From the CEO
Gov. Scott powerfully remarked back in February that “our kids are not okay.”

He is right. Social isolation, continued disruption in schools and the ongoing effects of the pandemic have taken a major toll on young people. Over the past many weeks, we have seen this play out in hospital emergency departments where a growing number of young people are waiting for proper mental health care.

Last month, pediatricians, emergency room physicians, advocates and families told the legislature in a clear and resounding voice that they agreed the kids are not okay—that youth and families are under more stress than ever as a result of living in a pandemic while managing social isolation, economic insecurity, and the pervasive threat of COVID-19.

Families and clinicians are correct when they say any child waiting in an emergency department for help is one child too many. The reality is that we now face a public health crisis a decade or more in the making. Vermont teens, for example, described their struggles before the pandemic—31% reported feeling sad or hopeless; 13% had made a suicide plan; and 7% had attempted suicide. All of these rates are higher than they were a decade ago.

With diminished capacity in our schools, community and inpatient settings, and growing need among patients, one result is youth waiting in emergency rooms for days or even weeks to receive the right inpatient care.

We know we have to act quickly and thoughtfully to get our kids and families the help they need. To start, we need to understand the magnitude of the problem. In the last few weeks, VAHHS began collecting data to help inform providers and policy makers. We have also outlined several short-term and long-term actions to address this public health crisis.

As I mentioned, this is not a new problem. Hospitals themselves have been addressing this challenge for many years. They have:

  • Retrofitted spaces, especially emergency departments, to improve safety and privacy.
  • Hired more staff, including one-to-one sitters—a significant feat with our workforce challenges.
  • Increased telepsychiatry services to see more patients and continue care during quarantine and stay-at-home orders.
  • Added beds where possible.
  • Advocated for workforce, physical and financial resources at all levels of the system. 

Patients—both adults and children—waiting for mental health care in hospital emergency rooms is a persistent challenge, not just in Vermont but across the country. It is an intolerable situation that requires our immediate attention and long-term planning and resourcing. Some things can be done quickly while others require much more time. Here is a partial list of needed steps:

  • Continue to look at our admission and transfer processes to help children get the treatment they need faster.
  • Make available more telepsychiatry services. We are working hard to be sure providers can be paid for that care, which does take place now.
  • Obtain state and federal support for the infrastructure and workforce we need
  • Work with the state to determine how and where to increase capacity for both inpatient care, community care, and the intersections of/alternatives to emergency departments. That work will likely take years, especially if new buildings are needed.

This week, the legislature will hear from the Agency of Human Services on their proposed solutions. I know hospitals will be eagerly listening and ready to roll up our sleeves to help Vermont’s kids.

To work through this set of challenges, everyone needs to be at the table and employing a collective, thoughtful approach rather than a piecemeal or finger-pointing one. VAHHS and its member hospitals and clinicians will continue to work closely with state leaders and community partners to improve the outlook in every way we can.

This is children’s mental health awareness week, and May is mental health awareness month. There is no better time to commit to a different and better reality. I am optimistic that if we stay focused on this work and bring the right resources to it, we will make meaningful progress this year on behalf of young and older people alike.
Legislative Report
by Devon Green
Vice President of Government Relations

Legislative Update

Although our recent weather screams March, the legislature is moving full steam ahead with typical May activities. Vermont’s senators serve on two legislative committees—a morning committee and an afternoon committee. Last week, the Senate morning committees shut down, signaling that a lot of the policy work has been completed and the legislature is shifting gears to focus on finalizing the budget and setting up conference committees with the House to work out the kinks of final bills.  
Last Week

Budget: The Senate passed H.439, adding $191 million to the House-passed budget for a total of $7.175 billion, including half of the American Rescue Plan Act funding. The bill includes:
  • $2.72 million to continue nursing and primary care scholarships
  • $11.6 million for a 16-bed secure residential facility from the capital bill
  • $600,000 for a mental health mobile crisis unit in Rutland
  • $5 million for mental health/substance use disorder treatment workforce
  • An additional $3.9 million to support the All-Payer Accountable Care Organization Care Model
  • Funding for health care coverage for pregnant individuals and children who do not qualify for Medicaid due to immigration status
  • Funding for a mental health warm line
  • Funding for work on health disparities
  • $40,000 for the expansion of forensic medical care for sexual assault patients to primary care settings
Much remains to be seen on the budget after Governor Scott expressed concerns about the ARPA spending last week.
Interstate Nurse Licensure Compact: The Interstate Nurse Licensure Compact, a key proposal for addressing the nursing workforce crisis, looked like it was faltering in House Government Operations last week until the committee agreed on language that would ensure the Office of Professional Regulation would not increase licensure fees without looking at alternative fee structures and coming to the legislature for approval. The bill, S.48, is now in House Ways and Means after receiving a brief review in House Health Care. Many thanks to the health care providers who reached out to legislators in support of this bill—your advocacy is invaluable!
Health Care Reform: Several proposals in bills S.210 and S.120, including proposals to give the Green Mountain Care Board the power to distribute shared savings and approve health care provider contracts, have been stripped away to focus on health care coverage affordability for Vermonters. The task force for accessible, affordable health care for Vermonters from S.120 is now in the budget. 
Prohibition on PBM 340B Modifier: If you had any idea what the words “PBM 340B Modifier” meant, congratulations! You are a true health care policy expert. VAHHS and Bi-State pitched a last-minute proposal to counteract the recent efforts of a large pharmacy benefit manager to require pharmacies to flag prescription drugs under the 340B federal drug pricing program. This action by the PBM is seen as part of a larger effort to attack the 340B program. The proposal also has DFR and the Attorney General’s Office studying national activity around the 340B program and possible State responses. The Senate Health and Welfare Committee voted in favor of the proposal and Sen. Ginny Lyons was able to get the proposal into the budget as an amendment. Thank you, Sen. Lyons!
Forensic Care Working Group: The House Judiciary Committee passed S.3, which creates a forensic care working group to identify gaps and provide recommendations on coordination of treatment for individuals who are determined incompetent to stand trial or are adjudicated not guilty by reason of insanity.
Changes to Current Mental Health Law: The Senate passed H.46, which requires inpatient psychiatric units to inform patients with voluntary legal status that they may be treated on a locked unit and that a requested discharge may be deferred if their treating provider considers them a person in need of treatment. It also requires hospitals to provide information on assisting with changing a status from involuntary to voluntary with patient’s posted notice of rights.
Stem Cells: House Health Care passed S.22, a bill requiring health care providers to notify patients that a stem cell product has not received FDA approval prior to administration.
This Week

Children Awaiting Mental Health Treatment in Emergency Departments: The House Health Care Committee will be hearing from the Department of Mental Health and VAHHS on children waiting in emergency departments for psychiatric beds. VAHHS will advocate for:
  • Regulatory flexibility, including expedited CONs for changes to accommodate patients seeking mental health treatment
  • Resources across the care continuum, including partial hospitalization programs and workforce initiatives
  • Statewide coordination and accountability where ED wait times are used to help determine the effectiveness of mental health programs and initiatives

In the News
State to propose solutions for kids stuck in emergency rooms waiting for mental health care

The Department of Mental Health will propose a slate of options to help reduce the number of children waiting in emergency rooms for mental health care — but fully addressing the problem will require a system-wide overhaul, according to commissioner Sarah Squirrell.

Kids and teens who show up at the hospital while experiencing a mental health crisis have been left to languish in emergency rooms for days, waiting for open hospital beds or other treatment options.

In March, the average wait time in emergency rooms rose above 100 hours — more than four days. At one point this month, 19 children were waiting for care in hospitals around the state. 
Vt. COVID cases continue sharp decline

Coronavirus cases in Vermont continue to drop as more people get vaccinated and spend more time outside, and state officials say the state is on course to meet reopening benchmarks.

Tuesday marked nine straight days that Vermont has reported fewer than 100 cases, the longest stretch in five months. That, along with the rate of vaccinations is giving administration officials confidence they are on track. “Our cases are in a steady retreat and over the last seven days Vermont has had the second-fewest hospitalizations and deaths on a per capita basis in the country,” said DFR Commissioner Mike Pieciak.

UVM vaccine clinic prompts strong response

Johnson & Johnson Covid-19 vaccine clinic scheduled for Sunday at the University of Vermont is well on its way to being fully subscribed.

The clinic, set for 10 a.m. to 4 p.m. in Patrick Gymnasium, is open to students and members of the public interested in receiving the vaccine, which was made available again earlier this week after a 10-day pause.

Gary Derr, vice president for operations and public safety, said the clinic plans to administer 600 doses of the one-shot vaccine. As of Friday afternoon, only about 25 appointments were still available. 
Senate committee set to pass buprenorphine legalization bill

A Senate committee is prepared to approve a bill that would legalize the possession of small amounts of buprenorphine, a prescription drug used to treat opioid addiction.

Lawmakers heard hours of testimony on the measure in a joint hearing Thursday of the Senate Committee on Judiciary and the Senate Committee on Health and Welfare — mostly from advocates, state’s attorneys and lawmakers who spoke in favor of the bill, H.225, which they said could save lives.

Health Commissioner Mark Levine and Public Safety Commissioner Mike Schirling, however, spoke in opposition to the bill, suggesting that it could encourage more Vermonters to sell their medication-assisted treatment, rather than take it as prescribed.

A LOOK INSIDE: See video from within the Champlain Valley Expo’s vaccination clinic
Milton Independent

Vermont Care Partners(link is external) (VCP) and four member agencies announce the successful launch of the Unified Electronic Medical Records project using the Netsmart myAvatar(link is external) solution. myAvatar is the industry-leading electronic health record(link is external)

 (EHR) for behavioral health and addiction services and is a component of the Netsmart CareFabric(link is external) platform, an integrated framework of solutions and services used by providers for integrated healthcare.
Scott loosens outdoor mask rule as state expands reopening measures

Coronavirus cases in Vermont continue to drop as more people get vaccinated and spend more time outside, and state officials say the state is on course to meet reopening benchmarks.

Tuesday marked nine straight days that Vermont has reported fewer than 100 cases, the longest stretch in five months.

That, along with the rate of vaccinations is giving administration officials confidence they are on track. “Our cases are in a steady retreat and over the last seven days Vermont has had the second-fewest hospitalizations and deaths on a per capita basis in the country,” said DFR Commissioner Mike Pieciak.
Some non-residents eligible for COVID-19 vaccine in Vermont

Today, people who live in Vermont for part of the year can now sign up for COVID-19 vaccines.
People living in the state for part of the year, including college students who do not plan to stay for the summer, became eligible for the vaccine 10 days after Vermonters 16 and older got the green light.

UVM, Champlain College and Middlebury College have an 80-90% student population that’s from out-of-state.

However, because the last day of classes is coming up in about two weeks, many of them won’t get the shot in Vermont for convenience’s sake.
Hospitals in the News
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