Legislative Update: 5-3-21

by Devon Green
Vice President of Government Relations
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