Legislative Update 4-12-21
By Devon Green
Vice President of Government Relations
Much like the weather, April in the legislature often brings its share of chaos and frenzy as we head into the home stretch. While it’s usually exciting, the unpredictability of the legislature hits a bit differently this year. Under COVID, every time our hospitals get their feet under them, another operational challenge presented itself—procuring PPE, creating negative pressure spaces, suspending services, testing and screening, resuming services, and administering community vaccinations. As the prevalence of variants rise, we continue to see outbreaks that fill ICUs and other hospital beds. Hospital budgets statewide have only a $3 million operating margin on a $2 billion dollar system. Unpredictability is hitting our hospitals from every angle right now. Adding legislative unpredictability on top of it feels like a bridge too far.
Health Care Reform: The Senate Health and Welfare Committee looked at two bills related to health care reform, S.132 and S.120.
Chair Lyons noted that it is unlikely everything in S.132 will pass, given the late date in the session. The bill includes expansion of hearing aid coverage, durable medical equipment reform and coverage of two primary care visits per year. The bill also shifts distribution of value-based payments and shared savings from Accountable Care Organizations to the Green Mountain Care Board, requires the Green Mountain Care Board to review and approve every health care contract between health care providers and payers and gives the state auditor access to Accountable Care Organization records.
S.120 creates a study committee to explore health care affordability for Vermonters. It is possible that the latest provisions in the American Rescue Plan Act, which increases subsidies for premiums and out-of-pocket costs will substantially improve health care affordability for Vermonters buying health insurance in the individual market.
Provider Reimbursement Options: The Senate Health and Welfare Committee has heard significant testimony on the Green Mountain Care Board’s Act 159 report regarding options for regulating provider reimbursement, including:
- Setting health system budgets, similar to the global budget process in Maryland and Pennsylvania
- Reimbursement parameters, similar to what the Green Mountain Care Board does now with hospital budgets, but expanded to entity-based or service-based caps and floors
- Fee-for-service rate setting
The fee-for-service rate setting model appears to be a nonstarter because it does not align with Vermont’s current health care reform goals. It is unclear how much can be done in the other areas, given the late date in the session and the impact that such a change would have on the health care system.
Stem Cell Legislation: The House Health Care Committee heard testimony on S.22, which would require health care providers to notify patients that a stem cell product has not received FDA approval. Dr. Daniel Weiss from the University of Vermont Medical Center testified that “stem cell” clinics using therapies not approved by the FDA are putting patients at risk.
Competency to Stand Trial and Study of Forensic Care Working Group: VAHHS will be testifying in the House Corrections and Institutions Committee on S.3, which includes a working group to identify gaps in the current mental health and criminal justice system and opportunities to coordinate treatment for individuals who are incompetent to stand trial or who are adjudicated not guilty by reason of insanity. It is crucial that we examine ways to improve the treatment of individuals who fall in this category of “forensic” mental