The Vermont General Assembly adjourned on May 7 and the Vermont Medical Society breathed a sigh of relief at the close of a very busy and difficult legislative session. Last fall, then VMS President David Coddaire, MD, predicted that the legislature would be focused on three Ms. The issues Dr. Coddaire cited are: addressing a large deficit in the state’s Medicaid program; the enactment of legislation legalizing recreational Marijuana; and Vermont's application for a waiver from current Medicare payment policies.
With the assistance of a large taskforce, VMS also was activity involved in the drafting of legislation to address Opioid Abuse Prevention and it also had to contend with a proposed new private- right-of-action for inappropriate HIPAA disclosures. And while on the political front, Vermont Senator Bernie Sanders has received most of the attention, a large number of retirements will result in an almost complete change in the state’s political leadership in 2017.
1968 was the last time the four key power players at the Vermont Statehouse — governor, lieutenant governor, speaker of the House and Senate president — all left office at the same time and a whole new slate was elected into power. However, notwithstanding whoever replaces these political leaders, VMS anticipates that the new Governor and legislative leadership will be very active in proposing additional health care reform legislation in 2017.
The below articles detail the major health care-related bills that the VMS and its members devoted significant effort in helping to shape during the 2016 legislative session.
In his Fiscal Year 2017 Budget Address, Governor Peter Shumlin asked the Vermont General Assembly to enact a new 2.35 percent tax on the net patient revenues of independent physicians and dentists, including payments from Medicare, Medicaid and Commercial Insurance. The tax was to be applied retroactively to January 1, 2016 and it would raise $17 million in new state revenue.
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Thanks to a collaborative effort with the VMS, the American Academy of Pediatrics Vermont Chapter and the Vermont Academy of Family Physicians, the legalization of recreational and retail marijuana, as well as the decriminalization of up to two home-grown marijuana plants, was defeated this legislative session.
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On Tuesday, May 3, 2016, the Senate agreed to concur with the House proposal of amendment to S. 243 and the bill is on its way to the governor for his signature. VMS thanks its members and the Opioid Task Force for their input on the bill and for contacting legislators throughout this process.
VMS ended up supporting both the House and Senate versions of the bill after provisions opposed by VMS were removed through the process. The bill that achieved final passage is much better than the bills that were originally introduced, which would have limited prescriptions to ten pills for minor procedures and would have required prescribers to check the Vermont Prescription Monitoring System (VPMS) before prescribing or refilling any opioid prescription. The bill passed by the legislature instead requires the Commissioner of Health to adopt rules after consulting with the Controlled Substances and Pain Management Advisory Council, a group that includes many clinicians. In addition, the Commissioner is required to consult with the Opioid Task Force and with additional clinicians as needed to address particular topics in question.
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Passionate advocacy by VMS members and VMS President Dr. James Herbert prevented the creation this session of a new private right-of-action allowing patients to sue their physicians in Vermont civil court over violations of HIPAA. S. 155 was introduced in the Senate to address a range of information privacy issues ranging from health care privacy to the use of drones and license plate monitoring by law enforcement.
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In response to concerns about health care consolidation in the state, the legislature passed S. 245, a bill that will require hospitals to notify patients when they acquire health care providers.
Specifically, Section 1 of the bill will require the Green Mountain Care Board to review new physician acquisitions and transfers by hospitals as a part of the Board’s hospital budget review responsibilities. The Board will also require hospitals to provide written notice to each patient served by an acquired health care provider including notifying the patient that the health care provider is now affiliated with the hospital and that the affiliation may affect his or her out-of-pocket costs for care.
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H. 761 directs the Green Mountain Care Board, in consultation with the Agency of Human Services and the Vermont Medical Society, to survey and catalogue all existing performance measures required of primary care providers in Vermont, including the Centers for Medicare and Medicaid Services’ quality measures. The Board is then required to develop a plan to align performance measures across programs that impact primary care. The plan’s goal must be to reduce the administrative burden of reporting requirements for providers while balancing the need to evaluate quality of, and access to, care adequately.
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H. 812 contains a number of provisions related to health reform in Vermont. VMS most actively advocated for Sections 9 and 10 of the bill. Section 9 directs the Green Mountain Care Board to examine, on its own or through collaboration or contracts with third parties, the effectiveness of existing requirements for health care professionals, such as quality measures and prior authorization, and evaluate alternatives that improve quality and reduce costs and administrative burdens. While containing similar language to H. 761, the examination would not be limited to primary care and also asks the Board to review the burden of the prior authorization process. Section 10 of the bill directs the Board to create a Primary Care Professional Advisory Group to provide input and recommendations.
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S. 255 restores and revises consumer and provider protection and quality assurance standards for insurers and managed care organizations. The bill requires insurers that cover a minimum of 2,000 Vermont lives to report a list of measures to the Department of Financial Regulation (DFR).
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VMS has been working with the Vermont Ethics Network, the Vermont Department of Health, and others for several years on designing a process for informed consent when patients have not identified a health care agent to make decisions for them and do not have a guardian appointed by probate court. S. 62 is a bill that attempts to put in law the way the decision making process is working today for incapacitated patients without agents or guardians who may need someone to consent or withhold consent to a DNR or COLST order for them.
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H. 559 creates a Vermont licensing exemption for physicians, podiatrists, osteopathic physicians, physician assistants, and advance-practice registered nurses who are licensed and in good standing in another state or in Canada, if the professional is formally designated as a team clinician by an athletic team visiting Vermont for a specific sporting event and the professional limits his or her practice to the treatment of team members, coaches and staff of the sports team.
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H. 690, a bill that will authorize physicians to practice acupuncture without having to obtain a separate, additional acupuncture license in addition to their medical license has passed the House and Senate and is on its way to the governor to sign. The bill will be effective as soon as the governor signs it.
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In the final weeks of the legislative session the House Human Services Committee took up S. 14, a bill discussed last year in the Senate. Originally the bill contained several minor changes, supported by VMS, to the Marijuana for Symptom Relief Program.
These changes included requiring that marijuana infused edible or potable products sold by dispensaries be contained in single dose, child-resistant packaging and be labeled with the amount of tetrahydrocannabinol in each dose.
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After consideration by several committees in both the House and the Senate, the legislature ultimately approved H. 620, a bill aimed at increasing access by Vermonters to long-acting contraceptive methods.
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S. 157 creates a new requirement for all facilities that provide mammograms to inform a woman if the mammogram determines that she has dense breast tissue. The Vermont Medical Society facilitated input from the Vermont Radiologic Society (VRS) and the House and Senate ultimately adopted language for the patient notice recommended by VRS. The requirement will apply to exams performed on or after Jan. 15, 2017.
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H.171 passed both the House and Senate and will ban the use of e-cigarettes where lighted tobacco products are banned. The bill exempts vape shops that sell only hardware and liquid.
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H.93, a bill to increase the age to purchase and use tobacco products to 21 passed the House by a voice vote. Since this passed after the crossover date, the bill unfortunately got stuck in the Senate Rules Committee as the committee of jurisdiction, Senate Health & Welfare, decided not to take it up.
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