being evaluated on this grant money? On how well it's spent and whether it's been worthwhile and what have you? I think in general, I think we say it's worthwhile, but has it actually improved for modern self? I'll just leave it there. This particular grant program, these funds are intended to assist providers who have experienced lost revenue and increases expenses due to COVID-19 and there are not quality metrics associated with this program as it is a very essential program for maintaining providers and access to care. In other of our programs, our healthcare reform initiatives, oh dear, our healthcare reform initiatives, I'm having bad technical difficulties today. Our healthcare reform initiatives as well as the regular contracts that the Department of Vermont Health Access has and others of our departments at AHS have with providers, there are many quality and performance metrics associated with those regular and ongoing activities that we have with the healthcare system. But if there is future money or another goal around, wouldn't it be important to know what some of those quality metrics are and whether we can affect them in distributing this money? With the future phases of relief, that relief would be for further incurred expenses and losses and again, the goal remains the same that we are intending to replace revenue that providers have lost because of the global health pandemic and to assist with expenses that were entirely unforeseen due to the global health pandemic so that the providers can continue to be available and providing much needed services in all of these areas to Vermonters. Thank you. Representative Christensen, Representative Smith. You're muted, you're muted, Anne-Marie. Okay, I'm going from a higher level to more to my neck of the woods and it's a quick question. Yes or no? Is Springfield Hospital eligible for any of these stabilization grants because they're in bankruptcy? Yes, they are eligible to apply. Okay, thank you. Okay. Representative Smith. Thank you. I don't think I heard the answer to Representative Page's question. Okay, I got a little confused about if it is being effective and I don't think I heard an answer. I'll translate for you. The answer is no. The goal of the program is to keep the provider community stable during a public health emergency. The only caveat I would say to that is that I think if you got provider groups on here, there are a really solid number of quality programs and metrics that they have to live up to in their normal practice. So it's quality always a consideration and concern of policymakers and the departments in the state. But in this case, it was really in reaction to a public health emergency and a shutdown of the healthcare system that we were trying to react to. So that's the answer to that question. Thank you. Okay, okay. I don't see any other questions here. It seems like I have a question in a comment. Somebody's not on mute and there's a phone ringing. So thank you. I came across a figure which I think is, well, it's an amazing figure in terms of the amount of federal dollars. This is going beyond healthcare, but the amount of federal dollars that Vermont has received per capita, that the average state, more than 40 states in the country received $388 per capita and that Vermont has been averaging over $2,000 per capita in federal relief dollars. And so I think as we look at all of the dollars and where they're going even some of what we believe are still unmet needs, at least on a per capita measurement basis, because there's a small state minimum, we receive the small state minimum of $1.125, I think $1.25 billion that proportionately Vermont has fared quite well in terms of receiving federal relief dollars. Is that, are those figures anything you're familiar with Sarah or? I'm not familiar with those specific figures, but I'm not surprised. Okay. Yeah, that's why Sarah and I both came off mute to mention small state minimum. And then if you notice, as soon as you said small state minimum, we both went on mute again. So yeah, you're right on in terms of your interpretation of where that comes from. Yeah, I'm not quite sure who provided that dollar for you might have come out of the auditor's office, but I think it's just something for us to keep in mind as we are dealing with what we have received and the good fortune of it. Okay, hearing no other questions on this program, and I'm sure we'll have more in the future and we'll look forward to your coming back and presenting to us again. Let's continue with the presentation that Sarah Clark that you've put together. Sure, I'll go back to share my screen. I took it off so we could see each other. Yeah, that was good. That was helpful. Let's get reoriented here. Okay, great. Okay, so then moving along, there's an Act 136, there was a $2 million appropriation to AHS for distribution among populations made vulnerable by the COVID-19 public health emergency. So DCF is taking the lead on administering this appropriation and developing a strategy for it. There still needs to be a questionnaire submitted and approved by the administration through their CFO process. We are right now anticipating to be issuing one-time stipends for reach-up households with this appropriation. The next, there's 700,000. I might add, I think this particular section came from the Health Human Services Committee, primarily. Yeah, yeah. This had to do with reaching out to individual Vermonters. Correct. The next is $700,000 to be split equally between the Association of Africans Living in America and, excuse me, Living in Vermont. Living in Vermont. And the U.S. Committee on Refugees and Immigrants Vermont's Refugee Resettlement Program. The update there is that the grants have been executed and we have an invoice for July expenditures that's in process. So the money is getting out the door. Okay, let me see. I think, let me just, I'm sorry, I'm jumping around. Okay, the next is Department of Corrections. I don't know if you want me to provide you an update on that, but for the two appropriations, it's still in process, though. The next are all related to the Department for Children and Families. Do you want me to quickly run through those? I'm sure they're of interest to the committee, though maybe not specifically your jurisdiction. I'm happy to do what's your pleasure. Well, I'm scanning the remaining programs. I know there, an area of real interest for us is both suicide prevention and also special needs populations, high risk needs populations. And so I'm wanting to make sure that we have time to look at those. Sure. Why don't we, we'll go to the next slide and we can talk about the Department of Mental Health. You've got a solid team from the Department of Mental Health here today who can speak to you. Act 136, as you know, didn't actually appropriate dollars for suicide prevention, but it required the department to come back and notify you as soon as we heard about the SAMHSA grant. And then maybe I'll just defer to commissioner squirrel at this point, if you would like to update the committee on where we are with that. Sure, good afternoon, everyone. For the record, this is Sarah Squirrel, commissioner of the department of mental health. It's great to see everyone. We also have a couple of other folks from DMH on the call to answer questions. As Sarah noted, we did have the joint fiscal committee approve $500,000 at the end of July for suicide prevention efforts. I did discuss this in detail at the budget testimony last week that I believe this policy committee did participate in. I'm happy to walk folks through what the current strategies are. We are looking to implement across the state of Vermont. I would also just note just so the committee is aware, we also have applied with the Vermont Department of Health for a five year comprehensive suicide prevention grant from the Centers for Disease Control and we should know in the next few weeks if we are the successful recipient of that grant. So I will walk through at a high level the specific strategies that we are looking to implement related to suicide prevention, utilizing these funds. I would also just note that we were being very thoughtful and strategic in knowing that coronavirus relief funds would need to be, as we know now, need to be extended by the end of December, 2020. The Department of Mental Health is also looking to utilize our own carry forward funds to ensure that suicide prevention strategies can continue through the end of the fiscal year. I also know that this committee was very interested in understanding what was maybe in the SAMHSA application that did not, because we were not successful recipients, what were some of those activities that might have been in the SAMHSA application that would have been funded that are not funded. I know Representative Donahue had some specific questions about that. So Alison Cronk will speak to that in just a moment. So the strategies that we're looking at related to suicide prevention are of course continuing to expand zero suicide in Vermont. We know that zero suicide is an evidence-based public health approach preventing suicide. We're very excited about this opportunity, the opportunity to scale it up in Vermont. And the good news is that we already have the infrastructure in place through the work that we do with the Center for Health and Learning that already is implementing zero suicide in some areas of Vermont. We all know from an implementation science standpoint that the key to implementing suicide prevention is to do it at a scale. We can actually impact meaningful social change. So our ability to scale this up statewide is essential and we're very excited about the opportunity to do that. We will also be utilizing funding to expand Vermont's National Suicide Prevention Lifeline. We've talked a lot about that in this committee in terms of individuals being able to access our call number and to have those calls answered in state. So we're trying to build our capacity in state using some providers to answer those calls. Strategy three was something new that we were able to add which actually enhances some of our previous suicide prevention efforts which is really developing targeted suicide prevention resources that are culturally informed and targeted at risk groups. So that includes targeting groups such as LGBTQ community. We have already started working with outright Vermont using some of our mental health block grant dollars that we didn't expand this year. Racial minorities, older Romaners and domestic violence victims. Alison will speak to one of the big areas that the SAMHSA grant would have provided to us was a real focus on domestic violence victims. So that is a little bit of a gap in terms of the fact that we didn't receive that SAMHSA grant but we are trying to utilize some of these funds to provide outreach and support to those groups. And we have an existing multidisciplinary team that's poised to implement and execute that work. Another area that we're very excited about is expanding mental health first aid training. Vermont has been a real leader in implementing mental health first aid across the state. We would actually utilize this funding to implement teen mental health first aid. So that's actually training for high school students who can recognize kind of issues amongst their peers. It's an area of Vermont's suicide prevention that we've been wanting to lean into more. One of our designated agencies has piloted this program and currently there are only two instructors in this state. So this would really allow us to expand that particularly for vulnerable teams. And then as we look at hybrid models of school reopening certainly an area that we wanna continue to focus on. And then the last strategy of course is extending programs and supports for older Romaners. So we'll be working very closely with the Department of Aging and Independent Living to implement additional funding to support outreach to older Romaners in the state. So I am gonna turn to Allison. Allison, I'm wondering if you can give the committee an update based on the questions we received in our last testimony about maybe what was in the SAMHSA grant that we didn't receive. That is a little bit different than what we're able to utilize these CRF funds for. Absolutely. For the record, Allison Crumpf, I'm the Director of Quality and Accountability at the Department of Mental Health. One of the issues with the SAMHSA grant, although a wonderful opportunity, it did have some limitations. And so we had to work within those limitations. One of the biggest issues with it was that there were some difficulties with providing direct service. So right off the bat, you'll see some things in this proposal that were not in the SAMHSA grant proposal. And that was because if we were to serve, say older Romanters through the Elder Care Clinician Program, the SAMHSA grant required extensive administrative burden for that in the form of huge packets that providers would have had to fill out to meet their federal requirements. The same can be said for the crisis lines. If they were to take a phone call and provide a service, it was subject to the same level of administrative burden. So those were two things that with this opportunity through this funding, we were able to add things like Elder Care Clinician Expansion and Crisis Line Response. The other major distinction was there was a requirement for at least 20% of the SAMHSA funds to go towards domestic violence victims as the main target population. We have kept them as a target population, but broadened that to include LGBTQ older Romanters, racial minorities, and we also are working on something for individuals with disabilities. So again, it's a shift, but some of the same activities. The other pieces were the SAMHSA grant proposal included a position. So that would have been a project manager to manage the funds and DMHs of absorbing that. And then the other two, zero suicide and mental health first aid, those approaches remain the same. So those were sort of two foundational tenants that we've carried over. So that would be the easiest way I could think to summarize it, but I'm happy to answer any further questions. Representative Donahue. Thanks. I guess mine might have been a little bit more general question rather than directly to Sarah. I think it'd be helpful just to without details, just to kind of have a little list side by side of the SAMHSA, you know, maybe the original budget request, the SAMHSA and now the new grant part of it plays into what we look at Thursday in terms of the budget, but just to have it in writing at a high level list. But I guess in terms of both, but more specifically to Sarah, Commissioner, what you went over, we have a lot of conversations about the input of people with lived experience. It's a high profile in the 10 year plan. It's a lot of discussion. And I'm just wondering how much involvement there was in terms of making any discussions about priorities. Cause I know the adult standing committee has continued to meet and would have been available. So whether they provided input and so forth, because it really, I mean, it struck me most when I saw the mental health first aid funding, which is, I don't think was in any of the prior ones and is highly controversial. And it just got added in there. So I'm wondering how much input there was from the mental health survivor consumer community. Yeah, it's a great question, Representative Donahue. And these, I guess, strategies around suicide prevention in the state really built off the original governor's recommend from the previous FY 21. And maybe Allison, what you can speak to is there's a group of, I believe, advocates, stakeholders, individuals, family members. I can't remember the name of the group, I apologize. But these recommendations built off the recommendations of that group. So maybe Allison, you can speak to that a little bit. I can, yes. Tracy Dolan and I co-chair the AHS Suicide Prevention Committee. And in September, gosh, time really flies. It would have been 2019 in preparation for 2020 recommendations to the legislature. And throughout the year of 2019, we attend the Suicide Prevention Coalition. And that is, there's a huge effort in the Zero Suicide Prevention Coalition to include persons with lived experience, family members who've experienced loss. And we went there to do a specific activity. So not just have discussion and present, but actually solicited, had people stand up, vote with stickers, talk about what their top priorities are, have those priorities documented and summarized. And those were intended to be taken. And there were a lot of things on there that matched the 2030 vision that you're right, in some ways didn't quite fit into what we could do in an emergency funding before 12, 31, 20. But we've collected them all. And some of it includes more people who lived experience, more peer services, more community outreach. And so those are things that we're absolutely working towards, but they also included these issues as well. And so that input, we have it documented and I'd be happy to share it as well. But the formal entity that is supposed to advise the commissioner on mental health issues across the system is the adult standing committee. So I'm just wondering if they were asked or any input was provided by them, particularly in terms of the newest, because their turnarounds pretty quick, they meet monthly, in terms of the newest proposals. And again, I raised the mental health first aid because that seems to have sort of come out of the blue and is considered highly controversial. Was the state standing committee consulted at all? They're the formal advisory group for people with lived experience to the commissioner. Yeah, so, Ann, I, going back to the original slate of recommendations for the FY 21 budget. We of course, as we're preparing for the upcoming legislative session, bring these kinds of policy questions to the adult state standing committee, which yes, they are a group that we turned to for advisement related to our designated community mental health agencies. They're part of that kind of designation process. In terms of the impact of COVID, us trying to move quickly to ensure that we were keeping our suicide prevention efforts moving. I don't believe that the adult state standing committee was engaged in the last few months on this particular topic. And certainly we'd be more than happy if the adult state standing committee has impact put or feedback on some of these recommendations that we can go to them. We also, again, we were moving very quickly, I think when we're trying to look at new CRF funds, how do we leverage this opportunity? We don't wanna miss an opportunity. So we also turn to our community mental health agencies and said, gosh, if we have an opportunity to really strengthen what are some areas we wanna focus on. And that was one of the groups that really advocated for the expansion of mental health first aid training, particularly focusing on teens. So I think you're right. We wanna ensure that all the groups have been able to provide input. I believe we have an adult state standing committee meeting coming up in early September. So we'd be happy to make sure this is an agenda item for them to review. Yeah, that's after the decisions are made, obviously. But okay, because I know that there were things that our committee had recommended that we're not included in the proposal and this mental health first aid sort of came out of the blue in comparison to other priorities that we had suggested should be in the budget. So, okay, thank you. Thank you again. Representative Smith, and then I have a question. Thank you. Commissioner Squirrel, going back a little ways in this conversation today, I don't think it was you. I think Sarah Clark was going over, there's a $500 out of COVID money in appropriation for suicide prevention. $500,000. Is that the dollar or could more be received if it was asked for? We had a point now, well, we can't get anymore. We requested $500,000 from the CRF fund keeping front of mind that we needed to have executed those dollars by the end of December. So that was why strategically we also ensured and requested to utilize our carry forward dollars of the Department of Mental Health as part of our FY21 budget to ensure that our suicide prevention efforts would continue beyond the end of the timeframe where we can utilize the CRF funds. Right. The reason I asked, and it just recently came to my attention, we just had a very tragic suicide in our community, 24 year old young man. And his brother died three years ago in a DUI accident, he was not the DUI. So this poor woman is alone, their mother, and she's at which end. And this has just come to my attention that $500,000 does not seem like anywhere near an appropriate amount of money for suicide prevention after hearing what had just happened here in the area. And if it may have been prevented, I don't know. But I guess we have to wait for the 21 budget to ask for more money. Yeah, thank you, Representative Smith. And I'm so sorry for that tragic loss for your community. Certainly, as you're speaking to the ripple effects of suicide and the impacts on our community and us as community members are significant. I think what you see is the Department of Mental Health really working hard to expand our suicide prevention efforts. We have talked a lot about a comprehensive approach. I do remain optimistic about the CDC grant. I think that's exactly the kind of funding that we need to really sustain our efforts. That would be a five-year grant that would really allow us to do something comprehensive. So in the next couple of weeks, we should know if we are recipients of that, if we are successful recipients, then I think that will really set the stage for us to do some comprehensive long-term work around suicide prevention. And of course, it is a public health issue. So we want to work very closely with the Vermont Department of Health as well in terms of how we move those efforts forward. Good, thank you. Of course. So I'm going to suggest that we, speaking of Department of Health, that we move to hearing about their grant, they have a grant program. And I'm going to connect it also to the suicide prevention work that the Department of Mental Health has just been talking about. And let me just say broadly that this committee felt very strongly that there were some groups that were particularly high risk around COVID-19 and that we had proposed and moved through the House proposals that would have created grants to organizations that were primarily made of those who were affected. With the idea of outreach to these groups. And so I want to hear what's, and then we were persuaded, I have some misgivings about it, I have to say at this point, but we persuaded in the process of working with the Senate to understand that the Department of Health had a grant that was also going to reach out to these communities. And that we were persuaded that our proposal was not needed in the same manner and that the Department of Mental Health had proposals for reaching out to grants with grants, but primarily the Department of Health. And I want to understand what the Department of Health has done to this point and then try to understand what has happened with some of the priority groups that we articulated, but I don't see to this point listed. So maybe we can hear the Health Department grant proposals for their process and then return to that general question. Sure, so I think what I'll do, I can, what I'm going to do is I'll share my screen momentarily, which will be a report that the Health Department provided to the legislature on the half a million dollar appropriations in the Coronavirus Relief Fund to address health disparities. I do think, you know, I can give you a high level overview, but you may just judging from your comments, you may want someone from the Health Department to provide you some more context than what I will be able to. So they're not available today. I don't believe that they're scheduled to testify today. Okay, so we might want to ask for them to come back later. Okay, but if you can give us an overview. Yes, can you see a word document? Yes, we can. Okay, thank you. So this report provides you some additional context behind how they have planned to use that half a million dollar appropriation from the Coronavirus Relief Fund. It does acknowledge that it doesn't yet report on any potential use of the epidemiology and laboratory capacity grant that they've also received. This is focused on the CRF as part of their process to assessing and addressing the health disparity issue, the Health Department established the Health Equity and Community Engagement Team to consider the needs of vulnerable Vermonters facing health inequities during the pandemic. So they have issued grant awards to several organizations, including Spectrum Youth and Family Services, UVM Extension Bridges to Health, the Open Door Clinic and the United Way of both Wyndham County and Rutland County. I think that you will probably want to ask members from the Health Department to provide you some more of their kind of, because I'm just not privy to their thinking in terms of how grants were awarded and what their approach will be on an ongoing basis. Yes, I will want to do that because I'm particularly eager to hear about the outreach to the LGBTQ youth community. I understand that there's some suicide prevention monies that have been for some training, but that's a one-time training authorization, I believe, and that's not an outreach component. And some of the other groups listed here as well. Who is the lead person? Who should we be talking with at the Department of Health? I think you'd want to reach out to Shayla Livingston or David Englender, and I can follow up with them right after we test them. But they operate it if, I mean, they testify regularly in our committee, and I'm not certain that they would actually know the specifics and how things have proceeded. I mean, they operate clearly as an interface with the legislature, but- Sure. So maybe you could let them know that we're interested and we'd like to have more information before all these grants are finalized because, frankly, I'll say I'm a little disappointed. We were persuaded that the needs that our committee outlined were going to get addressed because this grant that already, maybe I'm confusing this $500,000 with a different grant. My understanding was that there was a, I have to go back and check, but there was a specific grant. Representative Donahue, can you help me with all of this? Yeah, so I think there were, we had, our proposal had been a million dollars and the reason it was cut back to $500,000 was that there was another $500,000 at the Department of Health, but their money was more circumscribed to information outreach, and we wanted the hands-on supports. And I think, I did read the report from the Department of Health, which didn't really seem consistent with what we had asked for and seemed more to be that educational outreach piece, which they already had the other $500,000 for. So I apologize, I apparently didn't. I'm the one who helped draft the request to AHS as to who we needed for witnesses today. And I apparently wasn't clear because I thought we were specific about wanting the hands-on people for each of these funds who could explain what had happened with them. And I guess maybe I should have listed to make clear that the Department of Health was really key to that, because it was one of the ones. Perhaps someone could be available on Thursday. Yeah, my apologies. If not Thursday, then early in the following week. But I wanna make sure we have a chance to interact with them before everything is finalized. Sure, I will find the right contact and I will share your concerns with the Health Department and we'll circle back. Thank you. Thank you. Representative Rogers, you have a question. Yeah, I think I'll save the bulk of it for when we have someone from the Department of Health. Okay, great. Speak with, but say that the report from the Department of Health about this money. And I did reply with, I had a large number of questions and concerns along the same lines that Chair Lippert and Vice Chair Donahue have voiced. I did respond to the prepare of the report with a list of questions and I haven't heard back on any of them, but hopefully I will get a chance to ask on Thursday. I will follow up. Can I use Representative Rogers speaking on the screen. You had indicated earlier that I'm just, I'm gonna jump back to something completely separate again, but you had mentioned that you had been in touch with Pathways Vermont about the warm line. Can you just share with the committee and others who are listening what you heard? Because I believe we covered that and so I understand that the money's have been forwarded, but what had you heard specifically from Pathways? Sure, yes. So this is the, I believe it was $200,000, Commissioner Spurl, is that correct? Yes, we have a part of Act 136 allocated $200,000 in coronavirus relief funds to support Pathways in their warm line operation and outreach. Hopefully I can be heard a little better without video, can people hear me okay? Yep. So has the money already been distributed? Yes, as far as I know, those grants have been executed in terms of dollars going out the door. We do have, or we did have, we have Patricia Singer on the call who manages that grant with Pathways and just for the committee's edification Act 136 allocated $200,000 to fund the Pathways support line. $120,000 of that was to allow the support line which is a pure warm line to operate for 24 hours a day, seven days a week. And then starting in January of 2021, just so folks are aware, DMH is also utilizing $60,000 from our stamps of COVID-19 emergency grant to continue that. And Pathways also received $80,000 to conduct outreach to other healthcare providers because of resources only as useful as folks being aware of it being there. So that was a nice package that we were able to put together. And Trisha, I'm wondering if you could introduce yourself and speak a little bit to the execution of that grant with Pathways. Yeah, hi, this is Patricia Singer. I'm the Director of Adult Services Utilization at the Department of Mental Health. In terms of the execution of the grant, the way that this works is they will invoices for the money is available, they will invoices for their monthly services. And that will go from July through December which will allow them to operate their warm line, their peer support line 24-7 as well as to support a staff person to do outreach as Commissioner Squirrel just said. And Chair Lippert, would you like me to share? I did reach out to the executive. Yes, please. Please. Just to get an update from their perspective. And so I just have a short email I can read to the committee from Pathways which says, the appropriated CRF funds are being put to good use. We have been operating our support line 24-7 for several months now and have seen the community respond. Understandably, a lot of folks are experiencing feelings of depression and anxiety due to the pandemic. On the outreach front, we have hired a new support line outreach associate who is focusing on a concerted statewide outreach effort. We're focusing on getting a route to organizations and in-sphere audience. To that effect, we have compiled a list of local service and medical providers around the state that we are making outreach visits, calls and emails to the awareness of the support line and the new extended hours. We are also focusing on a statewide advertising campaign including a mailing campaign, Google AdWords and social media campaigns as well as updated brochures, postcards and flyers that can be distributed throughout local. Thank you, Lucy. I think we lost a few words along the way. At least I did because of the connection but I think we have the general sense that Pathways is on their way to implementing the warm line as Ms. Singer and the commissioner indicated as well. So that's been a priority for this committee. So it's good to hear. All forward. Thank you. Thank you. We're approaching the end of our time but Sarah, I think we've pretty well worked our way through the outline that you had provided for us. I'm gonna just, I'm gonna turn to the representative Houghton and maybe just open it up generally to committee members for questions about anything that came to mind subsequent to the presentation. Is that representative Houghton? Thank you. So just to clarify for the Pathways warm line is the funding just one time funding and we'll have to find money in the budget for later years to keep it going. These are see the utilization of CRF funds. I will not be a part of our base budget as we go forward is my understanding. So being able to scale up the warm line through this year is utilizing the CRF funds as well as the SAMHSA COVID-19 emergency services grant. So based on that, it will be funded through 2021. That's correct. Okay, thank you. And then I have a question on the end. Through calendar year, can I, are we talking calendar through calendar year or through fiscal year, 21? In 30th, 2021. Okay. Thanks, Bill. That was a good clarification. And then my second question is in regards to the suicide prevention line that's being funded. Can you tell me who the, I'm sorry for the train in the background. Can you tell me who the companies are or the associations you're using? Can take that, Sarah. Like, so originally, and I know we've discussed this before on this committee as well. We had original crisis lines that were signed up to be 211 and pathways Vermont, as well as Northwestern's line. There is an update with that. 211 with their COVID response has not been able to manage becoming a lifeline successfully with their staffing capacity. So we've recently had those conversation with them and they are bowing out at this time. They're interested in maybe getting back into it in the future, but it's not within their capacity at this time. Pathways Vermont is very interested and we're having some good discussions with them. They have a peer model that they do not want to compromise in order to meet the risk assessment needs, which are medical model, which is a requirement from the federal national suicide prevention lifeline. So we're working with pathways to talk about and they do serve people who are suicidal through their warm line all the time and we believe they do it very well. I don't think they're a great candidate to fit in that box for this. And so we've talked with them about that and they are not interested in changing their practice right now. So we are looking to put it out to bid for either NCSS to cover 24 seven or another organization to come on and say that they would be able to do that. So that's exactly what this specific money is for is to bring on that further capacity from either an existing NCSS or an additional organization. Thank you. Great. So I'm remembering now as well that we have Laura Pelosi with us from the provider coalition that has worked with us so closely both in the early on in the emergency appropriation and the emergency legislation as well as feedback around the much of what we've talked about. And I think what I'd like to do is to maybe turn to Laura and see if there are comments from the provider community with regard to what we've been talking about today that would be helpful for our committee to hear at this time. Yes, thank you, Chair Lippert. It's good to see all of you doing so well. It's been a couple of months. So I'm glad to be back together with you again. And I want to again thank the committee for your hard work and support of the provider community in accessing those provider stabilization funds and getting those dollars allocated. I am here today. I was the elected voice for our provider coalition. We take turns on these things. So happy to be here. With respect to the stabilization funds a couple of things I want to point out and you did get to this in the testimony but the coalition excuse me my dog has entered the room and barking. Hacking rather. Trains, dogs, babies. Sorry about that. So we've always felt as a group of providers that it was going to be really important to have multiple opportunities for providers to apply for those stabilization funds. So when AHS had let us know they were going to do this in multiple rounds and focus on a March to June time period. And then another round that would focus on July going forward as close to the end of the calendar year as possible. The providers were quite happy with that decision. We always knew that provider turnout in this first round would be impacted by a number of factors. First was the provider payments that AHS made available for April, May and June. And then ultimately we did see federal funding come through a variety of PPP loans and federal HHS direct support to providers. Some of that has to be paid back. Some of it doesn't. But the fact of the matter is that the coalition's always been concerned that those increased costs and reduced revenues would continue well into the fall, winter and well into 2021. So we're certainly very grateful that there will be a second opportunity for folks to apply for funds. And frankly, we expect that those anticipated increased costs and reduced revenues will continue for quite some period of time. I think it's unknown, but certainly while we're awaiting an effective and widely available vaccine, our healthcare system is going to be challenged to be able to recover. The other thing I just wanted to point out, I know there were some concerns around the ability of some of the smaller providers in particular to access that application process. I can speak directly on behalf of the long-term care facilities and in particularly the small ones. And then just relay what I've heard from my coalition partners with respect to that issue. I got a phone call from AHS and they said, we really feel like the small residential care homes are really struggling with this application. Are you hearing this? And I said, I am. As of today, I got a bunch of emails and it's not just the little ones, it's the big ones as well. They don't really feel like the application is designed to meet the needs of a residential setting. And so they said, what do we need to do? So we talked through all of the issues and within two days, they did a webinar for long-term care facilities to be able to answer any questions they had, help them walk through the application. And I know a number of those providers were able to tap into resources at AHS to help them with that process. So I just wanted to relay that it's been a positive experience. We certainly understand that trying to create an application that meets everybody's needs is pretty challenging, but I've gotten similar feedback from the adult days, the FQHCs and other provider entities that feel like AHS has been responsive and helping providers get through this process. So I think that's just an important point that I wanted to make. I think you're muted. Yes. Thank you. So again, Laura, I appreciate hearing that. I think it's important for us to hear that feedback. I appreciate you joining us today. At this point, let me open it up broadly to committee members for questions for Laura, for Sarah, others who are still with us, the commissioner, Commissioner Squirrel. I mean, we've covered a lot of ground and I think this has been very useful. Again, I want to acknowledge that I know it takes you away from other work to spend time with us to update us and answer our questions. But for us, it's important to kind of circle back and we spent a great deal of our time trying to work with the agency. And I want to just say, at least for myself, that when we, particularly around the provider stabilization grant process, early on we heard from Secretary Smith and there was questions about timing and we all kind of pushed back and forth at each other and said, well, we've got to move. We've got things we've got to do. We've got to be here for so long. And I know there's some concern that the money hasn't gotten out into the community yet, but I think overall, at least from my own point of view, I think we've done a pretty good job of trying to design a process that's respectful of large and small providers. And I know folks aren't eager for the money to move, so we'll be anticipating that shortly. I don't see any other hands right now. Any other questions? I do actually know that all I need to do is say that and then the hands rise. Okay, so I represent Durfy and then I represent Cortis. Okay, thanks. We're gonna finish up in about five minutes. All right, I'm likely to have a truck go by in a moment here for a new kind of noise. And Laura, it may not be fair to ask you the question, but I'm wondering whether you have any insight into whether the provider community as a whole is where they stand and sort of the economic recovery curve. So we know that there was very few people were seeing, taking elective surgery and so forth in the spring, but I imagine that it's not back to normal yet. Right, so just speaking very broadly from some of my experience working with providers across the continuum, that has not fully recovered. Vermonters are still being very cautious about seeking services. I can give you a really clear example where I think this is gonna have a long-term impact. And that's if you look at our skilled nursing facilities, the patient flow from the hospitals into the nursing homes is really being impacted by the operational changes that nursing homes have had to make. So for example, now any new admission has to be quarantined for 14 days. That means their admissions capacity, their ability to admit someone is significantly affected. So patients have a harder time moving from the hospital into the nursing home. It creates revenue impacts for nursing homes. That's gonna go on until we have an effective and widely distributed vaccine. So that's just one example of where I can tell you that the system is gonna continue to see those kinds of challenges. And the elective surgeries haven't picked up fully. So certainly we see that also at the nursing home level, normally they'd have a certain number of admissions from hospitals for that hip and knee replacement or what have you. So that is just not fully picked up. And then it's exacerbated by these other specific COVID related challenges. So I think every provider group has examples like that that they can share with you. And I think we're anticipating certainly through 2021 that this will continue. Yeah, okay, thank you. Representative Curtis, did you have? Yes, thank you. Just a comment for our committee and others that may be involved. One of the groups, Chair, when you were mentioning groups that were left out or we were concerned would be left out was volunteer EMS providers. I know I've raised this issue recently. I'm hoping that we can address that this time. They did not qualify for any of the municipal grants for hazard pay. They did not qualify for any other grants. And in the legislative process around addressing that issue, apparently it was believed that there was going to be a tranche of money that could be accessed by the volunteer EMS providers, but that did not actually transpire. So I want to put that out there. Well, let me pick up on that quickly. I know we're at the end of our time, but when we went through the EMS dollars with Sarah earlier, I think there was $2 million, am I correct Sarah? There's some amount of money for- Training, right? Not hazard pay. Well, not hazard pay, but- The hazard pay is what I'm talking about. Okay. And my constituents have reached out to me about that, that as frontline workers, and it's already hard to recruit volunteer EMS providers, and this just makes it even harder. So I'm hoping we can address that. And so I just, in the brief response to that, I know that that issue was raised, and I think it has to do with the employer of those, the employer of those volunteer EMS employees, if you will, and not being an eligible per the legislation. So that may be an area where, if there's additional changes to the legislation during the next several weeks, that's a place where that might be able to be addressed. Representative Cortes, I would ask you to, let's be in touch with our colleagues who are looking at that. Because I think in terms of the EMT grants that were available for loss of revenue, I helped write that language, and I specifically made certain that it was eligible for volunteer programs, not just those with professionals, but that is different from what you were talking about. Correct. Right. Representative Durfee, I see your hand. Is that continuing from before? Okay. Well, I'm gonna suggest that we stop for today. Again, we've, I think we covered a lot of ground. There's certainly questions we will follow up on. But again, Sarah, thank you for you and your associates who put together the overview that became the framework for much of what we've looked at today that I think was very helpful, as usual, but it's nice to, it was very helpful. Just let me just say that. My pleasure. And so committee members, we, so let me turn to my fellow committee members. We are going to be working on, we have two priorities from the, really, for our committee. The first is the budget, and the second are federal dollars. We started with federal dollars today because in fact, we were hearing testimony last Thursday, Friday, and we felt like we could more easily schedule this for today, which we did. Get ourselves up to speed. There will be some follow-up on this. Thursday, we'll be turning to some particular budget questions, and we are meeting Representative Donahue, Representative Houghton and myself, we're meeting with staff to come up with requests for testimony on Thursday around budget in particular. Perhaps there will be some follow-up to some of what we talked about today, if people can respond in that short period. I don't know if that will be possible, but certainly we'll be back next week. And for committee members, I just received the tentative committee schedule for next week. It is not the same as this week. Unfortunately, there was supposed, we were going to try, they folks were gonna try to have it be predictable so that people could anticipate. I'm gonna look at that again and see if there's any way to put us in the same predictable schedule, but I will let you know as soon as I can. My reminder today is Tuesday. Tomorrow, we do not have a committee meeting and there is no general floor house action tomorrow. To my understanding still, I'm looking to represent Donahue, who serves on the House Rules Committee. So we will not be seeing each other tomorrow. I know it'll be a long time and great loss for everybody to not see each other for a day now, but we'll be back on Thursday. And really it is terrific to see each other. I wish we could see each other in person. And I say that as well to our witnesses and the people who have assisted us. We deeply appreciate all of us continuing to work through this unusual structure that we have, but I feel like we're using it to good effect. So thank you all. Oh, Representative Rogers, did you have a question or comment quickly before we finish? Because we're about to turn off. I just wanted to know if they're from what you're hearing, Chair Lippert, if there are bills that we should be aware of as possibly coming through, or if it's sounding like it's pretty much the budget. We'll try to review that more on Thursday. Our priorities are the budget, federal dollars. We're awaiting some bills from the Senate and those really are our priorities. Whether or not there's a very limited amount of floor time, most of what we had as committee activity was addressed before we recessed. If you remember some very important bills such as the physician assistance bill, we brought to full closure a number of bills. So we're actually awaiting some bills from the Senate. And I've had conversations with Senator Lyons and we'll be working on that. There may be some possibility of doing something further on bills that are in our committee still, but the priorities are going to be the budget and federal dollars and the speaker is really encouraging chairs. We need to limit, that's what this session is really all about. But as there's more information I'll provide it to you, but don't feel free to keep asking, okay? So let's stop there, it's 301, thank you all. And thank you Demis, thank you Demis for helping us out in the background.


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