Vermont Update 2-24-20

SFY2021 Budget

Last week, VNAs of Vermont Executive Director Jill Mazza Olson testified before both the House Appropriations and House Ways and Means committees. She urged House members to support the Choices for Care program through Medicaid reimbursement and home health provider tax relief.

Telehealth

The House Health Care Committee took testimony on H.723, a bill that requires health insurance reimbursement for expanded telehealth services. The primary focus of the bill is coverage for “store and forward” services. “Store and forward” is the term for communication that is “asynchronous”—more like email (the people communicating are not working at the same time) than like Skype (live video conferences). For example, a dermatologist might review images sent by another provider. The bill has broad support. Some controversy arose during committee deliberation when the Vermont Medical Society proposed an amendment on prior authorization that is opposed by the payers.

Miscellaneous Health Care Bill

The Senate Health and Welfare committee took testimony this week on S.290, a miscellaneous health care bill that would, among other things, create a two-year ACO budget review cycle, require Green Mountain Care Board oversight of community mental health center budgets and create ACO oversight requirements, many of which are redundant to existing requirements.  The bill has received little support from the health care provider community. This week, the Green Mountain Care Board proposed a number of substantive changes to the bill.

Workforce

The House Health Care Committee took testimony on the health care workforce crisis in Vermont. They heard from nursing schools about the shortage of clinical nursing educators. The schools support a proposal from the Office of Professional Regulation that would give schools the flexibility to hire instructors who do not have master’s-level training. The committee also discussed a variety of other ideas proposed by the Rural Health Services Task Force and others including scholarships, loan repayment programs, loan refinancing and lowering the age requirement for LPNs to 17 to allow high school students to take advantage of free dual-enrollment nursing courses. Committee members expressed concern about the growing use of traveling nurses across all sectors of the health care system. University of Vermont Professor Mary Val Palumbo asked the committee to consider recommending the creation of a Vermont Blue Ribbon Commission for 2022 and a new Governor’s Commission on Healthcare Workforce. The committee is likely to make the recommendations.

Transportation Demand Management

Representatives of the VNAs of Vermont, the Vermont Association of Hospitals and Health Systems, and the Vermont Health Care Association appeared before the House Transportation Committee on Thursday to oppose a proposal that would require all employers with 50 or more employees to design, adopt, and implement a transportation demand management plan to encourage telecommuting and carpooling. The group supported the goal of reducing carbon emissions, but recommended that any mandate should require existing transportation-focused organizations to collaborate with health care providers to the degree that is appropriate. The group also noted that health care doesn’t lend itself to telecommuting, that health care workers often don’t work the same schedule every day or even every week, and that public transportation options are limited in rural communities, especially for the second and third shifts. The group highlighted other efforts more appropriate to the health care sector to reduce carbon emissions, including hospital partnerships with Efficiency Vermont and telehealth visits.
 
VNAs of Vermont Executive Director Jill Mazza Olson pointed out that the proposal is especially mis-matched with home health and hospice services which, by definition, depend on staff driving alone in their own vehicles.

Planning for the care and treatment of patients with cognitive impairments

On Friday, the Senate Health and Welfare Committee took testimony on S.300, a bill that plans for the care and treatment of patients with cognitive impairments. The provisions in the bill are largely aimed at physicians and hospitals.

House committees finalizing budget memos for Appropriations Committee

The House Health Care and Human Services Committees are poised to finalize their recommendations to the House Appropriations Committee, but the final recommendations are not yet available.