Legislative Update
Devon Green, VP of Government Relations

Happy Valentine’s Day! Every year, just as the legislative grind is really hitting, Montpelier pulls off a small miracle and covers itself in hearts. Thank you to the forces behind this effort—it never fails to make me smile.
And now, for what’s happening underneath the golden dome and in all the Zoom rooms:
Workforce: VAHHS testified in House Health Care on hospital workforce needs, citing 2,600 open positions statewide with the highest need for RNs and LNAs—a big thank you to our HR Directors for getting us this information. VAHHS recommended the following:
  • Data hub housed within state government to better target need and measure success of initiatives
  • Resources for hospital partnerships with higher education to increase shared clinical faculty and develop talent pipeline programs
  • Dedicated health care workforce liaison at the state to focus on retaining recent grads and attracting international professionals
  • Student loan forgiveness and scholarships
  • Reduced administrative burden, such as less prior authorization, to retain current workforce
  • Sustainable funding through increased Medicaid rates so that hospitals can invest in retaining, training, and attracting workforce

Combined with hearing last week’s testimony from higher education institutions, the committee appears to be coalescing around supporting nurse faculty and training opportunities.
Mental Health: The Department of Mental Health presented its report on Residential Beds for Individuals Discharged from Inpatient Psychiatric Care to the Senate Institutions Committee. The DMH put out a request for information on transitional support in unlocked community residences for individuals discharged from inpatient psychiatric care or to prevent inpatient admissions. The Department received six responses from community organizations.
Senate Institutions also heard from the Agency of Human Services with an update on the IMD Waiver phasedown. At this point, CMS has not required further phasedown until June of 2022, when Vermont is renegotiating its Medicaid waiver and sustainable IMD funding will be a top priority.
Hospital Sustainability: The Green Mountain Care Board presented its Hospital Sustainability Planning Report required under Act 159 of 2020 to both Senate and House health care committees. The GMCB pointed out that Medicaid rates do not cover the cost of care. Under the current fee-for-service system, hospitals must raise commercial rates or make changes to their service mix to cover costs. While Vermont has moved toward a value-based model through its All-Payer Model agreement and OneCare, GMCB believes the transition has not been fast enough. To address these issues, the GMCB is proposing a $5 million appropriation in the FY ’23 budget to do the following:
  • Design predictable, flexible, and sufficient global payments to hospitals and apply the design to the next All-Payer Model agreement. Currently, global payments follow attributed lives in OneCare; this would attempt to apply a global payment to the whole hospital, although many details, including how commercial payers would be included, remain to be ironed out.
  • Bring in experts in health systems optimization and engage communities to reduce inefficiencies, lower costs, improve population health outcomes and increase access to essential services
  • Provide hospitals with technical assistance for care delivery reform efforts

The health care committees were very interested in moving forward with this work. VAHHS will continue to provide hospitals’ perspective as discussion continues. While hospitals have long supported reform work, any consideration of a new model must be careful and process-driven.
Primary Care: The Senate Health and Welfare Committee took testimony on S.244, which proposes to boost spending on primary care to 12% of overall health care spending. The bill also aims to bring audio-only reimbursement back to parity with in-person visits.
Prohibition of Firearms in Hospitals: The House passed S.30 in a vote of 91-53, and it now makes its way to the governor’s desk. VAHHS members, please be on the lookout for action alert e-mails in the coming weeks.
Prescription Drug Repository: The Senate Health and Welfare committee heard testimony from the Vermont Department of Health supporting S.243, requiring the Agency of Human Services to conduct a study on the feasibility of a centralized repository to accept, provide quality control, and re-dispense unused prescription drugs safely and affordably. VAHHS supports this effort.
In the News
Vermont edges downward toward pre-Omicron Covid case average

The Vermont Department of Health reported an average of 418 Covid-19 cases per day in the past week, bringing Vermont closer to the daily caseloads it reported before Omicron became the dominant strain in the state.

It’s hard to say exactly when Omicron became the primary source of new infections, since the state didn’t check the strain of every positive test for the coronavirus. But around mid-December, when federal data estimated that the Delta strain was still dominant in New England, Vermont was reporting about 400 cases per day.

That average was still significantly higher than cases during the summer, before Delta became dominant. In mid-July, Vermont reported fewer than 100 cases per day.

As Omicron recedes, experts warn against a premature shift
Mountain Times

Recent trends in Vermont’s Covid-19 case counts have officials and experts feeling optimistic about the course of the pandemic — but all warn it would be premature to brush off the Omicron threat just yet.

As of Friday, Jan. 28, the state’s seven-day average for daily new cases had fallen by more than half since its peak Jan. 9, a sign the worst of the past month’s surge may have passed.

But officials continue to warn that case counts have been skewed: The more people that use at-home rapid tests rather than state-administered PCR tests, the less accurate Vermont’s case and test positivity metrics will be.

And many of the most drastic effects of the Omicron variant are still being felt. Hospitals remain under serious strain with elevated numbers of Covid-19 patients continuing to stress a diminished workforce. Schools and families are still contending with the disruptions of widespread staff and student absences due to Covid-19 infections. And fatalities in Vermont continue to climb, with 54 Covid deaths — the third-highest monthly total of the pandemic — reported so far in January, as of Friday.
Pfizer postpones FDA request for Covid vaccine for kids under 5

Pfizer-BioNTech is postponing its rolling application to the Food and Drug Administration to expand the use of its two-dose Covid-19 vaccine for children ages 6 months to 4 years.

The move means that vaccines for this age group will not be available in the coming weeks, a setback for parents eager to vaccinate their young children.

Pfizer said on Friday that it will wait for its data on a three-dose series of the vaccine, because it believes three doses "may provide a higher level of protection in this age group." Data on the third dose is expected in early April, the company said.

Pfizer said in December that two doses didn’t generate a strong enough immune response in its trial of children ages 2 to 4. For young children, Pfizer’s vaccine has a dosage of 3 micrograms. For children ages 5 to 11, the dosage is higher, at 10 micrograms.
Final Reading: A Very Serious Inquiry

A bill that keeps in place looser regulations on Vermont’s health care system is nearing a final vote in the Senate.

If approved, the bill would keep in place Act 6, a set of relaxed health care regulations lawmakers first adopted in the early days of the pandemic. The House already OK’d this most recent extension. The Senate is expected to expedite the vote so that the provisions would not lapse when the law is scheduled to expire in March.

Senators slightly amended the bill to ask the Green Mountain Care Board to consider the “extraordinary labor costs” facing hospitals in this year’s budget review process.

RRMC doctor explains what to do after positive COVID test
Rutland Herald

With home testing tests for COVID now available, there may be some questions about the difference between tests and what to do if a test provides a positive result.

Dr. Rick Hildebrant, chief medical information officer and director of hospital medicine at Rutland Regional Medical Center, offers some guidance.

“I think there’s a lot of confusion about, ‘What exactly is an antigen test versus a PCR test?’ I think other than the fact that people know you can do an antigen test at home and a PCR test requires a lab, people don’t oftentimes understand exactly how the technology works,” he said.
Planned Parenthood announces Newport clinic closure

Planned Parenthood announced it will close its Newport Health Center on Feb. 24, leaving patients in the area to find alternative places to obtain affordable reproductive care and other health services.

However, the closure will not affect abortion services because the Newport clinic did not provide them. 

The closest Planned Parenthood clinics are in St. Johnsbury and Hyde Park, each about 45 minutes away. 

Kai Williams, senior vice president of Planned Parenthood of Northern New England, said in a statement that the organization faced challenges delivering care to Newport that were exacerbated by the pandemic. 

“Because of limited resources and the national crisis for reproductive health access, we’re reallocating our resources,” she said. 
Hospitals in the News
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