Paid Family Leave Could Be Costly

The House Committee on Ways and Means took up H.196, the Paid Family Leave bill this week after it passed out of the House Committee on General, Housing and Military Affairs over several members’ objections.

The proposal would expand the current unpaid family leave law by guaranteeing an employee his or her job (or a comparable job) upon return from up to 12 weeks of fully paid leave for pregnancy, adoption, foster care, serious illness, or the serious illness of a family member. Employees would pay a 0.93 percent payroll tax into a Family Leave Insurance Special Fund. An earlier version of the bill mandated a 50 percent employer contribution to the tax, but the committee made employer contributions voluntary. For state employees, the contribution split would likely become a part of the state employee bargaining process.

The cost of the program to the state is potentially high, according to the Joint Fiscal Office. JFO  estimates that it could cost up to $15.4 million annually to temporarily replace workers who fully utilize 12 weeks of leave. If state workers negotiate an employee contribution to the fund, the cost will be higher. JFO also estimates that the Department of Labor information technology system to manage the program would cost $2.5 million.

The Vermont Chamber of Commerce and the Lake Champlain Regional Chamber of Commerce raised concerns that the lack of a small business exemption would be an obstacle to growth for the 85 percent of Vermont’s businesses that have fewer than 25 employees. Vermont businesses Red Hen Bakery and the Alchemist countered by saying that the program could draw more young workers to Vermont and save money for those businesses that already offer paid family leave.

The committee is expected to continue reviewing the proposal.

Struggle Continues over Independent Contractor Definition

The House Commerce and Economic Development Committee continued this week in its protracted effort to craft legislation to clearly define who is an independent contractor for purposes of workers’ compensation.

The committee completed a walk-through of a new draft bill that left many fundamental issues unresolved. The core question is whether the definition will include consideration of whether a contractor performs work that is an “integral part” of an employing unit’s business. A similar requirement exists under current law, and employers have argued that it casts a net that is far too broad to reflect the realities of business relationships. Organized labor has insisted that the phrase be included in the bill. Committee members are divided over the issue.

The Scott Administration has indicated that it does not support the current version of the bill because it fails to provide clarity for businesses. The bill is scheduled for further consideration next week.

Committee Delays Consideration of Bill that Presumes Coverage for Emergency Responders

Emergency responders have asked the legislature to approve a bill, H.197, that would presume that post-traumatic stress disorder claims are work-related if they are filed by police officers, ambulance workers or firefighters. The bill would also eliminate a requirement in current law that limits the ability of any worker to file a claim solely based on an injury to mental health. A worker must now show that the job-related stress that he or she experienced is greater than that experienced by employees with similar positions, and H.197 would eliminate that requirement.

The committee is scheduled next week to consider a revised proposal that retains the presumption for PTSD claims by emergency responders. The draft bill would impose some limitations on the filing of mental-only claims by requiring a worker to demonstrate that a work-related event or stress was “extraordinary and unusual in comparison to pressures and tensions experienced by the average employee across all occupations.” Mental claims based on adverse personnel actions would not be allowed.

The bill and the new proposal are opposed by insurers, business groups and the Vermont League of Cities and Towns, as either would impose significant new costs on the workers’ compensation system.

Uber Bill Nears Approval

The Senate Judiciary Committee continued to work this week on a House-passed bill, H.143, that would establish minimum insurance requirements for so-called transportation network companies such as Uber and Lyft. Following a hearing last week in which there was virtually no opposition to the bill, Committee Chairman Dick Sears, D-Bennington, proposed a set of amendments that would require TNC’s to obtain a Department of Motor Vehicles license that could be suspended or revoked; require TNC’s to conduct driver background checks; allow DMV to inspect driver and company records; and allow municipalities to regulate TNC’s as long as any ordinance is at least as stringent as the legislation.

The bill as amended is expected to be approved by the committee.

Health Care Committee Takes up Chemical Issues

The Senate Health and Welfare Committee on Friday reviewed recommendations made by the Act 154 Study Committee that are within its jurisdiction, including a plan to expand the Chemicals of High Concern to Children program to cover all consumer products. The committee devoted about an hour to portions of S.103 as introduced, and it was unclear whether the group will work further on these issues this session.

The Act 154 study group made a series of recommendations, including many that are controversial, to address health threats posed by unregulated chemicals after PFOA was discovered in Bennington. The recommendations include expanded reporting and information gathering and imposing new liability protections, but the report also cautioned that the group had insufficient time to estimate costs and benefits.

As the Senate Natural Resources and Energy Committee worked on S.103, it sent portions of the bill to the Senate Health and Welfare and Senate Judiciary committees while advancing a slimmed down version of the bill. That version received approval of the full Senate on Friday and will move to the House.

Senate Continues Pushback on Agency of Economic Opportunity

Members of the Senate Economic Development, Housing and General Affairs Committee this week threatened to move the popular Vermont Training Program from the Agency of Commerce and Community Development to the Workforce Development Division of the Department of Labor instead of merging the two agencies as the governor had proposed. The idea is written into S.137, a bill introduced by Senate President Tim Ashe, D/P-Chittenden, that was the topic of discussion this week in the committee.

Since the original reorganization plan was panned by the Senate earlier in the year, ACCD leadership has sought a different configuration that would move workforce-related programs at the DOL to the ACCD within a new Division of Economic and Workforce Development.

The proposed move in the opposite direction drew immediate protests from the agency as well as Vermont regional development corporations, who argue that the VTP is aimed at the needs of employers to upgrade the skills of incumbent workers, rather than looking at gaining job skills from the employee perspective.

Committee Chair Sen. Kevin Mullin, R-Rutland, asked ACCD Deputy Secretary Ted Brady to return next week with a written outline of the agency’s view of the new division.

Carbon Cap and Trade and Carbon Tax Study Considered

A bill that would allocate up to $100,000 for a third party to study the risks and benefits of both a carbon tax and a carbon cap and trade program got a hearing in the House Natural Resources, Fish and Wildlife Committee on Wednesday, but the price tag might be too high in the current budget environment. The bill, H.394, calls for the Joint Fiscal Office to look at carbon taxes enacted in British Columbia and Ireland, as well as expansion of the Regional Greenhouse Gas Initiative in the northeastern United States.

In testimony before the committee, Fiscal Analyst Joyce Manchester said a company called Resources for the Future has created a Computable General Economic Model that was planned for a federal study, but will be scaled down to address regions and states since it is unlikely to be done at the federal level. But, she said, it would cost at least $150,000 to hire the company.

Manchester also reported that British Columbia’s goal of cutting greenhouse gas emissions by 30 percent by 2022 would fall short because gasoline and oil prices have collapsed and the program has experienced significant “leakage,” meaning that the province was now getting at least 50 percent of its energy from emitters outside of the region. The BC tax amounts to $30 per metric ton.

Last week, the committee passed H.424, a bill that calls for a comprehensive 50-year review of the iconic Act 250, but its proposed $50,000 appropriation failed to survive in the Appropriations Committee.

More Law Enforcement Officials Oppose Single Plates

Washington County Sheriff Sam Hill and Vermont Commissioner of Motor Vehicles Rob Ide were among the law enforcement officials and others opposing a Senate proposal to eliminate the requirement for front and rear license plates this week. The testimony took place in the House Transportation Committee, which is anticipating the arrival of S.127 from the Senate.

Ide said front plates are critical tools for law enforcement and admitted that it might have been a mistake to allow a plate proclaiming “Vermont Strong” to adorn the front of Vermont cars for a limited period of time after Tropical Storm Irene ravaged the state in 2011. He said law enforcement groups agreed to the change in 2012 as long as it was of limited duration.

The language proposed by the Department of Motor Vehicles would have ended the Vermont Strong program and strengthened the requirement for front and rear plates, but the Senate Transportation Committee substituted language dropping the front plate requirement.

U.S. Border Patrol Swanton Division Chief Bradley Curtis told the committee his unit patrols the U.S.-Canada Border around the clock and needs to make quick decisions regarding oncoming vehicles. “If Vermont goes to one plate it will make our jobs more difficult and may have some ramifications for national security,” he said.

Vulnerable Adults Proposal Sidelined for Now

A bill to significantly expand the remedies that are available to vulnerable adults who are exploited has been sidelined for now by the Senate Health and Welfare Committee.

The bill, S.283, was proposed by Vermont Legal Aid, and it would have created a presumption of undue influence if a property transfer by a vulnerable adult was made for less than fair market value and without a lawyer. The bill created a private civil action with broad remedies to void a property transfer.

Lenders and title insurers raised concerns about the impact of the proposal on innocent purchasers, including the difficulties it would create in certifying that title to a property is clear.

Legal Aid proposed a revised version on Thursday that substantially limited the earlier bill. The revised legislation would limit civil remedies to money damages, fees and injunctive relief, but would not include property rescission. Lenders agreed to review the proposal and report back any concerns.

Administrative Burden on Providers Reviewed

Former Green Mountain Care Board member Dr. Alan Ramsay came to the Senate Health and Welfare Committee on Friday to report on a pilot program he spearheaded to reduce the burden of prior authorizations in primary care. As a board member, Ramsay continuously advocated for easing administrative burdens for primary care physicians.

A radiology pilot created by Ramsay was conducted in two hospital service areas:  Rutland Regional Medical Center and Porter Medical Center. The project eliminated prior authorizations for two classes of drugs, proton pump inhibitors and statins, which are high-volume and low-cost drugs. It also eliminated prior authorizations for non-contrast MRI’s of the spine. Radiology groups approved or denied requests by ordering clinicians based on American College of Radiology criteria.

Ramsay said that a related one-year pharmacy pilot program increased Medicaid costs costs for non-preferred proton pump inhibitors, while Blue Cross Blue Shield of Vermont and MVP saw very little change. Given the volatility in Medicaid pricing, the pharmacy pilot ended on July 1 and normal prior authorizations resumed. Given the results of the pilot, Ramsay said payers were not able to agree on a common drug formulary or willing to continue with the elimination of prior authorizations because those are tools they use to control utilization and save on premium costs.

Prescription Drug Out-of-Pocket Provision Costs Discussed

The Senate Health and Welfare Committee on Friday heard testimony from representatives of MVP and BCBSVT on S.19, a bill that would delay a requirement that the Department of Vermont Health Access apply for a federal waiver to ensure the continued availability of Bronze-level exchange plans that meet Vermont’s out-of-pocket prescription drug cost limit. The bill would also direct an advisory group to look at prospective changes to the law that would ensure continued availability of Bronze plans. Because the bill did not make the crossover deadline, insurers requested the language be attached to H.507, a bill recently referred to the committee.

MVP Senior Government Affairs Strategist Susan Gretkowski and Blue Cross Blue Shield of Vermont Government Affairs Consultant Sam Nelson said there is no rush to apply for the waiver given the federal uncertainty and the plan’s current compliance with Vermont law. Gretkowski and Nelson supported the administration’s request that the waiver application deadline be delayed until 2019. They also requested that approved plan designs for 2018 be permissible for 2019.

In an attempt to limit consumer cost-sharing for expensive prescription medications, the Legislature in 2012 required health insurance plans to place a cap on prescription drug out-of-pocket expenses. Since the implementation of this requirement, health insurers have claimed that it has become increasingly difficult for them to develop Bronze exchange policies that not only contain the state-mandated prescription drug cap, but also meet federal guidelines. During the 2016 legislative session, lawmakers allowed the Green Mountain Care Board to approve plan designs for the 2018 plan year that either eliminate or raise the prescription drug out-of-pocket maximum as long as one Bronze plan maintained the drug cap.

Telemedicine Bill Scrutinized

The House Health Care Committee took testimony this week on S.50, a bill that expands Medicaid and private health insurance coverage for telemedicine services. The bill would allow the same number of consultations by live interactive audio and video services as if the service were performed in person.

The committee heard from a number of providers from various disciplines who support the bill, stating that the technology has allowed providers to deliver services that keep patients healthy and avoid higher-cost interventions. VNAs of Vermont Executive Director Jill Olson testified in support of the legislation and encouraged the committee to consider a study to evaluate the use of additional assistance in the home as telemedicine is utilized.

Committee Chairman Rep. Bill Lippert, D-Hinesburg, expressed concerns about qualitative differences between telemedicine visits and in-person visits. He said that interpersonal interaction is qualitatively different.

The committee will take further testimony next week.

Broad Supports ACO Reporting

The Senate Health and Welfare Committee took testimony from a number of stakeholders on Friday on H.507, a bill that would require the Department of Vermont Health Access to provide periodic reports on the implementation of the Next Generation Medicaid Accountable Care Organization pilot contract with OneCare Vermont, the state’s largest Accountable Care Organization. The bill also would require the Green Mountain Care Board to provide a written update on its progress towards meeting the benchmarks identified in the first year of the All-Payer ACO Model Timeline and its preparations for regulating ACOs.

DVHA and OneCare Vermont expressed support for the bill so long as it is consistent with the reporting requirements in the Medicaid ACO pilot contract.