Vermont Legislative Update 04-05-2019
An analysis from DRM's Government & Public Affairs Team
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House passes paid family leave bill
The House approved a paid family leave bill, H.107 on Friday. Notably, the vote was 92-52 -- eight votes short of the threshold needed to override the governor’s expected veto.
The version of the bill that passed was pared down considerably by the Ways and Means Committee. It would provide 90 percent wage replacement up to the Joint Fiscal Office’s livable wage, and 50 percent replacement above that level. The program would be funded by a 0.55 percent payroll tax that would be paid by employees, although employers would have the option to pay part of or all of that cost. Employees would be allowed to take 12 weeks of family leave or eight weeks of medical leave. An employer with an existing paid family leave benefit would be allowed to maintain it if it is at least as generous as the state’s program..
Committees hear about Vermont Talent Pipeline Management
Two Senate committees heard this week about Vermont Talent Pipeline Management, a program aimed at aligning the needs of Vermont’s employers with certification and training programs at Vermont educational institutions.
VTPM Executive Director Mary Anne Sheahan testified on H.533, a bill to promote workforce development, before the Senate Economic Development, Housing and General Affairs Committee on Thursday. Sheahan made the case that VTPM complements the state’s work on career pathways, rather than replicating it. Tom Clavelle of Engelberth Construction also testified in support of VTPM, saying it was an effective way to involve employers in workforce development.
Sens. Michael Sirotkin, D-Chittenden, and Alison Clarkson, D-Windsor, expressed concern about whether the legislation should simply recognize the work of VTPM and urged the Vermont Business Roundtable to submit an alternative proposal.
Following Sheahan’s testimony, Laura Pelosi, representing the Vermont Health Care Association and Bayada Home Health, testified on the nursing shortage in Vermont. Pelosi cited VTPM as an important partner in solving the shortage and defended the Pipeline from charges of redundancy.
Meanwhile, the Senate Health and Welfare Committee also heard this week about the state’s health care workforce shortage and how VTPM could help.
Sheahan told the committee that VTPM is helping fill the 3900 openings for nursing positions by working to eliminate bottlenecks in clinical placement and clinical education. Sheahan reported that the University of Vermont and Vermont Technical College both have to turn away 50 percent of their qualified nursing program applicants because they don’t have clinical placements available. Employers and educators have collaborated to improve clinical placement strategies and grow placement partnerships, and employers have developed employment incentives such as education scholarships, apprenticeships, and bonus wages above standards.
Elizabeth Cote, Director of the Office of Primary Care and Area Health Education Center Program at the University of Vermont, stressed that loan repayment is an effective tool in workforce recruitment and retention. Expansion of AHEC’s current loan repayment program through additional funding would address unmet needs and allow Vermont to compete with other states that have robust repayment programs for healthcare professionals, some of whom carry more than $700,000 in educational debt.
Sen. Ginny Lyons, D-Chittenden, indicated that the committee will continue to work on the issue in coming weeks.
OneCare Vermont provides overview to House panel
The House Health Care Committee received an overview of OneCare Vermont from OCV Chief Operating Officer Vicki Loner on Tuesday. As the state’s all-payer accountable care organization, OCV brings providers together to deliver outcomes to patient populations for a fixed price. OCV works with all major players in the health care sector – Medicaid, Medicare, commercial and self-funded insurance programs – to improve the health of Vermonters and lower health care costs.
Loner told the committee that the organization comprises the continuum of health providers, including federally qualified health centers, independent doctors, hospitals, designated mental health agencies, and consumers. With over 430 providers in 13 communities in its network, OneCare expects to have 172,000 Vermonters enrolled in 2019.
Loner reminded committee members that we are in year two of the model and that OCV’s role is to support health care reform efforts to improve patient outcomes and experience at a predictable rate of growth. OCV has invested more than $37 million in Vermonter’s delivery system. Investments have been made in primary care practices, complex care coordination, the Developmental and Legal Collaboration for Everyone Pilots – a partnership with the Parent Child Centers, and the designated mental health agencies.
The committee is scheduled to take more testimony from OneCare next week.
Plight of rural hospitals highlighted for GMCB and health committees
Members of two key committees took a field trip on Wednesday to the Green Mountain Care Board to hear from a panel of experts on the opportunities and challenges facing rural hospitals in Vermont and around the country. Panelists included representatives of hospitals, OneCare Vermont, and a national health care consultant.
Stroudwater Associates consultant Erick Shell told the audience that rural hospitals have been challenged for decades with low volumes, declining populations, difficulties with provider recruitment, and limited capital constraining necessary investments. Shell said as payment systems transition away from volume-based payment, new economic models based on patient value must be developed by hospitals. Smaller hospitals will have to position themselves for this new approach where revenue streams align with primary care services. His presentation can be found here.
Executives from Vermont hospitals and the Vermont Association of Hospitals and Health Systems discussed Vermont’s specific approach to reform and the challenges they face on a daily basis. The health care system has a workforce shortage, an aging population, a challenging payer mix, and declining patient volume. They said small hospitals recognize that they cannot continue to provide all services to their communities, but that they need to provide a pathway for those services.
OCV Interim CEO Kevin Stone provided an overview of the all payer model. Stone explained that hospitals have invested heavily in reform efforts and have done so even though they are in a much more fragile state then when the model first began. He said stakeholders must work together to create ways for small hospitals to fully participate in reform efforts. Stone said the Medicare portion of the program carries the most financial risk for hospitals, and Medicare has struggled at times to process claims under the new payment model. “Because we’ve had such turmoil in receiving accurate and consistent reports – particularly from Medicare – it makes it hard for the hospitals to feel really confident that the work that they’re doing is, in fact, bearing fruit. I think that creates anxiety and is daunting in the minds of some of the smaller hospitals,” said Stone.
Committees continue focus on primary care
The House Heath Care Committee heard from a number of interested stakeholders in support of S.53, a bill that requires the Green Mountain Care Board to determine the proportion of health care spending that is now allocated to primary care in order to determine any appropriate increases. The bill as passed the Senate requires the GMCB and the Department of Vermont Health Access to identify the categories of health care professionals that should be considered primary care providers and which procedures should be considered primary care services.
On Friday, the Senate Health and Welfare Committee heard from Department of Vermont Health Access Commissioner Cory Gustafson on DVHA’s primary care network and its continued investments in primary care. He told the committee that fee-for-service payments to providers are now at Medicare levels and payment adjustments will continue to be made to stay on par with Medicare. Gustafson said DVHA has provided a cumulative average annual increase of nine percent in primary care payments each year, translating into an 87 percent increase in per member per month payments for primary care services. The increase is attributable both to growth in DVHA’s fee-for-service rates as well as payments made in value-based, alternative payment models.
The House Health Care Committee will continue to work on S.53 next week.
Senate mulls weatherization goals
The Senate Natural Resources Committee continued discussion of S.171, a bill that would increase the number of Vermont homes receiving weatherization treatments. The bill proposes to raise fuel and electricity taxes in order to increase the number of low-income households eligible to receive grants for weatherization work.
While the full committee supports the goal to provide more weatherization services in order to lower Vermonters’ heating bills and reduce statewide energy usage, there is a stark disagreement between liberal and conservative committee members about whether to raise taxes in order to accomplish it. A representative from Vermont’s Agency of Natural Resources, speaking on behalf of the Scott administration, lent weight to the conservatives’ position by offering a one-time infusion of $500,000 into this year’s budget for weatherization work, but declining to support any tax increase.
The committee, having made no attempt to address the bill before last month’s crossover deadline, is considering this as a two-year project.
House takes up PFAS bill
The House Natural Resources Committee took up S.49 this week, a bill directing Vermont’s Agency of Natural Resources to develop strict regulations for the use of PFAS substances. Committee members are enthusiastic about the bill’s purpose and are pushing to see whether the bill can go further.
The Senate Natural Resources Committee invested an extensive amount of time during the first half of this legislative session taking testimony on exactly how far ahead of the rest of the country the bill can go in regulating these substances. Each time the House committee tried to push the bill further this week, the committee learned from legislative counsel and witnesses exactly how ambitious the bill already is.
Despite their enthusiasm, House committee members were more receptive than their Senate counterparts to ANR testimony that a 2022 deadline for promulgating these regulations will be impossible for the agency to meet. This deadline may be pushed back to 2024, giving ANR an opportunity to work with other states.
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