Vermont Legislative Update 04-12-2019
An analysis from DRM's Government & Public Affairs Team
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PFAS bill progresses
The House Natural Resources Committee finished deliberation this week on S.49, a bill that grants the Agency of Natural Resources more discretion in setting the maximum contaminant level for PFAS compounds and provides the agency an additional two years to complete rulemaking on new regulations related to PFAS levels in the natural environment. The bill was approved Thursday afternoon by a vote of 9-1-1.
A mid-week press conference in the Governor’s ceremonial office shone a spotlight on the subject of chemical management and provided another nudge of momentum for S.49. Gov. Phil Scott, along with Attorney General T.J. Donovan, ANR officials, as well as House and Senate leaders, announced a final settlement in the Bennington PFOA matter. The officials and legislators expressed support for S.49 and confidence in the bill’s passage.
Committee moves bill to increase age for purchase of tobacco
The House Human Services Committee gave its unanimous approval this week to S.86, a bill that increases the minimum age for purchase of tobacco products from 18 to 21. The bill passed the Senate by voice vote in March.
Vermont follows fourteen other states that have passed bills increasing the age for tobacco purchase. The recent flurry of legislative activity has been spurred in part by the growing epidemic of vaping by schoolchildren.
A floor amendment may be offered to exempt from the law individuals who serve in the military. That amendment is not supported by the Adjutant General of the Vermont National Guard and is unlikely to pass.
Vermont’s health care reform efforts receive national praise
Agency of Human Services Secretary Al Gobeille told the House Health Care Committee on Wednesday that Vermont’s health care reform efforts over the last six years have saved the state Medicaid program $97 million over three years. Gobeille’s testimony was based on a report released by RTI International, an independent, third-party research institution retained by the Centers for Medicaid and Medicare Services. According to the report, Vermont invested $45 million of CMS grants over a five-year period, beginning in 2012, to fund the multi-payer health care delivery and payment reform systems that have resulted in savings.
The RTI International evaluation concludes that Vermont has outperformed all other states that received grants and has advanced alternative payment methods and innovative delivery models that pay for value and quality rather than volume. Of the nine alternative payment and delivery models tested, Gobeille told the committee that Vermont’s Accountable Care Organization has alone achieved statistically significant Medicaid savings. Those savings are attributable to reductions in emergency department visits and inpatient admissions to hospitals and a slower growth in Medicaid costs.
Gobeille said the findings demonstrate the positive impact that a coalition of willing heath care providers can have on the health care system, especially when leveraging previous reform efforts like the Blueprint for Health’s Patient Centered Medical Homes program. Now that Vermont has moved from shared savings programs to the more complex all payer model, participating health care providers receive a fixed payment to incentivize preventive medicine and improved health outcomes.
House takes up strict liability and medical monitoring bill
The House Judiciary Committee began hearing testimony this week on S.37, a bill that would impose strict liability on manufacturers for harm resulting from the release of hazardous substances. The bill would also create a new cause of action for medical monitoring for individuals who have been exposed to chemicals but do not show signs of harm. Representatives of Vermont’s manufacturing sector, municipalities, and the state Department of Financial Regulation all told committee members that the bill disrupts basic tenets of tort law, will deter business investments in the state, and will raise insurance costs for all Vermonters.
The committee is divided over the strict liability provision, but passage of the medical monitoring cause of action is almost certain. The bill will be next referred to the House Commerce Committee where business advocates are likely to receive a more sympathetic ear.
Medical expense deductions considered
The Senate Finance Committee took testimony this week on S.126, a bill that proposes to restore an income tax deduction for qualifying medical expenses. Vermont eliminated the deduction of medical expenses last year.
On Tuesday, the committee heard from a wide range of witnesses, including certified public accountants, AARP, and the Coalition of Vermont Elders on the personal costs and distress that the current code has imposed on seniors. Witnesses said that removing the medical deductions can hasten an elderly person’s descent into poverty.
The committee appears to support the restoration of the deduction, but it will cost the state approximately $5 million.
Automatic contract renewal bill met with skepticism
The Senate Committee on Economic Development, Housing and General Affairs this week took up H.327, a bill that would repeal parts of a law passed last year that mandates additional disclosures for contracts that have automatic renewal terms. Last year’s bill requires that customers obtain a separate acknowledge (a so-called “double opt-in”) from customers before enrolling them in automatically renewing contracts. That bill was seen by tech companies as placing a significant burden on them without providing any meaningful benefit for consumers.
H.327 is modeled after a recent California law and require companies to notify customers of the automatic renewal at the time of contract agreement, notify them that the contract is set to renew shortly before the expiration date, and provide an easy process for customers to cancel contracts.
Committee Chair Michael Sirotkin, D-Chittenden, and Sen. Alison Clarkson, D-Windsor, objected to revising last year’s bill. Both said the double opt-in does not seem like a significant burden in exchange for the consumer benefit provided. Additional testimony is expected, and the bill’s future is uncertain.
OneCare Vermont continues overview; addresses quality measures
Vicki Loner, Chief Operating Officer for OneCare Vermont, appeared before the House Health Care Committee on Thursday to discuss the state’s health care delivery reform efforts and OCV’s quality scores. Loner said this effort involves a random sampling of patients whose cases are reviewed to determine whether providers are adhering to best practice guidelines. The information is collected from claims, medical record reviews, and patient surveys. An annual audit monitors performance on payer-specific quality measures and serves as a review for quality gaps.
Loner told the committee that the OCV care coordination program supports provider-driven, integrated health care delivery systems at the local community level. OCV partners with a clinical representative in each community to champion and lead community-based projects, prioritizing community decision-making to improve coordination of local systems, improve care systems and reduce duplication or wasteful care. OCV’s data analytics platform supports the work of the community collaboratives, and OCV’s Quality Improvement Committee helps to prioritize projects aimed at different populations.
Loner said care coordinators convene a conference with the patient and members of that individual’s support team to delineate each person’s role in supporting the patient, highlight any gaps in services or duplicative activity, and choose a lead care coordinator who then works with the patient to create a shared care plan. A shared care plan is especially beneficial for individuals at risk for multiple chronic conditions.
Finally, Loner provided additional information regarding OCV’s budget and cash flow, emphasizing that their budget of $843 million is not “new” dollars, but money currently in the system. OCV distributes $528 million of fee-for-service payments to non-hospital providers in the network, $315 million in fixed payments to hospitals, and $37 million in health care reform investments.
House committee closer to approving cannabis bill
After two weeks of testimony, the House Committee on Government Operations on Friday began marking up a bill to tax and regulate cannabis, S.54.
The committee heard emotional testimony on Thursday afternoon from several parents who spoke about the impact they believe marijuana use had on their children. They argued that legalization will result in higher consumption by children and create more hardship and misery. On that same page, a former Colorado U.S. Attorney described what he said were the negative effects of that state’s legalization law.
That testimony was rebutted on Thursday afternoon by Matt Simon of the Marijuana Policy Project. Simon submitted a lengthy set of research documents to dispel the notion that legalization results in higher consumption by adolescents.
The committee appears to have been persuaded by Simon’s testimony, and on Friday afternoon they began to make preliminary decisions about the bill. They agreed to give existing medical marijuana dispensaries a one-year head start selling marijuana to the general public. While acknowledging the investments made by dispensaries as one factor, the committee’s decision was ultimately motivated by the revenue a head start will provide for the state. The extensive new regulatory system to be established will eventually pay for itself through fees and taxes on cannabis sales, but the lag time during which a new Cannabis Control Board will be working before sales begin creates a need for immediate funding.
The head start provision, projected to generate between $500,000 and $1 million, will help fill this funding gap. Dispensaries, under the committee proposal, will be required to pay a $75,000 fee for the privilege of opening first and then must apply again with other applicants for a permanent license.
House continues work on minimum wage increase
The House General, Housing, and Military Affairs Committee continued to take testimony this week on S.23, a bill to increase the minimum wage incrementally to $15 an hour by 2024.
On Tuesday, VNAs of Vermont Executive Director Jill Mazza Olson told committee members that home health agencies very much want to increase wages for lower wage employees like personal care attendants but need support in the Medicaid budget to do so. She provided the committee with draft language aimed at ensuring that the bill is funded.
Olson said home health agencies have very few options for adjusting to major cost increases. Medicaid payment rates for the program have increased at levels well below the rate of inflation and Medicare has cut home health payments significantly over the last decade. Mandated wage levels have been rising at a much faster pace and any further wage increases must be funded in the Medicaid budget.
On Thursday, Virginia Renfrew, representing the Vermont Association of Adult Days, voiced support for the language offered by Olson. Adult day service programs are primarily funded through Medicaid and would face the same issue as the VNAs. Committee members were sympathetic but noncommittal in their response to this request.
House panel advances primary care bill
The House Health Care Committee advanced S.53 on Thursday with no changes from the version passed by the Senate. The bill requires the Green Mountain Care Board to determine the proportion of health care spending that is allocated to primary care in order to determine any appropriate increases. To accomplish this work, the GMCB and the Department of Vermont Health Access will identify the categories of health care professionals who should be considered primary care providers and which procedures are considered primary care services.
Human Services Committee takes up substance misuse prevention bill
The House Human Services Committee heard initial testimony this week on S.146, a bill proposing to establish a Substance Misuse Prevention Council to replace the Alcohol and Drug Abuse Council. The bill also would eliminate the Tobacco Evaluation and Review Board and rename the Controlled Substances and Pain Management Advisory Council as the Vermont Prescription Monitoring System Advisory Council.
The nine-member Substance Misuse Prevention Council Advisory Council would be directed to advance evidence-based and evidence-informed substance misuse prevention initiatives across program areas in the Department of Health. The council would also provide advice to the commissioner aimed at improving prevention programs and policies. The council would focus on prevention initiatives for all substances at risk of misuse, including tobacco, tobacco substitutes, cannabis, opioids and alcohol.
The committee expressed concern that the consolidation of cross-agency prevention efforts could result in programming gaps, but Dr. Mark Levine, Commissioner of the Vermont Department of Health, assured the committee that consolidating resources would offer greater programming coordination and reduce redundancy. Jolinda LaClair, Director of Drug Prevention Policy on the Governor’s Opioid Coordination Council, agreed that it is important not to silo substances in prevention efforts. LaClair added that Vermont lacks a statewide system of prevention and needs to capitalize on current prevention interest to drive the recommendations of the Marijuana Advisory Council and the Opioid Prevention Council.
S.146 appropriates $400,000 from the Evidence-Based Education and Advertising Fund to support council efforts in 2020, and includes an intent to explore revenue generated by the taxation of substances such as cannabis, tobacco and alcohol for the purpose of funding future prevention initiatives.
The House Human Services Committee will continue to take testimony on the bill in the coming weeks.
House Natural Resources Committee begins work on water bill
After working for months on a failed effort to modernize Vermont’s iconic Act 250 land use law, the House Committee on Natural Resources, Fish and Wildlife does not have any major legislative accomplishments under its belt this session. The committee’s work got more complicated this week as it took up S.96, a complex Senate-passed bill that would create a new governance structure to prioritize state investments in clean water projects for Lake Champlain and other nutrient-impaired waters.
The bill would require the Agency of Natural Resources, after identifying a water body as impaired, to determine whether existing laws and regulations are sufficient to achieve cleanup goals agreed to by ANR and the U.S. Environmental Protection Agency. Where effort beyond current regulations is needed, S.96 would require ANR to allocate additional pollution reduction targets, along with proportional state funding, to those “gap” watersheds. Regional clean water service providers responsible to achieve the pollution reduction targets would be assigned to the regions by ANR.
The committee heard this week from a diverse group of clean water stakeholders, including state officials, environmental groups and representatives from Vermont’s watershed groups and conservation districts. While ANR supports the bill, their partners in clean water at the Agency of Agriculture, Food and Markets raised a number of difficult questions about the efficacy of the bill to support investments on farms. Stakeholders offered a range of comments from friendly suggestions to outright rejection of the bill’s core concepts. Concerns include how the bill’s requirements will be funded, whether it represents an abrogation of ANR responsibility to non-governmental actors, and whether prioritizing gap watersheds will starve funding for other priorities, like preserving high quality waters where they still exist.
The committee will continue to debate the bill in coming weeks. It is not clear whether there will be wholesale changes to the proposed governance structure, or if the committee will send a roughly intact version to the House Committee on Ways and Means for debate on how much and what kind of funding will be needed to support clean water in Vermont.
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