Legislative Update 4-26-21

I was going to write something about the different “personalities” of the legislative committees, but it rang hollow upon reflecting that our emergency departments are overwhelmed right now—not with COVID patients—but children and adults in mental health crisis waiting for days and weeks at a time. The mental health of Vermonters is the next public health emergency. VAHHS is hoping to work with the legislature and state agencies to bring to our current mental health crisis the kind of resources, regulatory flexibility, workforce development and data collection efforts Vermont successfully deployed to take on COVID-19.

Last Week

Children and Adolescents in Mental Health Crisis in Emergency Departments: The House Health Care Committee heard testimony from Dr. Christian Pulcini, Pediatric Emergency Medicine at UVMMC, Dr. Alison Kapadia, Service Director for BMH Emergency Department, and Dr. Kathleen McGraw, Chief Medical Officer at BMH, on children in mental health crisis waiting for days and weeks in emergency departments. VAHHS supported the health care provider testimony with additional statewide data. The committee also heard from the Department of Mental Health, Vermont Care Partners with more information on the Psychiatric Urgent Care for Kids, as well as concerned parents. Chair Lippert expressed his desire that this be treated as a public health emergency with a goal of zero children in mental health crisis waiting in emergency departments for more than a few hours.

Health Equity Legislation: H.210, a bill creating a commission to promote health equity and eradicate health disparities among Vermonters, continued to move forward with an unanimous vote from the Senate Health and Welfare Committee. The commission will consult with stakeholders, including health care providers, and report back with proposals to improve cultural competency and antiracism in the health care system. 

Secure Residential Facility: The House Institutions Committee passed the Capital Bill out of its committee, including $11.6 million in funding for a 16-bed residential facility serving Vermonters who no longer need inpatient mental health treatment, but still need a transitional level of care before going back to the community. The facility will be funded by the American Rescue Plan Act. The bill also requires the Department of Mental Health to conduct a bed needs assessment at all levels of care in the mental health system. 

Interstate Practice Telehealth Work Group: The Senate Health and Welfare Committee approved H.104, which will take lessons learned from the COVID-19 public health emergency and evaluate ways to promote the use of telehealth across state lines, including telehealth licenses, waiver of licenses, national licensure compacts, and regional reciprocity agreements. 

Mental Health Bill: The Senate Health and Welfare Committee passed out H.46, a mental health bill that requires the following:

• voluntary patient consent to the understanding that inpatient treatment may be on a locked unit
• DMH to collect information and report on data regarding the use of emergency involuntary procedures for patients admitted to a psychiatric unit regardless of whether the patient is under the care and custody of the DMH commissioner.
• Reporting of emergency room delays for patients seeking mental health care in hospital settings until 2023 

This Week

Interstate Nurse Licensure Compact: Thank you to the health care providers who reached out to members of the House Government Operations Committee on S.48, the Interstate Nurse Licensure Compact. The committee continues to work on the bill and will likely vote on it Tuesday afternoon. We will keep a close eye on it and keep you informed.

Health Care Reform Legislation: Last week, the Senate Health and Welfare Committee heard testimony from VAHHS and other health care provider organizations on S.132, which gave the State Auditor the power to audit OneCare Vermont and required the Green Mountain Care Board to approve all health care provider contracts and determine how shared savings under the All Payer Model should be spent. They also heard testimony on S.120, which would create a task force to evaluate OneCare Vermont and examine ways to make health care more affordable for Vermonters. VAHHS testified that while the All Payer Model and OneCare Vermont are trying to lower the overall cost of care through coordinated care and preventive care, real relief from high premiums and deductibles needs to come through examining the latest opportunities under the American Rescue Plan Act and changes to insurance plans. This week, the committee will likely finalize a bill that strips out the proposed new powers for the Green Mountain Care Board and State Auditor and will create a task force to explore opportunities to expand existing programs and make Vermont’s health care more affordable. 

VAHHS and Bi-State Primary Care also proposed language that would prohibit Pharmaceutical Benefit Managers (PBMs) from requiring pharmacies to follow additional requirements or restrictions on prescription drugs under the 340B program. We will learn more when the committee revisits the bill this week.