Vermont Health Care Update | Week 21

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Senate health committee works on miscellaneous health care bill and Act 91 extensions  

The Senate Health and Welfare Committee took up H. 960 this week, the recently House passed miscellaneous health care bill. The committee will be proposing a series of amendments, including the addition of Act 91 of 2020 extensions.

As passed by the House Health Care Committee, the bill addresses several areas including mental health, hospital budget review, expansion of the VPharm prescription drug coverage for certain Medicare beneficiaries, and review and modification of prior authorization requirements. A summary of the bill can be found in the DRM update dated May 22.

The bill requires the Brattleboro Retreat to fall under the Green Mountain Care Board hospital budget review process gradually, requiring a full review by FY 2024. In developing the process for full review of the budget, the GMCB will collaborate with the Brattleboro Retreat and the Agency of Human Services to prevent duplication of efforts and reporting requirements. The GMCB and AHS will jointly determine which documents submitted by the Brattleboro Retreat are appropriate to share with the GMCB.

As a condition of further state funding, the bill requires quality oversight measures be implemented by the Brattleboro Retreat under the direction of the Department of Mental Health. It requires the Department of Mental Health and the Brattleboro Retreat to meet jointly each month with the mental health patient representative (an independent, peer-run organization contracted with DMH) and the mental health care ombudsman to review patient experiences of care, to discuss quality issues, and to review other patient care and safety topics.

Senate Health and Welfare committee chair Ginny Lyons, D-Chittenden, requested an amendment to be drafted that adds a requirement for the Brattleboro Retreat’s Board of Directors to meet independently with staff members in implementing the Retreat’s Action Plan for Sustainability, but Brattleboro Retreat President Dr. Louis Josephson, and the Brattleboro Retreat’s legal counsel Craig Miskovich, told the committee that the requirement is inconsistent with federal and state law labor and non-profit law. Josephson added that the Brattleboro Retreat’s recently drafted Sustainability Action Plan includes an action item on labor relations.

After taking testimony for the University of Vermont Health Network, insurers, and the Department of Vermont Health Access, and the Department of Health, the committee will likely retain bill provisions pertaining to prior authorizations and an expansion of VPHARM benefits.

Citing financial pressures on the insurance industry, the committee decided to strike a provision that requires the Green Mountain Care Board to prioritize plan affordability over insurer solvency to the greatest extent actuarially feasible requires the Department of Financial Regulation to take into account insurer’s claims experience when considering insurer solvency opinions.

Panel considers extensions to emergency measures

In response to the continued COVID-19 crisis, and at the request of providers, the Senate Health and Welfare Committee will propose inclusion of several extensions of Act 91 of 2020 provisions. The committee will propose extending many of the sections to March 31, 2020, including sections that grant employee protections, allow the Secretary of Human Services to waive or permit variances from specified rules and standards governing providers of health care services, to deem out-of- state licensed health care professionals licensed in Vermont, and to waive certain telehealth requirements during the state of emergency. Provisions that the committee will propose extending to June 30, 2020 include language that permits the Department of Financial Regulation emergency rules and rulemaking, and extensions and early refills of prescription maintenance medications.

The provider community requested the extension of provider tax modification authority, but Appropriations committee concerns over delaying or waiving the tax and the resulting impact on Medicaid funding led the committee to decide against extending the authority.

The committee will return to the bill on Monday, June 22 to continue taking testimony and finalize language. 

Senate panel considers adjustments to the House CRF spending plan

The Senate Health and Welfare Committee began working on their recommended changes to H. 965, the House passed bill relating to health care- and human services-related appropriations from the Coronavirus Relief Fund.

Their current working proposal reduces the total bill appropriation from $300 million to $211.9 million and reduces the appropriation to the Health Care Provider Stabilization Grant Program by $84 million. The proposal includes language that requires grant fund applicants to “use the funds to ensure that patients are able to receive necessary, appropriate, and timely health care services.” An additional section requires hospital applicants to “break out the financial needs of their outpatient medical practices separately from those of the rest of the hospital in order to compare the needs of hospital owned medical practices with those of independent medical practices.” The Vermont Association of Hospitals and Health Systems told the committee that that submitting that information would be difficult and burdensome on the hospitals. Chair Ginny Lyons, D-Chittenden, recognized the need to streamline the process and will continue to the discussion with the Green Mountain Care Board and the Agency of Human Services to determine how to get important information without encumbering the grant process.

In discussions on Friday, the committee decided to eliminate most of specific “carve outs” in the provider relief fund. The committee was concerned that the specified amounts for the various providers would be viewed as a ceiling, rather than a floor of funding and could limit the amount that each group would be able to receive from the fund.

On Friday, the Senate Appropriations Committee also did a review of the H.965. The committee is leaning towards less prescriptive language that will allow the Agency of Human Services to use discretion.

The Senate Health and Welfare committee will continue to work on the bill on Monday.

Senate passes bill expanding pharmacist prescribing power

The Senate passed S.220 this week, after approving an amendment offered by the Senate Government Operations Committee that allows pharmacists to administer tests for COVID-19 and related SARS associated viruses. The amendment language states that pursuant to state protocol, pharmacists may  prescribe, administer or order “tests for SARS-CoV and SARS-associated viruses for asymptomatic individuals and antibodies consistent with recommendations for testing of individuals made by the state Serology Working Group.”

Previous amendments to the bill by the Senate Health and Welfare Committee will allow pharmacists to prescribe, order, or administer in an influenza vaccine or vaccine to mitigate a significant public health risk, or, another vaccine pursuant to a collaborative practice agreement. In the event of a significant public health risk, the bill also allows pharmacists to administer an appropriate vaccine to mitigate the effects on public health after finding that existing channels for vaccine administration are insufficient to meet the public health need.

Senate committee approves physician assistant licensure bill

The Senate Health and Welfare committee advanced S.128 on Thursday, and the Senate approved the bill on Friday. The bill removes the requirement of a delegation agreement between supervisory physicians and PA’s, and substitutes it with a practice agreement requirement. The bill also requires that the practice agreement include a plan to have a physician available for consultation at all times when the physician assistant is practicing medicine. The proposed changes would bring the law into alignment with current practice, and would not change the scope of practice of PA’s.

First quarter budget bill keeps moving while the other three quarters loom large

The first quarter budget bill and Coronavirus Relief Fund spending bill continues its march towards passage. On Thursday the Senate gave final approval to the bill which funds state government for the first quarter of the fiscal year.

The Senate bill includes the addition of several CRF allocations. The Department of Disabilities, Aging and Independent Living received $2.45 million to provide financial stability grants to the twelve adult day providers in the state who were ordered closed due to the pandemic. The funds will help continue to support the facilities, service infrastructure and necessary operating costs as adult day cares prepare to reopen safely to vulnerable populations.

In addition to H.961, the House Appropriations Committee Chair Rep. Kitty Toll, D-Danville, addressed the issue of State budget shortfalls, which the General Assembly will address when it reconvenes in August. She asked committee members to work with policy committees to begin considering what they would propose to remove from the State budget if budget shortfalls necessitate programming cuts. Toll said starting that work in August will be too late.

Toll has asked State Treasurer Beth Pearce to be prepared to discuss the benefits and detriments of state borrowing as well as various borrowing options for the House to consider as it weighs strategies to address the State’s budget shortfalls when the General Assembly returns in August.

Maternal Mortality Review Panel Changes

The Senate Health and Welfare Committee passed H. 572 on Friday, a bill related to the Maternal Mortality Review Panel. The panel will conduct comprehensive multi-disciplinary review of maternal deaths in Vermont for the purpose of identifying factors associated with those deaths and making recommendations to system changes to improve health care services in Vermont. The committee amended the bill to exempt Panel meetings from the Open Meeting Law. Records produced or acquired by the Panel are currently exempt from public inspection and copying under the Public Records Act.

Green Mountain Care Board

The Green Mountain Care Board met on Wednesday to approve the Vermont Information Technology Leaders FY 2021 budget. The budget includes $8.1 million in revenue and $7.7 million in expenses. As part of the budget approval, VITL is required to provide the Board with quarterly updates, including updates on Governance and Operations; Finances; and Technology to include Collaborative Services and continued Consent implementation efforts, as well as the integration of sensitive data in the Vermont Health Iinformation Exchange).  It will also include a copy of VITL’s plan for stakeholder outreach to gather feedback on integration of sensitive data into the VHIE.

The board also approved OneCare Vermont’s FY2021 budget guidance and reporting requirements. There were no comments by the board or by the public.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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