Legislative Update
Devon Green, VP of Government Relations
Dear reader, apologies in advance, but this session is going to be short on intros and long on substance. Hope you’re ready to dive in for week 4’s recap:
Health Care Reform and Regulation: The Senate Health and Welfare Committee heard further testimony on S.211, the health care omnibus bill that includes changes to the Green Mountain Care Board in preparation for global hospital budgets under the AHEAD model. A professor from the Dartmouth Institute provided his suggested language and Blue Cross Blue Shield of Vermont opposed the bill in its entirety. The Vermont Medical Society and OneCare Vermont were in support of clarifying regulatory roles and stabilizing regulatory processes.
Direct Billing: In addition to standardizing claims edits and reducing prior authorizations, H.766 also proposes shifting the collection of out-of-pocket costs from health care providers to health insurers. Health insurers pointed out that the bill would only apply to some payers and would require a serious upgrade to its operations. VAHHS and the Vermont Medical Society supported the proposal because it reduces the administrative burden on health care providers and removes conflict from the provider-patient relationship. The Health Care Advocate questioned how insurers would absorb the cost of the effort and how financial assistance policies would work. The committee realized that direct billing is a massive shift but remained interested in alternatives to address the issue.
Medicaid Expansion: The House Health Care Committee heard testimony on H.721, the Medicaid Expansion bill that covers all individuals who are pregnant or under age 26, regardless of income, and phases in adult coverage up to 312% of the federal poverty level by 2030. The bill also proposes reimbursement increases of 125% of Medicare for primary care, mental health, substance use disorder treatment, and long-term care. VAHHS testified in support of greater access to care and the need for more analysis. For instance, prenatal, birthing, and post-natal services should be reimbursed at a higher rate if coverage extends to all pregnant individuals to ensure that birthing units stay open. As for other specialty care, hospitals would need to analyze whether greater coverage of services at a lower reimbursement rate would offset our current uncompensated care challenges.
Workforce Initiatives Update: The Vermont State Auditor testified on his report regarding the nursing workforce programs passed in 2022 in front of a joint meeting of the House Health Care and Commerce Committees. The Auditor is concerned about a lack of data and multi-year contracts. The Committees also heard from the Joint Fiscal Office and the Office of Legislative Counsel on ways to streamline the programs and make them more accessible. The Office of Primary Care and Area Health Education Centers (AHEC) testified that they collect a lot of data on each individual in their forgivable loan program and that multiyear contracts were less cost effective because the current contracts are a public-private partnership and nurses tend to change employers within the state. AHEC testified that the majority of nurses in their programs stayed in Vermont.
Agency of Health Care Administration: The Agency of Human Services (AHS) testified on S.183, a bill that breaks out an Agency of Health Care Administration from AHS. The AHS testimony included the benefits of an integrated agency and asked what issue the bill was trying to solve.