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Delivery System Reform Showing Promising Results

Cannabis Debate Lights Up

Right to Repair Falters

Administration Proposes Mental Health Workforce Spending Plan

Delivery System Reform Showing Promising Results

The Senate Health and Welfare Committee reviewed a report Thursday on the state’s progress with health care payment and delivery system reform efforts. Department of Vermont Health Access Deputy Commissioner Michael Costa said the department is implementing several payment reform projects that impact Medicaid-enrolled providers and Medicaid-covered services.

Costa focused his remarks on the Vermont Medicaid Next Generation Accountable Care Organization Program. An ACO is an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of its beneficiaries. He explained the multi-year process for Medicaid providers that aligns Vermont’s All-Payer ACO Model and other existing payment and delivery system reform initiatives. Costa said the All-Payer Model allows the payers – Medicare, Medicaid, and commercial health insurers – to incentivize providers to focus on health outcomes under the same payment structure.

Costa told the committee that health care providers, regulators, and policymakers continue the slow and steady work of creating an integrated system of care. He said program results for 2017 show an increase in the number of providers, payers, and people enrolled in the program. He emphasized the ACO spent approximately $2.4 million less than expected on health care in 2017 and that DVHA saw an increase in the use of primary care among the ACO-attributed Medicaid members. “This warrants cautious optimism and a continued commitment to the program,” said Costa.

Cannabis Debate Lights Up

The Vermont Marijuana Commission issued a much-anticipated final report in December. This week, the Senate Judiciary Committee received a summary from the Commission’s co-chairs regarding 70 recommendations on which the Commission was able to achieve consensus, as well as four areas where the Commission could not overcome significant policy disagreements. The four areas of non-consensus likely forecast the direction of this session’s legislative debate:

• Whether to allow a market for edibles;
• Whether each town’s decision to allow commercial cannabis operations should be based on an opt-in or opt-out default;
• Whether the new regulatory structure should be funded by a hefty excise tax alone or a smaller excise tax paired with fees; and
• Whether saliva testing to determine impaired-driving should be admissible in court.

Saliva testing, echoing the robust disagreement heard on the House floor last year, proved to be the Commission’s most contentious subject.

Considering that Judiciary Committee Chairman Dick Sears, D-Bennington, favors a fee system at odds with the Commission’s excise tax recommendation, the coming debate is certain to be lively. House Speaker Mitzi Johnson, in separate remarks this week, expressed ambivalence about allowing a Tax and Regulate bill to move forward in the House.

Right to Repair Falters

Sen. Chris Pearson, P/D-Chittenden, and Rep. Matt Hill, D-Wolcott, the co-chairs of an electronic device Right-to-Repair Task Force that met last fall, spoke with the Senate Committee on Economic Development, Housing and General Affairs on Thursday about the bill the pair had hoped to advance this session. Pearson and Hill now seem to have abandoned their goal of passing an expansive proposal following extensive Legislative Council analysis that raised questions about the proposal’s legal pitfalls.

Pearson expressed an interest this week in keeping the issue alive by studying an approach taken by several states that requires manufacturers to make product parts available for a certain period of time or be willing to replace the product. This scaled-back approach could receive a favorable reception in the Senate committee.

Administration Proposes Mental Health Workforce Spending Plan

The Legislature set aside $5 million in one-time tobacco settlement funds last year to expand Vermont’s mental health and substance use disorder workforce. In response to a legislative requirement, the Agency of Human Services submitted a spending plan to the Legislature as part of its consideration of the FY 2019 Budget Adjustment Act.

The plan proposes new training programs in both the Vermont State College System and at the University of Vermont and includes:

• Scholarships at VSC for Masters’ level mental health counselors;
• New introductory courses on addiction and clinical studies at VSC;
• Scholarships and programming for psychiatric mental health nurse practitioner degrees at UVM; and
• Scholarships and programming for a recovery/addiction integrative health and wellness coach program at UVM.

UVM and VSC representatives told the House Appropriations Committee that the new funding will allow them to “stand up” the proposed programming and that they do not anticipate program sustainability issues when the funding ends in 2023. Committee members indicated that they support the plan, but may adopt language that requires success metrics, program review, and a requirement that program scholarship recipients work in Vermont for three years after the completion of their degree or certificate.