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Legislative Update 2-18-19

February 15, 2019

Last Week

Mental Health Data: VAHHS testified with the Department of Mental Health in Senate Health and Welfare on the number of visits and length of stay for patients seeking mental health treatment through emergency departments as well as patients receiving inpatient psychiatric treatment.  VAHHS noted that there were about 10,000 visits to the emergency department and 5,000 visits to inpatient units.  We concluded, similarly to the UVM Health Network’s analysis, that a significant number of individuals waiting in emergency departments would benefit from community services, and all parts of the mental health care continuum must be fully resourced.  VAHHS started collecting this data in 2017 when it emerged that there was no centralized data collection effort to capture all adult psychiatric inpatient stays, since the Department of Mental Health only has complete data on people served involuntarily in hospitals. We hope to continue our data collection efforts and work with the Department of Mental Health so that we can identify trends and help inform policymakers and health care providers with a complete view of Vermont’s mental health care system.

Bill Back: VAHHS testified in House Ways and Means on the Administration’s budget proposal shifting $2.5 million in Green Mountain Care Board funding to hospitals and insurance companies.  VAHHS emphasized the current contributions hospitals are making towards health care reform and mental health in the form of $27 million towards community provider coordination through OneCare Vermont and over $30 million dollars for inpatient beds, emergency department improvements, and new staff.  At the same time, Vermont’s hospitals face substantial challenges from $15 million in previous year Medicaid cuts, to workforce shortages, and caps on budgets. 

Disclosure and Surprise Billing: VAHHS testified on S.31, which would require hospitals to disclose to patients whether bills will be sent to collections, if there is a financial conflict of interest, the cost of elective services and alternatives, and facility fees.  VAHHS explained that hospitals disclosing facility fees would not solve the problem of the independent provider who has privileges at a hospital because hospitals do not have authority over independent providers.  VAHHS also put forward the idea of simple billing—having insurers collect out of pocket costs to shift the administrative burden off the consumer.  The bill would also codify Vermont’s current regulatory protection of insured patients for out-of-pocket costs from out-of-network providers.  Blue Cross Blue Shield of Vermont proposed that in addition to protecting the consumer, the legislation should require all providers working in a hospital setting to be in the same networks as the hospital.   

Tobacco 21:  Senate Health and Welfare heard testimony on S.86, raising the age limit for tobacco use from age 18 to 21. In last week’s VAHHS Update you read how the Hawaii legislature wants to raise the minimum from 18 to 100, making 21 seem like an attainable goal. Mark Levine, Commissioner of the Department of Health, emphasized the public health benefits of avoiding addiction to tobacco products at a young age and pointed out how enforcement would be simplified if alcohol, marijuana, and tobacco age limits were all 21 years of age.  He also noted that the governor would not oppose this initiative. 

Mental Health Payment Reform: The Department of Mental Health and Vermont Care Partners presented on payment reform efforts with the Designated Agencies.  Under the new payment model, Designated Agencies will receive a monthly case rate based on a weighted average of the past three years.  This new model will provide some flexibility for managing care. 

This Week

Budget: The House Health Care Committee is working on its budget memo and will be tackling issues such as:

  • funding for sheriffs in the emergency department;
  • new beds for community living programs for individuals with complex mental health needs;
  • bill back proposal of increasing hospital and health insurer contribution to the Green Mountain Care Board by $2.5 million.


 Devon Green, Vice President of Government Relations