House passes budget bill

Revenue bill advances to Senate

House panel reviews all-payer model

Childcare advocates celebrate 133-0 win on H.531

House passes capital construction bill

House advances home health CON moratorium extension

House mandates individual coverage, prohibits association plans

House passes budget bill

The House approved a $6.1 billion FY 2020 budget this week. The bill, H.542, provides for a 3.1 percent growth in spending over FY 2019.

The bill:

• Increases the state’s reserve funds;
• Provides for a two percent increase for home health agencies, adult day providers, meals on wheels, and traumatic brain injury waiver services providers;
• Provides funding for substance use disorders and mental health initiatives to include 12 new inpatient beds at the Brattleboro Retreat, an increase in funding for Community Rehabilitation Treatment to enable additional intensive support services, and to provide one-time grants to implement electronic health records at the designated mental health agencies;
• Increases child care funding by nearly $8 million and provides $1 million in one-time funds for parent-child center infrastructure improvements;
• Funds the Governor’s Climate Commission initiatives to include incentives for Vermonters to purchase and lease electric vehicles, to increase the number of electric vehicle charging stations, and to provide grants for weatherization services for moderate income Vermonters; and
• Provides a $3 million increase to the Vermont State Colleges to prevent a tuition hike.

Additional budget highlights can be found here.

Revenue bill advances to Senate

As expected, the Vermont House gave its approval this week to H.541, the Ways and Means Committee’s revenue bill. Key provisions of the bill include:

• An increase in the Vermont’s estate tax exclusion from $2.75 million to $5 million by Jan. 1, 2021;
• A reduction in the capital gains exclusion from 40 percent to 30 percent;
• An increase of $125,000 for affordable housing tax credits;
• A $200,000 increase to the credit cap for downtown and village center tax credits; and
• Numerous clarifications and definitional changes affecting the rooms tax, property transfer tax, land gains tax and fuel tax.

Given the relatively modest aim of H.541, the lack of controversy during floor debates this week was hardly surprising. But now the bill heads to the Senate where the Finance Committee will almost certainly add its priorities to the bill before all is said and done.

House panel reviews all-payer model

Alicia Cooper, Director of Payment Reform, Reimbursement, and Rate Setting for the Department of Vermont Health Access, appeared before the House Health Care Committee on Tuesday to provide an overview of the Vermont Medicaid Next Generation Accountable Care Organization Pilot Program. The VMNG represents Medicaid’s participation in the Vermont All-Payer Accountable Care Organization Model. The all-payer model ACO is an alternative payment model in which the state’s major payers pay for value-based care for a fixed price.

Cooper said the pilot program:

• Empowers health care providers to take responsibility for cost containment and quality;
• Expands the pilot by adding additional communities and Medicaid members incrementally each year;
• Creates sustainable costs by moderating Medicaid spending by pushing risk to providers; and
• Promotes value-based payments by moving away from fee-for-service payments towards payment arrangements based on quality, risk, and accountability.

Cooper offered the committee with program performance results for 2017:

• DVHA and OneCare Vermont, the state’s only ACO, launched the program successfully and continue to jointly monitor and report on program performance on a quarterly basis;
• The program is growing with additional providers and communities joining the ACO;
• In 2017, the ACO spent $2.4 million less on health care than the projected $82 million;
• The ACO met most of its quality targets; and
• DVHA is seeing more use of primary care among ACO-attributed Medicaid members.

Childcare advocates celebrate 133-0 win on H.531

Although scores of bills advance each year on unanimous or nearly unanimous voice votes, it is an unusual occasion when that unanimity is reflected in a roll call vote on a substantive bill. This is especially true on major initiatives like H.531, a bill that provides major new investments and support for Vermont’s childcare and early learning system.

As passed by the House, H.531 would enhance the capacity and affordability of childcare in Vermont by increasing subsidies for low-income families under the Child Care Financial Assistance Program by nearly $8 million and by adjusting the sliding scale for eligibility to include more families. The bill adds $1 million to modernize the Bright Futures Information System run by the Department of Children and Families. In order to support workforce development within the childcare system, the bill appropriates $1 million for student loan repayment assistance and scholarship funding for qualified childcare workers.

Advocates and legislators alike celebrated an important win this week, but sounded a cautious note that this is only a first step towards a full redesign of the state’s childcare system.

House passes capital construction bill

The House advanced H.543, a $63 million capital construction and state-bonding bill for fiscal year 2020 on Wednesday. The legislature moved to a two-year biennial capital bill budgeting cycle in 2011 to accelerate the construction of larger projects. A final vote in the House will occur on Tuesday.

The 2020 bond package approved includes:

• $20.1 million in state building renovations and enhancements;
• $8.3 million to the Agency of Human Services for a number of projects – this includes the plan and design for a state-run secure residential recovery facility and to continue with the upgrade of the state’s integrated eligibility and enrollment system;
• $3.4 million to the University of Vermont and Vermont State Colleges for renovation and major maintenance projects;
• $12.1 million for clean water initiatives;
• $1.5 million for the school safety program; and
• $1.8 million to the Vermont Housing and Conversation Board for housing projects.

Although the capital bill normally focuses on the “bricks and mortar” of state buildings, this year’s bill also requires the executive, judicial and legislative branches to work with the Council of State Governments to conduct a review of programming and population trends in Vermont’s correctional facilities. The bill also directs the Agency of Human Services to explore the placement of interim secure residential beds at Rutland Regional Medical Center. Finally, it requires AHS to develop a proposal that expedites the closure of the Middlesex Secure Residential Recovery Facility and provides for construction of a 16-bed state-owned secure residential facility.

House advances home health CON moratorium extension

The House advanced S.14, a bill that extends the current moratorium on home health agency certificates of need to 2025. The moratorium is set to expire this year. The House Human Services and Health Care Committees unanimously approved the provision earlier in the week.

House mandates individual coverage, prohibits association plans

On a vote of 92-44, the House passed a bill on Friday that requires individuals to purchase health benefits, but provides no penalty for non-compliance. That penalty was stripped out by the Ways and Means Committee.

The House rejected a floor amendment by Rep. Jim Harrison, R-Chittenden, that would have allowed those enrolled in association health plans to continue their coverage until next year when a report is due that examines the impact of AHPs on the health insurance marketplace. The Department of Financial Regulation allowed small businesses to offer AHPs this past year, but H.524 would prohibit them. Harrison argued that federal rules now allow the plans, which have created savings for both employers and employees. Democrats responded that removing small business employees from the insurance pool could destabilize the insurance marketplace and increase costs, and the plans need to be put on hold until a health insurance market study is completed. Coincidentally, on the day the amendment failed, a federal district court judge ruled that a federal rule allowing AHPs was an illegal “end-run” around the Affordable Care Act.