Vermont Legislative Update 05-03-2019
An analysis from DRM's Government & Public Affairs Team
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Senate committee overhauls paid leave bill
The Senate Economic Development, Housing, and General Affairs Committee plans to vote Monday on H.107, the paid family leave bill. Committee Chair Michael Sirotkin, D-Chittenden, made it clear he is looking to significantly reduce the cost of the bill in an effort to avoid a veto from the governor, or to pick up enough votes to override a veto.
The committee is considering major changes to the legislation. First, it has agreed to reinstate a 50/50 funding split between employers and employees that the House Ways and Means Committee removed. Second, it decided to reduce the number of weeks allowed for medical leave from eight to six. Third, it is considering whether to remove personal medical leave from the bill. This would significantly reduce the cost of the program, but a few committee members see that benefit as a major purpose of the bill.
House committee approves cannabis legislation
The House Government Operations Committee completed several weeks of exhaustive review of a Senate-passed bill to tax and regulate cannabis on Thursday night and passed it on a 10-1 vote. Rep. Jim Harrison, R-Chittenden, obtained numerous changes to the bill, S.54, during a lengthy markup session, but then voted “no.” The most significant amendment requires that communities vote affirmatively to allow the siting of cannabis retail locations. As passed by the Senate, communities could ban the sale of cannabis stores only through a town-wide vote.
Another significant change from the Senate bill allows medical marijuana dispensaries to enter the retail market five months before permits may be issued to other applicants.
Clean water funding debated in Ways and Means
As expected, the House Committee on Ways and Means worked this week to identify funding for the clean water governance proposal that would be created by S.96. In January, Gov. Phil Scott’s budget proposed diverting proceeds from Vermont’s estate tax to fund clean water investments, but the House-passed budget did not include any additional funding to pay for new investments, nor did the Senate propose any additional funding in the bill. As a result, there was great pressure on Ways and Means to find a solution, even though the total additional amount needed, just over $8 million, would be a rounding error for many state priorities.
On Friday, the committee passed an amended version of S.96 by a vote of 10-1, filling the funding gap with a four percent diversion of the rooms and meals tax. Despite the strong vote, the committee struggled with the decision to “raid” the Education Fund, even for this important policy priority. Committee Republicans convened with the governor and held out for additional time before voting, but ultimately joined their colleagues to support the amendment.
Panel supports opt-out for health records
The House Health Care Committee took testimony this week on the Vermont Information Technology Leaders current consent policy. On Friday, the committee approved language to move to an opt-out policy, where patient data is automatically added to the Vermont Health Information Exchange unless a patient explicitly requests that his or her data be removed. VITL manages the state’s VHIE – a secure, statewide data network which gives health care providers the ability to electronically exchange and access patient data.
The committee grappled with how to preserve privacy and confidentiality while also having an effective health information exchange. The committee included language in S.31 that attempts to address the need for clear, uniform, and up-front communication about the VHIE and what it does so that patients can make informed decisions about whether to allow their health information to be shared through that medium. The approved language requires a robust stakeholder and public engagement process to develop an implementation strategy.
Low participation numbers have led the Department of Vermont Health Access and VITL to recommend an opt-out policy to ensure that health care providers have access to the most up-to-date information about patients so they can make more informed decisions about patient care. Vermont is one of the few states that have an opt-in policy for a health records exchange, resulting in a low participation rate.
Panel passes social services integration bill
The House Health Care Committee advanced S.7, a bill that evaluates the extent to which social services are integrated into Vermont’s health care system and OneCare Vermont, the state’s only accountable care organization. The House Human Services Committee has asked to review the bill to address the human services provisions.
The bill requires:
- The Agency of Human Services to submit a plan to coordinate the financing and delivery of Medicaid behavioral health services and Medicaid home and community-based services with the all payer model, an alternative payment model that incentivizes value and quality. It requires AHS to consult with individuals and family members receiving social services in preparing the plan. AHS will provide an interim update on plan development in Jan. 2020.
- The Green Mountain Care Board to evaluate the degree to which parent-child centers, designated mental health and specialized service agencies, and home health and hospice agencies are integrated into OCV. It requires the GMCB to consult with individuals and family members receiving social services in preparing the report.
- The director of trauma prevention and resilience development and the director of maternal and child health to assess the effectiveness of embedding social service providers within primary care practices, as well as an evidence-based nurse home visiting model used in the Children’s Integrated Services Division.
Panel advances informed health care decisions bill
The House Health Care Committee on Friday gave its approval to S.31, a bill that aims to provide consumers with information to make informed health care decisions. It also changes the consent policy for Vermont Information Technology Leaders, the state’s legislatively designated operation of the Vermont Health Information Exchange.
- Requires hospitals and ambulatory surgical centers to provide patients with a single, comprehensive bill that reflects a patient’s entire financial obligation. It also requires ASC and hospitals to provide patients with information on their financial assistance, billing, and collections practices.
- Requires the Green Mountain Care Board to collect and review data from the Brattleboro Retreat and the Vermont Psychiatric Care Hospital on scope of services, volume, utilization, payer mix, quality, coordination with other parts of the health care system, and financial conditions. The GMCB will also consider ways in which the Brattleboro Retreat and the Vermont Psychiatric Care Hospital can be integrated in payment and delivery system reform.
- Applies the hospital “Patient Bill of Rights” to the Brattleboro Retreat and the Vermont Psychiatric Care Hospital. The bill of rights states the responsibilities that a hospital and its staff have toward patients and their families during hospitalization.
- Moves to an opt-out consent policy for the Vermont Health Information Exchange, where patient data is automatically added to the health information exchange unless a patient explicitly requests that his or her data not be stored and be removed.
Rural health bill passes Senate
The Senate gave its final approval to H.528, a bill that creates a Rural Health Services Task Force. The Task Force, in consultation with OneCare Vermont, will look at financial, administrative, and workforce barriers in Vermont’s rural health care system. It requires the Department of Mental Health to determine the mental health bed needs for residential programs across the State by geographic area and provider type. The evaluation will include a review of needs in rural locations, current and historic occupancy rates, an analysis of admission and referral data, and an assessment of barriers to access for individuals who require residential services.
The bill also calls for the Department of Mental Health to collaborate with the Vermont Housing and Conservation Board, the Vermont State Housing Authority, and other community service organizations to increase affordable housing opportunities for individuals with mental health needs and those experiencing homelessness by identifying potential funding sources to support housing.
On Thursday, the House Health Care Committee concurred with the Senate changes.
House panel approves ambulatory surgical center licensing fee, declines to add provider tax
After the House Health Care Committee advanced S.73 last week, the Ways and Means Committee voted to approve a proposed $600 licensing fee that would pay for the Department of Health to administer the bill’s ambulatory surgical center licensing program. The committee considered but declined to add a three percent provider tax for ASC’s to the bill. However, the committee did add a requirement that the Green Mountain Care Board report each ambulatory surgical center’s net patient revenue to the legislature annually, as well as report on changes in utilization of ASC’s and hospitals for outpatient surgeries and procedures. If the data indicates a substantial shift in services from hospitals to ASC’s, resulting in a decrease in provider tax revenue, the committee said it would likely expand the provider tax to ASC’s in the future.
The House Health Care Committee supports the changes.
Senate panel proposes next steps to drug importation
During its final meetings this session, the Senate Health and Welfare Committee took testimony this week on S.136, a bill that would establish a wholesale importation program for prescription drugs from Canada. Because of the late date, the committee added language from the bill to the budget before it was voted out of the Senate Appropriations Committee on Friday afternoon.
Under those changes, the Agency of Human Services will administer the wholesale importation program in consultation with the National Academy for State Health Policy. AHS is directed to work with other states who are interested in pursuing a similar program to identify opportunities to collaborate. The bill also directs the Board of Pharmacy and the Office of Professional Regulation to explore whether any new prescription drug wholesaler license categories would be necessary to operate the program. The agency will need to apply and receive a federal waiver before the program can be implemented.
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