State Update 2-14-22

The legislative session is now in full swing. The House and Senate should finalize the Budget Adjustment Act this week. The House Appropriations Committee is actively debating the SFY23 budget, and policy committees in both bodies are taking up a variety of initiatives related to health care reform, COVID response and workforce.

SFY2023 Budget

Debate has begun on the SFY2023 budget, which contains a number of provisions of interest to home health and hospice agencies including:

• A 3 percent rate increase for home- and community-based long-term care services, including Choices for Care and Assistive Community Care Services (ACCS) rates$304,000 for the High-Technology Nursing Payment Reform model
• $10 million to cover increased Medicaid caseload/utilization in Department of Aging and Independent Living (DAIL)-administered services, such as Choices for Care
• $48 million to cover increased caseload and utilization in Department of Vermont Health Access (DVHA)-administered programs; skilled home health, hospice and high-technology nursing fall into this category
• $12.5 million for rate schedule increases, which includes skilled home health services
• $3 million to expand nurse scholarship programs
• $14,700,000 to provide free “last dollar” tuition for one year of undergraduate studies for critical occupation careers including LPNs.
• $2 million to expand nurse student loan repayment programs
• $1,000 refundable tax credit for nurses
• Creation of a state marketing campaign to attract health care workforce from outside Vermont and to increase enrollment in health care education programs
• Investments in childcare and housing

Task Force on Affordable, Accessible Health Care Recommendations

The Senate Health and Welfare Committee continued its work on S.285, a bill that would expand the Blueprint for Health and the Choices for Care Moderate Needs program. The bill is based on recommendations in the Task Force on Affordable, Accessible Health Care report.

VNAs of Vermont Executive Director Jill Mazza Olson testified on the recommendation to expand the Choices for Care Moderate Needs Group Program (MNG). She supported the committee’s interest in exploring strategies to support family caregivers who play a critical role in long-term care. Olson raised significant concerns about the proposal to invest more dollars in a large expansion of the Moderate Needs program given the pressures on the current high/highest needs and moderate needs programs.

COVID-19 Flexibilities

The Senate Health and Welfare Committee took up the House-passed H.654, a bill that extends many regulatory flexibilities to aid in COVID-19 response to March 31, 2023. Most of the provisions have been in place with since the start of the pandemic and have been extended several times by the legislature. The current language expires on March 31, 2022. Of greatest interest to home health agencies are some licensure provisions that facilitate the process of hiring nurses from out of state and bringing retired nurses back to the workforce.

Workforce Shortage

The House Health Care Committee continued testimony from provider organizations on the health care workforce crisis. The committee heard from many provider associations, including the VNAs of Vermont. Together, witnesses from across the health care continuum described how the pandemic has accelerated the workforce crisis already underway when the pandemic started.

Common themes throughout the testimony highlighted the following needs:

• Increases in Medicaid rates to support salary and wage requirements of current and potential staff and to support provider investments in workforce development;
• Increases in salaries for nurse educators and financial incentives for preceptors;
• Significant increases in funding for scholarship and loan repayment programs;
• Additional medical residency and nursing student clinical placement opportunities.
• Funding for innovative provider-higher education workforce development partnerships.