Early May
From the Executive Director
The Vermont Legislature is in its final weeks. On Friday, the Senate passed H.439, a $7.175B budget that includes state spending along with the allocation of roughly half of the American Rescue Plan Act (ARPA) funds. The next step is for the House and Senate to reconcile the differences in their budget proposals.

For home health and hospice agencies, the key provisions from the Senate proposal fall into three categories – support for programs like Choices for Care, workforce initiatives, and health care policy.

Still outstanding is a plan for spending the federal American Rescue Plan Act (ARPA) funds that are dedicated to home and community-based services. The Center for Medicare and Medicaid Services has still not released guidance for how those dollars can be spent. In addition, the funds are only available for a single year. Vermont’s well-established home and community-based long-term care Medicaid program needs ongoing and sustained funded.
State Update
The Senate version of the budget includes support for programs, workforce initiatives, and health care policy.

  • A 3% rate increase for home and community-based Choices for Care services. The House version of the budget calls for a 2% increase. 
  • A $1.50/day increase in Assistive Community Care Services rates. The House version calls for a $1/day increase.
  • $5M in ARPA funding to support re-opening adult day programs.
  • $3.9M to support health information technology projects and “delivery system reform” projects through OneCare Vermont under the auspices of the all-payer model. This includes funding for care coordination and the home-health led “longitudinal care” program under which extends services for people discharged from home health to prevent hospitals and emergency department visits. 
  • Similar to the House budget, directs that the one-year, 10 percentage point increase to federal Medicaid matching to support home and community-based services (ARPA funding) carry forward in future years to sustain the 3% increase contained in the budget, to the extent allowed by federal law. 

  • $2.72M in funding for nursing and primary care scholarships through VSAC, also included in the House version of the budget.
  • One-year free tuition for critical occupations including allied health programs at CCV and nursing programs at the VT State Colleges, also included in the House version of the budget. 
  • Extends the date for submission of the draft Health Care Workforce Strategic Plan required by Act 155 to the Green Mountain Care Board from July 15, 2021 to October 15, 2021; and submission of the final strategic plan to the legislature by December 1, 2021 rather than August 15, 2021.

  • Tasks the Department of Financial Regulation (DFR), in consultation with the Department of Vermont Health Access (DVHA), the Green Mountain Care Board (GMCB) and stakeholders to consider whether to add coverage for various services to Vermont’s the health benefits exchange (Affordable Care Act) insurance products. At a minimum, DFR is required to consider adding coverage for hearing aids, dentures, vision care, durable medical equipment, fertility services and two primary care visits annually with no cost-sharing. Changes to the plans require federal approval and additional state funding.
  • Creates and funds a Task Force on Accessible, Affordable Health Care, formerly part of S.120.
  • Directs the Secretary of Human Services to seek extend or renew the Global Commitment 1115 Waiver in a manner that allows Vermont to have “increased flexibility to use investment dollars to increase access to care and coverage, improve health outcomes, strengthen delivery systems, and promote transformation to value-based and integrated models of care.”
Federal Update
On April 22, a bipartisan group of U.S. Senators introduced S. 1309, the Home Health Emergency Access to Telehealth (HEAT) Act. The legislation provides reimbursement to home health agencies for telehealth services provided under the Medicare program.

Unlike most provider groups, home health agencies endured a Medicare payment penalty for delivering some services by telehealth under the public health emergency. While limitations on reimbursement for telehealth are long-standing, the pandemic made the restriction a glaring problem.

The new legislation grants CMS the authority to issue a waiver that would allow telehealth visits to count towards in-person visits under a home health episode. Under the current home health Medicare payment model, low-visit episodes are reimbursed at a lower rate. With telehealth visits excluded from “visit” counts, agencies were penalized for providing some services by telehealth, even as they were being urged to do so where appropriate by public health authorities. The bill also includes guardrails including patient consent for telehealth services, a requirement that telehealth visits comprise of no more than half of all visits and a pre-existing relationship between the patient and ordering physician.

Vermont’s Congressional delegation has been supportive of national efforts to reimburse home health for telehealth services since the beginning of the pandemic.
In the News
Educational Opportunities
Materials Available Online
Recording available for purchase
Hosted by National Association for Home Care and Hospice

Aide/LNA/Direct Care Resources
In conjunction with the Home Care Hospice & Palliative Care Alliance of New Hampshire, we offer resources for Aides, LNAs and Direct Care professionals. They include a newsletter, sent on the second Thursday of each month, along with a post-test to help readers assess their understanding of the material. Here are the December resources as examples. Past newsletters, quizzes and certificates (organized by topic) appear on this webpage.If you would like to receive these as part of your member benefit thoughout 2021, please register here.

On demand 4-part, 
nine hour series.
May 12, July 21, November 16
11:30 a.m. to 1 p.m.
Hosted by VNAs of Vermont

May 13 | 1 to 4:30 p.m.
Hosted by VPQHC
CEUs and CMEs available

May 27, June 3 | 12 to 1 p.m.
Hosted by VNAs of Vermont

June 2 and 3
Live virtual conference

June 8, 9 | 9 a.m. to 5 p.m.
Hosted by VNAs of Vermont

Fireside Inn, West Lebanon, New Hampshire
Hosted by VNAs of Vermont
In-person event