May, 2020
From the Executive Director
Usually at this time of year, the Vermont legislature has adjourned until January and I’m in the process of writing a final legislative wrap-up. Instead, this week, the Vermont House is expected to pass a second SFY2020 budget adjustment to address the loss of state revenues caused by the COVID-19 public health emergency. That process was relatively straightforward, and a Joint Fiscal Office  summary   outlines the bill’s highlights. The next planned step is the passage of a “ skinny budget ” for the first three months of SFY2021.

The hard decisions will likely come in August, when lawmakers will have to develop a budget for the rest of the fiscal year with revenues down and every sector of Vermont in trouble. And somehow the debate will be done via Zoom. 

Meanwhile, legislative policy committees are starting to take up bills that aren’t related to COVID-19 but were in progress when the COVID-19 pandemic closed the State House building – including the Older Vermonters Act and the nurse licensure compact.
We’ll be following these developments closely and advocating to make sure home health and hospice services remain available to all Vermonters. 
Federal Update
Advanced Practice Registered Nurses and PAs Can Now Order Home Health 
CMS has clarified the  federal waiver  allowing APRNs and PAs to order home health services under the COVID-19 emergency. Combined with the CARES act, the change is permanent and will remain in place when the emergency is over. This is a common-sense change that was a long time coming.

Vermont’s Division of Licensing and Protection has confirmed that NP and PA orders are now allowed in Vermont, based on this federal waiver. Unlike some states, Vermont has no licensing barriers to implementation. Medicaid payment rules require a physician order, however when we brought the issue to their attention, the Medicaid Policy Unit quickly issued Clarification 20-063:  Home Health Services – Ordering Providers , which removes this final barrier.

Conditions of Participation Waivers
On April 30 CMS issued new waivers, available  HERE . Additional information about the waivers is accessible at the CMS  Current Emergencies  and  Coronavirus Waivers & Flexibilities  links.
State Update
Incentive Pay for Frontline Employees (S. 346)
The House Commerce and Economic Development Committee met last week to discuss S.346, a bill that establishes an essential employee grant program for frontline workers. As passed by the Senate, the grants would be provided to frontline employees earning $25 an hour or less as a base wage. Home health agencies and long-term care facilities are excluded from the wage cap – all direct care staff would be eligible for grants under the Senate proposal. The committee raised concerns about whether the program is a permissible use of the federal Coronavirus Relief Fund because it is not explicitly allowed. The committee may wait for input from Vermont’s federal delegation before moving forward and at this writing, its future is uncertain. This is a sobering development. Vermont had done little to support the wages of employees serving Vermonters under the Medicaid long-term care program known as Choices for Care, a program that was fragile before the COVID-19 pandemic began. 
 
Interstate Nurse Licensure Compact.
The House Health Care and Government Operations Committees held separate hearings on Tuesday on  S.125 , a bill that allows Vermont to join the Interstate Nurse Licensure Compact. The bill will enable a licensed practical nurse or a registered nurse to practice in all Compact states without obtaining individual state licenses.  Thirty-four states are signatories to the Compact . The Office of Professional Regulation, the Board of Nursing, the VNAs of Vermont and many other health care organizations are supportive of the bill as one tool to address the nursing shortage.

COVID-19 Testing and Quarantine
The Vermont Department of Health is working to ramp up COVID-19 testing to  1,000 tests per day  through a variety of mechanisms including pop-up testing sites. The health department has opened a dialogue with the VNAs of Vermont about how home health and hospice agencies can help with these efforts.

The health department issued a health alert reducing the  period of quarantine  for possible COVID-19 exposure from 14 to 12 days, with a negative test.

Provider Relief
DVHA has released a Sustained Monthly Retainer program available on the main  DVHA COVID-19  page. DVHA has also released an  updated FAQ . 
Time to Respond to the Census
If you haven’t yet responded to the 2020 US Census, now’s the time: go to my2020census.gov. Responses to the 2020 Census shape decisions about how billions of dollars in federal funds flow into communities each year for the next 10 years for critical services. And Vermont is currently about 10 percentage points behind the national average for self-responding. On more rural areas, the reponse rate is even lower. Health care, emergency response, schools and education programs, and roads and bridges are all impacted by the 2020 Census.

Educational Opportunities
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