Updates
February 10, 2020

Vermont Health Care Update 02-10-2020

An analysis from DRM's Health Law Team

House fails to override veto of paid family leave

Despite pressure by House leadership, the attempt to override Gov. Phil Scott’s veto of the paid family leave bill failed by one short of the 100 votes required. If passed, the bill would have mandated a nearly $30 million payroll tax.

In December, Scott announced a voluntary paid leave program and the state employees union ratified a two-year contract that includes the benefit, which will be paid for by the state. The program offers six weeks of leave at 60 percent wage replacement. The plan is to open the program to businesses who are not affiliated with state government for its employees.

Analysis of mental health bed needs reviewed

Department of Mental Health Commissioner Sarah Squirrell and Deputy Commissioner Mourning Fox appeared before the House Corrections and Institutions to report on its analysis of the mental health bed need in the state. Squirrell said the report provides an analysis of residential settings serving individuals with mental health treatment needs in Vermont and an overview of each type of residential setting. She said the report does not include a discussion of non-residential individual living arrangements such as supportive housing.

Squirrell reported that there are significant needs for secure residential with capacity to do involuntary procedures and long-term intensive recovery residences. She emphasized the need to expand group home capacity. Group homes are at 100 percent occupancy and people are not moving out of those beds. She said barriers for discharge include a lack of community services, an absence of a group home or community care home availability, or a lack of a nursing home placement. She said there are plans to increase capacity in the state. There will be 12 new beds at the Brattleboro Retreat to serve the highest level of acuity patients, 25 beds at the Central Vermont Medical Center that will treat across the continuum, and a 16-bed secure recovery residence.

Health committee continues work on prescription drugs

The House Health Care Committee heard from Blue Cross Blue Shield of Vermont Director of Pharmacy Brian Murphy and Department of Vermont Health Access Director of Pharmacy Nancy Hogue on Tuesday on the impact of prescription drugs costs on their organizations. Murphy addressed the pressures health insurers are facing due to rising costs in specialty drugs and excessive manufacturer profit margins. Murphy said although the costs of specialty drugs are decreasing, utilization of these drugs are increasing, so costs continue to grow. His presentation can be found here.

Murphy said he has concerns with the current law on prescription drug transparency. He said the formula for creating the list of drugs for review by the Attorney General is flawed. He prefers a process where the AG identifies concerns for follow up with the manufacturers. He highlighted the similar percentage increases in the prices of two specialty drugs as an indication of an area where the AG should investigate further.

Hogue provided testimony on the Medicaid program. She said the program benefits from manufacturer rebates. She stressed that advances in research will result in more high-cost drugs likely coming to market which will have an effect on the state budget. Hogue said there is also potential future growth in value-based manufacturer agreements.

Rep. Mari Cordes, D-Lincoln, presented an overview of the National Academy of State Health Policy model bill on pharmacy benefit managers and a proposal to create a state purchasing pool. Cordes said while PBMs do not buy drugs directly from manufacturers, they do create drug formularies for their clients and designate which preferred drugs the insurance plans will cover. This puts them in a powerful bargaining position. She said PBMs can insist on discounts or rebates from manufacturers in exchange for placing their drug products in a health plan’s formulary.

Murphy added that Vermont does not experience the issues raised by Cordes since Blue Cross has 70 percent of the market and does an exceptional job at negotiating its contract with its PBM. Murphy said that PBM’s allow insurers to join together to negotiate better deals with drug manufacturers to help contain drug costs. Chair Bill Lippert, D-Hinesburg, asked how PBM’s are licensed or regulated, and Murphy replied that that the contracts with insurers require compliance with Vermont law, but insurers are responsible for ensuring compliance. Lippert said that he’d like to look further into PBM oversight.

Lippert said the committee will continue its discussion on drug-related proposals, including PBMs, as part of its focus on affordability.

Overwhelming support for expansion of telemedicine services

On Wednesday, the House Health Care Committee heard from supporters of H.723, a bill to require health insurance reimbursement for expanded telehealth services.

723 would require reimbursement for a category of telehealth services, store-and-forward, which is commonly used for provider-to-provider consultations, also known as eConsults. Although health care systems regularly use eConsult technology for a wide range of specialties, Vermont statutes allow reimbursement only for dermatology and ophthalmology services.   

Provider groups urged the committee to support insurance reimbursement for eConsults, an electronic medical record-based tool that allows primary care physicians to deliver specialist-guided care to lower-acuity patients in a timely manner while freeing up specialist visits for more complex patients. Dartmouth Hitchcock Vice President of Population Health Dr. Sally Kraft said that Dartmouth-Hitchcock was selected in 2014 to participate in the Association of American Medical Colleges’ Project CORE as a pilot site. Project CORE improves the referral process between primary care providers and specialists by implementing eConsults. Kraft said this technology saves time for their patient, offers efficient use of specialist time, provides satisfaction for its primary care workforce, and increases continuity of care for patients within a system. Kraft and representatives from the University of Vermont Health Network said they are providing these services within their networks without being reimbursed, which has caused limited expansion of the program.

Bi-State Primary Care Association Director of Vermont Policy Helen Labun said eConsults improve patient care by providing a convenient system for primary care providers to work with specialists offsite to determine which conditions require specialist treatment and which can be treated in the primary care setting. They emphasize the primary care provider relationship and keeping medical treatment close to home with that provider, which is more convenient for patients and less expensive. ‚ÄčeConsults are also an easy first step into telehealth and telemedicine because they work on existing electronic medical records systems and the consultation happens outside of the patient visit, leading to high acceptance for patients who might not otherwise want new technology as part of their health care experience. Labun’s presentation can be found here.

Flavored tobacco ban nears committee approval

The Senate Health & Welfare reached a tentative consensus on Friday on legislation to ban the sale of all flavored tobacco products, including menthol cigarettes and all flavored e-cigarettes liquids.

Lobbyists for the tobacco industry were highly engaged on the issue this week, and their influence could be seen as senators felt the pressure from industry-generated emails in opposition to the bill.

Several other Senate committees will review the bill before it goes to the floor, with the next stop at the Economic Development, Housing and General Affairs Committee

DVHA presents FY 2021 Medicaid budget

Department of Vermont Health Access Commissioner Cory Gustafson appeared before the House Appropriations and Health Care Committees on Thursday to present his department’s FY 2021 budget request. The proposed budget shows a reduction of $243 million, the majority of which is attributed to a transfer of the long term care appropriation from DVHA to the Department of Disabilities, Aging and Independent Living.

Gustafson said his department continues to focus on its three main priorities: adoption of value-based payments, management of information technology projects, and operational performance improvement. The Department continues to advance value-based payments through its Accountable Care Organization program and payment reform for Medicaid providers through Applied Behavioral Analysis, Children’s and Adult’s Mental Health, Residential Substance Use Disorder Treatment, Developmental Disabilities Services, and Children’s Integrated Services program work. The goal of this work is to control the rate of growth and variability in health care costs by incentivizing quality over quantity.

DVHA is working with the Agency of Digital Services to transform the way it plans for, implements, and manages large scale Medicaid information technology projects. These approaches are designed to improve outcomes and efficiency and reduce financial risk to the State. Accomplishments include the new online provider management module for enrolling providers in Vermont Medicaid, the new fully electronic process for prior authorization requests, and the ability of Vermonters to upload application and verification documents through their mobile device.

Finally, DVHA has focused on business efficiencies for improving the way Medicaid members and providers are served and has implemented scorecards for performance metric tracking. The performance measures are used to drive decision making and better customer service, a higher quality of care, and operational efficiencies.

Prior to passing the Budget Adjustment Act in the committee with further proposal of amendment, Committee Chair Kitty Toll, D-Danville, raised the issue of the budget cut to RiseVT, the lead primary prevention initiative for OneCare Vermont. Toll made it clear that the committee wanted to better understand the program before allocating funds. “There are a lot of unanswered questions that the budget adjustment does not give us the time to answer,” said Toll. It is expected the RiseVT appropriation will be added to the FY 2021 budget after further testimony and discussion.

DMH presents FY 2021 Budget

The Department of Mental Health presented its proposed $279 million FY 2021 budget to the House Appropriations and Health Care Committees this week. DMH Commissioner Sarah Squirrell provided an overview of her department, the provider network and capacity, the system of care for adults and children, and people served by each program.

Squirrell highlighted notable changes to include a Brattleboro Retreat rate increase, a community rehabilitation treatment rate increase, an increase of $575,000 in suicide prevention initiatives, and a $600,000 appropriation in one-time funds to implement a mobile-response pilot in Rutland.

Squirrel concluded with an update on the Brattleboro Retreat saying that the agency of human services continues to meet with representatives of the Brattleboro Retreat on a weekly basis. They have hired a consulting group, redesigned their admissions process, and engaged other opportunities to ensure fiscal stability. We have another meeting with them this week. There is no money proposed at this time.”

Senate committee begins work on health care reform bill

The Senate Health and Welfare Committee began a review of its omnibus health care reform bill, S.290, on Friday with Legislative Council Jennifer Carbee. Committee Chair Ginny Lyons, D-Chittenden, said “This is a very important bill. And there is something for everyone to hate.”

The bill:

  • Requires additional reporting, certification, and budget requirements for OneCare Vermont, the state’s accountable care organization;
  • Directs hospitals to report certain rate increases to the Green Mountain Care Board;
  • Requires GMCB approval for contracts between health insurance plans and providers;
  • Requires the Agency of Human Services to report on a two-year budget and reporting cycle for OneCare Vermont;
  • Provides GMCB oversight of the designated mental health and specialized service agencies;
  • Requires that one of the GMCB membership include a health care professional;
  • Requires the GMCB to begin exercising its rate-setting authority and establish site-neutral reimbursement; and
  • Imposes limits on health insurance rate increases attributable to administrative expenses.

The committee will take testimony on the bill starting next week.

Legislative committees continue review of primary care cost-sharing bill

The House Health Care Committee took up H.786 this week, a bill to eliminate health insurance co-payments for primary care services. Bill sponsor Rep. Sarah Copeland Hanzas, D-Bradford, told the committee that the intent of the bill is to expand health care to more people by removing barriers to access.

Copeland Hanzas acknowledged that the bill does not have a definition of primary care, and Rep. Cordes, D-Lincoln, suggested that primary care should have an expansive definition to help people access care. Rep. Annmarie Christensen, D-Weathersfield, reminded the committee that it passed a bill last year requiring the Green Mountain Care Board and the Department of Vermont Health Access to identify which health care providers and services constitute primary care. Chair Bill Lippert, D-Hinesburg, said that his committee will consult the report if they decide to work on the proposed measure.

On the Senate side, the Finance Committee reviewed H.786’s companion bill, S.245, on Thursday. Vermont Medical Society representative Dr. Louis DiNicola endorsed the bill, reiterating previous testimony that reducing barriers to primary care will improve health outcomes and reduce costs. Margaret Laggis, speaking on behalf of America's Health Insurance Plans, reminded the committee that federal metal level requirements, which require insurers to offer plans with certain cost-share ratios between insurers and consumers, would make the proposal difficult to comply with. 

Chair Ann Cummings, D-Washington, told her committee that she was concerned about the collective cost shift impact of the six current proposals to cut or eliminate cost-sharing requirements in health insurance plans. In order to meet the federal requirements, insurers would likely have to increase premium costs, impacting consumers and employers.

Emergency service responders ask for wellness support

The Senate Health and Welfare committee heard compelling testimony on Thursday from first responders and law enforcement officers on the need to increase mental health and wellness services for their community. They spoke in support of S.243, a bill that would establish an Emergency Service Provider Wellness Commission. The large commission, established within the Agency of Human Services, would confidentially report health and wellness data on emergency service providers and recommend policies, training, legislation and services that increase support for the providers to improve health outcomes, job performance and personal well-being.

Margaret Laggis, an EMT with Hardwick Rescue, detailed the difficult situations that she and her colleagues deal with, saying that they share in deaths, respond to calls for their friends, their children’s friends, and get involved in many sad situations. Laggis said, “After many years of this, it becomes too heavy to carry and that’s why we lose members.”

Drew Hazelton, Chief of Operations and Chair of the Emergency Medical Services Advisory Committee for Rescue Inc., told the committee that 25 percent of EMS responders are leaving every year, many due to the mental stress of their positions and inadequate support. The report of the Emergency Services Advisory Committee to the legislature states that “the Emergency Medical Services System in Vermont is in critical condition …and changes in regulation, funding and education are required.” Seventy percent of EMT departments do not have the financial means to provide mental health treatment for providers, and 70 percent cannot fill positions if people take time off for mental health treatment.

Members of the Vermont State Police and the Burlington Fire Departments stressed the success of peer support and behavioral health programs, and the need to ensure that they are available statewide. Vermont League of Cities and Towns Trevor Whipple, retired chief of police in South Burlington and Barre City, told the committee that the proposed Commission could help serve the communities that currently do not have the resources to help emergency service providers.

Senate panel considers cutting insulin co-payment

The Senate Finance Committee continued to take testimony on Thursday on S.296, a bill that proposes to limit the amount of a beneficiary’s out-of-pocket expenses for prescription insulin drugs under a health insurance plan to not more than $100.00 per 30-day supply. Margaret Laggis, speaking on behalf of America's Health Insurance Plans, said that the proposal would initially reduce costs to consumers, but would put pressure on the cost of insurance plans, and drug companies would not be held accountable for high list prices. Laggis asked that if the proposal moves forward, the cap be set at $100 per prescription, rather than $100 per 30-day supply.

Chief Health Care Advocate Mike Fisher presented an alternative proposal to the committee. He suggested requiring hospitals to sell 340B-eligible insulin to their patients at 150 percent of the 340B price plus a reasonable dispensing fee. Fisher explained that the 340B drug program requires drug manufacturers to sell outpatient drugs to eligible entities (mostly hospitals and Federally Qualified Health Centers) at drastically reduced prices for patients. The hospitals then sell the reduced price drugs to patients at their retail cost – using the revenue to expand services offered to patients or provide services to more patients. The proposal would only apply for commercial payers. Although Fisher said that it would not have a “material impact” on hospitals, the retail price cap would cut into needed revenue for potentially financially fragile hospitals.

The committee will take more testimony next week.

House health care committee reviews GMCB budget

Green Mountain Care Board Chair Kevin Mullin presented the Board’s proposed FY 2021  budget to the House Health Care Committee on Thursday. Mullin reported that the board is properly staffed, and with their current level of responsibilities, are “whole.” There has been an increase in the salary and benefits budget line, due in part to health insurance cost increases somewhat attributed to a staff baby boom. They have offset the increased expenses by bringing projects in-house and reducing reliance on costly contractors. When asked by Rep. Ann Donahue, R-Northfield, if the GMCB could handle take on the task of reviewing the full Brattleboro Retreat budget with its current resources, Mullin responded that they could do it with current staffing and resources.

Mullin brought up bill H.785, a proposal that would authorize and direct the Green Mountain Care Board to evaluate the costs of certain high-cost prescription drugs and recommend methods for addressing those costs, including setting limits on what Vermonters would be expected to pay for some high-cost drugs. He said that “if you do the price control alone, you’re not really going to get at the net value”  and it would be good to couple price control with a state wholesaler program. He said that he’d reached out to the National Academy for State Health Policy to see what other states are doing.

Mullin asked the committee to consider two legislative actions. First, he asked for service locations to be required on claims forms for transparency reasons, a proposal that Chair Bill Lippert, D-Hinesburg, asked legislative counsel to draft for possible inclusion in a bill. Second, he asked the legislature to authorize hospitals who are required to submit sustainability plans to be allowed to do so confidentially. This past budget season, the board required six hospitals to develop sustainability plans and file them with the board, but they were subject to open record requirements. Mullin doesn’t want hospitals experiencing financial challenges to have to disclose if they are discussing affiliations with other hospitals or other changes that may affect staff retention. He feels that the board will not get the full plan picture without the benefit of confidentiality.

Mullin and board staff will be returning to the committee to continue reviewing the GMCB’s proposed budget and priorities for 2021.

Senate panel approves physician assistant licensing changes
The Senate Health and Welfare Committee passed out a bill unanimously on Wednesday that would modernize state law regarding the licensure of physician assistants. S.128 would simplify documentation and administrative requirements in the current PA and physician relationship.

The proposed changes would bring the law into alignment with current practice, and would not change the scope of practice of PAs. The need for delegation agreements with primary and secondary supervisory physicians would be removed, as would physician liability for PA practice solely based on being a participating physician who completes a practice agreement. The bill mandates a practice agreement between a physician assistant and a physician that must be filed with the Board of Medical Practice. The agreement can be filed electronically and the Board cannot request or require any modifications to the practice agreement.

Nurse educator shortage reported to committee

The House Commerce and Economic Development committee continued to work on finding solutions for Vermont’s workforce challenges, this week focusing on the nurse educator shortage.

Green Mountain Care Board Chair Kevin Mullin told the committee that prohibitive education requirements and pay disparities between nurse educators and nurses are creating a shortage of nurse educators. Mullin said that changes to educational requirements have to made by the Board of Nursing. Professor and Director of the Norwich University School of Nursing Paulette Thabault explained that nurse educators currently must have a master’s degree to teach nursing. Unlike 48 other states, Vermont does not offer a waiver process that can be approved by the board to enable non-master’s degree nurses to become nurse educators. The Office of Professional Regulation recommends a rule fix to create a process to address waivers, relying on national accreditation standards.

A health care workforce report drafted by a sub-committee of this year’s Rural Health Task Force reported that the workforce shortage is Vermont’s greatest healthcare threat. Task force member Laura Pelosi presented the report and told the committee that stresses on the nursing market include educational debt and limited educational capacity in Vermont. Nursing homes can’t accept patients when they can’t meet federal staffing requirements, so patients are backing up in hospitals. 293 students nursing students are graduating in Vermont, and there are 5,000-6,000 jobs available.

Older Vermonters Act receives support

The House Committee on Human Services continued taking testimony this week on H. 611, the Older Vermonters Act. The legislation describes a system of services, supports, and protections for Vermont residents 60 years of age or older. The bill would also establish annual inflationary increases to Medicaid reimbursement rates for home- and community-based service providers. It is intended to work in tandem with the federal Older Americans Act, the Vermont State Plan on Aging, and the Choices for Care program.

The proposal received support from Disability Rights Vermont, Vermont Legal Aid,  LGBTQIA Alliance of Vermont, the Vermont Association of Adult Day Services, and the Central Vermont Council on Aging. Many of these groups requested to be added as members of the Self-Neglect Working Group that is proposed in the bill.

Molly Dugan, the Director of Support and Services at Home, told the committee that SASH strongly supports the bill’s annual increase for providers of home and community based services. She said that not only is the increase “absolutely essential for providers like Cathedral Square to continue to serve our very low income residents of our two assisted living facilities, it is essential for the home care providers that we partner so closely with in the SASH program and who serve our residents day in and day out with essential home care; keeping them from moving into higher level facilities.” Dugan also told the committee that the workforce shortage is adding to the gap between expenses and reimbursement rates that they are dealing with. They are pressured to compete with higher paying organizations to attract high quality staff.

The committee will continue to take testimony on bill in the coming weeks and have noted it as a priority for the committee.

Chiropractic co-payment bill likely to add physical therapists

The Senate Committee on Health and Welfare heard more testimony on S.202 this week. Representatives from both MVP and Blue Cross Blue Shield Vermont highlighted the fact that S.202 was one of many bills being introduced to remove or reduce co-payments, such as H.822  and S.296 for insulin and H.663 for contraceptives. (See discussion of S.296 above) Both representatives expressed concern about the  cumulative impact that all of these bills, if passed, would have on plan designs and the price of other services.

Although the insurers said a proposal to add physical therapist copayments to the bill would further add to that impact, Committee Chair Ginny Lyons, D-Chittenden, said that physical therapists would likely be added into S.202 after hearing testimony on the benefits of physical therapy. Physical Therapist Jeff Albertson, SCD, OCS, testified that physical therapy results in an earlier return to work and a reduced need for imaging, surgery, injections, and opioid medication. Echoing the concerns expressed by the insurers from last week, the Department of Vermont Health Access’s main concern was not over the substance of the bill but about the timing of the process, adding that it would be helpful for DVHA if the legislature was instead talking about impacts to plans for FY 2022.

Green Mountain Care Board

On Wednesday, the Green Mountain Care Board approved the following items:

Act 53 Health Information Exchange Consent Implementation: The Department of Vermont Health Access proposed an amendment to the HIE Plan, including an addendum on HIE Consent. In response to Board member questions regarding commercial use of data, including de-identified patient information may be used for research, quality review, population health management and public health purposes. No re-identification of de-identified information shall be permitted, and de-identified information shall not be made available for any commercial use, including but not limited to the sale of such information or the use of such information for marketing purposes. (see DRM Health Care Update dated January 27, 2020)

VITL FY 2020 Budget Adjustment: VITL’s request for an amended budget order reflects its expanded scope of work (see DRM Health Care Update dated January 27, 2020). Staff recommend approving the adjusted VITL FY2020 budget as presented, with one condition: VITL will be required to present quarterly to the Board for the duration of FY2020. VITL’s quarterly presentations should include updated information regarding Governance and Operations; Finances; and Technology; and the Collaborative Services Initiative.

Non-Standard QHP Design Approval Process and 2021 Evaluation Criteria: GMCB staff recommend approving the Non-Standard QHP Design Approval Process and the Evaluation Criteria, modified to include support of current health care reform efforts in the state.

Green Mountain Care Board hears from RiseVT

The Green Mountain Care Board heard from leadership of RiseVT on Wednesday. Executive Director Marissa Parisi said RiseVT partners with individuals, employers, schools, childcare providers, and municipalities to amplify and implement opportunities to make the healthy choice. RiseVT utilizes an evidence-based model, behavior change interventions, and a comprehensive evaluation approach to achieve measurable and sustainable improvement in community health. Started in 2015 in Franklin & Grand Isle Counties out of Northwestern Medical Center, RiseVT is now the lead primary prevention program for OneCare Vermont.

Parisi said RiseVT is in nine hospitals, serving 36 communities. There are16 RiseVT Program Managers embedded in local communities employed by Vermont hospitals. It launched the “Sweet Enough” campaign to reduce sugary beverage consumption in September of 2019. RiseVT is funded with Delivery Service Reform funds which flow to the ACO. From there, the ACO must ensure there is a coordinated, evidence-based response statewide to increase impact.

Parisi said its mission is to work together in communities to improve the quality of life and build healthy environments where people live, work, learn, and plan. Their top value is partnership. They amplify existing work before launching something new. This involves extensive assessment in communities and work with state partners. RiseVT provides additional capacity to existing efforts that did not exist before.

The Board also heard from individuals who work in the communities on a day-to-day basis highlighting trends, key findings from the Healthy Communities Study, and projects adopted in each jurisdiction. The presentation can be found here.

BILL REVIEWS:

300 – This bill relates to the planning for the care and treatment of patients with cognitive impairments. Sen. Randy Brock, R-Franklin, reported to the committee that Alzheimer’s disease is the sixth leading cause of death in Vermont. The disease is very costly because it often leads to those diagnosed with the disease becoming institutionalized in long term care facilities. People often spend down their savings and become dependent on Medicaid for long term care. In 2018, Vermont spent $106 million in Medicaid dollars on Alzheimer’s care. Brock introduced the bill, modeled on a Massachusetts statute, at the request of the Governor’s Commission on Alzheimer’s Disease and Related Disorders.

302 – This bill would establish and fund a mental health mobile response unit pilot program in the Rutland county. The program would be implemented through Rutland Mental Health Services and would provide immediate in person mental health services. Laurel Omland, Operations Chief of the Adolescent and Family Unit of the Department of Mental Health, told the committee that Rutland County was chosen as the pilot location because the county has a high rate of intense mental health needs and the highest level of emergency department visits for mental health needs for children. She also said that many other states have implemented similar programs successfully, but often in response to a tragedy or lawsuit. She would like Vermont to act before that happens. The bill requests a $600,000 appropriation for the pilot, but Omland said that the program could leverage federal funds from other collaborating departments.

246 – This bill directs the Green Mountain Care Board to evaluate the costs of certain high-cost prescription drugs and recommend methods for addressing those costs, including setting limits on what Vermonters would be expected to pay for some high-cost drugs. Sen. Chris Pearson, P/D-Burlington, told the committee that Maryland and Maine have figured out a way to structure costs for a small subset of drugs and “if other states can figure out, we need to.” He admitted to not understanding how they did it, but said that the legislature could assign the task of developing the system to the Board. Chair Ginny Lyons, D-Williston, would like to schedule additional testimony from National Academy for State Health Policy and states who have had success with the setting drug costs.

247 – This bill requires hospitals to report to the Green Mountain Care Board, as part of their budget filings, the amount of savings they realized through 340B drug pricing and how they used those savings. Introduced by Sen. Chris Pearson, D/P-Chittenden, he said the goal with the proposal is to determine whether the 340B Medicaid program is increasing health care affordability for Vermonters. The 340B Drug Discount Program is a federal government program that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. He expressed doubt that the hospital savings gained through the program are being passed on to Vermonters. He said the federal government is “increasingly frustrated that the program is not resulting in cheaper pharmaceuticals for patients, but is subsidizing hospitals.” Committee Chair Sen. Ginny Lyons, D-Chittenden, responded that she would like to pursue the issue and get additional perspectives on the proposal.

778 - This bill would appropriate $1million from the General fund for the development of a system by the Agency of Human Services for the delivery of home visiting services throughout Vermont. The proposal was included in the governor’s proposed FY 2021 budget, and a white paper gives details the need for expanded sustained home-visiting for families in need.

Currently, 325 Medicaid eligible families a year receive the voluntary service, and the governor’s proposal would provide funding for an additional 550 families to receive up to two years of home visits by a trained family specialist or nurse. Morgan Cole, Director of the Children's Integrated Services that implements the program, told the House Human Services committee that there capacity to expand the program, with trained staff in all areas of the state and license and data systems already in place.

Chair Ann Pugh, D-S. Burlington, said that her committee will hear testimony on the proposal from home health agencies and parent-child centers.

H.787 – This bill would require hospitals to report to the Green Mountain Care Board, as part of their budget filings, the amount of savings they realized through 340B drug pricing and how they used those savings. The 340B Drug Discount Program is a federal government program that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. Sponsor Rep. Sarah Copeland Hanzas, D-Bradford , told the House Health Care Committee that she introduced the bill to ensure that scarce federal Medicaid money is being used in the most efficient manner. The 340B federal drug pricing program requires drug manufacturers to sell outpatient drugs to hospitals and other eligible health organizations at significantly reduced prices in order to stretch those federal Medicaid dollars.

Committee member Rep. Peter Reed, I-Braintree, said that he was concerned that it would be impossible for hospitals to separate out and report their 340B Medicaid funding to meet the requirements of the proposal. Reed also said that the new requirement would add to the already burdensome reporting requirements that are placed on hospitals. Copeland Hanzas replied that she would welcome a sunset on the report to alleviate that burden.  

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