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The VMS Policy team has prepared this Final 2021 VMS Legislative Bulletin to provide you with the status of 2021 State legislation covering topics relevant to healthcare including: the COVID-19 emergency, health reform, insurance regulation, public health, scope of practice, mental health, health equity and regulating the practice of medicine. This end of session bulletin provides a comprehensive status update on 2021 health care legislation that advanced during this session. Because this is the first year of the 2021/2022 legislative biennium, some VMS priority bills that did not receive action in 2021 were not included in this report, but could be taken up in the second year of the 2021/2022 legislative biennium.

At this time last year, Vermont was still fully locked down due to the COVID-19 virus and the Vermont legislature, filled with uncertainty, extended the legislative session until the end of August and then returned in October to finalize the FY21 Budget. This year, lawmakers were diligently focused on adjourning the session close to the middle of May, which is the typical time for adjournment and with vaccination rates soaring across the State, a sense of hope permeated the end of the session with the promise that restrictions would soon be lifted.

On the last day, the Vermont legislature said farewell to their colleagues in their Zoom squares, as they successfully closed out the historic, fully remote, 2021 legislative session. Although the term “unprecedented” has possibly been worn out after 14 months of this pandemic, this session has been like no other for several reasons: most notably the unfathomable amount of federal relief money and unanticipated bump in state revenue that allowed lawmakers to make significant investments in the future of Vermont. This year’s budget spending increased by roughly 20 percent over last year’s budget, with the final FY22 Budget allocating $7.35 billion, that’s with a “b,” and was buoyed by roughly $600 million in American Rescue Plan Act (ARPA) dollars and $200 million in additional state revenue. This year’s budget moved the needle on services that impact social determinants of health with significant investments in health equity advancement, community mental health services, affordable housing, universal broadband, climate change and access to affordable, quality childcare. Workforce was a top priority, as the legislature invested in scholarships for nursing and primary care professions, mental health providers and childcare providers. Health reform was also an ongoing priority with dollars appropriated for delivery system reforms and the creation of a legislative taskforce focused on how Vermont can achieve affordable, accessible health care.

This report will provide summaries and the status of legislation that VMS actively tracked this session on behalf of our members, grouped into seven categories: For more information, please contact:
Jessa Barnard, VMS Executive Director, jbarnard@vtmd.org
Stephanie Winters, VMS Deputy Executive Director, swinters@vtmd.org
Jill Sudhoff-Guerin, VMS Policy and Communications Manager,  jsudhoffguerin@vtmd.org

COVID-19 Emergency

S.117 Extends COVID-19 Regulatory Flexibilities & Requires Coverage for Audio-Only Telehealth With Consent Requirements
S.117/Act 6, one of VMS’ top priorities coming into the legislative session was signed into law on March 29, 2021. The House Health Care and Senate Health & Welfare Committees quickly took action on the bill, which extends a number of health care regulatory flexibilities during and after the COVID-19 pandemic and makes permanent requirements for coverage of health care services delivered by audio-only telephone. Consent is now required for audio-only telehealth services, so practices currently need an updated consent form and process. VMS has a sample available here.
 
Regarding coverage of audio-only telephone services, practices should know that the law:
  • Requires health insurance plans, and Medicaid to the extent permitted by the Centers for Medicare and Medicaid Services (CMS), to cover all medically necessary, clinically appropriate health care services delivered by audio-only telephone to the same extent they would cover the services if provided in person
  • Allows cost-sharing (deductible, co-payment, coinsurance)
  • The practice must document in patient’s medical record:
    • Patient’s informed consent for audio-only telephone services
    • Reasons provider determined audio-only telephone services were clinically appropriate
  • A provider cannot require patient to receive services by audio-only telephone if patient does not wish to receive services in this manner
  • Informed consent must include:
    • That patient is entitled to choose to receive services by audio-only telephone, in person, or by telemedicine, to extent clinically appropriate
    • That receiving services by audio-only telephone does not preclude patient from later receiving services in person or by telemedicine
    • Explanation of pros and cons of delivering and receiving services by telephone
    • Informing patient of anyone else who will be listening to/participating in visit and getting patient’s permission
    • Whether services will be billed to patient’s health insurance plan and what it might mean for patient’s out-of-pocket responsibility
    • Informing patient that not all audio-only services are covered by all health plans
  • For the remainder of 2021, health insurance companies regulated by the State of Vermont must reimburse for audio-only telehealth services at parity with in-person services; for insurance plan years 2022, 2023, and 2024 the Vermont Department of Financial Regulation, in consultation with stakeholders, will determine amounts for health insurance plans to reimburse providers.  
This law also extends a number of regulatory flexibilities that the legislature had previously granted in response to COVID, including:
  • Flexibility in provider credentialing requirements from Medicaid and health insurers (until March 31, 2022)
  • Ability for out-of-state licensed health care professionals and recently retired/inactive Vermont licensees to provide services in Vermont by telehealth, as volunteer member of Medical Reserve Corps, and on staff of licensed facility or federally qualified health center (until March 31, 2022)
  • Authority for the Board of Medical Practice to issue temporary licenses to out-of-state providers and waive certain requirements for physician assistants (until March 21, 2022)
  • Ability to waive HIPAA-compliant-connection requirements for telemedicine, to extent permitted by federal law (sunsets 60 days after the end of declared state of emergency)
VMS Position: Support
Status: Signed into Law, Effective Immediately. 
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2021 State COVID Relief Bill Goes Into Law Without Governor's Signature
H.315/Act 9, was designed as a "fast-tracked" coronavirus relief bill, aimed at quickly providing one-time economic recovery dollars for Vermont businesses and programs impacted by the pandemic. The Governor did not sign the bill the Legislature delivered to his desk, instead letting the bill go into law without his signature. In a letter sent to House and Senate leadership in mid-April of 2021 he said he was disappointed that the legislature took as long as they did to pass the bill and that the bill appropriated a portion of the federal American Rescue Plan Act (ARPA) dollars. He urged the legislature to work with his Administration to develop a comprehensive strategy on this "once-in a lifetime chance" to use ARPA dollars to make historic investments into long-standing priorities for the State. After posturing like he would also veto the FY22 Budget if they did not compromise on ARPA allocations, the legislature softened their position and replaced state general funds for H.315 initiatives where possible even after it became law. The Governor and VMS were also disappointed in a last-minute amendment to the bill that removed the tax exemption on Payment Protection Program (PPP) loans that were forgiven by the federal government in tax year 2021, in order to treat these relief funds as taxable income. After resounding pushback from Vermont's beleaguered business community, lawmakers repealed the PPP tax in H.436, the Miscellaneous Tax bill. The final bill included these health care and social determinants of health initiatives: 

  • $10,000,000 - Housing Assistance for At-Risk Populations
  • $1,400,000 - Upskill Nursing Program
  • $4,000,000 - for Afterschool and Summer Programming
  • $300,000  - Emergency Outreach to Peer Support 
  • $4,000,000 - Department of Mental Health Housing Capacity 
  • $850,000 - Mental Health Urgent Case Management Services 
  • $150,000 - Mental Health Frontline Health Care Workforce Wellness Training 
  • $240,000 - VDH Recovery Centers
  • $700,000 - New Americans Refugee Resettlement Support
  • $1,300,000 - ReachUp Program Grants 
  • $5,500,000 - Summer Meals for Vermont Children and Families
  • $100,000 -  DAIL: VT Assoc. for the Blind 
  • $200,000 - Enhancing Data Collection Regarding Health Disparities
VMS Position: Support
Status: Enacted Without Governor's Signature. Effective Immediately. 
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Resolution Honoring Vermont's Health Care Workers Supported Unanimously
H.C.R 9, a house concurrent resolution recognizing the unwavering dedication of Vermont’s health care workforce during the COVID-19 pandemic, a VMS advocacy priority, was unanimously supported by the entire legislature. 


VMS Position: Support
Status: Adopted, Effective Immediately 

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Health Financing/Health Reform

FY2022 Budget Includes Primary Care Scholarship Funding - H.439
Flush with federal American Rescue Plan Act (ARPA) dollars and $200 million in additional state revenue, H.439, the FY22 Budget bill, was one of the largest in Vermont's history; spending $7.35 billion. The legislature only allocated roughly half of the $1.3 billion the State received in ARPA funds in 2021 spending bills and has until 2024 to spend the ARPA monies on COVID-19 relief and recovery broadly. The VMS strongly advocated for this bill to include recommendations made by the Senate Health and Welfare Committee, urging the legislature to determine a stable funding source for the primary care physician scholarships and to increase Medicaid reimbursement rates to 105% of the Medicare rate for primary care providers who participate in the Medicaid Enhanced Primary Care program. The legislature did not increase primary care rates this session, but the VMS will continue to advocate for a rate increase in 2022, and the bill did include VMS’ recommendation to fund primary care scholarships. The budget bill also includes funding for health care proposals that got traction late in the session, so their bills did not make crossover, but the proposals were funded in this year's budget. The budget includes these investments: 

Sec. E.311.1-E.311.3:  Primary Care Physician Scholarships: The budget appropriates $2 million in general funds for 2 years, which with Global Commitment dollars will provide $2.1 million per year for the primary care scholarship program, which has been renamed as the "Medical Student Incentive Scholarship Program." The program will be established through an MOU between the Area Health Education Centers and the Vermont Student Assistance Corporation with the intent of increasing the primary care workforce in rural areas of our State. Medical specialties eligible for this scholarship include: family medicine, internal medicine, adult primary care, pediatrics primary care, obstetrics-gynecology, and psychiatry. The scholarship program will award 10 students annually with a scholarship equivalent to one year of in-state tuition at the UVM Larner College of Medicine in exchange for a year of delivering primary care in a rural area of the State. The funding will become available when the MOU has been finalized.

Childcare Financing: the budget includes roughly $8.2 million to fund a comprehensive childcare investment bill (H.171) that includes increases to childcare financial assistance, modernizing of the Bright Futures Information System, and scholarships and loan repayment programs for current and potential early childhood providers. The funding was passed in the FY22 Budget (Sections B.1106, Sec. E.318.2, Sec. E.318.3) and the childcare bill awaits the Governor's signature.

Section E.126b: Health Reform Task Force , the budget allocates $125,000 to create a "Task Force on Affordable, Accessible Health Care", called for in S.120. This joint legislative taskforce will be made up of 6 members of the House and Senate, who will be charged with analyzing potential ways to make health care, including prescription drugs, more affordable for Vermont residents and employers, including identifying opportunities to leverage federal flexibility and financing and to expand existing State public health care programs. The Task Force is required to deliver their recommendations to the legislature on December 1, 2021. In order to inform their work, the Task Force will conduct a series of regional listening sessions this Fall to hear from Vermonters on their perspective of health care cost drivers. The VMS will keep our membership informed of these public sessions to ensure clinicians can participate in these conversations.

Section E.227: Department of Financial Regulation Essential Health Benefits Benchmark Review, the budget also includes funding for the Department of Financial Regulation (DFR) to review Vermont’s benchmark health insurance plan that establishes the State’s essential health benefits. The review will consider whether Vermont's benchmark plan is appropriately aligned with Vermont’s health care reform goals regarding population health and prevention included in the Vermont All-Payer Model agreement and the Department of Health’s State Health Improvement Plan: 2019–2023, and to determine whether to recommend requesting approval from CMS to modify the benchmark plan to include coverage of:  
  • hearing aids;
  • dentures;
  • vision care;
  • durable medical equipment;
  • fertility services; and
  • to analyze the likely impact on qualified health plan designs, actuarial values, and premium rates of requiring individual and small group health insurance plans to provide each insured with at least two primary care visits per year with no cost-sharing requirement.
DFR is required to report the findings of the benchmark review on January 15, 2022. 
 
VMS Position: Support
Status: Passed the House and Senate, Advances to the Governor's Desk.
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Health Equity

Office of Health Equity Bill Signed into Law – Requires Study of Professional Training Requirements
Governor Scott signed into law on May 18th, 2021 H.210/Act 33, a bill creating a Vermont Office of Health Equity. The overarching goal of this new law is to address disparities in the health status of Vermonters based on race, ethnicity, disability, and LGBTQ identity and to promote health equity for all Vermonters through the establishment of this new office. The bill as introduced would have mandated two additional hours of continuing medical education (CME) on cultural competency as part of Vermont's physician licensing requirements. The VMS testified that more meaningful improvements in cultural competency education can be achieved through collaboration, rather than a one-size-fits-all approach of two hours of mandated education, and highlighted the breadth of existing anti-bias training currently being offered by health care organizations. The bill, as enacted, focuses on creating a Health Equity Advisory Commission, which, as part of their primary charge, will develop the Office of Health Equity by January 2023. The Advisory Commission will be led by Vermont's Executive Director of Racial Equity and will be made up of approximately 29 members of Vermont's BIPOC and LGBTQ communities. The Commission has a charge to: 
  • provide guidance on the development of the Office of Health Equity including its responsibilities and how it is staffed;
  • review, monitor, and advise all State agencies regarding the impact of current and emerging State policies, procedures, practices, laws, and rules on the health of individuals who are BIPOC, LGBTQ or have disabilities;
  • advise the Department of Health and General Assembly on any funding decisions relating to eliminating health disparities and promoting health equity;
  • to the extent funds are available for the purpose, distribute grants that stimulate the development of community-based and neighborhood-based projects that will improve health outcomes;
  • advise the General Assembly on efforts to improve cultural competency and antiracism in the health care system through training and continuing education requirements for health care providers and other clinical professionals. 
Act 33 also requires report backs to the legislature on:
  • recommendations for improving cultural competency, cultural humility, and antiracism in Vermont’s health care system through training, continuing education, and investments (report due back October 1, 2022;
  • FY2023 budget recommendations to fund the Health Equity Advisory Commission and the Office of Health Equity;
  • recommendations on appropriate and inclusive terms to replace the term “non-White” and on disaggregating data categories and tabulations beyond “non-White” and “White:”
  • recommendations for most effectively using ARPA one-time funding to promote health and achieve health equity by eliminating disparities on the basis of race, ethnicity, disability, and LGBTQ status.
VMS Position: Support
Status: Enacted, Effective as of July 1, 2021.
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Resolution Declaring Racism as a Public Health Emergency
J.R.H 6,  a resolution that dovetails directly with the statement the VMS Council adopted in June of 2020 also declaring racism as public health emergency, was adopted by the House and in the Senate by concurrence. J.R.H. 6 focuses on the disproportionate impact the COVID-19 virus has had on non-White Vermonters and the how social determinants of health contribute to health inequities and outcomes for Black and Latino Vermonters. The legislative body commits to eradicate systemic racism and to eliminate race-based health disparities in this resolution.

VMS Position: Support
Status: Adopted in the House and Senate.

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Mental Health

Bill to Create Forensic Mental Health System Advances to the Governor
S.3, a VMS and Vermont Psychiatric Association priority bill aimed at creating a forensic mental health system in Vermont has passed the House and Senate and awaits advancement to the Governor's desk for his signature. Vermont is one of a few states that do not have a formal forensic mental health system, which has had repercussions for those found incompetent to stand trial and for victims of crimes perpetrated by people whose competency and sanity may be in question. This bill seeks to ensure a more equitable process for those who may be deemed incompetent to stand trial, as well as to require improved notification systems to better provide public safety. In order to right size a forensic mental health system for Vermont and to determine whether this system requires a stand-alone facility, the bill requires the Department of Mental Health to create a "forensic mental health workgroup." The Vermont Medical Society is named as an interested stakeholder that can appoint a representative to the workgroup. The workgroup is required to report back to the legislature on August 1, 2022 on: 
  • any gaps in the current mental health and criminal justice system structure related to individuals incompetent to stand trial or who are adjudicated not guilty by reason of insanity;
  • opportunities to improve public safety and address the treatment needs for individuals incompetent to stand trial or who are adjudicated not guilty by reason of insanity; and to consider the importance of victims’ rights in the forensic care process;
  • competency restoration models used in other states, including both models that do not rely on involuntary medication to restore competency and how cases where competency is not restored are addressed;
  • models used in other states to determine public safety risks and the means used to address such risks, including guilty but mentally ill verdicts in criminal cases;
  • due process requirements for defendants held without adjudication of a crime and presumed innocent;
  • processes regarding other mental conditions affecting competence or sanity, including intellectual disabilities, traumatic brain injury, and dementia;
  • models for forensic treatment, including the size, scope, and fiscal impact of any forensic treatment facility; along with any additional recommendations.
The workgroup is also required to provide an update on the status of their analyses prior to the final report date on February 15, 2022, regarding how to address notification of victims, which was a point of contention between the House and Senate versions of the bill. The bill also includes:
  • A requirement for evaluations regarding competency to stand trial and sanity at the time of the alleged offense to be presented in separate reports. The sanity evaluation will only be initiated if the person is deemed competent to stand trial unless the defendant requests both evaluations to occur together. As passed, the bill also requires the evaluating psychiatrist to make a reasonable effort to collect and preserve any evidence necessary to form an opinion as to sanity if the person regains competence.
  • When a person is found incompetent to stand trial, legal counsel will be assigned from Vermont Legal Aid and the legislature appropriated $250,000 for this representation.
  • The Department of Mental Health (DMH) and/or the Department of Aging and Independent Living (DAIL) will be entitled to appear and call witnesses when a person is found incompetent to stand trial.
  • 10 days before being released from the custody of DMH, the Commissioner will inform the State's Attorney from the County where the prosecution took place. The State's Attorney will be charged to provide notice to any victim of the offense. 
  • Directs DMH and the Department of Corrections to prepare an assessment of the quality of mental health services delivered in Vermont's correctional facilities that include analyses on: a comparison of how the timeliness and quality of mental health services delivered in correctional facilities differ from those delivered in the community; how mental health services differ in Vermont correctional facilities; whether DMH should provide oversight authority on the mental health services delivered by the entity contracted by the Department of Corrections (DOC); how the MOU between DMH and DOC impacts the quality of mental health services delivered by the entity hired by DOC and whether these services adequately address the needs of those with severe illness or in need of patient care; and that racial and social equity issues are considered during these analyses.
VMS Position: Support
Status: Passed the House and Senate, Advances to the Governor's Desk.
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Mental Health Treatment Law Passes Legislature
H.46/Act 30, passed the Legislature and was signed into law by the Governor on May 17th, 2021. This new law makes changes to the consent form required for voluntary admission to inpatient psychiatric units to inform patients 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 in patient’s posted notice of rights on how to change a status from involuntary to voluntary. The act also requires the Department of Mental Health to collect 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 Commissioner. 

VMS Position: Monitor
Status: Signed into Law, Effective July 1, 2021.

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Middlesex Secure Recovery Residence Replacement Fully Funded
The Legislature approved $11.6 million in H.438, the Capital bill, for the construction of a 16-bed secure recovery residence to replace the Middlesex Therapeutic Community Residence. The Recovery Residence will be built in Essex and will be designed to provide transitional support for individuals who are being discharged from inpatient psychiatric care. The bill instructs the building of the 16-bed facility to include two eight-bed wings served by common clinical and activity spaces, with ample outdoor space for exercise and other activities. During the design and construction phase, the Department of Mental Health would also be required to do a comprehensive bed needs assessment for all levels of care in the mental health system and an analysis of any federal funding opportunities in the new American Rescue Plan Act. The Capital bill was sent to the Governor's desk on May 26, 2021 and he has 5 days to sign the bill. 


VMS Position: Monitor
Status: Passed the House and Senate, On the Governor's Desk Awaiting his Signature

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Practice of Medicine

S. 22 Requires Patient Notice of Unapproved Stem Cell Products
S. 22 will require that health care practitioners notify patients before administering a stem cell product that has not received approval from the U.S. Food and Drug Administration (FDA). This is a consumer protection measure to address clinics in Vermont that are marketing unapproved stem cell products with claims of efficacy and safety that are not evidence-based. The bill is supported by the Vermont Board of Medical Practice, the Vermont Ethics Network, the Office of Professional Regulation, the Attorney General’s Office and the University of Vermont Medical Center along with the Vermont Medical Society. Clinics in Vermont and nationwide promote “stem cell treatments” for myriad diseases, including COVID-19, that have unknown or unproven benefits and may pose risks to the health and finances of vulnerable patients. In addition to requiring notice to patients before products are administered, the law will also require that any advertisements relating to the use of stem cell products that are not approved by the FDA contain a notice informing patients that the products have not been FDA-approved.  There are some exceptions to the notice requirements for clinical trials or products that do not require FDA approval; violations will be considered unprofessional conduct.  The law takes effect on July 1.

VMS Position: Support
Status: Enacted, Effective as of July 1, 2021.
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Act 21 (H.104) Directs Study of Permanent Telehealth Licensure Flexibilities
Act 21 creates a study of the interstate practice of health care via telehealth for all health care professionals.  The bill creates a work group, led by the Office of Professional Regulation, to compile and evaluate methods for facilitating the interstate practice of health care professionals using telehealth modalities, including through the creation of telehealth licenses, waiver of licensure, national licensure compacts, and regional reciprocity agreements. VMS strongly supports this study of ways by which clinicians can most flexibly practice medicine after the end of the COVID public health emergency. The law took effect on passage and the work group must hold a first meeting by July 1, 2021.  The Office of Professional Regulation must submit initial findings of the work group to the legislature by December 15, 2021. 

VMS Position: Support
Status: Enacted, Effective Immediately.
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Insurance Regulation

Expansion of Dr. Dynasaur-Like Coverage for Children and Pregnant Women Regardless of Immigration Status
H.430 expands eligibility for Dr. Dynasaur-like Medicaid coverage to all income-eligible children and pregnant women who would otherwise qualify for Medicaid except for their immigration status. The bill has passed the Legislature and was sent to the Governor's desk. The legislation appropriates one-time State funding to the Agency of Human Services to begin implementing the expansion in 2022 by offering grants to health care providers who care for this population; beginning in State fiscal year 2023 the program would be fully established. VMS supports this expansion and awaits the Governor's signature. 

VMS Position: Support
Status: On the Governor's Desk, Effective dates for provider grants are July 1, 2021. Effective date for coverage begins July 1, 2022. 

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Professional Regulation/Scope of Practice

H.289: 2021 Office of Professional Regulation Bill
H.289 passed both the House and the Senate and will be sent to the Governor’s desk for his signature. This bill, referred to as the “OPR bill”, is a bill that the Office of Professional Regulation puts forward every year to amend regulation for the professions it regulates. There were no changes in the bill that VMS is concerned with. The bill does authorize OPR to more closely regulate Mixed Martial Arts (MMA) in Vermont.  VMS, following the lead of the American Academy of Pediatrics Vermont Chapter, supports OPR’s ability to regulate these competitions to protect the public, especially children.

VMS Position: Support
Status: Passed the House, Advances to the Senate Government Operations Committee for 2021. 

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Vermont to Enter Interstate Nurse Licensure Compact
The House and Senate have passed S.48, which authorizes the State to adopt and enter into the interstate Nurse Licensure Compact. The Compact will provide opportunities for interstate practice by nurses who meet uniform licensure requirements and has been promoted as a workforce initiative to help attract nurses to Vermont. The law will take effect on February 1, 2022.

VMS Position: Support
Status: Passed the House and Senate, Advances to the Governor's Desk.
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Public Health

Flavored Tobacco Ban Bill Passes Senate Health and Welfare Committee
S.24, this year's bill to ban the sale of flavored tobacco products including menthol products, passed the Senate Health and Welfare Committee by a tepid vote of 3-2 and advanced to the Senate Economic Development, Housing and General Affairs Committee, but technically did not meet the crossover deadline. This means that the bill, which still needs to pass the Senate Economic Development and Finance Committees before going to the full Senate, cannot advance to the House until 2022. This public health and health equity proposal aims to stop the initiation of youth to tobacco use and stop the aggressive targeting of Black and LGBTQ Vermonters by the tobacco industry. Propero Gogo, M.D., cardiologist at UVMMC, and L.E. Faricy, pediatric pulmonologist, both testified in the Senate Health and Welfare Committee on the health impacts of increased youth use of all flavored tobacco products including vaping products. Click here to read L.E.'s testimony. The VMS will continue to work with public health champions on this proposal in 2022.


VMS Position: Support
Status: In Senate Economic Development, Housing and General Affairs Committee for 2022. 
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Miscellaneous Cannabis Regulations & Procedures
S.25 passed both the House and the Senate and will be sent to the Governor’s desk for his signature. The bill makes modifications to S.54/Act 164 of 2020, which created a commercial cannabis market in Vermont. As passed S.25 meets some of Governor Scott’s requests from last year to strengthen protections with a commercial cannabis market.
 
The bill limits advertising to venues where not more than 15 percent of the audience is reasonably expected to be under the age of 21. It also mandates that all advertisements contain health warnings, created in consultation with the Vermont Department of Health, and the advertisement must be approved by the Cannabis Control Board prior to dissemination. The bill creates “guard rails” to ensure that 30% of the revenue raised by the cannabis excise tax is used for the purpose of funding substance misuse prevention programming, even if carried over from a previous fiscal year. The Senate initially proposed adding a deadline for municipalities to hold a vote on whether to they want a cannabis establishment in their town, and the caveat that if they did not hold a vote they would automatically opt-in to allowing retail sales. The House removed this provision and the bill as passed states that for a cannabis retailer to operate in a municipality there must be a vote by that municipality. 

The law also addresses some changes in timelines for establishing the cannabis market and transferring the medical cannabis registry from the Department of Public Safety to the Cannabis Control Board and establishes funding to support social equity applicants in starting licensed cannabis establishments. The law states that in the 2022 legislative session, the General Assembly intends to establish a Medical Cannabis Oversight Advisory Panel – to replace the current Cannabis for Symptom Relief Oversight Committee -  and requests that the Cannabis Control Board submit its recommendations for the membership and duties of this panel to the General Assembly on or before November 1, 2021.


VMS Position: Monitor
Status: Passed the Senate Judiciary Committee, On the Senate Floor for FY2021.
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Feminine Hygiene Products Sales Tax Exemption Passes 
A proposal to provide an exemption from the 6 percent sales tax for feminine hygiene products was incorporated into H.436, a bill commonly referred to as the "Miscellaneous Tax bill", before passing the House and Senate and advancing to the Governor's desk. Originally this exemption was in a stand-alone bill, S.53, introduced by Sen. Chris Pearson, P/D-Chittenden, who said he introduced the bill to right an injustice, as most health care products are exempt from sales tax, but not menstrual products. This exemption will become effective upon the Governor's signature. 

VMS Position: Support
Status: Passed the House and Senate, Advances to the Governor's Desk.

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Prohibition on Possession of Firearms in Hospital Buildings
S.30, would make knowingly possessing a firearm in a hospital a criminal offense. VMS strongly supported this bill, both as introduced and as amended by the Senate. Unfortunately, S.30 stalled after passing the Senate. The House Judiciary Committee failed to take it up for a hearing, so it will sit until next session when VMS will urge the Committee and House as a whole to take it up and pass it. 

VMS Position: Support
Status: Passed the Senate, Advances to House Judiciary Committee for 2021.
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Decriminalization of Possession of Bupernorphine
H.225, a bill that decriminalizes the possession of 224 milligrams of bupernorphine for people over the age of 21, was signed into law by Governor Scott on June 1st and became effective immediately.  Advocates of the legislation argued that the greater the availability of bupernorphine, regardless of prescription, will lead to a decrease in opiate-related deaths and an increase in those who seek out treatment for substance use disorder. The Governor signed the bill, despite reservations and a lack of data that decriminalization has lead to these favorable outcomes. Therefore, he issued an Executive Order  at the same time as signing the bill that directs Vermont's Chief Prevention Officer to form a Buprenorphine Task Force made up of representatives from the the Agency of Human Services and the Department of Public Safety to establish metrics and to gather baseline data as necessary to assess the impact of the decriminalization of buprenorphine on Vermonters and Vermont communities. The first meeting of the Task Force will take place on or before June 30, 2021. The VMS remained neutral on this legislation after receiving mixed feedback from members both supporting harm reduction but also strongly encouraging individuals with substance use disorder to engage in treatment with a clinician with expertise in a broader array of treatment modalities and in prescribing bupernorphine. 

VMS Position: Monitor
Status: Signed into Law on June 1, 2021. Effective Upon Passage, Sunsets June 30, 2023.
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Constitutional Amendment to Support the Fundamental Right to Reproductive Liberty
Proposition 5, the constitutional amendment creating a right to reproductive liberty, passed the Senate by a vote of 26-4 and advanced to the House, where it will be voted on in 2022. If it passes both chambers in 2022 it will then go before the voters of Vermont as a referendum on the ballot in November 2022. What would be known as "Article 22" states: Article 22. [Personal reproductive liberty] That an individual’s right to personal reproductive autonomy is central to the liberty and dignity to determine one’s own life course and shall not be denied or infringed unless justified by a compelling State interest achieved by the least restrictive means." The language for Proposition 5 was finalized in 2019 by the Senate Health and Welfare Committee and cannot be amended any further during this biennium. The VMS will take an active role in advocating for this landmark proposal in 2022.

VMS Position: Support
Status: Passed the Senate, and Will Be Taken Up In the House in 2022.

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