Vermont Legislature SmartTranscripts:

[Alyssa Black (Chair)]: Welcome back. That was the quickest break ever. Thank you, Katie, for coming on in. Yeah.

[Katie (Office of Legislative Counsel)]: Happy crossover day. I heard

[Alyssa Black (Chair)]: we have a dispensation from another committee that you have four minutes. Yes. Okay.

[Katie (Office of Legislative Counsel)]: So this is draft 2.2 of H817. This is the bill on mental health literacy and also peer support initiatives. You made a few changes after we met. So with regard to the peer to peer mental health support, you wanted to expand it beyond schools and to have it in after school programs. And also there was the addition of youth mentoring agencies. So that language has been added. So now it reads, a school, after school program, or youth mentoring agency may establish peer to peer mental health program that. A is a similar change, provides structured opportunities for student connections in a supervised school or after school setting because the school mentoring would be happening in the school. Subdivision B is overseen by an adult, but you have qualifiers later on. Top of page three, subdivision two, DMH shall provide oversight and guidance to any school, after school program or youth mentoring agency seeking to establish or maintain a peer to peer mental health program pursuant to the subsection, including qualifications of the adults overseeing the peer to peer mental health support program. There's your qualification on who the adult is. In D, we looked at this language a little bit yesterday, but this is instead of, did we say in an elementary school setting? We we broadened it from just school to the age of the youth because now they might not necessarily be in a school setting. So age appropriate guidance for elementary school age youth that and similarly in subdivision b line So as used in the subsection, guidance means defining and disseminating best practices in a written format. Here's the guidance fee. And those are your changes. I'm more. You're reporting. So you're providing aggregated information on the number of schools and after school programs requesting and receiving the department support. If you want youth mentoring agency there, we can add it.

[Daisy Berbeco (Ranking Member)]: Yeah. You do? Yeah.

[Alyssa Black (Chair)]: Okay. Let me

[Katie (Office of Legislative Counsel)]: make that change now.

[Alyssa Black (Chair)]: Okay. Great. That's it.

[Katie (Office of Legislative Counsel)]: I'll give it a new number now that we've made a change.

[Francis “Topper” McFaun (Vice Chair)]: It says to the extent that public schools may And apply for the then as you go through this, on page three, one, two, it talks about the Department of Mental Health shall provide oversight and guidance. And you just gave the definition of guidance to any school.

[Katie (Office of Legislative Counsel)]: Guidance only applies in the subsection D, it wouldn't apply here. Definition of guidance is limited to subsection D. I think your point is, does the the extent funds permit

[Francis “Topper” McFaun (Vice Chair)]: My point is, are we talking about any school can do this? Because in the perfect sense

[Katie (Office of Legislative Counsel)]: Oh, I see, I see.

[Alyssa Black (Chair)]: And

[Francis “Topper” McFaun (Vice Chair)]: then later on it talks about any school and when you define guidance.

[Katie (Office of Legislative Counsel)]: That's a good point. I think that's a policy question, and we could make an adjustment depending what the committee decides.

[Alyssa Black (Chair)]: She's talking about training, being well,

[Francis “Topper” McFaun (Vice Chair)]: she's going school.

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: So can I

[Alyssa Black (Chair)]: I maybe try it in my opinion?

[Jen Tarby (Office of Legislative Counsel)]: So, to the extent funds are available, they may go to public schools.

[Alyssa Black (Chair)]: But the rest of the bill is really about schools, after school programs. Schools are able to establish this with guidance from just is that they would not be eligible for grant funding if it was not a public school?

[Katie (Office of Legislative Counsel)]: It's two different programs, the two sections you're referring to now I'm realizing. So B is the Mental Health Literacy Training Program. And so that's the public school they apply for a grant for that program. And then the language that you're referring to on page three, that's under the peer to peer mental health support. So that would be available to any school that wants to stand up a program or an after school program does

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: that.

[Alyssa Black (Chair)]: Karen? I'm not sure with that interpretation, if I still have the question, I'll just ask it anyway. Would this include, I'm just thinking specifically Bristol has a wonderful third space teen center called the Hub. They'd be able to access

[Katie (Office of Legislative Counsel)]: grant money. I think to the extent that they operate as an after school program or youth mentoring agency, then they would. I don't know enough about that organization to

[Alyssa Black (Chair)]: It seems like a really good fit for them, but I'm not sure they're included. Any other questions? Any questions for Katie? I've

[Allen “Penny” Demar (Member)]: got some sessions, but not for Katie.

[Alyssa Black (Chair)]: Okay. Do we feel as though we can let Katie go?

[Daisy Berbeco (Ranking Member)]: Three minutes and fifty two seconds.

[Unidentified committee member (possibly Brian Cina)]: We'd like to go back to another committee.

[Alyssa Black (Chair)]: Yes. You send a clean version without the yellow and all? Yes.

[Daisy Berbeco (Ranking Member)]: Thank Okay. You for giving me I'm

[Alyssa Black (Chair)]: sorry because it's not up there. It'll be 231. Thanks for squeezing us in. Yeah. Fun. All right. Allen?

[Allen “Penny” Demar (Member)]: I guess I got a couple of questions. It says that I think on page two, it's line 11, it says there's not a requirement for adoption of any specific curriculum on structural content. I guess my question is why not?

[Daisy Berbeco (Ranking Member)]: Because the AOE asked us not to. We don't do that as a legislature. We don't dictate what curriculum they need to do.

[Allen “Penny” Demar (Member)]: And then down on 18, B, it says overseen by an adult who is not required to be licensed, certified or a prostrate mental health professional. I'm just wondering why. So you're looking for a volunteer?

[Daisy Berbeco (Ranking Member)]: No. This is just articulating that we're looking for someone over 18 and that we would let the Department of Mental Health determine which qualifications. Because there is

[Allen “Penny” Demar (Member)]: qualifications over here. Yeah, we talked about

[Daisy Berbeco (Ranking Member)]: it yesterday and then added

[Allen “Penny” Demar (Member)]: Okay, I just see that. But do we have a list of what the qualifications are?

[Daisy Berbeco (Ranking Member)]: They will. The language we added says that they will define them. They will define. Yes, because they understand what licenses people need to have.

[Allen “Penny” Demar (Member)]: Okay, I guess I'm all set.

[Jen Tarby (Office of Legislative Counsel)]: Any

[Daisy Berbeco (Ranking Member)]: other? Yes? I would just add that we have a lot of written testimony in this bill document folder and make sure that folks saw there were a couple students from Wenuske that gave really thoughtful testimony, and it was very instrumental to developing this final version of the bill, as well as AFSP and the youth that came in during their advocacy day. It was incredibly helpful to hear from them, and it just reaffirms the need for this.

[Allen “Penny” Demar (Member)]: I guess I got another question. Sorry. Okay. As far as the peer to peer services, I asked this young lady, and she said she was more comfortable with an older peer supporter. Would there be there's no age limit on teenager or even youth younger getting peer support from another person their own age?

[Daisy Berbeco (Ranking Member)]: We don't define the parameters of the program that closely, because there's programs happening all over the state, like in some of those organizations that testified that they have different models that they tested and they found work best for different ages. The Department of Mental Health advised us to try to determine how things are age appropriate. And so we put that in there. That's what they said was important is that appropriate. Put age appropriate, and it will define the best practices for working with those aged kids.

[Alyssa Black (Chair)]: Thank you. I don't remember

[Daisy Berbeco (Ranking Member)]: a friend's name that testified. Addison?

[Alyssa Black (Chair)]: Or earlier. The

[Department of Financial Regulation representative (name not stated)]: young lady.

[Daisy Berbeco (Ranking Member)]: She was in charge of the program. So I apologize for that. But she did It was just thought process. It's more of a statement that I was wondering if it would be a supervised peer to peer, and she said it was. So I just Maybe that was Vermont after school Nicole.

[Alyssa Black (Chair)]: Vermont after school. On the screen? Oh,

[Jen Tarby (Office of Legislative Counsel)]: was the one kid that goes into the other schools.

[Alyssa Black (Chair)]: That's why we have that whole is overseen by an adult and then DMH will create the qualifications of that adult overseeing the program.

[Daisy Berbeco (Ranking Member)]: And I would also just lift up, because we've heard from witnesses and committee members as well the importance of making sure this allows space for the whole family in the approach. What I mean by that is that parents are aware of what's going on. If their kid is in danger, that parents have a way of knowing that. And so because we can't prescribe curriculum in that granular level of detail, I would just note that any adult that is hired to work on a grant that is funded through the agency of education or the department of mental health has to go through a rigorous process to work with them. And each school locally gets to decide whether or not to do this and how to do it, with who, and how to notify parents. So you can, in your own district, go to your school and make sure that the process that your constituents want is happening locally.

[Alyssa Black (Chair)]: Any other questions, concerns, thoughts? So, in curriculum, it states that parents will be made aware of, so

[Katie (Office of Legislative Counsel)]: how do we know that?

[Alyssa Black (Chair)]: We're not prescribing curriculum because we do not do that to schools.

[Daisy Berbeco (Ranking Member)]: No, but it's in the curriculum on how parents would be We can't do that. AOE won't let us tell them what

[Alyssa Black (Chair)]: That's not what I'm asking. Where is it stating that parents will be notified? You said that parents would be notified.

[Daisy Berbeco (Ranking Member)]: No, we leave that up to the local school. So they decide if the school wants to adopt a program like this, they write it. It's up to your local school. So the local community gets to weigh in when they're developing that grant, when they're hiring whatever program they want to come in and do the mentoring. The local community gets to decide whether or not to put in parental control and all of that stuff. And that's intentional because some communities really, really need that and some communities don't want it. And I think we have to It's difficult to find the right size with something that important. But after three years, I feel like this version of the wheel, I feel like it does it.

[Alyssa Black (Chair)]: All right. Any other comments? If not, I would entertain a motion that we pass H817 version draft 3.1. Second. Well, I didn't make

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: a motion. Will entertain a motion.

[Alyssa Black (Chair)]: Can I make a motion that we pass eight seventeen, or we can vote on eight seventeen? Three point one. Alright, let's call the world. Brian Cina. Yes. Lori Houghton. Yes. Leslie Goldman. Yes. Lori Houghton. Oh. Can I stop in the middle of the roll? Do you want me to call her? Let me call. Come back to

[Allen “Penny” Demar (Member)]: me too. Yes, I'll vote, yes.

[Daisy Berbeco (Ranking Member)]: Okay.

[Allen “Penny” Demar (Member)]: No, you forgot me.

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: I did.

[Alyssa Black (Chair)]: Sorry. Here you need

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: this. Yes.

[Alyssa Black (Chair)]: Debra Powers, yes. Valerie Taylor. Daisy Berbeco. Yes.

[Katie (Office of Legislative Counsel)]: She's okay.

[Daisy Berbeco (Ranking Member)]: She's okay with not being here.

[Alyssa Black (Chair)]: Yes.

[Allen “Penny” Demar (Member)]: Yes.

[Alyssa Black (Chair)]: It is 1001. The reporter of this bill will be representative for Taco.

[Francis “Topper” McFaun (Vice Chair)]: Baby.

[Alyssa Black (Chair)]: Alright, thank you. Yes. Okay, moving on. Let's go to the eighth. I really bust a little marker. I sent a message to Natasha earlier today, I'm like, we're going to start with seven eighty five, and she was like, what? Don't know. Whatever the $8.51 was. Alright, so thank you, Jen, because this one has a fair amount of changes in it. So thanks for working this through. We are on version 3.1. Do you want to put it up? Yes.

[Jen Tarby (Office of Legislative Counsel)]: Jen Tarby from the Office of Legislative Counsel. This is five eighty five and activating to health insurance reforms, and we do have some changes from the draft. So as usual, I have incorporated everything that you saw yesterday and didn't change. Now the new step is what is highlighted. And so we scroll down to page 15 to start. Section five, and this is that in addition to some of the language that we looked at, I think, yesterday around association health plans and the federal landscape and a report from Department of Financial Regulation. So this expands that report. This would now say on or before 01/15/2027, the FR would report to this committee and Senate Health and Welfare and Senate Finance the following information related to expanding access to association health plans beginning on 01/01/2028, as permitted by APSA Sections four thousand thirty one and four thousand forty three as amended by Sections three and four of this act. Decided to move that up to the lead in language so I didn't have to repeat that whole phrase three times. So first, they're still going to report on the status of federal law regarding association health plans, including the extent to which federal law would allow for the expanded access to association health plans in Vermont beginning on 01/01/2028. Second, an analysis of the projected impacts on Vermont's health insurance markets of expanding access to association health plans beginning on 01/01/2028, including the likely effects on enrollment in and premiums for qualified health benefit plans and the individual and small group markets using scenarios that show potential impacts over consecutive years if various percentages of healthier lives were to leave the individual in small group markets to enroll in association health plans. And third, in consultation with the Green Mountain Care Board, the potential impact of expanding access to association health plans beginning on 01/01/2028 on the board's health insurance rate review responsibilities under the Title VIII provision that has them reviewing major medical plans.

[Alyssa Black (Chair)]: Do we stop there or keep going? Anyone have any thoughts? Concerns? Would it be can I look over to, if this, I mean, I know you don't love it, but it works? It works. Okay, Great. And that was with internal funds, don't you? Is that what we call

[Department of Financial Regulation representative (name not stated)]: No additional funds necessary. Right. Alright.

[Jen Tarby (Office of Legislative Counsel)]: Next, we're striking this section on expanding access to short term limited duration plans. So that would just come out. And the next section would become section six. Otherwise, no changes to that section on I dollar claims or claims edit purposes. There was an expansion, as I understand it, to site neutral billing to include occupational therapy and athletic training. I did talk to the press a little bit to see if there's some other terminology we could use without repeating those three. And it really I have to say, when I looked at it, I feel like the terms that were maybe used sort of as shorthand were not sufficiently clear and created additional questions. So instead, I added and for the the reader assistant setting, I just said certain services. And for the section title ends for the text, it talks about site neutral reimbursement for physical therapy, occupational therapy, and athletic training. And I moved the reimbursement amounts down here. So it would say each health plan shall establish and pay for all physical therapy, occupational therapy, and athletic training items and services provided to its insureds and reimbursement amounts that are uniform and consistent across all of the health plans, contracts and fee schedules, except that a plan may reimburse different amounts for an abstract physical therapy items and services that are delivered in an inpatient setting. And then it directs the plans to express each reimbursement amount as a percentage of the Medicare rate for that item of service.

[Francis “Topper” McFaun (Vice Chair)]: Did we define what athletic training is?

[Jen Tarby (Office of Legislative Counsel)]: No, but it is a required covered service in Title VIII. I can include a cross reference, or maybe that's useful. Is that maybe useful looking also at DFR and insurers? Is it useful to cross reference? That's a licensed profession,

[Alyssa Black (Chair)]: isn't it?

[Department of Financial Regulation representative (name not stated)]: It is, yes. And Courtney Harness, Blue Cross and Blue Shield of Vermont, there's a really good couple of paragraphs, I think it was in the letter from Lancaster that laid out really specifically what the profession does.

[Allen “Penny” Demar (Member)]: But it is a license at multiple levels

[Department of Financial Regulation representative (name not stated)]: of profession.

[Jen Tarby (Office of Legislative Counsel)]: Right. I think the question I'm hearing from Representative McFaun is, do we need to point to somewhere where it specifies what's included? Because I think you could argue in a non licensure or benefit mandate sense that athletic training could be pretty broad.

[Francis “Topper” McFaun (Vice Chair)]: I was just thinking, if somebody says, Okay, Representative McFaun, what's athletic training mean?

[Alyssa Black (Chair)]: I will point out that this provision means that the billing, it has to be site neutral for billing, and you cannot bill for services unless you are qualified by some form of licensure to bill for those services. So not everyone can just say, hey, I'm an athletic trainer and start billing for stuff. So it only affects

[Jen Tarby (Office of Legislative Counsel)]: bill. Right. There is not a definition. So the definition in insurance statute talks about services that are within the scope of practice of athletic trainers.

[Francis “Topper” McFaun (Vice Chair)]: I know what they do.

[Jen Tarby (Office of Legislative Counsel)]: Acting within their authorized scope of practice.

[Francis “Topper” McFaun (Vice Chair)]: That's what it is. Okay. I know what they do. I can't.

[Jen Tarby (Office of Legislative Counsel)]: So I will defer to the committee if you want me to put in any kind of additional language or information or if you're satisfied with it, with the parameters you've heard.

[Alyssa Black (Chair)]: I'm comfortable it also.

[Jen Tarby (Office of Legislative Counsel)]: Are you comfortable? Yeah. Okay. Alright. So then we have section eight, which is the report back requiring that each insurer required to make site neutral reimbursements for and adding in occupational therapy and athletic training in addition to physical therapy would report back by 03/01/2027 with an update on its implementation, any trends or other financial impacts it has identified so far, and any recommendations around the enactment of additional site neutral reimbursement requirements. Requirements. So just adding in the occupational therapy and athlebipramine. Next, we strike this section that it would eliminate the prescription drug specific out of pocket maximums that will come out of the bill and be instead replaced with a section I call I've used reader assistant setting saying increasing flexibility in health insurance plan design, as the name of the section as well. And this would direct the Department of Vermont Health access in consultation with the Department of Financial Regulation to consider the feasibility and potential impacts on premiums and on plan design of allowing health insurers to offer health insurance plans in the large group market and at each metal level in the individual and small group markets that do not include the out of pocket limits for prescription drugs in APSA 4092, provided the insurers also offer plans in the same markets that do include the out of pocket limits for prescription drugs that are in that statute. And on or before 01/15/2027, Ziva would provide its findings and recommendations for increasing flexibility to help insurance plans out of pocket prescription drug limits to this committee, Senate Health and Welfare and Senate Finance. That look more like what people had in mind at this point in time?

[Alyssa Black (Chair)]: I believe they've indicated that they can do that. I bet you, in this question of flexibility or design, were thinking not only of prescription dose but medical? That's what that statute refers to. Sort of.

[Jen Tarby (Office of Legislative Counsel)]: Basically, it would be just what it would look like if it didn't have that. Right. And because everything is still within the annual out of pocket overall maximum, allowing flexibility in the prescription drug limit, then allows flexibility in the medical limit as well. And they don't have to I mean, neither limit has to go up to the or the combined limit doesn't have to go up as high as the federal maximum, but that is the overall max. Alright. Then section 10 just renumbered the sharing plan language, reporting language. And then we have the effective dates, and effective dates are the same as they had been. I had to update some, one cross reference, but the association health plan changes would take effect on 01/01/2028 with that report coming back from CFR in January 2027. And then I added the inclusion of occupational therapy and athletic training, references to site neutral reimbursements, including apply to items and services on and after 10/01/2026. That's the beginning of the hospital budget. Yes, hospital fiscal year. Yep. Is that may

[Alyssa Black (Chair)]: I ask the hospital? When I saw this date, mean, I understand why it's there, but would it interfere with like contract, which starts January 1, I think?

[Devon Green (Vermont Association of Hospitals and Health Systems)]: So, Dan and Green, Vermont Association of Hospitals and Health Systems. I actually was thinking about this at lunchtime and didn't get a chance to look at it, but maybe we can just check the language because usually we'll be getting contracts starting after October 1 because some contracts go January to December, some go October and September, so you can't necessarily disrupt the contract and start changing the reimbursement at that point, but if we apply it to the contracts, they start after that date.

[Jen Tarby (Office of Legislative Counsel)]: Similar to the language in 01/1990, that's what I can make that work pretty quickly.

[Daisy Berbeco (Ranking Member)]: You want to know about a typo?

[Alyssa Black (Chair)]: Yes. Effective dates too, there's a parenthesis after train.

[Jen Tarby (Office of Legislative Counsel)]: Yes, because it's, if you look at the begins after sex marriage Oh, that's after '18. Yep. Got it. A whole long period. Yeah.

[Daisy Berbeco (Ranking Member)]: So I'll admit when we took our section to section polling, this was something I misrepresented my feelings about. I don't like to be negative. Did we get it? I feel like I remember that we did not get a lot of positive feedback from

[Alyssa Black (Chair)]: A lot of people that we had testify about the amount of paperwork that this would entail, or maybe even I'm just sorry, which section? Yeah, I think that some of the sharing plans were concerned with what they would we did hear from Mary Block from part of financial regulation regarding this. May I ask DFR? I'm assuming that this is I don't want to say equivalent, but that it's consistent with what types of information

[Jen Tarby (Office of Legislative Counsel)]: Would that have to provide at least at a bare minimum.

[Department of Financial Regulation representative (name not stated)]: The reporting requirement itself, is the concern the burden on the bearing plans or on the department?

[Alyssa Black (Chair)]: I think that they, anyone involved in this.

[Department of Financial Regulation representative (name not stated)]: From DFR's perspective, no concerns in terms of it's a pretty straightforward report. My recollection of the defendant's concerns were not so much or even they did come to our office and meet with us to say, set this week, the same week they testified and their concern, my takeaway, their concern was less about the operational volume of reporting numbers, more about how that has been used by some states and the way they feel was unfair. That is not how I intend to use the data. It just helps us understand, albeit a small part of the market, but it's for those involved in the important part of the market. Thank you.

[Alyssa Black (Chair)]: And thank you for the clarification. Alright, so I go ahead Deb, did you have a question or were you just holding? No, Why do we have to have a list of other states that are using these plans?

[Department of Financial Regulation representative (name not stated)]: Looking at me, are you asking me?

[Alyssa Black (Chair)]: Well, kinda, I

[Department of Financial Regulation representative (name not stated)]: guess. I mean,

[Alyssa Black (Chair)]: I don't know. It's it's page 26, line four, a list of other states in which the person offers a plan or an agreement arrangement. I believe that it's sort of standard that if somebody's doing business in their state, they don't even know if they're doing business in other states as well. Do you have another question? No.

[Department of Financial Regulation representative (name not stated)]: Do you have

[Francis “Topper” McFaun (Vice Chair)]: anything behind that, Deb, that makes you question that? Well,

[Alyssa Black (Chair)]: don't understand the importance of why we need to know what they're doing in other states. We're not asking what they're doing in other states, we're just asking in what other states they do business in. We're not asking them what the business is, or how their business is conducted in other states. Do you do business in other states? Go ahead. Brian.

[Unidentified committee member (possibly Brian Cina)]: Does that mean if a health sharing ministry is owned by a corporate entity that has a variety of operations or businesses, they would have to report the states in which they do business besides health sharing plan ministries. For example, if they were property owners, like if a church owned property in many states and they were renting affordable housing in some states, to some people, but they didn't have a health ministry in that state where they have to say they do business in that state too.

[Alyssa Black (Chair)]: No, it says plan or arrangement. It's pretty clear.

[Department of Financial Regulation representative (name not stated)]: It's a plan or arrangement. Arrangement.

[Unidentified committee member (possibly Brian Cina)]: A health sharing arrangement, not a housing arrangement, not

[Alyssa Black (Chair)]: I I think it well,

[Jen Tarby (Office of Legislative Counsel)]: that's your lawyer. Yes. I think it's all coming off of the same made in language.

[Alyssa Black (Chair)]: I'm sorry. I don't my glasses down, so I keep it. Did somebody have a hand up?

[Unidentified committee member (possibly Brian Cina)]: A hand is as down as it possibly could be.

[Department of Financial Regulation representative (name not stated)]: Are

[Alyssa Black (Chair)]: people perusing, waiting, I mean trying to see if they have questions or there just no other thoughts? Just reading

[Department of Financial Regulation representative (name not stated)]: curious. I know. Know.

[Francis “Topper” McFaun (Vice Chair)]: I'm trying to figure out

[Alyssa Black (Chair)]: Do people need some additional time?

[Unidentified committee member (possibly Brian Cina)]: It's not negotiable at this point, right? It's either yes or no.

[Alyssa Black (Chair)]: No. If there's language that you feel as though would add or specify for a spelling error maybe.

[Unidentified committee member (possibly Brian Cina)]: So clerical changes or minor adjustments, but not substantial changes at this point. Yeah.

[Alyssa Black (Chair)]: Or or if you need understanding. Yeah. Alright. Because if you make some I think we wouldn't

[Jen Tarby (Office of Legislative Counsel)]: be able to have this. That's fine. I did make the the effective date change that was mentioned, if I can just put that up, so I've sort of incorporated everything in while you're talking. So this would say then that section seven, those site neutral reimbursements would take effect on 10/01/2026 and apply to provider contracts entered into amended or renewed on and after that date. Does that seem

[Alyssa Black (Chair)]: Yes, go ahead. Sorry.

[Department of Financial Regulation representative (name not stated)]: Just trying to answer the A. Question. Would that be effective, contracts effective after that date, or just insurer A contracts for 2027, calendar year 2027, on September 30.

[Jen Tarby (Office of Legislative Counsel)]: Oh, they're gonna make me change s-one hundred ninety too. You

[Alyssa Black (Chair)]: can see it on Jen's face.

[Department of Financial Regulation representative (name not stated)]: That that would be something. It seems the intent might be

[Jen Tarby (Office of Legislative Counsel)]: Yeah. Think maybe it is a little different from s one ninety in the sense that that one is really more because you are entering into them for how you express numbers, and this one is about when it is effective. So would we say that well, beginning on or that begin on or after that date? I guess or it's still, though, that they are apply on the effective date of provider contracts. I don't I don't know. I'm gonna need a minute to

[Alyssa Black (Chair)]: think about it because we have

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: to put this in other piece of Yeah.

[Jen Tarby (Office of Legislative Counsel)]: I mean this is the language that was in S-one hundred ninety.

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: I'll

[Department of Financial Regulation representative (name not stated)]: tell you that it's not known there are contracts that are entered into after the effective date so they're retroactive in terms of payment provisions and there's ones that are entered into prior.

[Jen Tarby (Office of Legislative Counsel)]: So what if we just had entered into amended effective or renewed or some version of that?

[Department of Financial Regulation representative (name not stated)]: My understanding is that the intent here is for effective after picking up or services that occur after October on or after October 1, they will be cytotolish. To me, it's not more entered into, it's just effective.

[Jen Tarby (Office of Legislative Counsel)]: Well, I'd had it that applied to services delivered on and after that date. Now it would change to contracting.

[Alyssa Black (Chair)]: My concern is, I mean, I understand that it should be in effect October 1, but there are still contracts, particularly hospital contracts. Most contracts with insurers start January 1, maybe. I mean, I'm Right. So that I thought that this would create that buffer so that it's in effect October 1, but it's not undoing the contract that's already in effect for the remaining two months of the year. And then the new site neutral would take effect on one month. That was kind of what I was saying.

[Jen Tarby (Office of Legislative Counsel)]: Yes. I think the commissioner's question is if the negotiation happens before the date, but the effective date of the contract happens after the date, is it arguably entered into prior to October 1, even though it doesn't take effect until after October 1?

[Alyssa Black (Chair)]: So couldn't we just put or effective provider contracts to amended, renewed, or becoming effective Or taking effect?

[Daisy Berbeco (Ranking Member)]: Yes.

[Alyssa Black (Chair)]: That work? Does that help?

[Department of Financial Regulation representative (name not stated)]: I think that means that if for whatever reason your contract start date is November 1 or January, it's basically anything, yeah, I that does. I am not an attorney.

[Alyssa Black (Chair)]: I was gonna say, did I just did I just have to create language that worked? That actually might be a first. No nexus in marriage.

[Unidentified committee member (possibly Brian Cina)]: Neither articulate nor articulate alone. I

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: think

[Alyssa Black (Chair)]: that makes it can change.

[Jen Tarby (Office of Legislative Counsel)]: Maybe we say we're otherwise taking effect. Don't wanna get into a universe where it's like, it's an oar. Right. And it was two of them, two of those.

[Department of Financial Regulation representative (name not stated)]: Well I could further complicate things and say it's not beyond imagination that a contract for services being done right now could actually not be signed until late October if things went south. That's not crazy, if that makes sense.

[Alyssa Black (Chair)]: So ads signed? No,

[Department of Financial Regulation representative (name not stated)]: I mean that would That

[Jen Tarby (Office of Legislative Counsel)]: would complicate it. I'm gonna say that are entered into amended, renewed, or otherwise take effect on or after. Can that work? Oh, can I make a request that people sort of flag this and that we use this language currently, but if you come up with better suggestions that maybe make sure you suggest it to our count or the senate, the other body?

[Alyssa Black (Chair)]: Oh. Is that is that okay?

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: Yes.

[Jen Tarby (Office of Legislative Counsel)]: Okay. So I'm gonna Doesn't

[Alyssa Black (Chair)]: seem to be a big policy decision, just a language decision.

[Jen Tarby (Office of Legislative Counsel)]: Okay.

[Alyssa Black (Chair)]: Any other questions that people have had fun to? Alright, what version are we on now, Jen? I'm gonna use 3.2,

[Jen Tarby (Office of Legislative Counsel)]: yes? Two. Alright, just trying to 3.2. Looks like it's now.

[Alyssa Black (Chair)]: I

[Francis “Topper” McFaun (Vice Chair)]: move that we move to vote on revision 3.2 of h five eight five. Don't leave.

[Alyssa Black (Chair)]: Clerk all the world. Brian Cina? No. Wendy Critchlow? Yes. Allen Demar? No. Leslie Goldman? Yes. Lori Houghton?

[Jen Tarby (Office of Legislative Counsel)]: Yes.

[Alyssa Black (Chair)]: Annimators? Yes. Have the powers known. Valerie Taylor? Yes.

[Unidentified committee member (likely Karen Lueders or Lori Houghton)]: You see, Berbeco? Yes. It's just like following. Yes. Yes.

[Alyssa Black (Chair)]: 830. Thank you. 830. The reporter It's office. The re official reporter of this bill is representative McFaun.

[Francis “Topper” McFaun (Vice Chair)]: Francis Matthew Jane.

[Alyssa Black (Chair)]: And Francis

[Daisy Berbeco (Ranking Member)]: Matthew Jane.

[Alyssa Black (Chair)]: Sister Francis And we will be reporting it together.

[Department of Financial Regulation representative (name not stated)]: I'll get up to post

[Alyssa Black (Chair)]: you after this. I'm gonna go on record as last year I said to Topper, you need to report a bill. I've never seen you report. He's like, I don't sue bills.

[Daisy Berbeco (Ranking Member)]: You did it once. And it

[Jen Tarby (Office of Legislative Counsel)]: was a poll report, and

[Alyssa Black (Chair)]: then you did that one, which by the way, don't you think that I haven't noticed that you're leaving me to be the one to report that when it comes back from the Senate? So, this is going be the last bill. Almost the first and the last bill you've ever heard. Thank you everybody. We are going to take a short break and we'll be back in fifteen minutes.