Legislative Update 2-21-22: Rise and Legislate

Rise and Legislate!

by Devon Green, VP of Government Relations
When Rep. Fagan from the House Appropriations Committee asked me to quickly pull together all of our chief nursing officers to discuss workforce and increasing clinical education opportunities, I knew it was a tall order. Our chief nursing officers are working the floor right now due to staffing shortages. In the end, the only time that worked was 6:30 a.m. on Friday. Luckily, key legislators and several representatives from higher education accommodated our schedule, and our chief nursing officers had the opportunity to advocate for increasing resources towards the shared faculty model, preceptor pay, backfilling clinical positions that are used for instruction and livable stipends for nurses pursuing advanced degrees. 
Thank you to Rep. Peter Fagan from the House Appropriations Committee, Rep. Anne Donahue from the House Health Care Committee, and Rep. Stephanie Jerome from the House Committee on Commerce and Economic Development, as well as several representatives from Vermont State Colleges, Norwich University and the University of Vermont for getting up so early to meet with us. Most importantly, thank you to our chief nursing officers and all our nurses throughout the state.
Workforce: House Health Care considered a draft memo, informed by the meeting with chief medical officers, to send to the House Commerce and Economic Development Committee for incorporating in H.703, a larger workforce bill. The recommendations include:
  • increasing nurse faculty pay by $10,000 per year for three years—total $2.4 million funding for nurse preceptors at hospitals
  • $3 million in funding for pipeline programs
  • $3 million for continuing nurse scholarship programs 
  • $2 million for a loan repayment program that includes APRNs
  • $500,000 for scholarships and/or loan repayment for graduate level nursing programs
  • $2 million in funding for simulation labs
  • Green Mountain Care Board (GMCB) review of hospital investment in workforce and consideration for excluding such investment from caps set
  • GMCB review of executive and clinical leadership pay and hospital salary spreads
  • Establishment of a health care workforce coordinator at the Office of Health Care Reform
Mental Health: The House Health Care Committee heard from the Department of Mental Health on suicide prevention efforts in the FY ’23 budget, including the Zero Suicide Initiative, a statewide coordinator position, expanding programs and supports for older Vermonters and the 988 Suicide Prevention Line taking effect on July 16, 2022. The Committee also heard from University of Vermont Medical Center and the Larner College of Medicine about the role firearms play in suicides in Vermont.
Prohibition of Firearms in Hospitals: S.30, the bill prohibiting firearms in hospitals, is on Gov. Scott’s desk. In the next day, he will have to decide whether to sign it, veto it or allow the bill to pass into law without his signature. Please show your support for the bill by contacting the governor’s office today.
Global budgets: The House Health Care Committee heard from VAHHS on the Green Mountain Care Board’s request for $5 million to pursue hospital global budgets and community-centered care transformation and technical support to hospitals and communities. VAHHS testified that our current health care system is fragile, with Vermont having the highest number of hospitals in the nation reporting critical staffing shortage, about 100 patients waiting for subacute or long term care beds and 35 patients waiting in emergency departments for mental health treatment. Any health care reform efforts going forward need to formally involve hospitals in the development and governance process. Additionally, the Green Mountain Care Board should work with hospitals and communities to hear about needs on the ground, instead of a top-down approach with consultants. The Green Mountain Care Board and the House Health Care Committee agreed on the importance of an approach that involves hospitals and communities.
Reference pricing: The State Auditor’s Office presented information to the Senate Health and Welfare Committee on reference-based pricing for the State of Vermont employees’ insurance plan. The concept is to take prices for medical services across all hospitals and pay no higher than the midpoint price. The Auditor’s Office estimated that this would save the state $16.3 million and proposed that the Agency of Administration conduct a more comprehensive analysis for going forward with implementation. VAHHS has requested an opportunity to comment on this proposal and will emphasize how little capacity there is in the hospital system to sustain this large of a reimbursement cut, especially with several other health care reform efforts being considered. 
Health Equity: Both health care committees came together to hear the Preliminary Findings on Health Equity in Vermont from the Health Equity Advisory Commission. The Director of Racial Equity noted that the breadth and depth of this work requires significant time and community input. To tackle Act 33’s legislative mandate, the Health Equity Advisory Commission has established seven subcommittees:
  • Access to Care
  • Policy and Programming
  • Training
  • Engagement and Communication
  • Data
  • Prevention, Upstream Services and Social Determinants of Health
  • Grants and Funding
Although significant time is needed to thoroughly do this work, the committee should still consider making investments in data infrastructure now to help address gaps and disparities across systems.