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Legislative Update
by Devon Green
Vice President of Government Relations


VAHHS 2021 Legislative Session Summary

Back in January, as I worked with hospitals on setting up vaccine clinics, procuring testing supplies, and other COVID-related responses, I hoped against hope that the legislature would limit their activity to COVID issues.
 
Of course, not even Zoom squares can contain our legislators. Now, I’m relieved that they expanded their scope because we made a lot of progress in important areas like workforce, mental health, and health equity. I thank all of our legislators for their support on these initiatives and of their local hospitals. 
 
Below is a summary of the legislative initiatives tracked by VAHHS that passed this year.
 
COVID-19 State Regulatory Flexibilities
  • Regulatory flexibility extension: Under Act 6, many regulatory flexibilities will be extended to end of March 2022. For a summary, go here.
  • Audio-only reimbursement: Act 6 also requires the Department of Financial Regulation (DFR) to determine the appropriate codes in the billing and payment of audio only by July 1, 2021 and requires all health care providers and health insurers to use those codes by January 1, 2022. It also requires DFR to determine reimbursement amounts for audio only for health plan years 2022-2024.
 

Workforce Initiatives
  • Interstate Nurse Licensure Compact: S.48 passed, allowing Vermont to enter into the interstate Nurse Licensure Compact and takes effect on February 1, 2022.
  • Scholarships for physicians and nurses: $2.27 million in the budget
  • Higher Ed Tuition-Free Year: the budget includes funding for one year of free tuition for critical occupations, including allied health programs at CCV and undergraduate studies at Vermont State Colleges for dental hygiene, radiologic science, respiratory therapy, and paramedic/EMS programs. Funding at Vermont State Colleges is also available for practical nursing, nursing, and mental health counseling.
  • Working Group on Interstate Practice Using Telehealth: Act 21 creates a working group to make recommendations on facilitating the interstate practice of health care professionals using telehealth.
 

Mental Health
  • Changes to notice of rights and consent: Act 30 goes into effect on July 1, 2021 and requires all inpatient psychiatric units to inform patients:
  • Notice of rights: that the patient may apply to have his or her status changes from involuntary to voluntary.
  • Consent: voluntary patients understand that they may be placed on a locked unit.
Act 30 also requires continued reporting of emergency room wait times for patients seeing mental health care in hospital settings until 2023.
  • Secure residential recovery facility: The capital bill provided funding for the design and construction of a 16-bed secure residential recovery facility to replace the temporary Middlesex Therapeutic Community Residence.
  • Mobile crisis pilot in Rutland: Funding in the budget for a pilot mobile crisis intervention program in Rutland.
  • Children waiting in emergency departments: The House Health Care Committee sent a letter to the Department of Mental Health, the Agency of Human Services, and VAHHS setting out timelines and a framework for addressing the issue of children in mental health crisis waiting in emergency departments.
 

Addressing Disparities and Promoting Equity in Health Care
  • Act 33 creates a Health Equity Advisory Commission advise the Office of Health Equity, make recommendations to the Office of Health Equity, once it is established, and identify issues with existing policies related to the health status of individuals who are Black, Indigenous, Persons of Color; individuals with disabilities, and individuals who are LGBTQ.
  • The commission will also provide recommendations by October 1, 2022 to the legislature for improving cultural competency in Vermont’s health care system as well as recommendations for using funds under the American Rescue Plan Act to promote health equity.
  • The law also requires all state entities collecting health-related individual data to disaggregate health equity data by race, ethnicity, gender orientation, age, primary language, socioeconomic status, disability, and sexual orientation.
 

Health Care Reform
  • Delivery System Reform Investments: The budget included $3.9 million to support health information technology projects and Delivery System Reform efforts to implement the All-Payer Accountable Care Organization Model including health information technology projects and the continuation of the Longitudinal Care Home Health Program. 
  • Coverage for eligible children and pregnant individuals regardless of immigration status: Act 48 created Dr. Dynasaur-like health care coverage for Vermonters who are pregnant or under 18 and otherwise financially eligible for Dr. Dynasaur but do not qualify due to their immigration status.
  • Report on including coverage of hearing aids and DMEs and more: The budget requires the Department of Financial Regulation to determine the potential impacts of including coverage for hearing aids, dentures, vision care, DMEs, fertility services, and at least two primary care visits in Vermont’s benchmark plan.
  • Task Force on Affordable, Accessible Health Care: The budget created a legislative task force to provide recommendations to the legislature by January 15, 2022 on the most cost-effective ways to expand access to affordable health care for Vermonters.
 

340B
  • Prohibitions on PBM reporting and network requirements: The budget includes a prohibition on pharmacy benefit managers from requiring pharmacies to do certain reporting on 340B drugs or restrict access to a pharmacy network due to participation in the 340B program.
  • Report on State responses to prescription drug manufacturer and PBM actions affecting 340B: Also in the budget, by January 15, 2022, the Department of Financial Regulation, in consultation with the Office of the Attorney General, will report on the latest national activity affecting the 340B Drug Pricing Program and possible State responses.

In the News
Welch in Brattleboro: Community response to pandemic was 'truly humbling'
Brattleboro Reformer

Rep. Peter Welch was in town on Friday, visiting with care providers at Brattleboro Memorial Hospital, checking out a performance at the New England Center for Circus Arts and meeting with the organizers of a BIPOC-specific CSA at the Retreat Farm.

The message he took away from the visit was that when the going got tough this past year, people across the community pulled together to weather the pandemic storm.

“It’s truly humbling to listen to you and hear what you did,” Welch said during the meeting at BMH. “There was no roadmap. Everybody had to find a way and you had to do it when you were getting the same warnings about how contagious and how fatal this disease was. You had a lot of responsibility for the people who were depending on you.”
Town-by-town vaccination data shows strong overall picture with some lagging areas
VTDigger

As of last Thursday, Vermont reported 77.6% of the state’s population received at least one dose.

When the state reaches an 80% vaccination rate, Gov. Phil Scott says he’ll drop all remaining mandates and restrictions.

In Burlington, where the city council extended the mask mandate – reaching the 80% mark could lift it sooner.

Vermont’s largest city extended the mask mandate even after the CDC released its latest guidelines. Mayor Miro Weinberger’s emergency order allowed city council to do so.

However, when the governor lifts all mandates, Weinberger can lift the emergency order, which means mask guidance could change as soon as today.
Even as Vermont plans to reopen, residents weigh ongoing risks of Covid-19
VTDigger

The end of the pandemic is in sight — at least by the state’s official measures. 

Vermont is on target to achieve an 80% Covid-19 vaccination rate this week, clearing Gov. Phil Scott’s threshold to relax virus-related safety precautions. Scott eliminated the 10 p.m. curfew at bars and restaurants as of Saturday, and case counts are the lowest they’ve been since fall. 

But as some public health experts warn of a possible spike in cases this fall, the virus continues to run rampant in parts of the world, portions of the population remain unvaccinated, and some Vermonters are hesitant to shed their masks and return to a pre-pandemic way of life.

“I’d rather be a little bit cautious for a little bit longer,” Burlington resident Jenn Moore said.

“I think about going to a busy amusement park or something, and it just makes me cringe.”
Vermont's restrictions 'days away' from being lifted
Bennington Banner

With about 78 percent of Vermonters 12 and older getting at least one dose of a vaccine, Gov. Phil Scott anticipates the state is “days away” from rescinding its COVID-19 restrictions.

“Just 11,346 to go before we hit 80 percent and all restrictions will be lifted,” he said Tuesday at his twice-weekly news conference.

Federal data regarding shots given Sunday and Monday was expected to arrive later in the afternoon and bump the number up a bit. Scott said a news conference could be scheduled before Friday’s if the 80 percent threshold is met sooner.

Indoor spaces are currently required to have 50 square feet for every unvaccinated person and masking is required inside establishments for unvaccinated people.

Masks are still mandated in hospitals, prisons and public transportation as well as places where municipalities or establishments require them.
Vt. offers weekend vaccination clinics in push to 80%
WCAX

Governor Phil Scott is announcing new walk-in clinics for the weekend as the state works to make the COVID vaccine more accessible.

As of Thursday, 78.6% of eligible Vermonters had at least one dose of the vaccine. That means 7,878 more people are need to reach the governor’s 80% goal. Scott says when the state reaches 80%, the state will lift all restrictions.

“Vermonters have stepped up throughout this pandemic and we are very close to our vaccination goal,” Scott said in a written statement. “As we’re seeing a slow-down in the number of people being vaccinated, we need those who have not yet gotten their shot to find a clinic today. It has never been easier, with hundreds of clinics across the state. Vaccines are free, safe and very effective - now is the time.”

To ensure as many Vermonters as possible can get their vaccine, the state is offering dozens of new walk-in clinics this weekend. Many pharmacies will also now take walk-ins, Scott said.
Vermont becomes the first state to legalize limited possession of buprenorphine
VTDigger

On Tuesday, Vermont became the first state in the nation to legalize possession of buprenorphine, a prescription drug used to treat opioid use disorder. 

This week, Gov. Phil Scott signed H.225, a bill that will allow people to possess up to 224 milligrams of the drug — roughly a two-week prescription of the substance — even if they don’t have permission from a doctor. Previously, that qualified as a misdemeanor. 

Before it became law, the measure was debated in the Legislature for three years and hit a delay when the Covid-19 pandemic struck last year. Since then, drug overdoses in the state have spiked, which lawmakers said gave the bill new urgency. 

Supporters of the policy say it will prevent overdoses and save lives by encouraging people with substance use disorders to choose buprenorphine over heroin. 
Hospitals in the News