Speaker gives committees instructions for CRF proposals  

With only a few working days to craft federal Coronavirus Relief Fund proposals before the June 10 deadline for submission to the House Appropriations Committee, the House policy committees turned their attention this week to determining priorities for the money.

According to a memorandum drafted by legislative council and the Joint Fiscal Office, CRF money can only be used to cover: necessary expenditures incurred due to COVID-19, costs not accounted for in the budget most recently approved as of March 27, 2020 for the State or government; and costs that are incurred between March 1, 2020 and Dec. 30, 2020. The funds cannot be used for revenue replacement, and must be expended—not just allocated or appropriated—by Dec. 30, 2020 or they will be returned to the U.S. Treasury.

Speaker Mitzi Johnson, D-South Hero sent a memorandum to each House committee giving targets for CRF spending proposal amounts. A total of $575 million dollars was designated as “Tier 1” funding for all committees for top priority items that are the most critical and the most time-sensitive. The Speaker designated a second $400 million block of money as “Tier 2” funding for additional priorities that will be held until funds are available. The $400 million will be initially be set aside in case federal CRF rules change and the money can be used to fill budget gaps or more money is approved by the Congress.

House panels begin work on CRF priorities

The House Health Care Committee met on Thursday to discuss the Agency of Human Services health care provider stabilization proposal and to review the different parameters established by Speaker Mitzi Johnson in her Coronavirus Relief Fund proposal memorandum.

Committee Chair Bill Lippert, D-Hinesburg, reviewed the Agency of Human Services proposal for the committee in AHS Secretary Mike Smith’s absence. The proposal’s stated priority is to preserve Vermonters’ access to health care services during and after the COVID-19 emergency by buffering providers from financial instability and identifying and assisting providers in financial distress. Health care providers across the care continuum indicate that there is a need of $375 million in stabilization funding to maintain the system. Providers indicate that without further financial assistance practices and organizations that provide essential services may be forced to close.

AHS is proposing a total healthcare stabilization package of $375 million. This includes the $42 million funds obligated to date for retainer payments for Medicaid providers, hazard pay, payments to hospitals, and financial relief to nursing homes, among others, and $333 million yet-to-be allocated and appropriated. The funds would be allocated based on each provider category proportion of overall annual health care spending. It would be an application-based needs assessment process that will require reporting of fiscal impacts of business disruption for Medicaid, Medicare, commercial and private payers, and increased expenses. It will also take into consideration previous state and federal funding awards as well as any future federal allocations. The proposal allows that during the application process funds could be reapportioned to different provider categories based upon demonstrated need.

There are several principles that will be applied when evaluating applications. Applicants must:

  • Spend money for the purpose indicated in the application;  
  • Indicate how funds will sustain or improve health care quality and preparedness in the context of COVID-19;  
  • Indicate how funds support current or future participation in payment reform;
  • Indicate intent to continue providing essential services in the community; and
  • Attest that funds received will be used to offset costs for Vermonters associated with the pandemic.

Lippert also reviewed the directive received by the Speaker, which includes significantly less funding than the administration proposal. The health care committee was asked to operate within a budget of $150 million for Tier 1 funding for immediate allocation for the most critical and time-sensitive needs and $75 million for Tier 2 funding for possible additional allocation at a point in the coming year if funds are available.

Committee members expressed initial thoughts with free-flowing discussion. The committee understands that the legislature needs to be efficient in getting money out and expressed its desire to not have a lot of strings attached. Rep. Lori Houghton, D-Essex, said the committee also needs to be cognizant of what will be required of the legislature and of the providers who receive money and the reporting requirements to the federal government.

Meanwhile, the House Human Services Committee was allotted up to $50 million in Tier 1 spending, and $50 million in Tier 2 spending. The committee spent time on Thursday putting forth initial proposal ideas, including a statewide summer meal program for students, additional money for Adult Day centers, additional money for child care centers, funding for recovery housing and substance use disorder treatment,  support for migrant workers, and technology resources for older Vermonters.

Provider coalition offers CRF grant proposal

On the heels of the Agency of Human Services rollout of program details for their healthcare stabilization proposal, and facing the deadline for Coronavirus Relief Fund spending proposals, the House Health Care Human Services committees met Friday to review a grant program proposal from a broad provider coalition.

The proposal, presented by the provider group spokesperson VNAs of Vermont Executive Director Jill Mazza Olson, proposes the distribution of $333 million of CRF money through a needs-based Provider Relief Fund authorized by the legislature and administered by the Agency of Human Services according to US Department of Treasury guidance. The proposal would apply to a broad and inclusive group of provider types, as defined by the AHS, and lists examples of allowable expenses and fiscal impacts that the grants can cover. Olson told the legislators that the coalition proposal is similar to AHS’s proposal, and the goal is to get to a consensus proposal.

AHS Director of Health Care Reform Ena Backus said that the agency is well prepared to process the grant applications and could launch the program within a week of approval. Backus said that the agency proposed a single application date instead of a rolling one, so that the allocation can be need-based and funds can be equitably distributed. Olson noted that application and disbursement timing is a concern, as providers may not be able to ascertain their full need at this point in time.

Both committees appeared to support moving forward with a framework of a grant process administered by AHS with some carveouts for additional needs that don’t fit within the program. Funding from both House Human Services and Health Care’s CRF allotment from House leadership could be used for the program. 

Panel looks ahead to transition out of crisis

The Senate Health and Welfare Committee met on Tuesday and quickly reviewed the five priorities they will recommend to the Senate Transition Committee that will then be forwarded to the Senate Finance and Appropriations committees. The list includes priorities that are not currently being addressed in the broader discussion and could potentially fall through the cracks if not addressed. The list includes:

  • Support ongoing links between health care institutions, providers and substance use disorder treatment and related support systems as provided by designated mental health agencies.
  • Federal dollars to provide hero pay for families who have supported their children with development disabilities during COVID-19.
  • Identify federal grants for the Agency of Education and the Agency of Human Services to build behavioral interventions support services through systemic transitional change and/or through telecommunications services.
  • Link schools with primary care and pediatric care to continue family access to telehealth and counseling services through the transition period by using available federal dollars.
  • Engage in robust and reliable testing and contact tracing until a vaccine can be developed.

House panel advances new version of Older Vermonters Act

The House Human Services Committee advanced a strike-all amendment on Tuesday to H.611, the Older Vermonters Act. The committee agreed to language that requires the Department of Disabilities, Aging and Independent Living, and the Department of Vermont Health Access to develop criteria and a process for calculating an annual inflation factor for potential application to the Medicaid rates for providers of home- and community-based services in future fiscal years. The departments will be required to submit a report on the criteria and process by April 15, 2021.

First quarter budget bill advances to House floor

The first quarter budget bill passed the House Appropriations Committee on Wednesday. Rep. Kitty Toll, D-Danville, told House members that the bill looks completely different than a “typical” budget bill and relies on language rather than the usual money sections to describe appropriations. She described it as a very simple bill which just tries to “keep the lights on” in state government.

It funds state government at 25 percent of the adjusted FY2020 budget. The Scott administration proposed 23 percent. Toll said the bill focuses on building fiscal capacity wherever possible, through a non-essential position hiring freeze, identifying and carrying forward balances from FY 2020 to FY 2021, and it allows for a greater degree of interagency transfer. There is a provision allowing the E-Board to authorize special emergency appropriations during the time when the legislature is not in session. $47.2 million has been identified in one-time Coronavirus Relief Fund money. Reversions are set for December 20 so that if CRF are not spent by then, they can be reallocated before the final end-date of December 30.

Workforce development grant fund proposed in House health care committee

The House Health Care Committee met on Wednesday to review a workforce proposal being spearheaded by Rep. Annmarie Christensen, D-Weathersfield, and Rep. Peter Reed, I-Braintree, that would provide workforce development grants to prepare for, respond to and mitigate the impact of COVID 19.

Christensen said a coalition of health care providers offered a proposal that $7.6 million of Coronavirus Relief Funds be allocated to assist providers address workforce needs and anticipated future impacts of COVID-19. The coalition recommends creation of a workforce development grant fund for all heath care providers to apply for one-time funds to support staff training, re-training, or cross-training initiatives; and staff recruitment and retention. She said a grant process would allow providers to apply for funds and tailor their requests to individual needs.

Christensen said providers have reported staffing losses due to staff fear of COVID 19, a lack of child care due to shut downs, the need to home school children due to school closures, a staff member or family member contracted COVID 19, and on medical advice due to age or underlying health condition.

Committee approves primary care and nursing scholarship spending

On Thursday, the House Appropriations Committee unanimously passed the bill, H.607, a bill aimed at increasing the supply of primary care providers in Vermont.  The committee agreed to use $1 million of state dollars from the Substance Use Disorder fund, which will draw an additional $1 million in federal match.

The bill requires the Vermont Department of Health, in collaboration with the Office of Primary Care and the Area Health Education Centers at the University of Vermont College of Medicine, to establish a rural primary care physician scholarship program. This scholarship would provide medical school tuition for up to five third-year and up to five fourth-year medical students who commit to practicing primary care in a rural, health professional shortage or medically underserved area of Vermont. Recipients must incur two-years of full-time service or four-years of half-time service for each academic year of tuition covered by the scholarship. The bill also appropriates money to VDH for additional scholarships for nursing students through the Health Care Educational Loan Repayment Fund. The bill sets up priorities for how the funds should be administered. The committees amendment pulls $1 million from the Substance Use Disorder fund to match Global Commitment dollars to fund the scholarships.

Climate change response plan reviewed in House committee

The House Human Services Committee reviewed S.185 on Thursday, a bill relating to adopting a climate change response plan and regional planning commission involvement in identifying health care-related needs. The bill directs the Vermont Department of Health, in collaboration with the Chief Prevention Officer, to develop and adopt a statewide climate change response plan to foster resilience to the impacts of climate change in Vermont. Using a public health model, the Department’s response plan will seek to prevent and mitigate public health risks caused by climate change in Vermont, with particular attention shown to vulnerable populations. The bill also directs regional planning commissions to assist hospitals with the development of health needs assessments and to consult with and assist the Agency of Human Services, Department of Health, and Vermont Emergency Management to incorporate public health and safety concerns related to climate change into State and local emergency and hazard mitigation, response, and recovery plans.

Sen. Ginny Lyons, D-Chittenden, told the committee that the bill is necessary because it puts in place a plan to ensure that vulnerable people receive assistance during climate change disasters. The bill would also help solidify relationships between planning and communications partners that would be helpful for future pandemic response planning processes. Committee chair Ann Pugh, D-South Burlington, said that her committee will soon decide if they are going to take the bill up later next week.

Senate panel considers House bills

The Senate Health and Welfare Committee on Friday advanced H.635, a bill that clarifies and provides parameters for long-term care facilities. The committee did not make any changes to the bill as passed by the House. The bill includes a definition for insolvent that is in line with the definition provided in the Uniform Commercial Code. It also adds mental harm in addition to physical harm as an enforcement action. It also includes a provision that any facility owner being charged would not be able to benefit from the remedial actions of the temporary receiver.

The committee delayed action on two bills and will take action next week. These include:

  • 572 – a bill related to the Maternal Mortality Review Panel. The panel will conduct comprehensive multi-disciplinary review of maternal deaths in Vermont for the purpose of identifying factors associated with those deaths and making recommendations to system changes to improve health care services in Vermont. The committee plans to amend the bill to exempt Panel meetings from the Open Meeting Law. Records produced or acquired by the Panel are currently exempt from public inspection and copying under the Public Records Act.
  • 663, a bill that expands access to contraceptives and requiring health insurance to cover at least one drug without cost-sharing. The committee would like to amend the bill to include a new Advisory Council on Wellness and Comprehensive Health. The amendment also includes a provision to ensure that females students attending public or approved independent schools have access to menstrual hygiene products at no cost.

Green Mountain Care Board

The Green Mountain Care Board met on Wednesday for a presentation on Vermont Information Technology Leaders’ proposed FY2021 budget and to review the proposed FY2021 Accountable Care Organization Budget Guidance and Certification Verification.

In 2021, VITL plans to implement a new data platform and value-added services, expand data types, create a program of outreach and client engagement, enhance and maintain system security and availability, and continue support of Vermont’s pandemic response. In order to achieve these goals, the organization is proposing a $7.8 million budget. Labor represents 40 percent of their total expenses, information technology costs are 28 percent of expenses, and Vermont Health Information Exchange hosting expenses are 13 percent. Predicted revenue is $8.1 million, which reflects a six percent negative contingency due to the uncertainty of the COVID-29 impact. The CY 2021 state contract is yet to be determined, but VITL and the Department of Vermont Health Access will be working collaboratively to determine and define the work scope and cost. The CY 2020 contract increased due to investments in Collaborative Services projects and future data platform.

Outreach regarding the recent consent policy change has slowed due to the COVID-19 crisis, but VITL reports an uptick in usage since the change. VITL said that they have been contributing to the pandemic crisis response by supporting Vermont Department of Health’s data needs to complete surveillance reporting and monitoring hospitalizations and resource usage. They have also been ensuring that test results are available in the VHIE.

For the development of FY2021 ACO budget guidance, GMCB staff goals included simplifying questions and reducing redundancies, separating content necessary for budget guidance versus ongoing monitoring, relying on data over narrative, and understanding changes due specifically to COVID-29 versus other factors. GMCB staff would like to request additional information from OneCare related to their role and contribution to the state’s goals under the All Payer Model, but due to COVID-19, those questions will not be required this year. There were no changes to the certification criteria this year and no material changes to the FY 2021 Certification Eligibility Verification Form. The verification form must be submitted by OneCare on or before Sept. 1, 2020. The board will potentially vote on the budget guidance on June 17, and OneCare’s proposed FY 2021 budget submission deadline is Oct. 1, 2020.